The value of direct child observation in a therapeutic parent-toddler group, for students of psychoanalysis

ABSTRACT

Starting in Vienna in the 1920s, Anna Freud’s first tentative attempts at observing children became a crucial component of the ‘double approach’ which integrated direct child observation with psychoanalytic reconstruction. This approach enabled the detailed study of unfolding developmental processes and the construction of a theory of normative as well as pathological child development. Direct child observation was an integral component in the curriculum of the Psychoanalytic Master’s degree at Anna Freud’s Hampstead Clinic (later, the Anna Freud Centre) in London. The process, experience and value of observation for students of psychoanalysis is described, focussing on observers in a therapeutic parent-toddler group. The experience of observing or being observed is discussed from the perspective of staff facilitating the group, students, parents and children.

KEYWORDS:

• Anna Freud
• direct observation
• therapeutic parent-toddler groups

Introduction

In the early 1920s in Vienna, Anna Freud was already pioneering the use of direct observation to gather data about child development. This paper traces the development of her use of observation in Vienna and in the Hampstead War Nurseries, in London until it became an integral part of the child psychotherapy training programme. Anna Freud’s early and tentative attempts at observing children became a crucial component of her ‘double approach’ which integrated naturalistic child observation with the psychoanalytic reconstruction of childhood experience from the psychoanalyses of children and adults. This enabled the detailed study of unfolding developmental processes and the construction of a theory of normative as well as pathological child development.

Early observations in Vienna

In the early 1920s, a group of young Vienna University medical students gathered around Anna Freud, Heinz Hartmann and Wilhelm Reich to form an informal study group. These meetings developed into regular seminars on child analysis. While analysing verbal children and observing babies, these analysts began to think about the importance of the mother–infant relationship for the child’s future development. The naturalistic, longitudinal observations that took place within the context of a training analysis, were regularly published in the psychoanalytic journals of the time (Pretorius, 2011; Young-Bruehl, 2008).

While Anna Freud conducted naturalistic observation, Charlotte Bühler conducted systematic, empirical longitudinal observations of infants and young children in her department of Child Development at Vienna University (Datler, 2009; Ludwig-Körner, 2012). She continued this practice from 1923 until her emigration in 1938. Her colleagues included Esther Bick (née Wander) as well as, Liselotte Frankl and Ilse Hellman who both, later worked with Anna Freud. Bühler disapproved of psychoanalysis and is said to have forbidden her colleagues from attending Anna Freud’s public seminars and lectures. Nonetheless, Liselotte Frankl and Esther Bick did attend (Hellman, 1990). Bick’s growing interest in the child’s inner world (Wander, 1935) culminated her breaking sharply from the behaviouristic methodology she learned at Vienna University, once she arrived in London. It appears that this this dramatic change in methodology was stimulated and influenced by listening to Anna Freud.

Anna Freud (1926) documented her innovative method of directly observing infants, but commented, ‘What was not available to us, was detailed knowledge of the important development between age one and two’ (Freud, 1980, p. xiii). The Jackson Nursery would begin to fill this gap. She explained,

Our wish was to gather direct (as opposed to reconstructed) information about the second year of life, which we deemed all important for the child’s essential advance from primary to secondary process functioning; for the establishment of feeding and sleeping habits; for acquiring the rudiments of superego development and impulse control; for the establishment of object ties to peers. (Freud, 1978a, p. 731)

Opened in February 1937, it was a day nursery for toddlers aged 12–17 months from Vienna’s poorest families (Freud, 1980, p. xiii). The nursery aimed to nurture the children’s well-being and physical condition, to promote their sociability, and for staff to research child development (Krivanek, 2014). Anna Freud was particularly interested in learning about children’s independent eating, toilet mastery, sleep patterns and aggression.

As part of the research, nursery staff recorded their observations which were then discussed at weekly meetings. Monthly seminars covered more theoretical concerns such as data collection methodology, and the benefits of objective behavioural observations vs. the ‘analytic method’ (Kennedy, 1988, p. 272). According to Kennedy,

With hindsight, there is no doubt that these observations were from the beginning, not mere records of observed behaviour but a method of collecting data on the basis of pre-existing knowledge: an attempt to observe children’s behaviour which aimed at confirming or contradicting psychoanalytic assumptions. (Kennedy, 1988, p. 272–273)

With its research program, inspired leadership and community of learning, the Jackson Nursery became an international training institution (Krivanek, 2014). However, it was soon forced to close after Germany’s annexation of Austria in March 1938, which sent the Freuds into exile (Kennedy, 2009).

The Hampstead War Nurseries

In 1946, as World War II was breaking over London, Anna Freud and Dorothy Burlingham opened the three residential homes that became known as the Hampstead War Nurseries (HWN) (Hellman, 1983). Expanding on their experience at the Jackson Nursery, they used psychanalytic knowledge to enhance the welfare of children.

Of the 103 children housed in the nurseries in 1941, most were one to five years old, but some were as young as one week and others up to the age ten (Freud, 1973a). Some of the children were homeless, while some of their mothers had developed physical or mental illnesses.

Beyond the HWN’s innovations in wartime childcare, the settings also provided excellent platforms for observation, research and teaching. The longitudinal studies have endured as some of the most significant studies of child development (Burlingham and Freud, 1942a). Children could be observed, almost from birth, with or without their mothers, being breast- or bottle-fed, separated or reunited with parents, and relating to mother substitutes and peers (Freud, 1951). So too, could the process of weaning and achieving toilet mastery, the acquisition of language and the development of various ego functions (Freud, 1966). Staff observed the influence of communal life and the impact of war events on the children’s libidinal and aggressive development (Seifert, 2009). Some research questions, like significance of attachment in the child acquiring toilet mastery, that had arisen at the Jackson Nursery in Vienna, were later resolved at the HWN (Krivanek, 2014).

The data collection was based on detailed, direct observation. These observations were grouped into categories and then integrated into the overall theoretical framework, itself continually modified by new observations and resulting information.

Apart from six highly qualified people, most staff were young refugees who had not been exposed to psychoanalytic theory. Anna Freud described the early observational work and stance,

The observation work itself was not governed by a prearranged plan. Emulating the analyst’s attitude when observing his patients during the analytic hour, attention was kept free-floating and the material was followed up wherever it lead. (Freud, 1951, p. 9)

Anna Freud and Dorothy Burlingham based three major books on these recorded observations (Burlingham and Freud, 1942b, 1944; Freud and Burlingham, 1943). The books blend empirical data with psychoanalytic interpretation. They revealed some major scientific findings based on unexpected observations and insights, including the children’s reactions to the war. Anna Freud concluded that the child’s response to war was profoundly determined by the mother figure’s absence, presence and state of mind. For children, broken family attachments cause greater stress and trauma, than war. She concluded, ‘To lessen the shock of the breaking up of family life’, nurseries should facilitate new attachments, or ‘a really good substitute for the mother relationship’ (Freud, 1973a, p. 127). Accordingly, she organised the children into family groups, each with a ‘substitute mother’ which had a dramatically positive effect on their development (Freud, 1973a, p. 221).

Anna Freud’s ‘double approach’

Having initially been sceptical about the value of child observation, by 1958, she noted that naturalistic observations were confirming some psychoanalytic assumptions, such as the overlapping of libidinal phases. Observations also enabled regressive and repetitive behaviours to be recognised and linked to early trauma (Freud, 1958). She came to value the ‘double approach’ to gathering data – observation and reconstruction – and the way in which direct observation and psychoanalytic insight could reciprocally enrich each other to create a psychoanalytic child psychology (Freud, 1958). She wrote,

While observing the coming and going of the manifestations of pregenitality in their inexorable sequence, the observer cannot help feeling that every student of psychoanalysis should be given the opportunity to watch these phenomena at the time when they occur so as to acquire a picture against which he can check his later analytic reconstructions. (Freud, 1951, p. 21)

The ‘double approach’ enabled the detailed study of unfolding developmental processes and the construction of a theory of normative (typical or age-appropriate) as well as pathological child development. Anna Freud emphasised, ‘Concern with problems such as prediction or prevention leads inevitably to a study of the normal, as opposed to the study of the pathological mental processes’ (Freud, 1965, p. 55). Anna Freud’s concept of Developmental Lines epitomises the synthesis of data gathered by the ‘double approach’, as does the Provisional Diagnostic Profile (Freud, 1965). While the Developmental Lines give an external picture of the child from which psychic development is inferred, the Diagnostic Profile includes the child’s subjective, inner world. Essentially a developmental assessment instrument, the Profile drew on and reinforced Anna Freud’s quest for a greater understanding of normality and pathology.

Observation in the child analytic training

With the help of Kate Friedlander, Anna Freud founded the Hampstead Child-Therapy Course (HCTCC) in 1947 (renamed the Anna Freud Centre, AFC, in 1984). The four-year full-time course in child and adolescent psychoanalysis aimed to train ‘child experts’ and included year-long naturalistic observations of babies and young children. Applicants required pre-clinical experience of ‘at least 12 months continuous practical experience with children including children under five years’ (HCTCC Training Prospectus, 1948). In 1993, this ‘pre-clinical’ requirement was formalised into a one-year full-time Master of Science (MSc) degree in Psychoanalytic Developmental Psychology in conjunction with University College London (UCL). This MSc became the pre-clinical course for the 4-year child and adolescent psychoanalytic psychotherapy training. Undergoing a 5-session weekly analysis was not a prerequisite for this Master’s course, although some students were in analysis – especially those aiming to become analysts. (The psychoanalytic training was closed in 2009 and the Masters course, in 2021).

The AFC-UCL MSc curriculum included year-long courses in Psychoanalytic theory and Psychoanalytic Child Development as well as a research component that culminated in a research thesis. The curriculum included 3 parallel observation modules; each comprising a year-long, weekly observation of an infant (0–1 year), a toddler (1–3 years) and a nursery-aged child (3–5 years). Students recorded detailed observations that were discussed at weekly seminars. Thus, students conducted 3 observations (60–90 min each) and attended 3 observation seminars per week (90 min each)! At the end of the academic year, students wrote an Observation Paper on the child they followed.

The observation of a baby was called ‘parent-infant observation’ emphasising Anna Freud’s awareness of the role of the relationship and of the parent on the developing baby’s psyche. Observations were written in the form of process notes describing the entire hour of observation, from beginning to end.

The parent-toddler observation took place in one of the therapeutic parent-toddler groups facilitated at the AFC. The nursery-aged child was observed in a local nursery school. Toddler and nursery observations were not written as continuous process notes, but as a few distinct sequences of interactions or play, each sequence was up to half a page long.

Observation in the therapeutic parent-toddler groups

The first parent–toddler groups emerged from the Well-Baby Clinic that Anna Freud had asked Joyce Robertson to set up as part of the HCTCC in 1952 (Zaphiriou Woods & Pretorius, 2016). The parent–toddler groups grew from these early roots to become an integral part of the AFC, offering a clinical service, observation, training, and research, until the service was closed in 2018.

Because the approach to running psychoanalytically informed parent-toddler groups is well documented (Zaphiriou Woods and Pretorius 2011, 2016) only a few aspects will be highlighted. The groups at the AFC had a consistent membership of up to 8 parents and their toddlers aged 1–3 years. The groups met for 90 min each week in a purpose-built playroom in the garden of 21 Maresfield Gardens. Parents were asked to commit to attend regularly for at least a year. The children were encouraged to play with their parents and the staff. Group sessions were unstructured except for the snack and tidying up time.

The groups were run by a qualified child psychotherapist and one or more assistants who held MSc degrees in psychoanalytic child development. Each week, the same facilitators welcomed the families to foster continuity and cohesion. During the group session, the leader and assistant(s) moved freely among the parents and toddlers, observing and reflecting inwardly, and intervening when necessary. They aimed to maintain an ‘internal analytic setting’ (Parsons, 2007, p. 1) to make sense of the unconscious communications and intense transference and countertransference feelings that inevitably arise.

AFC toddler group meetings were video recorded, with the parents’ written consent. This video material complemented the more subjective observations and enhanced the discussions in staff supervision meetings.

The aims and expectations of the observation course

The overall aim was for students to learn in vivo, about toddler development and the parent-toddler relationship. The course aimed to teach students how to observe; to actually see what was happening between the parent and child, between toddlers, between staff and group members. Students learned not only to observe the interactions and play in the group but also, to observe themselves, while observing.

The Master’s students observed in the same toddler group for a year. At the beginning of the year, each student was asked to choose one main toddler to observe throughout the year, and a second toddler, in case the main toddler was absent or stopped attending the group. They were advised to choose without giving it much thought. At the end of the academic year, students were encouraged to reflect on why they had chosen their particular child. By then, students had become more reflective, more trusting of their fellow students and so more open to share their self-reflections. Invariably, students reported that as the year progressed, they realised that an aspect of the toddler resonated with their personal history, so unconscious forces had motivated their choice.

During the playgroup session, students either sat in the playroom (2 students) without interacting with the children, or in an observation booth (3–4 students) where they could observe the group activities through a one-way mirror. Students were taught the observational stance and about confidentiality. They were asked to maintain a neutral, quiet and respectful attitude, with ‘free-floating’ attention (Freud, 1951, p. 9). When sitting in the playroom, students were instructed not to initiate, reciprocate or encourage interactions with toddlers or conversations with adults in the group, but to maintain a friendly distance. Students were asked to be punctual, to remain in position and to refrain from eating, drinking and writing notes. They were allowed to take bottles of water into the observational booth. Students were instructed to break the observational stance and call me, if they saw that a child was in danger of being hurt, that I had not noticed. This did happen once, when a toddler lunged towards a baby, left momentarily unattended. I was able to intervene to protect the baby.

An observation was conceptualised as a detailed record of a specific interaction or play activity that occurs within a relationship. It is an attempt to describe the child's behaviour in terms of the context, sequence and timing of the play or interaction; affective expression; verbal and non-verbal communication; the consequences of communications in terms of the reaction of the child as well as the reactions of others. The observation is not a general description, but a detailed record of a specific sequence of events. It is an attempt to describe observable events, without attributing feelings or motives to the protagonists. The interaction could be characteristic or uncharacteristic of the child, striking or interesting.

In addition to observing the children, students were asked to observe the self, while observing. They were asked to record their own personal reactions and feelings towards the behaviour, the child or parent, thus, to record their countertransference. The subjective response was written separately, underneath the observation paragraph. This process encouraged the students to learn how to separate their own thoughts, feelings and interpretations from what they observed. It also encouraged them to become more curious and reflective about themselves. Students experienced a range of feelings towards the children and parents that often changed over the course of the year. These subjective feelings provided an important source of understanding for staff as well as students. The feelings enriched the observations, could inform interventions and contribute to growing self-awareness.

At the end of each group session, students recorded their observations which were discussed at the weekly seminars, facilitated by the psychotherapist who ran the parent-toddler group. The detailed observations formed the basis of hypotheses about the child and parent. The therapist did not share background information about the toddlers and their parents with the students. Observers had to glean information as it was revealed in the group to gradually build a coherent understanding of the toddler and parent.

In seminars, students were encouraged to consider other people’s viewpoints on the material, and to learn to observe empathically rather than critically. They were encouraged to consider different cultural practices in child-rearing and to tolerate uncertainty and not knowing. Thus, the observation process was designed to bring together the observed behaviour, subjective element and later in the academic year, to link the observed material to their growing knowledge of child development theory.

Students invariably became extremely attached to their observed toddler. Their detailed attention to the child and parent fostered a sense of familiarity and of ‘knowing’ the dyad. The final observation session was often quite emotional for students who complained that the observational stance precluded them from marking the ending in a manner that matched their feelings. To complete the course, students wrote a longitudinal observation paper on their toddler. A number of these papers have been published with the parents’ consent (Dainesi & Pretorius, 2020; Hadary, 2015; Martinez del Solar, 2003; Plagerson, 2011; Pretorius, 2004, 2022; Pretorius & Wallace, 2008).

Although the course aimed primarily to teach students about toddler development, they learned far more than child development. Observers became aware of the struggle of making sense of the emotional reactions to what was being observed and through this, learned about the self. What the observer experienced and the growing ability to reflect on that experience is the essence of what was learned during a naturalistic observation. This learning corelates with the development of capacities and skills that psychoanalytic adult and child psychotherapists need.

The experience of observing or being observed

A student’s observation and the discussion in the seminar

Lina (2 years 1 month) ran smiling into the playroom, ahead of her mother. Her mother paused to speak briefly with the therapist before going to sit on a chair. Lina went to the ball run toy and dropped a few balls down the chimney. She jumped and squealed as the balls clattered down the ramp and came to a stop. Lina looked at her mother and smiled. Her mother was looking down and did not catch Lina’s glance. Lina moved rapidly to the toy kitchen and started ordering the pots. She looked and her mother who was looking out of the window. Lina took a cup and saucer to her mother and said ‘tea' offering her the cup. Mother said ‘thank you', smiled briefly and placed the cup on the table in front of her. Lina looked at her mother before moving to the book corner. She took a book and looked towards her mother who continued to look out the window. Lina dropped the book and went to the toy garage where she pushed a few cars down the ramps. The group assistant joined Lina at the garage and began pushing a car up the ramp, while verbalising her actions. Lina smiled at her and made her car follow the assistant’s car up the ramp. They continued to play together at the garage, taking turns to lead the cars driving up and down the ramps, while looking at each other and smiling.

Lina seemed very pleased to be back in the playgroup after a week’s absence. I was pleased to see her! Her mother seemed preoccupied and not as attuned as usual, to Lina’s invitations to play or read. Lina persisted in trying to connect with her mother. She seemed unable to remain with one toy for any length of time, moving rapidly from activity to activity until the assistant joined her at the garage. I felt increasingly frustrated and annoyed with the mother who seemed emotionally absent. It was a relief to see the group assistant join Lina and observe them playing together with obvious pleasure.

In the seminar, some observers also commented that Lina’s mother was less playful and attuned than usual. Some speculated that Lina and mother might have had a ‘bad night’ resulting in mother’s greater passivity. We speculated that the observer identified with Lina which led the observer to feel frustrated with the mother. One student suggested that they wait a few weeks to see whether the changes became a pattern.

I did not tell the students that as Lina’s mother entered the playroom, she told me that she had just discovered that she was unexpectedly pregnant. It was some weeks later, when students overheard Lina’s mother say that she was pregnant, that they could make more sense of the change in mother’s behaviour in this observation. This experience conveyed powerfully to the students, the importance of trusting what they saw and felt while observing.

Toddler and parents’ experience of being observed

Most parents and toddlers became quickly accustomed to the observers sitting in the playroom and ignored them. Toddlers occasionally tried to engage an observer in play by offering them an object. As instructed, the students would smile and place the object on the floor and so, the child looked for a more responsive playmate.

Some parents seemed not to mind the observers because they spoke freely in front of them, while others found ways to evade their watchful gaze. Parents realised that they could avoid the cameras and students in the garden. Occasionally, a parent would ask me walk with them in the garden and invariably, tell me something confidential that they did not want shared.

Very occasionally, parents were bothered by the observers, and this could result in them provoking or teasing the students. This tended to happen in the group leader’s absence and I would only become aware that it happened when students reported it in the seminars. For instance, one Spanish mother encouraged her toddler to approach and ask in Spanish, what the student’s name was. The student smiled but remained silent. In the seminar, we speculated that the mother had guessed – correctly – that the student spoke Spanish. Students commented that mother’s curiosity set her toddler up for rejection which elicited strong feelings in them. The student who had been approached by the toddler, felt guilty and upset about not answering the toddler.

Occasionally a parent’s provocation was caught on camera. The following is a description of a sequence caught on camera the group facilitators were interacting with other group members.

Gary (2 years 3 months) gave his mother a toy broom while holding one himself. His mother said ‘sweep, sweep, let’s clean up' while sweeping in front of her. Gary smiled and swept the floor alongside her. Gary’s mother moved towards the two seated student observers and said, ‘sweep, sweep their shoes' while brushing her broom over their shoes. The observers remained immobile. Gary copied his mother, sweeping the shoes, while looking at the students. Gary turned away, but his mother caught his attention by continuing to sweep the shoes, saying, ‘make them laugh!' Gary looked at his mum and then the students. His mother persisted in sweeping, saying ‘let’s see if they are human'. The students remained immobile, and Garry moved away.

Over the years, it became apparent that more confident and mature parents did not mind the observers, while those who were more disturbed or had a borderline personality disorder tended to be more paranoid and provocative.

The students’ experience of observing

Parental projections could affect the students in different ways. Students reported stronger counter-transference feelings when sitting in the room, as opposed to observing from the booth. It seems that being in a small room, separated by one-way mirror from the action, diluted the strength of projections and counter-transference feelings.

Once, a student had an extremely strong response to observing. At the beginning of one academic year when students were new to observing, I opened the observation booth door after the end of a group session. I was shocked to see one young woman lying on the floor with the other two students ministering to her! They related that she had felt faint during the toddlers’ snack-time. As they had water and one observer in the booth was a medical doctor, they did not feel the need to alert me to the crisis!

In the seminar we discussed the group process. Students identified one moment in the group session that they all found more of less perturbing. As staff encouraged the toddlers to gather at the snack table, one mother sat with her back to the snack table, facing the booth and called her 2 ½-year-old son to her. She removed her T-shirt revealing that she wore no bra and so she was effectively naked, from the waist up! She placed her son firmly on her breast. This very disturbed young mother had a mental health diagnosis and an adhesive relationship with her son. She regularly breastfed him at snack time, without him asking for milk, preventing him from participating with the other toddlers. It seemed that the mother’s disturbance and exhibitionistic manner of breastfeeding her son, overwhelmed the student. It is interesting that the student had selected that toddler to observe, apparently attracted unconsciously to some aspect of the dyad. She chose a different toddler after that and managed the year-long observation satisfactorily.

I felt extremely guilty about the episode and wondered to myself if I had been too strict in imposing the observational stance to the students such that they felt unable to call me when their colleague fainted. After that event, I instructed the students very clearly to open the booth door and call me if there was a crisis!

Such negative experiences were extremely rare, most students had extremely positive and memorable experiences observing the toddlers. One student described her experience of observing,

I had the unique opportunity to attend the therapeutic parent-toddler groups initially as an MSc student observer and eventually as a staff member, as an assistant in a group. The opportunity to practice the role of an observer helped me improve and understand the importance of observational skills, because it reveals the surface and depth of the mental functioning of the child–parent relationship and reveals important counter-transferential feelings evoked by unconscious communications. As students, we had minimal information about the families, and this allowed us to observe with an unsaturated mind. Through the seminars of the observational course, I learned to manage the anxiety of the projections and deal with uncertainty, which eventually flourished into thoughtful internal conversations about my feelings as I was observing, opening a space for reflective thinking and consequently fostering a non-judgmental attitude and emotional availability. It was a great privilege and bonus to observe a qualified child analyst at work over the course of the year!

My journey as a student was pivotal and contributed directly to my work as a Toddler Group Assistant the following year, since the structure of the module and the group setting acted as a container and fostered growth for students, staff, parents and toddlers. It allowed me to acquire the capacity to observe and think before engaging and ‘doing', which parallels the toddler’s ongoing acquisition of ego functions, sense of self and the development of a mind. On a practical level, my experience as an assistant reinforced the importance of attunement, play and a consistent setting in the dynamic interplay between parent and child as foundation for the development of a sense of self. Reflecting on my role, I sometimes saw myself as an ‘attunement moderator’, working as a relational maestro in the midst of the melody of mother and child within the playgroup.

The weekly clinical supervision of the group staff was fundamental as it served as an important space to allow the projections from the families to be thought through and processed, as opposed to reacted to. Supervision provided a forum to discuss theoretically informed and thoughtful interventions. I believe that my practice as an observer had a direct effect on my clinical practice on my path to becoming a child and adolescent psychotherapist, since it allowed me to manage silence, bear uncertainty and cope with uncomfortable feelings before acting out (Victoria Nicolodi).

Research into the parent-toddler groups

In addition to the year-long observation, numerous students conducted their research on aspects of the group. The research could be qualitative, using observational data or quantitative, using measures that were gathered on the families. Between 2002 and 2019 when the groups were closed, there were 17 MSc theses on diverse topics like:

• ‘A qualitative single case study of a mother’s experience of attending a PTG’ (2003) Annabel Kitson

• ‘How do parents view relationships with visually impaired toddlers? An examination of reflective capacities and attachment representations’ (2006) Ethan Schilling

• ‘Snack time: microanalysis of social eating in toddlerhood’ (2007) Joshua Holmes

• ‘Does a psychoanalytically oriented PTG enhance Reflective Functioning capacities in parents? A comparative study of Entry- and Exit-Parent Development Interviews’ (2007) Carolina Camino Revera

• ‘Understanding and breaking intergeneration patterns in mother-toddler relationships’ (2010) Gloria Jaramillo

Two PhD research projects focussed on the PTGs;

• ‘Parent–Toddler Groups: promoting mental health in the family. A programme of prevention and primary intervention in the community’ (2013) Evanthia Navridi

• ‘Maternal depression, Reflective Functioning and toddler play in the Parent-Toddler Groups: A Mixed Method Study’ (2023) Fernanda Ruiz-Tagle Gonzalez.

Advantages of observing in a parent-toddler group

A major advantage to observing a toddler in a group as opposed to in the home, is that the impact of an unresponsive observer on the child and parent is minimal. In a group, the child is surrounded by responsive and playful others; their parent(s), the facilitators and other children. Similarly, parents have plenty of opportunity to interact with others.

Another advantage is that the child psychotherapist leading the group monitors the children’s development closely and is responsible for any safeguarding issues. The group leader’s presence also ensures that students keep the observational stance and do not act out.

Thus, the presence of the therapist and the group setting circumvents the various ethical concerns about observers in the home, raised by various authors (for instance, Hindle and Klauber, 2006; Hollway, 2012; Ludwig-Körner, 2015, 2020; Urwin and Sternberg, 2012).

A further advantage is that students not only observe the toddlers, their parents and the group dynamics, but also the therapeutic interventions of the therapists. It is very rare for students to be able to observe a Child Psychotherapist in action; to observe the manner, posture, verbal expressions and therapeutic interventions. Numerous students attributed their wish to train as a child psychotherapist to having observed a therapist running a parent-toddler group.

Conclusion

Anna Freud’s early publications of direct observations of children in Vienna (Young-Bruehl, 2008) and in the Hampstead War Nurseries (Freud & Burlingham, 1943) were the forerunners of her subsequent advocacy of direct observation. A longitudinal observation of a baby, toddler and nursery aged child became an integral part of the training of a child psychoanalyst at her Hampstead Clinic and the Anna Freud Centre.

Today, longitudinal observations are an integral part of most adult and child analytic trainings; ‘observation is used by training schools because learning psychoanalytic skills from books is impossible, and it offers a direct experience’ (Sternberg, 2005, p. 11). Naturalistic baby or young child observation is not only about what can be seen. The student learns far more than child development: the observer learns a great deal about him/herself and this learning correlates with the development of capacities and skills that psychoanalytic psychotherapists need. The observer becomes aware of and struggles with making sense of the ebb and flow of the emotional reactions to what is being observed. What the observer experiences and the ability to reflect on that experience forms the essence of what is learned during a parent-infant or young child observation.

Acknowledgements

The author would like to thank Victoria Nicolodi and other students who contributed to this paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Inge-Martine Pretorius

Inge-Martine Pretorius, PhD (Microbiology) and DPsych (Psychoanalytic Psychotherapy), qualified as a Child and Adolescent Psychotherapist at the Anna Freud Centre (AFC) in London. She is a Visiting Professor at Vienna University and a Lecturer at University College London. For over 20 years she worked at the Anna Freud Centre; as Clinical Lead of the Parent-Toddler service, facilitating a therapeutic Parent-Toddler Group and Observation Seminars; organising and teaching the AFC-UCL MSc Psychoanalytic Perspectives of Child Development Course and curating Anna Freud's Hampstead War Nursery Archives. She currently works in Private Practice and for the National Health Service, running a Child Psychotherapy Service in a nursery school in a deprived area of London. She has published in the field of molecular genetics and psychoanalysis.