Services for children with learning disabilities have undergone significant paradigm shifts in the last few decades. Increasingly, psychologists are looking not only to provide information to parents and to foster child development, but also to facilitate and support real therapeutic change with the families they work with. This workshop explored the application of therapy outcome research to this change process.
At the outset, a historic perspective on the development of family-centred practice was presented. The shift in the perception of parents was noted, from passive bystanders who either did or didn’t interfere with professionals, to legitimate recipients of service in their own right. The shift in the role of professionals, from specialists to supporters, and the shift from the specific focus on specific therapies, to the broader focus on interactions, were also considered.
Using Michael Lambert’s research on the relative contribution of common and specific factors in therapy outcome, the workshop considered the implication of these factors for work with parents. Lambert’s research identified client factors—the abilities, strengths and resources clients bring to the table—as the single most important contributor to changes. The workshop considered how parents’ own resources could best be supported to create the change they desired, recognising parents as active agents who purposefully interpret, change and adapt inputs from professionals to create the meaning that they want or need.
The importance of relationship factors (the second most important factor) were considered. Ways of developing the parent-professional relationship were discussed, noting that clients’ rating of relationship was the most consistent predictor of improvement. The contribution of hope and expectancy to outcome was discussed. It was recognised that parents will do as well as they expect to do in interventions, and that parents’ expectation of outcome was more predictive than professionals’. The role of models of intervention was considered. The pitfalls of allegiance-effect were discussed and the importance of selecting models which fitted with parents’ own theory of change was stressed.
Engaging with parents was discussed in relation to the Prochaska’s Readiness-to-Change Model, developed originally to address addictive behaviours. This model conceptualises engagement in change behaviour in a number of stages—pre-contemplation, contemplation, preparation, action and maintenance. A key tenant of this model holds that interventions will only be effective if they address the client’s current stage of change.
It was argued that services, at the time of initial engagement with parents, are in an action stage. They have passed through the pre-contemplation stage (pre-referral), the contemplation stage (making the decision to accept the referral) and preparation stage (deciding how the service will engage with the parents). They meet parents offering action-stage interventions, reflecting the stage of change of the service. However, some parents are at the pre-contemplation stage (they don’t see themselves or their children requiring a specialist service), or at the contemplation stage (trying to weigh up the advantages and disadvantages of attendance at a specialist service). Parents at these stages are characterised by reluctance and ambivalence. It was argued that professionals should address parents’ need for information, time and emotional processing at initial engagement, and then collaborate actively with parents to identify beneficial interventions. It is not a question of whether a parent is motivated or not, but rather what a parent is motivated for. Service interventions need to be offered at the parents’ stage of motivation. Drawing on therapy outcome research, practical strategies were suggested for increasing parental motivation, collaborating with parents and supporting change.
The specific challenges of engaging fathers in services were also addressed. It was recognised that supports and interventions for parents are often directed at and availed of primarily by mothers. The specific contribution of fathers to their child’s development and to the outcome of psychosocial interventions was noted. Research was reviewed which identified that fathers of children with disabilities had specific needs, but were more likely to feel excluded from services than mothers were. The importance of practical considerations, such as time and location of appointments, was discussed and the adoption of directive interventions using problem-solving and structured task-focused approaches was suggested. The often overlooked strategy of directly asking fathers to be involved was stressed.