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V DEVELOPMENTS OF THE INFANT OBSERVATION MODEL

INTRODUCTION TO DEVELOPMENTS OF THE INFANT OBSERVATION MODEL

The widening scope of infant observation takes several directions: in training, teaching models, and observers' professional backgrounds, in intercultural observation, changing family structures, and different settings, and in clinical applications.

Infant observation has been introduced into psychoanalytic and psychotherapy trainings of different orientations in over thirty countries including Russia (Dubinsky & Bazhenova, 1997), Taiwan (Yu-Hua Lin, 1997), Africa, India, (see Chapter Twelve) and China. It has been extended to training in other disciplines such as psychiatry, psychology and social work in the United Kingdom, and North America (Muir & Tuters, 1992; Trowell & Miles, 1991). Many social workers or clinicians who are not able to train as a psychoanalyst or psychotherapist carry out an observation to develop their skills. Trowell and M. E. Rustin (1991) suggested that, for professionals in training, infant observation helped to develop the "internal observer" to become a reflective practitioner. Variations of teaching models have been tried, for example starting the observation two months before an infant's birth to reduce an observer's anxieties and the move to a more traditional observer stance after the birth is more easily achieved in the relationship that has been established. Occasionally seminars have included members who are not doing an infant observation themselves but listening to other members present. With the range of observers widened from trainees in their own analysis to include other clinical and non-clinical professionals, there may be students for whom this kind of observation does not work out and what is needed is to help them see that, at this time, this is not the right learning opportunity for them (Edwards, 2009; Rustin, M. E., 2009). The observation period has been shortened to three months when used for trainings in a university setting (Briggs, 1992) and while the shortcomings of such brief observations are acknowledged they may nevertheless powerfully convey an experience of an infant's internal world. Observing the first eight months of an infant's life is often transformational in perspective. The preferred mode however remains the one to two year one. This indicates the robustness of this particular form of experiential learning that it is capable of so many variations and offers so much.

Training for leaders of infant observation seminars has yet to be systematised. Some prospective leaders co-teach with a more experienced teacher (Miller, 2011). Sometimes therapists undertake another infant observation as preparation for becoming a seminar leader. Increasingly there is awareness of the need for consultation for seminar leaders, with dedicated conferences for them and a move towards more formalised training (Rustin, M. E., 2009).

New technologies bring new developments: different uses of video in infant observation (and infant mental health interventions) have been described in a special edition of the Infant Observation Journal (2006, 9: 103-214). Observations can be discussed by email by a seminar leader in another country and seminars can be conducted by telephone or Skype with observers and seminar leaders in different continents (Magagna et al., 2005). In the tradition of microanalysis of mother-infant interaction conducted by Beebe and her colleagues (2005), a recent study (Kemppinen et al., 2005) suggests that five minutes of video-taped observation may provide an assessment of development as accurate as a year of infant observation, but this would not give the experiential learning gained from psychoanalytic infant observation.

The spread of infant observation in other countries and of observations that aim to develop awareness of cultural differences has grown rapidly. From Australia, Meyer (2007) described an observation by a white female clinician who was trusted to enter the home of an indigenous family where the infant very early made it known that she saw Meyer as friend and ally. Maiello (2000) gave a vivid picture of a boy baby and his single mother in a Cape Town township, whom she observed for the first three months, showing how much communication between them occurred through tactile interaction and much less visually compared with Western mother- infant dyads. She recommended that infant observation for students in psychoanalytic training should take place in a shared cultural setting so that communication would follow the same implicit shared unconscious phantasies and the observer could open up entirely to the full impact of the primitive mental states. Articles such as these, Barnett's cross-cultural videos, and the film, Babies (Balmes, 2010) featuring the first year of life of babies in America, Japan, Mongolia, and Namibia, approach the question of what can be learnt from studies of different cultures and how feasible is it to extrapolate across cultures (Blessing, 2011). In an observation in Chile, a mother is reported as quickly giving her observer a kiss: in Latin America a degree of closeness may be seen as respectful more than in other cultures (Castro, 2011). A number of parents who move to another country arrange an observer from the host country or an observer of the same nationality observing them in a culture which is foreign to them both (Escandon, 2008). (An empirical study, however, suggests that there may be little difference in responding to infant face across ethnic "race" (Proverbio et al., 2011)). Cultural aspects of infant observation are explored further in Chapters Twelve and Fourteen.

The infant observation method has been extended to a number of different settings includ- iny observing the development of older children in settings such as the creche of a paediatric hospital (Cardenal, 2011). These may have the dual aim of the observer's learning and using psychoanalytic observation to understand better the functioning of a wide range of settings, for example a classroom setting with children with special needs (Diamant, 2009) or a music therapy group (McLaughlin, 2009). Winship (2001) carried out a child observation in a day nursery and a whole-group observation in another day nursery, in which he felt that the space of the observation setting was as important as the children observed. The method has been used to deepen understanding of the functioning of institutions or services such as psychiatric wards (Chiesa, 1993; Hinshelwood & Skogstad, 2002), geriatric wards, (McKenzie-Smith, 2009) and prison (Candelori & Dal Dosso, 2007). More recently the method has been used in a hospital in Brazil with family members who are present for a pregnant woman's ultrasounds, in order to learn about how conflicts in the wider family are worked through (Caron et al., 2008), or to understand the experience of adolescents in an inpatient psychiatric unit (Liddell, 2011).

A wider range of family structure emerges from recent infant observations than was observed in Bick's time. With social changes come changes in the infants observed, such as infants whose father is the main carer or where there may be a "social" parent rather than a biological parent, or infants who very quickly enter childcare. Assisted reproduction has made it possible for a wider range of couples to raise children, who may agree to be observed (see Chapter Thirteen). Clinicians and health professionals working with particular groups may undertake an observation to increase their knowledge and understanding of the experience of infants in these communities or of certain aspects of development, such as in families with the experience of serious mental illness or severe deprivation, where intimate relations may be expressed with a degree of interpersonal verbal violence towards infants (Midgley, 2011).

Since 1998 in the literature the direction of identifying the level of difficulty in infant observations has been noted. While the dangers of an unthinking move out of traditional observer role have been noted (Magagna, 2012), there has been a change of technique to a slightly more active infant observation, sometimes called "participant observation" where the aim is to be therapeutic (M. J. Rustin, 1997). This may reflect a greater sense of understanding infant development (M. J. Rustin, 2002). It offers support to the family as a form of containment that is more holding (Alvarez, 1985) combined with a greater awareness of the potential of infant observation to be therapeutic for family and infant. As outcomes can be measured, this will add to the body of infant observation research. This more active infant observation remains to be systematically conceptualised in the literature.

Infant observation is also used as part of a clinical therapeutic intervention. In Neonatal Intensive Care Units in Europe, North America, and South America, parents and staff have found it helpful to have a staff member or student observing premature babies (Anscombe, 2008; Castro, 2011; Kraemer & Steinberg, 2006; Simon, 2010; see also Chapter Six). Even very premature infants can be aware of the special quality of a thoughtful gaze of parent or observer, who is trying to understand their experience (Cohen, 1995; 2000; 2003). McFadyen (1994) describing how an observer could help parents to observe their baby more sensitively in NICU and begin a containing process for the baby wrote that, "(P)sychoanalysts have emphasised the value of attentive observation and reflection as a healing process in itself ... (A)n active interest in the baby, no matter how premature, fragile or disabled, provides a model for both parents and staff. The curiosity aroused in those observing the observer often seems to act as a powerful catalyst for a new kind of way of looking at the infant, and consequently a new kind of interaction" (p. 164). She suggested that spending time tuning into what these babies might be feeling was richly rewarding, particularly for parents.

Infant observation is widely used therapeutically in France in day-care facilities and hospitals, to help mothers emerge from postpartum depression, or when an infant is thought to be at risk of early autism spectrum or psychotic disorders or a disability that the parents find traumatic (Anzieu-Premmereur, 2005). It has been used in England in early therapeutic intervention with high-risk babies who are in the care of protective services or in foster care (Wakelyn, 2011). Another promising development is a flexible model of therapeutic observation of young mothers and infants in care proceedings, which, while making considerable demands on the observer, produces good therapeutic results (Hall, 2009).

Observation is part of many clinical interventions with infants and young children. In infant- parent psychotherapy observing the infant is an essential part of the therapeutic intervention (Miller, 1992). In the "Watch Wait Wonder" intervention developed by Muir (Cohen et al., 1999) a parent is asked to observe the activities that their baby introduces, and to interact only when the baby indicates that they want this; the parents subsequently discuss with the therapist what they felt and thought about their baby's activity. This aims to place the parent in the position of becoming more knowledgeable about their baby, to develop confidence in their capacity to resolve difficulties in the relationship with their baby. Other forms of infant-parent psychotherapy blend close observation of the dyadic relationship and videotaping with verbal intervention to further the clinical aims (Jones, 2006; Sorensen & Eekhoff, 2004; Vliegen, 2006).

In the infant mental health field therapists acknowledge that having carried out an infant observation contributes to becoming a more sensitive clinician, able to keep the infant's perspective better. As infant mental health clinicians began to carry out psychoanalytic infant observations as part of their training and work they try, while as open to the countertransference as possible, to be minutely aware of the affects in an infant's behaviour and seminar leaders enquire about the tone with which behaviour is imbued, as Bick did (Stern's 1985 vitality affects). Trying to elicit what an infant is likely to be feeling and thinking about the observer, and how they are relating to them, seems particularly to contribute to a more vivid picture of the infant, suggesting that it is important to focus on this as well as an observer's countertransference responses. Raphael-Leff (2012) listing some principles of observation in working with teenage parents notes that developmental observations have shifted from investigating the baby to on-going observations of reciprocal influences and that over the last twenty years as studies show that together with their carers babies co-construct both external and internal realities, this "relational and intersubjective emphasis has shifted the focus from the individual and his/her intra-psychic processes to the relational matrix" (p. 168). Recent years have seen the development of a fuller awareness of the contribution that observation may make to the development of the infant sense of self, with the infant seen as often initiating a relational experience with the observer. The importance for infants and their mothers in having an observer who gazes containingly at them both is continually confirmed. This is taken up in the Afterword.

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