Reviews

Despite major differences in style, tone and purpose, both of these books describe ways of understanding babies and their families, and raise some interesting questions about different ways of being ‘therapeutic’. The Practice of Psychoanalytic Parent–infant Psychotherapy, coming from the Anna Freud Centre’s Parent–infant Project, describes direct therapeutic intervention with families where help is urgently needed to prevent difficulties in parent–infant relationships from becoming acute crises. Intimate Transformations describes an international video-linked infant observation seminar group run by Jeanne Magagna at the Tavistock Clinic, with reflections on the individual babies and families observed, descriptions of applied work, and finally the authors’ own experiences within this ‘affective learning’ group. One of the most striking contrasts between the two books is in their reflection of the different responses of a clinician and an observer: clinicians feel the pressure to act fast in response to the urgency of a baby’s need, while observers may struggle with the experience of observing without having permission to act at all. The Practice of Psychoanalytic Parent–infant Psychotherapy is clearly structured and organised. It offers a thorough account of the theoretical and technical components of this psychoanalytic model, which draws on attachment and developmental research, followed by clinical papers which bring the therapeutic encounter to life. A thorough glossary of terms is followed by sections devoted to the theoretical and clinical framework. These provide a lucid account of the background, aims and therapeutic tools of this work, including some explorations of complex issues such as the countertransference, how to use the Adult Attachment Interview, and key clinical concepts such as ‘regulating emotional states’, ‘mirroring’ and ‘scaffolding’. Bullet points at the end of each chapter summarise what has been said: for example, ‘outcomes of good enough experiences’ and ‘not good enough experiences’ for babies, or ‘what constitutes attachment-related risk’. The preface suggests many uses for this book, but I think overestimates its accessibility to nonclinicians – a lot of the language is very technical. Perhaps it is best described as ‘a handbook for psychoanalytic practitioners’. We find out in these early chapters exactly why this work is done, how it is done, and how you know whether or not it is working. This is a major undertaking and an admirably clear account. Perhaps inevitably within these more theoretical and technical chapters, with all their explanatory and scientific zeal, one misses some of the mysteriousness, subtlety and complexity of human interaction, in parent–infant relationships as well as in clinical work. The second section is devoted to ‘the therapeutic process’, covering beginnings, middles and endings in clinical work, followed by a description of a therapeutic group for mothers and infants. The sense of urgency in this work of early intervention is strong, with clinicians making great efforts to engage hard-to-reach families – even literally, with one clinician going out and escorting a family to the clinic. There is also a range of thoughtful discussion about some clinical quandaries: for example, the impact of working directly with the baby, especially voicing his or her unmet needs. How might this feel to a vulnerable, underconfident parent? This is a major dilemma: ‘The therapist may feel that the parent needs to feel contained and understood before she challenges her JOURNAL OF CHILD PSYCHOTHERAPY