# data[].attributes.attachment_link.readable_text
Over recent years there has been a crescendo of political and public concern about a variety of issues which taken together suggest an impending crisis in our society. These include a rising incidence of *crime, violence, and delinquency and an ever increasing prison population, together with concern about deteriorating discipline in many schools. In addition there is increasing evidence that family breakdown through parental separation, divorce, or single parenthood has deleterious effects on the lives of children. 1 Drug addiction and homelessness are increasing, as is the number of children living in conditions of poverty. 2 There remains a continued background of concern about the high incidence of child abuse and neglect in all its forms, and confusion about society's apparent failure to manage it effectively. 3 (*Recorded crimes per year rose from l.6 million offences recorded by police in l970 to 5.6 million in l992; the figure for total crimes in l992 is estimated at about 15 million pa.)

Over the last 10 years society has had to face the following dramatic examples that have each in their separate ways symbolised some form of failure in society: (a) The death of Jamie Bulger at the hands of two 10 year old boys; (b) the murder and abuse of many children carried out over a long period of time by Fred and Rosemary West; (c) the Dunblane massacre; (d) the stabbing of the headmaster Philip Lawrence outside his school, and his wife's call for a national revival of morality; and (e) the apparently racist killing of Stephen Lawrence.

All these dramatic examples have increased the sense of crisis in society. Unfortunately in none of the above cases has there been a proper analysis of the lessons that can be learnt for the good of society.

The response of politicians of both main parties has been to compete as to who can sound toughest on crime, who will build the most prisons, and keep the most prisoners locked up the longest. When not being purely punitive, politicians unite in calling for a need to strengthen "family values". There is also much talk about various forms of symptomatic treatment, such as punishing parents for their children's wrongdoing and introducing "morality" into the National Curriculum. Yet, "one cannot hope to abolish suicide by legislating against the existence of tall buildings and the sale of rope"!

It is unfortunate that politicians in their resort to sound bite solutions should ignore the vast amount of knowledge that is available which could form the basis for a rational and cost effective strategy for a healthier society. In this article we intend to concentrate on the issues of child rearing. We accept that wider economic and social issues are also involved (such as the problems of unemployment, poverty, homelessness, and deprivation) but these are outside the scope of the article. The concept that improving child rearing is a vital recipe for the prevention of delinquency and crime in later life is not new. For a fuller development of this theme we highly recommend a publication on this topic by the Family Studies Centre which reviews much of the extensive literature on the subject. 1 In this article, we are concentrating on an analysis of the concept of "parenting".

It is reasonable to start from the premise that the needs of children are best met by being raised in "families". However, it is naive to assume that as long as all children are brought up in their natural/biological families there will be no problems. One of the common threads linking most of the above examples is how spectacularly natural families can fail to provide normal happy childhoods. There is nothing foolproof or sacrosanct about natural families as a recipe for a healthier society.

Families (whether natural or substitute) can only meet the needs of children if they provide them with good (or "good enough") parenting.

Concept of good enough parenting

To the best of our knowledge, the concept of "good enough parenting" was first used by Winnicott. 4 In doing so he was recognising that it is unhelpful and unrealistic to demand perfection of parents, and to do so undermines the efforts of the vast majority of parents who are in all practical respects "good enough" to meet their children's needs. Of course, society has already had to face up to the fact that some parents are "not good enough" by recognising the problem of child abuse and neglect and setting up structures to deal with it, and where appropriate, providing alternative parenting.

Concept of parenting

Despite its frequent use the concept of parenting is difficult to define. We use it to refer to a relationship, a process, and a group of activities. "To parent" is an active verb which denotes positive activities undertaken by parent figures towards children. Although the noun "parent" usually implies a natural or biological parent, it should be stressed that "good enough" and indeed "super" parenting can be delivered by non-biological parent figures.

Anyone concerned with the care of a child can be seen as part of the parenting process. Anyone concerned with any part of a child's care, control, and development in any setting can be said to be engaging in parenting. Thus grandparents and other members of the extended family, family friends and neighbours, school teachers, family aides, community workers, and even doctors and nurses can all be seen as part of the parenting process.

Far from widening the definition of parenting so far that it becomes meaningless, we believe that it is essential to recognise the wide continuum of parenting a child needs as he or she moves through childhood and adolescence to adulthood. Even adults have a need for parenting as every parent of "grown up children" knows.

Importance of parenting and the needs of children

It is generally accepted that the needs of children are at their most intense in the first five years of life when they are at their most dependent on parent figures for physical and emotional nurture and protection. Good enough parenting delivered consistently over this critical period enables attachment and fosters the child's sense of basic security, which is essential for subsequent mental health and self esteem. Once acquired, these attributes constitute a firm foundation for the rest of childhood and adult life.

The crucial role of secure attachment to a parent/parent figure in this context was highlighted as long ago as l95l by John Bowlby 5 for whom the development of this theory constituted his life work. In general, the basic tenets of attachment theory have stood the test of time, although Rutter 6 has summarised important changes of emphasis over the 30-40 years since Bowlby first proclaimed its importance. Tizard, in a study of adoption of older children, showed that although the concept of a critical period for attachment remained valid, the duration of this period can extend into later childhood. 7

Rutter also stressed that the extent to which distortions of attachment impacted on a child varied as a result of the child's temperament, genetic endowment, and special needs.

Components of good enough parenting

We can define good enough parenting as a process that adequately meets the child's needs, according to prevailing cultural standards which can change from generation to generation. Of course all children need physical care, nutrition, and protection. Over and above these basics, the child's emotional needs can be regarded under the following three headings: (1) love, care, and commitment; (2) consistent limit setting; (3) the facilitation of development.

It is vital to realise that the long term provision of all three aspects of parenting is essential to ensure that the child grows up into an emotionally secure, fully developed, and competent adult.

(1) LOVE, CARE, AND COMMITMENT

We make no apologies for the use of the word "love". It is ironic that this most vital and easily understood concept is hardly to be found in the scientific literature. Children need to feel that they are loved consistently and unconditionally, and attachment behaviour is the natural consequence of this. If a child is severely emotionally deprived throughout early childhood, there is a risk of developing Bowlby's "affectionless psychopathy" with all the social handicap that will result for both the individual and society. If the deprivation is partial, the child will be at risk of developing insecure attachments with subsequent disturbance of social and emotional relationships.

Unfortunately some child care professionals seem to have lost sight of the crucial importance of "emotional deprivation" as highlighted by Bowlby. In child protection work the concept has been virtually lost, or subsumed within the category "emotional abuse", which is really quite different, being a positive rather than a negative form of abuse. Paediatricians can document failure of physical growth in severe cases of non-organic failure to thrive. They (and child psychiatrists) are less good at recognising and acting upon "emotional failure to thrive". Perhaps we need the equivalent of a blood test for "serum love", which when low levels are recorded would indicate the need for urgent replacement therapy.

(2) CONTROL/CONSISTENT LIMIT SETTING

Control is concerned with setting and enforcing boundaries to help the child in his/her dealings with the outside world. Boundaries must be set to show what behaviour is unacceptable, with due allowances made for developmental stages. Enforcement involves clear actions of either reward or disciplinary sanctions to ensure compliance within these boundaries.

"Good enough" control requires the setting of reasonable boundaries which are enforced in a consistent yet loving way so that the child eventually accepts the reality of the boundaries and incorporates them in its actions. Ideally the child learns to live within generally acceptable boundaries for behaviour, that is becomes socialised. If the boundaries are inherently unreasonable or control is applied inconsistently or too punitively this will be damaging to the child's development. Many habitual delinquents have been the subject of an indulgent lack of discipline interspersed with unpredictable and sudden outbursts of harsh discipline.

(3) FACILITATION OF DEVELOPMENT

This third aspect of parenting involves fostering the child's development to enable the child to fulfil his/her full potential. This involves every area of functioning, from the physical and intellectual to the moral, aesthetic, and spiritual. The child has a fundamental need for a secure base from which to explore his/her environment. "Good enough" care involves providing rich and varied stimulation in early childhood followed by involvement and support for the child throughout later years until adulthood is reached.

Consequences of not good enough parenting

Children can suffer deficiencies in any or all of the above aspects of parenting, and considerable overlap is common. However, if one postulates pure deficiencies of each modality in isolation the following patterns would be expected.

TYPE A

Defective loving care and commitment throughout early and middle childhood is a barrier to normal attachment. This will be expected to produce an insecure personality with low self esteem, and problems with peer relationships, marriage, and parenting. One or more types of personality disorder may be the consequence, 6 with the most extreme result being "affectionless psychopathy".

TYPE B

Children brought up without controls or with totally confusing controls are at risk of future conduct disorder, delinquency, and criminal behaviour. 8

TYPE C

Children whose early development is blighted by neglect and understimulation are at risk of subsequent educational failure and social handicap.

Of course, many children are subjected to a mixture of all three forms of defective parenting and end up with a combination of any of these end results. Each of these three end results has been shown to be strongly associated with subsequent criminal behaviour.

Possibility of predicting criminality

If we consider the above end results of "not good enough" parenting, together with evidence from criminological literature, it becomes apparent that there is strong evidence for the concept that juvenile delinquency and adult criminal activity can be predicted. If criminal behaviour can be predicted early enough and its aetiology understood in sufficient depth, then there should be excellent opportunities for a preventive strategy. This is arguably the current state of affairs regarding crime, but what is lacking is a consensus on how to intervene effectively and where the resources are to come from.

Much of the best evidence in the UK comes from the Cambridge Study in Delinquent Development by Farrington and West. 9 They found that one of the best predictors of later delinquency was the teacher's assessment of "troublesomeness" at the age of 8-l0 years. Nearly half of a series of recidivist delinquents had been previously identified as troublesome by their primary school teachers.

Similarly evidence from Norway has shown that 60% of known school bullies had committed a criminal offence by the age of 24, and that bullies were four times likelier than non-bullies to become recidivist criminals. 10 Poor parenting was seen as the basic underlying cause of these problems. However, such examples of prediction apply to a relatively late state in a child's development. If prevention is possible, logic dictates that the sooner it can be instituted the greater the chances of success. Accordingly, predictive factors that can be identified earlier in childhood are needed. The Cambridge study again yields valuable evidence, to the effect that four other factors were found to be strongly and independently associated with future delinquency, each to roughly the same extent. 9 These were: (i) poor parenting; (ii) economic deprivation; (iii) family criminality; and (iv) educational failure.

Economic deprivation is obviously important but is outside the scope of this article. Family criminality does not lend itself easily to a preventive strategy (other than adoption!) Educational failure manifests itself late in a child's development, and a preventive strategy based on this should be aimed at the preschool period. Anyway, much of the educational failure that is preventable is probably secondary to poor parenting.

This leaves poor parenting itself as the single factor most likely to respond to a preventive strategy, because it is (a) easily identified early in a child's life and (b) very likely that its association with subsequent criminality is a causative one (see above).

Evidence from the Newcastle 1000 Family Study endorses this view. 11 This showed a strong association of criminal behaviour in adults with their having been exposed to "multiple deprivation" as children. However, it was found that children from deprived backgrounds who did not acquire a later criminal record had almost all received "good parenting". The authors concluded "Good parenting protects against the acquisition of a criminal record".

Economic arguments for prevention by targeting parenting

Presumably one of the functions of the criminal justice system is to prevent crime by the deterrent effect of detecting crimes and punishing criminals. However, it has failed to prevent a 300% increase in crime over the last 30 years so by any standards it is a near total failure. Unfortunately it is also an extremely expensive failure.

A Home Office working party has attempted to quantify the total economic cost of crime to society. 12 The official costs of the criminal justice system in l992 were £9 billion, a 100% increase since l978. If the costs to victims and property are included the cost of crime is thought to roughly equal the entire cost of running the National Health Service (£18 billion in l988). Yet staggeringly, only 3% of offences committed by adults result in a perpetrator being cautioned or prosecuted. 13 The figures for juvenile crime are probably even lower. The Audit Commission report Misspent Youth has recently highlighted this gross misdirection of public money. 14

While many of the measures needed for a preventive strategy will require considerable resources, in view of the expensive failure of the criminal justice system, it is not a question of "Can we afford a preventive strategy" but "Can we afford to carry on the way we are going?".

Although a preventive strategy aimed at providing better parenting for all vulnerable children in society will be expensive, it is likely to be vastly more cost effective than continued reliance on the criminal justice system.

Governments as parents of society

Governments should be regarded as the parents of society. A "not good enough parent" of a government will show a general lack of care for the whole population, will put its own interests first, will discriminate against some of its "children" in favour of others, and will react excessively punitively when some if its children misbehave. A "good enough parent" of a government will truly care for all its children and will seek to promote their welfare, while still being firm and fair in applying sanctions for unacceptable behaviour. It will also be interested in using available knowledge to understand and ameliorate problems arising in society, like a well meaning family accepting they have problems and seeking appropriate help. A preventive strategy aimed at promoting good enough parenting is the treatment that British society would seem to need as a matter of urgency. A central aim should be to instil the idea that we are all responsible for society's children.

Good enough parenting for all children

We offer the following policy proposals for consideration as part of a preventive strategy.

Firstly, it should be recognised that the vast majority of parents in society are already providing good enough parenting, and accordingly a strong degree of targeting is in order. Health visitors are already perfectly capable of detecting poor parenting in early childhood, but they lack support for effective intervention. (The features of the whole spectrum of parenting are well described by Cooper. 15)

The majority of not good enough parents should hopefully benefit from early and intensive support, enabling them to become good enough parents. Supportive measures could involve: (a) universally available nursery placements; (b) well resourced and expert social work help/family aides/respite care; (c) parenting classes for teenage parents; (d) easier access to child guidance/child psychiatry services; (e) early referral from nursery/infant school for children with remediable problems such as attention deficit hyperactivity disorder, dyslexia, and severe behavioural problems; (f) effective antibullying strategies in schools; and (g) strategies for prevention of teenage pregnancies.

The school health service as a whole has a potentially crucial role in the development of the above strategies. (In this context it is extremely worrying that in many areas school health services are currently under threat.) However, considerable resources will also be needed for health visiting, social services, child psychiatry, and education to reverse the low morale and near despair that years of underfunding have caused. Hopefully this will allow the professionals to recharge their batteries to the extent that they can tackle these problems effectively on a population-wide basis. It is essential that multiagency responses are coordinated so that identification of problems by health visitors, school doctors, etc can lead to effective intervention.

Important and innovative work by Davies et al has shown that it is possible to achieve significant improvements in families in areas of high deprivation in London. 16 This programme involved extra training and supervision of health visitors and school doctors and did not require major new resources. Extending programmes like this on a nation-wide basis would seem a practical way of beginning to tackle the major task we are considering.

Finally, society and professionals should face up to the fact that not all parents can respond to professional intervention to a degree sufficient to meet their children's needs. The Kempes' concept of "the untreatable family" is relevant here. 17 Society and social workers accept the need to remove severely battered or sexually abused children from their natural families for good. However, society finds it harder to accept that there is a far larger number of children who suffer significant harm from neglectful parenting to their detriment and to the future detriment of society. Most of these children never even get on to an at risk register, let alone have a protection/nurture plan drawn up. Child A in the Bulger case is a dramatic example. All the features of his emotional deprivation were well known to professionals for several years before the murder yet no action was taken. There is ample evidence that the conditions associated with poor parenting are becoming more widespread. 18 There are strong hints that our politicians are at last waking up to the central importance of good parenting, as evidenced by the formation of the All-Party Parliamentary Committee on Parenting, and the recent document on parenting from the Labour Party. 19 However, unless this leads to a coherent strategy supported by adequate resources, we seem doomed to continue current policies of "too little, too late".

# data[].attributes.attachment_link.title
Good enough parenting for all children-a strategy for a healthier society

# data[].attributes.attachment_link.description
Over recent years there has been a crescendo of political and public concern about a variety of issues which taken together suggest an impending crisis in our society. These include a rising incidence of *crime, violence, and delinquency and an ever increasing prison population, together with concern about deteriorating discipline in many schools.

# data[].attributes.body
Talking, reading, playing, cuddling and communicating

The Joseph Rowntree Foundation report ‘Assessments of Parents and Parenting Support Needed’ showed that professionals who worked with families, together with those in health and education, could agree on  the main components of good enough parenting:

meeting children’s health and developmental needs;

putting children’s needs first;

providing routine and consistent care;

parental acknowledgement of any problems and engagement with support services.

‘Risky’ or ‘not good enough parenting’ was basically the reverse of this: not meeting the children’s needs, not putting them first etc. but it would be important to recognise if the risky behaviours identified represented a ‘one off’ or was a more regular part of the parents’ approach.

Part of being a good parent is preparing your child for environments outside your home. See the Social Mobility and Child Poverty Commission report in October 2014, ‘State of the Nation 2014: Social Mobility and Child Poverty in Great Britain’, which looked at what Frank Field highlighted as the essential skills children need by the time they join the reception year at primary school:

To sit still and listen;

To be aware of other children;

To understand the word no and the borders it sets for behaviour;

To understand the word stop and that such a phrase might be used to prevent danger;

To be potty trained and able to go to the toilet;

To recognise their own name;

To speak to an adult to ask for needs;

To be able to take off their coat and put on shoes;

To talk in sentences;

To open and enjoy a book.

Good Enough Parenting | Child Protection Resource

# data[].attributes.body
Strength based practice

# data[].attributes.attachment_link.authors[].name
Social Care Institute for Excellence (SCIE)

# data[].attributes.attachment_link.title
Defining strengths-based approaches to children's social care in Doncaster

# data[].attributes.body
https://www.youtube.com/watch?v=9CjAKrqWInY
https://www.youtube.com/watch?v=ZaZkvvB367I

# data[].attributes.attachment_link.readable_text
John Philip Louis,

Vida Ortiz,

Joanna Barlas,

Joyce Sue Lee,

George Lockwood,

Wayne Freeman Chong,

Karen McDonald Louis,

Patricia Sim

Subject Areas

For more information about PLOS Subject Areas, click here.

We want your feedback. Do these Subject Areas make sense for this article? Click the target next to the incorrect Subject Area and let us know. Thanks for your help!

Abstract

Background and objectives

Schema therapy (ST) has become a mainstream therapy for the treatment of psychopathology and has been validated through a series of large scale, international randomized control trials. Among other things, schema therapy emphasizes the meeting of core emotional needs in children by primary caregivers as these unmet needs continue to adversely affect their lives into adulthood. An early intervention parenting program has been developed to help parents meet these core emotional needs in order to prevent the development of psychopathology in the first place. The program, Good Enough Parenting, is equally focused on reducing problems and strengthening parenting practices, regardless of where the child is on the "disordered to well-being continuum". This study aims to explore "patient experience" by users of this program. Best clinical research guidelines advocate that participants should be used as collaborators rather than pure recipients; this process should predate large scale trials.

Design

An exploratory qualitative study with 55 parent-participants of Good Enough Parenting was conducted.

Methods

One-to-one interviews were conducted with participants, using critical incident technique and guided by semi-structured interview schedule, to explore their experiences with the program. Transcripts were then analyzed using thematic analysis.

Results

Coding showed a high degree of inter-rater reliability (kappa value of 0.78). The themes that emerged were Cultivating Awareness of Parents' Own Schemas, Cultivating Intentionality, Working through Developmental Issues, Responses to Challenges at Home, Performing Multiple Roles, and the Learning Process. Participants overwhelmingly reported satisfaction within these key themes.

Conclusions

The results support the development of the program and the choice of "participant reported outcome measures" for use in subsequent randomized controlled trials.

Citation: Louis JP, Ortiz V, Barlas J, Lee JS, Lockwood G, Chong WF, et al. (2021) The Good Enough Parenting early intervention schema therapy based program: Participant experience. PLoS ONE 16(1): e0243508. https://doi.org/10.1371/journal.pone.0243508

Editor: Bronwyn Myers, South African Medical Research Council, SOUTH AFRICA

Received: March 26, 2020; Accepted: November 22, 2020; Published: January 22, 2021

Copyright: © 2021 Louis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting information file. Transcripts are available upon request to Phua Hee, pheerless@gmail.com. Mr. Phua Hee is also the part of the ethics committee of this research.

Funding: The author(s) received no specific funding for this work.

Competing interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: John P. Louis and Karen M. Louis receive revenue from the Good Enough Parenting program that they teach, and books that they sell, worldwide. HOPE worldwide Singapore and HOPE worldwide Malaysia are both charities that receive income for Good Enough Parenting workshops. John P. Louis is also the President of HOPE worldwide Singapore. Vida B.Ortiz and Joyce S. Lee are employees of HOPE worldwide Singapore. Joanna Barlas, George Lockwood, Wayne F. Chong and Patricia Sim declare that they have no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Introduction

Children who experience adverse childhood experiences are at greater risk of mental health problems in adulthood [ 1- 3]. Early intervention programs that involve parents are an effective [ 4] and economically viable [ 5] way to mitigate this risk. Schema therapy is an integrative theory and treatment that combines elements of cognitive behavioral, emotion-focused, attachment and psychodynamic models. Schema therapy has considerable empirical support [ 6] for the underlying model and its efficacy in treating adults with disorders ranging from depression [ 7] to personality disorders [ 8, 9], including those with borderline features [ 10- 12]. An early intervention schema therapy-based parenting program has been authored and designed, known as Good Enough Parenting (GEP) [ 13, 14]. It is aimed at the prevention of psychopathology before it develops, as well as the promotion of resilience and healthy functioning.

Good Enough Parenting has been increasingly and widely implemented since its development in 2009 [ 14]. It is rooted in the empirically supported schema therapy model which forms the basis of the well validated schema therapy interventions. Good Enough Parenting is referenced in several recent articles exploring key constructs in schema therapy [ 15- 17]; there is a professionally developed program to train facilitators and trainers [ 14], and there is a book written for the general public describing the program [ 13]. Increasingly, Good Enough Parenting is being accepted and used internationally based on the perceived fit with stakeholder needs and its apparent popularity amongst participants. It is being used in Malaysia, Singapore, India, Indonesia, Cambodia, Vietnam, Thailand, Japan, Lebanon, Ukraine, Russia, Norway, Sweden, France, the United States, and Australia, as well as parts of South America and Africa.

Since the Good Enough Parenting program has gained acceptance in different cultures, it is important to provide an overview of its link to current parenting literature. The program is built on schema theory literature [ 6] to consider a broader range of adaptive and maladaptive parenting patterns that relate closely to the core emotional needs of children [ 15, 16, 18], and thereby prevent the development of psychopathology. It is also important to see if these types of parenting patterns cut across cultures, and to identify key patterns, if any, that are culture specific. As such, consideration will also be given to the measures underpinning Good Enough Parenting [ 15, 16] and their links to other established instruments measuring parenting patterns.

Interest in parenting constructs and their effect on developmental outcomes in children began about 75 years ago with the identification of two parenting dimensions: autocratic and democratic [ 19]. This was initially expanded to three parenting dimensions based on variations in warmth and control: Authoritative (high warmth-high control), Authoritarian (low warmth-high control), and Indulgent / Permissive (high warmth-low control) [ 20] with a fourth dimension of Neglectful (low warmth-low control) being added later [ 21].

The benefits of the Authoritative parenting style have been replicated across many European and American populations but its benefits in other cultures have been questioned. For example, Chao [ 22] contended that the three parenting styles may have different meanings in the Chinese culture. However, subsequent research on the Authoritative parenting demonstrated its benefits in a broad range of cultures including China, Pakistan, Hong Kong, Scotland, Australia, and Argentina [ 23- 27].

In the USA, a major study of 10,000 children clustered in 16 ecological niches showed that homes with Authoritative parenting benefitted all these groups with respect to psychosocial development, symptoms of internalized distress, and problem behavior in children. However, the influence of culture also contributed to the outcome, in that African American adolescents, and to a lesser extent, Asian American adolescents, were not as negatively affected by Authoritarian parenting as those from the White population [ 26]. The effect of parenting styles on different cultures has also emerged from a meta analyses of 428 studies in Western countries conducted by Pinquart and Kauser [ 28]. On the whole they found that while different regions and various ethnicities exhibited more similarities than differences, specific parenting styles also varied across different cultures. For example, associations of Authoritative parenting with academic achievement were stronger in non-Hispanic, White families than in Asian minorities, but associations of Authoritarian parenting with academic achievement were less negative in Hispanic families than in non-Hispanic, White families. The effects of culture and ethnicity on the outcome of parenting is not new as Darling and Steinberg [ 29] have noted that Authoritarian parenting was associated with fearful and timid behavior among European-American children but was conversely associated with assertiveness among African-American girls. On the other hand, Authoritative parenting was most strongly associated with academic achievement among European-American adolescents but least among Asian-African American youths. This may be due to other processes operating within a specific culture such as methods parents used to achieve the same goals [ 29]. The less negative effect of Authoritarian parenting also emerged in a study by Dwairy and Achoui [ 30] where Authoritarian parenting was not found to be associated with any negative outcomes in relation to mental health such as anxiety and depression. One study by Dwairy, Achoui, Abouserie, Farah, Sakhleh, Fayad, and Khan [ 31] found that the three parenting styles did not emerge distinctly but as hybrids of the three parenting styles from Baumrind's model [ 20], namely Inconsistent (Permissive and Authoritarian), Controlling (Authoritarian and Authoritative), and Flexible (Authoritative and Permissive).

Positive effects of Indulgent or Permissive parenting were found in studies conducted in Sweden, United Kingdom, Spain, Portugal, Slovenia, and the Czech Republic [ 32], Portugal and Brazil [ 33] and Germany and the United States [ 34]. A recent study in Spain also showed that Indulgent and Authoritative parenting styles were associated with better outcomes with respect to children being less aggressive, having greater self-esteem, and greater psychological adjustments than either the Authoritarian or Neglectful parenting style [ 35]. This study highlighted that the Indulgent parenting style was associated with the best outcomes and was shown to be associated with personal adjustment [ 36] and protection against alcohol [ 37]. Homes with Indulgent and Authoritative parenting styles also resulted in adolescents with higher self-esteem and greater internalization of environmental values than their counterparts [ 38]. Together, these results suggest that "parents across the globe could be recommended to behave Authoritatively, although Authoritarian and Indulgent parenting is, to some extent, tolerable in a few cultural contexts" [ 28, p.75].

However, while the influence of culture may explain why Indulgent parenting style is the most optimal in some countries, such variations may also be due to the different definitions associated with the Authoritative parenting construct. For example, Garcia and Serra [ 39] based their definition of Authoritative parenting on Baumrind's model [ 20] which was made up of two dimensions-high warmth and high control. Using the parental control scale (PCS; 4-point Likert scale from "1 = almost never true" to "4 = almost always true"), examples of items representing control were, "They make sure I know exactly what I can and cannot do"; "and "They believe in having a lot of rules and sticking to them" [ 39]. Such items representing control portray a very directive, over-controlling approach when higher scores on the Likert scale such as 3 or 4 were selected. However, when another measure known as the parenting style index (PSI; 4-point Likert scale, from "1 = Strongly agree" to "4 = Strongly disagree") was used [ 26], the items describing control were not as dictatorial as they were in the PCS. For example, in the PSI there are three dimensions to Authoritative Parenting, namely Firm Control (e.g. "How much do your parents try to know where you go at night?"); Acceptance/Involvement (e.g. "I can count on (them) to help me out if I have some kind of problem"); Psychological Autonomy (e.g. reversed scored, "How often do your parents tell you that their ideas are correct and that you should not question them?") [ 26]. Therefore, the exact definition of strictness that made up part of the Authoritative parenting construct differed depending on whether the PCS or the PSI was used. Given that different definitions of control were used, it is not surprising that different results were obtained on the efficacy of Authoritative parenting. In fact, Osorio and Gonzalez [ 40] investigated this very issue by using the PSI in a sample of adolescents in Spain. Results showed that the Authoritative parenting style yielded the best outcome which was consistent with findings from other Anglophone countries. The different definition of control may likely explain some of the different results regarding the optimality of the Indulgent parenting style in studies done in Spain in comparison to other Anglophone countries [ 40, 41]. On balance, after extensive research over the last 50 years, notwithstanding the effects of culture and ethnicity on parenting styles, the Authoritative parenting style has been shown to provide the greatest benefits to children across cultures [ 42].

Even though Baumrind's [ 20] parenting constructs have been found to be associated with a range of developmental outcomes in children [ 43], there were concerns that the model was predicated on normal variations in parenting rather than deviant ones [ 44, 45], and therefore there was a need to look at parenting dimensions that went beyond the dimensions of control and warmth found within this cultural paradigm [ 28, 46, 47]. For example, other dimensions have been identified from studies showing their link to the development of Borderline Personality Disorder [ 48- 52]. These deviant parenting patterns include invalidation of children's emotions, various forms of abuse, neglect and overprotection.

The current and most widely used parenting instruments measuring past parenting patterns are also limited in their scope. For example, the s-EMBU (Swedish acronym for "My memories of upbringing") has three subscales with two being maladaptive and one adaptive: Parental Rejection, Emotional Warmth, and Overprotection [ 53]. The Childhood Trauma Questionnaire has five maladaptive subscales [ 54] and no adaptive subscales. The Parental Acceptance-Rejection Questionnaire Adult version has one subscale representing Acceptance called Warmth, and three maladaptive ones representing Rejection called Hostility, Indifferent and Undifferentiated [ 55]. The Parental Bonding Instrument (PBI) has three parenting constructs, one adaptive subscale called Care, and the other two maladaptive ones called Overprotection and Authoritarianism [ 56]. The Alabama Parenting Questionnaire [ 57] has two adaptive constructs-Involvement, and Positive Parenting, and three other constructs involving Control called Poor Monitoring, Inconsistent Discipline and Corporal Punishment. In summary, all these instruments measuring parenting patterns consist of only three to four maladaptive constructs, and one to two adaptive ones. It may be that these parenting constructs, like Baumrind's, though used in multicultural settings, were generally based on normal variations of parenting, not deviant ones. The need to relook at parenting dimensions that go beyond control and warmth as conceptualized by Baumrind [ 58] and its limited scope was highlighted by several important studies [ 28, 46, 47, 59]. Further, while the Baumrind [ 58] model has been used extensively in many parts of the world, studies especially in non-Western populations, have also shown that the Baumrind's model [ 20] did not fit exclusively [ 31, 60] Given this limitation, a more nuanced parenting model is needed [ 47].

From the vantage point of the prevailing parenting constructs, The Good Enough Parenting program uses a broader and more nuanced range of parenting constructs that are grounded in schema theory; a theory that has clinical origins, and therefore a better grasp of maladaptive and adaptive patterns. These constructs have been found to be robust in both Eastern and Western samples, as well as in developing and developed countries [ 15, 16, 18]. There are seven adaptive parenting patterns known as nurturing interactions and labelled as: Autonomy Granting, Autonomy Support, Confidence and Competence, Dependability, Emotional Nurturance and Unconditional Love, Intrinsic Worth, Playfulness and Emotional Openness [ 15]. These seven subscales go beyond the dimensions of high warmth and high control (Authoritative) that previous models were based on [ 20, 21] and include dimensions of parenting such as believing in a child, providing age appropriate autonomy, cultivating intrinsic values, being dependable, providing emotional openness, and being playful. The parenting program also utilizes ten maladaptive parenting patterns known as exasperation interactions and labelled as: Competitiveness and Status Seeking, Over-Control, Disconnection and Rejection, Neglect and Insufficient Guidance, Emotional Inhibition and Deprivation, Intrusiveness and Exploitation, Overprotection and Overindulgence, Punitiveness and Abuse, Social Exclusion, Undependability and Irresponsibility [ 16, 18].

Both the nurturing and exasperation interactions have been developed into self-report scales. These are administered to adults when parental socialization is over and are therefore worded in the past tense to measure perceptions of past parenting experiences. These represent a fuller spectrum of maladaptive and deviant parenting patterns that go beyond the dimensions of control and warmth, represented by Authoritarian, Neglectful, and Permissive parenting styles. As a result, and not surprisingly, the nurturing interaction scale and the exasperation interaction scale demonstrated incremental validity [ 61]. This means that they added additional statistically significant variance in measures of well and ill being (depression, anxiety, stress, personality dispositions, and psychological well-being) over and above that contributed by several of the aforesaid established parenting scales; namely the s-EMBU, the Childhood Trauma Questionnaire, and Parental Acceptance-Rejection Questionnaire [ 15, 16]. Therefore, this provided justification for their development in that they were shown to not be just proxies for the existing parenting scales [ 61].

The nurturing interaction subscales of the Positive Parenting Schema Inventory (PPSI) [ 15] also correlated with subscales of the s-EMBU, PARQ and CTQ [ 15]. The average statistically significant correlation values of the PPSI scale with the s-EMBU, CTQ and PARQ were moderate; |r| = .40, .31 and .47 respectively. As expected, the Emotionally Nurturing and Unconditional Love subscale of the PPSI correlated positively with the Emotional Warmth scale of the s-EMBU and negatively with the Warmth scale of the PARQ (reversed scored). The PPSI subscale Autonomy Support, measuring the dimension of parents' "belief" in the child, had the highest negative correlations (moderate in strength) with subscales of Rejection and Warmth (reversed scored) of the PARQ and Emotional Neglect of the CTQ. It also correlated positively with the Warmth scale of the s-EMBU. The PPSI (Fathers) subscale Autonomy Granting had the highest negative correlations (moderate in strength) with the Overprotection subscale of the s-EMBU [ 15].

For the exasperation interactions subscales, the average statistically significant correlation values with the s-EMBU, CTQ and PARQ were .30, .29, and .42, respectively. The exasperation interaction subscale Degradation and Rejection correlated the highest (moderate in strength) with the Rejection subscale of the s-EMBU. All subscales of the CTQ contained facets of Abuse and Neglect, while all the PARQ subscales contained facets of Acceptance-Rejection constructs. As expected, their highest correlation (moderate in strength) was with the Degradation and Rejection and Punitiveness subscales. The exasperation interactions subscale of Emotional Inhibition and Deprivation correlated the highest with the Warmth (negative direction) sub scale of the s-EMBU, the Emotional Abuse and Emotional Neglect sub scales of the CTQ, and the Warmth and Indifference / Neglect (score reversed) subscales of the PARQ. The Over-Control exasperation interaction sub scale correlated mostly with the s-EMBU subscales of Rejection, and Overprotection [ 16].

Since both these broader and more nuanced adaptive and maladaptive parenting patterns were also found to be associated with Early Adaptive Schemas and Early Maladaptive Schemas respectively [ 15, 16], leveraging them will help parents to meet children's core emotional needs more effectively and thereby prevent the development of psychopathology later in life [ 6, 18].

Schema therapy and Good Enough Parenting

Early maladaptive schemas [ 6] and early adaptive schemas [ 17, 62] are key constructs within the schema therapy model and the Good Enough Parenting program. At a cognitive level, schemas are the structures in which data from experiences are stored in autobiographical memory from early childhood onwards [ 63]. In psychotherapy broadly, schemas are thought of as the lens or filters through which people view the world, their relationships with other people, and themselves [ 64]. Schemas feature in traditional cognitive models where they are defined as "stable cognitive patterns" that provide rules for the processing of information and subsequent behavior [ 65]. Schema therapy, being an integrative approach, defines schemas more broadly including patterned affect, neurobiological reactions, and implicit and explicit memory in addition to cognitions or "core beliefs". Schema therapy focuses on 18 early maladaptive schemas and their importance in psychopathology. These have received extensive empirical support across different populations and cultures [ 66- 69]. More recently, 14 early adaptive schemas have been identified which are believed to promote well-being and resilience against mental disorder [ 17]. To date, schema therapy has yet to formally incorporate the 14 early adaptive schemas in its treatment protocol [ 17]. The Good Enough Parenting early intervention program is the first schema therapy-based treatment to do so, including a dual focus on the prevention of early maladaptive schemas and the enhancement of early adaptive schemas via parent training [ 13].

A central assumption of schema therapy is that early maladaptive schemas develop when a child's core emotional needs are not met and that early adaptive schemas develop when they are [ 6, 18]. This is believed to occur in the context of parenting and to involve an interaction between child and parent and to be influenced by the temperament of each. When early maladaptive schemas are triggered in adulthood, they lead to emotional distress and problems in interpersonal relationships both directly and indirectly via maladaptive coping behaviors [ 6]. In contrast, when early adaptive schemas are triggered they are believed to lead to adaptive functioning that contributes to overall well-being [ 17]. These are believed to be related to but distinct from the parent's own early adaptive schemas and early maladaptive schemas, although there is also evidence that parental schemas transfer to their children [ 70].

Core emotional needs, previously defined by Young et al. [ 6] and Lockwood and Perris [ 62], have most recently been investigated and conceptualized by Bach, Lockwood and Young [ 71] in relation to early maladaptive schemas, and by Louis, Davidson, Lockwood and Wood [ 72] in relation to early adaptive schemas. Consistent empirical support has been found for four categories of early maladaptive schemas which are believed to arise from the frustration of core emotional needs associated with maladaptive parental styles [ 71]. These domains are: Disconnection and Rejection, Impaired Autonomy and Performance, Impaired Limits, and Excessive Responsibility and Standards. Similarly, four categories of early adaptive schemas have been identified that are believed to arise when core emotional needs are met through patterns of positive parenting [ 72]. These are: Connection and Acceptance, Healthy Autonomy and Performance, Reasonable Limits, and Realistic Standards and Reciprocity. The four clusters of early maladaptive and adaptive schemas appear to run in parallel, supporting the theoretical basis of both schema therapy and the Good Enough Parenting early intervention program in terms of the relationships between core emotional needs, parenting patterns, and schemas. These four categories of early maladaptive and adaptive schemas represent unmet and fulfilled needs, respectively, by early primary caregivers. However, these four categories are not the parenting patterns themselves. The parenting patterns that are believed to fulfill or thwart core emotional needs are the nurturing interactions and exasperation interactions respectively [ 6, 13].

Good Enough Parenting involves parents and their children in the process of promoting the conditions needed for core emotional needs to be met, aided by specific parenting patterns [ 15, 16] with the goal of reducing the development of early maladaptive schemas and promoting the formation of early adaptive schemas during the formative years, which can help reach parenting socialization goals.

Parenting socialization is an adult initiated process through which the young person acquires his / her culture as well as habits and values congruent with the adaptation to that culture so that children may become responsible members of their society [ 73]. For many societies, parenting socialization is over when children become adults. For many cultures, the age when this transition takes place is somewhere the ages of 18 and 21, despite a new body of emerging evidence showing that the period of adolescence does not end until the age of 25 [ 74].

Schema theory explains that problematic adulthood behavior and dispositions as being due to a thwarting of core emotional needs that leads to the development of maladaptive schemas. These schemas, along with their associated copying styles, become pathological in that they become rigid ways of viewing and acting in relation to the world, others and oneself that are not amenable to later environmental changes or disconfirming evidence. When this occurs, the goals of parenting socialization are not reached as schemas can lead to problematic behavior and dispositions causing harm to a person's relationships all the way into adulthood and old age. In schema therapy, an adult person with strong, active maladaptive schemas will undergo a process of "resocialization" with the therapist serving as a transitional parent figure through a process called "limited reparenting" [ 6]. This underscores the importance of parenting as it has lifelong effects regardless of whether the child has reached an "adult" age.

The Good Enough Parenting program takes an early intervention perspective whereby it is easier to prevent the development of maladaptive schemas than it is to change them later [ 6], and meeting core emotional needs adequately during childhood will help achieve parenting socialization goals. In Good Enough Parenting, parents are provided with concrete strategies and interventions to increase the number and quality of positive interactions as well as taught to recognize the presence of negative parenting patterns. They also learn how to avoid them or withdraw from them once they start [ 13] and to practice positive parenting patterns.

As the popularity of the program increases, there is a clear need for independent testing of the program rather than just drawing inferences from the well-supported theoretical basis and the wide support for schema therapy in adults. Guidelines for the refinement and testing of new complex interventions stress a multi-stage process in which a focus on end-user acceptability and ease of implementation are as important as showing that the intervention works in controlled conditions [ 75, 76]. Judging the acceptability of an intervention is partially based on understanding the experience of program participants, their views on the coherence and effectiveness of the program, and their sense of self-efficacy in implementing program techniques [ 77]. Participant views are important for informing the perspective of key stakeholders and the real-world success of a program [ 78]. Even where different interventions have been shown to be equally as effective in clinical outcomes in randomized controlled trials (RCTs), how effective they are in uncontrolled settings depends on factors such as disengagement and drop out that arise from patient experience [ 79]. Finally, participants' subjective views of the legitimacy of the program and associated expectancies of change are themselves key factors in determining objective therapeutic change [ 80]. For these reasons, we conducted a qualitative study focusing on Good Enough Parenting participant experience as part of an evaluation program which will also feature RCTs when that step of the complex intervention framework is reached.

Method

Participants

The host organization and the stakeholder of this research is a global affiliate of a nongovernmental organization (NGO), an international faith-based charity headquartered in the United States, and registered as a charity in Singapore. Ethical considerations were in accordance with standards advocated by the British Psychological Society as well as the American Psychological Association. Approval to conduct this study was granted by an ethics committee consisting of a representative member of the Board of the Singapore NGO, and the NGO's family life educators and resource speakers. The committee attests regarding voluntary participation with informed consent, no participation from vulnerable groups, no exclusion because of race, colour, religion, or marital status, participants' anonymity, data confidentiality, no harm will be experienced by any participant, and that no incentives were given. It also confirms the exclusion of program authors in data collection and analysis and that an independent expert was involved to ensure objectivity and integrity of the process carried out.

Parents in Singapore who attended at least one Good Enough Parenting workshop session from 2009 and 2019 were contacted by the NGO over the phone and via email, explaining the purpose and method of this study. No participants were excluded because of race, color, religion or current marital status. Only those without adequate command of the English language were excluded. Participation was voluntary and consent forms were signed by each participant. 68 parents from nonclinical English-speaking community indicated interest to attend the program, but 55 were shortlisted to represent the Singapore population demographics for this exploratory qualitative study. The sociodemographic profile of the participants is presented in the results section.

Program modules and feedback from parents and facilitators

Good Enough Parenting targets parents with children from infancy to late adolescents / young adulthood. Practical points are given which are age-specific in order to meet parenting needs at different ages. Good Enough Parenting is taught either as stand-alone modules or as full program. Module 1 is titled "Avoiding Exasperation Interactions" which provides an overview of the Good Enough Parenting model, core emotional needs, and the detailed explanations of exasperation interactions and nurturing interactions. Modules 2-5 present an in-depth discussion of each core emotional need (i.e., Connection and Acceptance; Healthy Autonomy and Performance, Reasonable Limits, and Realistic Standards and Reciprocity) and the parenting strategies that can be used in order to meet each need. Module 6 discusses Intrinsic Values and Community, as well as Repair and Reconnect, or resolving conflicts through the power of vulnerability and forgiveness.

To ensure that the program is delivered based on its intended outcomes, Good Enough Parenting is taught by the program authors and developers, along with facilitators and trainers who have completed advanced level trainings. Most of these facilitators have relevant training in counselling, social work, psychology or family life education.

Good Enough Parenting has been favorably received by parents and facilitators. Based on feedback from 645 parents in Singapore who attended the workshops from 2016 to 2019, the mean score for overall satisfaction of the program was 4.52 using a 5-point Likert scale, or 90.4%. Further, 96% of 150 facilitators who attended advanced trainings from 2017 to 2019 rated "strongly agree" and "agree" when asked to evaluate the overall course content and structure.

Data collection

Participants were asked to reflect on their experience of parenting prior to and after utilizing the principles of Good Enough Parenting. They were interviewed using a semi-structured interview schedule which incorporated the Critical Incident Technique from May to July 2019 (see S1 Appendix).

CIT was first developed by Flanagan [ 81] to collect direct observations of behaviors in order to examine the effectiveness of a pilot's performance. CIT has been used in the field of counselling and psychology [ 81, 82] to complement the attributes of qualitative research, including recording complex, rich data, so as to understand and capture the meaning, experience and actions of individuals as they go through their lived realities [ 83].

Inherent within CIT are five steps: (i) identifying general aims, (ii) planning, (iii) collecting data, (iv) analyzing data and (v) interpreting and reporting results. Table 1 highlights each step of the CIT process [ 81- 83].

The collection of data for CIT typically requires the respondents to share an experience. In this study, participants were asked to share incidents that happened between them and their child(ren), and to reflect on factors that contributed to the positivity or negativity of these incidents. These incidents deliberately did not require Good Enough Parenting to be considered to allow participants to talk freely about any aspects of, or approaches to, parenting. The rest of the semi-structured interview schedule was focused specifically on eliciting participants' key learnings from Good Enough Parenting workshops such as its impact on their relationship with their child, challenges they faced, and their understanding and use of Good Enough Parenting principles. Example questions were: "What were some of the most natural, and therefore, easiest principles to apply for you?" "Looking back, how do you think you have grown as a parent?" "What nurturing interactions would you like to see more of?" What do you think are challenges that prevent nurturing interactions from happening more?" Whilst a standard interview schedule was provided, interviewers were encouraged to ask other types of second questions, like probing questions ("Could you tell me more about that?") and interpreting questions ("Is it correct to say you feel...?").

CIT comes with multiple advantages [ 84] such as documenting data from the respondents' perspective, according to their own words, as well as providing respondents with the autonomy to decide on the incident which is most relevant to the research being conducted. This approach is inductive in nature [ 85] and effective when the research topic is sparsely documented [ 86] and useful when attempting to gather a more thorough understanding of the phenomenon [ 87]. Unlike other research methods, CIT does not require a fixed hypothesis, and flexibility is provided for the researcher to generate concepts about the theories, rich data consisting of a sequence of events [ 86, 88] and analyzing respondents' perceptions of different cultural backgrounds [ 89, 90]. As this study was the first that collects data from Good Enough Parenting participants, the ability of CIT to facilitate the collection of rich and exploratory data was deemed useful.

Development of codes and pilot testing

The first and sixth co-authors, as developers of Good Enough Parenting, were not involved in either interviewing or data analysis to avoid any unintentional bias in data collection and interpretation. The development of the codes was done over two rounds from both deductive and inductive perspectives. The first round involved developing key themes from the Good Enough Parenting book, providing a framework for the codebook. In the second round, two pilot interviews were conducted, transcribed and four new codes were developed (Context, Learning, Support Factors and Aspirations). The eventual codes which were most salient that emerged were: Principles and Interactions at Work, Context, Learning, Support Factors, Aspirations, Challenges, and Seeing Less Of. Open coding was used for the sub-node. For example, the Principles and Interactions at Work code captured all mentions of the principles that participants associate with Good Enough Parenting as well as interactions with their children since learning Good Enough Parenting. Sub nodes under this code included "good enough" and "reasonable limits". Support factors coded for when participants recognized things that supported them in their parenting, including but not limited to practicing Good Enough Parenting. Sub-nodes included things like grandparents and community.

Data analysis

Six transcripts were selected to be coded independently by two coders using the developed code book. The coders came together to discuss their coding twice to resolve discrepancies and check that the codebook worked and their understandings were correct. The final overall kappa coefficient for the coding is 0.78 which reflects reasonably consistent and substantial inter-coder reliability in terms of coding of the transcripts [ 91]. Once this was achieved, the coders applied the coding schema to the remaining transcripts. The final codes were then synthesized into a master analysis file and analyzed using thematic analysis.

Thematic analysis is one of the most common approaches to analyzing qualitative data. It is especially useful when applied to interview transcripts, as it involves examining repeating patterns or key themes that appear in the transcripts. Following Braun & Clarke's [ 92] six steps of thematic analysis, codes were used to generate a set of initial themes. These were then reviewed to identify areas where they may overlap, and to check that the themes accurately represented the data they were trying to describe. The list of themes was refined; they were given titles and then written up. The following section describes each theme that emerged from the analysis.

Results

Sociodemographic profiles of the participants

While the ethnic distribution of Singapore's population is 74.2% Chinese, 13.2% Malays, 9.2% Indians, and 3.4% from other minority groups [ 93], the sample distribution in this study was 67% Chinese, 9% Malays, 15% Indians, and 9% from other minority groups. The percentage of male and female participants were 51% and 49% respectively. The mean age of the participants was 46.55 years, and the Standard Deviation was 7.32 years. As for marital status, 96% classified themselves as married and 4% as divorced.

98% of the participants attended the full program of at least 21 hours, or 3 full days, conducted by the program authors and developers; the remaining 2% attended at least one module. 27% of the participants attended Good Enough Parenting for the first time from 2009-2010; 60% from 2011-2015; and 13% from 2016-2019.

93% of the participants attended the workshop more than once, providing a refresher to the parents as their children grew up and as the number of their children increased. These workshops were taught either by the authors and developers or other accredited trainers. The parents learned age-specific practical applications, along with updates on key concepts such as exasperation interactions, nurturing interactions, and positive schemas. The remaining 7% attended once and less than one year since the time of the actual interview. Since Good Enough Parenting underscores the importance of community support, 91% of the participants attended at least one support group or were still actively part of parent support groups once every two months, or six times a year, which reinforced the teachings of Good Enough Parenting.

As for the number of children, 14% of the participants have only one child; 40% have two children; 42% have three children; and 4% have four children. The distribution of the ages of the children whose parents participated in the study were as follows: 36% (0 to 10 years), 40% (11 to 19 years), 22% (20 years or above), and 2% were not disclosed. As to the age of the participants' first child since learning Good Enough Parenting, 60% were from 0-10 years; 38% were from 11-19 years; and only 2% with first child aged over 20 years. (See Table 2).

Themes

Learning process.

Interviewees also shared how Good Enough Parenting has been instrumental in helping parents learn about the core emotional needs of their children, as well as their children's temperaments and personalities. Interviewees with more than one child realized that each of their children behaved differently, so parents learned to utilize different approaches in communicating with them. In this process, they learned how to set their expectations differently for each of their children.

Besides learning about their children, Good Enough Parenting also helped parents to learn about other parenting styles. For example, one parent reported that after he learned about autonomy granting and autonomy support, he became more supportive towards his children. Additionally, Good Enough Parenting also helped some of the parents know which core emotional needs of their children were lacking. One parent reported that when her daughter was hospitalized, instead of looking at the contents of her daughter's phone, the parent decided to apply the Good Enough Parenting principles to practice acceptance and nurturance.

This theme elucidates how Good Enough Parenting acts as a framework to incorporate other relevant knowledge and parenting strategies. It was also important to incorporate reflections in the learning of Good Enough Parenting itself, as shared by one interviewee:

Discussion

This article reports on a study into participant experience in using the Good Enough Parenting program [ 14]. Given the aim to provide insights into the experience of Good Enough Parenting amongst parents, this study utilized a qualitative approach involving 55 interviews with parents who have been practicing Good Enough Parenting for various periods of time. The ethnic distribution of the sample used was comparable to the national distribution of Singapore. All transcripts were extensively coded with good inter-coder reliability kappa value of 0.78 after two rounds of inter-coder discussions. Using CIT and thematic analysis the results provide evidence to support the overall effectiveness of Good Enough Parenting for both parents and their children, from the perspective of the parents.

At the thematic level, the findings support several of the theoretical aims of Good Enough Parenting. The program addresses negative early experiences that arise out of negative parent-child interactions (exasperation interactions) by helping parents to develop increased self-awareness of their own early maladaptive schemas and coping styles so that they could parent more reflexively. Parents reported enhanced patience and increased intentionality in their communications and actions which in turn reduced their reactionary and unhelpful responses to triggering interactions with their children. This is significant because reducing negative early experiences reduces the risk for poor outcomes for children [ 2, 3, 94, 95].

The program also aims to enhance mental well-being through its direct focus on positive parent-child interactions (nurturing interactions) and the enhancement of early adaptive schemas which in turn reduces risk factors for later mental health problems. Parents valued learning to identify and focus on their child's unique strengths and characteristics, and learning to connect with their children emotionally to overcome challenges and foster resilience, particularly when faced with impairments and developmental disorders. As such they were better able to navigate the tensions between being emotionally supportive and limit-setting.

This inclusion of well-being and integrated focus on positive and negative characteristics and functioning in theory and intervention is seen as a key development within clinical psychology [ 96, 97] and psychiatry [ 98]. A child who develops early adaptive schemas will likely demonstrate self-directedness, self-reliance (amongst other things) which is in line with research showing that the use, over and above the possession, of strengths leads to enhanced well-being [ 99].

In line with behaviorally-based parenting programs, Good Enough Parenting provides concrete behavioral strategies and interventions for families that are explicitly linked to the nurturing and exasperation interactions, and therefore to the development of early adaptive schemas and reduction of early maladaptive schemas respectively [ 15, 16]. Parents appreciated these strategies when attempting to resolve misunderstandings and find ways to break out of repeated, habitual and negative patterns of interacting. They found that Good Enough Parenting provided a mutual language for both day-to-day communication and conflict resolution.

However, Good Enough Parenting goes beyond behaviorally-based parenting programs. It also focuses on the internal world of the child, specifically how children interpret interactions with their parents to form mental representations of themselves, the world and others, and how parents can either directly or indirectly provide learning opportunities for children that affect their emotional expression and their behavior. These are central ideas within any approach with cognitive-behavioral foundations such as schema therapy [ 100] and as such are important elements of an early intervention program. Above and beyond learning about different parenting approaches, parents valued learning about the constructs of core emotional needs and schemas, unique cornerstones of both schema therapy and Good Enough Parenting [ 17, 71].

Finally, the findings also show that the benefits are not limited to particular developmental phases for children; parents of children of all ages perceived Good Enough Parenting to be an effective parenting approach. This is significant because in some cultures, some parents continue to intensively parent, for example, through Over-Control even after their children have reached adulthood, not realizing that such practices will then become harmful [ 101]. Disciplining an adolescent may be constructive but repeating the same practice with adult children who have entered university, regardless of whether the adult has reached acceptable levels of socialization, could be harmful. At these later developmental stages societies cannot be called upon to provide unsolicited intervention in order to bring about the necessary changes to young adults who have not reached adequate socialization levels [ 73]. In these instances psychotherapy can serve an important role in compensating or filling in the gap for these unmet needs however effective parenting beginning in childhood will be a more effective and less costly means of helping children reach important socialization goals, become contributing members of society and lead more fulfilling lives [ 73].

Limitations

The first limitation has to do with the relatively small number of interviewees and convenience sampling in most qualitative studies-although in the context of this study the number of interviewees is considered relatively large, the sample is limited because of its convenience. However, it could also be argued that the sample was very much a purposive one-given the focus on Good Enough Parenting, interviewees needed to be parents who practiced or have been exposed to Good Enough Parenting, even though some may not have practiced it for long. There could also be potential self-selection bias given that majority of the participants completed the full program, attended more than once since their first exposure to Good Enough Parenting, and participated in or were currently actively part of parent support groups practicing similar concepts. A sizeable group learned Good Enough Parenting when their children were between 0-10 years, and these children are now in adolescent or early adulthood years. This could have reinforced the key learnings over the years, compared to those who were exposed to the program only once. Given the qualitative nature of this research, it was not possible to establish the effects of attending the program more than once on outcomes.

Another limitation of qualitative studies is the relatively subjective nature of analysis as it can depend on the coders and how they interpret them. This was addressed somewhat through the inclusion of the inter-coder discussion and computation of inter-coder reliability, but due to the large number of interviewees it was not possible to compare the coding on all the transcripts. However, care was taken to ensure that coding began only when there was sufficient satisfaction that the coders had consistent and coherent understanding of the coding.

Future research

Having established the effectiveness of the program from the participant perspective, the next step in overall intervention evaluation is to establish objective efficacy [ 75] for which RCTs are being planned. Current results will contribute to the design of the RCTs by informing the selection of patient-reported outcomes [ 102, 103].

Conclusion

Regional authorities, educational services, police, medical, and social services are increasingly using or referring children and adolescents to early intervention programs. Such interventions commonly focus on either those children at high risk of developing adult psychological and behavioral problems (e.g., due to disadvantaged background or existing behavioral difficulties), or all within an area as part of population level investment in ensuring a psychologically healthy and productive next generation. Good Enough Parenting is designed to be used in both cases. Early intervention programs are effective [ 4] and cost saving versus the later financial impact of the psychopathology of the individuals who could have been helped by the program [ 5]. Schema therapy is a well-established cognitive behavioral approach with a firm evidence base for both theory and practice [ 104] with acceptability of specific techniques from the perspective of patients [ 105, 106] and therapists [ 107]. This large-scale qualitative study showed that Good Enough Parenting, the schema therapy early intervention and parenting program, has considerable acceptability to the end user participants. Further, the participants generally considered the program to be effective and their participation to be a positive experience.

Acknowledgments

We wish to thank Alex Wood for his advice and guidance on this qualitative study. We would also like to thank Dr. Natalie Pang for her guidance and help.

References

1. 1. Center on the Developing Child at Harvard University. Applying the Science of Child Development in Child Welfare Systems [Internet]. Cambridge (MA): Center on the Developing Child at Harvard University; 2016 Oct [cited 2019 Dec 26]. www.developingchild.harvard.edu

2. 14. Louis JP, Louis KM. Good enough parenting official website [Internet]. Singapore: Louis JP, Louis KM; 2009 [cited 2019 Dec 26]. https://www.gep.sg.

3. 18. Louis JP, Louis KM. Good enough parenting: An in-depth perspective on meeting core emotional needs and avoiding exasperation. 2nd ed. Singapore: Louis Counselling and Training Services; in press.

4. 41. Dewar G. The permissive parenting style: Does it ever benefit kids? [Internet]. Place unknown; Parenting Science; 2019 [updated 2019; cited 2020 Oct 13]. https://www.parentingscience.com/permissive-parenting-style.html.

5. 44. Darling N. Parenting style and its correlates. Champaign, IL: ERIC Clearinghouse on Elementary and Early Childhood Education. 1999. https://www.ericdigests.org/1999-4/parenting.htm.

6. 72. Louis JP, Davidson AT, Lockwood G, Wood A. Positive perceptions of parenting and its link to theorized core emotional needs. J Child Fam Stud. 2020; https://doi.org/10.1007/s10826-020-01807-0

7. 73. Maccoby EE. The role of parents in the socialization of children: An historical overview. Dev Psychol. 1992;28(6):1006-17. https://doi.org/10.1037/0012-1649.28.6.1006

8. 78. Carter SL, Wheeler JJ. The Social Validity Manual: subjective evaluation of interventions. 2nd ed. San Diego (CA): Academic Press; 2019.

9. 93. World Population Review [Internet]. Walnut (CA): World Population Review; 2019. Singapore Population; 2019 [cited 2019 Dec 26]. http://worldpopulationreview.com/countries/singapore-population/

# data[].attributes.attachment_link.title
The Good Enough Parenting early intervention schema therapy based program: Participant experience

# data[].attributes.attachment_link.description
Background and objectives Schema therapy (ST) has become a mainstream therapy for the treatment of psychopathology and has been validated through a series of large scale, international randomized control trials. Among other things, schema therapy emphasizes the meeting of core emotional needs in children by primary caregivers as these unmet needs continue to adversely affect their lives into adulthood.

# data[].attributes.body
This is the one ritual that every caregiver should provide their child with.

‘Building routines with your children helps them to feel safe’.

# data[].attributes.body
… sincerely preoccupied with being a mother. She pays attention to her baby. She provides a holding environment. She offers both physical and emotional care. She provides security. When she fails, she tries again. She weathers painful feelings. She makes sacrifices. Winnicott’s good enough mother is not so much a goddess; she is a gardener. She tends her baby with love, patience, effort, and care.

# data[].attributes.attachment_link.readable_text
There is no such thing as a 'perfect parent'
Society must be willing to tolerate very diverse standards of parenting, including the eccentric, the barely adequate and the inconsistent. It follows too that children will inevitably have both very different experiences of parenting and very unequal consequences flowing from it. It means that some children will experience disadvantage and harm, whilst others flourish in atmospheres of loving security and emotional stability. These are the consequences of our fallible humanity and it is not the provenance of the State to spare children all the consequences of defective parenting. In any event, it simply could not be done. ...It would be unwise to a degree to attempt an all embracing definition of significant harm. One never ceases to be surprised at the extent of complication and difficulty that human beings manage to introduce into family life. Mr Justice Hedley in Re L (Care: Threshold Criteria) (Family Division 26 October 2006)
The state can only interfere in your parenting if your child is beyond your control, you have caused your child significant harm or there is a serious risk you will cause that harm in the future.

Being a less than 'perfect parent' does not mean that professionals can assume you will cause significant harm to your child. You just have to be 'good enough'. Its a phrase you will often hear in care proceedings. But what does it mean?

Who are parents and why is parenting important?

You don't have to be a child's biological mother or father to be involved in 'parenting' that child. Anyone in the wider community who is involved in the child's development could be said to be part of the parenting process - such as grandparents, teachers, friends and neighbours.

A child needs 'good enough' parenting to survive and grow into a healthy, functioning adult. His basic needs for food and shelter have to be met to ensure his physical survival, but meeting such basic needs is not the only obligation of parents. If a child's emotional needs are neglected or ignored, that is likely to have a serious impact on the child for all his life. Developing a healthy 'attachment' between child and adult carer is an important part of parenting.

What do we mean by 'good enough parenting'?

Donald Winnicott was an English paediatrician and psychoanalyst and probably the first to use the phrase 'good enough parent'. He recognised that it was unrealistic to demand perfection of parents, and was interested in finding out what made them 'good enough'.

He believed that the key to healthy development was rooted in a child's relationships and interactions with others.

With the care that it receives from its mother each infant is able to have a personal existence, and so begins to build up what might be called a continuity of being. On the basis of this continuity of being the inherited potential gradually develops into an individual infant. If maternal care is not good enough then the infant does not really come into existence, since there is no continuity of being; instead the personality becomes built on the basis of reactions to environmental impingement." (Winnicott, 1960)

Dr Jennifer Kunst describes Winnicott's 'good enough mother' as:

... sincerely preoccupied with being a mother. She pays attention to her baby. She provides a holding environment. She offers both physical and emotional care. She provides security. When she fails, she tries again. She weathers painful feelings. She makes sacrifices. Winnicott's good enough mother is not so much a goddess; she is a gardener. She tends her baby with love, patience, effort, and care.

Components of good enough parenting

The Joseph Rowntree Foundation report 'Assessments of Parents and Parenting Support Needed' showed that professionals who worked with families, together with those in health and education, could agree on the main components of good enough parenting:

meeting children's health and developmental needs;

putting children's needs first;

providing routine and consistent care;

parental acknowledgement of any problems and engagement with support services.

'Risky' or 'not good enough parenting' was basically the reverse of this: not meeting the children's needs, not putting them first etc. but it would be important to recognise if the risky behaviours identified represented a 'one off' or was a more regular part of the parents' approach.

Part of being a good parent is preparing your child for environments outside your home. See the Social Mobility and Child Poverty Commission report in October 2014, ' State of the Nation 2014: Social Mobility and Child Poverty in Great Britain', which looked at what Frank Field highlighted as the essential skills children need by the time they join the reception year at primary school:

Things which can get in the way of good parenting.

The Department of Education reviewed the literature in this field as part of the Childhood Wellbeing Research Centre programme (see further discussion below).

An extensive body of evidence shows how factors such as domestic abuse, substance misuse, mental health problems and learning disability undermine parenting capability and increase the likelihood of significant harm, particularly when they occur in combination. Moreover, parenting does not take place in isolation. Parents are also influenced by stressors within the wider environment and family, such as poor housing, poverty and unemployment that make parenting more challenging and increase the likelihood that difficulties will arise.

Is there a universal definition of 'good enough' parenting?

While we can probably all agree about the importance of the basic needs of providing a child with food and clothes, problems may arise in care proceedings when professionals don't share the same outlook as the parents as to what is important for the children and why.

The participants in the JRF report above were aware that they bought their own personal beliefs about parenting to the process and there could be problems if those doing the assessing came from a very different background to the parents being assessed.

For example, parents from some cultures may have strong views on whether or not it is acceptable to physically punish children. Are they automatically not 'good enough' parents because their approach is not universally accepted? The NSPCC and others in 2015 raised serious concerns about a judgment that appeared to ask for 'allowances' to be made for those from other cultures who smacked their children.

The DoE commented:

Practitioners reported concerns about making judgements and assumptions or being too accepting of behaviours, assessing whether parental practices were the cultural norm or individual beliefs and behaviours, and fears about damaging parent-practitioner relationships.

This can be a particularly acute problem when dealing with parents with learning disabilities or mental health problems, who may face discrimination and lack of understanding from professionals.

It is important to give every parent an opportunity to show they can be 'good enough', with support if necessary and professionals need to be wary of making automatic negative assumptions about certain parenting styles. The key issue of 'significant harm' must always be borne in mind.

The case of BR (Proof of Facts) [2015] set out a useful precis of what is commonly identified as 'positive' and 'negative' factors that might impact on parenting.

However the court stressed that the existence or otherwise of any of these factors proved nothing - children can still be abused in a supportive family environment or thrive in care of physcially/mentally disabled parents. But they offer a useful framework for an assessment, and highlight the areas that professionals will be looking at.

Risk factors

Physical or mental disability in children that may increase caregiver burden
Social isolation of families
Parents' lack of understanding of children's needs and child development
Parents' history of domestic abuse
History of physical or sexual abuse (as a child)
Past physical or sexual abuse of a child
Poverty and other socioeconomic disadvantage
Family disorganization, dissolution, and violence, including intimate partner violence
Lack of family cohesion
Substance abuse in family
Parental immaturity
Single or non-biological parents
Poor parent-child relationships and negative interactions
Parental thoughts and emotions supporting maltreatment behaviours
Parental stress and distress, including depression or other mental health conditions
Community violence

Protective factors

Supportive family environment
Nurturing parenting skills
Stable family relationships
Household rules and monitoring of the child
Adequate parental finances
Adequate housing
Access to health care and social services
Caring adults who can serve as role models or mentors
Community support

Assessing parents' capacity to change.

How can parents move from 'not good enough' to 'good enough'? In July 2014 the Department of Education published ' Assessing Parental Capacity to Change when Children are on the Edge of Care'

# data[].attributes.attachment_link.description
Society must be willing to tolerate very diverse standards of parenting, including the eccentric, the barely adequate and the inconsistent. It follows too that children will inevitably have both very different experiences of parenting and very unequal consequences flowing from it.

# data[].attributes.body
A consistent routine gives the child security in the home.

On the emotional side, consistency means purposely choosing how you are going to engage with or respond to your child, and not varying with that choice over time. Choosing to not yell and to calm yourself down before you respond to your child is one of the greatest gifts you can give your kid.

Consistency in terms of structure and routine provides limits and boundaries for children. These help them to organize and integrate information into their brain and gain an understanding of how the world works.

‘They know what to expect when they go home, and it provides them with clear boundaries, expectations, and consistency.’

# data[].attributes.body
Assessments of parenting and parenting support needs

# data[].attributes.headline
Importance of parenting and the needs of children. Importance of parenting and the needs of childrenIt is generally accepted that the needs of children are at their most intense in the first five years of life when they are at their most dependent on parent figures for physical and emotional nurture and protection. Good enough parenting delivered consistently over this critical period enables attachment and fosters the child’s sense of basic security, which is essential for subsequent mental health and self esteem. Once acquired, these attributes constitute a firm foundation for the rest of childhood and adult life.

# data[].attributes.subject
Importance of parenting and the needs of children. Importance of parenting and the needs of childrenIt is generally accepted that the needs of children are at their most intense in the first five years of life when they are at their most dependent on parent figures for physical and emotional nurture and protection. Good enough parenting delivered consistently over this critical period enables attachment and fosters the child’s sense of basic security, which is essential for subsequent mental health and self esteem. Once acquired, these attributes constitute a firm foundation for the rest of childhood and adult life.

# data[].attributes.body
Source: https://adc.bmj.com/content/78/4/293

# data[].attributes.headline
Acknowledging problems and engaging with support services

# data[].attributes.subject
Acknowledging problems and engaging with support services

# data[].attributes.headline
Meeting children's health and development needs

# data[].attributes.subject
Meeting children's health and development needs