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Dr Mallouh’s therapeutic interventions are so moving and successful, it is a privilege to be a discussant. I shall first say something briefly about analytic therapy, in particular with Dr Mallouh’s second patient, Ms D, and then move to the concept of primary maternal preoccupation. I think that what Dr Mallouh describes so beautifully are “moments of meeting” in a mother’s contact with an empathic therapist and she also conveys so clearly how the therapist’s countertransference can be agonizing. Dr Mallouh is also real in her therapeutic presence and suggests actions or points others ways to forward development. She is speaking from knowledge and experience, and it is not just reassurance that has become false because one’s empathy is exhausted, but is the therapist intuiting a possible future, so that it can be trusted and a mother can grow from it. The therapist had found a space for the mother to feel that she was “alongside” her in a supportive way, rather than the therapist confronting her, so that the “ghosts in the nursery” (Fraiberg, 1975) did not need to have a major effect on the developing infant-mother relationship.
Dr Mallouh also writes of the need, sometimes urgent, to make interpretive links between a mother’s current emotional difficulties with her infant and her own deprived or traumatic early experiences. I wish that there was always the time to do this. Sometimes, in short-term therapeutic settings, there may be a pressure to work fast but containingly, as time is very precious for the infant-mother dyad. Here, we must trust that what Winnicott called “silent” interpretations will be effective - those made in one’s mind, often preconsciously, sometimes only consciously called to mind after a session - that they would be transmitted from therapist to mother and baby, and provide another layer of holding, and a containment that nurtures.
Mothers “get it” when therapists try not to judge and shame - that they want to understand, not impose a positio