It is difficult to watch. On a videotape is a mother and a baby. Something is off. The infant, reclining in a plastic seat, looks ill at ease. He makes small fussing sounds. The mother, facing him, has a broad smile, and says, “What is going on? Are we a little annoyed? A little annoyed?” Her voice is rapid, high-pitched, friendly rather than aggressive. But the more they trade these signals back and forth, the more upset the child becomes.

This mother has been sent for therapy. She has mixed feelings about coming. Legally the court has required her to seek help at our unit. It is a mandated case of a rather typical kind. She is a single mother, somewhat isolated, in difficult economic straits, trying to make do with a four-month-old baby. The baby is not easy to handle, and on her side she feels inexperienced as a parent, and frightfully unsure of herself.

She is also a person prone to rage attacks. This goes on all too often between her and David, the infant. Recently in the night she lost it. David was crying intensely. She had already been up with him several times that night; nothing she had tried seemed to help. She grabbed him and started screaming. She shook him so violently he had to be brought later to a hospital emergency room. In that moment she lost control, it was all she could do to keep from throwing him against the wall.