The International Journal of Psychoanalysis

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Infant observation: A range of questions and

challenges for contemporary psychoanalysis

Marina Altmann Litvan

To cite this article: Marina Altmann Litvan (2007) Infant observation: A range of questions and
challenges for contemporary psychoanalysis, The International Journal of Psychoanalysis, 88:3,
713-733, DOI: 10.1516/9031-19R0-3704-2371

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Int J Psychoanal 2007;88:713–33 EDUCATION SECTION

Infant observation:
A range of questions and challenges for contemporary psychoanalysis1

MARINA ALTMANN DE LITVAN

José María Montero 3096, 11300 Montevideo, Uruguay — altmanli@chasque.net
(Final version accepted 3 February 2006)

The author attempts to integrate several perspectives within the field of infant
observation that reflect the analyst’s personal experience as a clinician, as a
professor at the analytic institute and as a researcher in the field of psychoanalysis.
Can infant observation contribute to analytic technique, theory and training?
If so, what would be the nature of such contribution? To answer these questions,
the author reviews the literature on infant observation from Freud to the present,
highlighting Latin American contributions to this subject. She makes reference to
the role of technological innovations, which have allowed videotaping, repeated
observations, temporal segmentation and computerized programs, thus giving rise to
microanalytic research. This discussion prompts the question about the contributions
made by systematic research to clinical practice. To tackle this question, the author
presents both a clinical vignette taken from her personal experience, and the current
debate on this subject as it appears in the work of Daniel Stern and André Green.
Finally, she presents some conclusions that are part of an ongoing debate in the
psychoanalytic field.

Keywords: infant observation, analytic training, Latin America, from the

reconstructed to the observed infant, Green–Stern debate, microanalytic research
and its contributions to clinical practice

Introduction
I approach this topic through the synthesis of various perspectives, namely, that of
the practising analyst, the researcher in the field of infant mental health, and the
professor at the psychoanalytic institute. My exposition is based on a review of the
literature on infant observation, on my own experience, and on information obtained
through a survey of analysts belonging to various Latin American institutes taken
between October and December 2004.
In my professional life, analytic research and clinical practice have represented
separate training processes and followed parallel paths for many years. Over time,
and due to certain aspects of my clinical and teaching experience, there emerged
in my mind areas of intersection and mutual enrichment, and I refer to these areas
throughout this paper.
According to Klimovsky, ‘scientific observation constitutes research in a broad
sense, which means that scientists’ empirical work always implicitly presupposes

Translated by Judith Filc.

1

©2007 Institute of Psychoanalysis

714 MARINA ALTMANN DE LITVAN

a theoretical framework constituted by all those theories that have already been
accepted by the scientific community’ (1997, p. 42). Knowledge is inferred from
perceptual data. ‘In science, data stemming from the empirical methodological basis
are inferred with the empirical epistemological basis as a starting point’ (p. 42). In
the analytic field, observation bears a different meaning. We listen, hear and feel,
involving our whole being in our relationship with the patient.

The reconstructed baby

Literature review
Many psychoanalytic theories (Freud, Klein, Winnicott, Bion and Marty, among
others) are based on the reconstruction of the mother–infant relationship. I briefly
explore the place infant observation has occupied in these theories, by referring to
those ideas that have most influenced the development of my own views on this
topic.
Freud (1895, 1896, 1918) refers to the helpless newborn who needs another
person to satisfy its needs (thirst, hunger) and to put an end to internal tension. In
this way, the child gives rise to the action that will invest it narcissistically. The
mother has a decisive influence in the structuring of the newborn’s psyche, for she
appears as the object of the self-preservation drives in her role as a nurturing mother,
and as the object of the sex drives that stimulate the libido.
Freud’s (1920) observation of a game played by an 18 month-old child is framed
within his research on repetition compulsion and highlights the tendency to relive
something painful again. The repetition of the painful separation from the mother that
Freud observes in this infant entails a search for psychic binding, that is, an effort to
master the stimulus; repetition compulsion and pleasurable drive satisfaction would
tightly interweave (1920, pp. 35–6, 50–4). Freud’s observations hinge on his theo-
retical concerns at that time, and particularly on his new finding, the death drive.
Melanie Klein’s school puts forth object relations as a central theoretical proposi-
tion. What is expressed/recalled in the transference is the patient’s early relationship
with primary objects. Infant observation is naturally intertwined with Kleinian
thought. Klein observes infants at play and interprets that playing enables them to
alleviate their anxiety and emotions from a very early age. To understand infants,
Klein points out, we need not only a greater knowledge of them, but also a full
empathy with them that stems from the intimate contact between our unconscious
and theirs. According to Klein,
Already in the fifth or sixth month many infants respond with pleasure to “peep-bo” … . It
seems that the repetition of such experiences is an important factor in helping the infant to
overcome his feelings of loss and grief. (1952, p. 258, original italics)

Based on the observation of one of her own children (5 year-old Fritz) and
of children’s play in her clinical practice, Klein created play technique in child
analysis, equating the adult’s verbal associations with the child’s play. Another very
significant contribution of Kleinian thought to analytic technique is the interpreta-
tion of the child’s play, and the possibilities this interpretation offers of modifying
 INFANT OBSERVATION 715

the child’s fantasies so that they will be symbolically expressed in a different way.
This contribution was later applied to the theory of interpretation.
The Kleinian infant’s mental life is construed along the lines of primal, instinc-
tive fantasies that are expressed in a bodily rather than a verbal way, as well as
through primal mechanisms of projective identification. Klein adds to her theoretical
developments Merell Middlemore’s (1941) infant observations (Klein, 1952, pp.
240–2), as well as her own (pp. 258–9). In this regard, I find particularly interesting
her description of the weaning period and of the specificities of this process, which
is connected to anxieties and defences that will reappear later in life, set off by
experiences of loss or separation (pp. 252–6).
Her development of play technique allowed Klein to make, in just a few months,
the three great discoveries that would constitute the scaffolding of the Kleinian
analytic edifice to this day, namely,
…the existence of an ‘early’ oedipus complex at the end of the first year of life; the existence
of an archaic form of the superego at this same period; and the possibility and daily reality of
transference in the analysis of very young children. (Petot, 1990, p. xi)

Despite the value Klein attaches to the reconstruction of the baby carried out in
the transference field, she leaves many paths open to infant observation:
The very young infant’s mental life is still a mystery to most adults. I venture to suggest
that a closer observation of babies, stimulated by the increased knowledge of early mental
processes which was derived from the psychoanalysis of young children, should in time to
come lead to a better insight into the baby’s emotional life. (1952, p. 264)

The significance Kleinian thought attributes to the infant’s anxieties and emotions
in their different relational configurations—paranoid and depressive—foreshadows
current developments and research on affective regulation (Fonagy, Gergely, Target)
and proves its validity (Fonagy et al., 2002).
Descriptive observation, which confirmed Freud’s and Klein’s hypotheses, may
be contrasted with a different kind of observation posited by Bion, in which the
psychoanalytic event, from the analyst’s perspective, is produced not just through
the senses but also through the analyst’s intuition, which is based on an experience
devoid of sensory origin. It consists in the ability to grasp, above all, the emotional
states that are part of the analytic function of the personality. Such ability is closely
linked to the analyst’s style, observation mode and theoretical framework. The
difference between these types of observation lies in the fact that Bion’s method
involves a greater degree of conscious and preconscious selection of what analysts
perceive in the other and in themselves and the search for meaning, which already
implies a first level of abstraction and conceptualization (Bion, 1962).
Bion tackles the maternal function through the concept of reverie, which entails
not only the mother’s containment of the infant’s feelings, but also her metaboliza-
tion ( -function) of its emotions and anxieties. The mother must reflect upon ‘how
the child thinks’ so as to help it to ‘think about itself’. With her reverie, the mother
organizes the chaos of feelings and emotions experienced by the child and returns
these reorganized emotions to the child (Bion, 1962, p. 36).
716 MARINA ALTMANN DE LITVAN

Winnicott points out that psychoanalysis has a lot to learn from those who
practise direct observation of mothers with their children, that is, of small children
in their own environment. He states, however, that direct observation in itself
cannot lead to the construction of a psychology of early childhood (Winnicott,
1965). Through constant co-operation, analysts and researchers may succeed in
establishing a relation between the deep elements observed in analysis and the early
aspects of infantile development (p. 114). Winnicott grants a pivotal role to obser-
vation in psychoanalysis as a means to discard hypotheses that are too speculative
(pp. 112–4). This view goes against his affirmation that the ability to reach a clear
view of what happens during childhood depends less on direct infant observation
than on the study of transference within the analytic framework (p. 54). It is in this
context that we will be able to reconstruct the dynamic of infantile dependence and
of the maternal care that satisfies such dependence.
Winnicott (1958) considers that there is no such thing as a baby, meaning
that what exists is a baby with its mother. He distinguishes between the ‘mother-
environment’ and the ‘mother-object’ functions of the drive or instinct, positing that,
in the first case, the baby is part of a relationship, and that it needs a ‘good-enough
mother’ at the beginning of its development. In a first phase of mother–infant unity
(‘absolute dependence’), the mother constitutes the enabling environment, a role that
requires the support of others (the father, the maternal grandmother, the family, and
the immediate social environment). The first interactions take place in the context of
the so-called ‘primary maternal preoccupation’, which encompasses the last weeks
of pregnancy and the first weeks after the child’s birth. The functions involved here
are holding, handling and presentation of the object. The mother settles and operates
as a real presence, holding and manipulating the baby and presenting objects to it.
By means of the presentation of objects to the child when it needs to find them, the
mother’s ego-relatedness fosters the child’s creative mental functioning. Winnicott
describes the mother’s role as mirror from the perspective of the baby’s emotional
development. The first mirror is the mother’s face; the infant sees itself when looking
at the mother’s face.
I mentioned earlier different psychoanalytic theories that are based on the recon-
struction of the mother–infant link. What is then the role of infant observation, and
how is it introduced into the psychoanalytic field? Winnicott suggests that when
the infant looks at its mother, who is simultaneously looking at it, it sees itself in
her face. Implicit in both Winnicott’s insight and the subsequent contributions of
Gergely and Watson (1996) (based on experimental results) is the complex structure
of the interaction between the mother’s and the infant’s face.
The child learns about the dispositional content of emotional expressions through
the observation of the effects the others’ affective expressions have on each person’s
behaviour. The parents’ display of a mirroring affect expresses an emotion-state
whose category the infant is capable of recognizing. But how does the baby know
that this expression refers to its own state and not to that of its mother or father? How
does the infant know that the state expressed by the display of external emotions
that it seems to control belongs to it and not to its parents, who are the ones who are
actually expressing them? Even though the parents’ facial and verbal behaviours
 INFANT OBSERVATION 717

may reflect those of the baby, the parents’ behaviours never occur at the same time,
in the same space or with the same sensory intensity as the baby’s. This disparity
is crucial, for the baby is extremely sensitive to differences between perfect levels
and high, yet not perfect, levels of stimulus–response contingency, and it uses this
information very early on to categorize stimuli as belonging to the self or to a social
object.
The parents’ instinctive tendency to exaggerate the infant’s affect-reflective
behaviour during the interactions that regulate its emotions have three consequences
that are significant for the infant’s development. The infant will detect and group
into categories signs of internal states that indicate its own emotion-states, and will
establish secondary representations associated to its primary affective states that
will provide it with cognitive meanings. Such meanings will enable the infant to
assign emotional states to its self, thus acquiring a shared communicative code of
‘marked’ expressions whose representational functions are ‘referential decoupling,
anchoring and suspension of realistic consequences’ (Gergely and Watson, 1996,
p. 1199). The developmental functions promoted by the child’s mirroring of the
parents’ affects are sensitization, the construction of representations, the regulation
of emotional states, and communication and mentalization.
What is the contribution these findings offer to psychoanalysis? I have observed
in my clinical practice that they help analysts develop their interpretation technique.
There is a style of interpretation that depends on the maximization and contingency
of the affects that analysts must include in their interventions through dramatization
or expression. This is not only relevant in psychotherapeutic interventions with the
mother/father–baby, but also in the case of analytic work with some adult patients
who show significant affect inhibition and deficiencies in their representational world.
For instance, an adult analytic patient who sought analysis while making up her mind
to separate from her husband cried constantly during her hour, and said that she did
not know why, that she was not crying because of her loss. The analyst had to find
out on each occasion the reason for the patient’s crying. When an association with a
concrete narrative appeared, the analyst would repeat it for the patient, maximizing
it, exaggerating it dramatically—sometimes ironically—and would show the patient
how she could not deal with what the analyst might feel for her. The analyst returned
to the patient as a reflection—yet not an exact reflection—those affects the patient
could not experience, express or unfold.
Lacan (1949, p. 76) designates as the ‘mirror stage’ the genetic moment when
the child reaches the unification of its body precisely thanks to the other’s presence.
For Lacan, at the beginning, the child does not desire just the mother’s contact
and care; it wants to be everything for her—a complement of her lack, that is, the
phallus. This is the desire of the mother’s desire, and to satisfy it the child identifies
with the object of this desire, namely, the actual phallus. It might be said that, in
this phase, the child, identifying with the object of the other’s desire and passively
subjected to maternal servitude, is not a ‘subject’ but a lack, the absolute zero, for
it is not situated within the symbolic network. The child mingles with the object of
the other’s desire and, in an undifferentiated fusion with its mother, is deprived of
individuality and subjectivity.
718 MARINA ALTMANN DE LITVAN

The introduction of the mirror stage and its various moments is tied to the
primary dual relationship, which is characteristic of the imaginary and evinces
no distinction between signifier and signified. It belongs to the register of imagi-
nary capture—the ego is its double (identification with the mother through the
identification with the object of her desire) and the realm of primary narcissism
(which refers to the first stage in the development of the Oedipus complex)
(Lacan, 1998).2 Lacan’s mirror stage is linked to the subsequent structuring stages
of the psyche and to the advent of the symbolic through the Oedipus complex. His
theory is based on logical rather than chronological time because it does not attach
significance to development.
In the past 30 years, we have witnessed the accumulation of a great volume
of evidence in the field of developmental psychology. Such evidence has radically
changed our views on the initial stages in the infant’s life. While until recently the
shared view on this stage was that the infant was a passive and undifferentiated
organism (e.g. Mahler et al., 1975), today it is widely accepted that the infant is
furnished from the start with remarkably fertile skills to learn, perceive and repre-
sent, and that it is specifically adjusted to the physical and social structure of its
environment (Bower, 1982; Emde, 1988a, 1988b; Gergely, 1992; Meltzoff, 1990;
Stern, 1985).
Bowlby focuses on the infant’s and the child’s experiences regarding separation,
loss, sorrow and mourning. He studied and observed the baby’s early connection
with its caregiver and recognized the disorganization caused by the break—even
temporary—of such unity. He identifies the infant’s need to maintain its proximity
to its caregiver, whose safe and reassuring presence provides support. The system
of attachment is an affective link that is present in all human beings. Bowlby (1969,
1973, 1980) describes it as a special type of social relation of which the interaction
between the infant and its caregiver is paradigmatic, and which is typical of affec-
tive bonds. He bases his theory on the existence of a bond of primary attachment
that starts at birth and does not depend on an oral drive or on the need for food; its
developmental function is that of protection. In the context of attachment theory, the
emphasis on the determining role of early experiences is expressed in the assump-
tion that the styles of attachment that are established early in life remain relatively
stable during the rest of the person’s life (Eagle, 1995). According to attachment
theory, the search for safety surpasses all other psychological motivations, and the
attachment bond is the starting point of survival (Holmes, 2001).
In Latin America, Hoffmann et al. (1998) have recognized the infant’s active role,
attributing intentionality to its acts. Hoffmann (1993) studied the feeding situation
because he saw it as an ideal window to observe the baby’s initiatives and their influ-
ence in the construction of early relationships. Hoffmann’s main findings were that
infants may behave in ways that have not been described by psychoanalytic develop-
mental theories, and that power struggles occur in the mother–infant interaction. We
may observe manifestations of mastery and aggression as well as ways to react to such
modes of violence and mastery that are characteristic of certain types of pathology
2
A partial summary was published by Pontalis (1958).
 INFANT OBSERVATION 719

(overadaptation with psychosomatic behaviour, false-self pathologies, and so on).

These findings coincide with studies we have carried out in the field of developmental
psychopathology following Marty’s approach (Altmann et al., 1993).
There have also been numerous studies carried out under the strong influence
of Marty’s psychosomatic school, which includes authors such as Leon Kreissler,
Rosine Debray and Serge Lebovici. Marty (1985), Kreissler (1985) and Debray
(1987) have studied the processes of psychosomatic organization, disorganization
and reorganization that take place in the context of the mother–infant relation-
ship—the way in which mother and child regulate the quantity of drive stimuli
that circulate between them. The various events and situations that occur every day
between mother and infant have an effect upon their affective worlds.
Each subject will gradually build a progressive and specific organization of
representations through different excitations, that is, through experiences of pleasure
and pain. In this way, excitations will be triggered that some individuals will process
through sensory and motor behaviours that may or may not be linked to mental
work, while others will discharge them directly through their somatic apparatuses.
This construction of representations will therefore depend on the extent to which the
mother is able to be affectively present for her child (with excessive, nonexistent or
insufficient excitations); on the constitution of the family (if it is a large family, the
mother will have a hard time fulfilling her role in a suitable way); or on the existence
of congenital or accidental deficiencies either in the mother or in the infant that
hinder or prevent the unfolding of sensorimotor functions in the child, that is, of the
child’s perceptual functioning, which is the basis of representation.
Furthermore, the prevailing biosocial perspective on emotional development
contends that mother and infant form an affective communication system from the
moment the baby is born (Beebe et al., 1992; Bowlby, 1969; Brazelton et al., 1974;
Sander, 1977; Stern, 1977, 1985; Trevarthen, 1979; Tronick, 1989). The mother
plays a vital interactive role in this system, for she participates in the modulation of
the infant’s affective states. While babies show some rudimentary forms of affec-
tive self-regulation during early childhood (such as escaping excessive stimuli or
sucking their thumb) (Demos, 1986; Malatesta et al., 1989), researchers agree that
the quality of mother–infant interactions exerts a strong regulatory influence on
the dynamic of the babies’ affective states (Field, 1994; Malatesta and Izard, 1984;
Tronick, 1989; Tronick et al., 1982). Mothers are usually very efficient readers of
their babies’ emotions, and sensitive mothers tend to attune their own affective
answers to modulate their children’s emotion-states (Malatesta et al., 1989; Tronick,
1989). Such systems of emotional communication (typical of the first year of life) are
based on facial expressions, imitative behaviour, tone of voice and vocal expression,
posture, and so on. When words are not yet available as a means of communication
(between 5 and 7 months), early imitative mechanisms constitute the first step in
the babies’ ability to feel the other’s emotion-states (Meltzoff and Moore, 1977;
Meltzoff, 2002).
Emde has been one of the scientists to bring early development research—
particularly affect research—closer to psychoanalysis and psychotherapy (Emde,
1980, 1988a, 1988b, 1990; Emde and Robinson, 2000; Fonagy and Target, 2003).
720 MARINA ALTMANN DE LITVAN

A whole area of knowledge concerning the mother and her baby may be revealed
in psychotherapeutic work, and several studies should be mentioned in this context,
namely, Lebovici (1988), Manzano and Palacio Espasa (1993), and Garbarino
(1992).

Latin American contributions

In Latin America, there is extensive experience in infant observation following
Bick’s method (for instance, at the Brazilian Psychoanalytic Association in São
Paulo, Brazil). This method involves direct observation of the infant’s development
at home, yet within the framework of institutional training. Even though these
studies are specifically designed for analytic training, we should consider whether
they might also generate hypotheses and questions for research, since they consist
of weekly observations.
Infant observation was introduced into the curriculum of the Institute of Psycho-Analysis in
London in 1960 as part of the course for first year students. …
I thought this important for many reasons, but perhaps mostly because it would help the
students to conceive vividly the infantile experience of their child patients … . It should also
increase the student’s understanding of the child’s nonverbal behaviour [and the significance
of observing the mother–infant pair]. (Bick, 1964, p. 558)

Bick’s methodology was specifically designed for analytic training, and it has
been suggested that observations should be carried out prior to such training so
that candidates may get in touch with their most primal bonds. Since this method
promotes the development of the analyst’s mind in what concerns responsiveness,
tolerance and the reliving of the relationship with primary objects, it facilitates the
integration of certain aspects of training such as abstinence, containment and the
setting, all elements that are constitutive of the analytic function.
The internalization of the analytic function takes place through the various experi-
ences we undergo that involve our minds and our bodies, and other analysts in different
roles—personal analysis, seminars and supervision. The institution, with its manifold
transferences and the presence of several generations, shapes the space in which
psychoanalytic transmission develops. Dorado de Lisondo and Ungar (2002) believe
that clinical seminars where infant observations are discussed constitute an important
pre-clinical antecedent for the training of future analysts, because in such seminars
‘very intense emotions circulate, and interesting group phenomena take place, such
as identification with the infant, the mother, or another character in the scene’. These
emotions and phenomena are linked to Bion’s concept of learning from experience.
In Mexico, there is a group of analysts who engage in infant observation
according to Bick’s method, among them Noemí Reyes de Polanco and Esperanza
Plá. In Brazil, numerous psychoanalysts have carried out studies on this topic,
including Pelella Méllega (1997), Barros (1996), Caron (2000), Rosa (2000), and
Wilhelm (2000). At the Porto Alegre Psychoanalytic Society, seminars are currently
being taught on this method of infant observation. Similar seminars are also taught
in Argentina at the Argentine Psychoanalytic Association and the Buenos Aires
Psychoanalytic Association.
 INFANT OBSERVATION 721

Bernardi et al.’s (1982) paper chooses a different approach. There is also a

pioneer study launched in 1984 by the study group of the Centro Latinoamericano
de Perinatología (CLAP, Latin American Perinatology Centre), which dealt mainly
with the observation and description of interactive parameters shared by all mothers,
without taking into account their personal histories. This interdisciplinary study
(Díaz Roselló et al., 1989) was carried out by a paediatrician–neonatologist, three
psychologists trained in medical research, a psychiatrist and a psychoanalyst.
The trend of thought linked to rhythms and synchronies in the mother–infant
relationship has been developed by Altmann et al. (1998, 2000) and Altmann (2005)
on the basis of brief psychotherapeutic processes with babies who suffered infant
asthma.
In Uruguay, Garbarino constitutes an influential presence in this field. She has
considerable psychoanalytic experience and has published extensively. The work of
Garbarino (1992) is based on a psychoanalytic theoretical framework that involves
what she has designated as early interactive structure, which is a psycho-biological
unit comprised of three elements: the mother’s internal image of her baby, the
trophic encounter of rhythms and synchronies, and the semantization and decoding
the mother carries out in order to attribute meaning to her baby’s gestures. The
narcissization of the mother is emphasized so that she may develop her maternal
role in a more appropriate way.
There are other groups in Uruguay that continue to work following Cramer
(1998), who has focused on changes in the mother–child interaction produced by
mother–infant therapies. Taking conflicts in the mother’s history as a starting point,
Cramer works on the image the mother creates of her child, an image that is imbued
with her conflicts.

Technological contributions to infant observation

Just as it has aided the work of many of the abovementioned researchers, theoreti-
cians and analysts, technological innovation, including the ability to videotape, allows
analysts to engage in a first phase of clinical work and a second phase of research. It has
also given rise to new forms of observation, such as repetition and frame freezing, and
to observation time units that were unthinkable when psychoanalysis was conceived.
We may also add the more recent ability to systematically use videotapes in conjunc-
tion with computer programs that allow the analysis of dyadic interactions occurring in
milliseconds. It is as though we were in touch with different superimposed worlds that
study the mind and the affects with utterly different methodologies and procedures. In
the clinical realm, the analyst is both an observer and a constitutive part of the process
that is being observed. The use of videotapes, by contrast, brings up the issue of the
inclusion of a third one who observes.
The mother–child relationship is an object of study that has been approached
through various research methods, that is, different enquiry processes with
different types of findings as their goal. Each methodology implies the choice of
certain dimensions of observation, and therefore a certain perspective from which
this choice is made.
722 MARINA ALTMANN DE LITVAN

Microanalytic observation
The use of technological resources allows us to explore a series of movements,
affects, expressions, actions, and so on, that appear during mother–child interactions
and that would otherwise remain concealed.3 This type of methodology amplifies
and complements our analytic observation, which is based on different meth-
odological premises. Thanks to the introduction of new technology, microanalytic
research in the field of infant observation has shown the enormous complexity and
variability of affects, thus introducing new questions into the psychoanalytic field.
The transference–countertransference axis constitutes our emotional soundbox as
analysts; microanalytic research and new methods of observation and research
increase our ability to perceive these emotional registers.

The baby reconstructed with the aid of systematic observation

Clinical vignette: Vicissitudes of an adoption
Liza is 40 years old and has recently arrived in the country. She has been married for
more than a decade and fruitlessly tried a variety of fertility treatments in different
parts of the world. Two years ago, she and her husband adopted a newborn girl. A
few months later, they found out that a brother of their adoptive daughter would
also be given up for adoption, and they immediately agreed to adopt him. It is in this
context that Liza seeks psychoanalysis.
The conflict and the psychic work inherent to the adoption process unfold in
the everyday appropriation of the baby by the parents through the bond and the
relationship they forge with their child. It is important to show the mother what
she gives to the child, but also what the child takes from her, which may be seen
through the reverie function (container–contained) and the various mechanisms
of projective identification that are clearly perceived in the session. Microanalytic
observation constitutes a great support, for it indirectly enhances the analysts’ ability
to adjust their interpretative modalities. By freezing images, microanalytic observa-
tion enables the scrutiny of the baby’s different affective signals and the mother’s
interpretation of such signals. In other words, we can observe the mother’s ability
to ponder the mental states that underlie her child’s ‘tantrums’ and complaints. Yet,
in order for the mother’s reflections to be of help to her child, they must involve
a subtle combination of mirroring and the communication of a contrasting affect
(Fonagy, Gergeley, Jurist, Target, 2002).
The following example refers to a treatment carried out within the setting of an
analytic psychotherapy.
Lisa says, ‘To stop talking about fertility treatments and start talking about
adoption meant a very serious commitment. We wanted to raise a family. I wanted
him to be the father of my children and he wanted me to be the mother of his children.
This is a twofold choice, as is the decision to adopt a child. If there is something that
is true about adopting a child, it’s that this child is not an accident or an oversight but

I am referring here to the observation methods developed by Stern and Tronick, among others.
3
 INFANT OBSERVATION 723

a highly desired child. It’s a desire connected with the most basic aspects of a human
being—the procreation instinct, to perpetuate oneself, one’s blood, atavistic things,
as in the case of animals, life instincts, and so, when that is not there, it’s like death,
and one lives with this every day of one’s life; one faces finitude much more clearly,
like, one can’t have children and so, does one end there? … The issue of infertility
has a lot to do with death, with a negation of life’.
Speaking about Diego, her younger child—who is 11 months old—Liza says
that his personality has changed. Lately, he has become a grouch (just like his
2 year-old sister). The mother cannot recognize him—he seems foreign to her,
odd, a screamer. She mentions that she bought him his first pair of shoes, that
she devoted a long time to choosing the most suitable ones, and she dwells on a
narrative of all the places where she went looking for shoes that would be flexible
and soft for Diego’s feet. It is a long narrative of a search that meets with confusion
when Diego screams and rejects the shoes, refusing to give up his free feet. The tale
of the patient’s shopping trip floods the session. Liza says that, before, Diego used
to be barefoot, and that he has become very rebellious. She does not understand
what is going on; she has been telling everybody about going shoe shopping.
When the analyst asks, ‘And what did you tell Diego?’ Lisa replies, ‘Nothing’.
‘You told everyone except Diego!!’
What the mother had not realized was that the shoes represented the child’s
body, the beginning of a new stage in his socialization, the possibility to practise a
new skill such as walking. She had utterly ignored everything that was at stake for
Diego at the time. In other words, she had ignored her son’s person, the symbolic
meaning of walking, that walking represents a sign of separation, a new stage in
the child’s autonomy—the possibility to distance himself from his mother—and
its interweaving with other development functions. Appropriating her son meant
starting to work on the mutual recognition of Diego’s and her own everyday needs,
feelings and thoughts.
Adoptive mothers usually very much idealize the mark of origin implied in the
myth of being born from the mother’s womb. The other marks—those that are estab-
lished in everyday life—are also ways to appropriate the child, to gradually mark the
child as their own, but they often appear as faded or blurred. From a technical point
of view, I considered that it was very important to introduce a mode of work and
intervention that was linked, in my case, to my experience with microanalytic infant
observation, which allows us to perceive every moment of the daily mother–child
meetings and the different reactions and effects they produce.
I was surprised by the fact that certain things I had learned in such research
activities emerged spontaneously when I had to interpret situations that showed this
mother’s difficulties to appropriate her children. I am referring here specifically to
those mechanisms that enable the mother to gradually discover the ‘person’ present
in her baby, and this meeting takes place moment to moment in the everyday. It
amazes me how this example contradicts Green’s observation to Stern (2000)
regarding the absence of subjectivity in early childhood. Through his tantrums,
Diego marked his presence as a person, but his mother was incapable of recognizing
him as such. My realization marked a clinical moment in which I became aware of
724 MARINA ALTMANN DE LITVAN

how much my observation work had contributed to my interpretation technique.

I did not interpret Diego just as an object of maternal phantasy, but rather as the
mother’s actual child, as a person at a certain stage of development, even though I
was treating his mother.
The experience of infant observation provides tools for an interactive work,
a linkage work of ‘mutual adjustment’ (Tronick, 2002). As an analyst, it is as
though I had to encounter—besides the shoes and the clicking they produced in my
listening—the everyday scene represented by infant observation work. This scene
unfolds in connection with various key moments of development, with anxieties or
crucial activities such as eating or sleeping that demand flexibility from the analytic
function (Process of Change Study Group [PCSG], 1998).

The current debate

With regard to the understanding and interpretation of psychoanalysis and of the
analyst’s role, Green (2000) believes that the notion of psychoanalysis is associated
with a model based on unconscious conflicts, with dreams and mainly with intra-
psychic conflicts. For other thinkers such as Stern (2000), psychoanalysis and the
very construction of the psyche have the notion of intersubjectivity as their starting
point. According to Green, the unconscious and psychoanalysis unfold fundamen-
tally through language, even though he also acknowledges that the prosodic and
semiotic aspects of communication play a role. Stern, by contrast, insists on the
role of the preverbal and nonverbal aspects of mother–infant interaction, a form of
communication that he has studied.
The classic psychoanalytic description of the child’s mental life prior to symbolic
representation (which starts in the second year of life) posits the prevalence of a
chaotic, formless emotional dynamic that cannot be observed. Stern’s view is that
the child’s emotional exchanges with its environment are the ones that initially
constitute the organizing principle of infantile subjectivity by allowing the forma-
tion of presymbolic representations of experience. It is not possible to gain access
to a small child’s subjective experience save by observing the emotional profiles it
displays during its interactions with significant ‘others.’
The first essays on these contrasting views were published in Wolff (1996), and
the topic is still current, having become the object of analysis and debate at national
and international meetings, as well as the root of manifest or latent controversies at
the various psychoanalytic institutes. Local differences are linked to the hegemony
of either French or Anglo-Saxon thought in different countries. Green and Stern are
influential authors within their respective orientations. Besides personality differ-
ences, the debate reflects at least two different ‘cultures’ and ways to understand
and interpret psychoanalysis and to define the present-day psychoanalyst, who has
to consider how to evaluate and use empirical research and not just the research
stemming from systematic and scientific infant observation (Steiner, 2000, p. 3).
The dialogue between these two authors not only shows differing methodo-
logical choices but also, in a deeper and more fundamental way, different ways to
approach the subject from an epistemological perspective. The debate encompasses
 INFANT OBSERVATION 725

broader issues, such as conceptions of science, the relation between method and
object of knowledge, the confrontation between objectivity and subjectivity, the
relation between psychoanalysis and psychology, definitions of the unconscious
and of intrapsychic reality, ways of conceiving of emotions and representations,
and notions of time.
The temporal notion of après-coup is central to Green’s ideas. This notion
establishes a complex and reciprocal relation between the significant event and its
subsequent signification, which confers a new psychic efficacy to the event [the
notion of Nachträglichkeit (Freud, 1896) has been particularly valued by Lacan,
Laplanche and Pontalis (1973, p. 111) and Freud (1918)].
Stern (2000), alongside Emde and Fonagy (1997) and others, suggests that
psychoanalysis needs empirical development studies to remain at the forefront of
the scientific exchange with other disciplines. He states that infant observation is
relevant to psychoanalysis in an indirect way; it can neither prove nor disprove
a clinical or theoretical principle, but it plays a main role in the accumulation of
knowledge of indirect relevance.
As already mentioned, Green (2000) highlights the temporal concept of resig-
nification and favours language as the expression of the unconscious. Stern (2000),
conversely, considers himself a researcher of hypotheses that arise both from the
psychoanalytic field and from the field of the mother/father–infant relationship,
hypotheses that he then transfers to an experimental design. He observes, amplifies,
imitates and incorporates elements from other disciplines—he uses models from
music and dance, as well as an array of technological resources such as videotapes
and audiotapes. These tools allow him, for instance, to understand how preverbal
and nonverbal interaction processes develop between mother and infant. In the case
of music, for example, we are dealing with a language that does not need words to
be conveyed.
Stern uses the notion of ‘present moment’. The baby is preverbal and presym-
bolic. I believe that his approach entails a challenge: by resorting to other disciplines
and designing research models to study events that occur outside the analytic session,
he indirectly provides hypotheses and information that enrich our knowledge of the
development and structuring of the mind in contact with another mind (mother/
father–baby), thus giving rise to the formulation of specific hypotheses about the
child’s subjective experience based on the wealth of information provided by obser-
vation. Even though it cannot replace psychoanalysis, child research may play a
complementary role that may be productive for both disciplines. From Stern’s (2000,
p. 79) point of view, the reason why certain observational studies of infants present
some problems is that there may not exist a suitable method to exhaustively answer
the questions posed by the researchers (such as what is the baby experiencing).
Green emphasizes the specificity and value of interpretation in psychoanalysis,
while Stern uses a developmental perspective to search for valid hypotheses for
psychoanalysis. There are basic epistemological differences, but psychoanalysis
must verify the plausibility of its hypotheses regarding the unconscious meaning of
behaviour through the confrontation of its findings with the knowledge accumulated
outside its realm. In my view, a key difference between the authors is that Stern’s
726 MARINA ALTMANN DE LITVAN

work builds a bridge among disciplines that facilitates interdisciplinary work; his
research enables a specific dialogue with academic psychology, neuroscience,
statistical research and other fields.
The Green–Stern debate takes place in the realm of ideas, but we should also
look at the ways in which empirical infant observation interacts with psychoanalytic
clinical practice through the clinical example above. When discussing the place the
shoes occupied in the mother’s and the child’s scene, I was not referring to a conscious,
real scene. I appealed to the mother to make use of her preconscious–conscious
resources to handle her son, but I also encouraged her to dwell on the nature of
her moment-to-moment exchanges with her 11 month-old child—what were her
requests and her responses, and what were her son’s responses, conveyed by means
of facial expressions, vocalizations or muscle tone? In this way, it becomes possible
to reconstruct the analytic session, to display in it this moment-to-moment of the
mother–infant relationship and observe how it is possible to produce transforma-
tions in this relationship. In the analyst’s mind, Diego’s shoes, rather than being a
continuity in the regressive associative process, led to the emergence of a clicking, a
virtual–real scene where Diego and his mother were interacting in the present.
The analyst then brings her experience of mother–infant observation to the
session, and this experience articulates with the analytic material. In the analytic
session, we find a mother who loves–hates her children. In our example, the patient,
referring to her conflicted maternity, told me that, while she was Liza C (her maiden
name), she had had four abortions and, as Mrs M (her married name), she could
never get pregnant. ‘I was talking to a friend, I was convinced that God would
punish me … It was very important to me with whom I would have a child, and
the bottom line was, I could have anybody’s child! My children are the children of
someone I’d never have chosen!!! Me, so picky!!!’
In this concrete example, systematic research within the analytic field enables us
to introduce in certain moments of the analysis an interpretive modality that takes
into account aspects of a shared reality (the patient could not have children) and the
fact that her son was experiencing a concrete and key stage of his development that
she was ignoring.
The River Plate region has been strongly influenced by a trend of thought
concerned with intersubjective development, from Pichon Rivière’s (1970) link
theory to Berenstein and Puget’s (1997) intersubjective theory, which appears as
expansions of the traditional psychoanalytic perspective. According to a survey
carried out by Altmann and Corti (2004) that gathered answers from Brazil,
Argentina, Chile, Venezuela, Mexico and Uruguay, infant observation is part of
psychoanalytic training in some institutes in Argentina, Brazil and Mexico. In
Chile and Uruguay, infant observation started more than 20 years ago outside the
analytic institutes, but it has been discontinued, in the case of Uruguay probably
due to the influence of French thought. These activities are mostly carried out
following Bick’s theoretical model and also incorporating neo-Kleinian authors.
In the case of São Paulo, Latin American authors have also been included. Unlike
that of other countries in the region, Mexico’s approach clearly evinces the influ-
ence of American and Anglo-Saxon thought.
 INFANT OBSERVATION 727

Conclusions
In Latin America, psychoanalysis is characterized by its receptiveness to the influ-
ence of thinkers from various origins and schools, which coexist with different
trends in different countries in the region. Concerning infant observation, Bick’s
is the most common method used in psychoanalytic institutes. Nonetheless, an
array of modes of observation and of psychotherapeutic mother–infant treatments
has been developed by psychoanalysts and has circulated mainly outside official
institutions.
Some analysts (Borensztejn and Finzi, 2001) have suggested that infant
observation following Bick’s method should become the fourth pillar of analytic
training, complementing Eitingon’s classic tripod—personal analysis, supervi-
sion and theoretical seminars. They maintain that such incorporation would
help carve the analytic identity. As mentioned, I believe that the inclusion of
systematic and microanalytic methodologies of infant observation would enrich
analytic work. I would like to suggest some facets of psychoanalysis that might
benefit from this type of research, yet I believe that the topic deserves further
exploration.
Microanalytic infant observation constitutes a research methodology that
may contribute valuable findings to psychoanalysis, which will then produce new
hypotheses within psychoanalytic theory.4 At the same time, this type of observa-
tion also enriches the technique of interpretation, for it allows analysts to find the
right interpretive mode and style that will ensure a match between analyst and
patient.
The state of the analyst’s mind during the session is completely different
from the state of the mind of researchers devoted to their task, since the analytic
situation requires a specific mode of listening, evenly suspended attention, asso-
ciative processes, and a necessary porosity between unconscious and conscious
processes. Microanalytic research decentres narrative. It enables us to come into
contact with those configurations, those units of relationship that are established
between mother and infant, units of nonverbal relationship that bear meaning yet
are very different from words. Moreover, the researcher’s state of mental avail-
ability is very different from that of the analyst. It requires focused attention, the
prevalence of logical thought processes, and planning and strategizing skills. At
the same time, emotion and surprise in the face of discovery are present in both
cases, and yet, in both cases, either a methodologically inaccurate treatment of
data or the exclusive representation of the phantasy world dissociated from reality
might be deceptive.
4
In our study (Altmann and Gril, 2000) which compared the relation between verbal and nonverbal
systems in psychoanalytic psychotherapeutic treatments of 10 mother–infant dyads between 3 and 18
months old, no linear correlations were found between both systems. This finding had a great impact on
me because it was totally unexpected. The processes that developed in the narrative were independent
of the processes established through nonverbal indicators (gaze, tact, proximity, and so on). In other
words, there exists a dynamic characteristic of nonverbal processes, processes that do not necessarily
become verbal and symbolic. These findings coincide with other studies, such as those of Bucci (1997),
of which we were not aware at the time.
728 MARINA ALTMANN DE LITVAN

How is it that systematic and microanalytic infant observation contributes to

psychoanalysis? It contributes to psychoanalytic theory because it opens up new
dimensions in the complex topic of affects and their significance in the construc-
tion of the self. Furthermore, observation allows us to identify nonverbal meanings
of psychic life experiences, that is, the pre-reflective structures. This procedural
knowledge does not necessarily generate psychic events, but it has a crucial influ-
ence over them (Perry et al., 1995; Schore, 1994). Rhythms, tonalities and organized
movements gradually create a dance, a choreography of the mother–child relation-
ship, and we can see how these patterns are registered in unspoken levels, how each
participant in the relationship feels about the other.
The notion of procedural knowledge refers to ways of ‘knowing-in-action’ that
have relatively little connection to language and reflection and that may actually be
disturbed if we think about them too much; it’s what Stolorow et al. (1994) desig-
nate as ‘prereflective unconscious’. What we may grasp through infant observation
is that these basic organizers of the mother–infant relationship influence psychic life
as a whole, especially regarding significant figures (Beebe and Lachmann, 1988;
Emde, 1983; Seligman, 1996; Stern, 1995).
If I had chosen a perspective that took into account traditional psychoanalytic
thought, I would probably be much more attentive to the mother’s narrative, to
language, to the significance the various maternal representations have for the
child, and to the place the child occupies in the mother’s desire; I would be working
from a different vantage point. Yet I see these views as complementary rather than
exclusive. This line of thought is very close to Kleinian ideas, which underscore
very early object relations as well as anxieties and emotions connected to elements
not symbolized through words. From the perspective of intersubjective research
on infants, we could also see Bion’s (1962) maternal reverie function as having a
regulatory role.
Infant observation with an intersubjective approach shows the infant–parents
relationship as a bi-personal system of mutual influence and regulation. The baby
and its parents are continually observing and influencing one another, and they deter-
mine each other’s behaviour and meanings. These reflections bear significance for
analytic technique, because this way of understanding the relationship with the other
entails recognizing the inextricability of transference and countertransference.
The answer to the question whether or not to include infant observation in
analytic training is closely tied to each psychoanalytic society’s views on the kind
of analyst it wants to train, and we may find differing stances on this issue. If
we want to train analysts who are able to relate with ease to concrete problems,
development issues, health sciences and neuroscience, we must include systematic
infant observation in the curriculum. Infant observation allows analysts in training
to come into contact with very primal bonds that will trigger their internal affects.
In so far as this process occurs alongside the analytic process, candidates will
come closer to the unconscious contents of their psyche. Conversely, if psychoa-
nalysis is seen as an isolated discipline that does not need to be articulated with
other fields, it will not be necessary to incorporate infant observation into the
candidates’ training experience.
 INFANT OBSERVATION 729

Translations of summary
Säuglingsbeobachtung: Fragen und Herausforderungen für die heutige Psychoanalyse. Die Autorin
versucht, verschiedene Perspektiven auf dem Feld der Säuglingsbeobachtung zu integrieren. Sie spiegeln
die persönliche Erfahrung wider, die die Analytikerin als Klinikerin, als Professorin eines analytischen
Instituts und als Forscherin auf dem Gebiet der Psychoanalyse sammeln konnte. Können die analytische
Technik, Theorie und Ausbildung von der Säuglingsbeobachtung profitieren? Wenn ja – wie sähe der Beitrag
der Säuglingsbeobachtung aus? Um diese Fragen zu beantworten, unterzieht die Autorin die Literatur zur
Säuglingsbeobachtung, beginnend mit Freud, einer kritischen Sichtung. Besonderes Gewicht liegt dabei auf
den einschlägigen lateinamerikanischen Beiträgen. Sie erläutert die Rolle technischer Neuerungen, dank deren
Videoaufzeichnungen, wiederholte Beobachtungen, zeitliche Segmentierung und computerisierte Programme
und schließlich eine mikroanalytische Forschung ermöglicht wurden. Diese Diskussion wirft die Frage
nach den Beiträgen auf, die systematische Forschung zur klinischen Praxis leistet. Um sie zu beantworten,
präsentiert die Autorin eine klinische Vignette aus ihrer eigenen Arbeit und referiert die aktuelle Debatte über
dieses Thema, die in den Schriften Daniel Sterns und André Greens verfolgt werden kann. Abschließend
formuliert sie Schlussfolgerungen, die Teil einer aktuellen Debatte innerhalb der Psychoanalyse sind.

Observación de bebés: una serie de preguntas y desafíos para el psicoanálisis contemporáneo.

La autora intenta integrar diversas perspectivas en el campo de la observación de bebés que reflejan
la experiencia personal de la analista como clínico, como docente del instituto psicoanalítico, y como
investigadora en el campo del psicoanálisis. ¿La observación de bebés puede aportar a la técnica, a la teoría
y a la formación psicoanalíticas? De ser así, ¿cuál sería la naturaleza de esta contribución? Para responder
a estas preguntas la autora revisa la literatura sobre observación de bebés desde Freud hasta hoy, y destaca
los aportes latinoamericanos sobre este tema. Se hace referencia al papel de las innovaciones tecnológicas,
las cuales han permitido la filmación de videos, la observación repetida, la segmentación temporal y los
programas computarizados, que han dado lugar a la investigación microanalítica. Esta discusión invita a
preguntarse por los aportes de la investigación sistemática a la práctica clínica. Para abordar esta pregunta
la autora presenta una viñeta clínica de su experiencia personal y el debate actual sobre este tema tal como
aparece en los trabajos de Daniel Stern y André Green. Por último presenta algunas conclusiones que son
parte de un debate actual en el campo psicoanalítico.

L’observation de l’enfant : Une série de questions et de défis pour la psychanalyse contemporaine.

L’auteur tente d’intégrer diverses perspectives au sein du champ de l’observation de l’enfant, reflétant
l’expérience personnelle de l’analyste en tant que clinicien, en tant qu’enseignant de l’institut de
psychanalyse, et en tant que chercheur en psychanalyse. Est-ce que l’observation de l’enfant peut contribuer
à la technique, à la théorie et à la formation psychanalytiques ? Si oui, quelle serait la nature d’une telle
contribution ? Pour répondre à ces questions, l’auteur passe en revue la littérature de l’observation de
l’enfant depuis Freud jusqu’à l’époque actuelle, en soulignant les contributions latino-américaines sur ce
sujet. Elle fait référence au rôle des innovations technologiques, qui ont permis d’enregistrement vidéo, le
observations répétées, la segmentation temporelle et les programmes informatiques, ce qui a conduit à la
recherche microanalytique. Cette discussion pose la question des contributions de la recherche systématique
à la pratique clinique. Pour traiter cette question, l’auteur présente d’une part, une vignette clinique issue
de son expérience personnelle, d’autre part, le débat actuel sur ce sujet tel qu’il apparaît dans les travaux de
Daniel Stern et André Green. Enfin, elle présente quelques conclusions qui font partie d’un débat en cours
dans le champ psychanalytique.

Infant Observation: Sfide e interrogativi per la psicoanalisi contemporenea. L’autrice vuole integrare
diverse prospettive nel campo dell’osservazione infantile che riflettono la sua personale esperienza clinica
di analista, la sua docenza all’istitutodi psicoanalisi e la sua attività di ricerca psicoanalitica. La questione
fondamentale è se l’osservazione infantile possa contribuire alla tecnica, alla teoria e alla formazione
psicoanalitica e, in caso affermativo, quale sia la natura di questo contributo. Per rispondere a queste
domande, l’ autrice passa in rassegna la letteratura sull’osservazione infantile da Freud ai nostri giorni, con
particolare attenzione al contributo specifico dell’America Latina. Accenna all’importanza delle innovazioni
tecnologiche che hanno consentito registrazioni video, osservazione ripetuta, segmentazione temporale e
programmi computerizzati. Si chiede poi in quale misura la ricerca microanalitica in tal modo generata
contribuisca alla prassi clinica. Per affrontare tale questione, l’autrice presenta una tranche clinica tratta
dalla sua esperienza personale, e discute le questioni relative a questo soggetto che emergono dal lavoro
di Daniel Stern e André Green. Presenta infine alcune conclusioni che fanno parte dell’attuale dibattito nel
campo della psicoanalisi.
730 MARINA ALTMANN DE LITVAN

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