I use video feedback sessions with parents to help parents see the impact of their behavior on their child and address their perceptions of their child. These sessions are scheduled without the child present so the parent and I have a chance to discuss the interactions and their emotional responses without distraction. Watching yourself interacting with your child on video can be extremely stressful for parents. Parents may become defensive so it is important to move slowly and have a good working alliance with the parent. I set up the video review to be as relaxed and nonthreatening as possible. I set up the room for video review sessions with a table with drinks and snacks between the parent and I with both of us facing the television screen. Initial video feedback sessions focus on pointing out the positive impact of their behavior on their child and moments of mutual enjoyment. I often make the same types of statements I make during in vivo coaching (see Tables 4.1 and 4.2). However, since I have the luxury of not having a busy, disruptive young child present, I am also able to find out about the parent’s perception of the interactions.

I find it especially important to reflect on my countertransference reactions to the parent prior to these video sessions. My initial inclination in doing video review was to show parents the interactions I found problematic. I have learned that parents tend to be much harder on themselves than I am on them. It is important for me to provide a supportive environment and recognize their strengths as parents so they are able to feel safe enough to look at the areas where they struggle. I also find video feedback sessions helpful in remaining supportive and compassionate towards the parent. The parent’s perceptions of the interactions gives me a small window into their view of relationships.

In later video feedback sessions, I begin to have parents look at how to improve their behavioral parenting skills—e.g. lost opportunities for praise or reflection. Once parents are more comfortable with the video feedback sessions, I begin asking questions designed to help parents identify their feelings during the interaction and how those feelings may have colored their perceptions and response to the child. Examples of the types of questions or prompts I might use in a video feedback session to encourage parents to examine their emotional responses are listed in Table 4.4. Video review often serves as a jumping off point for parents to discuss barriers to improving their interactions with their child such as feelings about how they were parented or their feelings about their child.

Given their focus on behavior, countertransference is not a term typically used by behaviorists. However, from a behavioral perspective, parents are reinforcing, punishing, and shaping our interactions with them just as we are reinforcing, punishing, and shaping their behavior with us and their child. This section provides a framework for understanding and addressing this “behavioral countertransference”.

When coaching parents in behavioral parenting skills, the goal is to use the same skills with parents they are being coached to use with their children (Eyberg 2005; Eyberg and Funderburk 2011; McNeil and Hembree-Kigin 2010). That is, when coaching parents in child-led play, behavioral parent coaches strive to primarily use positive reinforcement and differential attention—i.e. noticing and praising the parent’s use of positive behavioral parenting skills.

Despite this emphasis, there seems to be a strong pull for behavioral parent coaches to become more directive and critical of parents over time, especially when the primary focus is getting parents to master specific skills. In an analogue study with a community sample, parents who receive “constructive criticism” (criticizing parents’ use of negative parent behaviors and describing parents’ use of positive parent behaviors) demonstrate significantly more positive parenting skills after 20 min of coaching than parents who receive only positive or neutral feedback (Herschell et al. 2008). Thus, in the short-term, therapists are reinforced for providing more critical feedback to parents by the parent’s improvement in skill acquisition—just as parents are reinforced for criticizing their child by short-term improvement in their child’s behavior.

Consistent with the idea that behavioral therapists are likely to be more directive than responsive during their coaching, a study of parent coaching of child-led play sessions in Parent-Child Interaction Therapy (PCIT) found therapists gave significantly more directive than responsive coaching statements (Barnett et al. 2014). This study also indicates how the therapist’s coaching is impacted by the parent’s behavior. Parents who praise their child more receive a greater number of responsive coaching comments (primarily praise) while parents with more deficits in child-led play skills receive more directive comments (Barnett et al. 2014). Thirteen percent of the parents in this study failed to return for a subsequent coaching session. For the families who did return for another coaching session, responsive coaching comments were associated with their use of labeled praises in the subsequent coaching session.

Research on attrition in PCIT indicates mothers who praise their child more and criticize them less at pre-treatment are more likely to complete PCIT (Fernandez and Eyberg 2009; Werba et al. 2006). It is easy to see why parents who praise their child more at the beginning of behavioral parent coaching are more likely to successfully complete treatment. The parent praises the child, the therapist praises the parent, and a cycle of responsive, positive reinforcement is quickly established. However, what about the families who at the beginning of treatment are praising their child less and criticizing them more? The relatively high drop-out rate in behavioral parenting interventions and research indicating parents are more resistant to implementing behavioral parenting skills when therapists are more directive (Patterson and Forgatch 1985) suggests behavioral therapists are becoming caught up in the “coercive cycle” (Patterson 1982) that characterizes many of the families referred for behavioral parenting interventions.

In coaching parents, I find it helpful to remember the distinction made in the Adult Attachment Interview (AAI) between showing and telling. When coaching parents, it is important that what we are showing them during our coaching is the same as what we are telling them. For example, if we are telling parents to be positive and responsive to their children, we need to be positive and responsive to them. It is especially important to establish a high rate of responsive, positive coaching with parents who are not yet exhibiting a high rate of positive behavior towards their child. In fact, I think it is probably more important for these parents to experience responsive, positive coaching given their risk of dropping out of treatment (Fernandez and Eyberg 2009) and the likelihood they do not have much experience with positive, responsive relationships. I try to follow Pawl and St. John’s (1998) “platinum rule” during coaching; “Do unto others as you would have others do unto others.”

A form for coding parent coaching during child-led play is displayed in Table 4.5. Having a method for tracking my coaching helps me guard against “behavioral countertransference” drift by allowing me to evaluate whether what I am “showing” parents during coaching is the same as what I am “telling” them. My goal is for at least 80 % of my coaching statements to be positive and responsive. For some parents, I aim for an even higher rate of positive responsive coaching in order to counteract the parent’s tendency to be directive and critical with their child. (Table 4.6)