Being Taken In

The Framing Relationship

Sarah Sutton

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9781782200710
• eBook ISBN:
  9780429911309
• Topic: Psychology
• Subtopic: Cognitive Neuroscience & Neuropsychology
• Index: Psychology

Why is love not enough for children whose early lives have been disturbing? What makes it so hard for such children to make the most of new relationships? How can we help children whose minds are adapted to adversity take in new experience? In the new era of brain research, neuroscience shows the way ahead. Being Taken In looks at the neuroscience showing how the mother/infant framing relationship wires in our way of understanding the world, and sets a navigation system, complete with built-in danger alerts. For disturbed children, these danger alerts are everywhere, and can even be triggered by the caregiver themselves. This makes the world a disturbing place, not just in the past, but right now. This book applies neuroscience and child development research to clinical practice, and points to emotional regulation through attunement and reflexivity as key factors in effecting change.

CHAPTER ONE

The framing relationship

Darwin, Marx and Freud’s reframing of biological, political and psychological science in the nineteenth and early twentieth century put humans in a different relation to the world than that which had long been assumed to hold sway. The shock of these modern ideas seems to have been not so much the shock of the new per se as the shock of the new perspective—the dizzying step outside to see the frame, the set up. Postmodernism, as the aftermath of these groundbreaking ideas, carried with it the aftershock of the shaken world view: this is not the only way of seeing things. Having noticed the frame, postmodernity, we are in a position to play with the frame. There is a realisation that different frames, ways of seeing (Berger, 1972), can apply, and can affect the content. It raises the unsettling suspicion associated with the postmodern that if perspective is all then nothing is of substance. However, the fact of the frame does not necessarily mean that all ways of seeing are equivalent. The evidence of the neuroscience and development studies that follow seems to suggest that the feeling of substance is created by the qualities of the implicit process. Perhaps those of integrity and authenticity are particularly relevant here. But in an era post-postmodernism it seems to me that we do have to do the work of noticing how the frame affects the content. Berger (1972) alerts the viewer of his own television programme to the frame in the hope that they will be sceptical of it. Post-postmodernism, we have to acknowledge that our framing of experience is always provisional and to be understood in a specific context, but always present; dependent on what we bring to the relationship as well as on what the other brings:

If what it is that exists comes into being for each one of us through its interaction with our brains and minds, the idea that we could have a knowledge of it that was not also an expression of ourselves, and dependent on what we brought to the relationship, is untenable. (McGilchrist, 2009, p. 37)

The neuroscience of the last two decades has made clear how our social nature depends upon the framing relationship, from which we learn to adapt to the social circumstances into which we are born, and so survive. Schore’s (2003) work shows how our very minds are adaptive in this way, developed through the particular primary relationship, as emotional experience makes neural connections which, having fired together, wire together. A child’s early relationships thus establish through intersubjectivity the brain patterns that make a mind (Balbernie, 2001).

Furthermore, the qualities of these ways of being together are wired in as a template for relating; a frame of reference through which experience is understood. It shapes the world as experienced by the child and makes some things seem possible, and others not. It seems to me that the implications of this for helping children whose early experience has been disturbing are worth examining.

The idea of the framing relationship arises in the convergence of the fields of child psychotherapy, psychoanalytic theory, child development research, and neuroscience. I will begin by giving the child psychotherapy context, looking at thinking in this field about work with severely disturbed children, particularly the formative impact of the relationship with the maternal mind. Adoption will be a particular focus, representing as it does severe disturbance in early experience compounded by shifting patterns of caregiving, and offering the chance of a new relational frame of reference in the adoptive family, which is often so bewilderingly hard for the adopted child to take up. I will then draw on psychoanalytic theory of the relational development of the mind, especially Bion’s ideas about dynamic containment in relation to the growth of mind, Klein’s ideas about the internal world, and Winnicott’s thinking on the facilitating environment and the development of the self.

My intention is to make explicit the links between emotional experience and awareness, and so I will draw on child development studies of intersubjectivity, looking at the way in which emotional experience is mutually communicated in the mother–infant dyad. Finally, I will consider findings from neuroscience about the relational nature of the way the mind is built and works, focusing on intersubjectivity as the mechanism of mental development, and the processing interrelationship of the two hemispheres of the brain.

Child psychotherapy and the formative impact of the relationship with the maternal mind

Boston and Szur’s (1983) work on severely deprived children led the way in using child psychotherapy techniques with children who had endured very painful early experiences without access to a containing maternal mind, and had then been subject to shifting patterns of care. They noted that “all the children, at times, some in more subtle ways than others, made their therapists feel useless, helpless, rejected, abandoned, messed up or cruelly treated—precisely the experiences and feelings which the patients themselves found intolerable or hard to bear” (Boston & Szur, 1983, p. 58).

Marsoni (2006) considers the links between a child’s early and ongoing traumatic experience in the context of the absence of a containing mind, and the absence of his capacity to be aware of the trauma, and thus have a perspective on it, rather than be caught up in it. She connects his inability to “process and transform in his mind the concrete memory of what had happened to him” with his fear “that he could be caught in it again any minute” (2006, p. 313).

Using Freud’s “unlaid ghost” metaphor (1909b, p. 122) as a frame of reference, Marsoni made sense of the explosive sessions she experienced in working with an adopted boy during the initial year of therapy. She understood his behaviour in this context, feeling that “through these murderous fights Luke was making contact with his past” (2006, p. 314). She was sensitive to the force of his emotions and sensed that her containing response needed to be limited to naming what he was showing her. She used a “grammar of description”, not a “grammar of explanation” (Alvarez, 1997, p. 755). Her feeling was that any attempt to explain or interpret the violence would escalate rather than contain it. There seems to be something important here in relation to the process of co-construction of meaning in the therapeutic relationship. If external therapist-led meanings are applied too readily, it seems to reinforce the child’s feeling of not having been really taken in to the mind of the therapist and understood. There seems to be a need for a phase where, paradoxically, in order for the child to be taken in, the therapist is taken into the emotional world of the child. This seems to happen through resonance—that is, receiving the force of feeling from the child. I would like to explore this idea further in Alvarez’s contribution to the child psychotherapy literature.

Alvarez’s experience of work with deprived and abused children has led her to think about the behaviour of disturbed children as communication, rather than as defence. She writes about a boy for whom “some of my interpretations seemed to make him more mad. He complained that I did not know what it was like to be near a light bulb that is going to explode, and he was right—I was not getting the message” (1997, p. 762).

She was influenced by Joseph’s (1978) highlighting of disturbed patients’ need for the therapist to be willing to feel the feelings evoked by the patient, and furthermore to feel them long enough “to experience the missing part of the patient” or “his or her previously unexamined internal object” (Alvarez, 1997, p. 755). There seemed to be a need to take in, hold and digest the emotional experience of being with such children, painful and disturbing as it is, rather than serve it back to them too quickly in an interpretation, however accurate, of what might be going on. Alvarez attributes her change of approach in this area to being supervised by someone influenced by Bion’s (1959) theory of containment. She stresses the distinction between “the grammar of wishes in neurotic patients and the grammar of imperative needs in borderline patients” (Alvarez, 1997, p. 753). This allows for the developmental importance of offering the containment of primitive anxiety that children with disturbing early experiences have not had. It also involves recognition of their struggle to protect themselves from emotional fallout that they cannot process. In terms of neuroscience, it offers a right brain responsive attunement to their unconscious communication of disturbed states of mind, which can eventually be wired in as the template of a processing function. Hence emotional regulation acts as a transformative influence on mind change.

Canham describes this dynamic in terms of digestion. In writing about work in a children’s home, he notes that the lack of it can mean that a child’s feelings and expectations from their previous experience “can easily get recreated between the child and a particular worker, or within whole staff teams”. He explains that the “dynamic re-enacting of past experiences that have not properly been understood and digested has, for a long time, been one of the key tools used in psychoanalytic psychotherapy” (2006, p. 260).

Thus the reflective process of exploring the child’s mind in psychotherapy involves a dynamic re-enactment, with experiences from the past relived and experienced in the present moment in the hope of being psychically and emotionally digested—that is, taken in and understood so that the possibility of something new becomes available. The mental and emotional digestive system of the therapist needs to be made available to the child in the way that his or her parents’ could not. The wisdom of Alvarez’s (1997) paper would suggest that if a child’s extreme behaviour in a school or children’s home is not taken as an emotional communication belonging to the world of his early experience, which the child desperately needs someone to digest, but is instead attributed to the child, this would exacerbate the feeling of not being taken in and urgently reinforce the behaviour. No doubt those of us who work with disturbed children will have witnessed this painful process.

Although adopted children potentially have their new parents to take in their terrors in a way that is hard for staff to manage in a children’s home, they face another difficulty. Associated with the prelude to and lifelong process of adoption, there are heavy losses to be mourned on all sides. An aspect of this theme is discussed in Tollemache’s (2006) paper on reconciling the differences between expectation and reality in work with adoptive families. She focuses particularly on the hopes and expectations of adoptive parents, and the difficulty of relinquishing these. Adoptive parents—though not of course only adoptive parents—thus have the daunting task of trying to contain powerful emotions for their children, while inevitably sometimes struggling to contain their own.

Although the expectations that adoptive and birth parents alike bring to the task of parenting are often unvoiced and perhaps unconscious, they are crucial to an understanding of the child’s situation and behaviour. They are influential from the first weeks and months of life, or indeed of adoption, in shaping children’s attitudes and behaviour. Music makes the point that Winnicott’s (1964, p. 88) famous dictum “There’s no such thing as a baby” reminds us that “we can only ever understand a baby in relation to the minds and behaviours of those around it” (Music, 2010, p. 2). In the light of this insight, I would like to explore the child psychotherapy literature that describes the effects of shifting, abusive and neglectful patterns of care on the child’s own capacity for taking in.

Klein suggests that “in unravelling the details of the transference it is essential to think in terms of total situations transferred from the past into the present, as well as of emotions, defences and object relations” (1952, p. 55). Her idea is that the child will bring to therapy expectations about relationships and mental representations of figures from their past, interacting in their mind and charged with the visceral emotions they carried at the time.

Rustin (1999) discusses the complexity of the adopted child’s predicament when moves have meant the new geographical and emotional territory is lacking meaningful landmarks and connections. She notes that the adoptive child often carries in mind a plethora of figures: birth parents and other family carers, adoptive parents, significant foster carers, and social workers. She alerts us to the “area of disorganised experience” (1999, p. 52) in the child’s mind, formed when patterns of care have been too transitory to take shape: different adults in the family caring for the child in a disorganised way, institutional care with its shift patterns, or the experience of being cared for by a mentally ill parent.

The implication is that this complicated shifting series of placements constitutes an environmental failure, which is experienced by the child as a formative pattern of caregiving, albeit disorganised, frightening, and neglectful. It is not an absence. As Klein emphasised, the absence of something good, say, a feed, is experienced by the infant as the presence of something bad—a hunger pang. This is borne out by Tronick, Adamson, Als, and Brazelton’s (1975) “still face” experiments (discussed further in the child development studies section of this chapter) in which a very short absence of responsive emotion on mother’s face is seen to be disturbing for babies.

Klein (1930) suggests that when such a bad feeling is experienced there is a need to seek a representative to stand for the badness as a regulation of this emotion. If such a figure is not available to mediate the experience then the fear is overwhelming, and the internal representation carries the dread of the original feeling; it becomes symbolically equated with it in phantasy. Thus the child who has suffered overwhelming fear without the protective function of a parental mind to mediate and regulate it, in Klein’s terms, cannot “distinguish between phantasy and reality in terms of the effect on him or herself, and reacts to the representation as if it were the original feared object” (1930, p. 251). Those of us working with very disturbed children will have seen this happen many times. In more everyday terms, the child is so flooded with fear that he or she cannot tell the difference between their own terror and the intentions of the other. Emanuel (2004) has pointed out how primitive responses are then triggered instantaneously by wired-in connections. Thus the antisocial behaviour of a child taken into public care is to be understood in the context of the frightening early experiences in which mind-body connections were made.

In contrast, where a relationship with a parental figure has helped to mediate suffering for a child, the fear is less overwhelming; there can be a representational object that carries some, though not all, of the emotional load. The frightening experience is processed in the parent’s mind, and then begins to be understood between parent and child. It is not borne by the child’s immature coping strategies alone, and thus is felt to be thinkable and survivable, inside a frame of reference. The experience is then moderated for the child, first in an external relationship, and then once this is internalised, in an intrapsychic relationship that can bear it, as opposed to the child feeling subjected to an onslaught of overwhelming emotion.

If, as for many adopted children, no adult is available at a critical period to be seen as responsible for the terror, as a representative of the external world, then the child seems to be left with the feeling that they must be responsible, and that the terrifying thing is inside them. Much of the child psychotherapy literature on work with severely disturbed children illustrates this process. Perhaps one way of looking at the purpose of child psychotherapy is to view it as an attempt to take compassionate responsibility for the failure of early relationships and consequent terrors.

I will now turn to key ideas in psychoanalytic thinking about the relational development of the mind and the building of the internal world.

Psychoanalytic thinking about the relational development of mind

Bion’s ideas about containment provide a useful starting point. He records being struck by something a patient said to him about not being able to take something in. Building on Klein’s (1935) insight that Freud’s (1917) shadow of the object does not simply fall upon the ego, but moves in and takes its own shape so that internal representations of objects relate to each other in a whole internal world of object relations, he felt that “the statement that something cannot be taken in must not therefore be dismissed as a mere way of speaking” (Bion, 1963, p. 6).

He went on to say that such words did not just represent but actually conveyed to him something of the nature of the emotional experience. He was being given something to contain—a sense of something not being able to be taken in. He developed from this the idea that something in the patient is seeking containment, and is potentially found by the analyst’s mind, in a way that is similar to an infant seeking and being found by the mother’s mind. He sees this as taking place in extreme form when the baby is distressed or in pain, such that there is a fear of breaking down or falling apart. The mother’s response will be decisive in shaping the baby’s feeling about whether the world is a safe place or not; whether fear of annihilation can be contained, thought about, and survived or not.

It is important to note that different mothers will of course experience (and so think about and name) feelings in different ways, thus making different connections in a child’s mind. When a child screams, his mother may understand this as a cry for help and seek to allay the suffering, soothing the child and saying that it is a bad pain and will get better. When things go well, both partners can be perceived as loving—to others and perhaps to themselves. “In a loving relationship they can be mutually beneficial. A model of this is the mother with her baby; both can grow through the experience of containing and being contained” (Symington, J., & Symington, N. 1996, p. 58). The implication of Bion’s containment theory and Klein’s internal world is that the child takes in a number of things from this process: not only the soothing, but an internal relationship in which there is the capacity to soothe, and the capacity to be soothed. Importantly, in understanding the pain as not essentially part of the baby but in painful relation to it, the mother helps the child to separate himself from it; hence there may also be taken in the feeling that the pain is bad but it is not the baby himself that is bad. The infant also takes in the experience of things getting better, and thus the feeling that things can get better and annihilation may not lurk round every corner as he may have feared.

Another mother, however, may understand her child’s scream as an attack on her and think of the child as being bad. In this case, what the child experiences and internalises is likely to be very different; perhaps more like an unsoothability and a sense of badness. Furthermore, a relationship is internalised in which things cannot get better and instead can get appreciably worse. Being in pain and frightened with no sense that things can get better, with no separation understood between pain, screaming and child, the child is likely to internalise a feeling that he is himself essentially part of the badness. Perhaps here are some of the roots of disturbed children’s damaged capacity to take in or be taken in.

Thus the relationship with the mother provides a context, a frame through which experience can be understood. Perhaps sensation cannot be said to be experienced unless it has gone through this framework. The feeling may be of raw sensory onslaught that makes no sense, for the child has no way to bring it into awareness. Bion writes:

If alpha-function is disturbed and therefore inoperative the sense impressions of which the patient is aware and the emotions which he is experiencing remain unchanged. I shall call them beta-elements...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• INTRODUCTION
• CHAPTER ONE The framing relationship
• CHAPTER TWO Researching psychotherapy
• CHAPTER THREE Learning the body language
• CHAPTER FOUR Changing minds
• REFERENCES
• INDEX