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This paper aims to further our understanding of the process of therapy in psychoanalytic parent-infant psychotherapy (PPIP). Using a single-case study methodology, it examines the emergence of atypical maternal behaviours in the sessions and considers direct therapeutic work with the baby. The research material for this study consists of video tapes and verbatim transcripts of two sessions from different time points in one good outcome PPIP treatment. The Atypical Maternal Behaviour Instrument for Assessment and Classification (AMBIANCE) coding system is used as a basis for identifying atypical maternal behaviours, as they manifest in the sessions. In addition, the therapist’s intervention in moments of interactive disruption are analysed discursively, with a focus on the utterances that directly address the infant. Findings suggest that the mother exhibited a high frequency of disruptive behaviours, as coded in the AMBIANCE, in the beginning of therapy. These decreased considerably by the end of treatment. In addition, the therapist was seen to respond consistently and flexibly to maternal disruptive behaviours, employing different interventions. Furthermore, the therapist talked directly to the baby for a significant amount of the session time, especially early on in treatment, addressing several different issues. Disrupted maternal behaviours can be discerned and systematically observed in PPIP sessions; these may be addressed in psychoanalytic parent-infant psychotherapy through the therapist’s verbal and nonverbal interactions with the mother and baby. Using different coding systems to examine patterns of interaction in detail, it is possible to gain insight into the therapeutic process, furthering our understanding of change mechanisms in psychoanalytic work with infants and their parents.