Perceived Effectiveness of Filial Therapy for a

Jamaican Mother: A Qualitative Case Study

Natalya A. Edwards, Jana Ladner, and JoAnna White
Georgia State University
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Although filial therapy has traditionally been viewed as suitable for children
of diverse cultures, there is limited research to support this perspective. This
qualitative case study examined the perceived effectiveness of filial therapy
for a Jamaican mother and the perceived effect on the mother– child rela-
tionship. Findings indicate that some aspects of filial therapy are congruent
with the parenting practices and values of this Jamaican mother. The mother
reported an increase in empathy, a heightened awareness of her child’s
needs, and a stronger relationship with her child. She expressed some
difficulty with limit setting and tracking skills taught as part of the model.
Future research directions include further examination of the compatibility
of filial therapy with other Jamaican parents and the effectiveness of group
filial therapy with Jamaican parents or other parents of Caribbean descent.
Keywords: Jamaican parenting, filial therapy, treatment acceptability, perceived effec-
tiveness, qualitative case study

Play is essential to children’s cognitive, social, and emotional develop-

ment (Piaget, 1962). Through play, children communicate, learn, practice
adult tasks, and work through emotional issues. According to Landreth
(2002), children use toys as their words and best find expression in the
context of play.
For almost a century, child therapists have used the natural language of
children to help them cope with emotional difficulties. Axline (1947)
adapted Rogers’s nondirective therapy techniques for use with children.
Landreth (1991) extended Axline’s work and developed child-centered
play therapy, which focuses on providing the child with a permissive

Natalya A. Edwards, Jana Ladner, and JoAnna White, Department of Counseling and
Psychological Services, Georgia State University.
We thank Jonathan Orr and Kristen Varjas for their valuable contribution to the project.
Correspondence concerning this article should be addressed to Natalya A. Edwards,
Department of Counseling and Psychological Services, Georgia State University, P.O. Box
3980, Atlanta, GA 30302-3980. E-mail: natalyaedwards@yahoo.com

36
International Journal of Play Therapy Copyright 2007 by the Association for Play Therapy
2007, Vol. 16, No. 1, 36 –53 1555-6824/07/$12.00 DOI: 10.1037/1555-6824.16.1.36
 Perceived Effectiveness of Filial Therapy 37

atmosphere and a nonjudgmental relationship that is different from all

other relationships that the child encounters.
B. Guerney (1964) applied many of Axline’s (1947) child-centered
principles to parent education and developed a parent consultation model
called filial therapy. Through filial therapy, parents are taught to work
directly with their children using child-centered play sessions. Landreth
and Bratton (2006) outlined 27 filial therapy studies investigating the
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effectiveness of using paraprofessionals (primarily parents) as therapeutic

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agents of change for children in a 10-session model. These studies included

more than 800 participants, many of whom were from diverse cultural
groups.
The quality of the therapeutic alliance is a significant factor in positive
client outcomes. Research has indicated that the therapist’s technical skills,
theoretical orientation, and related techniques play less of a pivotal role in
improved treatment outcomes. Therapists who wish to transfer therapy
techniques from one culture to another therefore tend to focus on the
relationship (Strupp, 1993). More attention is given to the client’s needs
within the context of a healthy therapeutic bond with less emphasis on
culturally bound interventions. Filial therapy is relationship focused and is
therefore traditionally viewed as suitable for children of diverse popula-
tions. There is, however, limited research to support this perspective.

FILIAL THERAPY

Filial therapy is intended for children ages 3–10 who may be experi-
encing emotional or behavioral problems and is also designed to help
parents understand their children better, develop more confidence in rais-
ing them, and build stronger parent– child relationships (L. Guerney, 2000).
It is therefore appropriate for use with both clinical and nonclinical pop-
ulations. Filial therapy is based on the assumption that the parent– child
relationship is usually the most significant and influential relationship in the
child’s life. Parents are taught to be therapeutic agents of change as they
carry out child-centered play sessions with their children (Landreth, 1991;
Vanfleet, 2005).
Studies have examined the effectiveness of filial therapy with various
parent populations, including single parents (Bratton & Landreth, 1995),
parents of children with learning difficulties (Kale & Landreth, 1999),
incarcerated mothers (Harris & Landreth, 1997), incarcerated fathers
(Landreth & Lobaugh, 1998), parents with chronically ill children (Tew,
Landreth, Joiner, & Solt, 2002), and nonoffending parents of sexually
abused children (Costas & Landreth, 1999). Findings included increases in
 38 Edwards, Ladner, and White

parental empathy and acceptance, reduction in parental stress (Bratton &

Landreth, 1995; Costas & Landreth, 1999; Harris & Landreth, 1997; Kale &
Landreth, 1999; Landreth & Lobaugh, 1998; Tew, Landreth, Joiner, & Solt,
2002), and decreased problem behaviors of children (Harris & Landreth,
1997; Landreth & Lobaugh, 1998; Tew et al., 2002).
The growing diversity in the United States highlights the importance of
using culturally appropriate filial therapy interventions. However, the lit-
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erature tends to focus on the broad application of techniques to all children

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regardless of culture. There has been limited research focusing on ethni-

cally diverse cultures, but studies have shown promising results. Research-
ers have conducted filial therapy research with a Chinese family (Chau &
Landreth, 1997; Yuen, Landreth, & Baggerly, 2002), Native American
families (Glover & Landreth, 2000), Korean families (Jang, 2000; Lee &
Landreth, 2003), Israeli families (Kidron, 2004), and an African American
parent and child (Solis, Meyers, & Varjas, 2004). Findings reflected de-
creased parental stress (Chau & Landreth, 1997; Kidron, 2004; Lee &
Landreth, 2003), a reduction in perceived problem behaviors of children
(Kidron, 2004; Yuen et al., 2002), parents’ increased acceptance of their
children (Jang, 2000), increased parental empathy (Glover & Landreth,
2000; Lee & Landreth, 2003), and increased awareness and analysis of
parenting practices (Solis et al., 2004).

RESEARCH ON JAMAICANS

It is estimated that by the year 2025 the number of minority children

in the United States will outnumber the number of Anglo American
children (Gibbs & Huang, 1998) and that by 2010 children of immigrants
will make up nearly one fourth of the school-age population (Lambert,
1996). Statistics available from 2000 indicated that nearly one million
Jamaican immigrants resided in the United States (an increase of 69.3%
between 1990 and 2000). Between 2000 and 2002, an additional 30,300
Jamaicans immigrated to the United States (U.S. Census Bureau, 2004). As
the Jamaican immigrant population increases, filial therapists should con-
sider the unique needs of this group.
To date there has been no research exploring the perceived effective-
ness of filial therapy with Jamaicans. The literature reflects some empirical
data on Jamaican parenting values, styles, and practices, which indicate
that filial therapy may conflict with some features of traditional Jamaican
parenting while aligning with others. Brown (2001) examined the root of
Jamaican parents’ resistance to the notion of children’s rights. She explored
Jamaican parenting practices and beliefs from a sociocultural perspective.
 Perceived Effectiveness of Filial Therapy 39

Children are often seen as economic property representing a large portion

of the Jamaican workforce and the primary caregivers of aging parents. If
parents have historically seen children as an economic investment, it may
be difficult for them to consider the perspective of children’s rights.
Smith and Mosby (2003) investigated the role of corporal punishment
in Jamaican child-rearing practices. They noted that many parenting and
disciplinary practices in Jamaica would be seen as child abuse in other
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Western countries. In examining child outcomes, these authors argued that

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harsh disciplinary practices may be partly responsible for some of the social
ills of the island nation and recommended confronting parenting practices
that endanger the welfare of children.
Yearwood (2001) explored the current child-rearing practices among
immigrant Jamaican families and found a very different outcome. Emerg-
ing themes included engendering relationships with children grounded in
encouragement, love, and respect; listening to children; valuing structure,
limits, and discipline; spending time with children; and being aware of the
developmental needs of children.
The literature on Jamaican parenting practices seems to reflect mixed
perspectives. According to Brown (2001) and Smith and Mosby (2003),
there may be elements of the Jamaican culture that are incongruent with
the child-centered nature of filial therapy. One of the major goals of filial
therapy is to help children grow emotionally and socially. The structure of
the play sessions themselves involves allowing the child to take the lead.
This may not fit with a cultural belief that does not embrace the idea of
children’s rights. Many filial therapists also discourage punishment, instead
highlighting the use of logical consequences, encouragement, and similar
techniques. However, cultures that value corporal punishment may be
hesitant to accept a system that does not favor punishment. Filial therapists
should be aware of culture-specific values and promote dialogue with
Jamaican parents regarding their perceptions of parenting, discipline, and
the filial therapy model. This dialogue should include an awareness of their
beliefs concerning corporal punishment and how those beliefs might affect
the therapeutic relationship.
Filial therapists who work with Jamaican immigrant parents should
also consider Yearwood’s (2001) findings and take into account the impact
of acculturation, the obligation to abide by U.S. laws, and the socioeco-
nomic variables that allow for immigration to the United States. These
factors may influence parenting styles and practices and therefore inform
therapeutic interventions. Filial therapists may focus on the central role
that the parent– child relationship appears to have in the Jamaican immi-
grant family context (Yearwood, 2001). If parents perceive filial therapy as
an opportunity to enhance this relationship rather than as an affront to
 40 Edwards, Ladner, and White

current parenting practices, they may be more open to adapting this

approach.
In Jamaica, there has historically been a stigma attached to seeking
mental health services. This stigma may be reflected by the number of
mental health referrals that come from primary care physicians and the
paucity of mental health service personnel. Mental health providers in the
United States should be aware of culturally entrenched values related to
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counseling and encourage open discussions with Jamaican parents regard-

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ing their beliefs and perceptions of the filial therapy process. Because filial
therapy tends to focus on the parent– child dyad and the development of a
healthy relationship, reflecting a strengths-based perspective rather than a
problem perspective, it may be more acceptable to Jamaican parents. They
may be more apt to embrace a treatment model that positions them as the
agents of change and facilitators of a healthier relationship.

TREATMENT ACCEPTABILITY

Treatment acceptability refers to the extent to which participants

believe that a treatment is fair and reasonable (Kazdin, 1980). Witt and
Elliott (1985) expanded on Kazdin’s work and developed a model that
details the interaction of treatment acceptability, treatment integrity, treat-
ment effectiveness, and treatment use. The model treats the acceptability
component as a pivotal aspect of the relationship among the other vari-
ables. If participants believe that an intervention is just, they are more
likely to implement procedures as they are taught (integrity). This will in
turn affect the effectiveness and sustainability of the treatment.
Reimers, Wacker, and Koeppl (1987) indicated that the treatment
acceptability of a model will be influenced by the participants’ degree of
understanding. When the content presented is properly understood, the
likelihood of its being seen as reasonable and palatable to participants
increases.

PURPOSE OF THE STUDY

The goal of this study was to add to the literature regarding the
globalization of filial therapy. Specifically, we explored a Jamaican immi-
grant mother’s perceptions of the effectiveness of filial therapy. The re-
search questions addressed were the following: (a) What perceptions does
a Jamaican immigrant mother have of the process of filial therapy and (b)
 Perceived Effectiveness of Filial Therapy 41

from this mother’s perception, how does participating in filial therapy

training affect the mother, the child, and the mother– child relationship?

METHOD

Case Study Design

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A qualitative case study design was selected to provide us with an

in-depth examination of the process and perceived effectiveness of filial
therapy with a Jamaican mother. This research design involves a system
bounded by time and place, thorough data collection, and multiple sources
of information (Creswell, 1998). The Jamaican mother was taught the basic
concepts of filial therapy during an 8-week in-home training and was asked
to conduct weekly play sessions with her child. We used transcripts of the
training sessions, interviews, observations, videotapes of parent– child play
sessions, and journal entries to explore the mother’s view of the process
and the perceived impact of the filial therapy training. Through this qual-
itative case study design, we hoped to gain perspective into one immigrant
Jamaican mother’s values and perceptions in the framework of filial ther-
apy. Although the results are not intended as a general application to all
Jamaican immigrant parents, this instrumental case study provides data
that may inform future filial therapy research with immigrant Jamaican
parents.

Participants

An immigrant Jamaican mother and her 4-year-old daughter were

invited to participate in the research project. Patricia and Jodi (names are
pseudonyms) were members of a local community group with which-
Natalya A. Edwards was affiliated. Patricia was born and raised in Jamaica,
but moved to the United States approximately 10 years before the training.
She is married and is a professional businesswoman. Patricia and her
husband, Brian, have two children, Jodi and a 1-year-old son, Simon.
Patricia and her family live in a quiet suburban community in the
southeastern United States. They are middle-income earners who appear
to value family ties. Before the filial therapy training, Patricia told Edwards
that her hectic schedule prevented her from spending as much time with
her children as she would have liked. The value placed on family could also
be seen in the active role that Patricia and her sister, Mia, play in each
others’ lives. It is very common, for example, for Mia to babysit Jodi and
 42 Edwards, Ladner, and White

Simon. When Mia had a baby of her own, Edwards went to her house to
have training sessions when Patricia was helping Mia with the baby. Brian’s
family seemed to be very involved in caregiving as well. They would often
assume baby-sitting responsibilities as well as after school pick-up duties.
Although Brian was busy with school during the intervention period,
he seemed to be very involved in the children’s day-to-day lives. During
one training session, Patricia told Edwards that both parents would put the
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children to sleep each night.

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Jodi seemed to be a very quiet and polite child. She was initially
hesitant to interact with Edwards and used her mother as “base” during the
first training session. After a while, she would come and show Edwards her
toys on each visit.

Filial Therapy Intervention

Filial therapy was traditionally designed for use with a group of parents
(B. Guerney, 1964). Landreth (1991) developed a 10-session model of filial
therapy, and Vanfleet (1992, 2005) adapted this model for use with one
family or one parent. The filial therapy intervention was based on the
Vanfleet (2005) model for an individual family. Through approximately 18
1-hr sessions, parents are taught the basic skills of structuring, empathic
listening, child-centered imaginary play, and limit setting. The filial thera-
pist models the skills, conducts role-plays with the parents, and helps them
to transfer play sessions to the home setting.
The current study adapted the Vanfleet (2005) model by lengthening
each training session to 2 hr and conducting a total of eight sessions
throughout the intervention period. All parent– child play sessions were
conducted in the home so that there was no transfer necessary.
Natalya A. Edwards taught Patricia specific skills (tracking, empathy,
encouragement, and limit-setting) through direct teaching, handouts, mod-
eling, video demonstrations, and role plays. Patricia was asked to practice
the filial therapy skills during weekly 30-min child-centered play sessions
with Jodi and to keep a journal describing her thoughts related to the
process. Weekly meetings with Edwards involved the examination of vid-
eotaped play sessions and in-depth discussion of skill acquisition.

Data Collection

Creswell (1998) suggested extensive modes of data collection for a case

study design including documents, records, observations, physical artifacts,
 Perceived Effectiveness of Filial Therapy 43

and interviews. For the purposes of this research project, we used the
following sources of data collection: (a) demographic data, (b) audiotapes
of two in-depth interviews, (c) audiotapes of the training sessions, (d)
videotapes of the 30-min play sessions at home, (e) observations of parent–
child interaction, (f) parent journal, and (g) Edwards’s data contact sheet
and field notes.
Before the training began, Patricia was asked to participate in an
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in-depth interview to gather information about (a) the mother– child rela-
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tionship, (b) parenting practices and values, and (c) the perceived role of
play in Jodi’s life. A second interview was conducted after the training
period to explore Patricia’s views of the filial therapy training. Patricia was
also asked about possible changes in herself, her child, and their relation-
ship as a result of the training. Each in-depth interview was approximately
1.5 hr.

Research Team

The research team consisted of Natalya A. Edwards, Jana Ladner, and

two faculty advisors. Edwards and Ladner are doctoral students with
substantial experience and training in play and filial therapy and in quali-
tative methodology at the doctoral level. One of the faculty advisors is a
registered play therapist–supervisor and the other is a specialist in imple-
menting school and culture-specific interventions.
Only Edwards had direct contact with Patricia and her family. Their
interaction and Edwards’s perceptions and reflections may have been
influenced by their prior relationship. She therefore sought regular consul-
tation and peer supervision with a faculty advisor and Ladner, respectively.
Edwards is also Jamaican and may have been influenced by precon-
ceptions of the Jamaican culture. This may have been a hindrance in some
ways as she may have made cultural assumptions about Patricia’s parenting
rather than see her as a unique individual. Being Jamaican may also have
given Edwards some credibility from Patricia’s perspective, especially
when aspects of the content may have appeared to be culturally incongru-
ent.

Data Analysis

Data collection and analysis took place cyclically and concurrently.

Edwards and Ladner met weekly to analyze transcribed interviews and
training sessions and to develop a coding manual. Through constant com-
 44 Edwards, Ladner, and White

parison as more data were collected, the coding manual was adjusted and
reapplied to the transcriptions. Recursive methodology facilitated adapta-
tions to the training intervention as data analysis took place. Edwards
analyzed the videotaped play sessions using a treatment integrity protocol
developed by Edwards and Ladner. One of the faculty advisors aided in
discussion of culture-specific variables.
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Trustworthiness

To increase validity, we accounted for the following: (a) triangulation,

in which Edwards and Ladner compared and contrasted the interview and
training session data with parent journal responses and carefully noted and
examined any discrepancies; (b) peer debriefing between Edwards and
Ladner; (c) member checking in which the parent reviewed the transcrip-
tions to verify the accuracy of the content (Lincoln & Guba, 2000); the
parent was specifically asked to peruse each interview/training session and
ensure that Edwards had reported responses and discussions accurately;
(d) simultaneous data collection and analysis to inform subsequent training
methods and interview questions; (e) an audit trail conducted by Ladner;
and (f) Edwards’s data contact sheets and field notes.

RESULTS

The data revealed the following six overall themes related to the
process and perceived effectiveness of filial therapy: content, structure,
play, the mother, the child, and the mother– child relationship. Each of
these themes and the factors comprising each are examined within the
context of the research questions.

Research Question 1

The first research question examined Patricia’s perceptions of the

process of filial therapy. Responses were categorized according to content,
structure, and play.

Content of Filial Therapy

The content of the filial therapy intervention referred to the four basic
skills taught during the training period (tracking, empathy, encouragement,
 Perceived Effectiveness of Filial Therapy 45

and limit setting). Each of the first four training sessions focused on one
skill, with subsequent training sessions incorporating material that was
previously learned. Where appropriate, Patricia was given handouts detail-
ing the concepts discussed. Training sessions also involved viewing video-
tapes and discussing skill integration. Throughout the sessions, Patricia was
asked to give her perceptions of the training content. Subthemes related to
content included understanding, acceptability, integrity, and generalizing.
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Patricia reflected a clear understanding of the filial therapy skills

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presented. In each session, she asked clarification questions and reported

being able to apply skills learned to interactions with Jodi. In the final
interview, she noted the importance of encouragement and its impact on
children. “I think that it’s just good to know the difference between
encouragement and praise and . . . how it helps build self-esteem when you
give them encouragement.”
Acceptability of the filial therapy training was explored in terms of
initial reactions and later findings. During the first training session, Patricia
was shown a video demonstration of a play session. At that point, she noted
some ambivalence toward tracking, stating that it would be challenging, but
that she was willing to make an attempt. However, in subsequent training
sessions she expressed a dislike for the tracking skill. “It’s killing me . . .
don’t really like it.” She noted several times that it felt strange to simply
state what she saw Jodi doing. It seemed illogical to her to state the
obvious.
Patricia seemed more open to learning and using the other skills. “I
really like the empathy and the encouragement the best. It was easiest for
me to do. It came more natural and . . . I saw where it helped her.” During
the training, Patricia reported that she did not have a problem with the
limit-setting skill. However, in the final interview she stated that it was
difficult for her to follow the format for limit setting and to use a strategy
that did not involve corporal punishment, noting that she felt she should
get “right to the point” when correcting Jodi. When describing limit setting,
Patricia said, “It’s still a lot of talking” and that it involved too many
prescribed steps. Limit setting also involved returning responsibility to
Jodi, which allowed her to choose whether or not to break a limit. This
aspect of filial therapy did not seem to fit with Patricia’s view that children
should obey the first time and thereafter be physically punished.
Integrity referred to the extent that Patricia used the skills and lan-
guage of filial therapy as taught. The results indicated that the level of
acceptability of tracking could have affected the degree of integrity dis-
played. “The hardest thing about the tracking . . . I just forget to do it.”
Patricia also showed some difficulty using a limit-setting system that in-
volved giving Jodi a choice. For example, “No, Jodi, we have to clean up
right now” was a more typical response.
 46 Edwards, Ladner, and White

Throughout the training period, Patricia noted several times that she
used the filial therapy language and skills outside of the special play times
with Jodi (generalizing). “Any little new skill, I’ll definitely utilize it
because I don’t think it’s just for the play time, it’s to . . . develop our
relationship.” In fact, there was less focus on skill use during the special
play times. It seemed important to Patricia to incorporate the skills in her
everyday interaction with Jodi. The use of the filial therapy techniques also
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appeared to extend to communications with her son, Simon, as reported by

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Patricia and observed by Edwards. On one occasion, Patricia told Simon,

“The chair is not for playing in, the chair is for sitting in.”

Structure of Filial Therapy

The structure of filial therapy referred to the 2-hr weekly training

sessions, the weekly 30-min play sessions, and the format of the play
sessions (one on one and child centered). Factors that emerged from this
category included time, understanding, acceptability, and integrity.
Patricia’s ability to find time to participate in the training and to
conduct the play sessions was limited by her multiple roles. As mentioned,
she works full time and is Jodi’s and Simon’s primary caregiver. It is very
common for Patricia to work late nights and weekends. Throughout the
training, she noted the challenge of finding a consistent time and place to
conduct the special play times. Patricia and Edwards conducted training
sessions and interviews at multiple locations and times to accommodate
Patricia’s schedule.
As was the case with understanding the content of the filial therapy
training, Patricia also expressed a fairly accurate understanding of the
structural components. Patricia was aware that the structure of the training
entailed 2-hr weekly meetings with Edwards and 30 min of special play
time with Jodi each week. However, she needed additional clarification
regarding the format of the 30-min play sessions. In the first two training
sessions, her questions specifically related to the individual and child-
centered nature of the play sessions. “My son . . . what do we do with him?”
“Am I supposed to be playing with her?” “So [I] don’t say ‘that doll,’ or
‘that door.’”
The acceptability of the structure was also assessed during the training
and in the final interview. Patricia noted several times throughout the
training period that she thought the requirements of the training were
reasonable. However, her responses in the final interview reflected mixed
perspectives. Consistent with her desire to incorporate new skills into her
general parenting practices, Patricia seemed to view the play sessions as an
opportunity to practice for later application.
 Perceived Effectiveness of Filial Therapy 47

The play sessions were helpful . . . . It . . .got me started into trying to use the four
skills . . . being able to be in that environment where you know, okay, this is what
you can do and then from there you can take it outside into the real world.

Patricia did not seem to see the play sessions themselves as an oppor-
tunity to build her relationship with Jodi in a context that was child
centered. She reported having some difficulty getting involved in the play.
“I guess she has her little child-centered time when she gets to play while
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I’m cooking dinner. But this child-centered is me just watching her . . . and
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. . . I have to clean this stuff up and I’m tired.”

The preceding statement also reflects the impact of Patricia’s schedule
and energy level on the integrity of the filial therapy intervention. Al-
though Patricia was asked to have the play sessions at a consistent time and
place and agreed to do so, many of the training sessions were spent
brainstorming ideas related to scheduling difficulties. “We didn’t get a
chance to do our special play time this weekend.” Despite efforts to
maintain consistency, Patricia was only able to do four special play times
during the 8-week intervention period. The content of these videotaped
sessions was consistent with Patricia’s comments related to her fatigue. “I
was practically falling asleep and she’s just there playing and . . . I was
dead.” The videotaped sessions also reflected the degree of skill acquisition
reported by Patricia throughout the training period. In all four play ses-
sions, Patricia struggled to use tracking appropriately.
When asked if she would continue having the special play times with
Jodi after the training was complete, Patricia responded hesitantly. After
initially shaking her head, she explained her plan to make some changes to
the format of the special times.
I should pull out that toy kit. It gets Jodi so excited, and I think I will probably in
the summer. But not like every week. I definitely will do something with her every
week. I know that for a fact. But probably not the toy kit. I’ll do . . . stuff where we
can go out and do things, you know just me and her . . . and . . . when we’re doing
it then I’ll use these filial therapy skills even more.

Here the emphasis is on time spent together and less on structured play
activity.

Play

This theme was examined in terms of Patricia’s perceptions of play,

existing play practices, and the family dynamic. This category reflected
mixed results. Patricia reported her perception of play as something that
her children did apart from the adults or with adult supervision. When
asked what her role in Jodi’s play was, she stated that she tried “to make
 48 Edwards, Ladner, and White

sure that she’s having fun while still somewhat learning. But not really
realizing that she’s learning.”
Patricia seemed to have a keen awareness of Jodi’s existing play
practices and was able to describe play activities in detail. “She loves arts
and crafts . . . . She likes princesses . . . . She used to . . . cook a lot . . . in her
little kitchen area, but she slowed down a bit.” However, Patricia’s role in
Jodi’s play was not limited to observation. “We like reading or we used to
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pretend . . . . We have a little tent upstairs, so we usually play with that.” It

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appeared that Patricia’s involvement in Jodi’s play may have been largely
unintentional and spontaneous. This is supported by Patricia’s description
of a family play tradition (family dynamic) that took place when her
husband, Brian, came home from work. “As soon as they hear the door
open up . . . everybody has to hide . . . in the same spot . . . and he’ll come
and find them . . . . Sometimes I hide too and then he’ll find them and tickle
them.”

Research Question 2

The second research question explored the mother’s perceptions of the

impact of the filial therapy training on the mother, the child, and the
mother– child relationship.

Mother

The examination of the perceived impact on the mother provided

insight into Patricia’s parenting practices and values. Factors in this cate-
gory included a parent-centered approach, handling the child’s emotions,
values, views of parenting, awareness of the child’s needs, and view of self.
In the first training session, Patricia was very clear about her approach
to parenting. “I’m a more . . . parent-centered . . . where she doesn’t dictate
what she’s gonna do. We pretty much tell her what she can do.” Patricia did
not appear to use negotiation, which may be consistent with her struggle
with providing choices in limit setting. This parent-centered approach was
not significantly affected by the training and may in fact have largely
affected the degree of acceptability of components of the training on both
content and structure.
Patricia’s parent-centered approach also appeared to be linked to the
way that she handles her child’s emotions. During the training on empathy,
Patricia was asked to describe how she handles Jodi’s emotional expres-
sions. “I don’t want her to focus on it too much. If it’s something where she
 Perceived Effectiveness of Filial Therapy 49

doesn’t need to cry then I’ll let her cry and then I’ll say, you know, ‘All
right, you can stop now.’” In this way, Patricia managed how and to what
extent Jodi expressed certain emotions. As mentioned, Patricia seemed to
have embraced the use of empathy (“This is kinda neat. This empathy
business”), although she still maintained a parent-centered approach to
interactions with Jodi. Yet it appeared that she became aware of the
importance of empathic responses as a result of the training (“I need to
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have more patience with Jodi. I just need to be able to be in tune with her
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more. . . . I have to be careful . . . she still has little feelings and she’s still
only 4”).
Throughout the training, Patricia was very clear about the values that
she wanted Jodi to embrace. These included academic excellence, self-
control, work ethic, leadership, organization, and religion. Various disci-
plinary strategies were used to teach Jodi to respect authority and to obey.
“Spankings and time-outs. . . . I made her apologize.” The filial therapy
training did not seem to have a substantial impact on how these parenting
values were expressed. Rather, these values may have determined the
degree to which certain filial therapy techniques were used.
The impact of the filial therapy training on Patricia was most clearly
seen within the framework of the last three factors: Patricia’s views of
parenting, an awareness of her child’s needs, and her view of self. Patricia
told Edwards that the filial therapy training came at a time when she was
struggling to maintain a healthy relationship with Jodi. She noted that the
training helped her to “slow down” and spend time with Jodi. During one
of the training sessions, she stated, “I think it is very important to give each
kid the right amount of time that they need.” Patricia noted that she had
recently become very busy but that the filial therapy training had allowed
her to see how much Jodi needed her. “I know she wants that attention and
she wants to spend time with me. . . . I don’t want to be like a deadbeat
mom, like you know like always a bag of excuses.” As a result of the
training, Patricia resolved to spend more one-on-one time with Jodi and
“to be more conscious of doing things with her and not just . . . being there
but doing something else.” An apparent impact of the filial therapy was to
have Patricia focus on her parenting within the context of all the other
commitments she manages.

Child

The impact of the filial therapy training on the child was explored in
terms of described characteristics of the child and specific changes as
reported by the parent. Patricia expressed a keen knowledge of her child’s
 50 Edwards, Ladner, and White

characteristics and behavioral and emotional expression. “How does she

show that she’s happy? She’ll smile, you know, jog on spot.” One week
after this empathy training, Patricia detailed her response to Jodi’s sadness.
“I said, ‘I know you’re sad but . . . when you see Daddy rushing you have
to hurry up’ and she was like ‘I didn’t even know he. . . .’ and usually she
would just cry.” Here we see the impact on the child of the use of an
empathic response. Patricia also stated that the filial therapy training
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helped her to notice certain characteristics that she had not taken the time
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to notice. “She’s really funny. . . . I knew she was funny but I didn’t take the
time out to laugh at most of the jokes that she was giving me because I was
too busy.”
Patricia was clear about the effect that the filial therapy training had on
Jodi’s sense of self (changes). “It . . . encourages her and builds her self-
confidence ‘cause even like tonight we were reading and I was like ‘Jodi,
you’re tired’ and she was like ‘No, Mummy, I can do it.’”

Mother–Child Relationship

Factors that emerged under mother– child relationship included love

and affection, communication, and changes. In the first interview, Patricia
was asked to describe her relationship with Jodi. She noted that it was
loving. “In the morning when she gets up she usually comes in the bed and
she’ll lie down with me and you know we’ll hug up and stuff.”
Patricia also stated that she and Jodi have always had good commu-
nication. “I would talk to her all the time and say ‘I’m going to the . . . and
I’m going to do this, this, this, and then I’m going to come back and get you,
okay?’ ‘Okay, mummy.’ ”
Patricia described specific changes that she saw in her relationship with
Jodi as a result of the filial therapy training. “I definitely see . . . a differ-
ence. . . . We’ve definitely gotten closer . . . everything that we’re doing it’s
not negative anymore.” Patricia noted how good it felt to spend one-on-
one time with Jodi, and this increased her resolve to make time in her
schedule for relationship building.
Just trying to focus on what she’s doing and let her know I’m noticing her. . . . I’m
definitely trying to . . . put all that focus on her. So whenever she says, “Are you
proud of me?” I say, “Yeah, I’m proud of you . . . and . . . you’re proud of you too,”
and then she’ll start saying, “Yeah, I’m proud of me.”

DISCUSSION

It appears that there are components of filial therapy training that are
consistent with some parenting values and practices of this Jamaican
 Perceived Effectiveness of Filial Therapy 51

mother. The results of this case study indicate that several of the goals of
filial therapy training (Vanfleet, 2005) were met. Overall, Patricia reported
that the training helped her to increase in parental empathy and awareness
while strengthening the relationship between mother and child. These
findings are consistent with those of Glover and Landreth (2000), who
reported increased parental empathy through the filial intervention. The
findings also support Solis et al. (2004), who reported an increase in
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

parental self-awareness and analysis concerning parenting practices.

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Patricia made it clear that she wanted a close relationship with Jodi and
saw the filial therapy training as giving her the opportunity and skills for
relationship building. This is consistent with Yearwood’s (2001) findings
that Jamaican immigrant parents tend to place a high value on the parent–
child relationship. Yearwood’s findings suggested that parents emphasized
time spent, respect, and encouragement, just as Patricia did. This also
aligns well with Patricia’s openness to using both empathy and encourage-
ment with Jodi.
Patricia embraced some aspects of filial therapy but also stated that she
would not change her way of parenting entirely. Instead, she planned to
incorporate the filial therapy skills into her current parenting practices.
Although Patricia initially stated an acceptance of the limit-setting strategy,
she later told Edwards that she was unwilling to do away with spankings
completely. Brown (2001) highlighted the value that many Jamaicans
attach to corporal punishment. Like many Jamaicans, Patricia saw corporal
punishment as an integral part of discipline. Filial therapists may want to
use cultural sensitivity and creativity in presenting a model that may not be
congruent with specific parenting practices of the Jamaican culture. Filial
therapists should also be aware of their value system regarding corporal
punishment and its potential impact on the therapeutic alliance.
In addition to her view on discipline and the limit-setting sequence,
Patricia’s resistance to some aspects of the filial therapy training may be
seen in her stated dislike for tracking, her failure to conduct all required
play sessions, and the degree of integrity displayed in the videotaped play
sessions. As mentioned, the level of skill acquisition described by Patricia
and her discomfort with tracking was evident in our analysis of the play
sessions. Therapists who wish to explore filial therapy techniques with
diverse cultures should have open discussions with clients regarding the
acceptability of specific aspects of the intervention. Feedback from parents
may provide filial therapists with creative ideas that may enhance the
acceptability, integrity, and sustainability of future training models.
Although a detailed look at one Jamaican mother and child, this study
has limitations, which include lack of generalizability, convenience sam-
pling, and the examination of only one parent in a two-parent family.
Although Patricia had primary care of the children, as noted earlier, Brian
 52 Edwards, Ladner, and White

was involved in his children’s lives and had an active parenting role. Future
studies might examine the combined role of parents in two-parent house-
holds, including acceptability and integrity, parenting style, and relation-
ship issues between each parent and the child. Inclusion of fathers may
illuminate issues particular to parenting daughters and sons and the effects
of filial therapy.
The findings of this study provide insight into one Jamaican mother’s
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

values and practices within the context of filial therapy training. Although
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Patricia’s perceptions of the process and impact of the training cannot be

generalized to all Jamaicans, the results of this case study may inform
future research and practice with other immigrant Jamaican parents. The
psychoeducational component of the filial therapy training may align well
with other Jamaican parents who, like Patricia, value education and prac-
tical learning opportunities. In addition, because the Jamaican culture is
communalistic in nature (Moemeka, 1998), filial therapists may consider
using the group training model (Landreth, 1991) with Jamaicans to deter-
mine the impact of group feedback and shared experiences on the accept-
ability and integrity of the training.

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