Useful for work with families, so you’re (therapist) not asking the questions – feels more neutral, more like a game, and less pointed or personal.
The cards cover a range of life directions through naming mental states and asking questions
Could pass the same card round whole family in turn to make it less threatening e.g. “Have you ever longed for something?” – in order to take pressure off target child
In VIG could be the activity for videoing – 1-1, family, small group, class – but make sure participants feel in a place of trust and safety first
Choose carefully which cards to include – some could feel threatening in individual cases (PF, ML)
3. BabyCues: a child’s first language cards, School of Nursing, Center on human development & disability, University of Washington, Seattle www.ncast.org
Relevant to ante natal work i.e. recognition of facial expressions
Useful for trainee guiders if this area of work is new to them
Perhaps a set of photos could be created for your client and baby as part of the VIG work?
May be useful for VIG clients in MBU (Mother & Baby Units)?
Can use antenatally, then when baby’s born take stills matching the cards
Look for Brazelton cards (similar)
Make your own ‘bank’ of newborn cards to match the emotions shown in these (the subjects are older in lots of the cards) (PF, ML)
4. ‘Another point of view’, Jan Toyne and Clare Dhanushan, Community Practitioner April 2017, pp.36-7.
This article is about the importance of early interventions during the critical 1001 first days of a child’s life.
The focus is how Health visitors are using VIG as an intervention for building blocks of communication between the baby and its parents. The VIG intervention has successfully enhanced communication for the babies and their parents.
The article gives a short introduction to VIG and how it is used here. The outcomes from this project described are positive.
They also describe 4 cases and the outcome and changes for the baby and the parent. I think this could be a good introduction to the possibilities VIG has and it may also be very restorative for all VIG workers. (ÅLS)
5. ‘5 Steps for Brain-Building – Serve and Return’, Filming Interactions to Nurture Development (FIND) Center on the Developing Child, Harvard University (no date)
In the 5 steps, I can see much of the early Attunement Principles of VIG. The very concrete examples of each step do not only help show parents how to build the child’s brain i.e. exploring the world and nurturing verbal ability but also exemplify how the parent can interact with the child in an attuned way. Both are very helpful in developing parent-child bonds, and the child’s self-control and ability to get along with others. These steps and examples would be very useful for VIG practitioners in enhancing parents’/childcare workers’ understanding of the application and impact of the early attunement principles.
VIG Attunement Principles
Impact on parent & child
1. Notice and attend to the focus of child as indicated by his verbal and non- verbal expression e.g. making a sound and pointing at something
Learn about child’s abilities Strengthen parent-child bonds
2. Give support verbally and or non-verbally e.g. give a hug; say “I see; nodding
Receive and respond to initiatives
Reward child’s interest and curiosity; Child feels being understood
3. Naming the objects, feelings or action of which child is focusing
Make language connections in child’s brain
4. Wait for child’s response, then take turns
Taking turns helps child learn self -control and how to relate with others.
5. Attend to child’s signals as he ends his activity or move to a new one.
Being attentive receive and encourage initiatives
Enable child to take the lead and explore his world.
6. ‘Neuroception: a subconscious system for detecting threats and safety’ – Stephen Porges May 2004 Zero to Three pp 19-24
Polyvagal Theory and its relevance to VIG
In his paper ‘Neuroception: a sub-conscious system for detecting threats and safety (2004) Stephen Porges starts with the question ‘What determines how two human beings will act towards each other when they meet? He challenges the idea that learning from culture, family experiences and other socialisation processes are the whole story and suggests that the expression of a neurobiological process, programmed into our very DNA, is also involved. He calls this neurobiological process neuroception.
Neuroception is the processing of information from the environment through the senses so that the nervous system may evaluate risk i.e. is this situation safe, dangerous or life threatening? Porges argues that neural circuits in primitive parts of the brain are involved so without conscious awareness these circuits facilitate adaptive defensive behaviours such as fight, flight, freeze and pro-social behaviours. He has identified three developmental stages of a mammals’ autonomic nervous system: immobilisation, mobilisation and social communication, which he calls Polyvagal Theory based on research into the vagus nerve.
The vagus nerve is a complex bidirectional system that regulates homeostasis and associated responses to environmental challenges i.e. stress, as early as infancy. Porges (2011) argues that the mammalian development of a myelinated vagus is a key component of social and internal regulation. He further postulates that mammalian attachment is associated with an evolved increase in vagal tone in safe situations. This keeps stress responses dampened thereby enhancing exploration, socialization, and learning including the neural regulation of the heart to affective experience, emotional expression, facial gestures, vocal communication and social behaviour that is responsive to others. He argues that humans must subdue reactions to immobilisation in order to engage, attach and form lasting social bonds e.g. accept a hug.
In summary, Polyvagal Theory postulates that neuroception when detecting safety promotes physiological states that support social behaviours resulting in social engagement and defensive strategies if environmental cues are read as dangerous by that individual. Specific characteristics, however, may trigger fight/flight in one individual and total shutdown in another and this difference in thresholds he speculates may be linked to early experiences.
Porges then asked how does the nervous system, an essentially a social engagement system, know when the environment is safe, dangerous or life threatening? Based on research, using new technology neural structures involved in detecting risk have been identified. They found specific areas of the brain that evaluate biological features such as: body and face movements and vocalisations that contribute to an impression of safety and trustworthiness; recognition of the familiar and evaluation of intentions. If identified as safe then neural circuits actively inhibit areas of the brain that organise defensive strategies however slight changes in these biological movements can see neuroception shift from safe to dangerous, pro-social behaviours disrupted and defensive strategies triggered.
It seems social engagement is dependent on how well we regulate the muscles of our face and head via pathways linking the cortex with the brain stem, the corticospinal pathways. These muscles give expression to our face, allow us to gesture with our head, put intonation into our voices, direct our gaze and allow us to distinguish human voices from background sound and can decrease or increase social distance. Indeed, the polyvagal theory claims that humans have physical reactions, such as cardiac and digestive changes, associated with their facial expressions.
Social distance, they found, can be reduced with:
– making eye contact
– vocalising with an appealing inflection and rhythm
– displaying contingent facial expressions
– modulating the middle ear muscles to distinguish the human voice from background sounds
Alternatively, social distance can be increased as the tone of these muscles is spontaneously reduced in response to the perception of danger in the external or internal environment:
– the eyelids droop
– the voice loses inflection
– positive facial expressions dwindle
– awareness of the sound of the human voice becomes less acute (located in the middle ear)
– sensitivity to others’ social engagement behaviours decreases
Interestingly this work reinforces the importance of musicality (Malloch &Trevarthen 2010) as Porges sees acoustic features as one of the most potent triggers of neuroception (Porges & Buczynski). In addition, he provides us with another layer of understanding as to why ‘receiving others’ may be hard to do with his identification of fluctuations in ‘awareness of the human voice’ in response to a sense of safety or of stress.
As appropriate social engagement strategies are needed for infants, young children and adults to form positive attachments and social bonds Porges hypothesises that faulty neuroception i.e. an inability to inhibit defensive systems in a safe environment or the inability to activate defence systems in a risky environment or both could be at the root of autism, anxiety, depression, reactive attachment disorder etc. He considers therefore that stimulation of the cortical regulation of brainstem structures involved in the social engagement system is an important area of research.
Polyvagal Theory therefore offers video interaction guidance an insight into the neurobiological basis for the development of social engagement and attachment underlying the features associated with their development (eye contact, musicality, contingent facial expressions, sensitivity to others’ social engagement behaviours). Resonating as they do with several early elements of the principles of attunement it could be argued that VIG offers one way that ‘stimulation of the cortical regulation of brainstem structures involved in the social engagement system’ may occur through a positive cycle of reception, reciprocity, shared understanding and repair as necessary.
Porges W. S. (2004) Neuroception: A sub-conscious system for detecting threats and safety. Zero to Three. May pp19 – 24.
The Polyvagal Theory for Treating Trauma. Complete transcript of a Teleseminar Session featuring Stephen W. Porges and conducted by Dr Ruth Buczynski, PhD of NICABM. The National Institute for the Clinical Application of Behavioural Medicine. www.nicabm.com.
Porges, W. S. (2011) The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation. New York, NY: W.W. Norton & Company.
Malloch, S & Trevarthen, C. (eds) (2010a) Communicative Musicality: exploring the basis of human companionship
This article explores how an adaptation of video interaction guidance (VIG) with professionals, known as video enhanced reflective practice (VERP), developed a community of practice at a nursery school. The project was commissioned by the Head teacher (the second author of this paper), and involved 12 staff who worked in two units with children aged two to three, and three to four, in a nursery school. Attendance at the half termly VERP CPD sessions was strongly encouraged by the Head teacher, and was for practitioners who had video to share with their colleagues. I (the first author) had trained as a VIG practitioner and facilitated all the sessions, with a view to eventually setting up self-sustaining reflection sessions.
The article draws on literature by Wenger (1998) about communities of practice (see below), and on an evaluation of the nursery school VERP group process, which was completed after four VERP CPD sessions. The evaluation was based on individual short interviews with staff, including the Head teacher. Whilst this approach has limitations in terms of the risk of socially desirable responses, the tendency to give positive self-descriptions, it enabled formative assessment of the VERP process for the upcoming year. Within the VERP sessions, there was time for two groups of staff to meet for an hour each, over two terms. This article seeks to analyse how a community of practice developed in the nursery school and what is needed to sustain staff reflection over time.
What is video interaction guidance (VIG) and video enhanced reflective practice (VERP)?
Video interaction guidance (VIG) is an intervention through which a practitioner aims to enhance communication within relationships (AVIG UK, 2019). Initially the client together with the guider negotiates their goal, and then is guided to reflect on video clips of their own successful interactions. This can be with a parent and child, or professionals and the client they work with. In this case, the practitioners were early childhood practitioners working with young children in a nursery school. The intervention takes the view that change can be achieved more effectively in the context of an empowering, collaborative, coaching relationship focusing on strengths and potential (AVIG UK, 2019). In both VIG and VERP, clients select their own helping question, and in VIG the guider films and then edits the video, choosing the clips to share, whereas in VERP the client films, edits and selects their own clips. In this instance, the practitioners filmed each other, then selected their own clips to share with a staff group, with a VIG–trained facilitator to enable reflection, discussion and sharing of viewpoints. The Head teacher and senior staff did not attend the sessions, but were supportive of staff attending.
What is a community of practice?
Wenger (2001) highlights the importance of people as an organisation’s key resource, and the value of creating communities which share the capacity to create and use knowledge. Wenger and Snyder (2000) define communities of practice as:
‘…groups of people informally bound together by shared expertise and passion for a joint enterprise.’ (p.139)
In this nursery school, the staff are bound together by their shared expertise in early childhood education and care (ECEC) and their passion to support the young children in their care. The practitioners, in line with the principles of VIG and VERP, identified which particular aspect of their practice they wanted to focus on, enabling them to work within the community of practice to follow their own passions and interests.
The key features of a community of practice
Wenger (1998) outlines the three dimensions of a community of practice as:
The domain – the joint enterprise as negotiated by its members
The community – how the community functions and the mutual engagement that binds the members
The practice – the capability and shared repertoire of resources developed by the group
The joint enterprise as negotiated by the nursery staff
In the nursery school, the joint enterprise was initially identified by the Head teacher, and focused on the development of sustained shared thinking by the staff with the children. This had been identified in the Head teacher’s learning walks where she observed the practice in the nursery school, and was recommended as an outcome from a recent OFSTED inspection. However Wenger (1998) makes an important point that communities of practice develop around what is important to the people, and external mandates do not in themselves produce practice. In this instance, the joint enterprise identified by staff during short evaluation interviews was reflection on practice; sustained shared thinking emerged, amongst other issues, as part of these discussions. This was illustrated by comments from staff such as:
‘It’s good reflection on practice and how to make it better and better yourself.’
Scheduling the VERP CPD sessions
In terms of practicalities, scheduling of the VERP CPD sessions was a key area for consideration. It was agreed with the Head teacher that half-termly sessions on a Friday afternoon, when fewer children attended, was a practical solution. This enabled adult-child ratios to be maintained, and was the best use of the available time. Previously there had been additional, non-contact time in the nursery school when staff could meet, but with a reduction in budget, this was no longer possible. In addition to pragmatic considerations, the appreciative eye of VIG-/VERP-trained facilitator was noted as central by staff, with comments such as:
‘Normally you think low of yourself, but when the whole team are saying good things, you feel good about yourself and like the job more.’
Staff autonomy in choosing what to film
Other aspects of VIG that enabled the community to function, included the autonomy of staff to choose their own helping question and clips. Some staff focused on particular children (such as those with special educational needs and disabilities (SEND), or those children who are quiet and less likely to engage with adults), or on an aspect of their practice (such as how they supported children in groups or within child-initiated activity). As the Head teacher and staff members noted:
‘The staff set their own targets so they are in control and demonstrate who they are as practitioners.’
‘I am more in control of it because (you show) what you want to show.’
VERP as an inclusive process
A further aspect of VERP that was valued by staff was that the VIG process is inherently inclusive. This was noted by practitioners who spoke English as an additional language.
‘It is really good for someone like me who is a shy person and it (English) is not my first language.’
In terms of the capability and shared resources, the evaluation of the VERP sessions identified a number of positive outcomes, such as enabling the team to come together, sharing perspectives, seeing progress, feeling affirmed and gaining confidence.
Due to the requirement to maintain the adult-child ratio (DFE, 2017), the nursery staff were not able to meet in their units or as a whole group, and instead came together in mixed groups, depending on who had a video to share. The value of sharing different views and reflecting on practice with other practitioners was noted as an outcome of the VIG sessions:
‘Sometimes we don’t have time to see each what others are doing, what’s in their minds…’
‘It is nice that the other staff are with you, so you can see the other person’s point of view.’
‘Sharing it with other people is a brave way of moving forwards and enables peer support.’
A further outcome from the group, which resulted from sessions taking place over time, was the visibility and sharing of progress. This included individual children’s progress, staff members’ own professional progress, or the progress of colleagues:
‘It’s a good way of showing progress of a child from the first video to the last one.’
‘Someone like me…to be able to look back and reflect on how I was at the beginning and how I am now.’
‘It made her think critically and that was a wow.’
Communities of practice in early childhood education and care
Hord (2009) writes about the development of professional learning communities in schools and universities. She argues that a professional learning community, where educators work together to improve the learning of their students, models a learner-centred and constructivist approach. This reflects early childhood pedagogy which takes a child-centred approach to learning and development. Hord (2009) draws on Burns, Menchaca and Dimock (2001) six principles of constructivist learning theory to highlight professional learning community models should ideally be an active, reflective process, controlled by the learner, located in a social context where multiple perspectives can be shared.
This aligns well with the VERP process utilised in the nursery school, where practitioners identified their own helping questions, and shared and celebrated videos of their practice. Hord (2009) identifies a number of conditions for successful professional learning communities, including structures, time and space for staff to meet and talk about the students’ learning and progress, alongside their own learning.
Wenger (1998) in his categorisation of communities of practice would identify the community of nursery school practitioners as seeded and nurtured by the Head teacher, who plays a key role in legitimising participation. She does this by providing practical support including identifying a time for the VERP sessions, and values what the community of practice brings through her discussions with and observations of staff. Hord (2009) emphasises the key role of the leader to support collaborative dialogue within purposeful professional learning community meetings. The Head teacher highlighted in her interview that she is keen to further develop video enhanced reflective practice by working with other staff in other nursery schools.
In a final paragraph, Wenger (1998) notes:
‘…training departments must move the focus from training initiatives that extract knowledge out of practice to learning initiatives that leverage the learning potential inherent in practice.’ (p.10)
Taking a VERP approach to the professional development of practitioners within early childhood education and care, enables a community of practice, where reflection on videos of staff playing and working with children enables problem solving, sharing of perspectives, and makes visible staff progress and learning. As summed up by the Head teacher:
‘You had to video and therefore expose yourself in order to participate in the group sessions, so if you don’t put into it, you won’t get anything out of it!’
As part of the Association of Child Psychotherapists (ACP) 70th Anniversary events, the ACP and the Bridge Foundation (Bristol-based charity providing therapeutic services) hosted an inter-disciplinary conference on Saturday 9th November 2019 at the Watershed, Bristol.
The conference was conceived by Fiona Brodie (child psychotherapist) and Sara Tibbetts (documentary film-maker). Their idea was to examine the commonalities and differences between the psychoanalytic process of reflective observation, and the role of the documentary film-maker. The particular focus was on the relationships formed within both disciplines, and the potential for transformation within the ‘Observing Relationship’. The conference was attended mostly by child psychotherapists/trainees and film-makers, and proved to be a very stimulating day.
Margaret Rustin, Consultant Child Psychotherapist, Head of Child Psychotherapy at the Tavistock Clinic 1985–2009
Paddy Wivell, BAFTA and RTS Award winning documentary film-maker
Gail Walker, Senior Child Psychotherapist, Bridge Foundation
Hen Otley, Trainee Child Psychotherapist, Marlborough CAMHS
Sara Tibbetts, Documentary filmmaker
Conference Chair: Rachel Pardoe, Child & Adolescent Psychotherapist, Parent-Infant Psychotherapist, and Video Interaction Guidance Practitioner and Supervisor
Documentary film-making award: since the conference, Paddy Wivell has won the Grierson award for ‘Best Documentary Series’. We are delighted for him.The judges’ appreciation included the comment: ‘The full humanity of people on both sides of the story shone through because of the empathy and thought with which they were filmed.’ Paddy Wivell is currently working on a documentary on women’s prisons.
This article reviews the conference and makes some links between the psychoanalytic process of reflective observation, documentary film-making, and Video Interaction Guidance (VIG). VIG is a strengths-based, effective, brief intervention for parents of children across all ages. VIG aims to promote enhanced sensitivity, and capacity to mentalise, in both client and practitioner.
The evidence base for Video Interaction Guidance is an international one. VIG is recommended as an evidence-based intervention in the NICE guidelines.
To start the day, we viewed clips from ‘Observation Observed’: Closely observed infants on film – based on the BBC film series of the work of the Tavistock Clinic, called the ‘Talking Cure’ (1998). An observation seminar was specially convened, it was filmed, and each weekly visit to the two observed children – a baby and a young child – was also filmed. Interviews with leading teachers of Infant Observation provided the theoretical frame.
Gail Walker and Hen Otley then presented an eloquent infant observation, rich in detail, of a baby boy growing up in his family. We subsequently viewed clips from Paddy Wivell’s films, Prison (documenting life in HMP Durham, broadcast 2018-2019), and Boys and Girls (documentary about growing up in poverty in Britain, 2001). Paddy’s discussion of his films was titled Entering, Representing and Leaving the Field.
In the afternoon, Margaret Rustin presented a detailed examination of the Process and Power of Infant Observation, reflecting onthe ‘unconscious aspects of the emotional forcefield we become part of as observers’.
Throughout the day there were questions and lively discussion. We became engaged in a creative ‘translation’ process across disciplines, digesting comments from differing perspectives and backgrounds. The conference touched on emotional material, especially Paddy Wivell’s films. It was important to create a safe space for reflection. Paddy Wivell, in particular, was courageous in acknowledging his own emotional responses to his material (see below for comments on the impact on the film-maker of filming painful situations).
One reason I was invited to chair was my involvement in VIG. In drawing some links between VIG and the theme of the conference, I commented that I am always struck by the power for parents of seeing themselves in attuned moments of interaction: “I would never have believed it..”. “I think it makes you realise you are doing well.. ‘cos you don’t see it normally. I feel like I’m doing something right”.
However, the task for a documentary film-maker is different: to tell a story, to bear witness to both positive and difficult aspects of situations, rather than to provide a therapeutic experience. Through offering a new/different perspective, the documentary film-maker has the potential to change attitudes and the way systems function in society.
Several themes emerged around the ‘observing relationship’, including the following.
1. Receiving a “dose” of the subject’s feelings
Extracts from Observation Observed included commentary from Margaret Rustin and Hamish Canham (Child Psychotherapist, and organising tutor of the Tavistock’s child psychotherapy training, before his untimely death in 2003). Rustin spoke about the observer of the young child receiving a “dose” of what the child feels (for example, helplessness or feeling unwanted); Canham talked about using our own feelings as a “clue” to what the child may be feeling.
In Hen Otley’s observation, we heard about an 11 month old boy who enjoyed an intimate and affectionate secure attachment to his mother. During one visit he was observed to be “freezing out” Grandma, and behaving towards her in a rather disdainful way. The observer recorded feeling uncomfortable in the face of this; later she recorded feeling protective towards his mother when, aged 13 months, he grabbed her breast roughly, scratching her chest, during a particularly painful period around separation when he was starting with a childminder. The observer’s detailed observation, and self-reflection, helped us to think about the painful feelings the infant was struggling with, and how he was communicating these to his carers.
In Paddy Wivell’s film, Boys and Girls, we saw Jordan, aged 10, struggling with a chaotic home life including a preoccupied mother, an absent father, and domestic violence by mother’s partner. Paddy experienced at times feelings of vulnerability and helplessness, which it seems reflected Jordan’s feelings, often hidden behind a mask of ‘being in control’ and laughing at others’ vulnerability. Paddy felt intense concern for Jordan and the impact of his home life, which so clearly affected his emotional wellbeing and his ability to access education: school was Jordan’s main source of support, but he became increasingly absent as the chaos of homelife escalated. In the final scene, Paddy is encouraging Jordan to go to school, but Jordan is conflicted – with some insight he comments that he knows he will hit them [his peers] today… Jordan runs away and Paddy runs after him, but Jordan ends up at some distance; he seems to be isolated and adrift, with Paddy unable to reach him.
Similarly, we see Troi, in Prisons, entering and leaving prison, at both times experiencing difficult feelings: on entering he seems anxious and uncertain, masking this by laughter; on leaving he is fighting back his tears as he is taken through the routine of prison leaving procedures, devoid of any sensitivity to his state. We feel his upset.
Paddy Wivell commented that in the world of documentary film-making, these personal emotional responses are not attended to in detail, nor is it perhaps adequately recognised that film-makers may need support to process and digest their experiences. The conference was an unusual and safe place where such things could be thought about and powerful emotions rekindled.
With reference to VIG, being aware of our own responses, and managing emotions in the shared review (where we view with the client the edited ‘attuned moments’ of interaction) is central. The Video Interaction Guidance Skills Development Scale (VIG-SDS) includes a specific skill: Item 8 – Naming and managing emotions in shared review, which focuses on receiving and attuning to the emotional content of the shared review, and appropriate containment of the client’s emotion. This requires us to not only be aware of the client’s emotion when viewing the clips, but our own. VIG-SDS Item 12: Naming and receiving the process highlights, also, the necessity of being sensitive to the impact of our own responses on the client.
2. A relationship of trust
Paddy Wivell’s documentary work does not shy away from the painful struggles of vulnerable people in very difficult circumstances – his films are brutally honest, and can both shock and move us. Paddy’s empathy and compassion for his subjects shone through, in the films and in his commentary.
His biography included the comment:
“..they all shared something – a desire to speak and be heard, a glint in the eye and a spirit for adventure. There’s always a moment after we’ve first met when, despite the risks, they decide to throw in their lot and choose to conspire with me to make a film together. It’s a heady moment, a rush and a thrill and a little bit like falling in love. I’ll always be grateful to them for it.”
This rather extraordinary experience of being given access to another person’s life, can be as Paddy Wivell says a ‘heady moment’. We discussed how for many infant observers (and child psychotherapists too), we can ‘fall in love’ with our ‘subjects’ – infants, children, parents, grandparents; we can also experience very uncomfortable feelings. We share across our disciplines of infant observation and film-making, the joy and pain of this very personal engagement.
Margaret Rustin later spoke of the relationship of trust that film-makers and infant observers build with their subjects, and the common experience of being in an outsider/insider position: an outsider observing a passionate intimate relationship with the difficulties that arise – potential feelings of being intensely involved, and also peripheral or unwanted.
This, of course, links with one of the core VIG Values: Trust, which is essential to an effective therapeutic relationship.
3. The power of human connection: being ‘seen’ and understood
Paddy Wivell named his work as a “playground to explore how lives are lived”. He hopes to portray stories that are not just about the individual, but which speak to a “universal experience”.
In Boys and Girls, Jordan had sought out Paddy, after a period of Paddy being present in the school with no set agenda. Paddy felt that Jordan was “checking him out”, seeing whether he could be trusted. When Jordan presented himself, Paddy knew immediately that there was something about this engaging child – a potential for human connection, and the “love affair” began, with much shared humour along the way. Margaret Rustin commented on how Jordan had “chosen” Paddy, because he needed to communicate his anxieties and feelings to someone who would listen and hear his story. This emotionally containing experience would in turn, hopefully, allow Jordan to know and understand his story a little better.
The final filming was a difficult experience for Paddy Wivell, leaving him with unresolved questions about the impact of the relationship on Jordan? We discussed the importance of endings being managed with care, and the contrast between what can be potentially managed in a safe therapeutic relationship vs the context of documentary film-making where the film-maker also ‘enters and leaves the field’, and may have little control over what happens next (in both contexts, endings can happen suddenly with little opportunity to process emotions).
We thought about the longer-term positive impact on Jordan of this very powerful human connection. Paddy, and Jordan’s much-loved, sensitive teacher, are likely to have helped him to internalise a new model of human relationships: one in which there can be trust, warmth and safety. Margaret Rustin later spoke of the experience of containment which may be provided by the observer/film-maker: “being given house room in the mind of another person across time.. such a relationship provides a basis for development in the individual based on identification with the enquiring, holding, meaning-giving function of the observer or film maker”.
Hopefully, Jordan might be able to draw on this new model of relationships, given meaning through the emotional containment provided by both Paddy Wivell and Jordan’s teacher, to help him to form supportive relationships later in his life. However, as we all know, the impact of childhood trauma (particularly where family relationships remain conflictual and unresolved) can be significant and long-lasting, and therapeutic help hard to access. I think many of us at the conference feared that Jordan might go in the same direction as Troi, the subject of Paddy Wivell’s film on violence in prisons.
Troi, in Prisons, also suffered trauma in childhood. In the safe context of a prison rehabilitation group, Troi is asked to write about his childhood. This is an emotionally powerful scene, both for Troi, and us as observers. In a few moments, Troi moves from being ‘hard man’, using violence to stay ‘strong’, and be what others expect (having to “be someone”), to a state of vulnerability, wanting something different for himself in his life. The prison mentor is himself moved almost to tears. This is the beginning of hope for Troi.
Although the shift in Troi did not come about as a result of seeing himself on film, it came as a result of being ‘seen’ in the group, and being encouraged by the emotionally containing group leader and mentor to take on the ‘observer position’ in relation to himself by reflecting on his childhood. However, for Troi, despite the sense of hope in his mentor, and in us as we see him beginning to explore his vulnerability and another way of being, the therapeutic intervention was perhaps too little, too late. We see him being released from prison after serving his sentence, and his evident distress on leaving the community of relationships he has built during his stay. Prison has been a safe place for him – both physically and emotionally – but there has been insufficient support for the benefits to be sustained.
Practitioners of VIG are very familiar with the power of human connection, and the extraordinary power of being ‘seen and understood’ through using the video as ‘witness’. VIG clients make reflective comments that are profoundly moving: “I think it makes you realise you are doing well.. ‘cos you don’t see it normally. I feel like I’m doing something right” (mother of a 4-year-old boy who, prior to VIG, had been stuck in a negative narrative around both her son, and herself as a mother). Being seen, in the context of an emotionally containing relationship, is a force for change.
4. How are we looking, and what are we looking at?
Margaret Rustin raised this question at the start of her paper. She gave some in-depth analysis of infant observations where the observer and/or the parent’s feelings were powerfully influenced by their own life experiences, i.e. what they were bringing with them to the situation of being an observer or a parent being observed (with reference to Selma Freiberg’s seminal work on the ‘ghosts in the nursery’, 1952).
At times, observers may find themselves impulsively acting, and moving out of role – these may be opportunities to think about the emotional pressures which have led to this act, both within and outside the observer themselves.
She described how in infant observation seminars “members often feel drawn to identify with one person present during the observation” (this can include the baby, or, as above, when the observer found herself feeling protective towards the grandmother and the mother), “or they may feel their sympathies moving from one person to another sometimes at bewildering speed”. The range of responses in the group may reveal the ‘emotional currents’ present in the family life (as well as our own particular lens).
Margaret Rustin gave a poignant description of a mother, whose own mother had left the family when she was 9 years old, talking to the observer about fears that her baby and older daughter were blaming her as a ‘bad mother’. During the observation, the observer noticed that the baby shifted from being unsettled and crying, to engaging with mother in an animated way, which delighted both mother and baby. Margaret Rustin suggested that the conversation with the observer was containing mother’s misery, leaving a ‘good mother’ who could be attentive to her baby. The presence of an observer, consistently over a period of 1-2 years, can be transformative for the parent-infant relationship.
As with documentary film-making, the observer position is an opportunity to learn about oneself and one’s own responses. In infant observation, the seminar group can provide valuable emotional containment. In Paddy Wivell’s film-making, he tries to ensure that the subject views the film with him. Troi, in Prisons, was moved on too quickly for this to happen. Jordan viewed the film but at a difficult time, and Paddy was not sure what he made of it. We briefly discussed issues of consent and what it means for a child (or their parent on the child’s behalf) to consent to being filmed – and what meaning might the film have for the child as adult, later in life?
By contrast, in VIG, the exploration of the film is carried out within the safe therapeutic context of the shared review. As practitioners, we have the added learning opportunity in a filmed shared review of viewing ourselves and our interactions with our clients. As with infant observation, we have the opportunity to become aware of what we may be bringing to the relationship from our own experience, and where this may not be helpful therapeutically, the onus is on us to seek understanding and support in supervision.
5. Humility and not knowing
Margaret Rustin commented on the importance in infant observation of being aware of what we do not know, and what we do not see. She spoke of the “necessary humility” of the observer position.
In Boys and Girls, Paddy Wivell spent an initial period in the primary school, prior to filming, in a similar position of ‘not knowing’: trying to find his way and not being sure what might emerge, or when… In Prisons, too, Paddy spent time getting to know inmates and staff, waiting for something and a subject to evolve, being led by what happened. This state of not-knowing is often uncomfortable for observers/film-makers. There was agreement that this uncomfortable position is an important element of both infant observation and documentary film-making.
Margaret Rustin later linked the two methods (of infant observation and film-making) “as somewhat like a family relationship in their love of detail and their dependence on the closeness of their own human involvement, however disciplined that needs to be”.
Here, another link with VIG is the importance for the VIG practitioner, when going into a shared review, of being in a state of not-knowing, of humility, not having an ‘agenda’, but being open and curious about what the client sees, and the meaning this has for them. The love of detail is also relevant to VIG, as practitioners know through hours of microanalysis!
During the conference we recalled the seminal films made in the 1950s and ‘60s by James and Joyce Robertson, Young Children in Brief Separation, and also Lynn Barnett’s films Sunday’s Child (1985-2005), recording the development of a boy from infancy to 12 years. A final question arose about whether a current documentary about the parent-infant relationship, with little verbal commentary (as is a feature of observational documentaries), could be interesting for an audience? Are words necessary to convey the meaning, or could the film and soundtrack speak for themselves?
I think, in this era of increasing knowledge and concern about the impact of early experiences, further documentaries about the parent-infant relationship, which speak to the crucial experience for parents and infants of the early years, would be highly beneficial. I hope that a documentary film-maker takes up the challenge.
I have highlighted some of the links between the psychoanalytic process of reflective observation, documentary film-making, andVideo Interaction Guidance, including: the value of building a trusting relationship, the importance of being aware of our own responses and the other’s, of being sensitive to the impact of our own responses on the other, and being open to new meanings co-constructed with the other. Given these links, I hope there will be further collaboration between these disciplines to enrich our understanding.
Thank you to David Hadley and Marie Derome (both Child Psychotherapists on the conference organising committee) and Becky Wylde (Child/Adolescent Parenting Psychotherapist) for their comments on a draft of this article, and to the reviewers of Attuned Interactions.
The Association of Child Psychotherapists (ACP) is the professional body for Psychoanalytic Child and Adolescent Psychotherapists in the UK. See website for details of events, training and publications.
The Bridge Foundation is a Bristol-based charity providing psychodynamic clinical services to a wide range of individuals, professionals and commissioners. See website for details of events and training.
It is important to work with vulnerable families by promoting positive interaction and communication, in order to support better family dynamics and improve child development and wellbeing. Strained family relationships and poor attachment are acknowledged as having an adverse effect on child development and wellbeing (Doria, Kennedy, Strathie & Strathie 2014). Negative effects may be evidenced through low levels of resilience, internalising behaviours, or low self-esteem (Sheeber, Hops and Davis, 2001). These vulnerabilities can lead to parents being less able to prioritise their children’s needs and requiring statutory service involvement at the level of a child protection (CP) plan in some instances. This can trigger referral for interventions such as Video Interaction Guidance (VIG).
Through embodiment of the Principles of Attuned Interactions and Guidance (PAIG), VIG is a therapeutic intervention which promotes, and seeks to develop attunement through positive interaction and communication (Kennedy and Underdown, 2017). The PAIG inform the core values and beliefs of VIG, emphasising a ‘compassionate approach in which hope is maintained and trust is formed through building respectful relationships’ (Kennedy, Ball and Barlow, 2017: 3). VIG involves sessions of videoing created to capture the best possible moments between parent/carer and child. Each videoing session lasts for approximately 10 minutes. On first meeting, the VIG Guider and parent/carer will have a conversation regarding the goals the parent/carer wishes to aim for. The VIG Guider then edits the footage, selecting video clips including micro-moments and sometimes still pictures that best evidence attuned interaction between the parent/carer and child and which relate to the goals. The VIG Guider returns to the family home with the edited video for a shared review, wherein the VIG Guider and parent/carer carefully study the video clips, working together to understand what the parent/carer is doing to help build an attuned relationship with their child. This process of videoing and sharing is called a ‘cycle’ and there are typically 3 cycles in a VIG intervention. In some situations, 1 cycle is all that is needed for people to change their perceptions, start to progress towards their goals and then they can continue to work on them independently.
The use of VIG
Doria et al. (2014) conducted a study exploring what makes VIG successful. Their qualitative research sought the views of families, guiders, and supervisors. All of the families were considered vulnerable at the time of VIG commencement. One of the factors mentioned by both families and guiders as contributing to VIG’s success was the study of micro-moments of video. This process can ignite recognition of the emotions in the interaction, which subsequently increases empathy and positive attitude change towards the child. Additionally, a significant impact on the lives of the families was described, including increased feelings of happiness, self-esteem, self-efficacy, and behavioural and attitude change. Overall, it was deemed that the video playback and exploration of the video, which challenges preconceived negative self-perceptions, may be the ‘underlying mechanism’ (Doria et al. 2014: 85) to VIG’s success with families.
In 2015, The National Society for the Prevention of Cruelty to Children (NSPCC) published a report evaluating the findings of a VIG intervention offered to families where there were concerns about child neglect (Whalley and Williams, 2015). The impact of VIG was measured using the parent scale from the Strengths and Difficulties Questionnaire (SDQ) and Parent Child Relationship Inventory (PCRI) and they explored the barriers and means to success. Their results were positive overall. The SDQ scores showed significant improvements in the children’s emotional, hyperactivity and conduct problems. Parents expressed experiencing positive outcomes, including increased 1:1 time with their child, improvements in the way in which disputes were resolved and the way in which they disciplined their child, as well as greater encouragement for the child to make choices.
Referrals for VIG for families subject to CP plans are made for a variety of reasons. For some this can be done in an effort to help a family get out of a negative pattern of going onto, coming off and then going on to a CP plan repeatedly over years, by focusing more on the child’s perspective. It can be requested to help parents gain confidence after previous children have been removed and where the family are in a better place to parent their next child. For others it can be an effort to prove that all has been tried when a request for removing a child is being made through the legal system or at the request of the Children’s Guardian during court proceedings.
The primary aim of this current research project was to investigate whether VIG has a positive impact for families where at least 1 Child was subject to a CP plan at the point of referral. This work was carried out to ensure that VIG is appropriate and effective for this client group: to make good use of resources and to consider when it may not be beneficial to refer for VIG.
Historical data was obtained from all CP cases referred to the VIG Service in a Local Authority (LA) for the years January 2016 to July 2019. Cases were included if they had been subject to a CP plan at the time of VIG referral.
A total of 27 VIG CP cases were identified. 17 of those cases completed a VIG intervention, 2 cases had begun VIG but did not complete it (i.e. completed 1 cycle of VIG before the child was removed) and 8 cases were referred but did not proceed. The 27 cases were categorised as such (table 1.) and were subject to quantitative evaluation.
VIG incomplete before removal
Referred but VIG did not proceed
Number of cases
Table 1: Breakdown of VIG Service CP cases January 2016-July 2019
The five VIG Guiders who worked with the families were asked to consider the cases which had experienced positive change. Positive change was classed as a step down to either a Child in Need (CIN) plan or no LA service involvement. They were emailed with the single interview question, ‘What do you think went well for this/these particular case/s?’ and four of those guiders replied. Responses were then collated and were subject to thematic analysis, where common themes were identified.
Cases where VIG did not proceed were also analysed. Data collected from VIG relevant case notes and VIG referral forms were identified and a light, thematic analysis was performed.
Cases where VIG was incomplete were excluded from the analysis.
This mixed methods analysis aimed to investigate whether VIG has a positive impact for families subject to a CP plan and, if this is the case, what situations and circumstances at the time of referral make this more or less likely. Results from the quantitative analysis will be discussed first, followed by two thematic analyses: the first, the retrospective views of VIG Guiders about the families who had positive outcomes; the second, a light, thematic analysis exploring the possible reasons for VIG referral and no intervention.
In regards to the Children in Care (CIC), 2 were placed into care during the VIG intervention, suggesting that court proceedings were already underway at the time of referral to the VIG Service. 1 child was placed into care 2 years and 7 months after the VIG intervention.
The mean number of cycles for all groups was 3 and the average length of VIG intervention for all groups was 6 months.
As shown previously in table 1, a total of 17 families completed a VIG intervention. Of those, 13 (76%) of the children currently live in the family home and 4 (24%) of children live away from their birth family. This proposes that VIG may help contribute towards keeping families together. A deeper analysis was conducted on the data for the children living in the family home, in order to gain a greater understanding about the impact VIG may have on CP cases.
Children on a CP plan
Children on a CIN plan
No current LA service involvement
Status immediately after VIG
Table 2: Local Authority Service involvement status of the children living in the family home immediately after VIG intervention and again in July 2019
After VIG completion, 9 (69%) of the children currently living in the family home were subject to a CP plan, and 1 child (8%) had stepped down to having no current LA service involvement. As of July 2019, children with no LA service involvement have increased significantly to 46%, and children currently subject to a CP plan have decreased to 46% compared to the immediately after VIG data. This suggests that, where families are kept together, improvements may be sustained and increased over time. It is worth remembering that each case varies in the length of time between VIG completion and July 2019, from three years and 6 months and for a few cases this date will be the same. These results indicate a positive trend and for those who have recently ended VIG, their improvements may also be sustained and continue.
Thematic analysis of the retrospective views of VIG Guiders provides a greater insight into how VIG may contribute to a positive outcome for these families.
Thematic analysis 1: The retrospective views of VIG Guiders
Five VIG Guiders were identified as those who worked with the families who are no longer subject of a CP plan, and where children are currently living in the family home. They were approached with the simple question: What do you think went well for this/these particular case/s? Four guiders replied and a thematic analysis of their retrospective views identified three common themes; focus on the child, parental awareness and self-efficacy, and proactive positive engagement. Each will be discussed in turn.
Theme 1: Focus on the child
All four of the VIG Guiders reflected on improvements in parents’ focus on their child.
‘…worked on waiting more and allowing her child to lead’ VIG guider 2
‘…it helped her to focus on the experience of this child amongst the chaos and she prioritised him but also learnt to contain his feelings…’ VIG Guider 3
‘…helping him to feel held and have space’. VIG Guider 3
‘The parent changed her view of her child and was understanding him better.’ VIG Guider 4
The views of the VIG Guiders suggest that VIG improved the relationships between parent and child, and in different ways. Parents were seen to be prioritising their child more and viewing things from their child’s perspective. Some parents also developed the confidence to give their child space and to let them take the lead. Additionally, taking part in VIG improved a parent’s perception of their child, enabling the parent to better understand them.
Theme 2: Parental reflection and self-efficacy
Parents were described, by three VIG Guiders, as gaining self-efficacy through self-awareness and self-reflection.
‘…[she] could recognise the positive times that she thought were missing’. VIG Guider 1
‘…she noticed her strengths…’ VIG Guider 2
‘…became more aware of his [parent’s] communication style and how he was perceived by others.’ VIG Guider 3
‘He was able to talk about his own learning and ADHD and past school experiences and explore and then repackage some of that in a more positive light.’ VIG Guider 3
These views suggest that watching back their videos during the shared review prompted parents to self-reflect, and gain greater self-awareness. This not only improved their relationship with their child, but also their relationship with themselves i.e. VIG impacting positively on parental self-esteem. The theory of video-confrontation in VIG proposes that parents who lack confidence in their abilities are ‘confronted’ through play-back of their video, challenging their negative self-efficacy (Cross and Kennedy, 2011). There is clearly some evidence of this, with one Guider stating that a parent noticed their strengths, to another stating that a parent was able to reflect on, and explore, some of their life experience so far, to ‘repackage some of that in a more positive light’. VIG may therefore improve parent self-efficacy, through self-awareness and self-reflection, gained through the shared review.
Theme 3: Proactive, positive engagement
Lastly, three VIG Guiders shared how parents had been committed to VIG and engaged proactively in the process. For one Guider, their own engagement and relationship with the parent was significant, in order to provide the parent with the reassurance and trust to talk about his strengths.
‘…although mum was very hesitant to undertake VIG – she reported that she was very pleased that she had decided to take the offer…’ VIG Guider 1
‘…she […] received positive peer observations well and contributed positively to [a] group shared review.’ VIG Guider 2
‘Mum really signed up and wanted to do it. […] She didn’t have to do VIG as part of the CP plan, but it linked well to the reason for concern.’ VIG Guider 3
‘Providing a positive professional relationship through VIG meant he could become a participant and he was able to talk about his strengths’. VIG Guider 3
Despite there being initial apprehension for some, overall, parents engaged proactively and positively in VIG. For one parent, who was a member of a young mothers group, this involved taking part in peer observations and group shared reviews. For another parent, they had been really enthusiastic about taking part in VIG after seeing the outcome of a video intervention with their child in their pre-school setting. One VIG Guider’s own positive engagement with a parent encouraged the parent to ‘explore’ and learn during VIG. Empowerment and collaboration with families has been proposed as being a factor to VIG’s positive impact on families. One VIG Guider identified the contrast between the professional relationship between them and the parent, compared to his relationships with other involved professionals, as significant to his engagement in the CP process. This may be due to the Guiders’ wishes to solely share the improvements and outcomes their families made, rather than mention their own input. It is therefore unclear whether proactive engagement was encouraged as a result of the relationships the families had built with their Guider, or whether it was another form of motivation. Individual differences, such as personality, temperament, values, and self-esteem, are also likely to influence a family’s engagement in VIG.
Thematic analysis 2: Exploration of the reasons for no VIG intervention
As was identified in Table 1, 8 families were referred for VIG yet intervention did not begin. A light, thematic analysis identified two themes: complex family circumstances, and parent/carer not ready for VIG.
Theme 1: Parent/carer was not ready to engage in VIG
The most common theme identified four cases in which the parent/carer was not ready, or available, to engage in VIG. This was for various reasons, including soon moving out of county, anxiety, not feeling ready, and simply not wishing to take part. It is unclear from the case notes and VIG referral forms precisely why some of the parents/carers did not feel ready. However, it could be suggested that there may have been a lack of understanding and/or communication between the parents/carers and the professional who made the referral.
Theme 2: Complex family circumstances
The second common theme identified was that of complex family circumstances, including the child being placed into care. This was the case for 3 of the 8 families before the initial VIG visit could take place; 1 child was placed into care, 1 was adopted, and 1 was already subject to a Child Arrangement Order. This suggests that the referral for VIG was inappropriate, for both the families and the VIG Guider, due to the timeline of court proceedings i.e. court proceedings had begun at the time of VIG referral.
Of the 27 cases referred for VIG, 10 did not proceed. More than a third of all of the CP cases were allocated to a VIG worker, yet intervention did not commence. This is a significant resource issue. This would imply that more careful consideration needs to be made about which cases are referred. Some families did not have a chance to start the work as plans to remove their child were already well underway at the time of referral. Other families had not engaged: did not want it or did not understand VIG. Where time would have allowed it, perhaps more work prior to the VIG referral in order to help the family understand and explore the possible goals and outcomes of VIG and discuss their anxieties about taking part, could have addressed this and given more families the opportunity to benefit. The time available for this to happen could therefore be an indicator of whether or not VIG is appropriate for CP cases. Although VIG can be a relatively brief therapeutic intervention, it should perhaps be initially considered that, if decisions about placement may be anticipated to be made in less than 3 to 6 months from the point of referral, then a VIG referral is not appropriate at this time. Where there is a high chance that a child will be removed from the family imminently (i.e., soon after/before VIG has started), ethical dilemmas such as giving a family false hope, or encouraging closeness and bonding at a time when it is not expected that they will be able to stay together, needs to be seriously considered against how much impact can be realistically expected from a short term intervention. There should be very clear reasoning and agreed timescales for work to take place for any case referred for VIG which is already within the CP court procedures.
Despite the concerns regarding inappropriate VIG referrals, the quantitative analysis of the data collected on VIG CP cases, within the last three years, drew some positive results. In summary, the number of children with no current LA service involvement (July 2019) has significantly increased, in comparison to those currently subject to a CP plan. Of those who participated in a VIG intervention, 76% remained living in their family home. This suggests that VIG may help families to remain intact if referral for VIG is placed in a timely manner.
Thematic analysis of the comments from VIG Guiders, for cases currently living in the family home (with no current LA service involvement), identified the themes: focus on the child, parental reflection, proactive positive engagement and, as in Doria et al’s (2014) study, self-efficacy. Within these themes, it was recognised that parents demonstrated improvements in prioritising their child more, viewing situations from their child’s perspective, self-efficacy (through video-confrontation), and positive engagement during the VIG sessions. Partnership work is a core value and belief for VIG and, through positive engagement, authentic exploration may develop. Additionally, the light thematic analysis on the data of the families who were referred, but did not receive VIG intervention, revealed that over half of those referred were either not ready, or unable, to engage in VIG. Complex family circumstances, such as strained familial relationships and child in care placements, were also common. As such, it is important to be mindful of a family’s circumstances, relationships, and willingness before referring for VIG.
Future analysis of VIG CP cases may explore a longitudinal study involving a small group of families. This could provide a detailed insight into whether improvements after VIG are sustained over time for families who were subject to a CP plan on VIG commencement. Additionally, it may be beneficial to specifically identify families who are considered to be stuck in a repeating pattern of an on/off CP plan cycle, and investigate whether there is a break in this cycle after VIG intervention. It would also be advantageous to understand which of the themes were most influential in helping the cycle to change. Further study would also benefit from specifically investigating cases where previous children have been removed and how VIG helps a family in this situation to move forward positively with a new child. Finally, a study including a control group (e.g., of families in CP contexts who have turned down the offer of VIG), may provide the opportunity for comparisons to be made.
In summary some key points to conclude;
For those who had time to engage fully in VIG a high proportion have stayed together and over time further LA service involvement has continued to reduce and the cases have been stepped down
More work prior to referral or at the early engagement stage between accepting the referral and before attempting to start VIG, may increase participation for these particular families
From this current study data, where formal CP proceedings are already active i.e. where the social worker intends to pursue removal of a child, VIG does not appear to be appropriate and could be seen as unethical. This gives good reason for careful consideration and rejection of some referrals where court proceedings are already underway
VIG could be considered as part of a CP plan for cases already in the court arena, where the intended outcomes of VIG are clear, linked to the plan and where there is a considerable window of time in which the work can be meaningfully delivered. A case study from the VIG service of where this has happened and been seen to be helpful, could be available for future analysis
Cross, J., and Kennedy, H. (2011). How and why does VIG work? In H. Kennedy (Ed.), Video Interaction Guidance: A Relationship Based Intervention (58-81). London: Jessica Kingsley.
Doria, M., Kennedy, H., Strathie, C., and Strathie, S. (2014). Explanations for the success of Video Interaction Guidance (VIG): An emerging method in family psychotherapy. The Family Journal: Counseling and Therapy for Couples and Families. 22, 78-87
Kennedy, H., Ball, K., and Barlow, J. (2017). How does video interaction guidance contribute to infant and parental mental health and well-being? Clinical Child Psychology and Psychiatry. 1-18. DOI: 10.1177/1359104517704026
Kennedy, H., and Underdown, A. (2017). Video Interaction Guidance: Promoting secure attachment and optimal development for children, parents and professionals. In P. Leach (Ed.), Innovative Research in Infant Wellbeing (224-237). London: Routledge.
Sheeber, L., Hops, H., and Davis, B. (2001). Family processes in adolescent depression. Clinical Child and Family Psychology Review. 4, 19-35
Whalley, P., and Williams, M. (2015). Child Neglect and Video Interaction Guidance: An Evaluation of an NSPCC Service Offered to Parents Where Initial Concerns of Neglect Have Been Noted. NSPCC.
“One of my children was in crisis, failing crucial end of year exams in her chosen uni course and, in her despair, wanting me to take over and make the decisions for her. Should she ask to delay a year and retake exams? Drop out and try to find work? Give up and come home to rest until she felt stronger? Despite her distress I felt instinctively that to take over would be the wrong thing to do and that this was going to be the most important conversation we had ever had. In that moment I consciously thought about my VIG training – what would empower her to decide how to move forward for herself, so she could own and commit to her plan, and regain some self-respect? I realised I needed to do ‘VIG without a camera’ in that conversation. In other words, I needed to pay close attention, encourage her to make initiatives, show I’d really ‘received’ what she said before I responded….” In their accreditation Reflective Statement many VIG (Video Interaction Guidance) trainees describe how the skills they’ve learnt in their VIG training have spilled over into other areas of their lives, both personal and professional – in other words, they can now use ‘VIG without a camera’.
– I (Miriam) was fortunate to be included in a women entrepreneurs’ coaching group, organised by Fiona. The coaching group aimed to create a safe space for women entrepreneurs to share the challenges they were facing in their businesses and to receive coaching and encouragement from peers. The agenda for sessions was in part co-created at the start of the programme and in part emergent based on the issues the participants shared. In particular, the session on ‘change-making conversations’ rang many bells for me, both as an educational psychologist and as a VIG guider / supervisor.
– I (Fiona) valued the VIG perspective that Miriam bought to the session and noticed that the VIG values and approaches resonated with my business coaching and consultancy practice.
The two of us decided to co-author an article exploring the overlap between our influences and practice in the area of facilitating change, with a view to discovering fresh possibilities in each of our fields.
Key aspects of VIG
Video Interaction Guidance (VIG) is a therapeutic intervention for bringing about change in a client’s important relationships, by focusing on strengths. It is an empowering, respectful and optimistic way of working with others. The guiding hierarchical framework is called the ‘Principles of Attuned Interactions and Guidance’ (PAIG) (Kennedy, Landor & Todd 2011). These Principles can be summarised as: giving attention; encouraging initiatives; receiving and responding; developing attuned interactions; guiding; and deepening reflective discussion. There is also an adaptation of VIG for supporting professional development, Video Enhanced Reflective Practice (VERP) (Kennedy, Landor & Todd 2015). In VIG and VERP clients create a ‘helping question’ (HQ) that helps to focus their inquiry around their goal for change. In VIG, the guider takes a short video of the client and their interaction partner in an everyday situation. The video is then edited into short ‘micro-clips’, which relate to the client’s HQ, which show an exception to the usual pattern (‘better than usual’), and which exemplify elements of the PAIG. These clips form the basis for a ‘change-making conversation’ (‘shared review’ SR), reflecting on the skills the client already demonstrates, even if fleetingly, and from there co-constructing new meanings and pathways for action. VERP shares the same principles and values, but here the professional, with the guidance and support of a VIG-trained guider, videos themselves in a typical workplace activity and finds moments where their attuned interaction moved them towards their desired outcome, or HQ. They then take these clips to a Shared Review Meeting with a VIG-trained guider for a reflective strengths-based discussion, or SR, where together they micro-analyse ‘what works well’. The background and development of VIG was laid out in a special edition, Video Interaction Guidance, of the journal Educational Psychology in Scotland (The British Psychological Society, Scottish Division of Educational Psychology, 2014).More examples of how VERP works can be found in Doria (2015) and Strathie, Strathie and Kennedy (2011).
How VIG works
In order to develop a more attuned relationship – which is the foundation of learning and development, and of motivation and behaviour – we need to unpick the building blocks of attuned interactions. This is expressed through intersubjectivity theory (Trevarthen & Aitken 2001; Trevarthen 2011), where ‘subjects’ (i.e. people) attune themselves to their interaction partner. This has been shown to happen from birth onwards, by using non-verbal, affective and verbal means of expression and reception. The behaviours contributing towards intersubjectivity are described in the Principles of Attuned Interactions and Guidance (Biemans 1990) – see above. The VIG guider micro-analyses video to discover these elements in their client’s natural style, in order to support them to make changes towards their goals (HQ).
According to Vygotsy’s Zone of Proximal Development (ZPD; Vygotsky 1962 ) and Bruner’s scaffolding theory (Bruner 1996), learning takes place with the sensitively adjudged support from a more expert other. The ZPD can be visualised as a continuum, from the point at which a learner can achieve a goal only with maximum support from a more experienced other, to the point at which the learner can achieve the goal entirely independently; therefore all teaching and learning takes place within the ZPD. ‘Scaffolding’ refers to the way in which this support is delivered to the learner, like the scaffolding that supports a building until it can stand alone. Bruner describes this scaffolding for learning as being sensitively adjudged and delivered – responding appropriately to the need in the moment, rather than pre-formulated. For example, an adult helping a child learn to ride a two-wheeler bicycle will first run alongside holding the handlebars and the back of the saddle; once the learner seems steady they begin to withdraw support, letting go of the handlebars first, but they remain alongside to take hold again if the learner wobbles. A VIG SR follows this kind of learning model; the client is supported to be active in their own change, by the VIG guider’s position of curious exploration and receiving (i.e. ‘activating’ the client’s own resources) whilst sensitively judging whether they need to support more strongly by giving information (‘compensating’ for a lack of knowledge). An example of ‘compensation’ follows: a mother who is frustrated by the clinginess of her toddler when she’s trying to foster independence by pushing the child away may be helped by having attachment theory explained to her – that a securely attached child will explore independently only from a safe base, when they feel supported and protected. The video is like a third person in the VIG SR, being given equal ‘turns’ in the discussion and providing objective ‘evidence’ of the skills the client already has in their behavioural repertoire, and of the subsequent impact on the client’s interaction partner.
Another of the learning theories on which VIG is based is Bandura’s social learning theory (Bandura 1977). Stated simply, we learn from observing others who are more experienced than ourselves. Figueira (2007) demonstrated that learning is enhanced when the model more closely resembles the learner, which leads us to ‘video self-modelling’, where the model is the learner themself, captured on video in moments where they are achieving their goal more successfully than usual. Fullan (2011) suggested that in order for change to take place, there must be a balance between support and challenge – if a person is wholly supported there is no need for them to change, and if a person is too strongly challenged, they become self-defensive and can’t open themselves to change.
In this article, we suggest that the skills the experienced VIG guider becomes adept in using can support ‘change-making conversations’ even without their camera.
Why we used the term ‘change-making conversations,’ not ‘difficult’ conversations?
The participants in the women entrepreneurs’ coaching group co-created the programme’s agenda by identifying areas of their practice they wanted to grow and strengthen. Many wanted to improve their ability to skilfully engage in ‘conflict,’ ‘difficult conversations,’ and ‘challenging conversations’.
We intentionally chose to call these ‘change-making conversations’ rather than challenging or difficult conversations. When we mentally label a conversation as ‘challenging’ or ‘difficult’ it can generate a set of thoughts and assumptions about how the conversation will be. This in turn can trigger emotions such as anger, fear and defensiveness (Joseph Grenny, HBR, 2019). These emotions can generate a powerful ‘away’ state in the brain – which interferes with our ability to have an attuned, attentive conversation in which we co-create outcomes (Rock, 2009).
These ‘change-making conversations’ bear a strong resemblance to the ‘VIG without a camera’ discussions, which skilled VIG guiders find themselves using so effectively.
So, what’s going on in the brain when we have a conversation that feels ‘challenging’?
Basic human survival mechanisms mean that the brain is constantly scanning the environment for threats and rewards. The brain will attempt to influence us to move away from threats. The existence of threats is believed to put people into what Rock terms an ‘away’ state (Rock, 2006) and what others call an ’avoid’ state (Chaskalon, 2011). Equally, the brain will attempt to influence us to move towards rewards.
In evolutionary terms this basic threat and reward response was designed to enable rapid, focused reaction to physical threats such as risk to life. The general responses to a physical threat are ‘fight’ or ‘flight’. When we experience threat, the emotional centre of the brain (particularly the amygdala) is activated, which in turn releases transmitters that trigger a stress response in the body. This stress response takes blood, oxygen and glucose away from other body functions in order to prepare the body for action. This includes taking resources away from the part of the brain which is responsible for logic and processing new information, which creates distortions in thinking and perceiving.
Our understanding of the brain and body’s response to physical threats is not new – what is new is research indicating that the brain and body responds in the same way to social threats (Lieberman & Eisenberger, 2008; Arnsten, 1998; Rock, 2009). Social Cognitive Neuroscience has established that the brain uses similar circuits to handle social pain as it does to handle physical pain. Social pain – such as a conversation which feels threatening or risky – activates the brain threat circuitry far more than might be expected (Leiberman, 2007). This means that the more people feel socially threatened, the less they are able to think analytically, tune into the emotional needs of others and solve problems creatively – all the things that we need to have ‘change-making conversations’ (Arnsten, 1998; Rock, 2008).
How can we create the conditions for a ‘towards’ state in a change-making conversation?
David Rock created a framework termed ‘SCARF’ to help create the conditions for remaining in a ‘towards’ state in ‘change-making conversations’. SCARF is an acronym for Status, Certainty, Autonomy, Relatedness and Fairness. The elements of SCARF share many attributes with the values and methodology which underpin VIG. In the table below we explore the underlying principles that lead to the core practices in coaching and in VIG, which in turn create ‘towards’ states in change-making conversations.
Table: Exploring SCARF principles and practices from coaching and VIG perspectives.
SCARF (Rock 2008)
Business coaching descriptors
Links with elements of VIG
Status refers to one’s sense of importance relative to others (e.g. others in the conversation). If we feel less important than others around us, we are more likely to move towards a threat state. Giving others the chance to express their perspective, listening attentively to others, letting others know we’ve heard them by summarising and recapping all help to create a ‘towards’ state in conversations.
The underpinning values of VIG are: Respect, Trust, Hope, Compassion, Appreciation, Connection, Empathy. The VIG guider aims to embody these in all their dealings, thereby helping to create a ‘towards’ state in ‘change-making conversations’.
Certainty refers to one’s need for clarity and the ability to make accurate predictions about the future. How we invite people into conversations and how we structure conversations creates or removes certainty. The invitation of, “I think we have different perceptions about x and I’d like to hear your thinking” has a different impact to “I’m not happy with the way you’re doing x and we need to talk about it.”
Preparing for the SR involves: – the physical setting (ensuring equality of access); – non-verbal activity (warm, inviting, listening stance) – verbal initiatives and responses (introducing or recapping the HQ, the parameters of the SR, etc); – mindful state (ensuring own readiness to be present for the client).
Autonomy is tied to a sense of control over events in one’s life and the perception that one’s behaviour has an effect on the outcome of a situation. Hosting conversations in a way which assumes we don’t have the answers but can co-create solutions together creates autonomy.
Co-creating through ‘7 steps of SR’ – that is, showing video clip; giving space; offering client first turn; receiving client’s response verbally, nonverbally, affectively; tentative offering of own thoughts and checking for understanding; attuned interactions; co-creating new deeper understanding.
Relatedness concerns one’s sense of connection to and security with another person. Deep listening, acknowledging and appreciation build relatedness.
VIG is a relational and strengths-based intervention: through attending and receiving, VIG guider models attuned interactions and builds rapport with client.
Fairness refers to just and non-biased exchange between people. Giving people the opportunity to speak first, listening, playing back what has been heard, acknowledging and appreciation all contribute to creating a sense of fairness.
PAIG cover these elements too: giving attention, encouraging initiatives, receiving and responding, developing attuned interactions, guiding, and deepening reflective discussion.
Back to the group and their ‘change-making conversations’
Going back to the women entrepreneurs’ coaching group, and their ‘change-making conversations’, Kirsty (not her real name) came to the session to discuss a challenging conversation that she knew she needed to have. Kirsty runs her own business, dislikes conflict and actively avoids ‘difficult’ conversations. She knew it was an area of her leadership practice that she needed to explore.
She had recruited a new member of staff called Richard (not his real name), and after a year it was not working out. She had hoped Richard would become her deputy and ‘hold the reins’ when she was out of the business. This had not happened – and Kirsty could now only see what he was not doing, what he was weak at and how he had not lived up to her expectations. In her mind the best option was for Richard to go – and she just needed to get it over with and tell him this. She noticed that whenever she thought about the conversation, she felt anxious and fearful. She had labelled it as a ‘difficult’ conversation and didn’t know where to start.
During the session we introduced Kirsty to a 9 Step Framework for having a ‘change-making conversation’ in a way that created the conditions for both people to stay in a ‘towards’ state’. The 9 Step Framework provides a structure for two or more people to engage in dialogue about something that needs to change. The Framework is informed by Fred Kofman’s work (see references). We invited Kirsty to work through the Steps and think about how it might reshape the conversation that she wanted to have with Richard. Here is the 9 Step Framework and how it played out for Kirsty:
Step 1: Invite the other person to give their point of view. Listen carefully and attentively, with the intention of understanding their perspective.
Kirsty’s belief about the intent of the meeting shifted. She moved from seeing it as a pre-scripted ‘tell’ to a two-way exploration of how both parties perceived the situation. She ‘dialled’ down the volume of her story and what she wanted to say, and acknowledged and got curious about Richard’s perspective. This shifted her sense of what the ‘truth’ of the situation was and helped her take a more open-minded stance.
Step 2: Ask questions to deepen your understanding of the other person’s perspective.
As Kirsty opened to the idea that there were multiple perspectives, she got curious about Richard’s perspective and what assumptions she was making. She noticed that asking Richard to speak first made the conversation feel more equitable.
Step 3: Play back what you’ve heard in a clean, objective way to check your understanding and reassure the other person that they’ve been heard.
Kirsty noticed how in previous conversations she had moved on without checking whether what she thought she had heard was what was said. This had led to misunderstanding which made the conversation less open and more defensive.
Step 4: Validate and appreciate the other person.Challenging conversation triggers the brain’s alert system which makes us more likely to fight, flight or freeze. Appreciation (even if it’s just for small things) tells a person that it’s safe and this helps people to think resourcefully and creatively.
Kirsty started to pay deliberate attention to what she appreciated about Richard and what strengths he brought to her business. She got curious about what it would look like to create space for him to play to these strengths more often. She noticed she was increasingly able to see what she valued about Richard instead of simply zooming in on his weaknesses.
Step 5: Share the issue from your perspective, speaking in the first person using “I”. Phrase things in ways that allow for a different point of view, e.g. ‘I perceive…’, ‘my view is…’
Name the issue – be clear, simple and precise.
Offer evidence of the issue that the other person will recognise, so they understand what you’re seeing and responding to.
Describe the perceived impact on you/the business/your customers/the person.
Share your emotions – “ I feel…”
Identify your role in the issue and/or how you might have contributed.
State your ideas for resolving the issue (with no blaming).
As Kirsty viewed the situation through Richard’s eyes and appreciated Richard’s contribution, she began to reframe the issue and change her ideas on how to move forward.
Step 6: Invite the other person to ask questions to deepen their understanding of what they have heard.
Step 7: Ask the other person to play back what they have heardto check their understanding and give you reassurance that you have been heard.
Step 8: Work together to create solutions that meet both person’s needs.
By this stage Kirsty realised that there were far more options available to her than she had previously considered. Her stance changed from the outcome being ‘firing’ Richard to being open to creative options that would emerge during the meeting.
Step 9: Agree actions, ownership and timescales.
Throughout the conversation: Monitor and manage your own emotional state. If you notice yourself getting triggered, breath and mentally name what triggered you.
These frameworks (SCARF and 9 Steps), which led to the positive outcome for Kirsty, have much in common with ‘VIG without a camera’. Their key features mirror the PAIG – paying attention and feeling curious, inviting initiatives, receiving initiatives by summarising and checking understanding, giving own view and checking for understanding, developing an attuned interaction and co-constructing a deeper meaning. And what was the outcome for the daughter in the opening paragraph? Due to the VIG trainee’s careful use of ‘VIG without a camera’ (wondering, encouraging, receiving, supporting and tentatively challenging) she decided for herself to get a pub job near uni, study and retake the exams the following year. By the way, she now has a PhD!
I (Fiona) am curious about how ‘VIG without a camera’ can be used to build people’s capacity in the workplace. Most business-related strengths-based approaches assume that people have areas of strengths and areas of non-strength – and that there is little to be gained from trying to develop areas of non-strength. VIG’s perspective that strengths are exceptions to the usual pattern (‘better than usual’) creates greater possibility for change.
More broadly, I am struck by the absence of attuned conversations in many organisational settings and the possibility that Principles of Attuned Interactions and Guidance could form the basis for building better (and more human) dialogue.
I am also curious about how VIG and VERP (with a camera) can be used to enhance business coaching and leadership interventions. The presence of video could provide a powerful third perspective in 1:1 coaching work, providing objective ‘evidence’ of the skills the client already has in their behavioural repertoire. This may be particularly powerful for clients who do not have models in the organisation to learn from (e.g. most groups who are underrepresented in organisational leadership such as women and Black and Asian leaders). The absence of models who look like them within the organisation means self-modelling becomes a potentially important form of learning.
(Miriam) I was struck by the overlap between the VIG elements and the coaching stance – and the extent to which some business coaching practices contain elements of ‘VIG without a camera.’ I too can see opportunities to blend both approaches. At the simplest level, leadership coaches can engage VIG guiders to deliver VERP sessions to their coaching clients, 1-1 or in small groups. The Association of VIG UK website (www.videointeractionguidance.net) has a register of accredited VIG guiders. When the leadership coaches fully appreciate the synchrony between coaching and VIG / VERP they may subsequently undertake VIG training themselves, so they can incorporate VERP, and VIG for professionals, in their ‘toolkit’ of practice. Once they have internalised the VIG way of thinking and interacting, through initial training followed by a period of supervised practice, they too may find themselves employing ‘VIG without a camera’ as they help leaders develop more attuned interactions in their organisations.
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In this paper I will reflect upon my journey and experiences in delivering Video Interaction Guidance (VIG) interventions to families with complex needs who are known to a multi-agency Children Services team. I will reflect upon some of the difficulties I experienced in contracting VIG interventions and also on the benefits and challenges in working alongside other professionals with VIG. Reference will be made to mentalisation based approaches and links to working in a multi-agency manner.
What is VIG?
Video Interaction Guidance is an intervention which aims to improve communication and relationships for carers/parents and their children. Carers or parents work with a VIG Guider registered with Association of Video Interaction Guidance UK (AVIGuk) to review and discuss short video clips of their personal interaction. VIG aims to help carers/parents become much more aware of their effective communication through a process of viewing themselves and reflecting on what they observe on film. The Guider aims to empower participants in the process of change by exploring perceptions and assumptions, and building on their strengths. Relationships, interactions and behaviour can improve as carers/parents develop greater understanding and where appropriate adjust their communication style. Typically key ‘helping questions’, similar to hopes from the intervention, are named by the carer/parent and focused upon throughout. In working with older children, helping questions can also be gained from the young people themselves, involving them in the process of change by helping them to reflect on their communication and interaction style with their carer or parent.
The Family Recovery Project
The Family Recovery Project (FRP) is a multi-agency innovative team working with families with historical and recurrent complex needs, which may include school refusal, children at risk of going into care, substance misuse and unemployment. The project is funded by the local authority’s Troubled Families governmental programme, which is a national funded initiative (2012-2020) set up by Dame Louise Casey; please see link https://www.gov.uk/government/news/troubled-families-programme-annual-report-published for further information on the programme. The programme aims to support the families who are most marginalised in society and facing issues such as poor housing conditions, unemployment and parental physical and mental ill health.
FRP in the local authority I work in aims to build resiliency and long lasting change in families by developing a strong partnership with carers. The team consists of a large number of outreach workers who build up the key role with carers and children, and a number of multi-agency services including police, health visitor, adult mental health worker and child psychologist (my Educational Psychologist role). FRP emphasises the importance of not just building relationships with families but also building effective partnership working with professionals that are involved with the family, hence multi-agency working is at its core.
Evaluation of impact is key to the team’s role, given the funding for FRP is short-term. Managers have a key responsibility in using information gathered by the team’s two data analysts, to demonstrate positive outcomes and sustained impact on families.
The Child Psychologist role (part time to the team 0.5) provides support at training, consultation, assessment and intervention levels to the FRP team. One key development in the last two years has been the offer of VIG to families; this is now a key psychological intervention on offer.
The offer of VIG within a multi-agency team
Families known to FRP each have an outreach worker, acting as the key lead professional to the family. Outreach workers can deliver direct work with carers/parents on aspects of their parenting as well as help them to engage in community services. Each family has a Care Plan co-written between the outreach worker, carers and wider team. This is reviewed every 6 weeks, detailing what targets are being worked on by all in the network.
At the start of my VIG journey, I held twilight sessions and shared several resources to support my team’s knowledge and understanding of attunement principles and information on VIG. Together, the pathway below was developed to support and encourage VIG referrals:
I quickly learnt and experienced that it was through attending Team Around Family (TAF) meetings or even informal consultations with colleagues that VIG was identified for families, rather than colleagues directly requesting this support. Over time, as colleagues experienced VIG more, direct requests were made, which was encouraging and highlighted colleagues’ learning and appreciation of VIG.
In line with principles of FRP in effective multi-agency working, I started to think what this could look like in my team in regard to VIG but still be in line with VIG core principles and practice. Multi-agency working in FRP, helping the network to understand and respond to a family’s complex and sometimes confusing behaviour, underlies the team’s professional practice. The team has received substantial training on Adaptive Mentalisation Based Integrative Treatment (AMBIT), focusing on using mentalisation based practices to support understanding not only of a family but also of the professional network (Bevington and Fuggle, 2012). AMBIT is a team approach in working with clients, in FRP’s case, vulnerable families. AMBIT recognises that the dilemmas professionals have in working with clients with complex needs often generate high anxiety in the worker. AMBIT pays attention to both the worker’s ability to develop a therapeutic relationship with the client but also there is a strong focus on teamwork, incorporating a ‘team around the worker’ approach and not just ‘team around the child’.
Mentalisation refers to the imaginative activity of making sense of the behaviour of oneself and of others on the basis of intentional mental states such as desires, feelings and beliefs (Allen et al., 2018). Almost all aspects of social interaction entail the capacity to mentalise: to understand the other person’s behaviour in terms of the activity that has taken place inside their minds – that may provide a good explanatory model of their actions (Fonagy & Allison, 2012). In regard to many of the families working with FRP, often their behaviour can be very challenging and difficult to understand, therefore mentalisation can be a helpful framework to explore this behaviour and attempt to understand it from the person’s perspective in hope of identifying some ways forward. In addition, mentalisation of different aspects of a professional network is encouraged to support and develop multi-agency working e.g. why may be leading the social worker/school to take X action?
Offering consultations to outreach workers, helping them to reflect and mentalise, often at times on a large and complex network, is a significant part of my day-to-day work. Over time, I became curious as to how VIG interventions on offer could support outreach worker colleagues in helping to mentalise further the parents’ inner worlds. Therefore I was keen to involve colleagues as much as possible in VIG rather than it being seen as a stand-alone intervention.
In VIG Shared Reviews, a key aim of the experience is for the VIG Guider to encourage the parent to mentalise him or herself as well as his or her child in the interaction. This is detailed by Item 12 on the Skills Development Scale, Naming and Receiving the Process. The VIG guider helps the parent to reflect and identify key emotional states, thoughts and behaviours from what is seen on video. However, what is important both in line with VIG principles and with mentalisation based theories is that we can only begin to mentalise when we feel emotionally contained and not at threat. Therefore in the VIG Shared Review, the Guider works hard to receive the parents’ responses, behaviours and emotional states in order to enable a secure and safe space to develop. This may involve naming internal states that the VIG Guider may be experiencing as well as naming responses observed in the parent. In essence, when the parent feels mentalised by the VIG Guider, he or she may be more likely to mentalise his or her child and their relationship.
Contracting VIG with families
In offering VIG now for over 2 years, I have experienced that the more families can identify how VIG may be beneficial for them at the contracting and consent initial stages, the more likely a safe and working space will be developed. FRP works on a consent based model, therefore it is not statutory that parents have to work with the team. However, families can feel ‘directed’ by their social workers or other referrers to comply in working with FRP. This can make it harder for FRP professionals to establish honest, safe and working partnerships with families, if families are feeling anxious and in two minds about working with an intensive home visiting service.
With regard to VIG, I have experienced the importance of gaining informed consent from families for the work providing a space to consider what may be the benefits and risks of engaging in such work. I have found the videos from Kent Psychology Service (https://www.youtube.com/watch?v=YRVaL_ZlxHs) and Bolton CAMHS (https://www.youtube.com/watch?v=dpSHHS_YMLE) really helpful in explaining VIG to families, perhaps more so than any recorded written information. I have found taking one to three sessions to explain VIG, ensuring parents and children have time to ask questions and address the practicalities of the work, very beneficial prior to starting the intervention.
Below are two reflections on cases I have worked with. All names have been changed for confidentiality reasons.
Anya and her three children were referred to FRP from Anya’s social worker due to concerns about some aspects of Anya’s parenting. Anya’s children were on a Child In Need plan due to physical abuse, having previously been on a Child Protection plan. A Child in Need (CIN) Plan is produced for a child who has need of extra support for his or her safety, health or/and development. This is underpinned by Section 17 of the Children Act 1989. Parents can decline access to this support as working with Children Services under CIN support is on a voluntary basis. A Child Protection (CP) Plan refers to the local authority’s assessment findings that a child is experiencing significant harm. A child would be defined under Section 47 of the Children Act 1989 as a child in need of protection; under CP, Children’s Services do not require parental consent for their involvement. The CP plan will name members of a core group of professionals and family members with the social worker as lead professional, setting out steps needed to safeguard the child.
Anya was engaging well with her outreach worker Emily at the time, the children’s school attendance had improved and Anya had started university. Anya could easily become stressed when parenting her middle son Ali, who she described as not being able to listen to her and not following her instructions. Anya’s ‘helping question’ (goal) at the start was for Ali to listen to her instructions more readily; we reframed this through our discussion as ‘How I can speak more calmly and be more calm with Ali?’ Importantly, Anya’s helping question was shared with Emily and the social worker at the time. The purpose of this was to ensure joint working in seeing how the professionals could support Anya working towards her helping question in their own work.
VIG took place within the home and consent was sought from Anya for Emily to take part in the Shared Reviews. In reality Emily was only present for the latter part of the Shared Reviews, as childcare could not be found for the other children so Emily was needed to support in this capacity. We used this experience, which seemed like a barrier at the time, for Anya to show to Emily her favourite clip at the end of our session and to reflect on her reasons together. In this way, I facilitated a space between Anya and Emily for their shared learning to grow. This became a powerful experience for Emily, seeing Anya on film being successful and using particular skills and qualities that were supporting communication with her son. I believe involving Emily in this way also reinforced several of VIG’s core values of trust, hope and cooperation. It also enabled Emily to further understand and make sense of Anya’s internal world e.g. her thoughts and beliefs as a parent, enabling mentalisation of Anya’s emotional states. Through supporting Anya to discuss her strengths, this enabled her to feel more empowered and instil hope that change is possible. Anya’s reflections and learnings were re-enforced in Emily’s direct session later in the week. Emily through her visits was also able to ‘look out’ for Anya’s helping questions and keep them at the forefront of her own work. One particular learning point Anya made was that speaking softly to Ali helped her to feel less stressed and also that repeating instructions to him would often escalate situations. Emily later worked with Anya on the importance of giving clear instructions to Ali and using simple language with him as a follow-up to this learning.
Maria was also referred to FRP by her social worker. Her son Tom was on a supervision order following being on a Child Protection Plan due to Maria’s history of substance misuse. Maria had made great changes to her life as part of her personal recovery enabling Tom to still be in her care. Maria’s confidence as a parent was very low and her concerns about building a positive warm bond with Tom were at the forefront of her mind, given she had lost an older child to the care system. Maria suffered from depression and was keen to ensure her low mood did not interfere with her son’s ability to interact with her. Maria’s helping question was ‘How can I show more playfulness with Tom?’
Maria gave consent for her outreach worker Lisa to be present at the Shared Reviews. A separate consultation was held with Lisa to identify her role in the Shared Reviews. Through this we contracted that Lisa would keep a listening ear to Maria’s reflections and then add her own observations when directly asked. The purpose of keeping to this structure was to ensure Maria’s reflections and ideas were highlighted first, in line of VIG values of respect and cooperation. This structure was overall successful. It was interesting that Lisa’s third pair of eyes always added an additional different reflection and observation. Through the Shared Reviews, Maria’s low confidence about herself and low self-esteem in regard to her physical body came through. The Shared Reviews allowed a space for Maria’s worries and anxieties to be a little more understood by Lisa. As a result, Lisa was able to follow up on these concerns through in her sessions in a sensitive and perhaps more person centred manner as Maria’s thoughts and beliefs about herself were more understood by Lisa. This enabled a more thoughtful and considered approach in identifying support for her in this area, rather than just ‘signposting’ her to services.
Evaluation of the VIG intervention highlighted that Maria felt more confident in her parenting skills and was able to literally ‘see’ that she had a positive and warm rapport with Tom.
In both cases both parents gave consent for their outreach workers to be present throughout the VIG intervention and fed back that this was a positive and supportive experience to them. From the outreach workers’ perspectives, attending the VIG Shared Review sessions helped them to learn more about the parents’ strengths as well as on the parents’ own internal world and that of their children. Both colleagues fed back this helped to give a focus for their own sessions either following up certain areas (such as with Anya, in developing ways to give clearer instructions) as well as addressing new issues that had not yet come to light in their work. These case studies highlight the effectiveness of multi-agency practice when professionals work together to support the parents’ helping questions.
In working alongside my colleagues I was mindful of doing my best to ensure parents could decline having their outreach worker present. I attempted to explore both the benefits and disadvantages or worries in having their outreach worker present prior to the VIG intervention and to support the parent to make their own decision. I felt this was important to address, as some parents could have felt obliged to consent to this. It is possible that despite my attempts, this may have nevertheless occurred for some parents.
Another challenge I encountered in one case was the outreach worker shifted from participation in the Shared Review process, to a potential ‘Guider’. This then meant the session became less in line with VIG Shared Review principles. This highlighted the importance of holding a pre session or sessions individually with the outreach worker helping him or her to identify their role in the Shared Review.
In some situations I felt having separate time alone with the parent and then inviting the outreach worker at the end of the session worked best. It would be interesting to gather further VIG guiders’ experiences in involving other professionals in Shared Reviews and perhaps to gather some feedback on different structures from VIG participants.
VIG evaluations in FRP have been very positive. Feedback from not only parents and their children but also outreach workers and social workers has been gained in line with FRP’s principles of multi agency working.
Several of these families have struggled to engage in community services; therefore the ability to offer VIG in the home and flexibly has been a strength. It is an example of community psychology in action, being flexible in working with parents and families adapting to situations as they arise. In addition, I have experienced that the use of video as a concrete resource has supported parents and their children to reflect, by giving a medium for them to communicate with me. Often, these families have struggled to engage in more traditional talking therapies and models including attending CAMHS sessions. It is as if the video acts as a safe object helping to bridge the relationship between the parent and child but also between myself as a professional and the parent.
In this paper I have commented upon my use of VIG with families involving other professionals in the Shared Review Sessions. Multi-agency working and ensuring interventions are not carried out in silo are I am sure principles most VIG Guiders would believe in. However, the process of involving professionals in VIG can be complex and touches upon ethical issues of consent and power dynamics. I have also reflected on mentalisation based models and its strong links to VIG, in particular the Shared Review Process. Gaining further reflections and experiences from VIG Guider colleagues working in multi-agency teams would be helpful to further develop evidence-based approaches in this area.
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Fonagy, P. and Alison, E. (2012). What is mentalization? The concept and its foundations in developmental research. In Midgley, N. and Vrouva, I. (Eds.). Minding the Child: Mentalization-Based Interventions with Children, Young People and their families (p. 10-34). East Sussex: Routledge
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
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
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
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
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:
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
ML: …and also I’m looking for a moment that
is perhaps the exception to what sheoften 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…
AL: He looks
at her and she makes a very big face and it…
ML: Yes she’s really receiving that look
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
perhaps the signal from Mum was yes it’s ok you can head-bump it
ML: yeah you can
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
AL: from where we started – 122 to 126. You can start here
ML: Yes because by now he’s more
AL: He says ‘gaga’
and she reacts to that.
ML: That’s a nice short clip as
AL: And here S. takes up the block and looks at it…
ML: …and he
AL: something 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.
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
Meo and Video Interaction Guidance use a framework of ‘principles’ to guide
them in their selection of video clips for their client:
Video Interaction Guidance – Principles of Attuned Interactions and
Guidance (2011 Kennedy Landor & Todd)
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
Looking interested with friendly postureGiving time and space for otherTurning towardsWondering about what
they are doing, thinking or feelingEnjoying watching
2. Encouraging initiatives
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
The adult confirms the child –
the child’s attention-focus, initiative and adds his/her own reaction
3. Receiving initiatives
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
The adult awaits the child’s
response / response to this reaction.
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
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
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
The adult confirms the child as
it shows desired behaviour
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
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
N.B. Sometimes you may see
examples of every point in just one micro-sequence [clip]
C. Review (Marte Meo) / Shared review (Video
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
Have I micro-analysed the video?
Have I checked that my client is ready to
Have I explained what I plan to do?
Have I negotiated the purpose of the shared
Am I ready to receive my client’s
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:
you are about to see and explaining purpose. Looking at the video-clips
tentative questions or sharing what you see
creating space for the client’s response
the client’s response. Mindful response to your own feelings. Respond naming
your own thoughts or build on the client’s ideas
reception of your statement. Support the client to think about it
and taking short turns between you, your client and video-clip
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
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.
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!
Marte Meo method for
school: supportive communication skills for teachers, school readiness skills
for children 2006 Josje Aarts. Eindhoven: Aarts Productions.
‘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,
‘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
Video Enhanced Reflective Practice: Professional Development through
Attuned Interactions 2015. Eds. Hilary Kennedy,
Miriam Landor, Liz Todd. London: Jessica Kingsley Publishers.
Reflecting on the importance of being present through use of Video Enhanced Reflective Practice (VERP)
by Megan Tucker and Anita Soni
VERP is an application of Video Interactions Guidance (VIG), and is now more frequently termed VIG with professionals. It is a strengths based approach which enables professionals to analyse their practice to reflect on ways to improve their communication, therapeutic or teaching skills through shared review of video clips of attuned interaction in their everyday practice (Kennedy, Landor and Todd, 2015). VIG and VERP are based on the values of respect, trust, hope, compassion, co-operation, connections, empathy and appreciation, and both utilise the same principles of attuned interaction and guidance. The principles emphasise the importance of waiting attentively, encouraging initiatives from the child and following the child’s lead through receiving their initiatives as the basis to intersubjectivity. It is anticipated the child-learning mentor relationship and the VIG guider-client relationship mirror each other in terms of communication within an attuned relationship.
Meg and Anita started using VERP as a way of reflecting on practice in January 2018. Although Anita had used VIG with parents, this was Anita’s first experience of using VERP with a Learning Mentor in a primary school and Meg’s first experience of VERP. Meg as a Learning Mentor provides support and guidance to children and young people to help them overcome social, emotional and behavioural problems which act as barriers to their learning. She bridges academic and pastoral support roles, through building professional helping relationships with pupils, ensuring that individual pupils and students engage more effectively in learning and are participating in the life of the school.
The following account has been written to reflect on the idea of ‘presence’ and what this came to mean to us, both for Anita as a VIG guider and Meg as a Learning Mentor.
Anita: I had been keen to develop the use of VERP within a primary school. The Headteacher encouraged me to present information about VERP within a staff meeting, and then for staff to choose to volunteer. Two staff offered to try using VERP, and due to difficulties with cover for both staff at the same time, it was agreed to work with them individually.
Meg: My focus was within the context of individual mentoring sessions. I had been seeing children in small groups and individually for 18 months but felt unclear as to how effective I was being.
Anita: I was excited to work with Meg as I have been using group supervision with Learning Mentors for the past six years, but felt it was time to develop new ways of working. VERP seems to offer a valuable opportunity for Learning Mentors to reflect on their communication and attunement to the children they work with.
Meg: The VERP process provided the opportunity to assess my interactions more objectively and positively, as my tendency is towards a negative view of the way I work. It also gave me an opportunity to consider the responses and cues of the children I was working with.
Anita directed me to the positive features of the clips we looked at. It’s strange that something so simple can be such a revelation. After the initial session I felt affirmed that I did have positive interactions with children and we could identify the ways in which these were created e.g. eye contact, timely nods or acknowledgements, using the child’s own language and repeating their own phrases back to them, amongst many other small positive communications both verbal and non-verbal.
Initially when watching the clips my attention was on myself, partly because it’s strange to see yourself and because I wanted to see what I thought about how I was working on playback. But over time I became more interested in the impact of my actions on the child.
Anita: I was aware from the initial training session, and other experiences of VERP and VIG, that there can be a reticence to watch yourself back on camera. I was also aware that the focus on better than usual moments can be challenging as one of the teachers had queried it in the staff meeting. I admit to having been unsure of both of these issues myself at the beginning of my training on VIG, but gradually through my own supervision and further experience, I had become more certain of the approach. I hoped to open up dialogue on both issues in the training, but was uncertain I had answered in a way that was helpful and not defensive. I also felt that both of these concerns can only be fully answered through experiencing VERP yourself!
Meg: I had understood from the staff meeting that the aim of VERP is to identify the positives in what you are already doing and then build on them. Certainly that was my experience. I realised I was using lots of helpful strategies to good effect. In identifying the strengths in how I interacted with children I was able to apply those strategies more intentionally and consider how to build on them to engage in deeper more reflective conversations.
However, although the focus is on strengths, whilst watching a clip I realised I wasn’t always present in the moment and this provoked me more than any other observations to think about my practise in the individual mentoring sessions and about what my intention should actually be.
While watching a clip with Anita I realised I had missed a cue from a child as they tried to volunteer a comment. I missed the moment. Similarly Anita commented on a facial cue from a child which I hadn’t registered. On further reflection I realised I hadn’t missed these opportunities because I was looking the other way or setting up an activity but because in my mind I was busily thinking about something that had just happened and also about where I wanted to get to in that session. Looking at myself in the clip, I appear present but there was a short section of the clip I couldn’t actually recall. I realised I had been on autopilot at various points.
Watching myself there were times when I could see myself disengage momentarily from the interaction. I worked out this was when I was thinking on my feet as I assessed how to respond to what the child was saying or maybe reviewing something from before the session or planning ahead to my next task. Previously I had been unaware of this shift in my attention.
Anita: I remember this as a key point in the second shared review with Meg. I was so impressed at Meg’s ability to reflect on herself, and her honesty in her reflections. I was genuinely curious to hear what she thought! It made me also stop and reflect on what engagement or presence is. It also made me stop and consider my own presence in work more generally, and specifically within VIG and VERP, and the points at which I was most present. I reflected that I find it easier to be present and fully engaged in the discussion as I have become more confident with VIG and VERP. However in VERP, I find I have to be more present as I don’t know what is coming. As an Educational Psychologist, I sometimes would over-prepare for meetings, and would have defined thoughts on where I felt the discussion should go and the outcomes of a successful meeting.
This led to a deep discussion on presence and how difficult this can be in the face of the pressure of measurable outcomes. I have been a teacher, and now spend time observing in nurseries and schools. Meg too is a teacher, and we are both highly aware of the pressure on outcomes, and moving children on in their learning.
Meg: Yes, as measuring outcomes has become so important in education, I have become more focussed on an outcome than what is currently happening in the room. I plan activities to achieve an objective, so I can show that I have addressed a particular issue. Or perhaps I perceive a number of steps I feel it would be helpful to progress the child or group through, but my attention is more on completing the current step in order to move onto the next one, rather than the children.
Anita: I was curious to consider how we can be both available and attentive, but yet hold in mind other key ideas.
Meg: I know it’s important to be planned and have an aim in mind but it’s equally important to be conscious of how that can steal my attention away from the current situation. It’s natural to have moments where you have to think on your feet. Watching my VERP clips I can spot my ‘thinking on my feet’ face. Seeing this in the clips I am more conscious that I may need to re-engage or still be watching for communication cues from the child, even as I try to strategize on the go.
I’ve also realised that it helps me to take a moment or two to collect myself before I start a session. I am then more able to leave aside what has just happened or will be happening later so I can focus on the present moment. Also meeting up with other mentors at school to talk and support each other as a sort of debrief has helped me stay present when working with a child.
Anita: Yes, we discussed practical ways of managing being fully present as this is when time can race past, but can also be emotionally quite draining. In some ways, I reflected that having a focus on an outcome can feel safer and easier!
Meg: The VERP process has also made me think about how the activities I plan can facilitate interactions and gently provoke more reflective and deeper conversation. Previously the exercise was often more about completion within a time frame. I’ve realised that it is hard work to enable easy conversation and that there’s real value in giving a child room to chat and respond in their own time. This can then naturally lead to a child volunteering more reflective responses. I’m learning to provide more opportunities to chat whilst engaged in an activity, as this seems to encourage or allow the child to lead the conversation but doesn’t have to have a strict focus or outcome.
Anita: This particular use of VERP has helped me reflect on how I further support staff working in schools to take a different perspective on outcomes. As Vermeulen, Bristow and Landor (2011) highlight ‘…an essential part of VIG guiding is being present in the here and now’ (p. 267) and is modelled for the parent. When using VIG with professionals or VERP, this same presence here and now is vital, but may contrast with approaches traditionally taken within my own field of education. I have come to see this mindful presence as not only central to VIG and VERP, but also highly applicable to other aspects of my work as an EP. However, alongside this, I have to recognise that it contradicts dominant models within education policy and practice, where the focus is on progress towards outcomes identified by teachers from within the curriculum. This in turn means this may be a very new way of thinking for professionals within education, although could be said to be aligned to person-centred planning. For me, I have come to realise that the discussion itself is the outcome, and if I (and indeed the Learning Mentor I am guiding) focus on being fully present then the outcomes will emerge.
Kennedy, H., Landor, M. and L. Todd (2015) Video Enhanced Reflective Practice: Professional Development through Attuned Interactions, London: Jessica Kingsley Publishers
Vermeulen, H., Bristow, J. and M. Landor (2011) ‘Mindulness, attunement and VIG’ in Kennedy, H., Landor, M. and L. Todd (eds) Video Interactive Guidance: A Relationship Based Intervention to promote Attunement, Empathy and Well-Being, London: Jessica Kingsley Publishers
Review of Conference Workshop: VIG with Mothers and Babies, Natasha Gray Hertfordshire Community NHS Trust
By Rachel Pardoe (Child and Adolescent Psychotherapist, VIG supervisor)
Natasha Gray (clinical psychologist, advanced VIG supervisor) and her colleague, Emma Custance (mental health nurse and trainee VIG supervisor),presented an evaluation of VIG work with mothers and babies, which was both impressive and inspiring. Natasha had set out to provide evidence to commissioners of the effectiveness of VIG with this client group, and she certainly achieved it: one highly positive outcome is the funding of a new half-time post in the Hertfordshire perinatal mental health team, with the aim of furthering use of VIG in the perinatal service. Natasha is taking up this post in November 2018.
At the time of the study, Natasha was working in Child and Adolescent Mental Health Services (CAMHS) in a service ostensibly providing a service to 0-19 year olds, but in reality not offering any service to under 2s. This is not uncommon in CAMHS. In Bristol, where I worked in CAMHS for 25 years, we were unusual in having an infant mental health service (set up by Dr. Paul Barrows, Child Psychotherapist in 2004). I introduced VIG to this service in 2015, and provided evidence in 2018 of its effectiveness with infants, pre-school children and their parents. This evaluation has helped to promote VIG in CAMHS and in the perinatal service (Pardoe, R. 2018, paper submitted to Attuned Interactions).
Natasha was innovative in seeking funding from the CAMHS Transformation Fund for a 4-month pilot study for one clinician to work with 10 parent-infant dyads. The VIG clinical work and the evaluation were set up carefully, with considerable personal time and effort. The assumption was an average of 7 appointments per intervention and 2.5 appointments per day for the clinician – quite a challenge, given travel time, client documentation etc. The pilot was so successful that the commissioners provided further funding: 2 clinicians, 1 day per week for 7 months. Emma Custance then joined the project. A total of 25 client interventions were evaluated.
Outcome measures: Natasha used both quantitative and qualitative pre- and post-intervention measures. The main criteria for selecting measures was that they need to be “quick, easy, and free” (in addition to having been tested in the research field for reliability and validity). Unfortunately, many measures in the field of parent-infant research are neither quick, easy or free, and are therefore harder to use in clinical work. In particular, it is difficult to find an easy-to-use objective measure which evaluates the change in the parental representation of the parent-infant relationship, ie the expectations and beliefs the parent has of themselves as a parent, their infant, and their interaction/relationship. A positive change to this representation, and an increased capacity in the parent for mentalization (Fonagy, 1998) are the key goals of parent-infant therapeutic work, as both increase the likelihood that the infant will develop a secure attachment (Bowlby,1969; Ainsworth, 1978; Main, 1989). The evidence is building that video feedback approaches impact positively on parental representations and mentalization, hence VIG is recommended in the NICE Guidelines (2012, 2015).
The quantitative measures Natasha decided to use in her study were: the widely-used mental health measures PHQ-9 (Patient Health Questionnaire, depression module), and GAD7 (Generalised Anxiety Disorder); the MORS (maternal representations of the infant, Oates, J. 2005); Karitane Parenting Confidence Scale (Crncec et al, 2008); and VIG goals identified in collaboration with each client. She also used qualitative measures, including a referrer feedback questionnaire, a modified VIG Traject Plan, and audiotaped feedback of mother’s experience of VIG. The latter was particularly powerful for us at the conference, and for the commissioners, who, while viewing stills of parent-infant interaction, heard the voice of the mothers. VIG can speak with a strong emotional voice and can cut across barriers, funding being the main one. I think Natasha chose a very effective way of getting the message across.
Natasha’s view is that clients were remarkably honest in their reporting on outcome measures. As I found in my CAMHS Evaluation (to be published), there is always the risk that parents will be reluctant to portray themselves in a bad light by reporting low ratings on certain scales, or with regard to the VIG goals. One interesting outcome of this can be an apparent negative shift during the VIG work: a parent’s initial self-ratings may be higher than in subsequent cycles. As the parent’s trust in the practitioner and the process grows, the parent may become able to give a more honest and realistic view of themselves. This discussion and goal rating re-appraisal may need to happen over several cycles. Despite this negative shift occurring with some clients in Natasha’s study, the overall change was very positive.
The quantitative measures in Natasha’s study yielded statistically significant results showing clear improvements across all measures. This is very impressive. Natasha commented (in person to me) that marked progress was made even in just one cycle. This has also been my experience in CAMHS where my study of 39 families yielded an average VIG goal change of 3.1 after the first cycle. Given that the average change in national CAMHS Routine Outcome Measures Goals is 4.1 after up to 6 months of treatment, VIG is proving to be a very effective, brief intervention.
Natasha’s work with mothers and babies has convinced commissioners and senior clinicians in Hertfordshire that parent-infant services are needed, and that VIG is an intervention ideally suited to this client group. Not only has a new parent-infant post been created, but funding has been allocated to train staff in VIG.
The challenge for Natasha (and for me as a newly appointed Parent-Infant Therapist in the community perinatal team in the Bristol/South Gloucestershire/North Somerset area) is to work towards a more parent-infant focused service. Perinatal services, many of which are staffed largely by adult psychiatrists and mental health nurses trained to work with adults, can be oriented more towards adult mental health than parent-infant relationships and the family system including, crucially, fathers. ‘Keeping the Baby in Mind’ (cf Barlow, J. & Svanberg, P. 2009) is an essential task. VIG can have a powerful impact on clients, but also on clinicians, whether or not they themselves are training in VIG. VIG provides emotionally moving evidence of change, and an insight into the importance of working with the parent-infant dyad and the parent’s mental representation of the parent-infant relationship.
To end with a quote from one of Natasha’s clients that reflects this vital positive change: “I have got more patience with my baby. I have started understanding him better than before. I am more confident that I am a good mum.”
Ainsworth, M. (1978) Patterns of Attachment: A Psychological Study of the Strange Situation. New Jersey: Lawrence Erlbaum.
Barlow, J. & Svanberg, P. Eds. (2009) Keeping the Baby in Mind: Infant Mental Health in Practice. Routledge.
Bowlby, J. (1969) Attachment and Loss. Vol 1, Attachment. London: Hogarth.
Črnčec, R., Barnett, B. & Matthey, S. (2008)Karitane Parenting Confidence Scale: Manual. Sydney: Australia.
Fonagy, P. & Target, M. (1998). Mentalization and the changing aims of child psychoanalysis. Psychoanalytic Dialogues, 8(1), 87-114.
Main, M. et al (1985)Security in infancy, childhood and adulthood: a move to the level of representation. Monographs of the Society for Research in Child Devt. 50 (1-2), 66-104.
Oates J.M., Gervai J., Danis I., Tsaroucha. A: Validation studies of the Mothers Object Relational Scales Short Form (MORS-SF). Poster presented at the XIIth European Conference on Developmental Psychology. La Laguna, Tenerife, Spain: 2005.
The benefits of a Video Interaction Guidance workforce that reflects the ethnic, cultural and linguistic mix of the community
Video Interaction Guidance (VIG) is a strength based intervention to help improve communication and interaction between at least two people. Video is taken of the interaction and then this is edited to show particular moments of attunement which are then shared with the person seeking help. This ‘shared review’ of the film is a skilled conversation where micro-moments of interaction are analysed to see what is working well and this can be a catalyst for change.
In Tower Hamlets, VIG has been used in many settings, for example, to help improve the quality of contact between parents and children who have been placed in Local Authority care and to support assessments pre or during care proceedings; within the Education Psychology service including working with teachers and teaching assistants and their pupils; and within Child and Adolescent Mental Health Service, Disabled Children’s Outreach Service, Parental Engagement Team and Children’s Centres to support parent/child relationships.
Tower Hamlets is a diverse borough in East London, where 32% of the population at the 2011 census identified themselves as Bangladeshi and 31% White British; the other 37% being a combination of all different ethnicities with ‘White Other’ being the next biggest category (London Borough of Tower Hamlets 2013). Encouragingly, the workforce within the Local Authority reflects this ethnic mix with a lot of staff both living and working in the borough; approximately 55% of the Council employees are from a Black or Minority Ethnic background (Cooke 2016). Up until 2015 however, the staff training in VIG within the borough did not reflect this ethnic, cultural and linguistic mix.
That changed when a decision was made to train 12 staff from the Children’s Centres along with two in the Parental Engagement Team and two additional staff in the Disabled Children’s Outreach Service. Of this cohort, nine were of Bangladeshi heritage, three were White British, two were Black British or dual heritage, one was White South African and one White Australian. This was not by design – no conscious decision was made to recognise a previous gap and pro-actively train Bangladeshi workers, it just happened this way. A sociological or social policy perspective on this may highlight the multiple disadvantages that are often faced by people, especially women, from Black and Minority Ethnic backgrounds which may explain why more Bangladeshi staff were found in the lower paid Children’s Centre cohort – but that’s for another paper!
My experience of seeing how VIG is offered in the UK when English is not spoken by the family or person seeking help, is that an interpreter is used – that is certainly how I have undertaken my VIG work. With an intervention based so much on film, it may be easy to think that this would be fine, and indeed I am aware of lots of high quality VIG work that has taken place using interpreters. However, the purpose of this paper is to hear some different perspectives on the value that gets added when VIG is offered by people who share the same language, cultural or religious understanding as those they are offering VIG to; as well as share some learning that has happened along the journey!
Reflections from Ruhul Tapader, Early Intervention Worker (Family Support) in the Children’s Centre:
“I am an Asian British male of Bangladeshi heritage, and speak Bengali and Sylheti as well as English. I am so pleased to be able to offer VIG in Bengali and Sylheti because so many parenting programmes or parenting information is in English which means that some families miss out. However, I have found it isn’t just the ability to undertake VIG in a family’s first language that I can bring to my VIG work, but my shared cultural and religious background too. For example, in my experience a lot of the Bangladeshi families in Tower Hamlets have a different understanding of play than childcare professionals. It would not be uncommon within Bangladeshi families to think children play by themselves or with each other, but that there is no role for the parent to support a child’s development. I have been able to challenge that idea and help parents to see on film how beneficial it is for children when parents get involved in their child’s play.
Additionally, within Bangladeshi culture there can be different understandings of what causes difficulties for children, for example a belief in the “evil eye” or “jinns”, and this can lead to a belief that nothing can be done. Being a trained Family Support Worker and (trainee) VIG Guider gives me the confidence to challenge some of these ideas, but from a starting point of understanding where the beliefs are coming from.
Being a male Bangladeshi VIG Guider has been particularly helpful, because (like in a lot of cultures), there is often a tendency to view caring responsibilities as the mother’s role. I can encourage men to get involved with their children, and can speak with authority because I am from the same background. I understand that mothers may not want to be filmed or may feel they need permission from their husband. As a male, it is easier for me to talk with the husbands/fathers and when I work with them, they will usually encourage their wives to get involved. It would have been much harder for a female to engage some of the families I have undertaken VIG with.
I also bring an understanding from a religious perspective around filming, because I understand the teachings around modesty. However, I also understand that within Islam, there can be permission to film when it is necessary and beneficial, in the same way that seeing a Doctor would equally be permissible. I recognise the importance of offering reassurances that film will be deleted afterwards and will not be shared beyond the work being offered.
Sina Akter, Parent and Family Support Practitioner in the Parental Engagement Team has a similar story of success to tell. She writes:
“As we know, Video Interaction Guidance works for everyone. However, I have found that the intervention is great for non-English speaking immigrants because of the universal power of images. Although we have the option to deliver programmes in community languages, I still see that many parents find it hard to understand some systems and cultural aspects of this country. In such cases VIG is much more helpful.
One of my cases was a mother who was struggling with multiple problems with her teenagers who are subject to a Child Protection plan; one had been taken in to care. In particular, the mum was having a difficult time as she was anxious about the possibility of her youngest boy being taken to care. This 6 ½ year old needed more attention to his wellbeing within this household. Mum looks after the children full time and has lived in this country for a long time but has no UK education and only has primary level Bangladeshi education; she speaks Bengali.
In my introductory visit, mum looked unsure about what was going on but she was cooperative throughout the programme. The parent’s first thoughts around a helping question were, ‘how do I make my child listen to me?’ which needed some re-framing, and ‘how do I spend quality time with my child?’ So far I have done three complete cycles of filming. Through micro-analysing the clips during the shared reviews, the mum was able to realise the benefits of child led interaction and she was enabled to see where she was attuned to her child.
I have noticed an increased positive outlook in mum’s interactions with her son that helped build her confidence. She has spoken positively about the effectiveness of the VIG intervention. Now she values spending quality time with her son as she recognises the impact this has on their relationship, which ultimately has led to him being more responsive. By the end, I saw a happy parent-child relationship where mum often praises the child, allows him to take initiatives, listens to and helps him. It seems this interaction has helped to improve his self-esteem and happiness.
The mum underwent a parenting assessment by the Local Authority where she was able to adequately evidence good enough parenting capacity, including to the Court. She was successful and now her son lives with her. It is my view that it is the VIG intervention alongside other interventions that has helped her to achieve this success”.
Through supervising Bengali speaking staff in their VIG work, we have also had to reflect on some of the challenges of working in another language, as Rozina Aktar, an Early Intervention Worker (Family Support) in the Children’s Centres writes:
“Undertaking VIG with Bangladeshi families whether in Bengali or English has been an interesting but challenging experience at times. It has been an advantage to speak both languages, because there have been times when I am talking with Bangladeshi families in English and the words they use do not directly reflect what they mean. Because I speak both languages, I understand what the parent is communicating because I can see how the “mistranslation” has happened. If I only spoke English, then I may have taken what they said literally which could have led to misunderstandings.
However, some difficulties have emerged because there are lots of words in English that don’t translate easily into Bengali and vice versa. Although with my Bengali speaking clients I have managed to show families progress, it has sometimes been a difficult journey for clients to articulate themselves deeply. For example, the most common word to describe feelings in Bengali is the word ‘kushi’ which would be translated into English as happy, but is used more generally than that. I started to put a lot of thought into other possible words in Bengali to describe emotions and would try to offer these words to parents, as a possible way to explain how they or their child may be feeling; but more often than not, the parents would look very blank. At first I thought they were not taking much of an interest, but realised as I was doing VIG with more Bengali speaking families that there may be another explanation.
Although I was trying to find alternative words to describe feelings, these are not commonly used, and I began to realise that the families were not actually understanding these words in Bengali. I became aware that even when speaking in the same Bengali language that I need to be mindful about the parent’s level of understanding. This is especially the case for the families living in Tower Hamlets who have sometimes come from Bangladesh with only a primary level of education and so use quite basic language; using an interpreter would not have been helpful as it wasn’t the translation that was the issue! This has made it really difficult at times to tease out more subtle feelings and thoughts that the parent may have. However, I have learnt that by asking the parents in Bengali about their thoughts rather than feelings, this has led to much richer conversations. This is an area I am keen to explore and put more thought into as I continue to offer VIG to Bengali families”.
As the VIG supervisor of Ruhul and Rozina,it has been a really rewarding learning experience for me to be supervising Bangladeshi staff who are often undertaking their work in Bengali without the need for an interpreter. It has been particularly interesting to reflect with Rozina as she worked through the frustration of how to move beyond “kushi” as a way to describe feelings; and this has been really helpful learning that I have been able to share with non-Bengali speaking VIG Trainees in their work with Bangladeshi families.
I was interested to learn more about how Rozina’s reflections about language is supported by the work of linguistic anthropologists. In an interesting article by Benoid (2014) he shares how Hawaiians have 65 words for fishing nets and 108 for sweet potato! Hawaiians may therefore struggle to communicate which type of sweet potato they are referring to if trying to translate this into English! Other cultures have developed language to describe concepts that do not really exist in British culture – the word “mmbwe”, from the Venda language of South Africa, for example, refers to “a round pebble taken from a crocodile’s stomach and swallowed by a chief”; or “nakhur” the Persian word that describes a “camel that gives no milk until her nostrils are tickled”. People familiar with these languages may find it surprising that there is no direct translation into English! Interestingly, other concepts are more universally understood, yet do not necessarily have their own word in major languages – “wo-mba”, for example, from the Bakweri language spoken in Cameroon is a beautiful word to describe the smile on a child’s face whilst sleeping.
It is fascinating to consider how language develops contextually, and that there is a richness in all languages. Where that richness lies may be explained at least in part, by what is needed in the context it is developed. This is a good reminder that when undertaking VIG in a different language and needing to use an interpreter, there may not actually be the words to describe what we or those we’re working with want to say.
It has also been really helpful to hear Bangladeshi staff add more meaning to what they are seeing, perhaps recognising some additional significance in the interaction than I would. An obvious example is seen in the area of feeding. Bangladeshi families often like to feed their children using their hands, even when the child may be of school age. This would look strange and usually be frowned upon in the White British culture that I am from, but Bangladeshi staff can see this through a helpful contextual lens that starts with understanding that feeding in this way is viewed as a very nurturing part of care. They also recognise that making sure children are well fed is particularly key to families who have grown up in a country with significant poverty. Thus clips are looked at with more respect for what may be ‘better than usual’ moments than may happen without this level of understanding.
One other area of learning for me as a supervisor is more practical. When I undertake VIG with families using an interpreter, I am aware that the shared review may take longer. However, I realised I had not factored in that VIG supervisions often need to be a bit longer, if a VIG trainee is needing to translate what is being said in the film in order to help understanding. I realised that what was often happening initially was that we were spending most of the session just understanding what was going on verbally in the clip, and that there was less time and space left to reflect on what the VIG trainee and parent were doing, thinking and feeling in what we were seeing. I have had to allow longer for supervision sessions where the film is not in English, but I have also had to be a bit more intentional in not getting too bogged down in what was said before moving on to thoughts, feelings and new meanings. This may be something for other supervisors to factor in when setting up contracts and expectations about VIG supervision if shared reviews are not taking place in English.
In summary, I hope this article has provided food for thought in relation to what can be gained when VIG is offered by people that share certain aspects of identity with the community they are working with. Whilst the power of the visual image is undisputable, we know that it is the skilled conversation around this that can help to develop the new meanings that are being created. When this is facilitated by a VIG guider who understands both the first language and how this may look when translated in to English, the risk of misunderstandings are reduced and subtleties more easily received. When there is understanding of the religious and cultural context of a family, there is an even greater likelihood of VIG being offered in a way that the family feels respects and honours their beliefs which increases the potential to explore new meaning. There is also an opportunity to notice interaction that takes on a new significance when seen through a particular cultural lens, that could otherwise go unnoticed. These are all important components that can help with embodying the AVIGuk values and beliefs.
The expertise of the VIG workers sharing in this article have also helped recognise the subtlety of language that sometimes, quite literally, gets lost in translation; and that sometimes there are no words, or the words there are, are not fully understood. It is good to be reminded of the need to adapt our communication style accordingly, rather than assuming the difficulty is solely about poor translation.
I believe there is still lots to learn for those of us who are supervising VIG work that is undertaken in a different language to our own – how we find ways of allowing enough time to ensure there is both an accurate understanding of what has been said verbally, but also enough space to explore thoughts, feelings and new meanings. And for those who are involved in making decisions about who should be trained in VIG within an organisation, I believe this article is an encouragement to look at the demographics of those who we are working with and recognise the added value that can be gained from ensuring the workforce reflects this.