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].

Method

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].

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Table 1. Five steps in critical incident technique.

https://doi.org/10.1371/journal.pone.0243508.t001

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.

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).

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Table 2. Sociodemographic characteristics of the community sample in Singapore (n = 55).

https://doi.org/10.1371/journal.pone.0243508.t002

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].

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.

Supporting information

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.