Psychoanalytic Therapy with Infants and their Parents

Practice, Theory, and Results

Björn Salomonsson

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780415718561
• eBook ISBN: 9781317907572
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Psychoanalytic Therapy with Infants and Parents provides a clear guide to clinical psychoanalytic work with distressed babies and unhappy parents, a numerous clinical group so often in need of urgent help. Although psychoanalytic work is primarily verbal, and infants may have limited language, this form of treatment is receiving increased attention among therapists. Björn Salomonsson explores how such work can be possible and benefit infants, how to work with the parents (especially the mother), and how major psychoanalytic concepts such as primal repression, infantile sexuality and transference can be worked with and understood in these therapies.

Björn Salomonsson argues that attachment concepts, though important, cannot solely help explain everyday problems with breastfeeding, sleeping, and weaning, or more recalcitrant interaction disorders. He shows how we also need psychoanalytic concepts to better understand, not only such "baby worries", but also adult clients' non-verbal communications and interactions. Throughout, he uses extensive practice-based examples and also refers to his research which provides evidence for the effectiveness of this practice.

Psychoanalytic Therapy with Infants and Parents provides a unique perspective on working psychoanalytically with parents and infants. This book will be essential reading for psychoanalysts and therapists working with children as well as adults.

Chapter 1

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What goes on in a baby’s mind?

One-month-old Nic

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Sweet babe, in thy face
Soft desires I can trace,
Secret joys and secret smiles,
Little pretty infant wiles.
…..

From thy cheek and from thy eye,
O’er the youthful harvest nigh,
Infant wiles and infant smiles
Heaven and Earth of piece beguiles.

From the poem “A cradle song”

(Blake, 1994, p. 107. Originally published after 1789)

What are babies thinking of? Or, if we restrict the verb “think” to more advanced beings than babies, let us reformulate our question: what goes on in their minds? To parents these questions seem redundant. They claim their babies display humour, joy, anger and other emotions – without clarifying on what grounds they base their opinions. Unhesitatingly they describe their children as wanting, disliking, loving and having other intentions – though they have never received any verbal confirmations from the young. The British poet William Blake also thought babies harboured desires, from “secret joys” to “infant wiles”, which formed part of their enigmatic, distressing and endearing character.

What goes on in the baby’s mind? In contrast to parents, therapists working with them and their infants must grapple with this crucial and complex question. Certainly, if we claim that our therapies work because the parent is affected by our interventions, the question is superfluous. According to this claim, she will be affected by our interventions and change her behaviour with her baby, who then functions better. However, today many clinicians (Baradon et al., 2005; Dolto, 1985; Lebovici & Stoléru, 2003; Norman, 2001; Salomonsson, 2007b; Thomson-Salo, 2007; Watillon, 1993) believe that babies are not only affected via interventions to the parent. They also feel that they may be reached directly in a “dialogue” with the analyst. These observations force us to re-approach our initial question. Let us do this by first recalling the everyday example from the introduction: one-month-old Andrew and his mother in the kitchen. When Andy started crying his mother picked him up and then breastfed and comforted him. Nonetheless, Andy did not calm down but continued crying and glaring at Mum. She responded by saying, “Now, now Andy, aren’t you angry at your silly Mum who didn’t pick you up at once!?”

Why didn’t Andy calm down immediately? Why did his mother speak of him being angry and her being silly? Concerning the first question, we might apply a biological perspective and claim that he simply failed to re-establish a physiological steady-state. This argument would apply to a newborn; he is “anterior to the organization of fantasies that bring meaningful structures” (Van Buren, 1993, p. 574). To be true, various research experiments have shown that infants only a few hours old can discriminate their mother’s sensuous characteristics from those of other women (Beebe & Lachmann, 2002; Meltzoff & Moore, 1994; Reddy, 2008). We also know that they can imitate an adult’s tongue protrusion and mouth opening (Meltzoff & Moore, 1997; Nagy & Molnar, 2004). On the other hand, such capacities do not imply that they are fantasizing about the parent. For the time being, we only feel certain that a newborn’s crying represents biological regulatory processes. Whether it also reflects experiences that we might label “emotional” remains unverifiable.

Andy, however, has already reached one month of age. A subjective world seems to be dawning in him. His mother thinks his crying involves a primitive mind with direction and intentionality; he wants to cry to her because he is driven by something that’s on his mind. How should we label this “something”? Psychoanalytic theory suggests our mind works with psychic representations. This term covers what we assume goes on in the individual’s mind; that which he is about to sich vorstellen. The German reflexive verb means to put something “before oneself”; a splitting of the mind where one part is observing the other. When I think of “coffee” I envisage a black and slightly bitter liquid that I like drinking in the morning. This is my representation of coffee.

The infant researcher Reddy (2008) questions the concept of psychic representation for describing what goes on “inside” a baby. Such a term would suggest that we can gain objective knowledge of a baby’s mind, from a “third-person perspective” as she labels it. Instead, his emotional expressions carry “an interactive meaning” (p. 79). When an infant is imitating an adult’s tongue protrusion, this does not result from any subjective representation such as ‘I feel like smiling and protruding my tongue just like that guy in front of me’. Instead, he is involved in an interaction or a game: ‘This guy and I are doing a funny smile-and-protrusion game together’. The game demonstrates his primary intersubjectivity (Trevarthen, 2001) rather than any representations inside his mind.

I agree that we often interact with babies and thus shape our imaginations about what might lie beneath their behaviour. This was the method Andy’s mother used to arrive at her conclusions. I also agree that babies are skilled interactors who observe emotional signals from the people around. Still, I argue that we may consider his representations separately. We tend to also assume representations in babies whom we are not interacting with. If Andy’s father is in the next room overhearing that the boy is crying and if the two do not interact, he might nevertheless assume that something goes on inside Andy. Second, representation is a theoretical construct that is “inferred from the observable workings of an individual’s mind” (Skelton, 2006, italics added). Nobody has ever seen a representation. Nevertheless we assume that people have thoughts, whims, feelings and intuitions; phenomena we subsume under the term representation: a “more or less consistent reproduction within the mind of a perception of a meaningful thing or object” (Moore & Fine, 1990). In psychoanalytic theory, it generally refers to unconscious mental phenomena. According to the French psychoanalytic tradition, representations form the essence of our being. In the words of Lionel Bailly (2012), “we are what we think and how we feel” (p. 6) and this is all built on experiences inhabiting our minds in the form of signifiers. They are sliding in and out of consciousness and held together in “a system of theories”.

Any psychoanalyst might agree up to this point but then object: “Agreed, without the concept of mental representations any psychological theory would crumble. But what makes you think babies have representations? And how do you know they are involved in little Andy’s crying? In my daily practice, I work with representations that my patient and I verify or refute in the therapeutic process. For instance, a man might report that he dreamt of a baby who was crying inconsolably. Due to the clinical background, I might interpret it as reflecting his loneliness, his anger with me, etc. Issuing from this response, we would then carry the analysis further. But I have no right to say anything about a real baby’s crying!”

The logic beneath our colleague’s argument is respectable and challenges us to investigate the notion of infant representations. I will now demonstrate that Freudian theory has always taken for granted that infants form mental representations. Freud was not perturbed by the fact that such representations were unverifiable. He assumed they contained passions and ideas and were directed towards another human being. In the beginning he called this person “extraneous help” or “the experienced person”. Later, he switched to talking about the mother and her breast as being the first objects of the baby’s representations.

In contrast, infant researchers such as Daniel Stern are more restrictive when describing infant representations. I will delineate his position and compare them with mine as it has been formed over years of psychoanalytic work with babies and parents. This chapter concludes that we need a special concept for conceptualizing representations in infants. Without it, our understanding of the infant’s psyche becomes reductionistic and focused merely on behavioural manifestations. Chapter 2 will elaborate on some ideas by two French psychoanalysts, Jean Laplanche (1989, 1999a) and Piera Aulagnier (2001). Laplanche focused on how the baby is affected by the mother’s “enigmatic messages”. Aulagnier suggested the term “primal process” for the baby’s mental processes. Finally, I will suggest the term primal representation to answer our initial question: what goes on in a baby’s mind?

Our perspicacious colleague above argued against representations in babies. However, he overlooked that it is impossible to draw a sharp dividing line between pre-representational and representational life. He might retort that this line is drawn when the child learns to understand and speak language. However, a simple clinical example indicates that this position is untenable. Ten-month-old Pierre has insomnia. His mother tells me she feels a bit lost after the family moved to our town. He is sitting silently in her lap but suddenly he starts crying while staring at me. Mother tells me this happens with other people, too: “He seems afraid but I don’t know why.” I might dismiss this as an unverifiable comment. I could state that I know nothing of what goes on in his mind or if he wants to communicate something. This view would concur with a strictly behaviouristic perspective but would contradict everyday intuition and basic assumptions in psychoanalytic theory. The scarce references to Freudian theory among present-day infant clinicians might intimate that classical psychoanalysis has been uninterested in infant psychology. We will now consult Freud’s texts to investigate if this is correct.

Freud on infant representations

When we read Freud’s grand effort at integrating psychology and neuro-physiology into a psychoanalytic metapsychology, Project for a Scientific Psychology (1895/1950), the abstruse language may conceal its focus on the infant’s psychological life. Freud describes the experience of satisfaction, which obviously is a psychological event, in neuro-physiological terms; as a neuronal discharge. But he adds that it cannot come about unless there is an “alteration in the external world (supply of nourishment, proximity of the sexual object)” (p. 318). This takes place via “extraneous help” by “an experienced person” who is drawn to the child’s state “by discharge along the path of internal change” (idem). Put in everyday language, Freud explains that the baby keeps crying until the mother listens to him and comforts him. Another example of his struggle to describe psychological events in neuro-physiological terms is his suggestion that there occurs a cathexis of “neurones which correspond to the perception of an object” (idem). Today, we rarely say that the mother-object is cathected but that she has become a containing object (Bion, 1962a) or an attachment figure (Bowlby, 1969) – whichever terminology we prefer.

Though Freud does not yet speak of infant representations, such a notion is easy to discern already in the Project. For example, he suggests that when a baby communicates longing and distress to “the helpful person” (p. 318), s/he will perceive this object as hostile. Freud depicts a screaming and distressed baby with negative representations of the object. One gets the impression of Freud being a Kleinian before Klein! In The Interpretation of Dreams (1900), he focuses on another entity corresponding to the term representation: the wish. When a need arises in a baby, a psychological impulse will “re-cathect the mnemic image of the perception and re-evoke the perception itself, that is to say, re-establish the situation of the original satisfaction. An impulse of this kind is what we call a wish” (pp. 565–566, italics added). Evidently, to re-cathect a memory of a satisfying event implies to re-evoke an affectively charged representation.

Freud’s infant focus is also evident in his works on hysterical symptoms, which he regards as a “re-activation of an infantile impression” (1909, p. 230). He depicts psychoanalytic therapy as a method by which the therapist provides “translations from an alien method of expression into the one which is familiar to us” (Freud, 1913, p. 175). He thus offered the patient interpretations that addressed what the hysterical symptoms might mean. Did he also think representations were involved in the symptoms? We have already hinted at a positive answer but will have to postpone a definitive conclusion.

In some works, Freud wavers between describing infants in biological and psychological terms. In a passage on infantile sexuality (1905b), it remains unclear if representations are involved when a “baby [is] sinking back satiated from the breast and falling asleep with flushed cheeks and a blissful smile” (p. 182). Another passage is clearer: anxiety in infants originally expresses “that they are feeling the loss of the person they love. It is for this reason that they are frightened of every stranger” (p. 224). Evidently, a baby who loves and fears people must have formed representations of them. Yet, in this passage Freud only speaks of infants old enough to distinguish parents from strangers. Therefore, we must return to his writings on “infants in arms” (Freud, 1925–26, p. 138). Their anxieties are conditioned by separation from the mother. They need not be explained on psychological lines but “can be accounted for simply enough biologically” (idem). Here, Freud denies representations in the newborn. But he is inconsistent; he labels such anxiety an “automatic phenomenon”, a “rescuing signal”, as well as a “product of the infant’s mental helplessness” (p. 138, italics added). Obviously, he assumes that mental processes, that is, representations, exist in the very young baby. In other words, the term hilflosigkeit or helplessness refers both to the baby’s biological and psychological condition. Repeated moments countering this helpless state, those moments when the baby experienced satisfaction, have created the maternal object. “This object, whenever the infant feels a need, receives an intense cathexis which might be described as a ‘longing’ one” (p. 170). To conclude, the term “longing cathexis” implies that the baby has formed a representation of mother.

In The Unconscious, Freud (1915c) continues struggling with the Vorstellung concept as he seeks to understand the difference between conscious and unconscious experiences. He states that an instinct can only be represented by an idea (Vorstellung). Then he amends and suggests that it may attach either to an idea or appear as an “affective state” (177). Here Freud differs, more clearly than ever, between two Vorstellungen: thing- and word-presentations. Every representation originates as an unconscious thing-presentation. Later, a word-presentation is added and now it may become conscious or, alternatively, remain under repression. Tentatively, we might conclude that if unconscious thing-presentations are “the first and true object-cathexes” (p. 201), they would be the only ones existent in the infant mind. However, this conclusion creates problems. As Maze and Henry (1996) have remarked, a baby has many conscious representations that are not yet attached to words; their mother’s voice, a dog’s barking, the scent of milk or Pierre’s anxious image of me. Such representations thus fall outside of Freud’s bipartite divis...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of figures
• List of tables
• Introduction
• 1 What goes on in a baby’s mind? One-month-old Nic
• 2 Primal representations: three-month-old Tina
• 3 Containment: maternal music and paternal words with three-month-old Frida
• 4 What does a baby understand? Eight-month-old Karen
• 5 An infant’s experience of mother’s depression: sixteen-month-old Beate
• 6 The infant “within” the adult: interacting with Monica
• 7 The living fossil: Tristan’s Urvergessen
• 8 Classical concepts revisited I: primal repression
• 9 Classical concepts revisited II: infantile sexuality
• 10 Classical concepts revisited III: transference
• 11 Mother-infant psychoanalytic treatment: does it work?
• Epilogue
• References
• Index