Therapeutic Infant Observation
The method of observing the infant in its family environment, from birth to age two, using the rigor of the analytic framework, was conceived by Esther Bick. The observer visits the infant at home for one hour once each week and maintains a strict neutrality. The field of observation is the relationship that is established between the baby and its mother, within the context of the transference instituted between the mother and the observer, and between the mother and her baby. The objective is training the observer in analytic work rather than the fabrication of an instrument for research. This method, used for the training of psychoanalysts and childhood specialists, later proved to be a remarkable tool for early treatment.
In 1948, at the request of John Bowlby, Bick developed a method of infant observation in a family context. As Bick explained in "Notes on Infant Observation in Psycho-Analytic Training" (1964), the aim was to provide an opportunity for practical experience as a part of first-year training for therapists at the Tavistock Clinic.
In 1963, Bick presented her method of observation to the British Psychoanalytical Society (BPS). A consensus was established among the various English schools that this method would be integrated into the first-year curriculum; the attentive observation of an infant's development enables the future analyst to live out a number of fundamental emotional experiences, then to think them through within the framework of the work group. It was Sigmund Freud's grandson, W. Ernest Freud—the "child playing with the spool"—who promoted this method for therapists at the Anna Freud Center, as he related in "Infant Observation: Its Relevance to Psychoanalytic Training." (1975). Bick's method of observation is a part of analytic training within the Spanish and Belgian psychoanalytic societies. Bick herself recommended training in this method for all categories of professionals involved in children's mental health.
In France, André Green strongly opposed the use of direct observation, noting in "Entretien avec Pierre Geissmannà propos de l'observation des bébés" (1992; Interview with Pierre Geissmann on infant observation) that it carries the risk of externalizing psychic life and confusing the infantile with the actual infant, which runs contrary to the work of representation and the spirit of psychoanalysis.
Bick's method was a conceptual innovation, described as "a stroke of genius" by Martha Harris. It is a precise technique used in a fixed framework, whose goal is the training of the analyst. The observer must be able to find a space within the family that is sufficiently neutral, yet not rigid, to enable him or her to experience the emotional impact of the baby's presence, without taking action. He or she must come unburdened by theoretical preconceptions, and be receptive without interfering. After the observation, the observer writes a report that conveys his or her experiences to a work group, which keeps an eye on methodological ethics and helps to make sense of the observed material. Observing a baby presupposes an ability to identify with the different points of view of family members; this flexibility makes it a sound preparation for analytic work. Through the analysis of his or her countertransference in relation to both the mother and what he or she feels from the baby, the observer can understand the impact of the mother's fantasies on the baby's mental space and perceive the manner in which the baby responds to this. Thus, the specific type of affective and counter-transferential opening up inherent in observation makes it an aid to the development of the future analyst's capacities for free-floating attention.
The observer's presence is a source for change. It often has beneficial effects for most families: helping the mother emerge from postpartum depression, developing the parents' attention-giving abilities, modulating the effects of repetition of the mother's past on the baby. Bick's method opened the way for new therapeutic possibilities. Infant observation in day-care facilities, hospitals, and in the home has been developed to sensitize staff, as a preventive measure against early disorders, and with a view to therapeutic intervention in cases of autistic or psychotic pathologies.
In day-care facilities, the main indicators for setting up observation are:
- Mental dysfunction in the mother. The containing effects of observation serve as a protective shield and allow for a reshaping of the imagos;
- Children who have to be entrusted to a series of foster care situations owing to inadequacies on the part of the parents can benefit from the presence of an observer who follows them from one place to the next;
- When a child has a disability that is traumatic for the parents. The observer tries to get them to recognize the child's performances and the support he or she needs;
- Early autistic or psychotic disorders. The observer serves as a support for child-raising and the parents. He or she identifies the sources of suffering, defense mechanisms, and factors that hinder the child's development, and helps to improve the family's responses in the form of caregiving and listening skills.
In hospitals, in obstetrics wards and neonatal intensive care units, attention given to the baby, especially when he or she seems to be disorganized, enables both medical providers and parents to "think" the baby, to find meaning in interactions, and to avoid functional repetition.
Observation is a remarkable tool for prevention and treatment. It is an aid to the baby, who is helpless in the face of its intense anxieties, to the mother in need of solicitude, and to other caregivers.
Bibliography
Bick, Esther. Notes on infant observation in psycho-analytic training. International Journal of Psycho-Analysis, 45, 558-566.
Freud, W. Ernest. Infant observation: its relevance to psychoanalytic training. Psychoanalytic Study of the Child, 30, 75-94.
Green, André. Entretien avec Pierre Geissmannà propos de l'observation des bébés. Journal de la psychanalyse de l 'enfant, 12, 133-153.
Haag, Michel, and Geneviève Haag. L'observation des nourrissons selon Esther Bick (1901-1983) et ses applications. L'Information psychiatrique, 1 (1995): 7-17.
Pérez-Sánchez, Manuel. (1981). L'observation des bébés. Paris: Clancier-Guénaud.
—CHRISTINE ANZIEU-PREMMEREUR
