Merging and Emerging: Separation-Individuation Theory and the Treatment of Children with Disorders of the Sense of Self

I had the good fortune to join both of Margaret Mahler's research projects at the Masters Children Center at their inception in 1959: one, the observational research on the normal separation-individuation process, the other the research on symbiotic child psychosis, during which the tripartite treatment design was developed under the leadership of Margaret Mahler and Manuel Furer. While the two studies were separate, there was nevertheless a cross-fertilization between them. The painful and distorted developmental processes of psychotic children with exaggerated crises of separation at times helped us to notice the more subtle crises that any child experiences during the first three years of life. In turn, the articulation of the phases of separation-individuation helped to guide the treatment of psychotic children and their mothers, whose navigation of the separation-individuation process was so complicated and so painful. It was easier to bear the pain that these children experienced and endure years of intensive treatment if one could understand the treatment process in relation to developmental processes.

The tripartite treatment design was developed over a number of years and was built on the premise and the observation that psychotic children had never formed a symbiotic bond with their mothers from which the process of separation-individuation, culminating in the achievement of emotional object constancy, could evolve. Therefore, children with psychotic and autistic pathology were treated together with their mothers to facilitate the symbiotic bond between them: at the beginning of treatment, the task of the therapist was to form a bridge between the psychotic child and the mother who felt she could neither understand her child nor be understood by her. The hope was that, by forming a bridge between mother and child, the therapist could help the child to accept the mother's care and use it so that an affect feedback system between them could evolve