This qualitative study presents an in-depth and idiographic analysis of the lived experience of parent-caregivers with a child diagnosed with autism spectrum disorder (ASD) who exhibits challenging behaviours. Semi-structured interviews were conducted with six parents of children with ASD and who met the Child Behaviour Checklist for Ages 6-18 (CBCL/6-18) Total Problems T score of 60 and above. The interviews were conducted at a child and adolescent psychiatry clinic in Singapore. Transcripts were analysed using interpretative phenomenological analysis. Two dominant themes emerged: sense of responsibility and renewed appreciation of self. The caregivers' sense of responsibility not only encompassed parental duty, spousal duty but also duty to the community. Through the process of meaning making and coordinating actions with their child, spouse and social relations, over time the caregivers developed a deeper appreciation of their personal strengths and resourcefulness. The findings suggest that clinical practice and future research would benefit from a family resilience perspective in understanding caregivers' experience.
Our theory of harmony therapy explains how therapists have helped disharmonious families or couples build relational harmony without sacrificing intrapersonal harmony. In collectivist Singapore, where the family is the basic unit of society, and racial and religious harmony is the dominant discourse, therapists may worry that family harmony is valued so much that individuals’ intrapersonal harmony might be sidelined. We used grounded theory to guide our interviewee selection and qualitative analysis of thirty clients who sought therapy to find harmony in their conflictual relationships. Clients perceived that therapists who built both family and intrapersonal harmony (1) were helpful professionals, (2) encouraged collaborative conversations, (3) had expertise, (4) were more involved than usual, and (5) were collaborative experts. Therapy was perceived as less effective due to (a) insufficient or unhelpful expertise, (b) insufficient or unhelpful involvement, and (c) perceptions of unhelpful professionalism.
Practitioner points
We aim to build interpersonal harmony without sacrificing intrapersonal harmony with families from collectivistic cultures
This means owning our professionalism and expertise with clients lightly, as both can sometimes be experienced as unhelpful
We encourage collaborative conversations, which are rarely experienced as unhelpful
We want to ensure that clients feel we are sufficiently involved with them and sometimes go ‘beyond the ordinary’
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