ABSTRACT

The middle of the treatment holds the key to change in the parent-infant relationship. Even if the therapeutic alliance-the shared commitment to find a way of understanding and addressing the problem-still feels shaky, there is a sense that the process of engagement and negotiation is ongoing. There is hope that things will get better despite possible tension between the slow groundwork needed to build a therapeutic relationship and the fantasies brought and acted upon by the parent. For example, the therapist may be faced with idealization and unrealistic expectations on the part of the parent for a painless, almost magical resolution. Inevitably there is disillusionment and moments of despair where the therapist has to hold on to hope. If the process of engagement is strong enough, the parents accept that they have to come back session after session just as they have to get up night after night with their baby, having done something with the powerful emotions in play. Where parent and infant have come reluctantly, perhaps urged on by a referrer, the therapist may have to create hope-that change is possible and that she can bear the tedium and the pain of the material that they bring.