Effects of outsider witness practice on a support group for parents of children with autism spectrum disorder

ABSTRACT

Purpose

Providing effective support to parents of children with autism spectrum disorder (ASD) is an important part of clinical work. This study used outsider witnesses in group counselling for parents of children with ASD and explored the mechanism through which the therapeutic effects occurred.

Method

Parents of children diagnosed with ASD participated in an eight-session group activity. Two outsider witnesses were introduced into some of the sessions. The participants were interviewed to collect their experiences of and reflections on the outsider-witness practice. Texts were analysed using the categorical content approach.

Results

The intervention was effective because the participants shifted their subjective experiences to an objective position, leading them to reflect on their previous limited perspectives, thus resulting in self-redefinition. These therapeutic effects may arise due to physical displacement, experience resonance, and externalization of subjective experiences. The results of this study have important implications for parents and practitioners.

KEYWORDS:

• Outsider witness
• narrative therapy
• group counselling
• ASD
• autism spectrum disorder

Providing effective support to parents of children with autism spectrum disorder (ASD) has always been an important part of clinical work. Due to their difficulties of social interaction and communication and repetitive behaviour, children with ASD rely on constant care, placing more stress on their parents (DiRenzo et al., 2022). The greater stress experienced by parents of children with ASD may be due to several factors, such as stigma (Liao et al., 2019), emotional impacts (Rabba et al., 2019), and the child’s characteristics (Prata et al., 2019). These stresses related to child rearing influence parents’ ability to adapt, which is significantly associated with their children’s adaptation and development. When parents are less able to adapt, their children are also less able to adapt (Crowell et al., 2019). Therefore, supporting parents of children with ASD is important. This study explores the effects of introducing outsider witnesses into group counselling on parents of children with ASD and the factors that may cause these effects in order to provide a reference for future research and practice.

Narrative therapy and parental adaptation

Previous studies have shown that narrative therapy is an effective strategy for helping parents of children with ASD. Helitzer et al. (2002) noted that by narrating their feelings about raising children with ASD, parents can discover their strengths and create a new self-identity. Self-identity can be defined as “ … the salient part of an actor’s self … It reflects the extent to which an actor sees him- or herself as fulfilling the criteria for any societal role” (Conner & Armitage, 1998, 1444). It is important to assist parents of children with ASD to improve their self-identity because the parents often experience feelings of humiliation, social exclusion, and negative social judgement (Alshaigi et al., 2020; Griffith et al., 2012). They may also suffer from high levels of parenting stress and have great difficulty in parenting (Marriott et al., 2022). These stigmas, as well as parenting setbacks, can affect the self-identity of parents of children with ASD.

McAdams (2006) proposed a narrative identity theory that emphasizes the process of constructing the self by narrating life stories. By reconstructing the past in a narrative way, people can integrate meaning and purpose into their selves. Liu and To (2021) found that the narratives of parents of children with ASD allow them to reveal various experiences of personal growth and perceived meanings. This phenomenon has some similarities to the concept of re-authoring conversations in narrative therapy. Narrative therapy emphasizes incorporating the important subordinate storyline that the individual had ignored in their life narration. This allows the individual to face their problems and re-write their self-identity (White, 2007). A concrete form of such re-authoring conversation practice is the outsider witness proposed by White (2007).

Outsider witnesses and parental adaptation

The basic concept underpinning the involvement of outsider witnesses is inviting someone meaningful to the party concerned, such as someone with a similar background, to listen and reiterate the aspects of the life story of the party concerned that resonate with the outsider witness’s own experiences. This process is accomplished in three stages (White, 1995, 2007).

Stage 1: telling

The therapist interviews the party concerned and the outsider witness listens to the interview.

Stage 2: retelling

After the party concerned has finished telling their life story, the therapist interviews the outsider witness who then narrates aspects of the story that resonated with or inspired them. At this stage, the party concerned is the audience.

Stage 3: retelling of the retelling

After the outsider witness finishes their retelling, the therapist interviews the party concerned again and the outsider witness returns to being the audience. The party concerned retells aspects of the outsider witness’s retelling that resonated with or inspired them.

Outsider witness practices are based on narrative therapy that aims to reconstruct self-identity White (1997) explained why he introduced outsider witnesses into therapy:

Outsider witnesses are invited to respond to the concerned party’s narration. … If it wasn’t for these people’s retelling, many important moments in life may flash through the consciousness of the person like a light spot on the screen … and can no longer be pulled back into the story line of life

(p. 95).

The outsider witness’s retelling and experience resonance can redefine the self-identity of the party concerned and provide the strength to help them to face their difficulties (Morgan, 2000). Narrative therapy maintains that everyone’s self-identity and life stories are constructed through interpersonal relationships. Therefore, when the reconstructed self-identity of the party concerned is strengthened by others’ recognition, the thickness of life is made apparent and the power revealed therein is highlighted (Morgan, 2000; Payne, 2006; White, 2007).

Involving outsider witnesses in group therapy

Although previous studies have found that outsider witness practices are helpful for reconstructing self-identity, there seem to be few research attempts to use this method for group counselling.

To the best of our knowledge, very few studies have been undertaken on group counselling for parents of children with ASD. Two common intervention modalities are (1) parent training, which aims to improve parents’ skills for dealing with difficult child behaviours; and (2) parent education, which aims to shapes parents’ expectations and understanding of their child’s behaviour (Da Paz & Wallander, 2017). A few studies on parent support groups used group counselling to reduce stress in parents of children with ASD (e.g., Clifford & Minnes, 2013; Ede et al., 2020). Although these parent groups are valuable for assisting parents of children with ASD, they are limited in the help they can give to parents to reconstruct their self-identity.

As stated earlier, outsider witness practices based on narrative therapy are of great help in reconstructing self-identity. By using a dynamic form of storytelling, including telling, retelling, and retelling of the retelling, outsider witnesses can shift parents’ perspective from subjective to objective and back to subjective. As such, these multiple shifts in perspective may be more effective for reconstructing self-identity.

Thus, we believe that including outsider witnesses in counselling groups for parents of children with ASD is a feasible method of reconstructing parents’ self-identities. To the best of our knowledge, no previous studies have included outsider witnesses in group counselling interventions for parents of children with ASD. Therefore, this study aimed to understand how the inclusion of outsider witnesses in counselling groups for parents of children with ASD influences the parents. This study addressed the following specific questions:

1. Does the inclusion of outsider witnesses in counselling groups have a therapeutic effect on parents of children with ASD?

2. If it does, what is the possible mechanism of the therapeutic effect?

The definition of therapeutic effect used in this study was the same as the definitions of the therapeutic effects of outsider witnesses and narrative therapy, that is, reconstruction of the self-identity of the party concerned, which provides the strength to help them to face their difficulties (Morgan, 2000; Payne, 2006; White, 2007).

Methods

Narrative therapy group

The main method of this study involved designing a counselling group based on the above-mentioned narrative therapy. The purpose of the group was to allow group members to talk about themselves and respond to each other. The group members can then redefine themselves and their previously unaware selves through the dialogue between outsider witnesses and group leaders on the content of the narrative.

The group therapy involved eight sessions: (1) building a group; (2) narrating experiences of raising children with ASD; (3) catalysing members’ development of a new self-identity; (4) narrating experience of interacting with outsider witnesses; (5) organizing members’ new self-identities; (6) strengthening members’ new self-identity; (7) promoting change and action; and (8) providing final feedback. Activities in these eight sessions are provided in Supplementary Material 1.

Participants

Outsider witnesses

Based on previous studies (Payne, 2006; White & Morgan, 2006; White, 2007), the investigators selected outsider witnesses with the following characteristics: (1) they had a similar background to those of the parties concerned, i.e., they were parents of children with ASD; (2) they demonstrated cognitive complexity, i.e., they were able to perceive others from different points of view; (3) they demonstrated expressive capability, i.e., they were able to retell the life stories narrated by the parties concerned; and (4) they demonstrated emotional stability, i.e., they were able to remain unaffected by the emotions of the parties concerned and listen to their narratives.

With these characteristics in mind, the investigators invited two individuals who had previously participated in a counselling group for parents of children with ASD. Both of the two outsider witnesses were women aged 39–40 years. Each woman had a 13–14-year-old son diagnosed with ASD; one of the children was also diagnosed with attention deficit hyperactivity disorder.

Outsider witness training followed the repositioning practice described in White (2007). Both outsider witnesses participated simultaneously in two sessions of two hours each. During the training process, the investigators provided appropriate intervention and guidance by (1) demonstrating how to retell a narrative; (2) providing feedback while outsider witnesses retold narratives; and (3) providing support and intervening when the retellings stirred emotions in the outsider witnesses.

Group members

The narrative therapy group consisted of eight members. Seven were interviewed after the group; one was unable to attend the interview due to a work conflict. Of the seven people interviewed, six were female and one was male (one couple was present). The group members were aged 40–48 years. All participants were parents of children diagnosed with ASD. The children were aged 13–16 years and were diagnosed at the age of 2–5 years.

Research design

The study was conducted at a social welfare organization supporting those diagnosed with autism and their families. The organization arranges three parent support groups each year led by the investigators. With the cooperation of this organization, group members were recruited and eight two-hour sessions were held once per week.

One outsider witness attended the third session and the other attended the sixth session; these sessions were two and a half hours long. Outsider witness practice was performed in three stages, telling, retelling, and telling of the retelling (as mentioned above), as follows:

1. The telling stage: This stage lasted one and a half hours to ensure ample time for group members’ narrations. During this stage, the outsider witnesses sat separately from the group and listened to the narratives.

2. The retelling stage: This stage lasted 30 minutes. The group leader left the group to join the outsider witness for interviewing. The outsider witness only conversed with the group leader. The group members remained in their seats listening to the discussion between the group leader and the outsider witness.

3. The telling of the retelling stage: This stage lasted 30 minutes. The group leader returned to the group and discussed with group members how they felt after hearing what the outsider witness shared. The outsider witness remained in their seat listening to the group members’ retellings.

Data collection

The two outsider witnesses and the seven group members were interviewed; each interview lasted 1.5–2.5 hours. The outsider witnesses were interviewed after their task was completed (after the third or sixth session) and the group members were interviewed after the eighth session. The interview content is provided in Supplementary Material 2. The interviews consisted of three stages: (1) a self-governed storytelling stage in which the interviewer only listened and did not interrupt the interviewee’s narration; (2) a clarifying stage in which the interviewer inquired about the previous stage’s narrative content that was ambiguous or contradictory, or omitted details deemed unimportant yet were relevant to this study; this stage continued until the interviewees were no longer able to provide new information, thus achieving theoretical saturation; and (3) a reflection stage in which interviewees’ reflective thinking was stimulated; the interviewer asked questions based on her understanding of the research goals in order to help the interviewees become more aware of their profound thoughts.

Data analysis

The categorical content analysis approach proposed by Lieblich et al. (1998) was employed for data analysis. Open coding and a three-step analysis were performed: (1) creating subtext: all sections related to the research questions within the transcripts were gathered into a new text to serve as the main text for analysis; (2) defining content categories: ideas were created using this new text and concepts were then extracted; and (3) categorizing material: after categories were created, the investigators reread the new text and assigned the content to appropriate categories.

Research quality check

Based on the criteria of ontological authenticity and educative authenticity (Guba & Lincoln, 1994), the interviewees were asked to indicate the extent to which the analytical content reflected their subjective constructs. Interviewee agreement ranged from 90% to 100%, indicating that the results reflected the interviewees’ personal experiences.

Research ethics

All study participants completed an informed consent form before participating in the study. The main elements of the consent form were protection of the rights and interests of the research participants and a reminder of their obligations. The elements of the consent form were informed consent, the purpose of the research, a description of the research procedures, the expected effects, benefits of the research, and the rights of the participants. Specifically, the rights of participants stressed (1) privacy protection including anonymization of the data of all study participants and (2) the right of participants to withdraw from the study. The researcher fully explained and emphasized that each participant had the right to withdraw from the study at any time and that withdrawal would not cause any unpleasantness or affect their rights in the group.

Results

Therapeutic effects of the outsider witness

The results of content analysis indicated four factors related to the self-identity reconstruction of outsider witnesses and group members.

Becoming aware of past oversimplified and rigid perspectives

A common change among the participants was becoming aware of their past rigid perspectives. The outsider witnesses’ similar experiences caused them to feel as if they were listening to group members narrate their own story. The group members saw themselves from a third-person perspective when listening to the outsider witnesses retelling their narratives. Therefore, the participants realized that their perspective was inflexible and taken for granted. This awareness was gained by both the outsider witnesses and the group members. For example, one group member stated: Yes, it really struck me when she [outsider witness] said she was restricted by her child’s illness … I realized I was restricting myself, too. … After work I had to rush home to cook dinner … One coworker asked why cooking was so important; isn’t it okay if you’re just 10 minutes late? I said, no, it’s not okay! … I was defining myself by my role … that’s what a “good mother” does, so I had to go home to take care of my child after work … I couldn’t go anywhere, so I was restricting myself.

Recalling forgotten details

After becoming aware of their previous rigid perspectives, the participants recognized critical events that had been overlooked, i.e., story details that were forgotten. One participant mentioned:

When I heard him [the child] say that I cried [sobs]. Then I hugged him and apologized for my irrationality [sobs]. I just hope he knew that I didn’t know how to help him [sobs] … Then he asked me, “Okay, then, I’ve never made you happy?” [sobs]. At the time I thought, of course you have [emotional]! … If I was just blindly expressing that we have a lot of problems, I’m sure it’s unfair to my son … Sometimes the road may be a little bumpy, but we do have some fun, heart-warming, and beautiful moments.

Many instances of participants recalling forgotten experiences were recorded in the interview content. They often had a positive effect by enlightening and inspiring the participants.

Redefining people, events, and objects in their lives

The participants were able to redefine the people, events, and objects in their lives. This redefining encompassed their children, experiences of caring for their children, and their relationships with others. One participant said:

In my heart I know he [the child] is the reason I have the opportunity to be a good mother. I think I’m the recipient; without him I wouldn’t have experienced any of this … So isn’t it him who’s helped me? So I really feel that he is a gift.

The interviews also revealed that participants not only redefined their experiences of caring for their children with ASD but were also more accepting of other people. These new discoveries and changes also affected their social relationships. One participant said:

I think this experience is something very special. It reduced a lot of hard feelings between me and others. I’m more willing to be passionate with others and less cold and indifferent. … Maybe I’ll have seen someone’s story on the news and felt touched, and that ties us together. We may not have actually met in person, but we’re still bound together.

Redefining self-identity

These three changes—becoming aware of past rigid perspectives, recalling forgotten details, and redefining people, events, and objects—helped participants to self-reflect and deconstruct their old self-identities and reconstruct new self-identities. One of the outsider witnesses stated:

I feel very proud … although I’ve faced many obstacles and ordeals, I’d never felt like these experiences were anything special before. Now that I’ve told these stories again, looked at my past self and all that we’ve gone through. Since I’ve been an outsider witness … I think, actually, I’ve done a very good job [confident tone]! Ha ha ha [jovial laughter]! So I think it’s funny; I feel really good about myself, ha ha!

The group members also redefined their self-identities through the outsider witnesses’ retelling of their narratives. One group member stated:

Everyone needs to have some expectations for themselves … like my epitaph, something I hope others think of when they think of me … So it’s [outsider witness’ feedback] very important to me … [It made me feel] clearer about what I could contribute. Everything became more meaningful to me … so regardless of how many challenges, setbacks, or troubles you face, at times like this, [thinking you are capable] is very important.”

Possible mechanism through which the therapeutic effect occurs

The results of content analysis suggest three major mechanisms that may be related to participants’ self-identity reconstruction.

Physical displacement

Physical displacement due to the seating arrangement might have played a large role in causing changes in the outsider witnesses and group members. Outsider witnesses were separated by approximately two metres from the group members. Physical space created psychological distancing so that the outsider witnesses clearly understood that they were the audience. This psychological distance might have both prevented the outsider witnesses from becoming too emotional and allowed them to view the group members more clearly, thus enabling the outsider witnesses to get closer to group members’ narratives. One of the outsider witnesses stated:

That day … I had a really different experience; I was sitting on the outside. Although I was on the outside, I felt I could get closer to their life stories and then I felt like my own problems weren’t that bad. Before when I sat in the group, whenever I heard something that struck a chord with me, I wasn’t able to continue listening to their story; I was caught up in my own emotions.

A similar physical displacement effect also occurred during the retelling stage, when the group leader left the group to join the outsider witness for interviewing. Physical space created psychological distancing so that the group members clearly understood that they were the audience, thus allowing them to get closer to the narratives.

Experience resonance

When outsider witnesses, as the audience, listened to the group members’ stories, they could see experiences similar to their own, resulting in experience resonance. While the group members were listening to the outsider witnesses’ retelling of their narratives, they could feel the outsider witnesses’ empathy and achieved experience resonance. This may be an important mechanism behind the therapeutic effect. One group member stated:

When I hear her [the outsider witness’s] story, I thought that I have changed, too. [Just like the outsider witness’s] I dared to come out and join the group by myself … I have never participated in this kind of group before. I don’t know what will happen to this group … but I still dare to come out … We [she and the outsider witness] both have some changes.

Externalization of subjective experiences

The distancing due to physical displacement enabled outsider witnesses and group members to see their own life experiences from others’ perspectives, externalize their subjective experiences, and objectively view their own experiences. One group member stated that, after the intervention of outsider witnesses, she was able to evaluate her marriage more objectively:

I am very grateful to her [the outsider witness]. It was she who woke me up … I used to say that my husband is very good to me … However, because she said that, I found that … I didn’t think how lucky this “very good” was … I am very impressed with this … because it touches my heart.

The outsider witnesses also experienced the same externalization of subjective experiences as the group members. By listening to the group members’ narratives and objectively contemplating their own stories, the outsider witnesses were able to see their own experiences more objectively

The therapeutic effects and influencing mechanisms found in this study are listed in Table I.

Table I. Content categories and their definition.

Research question	Content category	Definition
Therapeutic effect of outsider witness	Becoming aware of past oversimplified and rigid perspectives	People become aware of the rigidity of the framework of their lives that they take for granted, thus making it possible for the old framework to loosen.
	Recalling forgotten details	People recognize past life experiences that were previously ignored and can look more closely at the details of these life experiences.
	Redefining people, events, and objects in their lives	People view other people and events in their lives from different perspectives and gain a new understanding of these people and events.
	Redefining self-identity	People acquire a different perspective of their own thinking and emotions, and thus gain a new understanding of themselves.
Mechanism through which the therapeutic effect occurs	Physical displacement	This refers to the physical distancing of the narrator and the listener. This physical distancing may lead to the listener’s viewpoint of the narrative changing accordingly.
	Experience resonance	The narrative arouses the empathy of the listener. Therefore, the listener compares the narrator’s life experiences with their own and assimilates them.
	Externalization of subjective experiences	People examine their subjective experiences from the perspective of a third party, which enables them to view their own life experiences more objectively.

Unique experiences of outsider witnesses

In addition to the above-mentioned common experiences of outsider witnesses and group members, this study also discovered some unique experiences of outsider witnesses.

A sense of independent mental and physical space

Because the outsider witnesses sat separately from the group members, they strongly felt that they were in a very different position from the group members. Psychologically, there was a similar separation effect. Since the outsider witnesses were not members of the original group, they tended to feel that they were psychologically different from the group members. The physical and psychological independence appeared to help the outsider witnesses to avoid becoming too emotionally involved in the group members’ stories, so that they could maintain a calm mood and look at things more objectively. For example, one of the outsider witnesses stated:

I feel like once [group counseling] starts, I’ve calmed down. Yeah, I’ve calmed down. I put the focus on the parent group and listened to group members’ stories. I heard them share their own life stories that day. Yeah, I think everyone has their own soul lessons, and everyone is trying their best to learn their lessons.

The outsider witness’s hybrid role of coleader and group member

In addition to the psychological and physical sense of space mentioned above, the outsider witnesses’ role in group counselling was also highly special. The outsider witnesses played a role similar to that of a coleader of the group, but not as a coleader who actively intervened. However, the outsider witnesses were to some extent like group members, but not the original group members. Therefore, they had a special hybrid role of coleader and group member. Such a role had never existed in group counselling in the past. Because of their mixed role, outsider witnesses did not always maintain objectivity like the group leader, but also did not become excessively emotionally involved like the group members. They expressed a kind of “moderate” involvement and concern. For example, one of the outsider witnesses stated:

I think … many caregivers need positive energy because they really live harder than their children. In fact, sometimes I feel sorry for them. I don’t know what I can … give back … But I think … just do it! As long as it is related to our children … [share witness’s experience and] let them open their vision and see more scenery from different angles …

Discussion

Therapeutic effects of the outsider witness

The subject of self-identity of parents of children with ASD received little attention in the past. Therefore, most parent group assistance programs do not aim to reconstruct parents’ self-identities. This study used narrative therapy and introduced outsider witnesses to assist parents of children with ASD, with the intention of providing another intervention approach. The results indicate that, after including outsider witnesses, the participants (1) became aware of past narrow perspectives, (2) recalled forgotten details, (3) redefined people, events, and objects in their lives, and (4) redefined their self-identities.

These changes were not isolated, but each was part of another change; one change may spur another. Participants became aware of past narrow perspectives and thus recalled forgotten details. After becoming aware of their past limited perspectives, they began to recognize other experiences. They thus expanded their view and redefined the people, events, and objects in their lives. This reinterpretation might have triggered the participants to redefine their self-identities.

These changes are very much in line with the spirit of narrative therapy. The main purpose of narrative therapy is to diminish the oppression of mainstream discourse and find untold alternative stories (White & Epston, 1990). In order for alternative stories to be found and told, they must first be deconstructed. By listening to people who have the same experience tell similar but not identical stories, participants can not only recognize the same parts of their own stories in the other party’s narrative, but also discover aspects that they have never thought of before. This is very helpful in deconstruction. The introduction of an outsider witness, a person who has had similar experiences, appears to be an effective method of achieving deconstruction.

Possible mechanism through which the therapeutic effect occurs

This study found that the participants’ changes in perspective might have been induced by three possible mechanisms: (1) physical displacement; (2) experience resonance; and (3) externalization of subjective experiences. These mechanisms may arise in large part due to the intertwined relationship between outsider witnesses and group members. First, physical displacement may allow the participants to experience the perspective of others. This may be as true for the outsider witnesses as it is for group members. When group members narrate their stories, outsider witnesses may experience others’ perspectives from the group members. When the outsider witnesses retell the narrative, group members may experience others’ perspectives from the outsider witnesses.

Second, experience resonance may allow participants to connect with others’ perspectives and thus expand their own perspectives. When group members narrate their stories, outsider witnesses may hear narratives similar to their own, and thus may be able to relate the experiences and perspectives of others to their own. When the outsider witness retells the narrative, group members hear their own stories retold by another and thus may be able to reinterpret their own experiences and perspectives.

Physical displacement and experience resonance may allow participants to more objectively examine their own stories and thus externalize their subjective experiences. The key to the participant’s ability to redefine self-identity might be the examination of their self through different perspectives. When different manifestations of the self are perceived, the participant may be able to recognize previously unseen parts of the self and redefine their self-identity. The new self-identity changes the participant, thus actualizing a therapeutic effect.

Some considerations when involving outsider witnesses

Since this study is one of the very few to introduce outsider witnesses to group counselling, we offer suggestions for the future implementation of this method based on our experience of its use in this study.

First, when training outsider witnesses, the focus should be on the core spirit of outsider witnessing rather than the subtleties of operations. Since outsider witnesses are usually non-professionals, they cannot be expected to exhibit precise therapeutic attitudes and behaviours during the intervention. Overemphasis of operational details can sometimes confuse them. Therefore, their training should be based on emphasizing core principles, which include listening attentively, being open-minded, respecting and appreciating the life experiences of group members, and being nonjudgmental.

Second, we found that outsider witnesses are highly concerned about whether their performance meets the expectations of the group leaders, causing them stress and anxiety. This may affect their performance in groups. Therefore, when training outsider witnesses, special emphasis should be placed on their immunity by declaring that they do not need to take responsibility for the group in order to reduce the pressure to participate.

Finally, the group’s own internal dynamics and cohesion will inevitably be affected when the outsider witnesses join it. To minimize this impact, the intervention plan involving outsider witnesses, including the outsider witnesses’ backgrounds, intervention methods, and the purpose of intervention, should be explained in detail to the group at the outset, and remind the outsider witnesses again one week before the intervention starts.

Limitations and suggestions

This study involved a group of parents of children with ASD. In consideration of counselling ethics and in the hopes of providing the highest benefit to the participants, only parents of children with mild autism were selected as participants. Thus, whether the results of this study can be applied to other counselling groups must be carefully considered. We suggest that future studies should involve outsider witnesses in different counselling groups, such as career counselling, grief counselling, and addiction counselling, to examine the effectiveness of outsider witnesses in other settings.

In addition, all participants in this study volunteered to participate in the hopes of solving their problems through group counselling. These parents’ proactive behaviour indicates that they were open-minded and motivated; they also had higher educational backgrounds and cognitive competencies. The high homogeneity of the group members also limits the external validity of this study. Therefore, future studies should consider group member heterogeneity during recruitment.

The results of this study show that the introduction of outsider witnesses into parental support groups has a positive effect. Group members generally reacted positively to the intervention involving outsider witnesses and believed that it was helpful to them. However, the data analysed in this study were collected after a single group activity (involving an outsider witness) or after eight group sessions (involving group members); therefore, the study can only show short-term and immediate therapeutic effects. We suggest that future research should further analyse whether the introduction of outsider witnesses to group counselling has long-term effects.

Since this study was a qualitative investigation and group consultation research was time-consuming, it was not easy to obtain a large sample of participants. In addition, this study did not perform a comparative analysis with a control group. We suggest that an experimental design could be used in future studies, enabling quantitative analysis to further test the effects of involving outsider witnesses in group counselling.

Finally, this study found that the primary function of outsider witnesses was to enable group members to view their own experiences from a more objective perspective. It appears that more healing is possible when people can disconnect from their subjective feelings. This is a significant reference point for parents of children with ASD. Excessive anxiety or a feeling of helplessness may be a reason for their poor adaptation, which is also worth noting by counselling practitioners. An important therapeutic approach to assisting parents of children with ASD is to help them to view their own subjective experience from a more objective perspective (by either using outsider witnesses as in this study or other relevant methods). Therefore, the results of this study have important implications for parents and practitioners.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17482631.2023.2196822.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Shu-He Chao

Shu-He Chao is an assist professor of Department of Psychology of Soochow University in Taiwan. Her expertise is mainly in the study of psychological counselling and qualitative research.

Ping-Hwa Chen

Ping-Hwa Chen is a professor of Department of Educational Psychology and Counseling of National Taiwan Normal University in Taiwan. Her expertise is mainly in the study of cultural diversity and psychological counselling.