(Engl. transl. from German origin. by author)
Observation of a Family With New-Born Child:
Developing a Secure-Frame-Attitude When Becoming a Psychoanalyst
(Copyright © 2001 by J. Kahl-Popp)
Proceding from E. Bick ("... infant observation ...", 1964) the author develops the "observation of a family with new-born child" at the John Rittmeister Institute, Kiel, in cooperation with her students. In the description and discussion of this observation concept, she stresses the question as to which psychoanalytic skills could be developed and trained in students when they start family observation. In this author's conceptualization, the frame conditions of family observation resemble the frame conditions of the psychotherapy relationship. Students can explore how they arrange the observational relationship. They can research the effects of these arrangements on both the family and on themselves. They can substantiate psychoanalytic hypotheses considered the bases of therapeutic relationship (e.g. "abstinence"). In this sense, family observation can challenge students to develop a frame-securing attitude concerning the family's relationships. This attitude could then be applied to the psychotherapeutic realm. Examples of the students' observational experiences are discussed in detail showing the possibilities and advantages of the "Kiel model".
After some introductory remarks, the development of secure-frame conditions for family observation at the John Rittmeister Institute, Kiel, is described. Then, the effects of family observation under secure-frame conditions on the students' psychotherapeutic attitude are considered.
Changes were made to the earlier version: the term "infant observation" is now called "observation of a family with new-born child". This also means a change of view from focusing only on the developmental aspects of the infant—or the infant-mother dyad—to observing and understanding the dynamics of the family interaction, as well.
What inspired thoughts about this topic follows: Looking around Germany, the question arose, "Why do so few psychoanalysts and psychotherapists adopt the communicative approach? Why do they ignore communicative insights—or even fight against them?" These questions lead to consider the psychoanalytical education.
For almost 10 years I have been a lecturer and supervisor in the education of psychoanalysts and psychotherapists at the John Rittmeister Institute in Kiel. I have focused on one part of the curriculum, the so-called "infant-observation"—or "baby watching" course for students who will become psychoanalysts for children, adolescents and their parents. For students, it is their very first exposure to the clinical realm. Family observation—as it is called nowadays—serves me as a model for reporting the problems and possibilities of imparting the communicative approach to students.
In 1948 Esther Bick coined the term "baby watching" for an element of the psychoanalytic education at the Tavistock Clinic in London. According to Bick, "baby watching" means :
· The student visits a family with a new-born child for regular sessions, once-a-week, for one or two years.
· Students are participants in an attending supervision group, where they report their observations and reflect on them with their colleagues.
For the past 5 years I have been supervising students during their family observation. In Germany, the opinion predominates that "baby watching" under Bick's conditions is good training for psychoanalytic students. They are initially exposed to different psychoanalytic approaches, then learn first therapeutic competence through clinical involvement.
When I started planning this practicum I asked myself how this learning process would work. This question led me to compare the frame of the clinical situation with the frame of the observing situation. If both frames do indeed resemble each other, there would be a great chance for students to train psychoanalytic perception, both acting in and understanding the results.
First, I had to clarify the interpersonal frame conditions of the family observation. Then, a most interesting question arose: "Are the frame conditions of the family observation assumed to be secure?"
I reviewed the recent literature about "baby watching" (e.g. articles and papers by Barbara Hirschmüller, 1992 and 2000; Manuel Perez-Sanchez, 1995; Angela Joyce, 1996; Gisela Ermann, 1996; and Ross Lazar, 2000), and found the following: In general, the authors discuss questions of the observer's participation and abstinence, the parents' motivation for being observed and the container-function of the observation. Some mention the meaning of the observation frame based on the observer's reliability and abstinence. One author refers to a frame break in her own observation experience.
There is no systematic investigation in which interpersonal frame conditions for observing a family with a new-born child might be considered as good enough, constant and secure.
2. The Development of Secure Frame Conditions for Family Observation at the John Rittmeister Institute, Kiel
The following results are inspired by Robert Langs (1978, 1988, 1989, 1992, 1995), Uli Berns (1994), Vesna Bonac (1998, 2000), and David Smith (1991), by my own experiences as a communicative psychotherapist, and last (but certainly not least), by the exchanges with the observers in my supervision group, who enriched me with their verbatim reports and creative thinking. I will develop my thoughts trying to answer three questions:
· How can the student make contact with an interested family under anonymous conditions?
· What are the parents' motives of being observed? Are these motives compatible with those of the observer? Are interpersonal exchanges balanced between observer and family?
· Can the observer be abstinent in the presence of parents with a baby, without being experienced as tactless or withholding?
2.1. How can the student make contact with an interested family under anonymous conditions?
If anonymity is to be preserved students must not actively search for an observation family—especially not in their private sphere—because they will be unconsciously perceived as an aggressive, mad and injuring intruder. Here is an example:
In one of the first sessions with her observation family a female student experienced a subliminal aggressive tension between the parents. Now the mother spoke directly to the silent observer and claimed that the "unlimiting father" would give their daughter (twelve weeks old) all that she was crying for. Then the father reported spontaneously that they got anonymous threatening letters and they suspected a woman living in their building of having written these letters. He supposed this woman to be angry because she maintained that their child was always crying.
The student had prior acquaintance with the mother from the student's husband's professional sphere. The student's husband had asked his pregnant colleague, if his wife might observe their family after the birth of her child.
Given these circumstances, I can understand the mother's view of her husband as a displaced message, originally meaning the "unlimiting observer". By exposing her husband, the mother acted out her feelings about the observer's injuring of their intimacy. The father communicated derivatively as to what the observer's frame break meant unconsciously to him—threat, persecution and madness.
To avoid such misalliances, the "Kiel model" takes care that the later observer will be "found" by the family to be observed, as the psychotherapist is "found" by his patients. In seeking families, the students put into words a short message written on a handbill for various professional institutions, where they are to be posted. Further, we discuss how interested parents might process the manifest and latent content of the message. This handbill for potentially interested parents includes the information that the student is a psychotherapist-in-training and the way in which the student could be called anonymously.
2.2. What are the parents' motives of being observed? Are these motives compatible to those of the observer? Are interpersonal exchanges balanced between observer and family?
When a woman gets pregnant, the couple starts to change mentally (see Daniel Stern's „The Motherhood Constellation“, 1995). Pregnancy and the birth of a child are accompanied by anxiety. Parents might wish a special container for this "threshold-situation". I think of "developmental help" resembling the many offers to help pre- and postnatal families. In this sense, the parents' wish for a stabilization of their identity is understood as a motive for being observed. It is a manifest or latent wish for psychotherapy without the pressure of suffering. In practice, the difference between wishing for "developmental help" and wishing for psychotherapy is not always clearly visible.
Here is another example (a male observer):
The parents invited the observer to a first meeting 6 weeks after the birth of their daughter, their first child. The observer offered the frame conditions of the potential family observation to the parents, and the parents agreed. The father mentioned in an aside, "The three of us could frequently be together." They began the observation, but the parents often broke the frame.
In the first time each parent used to stand behind an ironing-board, ironing and folding clothes. The child was left to herself. The observer described the later meetings as a comedy—when one parent came into the living room, the other left. The emotional atmosphere was cold and hectic, the phone was ringing all the time. The parents seemed mainly interested in their daughter's developmental progress she should demonstrate to them. When the father was late or out of the room, the mother would ask the observer for a book, or tell him that she would like to join him for a date to dinner when the observation period was over.
One time the parents mentioned their wish to have another child, and their fear that they would not be successful. To the observer it seemed that the mother was always competing, either with the father or with her daughter. In addition, the observer reported that the child showed a weight deficiency and that her motor development was retarded.
In the supervision group's discussion, the observer brought up that he had initially forgotten to mention one important frame condition to the parents: the 50 minute observation should take place in a closed room, without disturbance from outside.
In the following session, the observer offered the forgotten frame condition to the parents. They reacted immediately—they put the phone away, were always on time, and left the room only in urgent cases (e.g. to get something to eat for their child). Instead of running away, the parents now developed an aggressive tension. Then, one time they came to open conflict, attacking each other verbally. The mother left the room. At this point the observer took leave of the father and said good-bye to the mother, who stayed behind the closed kitchen door.
From that day on, the parents seemed emotionally changed. Their expressions of concurrence and cold efficiency decreased. Instead they played with their daughter on the floor, forgetting themselves. The daughter's general development accelerated. At the end of their observation the parents mentioned spontaneously that they were expecting another child and the father said, that the family would share much more time together than before.
It seems that the parents first communicated their wish for help on a latent level. The three of them were suffering from a lack of satisfying emotional contact, the child reacting symptomatically. Undoubtedly the observer provided a psychotherapeutic experience to the family, offering more and more secure frame conditions.
I think, where the predominant parents' motives for allowing observation are to seek developmental help or psychotherapy, observer and family can exchange insight and growth in a balanced manner. I found still other parental motives for being observed, involving unconscious pathological needs for exhibition or for acting out painful and seductive modes of relating with the observer. Of course these parents have unconscious wishes for help, but their disturbances are too severe to be contained by the observer under observation conditions. For the most part these parents break off the observation.
2.3. Can the observer be abstinent in the presence of parents with a baby, without being experienced as tactless or withholding?
Initially the students tend to interpret the psychoanalytic rule of abstinence as meaning that they must lay down rigid rules of behaviour for themselves and for the family. Indeed, the interaction between a family and a family's guest follows certain social conventions. These conventions are abrogated by the observer when psychoanalytical frame conditions are introduced. Also, the principle of free-floating attention, exemplified by the silent presence of the observer, is a break with convention. Being attentive at all times excludes the usual modes of interaction.
In my experience, parents become willing to share the initially strange observation arrangement because of three pre-conditions:
· The parents themselves wish to be observed.
· The observer offers secure interpersonal conditions (a secure frame) for the observation of the family.
· The observer brings a positive affective connection to the family.
Also, I believe that patients can only grow from the therapist's offer of a secure frame, if they bring a desire for involvement in psychotherapy and if there is a solid, mostly positive affective relationship between them. Only on this basis can patients contain and adapt to the specific anxieties and frustrations produced by secure frame conditions. And only on this basis can psychotherapists be abstinent.
Here is a summary of the interpersonal conditions necessary for a secure observation frame—developed together with my students:
· The observer meets the family with concern and empathy, and is responsible for a positive affective relationship.
· The observer keeps his own neutrality and anonymity, as well as respecting that of the family.
· The observer deals with the family following the rule of abstinence.
· The observer pays free-floating attention to all communications of the family, especially to their derivative meanings.
· The observer offers to the parents a consistent observation-session of 50 minutes, once a week.
· The observation is ongoing and takes place in a closed room in the family's home.
· In this room there is a regular seat for the observer.
· If the observation is arranged with the mother, the father and the child, it takes place only with this constellation.
· The observation period continues until the family derivatively communicates about its termination.
· The observer informs the family ahead of time as to any of his absences. The observer offers these interpersonal frame conditions to those parents interested in being observed at their very first contact. The observer will maintain the secure frame offer at all times, though the family might "play" with it. In this way, the observers experienced that their maintaining secure frame conditions and securing the observation frame was validated by parents as follows:
· Parents improved their emotional contact in dealing with their infant.
· Parents improved securing the developmental frame with their child.
· Parents changed their communication mode from infantile, oral or anal, forms to a more symbolic-playful interpersonal relationship with their child.
3. Effects of the Family Observation Under Secure Frame Conditions on Students' Psychotherapeutic Attitude
From a communicative point of view, the general frame of psychoanalytic education in most Institutes is neither "ideal" nor "secure". For example, training analysts are part of the staff; "couch-information" is used in Institute politics; and there is a strict curriculum to be followed by the students. Nevertheless, in the part of education for which I am responsible, I try to keep the frame as secure as possible. In the field of family observation this means, on the one hand, that the course of observation must be fullfilled by the students, yet on the other hand, when I am teaching the secure frame conception, it is merely offered to the students.
When the students begin to grapple with the secure frame concept at the start of their first observational experience, it brings up some characteristic anxieties: first, superego anxiety -- they are afraid of being unable to maintain the secure frame offer and to fulfill its implications for a professional ego-ideal; secondly, abandonment anxiety -- they are afraid that they will not find an observation family who will accept secure frame conditions.
Both students and families have never experienced such a strange and unconventional kind of social relationship. I think, apart from certain feelings of persecution inherent in being observed (found in psychotherapy patients, as well), the secure frame anxiety of the students is of the kind Vesna Bonac (1998) described as a projective fear of the future, and is probably connected to frame breaks in the students' past, and to breaks in the students' present educational frame, as well.
On one hand, most of the students I have supervised experienced that, despite their anxious expectations, the parents interested in being observed accepted the secure frame offer in a friendly way at the outset. On the other hand, as the family observation commenced, the students experienced how difficult it was to maintain the secure frame offer in practice. Often they "fell into" demanding, persecuting or abandoning behavior as projective pressure arose in the observation situation.
Like patients with therapists, parents put the observer's ability for containment to the test. They consciously or unconsciously design situations in which the observers must decide, if they keep or break the frame. For instance -- the family's entrance door is standing wide open; there are other people in the observation-room; suddenly, mother or father hands over the infant to the observer; the observer is offered food; the observer's seat is occupied; the baby is sleeping, and so on.
Bringing up these situations in the supervision group, the students learn about the functions of acting out, and learn about the parents' anxieties and conflicts, and their own triggering the breach of secure frame conditions. The students also learn to distinguish between projections displaced by the parents into the observer, and their own projections displaced into the parents. At the same time, students focus on the effects of their frame management on the observed families. For example, do they increase or decrease the family's feeling of safety, as well as their own.
Here is another example:
Initially the female observer had not settled on a regular appointment with her observed family at which a consistent constellation could be decided on. The father's participation in the observation meeting was uncertain -- sometimes he was present, sometimes absent, sometimes he was late or left before the end. The observer experienced the mother as depressed when the father was absent. She reported that the mother then used her baby to brighten up her mood by feeding, playing or communicating unilaterally with her. If the baby did not respond as the mother expected, the mother acted out her disappointment with the baby. When the father was present, the family's interaction seemed much more emotionally balanced and satisfying. With this experience in mind the observer modified the frame. She told the parents that her interest was to meet the complete family and that she would let the observation take place only under those conditions.
The very next meeting the father was absent. The observer left at once. The next time, the father was not present for the first 30 minutes. The mother persuaded the observer to stay with the promise that the father would come back in a few minutes. After the observer was seated in her place, the mother exhibited a depressive demeanour in her voice, action and gesture. She began to play a persecutor game with her daughter, shouting that she would catch and grab her. The observer described her as affectively tightly wound, artificial and threatening at that moment.
The child (who was now old enough to walk) cried and ran away from her mother, fell down and hurt herself. Spontaneously the mother said: „Every Thursday there is an accident“ (this was the regular observation day).
The observer interpreted the mother's communication to be an encoded message, given the mother's depression, the child's accident and the student's own management of the interpersonal frame. She decided not to change the observation constellation a second time. And from then on, the father's participation increased continuously, the mother's depression vanished, and there were no further accidents to the child.
I have perceived the following process with most students: they take steps toward effecting secure frame conditions in their observations, but stop halfway. An example:
In the observation of an unmarried mother with her baby, the female observer experienced a variety of frame breaks by the mother. For instance, at nearly every third appointment the mother was not at home – with no prior notice.
This time, when the observer arrived on time as usual, the mother greeted her, apologizing for not being there for the last appointment, inviting her to come in. Both of them stood in the corridor for a moment when the mother told the observer casually that she had unexpected visitors sitting in the living room who had even done some cooking for her. The observer was startled feeling herself taken by surprise because a short time earlier she had agreed with the mother that the observation would only take place without visitors. She responded that she would have to take leave immediately, but she stood waiting in order to give the mother a chance to say good bye. The mother reacted strangely. First she vanished into her bedroom, muttering, that she wanted to fetch some money. Then she returned to the observer who was still waiting. Suddenly, the mother fell down to her knees and while crawling on the floor she said, "This is the way my daughter (a 14 month old) is now moving on the ground. That is what she has already learned."
In the supervision group we discussed whether the mother's mention of the money was an encoded message of guilt. Could she feel guilty towards the observer whom she had left in the lurch several times, and because she had visitors sitting in her living room? Instead of leaving the mother immediately as she vanished into her bedroom, the observer remained in the corridor. Thus, she increased the mother's ambivalent tension. I presume that the mother introjected the observer's own ambivalence and then reacted in an acutely regressive way. One could organize the mother's acting out communicatively, in the following way:
She perceived the observer unconsciously regressed like a 14 month old infant. One implication of her encoded message was a model of rectification, that the observer should learn how to move away like her little daughter. In my opinion, here again are the two anxieties mentioned earlier that must be contained and processed if one is to fully effect and integrate a secure frame situation:
· One must bear the anxiety of separation, being all alone in the presence of the observed family, maintaining the offer of secure interpersonal frame conditions.
· One must tolerate and overcome threatened anxiety of persecution by one's own professional superego or ego-ideal, if one notices that the observed family's fantasies of unconscious, derivative scenarios might be reflections of one's own actions, breaking the frame.
The more the students understand the correspondence between how they handle the interpersonal frame conditions and the aggressive or depressive tension, and acting-out modes of communication put forth by the observed, the more they experience anxiety, shame or guilt. Therefore most students alter their point of view to find their way out of this dilemma. If these affects become too threatening, they avoid the communicative approach. Here, for reasons of tension relief, they understand the observation results as reflecting the unresolved intrapsychic and interpersonal conflicts of the parents. The more the students can stand their own uncomfortable affects or anxieties as unconsciously reflecting encoded messages of their observed family, the more they can risk perceiving their frame management communicatively.
I think of family observation as a part of the psychotherapeutic and psychoanalytic education. It is a special training situation for students. It allows them to come in contact with communicative psychoanalysis in practice, without the psychotherapist's full responsibility for all the consequences. The students are "only" observers. They can "only" keep or modify the offer of interpersonal secure frame conditions to the observed family. And they can study the effects on both the families and on themselves. At the very least, they can begin to listen in a communicative way.
Therefore, family observation and its supervision is a serious "playground" for students to verify communicative postulates and to risk the development of a secure frame attitude.
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