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What Can Be Learned from a Single Case of Psychoanalytic Infant Observation?

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What Can Be Learned from a Single Case of Psychoanalytic Infant Observation? What can be learned from a single case of Psychoanalytic Infant Observation? Wendy Shallcross A thesis submitted in partial fulfillment of the requirements of the University of East London in collaboration with the Tavistock and Portman NHS Foundation Trust for the Professional Doctorate in Psychoanalytic Psychotherapy with Children, Adolescents and their Families Submitted as part of the M18 December 2014 Abstract This study investigates a single retrospective case of psychoanalytic infant observation. Two principal aims emerged from the evolving investigation. The first concerned the methodology involved in examining observational data using psychoanalytic methods, the second being the exploration of what can be learned from the systematic study of a single recorded case of infant observation using Grounded Theory. The focus for the study concerned the infant’s first year and considered the structuring of the infant’s psychic life, which takes place in the initial relationship(s). From the phenomenological description of behaviours in the observed context, combined with the emotional field described in the observation reports, emotional meaning was inferred. The systematic use of line-by-line coding, abductive reasoning and the formation of categories led to discussion of the following detail: The first month of life; Exploration of the period when mother was traumatically absent, followed by her return; Selected observations that reveal parent/infant recovery. Several conclusions are reached regarding the observed infant. The first concerns the identification of synchronous rhythms or patterns in the mother/infant relationship where they were found to form a backdrop to aesthetic reciprocity. Rupture in aesthetic attunement was instrumental in activating a cascade of early proto-defensive organisation into later development. This took the form of oral preoccupation; namely regurgitation, rumination and choking. Whilst this defensive organisation may be specific to the observed infant, the study draws attention to developmental processes that may be relevant to infants in general. There is evidence to support how babies are more integrated than first thought by Bick (1968) and are ‘open’ to triangular relating in the first weeks. Proto-defensive structures may be evidenced from the start of post- natal life. This study makes a contribution to the body of knowledge concerning rumination in infancy. i Declaration This thesis represents my own research and original work. It cannot be attributed to any other person or persons. All participant names and identifying features have been changed for reasons of confidentiality. The account of the baby and family are true, observational material would only be recognisable by them. Name: Wendy Shallcross Award: Professional Doctorate in Psychoanalytic Psychotherapy Date of submission of thesis: December 2014 Signed: Date: ii Table of Contents Abstract .............................................................................................................................. i Declaration ........................................................................................................................ ii Table of Content ............................................................................................................... iii Acknowledgements .......................................................................................................... ix Dedication ........................................................................................................................ ix Chapter 1 – Introduction ............. .................................................................................. 1 Sonnet 34 .................. .................................................................................. 1 Context .................. .................................................................................. 1 Why observe babies – a research method?..................................................... 4 Infant Observation Revisited .......................................................................... 5 Developing a research focus .......................................................................... 6 Thesis Outline ............. .................................................................................. 7 Chapter 2 – Infant Observation .. .................................................................................. 9 The development of the Tavistock observational method ............................. 9 The method of infant observation ................................................................ 12 The therapeutic application of infant observation ........................................ 14 Observation and psychoanalysis .................................................................. 16 Infant observation and research .................................................................... 21 Chapter 3 – Theoretical Contexts for the Research ................................................... 28 The First Months: The Infants’ sensitivity to the environment .................... 28 Infant Development ..... ................................................................................ 30 Triangular thinking ...... ................................................................................ 33 Triangulation: the observer’s perspective .................................................... 36 How integrated/un-integrated are babies? .................................................... 36 Pre-oedipal integrations................................................................................ 40 The significance of the mouth in psychoanalysis......................................... 41 Biting and taking in ..... ................................................................................ 42 iii The mouth–nipple link - the relationship to aesthetic conflict ..................... 43 Trauma displayed orally – regurgitation and rumination ............................. 47 Rumination and the link to aesthetic rupture ............................................... 49 Responses to loss ......... ................................................................................ 50 Grief and Mourning ..... ................................................................................ 52 Theoretical overview in summary ................................................................ 53 Chapter 4 – Research Methods ... ................................................................................ 56 Research and Infant observation .................................................................. 56 The Emergence of Grounded Theory an Historical Context........................ 58 Merging Disciplinary Traditions: Points Of Contact And Departure .......... 61 Single Case Study Method ........................................................................... 64 Abduction .................. ................................................................................ 66 Ethical considerations . ................................................................................ 67 Chapter 5 – Observational Narrative part 1 .............................................................. 68 The First Month Observations 1 to 4 ........................................................... 68 Introduction ............................................................................... 68 The initial meeting .................................................................... 70 Coming into being: Observation 1 ............................................ 70 Elaboration of proto-defences: Observation 2........................... 74 Patterns of relating: Mind/ body connection with the mother: Observation 3 ................................................. 76 Vertical Positioning and the promotion of Triadic Thinking: Observation 4 ............................................... 79 Chapter 6 – Observational Narrative part two .......................................................... 84 The Legacy of Mother’s Accident: Observations 14 to 16 .......................... 84 Introduction ............................................................................... 84 The elaboration of defences: Observation 14 ............................ 86 Hospital Visit ............................................................................. 91 iv Ambivalence and Development: Observation 15 ...................... 92 Illustration 1a Observation 14 ................................ 94 Illustration 1b Observation 15 ................................ 94 Second Hospital Visit .............................................................. 102 Holding on with eyes and hands, a loss realised: Observation 16 ........................................................................ 102 Diagram 1 - Feeding relationship ............................................ 107 Reflections on the observer role .............................................. 108 Chapter 7 – Observational Narrative part three ..................................................... 110 Mother’s Return: Observations 17 to 20 .................................................... 110 Introduction ............................................................................. 110 Pleasure and Pain: Observation 17 .......................................... 112 Mother’s first feed: Observation 18 ........................................ 120 Restoration of the object: Observation 19 ..............................
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