Infant psychiatry clinic grand rounds. Unresolved grief: A two-year-old brings her mother for treatment

Rebecca was a 2 ¹/₂ -year-old Caucasian female who was brought to the Infant Psychiatry Clinic by her 28-year-old widowed mother. Her mother's chief concern was around parenting issues as well as how to explain to Rebecca the death of her father. This loss occurred when Rebecca was 6 months old and was a source of great pain and unresolved grief to her mother. Central to this case was the chaotic history of Rebecca's mother, who was a victim of incest from the time she was 13 until she was 23 years old. Both of her parents struggled with chronic alcoholism during much of her childhood. It appeared that a factor precipitating the mother's request for help was her struggle to move out of her own mother's home. This outpatient Infant Clinic case involved two primary goals: (1) the assessment of the parent-child relationship and (2) the development of confidence in this “good enough” mother. Vitally important to the process of treatment was the mother's modulation of timing and frequency of sessions. The issue of pacing was carefully monitored as this mother could have been overwhelmed by delving precipitously into her incestuous history. The use of a structured videotape interview to address mother-child interaction and parenting issues was particularly helpful. Referral to an AlAnon group provided the mother with social support as she separated herself from her alcoholic mother and moved toward autonomy in her own parenting role.     

How Do Mothers Feel About Their Very Low Birth Weight Infants? Development of a New Measure

The early relationship between a mother and her very low birth weight (VLBW; <1.5 kg) infant may be difficult to evaluate. Therefore, we aimed to develop a useful and practical method to describe a mother's early relationship with her VLBW infant. Mothers (mean age=27 years, 46% married) of 119 singleton VLBW infants (mean BW=1,056 g, mean GA=28 weeks) admitted to the neonatal ICU at Rainbow Babies and Children's Hospital completed a novel questionnaire regarding their feelings about their infant at 3 weeks' postnatal age, and at 35 weeks', 40 weeks' (term), and 4 months' postmenstrual ages. Factor analysis of initial interview data was used to construct subscales to measure unique domains hypothesized to underpin the beginning maternal–infant relationship. Three subscales were identified: (a) The Worry subscale focuses on the mother's concerns about her infant's current medical condition and future development, (b) the Enjoyment subscale examines the mother's positive feelings about and responsiveness to her infant, and (c) the Separation Anxiety subscale examines the mother's mental anxiety about being physically separated from her infant. Statistical and clinical validation of the subscales produced positive supporting evidence that the subscales are a meaningful measure of the mother–infant relationship. We have developed a unique and practical measure for describing the early mother–VLBW infant relationship.     

The early appearance and intergenerational transmission of maternal traumatic experiences in the context of mother-infant interaction

The paper describes the case of a girl of 8 weeks, referred by her mother because of 'intolerable hysterical attacks' triggering maternal impulses of abuse. Maternal perception of her infant was distorted to the extent that the mother was re-experiencing encounters with her own intrusive and traumatizing mother in the face of her screaming child. She also perceived the infant's motor impulses as physical attacks on herself and expressed intense anxieties about her daughter's future aggressive potential. The infant was viewed by her mother as extraordinarily and dangerously greedy. Even neutral infantile vocalizations were perceived as manipulating and sadistic. She tried to ward off these anxieties by employing a rigid scheme of rules and obsessively controlling the father's and grandmother's interaction with the child. The mother feared being overwhelmed by the infant's needs if she were to yield to them in a flexible way. The mother's background of early neglect and trauma is described, in the light of recent literature about the early intergenerational transmission of traumatic experiences, in order to demonstrate possible treatment modalities and the need to consider both protective and risk factors.     

The subjectivity of the mother in the mother–son relationship. Attachment,separation, and autonomy

Abstract

Margaret Mahler and John Bowlby's positions are crucial in understanding the tensions that can arise in mother–son relationships. A more recent development of a systems view illuminates the co-construction of this relationship that occurs mainly out of awareness. A systems model of development that describes the co-construction and bi-directional influence between mothers and sons will be used in this paper. The often-neglected subjectivity of the mother is the focus, and the relationship between the mother and her adult son is viewed as a process whereby all participants strive to achieve a balance among attachment, separation, and autonomy. In addition, the contributions of the mother and the impact on her of the son's difficulties in attachment, separation, and autonomy are highlighted. In a case illustration, the subjectivity of the mother in relation to her son is explicated, showing how the son distances himself from his mother and why themother is at a loss to understand how and why this has occurred. The mother's perspective was dominated by anger and disappointment toward her son as well as by self-blame and self-justification. As a result of psychotherapy, the mother was enabled to come to terms with the estrangement of her son.     

Development of a structured psychiatric interview for children: Agreement between child and parent on individual symptoms

To test the reliability of children's reporting as compared with that of their mothers, a highly structured psychiatric diagnostic interview was used with 307 subjects, ages 6 through 16. Another interviewer gave each mother a similar interview about the child. Responses of each mother-child pair to 168 questions were compared using the kappa statistic. Highest agreement was found on questions concerning symptoms that are concrete, observable, severe, and unambiguous. Mothers tended to report significantly more behavioral symptoms, and children more subjective symptoms. Reasons for low kappas and asymmetrical reporting of symptoms are discussed.     

Between Races and Generations: Materializing Race and Kinship in Moraga and Irigaray

Juxtaposing Cherríe Moraga's Loving in the War Years and Luce Irigaray's Speculum of the Other Woman, I explore the ways that sex and race intersect to complicate an Irigarayan account of the relations between mother and daughter. Irigaray's work is an effective tool for understanding the disruptive and potentially healing desire between mothers and daughters, but her insistence on sex as primary difference must be challenged in order to acknowledge the intersectionality of sex and race. Working from recent work on the psychoanalysis of race, I argue that whiteness functions as a master signifier in its own right, and as a means of differentiation between the light‐skinned Moraga and her brown‐skinned mother. Irigaray's concept of blood deepens Moraga's account of her healing and subversive return to her mother. The juxtaposition of Moraga, Irigaray, and contemporary psychoanalysis of race can allow for a necessary revision of Irigaray's psychoanalysis that acknowledges the ways in which sexual difference is indexed by race and sheds new light on her account of the mother–daughter relation.     

Demeter's Compromise: Separation,Loss, and Reconnection in Mothers with Daughters Entering Adulthood

Drawing on contemporary theory of female development that focuses on the dynamics of the mother/daughter relationship regarding issues of separation and individuation, this article examines the treatment of a middle aged mother as she navigates her way through her daughter's adolescence and early adulthood. Psychoanalytic object relations, psychoanalytic relational theory, and feminist theory serve to frame an understanding of the case material in terms of developmental challenges that are uniquely female. Issues around mother/daughter attachment, separation, competition, conflict, and love are explored in the relationships between the patient and her mother, the patient and her daughter, and the patient and the therapist. The therapist's countertransference, intensified by her relationships with her own mother and daughter, suggests the possibility of both pitfalls and opportunities in the treatment. The article attempts to address a gap in psychoanalytic developmental theory, which offers little understanding of the challenges for women in midlife.     

“Keeping It in the Family”: Sarah Kofman Reading Nietzsche as a Jewish Woman

This article examines Sarah Kofman's interpretation of Nietzsche in light of the claim that interpretation was for her both an articulation of her identity and a mode of deconstructing the very notion of identity. Faulkner argues that Kofman's work on Nietzsche can be understood as autobiographical, in that it served to mediate a relation to her self. Faulkner examines this relation with reference to Klein's model of the child's connection to its mother. By examining Kofman's later writings on Nietzsche alongside her autobiography, this article contends that Kofman's defense of anti‐Semitism in Nietzsche serves to fend off her own ambivalence about being Jewish.     

A Review of “Mind to Mind: Infant Research,Neuroscience, and Psychoanalysis”

Abstract

This article examines current research pertaining to the relationship between a mother and her children, and how this relationship may affect sibling interactions. Issues such as temperament, gender, and the age gap between children are also explored to ascertain their impact on the sibling relationship.

The displacement of the first-born child and the ensuing sense of loss and anger he may experience as a result of this is explored. The mother's second pregnancy is also discussed in regard to the impact of unresolved issues relating to her own sibling relations. The mother's interactions with each child, her role as a model for identification, and marital relations are discussed in light of their impact on sibling relations.

The evolution of a positive attachment between siblings is explored. Rivalrous behavior between siblings is also discussed, particularly in association to the mother's treatment of her own children and the manner in which the mother deals with her own aggression.     

Lucy's dividing family: My discovery of the person in the subject

Abstract

This essay is excerpted from a larger project the author conducted with adolescent and preadolescent children of divorce. It tells the personal story of the author's first interview experience with her first participant in this project, here called Lucy. At the time of the interview, she was 11 years old and her parents had been divorced for 3 years. In the effort to engage the reader as an outside interpreter of her story, this essay invites the reader in, to the “raw data” of Lucy's experiences, as described in her words. Presented here in dialogue are the two voices of participant and researcher, as well as researcher reflections and recollections of this memorable experience.     

Crippled feet

Critics of Lars von Trier's film Antichrist have regarded the depicted woman's destructive fury as difficult to understand. In this paper, separation anxiety is discussed as a central unconscious motivation behind the aggressive interaction between husband and wife, and the child is discussed as an obstacle to the mother's exclusive relationship with her husband. The film powerfully conveys how sadistic aggression is unconsciously acted out between mother and son, as symbolized by the mother's crippling of her son's feet. The woman's violence is also a reaction to a her husband “therapist” who, wishing to correct her, fails to understand and contain her inner world, wherefore the therapeutic dialogue itself, disguised as help, is experienced as violently aggressive. This in turn engenders a wish for revenge. Against this background, the film is seen as a critique of cognitively oriented therapy.     

Mens sana in corpore sano: Psychotherapy with a cerebral palsy child aged nine months

This paper is the acount of the psychoanalytic understanding and treatment of a nine-month-old cerebral-palsy infant and her mother. When first seen, Abigail hung over her mother's arm, and would scream unceasingly if moved from this position. The mother-child relationship seemed to involve their sticking to each other without looking or losing contact. The mother's hidden hate, anger and resentment were communicated non-verbally and Abigail showed signs of finding it difficult or impossible to integrate experiences, given the amount of trauma she had suffered from an attempted abortion and the lack of enough experience of being loved to enable her to grow internally.

The process of assessing the internal world of the infant and her mother, and the thinking and planning of the psychotherapy that followed, are described. In order to promote the secure attachment of the mother-child dyad, and the emotional growth of both, the helping process focused on understanding both the baby's and mother's states in order to make sense of the child's inner world to the mother. Because of the acute pain this process involved for the mother, she was treated individually too, by a different therapist.     

A psychotherapeutic technique for mother-child intervention: A case study of a japanese down syndrome child

The purpose of this paper is to demonstrate our approach to the activation of mother-child interaction, by presenting a case study. We describe a Japanese mother's adaptation process (consisting of five stages) to her child's handicap through 6 years of continuous therapeutic support for both the mother and her child. In this particular case, the mother suffers from a mild form of cerebral palsy; therefore, the problem involves two generations, because both the mother and her child are handicapped. By analyzing the processes of this case, we also describe our method of intervention for problems in the development of multidimensional relationships. We discuss the mother's psychological maturation and the role of the therapist within the Japanese social and cultural context, under the following headings: (1) Sharing in the Mother's Ambivalence; (2) Natural Melting of the Mother's Frozen Emotional Availability; (3) Sharing in the Mother's Illusion and Disillusion; (4) Transformation of Relationships Between Family Members and Their Relationship to Society.     

Female Passion and the Matrix of Mother,Daughter, and Body: Vicissitudes of the Maternal Transference in the Working Through of Sexual Inhibitions

The maternal object is rarely seen as a girl's source of identification as a vibrant, sexually desirous woman. In this paper, I propose that the mother's capacity both to convey her own pride and pleasure in her female body, its sexual and procreative capacities, and to confer the privilege of passion on her daughter is requisite for a girl's full, pleasurable possession of her body and sexuality. Using observations from two analyses, I explore ways in which transformations of the negative transference manifestations of thwarted maternal sexuality and its pernicious expressions within the mother–daughter relationship paralleled recovery of a fuller capacity for sexual pleasure and agency. To offer clinical pathways toward development of female analysands' capacities for feminine pride and sexual passion, theories must allow for adaptive resolution of oedipal-period conflicts—resolution that can lead to a mature mutuality between mother and daughter.     

A home of her own: (Writing) a family story of separation and second chances

Abstract

On March 16, 1996, the author interviewed her mother, Beth Tillmann, about Beth's parents' divorce and her life as a foster child. From detailed notes taken during this phone conversation and from family stories told to the author throughout tier life, the author constructed a narrative titled “A Home of Her Own” Its structure and tone mimic the way her mother speaks about the dissolution of her family of origin and her attachments to and separations from those who tried to lielp her rebuild a sense of home. After the story is a discussion of what narrative representations of loss offer the writer, the subject, and the reader.     

Clinical interventions in parent-infant groups around issues related to separation-individuation

Parent-child groups as an educational method in a general hospital setting provide support for parents and an environment in which they can discuss their questions about their child's development. This paper illustrates the clinical use of parent-child groups as a means of early intervention in problems that become apparent during the Separation-Individuation stages of development. We present two case studies of mother-child pairs, who have been members of the group for 2 years. The first case is a bi-racial child whose mother is struggling to deal with the child's rapprochement stage behavior. Through the oral and anal stages, conflict has grown in their relationship due to the mother's way of viewing her child, as well as her own unresolved adolescent separation difficulties. The second case is an overprotective mother whose own pathology prevented her daughter from resolving her rapprochement crisis. Interventions by the leaders as well as the group's educational method help both mother-child pairs to resolve interpersonal conflict and to continue their essentially normal development.     

Relation‐based intervention with at‐risk mothers: Outcome in the second year of life

It has been shown that the UCLA home visiting/mother–infant group intervention made a significant positive impact during the child's first 2 years of life on two indices of the mother's support and on three areas of mother–child and child development: (1) The mother's responsiveness to the needs of her child and the related development of his or her security of attachment; (2) the mother's encouragement of her child's autonomy and the related development of his or her autonomy; and (3) the mother's encouragement of her child's task involvement and the related development of his or her task orientation. By child age 2 years, the mothers experiencing the intervention, in comparison with those that did not, also used verbally persuasive as opposed to coercive intrusive methods of control and their children responded more positively to these controls. Mothers who did not experience the help of the intervention had significantly more difficulty controlling their child if it was a boy as opposed to a girl. They used the least appropriate methods of control, and the boys responded more negatively to these controls. The nature of the development of the mother's use of appropriate controls and the child's response to that control was elucidated by determining on the total sample where 12‐month antecedents influenced the indices of control either independently of or in interaction with the intervention status. The child's endurance in the test situation was an independent predictor of mother‐appropriate control and the child's positive response to that control, while the absence of maternal intrusiveness further enhanced the impact of the intervention on that control. ©2001 Michigan Association for Infant Mental Health.     

Watching,waiting, and wondering: Applying psychoanalytic principals to mother-infant intervention

There is general acceptance that the intergenerational repetition of relational patterns is transmitted within the interactions between mother and infant. The highly invested nature of the mother-infant relationship makes it a prime arena for the playing out of unresolved relational conflicts of the mother. This occurs through the mother's responses to her infant in which she projects into the infant certain disavowed but highly invested positive or negative attributes. This leads to the interactional re-creation of a whole relational system reflecting the mother's current and past relationship experiences. When a mother's conflictual past is unresolved and unmitigated by current relationships, her interactions with her infant are more driven by such perceptions than by real appraisal of the infant's actual attributes. The sleeping, eating, and behavioral management problems of infancy are often manifestations of such situations. A deceptively simple set of instructions to the mother, to become a nonintrusive observer of her infant and only interact at the infant's initiative, allows a role for the infant's initiative in changing interactions and thus potentially changing a relational system.     

The Atonement of the Alleged Perpetrator's Daughter: Understanding of Model Scenes and Space Attachment in Analytical Dance Therapy

In this rich paper the analysand Annabelle is sent by her analyst to the dance therapist who reports in great detail how Annabelle manages to throw off and—to a certain extent—integrate not only her own life-long misunderstanding but also those of her parents. The reason for Annabelle's referral was straightforward: the analysis had ground to a halt. Words no longer reached her. The reader is reminded of the emotive-relational-motor clusters described in Chazan's and Shahar-Levy's papers. Body image distortions and space misperceptions curtailed this patient's ability to function. When she began to bring her distress to her analytic dance therapy sessions, she could not associate verbally but made use of props her therapist had in store. As she slowly progressed toward true symbolization and expression, her therapist found herself embroiled countertransferentially. The patient's long-suffering mother was remembered as someone who would, or could, only give partial information about the family's history. The father had been a Nazi and was now blamed for all the suffering the family had lo endure. This fact resonated both with Annabelle's analyst and the dance therapist who managed to take a long look at their own family's records during that troubled time.