Learning from infant and young child observation. Enriching development of future psychoanalytic psychotherapists and other professionals

Psychoanalytic Infant Observation, Esther Bick’s wonderful idea, was designed, originally, as readers of this Journal will know, to support the learning and development of Child and Adolescent Psychotherapists and, later of Psychoanalysts, starting with its introduction to the Tavistock Clinic in 1948. Bick, herself a brilliant observer of non-verbal behaviour and its possible meaning, wanted to encourage candidates for training in work with children, adolescents or adults to notice how much is always going on. She wanted them imaginatively to get the feel of another’s experience by quiet, focused ‘looking’.

Getting the feel of the baby. In the paper, ‘Notes on Infant Observation,’ which Bick published in 1964 she argues that infant observation is an important preparation for analytic training. She explained how she felt that the observation of babies ‘ … would help the students to conceive vividly the infantile experience of their child patients, so that when, for example, they started the treatment of a two-and-a-half-year-old child they would get the feel of the baby that he was and from which he is not so far removed’ (1964, 558). Observers were encouraged to recall and write down as much detail of what happened as they could remember. She wanted them to have a sense of what things were like for the baby in that observation and to make links with earlier observations which might or might not recur in subsequent presentations of the same baby and family. She looked for patterns over time and she wanted detail; lots of detail.

Seeking meaning in what is noticed, imagined, constructed and repeated. Stephen Groarke in this Journal, (Groarke, 2011) describes the infant observation seminar, where observers take turns to present a detailed observation report as a gathering of ‘ … an irreducible combination of the seen and the imagined’, where sense is made in a reconstruction worked out between observer, seminar leader and the other observers in the group. More understanding, formulation and reformulation takes place when the observer presents again, and the seminar leader and members continue to work on it. ‘When it works well the method engages the conscious and unconscious understanding of students and trainees … ’ (Groarke, 2011). This preparation for later clinical work sensitises the observers to what is unspoken and enriching as it is noticed, remembered and thought about, consciously, and unconsciously. The process is repeated with four or five weeks’ interval between presentations to the seminar for further discussion. In this way there is a ‘reaching for meaning’ over time in an interface between the observational setting and the classroom, according to Groarke (2011).

Paying attention to unnoticed but remembered detail. A number of my colleagues, at the Tavistock, have described the usefulness of introducing short observation exercises to students enrolled on a number psychoanalytically-informed ‘mental health’ courses, for example, for perinatal mental health professionals, nurses, mental health workers, nursery workers and social care workers. The aim of the exercise is to help them to realise, to begin with, how much they actually notice and remember, and to encourage them to set up an observation to discover its value. The value includes thinking about non-verbal communication, about states of mind, and that there is meaning in what is observed and thought about when time can be given to it, in the framework of a containing observation seminar.

An example which worked very well, comes to mind from a ‘short observation course’ for childcare workers with a range of levels of formal qualification, who are interested in understanding more about how babies and young children understand their world. In their first seminar meeting, the students were asked to focus on what they recalled of what happened in the fifteen minutes or so before they came into the seminar room. The exercise often began rather awkwardly, but, once a volunteer had offered to read her account aloud, it became clear that everyone was surprised at the richness of the detail recalled; and more emerged as the exercise continued. There is considerable pleasure for the anxious volunteers who discover, with such a simple experiment, how much they notice without conscious effort and without training or practice in observation. This encourages members of the course to find an observation setting, if possible, for a few weeks, with parents or grandparents or other carers, and to make spontaneous discoveries about how much is to be seen and thought about.

A colleague and I tried it with a group of psychologists, researchers, supervisors and ‘para-counsellors’ in Dhaka, Bangladesh, as a prelude to thinking about the value of observation, to encourage spontaneous observation accounts of the events of 15 minutes before they arrived in the room where we were working together. By far the most interesting and detailed observation accounts were given by the para-counsellors, some of whom were 17 and 18 years old, with little formal education and only a few days training for their current role in the Rohingya refugee camps of Cox’s Bazaar. Their vivid and detailed descriptions seemed to be all the better for not being encumbered by an ‘ … . irritable searching after fact and reason’ (Rollins, 1958). The multidisciplinary Dhaka group, inspired by the para-counsellors wholeheartedly embraced the thinking about observing and remembering, and their observing, quiet presence seemed very often to have a calming and therapeutic effect in the ‘Play-labs’ (Children’s play centres), in the camps where most of the children and their parents were highly traumatised, and the only support which was on offer was available from willing, sensitive minimally trained workers.

Even in an extremely short observation (perhaps as brief as ten weeks) the observer has to negotiate informally with the parent or parents, to find a physical place to be, to observe, without being actively involved in care or play, in order quietly to be focused and alert to what happens. Being able to set up an observation is an extremely important experience, and observers are required to focus, trying to remain still and quiet for the observation hour, allowing enough time to remember and write up the detail very soon after. They need to be prepared for their timetabled seminar presentation and to be ready for the discussion as well. Writing notes of what happens, often brings an overwhelming amount of detail to mind, both about events in sequence, and, sometimes a lot of feeling as well. As observers worry about remembering detail there are many preoccupations. Do they have the correct order of events? Did they speak too much or too little during the observation? Should they or should they not have accepted the offer of a drink? Some are very self-conscious, others worry about feeling critical or envious of the child or mother, or sympathetic to an older child who is present. Many are less aware of their identification with the baby and the kind of care she receives, which might be the source of criticism of the mother or father. Observers who are parents, often identify strongly with a tired or rather depressed mother. It soon becomes clear that there is nothing in the least simple about observation even if it is only for a short time.

The initial, inevitable, extreme self-consciousness of most short and longer-term observers, is, of course, a helpful reminder of how self-conscious most parents will be as well, with a stranger present amidst their private family life as they are themselves adjusting to a new life in it. Some feelings of persecution are the norm. It would not be natural to feel relaxed in the presence of someone whose expressed aim is to learn as much as possible about a baby or a young child in his or her family by sitting quietly for an hour, to see whatever happens!. It has been noted by authors such as Watillon-Naveau (2008) and Perez et al. (2018), that most, if not all, parents are certainly self-conscious or they feel persecuted, even though they have agreed to the observation, and may want very much to help the observer or simply to have their company once a week.

Observers also need to be alert to those mothers and fathers who seem to be wholeheartedly enthusiastic and welcoming of an observation. While they may consciously agree to be to helpful to the observer, there are many examples of lonely, isolated mothers who might feel depressed, unsupported by their parents who live far away or who have busy working partners. Others might unconsciously be seeking expert advice or support from an observer who has inadvertently revealed his or her own professional identity or expertise. Unconscious parental motivation often reveals itself after an observation has been set up and started. There might have been a bereavement, a traumatic birth, a previous miscarriage, or there is an older sibling with developmental difficulties. The baby might have been ill or in Special Care at or near birth. Observers often learn these things over time. They must wait, be attentive, patient and aware that their own minds and imaginations become very active and that it is difficult to keep quiet and not ask intrusive questions. All of this is such important learning for working with parents and children. The insights are not particularly psychoanalytic but are profoundly important learning about how one comes across, how difficult if might be to be patient, and quiet. Many observers learn over time, that being quiet allows parents to talk about whatever they want to when they feel ready, trusting and at ease.

Observers’ own subjective responses to the observation are another significant source of learning. There are many opportunities for observers to learn more about themselves, their personal preoccupations and areas of discomfort, which might lead to their own wish to have an analysis or personal psychotherapy and to discover more about their interest in observation or in seeking to train as a practitioner, whether psychoanalytic or another clinical approach. Undertaking an observation is a training and an opportunity, not always entirely comfortable or wanted, for insight into oneself. Bick clearly felt that doing observation might confirm the observer’s ambition to train in psychoanalysis, or, in some case, lead to a painful decision not to do so, or not yet.

I have set out thoughts about setting up and making psychoanalytic observations, as a prelude to introducing a group of presentations in this issue of Infant Observation. Below, we publish presentations from an event which took place a year ago, from which we have chosen three wonderful examples of observational writing- one a Young Child Observation, and two which are Work Discussion reports, each with a series of reports (Daligault, 2023) or of work with children (Gavériaux, le le Guédès, & Duriff, 2023 and Briguier-Huet, 2023). Readers will be struck both by the remembered detail, and evocative quality of the descriptions. In all three examples, observation is more evident than words and actions in the work presentations, yet its impact on the children and adults who are observed is powerful.

In March 2022, I was fortunate to be invited again to attend the Study Weekend (Jour- néés de Travail Tavistock) of the Centre d’Etudes Martha Harris, Larmor-Plage, Brittany), organised by Odile Gavériaux and her colleagues. I was asked to be a member of the discussion panel for the two days of presentations by Observation Course and Clinical Students from the Centre. This enriching annual event had been interrupted as a live event by the Covid Pandemic in 2020 and 2021. In March 2022, a large number of delegates came again in person. The discussion panel was present in person and on Zoom. In person, Simonetta Adamo from Naples, Biddy Youell from the Tavistock, were present with me, and the Chair of the event, Odile Gavériaux. On Zoom, Zoom were Gianna Williams and Alex and Hélène Dubinsky from the Tavistock all of whom have been working with the Centre d’Etudes since its inception. Gianna Williams is the President, and Alex Dubinsky, the Director of Clinical Training. Alex and Hélène Dubinsky have taught at Larmor Plage on the Observation and Clinical Courses from the start, with Gianna Williams. Professor Simonetta Adamo, from Naples is now a regular teacher too at the Centre d’Etudes, alongside similar work in the Centro Studi Martha Harris in Florence. Other Tavistock-trained child psychotherapists who have attended these events dand presented papers include Margaret Rustin, Jeanne Magagna, and several others including Jenifer Wakelyn and Ruth Glover.

Biddy Youell presented her paper on beginnings endings and transitions, (published in this issue of the Journal (Youell, 2022). The paper is based on work encouraging perinatal mental health workers with varied levels of training and qualification, to be more observant, and to realise how easy it is, when a mother is mentally ill, not to notice the baby who seems ‘fine’ or is quiet, very much. Her main emphasis is, as was the overall theme of the Study Weekend in Brittany, to observe the detail of beginnings, the impact of transitions, and the extremely powerful impact of any ending. The paper conceptualises much of what was exemplified in the other presentations both clearly and convincingly.

One of the pleasures of the Study Days, is the presentations given by graduates and current students of the Observation and Clinical programmes. These are always characterised by fine and beautifully observed and detailed material, in the Bick tradition. (We have published three observational presentations with commentaries, in this issue. The detail which each author provides is vivid, easy to picture and readily evokes many associations. The presentations are written by Florence Daligault, Véronique le Guédès and Christelle Duriff and Aurélie Bruguier-Huet with commentaries by Odile Gavériaux, Simonetta Adamo and myself.

The commentaries are published to capture a flavour of some of the rich, detailed discussion of each presentation from the Panel and members of the audience. A characteristic of all three presentations is the clear and vivid picture of the different situations over time in each case they give a clear impression of the observational stance of each presenter, who have clearly been inspired to describe situations in great detail, without jumping to conclusions or shutting down their minds and imaginations. And, in reading each of several presentations of each child or family, one gets to know the children, (and their parents with the children in the group described by Le Geulec and Duriff) and, one gets to know the observer, what holds their attention, and even, by inference, what they might be thinking about what they see. In each case, one has the sense of the observers’ impact on what they observe. They are not objective, they are clearly full of feeling and warm interest and affection for the children, and they are containing. They take in what they see. They think about it, and, over time, there is development and change in each of the observations. We learn a lot about containment and, without much or anything being said, that it can be extraordinarily transformative and therapeutic for the children. In her work with different Nursery Nurse colleagues and Louis Aurélie Bruguier-Huet is actively eager to help him to prepare to leave the residential home and go to a foster family. Although she actually reports saying little, Bruguier-Huet and her different colleagues contain Louis as his play and imagination unfold and we begin to feel there is something very important on his mind. His identification with the baby full of pooh who can never be clean and worthy of love gradually changes, and, as it does, it begins to seem possible that he could be leave the home and be fostered in a family. Much, in this process, goes unsaid, but understood as he has a place in the minds ofo the dedicated workers

Bruguier-Huet’s account is extremely touching, as is Florence Daligault’s of Maelle and Antonin settling into a rather rigid, understaffed, but not unkind, nursery where play and imagination are not given precedence over order, routine and skill-acquisition. The two children make considerable, quiet use of the observer, Florence, who again, offers friendly warmth and containment and clearly enables them to settle and to feel they have a place there.

The presentation of the CMPP group of parents and children with developmental difficulties is a third example of friendly, welcoming containment offering transformational experience, in particular to one little boy, Marius, and his anxious, deprived, touchy mother. They and the other children and parents, through play, talk about cooking and shared meals all grow in confidence under the welcoming, friendly eyes and minds of Christelle Duruff and Veronique le Guédès.

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I complete this Editorial by noting that we include a second fascinating paper about Tove Jansson’s Moomintroll- this time about the trauma and anxiety of war written by Debbie Hindle and Gita Ingrams. This paper, part of our occasional series Childhood and the Imagination illustrates wonderfully how observational skills are applied to a work of children’s fiction, making links with Jansson’s experience of the traumatic Second World War in Finland. Hindle and Ingrams’ imaginative construction of the unconscious links in Jansson’s fiction, along with her illustrations, will be of interest to readers whose imaginations, clinical insight and observational skills combine fascinating ways, which, I hope Esther Bick herself might have found interested and stimulating in making meaning.

In another paper from Scotland, written by Anne McFadyen and her colleagues (McFadyen, Armstrong, Masterson, & Anderson, 2022). The focus is on infant Mental Health and on how to access sand take into account the ‘voice’ of the infant. Anne McFadyen, a child and adolescent and infant mental health psychiatrist who trained at the Tavistock Clinic chairs the IMH Implementation and Advisory Group at the Scottish Government. She is strong supporter of psychoanalytic observation. Mc Fadyen has worked with a strong team of colleagues to find a way of understanding and taking into accounts the baby’s experience in developing infant mental health policy in Scotland. Not without considerable effort and work. The team has clearly understood the significance of baby’s communication of their experience and that it must be included in developing policy and guidelines on infant mental health. This is an important move and an important moment.

The publication of this issue has been delayed, but I hope that readers will feel that it has been worth the wait in terms of the richness of what we have been able to include.