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10. A family assessment based on the Esther Bick method

Harris Meltzer Trust 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.

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CHAPTER THREE Technical problems of the analysis

Melega, Marisa Pelella Harris Meltzer Trust PDF

CHAPTER THREE

Technical problems of the analysis

I

n this chapter, we can see the deeper focus on some of the technical problems of this analysis, discussed with Dr

Meltzer, as these became especially apparent during the next semester of the analysis, from January 1980 onwards.

Session of January 29th, 1980

Mário enters and immediately starts shouting at me:

Mário: Shut up! Otherwise I’ll cut your mouth or I’ll tie your mouth or I’ll cut your hand! What would you rather have done to you?

And he carries on with the business of filling up a page with numbers in decreasing order, then shows me the CIAM student list (his special school). I ask him if he is still going to study at CIAM this year (a decision to be made before he goes on holiday). He nods and tells me to shut up.

Analyst: You feel I am a threat every time I say something.

What do you expect me to do? Am I supposed only to listen to you?

43

44

POST-AUTISM

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8. The psychoanalytic observer in paediatric assessment

Harris Meltzer Trust 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.

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CHAPTER FIVE Mário reaches adolescence

Melega, Marisa Pelella Harris Meltzer Trust PDF

CHAPTER FIVE

Mário reaches adolescence

I

t is now February, 1983. Our sessions continue after a six weeks’ holiday. At the beginning of the year he continues with his list of candidates, which takes about two months to complete and runs to around 58 pages. The sense I make of this “great invention” is that of a manoeuvre that will infallibly maintain neutrality in the face of the threat of my attempts at

“anti-neutrality”. I believe this is the only way he can be with me. If I threaten to get up and leave (fighting against his mental customs), he gets up and leads me from the door back to my seat, asking me to stay. However his use of autistic manoeuvres has somewhat decreased. It seems we have reached a modus vivendi in which he feels bonded to me, does not dismiss me, and is more often able to listen to me.

Session of February 10th, 1983

As soon as he enters, Mário starts to draw up a calendar for

1983.

Analyst: Strange child. Now we’re getting a 1983 calendar.

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

Harris Meltzer Trust 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”.

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