Volume 5, Issue 4 (January 2025)
2025, 5(4): 196-213 |
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Hoseini S M, Kakavand A, Shiri E. (2025). Effectiveness of Filial Therapy in Maternal Sensitivity and Parental Stress of Preschool Children with Emotional and Behavioral Problems in District 10 of Tehran during the COVID-19 Pandemic. Journal of Childhood Health and Education. 5(4), 196-213. doi:10.32592/jeche.5.4.196
URL: http://jeche.ir/article-1-246-en.html
URL: http://jeche.ir/article-1-246-en.html
1- Master's Degree in General Psychology, Imam Khomeini International University, Qazvin, Iran
2- Associate Professor of Imam Khomeini International University, Qazvin, Iran
3- Assistant Professor of Imam Khomeini International University, Qazvin, Iran
2- Associate Professor of Imam Khomeini International University, Qazvin, Iran
3- Assistant Professor of Imam Khomeini International University, Qazvin, Iran
Keywords: Filial Therapy, Maternal Sensitivity, Parental Stress, Emotional and Behavioral problems, Corona
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| Background and Aim: The COVID-19 pandemic, which originated in China, quickly garnered the attention and concern of the World Health Organization, leading to its designation as a global pandemic shortly thereafter (Hosseini, Kakavand, Shiri, et al., 2024; Wang, Wai, Wang, et al., 2021). The pandemic has affected all segments of society, with children being among those profoundly impacted due to the necessary changes brought about by the pandemic. One significant negative impact of COVID-19 has been the emergence of behavioral and emotional problems in children (Hosseini et al., 2024). Research indicates that during the pandemic, children experienced heightened emotional symptoms and behavioral issues. The persistence of these problems can negatively affect interpersonal relationships, hindering children’s ability to interact effectively with others, including their parents. The quality of the parent-child relationship in early childhood forms the foundation for a child’s cognitive, social, and emotional development. A key factor influencing the quality of parent-child relationships is maternal sensitivity, defined as a mother’s ability to recognize and appropriately respond to her child’s cues (Moss, Dubois-Comtois, et al., 2011). Maternal sensitivity significantly impacts both cognitive and behavioral development in children (Seyyed Mousavi, 2012). Another negative consequence of the pandemic has been the increased tension and stress experienced by parents (Aperto, Coppola, Vionzio, et al., 2022). Issues related to quarantine have escalated levels of parenting stress, which refers to the psychological strain parents experience in their caregiving role. Parenting stress not only diminishes parental effectiveness but can also lead to more severe consequences, such as weakening parenting styles and instability in children’s behavior. Additionally, stressed parents are more likely to experience negative emotions. Given the psychological consequences of the COVID-19 era on parent-child relationship quality, parenting stress, and the impact of maladaptive parent-child interactions on children’s emotional and behavioral issues, appropriate psychological interventions are essential. One such intervention, rooted in relational foundations, is Parent-Child Relationship Play Therapy. This therapeutic approach can mitigate the negative effects of the pandemic, promote children’s mental health, and improve the parent-child relationship. Parent-Child Relationship Play Therapy, inspired by Rogerian theory, is based on the core assumption that parents possess a strong emotional bond with their children—something therapists lack. Enhancing this bond is likely to increase the efficacy of this therapeutic approach (Landreth, 1997). Given the detrimental effects of COVID-19 on children’s behavioral and emotional issues (Jo & Lee, 2022; Hosseini et al., 2024), and to prevent further complications stemming from these problems in the future, it is crucial to implement interventions that address both children’s issues and provide parents with necessary involvement and education. Since the parent-child relationship is the cornerstone of many treatments for emotional and behavioral issues, Parent-Child Relationship Play Therapy is an effective therapeutic strategy for resolving children’s behavioral problems and improving the quality of the parent-child relationship. Therefore, the present study seeks to examine the effectiveness of Parent-Child Relationship Play Therapy on maternal sensitivity and parenting stress among children with emotional and behavioral problems during the COVID-19 pandemic. Methods: This study is applied in its objective and employs a quasi-experimental design with a pre-test, post-test, follow-up, and a control group. The statistical population consisted of mothers of preschool children with emotional and behavioral problems in District 10 of Tehran, whose children were enrolled in school during 2022. The screening process began in selected schools within District 10. From an initial pool of 310 mothers, 41 participants were selected based on the research objective, a review of previous studies, potential dropout rates, and calculations using G*Power software. These mothers were invited to participate in the study. Screening was conducted using the Child Behavior Checklist (Achenbach & Rescorla, 1991), the Maternal Quality of Care Questionnaire (Ghanbari et al., 2012), and the Parenting Stress Index (Abidin, 1990). Participants were randomly assigned to either the experimental group (21 mothers) or the control group (20 mothers). After accounting for participant attrition, 16 mothers remained in the experimental group, and 17 in the control group. Inclusion criteria were including children aged 6 years old, a T-score above 63 on the Child Behavior Checklist and, mothers with at least a high school diploma or higher educational level. Exclusion criteria were including mothers unwilling to continue participation, unfavorable conditions during the study, such as the emergence of new disorders, and absence from more than two sessions. Mothers in the experimental group participated in group-based online training sessions on Parent-Child Relationship Play Therapy via the Skyroom platform, while the control group remained on a waiting list to receive the intervention after the study concluded. Following the completion of the training sessions, mothers in both groups were reassessed using the same questionnaires. A follow-up evaluation was conducted one month after the intervention. To test the assumptions of the study, the Shapiro-Wilk test was used for normality, and the Levene's test for homogeneity of variances. Data analysis was performed using analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA). Results: The results of the independent t-test indicated that there was no significant difference between the two groups in terms of mothers' age (P > 0.05). The results of the chi-square test showed no significant difference between the two groups in terms of mothers' education levels. The results of the chi-square test also indicated no significant difference between the two groups in terms of mothers' occupations. The ANCOVA analysis revealed that the significance levels for maternal sensitivity and parenting stress variables in the post-test and follow-up phases were less than 0.05. This indicates significant differences between the groups, confirming the effectiveness of Parent-Child Relationship Play Therapy in the experimental group. The MANCOVA analysis demonstrated that the significance levels for the subscales of maternal sensitivity and parenting stress in the post-test and follow-up phases were also below 0.05 (except for the spousal relationship subscale in the follow-up phase). This further confirms significant differences between the groups and the effectiveness of Parent-Child Relationship Play Therapy in the experimental group. Discussions: This study examined the effectiveness of Parent-Child Relationship Play Therapy on maternal sensitivity and parenting stress among preschool children with emotional and behavioral problems in District 10 of Tehran during the COVID-19 pandemic. The findings indicate that Parent-Child Relationship Play Therapy led to an increase in maternal sensitivity and a reduction in parenting stress among preschool children with emotional and behavioral issues in this area. These results align with the findings of Mousavi et al. (2010) and Ashouri and Karimzadeh (2019). To interpret the findings, it is essential to note that one of the key factors contributing to emotional and behavioral problems in children is the quality of the parent-child relationship (Jiao, Wang, Liu et al., 2020; Spinelli, Lionetti, Pastore et al., 2020; Wang, Tang, Wei et al., 2020; Feinberg, Mogle, Lee et al., 2022). Maternal sensitivity is a significant factor influencing this relationship, and it is not a static construct; it can be improved. By incorporating the positive elements of Parent-Child Relationship Play Therapy—such as enhancing a mother's understanding of her child's diverse behaviors, positively responding to her child’s needs, developing observational skills to identify those needs, and strengthening reflective skills—maternal sensitivity can be significantly improved. One critical component of maternal sensitivity is responsiveness and attentiveness. Increased maternal responsiveness and attentiveness entail understanding the underlying needs behind a child’s behaviors and effectively responding to those behaviors while embracing the parenting role and maintaining positive emotions toward it (Ghanbari et al., 2012). Furthermore, the results demonstrated that Parent-Child Relationship Play Therapy effectively reduced parenting stress among preschool children with emotional and behavioral problems in District 10 of Tehran. These findings are consistent with studies by Mousavi et al. (2010), Setyawati, Nurkharisina, Alfiyanti, and Armiati (2022), Landreth (1997), and Kiani, Mirzaei, Hosseini et al. (2020). To explain these results, Goldstein (1995) suggested that parenting stress often stems from a mismatch between parental knowledge/skills and the real-life demands of parenting. This mismatch can lead to negative emotions toward oneself and the child. Reducing this stress may involve addressing this gap by enhancing parental knowledge and competence (a key component of parenting stress) through learning skills associated with Parent-Child Relationship Play Therapy. These skills include teaching parents impulse control, reflective responses, the skill of offering choices, advanced limit-setting, and more. In this study, efforts were made to increase mothers' understanding of their children’s emotional needs and interactions. By fostering insights into the underlying motivations for their children’s behaviors and focusing on their strengths, unconditional acceptance was achieved. Improved maternal sensitivity toward their children’s needs reduced feelings of guilt and depression, enhanced problem-solving abilities, and ultimately improved the parent-child relationship. The study faced several challenges, including the lack of cooperation from principals of boys' schools in District 10 of Tehran, school closures due to air pollution, and delays in the screening phase. Future researchers are encouraged to examine the effectiveness of this type of play therapy in psychological centers and under other crisis conditions, such as pandemics, over longer periods. Ethical Considerations The participants were fully informed about the research process prior to the study. They were assured that all collected data would remain confidential and that their identities would be anonymized in all stages of analysis, documentation, and reporting. Additionally, they were guaranteed that their involvement in the study would pose no risk or harm. Funding This study received no financial support from any institution or organization. Authors’ Contributions All authors made substantial contributions to the development of the research title, data collection, and analysis of the results. Conflict of Interest The authors declare that there is no conflict of interest regarding the publication of the study. Acknowledgments The authors express their sincere gratitude to all the mothers and children who supported and participated in this study. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition: Yahya Seyed Mohammadi Tehran: Ravan Publications. 10.1176/appi.books.9780890425596 Achenbach, T. M. (1991). 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Filial Therapy: Goals, features and application. Rooyesh. 9 (10): 135-142. https://ensani.ir/file/download/article/1621409632-9974-55-14.pdf |
Article type Original research Pages: 196-213 |
| Corresponding Author’s Info Email: ar.kakavand@soc.ikiu.ac.ir |
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| Article history: Received: 2024/07/07 Revised: 2024/07/28 Accepted: 2024/11/03 Published online: 2025/02/28 |
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| Keywords: COVID-19 Emotional and Behavioral Problems, Filial Therapy Maternal Sensitivity Parental Stress |
Type of Study: Research |
Subject:
Special
Received: 2024/07/7 | Accepted: 2024/11/3 | Published: 2025/02/28
Received: 2024/07/7 | Accepted: 2024/11/3 | Published: 2025/02/28
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