Developing and evaluating the parent CARES-LGB intervention for nonaccepting parents of LGB adults in Malaysia and Singapore

Abstract

Parental rejection of lesbian, gay, and bisexual (LGB) adult children is associated with significant psychological harm and parent-child relational ruptures. In sociocultural contexts such as Malaysia and Singapore, where traditional norms, religious values, and systemic stigma remain pervasive, parents often respond with nonacceptance toward their LGB adult child. Despite the critical role of parents in fostering family-based support, few culturally responsive interventions exist to help them process their experience upon knowing their child’s LGB identity in constructive ways. This dissertation addresses this gap through three interrelated studies: a literature synthesis and conceptual framework, an intervention development and validation study, and a pre-experimental mixed-methods evaluation. Study 1 introduces an integrated conceptual framework that synthesizes Chrisler’s (2017) theory of parental reactions with Goodrich and Gilbride’s (2010) model of family functioning. Five key change mechanisms were identified: cognitive flexibility, emotion regulation, empathy, family communication, and social support, along with moderating factors that influence family outcomes. By integrating clinical research and intersectionality-informed insights, this framework provides a strong foundation for culturally relevant clinical practice and future research. Study 2 describes the development and stakeholder validation of Parent CARES-LGB intervention, a 10-session, theme-based, Emotionally Focused Therapy (EFT)-informed intervention for nonaccepting parents of LGB adults. Drawing on Emotionally Focused Individual Therapy and Emotionally Focused Family Therapy principles and refined through stakeholder feedback from mental health professionals, LGB adults, NGO staff, and EFT expert, the intervention was adapted for cultural specificity and therapeutic safety. Study 3 evaluates the feasibility, preliminary effectiveness, and clients experience of the Parent CARES-LGB intervention using a pre-experimental mixed-methods design with eight nonaccepting parents in Malaysia and Singapore. Quantitative results, as measured by the Reliable Change Index, showed clinically significant improvements in key variables such as parental acceptance, parental rejection, and emotion regulation. Although many other dimensions were also measured, these variables were highlighted due to their centrality to this dissertation. Most of these treatment effects were sustained at 3-month follow-up, supporting the intervention’s potential for lasting impact. Qualitative findings revealed that parents valued therapy as a safe space for emotional expression, gained deeper understanding of their child’s identity, developed greater self-compassion, and began to experience meaningful relational shifts in their family, including the relationship with their child. Notably, Parent CARES-LGB is among the first interventions of its kind in Asia and globally to be developed as low-intensity, high-impact, and non-coercive, and offers a valuable contribution to global LGBTQ-affirming practices. Together, the studies that constitutes this dissertation offer a culturally grounded, theoretically robust, and clinically pragmatic approach to working with nonaccepting parents of LGB adult children. This dissertation advances LGBTQ-affirming practice in Southeast Asia by bridging conceptual models, intervention development, and real-world application, with implications for practice, training, and future research that centres healing, empathy, and relational transformation in diverse family systems.