Academic journal article International Journal of Psychoanalysis

Recognizing the Infant as Subject in Infant-Parent Psychotherapy

Academic journal article International Journal of Psychoanalysis

Recognizing the Infant as Subject in Infant-Parent Psychotherapy

Article excerpt

Drawing on Winnicott's view of infants as subjects entitled to an intervention in their own right, infants as the referred patient have been seen in infant-parent psychotherapy for 20 years at the Royal Children's Hospital, Melbourne, Australia. This is a radically different view of infant symptomatology than viewing it as only expressing an aspect of the mother's unconscious. The clinical pathway differentiates the therapy from much parent-infant psychotherapy. The author describes the theoretical model of a two-fold approach to understanding the infant's experience through interactive dialogue between therapist and infant, and sharing this understanding with the parents, and illustrates it with cases of failure-to-thrive infants. She discusses two criticisms: first, that infant-parent psychotherapy may undermine the parents and, second, that brief parent-infant psychotherapy does not alter parents' insecure attachment status. Videotaped sessions often show rapid improvement; parents generally feel relieved. This approach potentially shapes not only parents' and infants' representations, but also their implicit knowledge of relationships-partly, it is suggested, through activating the mirror neuron system to bring about implicit memory change. Change may therefore be longer lasting than psychoanalytic theory presently conceives. The approach is relevant in an outpatient setting: gains were maintained long term in 90% of out-patient cases.

Keywords: failure to thrive, infant as subject, infant-parent psychotherapy, mirror neurons, reciprocal interactive intervention, therapeutic action

...in some way or other [babies] look around for other ways of getting something of themselves back from the environment. (Winnicott, 1971, p. 112)

Viewing infants as subjects entitled to an intervention in their own right is a different view of infant symptomatology from how it is often conceptualized in psychoanalytic theory as only expressing an aspect of the mother's unconscious. This way of working shifts the emphasis from working primarily with the parents' representations or behaviour. Infant-parent psychotherapy with very young infants who are referred in their own right has been developed for over 20 years at the Royal Children's Hospital (RCH), Melbourne, Australia. The theoretical model of a twofold approach to understanding the infant's experience through interaction between therapist and infant, and sharing this with the parents, is described and illustrated with vignettes about failure-to-thrive infants. This approach to infant mental health was pioneered by Winnicott (1941). But, as other therapists have noted, the infant has often been 'lost' in infant-parent psychotherapy (Lojkasek et al., 1994), partly because it is easier to remember verbal interventions and harder to be aware of the significance of non-verbal interactions with infants.

The RCH approach arose from the need to find ways to help distressed infants, who are often in a medical crisis, and their parents. The clinical pathway has shaped the therapy, differentiating it from much therapy with parents and infants around the world, in which the parents are the referred patients. Infants are referred in their own right to the multidisciplinary Infant Mental Health programme1 and videotaped sessions often demonstrate rapid symptom improvement. I discuss two criticisms: first, that parents may feel undermined by this approach and, second, that brief parent-infant psychotherapy does not alter the parents' insecure attachment status (Barrows, 2003). Clinical experience suggests that parents who are anxious that they are 'bad' parents usually find the RCH approach relieving. This approach seems to have the potential to alter the infants' representations and those of their parents, to begin to bring about change in implicit memories. The changes may be more substantial than previously conceived of in psychoanalytic theory and may add to an understanding of therapeutic action. …

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