THE STUDY AND TREATMENT OF MOTHERS AND INFANTS,THEN AND NOW: MELANIE KLEIN'S “NOTES ON BABY” IN A CONTEMPORARY PSYCHOANALYTIC CONTEXT

This paper draws on Melanie Klein's (unpublished) observational notes of her infant grandson, written primarily in 1938 and 1939. Apart from moving glimpses into a young family's life, the notes contain astute observations of an infant's behavior and emotions. Compared with Klein's published writings, the style is less theoretical and polemical. Later, in his latency years, Klein's grandson was in analysis with Marion Milner, who in 1952 published a paper drawing on the treatment. The present paper focuses on (1) how observations and treatment of the same child and his family by clinicians in close relationships with each other (Klein, Milner, and Winnicott) fertilized reciprocal influence but also brought into question the validity of Klein's observations, and (2) the relative merits and contributions of various modalities in understanding the infant's psyche, including experimental research, direct observation, parent–infant psychotherapy, and reconstructions from older patients—as occurs, for example, in psychoanalysis.     

“Of Course All Relationships Are Unique”: How Co-creative Processes Generate Unique Mother–Infant and Patient–Therapist Relationships and Change Other Relationships

The question of the uniqueness of relationships is examined: How do relationships come to be unique? What are some of the features of their uniqueness? And how can relationships, be it the mother—infant relationship or the patient—therapist relationship, have unique rather than archetypical effects on other relationships? A model of relationship uniqueness is presented that argues that mother and infant, and patient and therapist, co-create dyadic states of consciousness—states of making implicit and explicit sense of the world—out of their normally messy exchanges of age-possible meanings. These co-creative processes lead to change in the infant's and child's state of knowing the world, and also change the way the patient makes sense of the world and ways of being with others. Additionally presented are (I) a critique of attachment theory's assumption that the mother—infant relationship is the prototype of later relationships; (2) a critique of models of therapeutic change that see adult analysis as working primarily in the same domain as the workings of the mother-infant relationship; (3) a brain model of co-creative relational processes, Relational Activation Patterns (RAPs); and (4) possible psychodynamic processes in infants.     

Attachment in preterm infants and their mothers: Neonatal risk status and maternal representations

High‐risk neonatal status, indexed by an intracranial hemorrhage (ICH), and maternal representations of past and present attachment relationships were examined as predictors of infant attachment in a sample of preterm infants. Participants included 50 19‐month‐old infants and their middle‐class, predominantly African American mothers. A maternal‐report questionnaire and a structured interview were used to assess past relationship history with mother and current relationship with infant, respectively. The Strange Situation Paradigm was used to assess attachment security. Multiple logistic regression analyses suggested that maternal representation of the infant—but not ICH or maternal childhood history—significantly predicted infant attachment security. ICH and maternal history of childhood rejection were predictive of disorganized infant attachment. The findings are consistent with previous data that suggest that maternal factors are more important than infant factors in determining infant attachment security. These data also suggest that neurological deficits may contribute to disorganized infant attachment. © 2000 Michigan Association for Infant Mental Health.     

Altruism as Reparation of Mismatch or Disruption in the Self

ABSTRACT

After giving a brief summary of the scientific literature on altruism and empathy—a capacity necessary for altruism—I focus on a scientific paradigm, the face-to-face still face, and what insights it might offer psychoanalysts in their understanding of altruism. The face-to-face still face provides data about the communication of intentions and affect between infant and caregiver and demonstrates the procedure of mutual regulation, the foundation of self-regulation and empathy. Both infant and caregiver are highly motivated to repair mismatches or disruptions in the affective connection between them and this desire to repair disruptions can also be recognized in adulthood—both in relationships between individuals and within an individual in terms of disconnections with the self. The subjective experience of the altruist may derive from this domain of human experience—the repair of disruption. I thus suggest that altruism is not merely sublimation of inner conflict, but it is an adaptive, evolutionarily beneficial, attitude and behavior that is growth enhancing in that it expands the individual’s repertoire for repairing mismatches within the self.     

The “Perseverant” Personality: A Preattachment Perspective on the Etiology and Evolution of Binge/Purge Eating Disorders

The author integrates “psycho-digestive” metaphor with contemporary relational perspectives and developmental research to propose a way of thinking about the etiology and evolution of binge/purge eating disorders—including “purging anorexia,” bulimia, and “yo-yo” binge/dieting—and the personality organization that may underlie them. Focusing on the unifying, cyclical nature of these disorders, the author hypothesizes that an early-developing, fear-based form of somatopsychic perseveration may be set in motion from the beginning of life when a nursing infant is unable to achieve a psychic connection with a physically present and feeding (m)other. Without intervention, such a preattachment failure in (m)other/infant synchrony would inevitably impact all subsequent development. The author proposes that it may also lay the foundation for a uniquely intertwined somatopsychic personality organization—what she calls a “perseverant” personality—that fosters the development of binge/purge eating disorders. A perseverant personality is defined as a solitary and circular mode of being, thinking, and relating that is organized around a sustained physiological and psychological reliance on the feeding as a mode of thought-processing and affect regulation.     

Infant sustained attention but not joint attention to objects at 9 months predicts vocabulary at 12 and 15 months

Vocabulary differences early in development are highly predictive of later language learning as well as achievement in school. Early word learning emerges in the context of tightly coupled social interactions between the early learner and a mature partner. In the present study, we develop and apply a novel paradigm—dual head‐mounted eye tracking—to record momentary gaze data from both parents and infants during free‐flowing toy‐play contexts. With fine‐grained sequential patterns extracted from continuous gaze streams, we objectively measure both joint attention and sustained attention as parents and 9‐month‐old infants played with objects and as parents named objects during play. We show that both joint attention and infant sustained attention predicted vocabulary sizes at 12 and 15 months, but infant sustained attention in the context of joint attention, not joint attention itself, is the stronger unique predictor of later vocabulary size. Joint attention may predict word learning because joint attention supports infant attention to the named object.     

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.     

Minor illness and social behavior of infants and caregivers

Fourteen infants attending day care were observed during the first year of life when well and during acute minor illnesses. Comparisons of behavior during 46 afebrile illnesses and a like number of well observations revealed no differences in infant or caregiver behavior. During 24 febrile illness observations, however, infants moved less, contacted toys less, were in closer proximity to teachers, cried more, and looked at teachers more. During a subset of these febrile illnesses, in which teachers recognized that infants were ill, teachers vocalized, gave toys, looked at, touched, held, and fed infants more than when infants were well. Analysis of teacher behavior during infant crying demonstrated that infant cries played an important role in eliciting social responses from teachers during febrile illness. These results suggest that both caregiver perception of illness state and illness-induced changes in infant behavior contribute to increased sociability by caregivers during acute febrile illness.     

Disorders of Temporality and The Subjective Experience of Time: Unresponsive Objects and the Vacuity of the Future

This paper explores how the personal sense of time—temporality—is organized and experienced in different clinical situations. It uses examples from infancy observations to draw links between caregivers’ response to infants’ capacities for motor activity and emotional communication and the development of the senses of personal security, vital intersubjectivity and temporality, that is, the feeling of a meaningful self and an open future. In illustrations from both early child–parent interaction and an extended case, it suggests how moment-to-moment interactions reflect and sustain these core, highly personal experiences of what it feels like to live in the world, that is, how an accretion of “micro” interactions can contribute to and help us understand the “macro” structures that analysts usually describe, such as intersubjectivity, the sense of self, and here, the senses of time.

With that in mind, the paper evokes a few specific “disorders of temporality.” One group of these involves the blurring of past and present, especially following trauma. Much of the paper, though, is concerned with a basic deficit in the sense of time that can be observed, when the patient presents without the hope that new experiences can emerge, however fitfully, with the feeling of a forward-moving future. In an imaginative move, the paper links this image with the experience of an infant with an unresponsive parent, one who does not afford that infant the most basic senses of personal agency that come from having her feelings and gestures recognized and responded to in a way that gives her the feeling that she is having some effect on her world. Clinical implications are drawn, often demonstrating how brief moments of analytic interaction reflect the macrocosms of the broader analytic relationship and the patient’s psychological organization.     

Stern on “Self”

ABSTRACT

Self is a notion of common-sense psychology that several schools of psychoanalysis have built into their theories. Stern explores and expands its meaning, tracing its development back to birth and even earlier, and outlining how the psychological development of the preverbal infant contributes to its evolution. In the process, Stern discusses two perspectives on preverbal infant psychology—that of the observational empiricist developmental psychologist, and that of the reconstructing psychoanalytic clinician working from the subjective experience of adult patients, and what each might contribute to the other. His thinking suggests the importance of nonverbal models of infant (and, eventually, adult) subjective experience.     

Infant gaze following depends on communicative signals: An eye‐tracking study of 5‐ to 7‐month‐olds in Vanuatu

Gaze is considered a crucial component of early communication between an infant and her caregiver. When communicatively addressed, infants respond aptly to others’ gaze by following its direction. However, experience with face‐to‐face contact varies across cultures, begging the question whether infants’ competencies in receiving others’ communicative gaze signals are universal or culturally specific . We used eye‐tracking to assess gaze‐following responses of 5‐ to 7‐month olds in Vanuatu, where face‐to‐face parent–infant interactions are less prevalent than in Western populations. We found that—just like Western 6‐month‐olds studied previously—5‐ to ‐7‐month‐olds living in Vanuatu followed gaze only, when communicatively addressed. That is, if presented gaze shifts were preceded by infant‐directed speech, but not if they were preceded by adult‐directed speech. These results are consistent with the notion that early infant gaze following is tied to infants’ early emerging communicative competencies and rooted in universal mechanisms rather than being dependent on cultural specificities of early socialization.     

The You-I event: on the genesis of self-awareness

I present empirical evidence suggesting that an infant first becomes aware of herself as the focal center of a caregiver's attending. Yet that does not account for her awareness of herself as agent. To address this question, I bring in research on neonatal imitation, as well as studies demonstrating the existence of a neural system in which parts of the same brain areas are activated when observing another's action and when executing a similar one. Applying these findings, I consider gestural exchanges between infant and caregiver, such as reciprocal smiles and imitative vocalizations. Lacking self-awareness at first, the infant is unaware of her own agency. By returning her unwitting gesture, the caregiver singles out for her—thanks to neural matching—the gesture's kinesthesis. Moreover, the caregiver's smile, imitative vocalization, or other gesture is the form that focusing takes. The kinesthesis of the infant's gesture, in being singled out, is experienced by the infant as what the caregiver is focusing on. It is experienced as being within the focal center. In this way, the infant becomes aware of herself as a bodily entity acting toward the caregiver. Exchanges that involve matching are at first essential, I argue, in making the infant present to herself in action. Matching will cease to be necessary, but self-awareness continues to depend fundamentally on others until the acquisition of language, when the child becomes capable of talking to herself as if she were the caregiver.     

Synchrony in the Triad: A Microlevel Process Model of Coparenting and Parent‐Child Interactions

Guided by a microanalytic approach to the study of relationships, we assessed parent, infant, and coparental behaviors during triadic interactions in 94 parents and their 5‐month‐old firstborn child. Relational behaviors in each family subsystem—mother‐infant, father‐infant, and coparenting—were microcoded. Marital satisfaction and infant temperament were self‐reported. No differences were found in the infants' behavior toward mother and father or in the time spent with each parent. Mothers' and fathers' relational behavior during parent‐infant episodes were generally comparable, yet mothers vocalized more and the latency to father's displaying positive affect was longer. Conditional probabilities indicated that under conditions of coparental mutuality, fathers showed more positive behaviors than mothers. Lag‐sequential analysis demonstrated that change in the infant's social focus between parents followed change in coparental behavior. Fathers' coparental mutuality was independently predicted by maternal behavior during mother‐child episodes, father marital satisfaction, and infant difficult temperament, whereas mothers' coparental mutuality was only linked with fathers' relational behavior. Results highlight the importance of including a microlevel perspective on the family system at the first stages of family development.     

Response to Lombardi

We address some of the individual points that Lombardi makes, some that we agree with and some that as infant mental health clinicians we do not agree with—for example, that at the beginning of life the mind is still not there—and try to show why we think that is.     

Infant behaviors and maternal parenting practices: Short-term reliability assessments

Consistency in the order of individuals in a group across short periods of time—reliability—is both important developmentally and meaningful psychologically. For example, documenting the reliabilities of infant behaviors and maternal parenting practices elucidates the nature and structure of early development. In this prospective short-term longitudinal study (Ns = 51 5-month infants and their mothers), we examined reliabilities of individual variation in multiple infant behaviors (physical development, social interaction, exploration, nondistress vocalization, and distress communication) and maternal parenting practices (nurturing, encouragement of motor growth, social exchange, didactic interaction, provision of the material environment, and speech to infant). Medium to large effect size reliabilities characterize infant behaviors and maternal parenting practices, but both betray substantial amounts of unshared variance. Established reliability is essential to the application of these measures in infancy studies, it is central to replication, and it is a limiting factor in predictive validity.     

Dyadically expanded states of consciousness and the process of therapeutic change

This paper addresses an intersubjective issue that arises out of our model of therapeutic change: Why do humans so strongly seek states of emotional connectedness and intersubjectivity and why does the failure to achieve connectedness have such a damaging effect on the mental health of the infant? A hypothesis is offered—the Dyadic Expansion of Consciousness Hypothesis—as an attempt to explain these phenomena. This hypothesis is based on the Mutual Regulation Model (MRM) of infant–adult interaction. The MRM describes the microregulatory social-emotional process of communication that generates (or fails to generate) dyadic intersubjective states of shared consciousness. In particular, the Dyadic Consciousness hypothesis argues that each individual, in one case the infant and mother or in another the patient and the therapist, is a self-organizing system that creates his or her own states of consciousness (states of brain organization), which can be expanded into more coherent and complex states in collaboration with another self-organizing system. Critically understanding how the mutual regulation of affect functions to create dyadic states of consciousness also can help us understand what produces change in the therapeutic process. © 1998 Michigan Association for Infant Mental Health     

Effects of short-term interaction coaching with mothers of preterm infants

This study examined the effects of eight 40-minute interaction coaching sessions on the mother-infant interaction patterns of mother-preterm infant dyads. Thirty-five preterm infants and their mothers were matched for sex and then were assigned randomly to a treatment and a no-treatment control group. Behavior counts and ratings of maternal and infant interactive behavior (Interaction Rating Scale; Field, 1980) were obtained from naturalistic home observations, precoaching, postcoaching, and at a 2-month follow-up. It was hypothesized that coaching, which was intended to facilitate more sensitive responding by mothers, would positively influence mother-infant interaction and mothers' knowledge of infant development. The only marginally significant difference between the groups that emerged over time was in knowledge of infant development, in which the treatment group surpassed the control group.     

Neonatal functioning and the sudden infant death syndrome

A male infant, diagnosed as a Sudden Infant Death Syndrome (SIDS) at 5 months, 3 weeks, had been extensively tested as a part of a larger sample in a longitudinal study. The longitudinal sample was comprised of 137 clinically normal neonates, born to intact upper middle-class families, living in a large metropolitan area. A neonatal assessment consisted of 5 hours of polygraphic recordings of heart and respiratory rate during sleep and waking cycles, and 1 hour of behavioral testing. At 3 months of age the infant was observed for 12 hours in the home. Retrospective analyses of these data suggested that: (a) neonatal respiratory behavior during sleep did not distinguish this infant from a sample of control infants; (b) the infant lacked strength in movements requiring the involvement of shoulder and neck muscles (head lift from a prone position); and (c) informal observations by skilled and experienced observers distinguished this infant from the sample of controls.     

Convergence of multiple sources of information on infant individuality: neonatal behavior,infant behavior,and temperament reports

To shed light on the notion of enduring individual infant characteristics, convergence of three presumably interrelated measures of infant individuality was examined. Data collected included standardized behavioral assessments of the newborn (NBAS), maternal reports of infant temperament (at 3 and 9 months), and naturalistic observations of infant behavior at 1, 3, and 9 months. Infant temperament reports were significantly stable from 3 to 9 months; observed infant fussiness was significantly stable from 1 to 3 and 3 to 9 months; observed altertness/social responsiveness was not stable over time. Analyses of convergence of neonatal and infant behavior revealed that 9-month infant alertness/social responsiveness was significantly correlated with neonatal habituation. Similar analyses of neonatal behavior and reported temperament revealed that 3-month reported dullness was significantly correlated with neonatal habituation and range of state. At 9 months, temperament ratings of infant fussiness and unpredictability were significantly correlated with autonomic stability; fussiness was also significantly correlated with regulation of state. Finally, no significant relationships were observed between reported temperament and observed infant behavior. These results fail to support a simple notion of enduring individuality in infants over their first year of life.     

Death by non-feeding: Not in the baby's best interests

It has recently been suggested that doctors have a duty to act in their patient's best interest and that this duty demands that life-sustaining treatment—including food and fluids—should sometimes be withheld or withdrawn and the patient allowed to die. In this article, the author explores the scope of the ‘best interests principle’ in the context of treatment decisions for seriously handicapped newborn infants. She argues that those who hold that it is permissible to starve or dehydrate an infant to death are mistaken to think that this course of action is in the infant's best interests. While it may be true that there are times whendeath is, everything considered, in an infant's best interests, a slow and distressingmethod of bringing death about is not. Since death by dehydration and starvation is not benign, the withholding of food and fluids is generally not in an infant's best interests. The author concludes by suggesting thatwhenever the withdrawal or non-employment of life-sustaining means imposes a heavy burden on the infant, the ‘best interests principle’ would demand that the infant be killed rather than allowed to die.