Parenting with Love and Limits® (PLL) is designed for adolescent populations with the primary diagnosis of oppositional defiant or conduct disorder. PLL integrates group and family therapy into one system of care. Parents and teens learn specific skills in group therapy and then meet in individual family therapy to role-play and practice these new skills. This integration of group and family therapy enables parents to transfer these new skills to real-life situations.
PLL integrates principles of structural and strategic family therapy.
During group therapy, teens and parents participate together in a small group, led by two facilitators. The group can include siblings and extended family. Each group consists of no more than 6 families and average between 12-15 people per group. Six 2-hour sessions are held weekly. Parents and teens meet together as a group for the first hour. During the second hour, the parents meet in one breakout group and the teens meet in another, with one facilitator leading each breakout. During family therapy, teens and parents meet individually with one of the group facilitators in between classes in an intensive 1- to 2-hour session to practice the new skills learned in group. Extensive role-plays are used along with the development of a typed-out, loophole-free contract. Four to six family therapy sessions are recommended for low- to moderate-risk adolescents and up to 20 sessions for moderate- to high-risk offenders within a residential, outpatient, or home-based setting.
The PLL program consists of six group therapy sessions plus four or more family therapy sessions, as shown below:
- Group Session 1. Understanding Why Your Teen Misbehaves: Parents learn why their teen commits acts of parent abuse. Parents and teens go into their respective breakout groups to vent their feelings.
- Group Session 2. Button-Pushing: Parents learn how their teen pushes their "hot buttons" (whining, disgusted look, swearing, etc.), and teens learn how parents push theirs (lecturing, criticizing, talking in chapters, etc.).
First family session. Parents and teens meet individually to practice anti–button-pushing strategies.
- Group Session 3. Ironclad Contracting: Parents learn how and why their old methods of contracting have failed, as well as the steps to assemble a contract that works. Teens meet in their breakout groups to help write their own contract.
Second family session. Parents and teens meet individually to create their own contract.
- Group Session 4. Troubleshooting: Parents learn how teens have a special ability called “enhanced social perception” to think two steps ahead.
Third family session. Parents and teens meet individually to review their contracts and troubleshoot any loopholes. Extensive role-plays are used to practice delivery of rewards and consequences.
- Group Session 5. Stopping the Seven Aces: Parents choose creative consequences to stop the seven “aces” of the youth who doesn’t have a serious psychological problem, but is acting out of control: disrespect, ditching or failing school, running away, drugs or alcohol, sexual promiscuity, violence, and threats of suicide.
Fourth family session. Parents and teens meet individually to review their progress.
- Group Session 6. Reclaiming Lost Love: Parents learn to understand how conflict hinders the parent–child relationship and strategies to repair it.
Fifth family session and beyond, as needed. Parents and teens begin to solidify nurturance and to address any underlying family dysfunction.
11 to 17
Sells and colleagues (forthcoming) found that participants in the Parenting with Love and Limits® (PLL) treatment group had significantly fewer offenses during the 12 months after program completion than the control group (23.5 percent for PLL attendees, compared with 59.0 percent for control group).
Changes in Caregiver Attitudes and Behaviors
Three of the five constructs of the caregiver survey were significantly improved from baseline to postprogram for the PLL group, compared with the control group. The three constructs were parental resilience, social support, and problem solving and communication.
Changes in Adolescent Attitudes and Behaviors
There was no significant improvement on the total youth survey score from baseline to postprogram between the PLL group when compared with the control group, though there was a trend (p=0.063). Two of the 13 constructs, however, did result in significant improvements: high value on helping others and social competencies. The Positive Perception of Self and Others construct neared significance. Changes on the other 10 constructs were not significant.
Sells, Winokur-Early, and Smith (2011) found that participants in the PLL treatment group had fewer offenses during the 12 months after program completion than the control group (16 percent for PLL attendees, compared with 55 percent for the control group). Additionally, juveniles in the treatment group spent a total of 72 days in detention, while juveniles in the control group spent 543 days in detention.
On all but two subscales, the PLL group participants improved significantly more than the control group participants. Moreover, the two subscales on which there were no significant differences between the groups measured concerns (somatic problems and delusional thinking) that are not expected outcomes for the PLL intervention. The most significant difference between the groups was on the aggressive subscale, with the control group scores increasing from baseline to postprogram and the PLL group decreasing during the same time period.
Readiness for Change—Adolescents
Of the four readiness areas measured, only the Action subscale was significantly higher at posttest for the PLL group than for the control group, though it is unclear whether the youths rated this subscale high because they were ready for change or they thought their parents should change.
Readiness for Change—Caregivers
Results for PLL group caregivers suggest that these respondents were transitioning from the precontemplation stage to advanced stages of readiness for change. The group mean of PLL group caregivers increased 9 points in the Ready for Action subscale, compared with the group mean for the control group caregivers which decreased at posttest.
Communication Between Mothers and Youths
Adolescents in the PLL group reported that communication with their mothers was significantly improved, compared with the reports of youths in the control group. Mothers in the PLL group also reported improved communication with their youths, compared with mothers in the control group.
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