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Contemporary Family Therapy (2023) 45:394–409 https://doi.org/10.1007/s10591-022-09659-0

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ORIGINAL PAPER

Therapeutic Influences on Father Engagement in Family Therapy

Jason K. Martin1

Accepted: 19 December 2022 / Published online: 2 January 2023 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023

Abstract Helping family members engaged in the change process of therapy is an essential task of the therapist in the early part of the therapeutic process. Research demonstrates that fathers are frequently the least engaged family member in family therapy, but qualitative research into the nature of father engagement in family therapy is infrequent at best. This study aimed to under- stand factors that help or hinder fathers from becoming as fully engaged in therapy as mothers, in the fathers’ own words. The primary question that guided the development and execution of the study was, “What do fathers perceive as primary influ- ences (i.e., barriers and facilitators) to their engagement in the therapeutic process?” A grounded-theory qualitative approach was used to assess what fathers with a child in family therapy believe makes therapeutic engagement easier or more difficult. The study used semi-structured interviews with 10 fathers whose child was the identified patient (IP) in family therapy to learn about their therapeutic experiences. These voices subsequently came together to demonstrate therapeutic influences in seven themes: the role of the therapist, the structure of therapy, fear of the unknown, the inherently difficult process of therapy, observation of therapeutic change, the child’s enthusiasm about therapy, and fathers’ role in therapy. Those themes led to a revised conceptual map that may lay the groundwork for a theory of therapist influence, helping therapists better identify the areas where they may have more influence and action about father engagement. Implications for further research and improved therapeutic engagement of fathers is discussed, including further studying the proposed conceptual map.

Keywords Fathers · Family therapy · Therapeutic engagement · Grounded theory research · Therapist role

Introduction

The process of therapeutic engagement is central to the change progress of therapy. Therapists do not create change, as some might believe; clients do. Successful out- comes depend on clients actively engaging in the process of therapy, processing through their own issues, rather than passively taking advice from a therapist (Friedlander et al., 2018; Jackson & Chable, 1985; Mallonee et al., 2021; Shay & Maltas, 1998). Prior research suggests that father engage- ment in the change process of therapy is highly correlated with successful outcomes in family therapy with children (Andolfi, 2013; Freitas & Fox, 2015; Thomas et al., 2021; Walters, 1997). Unfortunately, fathers are often the least engaged members of the family in family therapy (Berg

& Rosenblum, 1977; Shay & Maltas, 1998; Walters et al., 2001). Their absences constrain the therapist and the rest of the family to proceed without a critical resource that could contribute to greater, lasting change in the family.

The current study suggests that the process of father engagement in family therapy has implications for how fam- ily therapists pursue therapy with fathers. The study focused on the father in therapy whose child is the identified patient (IP). All fathers involved in this study were at some level engaged in family therapy. Although non-involved fathers with a child in family therapy were actively recruited, none such fathers responded. The study sought to discover what these men believed made therapeutic engagement easier or more difficult by interviewing them about their therapeutic experiences, pre-existing ideas about therapy, and roles as fathers. One primary question guided the development and execution of this study: What do fathers identify as primary influences (i.e., barriers and facilitators) to their engagement in the therapeutic process? Identifying and removing barri- ers and enhancing facilitators to therapy is a goal central to all family therapists. As each family member becomes more

* Jason K. Martin [email protected]

1 Master of Arts in Counseling Program, University of Mary Hardin-Baylor, 900 College St, UMHB Box 8421, Belton, TX 76513, USA

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engaged in the process of therapeutic change, therapy has a better chance of aiding lasting, positive change (Jackson & Chable, 1985).

Fathers’ Roles Within the Family

The role of fathers in the family has changed dramatically in the last half-century. Lamb (2000) describes the perceived ideal role of the father as evolving in society from that of moral guide to breadwinner to gender role model to nurtur- ing caregiver in a relatively short amount of time, so short that a man born in the first half of the twentieth century would have witnessed much of that evolution first-hand. Other more recent studies have shown a remarkable cultural shift across generations that highly value nurturance from fathers, whereas the priority was usually discipline (Freitas & Fox, 2015; Sarfaraz et al., 2021). This rapid change has left fathers, therapists, and society confused as to exactly what the role of the father is and should be. Attempting to address this confusion, research of fathers and fatherhood has become more common over the past fifty years. Begin- ning primarily with Greenberg and Morris’s (1974) article on fathers’ engrossment with their newborn children, social scientists have begun to look at how fathers function in the family (e.g., Beitel & Parke, 1998; Bulanda, 2004; Hofferth & Anderson, 2003; Stargel et al., 2020) and society (e.g., Anderson et al., 2002; Dienhart, 1998; Fernandez-Lozano, 2019; Hawkins & Palkovitz, 1999; Li, 2020; Scharrer et al., 2021), as well as the impact of fatherhood on their chil- dren and themselves (e.g., Han et al., 2021; Nielsen, 1999; Palkovitz, 2002; Palkovitz et al., 2001; Park & Banchefsky, 2018).

Despite this recent strong interest in fathering research, the literature base is still lacking in many key areas, includ- ing the role of fathers in family therapy. Studies show that father involvement in family therapy can enhance change and efficacy (Bagner & Eyberg, 2003; Philpot, 2005; Thomas et al., 2021; Walters et al., 2001), but little is known about why this is or how therapists can best utilize father involve- ment in therapy. The body of literature addressing fathers’ perspectives of therapy is even smaller (Phares et al., 2005; Vetere, 2004). Even when both parents are involved in fam- ily therapy, some family members may be more engaged in the therapeutic process than others. Jackson and Chable (1985) describe engagement as a greater level of therapeutic investment than simply attending therapy. Engagement is a complex, reciprocal process in the client-therapist rela- tionship, referring to the specific adjustments that therapists make within themselves over time to accommodate to the family under therapy. Certain barriers and facilitators make this engagement process easier or more difficult. Therapeu- tic systems could potentially overcome many of the barri- ers, either by the initiative of the therapist, client, or both.

The current study sought to discover various influences that potentially prevent many fathers from fully engaging in the change process of family therapy, as well as facilitators that may enhance therapeutic engagement.

Common Factors in Family Therapy

Any attempts by therapists to address the effectiveness of family therapy should first examine how common factors in family therapy may affect how researchers and thera- pists understand engagement and therapeutic effectiveness. Building upon previous common factors research, Spren- kle et al. (2009) defined common factors as the variables that significantly contribute to the ongoing effectiveness of therapy, particularly relational therapy, transcending theo- retical model or technique to focus on what happens with the client, therapist, or therapeutic process that contribute to the effectiveness of therapy. Sparks and Duncan (2010) go as far as to claim that client or extratherapeutic factors may account for as much as 87% of the change process, leaving a paltry 13% divided among therapist effect, model/ technique, alliance effects, and other treatment effects. While that may sound discouraging to many therapists hoping to make a more notable impact, it further demonstrates the need to learn as much as possible about the client expe- riences and affecting influence in whatever way possible. Finally, Rober et al. (2021) described the benefit of using seeking feedback directly from clients to optimize whatever influence therapists may have in building and maintaining an alliance with families. While their research focused more on the child’s perspective with engagement in family therapy, they highlight the valuable feedback gained from direct engagement with all family members. This study attempted to learn directly from the fathers in family therapy, giving their voices primacy as a members of therapeutic systems that may sometimes be neglected (Vetere, 2004).

Fathers in Family Therapy

Despite efforts to destigmatize therapy for men, women continue to be much more likely than men to seek thera- peutic services (Brooks, 2003, 2010; Cole & Ingram, 2020; Tremblay & L’Heureux, 2011; Walters et al., 2001). Family therapy presents an added difficulty for both fathers and therapists. Not only are fathers asked to engage in therapeutic interaction counterintuitive to much of their gendered socialization by requiring them to be emotion- ally vulnerable, empathetic, and relationally adaptable (Brooks, 1998, 2010; Furrow, 2001; Shay & Maltas, 1998), but they are also asked to engage in overtly nur- turing and empathic caretaking of the child in therapy (Lazur, 1998; Rogers et al., 2021; Sarfaraz et al., 2021; Tremblay & L’Heureux, 2011), which they may view as

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socially counterintuitive as well. They must be empathic and vulnerable as well as collaborative and compassionate, characteristics many men are still socialized to avoid, and they may not feel comfortable engaging in such an emo- tionally responsible form of parenting (Roggman et al., 2013). These types of responsibilities create an environ- ment that is favorable to gender-socialized mothers tak- ing the primary interest in the change process of family therapy (Philpot, 2005; Walters et al., 2001). Therefore, therapists must work doubly hard to engage all available family members so that the maximum momentum of change in family therapy can develop. By better under- standing barriers that hinder father engagement in therapy and facilitators that make engagement easier, therapists would be better equipped to help fathers join in building that momentum more efficiently.

Because of the diversity of experiences children have with their fathers, and the variety of personalities that fathers may inhabit, family therapy with fathers may not always be appropriate. Even studies about the contrain- dication of father inclusion in family therapy is sparse, however. Where the literature appears to identify contrain- dications, it is not specific to fathers but any parent or caregiver who may be disruptive or counterproductive to the therapeutic process. Such examples include parents with significant psychopathology (Myrick & Green, 2013), parent who may have an abusive history with the child (Laracuente, 2017), or parents who are openly hostile towards the therapeutic process (Sotero et al., 2018). The current study did not encounter any participants who were identified as fitting any of those categories, so the research should be interpreted as excluding such parents and car- egivers from the conclusions. Future research would be needed to address the question of therapeutic engagement with such parents.

Research has discussed in a limited manner how thera- pists can begin to actively engage fathers in the change process of therapy (Hecker, 1991; Nelson & Trepper, 1993). However, studies have not yet addressed how thera- pists can learn directly from the fathers themselves about their general lack of investment in therapy. Phares et al. (2005) examined 577 studies of parental involvement in clinical child and family therapy. They found that “a total of 277 studies (48.0%) included mothers only, 151 stud- ies (26.2%) included both mothers and fathers and ana- lyzed for parental effects separately, 141 studies (24.4%) included mothers and fathers but did not analyze their data separately or more commonly only described their participants as ‘parents’ without specifying the parents’ gender, and 8 studies (1.4%) included fathers only” (p. 8). In the years since, nothing indicates that those numbers have improved. These findings demonstrate a large gap in the fathering literature and family therapy literature.

Purpose of the Present Study

The purpose of this study was to hear each fathers’ experi- ences and reflections of family therapy in his own words to identify influences on his engagement, specifically bar- riers and facilitators to involvement. The study assumed that simply addressing the barriers may not fully address how therapists can help engage fathers. Therefore, the study also sought to discover facilitators that encourage engage- ment of fathers in therapy. The subjective experiences and specific language used by the research participants can be easily lost in quantitative research, but that may not mat- ter if the research adequately addresses the research ques- tion. The existing research previously described engages quite a bit in this form of research, and the field is better for it. However, the subjective experiences, opinions, and language used by the fathers themselves are not well rep- resented in the existing literature, as demonstrated in the literature review. Because of the personal nature of family therapy, subjective experiences and opinions may be criti- cal to building rapport and breaking down barriers. This study is not intended to be a comprehensive description of those subjective experiences, but it is intended to provide a slice of representation that is otherwise lacking in the exist- ing literature. Identifying fathers’ barriers to engagement in family therapy allows therapists the opportunity to combat barriers and make therapy a more inviting place for fathers. Fathers’ reluctance to engage in therapy has sometimes been given the value-laden label of “resistant” (Berg & Rosen- blum, 1977; Walters, 1997). By better understanding their barriers to therapy, the therapist may better assist fathers in removing or working with those barriers, thereby refram- ing fathers’ experiences in therapy as a natural product of their circumstances, rather than simply resistance. By better understanding facilitators, therapists may be able to address what could uniquely engage fathers in the therapeutic experi- ence. This also could potentially help fathers address barri- ers that may exist in their daily parenting lives.

Methods

This qualitative grounded theory study used individual, semi-structured interviews approved by the Internal Review Board (IRB) at the researcher’s university. Grounded theory research is best suited when the researchers seek to better understand a subject from a new perspective, without the application of a preexisting theory to the researchers’ under- standing, thereby allowing theoretical themes, constructs, and ideas to emerge naturally from the data in an attempt to begin forming theory (Rafuls & Moon, 1996; Walsh et al., 2015). Grounded theory was chosen for this study to help the researchers understand the barriers and facilitators to

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engagement though a tentative model of involvement. Prior to conducting the interviews, the researchers created an ini- tial conceptual map containing the various systems of influ- ences that the interviews would specifically address (Fig. 1). Urie Bronfrenbrenner’s ecological systems theory (Tudge et al., 2009) was highly influential in guiding the research- ers’ formulation of the initial conceptual map, attempting to understand father experiences as a series of concentric circles, with concepts closer to the center of the circle seen as more central to fathers’ engagement in the family therapy process. The areas in these circles helped guide the construc- tion of the interview questions and prompts for the initial interview. (Table 2) As is typical of qualitative research, especially grounded theory methods, the richness of data and theoretical implications was emphasized over model- testing or generalizing to a population (Avis, 2003; Camic et al., 2003; Cobb & Forbes, 2002). This study examined the under-researched phenomenon of fathers in family therapy, which provided additional complexities of various therapeu- tic, familial, and sociological factors.

Participants

Family therapists known to the researchers in Lansing, Michigan and Houston, Texas, were informed of the sample criteria and asked to refer fathers who met the criteria to the researchers. The researchers were not the therapist for any of the participants, and none of the researchers’ own clients

were invited to participate. Fathers who self-identified as interested based on information they received from their family therapist contacted the researchers through email. If the father agreed to participate and met the sample crite- ria, he was scheduled for an initial interview. The research- ers recruited fathers in family therapy whose child was the identified patient (IP) of therapy using the family therapist key informants. The therapists were not interviewed for the study, and they had no bearing on the research aside from participant recruitment. The fathers who participated in the study were all involved in therapy, but the unifying factor was that the child was the IP, as opposed to a parent or other family member serving as the IP. Additionally, fathers were required to reside with the child in therapy and speak fluent English. Finally, the therapist for the IP child had to have presented family therapy to the father as a treatment option. For the sake of recruitment, the father need not have partici- pated in therapy, but each father who chose to participate in the research had engaged in therapy. Fathers were all over 18 years of age and participated voluntarily. Fathers were given the option by the recruiting therapist to contact the researchers directly, which certainly affected the sample participants and subsequent findings by making the sample self-selecting.

For theoretical consistency and simplicity, this study specifically restricted the sample in a few different areas. The study did not include fathers who did not reside with their child because these fathers usually do not have enough

Fig. 1 Initial conceptual map

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regular access to the child to expect them to engage to the degree that the residential parent does (Kissman, 1997). Gay custodial fathers were excluded from the study because of the significant other factors that gay fathers encounter, pre- sumably both facilitating and hindering therapy. Although they face their own unique barriers to parenting, they typi- cally do not face the same conflicts regarding gender in parenting that straight fathers do (Anderssen et al., 2002). Although each of these restricted cases deserve much more attention in research, this study excluded them for theoretical consistency and trustworthiness of the information gathered as most likely to generate meaningful themes in responses.

Table 1 provides a summary of the demographics of the fathers in the sample. It shows commonalities among many of the participants, especially regarding ethnicity, education, and religion, although none of those categories is completely homogeneous. There is fair diversity, however, in terms of age and income. The participants ranged in age from 33 to 54 years old. All participants had been to at least three therapy sessions, and one participant had recently ended therapy for his child because they had achieved their thera- peutic goals.

Once a potential participant was identified and consented to participation, he entered a series of semi-structured inter- views meant to create a window into how he viewed therapy and his role in the therapeutic process. All interviews were conducted by the researchers. None of the researchers were also the therapists of the participants, and the researchers had no prior relationship with the participant, therapeutic

or otherwise. Fathers who agreed to participate in the study received a $50 gift card to a local store as compensation for their time.

Interview Procedures

Prior to beginning any interview, the researchers reviewed all interview questions, prompts, and other notes to establish focus on those issues, rather than any preconceived opinions or expectations about the research. The interviews also had regular moments when the interviewer would check in with the participant about the interview, asking about how he was feeling, any discomfort or perceived misunderstanding about the interview. This was part of an ongoing process of brack- eting during the data collection and analysis. Fischer (2009) describes bracketing as taking measures to best ensure “that our understandings are not just our own and that if other researchers studied our data that they would come to similar understandings” (p. 584). This was an ongoing process in both the data collection and analysis processes.

The interviews asked open-ended questions meant to elicit information regarding the fathers’ experiences in ther- apy and in the different areas of life that could potentially influence therapeutic engagement. These interviews utilized some of the same techniques typically used in therapy, such as engaging with empathy, reflective listening, and circular questioning, to gain information about the fathers’ experi- ences in therapy. Unlike therapy, however, these interviews were conducted more as conversations than therapeutic

Table 1 Demographics of sample participants

a All participant names were changed. The names given here and throughout the article are pseudonyms b Although Dave was engaged to be married at the time of the interview, his fiancé serves in the role of mother to his son because his son’s birth mother is not involved in his life c Although Joel and Jerry are each divorced and have remarried, their children’s mothers are Joel’s and Jerry’s current wives

Fathera Age Years with partner

Total Chil- dren

Age and identi- fied gender of child(ren) in therapy

Education Ethnicity Income Marital status Religious Affiliation

Jim 49 23 2 16, Female Bachelors Degree White Over $80,000 Married Roman Catholic Dave 33 7 1 11, Male Technical/Trade

School Black $20,000–$30,000 Engagedb None

Ben 53 31 2 17, Male Bachelors Degree White Over $80,000 Married Episcopal Sam 33 13 2 6, Male Some College White Over $80,000 Married Baptist Joel 49 16 5 15, Male; 14, Male Some College White $50,000–$60,000 Remarriedc Roman Catholic Miles 44 18 2 13, Male Bachelors Degree White $70,000–$80,000 Married Baptist Jared 37 20 3 16, Male; 14,

Male; 10, Female Bachelors Degree White Over $80,000 Married Methodist

Martin 46 25 2 17, Male Bachelors Degree White Over $80,000 Married Christian (Non- Denominational)

Jerry 54 25 1 18, Female Technical/ Trade School

White $70,000–$80,000 Remarriedc Roman Catholic

Joseph 53 28 1 15, Female Doctorate White Over $80,000 Married Baptist

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interventions (Boss et al., 1996). Therefore, the conver- sational nature of the interviews created a back-and-forth dialogue, allowing the researchers more flexibility with the line of questioning to dig deeper or follow specific ideas and opinions put forth in the moment by the participant. Because directly obtaining the fathers’ perspective was of paramount importance, the interviews needed to capture the fathers’ language in their own words. The researchers used an active interviewing style, relying on the interaction and collaborative meaning-making effort between the inter- viewer and participant to construct an interpretive narrative of the participant’s perspective (Prout et al., 2020). Each participant was asked the same basic interview questions in the initial interview. A series of prompts was also available for each interview question if the interviewer believed them to be beneficial (Table 2).

All interviews were conducted in person in a therapy office, usually in the same building where the participant’s family therapy occurred but not necessarily the same spe- cific office space. The interviews were digitally recorded and transcribed by the researchers. The transcriptions were then reviewed and verified for accuracy by at least two other individuals, colleagues, and associates of the researchers. Following the initial interview, the researchers

completed a contact summary, which helped identify key impressions and preliminary themes that emerged dur- ing the interview. Key questions of the initial interview focused on fathers’ preconceived beliefs about family ther- apy, changes in those beliefs after participating in family therapy, co-parenting philosophies, and his general role in the family. A follow-up interview was scheduled with each participant to address questions and clarifications that emerged after the initial interview and to receive feedback from the father about the initial interview. Each follow- up interview began with a review of the initial interview, inviting the participant to correct any misunderstandings or inaccuracies. The protocol for the second interview was largely guided by the responses and processes of the initial interview, and there was not a common set of interview questions for the follow-up interview. Prior to the follow- up interview, the researcher-interviewer would identify four to six statements, stories, ideas, or opinions expressed in the initial interview to guide the interview. Such state- ments or stories were identified by the researchers as potentially carrying more intimate information into the participant’s influences on therapeutic engagement. Some of these eventually served as the basis for what eventually emerged as themes in the data.

Table 2 Sample of interview questions

This represents only a sample of all the interview questions asked. Because the full scope of the study looked at numerous potential barriers and facilitators to father engagement in family therapy in other domains, other interview questions focused on areas such as parental cooperation, parenting gender roles, emotional cohesion, and conflict resolution within the family. The interview questions related to those elements are omit- ted here because this article is focused specifically on the therapeutic factors related to father engagement

Initial interview question Additional prompt (used as needed) Area of focus

Tell about what you thought of family therapy prior to you or your child becoming involved with it

What did you think about family therapy before your child entered therapy?

What has been your experience with family therapy in the past? How have those experiences effected your perception of family therapy?

What made it difficult or easy to become involved in family therapy?

Tell me about how the decision was made to come to therapy

Therapeutic preconceptions Past experiences in therapy Decision-making processes Partner cooperation

How has the therapeutic process been for you? What are challenges that have made participation in therapy dif- ficult?

What about the therapeutic has been better or less difficult than you anticipated?

Do you believe that it is more important for you or your partner to be involved in family therapy?

How has your therapist made your involvement in family therapy easier? How have they made your involvement more difficult?

Lived experiences Examination of current

experience Perceived influence of

partner on therapeutic engagement

Perceived influence of therapist on therapeutic engagement

Since your or your child’s involvement in fam- ily therapy, how have your perceptions about therapy changed?

What has your current experience with family therapy been like? What is your role currently in family therapy? Do you consider

yourself to be an important part of the therapeutic process? Are you very active in the therapeutic process? If not, what

would make you more likely to take a more active role in family therapy? If you are, why and how did you become involved?

Do you think family therapy will help/ has helped your child and your family? Why or why not?

Perceived uniqueness of the self in therapy

Evolving beliefs and opinions

Value of the self in the therapeutic process

Value of family therapy for his child and family

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Data Analysis

All interviews were transcribed and coded using an open- coding technique to look for themes and connections regarding each father’s level of engagement in therapy. No fewer than three different people reviewed the tran- scripts and raw data for accuracy of words and meaning. The research also used a cross-case synthesis to develop themes and connections between participants. The goal of this analysis was to begin building a theory of father engagement in therapy that could be empirically applied, tested, and validated later.

Data analysis for qualitative research begins concur- rently with the data collection process (Miles et al., 2019). Prior to beginning the study, the researchers acknowledged assumptions that undoubtedly had influence on the design and analysis. For instance, the researchers assumed that fathers are valuable members of the parenting structure, and all members of the family benefit in his overall partici- pation in numerous aspects of parenting. The researchers also assumed that the family therapy process generally benefits when the father is involved. As the researchers gained exposure to the interview data, initial impressions were formed. Hypothetical links and preliminary theories about the data began to shape further analysis and data

collection, including shaping the questions addressed in each participant’s follow-up interview.

Coding of the interviews using the computer software package QSR-NVivo (Version 11) sought to illuminate the particular ideas that the father expressed. The unit of analy- sis, therefore, was a single idea, defined as a single expres- sion of an experience, as opposed to a single word, sentence, or a particular amount of time. This deliberate ambiguity allowed the researchers flexibility to analyze ideas, rather than structures of speech. The open coding technique is also a preferred method of coding in grounded theory research (Glaser & Strauss, 1973). Therapeutic factors were one of three systemic domains investigated. Therefore, the concep- tual map shows three separate domains, with therapeutic factors at the center considered by the researchers to be most intimate to father engagement in the therapeutic process. Coding was based by identifying statements and ideas that reflected different ideas embedded in the conceptual map. Themes began to emerge in a way that gave rise to additional concepts and helped to construct a revised conceptual map that focused primarily on the therapeutic influences (Fig. 2).

The researchers also used the constant comparative method of analysis. This method, for which grounded the- ory is known, involved a constant process of categorization, sorting and resorting, and coding and recoding of data for

Therapist Direct

Influence

Therapist High Indirect

Influence

Therapist Indirect

Influence

Role of the therapist

Structure of therapy

Inherent difficulty of therapy

Fathers’ role in therapy Fear of the

unknown

Observation of therapeutic change

Child’s enthusiasm for therapy

Facilitators

Barriers

Fig. 2 Revised conceptual map

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emergent categories of meaning (Glaser & Strauss, 1973). Open coding also allows the data to direct the nature of cod- ing and recoding, leading to theory development (Rafuls & Moon, 1996). As a coding scheme began to emerge, it evolved to represent themes, emerging constructs, and pre- liminary ideas about influences on engagement. This pro- cess allows the statements and comments to naturally group together around themes. As more data was examined more closely, certain themes emerged as more prominent than others. Researchers identified themes that appeared in the interviews of at least five (50%) of the participants. Such themes were determined to hold the greatest potential for helping to build a theory of father engagement. Cross-case analysis allowed the research to move beyond the individual context of each participant towards a greater understand- ing of the thematic processes at play (McAlpine, 2016). Fathers’ responses to interview questions were categorized into themes and corresponding sub-themes, allowing the researchers to identify commonalities among the partici- pants experiences and modify the initial conceptual map.

Results

Throughout the research process and throughout this article, pseudonyms are used for each participant. Although direct quotations are used, any personally identifiable information has been omitted or masked. Ten fathers discussed in detail their experiences in therapy and factors that contributed to their engagement. This was an uncomfortable and unu- sual experience for many of them, demonstrating that even fathers engaged in family therapy may still have difficulty expressing themselves in a manner conducive to the work of therapy. Their stories express the strong commitment and concern for their families that each man shares, demonstrat- ing a willingness to stretch beyond what is comfortable for the benefit of the family. Their desire to be involved in ther- apy and voluntarily participate in this study demonstrates eagerness to overcome their personal and familial struggles. The goal of family therapy is to guide families towards a more functional and preferred manner of interaction. By examining the experiences of these ten men, the study illus- trates how therapy can help and hinder that process for them.

The study results were grouped into three broad catego- ries of influence: therapeutic influences, socio-cultural influ- ences, and family influences. The scope of this article is to address only the therapeutic influences, although social- cultural influences and family influences are important and addressed in subsequent publications articles. Therapeutic Influences encapsulate the themes describing how the indi- vidual therapist, the structure of therapy, and other elements of the therapeutic experience influence father engagement in therapy. They speak to the events and processes in and

around the therapy room. These themes represent the pri- mary area therapists may have the most influence, making their identification and operationalization all the more rel- evant to therapists. Once fathers enter the therapy room, what happens there may be the most critical component to engaging fathers in the change process, essentially the “make or break” moment of engagement.

Emergent Themes

Seven therapeutic themes emerged from the study: the role of the therapist, the structure of therapy, fear of the unknown, the inherently difficult process of therapy, obser- vation of therapeutic change, the child’s enthusiasm about therapy, and fathers’ role in therapy. Each of these themes contributed to a revised conceptual map (Fig. 2), illustrating the hypothetical role that the therapist may play in address- ing each of the themes.

Role of the Therapist

The fathers identified numerous ways that the role of the therapist affected their therapeutic engagement, both for the better and the worse. The most common characteristic that the fathers identified for aiding in their engagement had to do with the overall fit of the therapist to join with the family and set them at ease. Six of the ten fathers interviewed said that finding a therapist who could develop a good rapport with them and had shared beliefs and values was important to their therapeutic engagement. Jerry talked about the impor- tance of the therapist creating a confidential safe-space:

[My daughter] evidently feels comfortable with the therapist and is able to express her feelings to her because after one of the meetings, the therapist said, “There are things that we talked about that I can’t tell you.” That is privileged information, and I understand that. That makes me think that our daughter is opening up to her and enjoys coming to where she can release, because I know that our therapist, when we meet all together, is pretty strict on what she says to her.

He explained the very practical reality that he cannot force his daughter to attend therapy. Moreover, he trusts the therapist to know that the work they are doing in private is in the best interests of the family. Without such a relation- ship with the child and the parents, the therapist would not be able to engage the family, Jerry included, in the change process.

Many fathers also identified the therapist’s role as a competently trained professional with a certain authority to conduct the therapy session and lead the family towards a more preferred interaction. This authority represents the therapist’s ability to insert him or herself into the family

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structure and help manipulate the family processes, either directly or indirectly, towards the more preferred outcome. Dave, who is also in his own individual therapy, expressed that as being important to the engagement process that his son has gone through with the therapist:

He may listen to me, but he may not want to soak it in, but when the therapist says it, he accepts it as law, because he sees her as a person who doesn’t have any reason to lie or any reason to mislead because she has nothing to gain from it, whereas I would, and his mom would, and my wife would. So he sees it just as someone who’s giving him that information so it really helps a lot.

Even when the therapist presented the exact same ideas and statements to the child that the father may have pre- sented already, they saw the authority that the therapist carries as providing the needed foundation for the child to internalize the changes and make necessary adjustments.

Perhaps even more fundamental to the therapist’s role, however, is the the ability to listen to clients and simply allow them a calm, neutral environment to express them- selves (DiCroce et al., 2016; Lee & Prior, 2013). This foun- dational role of the therapist was expressed by several fathers as well. Joseph expressed this idea together with his initial discomfort with it:

My daughter does not outwardly trust us and our judg- ments and our decision-making. And she does with her therapist. That is someone that she can speak to and someone that she can work with, and my wife and I are certainly in favor of that. We had some misgivings at first because it was like, “We’re the parents, and why can’t the child come to the parents?”

The authority of the therapist, therefore, extends into allowing the participants in therapy to defer in the direction of the session to the therapist. These fathers identified the therapist as necessarily having the authority and competence to allow the family to suspend their own agendas and defer to the direction of this objective third-party. They remarked about the environment and tone that the therapist set in terms of creating a welcoming, non-threatening setting for honest communication and relational improvement to occur.

Structure of Therapy

The structure of therapy refers to the people physically pre- sent in the therapy room and the therapeutic functions that they serve. While the therapist may have final say over who does or does not attend a particular session, the individual family members may also have some say in the type of struc- ture they believe will be the most productive. Seven of the ten fathers in this study expressed their opinions about the

importance of the structure of participants in therapy. They understood that change happens in the therapy room, and the structure of therapy identifies who has access to that change and who simply must adapt to the changes on their own at home. Not all fathers, however, thought that this would always be necessary. Joel mentioned that if a specific prob- lem existed between only one parent and a child, that might work best with only those two participating:

We were in counseling with [my daughter] for a while. [My daughter, my wife,] and myself went, although I was moved away from counseling and it was just them. Basically they worked through their own conflicts … There were some issues between them. I’m not sure where exactly that all went because I wasn’t involved in all of that counseling.

Although he did not participate in that phase of therapy, he did not indicate that he missed anything or was at a par- ticular disadvantage in the household because of his absence.

Martin, however, had a similar experience, except that his experience showed the need to include more of the family in session:

We initially came here because there was a blow-up between my son and myself. He put his fist through a window in a fit of rage and to my wife that was kind of, “You guys have a relationship problem. You guys need to go to the therapist.” As things started unravel- ling, it started to appear that it was more of an issue between my son and my wife, so she began attending sessions too.

Fear of the Unknown

Because many of these fathers had never been in therapy prior to their immediate experience, their exposure to what happens in the therapy was quite limited. Five of the ten fathers described reservations about becoming involved in such an intimate process with a stranger, as Dave stated:

I really didn’t see the point of going to a stranger, explaining what was going on, and they were going to be able to help you. Because my thought was, “They’re not going through it, they’re not going to understand and what are some words going to do” Someone’s going to say, “Hey, you should do this, and then you’re going to go home and deal with the same type of thing and so I didn’t want to do that at all.

To these fathers, engaging in therapy meant facing an unknown process with an unknown person as the guide. That would mean expanding the most intimate social cir- cle, the family, to include a complete stranger. Martin even expressed it in terms of actual fear, “I’d say it was a little bit

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scary for me. I mean, I felt that it was somewhat extreme, you had to have a really bad issue to consider that avenue.” Other men, however, expressed this unknown as simply a fact but nothing to be feared. Sam, a fairly detached father of two, stated, “I didn’t know what to think. It was like a mysterious place, but I came anyway.”

Inherently Difficult Process of Therapy

Some of the fathers’ apprehension about therapy did not come from a fear of the unknown or a bad prior experi- ence, but from a keen awareness of exactly how difficult the process of therapy can be. To varying degrees eight of the ten fathers described it as a concern. Jared expressed how difficult therapy had been for his wife:

She got upset, because a lot of time during the therapy session they would say, “Do you really think you’re suffering from depression? I think you really need to talk to a doctor.” It’s like she either really resented it, or she didn’t want to believe it. … So finally, she said she wouldn’t go anymore.

Overcoming that difficult experience was a significant barrier to his family’s engagement in therapy again. Miles also expressed concern about how his wife could handle the difficult process of therapy:

I was a little concerned about how my wife could han- dle the therapy. In fact, she expressed to me just a cou- ple of nights ago, we were about to go to our last ses- sion that our youngest son [not in therapy] was feeling a little alone, whenever we would all go off to therapy and leave him home alone…. And she admitted later that it’s hard for her to sit through the sessions and she was glad that I was doing it with [the older son].

By acknowledging the difficulty and pursuing therapy despite those difficulties, Miles helped his wife remain con- nected to a solution in the family while maintaining his own engagement in therapy. It is interesting to note, however, that both of these men, as well as others, discussed the difficulty that therapy posed for others, rather than themselves.

Observation of Therapeutic Change

Seven of the fathers cited specific milestones of improve- ment that helped validate and reinforce therapy as a worth- while engagement. Joseph, for instance, says, “She has been able to channel many of her more destructive kinds of behaviors into either something else or just reducing those kinds of behaviors altogether. So I think it has helped her.” He later said:

I am probably being more likely to recommend therapy to people who are undergoing family stresses than I would have before. I think that there is a whole range of problems that can’t be helped that I probably would have said that the family can work it out, read some books, do some self-help stuff in the past, but now I think I would be more willing to open it up to a wider range of problems.

Likewise, Miles expresses that the improvements he sees in his son have been so drastic and impressive that he is beginning to examine issues in himself:

I think I see improvement in him. I see that he’s getting a little more control over his issues. It’s not entirely there, but it’s getting better. He is getting help. In some sense, that’s led to the difficult part for me, which would be that I have to think about some issues of my own self, as I go through it, that I need to deal with.

Seeing the effect that therapy can have really affected these men and helped them see therapy as a valuable resource for them and their families.

By seeing the personal benefits of therapy, fathers also become invested in the change process, not only for the good of the child, but for their own good. Jim expressed, “It’s helped me become a better parent, and it’s probably also helped my communication with my spouse.” Joel explained how he began family therapy so that his wife and kids would see things differently, but he experienced changes as well:

[Family therapy] certainly helps me clarify some of the things, but yeah, it is changing me. It’s helping me to understand myself better, where I’m coming from, and maybe where I’ve been lacking that I need to work on … When [kids] are young, you’re all hands-on; as they get older, you become more hands-off. I guess it’s helping me to work through that.

Child’s Enthusiasm About Therapy

Six of the fathers described that some of their enthusiasm for therapy could be tempered or enhanced based on their child’s level of enthusiasm about therapy. If the child seemed to enjoy or appreciate therapy, then the fathers expressed a greater level of enthusiasm for therapy. Joseph explained his child’s appreciation of therapy:

I think [my daughter] sees it as very beneficial. That it’s someone who is not going to, in her view, judge her, but would rather listen to her and her concerns and offer advice or suggestions as to what could be solutions to particular issues that come up. I think she sees that as very positive.

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Some fathers also expressed some experiences in therapy that were distressing or unsatisfying for the child, and they were very quick to pull the child out of those therapeutic relationships. Jim, for instance, explained:

Our daughter did not take to that counselor, hated it, and refused to go. I thought it was helpful…, but that didn’t work long term because my daughter said she didn’t like the counselor, and we weren’t going to force her to go.

Some fathers were also encouraged by what they con- sidered their children’s future receptivity to therapy would be. When asked if their child would consider therapy as adults for problems in their own families, almost every father answered yes. Martin explained, “I think he would use as a role model, the quickness—we don’t have any hesi- tation reaching out for help. I don’t think he would hesitate to use this kind of tool. I would say he’s very convinced [in the value of therapy] because he will recognize his own improvements and his old faults.” Although Miles, generally agreed, he also added a caveat to his explanation:

The only thing that I could see as a potential negative, and this is something that I’ve felt as well, if in the insurance records, to be in there that you had therapy, and for some reason he lives with some sort of stigma of this experience later in life, he might try to avoid it.

Of course, this also speaks to the psychosocial stigma of therapy which is discussed in the broader discussion about socio-cultural influences on father engagement.

Fathers’ Role in Therapy

While the child’s level of enthusiasm in therapy goes a long way towards the father’s level of enthusiasm in therapy, the father’s enthusiasm is even more dictated by how he sees his own role in therapy. All ten fathers described to varying degrees the part their own role in therapy played in their interest in participating in the therapeutic process. For some men, their roles changed over time; they began their involve- ment simply to make sure that their perspective was heard. They wanted to make sure that the therapist did not instigate disagreeable change. Joel, for instance, expressed:

I listen a lot, if we were trying to work through the issues at home, I might be talking more, but now I just sit back and basically help clarify, I guess is what you would say, I clarify the issues or confirm or deny what I feel is going on.

Miles expressed a similar sentiment:

If he doesn’t tell the whole story, I feel that there are times when I have to come step in and say, “Do you

think that that’s the whole story? Do you feel that you are telling us everything?” I try to make sure that he’s completely honest with the therapist, and I let her know our expectations as parents, where they are met or not met, to make sure she’s aware of the boundaries in his life and whether or not he’s being honest with himself and with her.

Other fathers, however, explained they want to set a good example for their children by attending therapy. Jim explained, “I guess setting the example that therapy’s okay for [my daughter], to let her know—if I’m asking her to do it, and I’m doing it too, I guess it might not be too bad.” Martin also thought it important to set an example:

As much as providing information and insight for her to evaluate and try to get to the bottom of what was going on, I thought it was real important for me to be there as an example. Like in this [adolescent sub- stance abuse] program, for instance, there are quite a few mothers who come without the father. I know that they are operating at a disadvantage because their kids are getting a message that mom’s a little wacky and so we’ll go along with this, but if both parents are engaged, then it’s serious.

These fathers understood that many people, especially men, are not always open to therapy. By attending and engaging in therapy, they hope to show the viability of ther- apy and the importance of the situation to their children.

Discussion

The purpose of this study was to hear fathers’ experiences and reflections of family therapy in their own words. One goal was to provide a forum for fathers with a child in fam- ily therapy to describe their experiences in and around the therapeutic process. The second goal was to identify barriers that often prevent fathers from fully engaging in the change process of therapy as well as the facilitators that encour- age engagement of fathers in the therapeutic process. The final goal was to discuss the implications of the findings for therapists.

Three overall thematic categories supported the influ- ences to father engagement in family therapy: therapeutic influences, socio-cultural influences, and family influences. For the purposes of this article, only the therapeutic influ- ences are discussed and scrutinized.

Revised Conceptual Map

Using the initial conceptual map as a starting point, the researchers created a comparable conceptual map reflecting

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the results related to the therapeutic factors described in this article. The seven themes were divided into three categories based on the perceived degree of influence that the thera- pist may have on each theme: therapist indirect influence, therapist high indirect influence, and therapist direct influ- ence. The revised conceptual map (Fig. 2) was created to illustrate how the themes fit into each of the categories and visually demonstrate a tentative theory that emerged from the research and must bear more scrutiny. Both the initial conceptual map and the revised conceptual map form three concentric circles of influence, but the revised map describes the degree of influence the therapist has on the barrier or facilitator as reported by the subjective experiences by the participants. Further, the initially suggested themes were replaced by the themes that emerged from the data, as pre- viously described. Naturally, the themes and concepts are interrelated in that none of them are completely isolated and immune to the effects of the others, but the specific themes provided the researchers with an idea of how the therapists can focus on specific areas of influence to effectively address how a father engages in therapy.

“Therapist direct influence” refers to the themes that the therapist may directly control. This includes the role that the therapist plays in the therapeutic process and specifi- cally reducing barriers to father engagement. The therapist also controls the structure of therapy, meaning how therapy is organized and flows as well as who is invited into each session. “Therapist high indirect influence” refers to the themes that therapists do not directly control, but they have a significant role to play in mitigating those themes. The themes included in this category were largely described by the participants as areas where they looked to the therapist for guidance. While not directly controlling these factors, the therapists’ direct attention to them helped mitigate the nega- tive effects and grow the positive effects in the view of the participants. This includes the inherent difficulty of therapy, fathers’ role in therapy, and helping participants in therapy address the unknowns of the therapeutic process. Finally, “therapist indirect influence” refers to the themes that are still part of the therapeutic framework but with which thera- pists have notably less influence than the others, themes such as fathers’ direct observation of therapeutic change and the child’s enthusiasm for therapy. The therapists’ lesser influ- ence was believed by the participants to be based on the greater degree of challenge in shifting perception of the child who may not come to therapy of their own volition. Again, therapists can address these factors and perhaps exercise influence, but the effort compared to the benefit may be less, although that specific equation is yet to be directly studied or measured. Those three categories form the structure within which each theme resides.

The interviews demonstrated that sometimes the differ- ence between barrier and facilitator was often a matter of

perspective, and each exist across each category of thera- pist influence. For instance, if a father observes what he interprets to be positive therapeutic change, that will be a facilitator, but if he does not observe such change, regardless of others who may observe the change, it could be a barrier. Likewise, the structure of the therapeutic process and the degree to which the therapist wants the father involved may be perceived differently by different fathers. Ultimately, the therapist’s responsibility may be to attend to these themes of influence to customize the therapeutic experience mind- fully and intentionally. The fathers’ perceived barriers and facilitators, therefore, exist within these circles, as illustrated by dashed ovals that overlay each category.

Implications for Therapists

This study demonstrates that fathers understand their roles in the family and society in different ways, but there are particular areas that therapists should pay special attention to when attempting to engage fathers in family therapy because of the direct and indirect influences therapists can carry. Despite their various levels of engagement, each father’s engagement process was affected in some way by the fam- ily therapist he encountered. The results of this study may indicate that by focusing on the more central levels of the conceptual map, therapists may maximize their influence on positive engagement with fathers, although more study is needed to confirm this.

Fathers identified themes that relate to their in-session experiences. They highly valued the connection they and their family members developed with the therapist. They appreciated seeing objective, positive results of therapy. Because fathers do not always make their expectations and reservations about therapy known at the outset of therapy, therapists must be deliberate in assessing where fathers stand in relation to their therapeutic engagement. Even fathers who want to be engaged may have strong opinions about what they look for in the therapeutic experience, but they may not present or be aware of those opinions immediately. The therapist must attempt to engage the father directly and iden- tify how past experiences and current expectations affect their current engagement.

Additionally, therapists should recognize that while getting the father in the therapy room is the first step, the engagement process does not stop there. The therapist should consistently check in with both parents to identify their expectations and reservations about therapy, creating an open environment that helps them feel comfortable to express such ideas. Finally, instead of seeing a disengaged father as simply resistant to therapy, therapists could attempt to better understand the nature and meaning of his disen- gagement, again tending to the areas of direct and indirect influence. In doing so, the therapist may learn how the

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resistance functions, and he or she might be able to identify effective strategies for engaging the father in the therapeutic process.

Limitations

While this study provides needed information about father engagement in family therapy, the researcher recognizes it contains clear limitations. First, the sample was not rep- resentative of all fathers (See Table 1). This sample was largely White with only one Black participant and no Latino, Asian, or fathers of other ethnic groups. Every father who claimed a religion was Christian, and no gay fathers were in the sample. All of the fathers reported income above the fed- eral poverty threshold. Although there was some marginal geographic diversity, with two participants from Michigan and the other eight in Texas, all of the participants lived in suburban areas of the United States. None of the participants lived in urban or rural environments. Also, all fathers in the sample were married with full custody of their children. Populations not represented in this sample would be wel- comed in future studies to help develop a more universal account of fathers’ barriers and facilitators.

Another limitation is that because the sample was entirely self-selecting, each of the fathers was already engaged in therapy to some degree at the time of their participation. None of them were opposed to therapy. Most of them were as engaged in therapy as their spouses, which is in direct contrast to what the existing literature says about the rate of father engagement in family therapy (Frank et al., 2015; Freitas & Fox, 2015; Hecker, 1991). A truly representative and more informative sample would have more disengaged fathers represented. Because of the nature of this self-select- ing sample, the results are likely skewed to describe fathers who are more inclined to be engaged in therapy, rather than those who are not.

A third limitation was that the results reflect fathers’ thoughts and feelings after having engaged in the thera- peutic process. The researchers assumes that the amount of therapy they had already engaged in had some effect on their responses. Their responses certainly may have been different if asked before engaging in therapy, whether they engaged willingly or begrudgingly. Although some participants attempted to respond to this retrospectively, their answers had the benefit of hindsight. Asking the same questions of fathers prior to beginning therapy would be especially rele- vant to therapists to address fathers’ barriers to therapy early in treatment or even before treatment begins.

Future Directions

Future studies may examine the conceptual map (Fig. 2) to determine if the areas identified as theoretically more

central to the therapists’ influence indeed contribute to bet- ter engagement when positively addressed. Studies may also examine how the therapeutic themes identified in this study interact with themes that represent factors outside of the therapeutic framework and perhaps beyond the therapist’s influence. Building upon this nascent theory, research should attempt to test the degree to which therapists may maxi- mize their influence in a positive manner to enhance father engagement in family therapy.

Future studies should also expand the relative homoge- neity of the sample to include populations of fathers absent from this study. There are almost certainly different kinds of barriers and facilitators for fathers of different ethnic- ity, nationality, ages, sexual orientation, levels of income, cultural contexts, geography, and family structures. Future research should seek to better understand the ways that therapeutic engagement varies with fathers in different con- texts. From this and other studies, researchers should begin to determine how well the barriers and facilitators identi- fied apply to fathers who are not engaged in family therapy at all. Although the current study aimed to include fathers who decided to not engage in therapy, none chose to par- ticipate, and it quickly became clear that all the fathers in the study would be therapeutically engaged to some degree. Researching the barriers and facilitators of non-engaged fathers would provide excellent opportunities for compari- son and contrasting to determine the primary factors at play, allowing researchers to begin generalizing more broadly and better understand fathers in family therapy.

The findings of this research confirm the pivotal role that the therapist plays in engagement, and research should continue to pay closer attention to the role of the therapist in engagement, rather than dismissing non-engagement as mere resistance. While most family therapists want to engage fathers in family therapy and may attempt to engage fathers (Andolfi, 2013; Freitas & Fox, 2015; Furrow, 2001; Hecker, 1991), therapists may not fully understand the role that they play in the engagement process. Future studies should look specifically at the therapist’s role, identifying how therapists help and hinder engagement. From this line of research should evolve a model of father engagement that can illustrate the ways that therapists may better work with fathers who may find it difficult to engage in family therapy.

A father’s decision to engage or not to engage in fam- ily therapy involves processes that get to the heart of the his identity. Much research is still needed to better under- stand how the intricate interplay of father identity, social- cultural context, and family context may be best used to engage fathers in family therapy and reverse the trend of their absence from the therapy room. The researchers plan to publish at least two other manuscripts expanding on the family influences and sociocultural influences identified in this study, but more research is needed.

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Conclusion

The findings of this study point to numerous ideas and fac- tors that influence father engagement in therapy. While three distinct but intrinsically linked categories emerged (thera- peutic, family, and socio-cultural), the therapeutic influences served as the focus of this article because of the immediate relevance for therapists and their ability to maximize father engagement in therapy. The therapeutic influences encom- pass the themes that directly relate to the experiences in the therapy room, especially those with which the therapist may directly or indirectly engage. By hearing from the fathers in their own words, the researchers were able to value the direct perspectives of fathers in a way that has rarely been done in family therapy research. The tentative theoretical model requires a much greater amount of examination and scrutiny, but it provides a starting point for researchers and therapists to best make use of whatever influence therapists may have in father engagement. There is much more to learn about father engagement, and influences outside of therapy, such as socio-cultural and family influences intentionally avoided in this article, deserve much attention. Eventually, further research could develop a theoretical but empirically grounded model for father engagement to better help thera- pists engage fathers and facilitate comprehensive systemic change within the family.

Declarations

Conflict of interest There are no known conflicts of interest to dis- close, and no external funding was used for this study.

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