Parent Infant Treatment

Regression and Repetition as operative factors in psychoanalytic parent-infant psychotherapy

 

English version of a part of a lecture held by Angela Köhler-Weisker and Cornelia Wegeler-Schardt at the IPA - Congress in Berlin, July 25th- 28th, 2007

Please allow us to begin with a story: “The Story of the Weeping Camel“.

This story is told in quiet, unobtrusive pictures by Byambasuren Davaa, a film student stemming from Mongolia, and her colleague Luigi Farlorni.

It takes place on the outskirts of the desert of Gobi in Mongolia. It depicts the life of a group of traditional nomads living in their yurts along with their camel herds, sheep and goats. A camel is born. It is a long and painful birth.

Finally the foal has to be carefully pulled out with ropes tied to its limbs. The mare is already laying on its back and screaming, exhausted from the painful birth. Then the foal comes to her on shaky legs and wants to drink from her. The mare spits and screams, pushing the foal away again and again. She even kicks it. Finally the mare runs away, quite unlike the other camel mothers in the herd. The nomad grandfather and daughter understand that the mare cannot bond with her foal after her very difficult first birth. They carefully and softly try again and again to bring the two together. The mare runs away and trots far into the steppe. The foal stumbles awkwardly behind her mother but cannot reach her. The mare gives the impression that the foal had done something terrible to her.This reminds us of the extreme and anxious sensitivity of human mothers in the initial phase of bonding with their baby, when accepting the child and feeling accepted by the child takes place. Archaic feelings and fantasies are predominant in this phase.

 The newly born foal is white and looks different than the dark mare and all the other camels. Perhaps the mare is startled and feels alienated towards her foal. The foal becomes weaker and weaker, and all attempts to get the mare to let her child drink, fail. Then the Nomads, very concerned about this situation, decide to try the ,,Hoos ritual“, in order to heal the derailed dialogue between the mare and her foal. From far away a music teacher is engaged who is able to play a special instrument. 

Within the circle of the assembled family clan and with their completely concentrated attention, a young nomad woman hangs the stringed instrument to the Mare’s belly, allowing the evening wind to make tones by stroking the strings. As if the tones were to find resonance in the mare’s belly, where she felt injured. Thereby the defensive startled mare becomes visibly more quiet and begins to listen intently. After a while the woman gives the instrument to the musician and he begins to play. The young woman accompanies him singing a song with high long tunes during which she again and again firmly and softly strokes the mare’s belly. Everyone is listening attentively. Even the other camels turn their heads attracted by the duo’s tunes. lt seems as if the two musicians were trying to teach the - in the meantime - very peaceful mare and the apparently apathetic foal the right tunes  with their music and singing. The singer and the violinist are a couple in harmony. They show how beautiful it could be between the mare and her young one. Initially the mare defends herself a bit against the young one who is also resistant when led to her, until the mare finally allows her foal to drink for the first time. Tears roll out of her eyes, as if she were giving up her stubbornness.  At last the mare makes high tender tunes and her foal answers her. Both are now safe and secure in the family clan and the herd. Everyone around them has recognized her wound, respects it and understands her rejection and aggression.

(Angela Köhler- Weisker)

 

We have used this seemingly magical story as an introduction, because it shows with impressive images what we are trying to do in parent-infant psychotherapy. We listen to the parents’ suffering with their child and try to  understand their situation with empathy and psychoanalytic knowledge, seeking to bring the mother and her child close to each other.

 

Initially after birth the baby is a strange being for the mother. In order to keep the baby alive, she must accept it first. How well she is able to bond with her baby in this phase varies and depends on the extent of the injuries during pregnancy and birth, or her own childhood and biography, or her partner. Particularly the first childbirth is accompanied by specific fears: The fear whether the mother and child will make it through birth and survive; the concern whether the child is well developed and has no deformations; and whether the mother can feed the baby so that it can flourish and grow. On the other hand the physical and hormonal changes during pregnancy and the severe, painful, startling and overwhelming birth process prepare the mother psychically for the new state with her baby. The pregnant woman experiences a dependency and passivation beyond her control brought about by changes in her body, so she can grant space to a new being within her self. Women can experience these radical physical and mental changes in different ways, depending upon their tolerance of their own dependency: either as a special feminine strength and ability to grow or as a passive suffering creating a fear of losing one’s self and control. Disturbances of bonding can arise already at this early point. The experience of pregnancy and birth accompanied by pain bring about a regression of the mother’s ego in the service of progression. The dissolving of the mother‘s ego boundaries prepares the mother for the child and enables her to open herself for the newborn child with all its raw and primitive psychic states. Curiosity, pride and joy about her baby help the mother out of her chaotic and dissolved states. The love story with the baby which now begins allows the memories of pain to fade away and facilitates the restrucuring of her ego as mother with a child. Beginning with the first weeks after birth during which mother and father attend to their completely dependant baby, they learn to hold it and to understand it by empathizing with its suffering. This opens them for this new and alien experience. Winnicott calls this state of rapture and dissociatedness “primary motherness”: within this state the ego is subjected to storms of feelings comparable to falling in love. The mother centers herself around the child and the task to mother it. Everything else that was important up to now steps to the side and becomes temporarily insignificant. So in the first months mother and her baby are dependant on the help from their environment, which should create the space they need and acknowledge that she is a good mother for her baby and that she can be satisfied with herself and her child. In our culture the mother’s dependency in this phase is easily experienced as a loss of autonomy, and if the mother is left alone and her feelings of inadequacy are not contained the consequences can be very harmful.

 

Without help parents are left to themselves with their worries and their fears to fail as a new family. With the psychoanalytic parent baby treatment within the Frankfurt Infant Outpatient Department we are trying to substitute what in rural communities is usually offered by the family clan. The clan accompanies and holds the mother in the initial phase, protecting her from demands of the outside world, as well as from her own aversive feelings towards the child. Our work is based on infant observation (Esther Bick). Experiencing at weekly sessions how mother and child find each other, coordinate themselves and get used to one another in the course of their first year, gives us valuable insights and empathic images, not only for therapeutic work with older children and their families but also with adults. The images thus acquired allow us, as Daniel Stern says, to be more clearly aware of the very specific, spontaneous and preconscious “schemes of being together with an other” and to put them better in words. How the mother coordinates herself with the baby and responds to the stimuli coming from it, also forms the baby’s image of itself and of the mother. The infant is always open for new experiences, which rewrite the old ones so to speak, so that changes in relating to it also change how the child reacts and what it expects.

 

The mother communicates spontaneously and nonverbally with her baby by her body tonus, by touching and movements, her playful or serious facial expressions, her tone of voice and rhythm. She takes up the raw states of hunger, thirst, nausea, coldness, tiredness, boredom, pain, panic, and anger assailing the baby, and shares them with the child. She transforms these storms, by mirroring them, naming them and doing things that alleviate or even solve them. The constant exchange of the baby’s affects with the mother’s feelings brought about by its own affects, the mother’s translation of these affects and their transformation into motherly thoughts, actions and words convey something of her attitudes and feeling patterns to the baby. In this way her libidinous cathexis of the child gradually awakens and forms its inner life and also determines the quality of its bonding to her.

Where the mother is stuck or caught up in her feelings and thoughts, and the dialogue has derailed, the psychoanalyst can assist with her feelings and thoughts concerning mother, father and child. The field of our work is to widen the psychic capabilities of the parents, to consider the inner states of their child with them, and to perceive the child as a being capable of feeling and understanding, and to think with them about the baby’s states and the parental attitudes towards the baby. In this way we can increase the positive interactions between the parents and the child and free the dialogue of misunderstandings.

 

The misunderstanding can originate in old, not satisfied wishes and in the parents’ childhood experiences, that are not remembered – the “ghosts in the nursery” (S. Fraiberg), which have slipped in and remain hidden. Through the implicit, i.e. the preverbal and bodily exchange process between mother and child the “past unconscious” (J. and A.-M. Sandler) comes to the surface in the mother and in the father. The baby’s primitive defense mechanisms and its complete dependency actualize their own infantile history. The parents reexperience their own states of dependency with the  primitive defense mechanisms that go with them, and have therefore the tendency to unconsciously repeat their experience, though in a specific way: They want to avoid what they experienced as traumatic themselves which leads to gaps in their ability to empathize, and to barriers in thinking about their child. This happens unconsciously, even when they are determined to be better parents than their own parents were. But precisely because they are experiencing a state of partial regression, they are very accessible for psychoanalytic treatment: unconscious repetitive patterns and experiences are forcefully pushing their way up from the depths to the surface, because they have been resuscitated in the relationship with the child and the parents themselves are moving in a process of defining themselves anew.

 

Disturbances in the relationship with the child show themselves as so called regulation disorders for which no medical reason can be detected: e.g. when the child constantly screams, when it doesn’t sleep, doesn’t drink and has eating troubles, when it appears withdrawn and apathetic, or when it cannot come to rest. In this initial phase the child can only react psychosomatically. The physical expression reaching from withdrawal to overarousal, from uneasiness to muscular tension or from developmental delay to growth disturbance is in a certain way uniform. We try to understand these uniform symptoms in their individual different meanings, each with its own story.

In the session we direct our attention to three levels:

- to the activity of the child and its interplay with the parents, as well as to the states, feelings and thoughts brought about by them in the therapists,

- to the child’s history and

- to the parent’s unconscious intergenerational repetition.

The attentive listening of the analysts, as a “third” party coming from outside, brings about a transitional interim space, which functions as a stage (Annette Wattillion-Naveau). In successful cases the issues dealt with and preverbally staged can be transformed into an understanding of the symptoms through the analysts’ empathy and enduring of the feelings. Mentalizing the states oft the baby by communicating with the baby, the analysts make it possible for the parents to identify with them and with the baby. By taking up the feelings assailing everyone, the analysts are able to work them through. This process of identification allows the parents to have a new loving relationship with their child that had been formerly disturbed by for instance negative feelings. In the presence of the analysts the child feels the chance to send a meaningful message to the parents that it had only expressed as a symptom before. The moment when the child begins to do something, starts to “speak with us” or to act something out by expressing itself, contributes decisively to finding a new understanding. When the child’s “message” can be taken up and verbalized, it is possible to show that its actions are meaningful and connected with things the parents are discussing. When the baby for example shows a fear of separation or hunger, it might refer to the mother’s fear or hunger, because the child is so closely connected through the intimate sensomotoric contact to the mother’s experience. Interpretations that reach both the parents and the child together have a mutative effect. The new experiences that the analysts enable the baby to have and the changing attitude of the parents, result in a healing effect.

(Cornelia Wegeler-Schardt)

 

The authors:

Angela Köhler-Weisker, Dr. med., paediatrician, traininganalyst (DPV, IPA)  at the “Frankfurter Psychoanalytisches  Institut” and the “Anna Freud Institut”, Frankfurt, there 2001 cofounder of the „Babyambulanz“. Publications on Welfare of children, Focal Psychotherapy, Comparison of different psychotherapies, Infant observation. At present time ethnopsychoanalytical Research about the Himba in Namibia and research on the therapeutic process of parent infant psychotherapy with numerous publications together with Cornelia Wegeler-Schardt.

 

Cornelia Wegeler-Schardt, Dr. phil. in Philosophy, Classical Philology and History, Dipl.päd., Psychoanalytical Psychotherapist for Children, Supervisor and Teacher at the „Anna-Freud-Institut“ in Frankfurt am Main; assoc. Member of the “Frankfurter Psychoanalytisches Institut” (DPV); Cofounder of the Parent-Infant-Outpatient-Clinic at the Anna-Freud-Institute.

Publications on History of the Humanities at the Universities Göttingen and Vienna before and in the time of Nazi-Regime; on psychic and cultural Vicissitudes of migrated Adolescents, second generation; together with A.Köhler-Weisker numerous Publications on Psychoanalytic Parent-Infant-Psychotherapy; Teacher for Psychoanalytic Parent-Infant-Psychotherapy at the “Wiener Akademie für Psychoanalyse”.

 

 


What is parent-infant psychotherapy? 


Parent-Infant psychotherapy is supportive psychotherapy. The aims are not only to meet the immediate presenting problems in the baby or the toddler, but also to help the parent and child feel more positively about themselves and their interaction.

Some babies do not sleep well. Others reject the breast or will not let it go. Some seem sad and withdrawn, while others appear anxious and restless. Some cling to their mothers, whereas others avoid looking into their mothers’ eyes. Then there are the babies who seem well in the eyes of an outside observer, but whose mothers worry anyway. Some parents are anxious or uncertain about parenthood.

The relationship between the mother and baby has a history. While the mother’s history is long and the baby’s history is just forming, the therapist is trained to see how these histories affect the everyday interactions around the identified concerns of sleeping, feeding, playing, stimulation and regulation.

Parents and their infants are going through a momentous process of change in early development. In parent-infant psychotherapy, questions, worries and concerns are raised and addressed by focusing on the interaction between parent and baby This interaction goes on largely nonverbally. The parent-infant therapist is trained to pick up nuances of the relationship and put them into words, so the infant and parent can develop or continue to develop a healthy attachment.

The therapist helps the parent observe and address what works to reach the baby. The infant’s reactions to modifications lead to the next step in the therapeutic process until the problems are resolved.

The case of Anna

Here is a small example: Anna is a 4 month-old baby. Her mother, Susan, is depressed and crying because of her doctor’s recommendation to wean Anna early for medical reasons. Since Susan also had to put the baby in day care to go back to work, she is even more anxious about the bond between them and thinks her baby has withdrawn from her. Anna is very tense, looking at the therapist with a fearful expression but without tears.

The therapist is impressed by this young baby’s capacity for containing her emotions. The therapist describes this observation to the mother. Susan says that that’s exactly what she is afraid of, making her baby feeling lonely and too precocious, as she was herself with her own depressed mother. While Susan is deeply involved talking to the therapist, her attention is diverted from Anna who is slipping from her lap and begins to fuss. The therapist makes eye contact with Anna, waves and says,; “Hello, I see you!” Amazingly, Anna answers by doing the same motion with her hand. They start a kind of play at imitating each other and saying hello.

Susan observes, and the therapist affirms, that her baby is actually good at communication and very creative. Susan holds Anna firmly against her breast and starts playing by moving her hands and singing in order to amuse Anna, who begins to smile. Anna then sucks her thumb happily. Susan begins to explore the idea that she might modify the day care schedule and spend more time fully engaged with Anna.

In this simple exchange, Susan was able to recognize how her guilt and painful feelings of deprivation from her own childhood made it hard to really see her baby and to figure out how to be with her more. Her refocusing her attention on Anna helped to free the baby from her dispirited state. Susan could rediscover her own capacity to engage and delight her baby and feel like an effective mother. 

Published by the Columbia University Center for Psychoanalytic Training and Research http://psychoanalysis.columbia.edu/patients/children-and-teens/parent-infant-psychotherapy

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