Impediments to the Formation of
the Working Alliance in
Stephen P. Seligman, D.M.H
Jeree H. Pawl, Ph.D.
"Infant-parent psychotherapy," an original model of intervention into the problems in the relationship between infants and parents, was designed by Selma Fraiberg (1980) and her colleagues (Fraiberg et al., 1981) to accommodate the usual techniques of psychoanalytic intervention to the special situation of parents who face multiple difficulties. This model includes some of the more concrete, supportively oriented and educative techniques of nonpsychodynamic workers, such as developmental guidance and direct facilitation of social services, specifically applied in treating the social and psychological blocks that can be so destructive to the developmental potential of children in the first few years of life.
In this paper we describe some of the particular problems we have encountered in attempting this type of work with parents. We call special attention to the collaborative working alliance between parents and practitioners, and we hope to show how an understanding of the factors that impede the formation of such an alliance can make interventions more effective. In all intervention modes, successful work requires such rudimentary cooperative conditions as patients' confidence in our concern and ability to help, their willingness to consider our advice, information, or treatment plans, and a minimal adherence to appointment times. Moreover, when psychological exploration is attempted, patients must be willing to tolerate the effort and discomfort of painful self‐ examination (Sandler et al., 1980).
Unfortunately, the multiple and nearly overwhelming difficulties many families face as they try to raise their children—for example, economic vulnerability, sociocultural disadvantage, troubled family life, and tortured personal histories—thwart the use of proffered help. Effective and empathic responses to these difficulties can help establish the preconditions necessary for patients to accept the good will and specific skills professionals make available. Such understanding may relieve some of the frustration experienced by workers attempting to intervene with infants and their parents.
The establishment of a trusting relationship and the work needed to maintain it can provide the basis for a variety of interventions, includ