The effectiveness of Marte Meo Therapy (MMT) in treating attachment relationships has not yet been researched in Ireland. The purpose of this qualitative study was to explore what role, if any, MMT has in establishing, re-establishing and  supporting attachments between caregivers and their children. Pertinent previous work and current thinking on attachment theory was reviewed and suggested approaches in which the Marte Meo method may provide a practical application of this theory. MMT and attachment will be briefly outlined. It will then be discussed how MMT can assist caregivers form attachments with their children. However, MMT should not be assimilated into attachment theory or any other theories without further research.

Marte Meo


Maria Aarts (1996) developed the Marte Meo method in 1987. The words Marte Meo are selected from the Latin ‘Mars Martis’ to express the idea of “on one’s own strength”. The name was chosen with the intention of highlighting the central focus of the method, which is to firstly identify and then activate and develop caregivers’ skills, which enable and enhance constructive interaction and development between caregivers and their children. MMT is deemed a communications approach to child development, which focuses on the quality of interaction between child and caregiver. Situations are filmed and then analysed second-by-second to identify points in the communication where changes may be affected to improve child
caregiver interactions and also answer the caregiver’s question, which is frequently around behavioural interactions such as “how do I get my child to listen or take direction?” Usually, this question is the caregiver’s means of asking “how do I connect with my child?” which is often the primary reason for the intervention. 

The focus of MMT has expanded in recent years. Initially it was intended as a short-term support to parents experiencing difficulties coping with their young children’s behaviours; currently MMT is incorporated into various daily living situations to support placements such as children and caregivers in foster, adoptive and residential care situations. In this way MMT is also a solution focussed method that identifies the caregiver’s current level of functioning and builds on this by providing the caregiver with opportunities from their film to practise, one step at a time. In this way, MMT aspires to develop the competence of caregivers leading to enhancements to the quality of life for their family by supporting the social, emotional and communication development of their children. This is where MMT is perhaps most powerful as the focus of the intervention is always on the child’s development, with the competence of the caregiver developing in tandem with the child. Further enhancements for both the child’s and caregiver’s resilience can be observed when they realise change came about because of their own strength. 

Following moment-by-moment video analysis of their interactions, information is conveyed to the caregivers, which can be incorporated into the individual’s unique mode of communicating. These approaches are concerned with developing both emotional literacy and intelligence along with new ways of helping children to express and understand their feelings,
form secure attachments, build resilience and relate in caring and responsible ways to others. In other words, caregivers are developing based on what is shown from the analysis of “their own strength”. The aim of MMT is for caregivers to
connect with their children in ways that break the adverse models that frequently have been learned by intricate childhood experiences in the past and build new possibilities for the next generation. In the words of Bowlby (1988, p.1),

Successful parenting is a principal key to the mental health of the next generation. 

Attachment

Attachment has been defined by Fahlberg (1988, p.13) as “an affectionate bond between two individuals that endures through space and time and serves to join them emotionally”. has emerged as being invaluable within the framework of assessing children’s needs. Attachment theory research affords a vital developmental framework for making sense of the behaviours and relationship strengths and difficulties that children bring from their intricate backgrounds. It also offers a valuable resource for understanding the kind of caregiving that can enable children to feel more trusting, positive, and capable and secure (Fahlberg, 1994). It is fundamental that those providing therapeutic interventions to families support the development of stronger caregiver child relationships. Often this means facilitating the enhancement of a fragile or damaged caregiver child attachment or facilitating a child to connect emotionally with new carers. It is vital that those involved in making decisions around the lives of children and their families have at the very least a basic understanding of attachment theory.

Methodology

A qualitative approach was used for this study. Two focus groups and three semi-structured interviews were convened with Marte Meo therapists, employed as social care workers, social workers, psychologists and public health nurses. The aim was to elicit rich descriptive data from their perspectives on what role, if any, MMT has in establishing, re-establishing and
supporting attachments between caregivers and their children. Interpretive Phenomenological Analysis (Smith, 2004) was the approach adopted to analyse the collected data. 

Findings

Interviewees and participants believe that once MMT is able to itemise the elements of a good attachment from what they can see in daily interaction moments, coupled with understanding the concrete elements of MMT, MMT supports caregivers to have improved attachment relationships with their children. In Focus Group A, one participant stated that 

[Marte Meo] is a practical translation of attachment theory. I can actually see that in interaction every day with parents when you give back information you’re not just speaking, you’re nailing it down to nitty gritty stuff with the stills but you’re bringing your own experience and skills with you. 

Another Focus Group A participant believed that

It is around how she actually starts to see her son and begin to notice all the little things he does and how she can be in his world and I think in terms of attachment that’s what Marte Meo is good at, showing how parents are in their children’s world and what they do that does help their child but also where the gaps are. It really gives us a very clear picture of what’s going on for the child.

For two interviewees, MMT and attachment theory complement each other. One interviewee claimed that she does not understand attachment theory. This interviewee stated that she is informed from practice not from theories and then went on to say that 

What I did with the problems [caregivers questions] was make all abstract information concrete, understandable and useful to parents and people working with these sorts of problems. I don’t know so well [attachment]
because I don’t study theories... 

Participants in both focus groups and three interviewees recount times they have applied MMT with attachment issues, when there is a child who would be regarded in a family as difficult or isolated, possibly because of a diagnosis or lack of availability of the caregiver and they would see that as an attachment piece. All participants noted that when beginning MMT it is at the therapist’s orientation [the caregiver’s question] but as the work progresses from the first film it is possible to see the child’s attachment experiences with their caregiver, increasing the possibility of answering the caregiver’s question. Furthermore, in terms of attachment it is believed that MMT is good at showing how caregivers are in their children’s world, what they do that helps their child and also where the gaps are. It gives them a clear picture of what is going on for the child. 

In Focus Group A, one participant articulated 

In terms of attachment it [Marte Meo] can be very powerful.

Seven out of nine focus group participants and all three interviewees stated the significance of the therapeutic relationship: developing through activating dialogue particularly around the caregivers’ beliefs and ideas about their children and  eventually and slowly about their own experiences of being a child and that this assists the caregiver’s to come into their child’s world. One interviewee for example stated that

Anyone can give you information it’s how its given, how you connect with the parent and what happens in the review process that is part and parcel of the development of the therapeutic relationship for that parent, where the parent can feel very confirmed, listened to, can feel they have a very real space.

Discussion

The success of MMT may well rely on the relational abilities and experiences of the MMT, rather than any specific theories. The findings suggest that MMT clearly supports caregivers to form attachments with their children throughout the developing therapeutic relationship between caregiver and therapist; through the information given to caregivers from the analysis of their film and through the selection of pictures, which allow caregivers to “see” their child and enter the child’s world, often for the first time. 

MMT would benefit from a larger scale study before being assimilated into attachment theory. As the findings suggest, it is a practical intervention that can assist with establishing re-establishing and supporting attachments between caregivers and their children. It would seem that participants incorporate attachment theory but ultimately work in their own unique
way to answer caregivers’ questions. This in turn builds caregivers’ and children’s future resilience; caregivers now know the strengths within themselves to resolve relational issues between themselves and their children. Children now know how to activate their caregivers’ positive responses to them. The orientation of the MMT may be condensed or diverted from the caregiver’s question due to consciously incorporating attachment theory into MMT.