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Tristan at twenty months

Tristan has, during the preceding week, been refusing to go to bed. He cries whenever his mother tried to get him to lie down. He has never cried when put to bed before, though he has been rocking himself to sleep—probably an autistic mechanism. Now that he is emerging from his autistic shell, he is expressing his own desires, but this causes mother to complain.

"From time to time", she says, "I keep him beside me for a while, but that only postpones the matter. It's the same with his afternoon nap; I don't know whether a twenty-month-old really needs a nap in the afternoon."

therapist: "What happens if he doesn't have his afternoon nap?"

mother: "He grumbles a lot in evening round about dinner time. As to meals", she adds, "I have the same problem I had last Monday (this was when her husband left for a few days). Tristan refuses to eat anything. I have to tell him off."

The therapist asks her if she feels things are more difficult with Tristan now that he is making progress. Mother replies that she finds the whole thing surprising—previously, he was a quiet baby who never made any protest or offered resistance. All the same, she would rather see him as he is now.

In this session, the therapist avoided giving professional advice about the afternoon nap. All she did was to support the mother by asking the odd question from time to time.

iii. Sorting out inter-generational confusions

Communication between adult and baby assumes that the adult is capable of being in touch with his own infantile self before he can make contact with the external real baby, while, at the same time, he must remain in contact with his adult self in order to work through the infantile communications. While this is going on, the adult may find himself trapped in projective identification with his own infantile self, whereupon he will lose contact with his adult self and find himself in competition with the real baby. This is what I mean by inter-generational confusion.

Home therapeutic visits help to sort out this confusion both by containing parental anxiety and distress, and by enhancing the parents' own sense of competency. Parental distress often derives from infantile aspects within the parental psyche—so that providing them with a psychic container may alleviate their feelings of rivalry with the actual baby. Also, by helping parents to enhance their sense of competency, the therapist reinforces their adult identifications and helps them work through the infantile communications.

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