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

Leite da Costa, Mariza; Melega, Marisa Pelella; Mendes de Almeida, Mariangela Harris Meltzer Trust 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?

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

Leite da Costa, Mariza; Melega, Marisa Pelella; Mendes de Almeida, Mariangela Harris Meltzer Trust 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.

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10. A family assessment based on the Esther Bick method

Leite da Costa, Mariza; Melega, Marisa Pelella; Mendes de Almeida, Mariangela 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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8. The psychoanalytic observer in paediatric assessment

Leite da Costa, Mariza; Melega, Marisa Pelella; Mendes de Almeida, Mariangela 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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6. The psychoanalytic observer as model for a maternal containing function

Leite da Costa, Mariza; Melega, Marisa Pelella; Mendes de Almeida, Mariangela Harris Meltzer Trust 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.

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