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Five months onwards: the almost unthinkable

A visit when Ben was five months old was a watershed, as it marked the point where thoughts of abuse, which sometimes seemed to come from nowhere, became a constant thread running through the observations. The visit was a difficult one because I felt deskilled in understanding him, and had other painful and inexplicable emotional reactions. He gave me a wide smile almost immediately and talked a little to me. He was interested in me and a lot of the time he met my gaze directly, and occasionally smiled.

But during the course of the visit I felt less sure that I understood him, particularly what I described as his neutral look. I noticed that his mother had another cold sore, and I wondered about hidden depression. When Ben fed and came off the breast in response to her talking to me, I felt uncomfortable as I thought that she implied that I should not speak and distract him from feeding. I thought with dread that I would not be able to remember everything that happened in the right sequence. Unusually I sat with my hands clasped most of the time, and was reminded of Beebe's (1993) description of how babies fidget with their hands when they are anxious. I wondered how much I was a burden—Ben's mother had to cancel collecting a friend from the airport, as she felt obliged to be there for my visit. She left Ben on the settee while wiping up the (cold) coffee that Dave had spilt. I wondered how safe Ben was. I wondered if she was crosser with Dave when I was not there. I felt that Ben's smiles did not have much depth to them as they could suddenly disappear, and it was noticeable that he looked at me much less in the second half of the visit. It was hard to know what had evoked his smiles, and whether sometimes they were slightly placatory. I was mortified to find that I had not properly said goodbye to his mother.

In nearly every visit for the next five months, I either had apparently unrelated thoughts about child protection or was aware of how much Dave intimidated Ben. While the former may have been a measure of anger of which I was not fully aware about wanting to blame someone for his distress, it is also possible to think of the denial of vulnerability, shame, and depression as abuse. Ben's mother's ambivalence towards him and his observer was likely to have been heightened, as we were experienced as less than gratifying. Such a theme present in an observer's associations could point to how Ben and his mother felt some of their experiences had abusive aspects. During the observation I found it difficult to think about the projective identification to move from thinking that it was unlikely to be reportable abuse, to being able to think about how Ben, his mother, and I felt in different ways abused. For Ben's mother to have to put his gloves on every day, which he found painful, could have made her feel that the hospital was making her act abusively. Having to endure these experiences could have led to Ben and his mother having angry, hurtful feelings towards each other.

It seemed that I hardly reflected on these thoughts until on rereading my notes I saw the pattern emerging. Intuitive insights may arise particularly when there have been some unconscious symptomatic acts or defences on the observer's part, or unusual or intense feelings or cueing by intense autobiographical memories. There are powerful communicative possibilities in psychosomatic communication and intuitive thoughts, despite the nebulous nature of the triggers and that these seem unusual or bizarre. With greater awareness of the different ways of observing, we can increasingly recognise the effectiveness of countertransference information to understand the complexity of the developing self.

I had wondered when Ben was five months old whether his smiles were placatory without knowing why I had that thought. This association seemed to have some validity as I could later see his mother at times being angry so that Ben might have needed to be placatory.

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