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Observation as an adjunct to psychotherapy—when a patient delivers prematurely

Abstract The addition of an observational matrix following the premature birth of the patient's first child, a boy, at 28 weeks gestational age led to a deepening of the treatment. Visits to the NICU and subsequent inclusion of the baby, who was brought to my office by his mother for psychotherapy sessions, highlighted themes related to survival and the need for a containing object for the baby, for the patient and for the therapist. Making room for the baby in the treatment shifted the patient's stance from one of cordial self-sufficiency and pseudo maturity, developed early in life to cope with an anxious, preoccupied mother, to one of greater openness to emotions and needs. These shifts, which occurred in the therapist as well as the patient, were evident in the transference and counter-transference as well as in enactments described in the paper. A film script, which the patient had written as student more than a decade earlier but only now recalled, astonishingly foreshadowed her later experience of delivering prematurely and also expressed the patient's long standing terror about pregnancy and birth. This was the most dramatic of several clinical vignettes evoking anxieties stemming from the patient's early experiences related to absences of the needed containing object – as well as her related failure to develop an adequate internal object that could reliably and comfortably contain and modify. Finally, I consider how and why the addition of an observational matrix led to a deepening of this treatment.