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

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.     

Die therapeutische Allianz

Zusammenfassung  Im Teil 2 wird zunächst auf die kontroverse Auffassung eingegangen, dass Allianzbrüche unvermeidbar und für den Therapieerfolg nützlich sind. Dann wird der Versuch unternommen, eine Abgrenzung zu anderen Konstrukten vorzunehmen, die entweder als Moderatoren oder als prinzipiell ähnliche Zugänge zu sozialen Interaktionen aufzufassen sind. So wird z. B. in der Sozialpsychologie relativ häufig eine sehr ähnliche Thematik unter anderen Sichtweisen behandelt. Darüber hinaus gibt es auch noch weitere erwähnenswerte Zugänge, die empirische Untersuchungen einer Verbindung mit therapeutischer Allianz lohnenswert erscheinen lassen. Es wird die Schlussfolgerung gezogen, dass therapeutische Allianz, vorzugsweise als Begleitvariable zu interpretieren, ein mehrdimensionales Konstrukt ist, das unterschiedliche Verlaufsmuster aufweist, und dessen funktionale Validität weiter erforscht werden sollte.

Die Therapeutische Allianz

Zusammenfassung Ausgehend von frühen Konzeptionen der therapeutischen Allianz wird die Entwicklungsgeschichte des Konstrukts verfolgt. Es wird die Behauptung aufgestellt, dass seine Attraktivität in der Psychotherapieforschung vor allem von der Beziehung zum Therapieerfolg herrührt. Es gibt aber durchaus auch kritische Stimmen, denen die vorherrschende Auffassung zu positivistisch ist. Von einem Forschungsgesichtspunkt aus werden verschiedene Vorgehensweisen betrachtet, mit einer Zusammenfassung von Ergebnissen zur Perspektive der therapeutischen Allianz als Patienten- beziehungsweise therapeutenzentrierte Persönlichkeitsvariable, als Interaktions- oder Kommunikationsvariable. Da die therapeutische Allianz ursprünglich ein psychoanalytisches Konzept ist, und ihre Beziehung zur Übertragung ein immer wiederkehrendes Thema darstellt, wird auch hier diesem Aspekt besondere Aufmerksamkeit gewidmet. Die Darstellung schließt auch den Versuch ein, den Stellenwert der therapeutischen Allianz in verschiedenen Therapierichtungen und verschiedenen therapeutischen Settings zu erfassen. Es werden häufiger verwendete Skalen beschrieben und Versuche, ihre Ähnlichkeit nachzuweisen, zusammengefasst. Auch die mit Hilfe dieser Skalen erreichten Aussagen über typische Verläufe von Allianz kommen zur Sprache.     

Freud,Jung and The Great Chain of Being

For some time, it has been clear that psychoanalytic theories are built upon the kind of master narratives Roy Schafer, a New York psychoanalyst, described in 1980. As such, psychoanalytic theories may today have lost some of their initial scientific credibility in that they can no longer be seen as summarizing findings from data collected in a research environment. As aids in participating in their patients’ process of healing, however, narratives continue to be used by practitioners and reflect allegiance to core beliefs and propositions with roots in long‐standing Western thought. In this article, the metaphors in master narratives of Freud and Jung are compared with a conceptual system identified by cognitive linguists as ‘The Great Chain of Being’. Based on this analysis, the article proposes that theoretical formulations have mainly a secondary role to play in achieving good outcomes. The most critical element is the therapist's capacity to access a specific narrative for what transpires throughout each treatment.     

Working online due to the COVID-19 pandemic: a research and literature review

Given the contemporary situation of many analysts in the world now being forced to work online due to the effects of the COVID-19 pandemic, it is important to review the working online issue. Substantial debate over previous years has questioned whether a genuine analytic process can unfold through online work. This debate is reviewed with the conclusion that such a process is not necessarily precluded. Research outcomes are then reviewed to highlight those things that can facilitate positive outcomes when working online. These cover the ‘online disinhibition effect’, the therapeutic alliance, particular ways of using the screen, focussing on trauma, the importance of self-awareness, knowing the predictors of mental health, certain potential positives of isolation/quarantine and psychotherapy interventions that may be currently needed. Final recommendations and suggestions are then presented as in the diagnosis issue, professional development and guidelines to do with practical and ethical considerations.     

Pilot test of a measure to assess clients’ perceptions of their home visitors

Home visiting services for caregivers of infants and young children have been found to be an effective method for promoting child development. Unfortunately, such services suffer from high rates of attrition, suggesting the need to identify factors related to client retention in services. Research has indicated that the client-provider relationship is an important predictor of client retention in home visiting services; however, measures to assess this relationship are limited. This study reports on a pilot test of the Client Perceptions of Home Visitors Questionnaire, developed to assess home visiting clients’ perceptions of their relationship with their home visitor. The measure was completed by 39 diverse home visiting clients during pregnancy in a midwestern town in the United States. The scale was found to have good internal consistency. Validity analyses found that the scale was positively associated with client satisfaction with services and perceived provider cultural sensitivity. The scale was also positively associated with retention in services at an 8-month follow-up. Additional research should examine the measure's psychometrics with larger samples.