Studying the process of psychoanalytic parent–infant psychotherapy: Embodied and discursive aspects

This paper presents findings from an intensive, mixed methods case study of one session of psychoanalytic parent–infant psychotherapy (PPIP) addressing early relational trauma, and aims to shed light on the multimodal interactive processes that take place in the moment-to-moment exchanges comprising the therapeutic encounter. Different research methods were used on video material from PPIP sessions, including microanalysis of adult–infant interactions, discourse analysis of talk, and coding systems developed to study parent–infant interaction. These different perspectives were brought together with the clinical narrative to illuminate the complex, dynamic processes of parent–infant–therapist interaction. More specifically, the detailed analysis of one interactive episode revealed brief behavioral manifestations of fearful and disoriented states of mind, reflecting dysregulated interaction between mother and infant, which also powerfully affected the therapist. The processes through which the therapist gradually resolves this rupture are also described in detail. Through this pilot study, we were able to show that it is possible to systematically study the process of PPIP. The study contributes to the growing psychotherapy research literature that takes into account both the verbal domain and implicit, interactional processes in therapeutic practice, and underscores the therapist's comprehensive engagement in the therapeutic process.     

Brief mother–infant treatment: Psychoanalytically informed video feedback

Specific patterns of interactive regulation documented by microanalytic methods of infant research can be applied to clinical interventions with mothers and infants. A brief treatment model is described that includes face‐to‐face split‐screen videotaping (one camera on each partner) and therapeutic observation of the videotape with the parent. The intervention uses “video feedback” informed by a psychoanalytic approach, including positive reinforcement, modeling, and information giving, as well as interpretation, while watching the videotape. Specific interactions in the areas of attention, arousal, affect, and timing regulation are evaluated. The psychoanalytic intervention links the “story” of the presenting complaints, the “story” seen in the videotape, and the “story” of the parent's own upbringing. An attempt is made to identify specific representations of the baby that may interfere with the parents's ability to observe and process the nonverbal interaction. The mother's powerful experience of watching herself and her baby interact, and our joint attempts to translate the action‐sequences into words, facilitates the mother's ability to “see” and to “remember,” stimulating a rapid integration of the mother's procedural and declarative modes of information‐processing. One treatment case, involving six contacts, is presented to illustrate the approach. By applying the specificity of interactive regulation identified by microanalysis of videotape into the psychodynamic treatment of mother–infant pairs, basic research can be translated into clinical practice. ©2003 Michigan Association for Infant Mental Health.     

PSYKOANALYYSIN URANUURTAJAT SUOMESSA

This article discusses how the individual, on different levels of relating, connects towards the otherness of other persons. In Winnicott's theory, this may be seen as a fundamental issue in child development, psychoanalysis, and in psychoanalytic psychotherapy as well. In “holding”, the otherness and subjectivity of the caretaker is implied, but not recognized by the individual—care is taken as a given. In “mirroring”, the otherness of the other person is implied and dimly recognized by the individual, but only appreciated within an omnipotent frame. The full recognition of otherness comes through the “destruction of the object”, a process that also opens up for a relation to a “third” other, and for oedipal themes. In this article, these different levels of relating to otherness are viewed as a search for a “meaning bearing other”. That is, someone who allows the possibility of meaningful thoughts and feelings, either through his or her actual communicative presence, or as an unconsciously-imagined communication partner. This postulate is discussed and illuminated through a case study of a 6-year-old boy in psychoanalytic psychotherapy.     

The Apollonian Eye and the Dionysian Ear

A comparison of the aesthetic underpinnings of psychoanalytic praxis is undertaken using Nietzsche's distinction between Apollonian and Dionysian tendencies. Drawing from Nietzsche, Freud, Lacan, Jung, and Stephen Mitchell as well as research and theory from the study of infant–parent interaction, the author offers a clinical case to illustrate a perspective that gives more emphasis to Dionysian forces in psychoanalytic activity than in traditional case reporting, thus illustrating the utility of such an expansion of underlying assumptions for psychoanalytic praxis. The perspective highlights the importance of attention to “faintly conscious stimuli” on nonsymbolized embodied registers of interaction for their significance in the communication of affective meanings.     

A Comparative Assessment of an Analysis of Envy: Commentary on Paper by Julie Gerhardt

This discussion is introduced with emphasis on the need for comparative psychoanalytic studies in our pluralistic psychoanalytic world and describes an approach to such an endeavor. A very brief comment on the extensive literature review is followed by a more detailed focus on the “analysis of envy,” which gradually changed into the analysis of the patient, as a person. The discussant's “empathic entry” into the analyst's mode of listening and responding was simultaneously also applied to the patient's experience, to see how well patient and analyst communicated with each other and whether or not the patient indicated that she felt understood or not. When she did not feel understood, the patient signaled this with an intensification of her envy into furious “envy attacks.” The analyst's “decoding interpretations” implied that the patient was causing her own problems and should not feel the way she did. The analyst discovered this later herself. Her discoveries in the fourth year of the analysis yielded notable changes both in her approach and in the patient's progress. Ultimately, the analyst allowed her subjectivity to enter the analysis and became better amalgamated with her chosen theory, leading to the changes in a progressively more fruitful analysis.     

Parent‐infant‐psychotherapy and psychoanalytic treatment: contradiction or mutual inspiration?

Psychoanalysis and parent‐infant‐psychotherapy are compared. Although parent‐infant‐psychotherapy developed from psychoanalysis, it appears at first glance not to be “analytic” with its aim of dealing quickly with the symptoms presented and also with its different setting. The author shows that an analytic approach in understanding the multi‐facetted net of relationships between family members and the infant in its “phantasmic interaction” and a consideration of the implication for analysis of the empirical research carried out in conjunction with parent‐infant‐therapy can lead to a fruitful exchange of ideas. One example of this is research into the correlation between attachment patterns and the processing of conflicts. Furthermore a dialogue between these two disciplines can remind psychoanalysts that a critical discussion of the external circumstances of their methods does not immediately call into question their fundamental approach to therapy: the work in transference on relationship fantasies.     

Transferences in parent–infant psychoanalytic treatments

In parent–infant treatments, babies sometimes exhibit symptoms such as screaming, clinging, and fearful gaze avoidance of the analyst. The paper investigates if such phenomena may be regarded as transference manifestations, and if so, if they appear both in younger and older infants. Based on three case presentations, it is concluded that some babies are capable of forming both brief and enduring transferences. The term “indirect infant transference” refers to when a baby reacts emotionally to the analyst as long as the parent's transference remains unresolved. “Direct transference” refers to when a baby reacts in a non‐mediated way to the analyst. The necessary tool of investigation for discovering these phenomena is a psychoanalytic method with an explicit, though not exclusive, focus on the baby. Discerning them in the clinical encounter may help us understand the baby's predicament and when and how to address the baby or the parent. These treatments constitute an empirical field awaiting more extensive clinical and theoretical investigation. Already now, they suggest that transference may be rooted in, and may appear during, very early developmental stages. The paper's positions are compared with those put forward by other parent‐infant clinicians.     

Infantile defences in parent‐infant psychotherapy: The example of gaze avoidance

Findings from parent‐infant observational research have stimulated the development of intersubjective models of psychotherapeutic action. These models have brought out the infant as an interactive partner with the parent. Conversely, interest in describing the individual psyche of the baby has decreased, especially the unconscious levels of his/her experiences and representations. In parallel, clinicians and researchers have been less prone to apply classical psychoanalytic concepts when describing the internal world of the infant. The author argues that this is inconsistent with the fact that psychoanalytic theory, from its inception, was founded on speculations of the infant's mind. He investigates one such concept from classical theory; the defence. Specifically, he investigates if selective gaze avoidance in young babies may be described as a defence or even a defence mechanism. The investigation links with Selma Fraiberg's discussion of the phenomenon and also with Freud's conception of defence. The author also compares his views on the baby as a subject with those suggested by infant researchers, for example, Stern and Beebe. The discussion is illustrated by vignettes from a psychoanalytic therapy with a 3 month‐old girl and her mother.     

THE EYE OF THE BEGETTER: PREDICTING INFANT ATTACHMENT DISORGANIZATION FROM WOMEN'S PRENATAL INTERPRETATIONS OF INFANT FACIAL EXPRESSIONS

Infant–caregiver attachment disorganization has been linked to many long‐term negative psychosocial outcomes. While various prevention programs appear to be effective in preventing disorganized attachment, methods currently used to identify those at risk are unfortunately either overly general or impractical. The current investigation tested whether women's prenatal biases in identifying infant expressions of emotion—tendencies previously shown to relate to some of the maternal variables associated with infant attachment, including maternal traumatization, trauma symptoms, and maternal sensitivity—could predict infant attachment classification at 18 months postpartum. Logistic regression analyses revealed that together with women's adult history of high betrayal traumatization, response concordance with a normative reference sample in labeling infant expressions as negatively valenced, and the number of infant facial expressions that participants classified as “sad” and “angry” predicted subsequent infant attachment security versus disorganization. Implications for screening and prevention are discussed.     

SPONTANEOUS “CURES”: NORMAN REIDER'S FORGOTTEN PAPER,PART II

Part I of this paper combined an introduction to Norman Reider's original 1955 paper with a republication of the paper itself. Part II is a discussion of the complexities of a comparison of past and present psychoanalytic literature. The concept of enactment is proposed as one of many possible alternative views in considering Reider's notion of spontaneous “cures.” A careful consideration of these spontaneous cures within the ordinary ups and downs of any psychoanalytic treatment sheds important light on our continuing confusion about how we define the term cure, and therefore about the nature of change during psychoanalytic treatment. This alternative perspective is only one of many plausible ones for present‐day readers. The purpose of this republication is not to propose an explanation for “what really happened” with Reider and his patients; rather, it is to reconsider the fallacy of evaluating his paper outside its historical context and thereby failing to appreciate his courage in presenting what at the time were radical views. Questions about the complexity and confusion regarding cure and change require reexamination of the neglect of epistemology on the part of psychoanalysis in prolonging the confusion about distinguishing psychotherapy and psychoanalysis.     

Pete the diesel: Psychotherapy with a severely disturbed five-year-old boy

The psychic significance of the figure of the grandmother in psychodynamic psychotherapy has received scant attention. This paper develops the concept of the ‘grandmaternal transference’ in parent–infant psychotherapy and explores its identification, its possible functions and its therapeutic significance. The grandmaternal transference has special relevance to parent–infant psychotherapy since the grandmother often represents both the mother’s mother and the child’s grandmother and offers a unique third position between mother and child. Three clinical vignettes illustrate how the grandmaternal transference may operate in this third position. In the first vignette, the therapist becomes in the transference a containing grandmother thereby facilitating maternal containment. In the second case, the therapist may be experienced as a differentiating grandmother able to help mother and infant with separation and individuation. In the third one, the therapist is transferentially experienced as a paternal grandmother who acts as a pseudo-father able to embody the paternal function. In each of these positions, the transference and countertransference – whether positive or negative – require that the therapist responds to rather than enacts the grandmaternal role. The three configurations of the grandmaternal transference have different clinical manifestations and offer different therapeutic ports of entry.     

Day,Night, or Dawn: Commentary on Paper by Steven Stern

It was in the years immediately following World War II and through the 1950s that the psychoanalytic establishment officially defined psychoanalysis as a subspecialty of psychiatry, and it was in that context of the professionalization of American medicine that they codified the distinction between psychoanalysis and (psychoanalytic) psychotherapy. In this commentary on Steven Stern's “Session Frequency and the Definition of Psychoanalysis,” I deconstruct a series of binaries that was built into the analysis/therapy distinction and that has plagued our discipline. It is argued that psychoanalysis identified itself with the culturally “masculine” and heterosexual values of autonomous individuality (the intrapsychic), while it split off all that was relational and social (interpersonal), marked as “feminine,” homosexual, and “primitive,” onto psychotherapy, which it then devalued. The paper then examines the implications for practice and psychoanalytic education.     

Defensive patterns in reflective group supervisions at Child Health Centres

Reflective group supervision with infant healthcare workers has been described in several publications. It aims to enhance their ability to help distressed families, and to comprehend and relieve themselves of the distress that they encounter in such work. The ultimate aim has been formulated as an effort at increasing the professional's reflective function. The present article adds to the literature by applying an ego-psychological perspective on the group process and investigating defensive patterns in such supervisions. This approach includes a critical discussion of the place of the reflective function concept in psychoanalytic metapsychology. The article also suggests a Bionian perspective to account for skewed communicative patterns in groups, so-called basic assumptions. Some technical recommendations are provided on the frame in group supervision. They aim to disarm such defenses and facilitate the group participants’ possibilities of understanding and thus helping their colleague's problematic relationship with the family. To illustrate the discussion, and to help readers form an image of the supervision process, brief detailed accounts of such work are submitted.     

Notes on infant psychotherapy

The idea of „infant psychotherapy”︁ is easily misunderstood, especially by those who associate psychiatry with images of crazy behavior. Nevertheless, there is a type of activity conducted by adults with infants, discussed with increasing frequency in recent literature, which is best understood in an analogy with adult psychotherapy. This activity may be called infant psychotherapy or infant-centered activity. Briefly, it consists of encouraging the infant to take the lead, and asking the adult in charge to follow or „track”︁ the infant's behavior as unobtrusively as possible. This is more easily said than done, and the present work tries to show why this is so. A discussion of the maternal-infant program at the Milwaukee County Mental Health Centre accompanies the observations.     

“I'll Have What She's Having”: Commentary on Paper by Karen E. Starr and Lewis Aron

This discussion utilizes a feminist discourse originating in the 1970s to reconsider Freud's famous question, “What do women want?” and from there explores some hidden dimensions in Starr and Aron's paper concerning female agency, sexuality, and the twists and turns of psychoanalytic theory and social conventions. Highlighting Rachel Maines's researches into the use of vibrators in medical treatment in particular, the discussion illuminates how social conventions function as powerful determinants that legislate what is seen and not seen, what is questioned and what is accepted—and ultimately what is considered psychoanalytic “bedrock.”     

Freud's Ironically Jewish Science: Commentary on Paper by Jill Salberg

In his commentary on Jill Salberg's integrative and contextualizing article, “Hidden in Plain Sight: Freud's Jewish Identity Revisited,” Aron examines several ideas related to Freud's ironically “Jewish science.” First, this commentary takes up the question of what it has meant to speak of a “Jewish science” historically, and what it might mean today. Shockingly, Aron shows that the rise and fall of psychoanalysis has been traced to Jewish influence. He then expands on Salberg's article by reviewing the relationship between circumcision and castration and considers the impact of Freud's Jewish identity and his anxiety about anti-Semitism on the structure of the psychoanalytic method and specifically on Freud's discovery of the “royal road.”     

Love in the counter-transference: The uses of the therapist's excitement

SUMMARY

The psychoanalytic tradition has always had difficulty with the question of the therapist's sexual feelings toward the patient. This paper traces that difficulty: from Freud's original struggle to replace moralism with a psychoanalytic mode of understanding, to the more recent literature on countertransference which still seems particularly averse to the possibility of the therapist's sexual experience. By way of a discussion of a psychoanalytic psychotherapy, I argue for the sometimes central therapeutic role of the therapist's experiencing, and then containing, excitement.     

Searching for the enriching sense of otherness: The psychoanalytic psychotherapist as a meaning-bearing other

Abstract

This paper is a theoretical and clinical examination of the patient's search for the otherness of the therapist as a prerequisite for change and development in relational psychoanalytic psychotherapy. A basic assumption is that being in a relationship as well as being a personal self, is to be understood, as being with a “meaning-bearing other”; that is, someone who allows for the possibility of meaningful thoughts and feelings, either through an actual communicative presence or as a consciously, prereflective, or unconsciously imagined communication partner. The term “meaning-bearing other” is used to differentiate distinct, although often synchronic, modes of relatedness. The need for intersubjective “depth”—that is, to discover the otherness of the other, and for oneself to be recognized as an experiencing subject—is regarded as a main motivational force. Winnicott's, as well as Sullivan's developmental approaches, Mitchell and Aron's views on psychoanalytic interaction, and Heidegger and Gadamer's phenomenology and hermeneutics are used as theoretical points of reference for the present discourse. The theoretical points of view are examined and discussed through excerpts from twice-a-week psychotherapy with a six-year old girl.