Watch, Wait and Wonder

1. Introduction

Version followed: the Hincks-Dellcrest (Toronto) dyadic, infant-led model in Muir, Lojkasek & Cohen's 1999 manual (Watch, Wait and Wonder: A Manual Describing a Dyadic Infant-Led Approach to Problems in Infancy and Early Childhood), as used in the Cohen et al. (1999) trial and building on Muir (1992). Each weekly ~1-hour session has two parts: (a) about 20–30 minutes in which the parent sits on the floor and follows the infant's self-initiated play while the therapist watches, then (b) a discussion in which the parent talks through what they observed and experienced. It is for children aged 0–4. [source: Foundations Guidebook; WAIMH Perspectives 2011; CEBC] The manual itself is not drawn on [uncertain]. Detail below comes from published descriptions of it, and some is my own clinical inference, which is marked [uncertain] or [synthesis].

Watch, Wait and Wonder (WWW) is a psychodynamic, attachment-based parent–infant psychotherapy. Its distinctive move is to make the infant's spontaneous activity the starting point of treatment, an idea the authors trace to Mahrer, Levinson & Fine (1976). Change is thought to come through two channels. (1) The infant's channel: a parent who is attentive and physically available but does not direct gives the child an experience of initiating, mastering and regulating, and lets the child work through developmental and relational struggles in play. (2) The parent's channel: in the discussion the parent observes and reflects on the child as a separate person with their own feelings, thoughts and wishes, and examines their own emotional reactions. This revises the parent's representations of the child and of themselves as a parent and builds reflective (mentalizing) capacity. The stated aims are a more secure attachment, better infant self-regulation and sense of efficacy, more sensitive caregiving, and interrupting insecure attachment patterns passed between generations. [source: CEBC; Foundations; Psicologia em Estudo NICU paper p.618 citing Cohen, Muir & Lojkasek 1999; WAIMH Perspectives 2011; PLUDOC abstract on parental reflective functioning and WWW]

2. Framework

Format. One therapist works with one parent–child pair as an outpatient, weekly, about 1 hour per session. The research and most descriptions involve the mother as the parent. The treatment is manualised. [source: Foundations; NHS Scotland Early Intervention Framework]

Session count. On average about 15 sessions. NHS Scotland lists 15 weekly sessions. Training cases run at least 8 sessions for the Advanced Course, with one supervised case of 18 or more. [source: Foundations; NHS Scotland; Incredible Families NZ training page] In the 1999 trial, length was set by clinical progress rather than fixed. [uncertain: recalled from Cohen et al. 1999]

Stages.

The session template (core of every WWW session).

1. Infant-led play, about 20–30 minutes. The parent is on the floor within reach and follows the child's initiative. The therapist observes and does not intervene. [source: Foundations; WAIMH Perspectives 2011 (about 20 minutes); Psicologia em Estudo p.618–619]
2. Discussion, the remaining time (about 30 minutes). The parent and therapist talk about what the parent observed, how the parent understands the child's experience, how the play felt for the parent, and what made it hard to follow the lead. The child stays in the room and keeps playing. [source: Foundations; WAIMH Perspectives 2011] Keeping the child present is my reading of the descriptions, not a quoted rule [uncertain].

Adaptations reported.

• NICU: 15 minutes of infant-led interaction (baby on the lap or in the incubator) plus 15 minutes of discussion, ending at discharge. [source: Psicologia em Estudo p.619]
• Groups: e.g., "Together Time", 10 weeks with four dyads, and groups in UK children's centres. [source: Tavistock repository; Essex repository]
• Older children: NHS Scotland notes WWW can be adapted for ages 4–12. [source]

The details of these adaptations are [uncertain].

3. Guiding principles

[source for 1–8: Foundations; CEBC; WAIMH Perspectives 2011; Psicologia em Estudo p.618–619; NHS Scotland. Wording is paraphrased. The manual's own list of principles is not drawn on, so this list may be incomplete or ordered differently. [uncertain]]

1. The infant leads. In practice, the child's spontaneous activity sets the content of the session. Neither the parent nor the therapist directs play, teaches or tests.
2. The parent watches, waits and wonders. In practice, the parent stays physically available on the floor, responds when the child initiates, and otherwise observes with curiosity rather than acting.
3. The therapist mirrors that stance. In practice, during the play segment the therapist also watches, waits and wonders. The therapist is present and attentive but does not intrude, like Winnicott's holding mother as the trainers frame it.
4. The parent's observations come first. In practice, the discussion starts from what the parent saw and felt. The therapist builds on the parent's account rather than giving their own reading of the child.
5. The child is a separate person with a mind. In practice, the therapist keeps inviting the parent to consider the child's feelings, thoughts, wishes and intentions as the child's own, which builds parental reflective functioning.
6. The parent's emotional response is material, not error. In practice, irritation, boredom, hurt or the urge to take over while following the lead are explored with support, not corrected.
7. The therapist provides a holding environment for the parent. In practice, the parent receives feedback, support and validation so they can bear seeing what they had avoided seeing.
8. The therapist tolerates not knowing. In practice, the therapist stays open to seeing and feeling what has been avoided about the infant's experience, bears uncertainty about what is going on, and processes their own activated states rather than acting on them. [source: WAIMH Perspectives 2011]
9. Use your observing self. In practice, the therapist approaches the material as an experiential question (what is happening, and why now?) rather than through a fixed theoretical lens. [source: WAIMH Perspectives 2011, trainers' observation]
10. Advice is held back. In practice, the therapist does not instruct the parent in parenting techniques. Change is expected to come from the parent's own discovery. [uncertain: consistent with every description opened, and recalled from Cohen et al. 1999 as the contrast with didactic approaches, but not confirmed verbatim]

4. Intervention inventory

The published descriptions name a small number of core components: the infant-led play, the therapist's silent observation, and a discussion that covers the parent's observations, their understanding of the child's experience, their feelings, and any difficulty following the lead, with support and feedback from the therapist. [source: Foundations; CEBC; WAIMH Perspectives 2011] WWW is deliberately low on technique. The manual's own step-by-step scripts are not drawn on here. Below, each component is broken down into usable steps. Steps marked [synthesis] are my operationalisation of the described principles, not manual text. All example language is illustrative.

4.1 Assessment and fit

• Purpose / when: Before WWW begins. Clarify the referral problem (e.g., feeding, sleeping or regulation difficulties, or a parent troubled in the relationship), how the parent sees the child, family history, and whether a dyadic infant-led format suits this family. [source: CEBC (trial referral problems); NHS Scotland; WAIMH Perspectives 2011 (about 5 assessment sessions)]
• Steps:
  1. Take a developmental and relational history: pregnancy, birth, early months, the child's temperament and development, and the parent's own attachment history and supports. [synthesis, standard infant-mental-health assessment]
  2. Observe a free-play episode between parent and child, which also gives a baseline of how much the parent directs. [synthesis]
  3. Screen for risk: parental mental state, safeguarding, domestic violence. Apply standard risk and child-protection procedures before or alongside WWW. [synthesis]
  4. Formulate together why the relationship might be stuck and how infant-led sessions could help.
• Example language (illustrative): "Tell me about her from the start. What was she like as a newborn, and what was that time like for you?"
• Watch for: A parent who sees the child as a copy of someone else (e.g., the case in WAIMH Perspectives 2011, where a toddler reminded her mother of the absent father). Such attributions become central material later. The 1999 trial excluded some families, but its criteria are [uncertain].

4.2 Introducing the WWW frame to the parent

• Purpose / when: At the last assessment session or the start of session 1. Give the parent a clear task and a reason for it. Following the lead often feels unnatural to parents.
• Steps:
  1. Explain the two-part structure: floor time following the child, then talking together with the child still present.
  2. Give the parent's task: get down on the floor near the child, let the child start things, respond to what the child brings, and otherwise watch with interest. Don't teach, steer, or start activities. [source: WAIMH Perspectives 2011; Foundations]
  3. Explain that the therapist will mostly watch during play and not coach. [source: Foundations]
  4. Explain the reason: the child's play shows what the child is thinking and feeling, and both of you will learn from watching it. [synthesis from stated rationale]
  5. Anticipate the difficulty: many parents find it boring, awkward or hard to stop helping, and those feelings are useful to talk about afterwards. [synthesis]
• Example language (illustrative): "For the first part, I'd like you to sit on the floor with him and let him lead. If he brings you something or asks you to join, go ahead. Otherwise, see what he does and wonder what's on his mind. Afterwards we'll talk about what you noticed and what it was like for you."
• Watch for: Hearing the instructions as criticism ("so I've been doing it wrong"). Frame the task as a way of looking, not a correction. [synthesis]

4.3 Setting up the space

• Purpose / when: Every session. The room has to make infant-led play and parental availability possible.
• Steps: Use a floor area with a carpet or mat. Put out an age-appropriate set of toys that the child can explore without help, and keep the set roughly the same each week so changes in play stand out. The parent sits on the floor within the child's reach. The therapist sits a little apart, in view but out of the action. [source for the floor, the parent within reach and the therapist sitting apart: Psicologia em Estudo p.618–619; Foundations. Toy selection and keeping the set the same: [synthesis/uncertain]]
• Watch for: Too many toys or electronic toys that invite adults to demonstrate them. Phones and other distractions. [synthesis]

4.4 Infant-led floor play (the parent's task)

• Purpose / when: The first 20–30 minutes of every treatment session. The child experiences an available, non-intrusive parent and the chance to initiate and master things. The parent gains observational material and meets their own reactions directly. [source: Foundations; CEBC; WAIMH Perspectives 2011]
• Steps (for the parent):
  1. Sit on the floor at the child's level, within reach.
  2. Wait for the child to initiate. Notice where the child goes, what the child does, and how the child uses the parent.
  3. When the child initiates (offers a toy, looks, asks for help), respond warmly and follow, without taking the play over or extending it into teaching.
  4. Keep giving the initiative back to the child. Don't introduce new toys, questions or instructions.
  5. Notice your own feelings as you go. [source for 1–4: WAIMH Perspectives 2011; Foundations; Psicologia em Estudo. Step 5 is implied by the discussion content (Foundations), with wording [synthesis]]
• Example language: None from the therapist during play. If the parent asks for direction mid-play, give a minimal redirect (illustrative): "Just see what she does next." [synthesis]
• Watch for / working signs: Over sessions, the parent waits longer before acting, the child initiates more, uses the parent as a base (checking back, bringing things), and the play becomes more organised and sustained. Early signs of strain include frequent parental questions, praise-as-steering, tidying, and withdrawing onto a phone. [synthesis]

4.5 The therapist's watching, waiting and wondering during play

• Purpose / when: During the play segment. Provide holding for the dyad and gather material without disrupting the child's lead or the parent's discovery. [source: Foundations; WAIMH Perspectives 2011]
• Steps:
  1. Sit apart and stay quiet and attentive. Don't coach or interpret.
  2. Track the sequence of the child's initiatives and the parent's responses, the child's affect, and repeated play themes.
  3. Track your own reactions (pulls to rescue, irritation, sleepiness, sadness) as possible clues to unspoken states in the dyad.
  4. Hold your hypotheses lightly. Don't plan to deliver them in the discussion. They help you listen. [source for 1 and 3: WAIMH Perspectives 2011. Steps 2 and 4: [synthesis]]
• Watch for: The urge to step in when the parent intrudes. The model asks the therapist to tolerate this and bring it up in the discussion instead, unless safety requires action. [synthesis; immediate safety always overrides]

4.6 Moving from play to discussion

• Purpose / when: At about 20–30 minutes. Mark the shift without ending the child's play. [source: WAIMH Perspectives 2011 (about 20 minutes); Foundations (half hour)]
• Steps: Signal the change gently. The parent can stay on the floor or move to a seat near the child, and the child keeps playing. If the child protests or seeks the parent, that becomes discussion material, and the parent responds to the child as needed. [synthesis]
• Example language (illustrative): "Let's start talking now. He can keep playing, and you can stay right there with him."
• Watch for: Parents who use the switch to disengage from the child entirely. Notice it and, when it's useful, wonder about it with the parent. [synthesis]

4.7 Eliciting the parent's observations

• Purpose / when: At the opening of each discussion. The parent's own observations are the primary material. [source: Foundations; WAIMH Perspectives 2011]
• Steps:
  1. Open with a broad question about what the parent noticed.
  2. Ask for specifics: what exactly the child did, in what order, and with what face or tone.
  3. Reflect the observations back without adding your interpretation.
  4. If the parent jumps straight to judgement ("he's just being difficult"), go back to description. [synthesis]
• Example language (illustrative): "What did you notice today?" / "Take me back to the moment he brought you the cup. What happened just before?"
• Working signs: Over time the parent's accounts become more detailed, more specific to the child and less global or negative. The parent starts noticing small initiatives they used to miss. [synthesis]

4.8 Exploring the parent's experience of following the lead

• Purpose / when: In every discussion, especially when following the lead was hard. The parent's feelings while not leading (boredom, anxiety, feeling unneeded, the urge to teach or control) are named discussion content. [source: Foundations]
• Steps:
  1. Ask what it was like to sit and follow.
  2. Explore specific moments when the parent wanted to step in, and what they felt then.
  3. Accept the feeling without correcting the behaviour. Get curious about where the feeling comes from.
  4. Let the parent make links to their own experience, and follow them when they do (see 4.11).
• Example language (illustrative): "What was it like to wait instead of showing her?" / "When he turned away from you, what went through you?"
• Watch for: Defensive answers ("Fine, it was fine"). Stay with the moment rather than pressing. Working signs: the parent names their own feelings separately from the child's behaviour. [synthesis]

4.9 Wondering about the child's inner world

• Purpose / when: Throughout the discussion. Help the parent consider the child's feelings, thoughts and wishes, and see the child as a separate self. This is the main route to parental reflective functioning. [source: Foundations; NHS Scotland; PLUDOC abstract]
• Steps:
  1. Take an observation the parent made and invite curiosity about what it meant to the child.
  2. Keep several possibilities open, and invite the parent's guesses before offering any of your own.
  3. Contrast the child's possible perspective with the parent's at the same moment.
  4. Over sessions, track recurring play themes (e.g., hiding and finding, containers, crashes) and wonder with the parent about what they might express. [synthesis]
• Example language (illustrative): "What do you think was going on for her when she kept putting things in the box and tipping them out?" / "I wonder what it was like for him to have you there, just watching."
• Watch for: The therapist doing the wondering for the parent, which turns into expert interpretation. Working signs: the parent offers mental-state explanations spontaneously ("I think he was checking I'd still be there"). [synthesis]

4.10 Support, validation and feedback

• Purpose / when: Throughout. Give the parent the holding they need to look at painful material and stay in treatment. [source: Foundations ("feedback and support"); Psicologia em Estudo (support and validate the mother's experience)]
• Steps: Acknowledge effort and difficulty. Validate feelings. Point out specific moments where the parent's waiting allowed something to happen for the child, based on what was observed, not general praise. [synthesis from source wording]
• Example language (illustrative): "When you waited just then, she came over and handed you the block herself."
• Watch for: Feedback turning into instruction ("next time do X"), which reintroduces the didactic stance WWW avoids. [synthesis]

4.11 Following the parent's links to their own history and representations

• Purpose / when: When the parent spontaneously connects what they feel in sessions with their own past, the other parent, or others in the family. These are the intergenerational patterns WWW aims to interrupt. [source: WAIMH Perspectives 2011 (preventing transmission of insecure attachment; case of a child reminding the mother of the father); Psicologia em Estudo]
• Steps:
  1. Follow the parent's lead in the discussion just as the parent follows the child's in play. Let the parent bring the links. [synthesis]
  2. Explore the link and its feeling. Then bring the focus back to the actual child and what the parent observed today, separating this child from the figure the child evokes. [synthesis]
  3. Avoid imposing reconstructive interpretations. Cohen et al.'s comparison treatment (psychodynamic parent–infant psychotherapy) puts more weight on the therapist's interpretation of the mother's history. How much interpretation WWW permits, and when, is [uncertain].
• Example language (illustrative): "You said his frown made you think of his dad. When you look at him today, what do you see that's just him?"
• Watch for: The parent being flooded by trauma material. Slow the pace and use the support in 4.10. Consider separate individual help (see section 5). [synthesis]

4.12 Therapist self-monitoring of reactions

• Purpose / when: In every session and in supervision. The emotional field between parent, infant and therapist can activate the therapist's own unmet needs. The therapist has to tolerate and process these states rather than act on them. [source: WAIMH Perspectives 2011, citing O'Rourke 2011]
• Steps: Note your reactions during play. After the session, ask what they might say about the dyad and what they say about you. Bring them to supervision. [synthesis]
• Watch for: Siding with the child against the parent (or the reverse), urges to teach, and boredom or sleepiness that may mirror avoided states. [synthesis]

4.13 Filmed-session supervision (practitioner level)

• Purpose / when: Throughout training and practice. Supervision centres on the clinician's filmed WWW sessions, and the Introductory Course includes observation and intervention film. [source: Incredible Families NZ; NHS Scotland] Consent and confidentiality are discussed for filming. [source: Incredible Families NZ]
• Note: In-session video feedback to the parent is not documented as a WWW component. Don't present it as part of WWW. [uncertain]

4.14 Ending

• Purpose / when: When the presenting concerns have eased and the parent can follow and reflect independently. In the trial, ending was set clinically. [uncertain: manual's ending procedure]
• Steps (synthesis): Give several weeks' notice. Review with the parent the changes in the child and in how the parent sees the child, using concrete moments. Allow space for the child's and parent's responses to the ending, which may show up in the child's play. Plan follow-up or onward referral if needed.
• Example language (illustrative): "Thinking back to the first weeks here, what's different in how you see her now?"

4.15 Adapted formats

• NICU: 15 minutes of the parent responding to the preterm infant's interactive gestures (baby on the lap or in the incubator) with the therapist watching, then 15 minutes of discussion near the baby. Sessions run until discharge. [source: Psicologia em Estudo p.619]
• Groups: A 10-week group with four dyads used WWW to build observation and discussion of infants' experiences. Children's-centre groups have also been run. [source: Tavistock repository; Essex repository] Group procedures are [uncertain].

5. Handling problems

The sources say little about specific difficulties beyond what is noted. Trainers report that the work is often very hard and that early practitioners found it less effective than they had hoped. They attribute this to viewing the dyad through a theoretical lens rather than staying with what is happening, and to the therapist's own avoidance. [source: WAIMH Perspectives 2011] Everything else in this section is [synthesis] unless a source is tagged.

• The parent can't stop directing (teaching, questioning, praising-to-steer). Don't correct during play. In the discussion, start with curiosity about one specific moment: "What was happening for you just before you showed him?" Look for the feeling that drives the directing, such as anxiety about development, fear of being judged, or not knowing what else to do. Repeat the task briefly before the next play segment. [synthesis; the directing itself is named discussion content in Foundations]
• The parent withdraws (phone, looking away, flat). Treat it as communication. Explore what made it hard to stay present: boredom, depression, feeling unwanted by the child. Screen for parental depression and refer for parallel treatment if present. [synthesis]
• The child ignores or avoids the parent. Help the parent bear the rejection rather than chase the child. Wonder together about what the child might need: distance, safety, control. Track the small approaches that do happen. [synthesis]
• The child is chaotic, aggressive or unsafe. Safety comes first. The parent or therapist sets a minimal limit (e.g., stops throwing a hard toy at a person), then returns the lead to the child. Discuss what the limit was like for each. Following the lead does not mean allowing harm. [synthesis]
• "Nothing happens" / stuck sessions. Narrow the focus to micro-observations: a glance, a pause, a toy chosen twice. Check your own pull to make something happen, which may mirror the parent's. Take filmed sessions to supervision. [synthesis; supervision on filmed work per Incredible Families NZ]
• The parent wants advice and finds watching pointless (non-adherence, dropout risk). Acknowledge the frustration. Restate the rationale in the parent's terms ("we're learning what he is telling us"). Link small observed changes to the presenting problem. If the parent repeatedly declines the frame, review fit and consider a more directive or skills-based approach rather than forcing WWW. [synthesis]
• Missed sessions or irregular attendance. Explore barriers practically, such as transport, illness or other children. Use phone contact. Home visits are mentioned as a possible extra demand on practitioners. [source for home visits/phone calls: NHS Scotland] When the dyad returns, resume the standard format without catch-up lectures. [synthesis]
• Overwhelm (trauma surfacing, flooding, dissociation). Slow down. Bring the focus back to the here-and-now observation of the child. Offer support and validation (4.10). Consider individual therapy for the parent alongside WWW. For suicidality or risk to the child, step out of the WWW frame and follow standard risk assessment and safeguarding procedures. [synthesis]
• Rupture with the parent (feels judged, watched, or that the therapist sides with the child). Name it openly, own your part (e.g., a comment that came across as criticism), and invite the parent's view. Being watched during play can itself feel like scrutiny, so name this early in the frame. [synthesis]
• The therapist's own reactions (irritation at the parent, rescue fantasies, sleepiness). Process them in supervision and reflect on them as possible clues to the dyad's avoided states, without acting them out in session. [source: WAIMH Perspectives 2011]
• Siblings or other adults present. Decide in advance who attends. If a sibling comes, the parent follows the target child's lead while keeping the sibling safe, and the dynamics this brings out are discussed. [synthesis; not addressed in the sources]
• Very young infants (pre-mobile). The infant's lead is shown through gaze, vocalisation, gesture and turning away. Position the baby on a mat or on the parent's lap and coach the parent to notice these cues. The NICU adaptation shows the format works with shorter segments. [source for NICU: Psicologia em Estudo p.619; rest [synthesis]]
• Parents with severe personality pathology. WWW has been discussed in relation to mothers with borderline personality disorder. Specific modifications are [uncertain]. Expect stronger reactions to the child's autonomy and to the therapist's silence. Consider shorter play segments, more explicit support, and parallel individual treatment. [synthesis]

Sources

Sources:

• Watch, Wait, and Wonder (WWW) – California Evidence-Based Clearinghouse for Child Welfare
• Watch, Wait and Wonder – Foundations Guidebook
• Guidebook intervention info sheet: Watch Wait and Wonder (Foundations, PDF)
• Watch Wait and Wonder – NHS Scotland Early Intervention Framework
• Training Corner: two-day training on attachment and psychodynamic theory and practice – WAIMH Perspectives in Infant Mental Health, 2011 (and PDF version)
• Watch, Wait and Wonder in a NICU – Psicologia em Estudo (UEM), PDF
• Learning to wonder together: a group approach – Tavistock & Portman repository
• O'Hanlon (2015), parents' experiences in WWW groups – University of Essex repository
• Watch Wait Wonder training – Incredible Families NZ
• Theoretical perspectives on parental reflexive functioning and the WWW approach (2013), catalogue abstract – PLUDOC

Further reading (primary works, not drawn on) [uncertain where relied on]:

• Muir, E. (1992). Watching, waiting, and wondering: Applying psychoanalytic principles to mother–infant intervention. Infant Mental Health Journal, 13, 319–328.
• Muir, E., Lojkasek, M., & Cohen, N. J. (1999). Watch, Wait and Wonder: A Manual Describing a Dyadic Infant-Led Approach to Problems in Infancy and Early Childhood. Toronto: Hincks-Dellcrest Institute.
• Cohen, N. J., Muir, E., Lojkasek, M., Muir, R., Parker, C. J., Barwick, M., & Brown, M. (1999). Watch, wait, and wonder: Testing the effectiveness of a new approach to mother–infant psychotherapy. Infant Mental Health Journal, 20, 429–451.
• Cohen, N. J., Lojkasek, M., Muir, E., Muir, R., & Parker, C. J. (2002). Six-month follow-up of two mother–infant psychotherapies: Convergence of therapeutic outcomes. Infant Mental Health Journal, 23, 361–380.
• Cohen, N. J., Lojkasek, M., & Muir, E. (2006). Watch, wait, and wonder: An infant-led approach to infant–parent psychotherapy. The Signal (WAIMH), 14(2).
• Lojkasek, M., Cohen, N. J., & Muir, E. (1994). Where is the infant in infant intervention? A review of the literature on changing troubled mother–infant relationships. Psychotherapy, 31, 208–220.
• Mahrer, A. R., Levinson, J. R., & Fine, S. (1976). Infant psychotherapy: Theory, research, and practice. Psychotherapy: Theory, Research and Practice, 13, 131–140.