Origins of Mental Representations: Enlightenment through Clinical Presentations” was the topic of a World Association for Infant Mental Health workshop held in Amsterdam on July 25, the Sunday preceding the recent IPA Congress. For many years WAIMH, an interdisciplinary organization committed to promoting positive beginnings for infants and families worldwide, has organized pre-Congress workshops offering colleagues around the world an opportunity to share theoretical and clinical work concerning infant development. The recent gathering brought together participants from more than a dozen countries on four continents. Videotaped case material was used by two of the presenters, which proved an excellent way of overcoming language and cultural differences.
The first presenter, past WAIMH president Serge Lebovici of France, discussed the case of a couple who were having difficulties with their baby, born twenty months after another who had died on their wedding anniversary. Neither mother nor baby were able to look at each other or to interact positively. Through Lebovici's sensitive interventions, the baby gradually became able to look and smile at him; later, mother and baby were able to look and smile at each other. Discussant Paulina Kernberg remarked that with Lebovici the infant showed a capacity for developing good object relations; the problem lay clearly in the mother-infant relationship. In an intervention nicely illustrating Winnicott's seminal idea that there is no baby without the mother, Lebovici showed the mother here a different way to relate to her baby. At this early stage of development, mother and infant were both open to the intervention, likely allowing the changes in their responses to go beyond what might be possible later. Audience discussion raised a number of issues about work with parents and infants, including the role of the father in parent-infant psychotherapy. The discussion ended with the important question of when to deal directly with the infant and when to focus primarily on the parentinfant relationship.
The second presentation, by Hisako Watanabe of Japan, used videotape to demonstrate a case of intergenerational transmission of deprivation and depression from grandmother to mother to infant. The mother had a great deal of difficulty even looking at her baby during play. It was striking that there was so little affective interchange between the two, almost as if they did not know each other. Interviews with the two adults revealed that the grandmother, because she had to work and had no one to care for her baby, had left her eight-month-old daughter at an orphanage for eight years.
Through Watanabe's sensitive therapy, which included recognizing the “ghosts” from the mother-grandmother relationship, the relationship between infant and mother changed remarkably, leading to greater interaction and even laughter during the play sessions. Discussant Peter de Chateau of the Netherlands commented that the interaction changed from bland and negative to positive and contingent, with much affective interchange. It seemed as if the transference relationship built up by the mother toward the therapist allowed her to develop a changed relationship with her baby and to replace earlier, more negative representations. The mother may never have enjoyed a “holding environment,” to employ Winnicott's term, and so had to learn through the psychotherapy how to create one for her baby.
The third presentation, by Dirk de Raeymaeker of the Netherlands, was of a case of an infant with significant developmental delay. The mother had difficulty relating to the baby and accepting the fact that she had an imperfect child. Depressed, she related to the child with little affect and involvement. In the therapy, de Raeymaeker worked with the parents to help them accept and relate to the child. While progress was made, because of the developmental delay the parents had recurring difficulties at each new stage. During the psychotherapy, intergenerational problems were uncovered in the early life of both mother and father that interfered with their ability to care for their child.
The discussant, Peter Fonagy of England, emphasized the importance of separating the physical sense of self from the mental sense. The mental or reflective self takes longer to take shape and requires input from the social environment to facilitate its development. At times the infant, regressing back to the physical self, will be unable to experience the psychological self. In this case, Fonagy felt that the child had not developed a core sense of self. The mother, he remarked, was depressed because she had never completely mourned the loss of her fantasized perfect baby. In the discussion it was remarked that the mother could not “see herself in the infant's eyes.” During interaction with the mother, it was observed, the toddler could not face separation. Because the mother was unable to view the child as separate, it was difficult for her to develop as a mother and for the child to become a separate entity.
Joy D. Osofsky, Ph.D., is President of the World Association for Infant Mental Health.