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Looking and Listening

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'Marisa Pelella Melega came to Rome in 1988 to celebrate the foundation of the first Centro Studi Martha Harris, and to establish a link between the Centro Studi and her initiative in Sao Paulo. The link with the Centro Studi and with the Tavistock proved very fertile and this book is a witness to it. The valuable work documented here exemplifies vividly Martha Harris' own often-cited statement that "psychoanalytical ideas have travelled... and found a home in which to flourish".'- Gianna Polacco Williams, Psychoanalyst and child analyst; founder of the Centro Studi Martha Harris'What an interesting collection of descriptions of Infant Observations and applications of the method of observing babies pioneered by Esther Bick in the seventies! Infant observation and its applications still constitutes the bedrock for understanding the origin of the human mind, and the training of all the authors is rooted in this method of observation as well as in the work of later object relations clinicians and theoricians (Klein, Bion, Winnicott, Meltzer etc). The authors from the Sao Paulo Mother-Baby Relationship Study Centre, working in the fields of infant, child and family psychology, cover a variety of interesting settings, such as: the seminar room where Esther Bick herself led a discussion group; the homes of observed babies; the consulting room with parents and children in therapy; a nursery; a child psychiatric hospital department; and a neonatal intensive care unit. The work and observations are described vividly and with the precision of refined observers who share their experience generously and openly. The book ends with an innovative and timely chapter on research on the link between maternal reverie and the development of symbolic play in babies. This is a book which I indeed recommend to all those interested in infant observation and its broad application.'- Maria Pozzi Monzo, Consultant child and adolescent psychotherapist; visiting lecturer, Tavistock Clinic

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1. Esther Bick in South America: supervision of the observation of a baby girl from birth to eight months

ePub

This chapter takes a look at Esther Bick at work, in the context of a series of group seminars on infant observation that took place in Montevideo in August 1970. Several sessions are transcribed here from Mrs Bick’s supervision of the observation of a baby girl, Andrea.

The observer says the parents had agreed to the observation sessions the previous week.

Observer: (reads) I telephoned the mother and a person who identified herself as her sister informed me she was unable to come to the telephone as she was in bed with a fever. I was asked to call back the following week. We agreed that the meetings would be held regularly at 5.30 pm on Saturdays, a time when the mother normally baths the baby. The telephone conversation was polite. I felt the mother was very depressed, but her voice

EB: The dog is the father’s baby. Before the baby was born, the dog was both parents’ “baby”, but now it is just the father’s – a very common situation.

O: (reads) The door is opened by a young woman who, on being asked, introduces herself as the mother’s sister. We cross a spacious patio and turn right, toward a patio surrounded by residences. This is where the dog is kept: a large and tough animal, kept on a chain, which jumps up and lets itself be petted by the sister before coming over to sniff me.

 

2. Aspects of supervision: an observation seminar about a ten-month-old triplet

ePub

Marisa Pelella Mélega

As a supervisor, I have had the opportunity over the years to observe many aspects of the process of how knowledge is acquired through the emotional experiences of both observational visits and supervisions. The following considerations about this process focus on an account of an observation seminar about a ten-month-old triplet, with a group that has worked with me for about a year.

When we began working as a group, each student/observer stated that she expected to learn about the mother-baby relationship and the infant’s development. The students were not fully aware that the group situation might be a source of knowledge in itself. This group developed relatively quickly into a work group (Bion, 1961); conflicts and anxieties were gradually overcome by concentrating on our common task, as most students were able to learn through introjective identification.

What are the tasks faced by a group of people who gather to talk about the emotional experience of mother-baby observation?

 

3. The fame of psychic life: reviewing a two-year observation twenty years later

ePub

Mariza Leite da Costa

The infant I shall call Caio was unplanned – the result of a forgotten contraceptive pill. Thus, from the beginning, he was considered a disruptive force, an intrusion into the life of his parents, both professionals in their late twenties. They had come to London a month before the delivery with the intention of staying for three years. They embarked on this new stage in their lives because the father planned to do his doctorate and the mother was to study English in order to apply for her Master’s. They had left behind successful jobs, family, friends, a warm climate and a high standard of living.

Caio was the couple’s first child. He and his mother had a difficult start. The pregnancy was complicated: the mother endured constant morning sickness and described it as a “real nightmare”. Caio´s delivery was also stressful. The labour was lengthy and exhausting, lasting twenty hours before the delivery had to be induced. When Caio arrived he bore marks on his forehead from the forceps and the mother noticed further bruises. What hurt her at the beginning was the feeling of loneliness. She felt isolated and without support, despite the husband having been with her in the delivery room. She experienced the birth as horrific and Caio’s arrival stirred up many different emotions. I understood the help of extended family was available to her, although she had refused it. The nightmare seemed to last beyond the pregnancy and appeared to contain the germ of a vital misfit.

 

4. Early feeding difficulties: risk and resilience in early mismatches within the parent-child relationship

ePub

Mariângela Mendes de Almeida

The very early paths of emotional development, built continuously through subtle interactions and complex exchanges between the infant and his caregivers, have been an object of detailed study in clinical and research fields. Child development studies of early relationships have shifted from an emphasis on parents’ and infants’ individual characteristics towards an exploration of the dyad’s regulation of its states and needs.

Early mismatches are part of the emotional life of parents and infants in every ordinary dyad. For some dyads these mismatches will be transitory, part of a daily togetherness, from which the partners may even learn. For others, however, they may gradually constitute a more persistent pattern, a building block in a rigid structure.

What makes mismatches either transient elements or rigid and impairing structures in the parent-child relationship, in other words, what characterizes them as either plastic or inflexible? This was the question that led me to the study of dyads and families experiencing early feeding difficulties. Could we assume that non-organic feeding problems would express transient or structural mismatches and regulation difficulties in the early mother-child relationship? What factors facilitate or complicate overcoming an early feeding difficulty? What would make it a transient perturbation, a repetitive but not yet pervasive disturbance, or part of a rigid disorder?

 

5. Psychoanalytic observation: the Esther Bick method as a clinical tool

ePub

Magaly Miranda Marconato Callia

Adriana, aged one year and three months, was sent to my practice by her mother’s analyst. She has a narrow face, curly blond, hair, a broad smile, and a facial and physical appearance often described as elfin or gnomish in books and by doctors – a somewhat peculiar face, the kind found in Down’s Syndrome cases. Both parents wanted to explore the difficulties they were having with their daughter. The couple were in their mid-thirties, each was in individual analysis. Both were professionally successful and had wanted to have a child, Adriana was a “planned” baby.

When they sought my help their primary concern was the difficulty Adriana had in feeding, since birth. She was currently highly selective in her choice of food and refused to eat most things outright. The mother felt that Adriana related much more to their nanny than with her; often she did not to respond to her. Despite her young age Adriana already showed signs of language difficulties. She communicated mainly through gestures, facial expressions, smiling, crying, etc. However, the impression I had was that the parents’ main concern, and what motivated them to seek me out, was that they received a diagnosis of Williams’ Syndrome at Adriana’s birth. From what they said and from a few articles they brought with them, I understood this was a genetic disorder that affects the ability to process information sequentially. Other characteristics of the syndrome include the possibility of slight mental retardation, a distinct elfin facial appearance, congenital heart disease and elevated calcium levels. The syndrome was identified in 1961 in New Zealand by cardiologist J. C. P. Williams. When I met the couple, I felt they were anguished and anxious about Adriana’s future. They compared her with other children and feared that she would fail to develop “normally”.

 

6. The psychoanalytic observer as model for a maternal containing function

ePub

Marisa Pelella Mélega

This paper is concerned with adapting the Esther Bick observation method for use as a prophylactic intervention in early mother-baby relationships. The work was developed in a study group that I coordinated at the Mother-Baby Study Centre in São Paulo. In order not to confine the work to description we elaborated our conclusions, which included reflections on technique, on help given the mother and other professionals, and on the profile of the psychoanalytic observer as a specific professional entity – his characteristics, technique, field of action and objectives. The aim is to assist mother-baby relationships (especially as regards the maternal function) and professionals who are expected to provide a container model: such as psychologists, psychiatrists and training analysts. It also addresses the various anxieties such professionals may face in dealing with infants.

Ideally the psychoanalytic observer should have one to two years of experience in observing mother-infant relationships using the observational method developed by Esther Bick. The observer watches and makes clear to the parents that, though he may be a psychoanalyst, he is there in a learning and not an advisory capacity and does not intend to intrude in their family life. The role is like that of an unusually silent friend. The apparent passivity is difficult to maintain. He must abstain from any tendency to guide or judge the mother and must maintain a state of receptivity and “negative capability” (Keats); he must be able to remain in doubt, to wait before assigning meanings or trying to change aspects of the mother-infant relationship.

 

7. The psychoanalytic observer at the nursery

ePub

Ana Rosa Campana de Almeida Pernambuco and Maria da Graça Palmigiani

This paper is an account of a study conducted at a child day-care centre between September and December 1989. Following the Baby and Child Observation Course at the Mother-Baby Study Centre, together with our professional experience in dealing with people, made us realize that the first few years of a child’s life are central to the development of its personality. We also know that appropriate care can assist the development of the resources needed for coping with life, and we felt that there was insufficient professional training available in Brazil regarding the emotional aspects of child development in its various stages.

Over the course of this study we noticed that information on its own does not modify the adult-child relationship. It is more important to be receptive and reflective than to simply counsel and inform. In other words, an attitude that reflects what is being communicated – that is self-reflexive rather than demonstrative – is needed. This enables the adult to think about what is happening at any given moment and to find solutions that can help the child’s development.

 

8. The psychoanalytic observer in paediatric assessment

ePub

Marisa Pelella Mélega and Maria da Graça Palmigiani

This paper aims to illustrate the usefulness of observing the paediatric patient both during the paediatric appointment and in the family environment. This may bring to light emotional factors implicit in paediatric pathology. The following example describes an infant seen in both situations, observed by Maria da Graça Palmigiani. The paediatric consultation took place in the São Paulo Hospital children’s ward, and the observations were supervised by Marisa Pelella Mélega in seminars at the São Paulo Mother-Baby Relationship Study Centre. They are part of ongoing research by the Social Psychiatry section of the Department of Psychiatry and Medical Psychology at the Paulista School of Medicine.

The mother being observed is a single parent from a low socio-economic class. She has taken Suzy, her 13-month-old daughter, to the doctor because of a cough and bronchitis, and is surprised to learn that her daughter is suffering from malnutrition. The child’s weight of 7.5 kg placed her in the category of “second degree malnutrition”. The mother is then invited to take part in a study which would mean being observed at her home, and she accepts.

 

9. Joint parent and child therapeutic interventions

ePub

Marisa Pelella Mélega

The approach of the Mother-Baby Study Centre to joint parent and child therapeutic intervention (family therapy) is inspired by Esther Bick’s mother-infant observation model and by Bion’s work with groups.

A framework in which the analyst and family observe and communicate what emerges during the encounter makes use of the full scope of the analytical model. Reports from students have often shown that the presence of a psychoanalytical observer can create a field of attention and observation within the family. Interaction during the meeting, expressed in verbal and pre-verbal language or through play or enactment, constitutes live examples of the family’s history and structure. Conflicts in relationships, which sometimes get repeated when no solution appears in sight, may be revealed. Mothers often seemed to use the experience of the observer’s visit as a model which could further their own communication with their infant.

In this approach the focus of the intervention is on parent-child interaction in the context of the maternal and paternal functions. The Esther Bick model can lead us from merely observing to actively promoting communication and thought among family members. This is what I mean by joint parent and child therapeutic interventions. I regard the promotion of thought and communication in the family group as therapeutic.

 

10. A family assessment based on the Esther Bick method

ePub

Ana Rosa Campana de Almeida Pernambuco

This paper, given at the third Brazilian Symposium on Mother-Baby Observation (2000), describes the first meeting of a family assessment based on the Esther Bick method of observing mothers and babies. The aim is to assess problem situations within a family group and to promote communication and understanding among the family members (Mélega, 1998). The family in question comprises five individuals: the father, mother, Mário (age six), Diogo (age four) and Rafael (the baby, age eight months). They were seen for a total of twelve sessions.

The mother and I had agreed on a time of 7.20 pm. They arrived at 8.15. The mother was at the gate, alone, explaining on the intercom that they were late due to heavy traffic. She said they were all in the car, but she was unsure whether I would still see them. I went to the gate and told her that I could see them.

We all go inside. The two boys, Mário and Diogo, say: “Look, she’s got toys.” Diogo sits on my chair and I ask him if he would mind sitting somewhere else. He gets up and goes to the armchair directly in front of my chair (next to his father). Mário is on his feet, next to the toys, and the mother places Rafael on the sofa before sitting next to him. I introduce myself and say that I know only the mother’s name. The father tells me his name, Diogo remains silent and Mário says: “Tell her, Diogo”, to which he replies with a curt “No”, after which Mário tells me his name.

 

11. The observer in the neonatal intensive care unit

ePub

Mariza S. Inglez de Souza

This paper presents two cases from work done over a period of eight years on early parent-baby interventions within a Neonatal and Paediatric Intensive Care Unit. I was interested in observing what occurs in the mother-baby relationship when it develops in an adverse situation, such as the baby’s illness or premature birth with subsequent admission to a NPICU; and in considering whether it is possible to reduce the effect of factors that hamper the proper development of the mother-baby relationship in such circumstances. How can one helpfully intervene in such a complex situation?

I would like to thank Denise V.V. Paiva for her contributions to the clinical material

My interest in observing adverse situations arose from the clinical experience that many emotional problems have their origins in the first few days or months of life. This is especially so when this early period is marked by a mismatch in the mother-baby relationship – when such a relationship is out of step. This became clearer in my work with children, which always involved contact with the parents, who would give me detailed information about this early period. Over the course of a year I co-ordinated a group of observers with the aim of trying to understand what takes place in mother-baby relationships during the baby’s stay in the NPICU. I followed the Esther Bick mother-baby observation method but within the hospital rather than the home, and including the Unit’s multidisciplinary care team in the observation. Observations were made twice weekly, as the condition of the babies was subject to frequent change.

 

12. Infant observation and its developments: working with autistic children

ePub

Mariângela Mendes de Almeida

The Esther Bick Infant Observation method has for many years played a fundamental role in the training of professionals in the therapeutic and psychoanalytic field. It has enhanced our comprehension of both ordinary development and unintegrated states. According to Bick, training in Infant Observation should “increase the student’s understanding of the child’s non-verbal behaviour and play, as well as the behaviour of the child who neither speaks nor plays” (Bick, 1964, p. 558).

This paper considers some of the developments inspired by the observation of children who neither speak nor play due to severe emotional disturbances. These disturbances fall within the wide spectrum of autistic disorders. Psychoanalytic observation of infantile bonds and early intervention with parents and infants has helped us to comprehend infantile unintegrated states. The use of this method within the clinical and research fields has contributed to important developments in the psychoanalytic technique of working with children in the autistic spectrum. Susan Reid states that “insights gained from infant observation have informed changes in technique, making it possible to work more effectively with patients who are hard to reach or who would previously have been considered unsuitable for psychoanalytical psychotherapy” (Reid, 1997, p. 6).

 

13. A research methodology for the study o? wf symbolic activity in infants

ePub

Marisa Pelella Mélega and Maria Cecília Sonzogno

This paper describes a research methodology for studying the interplay between maternal reverie and the development of symbolic activity in infants aged 0 to 18 months. A pilot study was made, after we began collecting data to analyse the pre-verbal symbolic capacity in the context of the mother-baby relationship. The project used information from 212 observation reports describing 19 mother-baby dyads, each observed by a psychoanalytical observer over the course of two years.

The observation reports that constituted our material were comprehensive and detailed narratives of early mother-baby relationships, following the observational methods of Esther Bick. From the reports we selected moments that showed the baby dealing with situations of frustration, since these are indicative of the development of his symbolic capacity as demonstrated through play. We are referring here not to cognitive development but to the emotional capacity to deal with frustration by creating “something” to replace the absent object. Taking Bion’s concept of tolerance to frustration as foundational to the ability to think and symbolize, we constructed a category denominated “frustration episode”, and in this context we recorded the children’s interaction with their mothers and the environment.

 



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