Observing the nature and trajectory of infant defences against disturbing mothering on a mother and baby unit

De Rementeria, Alexandra (2018) Observing the nature and trajectory of infant defences against disturbing mothering on a mother and baby unit. Professional Doctorate thesis, Tavistock and Portman NHS Foundation Trust/University of East London. Full text available

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Introduction and aims: Mental health vulnerability emerges out of the interaction between the quality of early relationships and genetic inheritance. The quality of early relationships is strongly influenced by the mother’s unconscious memories of her first relationships: Fraiberg’s (1980) Ghosts in the Nursery. We propose that the intergenerational transmission of mental health vulnerability is largely mediated by such unconscious, internal-world phenomena.Genetic inheritance, historical relationships and internal world phenomena are all hidden from direct observation. However, psychoanalytic clinical practice has established that the quality of historical relationships and the way that they interact with temperament through the prism of our unconscious internal worlds to shape a relational interaction in the present, can be inferred. Close observation of mother-infant interactions, and observation of what impact these interactions have on the observer utilises the psychoanalytic technique of analysing the counter-transference to gain access to the unconscious phantasies of the observed.We argue that the earliest perceptions are inchoate and coloured by phantasy distortions. This is what lends Fraiberg’s (1980) ‘ghosts in the nursery’ their phantom quality. We seek to capture the moments when an unwell mother is being haunted by such figures from her own infancy and then trace how they come to take up residence, and new forms, in the internal world of her baby. The secondary aim of this study was to explore whether an infant observation approach can be captured in a standardised (or standardisable) rating scale without blunting the very sensitivity we hope to capture. The methodological challenge of creating a tool that respects the complexity of transference phenomena, without becoming too cumbersome to use, was only partially met. Methods: This study uses a two-pronged approach. One prong is designed to capture qualitative data in the form of transcripts of observation write-ups and further reflections on those transcripts. The second prong is designed to capture some of the complexity of this data quantitatively in a Psychoanalytic Infant Observation Scale (PIOS).A psychoanalytic infant observation of videotaped interactions on a mother and baby unit were written-up, including the observer’s counter-transference experience.A senior parent-infant psychotherapist used the transcripts to make a clinical formulation and treatment plan for the pairs. Comparison with another well-evidenced assessment tool was possible because Care Index ratings were available for our pairs. In order to distill the rich qualitative data iiiinto quantitative data that could be readily compared with the Care Index scores, an Infant Observation Scale was developed and applied to the transcripts. Results: The transcripts were rich in clinical deductions about the internal world of mother and infant, although there were more inferences made about maternal than infant defences.The Parent-infant psychotherapist felt confident making a formulation based on the transcripts and his treatment plans concurred with those indicated by the Care-index rating. When qualitative data was rendered as numerical scores on clinically derived scaled items, there was a good fit with the Care Index ratings for the same parent-infant pairs. Conclusions: Psychoanalytic infant observation can identify certain internal world phenomena. These are phantasy distortions impacting on interactions and various infantile defences, including manic, second skin, dissociative and narcissistic. These were not directly observable but inferred from countertransference experience and observable behaviours. Psychoanalytic infant observation Psychoanalytic infant observation is clinically useful for formulating parent-infant relational difficulties. In this early development of an Infant Observation Scale, the measure’s validity and reliability were found to be good. The particular strength of psychoanalytic infant observation is the use of transference phenomena to inform an understanding of unconscious processes and this study suggests that with further work it might be possible to develop and standardise a scale to capture and measure that phenomena.

Item Type: Thesis (Professional Doctorate)
Additional Information: Thesis submitted in partial fulfilment of the requirements of the Tavistock and Portman NHS Foundation Trust and the University of East London for the degree of Professional Doctorate in Child Psychoanalytic Psychotherapy
Uncontrolled Keywords: Professional Doctorate in Child Psychoanalytic Psychotherapy, University of East London
Subjects: Children, Young People and Developmental Pyschology > Child Development
Children, Young People and Developmental Pyschology > Child Psychotherapy
Families > Mother Child Relations
Research, Tests, Assessments > Psychotherapy Research
Department/People: Children, Young Adult and Family Services
URI: https://repository.tavistockandportman.ac.uk/id/eprint/1969

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