Father's engagement with child clinical psychologists : a grounded theory study of client and provider perspective

OBJECTIVES The objective of this study was to explore the factors that are perceived to influence fathers' decisions of whether to attend an initial appointment with a Child Clinical Psychologist when their child is referred. DESIGN The research explores the perspectives of fathers who are potential service users (n=5), and also those of the service providers: Clinical Psychologists working with children and their families (n=9). A mixture of focus group and individual interview procedures were used to collect data. All interviews were audio recorded and subsequently transcribed. The research employs the method of Grounded Theory to analyse the data. This involved developing codes, categories, and themes from the data and linking them together to form a conceptual understanding of the participants' accounts. RESULTS The participating fathers and psychologists gave very similar accounts, often using the same language and constructs to explain why fathers might or might not attend appointments. A theoretical model describing the key factors that are perceived to influence fathers' decisions is presented. Family involvement and commitment was described as a pivotal factor. Whilst it was suggested that uninvolved or uncommitted fathers would not even consider attendance, it was felt that more involved fathers would be affected by a host of other factors that would either inhibit or drive their motivation to attend. Fathers' perceptions of psychology services, sociocultural barriers to help-seeking, and organisational barriers to help-seeking were perceived to be particularly important. CONCLUSIONS Difficulties in engaging fathers in child psychology services appear to arise for a number of reasons. First, the engagement of fathers in therapeutic work might mirror their engagement with their family and child outside of the clinic setting. Second, attending child mental health appointments may be perceived by fathers to be at odds with their gender identity. Prevailing societal conceptualisations of masculinity suggest help-seeking, problem sharing, and emotional expression is not `manly' behaviour. Third, uncertainty about the role of Child Clinical Psychologists and what the appointment might entail, and negative or fearful expectations, may reduce fathers' willingness to engage. It is felt that services need to consider how they might promote father engagement. Improvements in terms of the information fathers receive when their child is referred, and efforts towards portraying a more `father-friendly' image, might help to encourage some fathers, particularly those who are already involved in childcare.