Special Commentary: How to Recognize and Work with Destructive Perfectionism

Margaret Robinson Rutherford, Ph.D.

“If it’s worth doing, it’s worth doing well.” How many times did I hear that growing up? Basically, my parents were attempting to teach me (just in case I hadn’t absorbed it from their own actions) that striving for excellence was valuable. They were teaching what’s now termed constructive perfectionism – where enjoyment and fulfillment in life can be found in doing things as well as you potentially can. In constructive or “positive” perfectionism, the focus is process-oriented; if you fall, you get back up again and learn from the experience.

Yet perfectionism can have a much darker side. Brené Brown, a premier researcher in shame and vulnerability, defined perfectionism in her first book, The Gifts of Imperfection, as… “a self-destructive and addictive belief system that fuels this primary thought: If I look perfect, live perfectly, and do everything perfectly, I can avoid or minimize the painful feelings of shame, judgment and blame” (2010, pg. 57). This facet of perfectionism, which is fueled by the need to quell intense and persistent voices of inner shame, isn’t fulfilling. It’s far from enjoyable. Rather, it’s an exhausting race to exceed your own expectations as well as expectations that others might have of you.

This is destructive perfectionism. The goal is achievement. It’s driven. It’s pressured. And it’s a growing mental health problem.

Many perfectionistic people will fall somewhere on a spectrum between the two poles. But there’s another issue. Ironically, destructive perfectionists may not even recognize themselves as perfectionists; they don’t believe their best is good enough. There’s always the next achievement. And then the next. And the next.

Within the last decade or more, I’ve treated more and more people who don’t quite know why they’ve come to therapy. They describe moderate anxiety, or fatigue. If asked if they were depressed, I’d hear a firm denial. “I have too many blessings in my life.” If questioned whether or not their childhoods provided safety and security, they’d laugh and deny or discount any kind of problem. Or sometimes they’d become very quiet and look out the window, as if they wished they were anywhere but my office. 

Yet, as they unveiled stories of families where sadness wasn’t tolerated or parents who screamed they’d never amount to anything, it became apparent that there was little access, if any, to hurt or pain. They were completely zipped up.  These clients were destructive perfectionists who were running out of steam but not sure what, if anything, was wrong. Their emotional pain was expertly, and often unconsciously, hidden.

Yet as they returned for one more session and then another, they’d slowly risk sharing one shame-filled secret after another. The pathos of their stories would timidly seep out, as a seemingly impenetrable cloak of silence would slip off to reveal tremendous loneliness and despair.    

And yes, depression.

What peaked my own curiosity in perfectionism?

In 2014, I was writing my usual weekly blogpost and thought the work I’d done with clients who had the traits and behaviors described above. I picked a term out of the air and entitled the post, “The Perfectly Hidden Depressed Person: Are You One?” The post went viral, which had never happened to me. The next day, it was published by HuffPost. In a 24 hour period, hundreds of emails swamped my inbox. “It’s like you’re in my head.” My curiosity was peaked as I read each and every one of them. I began researching myself, curious to see what existed in the popular literature about perfectionism, shame, and fear of vulnerability. I found the wealth of research and knowledge of Brené Brown, the much earlier thoughts on covert depression by Terrance Real,  Kristin Neff’s treatise on self-compassion. There were workbooks talking about how to become more comfortable with imperfection which were of course helpful. But what was available to the general public about the relationship between perfectionism and a potentially deadly depression? I couldn’t find anything.

Then I turned to academic sources and found a wealth of information.

The academic research on destructive perfectionism…

Perfectionism has long been identified as a potentially destructive character trait. Sidney Blatt was one of the first to amass research findings on perfectionism, its links to depression and suicide, and its implications on treatment. He suggested that certain types of depression should be identified through what someone’s lived experience was, rather than if their symptoms fit official criteria for classic depression. “This approach to understanding depression from a phenomenological, rather than a symptomatic, perspective has emerged as a major trend in both psychology and psychiatry over the past two decades…. Investigators have increasingly sought to understand depression not as a series of symptoms but as a complex phenomenon that emerges from two major classes of disruptive life events: (a) severe disruptions in interpersonal relations (e.g. loss of separation) or (b) profound threats to feelings of self-esteem and self-worth.” (pg. 12)

So, perfectionism can become destructive when its birthplace wasn’t a place of support, safety and nurturing. But where instead, trauma or familial/cultural dynamics required a mandatory strategy for emotional survival , where vulnerability was disdained.

Currently, there are researchers worldwide that are investigating perfectionism’s causes, be they cultural, political, familial, social or an interaction of all four of these factors. There’s some disagreement on whether or not perfectionism can be adaptive at all or if it’s almost always maladaptive. There are many people who view striving for excellence as a process, a situation where you learn as you go, where mistakes are tolerated and even expected. Yet a very recent meta-analysis found that perfectionistic concern (trying to reach external goals/expectations set by others) and perfectionistic striving (pushing yourself to perfection) are both linked with depression, are significantly linked to social disconnection, and the first is further associated with greater stress.

There are growing reasons to be concerned about the rate of perfectionism in younger generations as well, with studies showing it’s measurably getting out of hand. And when perfectionism is researched by itself, a certain type of perfectionism called socially-prescribed perfectionism (similar to perfectionistic concern) is not only on the rise, but is significantly correlated with the risk of suicide.

And as these rates soar, tragically so does the quest for the perfect-looking life, fueled by everything from helicopter parenting to social media.

The birth of perfectly hidden depression..

So, I started to ask questions and to write about the traits of people with “perfectly hidden depression.” I spoke with over 60 interviewees who identified with PHD, and who volunteered anonymously to come forward with their own stories. A brain surgeon, a motivational speaker, a dentist, an advertising exec. All successful. And all wanting to help others to not recreate lives similar to theirs.

I took their stories, as well as the ones from people I myself had treated, and tried to describe what this dangerous kind of depression might look like in someone’s life – “phenomenologically” to use Sydney Blatt’s words. How could someone who scored low on a depression inventory be living with secrets that ultimately might destroy their will to live? And clinicians like you and me might to think outside of the diagnostic box, and to pick up on these traits. A recent article by Scottish psychiatrist Dr. Rebecca Lawrence stated this very thing: “It takes a conscious effort to remind myself of a fact that psychiatrists know very well on an intellectual level but should perhaps recognize more: a cheerful demeanor can be profoundly misleading.”

I wanted to describe and offer a working model of what this kind of dangerous perfectionism might look like in daily decision-making and behavior. So, shame-based perfectionism - destructive perfectionism - became the first trait of the syndrome “perfectly hidden depression.”

 These traits have not been empirically validated. Yet, they mirror my clinical experience, and likely, will reflect yours as well. As one clinician said to me, “You’ve given a name to something we all know exists.”

The ten traits of perfectly hidden depression…

·                     You are highly perfectionistic, fueled by a constant, critical inner voice of intense shame or fear.

·                     You demonstrate a heightened or excessive sense of responsibility and look for solutions.

·                     You have difficulty accepting and expressing painful emotions, remaining more analytical or “in your head.”

·                     You discount, dismiss or deny abuse or trauma from the past, or the present.

·                     You worry a great deal (but hide that habit) and avoid situations where you’re not in control.

·                     You are highly focused on tasks and others’ expectations, using accomplishment as a way to feel validated.

·                     You have an active and sincere concern for the well-being of others, while allowing few (if any) into your inner world.

·                     You hold a strong belief in “counting your blessings” and feel that any other stance reflects a lack of gratitude.

·                     You have emotional difficulty with personal intimacy but demonstrate significant professional success.

·                     You may have accompanying mental health issues that involve anxiety and control issues, such as OCD, GAD, panic, eating disorders or high-functioning substance use/abuse.   

Working with someone who identifies with perfectly hidden depression…

In my own work, I’ve identified five stages of treatment that can be helpful to remember, as your own clients take the risk to gently confront their own silence – and learn to express what has long been suppressed.

The stages are consciousness, commitment, confrontation, connection and change.

The First Stage: Consciousness

Consciousness means becoming aware that perfectionism is a problem. Although part of every emotional/mental healing process, this stage may be more complicated for your client because they’ve convinced themselves that those traits are normal. “Isn’t everyone like this?” The answer to that is a resounding no. Yet giving up or tweaking a strategy that’s brought them external success is very difficult.

It’s important to distinguish between PHD and high-functioning depression. In the latter, your client knows they’re depressed, but hide it to the best of their ability.

This is where mindfulness comes into play. Mindfulness authors teach that mindfulness is changing how someone is paying attention. It can deepen the experience of the present.  For someone who’s trying to become more aware of how their shame and need for control scream at them in the background of each day, becoming more mindful can allow them to experience and identify that painful inner dialogue.

Here’s one simple mindfulness practice.

“Sit somewhere very comfortable where your body is supported well and set a timer for three to five minutes. Breathe deeply and close your eyes. Stay as focused on your breath as possible, even counting them from one to ten and then starting over. If your mind wanders (which it will), gently let go of those thoughts and refocus on the breath.  When the timer goes off, check in with your emotions, your eyes still closed. There could be irritation, relief, feeling silly. Simply notice and watch it dissipate.”

The Second Stage: Commitment

There are five major stumbling blocks to a commitment to challenging perfectionism’s grasp. And as the clinician, you can watch for their presence and help point out how these hurdles are threatening healing.

1)                  Adopting such a rigid commitment that when you falter or don’t do it perfectly, you’ll quit or simply want to stop thinking about it.

2)                  Beginning with a goal that’s too hard or too large.

3)                  Going it alone and not asking for help along the way.

4)                  Dealing with the fear and shame of giving up your persona with its familiar coping strategies -- while stress that change brings naturally… increases.

5)                  Other mental issues you might have worsening due to the pressure, such as OCD or an eating disorder. 

One of the best strategies here is to alter the goal of “commitment” to that of “intention.” It’s far less autocratic and holds within it much more grace and forgiveness. So, the first two blocks are fairly self-explanatory. Let’s look at the third block; here’s an exercise to try.  

“Reflect and write down instances you can remember where you didn’t ask for help, but in hindsight, it would’ve been helpful to do so. Go back and replay what you could’ve said or asked for. Practice those sentences coming out of your mouth and hear yourself say the words. How does doing that cause you to feel? Try to think now of the present, and a situation where you could ask for help.”

The fourth block may be the most difficult. It’s a bit like the client is shedding  their armor while in the midst of battle. Journaling here can be highly effective.

The fifth block reminds you that you may need to stop your client’s work for a bit and attend to any symptoms of anxiety or an eating disorder – because an actual mental illness may be co-occurring with destructive perfectionism.

The Third Stage: Confrontation

Let’s talk about the difference between beliefs and rules. Rules govern conduct. Beliefs are something you accept as true. The two are interactive. Beliefs may define the rules you follow. Yet the rules you follow may limit or expand your beliefs. For example, you might have the rule, “I always put a smile on my face, no matter what.” It’s connected with the belief, “People won’t like me if I don’t smile.”

This stage involves helping your client identify the rules they follow – what’s allowed or disallowed, what they should do, must not do, always need to do, never should do. They could be spoken rules from family, from culture, created from real danger or expectations. Some are spoken; some unspoken. So you guide your client in their identification – and then, in whether or not they find them truly helpful now as an adult.

First determine what your spoken and unspoken rules are. Decide whether or not they serve you well (and some will) and will guide you toward a more self-accepting and less shame-filled life. If you decide the rule does not serve you well, write out one that would take its place.

The Fourth Stage: Connection

Looking in control, pleasing others, keeping a foot on the accelerator at all times – all these choices have protected your client. To confront shame head on, to connect with anger, to admit fatigue – that’s an immense amount of exposure.

Think about a turtle. At any sign of danger, the turtle pulls his head back in and waits. So, to consider feeling deeply? To approach painful memories that have been tightly compartmentalized for years? It can be quite frightening.

Terrance Real has a quote in his book, I Don’t Want to Talk About It. He’s talking to a patient about emotional vulnerability, and the guy, who was trying his best to understand why it was important, finally said, “You either feel it or live it, right? The pain. Either feel it or live it. Isn’t that what you’re going to say to me?”

He got it. If you don’t connect with emotional hurt or anger or sadness, it will govern your life in ways that you cannot see.

Obviously, with severe trauma, this step needs to be taken with the prevailing principle that the client go only as quickly (or slowly) as they are able. Breaks may need to be taken.

Here’s the exercise.

Carefully create a timeline, where you divide a horizontal line by years of age. 2. 4. 8. 12. 20. And so on.  You’re going to go back to those years and write down both the good and the hurtful things that occurred to you. This is an exercise in acknowledgment. Not blame. Acknowledge the good, the bad, and the ugly. This will also take courage as you confront the denial that may still want to emerge and complain, “Oh… it wasn’t that bad.” You’re not whining. You’re acknowledging the emotional consequences or charge of an event with the same compassion you’d show someone else. You’ll begin to see patterns and connections between events. And hopefully, you will find self-compassion.

The third and fourth stages of healing are where your client is going to find the “why” they began needing to look perfect. And to begin to accept that their vulnerabilities don’t define them any more than their successes do. For the antidote to perfectly hidden depression – is self-acceptance.  

The Fifth Stage: Change

In my years as a clinician, I’ve learned that insight is a very helpful thing. If offers context and understanding. But hope comes from behavior change. This stage probably began from the very beginning as baby steps are taken toward healing.

One last exercise.

Go through each of the ten traits and with trusted friends, your partner, a parent or a therapist, think about very specific ways you can begin to put your insight to work and actually risk behavior change. Choose which is the simplest and give it a try. This isn’t something to do perfectly. Remember, you’re on a journey.   

The hardest work isn’t making a change; it’s maintaining it. There are so many pulls and tugs from that perfectionistic shaming voice that holding onto a fresh perspective and behavior can be challenging. Sometimes your client may have to end relationships that are too damaging and set appropriate boundaries in the ones that remain.

Two women immediately come to mind as I’m finishing up this article. Both said to me, right before they left therapy, “I had a plan to kill myself when I walked in your door. But I never would’ve told you that… until now.”

They finally feel seen. Understood. Cared for. And they want to remain alive just as they are.

Resources

This material is drawn from my own book, Perfectly Hidden Depression: How to Break Free from the Perfectionism that Masks Your Depression (New Harbinger, 2019).

My gratitude and mention to these researchers and authors:

Blatt, Sydney Ph.D.; 1995. The destructiveness of perfectionism: Implications for the treatment of depression. American Psychologist, 50(12). 1003-1020.

Brown, Brené Ph.D.; 2010. The Gifts of Imperfection. (Hazelden Publishing).

Flett, Gordon Ph.D; Hewitt, Paul, Ph.D. Mikail, Samuel Ph.D; 2017. Perfectionism: A Relational Approach to Conceptualization, Assessment, and Treatment (The Guilford Press).

Lawrence, Rebecca. 2021. When depression wears a smile, even psychiatrists like me can be deceived. The Guardian. Thursday 18 2021.

Neff, Kristin Ph.D.; 2014. Self-Compassion: The Proven Power of Being Kind to Yourself (William Morrow).

Real, Terrance Ph.D.; 1997. I Don’t Want to Talk About It (Scribner).

Williams, Mark, Teasdale, John, Segal, Zindel, Kabat-Zinn, Jon: 2007. The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness (The Guilford Press).

Parent-Child Interaction Therapy for Latinx and non-Latinx Families: A Comparison of Barriers, Treatment Attitudes, and Behavioral Outcomes

Amy Hendricks1, Ayla R. Mapes, M.A.1, Lauren B. Quetch, Ph.D.1, Emma Girard, Psy.D.2,3, and Cheryl B. McNeil, Ph.D.4

1University of Arkansas

2University of California Riverside, School of Medicine

3Riverside University Health System - Behavioral Health: Preschool 0-5 Programs, Riverside, California

4West Virginia University

Abstract

Parent-Child Interaction Therapy (PCIT) is an evidence-based parenting intervention for children with disruptive behavior problems. While PCIT has shown strong evidence for reducing disruptive behaviors and enhancing parent-child relationships, the model would benefit from greater explorations with diverse and historically marginalized families. The current study examined the effectiveness of PCIT and barriers to treatment participation. Participants were 83 families receiving PCIT. Participants were primarily Latinx from a community in Riverside, California. The study utilized a longitudinal design (pre, mid, post), with information collected on treatment barriers, treatment attitudes, behavioral outcomes, graduation rates, and number of sessions attended. Results indicated there were no significant different between Latinx and non-Latinx families on reported barriers or attitudes. There was low endorsement of cost and stress barriers and most families rated positive attitudes regarding comfort with their therapist’s ethnicity and acceptance of treatment skills within their community. Disruptive behavioral scores significantly decreased across both ethnic groups, and this relationship was not moderated by therapy attitudes. Finally, graduation rates and the average number of sessions attended did not significantly differ across ethnic groups. Overall, results suggest PCIT had similar reductions for disruptive behaviors for Latinx and non-Latinx families, and that treatment was viewed favorably. Future research should expand on the effectiveness of PCIT for diverse communities and examine other barriers to treatment, especially for Latinx communities.

Keywords: parent-child interaction therapy, disruptive behavior, Latinx families, barriers, treatment completion

Parent-Child Interaction Therapy for Latinx and non-Latinx Families: A Comparison of Barriers, Treatment Attitudes, and Behavioral Outcomes

There is a growing trend in psychological practice to implement evidence-based treatments (EBTs; Barrera et al., 2011); EBTs are treatments that have been scientifically shown to improve client outcomes in terms of symptoms, functional status, and quality of life as compared to alternative treatment models (Drake et al., 2001). However, concerns exist regarding the effectiveness of EBTs with culturally diverse clients (Sue et al., 2009). Treatment efficacy and effectiveness studies frequently neglect the recruitment and enrollment of marginalized groups such as Latinx, non-White populations, and fail to retain these families at a high rate compared to White, non-Latinx individuals (Cunningham et al., 2000; Miranda et al., 2005). This lack of representation in empirical work makes it difficult to determine if the current delivery of EBTs (often constructed for and normed on White, non-Latinx samples) in community mental health settings are effective, have no effects, or are even harmful for Latinx populations (Miranda et al., 2005). Through research, a better understanding is possible of how these populations respond to EBT delivery and why they are less likely to access services.

Parent-Child Interaction Therapy

            One effective, largely studied EBT for young children (2-7 years) and their families is Parent-Child Interaction Therapy (PCIT). PCIT is an evidence-based intervention developed for addressing child disruptive behavior problems by building stronger parent-child relationships and establishing clear and consistent discipline techniques (McNeil & Hembree-Kigin, 2010). PCIT is composed of two phases: (1) Child-Directed Interaction (CDI; a nurturing phase where parents let children lead the interaction while building positive parenting strategies) and (2) Parent-Directed Interaction (PDI; a discipline phase where parents lead the interaction while learning consistent discipline procedures). Unlike other parent training treatments, a PCIT therapist views the parent-child interaction through a one-way mirror, coaching and providing immediate feedback to parents as they learn to attend positively, consistently, and predictably to the child’s prosocial behaviors while ignoring or addressing negative behaviors. PCIT is designed to break the parent-child coercive cycle by teaching parents to reinforce children’s prosocial behaviors while also helping children gain healthy emotion regulation skills (Lieneman et al., 2020; Patterson 1982). In empirical studies, PCIT has been shown to increase both positive parenting skills and child compliance rates while reducing levels of parenting stress and child behavioral problems (Abrahamse et al., 2012; Schuhmann et al., 1998). Studies indicate impressive success rates of around 80 percent for PCIT (Eyberg et al., 2001; Gallagher, 2003). Moreover, this reduction in child behavior problems and increase in positive parenting skills has even been shown to be maintained 6 years after treatment (Hood & Eyberg, 2003).

            While there are significant empirical findings documenting the positive outcomes associated with engagement in PCIT for White families (e.g., Brinkmeyer & Eyberg, 2003), few studies have examined the effectiveness of PCIT for Latinx families (McCabe & Yeh, 2009; McCabe et al., 2010; McCabe et al., 2012; Ramos et al., 2017; Thomas et al., 2017). This lack of research on Latinx families is concerning. Given what is known about the unique needs of Latinx families and their concerns surrounding family-focused treatments, it is imperative that further research explores the effectiveness of PCIT for this population. Additionally, it is important to explore what Latinx families may like about the structure of PCIT as well as reasons why they may terminate from treatment to determine ways to improve the current PCIT model.

Cultural Considerations

Culture is an important factor in shaping individual beliefs and expectations for behavioral health treatment. For example, researchers have found Latinx families prefer family systems change approach because of an emphasis on interconnection, reciprocity, and filial responsibility (Kumpfer et al., 2002). Latinx families tend to practice parenting influenced by respeto (respect) and familismo (familism) culture. In respeto culture, children display respect for authority figures such as caregivers and teachers. Parents who highly value respeto culture may feel less comfortable with the child-led interaction component of PCIT and may be more inclined towards a strict discipline style, leading them to feel that punishments such as ignoring a child’s behavior problems and instituting time outs are too mild (McCabe et al., 2005). In familismo culture, families have strong bonds. Familismo is a source of support but can also be a source of stress; for example, grandparents may provide assistance with raising their grandchildren but may also be critical of the practices used by parents (McCabe et al., 2005). Latinx families also practice personalismo (personalism), which is the desire to form close personal bonds, meaning that Latinx parents are more likely to want to form a close relationship with the therapist (Matos et al., 2006). Moreover, Latinx parents desire interventions that promote group cohesion and supportive relationships (Parra-Cardona et al., 2009).

Another factor affecting parenting and parent-child relationships in Latinx immigrant families is acculturation. Acculturation is the dual process of cultural and psychological change that takes place as a result of contact between two or more cultural groups and their individual members (Berry, 2015). This often occurs when individuals or families move to a new country, and the process involves adopting the language, attitudes, culture, and behaviors of the new host country (Zane & Mak, 2003). While individuals experience changes in behavior through long-term psychological processes (Berry, 2015), families moving to new countries may experience different levels of acculturation among family members. Portes and Rumbaut (1996) proposed ideas of “generational consonance” (when the level of acculturation is similar for parents and children) and “generational dissonance” (when the level of acculturation is dissimilar). Generational dissonance has been linked with more frequent and more intense family conflict (Farver et al., 2002). It has also been identified as a risk factor for declines in the quality of the parent-child relationship (Birman, 2006). In fact, one study found that a high level of discrepancy in American attitude orientation between fathers and children was associated with unsupportive parenting practices (Kim et al., 2009). Often, level of acculturation is associated with language preference and may be why Spanish-speaking families are more influenced by respeto cultural values (Ramos et al., 2017). Acculturation may impact how or why Latinx families seek mental health services in several ways; a) Latinx families with a high level of generational dissonance may experience more intense family conflict, leading them to seek services for these issues, or b) Latinx families who are highly acculturated may be more likely to seek services because less importance is placed on familismo cultural values (desire to keep problems within the family). Acculturation can play an essential part in the relationship between immigrant parents and children and should be considered by the therapist. 

Cultural values are likely linked with primary language, with Spanish-speaking Latinx families being more strongly influenced by respeto cultural values (Ramos et al., 2017). In fact, research on one family intervention that was culturally adapted for Latinx families (with a focus on respect for family traditions) resulted in an increased completion rate from 65% of enrolled families to an impressive 98% after 5 years of implementation (Kumpfer et al., 2002). Latinx families have also stressed the importance therapists being respectful and collaborative toward Latinx cultural values while implementing parenting interventions (Parra-Cardona et al., 2009). For example, Latinx families with strong personalismo culture may require more rapport building. When working with Latinx families, therapists should consider cultural values such as respeto, familismo, and personalismo and how they influence Latinx families’ attitudes regarding therapy.

Just as Spanish-speaking in Latinx families can influence the presence of respeto cultural values and how families view mental health treatment, so too does the absence of English (i.e., Limited English Proficiency; LEP) which can impact individuals’ access to mental health treatment in the United States. Lower English proficiency is associated with a lower likelihood of seeking or acquiring mental health care, longer durations for untreated psychological disorders, higher likelihood of being uninsured, and lower education level (Bauer et al, 2010; Kim et al., 2011). A reason for this may be that low health literacy is more prevalent among those with LEP; Sentell and Braun (2012) found that those with LEP reported low health literacy at a greater rate (44.9%) than English-speakers (13.8%). Language barriers may be especially important in mental health care settings as mental health treatment relies on direct verbal communication rather than objective tests for physical illness (Sentell et al., 2007). Indeed, LEP was found to significantly decrease the odds of mental health service use among Latinx immigrants (Kim et al., 2011).

While factors such as acculturation and familismo were not directly assessed in the current study, these cultural considerations are important contextual pieces to be considered when examining the parent-child relationship for Latinx families. Awareness of these cultural considerations can improve the acceptability of the treatment for Latinx families and can be a way to help clinicians improve their cultural sensitivity. There have been efforts to incorporate Latinx cultural values into PCIT, most notably by McCabe and colleagues whose version of PCIT included increased collaboration and rapport building with parents, framing the program as an educational intervention rather than as a mental health treatment (to reduce stigma), as well as increased cultural training for clinicians (McCabe et al., 2005; 2010). It was found that there were no significant differences in child behavior outcomes between the modified version of PCIT (called GANA or Guiando a Niños Activos) and PCIT, although GANA did outperform PCIT on parent report measures and CBCL Internalizing (McCabe et al., 2010). This seems to suggest that PCIT aligns well with Latinx cultural values.

Barriers to Treatment

            It is evident that Latinx families, especially those with LEP, may have trouble acquiring mental healthcare. In fact, there may be particular factors (i.e., barriers) that impede their ability to seek, access, and remain in treatment over time. Indeed, literature supports that there are three types of barriers impeding access to mental healthcare: (1) structural barriers (e.g., treatment cost); (2) attitudinal barriers relating to perception of mental health services (e.g., acceptance by community, comfort with a therapist); and (3) attitudinal barriers related to perceptions of mental health problems (e.g., inability to identify a child’s need for services; Owens et al., 2002). These barriers need to be studied in the Latinx cultural context to better understand if and how they interact with treatment outcomes. In this study, we examined a number of barriers: treatment cost, parental stress, attitudes regarding the ethnicity of the therapist, and acceptance of treatment skills by the community to determine how these factors may impact Latinx as compared to non-Latinx families.

The cost of mental health care is a large barrier to accessing care, with costs greatly increasing among the uninsured over the years (Rowan et al., 2013). Unfortunately, Latinx families are the leading uninsured racial/ethnic group living in the United States (31% vs. 9% of White families; Flores et al., 2005; Ku & Matani, 2001). Additionally, poverty rates in the United States among Latinx families remain higher than White, non-Latinx counterparts (see Morales et al., 2002). In 1999, national income statistics showed that 22.8% of Latinx individuals live in poverty compared to 7.7% of non-Latinx Whites (Kouyoumdjian et al., 2003). A reason for this may be that Latinx individuals with comparable skills to non-Latinx Whites are paid less for their work (Kouyoumdjian et al., 2003). Regardless, socioeconomic disadvantage is linked with an increased risk for mental health problems due to an increased number of stressors and has been identified as a barrier predicting therapy drop-out (Santiago et al., 2012; Kazdin et al., 1997). Barriers associated with poverty (e.g., transportation, finances, childcare) often prevent utilization of services and predict poor engagement and retention in mental health services (Davis et al., 2008; Snell-Johns et al., 2004). Low socioeconomic status has also been linked to lower parent expectancies for child therapy (Nock & Kazdin, 2001). The families participating in the current study fall below the median household income level in the United States, making cost a likely barrier to treatment.

Acceptance of Treatment Skills by Community

Latinx communities are often described as collectivistic with emphasis placed on cooperation with the community rather than individual accomplishments (McCabe et al., 2005). Latinx families may experience stigma associated with engaging in mental health treatment (McCabe et al., 2005). This stigma is possibly tied to familismo cultural values which emphasize the importance of family and place importance on resolving child emotional and behavioral problems within the family (McCabe, 2002). Due to the perceptions sometimes held by Latinx caregivers, families may be less willing to engage in or stay in treatment which can lead to lower therapy outcomes or a higher rate of attrition for this community. To evaluate attitudes as moderators, they were dichotomized (with responses less than 5 coded as 1 and responses greater than 5 coded as 2).

Comfort with Ethnicity of Therapist

Ethnic matching refers to the ethnic match between the therapist and family (Sue, 1988). It has been hypothesized that when ethnicities match, the therapist and family are more likely to share a common background and experiences, that fewer miscommunications will occur, and the therapeutic goals will be similarly understood by the therapist and family (Sue, 1988; Flicker et al., 2008). A 2011 meta-analysis found a moderately strong preference for a therapist of one’s own race/ethnicity and a tendency to perceive therapists of one’s own race/ethnicity slightly more positively than other therapists (Cabral & Smith, 2011). This meta-analysis also found the effects of racial/ethnic matching to be highly variable and concluded that there is almost no benefit to treatment outcomes from racial/ethnic matching across 53 studies (Cabral & Smith, 2011). In this study, Latinx families were able to choose to have treatment measures delivered in Spanish from bilingual clinicians, but we explored family perceptions of the therapeutic alliance and comfort with the therapist.

Current Study

Various cultural and attitudinal factors influence the likelihood of seeking services, remaining in services, and benefiting from mental health treatments among Latinx families (McCabe et al., 2005). Given these cultural and attitudinal factors for Latinx families, it is reasonable to expect that barriers may be present and impact family involvement in PCIT. The first aim of the current study was to compare structural barriers to treatment for Latinx families and non-Latinx families participating in PCIT. We hypothesized Latinx families would endorse cost and parental stress barriers more often than non-Latinx families. The second aim was to investigate treatment attitudes for Latinx families compared to non-Latinx families. We hypothesized Latinx families would report higher attitudes regarding comfort with therapist ethnicity (given that most therapists identified as Latinx) and lower acceptance of treatment skills by their community compared to non-Latinx families. The third aim was to compare treatment outcomes between Latinx and non-Latinx families participating in PCIT. We hypothesized Latinx families would report similar reductions in child disruptive behaviors as non-Latinx families. However, we also hypothesized treatment attitudes would moderate this relationship, with families holding less positive attitudes reporting lower reductions in behavioral problems. Finally, we examined treatment completion rates across groups. We hypothesized that Latinx families would report similar rates of treatment completion as compared to non-Latinx families.

Method

Participants

Families

Participants in the current study were 83 caregiver-child pairs who received PCIT from a community mental health agency in southern California. To be eligible to participate in the study, the child had to be between 2 and 7 years old and the family had to be seeking treatment for disruptive child behaviors at the mental health agency. Families were asked to select one primary caregiver to complete assessment measures. Primary caregivers had to be at least 18 years old and have legal custody of the child. Caregivers were primarily mothers (n = 68, 81.9%) and largely Latinx (n = 52, 62.7%). The average household income for the sample was $26,515.94 (SD = 23,182.91). Children participating in the study were also largely Latinx (n = 50, 60.2%) and were mostly male (n = 55, 66.3%). The mean age of the children participating in the study was 3.73 years (SD = 1.09). Analyses were run based on child ethnicity data (see Table 1).

Clinicians

Clinicians providing PCIT were licensed clinicians and certified PCIT therapists. Clinicians were all female (n = 9), approximately 37 years old (SD = 7.62) and the majority were Latinx (n = 5, 55.6%). Most clinicians (88.9%) spoke English as their primary language, while 44.4% of clinicians spoke Spanish as a secondary language. At the time of study initiation, clinicians had a mean of 8.33 years (SD = 5.68) of clinical experience with a mean of 4.89 years (SD = 3.95) of experience in providing PCIT.

Procedures

The present study utilized secondary data from a larger research project which examined the effectiveness of incentives on families’ treatment attendance (Quetsch et al., 2020). During this study, families were randomly assigned to two different groups: (1) PCIT as usual and (2) PCIT plus the inclusion of incentives. Specific behaviors (timely attendance, homework completion, and therapeutic skill mastery) triggered the provision of incentives in the second group. PCIT was delivered based on the original manual (e.g., McNeil & Hembree-Kigin, 2010) with the only adaptation being that families who spoke Spanish could opt to have treatment measures delivered in Spanish and could also have a clinician who spoke Spanish coach them in their preferred language. Caregivers were given measures at pre-treatment (before starting PCIT), mid-treatment (CDI mastery), and post-treatment (PCIT graduation) for measures related to child disruptive behavior. Additionally, caregivers completed measures assessing for barriers preventing treatment participation as well as perceptions of treatment over the course of PCIT at three different time points (the third session of CDI-3, mid-treatment, and post-treatment). Pre- and post-treatment child disruptive behavior scores were used in moderation analyses and to compare treatment outcomes. Barriers preventing treatment participation and perceptions of treatment scores that were collected at CDI-3 were used in the present study’s analyses. The measures were given at CDI-3 to assess families’ attitudes at the beginning of treatment: after enough time had passed that they had adjusted to treatment but not so much time that there was significant treatment dropout.

Measures

Behavioral Outcomes

Behavioral outcomes were assessed using the Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000, 2001). The CBCL is a parent-report measure of child behavioral problems (ages 1.5 to 18 years). Parents rate their children on a 3-point Likert scale (0 = Absent to 2 = Occurs often) for 118 behavior problems. The CBCL has been shown to possess reliability, as well as convergent and discriminative validity (Nakamura et al., 2009). Although the CBCL produces several subscale scores, only the CBCL Total score was used in the current study.

Barriers to Treatment Participation

Barriers to treatment participation were measured using the Barriers to Treatment Participation Scale (BTPS) which is a 58-item measure evaluating psychological and practical barriers to participant engagement in treatment (Kazdin et al., 1997). Only two items were used in the current study: cost (“I felt that treatment cost too much”) and parental stress (“Treatment added another stressor to my life”). Each item was rated on a 5-point Likert scale ranging from 1 (Cost was fine/ No added stress from treatment) to 5 (Cost was much too high/ Treatment added a great deal of stress). Each item was dichotomized (no/yes) with response options 1-3 coded as “no” and response options 4-5 coded as “yes.” The BTPS has good reliability and structure and is reasonably valid (Nanninga et al., 2016). Although some families completed the measure in Spanish, a Spanish version of this measure has not yet been standardized. The BTPS was assessed at CDI-3.

Therapy Attitudes

Family attitudes towards therapy were measured using the Therapy Attitude Inventory (TAI). The TAI (Eyberg, 1993) is a 15-item caregiver-report measure of family perceptions of progress in treatment, relationship with the therapist, and satisfaction with treatment. Each item is rated on a 5-point Likert scale (1 = dissatisfaction/worsening, 5 = high satisfaction/ improvement). Individual items were explored to determine particular factors that may have impacted family outcomes more than others. Only two items from the TAI were used in the current study: 1) “Level of comfort with the ethnicity of your therapist/coach” and 2) “To what degree have the skills you learned in this treatment program been accepted by the people in your community (e.g., neighbors, other school/Head Start parent, friends).” The TAI has high internal consistency, an excellent Cronbach’s alpha (.91) and moderate external validity (Brestan et al., 1999). Although some families completed the measure in Spanish, a Spanish version of this measure has not previously been standardized. The TAI was assessed at CDI-3.

Treatment Completion

Clinicians recorded treatment completion rates. Graduation from PCIT required the successful completion of both the CDI and PDI phases.

Results

Demographic information and descriptive statistics on study variables by ethnicity are presented in Table 1.

Treatment Barriers and Attitudes

Chi-square tests could not be conducted to examine reported barriers between Latinx and non-Latinx families as the cell sizes were too small (ns < 5); therefore, descriptive statistics were presented for each barrier for each ethnic group (see Table 2). Overall, only n = 2 families (n = 1 Latinx families; n = 1 non-Latinx families) indicated that parental stress was a barrier to engagement in treatment. No families endorsed cost as a barrier to treatment (n = 0).

A t-test was conducted to examine the two treatment attitudes (comfort with the ethnicity of the therapist and lower community perceptions of treatment skills) between Latinx and non-Latinx families. For comfort with therapist ethnicity, there was not a significant difference between Latinx (M = 4.82, SD = .39) and non-Latinx families (M = 4.88, SD = .45), t(61) = -.51, p = .612 For acceptance of treatment skills by community, there was not a significant difference between Latinx (M = 4.10, SD = .99) and non-Latinx families (M = 4.13, SD =1.01), t(60) = -.11, p = .916.

Treatment Outcomes

A mixed-factor Analysis of Variance (ANOVA) compared reductions in child disruptive behaviors among Latinx and non-Latinx families. Results indicated a significant effect of time F(1, 31) = 57.76, p < .001, ηp2 = 0.65, such that CBCL scores significantly decreased from pre- to post-treatment for both groups. There was not a significant effect of ethnicity, F(1, 31) = 0.18, p = 0.679, indicating similar overall scores on the CBCL for both ethnic groups. Finally, the interaction between CBCL scores and ethnicity was not significant, F(1, 31) = 1.11, p = .300. Given the low endorsement of treatment barriers these variables were not examined as moderators in the current study.

 Two mixed-factor Analysis of Variances (ANOVA) were conducted with the two dichotomized attitudes variables entered into the model. For comfort with the therapist ethnicity, and consistent with the previous model, CBCL scores significantly decreased over time, there was not a significant main effect of ethnicity, and the main effect of comfort with therapist was not significant, F(1, 28) = 0.01, p = .920. Furthermore the interactions were not significant between CBCL scores and ethnicity, CBCL scores and attitudes, F(1, 28) = 0.09, p = .773, or the three way interaction, F(1, 28) = 0.40, p = 0.532. For acceptance of therapy skills by community, and consistent with the previous model, CBCL scores significantly decreased over time, there was not a significant main effect of ethnicity, and the main effect of acceptance of skills by community was not significant, F(1, 27) = 0.05, p = .832. Furthermore the interactions were not significant between CBCL scores and ethnicity, CBCL scores and attitudes, F(1, 27) = 0.13, p = .723, or the three way interaction, F(1, 27) = 1.37, p = 0.252.

Treatment Completion

A Kaplan-Meier survival curve analysis was conducted to determine if Latinx families remained in treatment for a similar number of sessions before dropping out than non-Latinx families. The overall graduation or treatment completion rate for the current study was 42.5% (n = 34), with 43.1% of Latinx families graduating (n = 22 of 51) and 41.4% of non-Latinx families graduating treatment (n = 12 of 29). Families did not significantly differ by ethnicity on the probability of graduating from treatment over sessions (χ2(1) = .04, p = .846; Figure 2). The mean termination-specific survival rates were 18.34 sessions for Latinx families and 15.95 sessions for non-Latinx families.

Discussion

This study is an important comparison of PCIT services for Latinx families as compared to non-Latinx families. Our results indicate PCIT had similar effect on reducing child disruptive behaviors from pre- to post-treatment. Most families (both Latinx and non-Latinx) indicated that neither cost nor added parental stress were barriers to engagement in PCIT. Furthermore, attitudes about the comfort with the ethnicity of the therapist and acceptance of the treatment skills within their community were comparable across Latinx and non-Latinx families and were relatively positive. These reported treatment attitudes did not moderate the relationship between ethnicity and outcomes. Finally, both ethnic groups did not significantly differ on graduation rates and number of treatment sessions attended.

Finding significant reductions in behavioral concerns is consistent with previous research demonstrating the effectiveness of PCIT (Thomas et al., 2017). Moreover, these reductions were similar for both ethnic groups, demonstrating the effectiveness of PCIT for families from different cultural backgrounds. The results seen in this study suggest that PCIT is effective with ethnically diverse families; however, the high level of therapist-client match, the efforts made by the research team to reduce barriers, and the fact that treatment was delivered in Spanish should be taken into consideration when interpreting these results.

In understanding the low endorsement of barriers (i.e., cost, stress), one possible explanation is that efforts from the community agency to reduce those barriers may have eliminated these concerns. More specifically, this community agency may have worked to reduce the cost of the treatment or all families had insurance, which may have also helped reduce the stress for parents. This notion is supported by the fact that this clinic primarily provides services to Medicaid clients. Another possibility is that we did not assess the barriers that impacted families the most. While the present study only explored cost and stress barriers, it is quite possible that these same families endorsed other barriers that were not examined, such as transportation issues or critical events interfering with a family’s ability to come to therapy (e.g., moving, losing a job; Kazdin et al., 1997).

When examining parental therapy attitudes, families reported high levels of overall satisfaction. These outcomes might demonstrate that the therapists worked to address family’s needs and cultural attitudes for both Latinx and non-Latinx families. For example, Latinx families in this study were able to choose to have measures delivered in Spanish; this may have contributed to high positive ratings by Latinx families who had LEP. Furthermore, multiple therapists delivered services in Spanish, potentially increasing the cultural sensitivity of the treatment delivery. Most of the families in this study were Latinx and most of the clinicians were also Latinx, possibly contributing to shared cultural understanding or experiences.   

Latinx and non-Latinx families demonstrated similar positive attitudes regarding the acceptance of treatment skills by community, meaning that although Latinx communities have been identified as possessing differing cultural values (Kumpfer et al., 2002; McCabe et al., 2005; Ramos et al., 2017), the treatment skills taught in PCIT were accepted by the communities of families participating in this study. Future research should evaluate the generalizability of these positive attitudes regarding acceptance of treatment skills by Latinx communities.

Moreover, Latinx families were shown to graduate at similar rates to non-Latinx families, meaning that Latinx and non-Latinx families shared similar rates of treatment dropout. Analyses were limited due to the high level of treatment dropout—planned analyses regarding the presence of barriers were unable to be completed due to the low cell sizes. Future research should explore factors contributing to therapy dropout in order to engage families and increase graduation from treatment. This might include the study of other barriers (Kazdin et al., 1997).

Strengths and Limitations

The current study included a diverse sample which allowed for questions to be asked exploring Latinx family experiences with PCIT; however, the sample was relatively small making comparisons of barriers and attitudes under powered. Even still, the collaboration with a local community mental health agency allowed for a diverse sample to be consented into the study that reflected the population of the community.

The finding that behavioral concerns reduced a similar amount for both ethnic groups should also be interpreted with caution given the small N values and the small non-Latinx sample that was used for comparison. Future research should build on the effectiveness of PCIT for diverse families by conducting more studies with larger sample sizes. Particularly for Latinx families, researchers should consider that the term “Latinx” comprises many different subcultures from many different countries with heterogeneity in socioeconomic status, education level, acculturation level, and English-language proficiency, among many other factors (Kouyoumdjian et al., 2003). The particular geographical origins and cultural values for the Latinx families participating in this study were not assessed limiting further analyses regarding group heterogeneity or homogeneity.

Although the barriers examined in the current study were not endorsed by the families participating in the study, future research should examine barriers to treatment, especially for the Latinx community. Previous research has shown that Latinx families under-utilize mental health services due to a number of barriers (Rastogi et al., 2012). In order to increase service utilization by Latinx families, it is important to understand and minimize these barriers to treatment (Rastogi et al., 2012). Additional research should also include examination of factors and cultural beliefs that might affect Latinx families’ experience of PCIT. (e.g., respeto, acculturation). Finally, although treatment measures (TAI, BTPS) were delivered in Spanish to allow for LEP individuals the ability to complete measures themselves, these Spanish-translated measures have not yet been standardized; it is possible that translation impacted the validity or reliability of measures.  

Results for the current study could indicate cultural modifications are not necessary for the effectiveness of this intervention, yet previous research has theorized that cultural modifications could improve treatment seeking, engagement and retention among Latinx families, which have historically been low for this population (Kapke & Gerdes, 2016). Treatment tailored for Latinx families might include increased focus on respeto culture by emphasizing the importance of respect in psychoeducation and during coaching, as well as providing appropriate psychoeducation during the child-directed portion of PCIT who may feel that the approach to discipline is too mild (McCabe et al., 2005). Furthermore, additional time focused on rapport building can encourage collaboration between therapists and Latinx parents who may feel hesitant to challenge the authority of the therapist (McCabe et al., 2005). Modifications may also be made in how the treatment is presented or disseminated to Latinx families to decrease stigma around the use of this treatment (McCabe et al., 2005). Overall, more research is needed into the unique needs of Latinx families and how to transform that knowledge into applicable interventions.

Conclusion

Overall, PCIT was effective in reducing behavioral problems for both Latinx and non-Latinx families and was well-received by families. Cultural beliefs can influence the impact of treatments to reduce child behavior concerns. While it is important for research to continuously examine ways to tailor interventions to various cultural backgrounds and linguistic needs, results from the current study suggest PCIT can be comparably effective for both Latinx and non-Latinx families. As with all therapy treatments, clinicians need to deliver services in a culturally sensitive framework.

References

Abrahamse, M. E., Junger, M., Chavannes, E. L., Coelman, F. J. G., Boer, F., & Lindauer, R. J. L. (2012). Parent-child interaction therapy for preschool children with disruptive behaviour problems in the Netherlands. Child and Adolescent Psychiatry and Mental Health, 6(1), 24. https://doi.org/10.1186/1753-2000-6-24

Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms and profile. Burlington: University of Vermont, Research Center for Children, Youth, and Families.

Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school age forms and profile. Burlington: University of Vermont Research Center for Children, Youth, and Families.

Barrera, M., Castro, F. G., & Steiker, L. K. H. (2011). A critical analysis of approaches to the development of preventative interventions for subcultural groups. American Journal of Community Psychology, 48(3-4). 439-454. https://doi.org/10.1007/s10464-010-9422-x

Bauer, A. M., Chen, C. N., & Alegría, M. (2010). English language proficiency and mental health service use among Latino and Asian Americans with mental disorders. Medical Care, 48(12). 1097-1104. https://doi.org/10.1097/MLR.0b013e3181f80749

Berry, J. W. (2015). Acculturation. In J. E. Grusec & P. D. Hastings (Eds.), Handbook of socialization: Theory and research (p. 520–538). The Guilford Press.

Birman, D. (2006). Acculturation gap and family adjustment: Findings with Soviet Jewish refugees in the United States and implications for measurement. Journal of Cross-Cultural Psychology, 37(5), 568–589. https://doi.org/10.1177/0022022106290479

Brestan, E. V., Jacobs, J. R., Rayfield, A. D., & Eyberg, S. M. (1999). A consumer satisfaction measure for parent–child treatments and its relation to measures of child behavior change. Behavior Therapy, 30(1), 17–30. https://doi.org/10.1016/S0005-7894(99)80043-4

Brinkmeyer, M. Y., & Eyberg, S. M. (2003). Parent-Child Interaction Therapy for oppositional children. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based Psychotherapies for Children and Adolescents (p. 204–223). New York, Guilford.

Cabral, R. R., & Smith, T. B. (2011). Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes. Journal of Counseling Psychology, 58(4), 537–554. https://doi.org/10.1037/a0025266

Calzada, E. J., Huang, K. Y., Anicama, C., Fernandez, Y., Brotman, L. M. (2012). Test of a Cultural Framework of Parenting With Latino Families of Young Children. Cultural Diversity and Ethnic Minority Psychology, 18(3), 285-296. https://doi.org/10.1037/a0028694

Celenk, O., & Van de Vijver, F. (2011). Assessment of Acculturation: Issues and Overview of Measures. Online Readings in Psychology and Culture, 8(1), 1-22. http://dx.doi.org/10.9707/ 2307-0919.1105

Cunningham, C. E., Boyle, M., & Offord, D. (2000). Tri-ministry study: Correlates of school based parenting course utilization. Journal of Consulting and Clinical Psychology, 68(5), 928–933. https://doi.org/10.1037/0022-006X.68.5.928

Davis, R. G., Ressler, K. J., Schwartz, A. C., Stephens, K. J., & Bradley, R. G. (2008). Treatment barriers for low-income, urban African Americans with undiagnosed posttraumatic stress disorder. Journal of Traumatic Stress, 21(2), 218–222. https://doi.org/10.1002/jts.20313

Drake, R. E., Goldman, H. H., Leff, S. H., Lehman, A. F., Dixon, L., Mueser, K. T., & Torrey, W. C. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52(2), 179-182. https://doi.org/10.1176/appi.ps.52.2.179

Eyberg, S. M. (1993). Consumer satisfaction measures for assessing parent training programs. In L. VandeCreek, S. Knapp, & T. L. Jackson (Vol. Eds.), Innovations in clinical practice: A source book: Vol. 12. Sarasota, FL: Professional Resource Press.

Eyberg, S. M., Funderburk, B. W., Hembree-Kigin, T. L., McNeil, C. B., Querido, J. G., & Hood,           K. K. (2001). Parent-Child Interaction Therapy with behavior problem children: One and two year maintenance of treatment effects in the family. Child & Family Behavior Therapy, 23(4), 1-20, https://doi.org/10.1300/J019v23n04_01

Farver, J. A. M., Narang, S. K., & Bhadha, B. R. (2002). East meets west: Ethnic identity, acculturation, and conflict in Asian Indian families. Journal of Family Psychology, 16(3), 338–350. https://doi.org/10.1037/0893-3200.16.3.338

Flicker, S. M., Waldron, H. B., Turner, C. W., Brody, J. L., & Hops, H. (2008). Ethnic matching and treatment outcome with Hispanic and Anglo substance-abusing adolescents in family therapy. Journal of Family Psychology, 22(3), 439–447. https://doi.org/10.1037/0893-3200.22.3.439

Flores, G., Olson, L., & Tomany-Korman, S.C. (2005). Racial and ethnic disparities in early childhood health and health care. Pediatrics, 115(2), 183–193. https://doi.org/10.1542/peds.2004-1474

Gallagher, N., (2003). Effects of Parent-Child Interaction Therapy on young children with disruptive behavior disorders. Bridges. Practice-Based Research Syntheses Research and Training Center on Early Childhood Development, 1(4). 1-17.

Hood, K. K., & Eyberg, M. S., (2003). Outcomes of Parent-Child Interaction Therapy: Mothers' reports of maintenance three to six years after treatment. Journal of Clinical Child & Adolescent Psychology, 32(3), 419-429. https://doi.org/10.1207/S15374424JCCP3203_10

Kapke, T.L., Gerdes, A.C. (2016). Latino Family Participation in Youth Mental Health Services: Treatment Retention, Engagement, and Response. Clinical Child Family Psychology Review, 19(4), 329–351. https://doi.org/10.1007/s10567-016-0213-2

Kazdin, A. E., Holland, L., Crowley, M., & Breton, S. (1997). Barriers to treatment participation scale: Evaluation and validation in the context of child outpatient treatment. Journal of Child Psychology & Psychiatry, 38(8), 1051–1062. https://doi.org/10.1111/j.1469-7610.1997.tb01621.x

Kim, G., Aguado Loi, C. X., Chiriboga, D. A., Jang, Y., Parmelee, P., & Allen, R. S. (2011). Limited English proficiency as a barrier to mental health service use: A study of Latino and Asian immigrants with psychiatric disorders. Journal of Psychiatric Research, 45(1), 104-110. https://doi.org/10.1016/j.jpsychires.2010.04.031

Kim, S. K., Chen, Q., Li, J., Huang, X., & Moon, U. J. (2009). Parent–child acculturation, parenting, and adolescent depressive symptoms in Chinese immigrant families. Journal of Family Psychology, 23(3), 426-437. https://doi.org/10.1037/a0016019

Knight, G. P., Gonzales, N. A., Saenz, D. S., Bonds, D. D., Germán, M., Deardorff, J., Roosav, M. W., Updegraff, K. A. (2010). The Mexican American Cultural Values Scale for Adolescents and Adults. The Journal of Early Adolescence, 30(3), 444-481. doi:10.1177/0272431609338178

Kouyoumdjian, H., Zamboanga, B. L., & Hansen, D. J (2003). Barriers to community mental health services for Latinos: Treatment considerations. Clinical Psychological Practice, 10(4). 394-422. https://doi.org/10.1093/clipsy.bpg041

Ku, L., & Matani, S. (2001). Left out: Immigrants’ access to health care and insurance. Health Affairs, 20(1), 247–256. https://doi.org/10.1377/hlthaff.20.1.247

Kumpfer, K.L., Alvarado, R., Smith, P., & Bellamy, N. (2002). Cultural sensitivity and adaptation in family-based prevention interventions. Prevention Science, 3(3), 241–244. https://doi.org/10.1023/A:1019902902119

Lieneman, C., Girard, E., Quetsch, L. B., & McNeil, C. B. (2020). Emotion regulation and attrition in Parent-Child Interaction Therapy. Journal of Child and Family Studies, 29, 978-996. https://doi.org/10.1007/s10826-019-01674-4

Matos, M., Torres, R., Santiago, R., Jurado, M., & Rodríguez, I. (2006). Adaptation of Parent–Child Interaction Therapy for Puerto Rican families: A preliminary study. Family Process, 4(2). 205-222. https://doi.org/10.1111/j.1545-5300.2006.00091.x

McCabe, K. M. (2002). Factors that predict premature termination among Mexican American children in outpatient psychotherapy. Journal of Child and Family Studies, 11(3). 347-359. https://doi.org/10.1023/A:1016876224388

McCabe, K., & Yeh, M. (2009). Parent-Child Interaction Therapy for Mexican Americans: A randomized clinical trial. Journal of Clinical Child & Adolescent Psychology, 38(5), 753–759. https://doi.org/10.1080/15374410903103544

McCabe, K. M., Yeh, M., Garland, A. F., Lau, A. S., & Chavez, G. (2005). The GANA Program: A tailoring approach to adapting Parent Child Interaction Therapy for Mexican Americans. Education and Treatment of Children, 28(2). 111-129. https://www.jstor.org/stable/42899836

McCabe, K. M., Yeh, M., Lau, A., Bertely Argote, C., & Liang, J. (2010). Parent-child interactions among low-income Mexican American parents and preschoolers: Do clinic-referred families differ from nonreferred families? Behavior Therapy, 41(1). 82-92. https://doi.org/10.1016/j.beth.2009.01.003

McCabe, K. M., Yeh, M., Lau, A., & Argote, C. B. (2012). Parent-Child Interaction Therapy for Mexican Americans: Results of a pilot randomized clinical trial at follow-up. Behavior Therapy, 43(3). 606-618. https://doi.org/10.1016/j.beth.2011.11.001

McNeil, C. B., & Hembree-Kigin, T. L. (2010). Parent-Child Interaction Therapy. Springer, New York, NY, US.

Miranda, J., Bernal, G., Lau, A., Kohn, L., Hwang, W. C., & Lafromboise, T. (2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology, 1(1), 113–142. https://doi.org/10.1146/annurev.clinpsy.1.102803.143822

Morales, L. S., Kington, R. S., Valdez, R. O., & Escarce, J. J (2002). Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes. J Health Care Poor Underserved, 13(4), 477-503. https://doi.org/10.1177/104920802237532

Nakamura, B. J., Ebesutani, C., Bernstein, A., & Chorpita, B. F. (2009). A psychometric analysis of the Child Behavior Checklist DSM-Oriented Scales. Journal of Psychopathology and Behavioral Assessment, 31. 178-189. https://doi.org/10.1007/s10862-008-9119-8

Nanninga, M., Jansen, D. E. M. C., Kazdin, A. E., Knorth, E. J., & Reijneveld, S. A. (2016). Psychometric properties of the Barriers to Treatment Participation Scale–Expectancies. Psychological Assessment, 28(8), 898–907. https://doi.org/10.1037/pas0000229

Nock, M.K., & Kazdin, A.E. (2001).Parent Expectancies for Child Therapy: Assessment and Relation to Participation in Treatment. Journal of Child and Family Studies, 10(2), 155–180. https://doi.org/10.1023/A:1016699424731

Owens, P. L., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J. M., Kellam, S. G., & Ialongo N. S. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child and Adolescent Psychiatry, 41(6). 731-738. https://doi.org/10.1097/00004583-200206000-00013

Parra-Cardona, J., Holtrop, K., Córdova, D., Escobar-Chew, A. R., Horsford, S., Tams, L., Villarruel, F. A., Villalobos, G., Dates, B., Anthony, J. C., & Fitzgerald, H. E. (2009). “Queremos Aprender”: Latino immigrants’ call to integrate cultural adaptation with best practice knowledge in a parenting intervention. Family Process, 4(2). 211-231. https://doi.org/10.1111/j.1545-5300.2009.01278.x

Patterson, G. R. (1982). Coercive family process. Castalia Publishing Company.

Portes, A., & Rumbaut, R. G. (1996). Immigrant America: A portrait (2nd ed.). Berkeley: University of California Press.

Quetsch, L. B., Girard, E. I., McNeil, C. B. (2020). The impact of incentives on treatment adherence and attrition: A randomized controlled trial of Parent-Child Interaction Therapy with a primarily Latinx, low-income population. Children and Youth Services Review, 112, 1-15. https://doi.org/10.1016/j.childyouth.2020.104886

Ramos, G., Blizzard, A. M., Barroso, N. E., & Bagner, D. M. (2017) Parent training and skill acquisition and utilization among Spanish- and English-speaking Latino families. Journal of Child and Family Studies, 27, 268–279. https://doi.org/10.1007/s10826-017-0881-7

Rastogi, M., Massey-Hastings, N., & Wieling, E. (2012). Barriers to seeking mental health services in the Latino/a community: A qualitative analysis. Journal of Systemic Therapies, 31(4). 1-17. https://doi.org/10.1521/jsyt.2012.31.4.1

Rowan, K., McAlpine, D. D., & Blewett, L. A. (2013). Access and cost barriers to mental health care, by insurance status, 1999-2010. Health Affairs, 32(10), 1723-1730. https://doi.org/10.1377/hlthaff.2013.0133

Santiago, C. D., Kaltman, S., & Miranda, J. (2012). Poverty and mental health: How do low-income adults and children fare in psychotherapy? Journal of Clinical Psychology, 69(2), 115–126. https://doi.org/10.1002/jclp.21951

Schuhmann, E. M., Foote, R. C., Eyberg, S., Boggs, S. R., & Algina, J. (1998). Efficacy of Parent-Child Interaction Therapy: Interim report of a randomized trial with short-term maintenance. Journal of Clinical Child Psychology, 27(1), 34-45. https://doi.org/10.1207/s15374424jccp2701_4

Sentell, T., & Braun, K. L. (2012). Low health literacy, Limited English Proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. Journal of Health Communication, 17(3). 82-99. https://doi.org/10.1080/10810730.2012.712621

Sentell T., Shumway M., & Snowden L. (2007). Access to mental health treatment by English language proficiency and race/ethnicity. Journal of General Internal Medicine, 22(2). 289-293. http://doi.org/10.1007/s11606-007-0345-7

Snell-Johns, J., Mendez, J. L., & Smith, B. H. (2004). Evidence-based solutions for overcoming access barriers, decreasing attrition, and promoting change with underserved families. Journal of Family Psychology, 18(1), 19–35. https://doi.org/10.1037/0893-3200.18.1.19

Sue, S. (1988). Psychotherapeutic services for ethnic minorities. American Psychologist, 43(4), 301–308. https://doi.org/10.1037/0003-066X.43.4.301

Sue, S., Zane, N., Nagayama Hall, G. C., & Berger, L. K. (2009). The case for cultural competency in psychotherapeutic interventions. Annual Review of Psychology, 60(1). 525-548. https://doi.org/10.1146/annurev.psych.60.110707.163651

Thomas, R., Abell, B., Webb, H. J., Avdagic, E., & Zimmer-Gembeck, M. J. (2017). Parent-Child Interaction Therapy: A meta-analysis. Pediatrics, 140(3). 1-15. https://doi.org/10.1542/peds.2017-0352

Zane, N., & Mak, W. (2003). Major approaches to the measurement of acculturation among ethnic minority populations: A content analysis and an alternative empirical strategy In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 39– 60). Washington, DC: American Psychological Association.

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The Role Women Play in the 21st Century Home and Gender Equality: A Literature Review

Sarah M. Dyson, MS, PhD and Lisa Woodruff

Abstract

Over the past 50 years, gender roles in the home have not changed significantly, yet environmental and technological factors have drastically changed. Women are still considered the primary caregiver and homemaker; however, their responsibilities, roles, and tasks have increased across the board. Although the roles of women of the 21st century have not changed, the gender dynamics in modern homes have radically transformed.

Research suggests that women working outside of the home have a negative emotional spillover into both work and home life. The negativity has contributed to a time squeeze leaving women little time to be productive at home. Negative emotions have also been found among women who engage in entrepreneurial ventures and multiple social responsibilities while maintaining in-home organization. This literature review is structured according to four main topics: (1) the overlap of cueing, goal setting, goal-attainment, and responsibilities of women in the 21st century home, (2) roles, and expectations of the 21st-century woman, (3) women of the 21st century and connections between homemakers and entrepreneurs, (4) proposal of a future research agenda based on the same topics and classification of analysis

Keywords: self-regulation, women at home in the United States, coping skills, gender inequality, family, goal setting for women, organization, entrepreneur, gender equality

During the last half-century, women have been working out of the home, yet women have never stopped being the primary caregivers and homemakers. The characteristics of modern households have changed drastically since the 1970s. Huffman, Matthews, and Irving (2017) and Rose (2017) noted that gender inequality in the home is still prevalent today. Gender roles defined in the 1950s and 1960s depict women as the primary homemaker. Women were both dependent on and inferior to men, and their primary job was to be pleasing to their husband and tend to their house and children. During the end of WWII the U.S. population increased by 42 percent while the number of widows grew by 45 percent. The U.S department of labor identified 15 million women as being potentially or becoming displaced (Irving 2017 & Levenstein 2014). Media described displaced homemakers as “a generation of women on whom the rules have been changed” and who were “caught between yesterday’s pedestal and tomorrow’s self-sufficiency” (Levenstein 2014). The US Department of Labor estimated that more than one million mothers joined the work force every year between 1970 and 1978 (Levenstein, 2014). During the late 70s and 80s the role of women evolved due to various feminist movements changing the way women were viewed. However, Levenstein (2014) identified problems of inequality between gender roles within the home and work life balance that employed mothers and working families are facing today. Various media sources such as radio, tv, magazine and newspapers continued to convey and propagate societal beliefs and expectations regarding the roles of women and men. Levenstein (2014) and Sears et al. (2016) agreed the ramifications of home and work tasks are fundamentally different; however, the overlaps of physical task, psychological awareness, and productive labor thatenable the functioning of the family are similar.

Researchers suggest that the female homemaker focuses on non-market work such as housework, in-home organization, and tasks of daily living such as paying bills, doing the laundry, and childcare (Kamp Dush, Yavorsky, & Schoppe-Sullivan, 2018). Several strategies have been employed to successfully organize, achieve goals, and increase productivity in the home. Yet researchers Huffman, Matthews, and Irving (2017), Jang, Zippay, and Park (2012), and Rose (2017) explained that tension, stress, and anxiety increase emotional spillovers into the home, therefore reducing a woman’s productive time at home. Additionally, researchers Sears, Repetti, Robles, and Reynolds (2016) concluded that home and work spillovers, as well as increased responsibilities related to specific tasks, caused women to complete more tasks while at work and leave the tasks at home undone or incomplete. In contrast, men of the household perceive these endeavors to be more of a hobby that can be started and stopped at any time. The term spillover or negative emotional spillover refers to feelings of frustration, anger, or disappointment at work that lead to greater irritability and impatience while at home (Repetti & Wood, 1997).

The present literature review integrates gender imbalances in the home with home organization, productivity, and time management. The following sections will explore gender inequality in the 21st century home, viewed through the lens of self-regulation as it relates to goal setting. Factors addressed in the following review will contribute to the existing knowledge and evaluate gaps in the current literature. The selected literature will explore self-regulation strategies of goal attainment as it relates to goal setting. Subsequently, an exploration of gender imbalances in the home will highlight current perceptions of gender. Finally, a discussion will follow based on recommendations and proposed solutions for female homemakers and entrepreneurs. Gaps identified throughout the research are addressed in the section on future research and, finally, a discussion of the recommended solutions will be proposed by researchers.

Cueing, Goal setting, Goal-attainment and Responsibilities of Women
in the 21st Century Home

Although self-regulation is normative, it extends beyond the typical description or deductive theory of phenomena. This is due to the theoretical mechanisms throughout which strategies influence and empower individuals (Bendell, Sullivan, & Marvel 2019). Self-regulation theory consists of several components that individuals cultivate to encourage constructive behaviors aimed at goal attainment while eliminating or decreasing destructive behaviors that may hinder achievement goals. Business managers and owners have used self-regulating strategies to ensure career progression. Researchers Cerrato and Cifre (2018) and Rose (2017) indicated that men had utilized self-regulation components to advance their careers and heighten their performance in sports competitions. Researchers have postulated that by incorporating goal-setting, self-regulation, and self-cueing in the 21st-century home, homemakers could have positive effects on home organization, tasks of daily living, and project completion (Bendell et al., 2019).

Self-cueing consists of creating a list, notes, and reminders, focusing on attention, and redirecting patterns of behavior. These external cues serve as a compelling reminders to keep one’s attention and effort focused on desirable actives that lead to goals or successful outcomes (Oettingen, Hönig, & Gollwitzer, 2000). Moreover, self-cueing can act as an effective means of tracking one’s progress or identifying tasks that need completion. Similarly, self-dialogue is a strategy, also referred to as self-talk, that increases self-efficacy or self-confidence, leading to effective self-regulation and increased performance (Carver & Scheier, 1998). Self-dialogue consists of a person telling themselves out loud or in their head what they have chosen to believe. Through repeated dialogue beliefs and assumptions become internalized and eventually automatically influence one’s information processing system. Successful self-dialogue can lead one to facilitate opportunities and persistence in the face of obstacles. Furthermore, researchers suggest that women of the 21st century should attempt to incorporate more tactics like self-cueing and self-dialogue to promote success throughout their daily lives. Bendell et al. (2019), Cerrato and Cifre (2018), and Rose (2017) suggested that women in the 21st century are more likely to not establish a positive self-dialogue, which contributed to the demise of goal setting and goal attainment.

Goal–setting provides specific strategies for managing one's behavior (Bendell et al., 2019). Individuals who exhibit vital self-goal-setting behaviors can incorporate cognitive and behavioral techniques, which allow them to evaluate a goal with more understanding and to assess the suitability of the motivation behind the goal-setting process (Heckhausen & Gollwitzer, 1987). Consequently, individuals who assume sub-optimal goal-setting behaviors reach inferior outcomes.

Successful goal attainment is the process of completing two different tasks; first, people must turn their desires into binding goals. Second, they must attain the set goals (Oettingen et al., 2000). Both tasks require self-regulation strategies to process and facilitate practical goal setting and successful goal striving. Researchers Cerrato and Cifre (2018), Kotlar and De Massis (2013), and Rose (2017) determined that goal attainment is challenging within the home if members of the household do not support the one who has proposed or set the goal. Goal attainment within the home is primarily regulated or formulated by female homemakers and not by men.

(Cerrato and Cifre 2018; De Massis et al., 2018). Researchers Kotlar and De Massis (2013) concluded that men who support the goal but not the process to obtain the goal tend to fail or never get started on the goal related to the household. In contrast, goal setting in an organization lends itself to teamwork and achievement-mindedness.

Goal setting within an organization is a vital function through which individual goals are transformed. Organizational goals are set and attained through teamwork, collaboration, and a similar mindset. However, goal setting within the home related to home organization, maintenance, and daily living has become problematic. Bendell et al. (2019) and Williams et al. (2018) noted that goal setting was not always problematic; problems originated over the past 30 years as responsibilities increased and priorities shifted from home to work. Williams et al. (2018) and Sears et al. (2016) agreed that work overloads expressed in negative moods and behaviors resulted in lack of communication in the home.

Kotlar and De Massis (2013) suggested that some family members do not have the same priorities or similar desires to improve daily living. Cerrato and Cifre (2018) and Rose (2017) found this coincides with miscommunication, time mismanagement, and organizational disparities within the home. Similar to miscommunications within organizations, the same types of errors occur in the home that can negatively impact goal setting and goal attainment.

 For example, family actives are likely to be more complicated due to unique interactions between close and distant family members (Kotlar & De Massis, 2013). Family-centered goals play a significant role in determining and formulating organizational objectives. Kotlar and De Massis (2013) explained that the relationship between family involvement and the adoption of family centered goals is problematic due to the mediation and moderation of several family factors. Factors such as family roles, family member participation, and individual goals challenge the goal’s attainment (Kotlar & De Massis, 2013). Even when a mother strategizes to increase available time effectively, Rose (2017) noted that this does not reduce time pressure, thereby leaving her goals to be unattainable at times.

Cerrato and Cifre (2018) noted that women perceive lower involvement of their male partners in household chores than men do (N=515, 1.8 and 2.8, respectively; F = 22.70; p _ 001).  Women’s involvement in household chores was more than twice that of men (N=515, 4.0 and 1.7, respectively; F = 82.60; p _ 001) (Cerrato and Cifre 2018). Finding sufficient time to meet work and family goals has posed immersive challenges for employed mothers in the 21st century. Goal setting among family members has continued to be the primary homemaker’s task over the past two decades, with little to no strategizing or support from other household members (Levenstein, 2014; Sears et al. 2016; & Rose 2017) .

Moreover, the traditional role of homemaker has remained female over the past few decades. Today’s female homemakers have more roles, responsibilities, and obligations than two centuries ago, yet Cerrato and Cifre (2018) discovered that gender roles have remained stagnant. The following section will introduce the role of 20th-century women in the home and 21st-century contemporary life as described by researchers today.

Roles, Responsibilities, and Expectations of 21st Century Women

The changing characteristics of both work and leisure consumption have been critical to women’s time and a requirement to multitask or complete tasks simultaneously has predominated (Southerton, 2003). Gender roles within the home have been predisposed to the traditional values carried over from the 1940s  to the 1970s. These roles consist of female homemakers planning and accomplishing the tasks of daily living such as grocery shopping, washing dishes and doing laundry, organizing the home, organizing routine maintenance on the home, child care, and working a full-time job. Research from the 1940s indicated that women have managed, planned and maintained goals within the home. Maloch and Deacon, (1970) and Dickins (1943) agreed that although men have similar management skills in the home, men lack the ability to make a decision, accomplish household tasks, or delegate appropriate task roles. Since the 1940s employment factors and equality for women have postulated positive changes; however gender roles in the home have not significantly changed. Household responsibilities, organization, and tasks of daily living remain the homemaker’s responsibility. Cerrato and Cifre (2018); Rose (2017); and Williams (2018) noted that when individuals experience conflict in gender roles it is primarily due to limited time, high levels of stress, and personal expectations.  Hences the fact that women spend twice as much time on chores has a strong negative impact on women’s adaptation to the role of homemaker. Cerrato and Cifre (2018) noted that women’s involvement in chores was more than twice that of men (N= 515 4.0 and 1.7, respectively; F = 82.60; p _ 001).

Researchers Southerton (2003) and Cerrato and Cifre (2018) agreed that tasks of daily living and the roles and responsibilities in the home are time-consuming and require, on average, 20 hours a week to complete. Although Southerton (2003) did not consider goal setting or goal attainment, Southerton noted home organization to be ongoing and unpredictable depending on the number of people in the home and household members’ support. Although some cultures still find these values to be the best for both partners, 21st century researchers have discovered a disparity in gender roles.

In general, men do not feel obligated to organize, maintain, or complete tasks of daily living as women do. Cerrato and Cifre (2018) noted that men tend to perceive house-related tasks, maintenance, and organization as a hobby or a free choice similar to shopping, cooking, washing dishes, washing clothes, and cleaning the house. This mindset is considered a cultural interpretation that women are more involved in in-house chores and do not want to share because of a belief that it is tied to gender identity, a source of power within the family dynamic. However, Rose (2017) explained that when mothers relinquish their partners’ and family responsibilities, they save five hours of unpaid work per week. An ongoing issue is that fathers or male partners usually work long hours outside the home, which is difficult to accommodate within work and family time (Rose, 2017). The problems of time pressure faced by female homemakers with caring responsibilities, including sole-earner mothers, have become concerning to researchers. Rose (2017) explained that juggling tasks and merging temporal boundaries degraded the quality of time for some women. This process changed the perceived pace of time and embodied the experience of time.

Sear, Repetti, Robles, and Reynolds (2016) defined an overloaded day as fast-paced, overwhelming, tiring, and demanding, related to employment, housework, and family responsibilities. Although marital behaviors change daily overload, overall tension and exposure to everyday stressors persisted across social contexts. Sear et al. (2016) reported the likelihood of anger and the disregard of a partner’s needs in response to overload. Although negative responses are less understood, they still play a vital role in goal setting, goal attainment, and tasks of daily living among 21st century women working in and out of the home. The subsequent response to overload, lack of energy, fatigue, exhaustion, and decreased household involvement has a significant adverse effect on women.

Overall resistance to change may contribute to the daily overload and contribute to the increased level of depression and anxiety. Southerton (2003) suggested that different orientations toward social practices are tied to social structure, particularly gender. This could contribute to time experiences and a further understanding of the structural changes that generate time and daily overload perceptions. Barigozzi, Creamer, and Roeder (2018) observed different gender patterns of career and childcare decisions through endogenously determined social norms. Furthermore, individual couples’ childcare and career decisions further impose an externality on couples so that the (female) labor market (Barigozzi et al., 2018). Zellweger, Kellermanns, Chrisman, and Chua (2011) agreed that some women experience a higher level of tension and anxiety when work demands prevent the completion of household responsibilities such as housework that goes sundown or delayed grocery shopping. 

Both men and women engage in leisure time on non-working days. Kamp Dush et al. (2018) explained that fathers engaged in 47% of their leisure time while mothers performed childcare and housework. In comparison, mothers engaged in 16% to 19% of their leisure time while fathers performed childcare and housework (Kamp Dush et al., 2018). Bendell et al. (2019) and Cerrato and Cifre (2018) agree that Gen Xers, or those born between 1980 and 2000, believe that both work and leisure time are equally important and strive to find an appropriate way to reconcile both aspects of their lives. This belief fostered in both partners a devotion to other areas of their life within the scope of non-work, such as family or productivity of greater importance. This understanding also facilitates the digital revolution and technologies for work, making workers less dependent on particular physical spaces and fixed schedules to perform their work albeit with similar goals and responsibilities.

Huffman et al. (2017) identified the importance of understanding gender ideology due to the misconceptions of the family system’s impact. Huffman et al. (2017) postulated individual family members as a family system rather than as individuals. Researchers find that understanding the family as a system rather than a domain further establishes the importance of responsibility, resources, management of daily stress, and productivity. Findings indicated that work-to-family conflict and spousal perception were related to both men and women in the home (Huffman et al., 2017). Furthermore, results suggested that men perceived themselves as under-benefiting from their investments in the family domain due to overload and spillovers from the family domain into their work life.

The individual’s perceptions of fairness are relevant in both the home and the workforce. Cohesive relationships are beneficial in both situations, which fosters self-goal-attainment. However, Huffman et al. (2017) noted that couples who strive for a more cohesive family tend to initiate strategies to increase fairness. In other words, couples who spent extra time communicating and planning home-oriented tasks obtained successful results and improved organization within their home.

Female Homemakers to Entrepreneurs

There has been substantial growth in female entrepreneurs over the past ten years. For some female employees, work demands can spill over, which affects family life negatively. These included lack of time to meet family obligations and increasing tension and stress at home (Jang, Zippay, & Park, 2012). Findings suggest that by establishing a predetermined path women entrepreneurs were less likely to have a successful outcome, whereas individuals who adopted a flexible schedule to endure stresses from home and work had a prolific and productive result.

Similarly, women with weak goal intention, which favors performance rather than behavior, failed to make conscious decisions to accomplish their goals, leading to dissatisfaction and unaccomplished goals (Bendell et al., 2019). Set plans and established self-cueing behaviors may, therefore, send female entrepreneurs down a  more successful path as compared to male entrepreneurs who maintain greater flexibility and adaptability. This logic echoes findings that indicate women are less likely to follow sequential steps in venture creation (Brush, 1990).

Therefore, women entrepreneurs may find it necessary to resort to other approaches to successfully develop self-regulation and self-goal-attainment. Bendel et al. (2019) and Zellweger et al. (2011) suggested that a homemaker’s role can make a female entrepreneur venture more complex by overlapping contemporary work and family demands. Communication and strategic planning incorporating self-regulation, and goal setting may benefit the female homemaker and decrease gender inequalities in the home.

Women have been battling the socio-culture, leaders who have been associated with masculinity assertiveness, competitiveness, and goal-focused deceives to change and act alone. Bendell et al. (2019) and Zellweger et al. (2011) agreed that negative work and family spillover have a more significant impact on women than men. Recently women have utilized flexible work practices; however, these processes have weakened relationships due to the limited amount of time parents spend with their children (Rose, 2017). Furthermore, Rose (2017) expressed concern regarding working mothers who implemented tools such as time squeezing. A mother who worked more intensively during certain times spent time with her children, thereby removing leisure, productive activities, and self-care time from their schedules.

 Gender impediments have affected both men and women in relation to self-regulation, self-goals-attainment, and self-leadership to achieve their innovation goals. Williams, Pieper, Kellermanns, and Astrachan (2018) explained that women are less likely to follow sequential steps in venture creation or in obtaining intellectual property. This finding emphasizes that all strategies are equally applicable or beneficial to all individuals within the family system.

Williams et al. (2018) indicated that self-leadership strategies such as self-regulation and self-goal-attainment could be learned and adjusted as needed. Furthermore, most businesses emphasize mentoring and coaching as part of their self-regulation effects. However, they are not considering gender differences when implementing goal attainment processes.

However, it is undoubtedly a positive starting point on which to build. Finally, gender differences in time pressure and work-life balance satisfaction will likely remain challenging social policy and practice issues to address in the future.

Future Research Agenda

There are several fractures to consider in furthering practical implications for female homemakers and female entrepreneurs. Bendell et al. (2019), Williams et al. (2018), and Zellweger et al. (2011) encourage future researchers to explore cognitive aspects that develop incremental goal setting, self-cueing, and goal attainment. Further evaluation of these concepts offers effective strategies in different circumstances, such as accomplishing the tasks of daily living, home organization among 21st-century women, female entrepreneurs experiencing spillover from work environments, and radical product innovations.

 Given the work concern throughout multiple studies, the effects of goals and family members’ relations broadly impact home and workplace stress, tension, and anxiety among employees and family members. Therefore, research should evaluate the possibility of scheduling flexibility to reduce workplace stress and home and family-related stress. Future research could also examine the effects of a flexible schedule that enhances the positive impact of life balance within the work environment and family experiences. A proposed solution could be an educational product that teaches 21st-century homemakers and male contributors how to share responsibilities within the home, organize the home, and establish a system that enables women of the 21st century to accomplish tasks of daily living. These would most likely have a positive impact on a schedule, allowing female homemakers to spend their free time advancing toward personal goals.

Considering the propensity for work-life balance found through the study, the potential effects that goal setting have on owning a business in the 21st century may be advantageous for female homemakers. The question of family members and the immense impact that conflict and family relations have on business and home life deserves further research. Furthermore, future research should examine the importance of entrepreneurial success to train women in various settings regarding organizational skills and self-regulation. Research should focus on a line of products and skills to assist in cueing, goal setting, and goal attainment within the home. These would better prepare women for in-home organization, a healthy work-life balance, and advanced goal setting while living a more productive lifestyle.

Researchers also suggested that mapping out plans for transitioning into and out of parenthood consists of a fair workload among both men and women. Kamp Dush et al. (2018) explained that men might feel that they currently contribute equally or “enough” to a household simply because they participate in the workday. Moreover, men were found to be less concerned with inequalities that enter the non-workdays. Researchers Kamp Dush et al. (2018) suggested that non-workdays are crucial for men and women to prioritize their discussion of self-goal-attainment. Future research should focus on the processes that women in the 21st century home are currently using to complete tasks of daily living and routine maintenance throughout the home. These should then be compared to male contributions in the home to determine if the homemaker’s responsibilities are equal. The ideology that gender roles in the home are more important today than before.

Nevertheless, men engage in over 50% more leisure time than women do every week. Moreover, Cerrato and Cifre (2018) suggested that gender ideology also determines the number of tasks couples split in the home during non-working days. However, household chores and productivity can be generalized among couples with school-age children. A disparity between gender roles and household responsibilities is evident among women in the 21st century home. Future investigative research should consider sociodemographic factors when interpreting results. Additionally, this kind of variable offers a better description of the sample and considers living situations and other specificities.

References

Achtziger, A., & Gollwitzer, P. (2007). Rubicon Model of Action Phases. First Publ. in Encyclopedia of Social Psychology 2 (2007), pp. 769-770.

Bendell, B. L., Sullivan, D. M., & Marvel, M. R. (2019). A Gender‐Aware Study of Self‐Leadership Strategies among High‐Growth Entrepreneurs. Journal of Small Business Management, 57(1), 110–130. https://doi.org/10.1111/jsbm.12490

Carver, C. S., & Scheier, M. F. (2017). Chapter One – Self-Regulatory Functions Supporting Motivated Action. In A. J. Elliot (Ed.), Advances in Motivation Science (Vol. 4, pp. 1–37). Elsevier. https://doi.org/10.1016/bs.adms.2017.02.002

Carver, C. S. (2018). Control Theory, Goal Attainment, and Psychopathology. Psychological Inquiry, 29(3), 139–144. https://doi.org/10.1080/1047840X.2018.1513681

Cerrato, J., & Cifre, E. (2018). Gender Inequality in Household Chores and Work-Family Conflict. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.01330

Dickins, D. (1943, May). Effects of good household management on family living. Mississippi Agricultural Experiment Station Bulletin, 380-410. https://ir.library.msstate.edu/bitstream/handle/11668/4673/bul_380.pdf?sequence=

De Massis, A., Kotlar, J., Mazzola, P., Minola, T., & Sciascia, S. (2018). Conflicting Selves: Family Owners’ Multiple Goals and Self-Control Agency Problems in Private Firms. Entrepreneurship Theory and Practice, 42(3), 362–389. https://doi.org/10.1111/etap.12257

Elliot, A. J., Sheldon, K. M., & Church, M. A. (1997). Avoidance Personal Goals and Subjective Well-Being. Personality and Social Psychology Bulletin, 23(9), 915–927. https://doi.org/10.1177/0146167297239001

Maloch, F., & Deacon, R. E. (1970). Components of Home Management in Relation to Selected Variables. 40.

Gollwitzer, P. M., & Sheeran, P. (2006). Implementation Intentions and Goal Achievement: A Meta‐analysis of Effects and Processes. In Advances in Experimental Social Psychology (Vol. 38, pp. 69–119). Academic Press. https://doi.org/10.1016/S0065-2601(06)38002-1

Heckhausen, H., & Gollwitzer, P. M. (1987). Thought contents and cognitive functioning in motivational versus volitional states of mind. Motivation and Emotion, 11(2), 101–120. https://doi.org/10.1007/BF00992338

Huffman, Matthews, and Irving. (2017)

Huffman, A. H., Matthews, R. A., & Irving, L. H. (2017). Family fairness and cohesion in marital dyads: Mediating processes between work–family conflict and couple psychological distress. Journal of Occupational and Organizational Psychology, 90(1), 95–116. https://doi.org/10.1111/joop.12165

Jang, S. J., Zippay, A., & Park, R. (2012). Family Roles as Moderators of the Relationship Between Schedule Flexibility and Stress. Journal of Marriage and Family, 74(4), 897–912.

Kamp Dush, C. M., Yavorsky, J. E., & Schoppe-Sullivan, S. J. (2018). What Are Men Doing While Women Perform Extra Unpaid Labor? Leisure and Specialization at the Transition to Parenthood. Sex Roles, 78(11–12), 715–730. https://doi.org/10.1007/s11199-017-0841-0

Kotlar, J., & De Massis, A. (2013). Goal Setting in Family Firms: Goal Diversity, Social Interactions, and Collective Commitment to Family-Centered Goals. Entrepreneurship Theory and Practice, 37(6), 1263–1288. https://doi.org/10.1111/etap.12065

Levenstein, L. (2014). “Don’t Agonize, Organize!”: The Displaced Homemakers Campaign and the Contested Goals of Postwar Feminism. The Journal of American History, 100(4), 1114–1138.

Mayfield, J., Mayfield, M., & Christopher, N. (2017). Speaking to the Self: How Motivating Language Links With Self-Leadership. Retrieved January 5, 2021, from https://journals.sagepub.com/doi/full/10.1177/2329488417731861

Oettingen, G., Hönig, G., & Gollwitzer, P. M. (2000). Effective self-regulation of goal attainment. International Journal of Educational Research, 33(7), 705–732. https://doi.org/10.1016/S0883-0355(00)00046-X

Rao, P. A., Bhardwaj, G., & Mishra, P. K. (n.d.). Daily stressors and coping strategies of homemakers and employed women. 7.

Rose, J. (2017). “Never enough hours in the day”: Employed mothers’ perceptions of time pressure. Australian Journal of Social Issues, 52(2), 116–130. https://doi.org/10.1002/ajs4.2

Sears, M., Repetti, R., Robles, T., & Reynolds, B. (2016). I Just Want to Be Left Alone: Daily Overload and Marital Behavior. Journal of Family Psychology, 30. https://doi.org/10.1037/fam0000197

Sheeran, P., Webb, T. L., & Gollwitzer, P. M. (2005). The Interplay Between Goal Intentions and Implementation Intentions. Personality and Social Psychology Bulletin, 31(1), 87–98. https://doi.org/10.1177/0146167204271308

Southerton, D. (2003). ‘Squeezing Time’: Allocating Practices, Coordinating Networks, and Scheduling Society. Time & Society, 12(1), 5–25. https://doi.org/10.1177/0961463X03012001001

Williams, R. I., Pieper, T. M., Kellermanns, F. W., & Astrachan, J. H. (2018). Family Firm Goals and their Effects on Strategy, Family, and Organization Behavior: A Review and Research Agenda. International Journal of Management Reviews, 20(S1), S63–S82. https://doi.org/10.1111/ijmr.12167

Zellweger, T. M., Kellermanns, F. W., Chrisman, J. J., & Chua, J. H. (2011). Family Control and Family Firm Valuation by Family CEOs: The Importance of Intentions for Transgenerational Control. Organization Science, 23(3), 851–868. https://doi.org/10.1287/orsc.1110.0665

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Introducing Proceedings of the Arkansas Psychological Association

Eric C. Prichard, Ph.D., University of Arkansas at Monticello

Welcome to Proceedings of the Arkansas Psychological Association. We are the new peer reviewed journal of the Arkansas Psychological Association (ArPA). Our mission is to promote psychological scholarship across the state of Arkansas. In particular, we want to focus on three broad groups of scholars:

(1)    Student Scholars: We want to provide Arkansas students with an opportunity to receive peer reviewed feedback on their research and to provide a venue through which they may get an opportunity to publish and share their work. Publication can provide students with a big competitive advantage when it comes to applying for graduate programs or jobs. In addition, being part of the scientific research process is exhilarating. Journals that are open to student research allow young people to catch the research bug.

(2)    Psychology Professionals in Arkansas: Practicing licensed psychologists in Arkansas have important perspectives to share about the issues facing psychology professionals in the state and region. We welcome commentary, case studies, and field research from practicing professionals in Arkansas. The experience of professionals in clinical settings and field settings may differ from the experience of purely academic psychologists, but that experience still has the potential to contribute to the knowledge of both clinical and academic professionals.

(3)    Academic Psychologists in Arkansas: Arkansas has a wealth of small colleges and universities. Many of us who work as professors teach between 4 and 5 courses a semester, work primarily with undergraduate students, and serve on various college and university committees. On the same token, most of us felt called to get our Ph.D.’s and teach because we loved the science of psychology. Most of us are also active as scholars and researchers. However, time and resource constraints can make it difficult to consistently produce studies with the theoretical scope, large sample sizes, and technology required for studies to be competitive in the journals of the highest tier. That does not, however, mean these studies are not of high quality and potentially useful as contributions to the literature or as steps towards more ambitious projects.  We want to create a venue where Arkansas psychology faculty can get peer reviewed feedback, disseminate their work, and help their research programs lay the groundwork of published studies upon which a research program can be built. Think of us as providing an important step onto the academic ladder for Arkansas faculty.

Above all, this new journal is about one thing. It is about promoting psychology and psychologists in the state of Arkansas. We do important work in the state. Our profession is filled with talented people and promising students. We want to amplify the voice of our state’s psychologists and create a community of knowledge dissemination and constructive critical feedback.

I hope you will consider joining us on this journey.

Eric Prichard, Ph.D.

Chief Editor

President Elect of the Arkansas Psychological Association

Assistant Professor of Psychology, University of Arkansas at Monticello