Infant observation in the method of Esther Bick. The reflection of the traumatic experience of a replacement child from the observer position

Inna Kyryliuk


Abstract: this article describes the experience of infant observation in the method of Esther Bick (Tavistock model). Early emotional experience in the dyad Mother/Child is described from the point of view of the trauma of a «replacement child». The observer position is researched as an additional container for the unconscious feelings of a mother and a baby.

Key Words: infant observation, Esther Bick method, «replacement child» trauma, infantile feelings, Mother/Child dyad, containing

Kyryliuk Inna Mykolaivna (Kyiv, Ukraine), Jungian analyst and supervisor of the IAAP, child analytical psychologist, sandplay therapist; PhD in psychology, Associate Professor of psychology, ex-President of the Professional Association of Child Analytical Psychology (PAChAP), participant of an educational group of infant observation (Tavistock model, the project supervisor is Raisa Altayevna Dairova, member of IPA (International Psychoanalytical Association).

I would like to present the two-year experience of infant observation in this article, which I received in the educational project «Infant Observation in Esther Bick method» in the period between the years 2011 and 2015.

I would like to share my reflection on the experience of infant observation as one of the strongest experiences of forming the strength and sensitivity of my therapeutic container.

Infant observation method was offered by Esther Bick in 1948 as one of the parts of analytical educational course for child psychotherapists in the Tavistock clinic. The scientific thought of great researcher psychologists of those times such as Melanie Klein and John Bowlby was concentrated on the formation of emotional connections in the Mother-Child dyad. Esther Bick, relying upon her own experience of infant observation, comes to a conclusion that it is the most effective and empirical method which develops analytical skills of containing and gives an opportunity to observe how the psyche is born.

She writes in her article: «I considered it necessary for a number of reasons, but especially because in would help students understand infantile emotional experience of child patients more vividly, in order to understand more subtly, for example, when they start the treatment of a two-year-old child, the sensations this child has experienced and from which this child hasn't gone too far yet. This course is also called to improve the students' understanding of non-verbal behaviour and the child play, as well as the behaviour of the child who neither plays not talks. Besides, it was supposed to help the students interview mothers and allow them to better understand her telling the story of the child. It would offer every student a unique chance to observe the development of a child from basically the very birth in their home environment and in the relationship with the closest relatives, and this way to make it clear for themselves how this relationship is initiated and how it develops. And finally, every student could compare and juxtapose their own observations and the observations of their peers during weekly seminars» (Bick, 2005, p. 106).

The experience of writing this article has in its turn returned me back to all the difficulties of translating into the verbal language of the experience based upon sensations and pre-verbal experiences. Esther Bick said that one should write in simple words in order to try to convey the details of observation without ascribing any extra meanings to it.

I would also like to tell you about this experience in simple words.

I recall two bright events which turned on my unconscious already at the introduction stage of the observation process, when my small group and the supervisor met in order to discuss the articles by Esther Bick. Our supervisor Raisa Altayevna Dairova offered us a bright metaphor of the process of our group entering observation: «It resembles the infant taking the mother's nipple into its mouth for the first time». Inside me fantasies about the first contact and interchange with the dyade came alive, how flexible and strong this felt but unseen tuning in is going to be. The second distinct sensation was that I needed time to prepare space inside me and inside my psyche. At one of the meetings I said emotionally that I needed 9 months – and it happened so. After a time I am able to explain my emotional outburst. In order to participate in the observation process one needs at least 5 free hours in the working schedule every week during two years (1 hour observation, 1 hour writing the protocol, 1 hour 15 minutes participating in the discussion group + commuting) and it is just the objective reality.

Subjective space gradually started to fill with life stories of infants in our mini-group of observers: infant diseases, various kinds of separation with mothers, operations, moving house, instability of the family triad and emotionally abandoned siblings. My own pre-verbal experience of feelings and reactions, the one we are not able to be aware of consciously, also let me know about itself in the most unexpected manner – in the child symptoms and resistance. If is a vital part of group identity where every participant becomes an additional container for the destinies of all five babies in these four years. David Rosenfeld has written very exactly about in: «Containing a patient – holding – means giving them in the transference the ability to see that someone is able to remember things they (the patient) said many months ago. This offering the patient an opportunity of researching in transference that they are accepted and stored by another psyche or memory… And it was what I was doing: giving him the feeling of being contained in the psyche of the therapist» (Rosenfeld, 2015, p. 53).

Nine months after entering the observation group my phone number was given to a mother who was interested. I learned from the conversation with her that a month ago she had had a son and everything went well. But she also told me about her other experience: a year ago she had also had a son, and he died having lived four days. I took in two experiences of this mother and two destinies of her sons at once. I had a feeling that her wise maternal essence was seeking the presence of someone else.

I felt that the trauma of loss was very strong and was pulsing inside this fragile dyad. My knowledge and the articles I had read about the replacement child also got activated and needed an additional container in order not to overwhelm me with anxiety. In this point it is very important for me to say that at that time (and till the end) the dialogue and the weekly discussion in the small group get fundamental importance in order for the observer to share her emotions, put in words the rest of memories and share what was experienced in loneliness.

I would like to start with the description of the first meeting. It is a very important meeting, just like an initiating dream in the analytical process, the synchronicity of events begins to constellate the process of encounter.

Trauma encountered me at the 11th minute of the meeting. I would like to quote a piece from the first protocol.

FROM PROTOCOLE #1, 11.09.2012; THE BABY IS 1 MONTH 11 DAYS OLD

I remembered that it was important to ask for the exact age for that day and I asked mother when Mikki was born and how many months old he was that day. Mother answered: «He was born on the …th of April, today he is one year old». And then she corrected herself: «Oh, a month!»

Then at once, specifying, she said: «It is exactly forty days today». This answer cut my ear. It echoed by funerals and memorial service, everything shrank inside me and then unexpected sadness came, it literally burst in, the light went out inside me, I was filled with this feeling. For these couple of moments I could not understand what was going on with my feelings, and then a thought came: «Here comes the first son; she is telling me about him, here is the start of the story, I am going to hear this story». Mother took me to the «future» child room – and it as if tore me out from my numbness. I said aloud, but as if to myself: «It is Mikki's room, he is going to grow here».

Here we can see how strongly the unlived grief possesses the mother's unconscious. At the unconscious level the connection is stronger with the image of the first child. My mixture of feelings and the momentary filling up with sadness connected me in the countertransference with the displaced affects of the mother. I heard what she was saying and about whom. It was important to take it in to my container for reflection and working through. At the same time in my phrase about Mikki's room there was a lot of fear and readiness for the fight, it shows how strongly the traumatic experience attacked my observer position. Moris Poro gives the following description: «Any child who was born after the death of the previous child becomes a replacement child to the extent in which it is limited by expectations and fantasies, projected to the dead child by its parents» (Poro, 2016, p. 133).

The last episode shows how the unconscious tuning in between the observer and the mother-child dyad continues.

Mother asked if I had other infants in observation. I didn't expect this question and I answered over-emotionally: «No, Mikki is the only one and the first one!» Mother clarified that she had thought that I needed statistics. I said again that it is a kind of deep learning where there is a unique opportunity to observe how the inner world of a child is born, how his emotions are born, to learn to feel their movement, the sounds and with the time to bring in understanding. First to just collect observations, impressions, and then something will probably get connected and will make sense. I felt that I was talking with inspiration and very seriously. Mother listened to me with attention and then said that it was all very important, complicated and interesting. She continued that she felt that her parents' upbringing had done a lot of damage and that she knew that some things did not have to be said, but she was saying them as she couldn't cope at that moment. That the unconscious was forcing her to do something undesirable. That she had a living example of her mother-in-law, who lived in the unconscious, didn't see the reality and had fantasies that a year later she would be taking care of Mikki.

Mother: «I didn't tell her anything but in would be the last thing I would allow!» Then she asked me some questions about the signals the babies reacted to. I pointed something out, that the most important thing was not to interfere with their dyad by my experience and professional knowledge, and quite opposite, to observe what is being born in this interaction and to take it in. I said that I couldn't give professional answers or advise but I could listen to her and react as a human being. I started to say goodbye when mother talked to me again with interest and a lot of trust. We appointed the meeting for the following Tuesday.

Here it is important to speak about the observer position. B. Feldman writes: «Using the metaphor of mother / baby, Bion postulates that the adult (the other) in the condition of reverie can through projective identification receive unmetabolised, unmentalised and frequently sensory experience of the baby and transform it for the baby by means of seeking understanding into the bearable and controllable emotional / bodily experience» (Feldman, 2012, p. 155).

As I understand now, my «natural» task of the observer was in keeping the balance. Mother's traumatic projections which witnessed about the incomplete process of grieving had influenced me so that I felt ready to protect Mikki in his right to be himself instead of occupying the place of the deceased brother. This role of a rescuer showed itself in the phrase: «It is Mikki's room, he is going to grow here». At the same time the observer cannot be rescuing anyone, that is, separate the baby from the mother. Holding the «natural balance» means taking in both positive and negative projections of the mother and being able to keep them and to metalize them. The conversation about the role of the observer (the second episode from Protocol #1) at the end of the first session can be viewed at the subjective level, where the observer is mastering one's role through talking through the role of the observer and thus is strengthening one's container. And mother can verbalise more her inner unconscious impulses that are frightening her and need containing. We can see that mother is polarising two aspects of the Mother archetype: negative mother appears in the image of the mother-in-law and at the same time it allows her to strengthen her own protecting / positive part when she says that she would never allow the mother-in-law to stay with her son.

During the same first meeting I observed breastfeeding:

«I listened to myself, I was searching for calmness and I simply started watching Mikki suckle the breast. He was negotiating with it more and more and the little hand I saw (the left hand) was less and less tense. Then I went all into observation, the stripe of light from the balcony door was lighting the breast and Mikki's little face, they were very harmonious. From grunting he went to sniffing and was gradually closing his eyes. Mother was looking at him, she didn't say anything, she was just looking, but there were many tender words for Mikki in me, they were swarming and kept appearing and it seemed to me that mother felt them too. Her eyes were loving and meek, a smile slid over her lips, she was with him, but she was yet unable to speak about her joy and happiness. We were quiet for 20 minutes, Mikki was eating».

For me this episode reflects the becoming of the attachment relationship, where mutual influence in the dyad mother-child is taking place, which activates the potential of the Great mother archetype, its positive dimension.

One can think that the trauma was attacking the natural ability of the mother to get attached to her son. During our weekly group meetings I could process my anxious fantasies, the sensations of the danger present, of dilapidation I encountered in countertransference.

But with every following meeting I observed the growing attachment and the tuning in between mother and child. Brian Feldman says that the transformation of somatic skin into the internalised psychic skin occurs through constant «bathing» the baby in words, emotions and touching (ibid, p. 157).

The following quotation from the observation shows the strengthened connection.

Mikki was sleeping, and mother started to take the nipple out of his mouth – carefully and slowly, watching Mikki react. Mikki relaxed a little and let go of the nipple by half, and then his lips sort of sensed the movement and tightened abruptly, mother froze and Mikki suckled actively, as if gulping, demandingly, and then he relaxed again, and mother took out the nipple and froze again. I noticed the nipple which seemed so lengthened, with a formed shape of a tube. I also noticed that it was long, and must be filling all Mikki's mouth (my fantasy). I merged into this sensation of a nipple in the mouth, how Mikki was sensing it there and controlling it as something that belonged very much to him. This feeling came when he was giving it up by millimetre and agreeing to part with in.

Mikki was developing well emotionally, but there was a delay in the musculoskeletal apparatus. He wouldn't turn over for a long time and he couldn't sit up. As if his spine didn't strengthen as a kernel, and frequently I was observing the immobility in this part. Mikki remained in a horizontal position and he was lacking durability to change it to vertical. I connected this rather anxious imbalance with the trauma. One could suggest that relying upon oneself, the ability to grow and develop were partially blocked, and the body was showing it.

Surprisingly, mother was coping with the anxiety better than I. She said that he needed time, all children grow at their own speed, but she was checking his condition regularly consulting doctors, she did physical exercise with him and massaged him.

Mikki was eight months old:

He was sleeping deeply with his little arms spread out and his lips smacking, he is a very cute little baby, light-haired, round-faced and pink. I dug up into an armchair and felt how I was relaxing all of me and could observe the room, I felt that I had feared the process of falling asleep very strongly all this time, fear was as if letting go of me. I felt that the last minutes of observation were passing, but I sat there without moving, as if I wanted to rest after hard work. Mother had settled on the sofa and moved towards me, I was tense for some reason and the feeling appeared that I had to get up and go. Mother was kind of nervous and the same was I. Mother said that she had wanted to ask me for a long time, if it influenced the baby that his brother had died before him and he was actually born right after that. How could it influence the second child? Perhaps his feeling of self-esteem? It was a direct question, definitely long prepared and demanding an answer. I felt «hot».

I didn't know what to say, it was unexpected, though I could have suggested that this question would come. I got lost and I tried to collect my thoughts. I stayed quiet and then I said that it was an important question but as the observer couldn't say anything definite. Perhaps, there is literature which could answer these questions. From myself I said that it was an important question and that she as a mother could feel be herself that there was a certain connection between these events. Mother was upset, but at the same time as if ready that I wasn't going to enter the dialogue. She continued that she was thinking about it frequently and she considered that she needed to know more and once she would have to tell Mikki somehow about his brother. I was leaving a bit deafened by feelings, I felt lost and I was sorting through possible answers in my mind and at the same moment I felt glad that mother had asked this question directly.

I have quoted the first non-verbal opportunity to talk about trauma at the first meeting and how it had transformed by the ninth month of observation. Mother could verbalise her anxiety and confront her fear, she could become aware of her loss and its influence upon her son and take off the chains of a family secret from this story. She accepted Mikki's right to know about the destiny of his brother.

By that time Mikki had grown stronger, he was growing well and he moved a lot, he enjoyed the activity and the resilience of his body. A year after, when the time came to say goodbye and the last month of observation was going on, Mikki started to pull out my observer chair. He would meet me and run to pull the chair to its usual place. And after the last-but-one meeting his mother told me that after I had left Mikki climbed into the chair and sat and looked for a long time, he observed, as if he was looking at his own world from my position.

I would like to think that this way the child was able to introjects this observation experience and my observer position which had strengthened his inner vessel and helped him form «psychological» skin. With the development of the psychological «primary skin» a child feels safety inside oneself. Similar experience becomes the basis for the awareness of one's own «I» in the dyad «I – the Other» and further development of mutual understanding, stability and intersubjectivity.

BIBLIOGRAPHY

Bick E. The notes on infant observation as part of psychoanalytical education / Бик Э. Заметки о наблюдении за младенцами как части психоаналитического обучения // Журнал практической психологии и психоанализа. 2005. № 2.

Poro M. Replacement Child / Поро М. Замещающий ребенок / Пер. с фр. – М.: Когито-центр, 2016.

Rosenfeld D. The Soul, the Mind, and the Psychoanalyst: creating psychoanalytical setting with patients with psychotic aspects of personality / Розенфельд Д. Душа, разум и психоаналитик: создание психоаналитического сеттинга с пациентами с психотическими аспектами личности / Пер. с англ. – Харьков, Планета-принт, 2015.

Feldman B. Creating a container for imagination, reflection and desire in child analysis / Фельдман Б. Создавая контейнер для воображения, рефлексии и желания в детском анализе // Материалы международной научно-практической конференции «Детство и семья в современном мире». Россия, Владивосток, 28– 30 сентября 2012 года. С. 153–166.