Innovation in parenting clinics

a professional and a mother with her baby on her knees observe and analyse together a video of interaction between mother/baby

video feedback session in the parenting clinical practice.

The use of video as an intervention tool:

The use of video as a parent/baby relationship intervention tool in parenting clinical practice is increasingly being adopted (Steele et al., 2014).

Video-intervention or video feedback or videotherapy can be used in different types of settings (parental guidance, home visiting consultation, mother-baby psychotherapy, VAD).

This involves making a video recording (subject to parental consent) of a short observation of the interactions between a parent and his or her baby/child during free play, a bath, a diaper change, a meal, a consultation, etc. in order to be able to observe interactive exchanges between the latter at a micro-analytical level (second by second, with the possibility of slowing down, going back). This observation is then made jointly with the clinician and the parent in a second time after recording.

The use of video makes it possible, in fact, to change the clinician’s position from a high position that observes, sees, judges (at least from the point of view and the experience that the parent often makes of it) to a position of equal to equal promoting parent-clinician collaboration and leading to a “see together” (Guedeney, Guedeney 2010) that considerably strengthens the therapeutic alliance.

Why use the video in the parenting clinical practice?

Parent-baby interactions take place in the here and now, with a certain speed and they are composed of multitudes of small signals sometimes extremely subtle and of which it is difficult to become aware in the immediacy of the interaction, especially since their treatment by the brain, as relational information, has a preconscious, procedural character.

Thus, the richness of the information they contain cannot be apprehended by the observer in real time, whether he is the parent (his child’s expert) or the clinician (observation expert) (Beebe, 2014).

No clinician, even very experienced and trained, can claim to see everything.

Observation without video will always be biased and subject to subjective interpretation because of the mental processes underlying the observation (visual performance, concentration, working memory performance, fatigue, cognitive and emotional biases).

The use of video reduces these biases and gives parents the opportunity to fully participate in the observation process by putting it at a distance, without the “stress” of having to care for their child simultaneously. It is this position that will considerably reinforce the mentalization skills and reflective function that we know have a protective function in the quality of parent/child relationship and therefore in the mental health of parent and baby. (Fonagy, & Target, 2005)

A number of approaches using video in parental guidance or therapy have already been developed. We can mention the Circle of Security (Powell, Cooper, Hoffman, Marvin,2013), the VIPP (Kalinauskiene, Cekuoliene, Van IJzendoorn, Bakermans-Kranenburg, 2009), Theraplay (Booth & Jernberg, 2009)…

A meta-analysis of 81 studies, with 51 controlled intervention studies designed to promote maternal sensitivity, showed that video use with parents is very effective and shows good results even after very few video intervention sessions (Bakermans-Kranenburg et al., 2003).

But why talk about video intervention in connection with training in the detection and evaluation of withdrawal in babies with ADBB?

Because training to use the ADBB and recording observations for relational withdrawal assessment is a good first step in starting to integrate video into clinical practice.

Indeed, ADBB training is already based on the use of video recording and, as part of learning how to detect the withdrawal of a baby’s relationship, you will be led through a process of reflection and mentalization in a similar way to what can be done with parents in video intervention sessions. It is therefore a first way to experience video intervention in a context that is enriching, reassuring and linked to your clinical practice.

In addition, the ADBB teaches you to focus on the baby’s relational engagement signal and therefore on the different modes of interaction (visual, vocal, behavioural).

Thus, at the end of the training, you have an observation grid and a clear and simple vocabulary which will allow you not only to think (mentally) what you observe, but also to be able to communicate it in a simple and explicit way to someone who is not an expert who could be the parent.

You also know, at the end of the training, when a baby engages and when it does not engage or withdraws. This allows you to easily spot the positive moments of the interaction (even if sometimes you have to look a little bit:)) to show them to the parents. Indeed, when video is used in clinics, among the first things to do with parents, the most effective and least risky is to show them the positive, the moments of affective attunement, of miroring, of mutual sharing, of satisfactions, the moments of interaction that work. Focusing on the positive from the outset will positively reinforce the parent who is often in distress or feels vulnerable. It is extremely difficult to ask for help for your child or to receive it. It will also make it possible to work to restore parental narcissism and parenting skills that are often damaged by showing what works with the baby and that the parent, in his difficulty, sometimes has difficulty perceiving, and finally to reinforce the therapeutic alliance with the clinician.

Training in the evaluation of relational withdrawal and the use of the ADBB with the support of video is therefore a good first approach to the integration of this powerful tool that is video feedback in the parenting clinical practice (but which nevertheless requires time to be fully trained to be able to further its use), especially since the tool is well validated and requires little training (4 days in class or 36 hours online training).

To go further, here are the references of the articles quoted on the use of video in clinics:

 

  • BAKERMANS-KRANENBURG M.J., VAN IJZENDOORN M.H., JUFFER F.: « Less is more: meta-analysis of sensitivity and attachment interventions in early childhood. », Psychological Bulletin, 2003 ; 129 (2) : 195-215.
  • BEEBE B. ‘My journey in infant research and psychoanalysis: Microanalysis, a social microscope. ’, Journal of Psychoanalytic Psychology, 2014, 31: 4–25.
  • BEEBE B., STEELE M. ‘How does microanalysis of mother-infant communication inform maternal sensitivity and infant attachment?’, Attachment & Human Development, 2013; 15: 583–602.
  • Booth, P. B., & Jernberg, A. M. (2009). Theraplay : Helping parents and children build better relationships through attachment-based play. John Wiley & Sons.
  • Facchini, S., Martin, V., & Downing, G. (2016). Pediatricians, Well-Baby Visits, and Video Intervention Therapy: Feasibility of a Video-Feedback Infant Mental Health Support Intervention in a Pediatric Primary Health Care Setting. Frontiers in psychology7, 179.
  • Fonagy, P., & Target, M. (2005). Bridging the transmission gap: An end to an important mystery of attachment research?. Attachment & Human Development Volume 7, 2005 – Issue 3
  • GUEDENEY A., GUEDENEY N. ‘The era of using video for observation and intervention infant mental health’, The Signal, 2010; 18 (2):1–5.
  • Kalinauskiene, L., Cekuoliene, D., Van IJzendoorn, M. H., Bakermans‐Kranenburg, M. J., Juffer, F., & Kusakovskaja, I. (2009). Supporting insensitive mothers: the Vilnius randomized control trial of video‐feedback intervention to promote maternal sensitivity and infant attachment security. Child: Care, Health and Development35 (5), 613–623.
  • POWELL B., COOPER G., HOFFMAN K., MARVIN B. The circle of security intervention New York, Ny: Guildford Press.
  • STEELE M., STEELE H., BATE J., et al. ‘Looking from the outside in: the use of video in attachment-based interventions’, Attachment & Human Development, 2014; 14 (4): 402–415.

 

 

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