Three to five months: early intuitions within a sense of not-knowing

By three months of age Ben struck me as very active and relating well to his mother except once when the thought crossed my mind as to whether he was autistic, a thought that I would not usually consider on so little evidence. He was vocalising, looking at his mobile, and his mother talked to him and touched his cheek, and I was surprised that he did not engage with her. She said that things were going well, and that Ben was a very good baby. She showed me where his fingers had been operated on. He was supposed to wear tight gloves all the time to minimise the scarring but she took them off every day to bath him, and because Ben did not like them she only put them on at night when her husband could help. She looked well and I thought how different this was from when she had been depressed after Dave's birth. When she changed Ben, there was a lovely interaction with him vocalising, and her fitting in beautifully. Her face was suffused with pleasure and adoration, a real losing of herself. While Ben was lovely when he was happy, I did not find him a particularly attractive child but found that hard to record.

The following week, I was surprised by my strong conflicting feelings. I had a sense of dread before visiting, which surprised me because I had enjoyed the previous visit. When Ben's mother came, she did not look quite as radiant as she had. There was a slight flicker of Ben's eyelid resulting in a very slight facial grimace and surprisingly I wondered whether Ben had a developmental delay. I also wondered if his mother was under a strain. I thought when she had put Ben in the bouncy chair a little distance from her that I would have held him on my hip. After the third failed attempt at the left breast, she tried him on the right, and he latched on immediately, sucking voraciously. Once or twice I thought that her smile at the children was slightly too brilliant. I was staggered when I thought, "Oh, good—nearly half way through the visit". After that, the time went quickly. She stroked Ben on his cheeks, and he looked in seventh heaven. She could not believe my visit had gone so quickly. I wondered afterwards whether I was sensing an unacknowledged depression.

When Ben had not immediately engaged with his mother on waking up I wondered fleetingly about autism. I would never have considered this on such slight grounds in previous infant observation or in clinical work. The following week I wondered about developmental delay, triggered by a slight flicker of Ben's eyelid and a grimace. That seemed to be all the "evidence" that I was aware of registering and usually I would not share such "unscientific" thoughts. The idea that he had a developmental delay was an intuition which I hardly trusted, and for which there was little evidence. In his second year, however, he was assessed as having a developmental delay. My trying to be in touch with his emotional states had led to me intuiting a difficulty at a stage when he was younger than he would be assessed as delayed.

I was struck that while he seemed to relate well to his mother, with many pleasurable feelings, from about three months onwards, however, when some interest in the observer might be expected, he often ignored me so that I wondered about him as developmentally delayed. (Rather than relying in assessment on what the infant does with the mother, that is, on a checklist kind of assessment, countertransference can begin to differentiate the existence of developmental delay or emerging pathology in the infant. Beebe (2003) argued that relating to the infant gives a therapist invaluable clues for understanding, and stated that the infant's capacity for engagement was an essential ingredient of her assessment.)

Intuition can take us by surprise or appear not to have a rational basis. The thoughts and feelings that come to mind with virtually no empirical evidence can feel farfetched or unduly blaming. The appearance in the countertransference of strong or uncomfortable images or metaphors is likely to have considerable communicative value. Of the dance of nonverbal communication between two people, Lieberman (2000) wrote that "when we get a sense of the other's state of mind as a result of nonverbal cues the other has emitted, we often have nothing other than our intuition to justify our inferences" (p. 123). The efficacy of intuition has, however, been supported in a study in the United Kingdom that shows that the intuition and clinical judgement of Health Visitors is likely to be as good as, and sometimes better, than information gained from the Edinburgh Postnatal Depression Scale (Leverton & Elliott, 2000).

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