Infant observation

1. Introduction

Version followed: Esther Bick's 1964 Tavistock model, as described in her paper "Notes on infant observation in psycho-analytic training" (IJP 45:558–66), and as Margaret Rustin (2009) and current Tavistock courses report it: one-hour home observation each week from birth (or before) to the second birthday, detailed process notes written afterwards, and a weekly small-group seminar. The therapeutic adaptations follow Didier Houzel's therapeutic observation (Brest/Caen, 1989/1999) as Maria Rhode (2007) describes it, Rhode's own participant-observer pilot, and Margaret Rustin's brief observational interventions. The primary texts of Bick 1964 and Houzel 1999 are not drawn on. Their content here comes from Rustin's detailed account and from Rhode's chapter. [source: Rustin 2009; Rhode 2007; Wikipedia: Psychoanalytic infant observation] [uncertain: exact wording of Bick 1964 not checked]

What it is. Bick's method is a training method for clinicians, not a treatment. An observer visits an ordinary family at home and watches the baby and its relationships without intervening. The aim is to grow the observer's capacity to perceive primitive emotional states, bear them, and think about them. Throughout this guide, "client" means the observed family, and the person learning is the "observer". Therapeutic uses are described separately (Track B). In those, a trained observer visits a family whose baby is at risk, for example of failure to thrive or a communication or autistic-spectrum disorder, and takes a more active, participant role. [source: Rustin 2009; Rhode 2007; Harris Meltzer Trust]

How change happens.

• Training (Track A): the observer gains clinical capacity by repeatedly taking in raw emotional experience without acting on it. They then write it down in detail and think about it with a seminar over time, waiting for meaning to emerge rather than applying theory first. [source: Institute of Psychoanalysis, Esther Bick page; Rustin 2009]
• Therapy (Track B): a reliable, receptive witness breaks a "vicious circle of discouragement" in which an unresponsive child leads carers to withdraw. Being witnessed validates the child and the parents. Parents start to notice their child's cues, and the observer contains feelings that would otherwise overwhelm the family. These mechanisms are Rhode's own stated speculations. [source: Rhode 2007]

2. Framework

Track A: training observation (Bick/Tavistock)

Track B: therapeutic observation (Houzel model, and Rhode's adaptation)

Who observes in Track B: psychiatric nurses or generic mental health workers who have completed a conventional infant observation and have regular supervision. [source: Rhode 2007, on Houzel]

3. Guiding principles

• Non-interference (Track A). Watch, do not guide, advise or treat. In practice, when a parent asks "Am I doing it right?", stay interested rather than giving an expert answer. [source: Prat 2004; WBCP]
• Free-floating attention. Bick's aim, reported by Rustin, is attention that takes in both fine detail and your own feelings. In practice, do not fix on a single hypothesis during the visit. [source: Rustin 2009, p. 377]
• Do not act out the role offered. Resist "acting out a role" that the family assigns or that your own infantile pressures stir up, such as rescuer, critic or extra baby. In practice, notice the pull, name it in your notes, and do not act on it. [source: Rustin 2009, p. 377]
• Tact and reliability. In Bick's ethic the observer is a learner and a guest. In practice, arrive on time, keep the same slot, and give notice of breaks. [source: Institute of Psychoanalysis, Bick page]
• Regularity and continuity. One hour is little, but weekly continuity over two years makes it meaningful. In practice, protect the slot as you would a clinical session. [source: Rustin 2009; Klauber 2024]
• Learner, not expert. In practice, ask about the baby with curiosity and never assess the parents. [source: Institute of Psychoanalysis; Klauber 2024]
• No notes during the visit. Writing would stop you "responding easily to the emotional demands of the mother." In practice, keep your hands and mind free and write immediately afterwards. [source: Rustin 2009, p. 377]
• Describe before you infer. Bick urged observers to be "meticulous in recording behaviour" and slow to read the baby's feelings. In practice, write "she turned her head away from the breast twice", not "she was angry". [source: Rustin 2009, p. 383]
• Wait for meaning to emerge. Hold hypotheses until further observations confirm or refute them. In practice, a seminar idea becomes something to watch for next week, not a conclusion. [source: Rustin 2009; Institute of Psychoanalysis]
• Tolerate not-knowing. Curiosity can "intrigue too much". In practice, do not question the family to fill gaps. [source: Rustin 2009, p. 378]
• Own feelings are data. In practice, record what you felt and what you cannot remember. [source: SPSI syllabus; WBCP]
• Non-judgemental stance. In practice, set aside blaming thoughts and accept the full range of parental feelings: exhaustion, resentment, pride and love. [source: Wikipedia; Rhode 2007]
• Confidentiality. Notes stay within the seminar and are anonymised. They are not shared with the family. [source: SPSI syllabus; Wikipedia]
• The seminar as container. The group helps the observer bear and think about what they take in. In practice, bring every visit, including ones that felt empty. [source: Prat 2004; WBCP]
• Child safety overrides method. Safeguarding concerns are rare. When they arise, observers consider them with their teachers. In practice, non-interference never means ignoring risk. [source: Klauber 2024]
• Track B: participant observation. Use your observations and feelings to respond directly to the baby and interpret its cues for the parents. In practice, you speak and act, but from an observing stance and without claiming to know better. [source: Rhode 2007]
• Track B: Houzel's three receptivities. These are perceptual (details and sequences), emotional (sympathetic attention) and unconscious (openness "at the deepest level"). Houzel ranks unconscious receptivity as most important. In practice, supervision is mainly for metabolising impressions you were not aware of. [source: Rhode 2007, on Houzel 1999]
• Track B: non-punitive adaptability. In practice, do not react to missed visits or an untidy home, and fit in with the family's needs. [source: Rhode 2007]
• Track B: supervision is essential. The observer needs time to process and bear painful feelings. [source: Rhode 2007]

4. Intervention inventory

There is no published step-by-step manual for either track. The steps below combine the procedures the sources describe with operational detail that is marked [synthesis]. All observer wording is illustrative.

Track A: training observation

A1. Choosing a family with the seminar leader

• Purpose and when to use: before any approach to a family. A suitable family protects the baby, the family and the learning. [source: Rustin 2009, pp. 386–7; Tavistock course page]
• Steps: (1) List possible contacts: friends of friends, antenatal groups or GPs, but not your own patients, close friends or relatives [synthesis]. (2) Discuss each option with the leader, including why you prefer it. Rustin notes that preferences can reflect the student's own values or anxieties. (3) Aim for a baby due near the start of the seminar. (4) Check that you can keep a fixed weekday slot for 1–2 years.
• Example language (illustrative): "I'm drawn to this family partly because they seem so like my own. Could that be a problem?"
• Watch for and signs it's working: strong pulls towards "interesting" or troubled families, which suggest rescue fantasies [synthesis]. It is working when the leader agrees and you can say why you chose this family.

A2. Preparing for the first meeting (role-play)

• Purpose and when to use: before the first contact. Some seminar leaders now use role-play for this. [source: Rustin 2009, p. 387]
• Steps: (1) In seminar, play the parent while a peer plays the observer, then swap. (2) Practise explaining the task in 2–3 sentences. (3) Practise answering "What will you write?", "Will you tell us if something is wrong?" and "Can you babysit?" [synthesis].
• Example language (illustrative): "I'm training to work with children and families. Part of the training is to see how one baby grows and develops in an ordinary family, week by week."
• Watch for and signs it's working: over-promising, or presenting yourself as an expert. It is working when you can explain the task plainly without jargon.

A3. Initial meeting and informed consent

• Purpose and when to use: before the birth if possible, with both parents where possible. [source: SPSI syllabus; Rustin 2009, p. 376]
• Steps: (1) Meet at the family's home. (2) Explain the visit: one hour a week at a fixed time, you will not take notes or give advice, and you are there to learn, not to assess. (3) Explain confidentiality: notes are written afterwards, anonymised, and discussed only in a small training seminar. They are not shared with the family. (4) Explain the safeguarding limit: if you ever became worried about a child's safety, you would talk with your tutor and, where required, follow child-protection procedures [synthesis on wording; source: Klauber 2024 on safeguarding]. (5) Make clear they can stop at any time without giving a reason. (6) Follow your course's consent procedure, whether a written form or recorded verbal agreement [uncertain: practice varies between courses]. (7) Have your DBS or equivalent check and your tutor's contact details ready if asked [synthesis]. (8) Listen to their story of the pregnancy and their preparations, and summarise this contact for the seminar. [source: SPSI]
• Example language (illustrative): "You can stop the visits at any time, and you won't need to explain why." / "I won't share anything outside a small, confidential training group, and names are changed."
• Watch for and signs it's working: consent given to please a friend, or a parent who is unsure. It is working when both parents can say in their own words what you will and won't do.

A4. Setting and keeping the frame

• Purpose and when to use: from the first visit throughout. [source: Wikipedia; SPSI; Rustin 2009]
• Steps: (1) Agree a fixed day and hour that suits the family. (2) Arrive and leave on time. (3) Give holiday dates weeks in advance. (4) Avoid contact between visits except for scheduling [synthesis].
• Example language (illustrative): "I'll be away the next two Tuesdays. I'll see you again on the 14th."
• Watch for and signs it's working: frequent rescheduling, by you or by them. It is working when the visit becomes a known, ordinary part of the family's week.

A5. Finding the observer's position in the household

• Purpose and when to use: in the early weeks, and again when the family changes, for example a parent returns to work, a sibling arrives or a nanny starts. [source: Rustin 2009, p. 377]
• Steps: (1) Sit where you can see the baby without crowding the caregiver. (2) Greet every household member, including siblings, fathers, grandparents and carers. (3) Accept an invitation to hold the baby if offered, and a small gift on special occasions is allowed. Notice what the invitation means. (4) Do not join in with care or play beyond ordinary courtesy. (5) Move position if the family moves, without making it an event.
• Example language (illustrative): "Don't mind me, I'll just sit here, if that's all right."
• Watch for and signs it's working: being treated as a visitor to entertain, or slipping into a dependent role, swinging between identifying with mother and with baby. [source: Rustin 2009] It is working when the family carries on its usual routine with you present.

A6. Free-floating attention during the hour

• Purpose and when to use: every visit. [source: Rustin 2009, p. 377; Prat 2004]
• Steps: (1) Let your attention move between the baby's body (posture, hands, mouth, gaze, skin colour, muscle tone), the interaction, the atmosphere and your own feelings. (2) Follow sequences: what came before and after an event. (3) Notice sensory detail with all your senses. (4) Do not theorise during the visit. Thinking belongs to the seminar.
• Example language: mostly silence. Brief, ordinary replies when spoken to.
• Watch for and signs it's working: fixing on a theory, daydreaming, or a blank mind. It is working when your notes become richer in sequence and detail over the weeks.

A7. Responding to questions, requests and invitations

• Purpose and when to use: when the family asks for advice, opinions or help. [source: WBCP; Rustin 2009] [synthesis on steps]
• Steps: (1) Answer social questions briefly and warmly. (2) Turn requests for expert advice back with interest, not a ruling. (3) Decline babysitting or practical favours gently. (4) If there is a real health worry, point them to their GP or health visitor. (5) Note the request and your feeling in the write-up.
• Example language (illustrative): "I'm not the person to ask about feeding, but the health visitor would know. What have you noticed when she fusses?" / "I'd better not babysit; it would change what I'm here for."
• Watch for and signs it's working: a repeated pull to advise, which points to the role being offered (A5). It is working when the family stops seeking expertise from you and keeps you as a witness.

A8. Monitoring your own emotional response

• Purpose and when to use: during and after every visit. This is central, not optional. [source: WBCP; Rustin 2009]
• Steps: (1) Notice bodily states during the visit, such as sleepiness, restlessness, cold or nausea. (2) Notice urges to act, for example to pick the baby up or to criticise. (3) Write them down separately from the behavioural record. (4) Bring them to the seminar as data.
• Example language (in notes, illustrative): "I felt an urge to pick him up while mother was on the phone, and found myself glancing at the clock."
• Watch for and signs it's working: feelings acted on rather than recorded. It is working when you can link your feeling to something in the baby or family that the seminar can think about.

A9. Writing the process notes

• Purpose and when to use: as soon as possible after each visit. It often takes about an hour. [source: Wikipedia; WBCP; SPSI]
• Steps: (1) Head each entry with your name, the date, the observation number, and the baby's birth date and age in weeks. (2) Write chronologically in plain, descriptive language: who did what, in what order, what was said. (3) Record what you saw, heard and felt. (4) Keep observation separate from inference, for example by putting inferences in brackets or a separate paragraph. (5) Note what you cannot remember. (6) Use no theoretical terms. (7) Anonymise the account. [source: SPSI; Rustin 2009, p. 383; Prat 2004]
• Example language (in notes, illustrative): "11:20. Mother laid T on the mat. He arched, fists tight, eyes on the window light; his crying rose and then stopped when she began to hum."
• Watch for and signs it's working: summarising ("a nice feed") or diagnosing ("anxious attachment"). It is working when peers can picture the scene from the notes alone.

A10. Seminar presentation and discussion

• Purpose and when to use: weekly. Observers take turns presenting to a small group of about 5 led by an experienced leader. [source: Rustin 2009; WBCP; Wikipedia]
• Steps: (1) Bring copies of the notes. (2) Read the notes aloud. (3) The group, led by the leader, explores the infant's and family's possible states of mind, offers hypotheses, links to earlier observations, and attends to the observer's experience. (4) The observer takes forward points to watch for, not instructions to act.
• Example language (seminar, illustrative): "Let's see whether the arching comes back when she's put down. We don't know yet."
• Watch for and signs it's working: the group judging the parents, or rushing to theory. Rustin notes that some leaders avoid published texts early on. It is working when the observer leaves more curious and less anxious.

A11. Forming and testing hypotheses over time

• Purpose and when to use: across the observation. [source: Rustin 2009, pp. 378, 383; Institute of Psychoanalysis]
• Steps: (1) State the hypothesis from the seminar. (2) Note what would support it and what would refute it. (3) Observe as usual, without testing it actively. (4) Review over several weeks.
• Example language (in notes, illustrative): "Possibly the clutching of the blanket when mother leaves is a way of holding himself together; watch whether it recurs at separations."
• Watch for and signs it's working: confirmation bias. It is working when you find and report evidence against your own hypothesis.

A12. Breaks, holidays and missed visits

• Purpose and when to use: before planned breaks, and when visits are cancelled. [synthesis]
• Steps: (1) Announce breaks early and remind the family the week before. (2) Notice and record the family's and baby's responses around breaks. (3) Record cancellations and how they happened. (4) Do not chase the family. Confirm the next visit once.
• Example language (illustrative): "Just to remind you, I won't come next week; I'll be back on the 3rd."
• Watch for and signs it's working: a run of cancellations after a break. It is working when breaks are survived and talked about.

A13. Safeguarding response

• Purpose and when to use: when you see or hear something suggesting risk to the child or a parent, such as injury, serious neglect, domestic violence, or a parent's severe depression or suicidal statements. [source: Klauber 2024 (rare; considered with teachers); steps are synthesis]
• Steps: (1) If there is immediate danger, call emergency services. Method does not override this. (2) Otherwise, write down facts and exact words promptly. (3) Contact your seminar leader or tutor the same day, not at the next seminar. (4) Follow your training institution's and your local child-protection procedures and your professional code. (5) Where safe and appropriate, be open with the parents about your concern and the next step. (6) Decide with your tutor whether the observation continues.
• Example language (illustrative): "I'm worried about how low you've been feeling. Would you be willing to talk to your GP? I said at the start I'd always mention it if I was concerned."
• Watch for and signs it's working: "non-interference" used to rationalise inaction, or over-reaction to ordinary chaos. It is working when the concern is shared, documented and handled through proper channels.

A14. Ending the observation

• Purpose and when to use: the last two to three months before the second birthday. [synthesis: none of the sources describe endings]
• Steps: (1) Remind the family of the end date well in advance. (2) Observe how the family and child respond to the coming end. (3) Accept a goodbye ritual if the family offers one. (4) Thank them. (5) Decide in advance with your tutor whether any later contact, such as a birthday card, is appropriate.
• Example language (illustrative): "We have six more visits before his second birthday, which is when we agreed to finish."
• Watch for and signs it's working: promising to stay in touch out of guilt. It is working when the ending is clear and the separation can be talked about.

A15. Integrative written paper

• Purpose and when to use: during and at the end of the course. Tavistock asks for several observation papers, and Seattle for a three-page summary of learning. [source: Tavistock course page; SPSI]
• Steps: (1) Re-read all notes. (2) Trace one or two developmental threads through them. (3) Use theory only after the material. (4) Include your own emotional learning.
• Example language: not applicable.
• Watch for and signs it's working: theory leading the material. It is working when the paper shows how meaning emerged over time.

A16. Young child observation (optional)

• Purpose and when to use: a further year observing a pre-school child, aged about 2 to 4, at home or nursery. [source: Tavistock course page; Rustin 2009]
• Steps: follow A1–A15, with consent from the nursery and the parents for nursery settings [synthesis].
• Example language: as above.
• Watch for and signs it's working: the same as for infant observation.

Track B: therapeutic (participant) observation

Prerequisite: you have completed a conventional infant observation, and you have regular supervision. Track A's frame, consent, note-writing and safeguarding steps (A3, A4, A9, A13) all still apply. Below, Rhode lists the observer functions; the step detail is [synthesis] unless cited.

B1. Referral, consent and baseline

• Purpose and when to use: at the start of therapeutic observation, for an infant at risk (failure to thrive, communication or autism risk, or compromised parental capacity). [source: Rhode 2007]
• Steps: (1) Take the referral from primary care. (2) A coordinator explains the intervention, its frequency and its purpose, and obtains informed consent. (3) Agree who visits and how often (Houzel: twice weekly; Rhode: weekly), and arrange the parents' separate appointments (Houzel: the supervising psychiatrist monthly; Rhode: a parent worker each fortnight). (4) Complete baseline measures if used (CHAT, separation–reunion task, PDI). (5) Explain how concerns will be shared and the safeguarding limits [synthesis].
• Example language (illustrative): "Someone will come to your home regularly to get to know your baby and to think with you about what she might be telling you."
• Watch for and signs it's working: parents agreeing because they feel accused. It is working when parents see the visits as interest in their baby, not as scrutiny.

B2. Receiving and containing communications

• Purpose and when to use: every visit, especially when the parents are distressed or the baby is unresponsive. [source: Rhode 2007]
• Steps: (1) Show steady interest in everything the baby does and everything the parents say. (2) Accept the full range of parental feelings without correcting them. (3) Bear your own distress, loneliness or boredom in the room. (4) Take it to supervision rather than discharging it on the family.
• Example language (illustrative): "It sounds like last night went on forever."
• Watch for and signs it's working: you becoming discouraged and withdrawing, which joins the "vicious circle". It is working when parents bring more feelings, including negative ones.

B3. Validating experience (witnessing and mirroring)

• Purpose and when to use: when the child's actions or the parents' efforts go unnoticed. [source: Rhode 2007, drawing on Winnicott's mirror role]
• Steps: (1) Notice small actions by the child, such as looking, reaching or a vocal sound. (2) Show the child you have seen them, with a facial response or a brief word. (3) Acknowledge the parents' attentiveness when you see it.
• Example language (illustrative): "Oh, you saw the light!" / "You noticed straight away that he wanted the cup."
• Watch for and signs it's working: Rhode notes that observers too can miss a child's capacities. It is working when, in Rhode's account, the child begins to imitate the observer and refer to absent people.

B4. Naming feelings and actions aloud

• Purpose and when to use: when the child seems to have no one to put experience into words. [source: Rhode 2007]
• Steps: (1) Describe simply what the child is doing or seems to feel. (2) Keep it tentative. (3) Leave space for the parent to add to it.
• Example language (illustrative): "You're banging hard, it's loud, maybe you're cross."
• Watch for and signs it's working: over-talking, or speaking over the parent. It is working when parents start to name things themselves.

B5. Imitating the child

• Purpose and when to use: with withdrawn or autistic-features children, to make contact. [source: Rhode 2007]
• Steps: (1) Copy a sound, rhythm or gesture of the child's softly. (2) Pause and wait for a response. (3) Vary it slightly to invite turn-taking [synthesis].
• Example language: echo the child's vocal sound, for example "ba... ba." (illustrative)
• Watch for and signs it's working: the child turning away or getting overexcited. It is working when the child looks, repeats or initiates.

B6. Explaining your actions to the child

• Purpose and when to use: whenever you do something that affects the child. [source: Rhode 2007, who gives the example of closing a door and saying why]
• Steps: (1) Say what you are doing. (2) Say why, linking it to the parent's wish where relevant.
• Example language (illustrative): "I'm moving the cup so it doesn't spill on you."
• Watch for and signs it's working: it is working when the child treats you as a person with intentions.

B7. Interpreting the baby's cues to the parents (linking)

• Purpose and when to use: when parents misread the baby, or do not read the baby's signals at all. [source: Rhode 2007]
• Steps: (1) Point to a specific, observable cue. (2) Offer a tentative meaning. (3) Ask the parent what they think. (4) Never correct the parent in front of the child [synthesis].
• Example language (illustrative): "Did you see how she turned to your voice just then? I wonder if she was looking for you."
• Watch for and signs it's working: parents feeling criticised. It is working when parents report cues that you did not see.

B8. Third-party regulating function

• Purpose and when to use: in escalating or tense moments between parent and child. [source: Rhode 2007, listed function; steps are synthesis]
• Steps: (1) Stay calm and present. (2) Slow the pace, for example with a quiet comment on what is happening. (3) Do not take sides.
• Example language (illustrative): "It's hard when he won't settle and you're so tired."
• Watch for and signs it's working: it is working when escalations de-escalate faster over the weeks.

B9. Including everyone present

• Purpose and when to use: when siblings, fathers or other carers are present. [source: Rhode 2007]
• Steps: (1) Greet each person. (2) Draw a sibling or parent into an interaction that began with the child.
• Example language (illustrative): "Your big sister is watching you. Shall we show her?"
• Watch for and signs it's working: sibling rivalry with the observer. It is working when interactions spread across the family.

B10. Modulating separations

• Purpose and when to use: at the end of each visit, and before breaks and the ending. [source: Rhode 2007, listed function; steps are synthesis]
• Steps: (1) Signal the end of the visit a few minutes before. (2) Say when you will be back. (3) Prepare for breaks in advance, and notice reactions afterwards.
• Example language (illustrative): "I'm going soon. I'll be back on Thursday."
• Watch for and signs it's working: it is working when the child shows a response to your leaving and later your return.

B11. Play to show the child can be understood

• Purpose and when to use: brief work with toddlers whose parents have lost hope of understanding them. [source: Rustin 2009, pp. 388–9, the Ted case using a doll and toy teacups]
• Steps: (1) Offer simple toys that relate to care, such as a doll and teacups. (2) Follow and put words to the child's play in the parents' presence. (3) Help the parents see the child as having a mind.
• Example language (illustrative): "The dolly's getting a drink. Maybe she's thirsty, like you after the park."
• Watch for and signs it's working: it is working when the parents' hope revives and they become curious about meaning.

B12. Supervision

• Purpose and when to use: throughout. Houzel's model has two supervision seminars a week; individual supervision is also possible. [source: Rhode 2007]
• Steps: (1) Write process notes after each visit (A9). (2) Present them regularly. (3) Explore your unconscious impressions and painful feelings. (4) Decide what to do differently in your participant role.
• Example language: not applicable.
• Watch for and signs it's working: it is working when you notice the child's capacities that you had missed.

B13. Parent sessions with the supervising clinician or parent worker

• Purpose and when to use: in Houzel's model, monthly meetings with the psychiatrist about development and concerns; in Rhode's pilot, parent-worker visits each fortnight. [source: Rhode 2007]
• Steps: (1) Meet regularly and separately from the observer's visits. (2) Discuss development and worries. (3) Increase frequency if needed (Rhode found monthly too little).
• Example language (illustrative): "What have you been noticing about her since we last met?"
• Watch for and signs it's working: it is working when parents can voice worries and use the observer's visits.

5. Handling problems

The sources name some of these problems; most of the concrete responses are [synthesis]. Bring every one of them to the seminar or supervisor.

• Being pulled into a role (rescuer, critic, intruder, rival expert, extra baby). Rustin, citing Magagna's observer, describes the observer cast as critic, outsider, intruder and rival expert. Response: name the role in your notes, refrain from acting it out, and keep your usual stance. Ask the seminar what the role says about the family's anxieties. [source: Rustin 2009, p. 377] [synthesis on response]
• Over-identifying with the baby, or with a parent's resentment. This can be strong enough to make the observer ill, as in Magagna's case. Response: record the feeling, take it to the seminar promptly, and consider personal therapy. Re-anchor in behavioural description. [source: Rustin 2009] [synthesis on response]
• Maternal depression. There is a pressure to "augment the vitality" of the mother and to side with the baby. Response: stay reliable and present without becoming the family's source of liveliness. Watch the baby's ways of coping. If depression is severe or there are risk statements, use A13. [source: Rustin 2009] [synthesis on response]
• Cancellations, lateness, forgetting the visit ("non-adherence"). Response (Track A): confirm the next visit once and do not pursue. Record the pattern and explore in seminar what the absences communicate. If cancellations persist for weeks, ask the parents gently whether the visits still suit them, and accept a withdrawal. Response (Track B): Rhode advises no punitive reaction to missed appointments; fit in with the family's needs. [source: Rhode 2007] [synthesis for Track A]
• The family ends the observation early. Response: accept it graciously and thank them. Ask whether a goodbye visit is possible. Process the loss in seminar, and with your tutor decide whether to start a new observation. [synthesis]
• The observer is bored, sleepy or "nothing happens". Response: treat the state as data (A8). Describe the small details more closely, and bring the "empty" visit to seminar. A baby's sleep or withdrawal can carry meaning, and so can the observer's sleepiness. [synthesis, consistent with WBCP's emphasis on observer feelings]
• Overwhelm (observer): witnessing distress, chaos, a sick or disabled baby. Response: bring it to supervision promptly. Rhode stresses the observer needs time to bear painful feelings. Keep your visits regular, and seek personal therapy if it persists. [source: Rhode 2007] [synthesis]
• Overwhelm (family): a parent wants to offload, or feels watched and judged. Response: listen briefly and warmly, without becoming their therapist. Remind them you are not assessing. If they want help, point them to the GP, health visitor or a parent–infant service. [synthesis]
• Requests for advice or expert opinion. Response: see A7. In Track B, give your thinking tentatively, and always as a question back to the parent. [synthesis]
• Gifts, invitations, babysitting, social contact. Response: Bick allowed holding the baby when invited, and small gifts on special occasions. Decline babysitting and social events gently, and discuss borderline invitations, such as a christening, with your leader. [source: Rustin 2009, p. 377] [synthesis for the rest]
• Writing problems: summarising, theorising, forgetting. Response: write sooner, chronologically, in short sentences. Note the gaps in memory as data. Ask a peer to read the notes back to you. [source: SPSI] [synthesis]
• Seminar ruptures: feeling judged by the group, or the group blaming the parents. Response: the leader returns the group to the material and to empathy with every member of the family. As observer, say directly if you feel criticised. [synthesis]
• Rupture with the family: a parent is offended by something you said or did. Response: acknowledge it simply, without over-explaining, and keep to the frame. Discuss it in seminar. [synthesis]
• Safeguarding or domestic violence concerns. Response: A13. Child safety overrides non-interference. [source: Klauber 2024] [synthesis on procedure]
• The observer's own life events (pregnancy, bereavement, illness). Response: discuss with your leader, and plan breaks or a planned early ending. Tell the family only what is necessary. [synthesis]
• Cultural difference: unfamiliar care practices. Response: record without judging, and use the seminar to tell difference apart from risk. Urwin et al. (2007) used the method with first-time mothers from different ethnic groups in East London. [source: Rustin 2009, p. 386] [synthesis on response]
• Track B: the child is unresponsive and the observer feels discouraged (the "vicious circle"). Response: keep visiting regularly. Look for and validate tiny initiatives (B3, B5), and use supervision to recover your interest. [source: Rhode 2007]
• Track B: parents feel criticised by your comments. Response: comment on the baby, not on the parent. Notice and acknowledge what the parents do well, use tentative language, and ask for their view (B7). [synthesis]
• Track B: when observation is not enough. For developmental delay, a medical problem, autism, or serious mental illness in a parent, refer for specialist assessment or treatment. Observation complements this; it does not replace it. [synthesis] [uncertain: Houzel's criteria for escalation not found]

Sources

Sources:

• Rustin, M. (2009). Esther Bick's legacy of infant observation at the Tavistock (Harris Meltzer Trust PDF)
• Rustin (2009) record, Tavistock and Portman repository
• Rhode, M. (2007). Helping toddlers to communicate: infant observation as an early intervention (in Acquarone, ed., Signs of Autism in Infants)
• Klauber, T. (2024). One hour a week observing the baby. A lot or a little?
• Tavistock and Portman course page: Working with children, young people and families (M7)
• Institute of Psychoanalysis: Esther Bick
• Harris Meltzer Trust: Esther Bick
• Prat, R. (2004). L'observation de bébé selon la méthode Esther Bick, Perspectives Psy
• Observation directe du bébé selon la méthode d'Esther Bick (EMC, with Houzel)
• Psychoanalytic infant observation by Esther Bick's method (psyjournals.ru, 2014)
• Seattle Psychoanalytic Society: Infant Observation Syllabus 2019–20
• Washington Baltimore Center: Observational Studies Online Program
• Wakelyn, J. Therapeutic approaches with babies and young children in care (Better Care Network)
• Wikipedia: Psychoanalytic infant observation
• PEP-Web record: Bick (1964) (citation only; full text not accessed)

Books and papers cited (not read in full here):

• Bick, E. (1964). Notes on infant observation in psycho-analytic training. IJP 45:558–66. Reprinted in Harris & Bick, The Tavistock Model.
• Bick, E. (1968). The experience of the skin in early object relations. IJP 49:484–6.
• Houzel, D. (1999). A therapeutic application of infant observation in child psychiatry. Infant Observation 3(2):42–53.
• Miller, L., Rustin, M., Rustin, M. & Shuttleworth, J. (eds) (1989). Closely Observed Infants. Duckworth.
• Reid, S. (ed.) (1997). Developments in Infant Observation: The Tavistock Model. Routledge.
• Sternberg, J. (2005). Infant Observation at the Heart of Training. Karnac.
• Wakelyn, J. (2019). Therapeutic Approaches with Babies and Young Children in Care. Routledge.
• Rustin, M. & Miller, L. (2002). Observation Observed (DVD). Tavistock Clinic.