In 1933 Freud declared that perhaps the greatest contribution of psychoanalysis would be its “application to…the upbringing of the next generation,” a contribution he characterized as “so exceedingly important, so rich in hopes for the future.” Our own work convinces us that what we have learned through psychoanalytic observation, both clinical and in direct settings, can be applied in a number of ways to the upbringing of the next generation. When in October 1978 I shared with Anna Freud some of our Education for Parenting work, within days she replied: “I agree with you absolutely that psychoanalytic knowledge can be invaluable if brought to the public in this and other ways, and that at present not enough is done about this.”
In 1969, when my research team and I began investigating the correlations between various qualitative aspects of the child-mother relationship and the development of specific ego functions in the child, we could not have anticipated that serendipitous findings would lead us into the area of prevention. But after two years of observing mother-infant pairs longitudinally in a group setting, meeting twice weekly with them for two-hour sessions, we had found, without setting out to look for it, a method of parenting education.
Prevention/Early Intervention Mother-Child Croups is a group educational model for parents in which seven to ten mothers and their infants attend a weekly group meeting lasting one and a half to two hours. The meetings are led by psychodynamically knowledgeable mental health professionals, and the instruction is not didactic. Rather, the focus is on the children's behaviors, with a view to talking about any aspect of these behaviors that is puzzling or troublesome, either to the mothers or to the children. We also respond to any questions the mothers may have about dealing with these behaviors or about child rearing generally. Although this approach is educational, and is meant to guide parents in their work, it is often necessary, whether we are working with disadvantaged families or not, to borrow the techniques of supportive psychotherapy in order to enhance parent's growth-promoting efforts and to facilitate the assimilation of information. We always search out a mother's growth-promoting parenting strengths and try to link them to any suggestions we may make for specific changes in the way a mother handles child rearing issues. Although we do not emphasize the psychotherapeutic aspects of this type of parenting group work, it is nonetheless similar to the therapy adjunct used by Fraiberg, which she called developmental guidance.
We have found that parents lack a good deal of factual information on matters essential to healthy child development. Fortunately, this information is readily teachable. For example, we have often found gross misunderstandings of what a child's emotional needs are, what will and will not spoil children, what thumbsucking is all about, what transitional objects do for children, what causes stranger anxiety and separation anxiety, and what the separation-individuation process achieves. Many parents know nothing about the oedipus complex, what it does for and to children, or how important it is to the development of morality, social conduct, and the ability to form good love relationships. Many parents do not know whether these ubiquitous phenomena are good, bad, or indifferent, nor do they know how to deal with the desirable and undesirable elements in them.
Here are a few examples. From the time their children were about six months old, two of the mothers would “sneak out” whenever they had to leave their children—say, for an appointment— because they felt they might thereby avoid upsetting them. They did not know that in this critical period of psychic immaturity, infantile omnipotence, and magical thinking, leaving in a way that does not allow the child to become aware of the actual separation can endanger the development of basic trust. Explanations of this matter were at first startling to these mothers, who of course could find no cues to it in their own repressed childhood experiences.
Discussions of thumbsucking, separation anxiety, and stranger reactions took place frequently. Some of the mothers could not distinguish acute anxiety from healthy narcissistic orneriness. They did not know when to yield to their children's wishes, or when to frustrate benevolently. Too often they would gratify or frustrate at the wrong time. For example, when they are reprimanded by their mothers, two-year-olds often become upset. And of course it is natural for them, when upset, to seek comfort from the mother. Several good mothers, however, when placed in this situation, would reject the child's request for comfort. Each mother felt that since she had just scolded the child, the child was now trying to “butter her up”; thus, the mother concluded that she would spoil her child by being comforting. The mothers agreed with one another that the lesson to be learned would be defeated.
They did not know the harm that this approach can bring. Nor did they know that comforting the scolded child can promote growth in two important ways. First, it better instills the lesson to be learned because the admonition repeated by the
comforting mother is more readily internalized than that of the rejecting mother, the fantasied bad mother whom the infant wishes to be rid of. Second, it facilitates the fusion of good with frustrating mother representations, prevents the splitting of both self- and object representations, and thereby secures a more advanced stage of object relatedness and psychic development. Indeed, rejecting the child under these conditions reinforces the pathogenic defense of splitting by strengthening the influence of the bad, frustrating mother and the bad self-representation. After a number of efforts at explaining these concepts, all but one of the mothers began dealing with this matter quite well.
Discussion of children's interests in babies and their genitals was introduced by a three-and-a-half-year-old girl who sent a shock wave through the mothers by announcing that she wanted to have a baby. Attaining conversational ease with sexual matters, perhaps the most difficult area for most of the mothers, is a rather slow process. By contrast, limit setting, ambivalence, hostility, and temper tantrums are much easier for them to discuss. Nonetheless, talking about sexual matters, when carefully dealt with, can be most beneficial. Mothers who understand their children's behavior better can deal with it less conflictually. Education about the oedipal period is only one of many examples of increased parental comfort with sexual material.
Gradually we came to recognize that our approach provides a method for educating mothers, fathers, and even children. Our experience with families at substantial risk (though none were drug using, there was some alcohol abuse) has been that the education-effected change in
quality of parenting began to appear after about eighteen months of twice-weekly group participation. Follow-up study and evaluation nineteen years after the group project was begun revealed that the parenting of participating mothers had changed from growth-disturbing to growth-promoting. On a ten-point scale it improved anywhere from 3.5 points (staff evaluations) to 5.4 (parent self-ratings), a substantial shift.
Within a year after the start of our observational project, a parallel study evolved (also out of unexpected findings) that was influential in pushing us into prevention, and into promoting mental health. By 1971 our findings were challenging the then prevalent theory of aggression, and we abandoned our study of ego functions to turn to the development of aggression. It was our studies in this area that made us aware of the many episodes of child-mother interaction in which hostile destructiveness was exacerbated or even instigated where it could as easily have been mitigated. Similarly, we found as many episodes where nondestructive aggression (and the assertiveness and thrust to autonomy it fuels) was prohibited and burdened with conflict where it could equally well have been protected, sustained, mediated with pleasure, and rendered effective. Psychoanalysts have long assumed that these episodes, once internalized, lend psychic structure its salient features through a Piagetian process of assimilation and accommodation. This recognition, in the context of twentieth-century Western history and present-day social problems, thrust us into an interventional study “Toward Preventing the Development of Excessive Hostility in Children.” To achieve the goals of this study it became necessary to operationalize the mother-child interactional unit of observation and to develop interactional loci of observation (i.e., prototypical mother-child interactions), strategies for educational intervention, and an instrument for recording aggressive activity in the child (the Excessive Unpleasure/Hostility Record), as well as qualitative measures of parenting functions in general and of parenting functions specifically geared to the handling of children's aggression.
In my The Development of Aggression in Early Childhood (1979), the hypothesis was advanced that “excessive unpleasure activates the generation of hostile destructiveness.” If that hypothesis is valid, as longitudinal research now suggests, then we can find ways to prevent the development of excessive hostile destructiveness in children, to begin with by educating caregivers, including parents and child care professionals, to this finding. Several years into our observational projects we became convinced not only that we had found a parenting education method but that we were in effect influencing these mothers to be less hostile and less hostility-provoking toward their children; as a result, the children were showing evidence that they were not themselves becoming excessively hostile. In fact, our nineteen-year follow-up study revealed not only that the mothers' parenting shifted from growth-disturbing to growth-promoting; in addition, the study showed that the children fared better in their aggression profiles than did the population from which they came. On three of four parameters of the Fitzgibbons Anger Inventory—Anger Expression, Passive Aggression, and Violence Potential—their grouped scores were more favorable (mild) than were those of adolescents from their community (moderate).
In the early 1970s the mothers we worked with often expressed the wish to have known, before they became mothers, what they were learning now. This confirmed our own thinking, and we decided to develop a curriculum for teaching parenting to school-age children. By 1976 the mental health team at Eastern Pennsylvania Psychiatric Institute—three child psychiatrists (two of whom are child analysts), three social workers, and three teachers—had begun to develop a curriculum for students from kindergarten through grade twelve, and in 1977 we were joined by two teachers from the German-town Friends School (GFS). The next year began a nine-year collaboration with educators at GFS, which included holding one of our weekly Prevention/Early Intervention Mother-Child Groups at the school. We found that teaching children about parenting was more feasible than we had anticipated. We knew from both observational and clinical work that these materials could be taught to elementary school children, a fact about which the teachers were at first skeptical. Encouraged by personal communications from Anna Freud and Margaret Mahler, we continued to develop our curriculum.
In the mid-1970s we found that educators at the national level were calling for parenting education courses for high school students. During the early 1980s, understandably impatient with our slow pace and the complexity of our curriculum, several educators at GFS developed their own introductory curriculum, Learning About Parenting, which broke ground for parenting education in schools in Philadelphia and elsewhere. With determination and a good deal of struggle, Education for Parenting, now under the directorship of Bonnie Raines, achieved its hard-won entry into public and private schools, where the program has now been in effect for over a decade.
Meanwhile, the mental health team continued to develop the Parenting Education for Emotional Growth Curriculum. Having occasion to twice review and make recommendations to the teachers' introductory curriculum, we became aware of a significant gap in language and concepts that exists between mental health professionals and educators. Though over the years that gap has substantially decreased, we nonetheless could anticipate a significant degree of difficulty in preparing teachers to bring to students those elements of the curriculum we considered most important in achieving our mental health prevention goals. We therefore set out, under the leadership of our chief social worker and collaborator Elizabeth Scattergood, to develop our own lesson plans, modeled on the form developed by the teachers in Learning About Parenting.
Much is known in the mental health field that is readily teachable to parents and young students. We have found that growth-promoting parenting can be greatly facilitated when parents have some basic understanding of the complex nature of human development and are able to apply it to child rearing. Our curriculum has several distinctive features. (1) It addresses the mental health domain of parenting. (2) The curriculum materials start at the kindergarten level; in a unique collaboration between mental health and education professionals, these materials will be developed into a pyramid for grade-appropriate courses from kindergarten through grade twelve. (3) It is a laboratory-type curriculum; as in biology, students are exposed to live materials, specific child-parent interactional activities both in the classroom and in outside assignments (audiovisual material will be used to supplement live observations). Our position is that parenting is a domain of information, knowledge, and skills that can be facilitated and enlarged through learning.
Parenting Education for Emotional Growth consists of a source book accompanied by model lesson plans drawn up for various grade levels on each issue detailed in the book. After two introductory units, on parenting and on pregnancy and delivery, units follow on (1) the first year of life; (2) years 2–3 (the toddler years); (3) years 3–6 (the preschool years); (4) years 6–10 (elementary school); (5) years 10–13 (preadolescence); and (6) years 13–21 (adolescence, three phases).
The six units are structured similarly. Each starts with a brief section on physical development as it pertains to mental life (e.g., brain maturations that underlie new cognitive capabilities; maturation pertaining to toilet training; physical and hormonal changes accompanying puberty). This is followed by a section on emotional and behavioral development, covering ego development; sleep-wake cycles; affects; cognitive functioning; self and relationships to others; sexual-reproductive life; aggression; dependence/self-reliance; defense mechanisms; empathy, altruism, and sublimation; and conscience formation. Each of these issues is addressed first from the vantage point of human development and then from the vantage point of child rearing. The human development section outlines age-adequacy as regards capability and function, while that on child rearing suggests growth-promoting, development-enhancing rationales and strategies for future parents.
The mental health team that developed both Parenting Education for Emotional Growth and
Education for Parenting (Elizabeth Scattergood, Andrina Duff, William Singletary, myself, and others) and the group of educators who developed the Learning About Parenting curriculum (Sara Scattergood, Bonnie Raines, and others) are now combining their efforts to develop a demonstration program, the Parenting Education Middle School Initiative, which will offer intensive parenting education in a Philadelphia middle school (grades 6–8). The curricula developed by both groups will be integrated to provide the best program possible for the target school. The overall mission of the project is (1) to teach parenting to middle school students who are not yet parents, and to those who already are, in order to better prepare them to be growth-promoting parents, (2) to develop a curriculum suitable for replication, and (3) to develop the context in which a longitudinal research project can be carried out. The parenting program for students in the school who are already mothers will be comprehensive. It will include our working in a parenting group with the young mothers, their infants, and, where they are involved, the infants' grandmothers. Where necessary, day-care services will be provided to the mothers so that they can continue their education. Home visits will be made by professionals and monitored by the program, and medical services for both mothers and their infants will be provided within the school district. Funding is currently being sought for this interdisciplinary program.
Working with mothers and their children from birth on (regrettably, fathers have not been engaged in our observational work), as well as psychoanalytic clinical work with children, has convinced our team and a number of child analyst colleagues that it is high time psychoanalysts put significant effort into the prevention of experience-derived emotional disorders, rather than waiting for them to appear in the clinical situation. This was part of Freud's larger vision. Efforts to prevent violence and the abuse of children in our society must be joined by psychoanalysts. We cannot afford to be timid in making our contribution.
Part of this article is based on a chapter appearing in Prevention in Mental Health, edited by Henri Parens and Selma Kramer (Aronson, 1993). References are available from the author, 111 Presidential Boulevard, Suite 133, Bala Cynwyd, PA 19004 (610 664–5220).