COCAP Children's Minds in the Line of Fire Blog
The use of technology in the observation of the parent-infant relationship, Bick method, in the SARS-COV-19 Pandemic.  Losses and gains

Author: Dr. Ester Malque Litvin

The Bick method of observing the parent-infant relationship was created by Esther Bick who, in 1948, included it in the course for child psychotherapists at the Tavistock Clinic. It is a method that contributes to the psychoanalyst’s training through the difficult task of “observing", that is, of receiving emotional experience prior to organizing it into a theoretical framework, (E. BICK, 1964). The observer experiences the emotional impact of being included in a family, without feeling committed to play roles that can be attributed to him, such as counselor or judge. The observer strives, as far as possible, to refrain from distortions in the environment. He also works to be as attentive as possible to his own emotions and to abstain from judgment in relation to what he observes (E. BICK, 1964). As Daghighi observes,"For many, this more passive role is a struggle and a revelation. Many health professionals in particular have been trained as "doers". Just being there can be quite hard".  (Daghighi, S.  et al, 2020)

The sudden traumatic situation of the COVID-19 pandemic and the consequent social restrictions made it impossible to go to the family's home, as the Bick method dictates. This method is integral to the training of psychoanalysts from various psychoanalytic institutions in our area and institutes wrestled with whether it could continue remotely. As Daghighi writes, “The defective capacity that is required to do this is an important part of  the equipment of  many professionals in the area of Infant and Child Health"(Daghighi S. et al 2020).

We accepted the challenge of using technology, and we started observing via whats app video call on our cell phones.

Online observation has its limits, but we also discovered some gains. First, it demands from the analyst an even more malleable mental space. Second, it widens the setting, allowing the observer to accompany the infant and family in a greater variety of settings. For example, when baby G. and his mother went shopping and the observer "went along.” (Zuanazzi J.B, 2022). At some point, the cell phone stopped being just an object and became another character in the setting. At 7 months old, baby G., looked at the cell phone screen and smiled. We wondered what he saw on the screen. The observer or himself? His father said to G.: "It’s J. (the observer)! Say hi to her. I know you want to hug J., but we can’t do it on the cell phone.” (Zuanazzi J.B, 2022) This description allowed us to understand the place the cell phone acquired as part of the frame.  The observer is clearly "present".  

A triangular mother-baby-observer relationship is usually built on in-person observation. However, in online observation, we observe for a longer time a mother-infant dyadic relationship. In some cases, the observer remains outside and becomes “the intruder”.  With online observation, the observer has to bear less agency than he has in in person observation. It is up to the parent whether to allow an observer in or not. Thus, in the case of G.’s father , one can observe how the observer is included when he says, "G., do you know that it will be a year since J. is with us?" The baby looks at the father and then at the cell phone screen.  (Zuanazzi J.B, 2022)

In the online mode, the observer cannot choose the angle to observe the mother-baby relationship. It is the mother who chooses. Sometimes the mother holds the cell phone for us to observe the baby, and we cannot observe the dyad. Thus, the scenes or angles selected by the mother with the lens can help us to understand what the mother wants to reveal or veil. 

In remote work, the observer also has to contend with the potential of being “turned off” at any moment. "I was dropped several times". (Daghighi, S. et al, 2020). The baby S. "blows kisses and cuts off the communication. She is the one to end the observation (...) leaving the observer". (Magagna & Cardenal, 2020)

In person, the observer is flooded by many different sensations. He has a wide view of the environment. He can circulate in space and help the baby if it is in danger. In online observation, the anxiety with which the observer is confronted is greater due to the impossibility of being able to act in risky situations. 

The three-dimensionality is missing in online observations. The screen gives us a two-dimensional, shallow view, limiting the detailed observation of the baby’s and caregiver’s gestures and gaze. As the baby begins to move, in the face to face modality, he proposes a direct, bodily interaction with the observer. Yet, we also observed that even through the screen, the babies seek to interact. They are curious. They know the person who weekly appears on the screen, silently but attentively.

Some of these observations allow us to say that it is possible to accomplish the observation of parent-baby remotely, with losses and gains. Perhaps, in some cases, we have lost the intensity of the emotional impact that physical observation can provide: "With the lockdown, each of us moved to the other side of the mobile phone gazing at each other, half real, half virtual; parts appearing and parts missing. The physical body of the observer acting as a sender and receiver of emotions is minimized and her eyes are replaced by the lens of the camera. The magic is gone!" (Daghighi S. et al, 2020).

We also discovered that the online observation highlighted the task of learning to "only" observe (Litvin EM, 2015), without intervening and without judging. It focuses the work of tolerating the way each mother deals with her baby, without rushing to theorize and interpret.

During this period of incredible disruption, we also observed that the observer continued to play a significant role in families routine, "offering a certain degree of continence, continuity and stability in these times of social isolation," ( Magagna & Cardenal, 2020). The observer could be one point of reflective continuity to contain some of the upheaval these families were contending with.

We also observed differences between observations that began online and those that went from in-person to online as happened with the case of S., who was 18 months old at the time of the COVID lockdown. The first online observation occurred 30 days after the COVID lockdown. Magagna and Cardenal (2020) report that in these 30 days that the family was without the observer, after 18 months of face-to-face observation, S. suffered losses in her development as “repetitive physical behavior with less symbolic play, fewer words and less interest in exploring widely.” Psycho-motor arousal and “an urge to control electronic devices replaced her explorations and she seemed to use these ways to calm her frustration and despair at being confined. (…) S. glances at the mobile phone from time to time and frowns when I talk. Then she looks towards the TV. Mother tells her to say hello to me and send me a kiss. (…) She opens and closes her mouth quickly, several times, clenching her teeth and making a sound, “Yai-yai-yai”. (…) Her mother coaxes her to blow me a kiss, S. puts her open palm against her mouth, kisses it and blows (...) Perhaps she is trying to work out the difference between people on TV, and this person, her observer who used to visit the house, and is now on a screen”. (Magagna & Cardenal, 2020) 

The use of technology was  inevitable during the COVID lockdown, as it was the only way to give continuity to the observation of the parent-infant relationship. Like so many aspects of clinical work during the pandemic, these adaptations in Bick’s method required flexibility from observers, families, and coordinators of the seminars. 

Author Bio 
Dr. Ester Malque Litvin
Psychoanalyst – Brazilian Psychoanalytic Society of Porto Alegre
Supervisor in Observation Parent-Baby Interaction 
COCAP Member to Latin America
Daghighi, S., Amini, M., Dodangeh, N., Hashemzadeh, M., Kiani Dehkordi, M., & Nekouei Shoja, N. (2020). “‘Tele-observation’ (with mobile phone) of infants discussed in online infant observation seminars during the ‘new normal’ of the Covid-19 pandemic”. Infant Observation, 23(1-2), 7–15. 
Bick, E. (1964): “Notes on infant observation in psycho-analytic training”. The International Journal of Psycho-Analysis, vol. 45. 1964.
Litvin, E.M. (2015) “Qual a utilidade de “só observar” sem intervir com uma interpretação”. Encontro Latino-Americano de Observação de Bebês Segundo o Método de Esther Bick, apresentação da ALOBB e AIDOBB. (comunicação oral). Porto Alegre.
Magagna,J. & Cardenal, M. (2020) A video-linked professional development event in Argentina, discussing infant observation in the style of Esther Bick: a discussion of two online observations of a baby in her family, during the COVID-19 lockdown, 13th August 2020, Infant Observation, 23:3, 116-132, DOI: 10.1080/13698036.2021.1876944
Zuanazzi, J. B. (2022) Observation reports, at the parent-baby relationship observation supervision seminar, under the supervision of Ester Malque Litvin. CEAPIA (Center for Studies, Care and Research of Childhood and Adolescence). Porto Alegre.

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