6200WK2 DISCUUSIN1

OR I G I N A L A R T I C L E

“Power together”: Professionals and parents of children with disabilities creating productive partnerships

Ayala Cohen | Atalia Mosek

Department of Social Work, Tel Hai College,

Tel Hai, Israel

Correspondence

Atalia Mosek, Department of Social Work, Tel

Hai College, Tel Hai 12008, Israel.

Email: [email protected]

Abstract

Disparity of power and authority in the relationship between parents and profes-

sionals has been shown to be a major challenge in creating a successful partnership

in caring for children with disability. The goal of this article was to evaluate workshops

attended by professionals and parents of children with disability by raising awareness

to barriers related to incompatible expectations and role definitions. The research

explored the experiences of the participants in order to identify factors that facilitated

or impeded their collaborations. Data were collected from three workshops attended

by 22 mothers of children with disability and 24 professionals (most of them are social

workers). This qualitative research used interpretative phenomenological analysis to

investigate the participants' experiences. Findings showed that parents and profes-

sionals joined forces to create a productive working relationship by taking advantage

of power over and power together relationships. This mutual process required

participants to be aware, empathic, and respectful of one another's needs and

limitations; acknowledge the contribution of experiential and professional knowledge;

and co‐operate in overcoming the effects of ineffective bureaucratic service systems.

Interventions geared to contain emotional burden, acknowledge differential

knowledge and experience, and structure the use of power are suggested.

KEYWORDS

parents of children with disability, partnerships between parents and professionals, power

embedded strategies: power over, oppression, co‐operation, and collusive power, professionals

working with parents of children with disability

1 | INTRODUCTION

Power and authority disparities in the relationship between parents

and professionals have been shown to be a major challenge in creat-

ing successful lay–professional partnerships in caring for children

with disability. Such partnerships are jeopardized by failure to estab-

lish a collaborative, trusting, empowering relationship that supports

effective service delivery (Blue‐Banning, Summers, Frankland, Nel-

son, & Beegle, 2004). This article examines three workshops

attended by professionals and parents of children with disability in

order to understand the disparity of power as a contributing factor

to successful relations.

1.1 | Parents–professional partnerships

Partnership is an agreement between equivalent but not necessarily

equal partners who share an understanding about caring and working

towards mutual goals (Rommetveit, 2011), and although the term

connotes shared responsibility, this is not always the case regarding

relations between professionals and parents of children with disability

(Vincent, 2000). A partnership between parents and professionals was

defined by Summers Hoffman, Marquis, Turnbull, Poston, and Nelson

(2005, p. 3) as “mutually supportive interactions … focused on meeting

the needs of children and families, and characterized by a sense of

competence, commitment, equality, positive communication, respect,

DOI: 10.1111/cfs.12637

Child & Family Social Work. 2019; :565–573. © 2019 John Wiley & Sons Ltdwileyonlinelibrary.com/journal/cfs 56524

and trust.” This relationship should be characterized by mutual respect

and trust, shared information and decision‐making, and intervention

processes that incorporate family beliefs, needs, and preferences

(Mihee & Palisano, 2014). The following sections describe parents'

and professionals' expectations regarding their working relationships

and barriers to creating successful partnerships.

1.1.1 | Parents' perspective

Parents have identified “trust” as one of the most important factors in

a partnership with professionals (Turnbull, Turnbull, Erwin, & Soodak,

2006). They also value communication, professional competence,

respect, commitment, equality, and advocacy (Hess, Molina, &

Kozleski, 2006). In addition, they expect professionals to acknowledge

their own knowledge of their family by actively seeking their input on

their situation and preferred solutions (Fereday, Oster, & Darbyshire,

2010). When these factors are absent, parents, who are inevitably

dependent on professionals as gatekeepers of the service systems

(Tétreault et al., 2013; Wilkins, 2015), cope with humiliating and disre-

spectful regulations or deal with breakdown in their relationships with

professionals (Blue‐Banning et al., 2004).

1.1.2 | Professionals' perspective

A review of the literature showed that professionals approached their

working relationship with parents with responsibility and care. How-

ever, most do not view parents as equal partners and expect to control

the relationship (Blue‐Banning, Turnbull, & Pereira, 2000). They feel

that parents should be involved in planning for their child's care, but

only to a certain degree. In conflict situations, they tend to blame par-

ents for being unco‐operative rather than assess their own practice

(Bezdek, Summers, & Turnbull, 2010). They also expect the parents,

not themselves, to take responsibility for securing the services their

children require. However, when parents use adversarial strategies

to this end, they are reluctant to assist them in addressing inadequa-

cies in the services (Clear, 1999).

1.2 | Factors in successful partnerships

Both professionals and parents stress the importance of communica-

tion, commitment, skills, respect, and trust as foundations for success-

ful partnerships and invest in flexible relations that contextualize,

individualize, and are responsive to family concerns (Gallagher, Smith,

Hardy, & Wilkinson, 2012). A trusting relationship is likely to develop

through warmth, friendliness, and humour and by conveying

compassion, empathy, and respect (Rommetveit, 2011). Professionals

who work with culturally and linguistically diverse families need to

be cross culturally competent and value the uniqueness of each family

(Kalyanpur, Harry, & Skrtic, 2000).

1.3 | Barriers to successful partnerships

Disparity between power and authority is a major obstacle to develop-

ing successful partnerships (Davis, Ravenscroft, & Bizas, 2015). Power

differentials relate to the different hierarchic power positions profes-

sionals and parents occupy in relation to the child. Professionals, as

experts, are considered powerful, whereas parents, as caretakers,

often feel powerless (Vincent, 2000). Consequently, both sides experi-

ence emotional stress. Together with the stress created by their child's

disability, some parents develop defensive attitudes towards profes-

sionals, which the latter, in turn, assess as “pushy” and resisting assis-

tance instead of as need for support (Fereday et al., 2010). These

mindsets are exacerbated by confusion in and delayed access to

needed services (Green, 2007). To be able to support parents, profes-

sionals need to evaluate their own feelings towards raising a child with

disability and work through them (Choi, Lee, & Yoo, 2011).

Barriers to productive working relationships also often trace to

overly bureaucratic practice cultures, which are irreconcilable with

the service users' needs (Gallagher et al., 2012). Likewise, profes-

sionals are hindered by barriers such as unclear service goals,

insufficient time, excessive workload, and lack of administrative

support (Bronstein, 2003).

1.4 | Disparity between power and authority

Both service users and professionals in their everyday interactions

experience sensations of power and powerlessness (Proctor, 2002).

Relationships underpinned by inequality and objectivity tend to com-

modify caring and thereby highlight power differentials (Clear, 1999).

Recognizing these inherent power imbalances in the relationship is

considered a major factor in developing a positive partnership

(Wilkins, 2015). Guilfoyle (2011, p. 14) warns against failing to make

the power dynamics visible in practice: “If we believe ... that we are

at all times inescapably immersed in power relations and dynamics ...

how we can facilitate clients' participation as social beings within

social power relations?”

Parent–professional relations are governed by knowledge and

power. Foucault (2000, p. 341) defined power as “an act upon another

person and as a type of relationship between individuals.” Using this

definition, researchers understand how power dynamics shape how

practitioners convey, seek, and use knowledge (Heizmann & Olsson,

2015). Following Foucault's (1981, p. 165) view of power as “a social

relation that may open up or close off opportunities for individuals

or social groups,” Tew (2006) conceptualized its operation as a

dualistic process—oppressive or limiting in some respects and

productive or protective in others—and so proposed a matrix of power

relations designed to distinguish between different modes of its

operation (Table 1).

As shown inTable 1, both vertical operations of “power over” and

“power together” combine with “productive” or “limiting” horizontal

operations. Protective power, the productive mode of power over,

deploys power to safeguard vulnerable people and their potential for

COHEN AND MOSEK566

advancement, whereas co‐operative power, the productive mode of

power together, shares mutual support and challenges by valuing com-

monality and difference. In contrast, oppressive power and collusive

power are the limiting modes of power. The former exploits differences

to enhance one's own position and resources at the expense of others,

whereas the latter bands to exclude or suppress “otherness” either from

within or from without. In this research, Tew's (2006) typology was

used to deconstruct the power relations that played out between

parents of children with disability and professionals during three work-

shops, which enabled us better to understand the facilitative factors

and barriers to successful partnership between the two groups.

1.5 | The workshops

The workshops were part of Shemesh (“Sun” in Hebrew), a programme

initiated in 2012 by two mothers of children with disability, that

focuses on empowering the parents and the family unit. The pro-

gramme was developed and funded by governmental and philan-

thropic organizations and a private donor. The authors of this article

were involved in a 3‐year evaluation of the programme.

The goal of the workshops was to improve the working relations

between professionals and parents. The process began by allowing

participants to become acquainted with one another and identify their

assumptions, attitudes, and expectations. This, in turn, enabled partic-

ipants to identify the conditions needed to create understanding,

empathy, and trust as a foundation for effective communication and

developing fruitful relations. The process was conducted in two

stages. The preparation stage composed of three separate meetings

of parents and professionals, enabling the participants of each group

to ventilate, share personal experiences, and clarify attitudes and feel-

ings towards members of the other group. These separate group

meetings were followed by three joint meetings that focused on shar-

ing experiences, identifying parallel processes and communication bar-

riers, and proposing tools for improved relationships. All the

workshops were moderated by veteran social workers experienced

in working with families of children with disability. The research

explored the experiences of the participants in these processes in

order to understand how they affected their ability to work together

and to identify factors that facilitated or impeded their collaboration.

1.6 | Research question

How did discourses expressed by professionals and parents of chil-

dren with disability during the workshops demonstrate the use of pro-

tective, oppressive, co‐operative, and collusive power as facilitating or

impeding factors in creating successful relationships?

2 | METHOD

2.1 | Research design

The research used interpretative phenomenological analysis (IPA),

which enables investigation of significant experiences in participants'

lives (Smith, 2004). IPA is affiliated with phenomenological epistemol-

ogy (Smith, Flowers, & Larkin, 2009) and a constructionist framework

(Watkin, 2011). It seeks to explore the participants' world view and to

adopt, as far as possible, an “insider's perspective” while recognizing

the researcher's own conceptions in making sense of “that other per-

sonal world” (Brocki & Wearden, 2006). IPA is extensively used in

child and family health research due to its strength in exploring and

interpreting the ways people articulate and understand their experi-

ences (Biggerstaff & Thompson, 2008).

2.2 | Participants

The workshops were held in three cities in southern Israel. An email

invitation was sent to all parents of children with disability on

Shemesh's email list, followed by personal invitations from the site's

coordinator to parents who took part in the organization's Parent to

Parent programme (107 parents) or Parent Leadership Group (56 par-

ents). Twenty‐two parents (7.4% of those personally invited) partici-

pated in the workshops, with an average of 15 per workshop. Twenty

were mothers and two were fathers. Their ages ranged from 33 to

57 years, with an average of 46.4 years. Their formal education level

ranged from high school to postdoctoral studies, with an average of

14.9 years. Most were middle class, half employed part time, and a third

full time. The age of their children with disability ranged from 3 to

20 years, whose impairments included mild to severe levels of hearing

deficiency, mental retardation, autism, cerebral palsy, pervasive devel-

opmental disorder, and Down syndrome. All the parents were familiar

with local organizations and services that could help their children.

Recruiting professionals for the workshops was done by sending

invitations to all social welfare, education, and health service profes-

sionals who worked with parents and children with disability at the

three sites. This was followed by a phone call from the site's coordina-

tor, usually based on previous acquaintance, encouraging them to join.

Twenty‐four professionals accepted (23 women and one man), most

of whom were social workers (17). The others were two educational

representatives, three health care personnel, and two members of

non‐governmental organizations. The parents and professionals had

no prior acquaintance with each other, and both noted the limited

number of men, physicians, and psychiatrists among them. Workshop

attendance averaged 82%. One parent and three professionals did not

continue to the second stage.

2.3 | Research procedure and instruments

Ethical approval for the research was granted by the Ethical Commit-

tee of the authors' college, and the participants were informed that

TABLE 1 Matrix of power relations

Power over Power together

Productive modes of power Protective power Co‐operative power

Limiting modes of power Oppressive power Collusive power

COHEN AND MOSEK 567

the proceedings would be documented and the results published. Pro-

tection of privacy and confidentiality was assured, and all participants

provided signed informed consent forms. Shemesh site coordinators

attended all the workshops as nonparticipant observers responsible

for documenting the proceedings in light of the participants' discom-

fort in using an audio recorder. Documentation included all verbal

communications and non‐verbal cues during the sessions. To

overcome the risk of the data collectors' inadvertently interpreting

meanings rather than solely capturing them, this material was

complemented by phone interviews by the researchers with the work-

shop moderators, by the latter's reflective notes, and by follow‐up

phone interviews with available parents and professionals who

attended the workshops. For presentation in this article, quotes from

these sources were translated from Hebrew to English by a native

English speaker, and an English editor then verified their authentica-

tion by performing a reverse translation.

2.4 | Data analysis

IPA was begun by reading and rereading the documented material by

both researchers and noting initial ideas, reactions, meaning, and pat-

terns. Each researcher used a systematically inductive approach to

choose the participants' quotes that, in her opinion, represented the

major topics raised in light of how professionals and parents of chil-

dren with disability convey feelings, thoughts, and behaviours regard-

ing their working relationship during the workshops. We then

contrasted similarities and disparities and, in the next stage, reviewed

and compared our analyses of the data, clarified our interpretations,

and discussed discrepancies. In cases where agreement was not

reached, the data were not included in the identified themes. When

discussing the significance of our interpretive analysis, we focused

on answering questions identified by Braun & Clarke (2006, p. 94):

“What do these themes mean? What assumptions underpin them?

What are the implications of these themes? Why do people talk about

these things in this particular way (as opposed to other ways)? What is

the overall story that different themes reveal about the topic?” While

searching for answers to these questions, our reflections made us real-

ize that our understanding of the workshops was not detached from

our professional perceptions of social justice and evaluation of the

programme. We found that we were unable to separate our own con-

cerns regarding the impact of power relations on the parents' and pro-

fessionals' relationships. To assist us, we undertook a literature review

in search of a theoretical paradigm that could help us describe the

relationship and chose Tew's (2006) matrix of power, previously

described in Table 1, as the theoretical framework for interpreting

our research question.

3 | FINDINGS

The following findings are presented under the four modes of power

identified by Tew (2006). Power over includes protective and oppres-

sive power. Protective power is the productive form of power over

that signifies deploying power in order to safeguard vulnerable people

and advance their possibilities for advancement. Oppressive power is

a limiting form of power over that utilizes differences to enhance one's

own position and resources at the expense of others. Power together

includes co‐operative and collective power. Co‐operative power is a

productive form of power together that signifies sharing mutual sup-

port and meeting challenges by valuing commonality and differences.

Collusive power is the limiting form of power together that involves

banding together to exclude or suppress internal or external

otherness.

3.1 | Protective power

Professionals were aware of their power to protect parents. This

includes protection from “the truth” regarding their child's prognosis:

“Parents ask to hear the truth. However, it is also important for the

truth to be presented in a way that will keep them safe.” Professionals

were aware that protective relations required from their self‐analysis

and reflection: “Very often, we come to a meeting with parents with

preconceptions. Therefore, I prepare myself for our meetings, as if I

know nothing and everything.” Another professional, aware of her

tendency to be practical, said that she prepares herself to be commu-

nicative with parents: “I have a tendency to offer solutions. I have

learned from my experience that you need to get to know a parent

first. This changes the conversation.”

In contrast, the perceived guardian role could serve to reinforce

professionals' negative assessment of the parents' capabilities: “Some

of the parents are not aware of their child's needs. We see their inabil-

ity to make well considered decisions.” The professionals highlighted

their belief of the parents' responsibilities to protect their children:

“Parents can also do something. They need to display their power,

and if they do not have power then they can bring someone along

with them,” or at least accept professional advice: “The mother is

not listening to our recommendations.” The failure to meet expecta-

tions for protection and deployment of power intensified the frustra-

tion, anxiety, and helplessness of both parties.

3.2 | Oppressive power

Parents complained that when professionals shared their knowledge,

they often did so condescendingly, using professional terminology

and “labelling,” which was perceived as alienating: “I didn't understand

her terminology; it made me feel that she was trying to hide some-

thing.” They often felt insulted: “(Professionals) tend to label the child,

put a stamp on him. They say all autistic children are similar but all of

our fingers aren't the same.” They also felt oppressed: “The profes-

sionals often label certain parents as “troublemakers,” a label which

is very hard to remove.”

Knowledge and experience are valuable assets in raising a child

with disability. This knowledge, however, was not appreciated: “When

I listen to you (a professional) I expect you to also listen to me.” The

preferential status accorded to professional knowledge was difficult

COHEN AND MOSEK568

to accept: “It's hard for us (parents) that others determine what is good

for our child; I feel they (professionals) are against me.” In contrast,

professionals felt that “parents talk endlessly about their own

knowledge to belittle me.”

Parents expressed feelings of shame, guilt, and helplessness when

attempting to secure resources for their children. They clearly alluded

to the stigma attached to dependence on the services: “I was ashamed

to go to the welfare office. I don't need money; I only wanted to know

where I can take my child for treatment.” They felt professionals were

not accessible: “When I was in crisis, my social worker didn't have time

to listen to me.” Parents who sought to rely on professional

knowledge were sometimes disappointed: “I received only crumbs

from them, nothing new; there is no sharing on their part.” They also

expend a lot of energy in confronting the authorities. As one mother

said: “From the moment my daughter was born, I have been constantly

fighting with the medical and welfare services. Nobody informs me

of my rights.” Parents felt oppressed due to their unavoidable

dependency on professionals in caring for their child.

3.3 | Co‐operative power

As the participants moved from separate to joint groups, parents and

professionals focused on their shared experiences. Professionals

expressed their identification with the parents: “When I meet parents

in a difficult situation, it is very hard for me. I feel similar experiences

of helplessness, pain, grief and the inability to see a way out of the sit-

uation. I am overwhelmed.” Parents expressed their sensitivity to

professionals' impatience: “There are professionals who say they do

not want to hear any more, they have troubles of their own.” They

noted that professionals were “afraid to smile” and interpreted this:

“as some of (them) are helpless.” They realize the difference between

their situation: “a parent with a child with disability is thrown into this

difficult situation: he didn't really choose it, but professionals chose

their occupation.”

Professionals recognized the unique contributions in skills and

insights they bring to the co‐operative partnership: “A good relation-

ship with parents demands empathy and understanding, as well as

assisting them in their struggle to do what's best for the child. Some-

times this means helping them distinguish between their own and

their child's needs.” Parents, for their part, contribute experiential

knowledge. In the words of a professional: “Parents can bring what

they know about their child. That is their strength. If the professional

allows parents to do so, and if the parents are aware of what they

know, our power will be balanced and they will be prepared for

cooperative work.”

Professionals stated that addressing conflicts proved helpful: “We

talked about areas of conflict as an integral part of the dialogue. In

such situations you need to listen to others.” “Conflicts and different

opinions can raise different points of view that are valuable and

worthy of consideration.” Parents were also aware that they need to

modify their behaviour to foster co‐operation: “We need to act

according to the situation ‐ assertively but not aggressively.” “In a

war, there are always injuries and causalities. If I choose to cooperate,

I may find the acceptance and understanding that I need.” Profes-

sionals recognized that “parental involvement is the key. Professionals

need to return control to the parents.”

Parents and professionals also shared similar emotions: “We work

together in a painful area; there is the parent's pain and also the pro-

fessional's pain.” Professionals acknowledged that “parents raising a

child with disability have suffered an injury to their self‐esteem, and

experience fear, helplessness, anger, confusion.” Likewise, parents

empathized with the frustrations experienced by professionals:

“Professionals feel incompetent when they cannot meet the parents'

needs and offer a proper response to their expectations.” In fact,

“we and the professionals are in the same boat.” In order to create

their power together, professionals and parents need to acknowledge

and value the similarities and differences between them.

3.4 | Collusive power

In order to enhance their resilience, parents and professionals joined

forces for the good of the child. One parent commented: “We need

to bring our strength together, not to block it; every situation has a

solution.” Likewise, a professional stated that “We have mutual

interests in many respects. If we work together, with mutual

appreciation and respect, we can do a lot to benefit both families

and children.”

Parents wanted professionals to join them in educating and

changing public attitudes: “We need to think about ways of changing

social perceptions regarding people with disability. How are we

perceived by the public? How do normative families view our special

family? We need to work together to make them understand.” In the

words of another parent: “We believe that a partnership with

professionals will reinforce our power as parents. Once we establish

a mutual dialogue that brings us closer together, we can use our com-

bined power to act together.”

Both parents and professionals desired a productive relationship

with emotional bonds. “I expect a professional to be more pleasant,

to connect to the family,” one parent said. Professionals shared this

aspiration: “At the end of the day, it's a meeting between people. It's

not a question of titles, abilities or difficulties. I mainly see the

person opposite me.” Another professional talked about the value

of engagement: “I am always excited to see the parents. I want

to hear and feel them, and then I express myself. For me it is a

learning process.”

Parents shared the significance of joining forces with the profes-

sional: “My doctor from the developmental clinic is walking with us

… we are climbing the stairs together, hand in hand … there is a

wonderful sense of cooperation between us.” Another parent said:

“Our physiotherapist went against all conventional practices; she

fought for our child to remove all obstacles to his development, and

we developed a communicative and mutual world view.” When

parents are supported to reach a common goal, they feel they can

achieve the unexpected.

COHEN AND MOSEK 569

Parents and professionals worked together against the “system,”

which both perceived as inadequate. In the words of one parent: “Pro-

fessionals and parents alike are not empowered to make decisions and

implement them without the system's consent.” Professionals, too, felt

confined by the system: “Every professional is sensitive, but his/her

hands are tied,” and “professionals have an inner drive to help, but

are trapped by the structural systems.” Parents expect the

professionals “to move quickly, but professionals are not prepared to

take risks that will not be approved by the system.” However, both

parents and professionals claimed to be trapped in an oppressive

system. It seems their abilities to escape are by uniting their strength

in creating collusive power.

4 | DISCUSSION

Workshops attended by professionals and parents of children with

disability provided the context for this research, which sought to iden-

tify and understand the elements that can support or obstruct their

partnerships. The findings show that the participants used all four

forms of power identified by Tew (2006) to negotiate their relation-

ships, albeit to a different degree and for diverse purposes.

Power over was exercised to meet the need of parents for

emotional support and protection. Parents expected professionals

to offer them emotional support and deploy their power to protect

them and their children. Professionals were aware that

protective relations require self‐analysis and reflection, because their

perceived guardian role could serve to reinforce professionals'

negative assessment of the parents' capabilities. The failure to meet

expectations of protection and deployment of power intensified

the frustration, anxiety, and helplessness felt by both parents

and professionals.

Oppressive power was exercised by using knowledge. Parents

staked a claim to their knowledge gained in raising a child with disabil-

ity and expected professionals to value it. They expected professionals

to share their knowledge with them but felt condescended by profes-

sionals' use of terminology and labelling. Professionals, for their part,

felt unappreciated and disrespected. Parents expressed feelings of

shame, guilt, and helplessness when attempting to secure needed

but inaccessible resources for their children.

Co‐operative power was noted as the preferred type of relation-

ship. Both groups sought a pleasant, genuine personal relationship

that would allow them to share the pain and emotional burden in rais-

ing a child with disability. At times, both felt helpless in dealing with

vulnerabilities: parents due to their unfulfilled aspirations and profes-

sionals due to their sense of incompetence. However, some parents

and professionals were able to recognize the unique contribution each

could make towards productive relationships.

Collusive power was relevant for parents and professionals who

felt trapped in an oppressive system. They shared mutual interest in

enhancing their resilience and achieving as much as possible for the

children. Parents wanted professionals to join them in educating and

changing public attitudes and to work together against the “system,”

which both perceived as inadequate.

During the workshops, we discerned changes in the purpose,

intensity, and prevalence in the use of different kinds of power. In

the preparation stage, the main goal was to enable each group to

create its own sense of togetherness by ventilating and levelling

complaints, mostly at members of the other group. Sharing collusive

power practices within each group enabled expressions and

legitimized feelings of anger, anxiety, and blame. The work

performed in the separate groups contributed to each group's ability

to identify its power and alleviate anxiety over interacting with

members of the other group (Page‐Gould, Mendoza‐Denton, &

Tropp, 2008). These feelings were found to be more profound

within parent groups who experience professionals' use of power

(Cross & Friesen, 2013).

In the second stage of the workshop, parents and professionals

worked together to overcome negative prejudice feelings for each

other in order to reach their common goals. These encounters

enhanced knowledge about each other, reduced anxiety, and

increased empathy and the ability for perspective taking (Pettigrew

& Tropp, 2008). When parents and professionals worked together

in the same group, they shared their experiences in dealing with

the service systems. These conversations focused on expectations

and experiences of co‐operation and explored the changes required

on both sides to achieve sustainable collaboration. The positive

experience of members of both groups contributed to an ability to

work together.

The progress achieved by the workshops may be conceived as a

shift from reality to fantasy. Parents and professionals joined the

workshops in the hope of ameliorating their tense relationships.

The former felt that professionals focused on their children and did

not appreciate them as parents; they felt chided and excluded from

making decisions regarding their children. Initially, they expressed

their anger and frustration towards professionals, unaware that the

latter were themselves caught between a rock and a hard place

due to limited resources and other service constraints. Both sides

needed to clarify issues such as: Who is the client—the child, the

parents, or the family? Why are parents and professionals so critical

of each other? Where does this mutual resistance stem from? Some

of the answers to these questions lie in both sides' codependence

that limits their ability to differentiate their respective roles. In such

relationships, when one partner is weak, the other becomes stron-

ger. The ambivalence imbedded in codependence renders self‐

differentiation difficult and productive co‐operation impossible

(Daire, Jacobson, & Carlson, 2012). However, on moving from the

separate to the joint groups, both sides became aware that they

were, in fact, undergoing similar experiences: Both sought encoun-

ters based on empathy and appreciation in a safe environment.

The yearning for an ideal relationship, built on productive, protec-

tive, and co‐operative power relations, supported this vision. To

come to terms with reality, the discriminating use of all four types

of power relations is essential. Professionals and parents play differ-

ent roles in the life of a child with disability. Professionals act as the

COHEN AND MOSEK570

“responsible adult” in crisis situations, when action guided by profes-

sional knowledge is called for to protect the parent and the child.

However, because the relationship is a life‐long journey, both sides

need to invest in building a realistic partnership. Consequently, an

extensive period of work is required to bring about change in cur-

rent parent and professional attitudes and practices.

5 | RESEARCH LIMITATIONS

Rigour in qualitative data is supported by the degree to which the

data are credible, dependable, confirmable, and transferable (Tobin

& Begley, 2004). Triangulation of the three sources of data—written

documentation of the proceedings, phone interviews with the

moderators and their reflection logs, and interviews with available

participants of the workshops—strengthened its credibility. However,

the small sample and over representation of socially active parents

and social workers among the professionals limit the findings'

generalization.

The parent–professional relations described in this article were

embedded in the cultural, political, and service ideologies and policies

specific to Israel. The State of Israel is characterized by a multicultural

population, in which professionals usually represent the dominant cul-

ture (Freeman & Couchonnal, 2006) and families of children with

disability are evenly distributed in the population. Sensitivity to

these power relations was recently recognized by the Ministry of

Welfare that is leading a reform expected to reduce professional

power by promoting partnerships with service users (Schmid &

Morley‐Sagiv, 2018). This research should be considered an explor-

atory case study of a contextualized event that calls for caution when

making generalizations.

6 | PRACTICAL IMPLICATIONS

Three main domains were found to require clarification to create suc-

cessful parent–professional partnerships: containing emotional burdens,

acknowledging differential knowledge and experience, and defining and

structuring the use of power. Caring for a child with disability entails frus-

tration, disappointment, and feelings of helplessness as well as pride

and joy. Indeed, emotional burden is also felt by professionals, who

identify with the arbitrary universal destiny of caring for children with

disability (Choi et al., 2011). However, contrary to researchers' interac-

tions with parents (Heiman, 2002), professionals tend to emphasize the

objective burden placed on parents and pay far less attention to the

parents' own emotional burdens (Green, 2007). Yet parents' emotional

stress should be acknowledged and contained by professionals. They

should also be aware of warning signs regarding their own emotional

burnout. Given the sensitivities of both parties that were found in this

research, replication of the workshops should be considered a routine

service provided for these populations.

Raising a child with disability requires both expert and experiential

knowledge and practice. Parents expect professionals to acknowledge

their experiential knowledge and to share their knowledge with them.

To achieve this goal, attention should be paid to parents' concerns

regarding the professionals' limited acquaintance with evidence‐based

practice (McGill, Papachristoforou, & Cooper, 2006) and their unfamil-

iarity with contextually appropriate practices.

Conclusions derived from a political perspective on participatory

discourse (Hickey & Mohan, 2004), which acknowledges the effects

of different kinds of power and their implications, have important

implications for the training and preparation of professionals working

with families of children with disability. The first step in building suc-

cessful partnerships involves paying respect, overcoming distrust,

and creating personal relations marked by concern and empathy

(Blue‐Banning et al., 2000). During this process, all participants

should be invited to reflect on any issues that surface and helped

to identify structural barriers that should be overcome. The neces-

sary changes in attitude and practice should be incorporated in train-

ing programmes in all service systems and made known to all

relevant stakeholders: practitioners, researchers, and policy‐makers

(Bruder, 2000).

The workshops provided an opportunity for professionals to share

with clients, organizational barriers created by overly bureaucratic and

managerial practice cultures, which often impinges on their ability to

provide the kind of service they would like to offer (Gallagher et al.,

2012). Professionals feel their ability to create successful partnerships

is jeopardized by structural factors related to unclear service goals,

insufficient time, excessive workload, scarce resources, and lack of

administrative support (Bronstein, 2003). Lessons can be learned from

innovative policy directives in England, which introduced self‐directed

support options that allow parents to design their care package and

sources of support (Hatton, 2013).

We believe that a productive partnership of professionals and

parents of children with disability should be grounded in the mutual

commitment of professionals, parents, and policy‐makers working

together to create productive power relations. Such an approach high-

lights potential benefit to understanding how professionals might use

their position better to support parents as informal caregivers and

how they can work co‐operatively to advance a stronger sense of coa-

lition. Parent–professional workshops can be a significant turning

point in this direction.

ORCID

Ayala Cohen https://orcid.org/0000-0002-3630-575X

Atalia Mosek https://orcid.org/0000-0003-3033-1903

REFERENCES

Bezdek, J., Summers, J. A., & Turnbull, A. (2010). Professionals' attitudes on

parenting with families of children and youth with disabilities. Educa-

tion and Training in Autism and Development Disabilities, 45(3),

356–365. https://www.jstor.org/stable/23880110

Biggerstaff, D., & Thompson, A. R. (2008). Interpretative phenomenological

analysis (IPA): A qualitative methodology of choice in healthcare

research. Qualitative Research in Psychology, 5, 214–224. https://doi. org/10.1080/14780880802314304

Blue‐Banning, M. J., Summers, J. A., Frankland, H. C., Nelson, L. L., &

Beegle, G. (2004). Dimensions of family and professional partnerships:

COHEN AND MOSEK 571

Constructive guidelines for collaboration. Exceptional Children, 70(2),

167–189. https://doi.org/10.1177/001440290407000203

Blue‐Banning, M. J., Turnbull, A. P., & Pereira, L. (2000). Group action plan-

ning as a support strategy for Hispanic families: Parent and professional

perspectives. Mental Retardation, 38(3), 262–275. https://doi.org/

10.1352/0047‐6765(2000)038<0262:GAPAAS>2.0.CO;2

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qual-

itative Research in Psychology, 3, 77–101. https://doi.org/10.1191/

1478088706qp063oa

Brocki, J. M., & Wearden, A. J. (2006). A critical evaluation of the use of

interpretative phenomenological analysis (IPA) in health psychology.

Psychology & Health, 21(1), 87–108. https://doi.org/10.1080/

14768320500230185

Bronstein, L. R. (2003). A model for interdisciplinary collaboration. Social

Work, 48(3), 297–306. https://doi.org/10.1093/sw/48.3.297

Bruder, M. B. (2000). Family‐centered early intervention: Clarifying our

values for the new millennium. Topics in Early Childhood Special Educa-

tion, 20, 105–115. https://doi.org/10.1177/027112140002000206

Choi, E. K., Lee, Y. J., & Yoo, L. Y. (2011). Factors associated with emotional

response of parents at the time of diagnosis of Down syndrome. Jour-

nal for Specialists in Pediatric Nursing, 16, 113–120. https://doi.org/ 10.1111/j.1744‐6155.2011.00276.x

Clear, M. (1999). Caring culture and the politics of parent/professional

relations. Australian Journal of Social Issues, 34(2), 119–136. https:// doi.org/10.1002/j.1839‐4655.1999.tb01073.x

Cross, T., & Friesen, B. (2013). Developing cultural competence and

youth‐and family‐driven services in systems of care. In M. Weil, M.

Reisch, & M. L. Ohmer (Eds.), The handbook of community practice

(pp. 725–740). Thousand Oaks, CA: SAGE. https://doi.org/10.4135/

9781412976640.n34

Daire, A. P., Jacobson, L., & Carlson, R. G. (2012). Emotional stocks and

bonds: A metaphorical model for conceptualizing and treating code-

pendency and other forms of emotional overinvesting. American

Journal of Psychotherapy, 66(3), 259–278. https://doi.org/10.1176/

appi.psychotherapy.2012.66.3.259

Davis, J. M., Ravenscroft, J., & Bizas, N. (2015). Transition, inclusion and

partnership: Child, parent and professional led approaches in a Euro-

pean research project. Child Care in Practice, 21(1), 33–49. https:// doi.org/10.1080/13575279.2014.976543

Fereday, J., Oster, C., & Darbyshire, P. (2010). Partnership in practice:

What parents of a disabled child want from a generic health profes-

sional in Australia. Health & Social Care in the Community, 18(6),

624–632. https://doi.org/10.1111/j.1365‐2524.2010.00935.x

Foucault, M. (1981). The history of sexuality ( ed., Vol. 1). Harmondsworth:

Penguin.

Foucault, M. (2000). The subject and power. In J. D. Faubion (Ed.), Power:

Essential works of Foucault 1954–1984 ( ed., Vol. 3) (pp. 239–297). New York, NY: New Press.

Freeman, E. M., & Couchonnal, G. (2006). Narrative and culturally based

approaches in practice with families. Families in Society, 87(2),

198–208. https://doi.org/10.1606/1044‐3894.3513

Gallagher, M., Smith, M., Hardy, M., & Wilkinson, H. (2012). Children and

families' involvement in social work faking. Children & Society, 26,

74–85. https://doi.org/10.1111/j.1099‐0860.2011.00409.x

Green, S. E. (2007). “We're tired, not sad”: Benefits and burdens of moth-

ering a child with a disability. Social Science & Medicine, 64, 150–163. https://doi.org/10.1016/j.socscimed.2006.08.025

Guilfoyle, M. (2011). The ethical subject in post‐structural therapy. Journal of Systemic Therapies, 30(4), 1–15. https://doi.org/10.1521/

jsyt2011.30.4.1

Hatton, C. (2013). Trends and variations in self‐directed support and

direct payments for adults with learning disabilities. Tizard Learning

Disability Review, 19(1), 35–38. https://doi.org/10.1108/TLDR‐10‐ 2013‐0043

Heiman, T. (2002). Parents of children with disabilities: Resilience,

coping, and future expectations. Journal of Developmental and

Physical Disabilities, 14(2), 159–171. https://doi.org/10.1023/

A:1015219514621

Heizmann, H., & Olsson, M. R. (2015). Power matters: The importance of

Foucault's power/knowledge as a conceptual lens in KM research and

practice. Journal of Knowledge Management, 19(4), 756–769. https:// doi.org/10.1108/JKM‐12‐2014‐0511

Hess, R. S., Molina, A. M., & Kozleski, E. B. (2006). Until somebody hears

me: Parent voice and advocacy in special educational decision making.

British Journal of Special Education, 33(3), 148–157. https://doi.org/10/ 1111/j.1467‐8578.2006.00430.x. https://doi.org/10.1111/j.1467‐ 8578.2006.00430.x

Hickey, S., & Mohan, G. (2004). Towards participation as

transformation: Critical themes and challenges. In S. Hickey, & G.

Mohan (Eds.), Participation: From tyranny to transformation. Exploring

new approaches to participation in development (pp. 3–24). London:

Zed Books.

Kalyanpur, M., Harry, B., & Skrtic, T. (2000). Equity and advocacy expecta-

tions of culturally diverse families participation in special education.

Development and Education, 47(2), 119–136. https://doi.org/10.1080/ 713671106

McGill, P., Papachristoforou, E., & Cooper, V. (2006). Support for

family carers of children and young people with developmental

disabilities and challenging behaviour. Child: Care, Health and Develop-

ment, 32(2), 159–165. https://doi.org/10.1111/j.1365‐ 2214.2006.00600.x

Mihee, A., & Palisano, R. J. (2014). Family–professional collaboration

in pediatric rehabilitation: A practice model. Disability and

Rehabilitation, 36(5), 434–440. https://doi.org/10.3109/09638288.

2013.797510

Page‐Gould, E., Mendoza‐Denton, R., & Tropp, L. R. (2008). With a little

help from my cross‐group friend: Reducing anxiety in intergroup con-

texts through cross‐group friendship. Journal of Personality and Social

Psychology, 95(5), 1080–1094. https://doi.org/10.1037/0022‐ 3514.95.5.1080

Pettigrew, T. F., & Tropp, L. R. (2008). How does intergroup contact reduce

prejudice? Meta‐analytic tests of three mediators. European Journal

of Social Psychology, 38, 922–934. https://doi.org/10.1002/ejsp.504

Proctor, G. (2002). The dynamics of power in counselling and psychotherapy:

Ethics, politics and practice. Monmouth: PCCS Books.

Rommetveit, M. (2011). The mother's voice in inter‐professional collaboration in a client support group. Scandinavian Journal of

Disability Research, 13(4), 299–310. https://doi.org/10.1080/

15017419.2010.540825

Schmid, H., & Morley‐Sagiv, D. (2018). Reforming the social welfare

bureaus: Current situation, accomplishments and difficulties in

implementing change in social services. Society and Welfare, 38(1),

175–203. (Hebrew)

Smith, J. A. (2004). Reflecting on the development of interpretative phe-

nomenological analysis and its contribution to qualitative research in

psychology. Qualitative Research in Psychology, 1(1), 39–54. https:// doi.org/10.1191/1478088704qp004oa

Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological

analysis: Theory. Method and research. London: Sage.

Summers, J. A., Hoffman, L., Marquis, J., Turnbull, A. P., Poston, D., & Nel-

son, L. L. (2005). Measuring the quality of family‐professional

COHEN AND MOSEK572

partnerships in special education services. Exceptional Children, 72,

65–83. https://doi.org/10.1177/001440290507200104

Tétreault, S., Freeman, A., Carrière, M., Beaupré, P., Gascon, H., & Marier,

Deschênes, P. (2013). Understanding the parents of children with spe-

cial needs: Collaboration between health, social and education

networks. Child: Care, Health and Development, 40(6), 825–832. https://doi.org/10.1111/cch.12105

Tew, J. (2006). Understanding power and powerlessness: Towards a

framework for emancipatory practice in social work. Journal of Social

Work, 6, 33–51. https://doi.org/10.1177/1468017306062222

Tobin, G. A., & Begley, C. M. (2004). Methodological rigour within a quali-

tative framework. Journal of Advanced Nursing, 48, 388–396. http:// doi.org/10.1111/j.1365‐2648.2004.03207.x

Turnbull, A., Turnbull, R., Erwin, E., & Soodak, L. (2006). Families,

professionals, and exceptionality. Upper Saddle River, NJ: Pearson

Prentice Hall.

Vincent, C. (2000). Including parents: Education, citizenship and parental

agency. Buckingham: Open University Press.

Watkin, S. (Ed.) (2011). Social construction and social work practice:

Interpretations and innovations. New York, N.Y.: Columbia University

Press.

Wilkins, D. (2015). The impact of ‘being assessed’ by a disabled children's

team: A personal reflective account. Child & Family Social Work, 20,

10–18. https://doi.org/10.1111/cfs.12026

How to cite this article: Cohen A, Mosek A. “Power

together”: Professionals and parents of children with disabil-

ities creating productive partnerships. Child & Family Social

Work. 2019;24:565–573. https://doi.org/10.1111/cfs.12637

COHEN AND MOSEK 573

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