Reducing Therapist Contact in Parenting Programs: Evaluation of Internet-Based Treatments for Child Conduct Problems

This study evaluated two Internet-based versions of Parent Management Training (PMT) and the effects of greatly reducing the contact required of a mental health professional on treatment of children referred for conduct problems. We were interested whether reduced contact with a therapist influenced treatment outcome, therapeutic alliance, parent adherence to treatment prescriptions, and parent reactions to and evaluations of the treatment procedures. Sixty children and their caregivers were assigned to receive either Full Contact PMT (with the amount of weekly contact similar to traditional PMT; approximately 50 min of direct therapist contact each week) or Reduced Contact PMT (with most information provided through recordings; approximately 10 min of direct therapist contact each week). Children in both groups showed significant and similar reductions in antisocial behaviors specifically, internalizing and externalizing symptoms more generally, and improvements in overall adaptive functioning. Therapeutic alliance also was similar across the two treatment groups. However, parents rated Full Contact treatment as more acceptable than the reduced version. Both treatments were similar in outcomes to in-person treatment as evaluated by a nonrandomized matched sample used as a benchmark in supplementary analyses. Overall, the findings indicate that therapist contact can be reduced while positive treatment outcomes are maintained but that interventions that reduce direct time with a therapist may be viewed less positively by clients.