INTRODUCTION

Infant mental health (IMH) clinicians, alongside their colleagues in child psychotherapy and adult psychoanalytic psychotherapy, have long recognised the educational and therapeutic value of undertaking ‘infant observation’ training. This was developed post the Second World War, by the Polish-English psychoanalyst Esther Bick to train child psychotherapists in being able to notice and learn the nonverbal communications of the ‘ordinary’ young child. Infant observation training commonly spans 1 or 2 years of observing the same infant and parent in their own home or surroundings (Bick, 1964). Following the observation period, the observer records verbatim the interactions they have witnessed. Subsequently, they bring these notes to the infant observation supervision group for discussion and reflection.

Infant observation is an intense learning experience. There is, as yet, no equivalent in family therapy training. We hope this paper may encourage discussion of sub-specialty training within family therapy career development. There is much one can learn from observing the infant's capacity and attachment dynamics through film, YouTube, and professional online training. However, infant observation is an experience dedicated to observing and to being emotionally present in the range of moments of one infant's emergence; simply put, it is about noticing relational – such as parent–infant, sibling-to-sibling – and developmental growth in real life, in real time.

The authors of this paper are in an unusual clinical position of being both experienced senior family therapists and trained IMH practitioners. We value how the marriage of IMH and family therapy has given us deeper capacities in observation, reflection, intervention, and being present for our clients, however young or old. Due to a synergistic effect, we feel that the therapeutic skill of infant observation has enhanced our family therapy practice well beyond what either discipline offers separately. This combination offers insights into exploring the content of what is said, what is felt, and what is seen.

Put simply, the rigour of the infant observation training process teaches the student to:

• Notice, reflect on, and be curious with families about the minutia of nonverbal communication.
• Attend to their own sensory presence and states of mind.
• Capture and distil what is and what could be.
• Bring the infant's experience alive in their own mind and in the minds of others.
• Increase therapists' self-awareness.

Here, we describe what training in infant observation involves, as well as canvas how an integration of the process and purpose of infant observation brings alive possibilities in revealing intergenerational threads across time, which offer powerful motivators for change. For the family therapist who needs to see the ghosts of past generations (Bunston, 2013; Bunston et al., 2022; Fraiberg et al., 1975; Jones & Bunston, 2012), ‘this work involves going back and reconnecting with the past to re-imagine the present. As workers, we can engage with the pull relationships have in the lives of those we work with, both positive and negative’ (Bunston, 2017, p. 149).

We will provide a brief examination of the literature on IMH and family therapy to capture an understanding of the combined effects between these two different but complimentary approaches to working with families. Included is an exploration into the historical reticence family therapy has shown towards embracing the powerful method of training that infant observation offers. In addition, examples of how infant observation techniques have been used in our work with complex cases and diverse family structures will be provided.

INFANT OBSERVATION TRAINING

Infant observation training may be provided by IMH courses; child or adult psychotherapy training programs; or arranged privately. There are four components to formally undertaking training in infant observation.

First, the observer, who is typically an IMH practitioner or child/adult psychotherapist in training (Sternberg, 2018), is required to find and then engage with parent/s who are in late-stage pregnancy or who have just given birth (Bick, 1964; Reid, 2013). Parents are not financially or otherwise compensated for their participation in the program. Some, but not all, programs provide parents with written program information and the credentials of the observer. If agreeable to all parties, the parents' consent to a weekly, 60-min visit in their home, by the trainee observer, until their baby is approximately 1 year old, but sometimes up to 2 years (Rustin, 2009). Observers are instructed not to view the parent/s as clients requiring help, but rather as co-collaborators; as such, parents should be provided with adequate documentation and/or preparation regarding the program's purpose and given sufficient opportunity to consider participating in what is ultimately an altruistic exercise.

Second, the observer commences weekly observation of the infant in their home, usually at the same time each week. The parents, caregivers, nannies, or babysitters are informed not to treat the observer as a special guest; the observer's task is to sit aside and quietly observe any interactions between the infant and all their family members (Bick, 1964). Most commonly, the infant–parent dyad is being observed; however, all siblings, grandparents, etc., present at the time are included in the observations. For instance, if the baby is asleep the observer watches the baby sleep. If the baby is having a bath, being fed, or lying quietly whilst their mother/father, etc., folds clothes, the observer watches this all, without purposefully participating.

Third, after the observational visit (but not during), the observer makes extensive notes regarding the baby and all that has happened with and to them during the hour. Writing up ‘process notes’ or ‘observer's notes’ of the entire observation can cover everything from the knock on the door to goodbyes. It is common, over time, for the observer's capacity for remembering and recording to become much more attuned. Thus their ‘process notes’ notes may eventually take several hours to complete, as more ‘observational data’ of the infant and feeling states of the observer are recalled (Caron et al., 2012; Rustin, 2014).

Finally, observers meet weekly for a 90-min group seminar with their group's supervisor, who is an experienced IMH clinician or psychoanalytic psychotherapist. The supervisors themselves have almost always undertaken their own (sometimes more than one) infant observation. In the seminar, observers usually read their notes, and then, the observation is discussed in detail within the group. These explorations enable expanded understanding, hypothesising, and imaginings by the observer of both the infant and of themselves. Moreover, the observer may experience many emotions resulting from the group discussion, exploring both their own feelings and fantasies (Monticelli, 2014). For example, the observer may talk about their own memories of being a child or the associations they make of seeing a baby's response to an aggressive nappy change by a parent. What grows is a new or renewed sense of the respect and privacy required in being within an infant's intimate family context and the powerful impact of sharing this within the seminar (Rustin, 2014).

1. Trainees can intensely explore the nuances of ‘their process of observing their particular infant,’ whilst also learning about the other trainees' experiences with their observed infants. Hence, the observation experience is not only a thorough exploration of the subjectivity of one's own observed infant but of all the observations presented within the seminar group.
2. Seminar participants usually work in small groups, which maximises the opportunity to have one's own experience explored. Four seems to be the optimal number, allowing one's own observations to be the focus once every 4 weeks.

THE OBSERVATION PROCESS

The process of sitting and patiently watching a very young baby, allowing yourself to be affected by what you see and feel, the close unfolding development of the infant–parent relationship, and then writing comprehensive (post-observation) notes commits the experience of observation to memory. The more you practice this discipline, the more acutely aware you become of the infant's vocal cues, emotional messages, and the physicality of infant communications, their preferences for one parent over another: occurring right in front of you. Often there are other young siblings in the home, and these intense sibling relationships can also become a focus of the infant observation. All that is seen and felt can be more powerful than the spoken word.

This method of observational data collection has been for the last 70 years a requirement of training in child psychotherapy. In 1948, John Bowlby, who was head of training in the child and parent department of the Tavistock Clinic, London, invited Esther Bick to head his clinic's child psychotherapy training (Bick, 1964; Rustin, 2009). Margaret Rustin, a British pioneer in child psychotherapy described it well in her paper looking at Esther Bick's legacy:

She wished it to give her students “some practical experience of infants” to prepare them for clinical work with children, in which they will be attuned to the infantile elements in their patients' material … The “free-floating attention” familiar in psychoanalytic practice which Bick wants observers to achieve is what will potentially give access to adequate remembered detail on the one hand, and access to the observer's own emotional responses on the other – both those recollected subsequently by the observer and those emerging in the later seminar discussion. (Rustin, 2009, pp. 30–31)

Infant observation has a rich psychoanalytic tradition, which is ‘seeking to access internal emotional states as well as the meanings of external behaviours, [and] can be seen as giving expression to the “voices” of the youngest children including babies’ (Elfer, 2012, p. 225). Analysing behaviour is preferred over offering opinions (Abrahamson, 1983). The most compatible and unobtrusive way through which to collect data on how the pre-verbal infant communicates is through observing their behaviour and engagement. To remain present to the infant requires attention, to watch without distraction. How the infant relates to, and is interacted with, is of greater significance than what is spoken. Furthermore, the observer ‘repeatedly allows him/herself to be affected by the experience’ (Caron et al., 2012, p. 229).

Infant observation makes prominent the experience of the infant, and as the observation takes place in their home, always includes the infant–parent relationship. It is a process that calls on the practitioner's ability to sit within the intuitive, right-brain realm, and in a space where ‘verbalisation has no meaning’ (Caron et al., 2013, p. 170). It requires the trainee to watch, without judgement, and to allow ‘ourselves to feel the sympathetic response that the other's actions and feelings invite’ (Reddy & Trevarthen, 2004, p. 9). It requires discipline. It is not for the observer (in situ) to pass comment or write copious notes on what they see but to be fully present, to watch every nuanced behaviour and interaction with their attachment figures and to absorb these, without comment. Cooper (2002) outlines the details of her observation, with particular focus on how a family of three creates psychological space for the new sibling relationship.

The structure and discipline of infant observation training might, for the trainee, be somewhat akin to what Trevarthen and Aitken (2001) describe as ‘primary intersubjectivity’ (from birth to 9 months) and ‘secondary intersubjectivity’ (from 9 to 18 months). That is, for the therapist, re-learning how to sit in a place from which to observe and remain within the intuitive, right-brain realm. ‘This relates to how communication begins and develops in infancy; how it influences the individual subject's movement, perception and learning; and how the infant's biologically grounded self-regulation of internal state and self-conscious purposefulness is sustained through active engagement with sympathetic others’ (Trevarthen & Aitken, 2001, p. 3). The infant is born with a brain already wired for engagement and seeking attachment (Fishbane, 2007; Siegel, 2001). This period of development and rapid growth takes place in the right (sensate and emotional) hemisphere of the brain, with development in the left-brain hemisphere (language and cognition) occurring in the second year of life (Schore, 2015; Stern, 1985/2003).

Such intensive, observational training results in:

• Distilling the space for thinking more deeply.
• Enhanced ability to absorb and remember nuanced details.
• Encouragement to imagine the baby's experience of their relational world.
• Creating a space for reflection, taking time to explore the world of the baby with no imperative to correct, change, challenge, or improve that world.
• Establishing a hierarchy of the observers' focus on the infant's communications, interactions, and emerging attachments.

INFANT MENTAL HEALTH AND FAMILY THERAPY

A central tenet of IMH practice is recognising that the infant has their own subjective experience (Paul & Thomson-Salo, 2014; Zeanah Jr & Zeanah, 2009). These experiences occur within the environment of their caregiving world (Stern, 1985/2003; Stolorow, 1994). Endeavours have been made to integrate certain IMH theories into family therapy approaches. Attachment theory offers both developmental and transgenerational understanding, which can be easily translated into therapeutic practice. Bowlby wrote about the need for children to have a secure base, from which they can explore the relational world. He also noted that ‘attachment behaviour is held to characterize human beings from the cradle to the grave’ (Bowlby, 1977, p. 2003).

Byng-Hall (1990, 2006), UK child psychiatrist and pioneering family therapist, articulated the ways that family therapists can adopt this principle and offer themselves as a secure base for families. Through this relationship, family members may begin to understand how they function as a family. Creating a safe, reliable, and regular relationship with their family therapist helps families determine what needs to be known and what needs to be thought about and to find potential reparative pathways to heal, grieve, and grow. Australian family therapist Carmel Flaskas (Flaskas, 2005) has long argued that systemic family therapy can benefit from drawing on certain psychoanalytic ideas. ‘We should be looking for intersections with analytic ideas, rather than attempting simply to “import” analytic ideas into the systemic context’ (Flaskas, 1996, p. 38).

Object relations theory is seen by some as the ‘psychoanalytic theory most applicable to a model of marital interaction and family dynamics’ (Scharff & Scharff, 1997, p. 141). Scharff and Scharff (1997) describe ‘object relations family therapy’ as a derivative of the work of multiple psychoanalytic pioneers in IMH, including Winnicott, Fairbairn, Klein, Bowlby, and Fraiberg.

LEAVING THE INFANT ON THE DOORSTEP

The delay in family therapy's embrace of what IMH offers is perhaps connected to the origins of family therapy itself. Emerging in the 1950s with its emphasis on systems thinking, it became a therapeutic vehicle which challenged the notion that problems lay within the individual. At its core, the conflict between family therapy and analytic approaches rests with interventions informed by systems/communications theories versus those informed by psychoanalytic theories (Cooklin, 1979). This seems to have set up a binary position theoretically. The importance placed by family therapy theorists on examining the influence of wider psychosocial systems, including political systems, left the infant and younger child on the outside of an approach which is heavily ‘adult centric’ (Bunston, 2017).

In their overview of family therapy, Goldenberg and Goldenberg (2012) state that:

The more we learned, the more we came to grasp the influence of the larger systems – race, social class, gender, ethnicity, sexual orientation – on the functioning of the family and its individual members. Postmodern thinking introduced us to the further importance of language and belief systems in understanding how people construct their view of reality. (xxiii)

Despite numerous authors espousing the value of integrating an understanding of IMH ideas within family therapy (Byng-Hall, 1990; Carr, 2009; Manigat, 2022; Mchale, 2007; Scharff & Scharff, 1977; Sved-Williams, 2003), such appeals have yet to substantially inform family therapy practices. Infant observation techniques have, however, been used as training, practice, and research tools in multiple other arenas such as social work practice, aged care, disability, dementia, child protection, organisational consultancies, and health (Bunston et al., 2020; Dearnley & Hartland-Rowe, 2009; Elfer, 2012; Fleming, 2004; Hingley-Jones, 2011; McKenzie-Smith, 2009; Meek, 2005; Ng, 2009; O'Dwyer, 2008; Rhode, 2004; Trowell & Miles, 2004; Vliegen, 2006; Wilson, 1992).

IMH was manifestly born, raised, and remains largely practiced by those within psychoanalytic circles (Weatherston, 2017; Zeanah, 2019). Family therapy sought to individuate from a psychoanalytic tradition, to be the group which moved from individual pathology to group/family process. ‘Systemic therapy has had an ambivalent relationship with the psychoanalytic therapies, and in many ways, it has had an oppositional relationship’ (Flaskas, 1996, p. 34). Family therapy was born as a somewhat subversive movement, as it challenged psychiatric thinking. ‘The difference in theory is so great that it is no wonder therapists who attempted family therapy worried about heresy and operated underground’ (Haley, 1962). In the heady days of the 1960s and 1970s, systems theory-informed family therapy eschewed any notions that aligned with psychoanalytic or traditional psychotherapeutic ideas (Fraenkel, 2005). The clinical portrait presented by the family therapist is revolutionary when contrasted with the traditional psychiatric portrait (Haley, 1962).

The large-scale exclusion of the infant from the therapy room also reflects a broader notion where babies have not been seen to be sentient, feeling people in our society. Family therapy models reflect these contemporary beliefs. Originally the medical profession had long made assumptions that infants could not feel or remember pain. The psychiatry profession engaged with treating depressed mothers/fathers but often failed to see the depressed infants of their adult patients. This was aided by the societal belief that babies could not remember any trauma, be that medically induced or as the result of family violence. Babies were removed from their parents and new caregivers told not to mention this as the babies would not remember (Kenny et al., 2012).

Think of our own country's removal of Indigenous children in Australia as one extreme example of this practice (HREOC, 1997; Read, 1981/2006). David Chamberlain (1992) argued against the long-held belief established in the 19th century that babies simply had small, underdeveloped brains. It was thought that they could not ‘organise themselves,’ or attach any meaning to their experience. Thirty years ago, he wrote ‘infants are much more than we thought. Nineteenth century science was materialistic in viewing the baby as body, brain, and reflex material. The 21st century view of babies will, I believe, focus on their sensations, emotions, sense of self, personality, communication ability, mind, and consciousness. This major paradigm shift is urgently needed’ (Chamberlain, 1992, p. 170).

Family therapy, a model developed to look at systemic patterns of interactions and with a focus on the spoken word, could benefit tremendously by embracing a paradigm shift which affords the infant the right to not only be in the room but also in the mind of the family therapist. Further, integrating infant observation training techniques into family therapy work provides a powerful opportunity for the therapist to become an astute observer. This is in addition to holding in mind the experience of the infant in the room, here and now, and the infants of the past: the parent, older siblings, and other important family members who have their own embodied memories of being an infant and young child.

We would do well to remember that we have all been infants. Our recognition and identification with their vulnerability and dependence on others, whether conscious or unconscious, may arouse painful feelings within us. ‘Anxiety, chaos, distress, hurt, indignation, outrage, pre-occupation and stirred memories are some of the many feelings that are part of this work’ (Bunston & Jones, 2019, p. 40). It is often less painful to ‘not see’ the infant, but we are poorer for doing so. The infant is the most available, ready, and amenable to relational change within any family constellation.

PRACTICE EXAMPLES

The following excerpts from process notes and practice examples illustrate how the authors of this paper believe the infusion of an infant observation lens enhances their work as family therapists.

Author 1

My training in family therapy preceded my introduction to working with infants by some 15 years. I was aware of feeling anxious when a baby was brought along to a family session, as I was unsure of what to do should the infant start crying. I clearly recall some level of chagrin when parents failed to find a babysitter. My work in child and adolescent mental health services led to me specialise in developing interventions to address the impacts of domestic and family violence on children and their families (Bunston, 2001, 2017; Bunston et al., 1999), which in turn showed me that I needed to go back to where it all begins: infancy. My training in IMH and, in particular, infant observation, changed how I saw the world, and how I kept the foundational, lived experience of the infant in mind and across time (Bunston, 2017, 2021; Paul & Thomson-Salo, 2014). I now consider myself to be an ‘infant-led’ family therapist, and I find that bringing alive the infant experience offers me a portal to travel through time, something akin to the Tardis in Dr Who, the television series.

The following is an example of how I believe my training in infant observation directly impacted how I worked as a family therapist. Rather than launching into asking about the story of this family, I sought to gently engage, keenly observe, and be curious about the dynamics and feeling states in the room. As a part-time consultant family therapist, I would often sit in on sessions with the family therapist from an inpatient unit. In this session, I was already seated in the therapy room when the inpatient family therapist brought in the family – two teenagers and a mother and father. It was my first meeting with this family. The parents were chatting to the inpatient therapist and seemed oblivious to my presence, perhaps used to having unintroduced staff sitting in on hospital consultations. I remained seated and simply watched. The following anonymised excerpt is from my notes on the session:

The mother was talking to her husband and the inpatient therapist as they entered the room. The mother sat down on a couch against the wall and one teenager quickly sat beside her. The father sat down on a couch opposite and the other teenager sat next to him, directly opposite their sibling. I watched as the parents continued to talk to the other therapist about the events that had occurred since their last session. The two siblings remained silent but were actively engaged in a vibrant non-verbal conversation as they rolled their eyes, smirked, and made fun of their parents' conversation. Neither parent seemed to notice me as they were engrossed in a heated conversation with the other therapist. I was curious that no one seemed to acknowledge my presence, and I remained sitting quietly, simply watching the family members.

There appeared to be little consensus between the parents as to how the teenager who was the in-patient was faring, whilst the two teenagers remained glued to watching each other and pulling faces. I slowly put up my hand like a student in a classroom, and eventually, the family members noticed and ceased their conversation. When all eyes were turned on me, I asked whether any of the family members were interested in who I was and why I was sitting, unintroduced in the room whilst they shared intimate details about their family life. The mother responded by asking why I was in the room. I explained my role and expressed my curiosity about them not asking who I was and why I was in the room with them. I then asked if they would be interested in what I had noticed about them as a family as I sat quietly observing them. They affirmed that they would like to hear about what I had noticed.

I began describing in detail what I had noticed about how they entered the room, how mother and father had to sit on opposite couches as the teenagers quickly took their seats and how the two teenagers were engaged in a very colourful non-verbal transaction; their parents seemingly oblivious to what was happening between the two teenagers. I wondered aloud if this seating arrangement told me something about the relationship of the parents and whether they might be divided as a couple. I wondered what would happen in the room if the mother and father sat together on one couch whilst the teenagers sat together on another.

I made no reference to what they had been speaking about but simply described what I saw going on between each family member. The father then moved seats and the two teenagers sat together. This led to a totally different atmosphere in the room, and a level of intimacy that rather quickly uncovered a very different, raw, and moving disclosure about the struggles for intimacy that this family felt with one another.

My ease with just observing, neither asserting my presence nor announcing my role nor privileging what was spoken over what I saw and felt in the space, allowed for something different to emerge. Like much observational work, my memory of this session is stored viscerally. The content of the initial conversation had by this family has long gone, but the emotional imprint on me of this experience remains. This imprint goes to the very heart of the emotional exchange which occurs within the embodied intersubjective space between people who we care about or who make a big impact on us. Just as I barely recall what academic lessons I learnt in primary school, I can still vividly recall occasions where I was shamed, embarrassed, ridiculed, felt pride, or felt valued. Potent emotional memories, including trauma, live in the body (Van der Kolk, 2014). The following passage comes from notes with a family I saw online during the first round of lockdowns during the COVID-19 pandemic. And yes, this approach can also work online (Bunston et al., 2022):

It was my first meeting with this couple and their twin infants. Both parents were seated on a couch, and each held a twin. I was introducing myself and inviting them to tell me something of what they wanted from the session. I was watching the interactions between the twins and their parents and the twins with each other. I felt that both parents were very loving and attentive to the cues from their infants, but less attentive with one another. I mentioned what I was observing and the story of how these two came to be parents tumbled out. As the mother was describing their very brief encounter which resulted in her pregnancy, I noted one twin constantly looking up towards the ceiling. I commented on what I was seeing and wondered what he was looking at. The mother immediately told me he was looking up at his dead grandmother. She explained that she believed the twins' grandmother was looking down on them and that the twins could see her even if they (the parents) could not.

I wondered aloud what the twins saw when they looked up at their grandmother. This powerfully brought the grandmother's presence into the space and the opportunity to explore what the mother thought the grandmother would make of, and would want for, her grandchildren, as well as her daughter. It also offered a space for the father to share what his mother's relationship was with the twins and opened a wonderful intergenerational thread of exploration both from the past and into the future.

When I reread process notes such as these, I vividly recall my emotional memories associated with the observation. I gained an enormous amount of understanding about these infants and parents through observation. Bringing the infant alive in the space by directly wondering about their experience, separate to that of their parents, invites the family to consider the infant's experience, as well as that of the other family members. My work with infants has also taught me something very pivotal, namely that the infant and young child, like any other member of the family, is fully entitled to be present and to have their experience considered (Bunston et al., 2021). Further still:

The beauty of the world of the infant and child is that they rely less on words and more on emotional connection. You have to pass the “Are you emotionally safe” test before they let you in – not a bad starting point for any relationship or setting where the job is to offer safety and healing. (Bunston & Glennen, 2015, p. 49)

Author 2

Working at the Royal Free Hospital, London in the late 1980s, I was amazed at the vast cultural mix of children's families, a world away from Melbourne at the time. As a young paediatric hospital social worker, I recall working with children from very privileged families, children of immigrants, infants and children whose experiences included extreme child abuse, sexual assault, and undergoing treatment for cancer. Fortunately, Dr Dora Black, child psychiatrist and pioneer family therapist, encouraged me to train with her at the London Institute of Family Therapy. Ms Riva Miller, social worker and pioneer HIV family therapist, agreed to supervise my work weekly, which led me to my more extensive family therapy training at London's Tavistock Clinic. My family systems training then opened my eyes to families but blinded me to the infants' experience. Returning to Melbourne, I began to work at the Royal Children's Hospital and joined the IMH team. Using the one-way screen, we juniors observed how our more experienced colleagues (Campbell Paul, Brigid Jordan, Frances Thomson Salo) met sick and frightened infants with their families, patiently and tenderly getting to know them and their parents. My own infant observation training began many years later; I came to regret not undertaking this much earlier in my family therapy career. Below are examples of my integration of infant observation within my family therapy work:

Many years ago, a couple, “Sally and John” (not their real names), were referred to me, 6 months earlier after their first child Jasmine arrived. Sally arrived looking frail and thin. Throughout the first session, Sally spoke of her struggles with motherhood following Jasmine's birth and her experience of post-natal depression. Her feelings confused her as she loved her baby and her husband, and everything had gone well during the pregnancy. John was supportive and concerned about Sally's struggles with anxiety and depression.

At the conclusion of the first session, I suggested they bring baby Jasmine along to the next session. They seemed surprised by this suggestion, commenting that Jasmine was healthy and developmentally age appropriate, so why would she come? Nevertheless, they brought Jasmine to the second session. I soon felt uncomfortable in the session.

Jasmine seemed intent on staying close to her mother, however, she seemed very wary with her father. What experiences were influencing Jasmine's parental preference? I felt uncomfortable for her and her parents too; it felt like Jasmine was exposing something not quite right – it was more a feeling, a tension, not a fully formed thought. Jasmine oriented urgently to her mother Sally. Her father made a desultory attempt to engage Jasmine but was unsuccessful and he gave up. There was no sense of pleasure in this attempt. Throughout the session she played perfunctorily at her mother's feet. Whilst I too was on the floor, not far from Jasmine, she clearly wasn't up for exploring anything with me. All during the session Jasmine actively avoided her father. She appeared visibly uneasy if her father attempted to engage her. As the session progressed, I felt more and more unable to say anything to them about what I was seeing. In retrospect, I now wonder why my own mind could not process the uncomfortable feelings in the room. I could not even entertain the possibility that maybe I felt what Jasmine was feeling. Whilst she demonstrated that something was awry in the relationship with her father, none of the three adults in the room could talk about Jasmine's discomfort.

After having time to reflect on this experience, in the following session I was able to comment on what Jasmine might have been showing us. Her father, John, looked upset, but denied anything was wrong, saying “she's a mummy's girl.” Sally looked anxious, as if I had asked something that I wasn't supposed to know about, or something that I was not allowed to ask about. The couple were, however, able to remain engaged in these ongoing, but often, painful sessions.

Sally started therapy, lost in the biological/pharmacological gendered focus of her diagnosis of post-natal depression. Sally struggled in the early stages of become a mother, and this was making it worse for John as a new father/different partner. John was eventually able to talk about his own previous struggles with depression, his anger with his own father, and his deep despair about not being good enough, which manifested in his being critical, anxious about money, and complaining about the lack of sex and his loss of sex and freedom.

As another paper in this issue attests, the father's experience in the infant–father relationship can be overlooked. Jasmine showed us where therapeutic action was required. She came to a few more sessions. It was noticeable how her father's capacity to “see, hear, understand, and connect” with his daughter was slowly enhanced. He gradually projected less of his own vulnerability into Sally. He came to know Jasmine better and to “forgive” her for his own loss of freedom. Jasmine and John began to play with delight in the sessions with me, a significant step forward in their infant–parent relationship.

Postscript

In hindsight, I can see how little understanding or capacity I had for asking about any emotional or physical violence which might have occurred between the parents. I certainly think I could have tried to explore with both parents bilateral pushing, pulling, violence, anger, arguments, and emotional or financial control, as well as any cruelty or belittling of the father by the mother. At the time I did not have the training or experience to address these issues in the sessions. Years later I was able to learn this from my co-author, who herself is a pioneer in working with infants and parents affected by family violence.

The following is a brief description of a family I worked with during the COVID-19 pandemic:

During the early days of the COVID-19 pandemic, I was working with “Sai and Aarav” (not their real names), two fathers in a same-sex couple. They had a 2.5-year-old toddler, Aryan, born via surrogacy. Due to Melbourne's infection prevention restrictions on leaving the home, they suddenly had their couple sessions moved online to a much later time in the evening. Both fathers felt highly frustrated about these changes to their therapy, as they did about everything else that changed for their work and family life during the pandemic.

With this move to online therapy, I noticed how much of the minutia of facial communications I observed. The micro-behavioural gestures, interpersonal cues and feeling states, and interpersonal frustrations were being exposed in a way I could never have captured if they were in the room, bringing both advantages and disadvantages.

In these sessions they often talked about how much the three of them were being flattened by the boredom of being housebound, and the fatigue of having their son constantly with them. They noticed how much less playful they were with each other and with their son. One of their concerns was how hard it was for them because their parents were unable to travel to Australia from India due to international travel restrictions. The fathers were very worried that their parents would get sick or die, and they may never see them again. One of Aryan's grandmothers frequently told them she was exceptionally sad she couldn't see her grandchild and feared he wouldn't know her.

For the first time, Aryan began having trouble sleeping, and one night during their 8.00 pm session he refused to settle. I suggested that maybe he needed to join us and that I needed to meet him too. Without much thought of how to engage him, I was suddenly looking at him on screen. I happened to have a toy car near my computer, so we played a game involving moving the car across the screen and “falling off” to my exclamations of “Oh dear – what happened to the car? Did we lose him, can we find him?” Looking back, I now see this was a quickly improvised version of Peek-A-Boo!

I introduced myself to Aryan and explained that I was helping his dads with sad feelings of being at home too much. That it seemed everything had changed too fast. I mentioned that his daddies' parents were far away from their family in India. Whist I was of course very interested in him, I was not sentimental. I was curious how he might relate to me, whether he would engage or reject the new woman on the screen. He was interested and playful, but it got late, and we all said goodnight. The following week, the fathers started the session with Aryan with them. Having him arrive at the beginning of the session was helpful, allowing me to play with him right from the start, when he showed me his own toy car – he had clearly remembered!¹ While I played with him, and with very little “adult talking,” both fathers sat back and watched.

After half an hour, one of the fathers put Aryan to bed and I noticed he was separately happily. I turned off my computer's camera until both fathers were reunited on screen. They then told me they were surprised that “he knows you! He remembered and wanted to play.” They were relieved to see how much he remembered me, which gave them some confidence that Aryan could get to know his grandmothers even at a long distance. This led to us talking about how their son was probably feeling the same feelings they were – boredom and frustration – and most likely craving novelty and play. We explored how they might create time out from each other and take turns playing alone with him. Like many parents of young children during COVID-19, they had not yet found a coherent story about the virus and why he was not at child care anymore. I emphasised that it appeared to me Aryan needed a narrative about what was happening to them and to him and to the world. I suggested we reflect on that together in the next session.

Postscript

Bowlby's trilogy of ‘attachment, separation, and loss’ kept coming to my mind whilst I was with this family (Bowlby, 1977). This young child needed more aliveness but that meant they all needed more ‘separation’ too. What could they create together, and further apart, during the crazy early days of the COVID-19 pandemic? I also noticed how much livelier I was with them when Aryan was with us. I commented that I wondered if they felt he had to hold the hope of a better future and that maybe it was also their job to learn how to find their own liveliness, their own libidinal energy, and not only rely on Aryan's.

CONCLUSION

This paper cannot do justice to the enormity of what IMH and infant observation skills offer the family therapist. Our aim has been simply to introduce the reader to the possibilities of what such knowledge and processes can offer as the therapist brings alive the mind and experience of the infant, in the here and now, in the past and in the future. How family therapy and training in family therapy invites infants and their parents and young children into the therapeutic space will be the measure of how family therapy, from the ground up, grows a developmental continuum that includes all ages within the intergenerational threads that exist across time. Such inclusions allow parents to be curious about the impact of their own infant and childhood experiences on their adult lives, how they imagine their own parents as infants and children, and what they know of their parents' early stories. Perhaps most powerfully, including infants and young children in family therapy sessions encourages parents to explore how their children experience them and how they experience their children, from conception, through birth, to the present, and how they want to be experienced in the future.

RECOMMENDATIONS

Infant observation training could be offered in current family therapy training programs, although this would require an organisational commitment. Integration of infant-family therapy training also requires the availability of skilled trainers. Bouverie Family Therapy Centre, in Melbourne, under its new director Professor Jennifer McIntosh, is an example of how this is possible. Whilst some programs might incorporate working with our youngest clients in the fundamentals of coursework, another option is to offer a further specialisation, or, at the very least, as an additional elective in existing training organisations. In turn, IMH training programs, which focus on the relational world of the infant and young child, would also benefit from bringing family therapy approaches and training into the skills taught in IMH training programs and the field of IMH in general.

FOR FURTHER INFORMATION ABOUT INFANT MENTAL HEALTH AND INFANT OBSERVATION

Australian Association of Infant Mental Health: https://www.aaimh.org.au/.

Infant Mental Health Association Aotearoa New Zealand: https://imhaanz.nz/.

World Association of Infant Mental Health: https://waimh.org/default.aspx.

Emerging Minds Australia: https://emergingminds.com.au/.

MERTIL: https://www.mertil.org.au.

Zero to Three: https://www.zerotothree.org/.