Clinical commentary by Sara Rance, Consultant Child & Adolescent Psychotherapist, Newham CAMHS

On first reading this account of such a young mother coming into therapy with her two-month-old baby girl, my emotional responses ranged from foreboding to righteous indignation and a desire to rescue both mother and baby. The worker faces a daunting task, both in the direct therapy with the mother and infant and in the crucial work with the professional network. My countertransference feelings also relate to the wider social context in which this difficult work is taking place. There is no shortage of outraged finger wagging at professionals from journalists, civil servants, politicians and members of the public when serious harm befalls an infant or young child through abuse or neglect. The spectre of castigation hovers above us and external as well as internal pressures restrict the potential for unhurried reflection on the work. Like this young mother, we as professionals can feel constantly monitored and fear making a wrong move, yet we need a degree of freedom to take risk in the therapeutic work if development is to occur.

There are different perils in commenting on a snapshot of past clinical work: information is limited and there is no dialogue with the therapist. I miss details such as the gender of the therapist and something of the physical appearance of mother and baby. But even at one remove I feel a pressure to get it ‘right’, to alleviate the discomforting anxiety of being unsure – about what is unfolding moment by moment in the session and about whether this mother is capable of providing what her baby needs from her. In place of the position of certainty, different perspectives need to emerge – seeing the baby from the mother’s point of view and the mother from the baby’s point of view and both from the point of view of members of the professional network who may be in conflict with each other about what is in the best interests of mother and baby. With thi