Two of the studies chosen (Feltham-King, 2010; Osterman et al, 2010) considered the application of video-feedback interventions and the impact that they had on the participants. Each of these studies was exploratory and small scale and focused on prospective adopters of pre-schoolers (Feltham-King, 2010) and parents who had recently adopted young children (Osterman et al, 2010). The outcomes of these small scale projects were generally positive. Parents found the experience reassuring
(Feltham-King, 2010) and felt calmer and were more secure in their parenting and this allowed them to trust their parenting skills (Osterman et al, 2010). Participants became more aware of their child’s verbal and non-verbal signals and how to receive them as well as being able to follow their interests in play. Additionally within the Feltham-King (2010) study being able to focus on the positive aspects of interaction as well as being able to share concerns with an external professional to the adoption process, an educational psychologist, in a non-judgemental way was valued. The timing of when video-feedback interventions were offered was considered within both studies. Osterman et al (2010) noted that the intervention was of sufficient length and met the parent’s needs. However Feltham-King (2010) acknowledged that for some parents this intervention was offered at a demanding time of considerable change when adoption proceedings were in process and this might have an effect on the perceived benefits.
The issue of informed consent was also considered (Feltham-King, 2010). From the information in the evaluation feedback and participant selection, it was not clear whether this was fully informed consent. Given the pressures on prospective adopters to do what was needed to become adoptive parents, it could have been have been perceived as a hurdle to jump. These small sample studies provided an insight into the application of interventions in the real world and how professionals supporting
parents might need to respond to the complexities of people’s lives in order to implement any such intervention.
The effectiveness of different interventions as shown in the literature has been mixed. Expected and hoped for gains particularly with regards to attachment status of young children did not appear to have consistently been found. Moss et al (2011) found that following a short intervention, 8 weekly visits, children between one and five years old showed greater attachment security, a reduction in disorganisation and parents showed greater sensitivity (small to medium effect sizes were achieved). Older children showed lower levels of internalising and externalising problems. In another study, Bernard et al (2012) found that children showed lower rates of disorganised attachment (medium effect size), when parent’s frightening or frightened behaviour was targeted. Both these studies used and focused generally on noting sensitive behaviours from the parents including proximity seeking, exploration and emotional attunement.
In another study with adopted infants, Juffer et al (2005), there were again increases in maternal responsiveness and a reduction in continuous disorganised ratings of attachment (medium to high effect size). Two studies that used the same group of families, Negrão et al (2014) and Pereira et al (2014) found that VIPP–SD had positive effects on parenting and child behaviour and were effective when parents perceived themselves to be under stress. Conversely, Klein Velderman et al (2006) found that VIPP had a medium effect size on increasing maternal sensitivity but attachment security did not differ across the different conditions whilst Høivik et al (2015) found that Marte Meo, a video-feedback intervention had limited impact on well-functioning dyads where the parent showed appropriate levels of sensitivity and therefore suggested that it was not suitable as a broadly preventative intervention.
The explicit use of VIG was used in two control group studies, Kennedy et al (2010) and Hoffenkamp et al (2015). Both of these studies targeted vulnerable infants. In the Hoffenkamp et al study, three VIG cycles were carried out within the first week of life of pre-term infant’s lives and it was found that some of the effects were not sustained. It was noted that those mothers who had the most traumatic births benefited most from the intervention. In a small study, Kennedy et al (2010) found that there was a medium effect size with parents being considered ‘good enough’ on measures within the CARE-Index (Crittenden, 1997-2004) in a residential setting for parents where Court orders had been given as a result of Child Protection concerns.
Doria et al (2014) contributed to the understanding of the factors that might explain the effectiveness of VIG by exploring the explanations of those who directly were involved with the intervention and had different roles within it through transcripts of shared reviews, interviews and focus groups. The participants included five families, VIG professionals and VIG supervisors. The families involved were considered vulnerable on the basis of issues associated with substance misuse and mental health. The explanatory model developed is shown below (p.8).
Methodological Components
Underlying Mechanisms
Outcomes
Figure 2: Explanatory Model of How VIG Works with Families in a Therapeutic Setting
The underlying mechanisms described two components. The metacognitive processes included the challenges to the parents’ perception of the family’s interactions and the consequent thinking and reflection by the parents of their thoughts and emotions and the thoughts and emotions of the child. The tension created through this cognitive dissonance12
(Festinger, 1957) created a context in which it was difficult to deny observed behaviours that were inconsistent with the parents’ view of reality. The challenge to held beliefs had the potential to change attitudes and behaviour shown by the parent. It was acknowledged that there was no evidence for testing the
‘dissonance-induced’ mechanism within the literature (Doria et al, 2014, p.9). The second identified underlying mechanism was the shared construction of a new reality. Two theoretical models were posited; social constructivism (Vygotsky, 1962) and partnership models of family intervention (Davis and Day, 2010), to support the
12 Cognitive Dissonance- a state of psychological conflict or anxiety resulting from a contradiction
between a person’s simultaneously held beliefs and attitudes (Encarta Dictionary: English (UK))
Guider receives and follows client’s initiatives and desired
aims
Videoed interaction with guiders presence
and support Success-focused
approach
Edited video as proof of success and change
Metacognitive processes Shared construction of new reality Happiness Self-esteem Self-efficacy Attitude-behaviour change
generation of constructing new realities for the family through ongoing facilitation of the guider. This work provided an initial contribution to the understanding of why and how VIG might work within a context of family psychotherapy. It brought together a range of participants to develop an explanatory model.