Surviving Space

Papers on Infant Observation

Andrew Briggs

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429919572
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Surviving Space is a collection of papers on infant observation and related issues by contemporary experts in the field, commemorating the centenary of Esther Bick and the unique contribution she has made to psychoanalytic theory. As part of the prestigious Tavistock Clinic Series, this is an essential addition to this highly-valued and innovative series. Infant observation is crucial to most psychotherapy training, and this work would be of obvious value to those commencing their training, as well as valuable insights for all psychotherapists.

Part II
Pushing at the Boundaries

Chapter Five
Three years of observation with Mrs Bick

Jeanne Magagna

Some years ago, in 1981, Mrs Martha Harris, Head of Child Psychotherapy Training, who was at that time the organizing tutor of the Tavistock Child Psychotherapy Course, contacted me to lead an infant observation seminar for social workers. Although I had observed one infant before, I felt inadequately equipped for the task, and so I asked Mrs Bick for supervision of my observation of a newly born baby. In 1948, when she began teaching at the Tavistock Clinic, she initiated the training method of having psychotherapy trainees visit a family and observe the development of an infant from birth to the age of 2 years. I am describing her method of infant observation in this chapter.

I began the observation of the infant and his family when Mrs Bick was 79 years old. This was her last formal teaching experience. Mrs Bick had at that time published three articles on the importance of infant observation, and she was intensely interested in pursuing the contribution of infant observation to psychoanalytic work. She was also very well known by former students as having extremely exacting standards for the observations. Mrs Bick was eager to have every little detail of the observation, in order that she should experience with Proustian clarity the relationship between the baby and his family. I was aware that she was facing the end of her life as the baby began his. It seemed to me that her own "intouchness" with the anxieties of dying enabled her to bring alive with utmost sensitivity the baby's fears of dissolution. Mrs Bick had such an enthusiasm for infant observation that somehow my individual supervision with her became a seminar of six to thirteen child psychotherapists who were doing a second infant observation. One year of observing became extended to three years of weekly observations, which I presented to the seminar.

In this chapter, I examine areas of special difficulty in the beginning, middle, and last phases of this three-year observation. I shall look at the following areas to illustrate some of Mrs Bick's central ideas:

1. the child in relation to his family;
2. the role of the observer in containing the mother/baby anxieties;
3. the role of the tutor and seminar members in helping the observer.

Initial stage—preparing for a new task

How do you prepare for a new task? Mrs Bick spent several seminars describing in detail how I should introduce myself to the professional worker—in this case, a health visitor—who would find a mother. She indicated a simple way of introducing baby observation to the mother, I should say to the mother: "I want to know more about babies and how they develop. I would find that useful." The arrangement with the mother included meeting with the father to acknowledge how my visits would affect both parents. Also, my meeting the father indicated that I considered him to be crucial for the baby's development. I was to introduce myself as simply as possible as someone wanting more understanding of babies, rather than as a professional, as a child psychotherapist.

I was to set a regular day, time, and hour limit of the visit as well as delineating possible times when I would not be visiting—Christmas, Easter, and August. There was to be a regular commitment to the specific times of meeting the family, just as there is in therapy arrangements with a patient. This was considered crucial to the task of the observations. Our seminar discussions about the visits stressed accommodating the mother so that she would feel that I was not making demands on her or intruding upon her desires for rest, her routine, or the baby's sleep. I was to be the psychologically containing person receptive to the family as much as possible, rather than someone requiring the family to be available to meet my needs. Making changes in appointments was considered to be making demands on the family and disrupting their routine. Being emotionally present for the family's sake was emphasized sufficiently for me to withstand the initial stresses of visiting.

The first observation: baby boy, 12 days old

The first visit after the birth was delayed, because the mother had had a Caesarian requiring over a week in hospital.

After my arrival, Mother, a tall, attractive, quiet-spoken lady in her late twenties, explains that the first two days at home have been terrible, but today, the day I visit, the baby was settled. They'd felt like two proud parents, going through the park with a new pram, a new baby. She adds, "we felt conspicuous and a bit silly because everything was so new". In a friendly way, the father—a highly educated, handsome, wealthy doctor in his late twenties—asks questions as to why I am coming, and he then gives a detailed account of the time before and after the baby's birth. He describes how four weeks before the birth everything was okay, but then the baby ended up in breach position. He adds that he argued with the doctor to see the delivery but he was not allowed to. When he saw the baby, his face was squashed. "It was a terrible mess." Father says that he is terribly worried that the baby might not be all right, might have difficulty feeding or talking because he has a very high palate. He adds that, because of the Caesarean and anaesthetic preventing Mother from seeing the baby, his wife felt that she was in hospital following an automobile accident, rather than because she was having a baby. Mother did not see the baby for the first two days in which the baby was in intensive care..

Meanwhile Mother is feeding the baby. When she sits him up to burp him, he raises his arms and gazes into the window, lifting his legs slightly. Back at the breast the baby's hands are clenched, while his arm rests along his side. His knees are drawn up and his toes slightly curled up. Mother's hand is wrapped around his leg, but baby isn't held very closely to her. Mother says the nurse told her to wrap the baby tightly in a blanket when feeding, but she didn't do this because she felt that some babies might like to move about and not feel cramped. Mother adds that she is anaemic, doesn't have much milk, and is worried that baby is getting too little. She has rented a scale to weigh him before and after feeds, to see if he is feeding. Mother supplements her milk with bottle–feeding at this point. While waiting for father to get the bottle, she burps the baby again. She then seats him on her knee and faces him outwards in my direction. He arches his neck with his head bent backwards so that his eyes look up in the direction of her face. She rubs his back, pats it slightly, and comments that babies arch their heads like that when they have wind.

Father returns with the bottle saying how he'd become an "old hand at it". He is worried about baby gulping down milk from the bottle. When Father later touches the teat, which Baby has sucked into a flat position, mother makes him get a new one. While waiting for the bottle, Baby arches his neck, looks in the direction of mother's face, and begins sucking noisily on his clenched fist.

When Mother moves him slightly, his hand falls out and he appears to be poised motionless in an interrupted movement. His body is tense. When he makes a few mouthing movements in the air, he seems more relaxed. He rolls his eyes in a backwards direction, arches his neck, scowls, and begins a muffled cry. He pushes his head back several times, while barely moving the rest of his body. When Baby resumes a light cry, mother rubs his tummy, but when the same intensity of crying continues, she gives him her breast, saying "probably there's nothing in there". We wait a few minutes until father returns with a new clean teat. Mother comments with relief that she can see how much baby drinks when he drinks from the bottle.

The couple joke about how indecisive they are about the baby's name. They say they have six weeks to name him. Father refers to the baby as "Algie" and recites a poem about the name given to the "bump on mother". Mother says he is number three in the family. It takes the couple two weeks to name the baby. This seems partially associated with their disappointment that, because his nose has been initially flattened from being pressed against the womb, he is not as attractive as the very perfectly formed parents hoped he would be.

Mother changes the baby, preparing him for sleep. She argues slightly with father, who wants Baby dressed differently for sleep. While changing the baby, mother says to the baby, "You're looking for the new visitor, aren't you. You can't get your eyes off her."

As I prepare to leave, mother tells me that she doesn't think she wants me to return. She is worried about my coming. She doesn't know why. I tell her that I appreciate how difficult it is to have so many new experiences with the baby and to have me present as well. Father says it will be all right for me to phone and come again the following week. Mother says she'd like more time to adjust to the baby first. She feels nervous about my being there. Father touches her arm and says, "By next week it will be okay, things will have settled more." I leave saying, "I'll phone. Thank you for the visit."

Observer in relation to the seminar

When I bring this first observation to the seminar, I am frightened of Mrs Bick. This fear superseded my original wish to understand the baby in his family. I, like Mother, have fears about the way in which I observe and describe my observations. I feel that Mrs Bick expects me to be a perfect observer, and there is too much nonverbal communication, like confetti, which must be caught, then knitted together into words and then paragraphs.

As I describe the initial visit, Mrs Bick asks questions which, on subsequent visits, act like a zoom lens of a camera to move the baby into very close, clear focus. Her questions are: "How is Mother holding the baby? Where is his head? How close to mother's body is he? Where is he looking? And what are his hands and legs doing when she changes position? What kind of movements or stillness do you see in the baby's body? Show us, we want to know." Through her questions Mrs Bick elicits more detailed descriptions of the quality of Mother's holding of Baby as well as additional comments on the various ways the baby "holds himself together". Each week the seminar begins with a reporter's summary of the discussion of the previous week, thus providing continuity between the observations. These are written in a literary style, telling the story of the family's emotional life evolving around the baby.

The observer in relation to the family

The seminar's interpretations of Baby's relationship to his parents have various effects on me. I feel that scales are being pulled off my defended "eyes", as Mrs Bick makes inferences about what I observe. I become eager to see in more detail how Baby and his parents are being held together. But at times I feel the seminar is exposing me too much. When Baby's experience has been fully described by Mrs Bick, I can hardly bear the experience of seeing him suffer. When Mother provides so little physical support for him, I tend to project into his experience my own infantile experience of not being emotionally held. I identify with Baby and become very critical of this mother, the bad mother of my internal world. I can barely restrain myself from saying, "He'll feel better if you hold him closer, if you hold his head."

When rashes develop on Baby's bottom, scalp, and face, I become ill and I have to miss a visit to the family. This illness occurs following a seminar in which Mrs Bick describes the baby's intolerable anxieties of spilling out and liquefying which are not being contained by Mother, leading to the baby's use of his skin as a kind of container. The interplay of my own infantile anxieties contained in earaches and colds as a child, stirred up by identifying with the baby's anxieties, results in my having a cold. This prevents me from seeing Baby.

Gradually, through the understanding and support of the seminar, I gain courage to work on the projections that I am carrying from the family members. This baby, in his damaged state, has been reluctantly accepted into his physically beautiful family. The mother is anxious about not being a perfect mother. I learn to "put myself in the shoes" of each family member, not just the baby's, and to remain sufficiently detached from my own anxieties to create a mental space to acknowledge my own anxieties and those projected into me by the parents. These include being experienced as the critic, the unwanted one, the competitive expert, the intruder.

A great deal of work on myself has to be done in order for me to be a good observer fully present with the baby and his family. When I do not do this work of keeping my feelings intensely alive and simultaneously thinking about them, I tend to cut off from intense emotional involvement. I become a wonderful video camera or I become a nanny, a second pair of helping hands to mother and baby. Then I can find emotional relief from the pain of being only an observer in the family without a child of my own, without the freedom to act in the capacity of a child psychotherapist, without the illusion of being a better mother than mother.

Finding new identities

Mother

Mother is obviously feeling very insecure. Not knowing what she should do to soothe the baby is unbearable. She worries, will her baby survive? Will she survive her baby? She responds to the advice of Father and the nurse by rebelling initially. Advice is felt as criticism of her not knowing what to do. She protects herself from feeling persecuted by the nurse by doing the opposite of the nurse's advice to wrap and hold the baby tightly. She shows her feelings of being persecuted by father by having him wash baby's teat the minute he touches it. Mother cannot invite her maternal grandmother, whom she admires, to her home until she, the mother, can show her that she is managing to care adequately for the baby. Mother's sense of persecution is transferred to her relationship with me and she tells me at the first visit, "Don't come back." When mother is bathing her 1-month-old baby and he cries, she feels that the cries mean she is not doing a good job mothering him. When she feels assailed by overwhelming demands to be a perfect mother, to have nothing for herself, these persecutory demands prevent her from using her good mothering capacities.

Clearly the baby's birth has precipitated in the mother a sudden and massive loss of identity. She is no longer the capable adult, the slim-figured woman, the competent librarian she was before the birth. She does not know who she is, having not yet acquired her identity as a mother. Her bewilderment and aching sense of loss of her old identity are joined to a realization of her total responsibility for this wee, helpless baby. Yet she feels utterly incompetent to the task. She feels herself to be like a newborn baby, suddenly vulnerable, exposed, unheld. By his responsiveness to Mother, his capacity to be comforted by her, Baby alleviates some of Mother's persecution. Mother introjects baby's responsiveness and appreciation towards her mothering. This helps her find an identity as a good mother. He does this by latching on to the breast, showing her that he wants and needs her and also by forgiving her quickly when she upsets him by not meeting his needs.

Father

In the initial weeks Father is more able than Mother to hold Baby closely and firmly in a way that enables Baby to feel secure. He is also able to be supportive to mother. At times, father's competence seems to be based on identification with good internal parents. At other times his competence seems to be based on projective identification with a "super-parent". This use of projective identification involves projecting his infantile anxieties into mother and baby and feeling an expert, an "old hand", at "mothering". On these occasions, being a good parent is out of competition with mother in order to cope with his infantile jealousy of baby frequently taking his place beside mother.

Father, like Mother, is also suffering a loss of identity and trying to find his place within the family. By the time baby is 3 weeks old, he has become more sensitive to his wife's insecurity about mothering and asks if she minds if he picks Baby up before he does so. However, as he allows her to be in the dominant position of being mother to baby, father's jealousy of Baby emerges. This is seen when Baby is being bathed at 3 months, with mother and observer in the bathroom. Father comes into the tiny bathroom carrying a photo of himself as a baby. He wonders if I think Baby looks like him. Now, feeling Baby is being cared for more than he is, feeling dropped and ignored, father defensively identifies with Baby. He says to me, "See my baby photo!"

Observer’s identity

I say to the group, "I don't know how to make the baby 'more of a person' yet. Can you help me write in a manner that is more readable and vivid in its descriptive detail?" Mrs Bick says, "The mother is more central in your description. Baby is still sort of a strange object. His existence is not quite whole or secure in your descriptions. Can you infer some feeling when he cries, raises his arms, pushes his head back? What sort of facial expressions does he have?" I, like the parents, am having difficulty finding an identity for the baby and an identity as an observer. Mother has said, "The baby feels just like a lump, a stranger, an intrusion these first few weeks." That is just how I feel, initially, in the family home. I also feel inadequate for the seminar and for these anxious parents.

Seminar members' sense of identity

During this initial stage, the group—including me—remain virtually mute as though listening to a symphony orchestrated by Mrs Bick. No one would know that for all of us in the seminar this is our second baby observation. Many of the members have children, and most are qualified child psychotherapists. We have become passive recipients of Mrs Bick's wisdom about the early anxieties of mothers and babies. We are afraid to speak our thoughts, afraid to disagree with the thoughts of Mrs Bick. It is not only respect for Mrs Bick's understanding that causes passivity. It is also that we have settled for passive conformity with her thoughts, for we are afraid that if we are different, if we...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• SERIES EDITORS' PREFACE
• ACKNOWLEDGEMENTS
• ABOUT THE CONTRIBUTORS
• FOREWORD
• THE LIFE AND WORK OF ESTHER BICK
• Introduction
• I Pioneering ideas: the papers of Esther Bick
• II Pushing at the boundaries
• Endpiece
• REFERENCES
• INDEX