Marte Meo and Video Interaction Guidance – similarities and differences. Landor, M. & Ljungquist, A.

Miriam Landor, National supervisor AVIGuk, miriam.landor@gmail.com

Åse Ljungquist, Licensed supervisor Marte Meo Sweden, ljungquist@icloud.com

INTRODUCTION

Marte Meo and Video Interaction Guidance (VIG) are closely related interventions; the aim of each is help people with their most important relationships, whether in their family, school, hospital, centre or workplace, through micro-analysing and reflecting on video of their interactions in everyday situations. This article has been co-written by Åse Ljungquist (AL; social worker, family psychotherapist, licensed (= VIG national) supervisor of Marte Meo in Sweden) and Miriam Landor, (ML; teacher, lecturer, educational psychologist, national supervisor of Video Interaction Guidance). We came together in November 2018 in Orkney, Scotland, when we co-delivered a Continuing Professional Development (CPD) event for accredited VIG guiders (i.e. practitioners using VIG with their clients) and VIG trainees, where Åse was the guest speaker.  We were fascinated by the similarities and differences between our two approaches, and wanted to share our reflections in the interest of building greater cooperation in the helping professions internationally.

How Marte Meo and Video Interaction Guidance began: Harrie Biemans, Maria Aarts and the Orion programme.

Following their interest in Professor Colwyn Trevarthen’s ground-breaking work on intersubjectivity and the building blocks of attunement, Harrie Biemans, a psychologist, and Maria Aarts, a family support worker, working with children and their families in the Netherlands, developed an intervention to help families develop or repair their relationships. It was at a time when children in care were being returned from residential homes to their birth families, and both children and families needed additional support to build or repair their relationships. This programme was called Orion and it was based on shared reflections and microanalysis of video-recorded everyday interactions. These videos were then edited to extract tiny moments of evident attunement, based on ‘principles’ of attuned interaction. The clips which were discussed in a meeting (called ‘review’ in Marte Meo and  ‘shared review’ in VIG) showed families visual ‘evidence’ that they were already achieving moments of successful interactions, even if fleetingly, thus giving them hope and also a way forward.

In around 1990, Orion then split into ‘SPIN’ in the Netherlands (with Biemans) – now translated into English as Video Interaction Guidance – and ‘Marte Meo’ (with Aarts) – which translates as ‘from my own strength’ or ‘of my own power’.  In 1991 Aarts began training therapists in Marte Meo in Sweden, and in the same year Biemans and colleagues presented SPIN to a conference in Scotland attended by several psychologists, from where training in Video Interaction Guidance cascaded in the UK and beyond.

Benefits for clients, and range of uses including Video Enhanced Reflective Practice (VERP)

Both Marte Meo and Video Interaction Guidance are strengths-based and solution-focused. This focus on showing clients only their moments of success, and none of their negative or ineffective behaviours, is a key difference between these approaches and some others. Our philosophy is that clients learn best from what is going well (even if it is an exception to the usual), and from studying what is already in their repertoire of communication skills; this means that they can learn from their own self-model to do more of ‘what works’.  These micro-moments are edited into brief video clips that show the adult’s sensitive attunement to the child’s need, by following the child’s lead or expression of need.

In Marte Meo the adult follows the child’s focus whether internally or externally directed; in Video Interaction Guidance the first ‘Principle of Attuned Interactions and Guidance’ (PAIG) is to give close attention. In both methods the client has a ‘helping question’ – a self-determined goal they wish to work towards. In family work, this is often about how they can better support their child – in their general development, learning, language, social skills or behaviour for example. Both Marte Meo and Video Interaction Guidance also apply the same principles and methodology when working in other contexts and with other age groups – in schools, residential homes, neonatal wards and so on.  When Marte Meo is used in these situations the person delivering the intervention is called a ‘colleague trainer’. In VIG this approach to supporting the professional development of others can be adapted to become Video Enhanced Reflective Practice (VERP), where participants select their own clips demonstrating their strengths in attunement from their daily work practice, following training.

COMPARING THE TWO METHODS

In Marte Meo the therapist selects the clip with the child’s needs always coming first, which they then connect to the parent’s helping question. The clip selected will be one where the child shares focus with the parent and gets his / her needs received in a supportive way. In Video Interaction Guidance clips are selected with a triple focus – the adult’s helping question, the child’s initiative and adult’s response, and examples of attunement as described in the Principles of Attuned Interactions and Guidance (PAIG).

We decided to jointly micro-analyse a piece of raw video in order to see how much difference – if any – these different starting points made in practice.

A. Micro-analysis of video

We checked how we each micro-analysed raw video by sitting down together with one which had been sent in by a Marte Meo trainee. The film was of a mother and her 18-month-old son (S), playing with blocks together. The mother’s ‘helping question’ was “We would like to not get into so many conflicts”. In the video the mother begins by trying to get her son to match the pictures on the blocks, but ends by stacking them for him to knock over. We found we micro-analysed the video for helpful clips in just the same way – even to the extent of often finishing each other’s sentences while we worked together, watching and re-watching micro-moments in the video. Our vocabulary was sometimes different; for example, in Marte Meo trainees look for the client to ‘confirm’ an initiative by the other – that is, show they’ve noticed or heard, repeat or summarise or name, before responding in an attuned way – which in Video Interaction Guidance is called ‘receiving ‘an initiative. Below are some excerpts from the transcript:

Starting out:

AL: I’m looking for her [trainee who sent video] to choose short sequences where the boy made an initiative and the mother confirmed it and…

ML: As well as looking for a moment where she’s following her child’s initiative, I’m looking for something which is a nice moment, that she’ll enjoy watching, where they’re happy, enjoying together…

AL: Yes an emotion…

ML: …and also I’m looking for a moment that is perhaps the exception to what she often does…

AL: we start the clip with a still picture where there is a real ‘meeting’ between them…

ML: … we have a similar advice – sometimes we tell them to look for just the Magic Moment, the moment that you think ‘oh isn’t that nice’, and then to microanalyse that and work out what made it so nice…

Interaction analysis:

AL: He looks at her and she makes a very big face and it…

ML: Yes she’s really receiving that look

AL: Yes she’s taking it in so that’s in a way a good picture

ML: and then he smiles, he gives a little smile and he moves forward to head-butt the bricks

AL: So perhaps the signal from Mum was yes it’s ok you can head-bump it

ML: yeah you can

AL: That could be something to ask the mother – if she thinks that he

read the signal ‘it’s ok’…  And he turns to…  he says nothing but she said ‘aah’ and she laughs and makes it nice and he’s smiling, he’s enjoying it …

ML: that could be a super clip

AL: from where we started – 122 to 126. You can start here

ML: Yes because by now he’s more interested in…

AL: He says ‘gaga’ and she reacts to that.

ML: That’s a nice short clip as well.

AL: And here S. takes up the block and looks at it…

ML: …and he tells her…

AL: something yeah

ML:… yeah because he isn’t just speaking to the block, he is telling her what it is

AL: yes. And then he

ML: ..throws it away

AL: with the foot, and she looks, and says yes take it

ML: yeah yeah ok so she is accepting that his method of giving it her is maybe not the best but it’s ok

AL: yes. So I think that’s enough for me because that is the crucial thing to show this Mum – that here this is him doing things.

Number of clips in a [shared] review:

ML: 3, 4. And maybe one of those is a still. And sometimes we say – especially if they’re new and they don’t know what to expect, if you start with the still which is easy and simple then that gets them to understand that they’re going to be looking for things which are going well and it gives them a voice and it’s easy to say something… so ok

AL: so that could be good …in order to get to the point where children understand, you have to be near, be following them so they know you are there for them.

ML: yes so I suppose for Video Interaction Guidance what I would hope is that by showing the videos, by getting the parents to see clearly what’s happening, to be able to put into words what’s happening, that I would have to judge how much help they needed to see how this could be applied to their problem [helping question]… and hopefully they might…  if you’re asking the right questions, if the parent is reflective, maybe they can see for themselves that ‘when I follow him it goes better, he is in tune with me I am in tune with him and then we don’t have conflict’.

B. The underpinning principles

Both Marte Meo and Video Interaction Guidance use a framework of ‘principles’ to guide them in their selection of video clips for their client:

Marte Meo – Developmental Principles (Samspelets kraft 2012 Hedenbro Wirtberg) Video Interaction Guidance – Principles of Attuned Interactions and Guidance (2011 Kennedy Landor & Todd)
Common focus.   The adult seeks information about the child and where the child has his/her attention and/or what initiative the child makes                     1. Being attentive  e.g. Looking interested with friendly postureGiving time and space for otherTurning towardsWondering about what they   are doing, thinking or feelingEnjoying watching the other  
2. Encouraging initiatives e.g. WaitingListening activelyShowing emotional warmth through intonationUsing friendly and/or playful intonation as appropriateNaming what the child is doing, might be thinking or feelingNaming what you are doing, thinking or feelingLooking for initiatives
Confirming   The adult confirms the child – the child’s attention-focus, initiative and adds his/her own reaction   3. Receiving initiatives e.g. Showing you have heard, noticed the other’s initiativeReceiving with body languageBeing friendly and/or playful as appropriateReturning eye-contact, smiling, nodding in responseReceiving what the other is saying or doing with wordsRepeating/using the other’s words or phrases  
Tuning in   The adult awaits the child’s response / response to this reaction.   Naming   The adult is naming the child’s initiative, action, reaction, response and emotions in a way that is confirming for the child   4. Developing attuned interactions e.g. Receiving and then respondingChecking the other is understanding youWaiting attentively for your turn.Having funGiving a second (and further) turn on same topicGiving and taking short turnsContributing to interaction / activity equallyCo-operating – helping each other
Guiding   The adult takes responsibility for the interaction so that it is formed into several turn-takings and a rhythm that enables the child to actively participate in this interaction   Confirming   The adult confirms the child as it shows desired behaviour   5. Guiding e.g. ScaffoldingSaying ‘no’ in the ‘yes’ cycle (attuned limit setting)Extending, building on the other’s responseJudging the amount of support required and adjustingGiving information when neededProviding help when neededOffering choices that the other can understandMaking suggestions that the other can follow
Guiding, confirming, common focus – the adult’s responsibility   7. The adult triangulates the child to the outside world by naming persons, objects and phenomena 8. The adult gives clear start and end signals 9. The adult is responsible for the emotional climate   6. Deepening discussion e.g. Supporting goal-settingSharing viewpointsCollaborative discussion and problem-solvingNaming difference of opinionInvestigating the intentions behind wordsNaming contradictions/conflicts (real or potential)Reaching new shared understandingsManaging conflict (back to being attentive and receiving initiatives with the aim of restoring attuned interactions)
N.B. Sometimes you may see examples of every point in just one micro-sequence [clip]    

C. Review (Marte Meo) / Shared review (Video Interaction Guidance)

Marte Meo: reviewing checklist for the Marte Meo therapist or guider

  • Sit so you can see both the screen and the person you’re showing the clips to.
  • Always start by expressing or demonstrating emotional warmth both verbally and nonverbally.
  • Use the person’s name.
  • Give the context  – what you are going to do during the review.
  • Repeat the parent’s/staff member’s question and your starting-point for the intervention.
  • Name what you are doing and have a neutral tone of voice when you give the information.
  • Be attentive to any initiative, both verbal and nonverbal, made by parents/staff during the review.
  • Always stop the video when you or parent/staff are talking.
  • Use your tone of voice and a tempo that keeps the parent’s/staff member’s attention.
  • Make your interaction analysis very clear: let the picture speak.
  • Allocate the appropriate Marte Meo principle to the clip you just have been showing.
  • Wait for a reaction. Look at the person and try to create a dialogue.
  • Link your clip to the meaning it will have for the child’s development, both in general and more specifically.
  • Share any emotions which arise. Deepen the dialogue if possible and confirm [receive] strongly all self-reflections from parent/staff.
  • Don’t talk about the video-picture. Show it.
  • Agree upon a working point always connected to the helping question for the next video session

(From Marte Meo Basic Manual – see Reading list)

Video Interaction Guidance: the shared review

Preparation (points to check in no set order):

  • Are the chairs set in an ‘interaction triangle’?
  • Have I micro-analysed the video?
  • Have I checked that my client is ready to start?
  • Have I explained what I plan to do?
  • Have I negotiated the purpose of the shared review?
  • Am I ready to receive my client’s initiatives?

Frameworks:

The Association of Video Interaction Guidance UK (AVIGuk) is in the midst of moving from the previous framework ‘Seven steps for a shared review’ to piloting a series of competencies called ‘Skills Development Scale’ (SDS).

The Seven steps are:

  1. Naming what you are about to see and explaining purpose. Looking at the video-clips
  2. Open tentative questions or sharing what you see
  3. Watching and creating space for the client’s response
  4. Reception of the client’s response. Mindful response to your own feelings. Respond naming your own thoughts or build on the client’s ideas
  5. Checking for reception of your statement. Support the client to think about it
  6. Continue giving and taking short turns between you, your client and video-clip
  7. Deepen discussion by exploring thoughts and feelings. Moving to possible new narratives about self, other and relationship

At each turn you judge if you want to give information or give space, or activate, possibly using video-clip.

The SDS are currently being piloted and may be amended at the end of this period; they currently cover: Identifying attunement principles / microanalysis*; establishing and revisiting the purpose of the shared review; use of video technology to maximise client activation*; embodiment of AVIGuk values and beliefs*; attuned dialogue*; attuned guiding*; pacing; naming and managing emotions in shared review; working with power; reviewing the shared review; co-constructing new meanings*; naming and receiving the process; widening the context (* = core SDS).

It should be understood that (at time of writing) Video Interaction Guidance itself has not changed; the principles behind it, methodology and values and beliefs stay exactly the same. All that is changing in this pilot is the training programme (see next section) and the wording of the frameworks for evaluating Video Interaction Guidance skills.

D. Differences in education / training model

The main differences between Marte Meo in Sweden and Video Interaction Guidance in the UK lie in what in Marte Meo is called ‘education’ and in Video Interaction Guidance is called ‘training’.

Marte Meo education

For Marte Meo trainees in Sweden, four terms over two years are taken up with monthly full-day group supervision sessions. The ‘reflective team’ method is used, whereby each trainee has a turn to work one-to-one with the supervisor on the video they have brought, whilst the other group members observe and reflect back to the group, thus maximising the learning of all.

Each term has a different focus. In the first term trainees work with video taken in families where interaction is normal and where there is no helping question. They practise microanalysis to identify clips that begin with the child making an initiative to the adult, with the adult responding in an attuned way – confirming (or receiving) the child’s initiative. In the second term the trainees start their work with families who are seeking treatment or have been recommended by the social services. For these beginning stages video clips are always shared with the supervisor before being taken back to the family for the review meeting.

As part of their final accreditation trainees write a paper reflecting on one or more concepts from their training period and describing how they use them in their work. The trainee has to work with at least 5 different casework families during those 4 terms. At their certification [accreditation] they have to show 2 of their casework families in an edited video-presentation and also deliver 5 written reports of their work with families or staff.

Video Interaction Guidance training

Trainees registered with the Association of Video Interaction Guidance UK usually work 1-1 or in pairs with their supervisor, often at monthly intervals.  Three stages of training, usually taking about 18 months, each with a pre-stage training session and a post-stage transition or final accreditation meeting, have recently been replaced with a pilot scheme of a shorter training period. The new Video Interaction Guidance pilot training uses the SDS as evaluation and consists of a minimum of 15 hours supervision with a mid-point review day and final accreditation.  This training can be followed with an optional ‘advanced’ stage.

Conclusion

Once we had clarified the meanings of some of our different terminology we were surprised to find how similar Marte Meo and Video Interaction Guidance remain after all these years – in the aims, philosophy and methods we both use. This has been a fascinating twinning exercise across the North Sea!

Reading list

Marte Meo method for school: supportive communication skills for teachers, school readiness skills for children 2006 Josje Aarts. Eindhoven: Aarts Productions.

Marte Meo Basic Manual, revised 2nd edition, 2008 Maria Aarts. Eindhoven: Aarts Productions.

Samspelets kraft 2012 Hedenbro Wirtberg

Marte Meo and coordination meetings: MAC. Cooperating to support children’s development. 2013 Ingegerd Wirtberg, Bill Petitt, Ulf Axberg. Tryck: Palmkrons förlag.

https://www.weforum.org/agenda/2018/02/how-you-talk-to-your-child-changes-their-brain/

‘Video Feedback Intervention With Children: A Systematic Review’ 2016

Stina Balldin, Philip A. Fisher, and Ingegerd Wirtberg. In Research on Social Work Practice 1-14, Sage.

‘Video Interaction Guidance (VIG) in Scottish schools’ 2011 Miriam Landor. In Verbondenheid in beeld: 10 jaar School Video Interactie Begeleidung (Connected through pictures) Retro Perspectief volume 3. ed. Hans Jansen. Amersfoort: Uitgeverij Agiel.

Video Interaction Guidance: a relationship-based intervention to promote attunement, empathy and wellbeing 2011. Eds. Hilary Kennedy, Miriam Landor, Liz Todd. London: Jessica Kingsley Publishers.

Educational Psychology in Scotland. Special issue: Video Interaction Guidance, 15:1 2104. Ed. Miriam Landor.  Leicester: The British Psychological Society. 

Video Enhanced Reflective Practice: Professional Development through Attuned Interactions 2015. Eds. Hilary Kennedy, Miriam Landor, Liz Todd. London: Jessica Kingsley Publishers.

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