Finding focus in a difficult landscape: Therapists’ experiences with challenging video guidance processes for parent–infant dyads

Abstract

Marte Meo video guidance uses filmed interaction of the actual parent-infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent-infant dyads may illuminate important aspects of the method itself as well as the therapists' role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent-infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent-infant dyads where child protective issues arise, where caregivers' insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists' role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges.

Learning to mentalize: Exploring vulnerable parents’ experiences of change during video guidance in an infant mental health clinic

“…This is in line with evidence that parents with mental health problems experience more early feelings of estrangement from, anxiety towards and anger with their infants [ 35 , 36 ], constituting risk factors for infant development [ 37 ] and contributing to manifest relationship disturbances [ 38 ]. Therapists working with insecure parents have described how they shift parents’ awareness from themselves onto their infants and into the present, focusing especially on contact moments [ 39 ]. The visual focus of guidance on successful, minute interactions and contact moments to highlight existing resources in both parents and infants to support intuitive caregiving competence [ 34 ] may be especially suited for this parent group.…”