The importance of the working alliance between parent and professional

Abstract

Introducation: Quality of relationships between professionals and clients in the form of Working Alliance is relevant for psychotherapeutic success Del Re et al., 2012. We tested whether Working Alliance also predicts outcome when professionals provide a short-term early intervention program for parents with a child with a visual or visual-and-intellectual disability. Methods: For parents of young children age: 9 months to 5 years with a visual or visual-and-intellectual disability the Intervention: ‘Video-feedback Intervention to promote Positive Parenting in parents of children with Visual or visual-and-intellectual disabilities’ VIPP-V; Van den Broek et al., 2016 was developed. The intervention aimed at increasing parental sensitivity and parent-child interaction quality. From the development of the VIPP-V program on, experts by experience parents and stakeholder groups were involved to promote implementation. A survey assessed parents’ support needs. Participants: Each parent-child dyad N=40 participated in seven 1,5Hr-VIPP-V sessions. Design: Pre-test, post-test and follow-up design. Instruments: The National Institute of Child Health and Human Development Scales NICHD-scales; Egeland & Heister, 1993 were used for coding parental sensitivity and quality of parent-child interaction. The Dutch translation of the short version of the Working Alliance Inventory WAI; Horvath & Greenberg, 1989 was used to assess working alliance. Results: For working alliance a quadratic interaction with parental sensitivity F1,34 = 4.14, p = .050, η2 = .011 was present, as well as for parent-child interaction F1,34 = 6.14, p = .018, η2 = .15. The median split for the level of working alliance indicated that for the parents reporting the highest working alliance at posttest, parental sensitivity and parent-child interaction improved more strongly compared to the parents reporting lower levels of working alliance. No differences were found at follow-up. Discussions: Parents who had a positive working alliance with their VIPP-V worker benefited more. Conclusions: Working Alliance may be related to short-term benefits in parenting intervention. For implementation a multiple strategy approach is used: the intervention is embedded in patient registrations and standard protocols; parents of a young child with a visual impairment are informed about the intervention; and several training and education materials are developed. Lessons learned: These results show that the quality of the working alliance may contribute to intervention effects. Research should elucidate whether working alliance is an indicator or a mediating factor. Limitations: The quality of the working alliance was only examined by a questionnaire and not observed. Future research: A factorial trial design may tease apart the independent and synergetic contributions of working alliance and intervention protocol. Also, the effect of the quality of the working alliance should be studied in other short-term interventions also for caregivers providing care for persons with an Intellectual Disability, in psychiatry or elderly. Furthermore, the outcomes of implementation into practice should be examined.