Infant Observation at the Heart of Training

Janine Sternberg

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367105471
• eBook ISBN: 9780429914874
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The study of infant observation is widely used as part of training to become a psychoanalytic psychotherapist; the skills learned through infant observation can be widely applied to practicing analysis with all ages. Through the delineation of the views of writers and teachers of infant observation and her own empirical research, the author addresses the reasons why infant observation is a vital part of training for all analysts.

Part I
Prelude

Observation vignette: Elliott at 22 weeks

Elliott was in his baby chair on the kitchen floor, smiling and stretching, with his socks coming off his feet through the movement of one limb against the other. Beth was amused by it, smiling repeatedly at him. He held his hands together firmly. His tongue protruded a lot, and his eyes scrunched up; at one point he almost squinted he seemed so excited. He made quick sounds: “da, da”. Beth busied herself with preparing to clean the floor, emptying bins, etc. Elliott wriggled in his chair, with a troubled expression on his face; he seemed to be agitated at the noise. During the silent mopping, Elliot, now calm again, followed her intently with his eyes. They felt peacefully connected. Beth opened the back door, and the air became chillier. Elliott trembled, but stayed patient for a few more minutes. Beth said, “You’re getting bored—it’s nearly done”. He brightened. She scooped him up deftly, holding him above her, nuzzling his face—he beamed down on her, she beamed up at him. Then she walked with him on her hip to the living room; I was behind them and did not see either of their expressions, but there was an ease in their movement down the hall. Still balancing Elliott on her hip, Beth played back a message on the answering machine. Then she sat down to return the call. Sitting in the comfy armchair she propped Elliott on her legs, jigging him up and down while she talked. He held himself up well, and he’d look round at me and smile. Beth talked in an efficient, but tense and somewhat exasperated way, and during the call Elliott became a bit distressed, starting to cry. I became anxious, tense, perturbed at Elliott’s crying; I wondered what the call was about. When Beth put the phone down, she said, half to me and half to him, she wondered if he didn’t like what she was talking about. She tried putting him in the pram near the armchair, and I could see signs of him wriggling; it seemed he didn’t want to lie down. I felt strained and uncomfortable. The light in the room seemed to lessen. Beth volunteered to me that the call had been about something problematic—distressing and stressful. Then she said to Elliott, a bit briskly, even pleadingly: “Do you want a suck?” She lifted him swiftly from the pram and moved across to the sofa, hoisting herself up on it, with Elliott resting across her lap. Elliott didn’t want to feed, he strained and arched his back, looking in to the middle of the room and away from Beth. Again I felt awkward and pained. She propped him up and he burped. Beth said, in a friendly way: “Is that what was making you grumpy? Do you want a play?” She put him on the floor and brought the baby gym round to him. He smiled, catching hold of the plastic animals suspended from the frame. He became absorbed in his play and seemed reassured by it. Watching him attentively, Beth said, “You can hold things now, you’re growing up.” She sounded proud and rueful at the same time. Elliott seemed better coordinated, and bouncier in mood. I began to feel relaxed.

We see Elliott excited on many levels, and his excitement giving pleasure to his mother. He is sensitive to her, following her while she cleans; and sensitive to the change in the environment when he trembles at the open door. Here Beth, as she often did, puts Elliott’s feelings into words—on this occasion “You’re getting bored”—and it leads to a relaxed, happy response from him, a rather familiar experience. He is responsive to her pleasure in holding him. Equally, when she speaks on the phone, his mood darkens, showing the “exquisite sensitivity to the caregivers’ moods” described by Brazelton and Cramer (1991, p. 142). The call initiates a break in the contact between them. In the awkward sequence that follows, in which Beth seeks to breastfeed Elliott, he takes his distance by physically straining away from her. Beth has herself wondered if the conversation has upset him. She returns to being in tune with him when she discovers that the baby gym is what would help him; Elliott has helped her to get there. In this sequence, which came near the end of my observation hour, I was aware of becoming quite identified with Elliott. I had felt at peace in myself earlier in the hour, comforted by the closeness between Beth and Elliott. The break in the contact between them made me anxious. I felt Elliott’s discomfort acutely and wondered how he made sense of the evident change in his mother’s mood. It almost seemed as if they needed a bit of physical separateness—negotiated via Elliott’s turn to the baby gym—to return to each other. I was relieved that the connection between them was restored and that they weren’t left in the unattuned state for long.

Note

I am indebted to Ann Scott for this observational material.

Chapter One
Introduction

The short observational vignette and the observer’s thoughts on it with which this part begins display many of the aspects of infant observation that I address in detail throughout this work. We see Elliott, aged five-and-a-half months, in a very ordinary domestic situation: sitting in his chair to begin with, watching his mother engage in domestic tasks. We see the fine detail of observation in the way the observer describes his small movements, noticing excitement, the baby’s tracking of his mother with his eyes, his response to being picked up. We see Elliott’s reaction to his mother’s change of mood with her phone call, and we follow the observer’s experience of watching Beth offer Elliott the breast at a point when, we might speculate, she is responding to her own need to feed him. The observer creates for the reader a vivid picture of Elliott’s response to this, both through the words she uses to describe him straining, arching his back, and looking away, and through her comments on what she feels at the time. In this way we see the observer showing an awareness of her own feelings, tolerating and processing them—activities to which we return repeatedly in the course of this work. Additional reflection on the experience, putting it into context, noting the familiarity of some aspects, thereby building up a sense of understanding emerging over time are shown. We also see the observer using theoretical concepts to further her understanding when she gathers her thoughts together in her comments on this experience. By the end of the vignette, we see Elliott and Beth again in tune: the observer is aware of the relief that she feels about this. She has had a live experience of seeing the importance of attunement, the infant’s capacity to make his needs known, deficit and repair, and many other significant aspects, which will hopefully remain inside her, available to be drawn on in future clinical work.

From this brief look at a small piece of observational material we see the observer engaged in many tasks. She has to be able to look, notice, feel, be aware of how what she sees impacts on her, reflect, remember, process, think, and then write about it all. In the course of this book I shall be looking closely at all these different capacities and skills and considering their relevance for practising as a psychoanalytic psychotherapist.

A brief description of infant observation

The term “infant observation”, as used in this work, refers to what Alvarez called “naturalistic infant observation” in the debate between André Green and Daniel Stern (in Sandler, Sandler, & Davies, 2000). This approach, developed initially by Esther Bick, is contrasted in its duration and regularity with observations of infants carried out on an occasional or even one-off basis. An observation student, studying on a course offered by a psychoanalytic or psychoanalytic psychotherapy training institution, is instructed to find a family who are about to have a new baby and who are willing to allow an observer to visit them at home regularly—usually weekly—for a minimum of a year. In child psychotherapy trainings such observations usually take place over a two-year period; for adult psychotherapy or psychoanalytic trainings they often last one year. After a preliminary visit to the family, the student begins regular observations as soon after the infant’s birth as possible. When visiting the family, the student tries to take up an unobtrusive, non-interfering position, attempting to concentrate on the infant and to take in as much as possible of what she sees happening—the classic “observational stance”. Some training institutions expect the observer to concentrate primarily on the infant, while others pay more attention to the mother–infant dyad, referring to the task as “mother–infant observation”. Exposure to the maelstrom of feelings experienced by observing a mother–infant couple is seen as being of use to the development of psychotherapeutic capacities in ways that I discuss in chapter 5. No notes are taken at the time, but the student aims to remember in as much detail as possible what she has experienced and to write this down soon afterwards. The fullest description possible of the baby’s actions and about his interactions with others present is recorded. Over time, patterns in the infant’s ways of behaving and responding may become apparent. The student may be encouraged to note, while acknowledging that it is separate, what she had felt as she observed what she is now recording. These recorded observations are discussed subsequently in a small seminar group (not usually exceeding six members), which meets on a weekly basis for the duration of the observational assignment. In the seminar group the students also share observations and come to know about the infants and families observed by their colleagues. In the course of this book we shall see both the myriad learning outcomes that are claimed for the infant observation experience and also some empirical evidence that matches this in certain dimensions.

Infant research versus infant observation

It is important to be clear from the beginning that there is a substantial body within the psychoanalytic community who do not value infant observation. Some of them have had the experience of it and did not find it personally useful. Others have concerns that the emphasis on the hypothesized internal experiences of the infant leads to a form of theoretical brainwashing. However, the majority of those who speak against it could be thought of as having their views represented by André Green, who, when he objects to infant observation as not being concerned with the unconscious, unfortunately fails to make a clear distinction between naturalistic infant observation as described and discussed in this work and infant observation research. It is fundamental to clarify the distinctions between these. Infant observation research, described by Elizabeth Spillius (in Sandler, Sandler, & Davies, 2000) as “systematic experimental infant observation”, should not be confused with “naturalistic infant observation”, although both are observational and both are, or can be, used as a form of research. Tyson (1989) also makes a distinction between longitudinal naturalistic research, where the emphasis is on development and the differentiation of psychic structures, and that carried out in academic psychology, where carefully designed experiments aim to test particular hypotheses. These researches have increased our understanding of the range and complexity of infants’ competencies. Although in recent years Stern has brought an interest in the inner life of the child to the more directly observable phenomena that had previously been the only currency of infant observation research, referring to the “inferred subjective life of the observed infant” (1985, p. 14), infant research can still be differentiated from naturalistic infant observation.

Infant observation research includes the many and varied studies that have been carried out to increase our knowledge of the capacities and the development of infants and to try to infer from these studies the development of relationships between the infant and his caretakers. These fascinating studies have included evidence of newborns’ ability to recognize their mother by smell and voice (Condon & Sander, 1974; De Casper & Fifer, 1980; MacFarlane, 1974, 1975) and young babies’ preference for patterns that follow the configuration of the human face (Bruner, 1977; Fantz, 1961). Work done by Brazelton and others (Brazelton, Koslowski, & Main, 1974; Kimberly, 1970; Sander, 1974; Wolff, 1963) charts the to-and-fro nature of interaction between the infant and his caretaker and shows how infants “learn the rules” and learn how to adjust and adapt their needs to what is available. The term “infant observation research” could also include the more longitudinal studies of researchers such as Lynne Murray (Murray, Fiori-Cowley, Hooper, & Cooper, 1996), which have shown the long-lasting effects of mothers’ postnatal depression on their children’s later cognitive abilities. Developments in technology, especially the use of video, split–screen, and microsecond analysis, have opened our eyes to knowledge that could not have been available earlier. The last three decades have seen a continuing creative use of this medium, by Beebe with her pioneering application of it for making psychoanalytically informed interventions with mother–infant dyads and, more recently, by Dean and Moore (2001) to aid early recognition of child protection issues.

Naturalistic infant observation—that is, infant observation carried out according to the Esther Bick method—brings different gains. It can also enable the observer to see patterns of behaviour, but it concentrates on those that are specific to each mother–infant dyad rather than those of a whole cohort, where small variations in patterns of behaviour will assume less importance. The weekly contact with the observed infant contrasts with “laboratory” studies of infant research, where the infant observed is likely to be seen less frequently and regularly. Observers have the experience of being exposed to often painful feelings and reflecting on them, as is substantially evidenced in this work. Such experience is of more direct relevance to psychoanalytic practitioners than is grudgingly acknowledged in the “indirect relevance” that André Green (in Sandler, Sandler, & Davies, 2000), Peter Wolff (1996), and others have conceded that infant observation research may have for psychoanalysis. For these writers, the emphasis within infant observation research only on what is observable severely restricts its value. Indeed, the main focus of those who are dismissive of infant observation research is that it has little of relevance to say to psychoanalysis. Wolff says: “Empirical infant observations are of interest as empirical studies on the process of social development, but… such observations are irrelevant for psychoanalysis as a psychology of idiosyncratic meanings and hidden motives” (1996, p. 377).

Green goes further in saying that not only are the findings of infant research, albeit interesting in themselves, ultimately irrelevant, but additionally, the emphasis on what can be observed may in the end be damaging to psychoanalysis. He makes an impassioned plea for keeping the emphasis of psychoanalytic work on things that cannot be seen. In his famous debate between with Stern, he states that “Its relevance or irrelevance depends on whether its object is the specific objective of psychoanalysis: That is, neither the infant nor the child, but the unconscious” (in Sandler, Sandler, & Davies, 2000, p. 51).

It is my contention that naturalistic infant observation uses both that which can be seen and that which can only be deduced or inferred, largely through awareness of the observer’s countertransference, to enhance the practitioner’s clinical skills. There is much to be learned simply from what can be observed, and I value what infant research can teach us. The work on making links between infant research and psychoanalysis with adults (Dowling & Rothstein, 1989) is fascinating. However, I want to emphasize again that infant observation, unlike infant research, goes far beyond what can be seen. Green argues with the view that infant research/observation can help the clinician better to understand the patient—a view put forward by Brenman-Pick in the dialogue between Stern and Green (in Sandler, Sandler, & Davies, 2000)—by quoting Winnicott, acknowledged as having vast “hands-on” experience of infants, as saying that the consulting-room may well be the most fertile ground for understanding more about infantile states: “My experiences have led me to recognise that depressed or deeply regressed patients can teach the analyst more about early infancy than can be learned from direct observation of infants, and more than can be learned from contact with mothers with infants” (Winnicott, 1960, p. 141). While this may be true, I will show that naturalistic infant observation has a value that goes far beyond teaching prospective clinicians about early infancy, although I would argue that to an extent it can do that very effectively.

Benefits of naturalistic infant observation

By conflating naturalistic infant observation and infant observation research, Green and others largely miss the point. Naturalistic infant observation is not only about what can be observed. The student of infant observation learns much more than child development: the observer learns much to do with herself, and such learning correlates closely with the development of capacities and skills that a psychoanalytic psychotherapist will need. The observer who experiences difficulty—as most do—in where to position herself, often quite literally in terms of where to sit in the room, is learning so much: perhaps she is experiencing the pain of feeling unwanted, excluded; perhaps she is feeling anxious at receiving attention that, she feels, the baby is lacking. She may be struggling to be a figure who is viewed in a benign way but who is not actively being helpful in a centre-stage manner. She will also be gaining an awareness that what you see depends on where you are seeing it from and what you are looking at. And all of this has happened within moments of arriving at the home.

In considering again the observation vignette of Beth and Elliott, we can note how the observer, now familiar with this family, is aware of and struggles with making sense of the ebb and flow of her emotional reactions to what she is witnessing. The core of learning is formed from what the observer experiences and the ability to reflect on that experience. This reflection is carried out with the help of the seminar group. If the student is in therapy at the same time, it is likely that the analytic space will offer opportunities for her to think about aspects of herself that have been stirred up by the experience, so that she can begin to make distinctions between what is personal and what belongs to the mother and baby.

The importance of experiential learning

While it is true that other forms of learning to be a psychoanalytic psychotherapist also use experiential learning—indeed, one might argue that it is only the theoretical seminars that do not engage in this manner—it is striking that infant observation is usually offered right at the beginning of the training experience. I believe that observation is used by training schools because learning psychoanalytic skills from books is impossible, and it offers a direct experience. Indeed, at this beginner stage of the process there is no other way that allows the would-be therapist to have such a complex experience, one in which the observer is both deeply involved and yet not expected to “do” anything, and which thus provides very fertile ground for learning. Additionally, I think the placement of infant observation at the b...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• CONTENTS
• ACKNOWLEDGEMENTS
• PREFACE
• ABOUT THE AUTHOR
• PART I Prelude
• PART II Conceptual research
• PART III Empirical research
• PART IV Conclusions
• REFERENCES
• INDEX