The Relation of Infant Observation to Clinical Practice in an under Fives Counselling Service*

In this paper I shall try to present some thoughts on the use of observation in a certain kind of psychoanalytically-oriented work. I shall do so by giving an account of a method of working and a service developed in the Child and Family Department at the Tavistock Clinic.

First, I need to describe the service offered in the Child and Family Department under the title “The Under Fives’ Counselling Service”. We offer brief help — only up to five sessions, which may be variously spaced out over a number of weeks — to families whose concern is focused on anxiety about their baby or small child. For example, we have mothers and fathers with babies who will not sleep, who will not eat, who cry incessantly; we have couples where the mother is depressed; we have parents anxious about the effects of bereavement or divorce; we have babies who refuse to be weaned, toddlers who suffer tantrums and jealousies; and of course we have those who come with more nameless and inexplicable anxieties. This service differs from the rest of the provision made in the Department insofar as here we do not regard ourselves as having a referred patient. We have parents coming for counselling; they come to think with an experienced outsider about the problems they perceive in their child or their children. The worker comes from a multi-disciplinary workshop where psychiatrists, social workers, psychologists and child psychotherapists meet regularly to discuss some of these cases and other aspects of work with very small children.

Flexibility, promptness and informality characterise the service. We see family members in various groupings: we like to see both parents, but we are quite willing to take what comes. We pride ourselves on being able to give an appointment quickly, sometimes very quickly, believing that in a case where anxiety involves a baby or small child help is needed now and can be used at once. The relative informality of the service means that self-referrals predominate. A mere te