Introduction and aims:
Mental health vulnerability emerges out of the interaction between the quality of early relationships and genetic inheritance. The quality of early relationships is strongly influenced by the mother’s unconscious memories of her first relationships: Fraiberg’s (1980) Ghosts in the Nursery. We propose that the intergenerational transmission of mental health vulnerability is largely mediated by such unconscious, internal-world phenomena.Genetic inheritance, historical relationships and internal world phenomena are all hidden from direct observation. However, psychoanalytic clinical practice has established that the quality of historical relationships and the way that they interact with temperament through the prism of our unconscious internal worlds to shape a relational interaction in the present, can be inferred. Close observation of mother-infant interactions, and observation of what impact these interactions have on the observer utilises the psychoanalytic technique of analysing the counter-transference to gain access to the unconscious phantasies of the observed.We argue that the earliest perceptions are inchoate and coloured by phantasy distortions. This is what lends Fraiberg’s (1980) ‘ghosts in the nursery’ their phantom quality. We seek to capture the moments when an unwell mother is being haunted by such figures from her own infancy and then trace how they come to take up residence, and new forms, in the internal world of her baby. The secondary aim of this study was to explore whether an infant observation approach can be captured in a standardised (or standardisable) rating scale without blunting the very sensitivity we hope to capture. The methodological challenge of creating a tool that respects the complexity of transference phenomena, without becoming too cumbersome to use, was only partially met.
Methods:
This study uses a two-pronged approach. One prong is designed to capture qualitative data in the form of transcripts of observation write-ups and further reflections on those transcripts. The second prong is designed to capture some of the complexity of this data quantitatively in a Psychoanalytic Infant Observation Scale (PIOS).A psychoanalytic infant observation of videotaped interactions on a mother and baby unit were written-up, including the observer’s counter-transference experience.A senior parent-infant psychotherapist used the transcripts to make a clinical formulation and treatment plan for the pairs. Comparison with another well-evidenced assessment tool was possible because Care Index ratings were available for our pairs. In order to distill the rich qualitative data
iiiinto quantitative data that could be readily compared with the Care Index scores, an Infant Observation Scale was developed and applied to the transcripts.
Results:
The transcripts were rich in clinical deductions about the internal world of mother and infant, although there were more inferences made about maternal than infant defences.The Parent-infant psychotherapist felt confident making a formulation based on the transcripts and his treatment plans concurred with those indicated by the Care-index rating.
When qualitative data was rendered as numerical scores on clinically derived scaled items, there was a good fit with the Care Index ratings for the same parent-infant pairs.
Conclusions:
Psychoanalytic infant observation can identify certain internal world phenomena. These are phantasy distortions impacting on interactions and various infantile defences, including manic, second skin, dissociative and narcissistic. These were not directly observable but inferred from countertransference experience and observable behaviours. Psychoanalytic infant observation Psychoanalytic infant observation is clinically useful for formulating parent-infant relational difficulties. In this early development of an Infant Observation Scale, the measure’s validity and reliability were found to be good. The particular strength of psychoanalytic infant observation is the use of transference phenomena to inform an understanding of unconscious processes and this study suggests that with further work it might be possible to develop and standardise a scale to capture and measure that phenomena.
This paper presents an overview of the author’s doctoral research project, a two-pronged study using both qualitative and quantitative methods. Excerpts of observation material based on video-recorded interactions between mother and infant are presented and discussed, in relation to a psychoanalytic framework with a focus on infantile phantasy. The author also describes the process of developing an assessment scale that attempts to render the rich qualitative data of the observation transcripts as numerical data for comparison with other available quantitative clinical assessments, for the mother-infant pairs studied. The author reflects on some of the challenges of the project and explores possible new directions it could take.
Finding Your Way with Your Baby explores the emotional experience of the baby in the first year, and that of the mother, father and other significant adults. It does so in a way that is deeply informed by psychoanalytic understandings, infant observation, developmental science and decades of clinical experience.Combining the wisdom of many years' work with the freshness of up-to-date knowledge, Dilys Daws and Alexandra de Rementeria engage with the most difficult emotional experiences that are often glossed over in parenting books - such as pregnancy, through birth into bonding, ambivalence about the baby, depression, and the emotional turmoil so often brought to the surface by being a new parent. Acknowledgement and understanding about this darker side of family life offers a sense of relief that can allow parents to harness the power of knowing, owning and sharing feelings to transform situations and break negative cycles and old ways of relating. With real-life examples, references to current thinking and a calm and simple writing style they also provide new insights into the more commonly covered issues such as weaning, sleeping and crying. Finding Your Way with Your Baby is primarily aimed at parents but it will be a helpful resource for all those working with parents and babies including health visitors, midwives, social workers, GPs, paediatricians and childcare workers. It will appeal to parents and professionals who are interested in ideas from psychoanalytic clinical practice and the latest research in developmental psychology and neuroscience.
This article discusses the work of groups of different kinds in psychotherapy. The different groups are an infant observation seminar group, a group for parents of children with disabilities, a peer support group for child psychotherapists. Each group has a different function, but during the pandemic they all became extremely important for their participants as a container for all that the pandemic stirred. The parents attending the clinical group found themselves, during Covid-19, at home, without support, caring full-time for children with complex care needs. The Greek observation seminar suffered an abrupt halt to their meetings with families, but soon the members realized that by meeting remotely as a seminar group they could think together of alternative ways to keep the connection with the infants and families. The peer supervision group, evocatively named the 'Town Hall Group', consists of a number of child therapists, working across different settings, who had a central point where they could meet and share their experiences. he Town Hall Group's shared history and geography felt important, as the group now had to come together remotely and set to work on building a collective understanding of how to navigate remote therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
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