Monica Hedenbro - Hedenbro Institute
I have been in private practice since 1986 and the Hedenbro Institute was founded by me. At the institute, we offer couple therapy, family therapy, supervision, teaching and research. I have published several articles in both English and Swedish, written books in Swedish and produced eight films about interaction.
I am trained as a psychotherapist and started training in Tavistock, London. My roots as a family therapist started in London but continued at The Philadelphia Child Guidance Clinic (US) where Salvador Minuchin was an important and influential therapist. Over the years I have taught and worked in various countries, including England, US, the Scandinavian countries, Russia and Erbil in Irak.
As a researcher I have been associated to the Karolinska Institute in Stockholm Sweden since 1996. My PhD thesis ”The family triad – the interaction between the child, its mother, and father from birth to the age of 4 years old” was completed in 2006, however the longitudinal study is still on going and the children are currently 20 years old.
The research is linked to the Karolinska Institute The Department of Child and Youth psychiatric health. In the research Infant and child development has been combined with a systemic family system perspective. It is a longitudinal study that started 1996 and we are now collecting and analysed data from the children that have been in the study since they were newborn up to the the age of 15 years. Up to the age of 4 years it was a multicenterstudy where four differents sites took part.
In Sweden we currently see the families when ”children” are 20 years old.
The families has been seen 13 times over the years and taken part in several Lausanne Trilogue Play situation. But I have also interviewed parents and the children and used questionnaires filled out both by parents, children and their teachers. I have been visiting the families in their homes and viderecorded play as well as in preschool. Siblings were included in the study at certain timepoints. We developed the coding system CPICS – Child-Parents-Interaction- Coding -System that is a microanalytic coding system that can be used both i dyads and triads. A instruction film is produced about the CPICS system.
Method and results can be read in published articles and researchgate.
Below follows an outline of my main approaches in my clinical work.
My special interest in clinical work
Working with families from a systemic perspective is most important, but we also use psychodynamic and cognitive/affect based methods. Children´s communication and interaction is a specialty of ours, where Micro Analysis plays an important role to be able to understand and help. Intervention is a method in which video filming and reviewing clips from that film is used to give the parents or professionals guidance on how to support the development of the child. It also helps the parents or caregiver to find ways to help the child with his or her difficulties and problematic situations. Attachment is important throughout our whole lives and therefore it is crucial to establish a secure attachment during infancy and early childhood. Attachment-based work is also important later in life, for example in work with adopted children.
Children are social beings from the very beginning of their lives, and this realisation has greatly contributed to an interactional view of the relationship between biological and psycho-sociological factors in the development of children. The interplay between a child and their caretaker is thus central and the aim of early psycho-sociological intervention is to strengthen, enrich and broaden the positive experiences in this interplay between children and those who care for them. A first step in turning a negative contact to a positive one is often to give the parent or caretaker a chance to feel competent and important to the child and their development here and now.
Important experiences of interplay for children in order to create ”representation of belonging” are often small, concrete and often repeated everyday events. These small events make up the core of the interaction. It can be difficult to evaluate the quality and intensity of small, important episodes and this can sometimes be a problem for us ”helpers”. We may be tempted to think of them symbolically and verbalize them, even though these small episodes, as Daniel Stern puts it, symbolize nothing but are simply what they are.
From the very beginning, an infant is capable of social interaction. The intimate interplay which normally occurs spontaneously between the caretaker and the child has shown that this early communication, composed of sounds, facial expressions and movements in a subtle interaction, is a real dialogue. In this dialogue, the signals between the adult and the child flow back and forth. When children are affirmed in this way, they experiences that they have seen, heard and understood. The child, in other words, is validated; I exist, I am loved.
Children are constantly exposed to new experiences and phenomena, which require an explanation and meaning. Parents need to help a child to find words for anything new and the child therefore directs their anxious questions again and again to the parents to find courage to take everything in. ”We see you and we love you” is the parental reframe, which gives the child the courage to receive and incorporate new things into its inner world and its own language; new words, new understandings.
Already from the beginning, children are prepared to experience pleasure or pain, satisfaction, security and kinship or the opposite. When a child is given the opportunity to interact with their caregivers, sensitive to their needs, they appears themselves to be able to influence or guide their environment so that it triggers satisfying care and contact, for example through smiles, eye contact and movements, which can be interpreted by the caregiver. The child’s own initiative and reactions can therefore be said to initiate and strengthen the sensitive and flexible adjustments shown by the parent, however absence of reactions from a child can contribute to the development of unsatisfactory care.
The apparent absence of such reactions may have several different causes. A child may give weak signals and their reactions are therefore difficult for the parent to understand and respond to. A child may have special needs and require extra or a great deal of time and/or support, or may perhaps have a different tempo compared to their parents. For some reason or another, a parent may need help to create positive feelings towards their child. They are perhaps preoccupied with their own difficulties and troubles. Right from the start, this may lead to a negative spiral with insecure relationships and mutually negative expectations between child and parents. This negative spiral can be difficult for the parents to break unaided.
A child´s development should be seen as a dynamic process of interaction capable of modifying the development and adjustment patterns of the child. This perspective makes early interplay an important point of entry for influencing the child’s development.
Interaction guidance and the Marte Meo method
Interaction-based interventions take place in the here and now -that which the parent and child can understand at that moment in time. In this relationship, focused on the intersubjective meeting of parents and child, parents can discover and ”see” their child, their behaviours and needs, the signals they send out, the initiative they take and also their reactions. Intervention can also provide parents with practical knowledge and information on what they can do to change and develop their parenting behaviour so as to favour the development of their child.
The knowledge gained from interaction-based interventions and the opportunities for changes in behaviour, which in turn alter the responses from the child, can stimulate parents to rethink and change their inner representation of their child and of themselves as parents. Representations grown out of earlier interaction experiences, myths and legends in the parent’s family of origin, act as a generalising force and are significant in this respect.
Marte Meo is one of several methods for interaction-based interventions. It was developed by Maria Aarts in Holland and can be translated to ”on your own strength”. Marte Meo is today used around the world to help and support parents, foster parents, school and preschool teachers, staff at mother and childcare clinics, those caring for people with mental disabilities, in child and youth psychiatry etc., to develop and encourage communication and interaction with children and young people. The aim is to help and support parents and others in caring professions to see the needs and resources of children and to understand that it is possible to react to their needs in a way designed to encourage child development and improve the interplay between themselves and the child. The work is based on problem definitions of the parent or caretaker. Marte Meo therapists (irrespective of whether they work in home environments, nurseries or schools) record short, everyday interaction sequences on camera, which represent daily experiences between the child and the caregiver. The film material is then analysed according to the Marte Meo principles for development enhancing communication.
The therapist and parent(s) then review the material in the absence of the child and focuses on the pictures of the child. The therapist highlights particular sequences of the film, which can be further explored and illustrate opportunities for improvement and deepened interactions between child and adult, so that the most effective development-enhancing communication can be achieved. By stopping at particular points in the film, for example when the child is expressing something verbally or non-verbally, taking the initiative or indicating a need, the parent may be able to recognise something which they were unable to do at that point in time. Perhaps the therapist can even show a golden moment when the parent succeeded in reacting accurately even if only for a second.
For parents to children with relation difficulties, or for parents who do not see themselves as important in a child/parent relationship, in can be very encouraging to see that the child is actively looking for the parent’s reaction or affirmation. Actually seeing the child’s face, their expression, their eyes, is what motivates the parent to be there for the child and resume supportive interaction. A close up of an infant/child can help the therapist to define the baby’s/child´s feelings and share this with the parents. It requires only a small positive feeling, just enough to make the parent feel good and supportive. In this way the parent can be helped to feel emotionally attached to the child and start responding to them.
The second reason for using a still picture of a child is to encourage the parent to start looking at their child in real life. This is a natural thing that parents normally do with infants. They look at their child with both curiosity and love and in this way get to know their child and understand their needs. When a mother/parent concentrates too much on their own role in a relationship, they tend to become preoccupied with what they do as a parent. By showing revealing pictures of the infant, the parent begins to understand that he/she needs to follow the child’s initiatives/needs.
It is the responsibility of the therapist that the films are welcomed, shared and discussed. The principles for a development-enhancing communication stem from nature and are therefore experienced as so dear and simple that most of us take for granted that these are principles that we always use in communication with others.
It is only when these qualities are lacking or are too weak that we realise how difficult they are to convey and give information about them. We tend to lose the most natural things when we are confronted with situations we are unable to control or recognise, when the difficult messages we receive are too different from those we expect.
There is a lack of focus on coparenting. Already in the 90’s, John Gottman in Seattle research on couples focused on spill-over effects on the child. I had the opportunity to be a visiting researcher there, and he and his team have been very important to me in the way they work with couples. James McHale in St Petersburg, Florida, US has focused on coparenting, which is how you work together as parents. This is an important part for the child; not only that there is cooperation for example in separations but also how parents support each other in daily life. This is also a focus in the systemic-based work where we work on alliances, different roles, coordination, joint focus and shared emotional engagement.