Positive Regard and Caregiving

Abstract

This article discusses the social phenomenon of positive regard, generally defined as underlying support and acceptance, in the context of caregiving. It contrasts between unconditional positive regard, in which care and affection is expressed by the caregiver no matter the behavior of the care receiver, and conditional positive regard, in which the level of caregiving depends on the care receiver meeting certain conditions. Various studies show that unconditional positive regard is highly beneficial to the care receiver’s emotional health and well-being. Positive regard is an especially important concept in the caregiving associated with raising children, but can also be applied to other caregiving situations, such as those involving older adults or people with disabilities.

Overview

Positive regard is an important aspect of caregiving because children and other care receivers thrive when they feel appreciated and warmly cared for. In parenting, unconditional positive regard is much more beneficial than conditional positive regard because it helps children to know that their parents always have affection for them, regardless of their performance. Unconditional positive regard has robust positive effects in numerous studies.

Children are the primary care receivers in society. Before reaching maturity, children are subordinate to and dependent on parents and other older family members, legal guardians, teachers, and nannies or daycare providers. As parents age or become ill, the roles may reverse, with adult children becoming caregivers of a parent or parents. Under rehabilitative or hospice care, people receive help from nurses, therapists, and others. Research findings regarding positive regard and communication have shown similar results among a number of caregiving scenarios.

The powerful concept of unconditional positive regard has been emphasized by many psychologists who have been influenced by the humanistic psychologist Carl Rogers. According to Rogers, clients with a variety of psychological problems will move toward thriving in the presence of unconditional positive regard from the psychologist or therapist. He believed that most people who were suffering emotionally did not receive unconditional positive regard from key people in their lives, such as parents, teachers, principals, managers, and spouses.

Unconditional positive regard is conveyed when a caregiver makes it clear on a regular basis that he or she values and appreciates the care receiver regardless of their past, present, or future performance and regardless of what emotions and thoughts they are experiencing or have experienced. Unconditional positive regard often involves closely listening to those receiving care, while continuing to express warmth and refraining from judging them (Rogers, 1957). This is much different than what most people experience from childhood on. Parents, schools, and society in general are more likely to show warmth and affection conditionally, as when children do exceedingly well in a certain area or show major improvement.

Further Insights

Parenting and Conditional Positive Regard. Conditional positive regard leads to a number of problems in children and youth. The regular use of conditional positive regard is a sign of controlling parenting, which is associated with numerous psychological difficulties among youth (Froiland, 2011). Furthermore, parents who were exposed to conditional positive regard when they were children are more likely to be controlling with their children, indicating that conditional positive regard is a key marker for intergenerational transmission of a baneful style of communication (Assor, Roth & Deci, 2004). Parenting with conditional positive regard can become insidious because parents do not realize the negative effects and may find it natural because it was part of how they were raised (Froiland, 2014). Another reason parents rely on conditional regard and other controlling parenting methods is that they often lead to children performing the desired behaviors (Assor et al., 2004; Froiland, 2014; Froiland, Oros, Smith & Hirchert, 2012), but what parents, teachers, and other caregivers often fail to realize is that this type of controlled behavioral change is fueled by the child's own internal suffering, via introjection (Assor et al., 2004; Froiland et al., 2012).

Introjection is a relatively unhealthy form of motivation in which good conduct and hard work emanate from fear, guilt, shame, or pressure from the parents that has been internalized by the child (Deci & Ryan, 2008; Froiland, 2014). In other words, the child may be doing many of the right things for the wrong reasons in many domains of life, such as education, chores, exercise, sports, and prosocial behavior. The problem with introjection is that it leads children toward resentment of their parents, anxiety, denial of problems, low self-esteem, self-disparaging self-talk, depression, reduced vitality, and a variety of other problems (Assor et al., 2004; Deci & Ryan, 2008; Froiland, 2014).

Parenting and Unconditional Positive Regard. Children that sense unconditional positive regard (an important aspect of autonomy supportive communication), on the other hand, are more likely to be intrinsically motivated, finding enjoyment and satisfaction in working hard, treating others well, self-care (for example, brushing their teeth), exercise, and contributing to the community (Deci & Ryan, 2008; Froiland, 2014; Roth, Assor, Niemiec, Ryan & Deci, 2009). Roth et al. (2009) examined the effects of autonomy supportive parenting (a style of parenting characterized by conveying empathy, warmth, and inspiring children to do their best), conditional negative regard (parents expressing disapproval or withholding affection when a child performs or behaves poorly), and conditional positive regard (expressing affection and attention when a child performs or behaves well). They found that conditional negative regard predicted very low motivation for academics and trouble with regulating negative emotions, whereas conditional positive regard predicted hiding one's emotions and focusing on grades at school.

While focusing on grades at school is a positive result in that it does promote achievement development, it may also lead to increased anxiety (Froiland & Oros, 2014). Only parental autonomy support led to healthy emotional regulation and a focus on interest in school (Roth et al., 2009), which promotes both mental health and long-term achievement (Froiland & Oros, 2014). Unconditional positive regard is part of an autonomy supportive and inspirational motivational style, which appears to support happiness, intrinsic motivation, and other aspects of positive youth development (Froiland, 2014).

Positive Regard and Parent-Involvement Intervention. Schools, social workers, pediatricians, psychologists, and parents, often focus on various important aspects of parent involvement that help children thrive, but unconditional positive regard could enhance many successful parent involvement interventions. For

instance, evidence-based parent involvement interventions that focus on parent-child shared reading and increasing the number of children's books at home are usually quite effective (Jeynes, 2012) because both of these aspects of the home literacy environment promote reading development (Froiland, 2011b; Froiland, Powell & Diamond, 2014; Froiland, Powell, Diamond & Son, 2013). Taking young children to museums, zoos, sporting events, faith-based activities, and aquariums also promotes early childhood development (Powell, Son, File & Froiland, 2012).

Parents limiting children's television use and replacing screen time with parent-child shared reading may prevent the development of hyperactivity and Attention Deficit Hyperactivity Disorder (ADHD) among young children (Froiland & Davison, 2014b). Thus, there are many healthy things that parents can do at home to help their children develop well (Froiland, 2014). However, autonomy supportive parental communication, including expressing unconditional positive regard, often has stronger effects on children's achievement than other types of parent involvement in studies that follow children's progression over a long period of time; Jeynes, 2012).

A small number of intervention studies have examined the effects of increased unconditional positive regard and other types of parental autonomy supportive communication during the preschool and school years. These studies found that unconditional positive regard and other forms of parental autonomy support improve children's intrinsic motivation, persistence challenging activities, and emotional health, while decreasing worry, sadness, apathy, and boredom (Froiland, 2011a; Froiland, 2013; Joussemet, Mageau & Koestner, 2014).

One study found that parenting interventions that focus on behavioral psychological techniques, such as using tangible rewards (such as tokens, candy, or stickers) for good behavior, and provide planned consequences for negative behavior (such as ignoring children when they display mild to moderate negative behavior) have extremely high attrition rates of approximately 33 percent (Assenany & Mcintosh 2002), even though parents are often receiving free training and are offered financial incentives for participation.

In contrast, parenting interventions that teach parents positive psychology and humanistic techniques such as unconditional positive regard have found much higher completion rates. For example, Froiland (2011a) discovered an attrition rate of 0 percent and found nearly perfect parent attendance over the course of an eight week intervention teaching parents to show more unconditional positive regard, patience, and other aspects of autonomy supportive communication, such as highlighting the beauty, interesting features, or real-life value of a task (Froiland, 2013; Froiland, 2014). This intervention reduced children's anxious and depressive symptoms among the treatment group (versus the control group), while increasing their love for learning and happiness (Froiland, 2011). This suggests that parenting interventions that teach unconditional positive regard and other positive psychology techniques are likely to attract and retain the interest of more families, while also promoting long-term psychological and academic well-being (Froh, Huebner, Youssef & Conte, 2011).

Positive Regard and Expectations. Strong and positive parent expectations have been repeatedly linked to the academic success of children and youth (Froiland, Peterson & Davison, 2013; Froiland & Davison, 2014b) as well as fewer behavior problems (Froiland & Davison, 2014b). Despite all of the positive effects, however, parents sometimes unwittingly convey to their children that they will only love them if they meet expectations. For instance, some children feel that they must maintain a very high grade point average, be the star player on a sports team, or follow every rule at home perfectly in order to deserve their parents love (Froiland, 2014). This can lead to introjected motivation (Assor & Tal, 2012). It is important for positive expectations to be communicated to children in an autonomy supportive way, especially in conjunction with unconditional positive regard. For instance, rather than pressuring a child by saying, "You have to become a doctor" a parent could say, "I believe that you would make a great doctor, but I'll love you forever, no matter what you choose to do." This lets the child know that his or her parent believes in him or her, but that he or she does not have to meet a certain expectation in order to earn parental positive regard.

Viewpoints

Rogerian unconditional positive regard underpins many forms of psychotherapy, educational models, and parenting practices. Critics of UPR argue that truly unconditional positive regard is problematic if not infeasible. Merely being in a superior position, as care receivers are by definition vulnerable or dependent, creates a dynamic where the caregiver has influence that cannot be entirely unconditional. Caregiving, especially caregiving that aims at developing or altering undesirable behavior, must determine what behaviors are acceptable, moral, or healthful, which requires some form of judgment. Where highly undesirable behaviors, such as harm to self or others, are likely, UPR may be lawfully impractical (Amadi, 2013). Nevertheless, the general principals of UPR, in particular empathy, are widely embraced as crucial to creating healthy relationships between care givers and receivers.

One effect of UPR in therapeutic situations is to model for the care receiver unconditional self-regard. By empathizing with feelings of self-loathing, anger, resentment, or guilt, the caregiver acknowledges their value while reframing their context and allowing the patient to view their own experience with greater perspective (Frankel, Rachlin & Yip-Bannicq, 2012). Empathy is crucial to patient self-regard in hospital, hospice, and nursing home settings as well. Patients who do not experience positive two-way interaction with caregivers, who may shy away from establishing even short-term relationships with patients, frequently feel depersonalized despite intensive medical care (Drew, 2007). Conversely, teachers, social workers, and nurses experience burnout at very high rates, and family caregivers (for example, an adult child caring for an elderly parent with dementia) can suffer negative health effects from extended or unsupported caregiving. Caregiving can be seen as a "thankless job," which exhausts the caregiver emotionally, physically, and often financially. Positive regard from care receivers is ideal but often unrealistic because of the nature of a receiver's dependence. Recognition must therefore come from employers, supervisors, peers, and those who have an interest in the welfare of the care receiver.

Terms & Concepts

Autonomy supportive communication: An inspirational way of caregivers speaking to others that entails conveying unconditional positive regard, closely listening to children's feelings and thoughts, helping them to see the underlying meaning in what they are being asked to do, and refraining from controlling language.

Conditional positive regard: Positive regard that is only revealed when a child or person receiving care performs the expected behaviors or performs them very well.

Control group: A group of young children, parents, or teachers that received no treatment. The control group serves as a statistical comparison with the treatment or intervention group.

Controlling communication: Telling children that they have to perform well or engage in behaviors without explaining the psychological or lifetime benefits. Controlling communication also includes ignoring children's feelings or objections to homework or family rules, failing to show empathy or positive regard, pressuring children, or relying exclusively on rewards and punishments to motivate good behavior and diligence.

Evidence-based interventions: Interventions that have studies that show that they lead to a positive effect. An intervention's effect should be established by studies that show that the intervention group improved significantly more than the control group on important measures of achievement, psychological health, or behavior.

Intrinsic motivation: Healthy motivation from within in which children or others receiving care enjoy engaging in learning, exercise, or behaving well.

Introjected motivation: A form of self-regulation that is characterized by being motivated by guilt, fear, shame, or internalized pressure often after being exposed to a plethora of controlling communication from caregivers.

Positive psychology: The scientific study of happiness, emotional well-being, and those things that people can do to make their lives, families, schools, or communities better.

Socioeconomic status: A combination of education and financial income that may also include the prestige of parents' occupations. Parent education levels are usually measured on a continuum from less than a high school education, associates' degree, college degrees, master's degree, and doctorate.

Unconditional positive regard: Love or affection for a child or person receiving care that is not dependent upon their past, current, or future performance or behavior.

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Suggested Reading

Assor, A, & Tal, K. (2012). When parents' affection depends on child's achievement: Parental conditional positive regard, self-aggrandizement, shame and coping in adolescents. Journal of Adolescence, 35, 249–260. Retrieved March 22, 2015 from EBSCO Online Database Education Research Complete, http://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=73762566&site=ehost-live

Bozarth, J. (2012). "Nondirectivity" in the theory of Carl R. Rogers: An unprecedented premise. Person-Centered and Experiential Psychotherapies, 11, 262–276. Retrieved March 22, 2015 from EBSCO Online Database Education Research Complete, http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=83932587&site=ehost-live

Chang, Edward C. (2016). Positive psychology in racial and ethnic groups : Theory, research, and practice. Washington, DC: American Psychological Association.

Roth, G, & Assor, A. (2012). The costs of parental pressure to express emotions: Conditional regard and autonomy support as predictors of emotion regulation and intimacy. Journal of Adolescence, 35, 799–808. Retrieved March 22, 2015 from EBSCO Online Database Education Research Complete, http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=77570313&site=ehost-live