Adult and child psychoanalysis has benefited from the work of infant observers and researchers. The field of infant research, developing in a systematic way since the 1980s, is providing psychoanalysts with scientific knowledge of early psychic functioning and primitive experiences, leading to the development of new tools for intervention.
Psychoanalysts are concerned with the genetic point of view but few of them analyze children and observe the early years of life. The importance of clinical experience with babies and young infants as part of analytic training has been debated for more than 60 years.
When Freud was writing Beyond the Pleasure Principle (1919), he famously observed his grandson’s repetitive “fort-da” play of reeling to and fro a toy on a string, in the context of the toddler’s reaction to separation from his mother. It helped him appreciate the need for repetition in play and in transference. This first child observation of preoedipal phenomena led to the discovery of symbolizing capability in toddlers and the significance of repetition in dealing with psychic challenge. Ernst, the little boy observed by his grandfather, in turn, became a psychoanalyst working with Anna Freud. He established infant observation as part of the analytic training in Germany. (Freud, W. E. 1975)
Judith Kestenberg (1977) wrote: “By 1920 Freud had replaced the descriptive terminology by a ‘systematic or dynamic’ one, which allowed him to say ‘the patient’s resistance arises from his ego’ (Freud, 1920a), a decisive change in theory and technique was already accomplished. The mutual influence of clinical insights and theory formation was evident. The interrelation between personal experience (to be distinguished from countertransference), incentives for new research and the beginning of an orderly psychoanalytic infant observation, as a counterpart for reconstruction in adult analysis, was also in evidence.”
How does understanding mother-infant communication inform adult treatment? Infant observational research can alert psychoanalysts to infant behaviors, interactions, and potentialities that influence adult mental life. Child observation may help adult psychoanalysts to intervene in a genuine and empathic way, by bringing closer proximity to their patients’ development. Infant research findings of relational disturbances in infancy show how nonverbal communication can inform adult treatment. Mother-father-infant treatments demonstrate the malfunctioning containment in mothers amid primitive anxieties in early interactions, with enduring consequences for the developing self. Psychoanalytic technique benefits by greater focus on the role of nonverbal communication, the notion of containment, and the work in countertransference with narcissistic disorders.
From the Issues in Psychoanalytic Education Editor
Christine Anzieu-Premmereur’s article on infant research is the second in the series of interdisciplinary forays in this column. Her comprehensive historical review invites reflection: Is infant research intra- or interdisciplinary for psychoanalysis? How has it moved the needle of psychoanalytic theory and practice? Bathing her work with infants and parents in richly informed theoretical pluralism, she gives voice to the need for ongoing rigorous integrations of psychoanalytic thought, practice, observation, and education.
—Luba Kessler
During the 1920s, Karl Abraham, Sandor Ferenczi and then Michael Balint explored the primitive states of emotions and conflicts. They contributed to psychoanalytic theory and technique by addressing the fundamental role of early stages of development in depression and melancholia, in particular the consequences of the quality of parenting in the child’s mental processes. Melanie Klein came from that world, observing her own children and the infants of her patients. She created a new view of the infant’s mental structures and contents, which led to a different technique in psychoanalysis. (Klein, M. 1933, published 2018).
Following the Kleinian School, Donald Meltzer and Martha Harris made further big contributions to psychoanalysis by observing infants and making links with their adult patients’ pathology. It was the beginning of important applications to the work with autism. Frances Tustin, Margaret Rustin, and Geneviève Haag developed new understandings in the treatment of autistic children. They were part of the work group with Esther Bick.
In 1948, John Bowlby developed with Bick (1964) an experiential approach to analytic training at the Tavistock Clinic in London. Weekly home observation of an infant over the first years of life became an essential feature in psychotherapy and psychoanalysis training throughout the world. It was Bick’s idea that this was to be an essential preparation for psychoanalysts, especially child therapists: to learn about how babies develop in the context of the family, to be attuned to the infantile elements in their patients’ material, to be in touch with maternal anxieties, to develop the “free floating attention” that gives access to detailed observation and to the observer’s own emotional responses, to learn about the building of the internal world and unconscious communications, to bear limitations to curiosity that lead to intrusiveness, and to understand the role of containment, introjections and projections.
Bick underlined the impact of maternal anxiety and depression. In technique, she emphasized the need to wait for meaning to emerge, in observation and in analytic work. Such explorations of the emotional importance of early mother-baby relationships had a long-term influence in psychoanalysis. It corresponded with the work of Wilfred Bion on the theory of thinking.
At the Hampstead Clinic created by Anna Freud in 1952, infant and child observation was also part of analytic training, with different emphasis. Her work on assessment of children and their developmental stages as well as suitability for analytic cure led to the establishment of analytic tools to formulate metapsycho-logical profiles of patients. She emphasized the functions of the ego, its normal “developmental lines” and the need for systematic defense analysis. It became the basis of the Ego Psychology movement in the U.S. For example, the Yale Child Study Center is specifically dedicated to the goal of promoting “developmental psychoanalysis.”
Observation and child analysis provided much-needed balance between a view of the real child and the “reconstructed child” of adult analysis. It also helped distinguish between the real and imaginary parents of adult patients. The analyst becomes acquainted with fantasies of the patient’s parents, which had been transmitted to the child.
Observing children in different settings, such as at the Hampstead nursery, after family separations during the War, or during hospitalization, led to research on separation and trauma. Soon after, in the early 1950s, Bowlby’s pioneering work would lead to the creation of the field of attachment. Willy Hoffer (1950) was a consultant at the Hampstead Clinic. A great observer of babies, he studied ego integration and the fundamental role of libidinal capacities. He greatly influenced Winnicott’s work.
From his work in pediatrics observing babies, Winnicott developed an extensive theory on “holding” and its technical consequences: The holding environment as “the foundation of health” fosters the ability to experience the body as the place where one securely lives. The work of the analyst is to offer a holding environment based on the mother-infant bond. In child analysis, he considered playing key to the psychological well-being of a true self, through the use of transitional phenomena. This perspective formulated aspects of the function of the analyst’s presence as the Other who demands
nothing, in contrast to the arousing or power-exercising object-mother. This focus explicitly informs Thomas Ogden’s work (2004) on analytic technique with difficult patients.
There is concordance between Winnicott’s maternal role and Bion’s maternal reverie. Bion’s alpha function involves two psyches connected, where one can digest and represent the experience of the other one. This mental process translates archaic bodily feelings and emotional states into something mental. As the mother is to receive and transform projections from the infant and to move them from perception to symbolization by giving meaning, the psychoanalyst uses attention, free association, and countertransference as a signal of the patient’s experience. The field theory, developed by Antonino Ferro, applies this notion of environmental unconscious communication.
Infant work and observation also had a strong influence on reintroducing the role of the body in psychoanalysis. In that regard, the containing function is an important part of the skin-ego theory of Didier Anzieu: The ego is organized from bodily sensations with functions of barrier, filter, and unifying envelope just like the skin. The skin-ego contains psychic objects, permits connections, and offers a screen, as a consequence of the introjection of the mother’s handling of her baby. This had important consequences in the treatment of narcissistic disorders, as in René Roussillon’s work (2011) with depressed patients lacking symbolization.
Following Freud’s drive theory, French psychoanalysts created in the 1970s a clinic for psychosomatics where babies were treated with their parents, using the “maternal function” of the analyst as a split that filters and differentiates attachment and erotic love, in order to help the infant develop psychic structure free from parental projections. (Fain, 1971, Kreisler, 1984).
Selma Fraiberg introduced parent-infant psychoanalytic psychotherapy. In the home intervention described in Ghosts in the Nursery (1975), Fraiberg developed the concept of “ghosts” impinging on the infant’s mental health. She said problems in infant development stem from unremembered trauma preventing parents from fully developing a deep attachment to their child. Parents strive consciously to bond with the child, but their unconscious impulses may run in opposite directions. Following Fraiberg’s work, Alicia Lieberman (2005) developed a psychoanalytic technique to work with traumatized families, opening the field of the transmission of trauma through generations.
The revolution brought by the amazing work of Fraiberg and the emerging field of infant research made some analysts, under the lead of Serge Lebovici, create, in 1980, what is now the World Association for Infant Mental Health. Its mission is to promote education, research, and study of the effects of mental and social development during infancy.
In Sweden, Johan Norman and Bjorn Salomonsson have developed a technique in which the analyst talks directly to the baby, providing the mother with meanings in the emotional field between them. Research on the salutary effects of this technique on the child’s mental health was published in 2010. This has the interesting potential of employing the mind of the analyst informed by such experiences with babies, in work with disorganized adult patients.
T. Berry Brazelton and Bertrand Cramer (1990), a pediatrician working with a psychoanalyst, applied infant research in parent-infant interaction, observing nonverbal communication by the parents whose loving ways were also expressing projections of ambivalence onto their child. In a pediatric clinic in Geneva, a psychoanalytic center for families with babies was set aside as a place for specific research on parental projections. The field of parenthood, already enriched by the work of Lebovici on “fantasmatic” interactions, was then a source of psychoanalytic approaches such as in the work with adults having a child. It served to promote psychic changes through the analytic understanding of narcissistic and Oedipal transformations inherent in the process. (Palacio Espasa, 2004)
All these creative clinical practices have enriched the scope of therapeutic action of work with adults, since they provided knowledge about primitive mental functioning and extended the reach of analysis beyond the neurotic range to psychotic and narcissistically damaged patients. Andre Green (2000) was explicitly opposed to baby research as a source of knowledge about the unconscious. He saw analysis as the specific way for understanding infantile unconscious mechanisms, independent from “applied psychoanalysis” in developmental research. Yet, his 1983 paper on the “Dead Mother” shows how adult analysis can meet the work of a parent-infant therapist. While this paper does not refer to child observation per se, it serves as a profound illustration of how knowledge about early narcissistic trauma offers an understanding of borderline patients’ representations of the internal object.
In 1935, René Spitz was one of the first analysts using direct child observations as an experimental method. His studies of the effects of maternal and emotional deprivation on infants showed how anaclitic depression and hospitalism are psychogenetic diseases that could be prevented. He described organizing principles in the development of the ego: the smiling response, the anxiety in presence of a stranger, and semantic communication. Psychoanalysts connected those discoveries to the development of neurosis.
Jean Piaget conducted experiments that collected behavioral tests on infants. He studied object permanence, evaluating memory, and furthering an understanding of separation anxiety.
After reading the work of Spitz on orphans, Bowlby accumulated a body of observations to indicate the fundamental importance for human development of attachment from birth. Building on concepts from ethology, he wrote papers that are classics. His research influenced international policies regarding childcare. According to this theory, attachment in infants is primarily a process of seeking proximity to an attachment figure in situations of distress for the purpose of survival. Infants become securely attached to adults who are sensitive and responsive. Parental responses lead to the development of patterns of attachment, which in turn lead to “internal working models” that will guide the individual’s feelings and expectations in later relationships.
Bowlby’s colleague, Mary Ainsworth, was completing extensive observational studies on the nature of infant attachments. In 1965, she designed the Strange Situation Procedure as a way of assessing individual differences in attachment behavior.
Margaret Mahler, while conducting long-term research on infants, developed in 1950 a treatment model, in which the mother participated in the treatment of the child. She initiated constructive exploration of severe disturbances in childhood. She carefully documented the impact of early separations, contributing seminal psychoanalytic insight into the process of separation-individuation as the psychological birth of an infant. The child separates from the mother and begins to individuate. Her theory shed light on the normal and abnormal features of the developmental ego psychology of childhood and adolescence.
Infant research began to coalesce into a distinct discipline in a more systematic scientific interaction with psychoanalysis in the past 40 years.
In 1975, Edward Tronick presented the “still face experiment” in which an infant, after three minutes of interaction with a non-responsive expressionless mother, “rapidly sobers and grows wary. He makes repeated attempts to get the interaction into its usual reciprocal pattern. When these attempts fail, the infant withdraws, orients his face away from his mother with a hopeless facial expression.” The experiment became a model for testing hypotheses about perception, communication, differences in attachment style, and the effects of maternal depression on infants.
Daniel Stern (1974) framed the study of mother-infant interaction in the larger context of its importance for interpersonal object relations and attachment, still a central research issue today, with the goal to modify current theories on the nature of object relations. Stern (1985) later developed these ideas in his groundbreaking work, The Interpersonal World of the Infant, which had a transforming effect on psychoanalysis.
Stern’s research created a bridge between psychoanalysis and research-based developmental models. This set the stage for the study of mother-infant communication, including the role of a competent, initiating, social infant. Stern proposed that an infant develops in a series of overlapping stages, which are increasingly interpersonally sophisticated. He distinguished four senses of self: “the emergent self, the sense of a core self, the sense of a subjective self, a sense of a verbal self,” and he introduced the “proto-narrative envelope.”
As an analyst, Stern identified himself as “post-Freudian,” in terms of his emphasis on self in relationship with others, relying less on interpretation of the past than on corrective attachment experiences and on self-psychology. He was part of the Boston Change Process Study Group that developed ideas in analytic treatment about forgoing interpretations in favor of pursuing relational meaning through implicit knowing and the micro-processes of interaction.
Colwyn Trevarthen (1979) has applied intersubjectivity to the rapid cultural development of newborns. Researchers suggest that humans are wired to “coordinate their actions with others.” This ability to coordinate with others facilitates cognitive and emotional learning. Intersubjectivity is a process of psychological energy moving between two subjects with a shared feeling of affection. This conception in psychoanalysis had been shared by analysts like Kohut, Stolorow, and Jessica Benjamin.
James Herzog and James Anthony, in the 1980s, articulated the importance of the role of the father as well as the influence of the baby’s own action on his surroundings.
Jeffrey Cohn and Edward Tronick (1988) documented bidirectional mutual influence between mother and infant. This work helped establish the empirical foundation for an interactive systems model of infant social development.
Following Stern’s research on video and micro-analysis of moment-by-moment mother-infant dialogue, Beatrice Beebe and Frank Lachman (1988, 2012) argued that a two-person field organizes infant experience from the beginning. They see infant and mother co-creating the nature of the infant’s experience. They think of dyadic bidirectional regulation as existing in dynamic relation to the self-regulation of each partner. They studied transmission of maternal psychopathology and origins of insecure attachment, examining nonverbal communication. This work has direct implications for early intervention and adult therapy.
Robert Emde (1994) made remarkable contributions using advanced technology to treat emotions as independent variables, in the investigation of the infant’s use of others’ emotional signals (social referencing). The research was about
deviant empathic processes (child abuse) and understanding the integration of conflicting emotional signals. Concepts like regulation of emotions, cognitive assimilation, and the role of empathy are important developments from those studies.
György Gergely and John Watson (1996) presented a new theory of parental affect-mirroring and its role in the development of emotional self-awareness in infancy. It proposes that infants first become sensitized to their emotional states through a natural social biofeedback process provided by the parent’s “marked” responses to the baby’s emotional displays during interactions. Having identified various types of deviant mirroring styles, they discuss what role their social biofeedback model may play as a mediating mechanism in the therapeutic process.
After Fraiberg, child trauma researchers identified psychological mechanisms that favor intergenerational transmission, including dissociation in post-traumatic stress disorder. Daniel Schechter (2003) is known for his research on intergenerational transmission of violent trauma involving parents and young children. Following Peter Fonagy (1991) and Mary Target’s concept of parental reflective functioning, the therapist may then be prepared to intervene thoughtfully by modeling and stimulating parental mentalization during parent-child sessions.
Elisabeth Fivaz’s (2004) recent contribution was the exploration of triangulation in infancy: the infant’s capacity to handle triangular interactions and share her affects with two parents, involving fathers.
All this research offers empirical evidence of the development of the psyche from very early on, complementing and expanding psychoanalytic developmental theories.
Contemporary child development specialists and neuroscientists agree on the representation of a baby equipped with complex adaptive capabilities and a biological instinctual organization. How does this meet with the psychoanalytic baby, libidinal and driven by anxieties? The answers to this question vary.
Some analysts did not use infant research and did not modify their theory. Others recognized the challenge to integrate research observations into drive theory, the theory of sexuality, and the genetic point of view. Infant research seemed to set aside those developmental theories by putting the emphasis on the quality and the formation of intersubjectivity and interpersonal bonds, associated with the development of a sense of self connected to the body, and stressing the part of nonverbal language.
Even without specific attribution, infant work seeped into psychoanalysis starting in the 1980s. Psychoanalysts working with adults became gradually more sensitive to the setting, the frequency, nonverbal sensorimotor communication, and the body as a somatic and erotic part of the self. As a result of the influence of the infant clinic, the analysts’ understanding of the patients’ versions of their stories began to give more room to the role of the mother, the primitive representation of her, as well as to the active baby not only driven by instinctual needs, but also seeking experiences adjusted to the mother’s mood and behavior.
Though most analysts agree the psyche is built from integration and internalization of early relations, there is a controversy about the nature of the internalized self-object relations.
In North America, under the influence of developmental ego psychology, the theory of economics of drive energy has been largely replaced by the internalized mutuality between baby and caregivers. Attachment and object relations prevail over psychosexuality. The early interpersonal relationships observed in infant research became paramount in developmental psychoanalytic theory: The infant only internalizes what is happening in external reality.
For post-Kleinian schools, the infant’s perceptions are affected by the play of introjection and projection. The Kleinian notion of fantasy, associated with drive activity, is fundamental in the nature of internalized object relations. This is more about unconscious processes than about the developing ego. Earliest relations are not seen as the causal agent of the mind, but rather as participating in a complex and non-linear integration with the mind as its own entity. This model of mental development, derived from the work of Winnicott, Bick, and Bion prevails in a number of European and South American countries. In their psychoanalytic cultures, the knowledge from infant observation and research about innate infant capacities certainly confirms that newborns prefer human relations and depend on the dynamic of the reciprocal action between mother and baby. However, those relationships are not viewed as primarily external and social, but as enabling the infant’s sense of having his own mind. It is the meeting between the instinctual needs and the external object that instantiates the beginning of mental development.
Infant observation allows analysts to witness the baby moving rapidly through different states: alert, fretful, screaming, disorganized, or satiated, withdrawing into sleep. Observing the dynamic between moments of emotional and cognitive integration and disintegration, analysts develop a representation of the emotional early relationship with the environment, seeing the role of the vulnerable mother in her tasks of holding and containing. For those analysts, mental activity starts at birth, with the baby’s experiencing the environment of physical and human contact in the context of its internal object
world. These interweave as infants find their own ways to contain themselves after integrating their mother’s holding. The fundamental process of identification enables the transformation of mental states into thoughts.
Knowledge about early and deep psychic functioning derives from infant research and direct observation as much as from analytic understanding of unconscious processes. This has contributed to major debates and intellectual shifts in psychoanalysis. Precise observational descriptions of infants’ lived experience had to be put in perspective informed by the narrative reconstructions that are at the core of analytic work. Data on the intensity and the quality of interactive relations in early infancy opened another window on the object relations theories. Contemporary psychoanalysts can integrate these insights into their working theories and praxes. Being aware of the epigenetic potentialities of development through time, the psychoanalyst works with the patient in the transference, in the afterward (après-coup) psychic elaboration of the impact of early emotional experiences of events or traumas.
Editor’s Note:
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