From Pregnancy to Motherhood

Psychoanalytic aspects of the beginning of the mother-child relationship

Gina Ferrara Mori, Gina Ferrara Mori

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317587545
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

From Pregnancy to Motherhood: Psychoanalytic aspects of the beginning of the mother-child relationship explores the mental states associated with pregnancy, birth and the early days of motherhood from a psychoanalytic perspective. Drawing on clinical research findings and the infant observation method originally developed by Esther Bick, the contributors examine a range of topics which include: how women's view of motherhood is influenced by social, cultural and biotechnological factors; how women's sense of identity changes throughout pregnancy and motherhood; how women's relationships with her family, partner and future child are shaped; and how mental health professionals can better understand ways to work with issues of maternal and infant mental health.

Gina Ferrara Mori presents the research of psychoanalysts and psychotherapists working in different settings with mothers-to-be exploring their emotions, wishes, dreams, phantasies, fears during the "time" in which they wait for the birth of their baby and experience the various phases of their bodies' development. Their work discusses the specific and complex developmental process in female identity which the authors have termed the construction of the 'internal motherhood/inner maternity' which becomes a 'psychic container' establishing the pre-conditions for developing bonds, affection and their relationship with the baby once it has been born.

From Pregnancy to Motherhood develops and elaborates theoretical thinking and research already available as well as presenting new material, it will be stimulating reading for psychoanalysts, psychologists, psychotherapists, gynaecologists, paediatricians, ultrasound doctors and technicians, midwives, social workers, healthcare assistants, registered and practical nurses, teachers and students.

Chapter 1
The story has already started

Preliminary meetings in the infant observation

Isabella Lapi and Laura Mori

THE CLASSICAL METHOD AND ITS EXTENSIONS

For Esther Bick, the Infant Observation method consisted in giving “… a unique opportunity to observe the development of an infant more or less from birth, in his home setting and in relation to his immediate family, and thus to discover how these relations emerge and develop” (Bick, 1964, p. 240). Michel Haag (2002) defines Esther Bick’s method as holistic, as the observation is extended to the whole family within which the child is born and also beyond, to relatives, friends, animals, all those who spend time with the family in those days. He remembers Bick saying: “It is not just the observation of the baby, because this is simply not possible”, thus adding to Winnicott’s statement that there can be no baby without a mother.

Bick’s interest was focused on understanding and grasping the change of identity of each family member when a new baby arrives, in particular the mother’s, and on how the relationship starts from the shocking (we could say “catastrophic”, using Bion’s term) event of the birth of a child, that represents a true caesura.

As it is well known, the method provides for a preliminary meeting at the beginning of the observation that should take place towards the end of the pregnancy. Before the birth of the child, the observer contacts the family, preferably with the help of a go-between, and sets up a preliminary interview (Falcao, 2002). Bick considered this first interview relevant to defining the contract between the observer and the family, advising to “give a simple explanation to the parents – namely, that the observer wished to have some direct experience of babies as part of his professional development” (Bick, 1964, p. 241). The goal also was to agree on terms and define the setting, convey to the mother the sense of the presence of the observer, an unobtrusive and indeed respectful container, emotionally present but without advancing demands (Magagna, 1991). The preliminary interview offers the chance to gather some initial information that will thus not need to be discussed again in the observation setting. Haag also notes that Bick suggests a first supervision after the prenatal visit or, even better, that the observer be prepared by participating in an observation group even before starting to look for parents-to-be (Haag, 2002).

Among the criteria for the choice of a suitable case for a training observation, Bick advised that birth should not take place too far away from the first meeting. According to her, it was advisable to have just one prenatal visit so as not to set up an observer-parents relationship having too much relevance before the birth, to avoid a maternal transference and the phantasy of an observer/therapist more interested in the mother than the child, and also so that neither the observer nor the group should wait too long (Haag, 2002, p. 243). One of the drawbacks an observer might face is that “the mother may attempt to build up a strong dependence relation” (Bick, 1964, p. 242), which would interfere with the attempt of the observer to remain “detached from what is going on” (p. 241), and to assume a psychoanalytic approach of “fluctuating attention, uniformly suspended”.

Therefore, the meeting is considered basically preliminary and preparatory to the actual observation, both for the choice of a suitable family and to lay the foundations of the future relationship. Bick placed a great deal of attention on the effects that the arrival of the child produces in mothers, and she described these effects with great precision and participation. There are mothers who become depressed and regress to a part object relation level, and in these cases they are not able to perform a maternal function. They offer their breast, the feeding-bottle, or their arms, but there is no mother behind them. There are mothers who cannot offer even this, such as in the following case – presented by Michel Haag (2002) – that Bick had defined as distressing.

During the preliminary interview the mother had told the observer: “I’m gonna buy a chair, a nice chair”, and the observer had thought that a baby cannot support himself/herself on a chair. When she went to observe the baby for the first time, the mother immediately handed her the baby, saying: “You are happy to look after him, aren’t you?”. The mother could not hold him – Bick commented – for this reason, she had thought about a chair. This baby would be put in his cot straight away, even when he was crying; from time to time the mother would go closer and touch him. By simply being touched, he would put himself back together again and the child would calm down and could spend quite a long time in his cot before starting to cry again until when, after a long time, the mother would go back and touch him. … In the rest of the observation, it was possible to observe how, luckily, this child, endowed with a strong vitality, saved himself by developing an adhesive identity. And the mother, to maintain her vitality, went on working and working, without any break. “What happened, Bick commented, is that the mother did put him on that chair!” Haag remembers how Bick showed him a photo in which one could notice the sharp contrast between the magnificent chair the mother had initially bought for the observer, which now could be used by the grown-up child, and the child’s anxious stare.

Over the years, as the implementation of the Infant Observation method expanded, the preliminary interview took up a different relevance in the sense of considering it the beginning of the observation and to acknowledge its value in terms of what the future mother-child relationship was going to become. There are two areas in which this new development has become mature: the Infant Observation groups and the implementation of the method for research purposes.

In the early eighties, Gina Ferrara Mori described, in her work with observation groups, a preparatory phase that coincided with the need to wait to find the mothers-to-be and wait for the births of the babies, when the observers’ resistances were made explicit and dealt with, along with their doubts, possible obstacles, and when a particular attention was devoted to getting ready for the initial meetings with the mothers. These meetings, recorded in a detailed manner and then read and discussed within the group, immediately revealed to us very interesting materials to understand the uniqueness of each relationship, but also highlighted how intense transference dynamics would strike the observer since the very beginning: “[…] The group begins to be emotionally involved and starts to project massively on the observer. These projections were not easy to recognize and were expressed by an abundance of verbalizations and enactments” (Ferrara Mori, 1981, p. 184 [own translation]).

Thus, the preliminary interviews started being considered an integral part of the observation work also because of the relational circuit that becomes activated in it and which contains aspects that are also predictive of the future relationship with the child (as we will illustrate further on); at times, though, this circuit is so intense that it might jeopardize the possibility itself of the observation.

A few problematic elements present before the first meeting with Lorena had instilled doubts about the possibility of actually starting the observation: the observer is a neighbour of the mother-to-be and she feels “in tune” with her because they both have recently experienced a loss. The preliminary interview confirms these elements: the mother-to-be is dominated by death anxieties, caused by a previous extra-uterine pregnancy but also by the regret of not having been close enough to her son, because of work commitments. The observer feels “affected by the story of the extra uterine pregnancy”, she appears clearly involved in the mother’s anxieties, and she thinks she has therapeutic expectations towards her and that perhaps she knows about the observer’s losses. It seems apparent that in the observer too there is the therapeutic expectation to heal her own losses by taking care of Lorena’s. We have therefore a symmetrical picture (perceived and put into words by the observer herself: “I felt we were in the same situation”, “after all, she and I have something in common”); the observer even recalls a very peculiar dream she has had (a blue ribbon appears¹ – and that morning she actually sees one on her mother’s building entrance door), which makes us suspect about the presence in her of merged or adhesive identification aspects. The situation of being on equal terms that has developed appears manifest even in the fact of sitting on the same sofa one next to the other, so much that the observer, as she herself tells us, must move away a little to be able to see the mother’s face. The “sofa” is too little, there is no space for the right distance, and the observer cannot fit. This symmetry, which prevents one from understanding who the observer is and who the mother to be observed is, is clearly very distant from the asymmetry necessary to the therapist/patient relationship and observer/observed relationship. There are many parameters that make Infant Observation contraindicated in such a situation, and the suggestion is offered to the observer to remain in contact with the mother to talk from time to time but that she should find another family for her Infant Observation.

Also in the eighties, Manuel Pérez-Sànchez recognizes the importance of the preliminary interview. Even if he restates that the first interview with the parents is aimed at getting to know each other and to decide whether the observation will take place, in a note he maintains that: “If the interview takes place before the delivery, we may find a reservoir of data on anxieties and expectations during the pregnancy, data which may turn out to be useful to understand specific conducts during the upbringing” (1982, p. 18 [own translation]).

The accrued importance attributed to this “observed [material]” before the birth enabled our current Infant Observation groups to always discuss the first meeting between the observer and the mother-to-be very carefully and with interest, because it allows sensing already a maternal atmosphere rich with many emotions, the immediate and complex game between the mother’s projections onto the observer and the strong emotional involvement in dealing with this new experience.

In parallel to the development of training through the observation practice, the extension of the method for research purposes has started to show an interest in life before birth, with a blossoming of studies that have shown the importance of the psychological and relational continuity between before and after the birth.

Alessandra Piontelli for instance, conducted (1987, 1992) “trans-natal” observations extending the Infant Observation to the prenatal life with the help of ultrasound techniques. They were observations of the foetal behaviour, month by month, starting from the fourth, and after observations of the newborn baby, using the classical methodology. The main conclusion of this study was the striking behavioural continuity between before and after the birth. This reminds us of Sigmund Freud’s famous statement: “There is much more continuity between intra-uterine life and earliest infancy than the impressive caesura of the act of birth would have us believe” (Freud, 1926, p. 138). The accent in this pioneering research seems to be mostly on the child.

Some other research focused more specifically on the mother using extensions and/or implementations of Esther Bick’s classical method. We will refer to two research projects carried out in Italy in the eighties.

At the Obstetrics and Gynaecology University Clinic in Turin, Livia Di Cagno’s team (1984) decided to study, using a psychodynamic approach, the mother’s unconscious phantasies in the last months of pregnancy and the way in which the initial stages of the relationship between mother and child developed. In addition, an in-depth research into the beginning of mental functioning was carried out (formation of the Self and first hints of Ego activity of the newborn baby). The research, which was very interesting and innovative in regard to the methodology plan, required the spontaneous collaboration of a sample of 16 first-time mothers-to-be, contacted on the occasion of their participation to a psycho-physical ante-natal course in view of the delivery. The tools used were the free interview, the technique of empathic listening, and the daily observation (lasting one hour, starting from the first day after the birth until discharge, at the moment of feeding). Three interviews were provided for (the first at the eighth month, the second after a fortnight, and the third three days after the delivery), close in time to foster the emergence of a transference bond and of deep themes, the possibility to project, reveal and possibly process anxieties, even the most intense ones. The observation was carried out by a different person from the one who did the interviews, to foster a different attitude in the mother. During the interview, a narcissistic concentration was encouraged in the mother regarding her emotions and feelings, while the observation was focused on the relationship between mother and child.

The research confirmed the typical unconscious phantasies and the ambivalence of maternal experiences during pregnancy and when childbirth approaches and the way in which these elements are important in establishing a relationship with the child in his/her first days of life. The presence or absence of anticipatory phantasies, the intensity of anxieties, and the characteristics of related defences – the different personalities and different couple-family relationships – would become dynamically intertwined with the experience of childbirth and the newborn’s characteristics. These are the final considerations of the research: the poor predictive nature of a single anamnestic note, whether positive or negative in relation to the babies’ vitality; the availability and readiness to communicate; the attraction for the maternal breast and the tolerance of frustration; the precise correspondence between the content of maternal anticipatory phantasies and the elements on which the mother’s perception focuses in relation to the sum of the activities and the baby’s characteristics; the cyclical trend of relational patterns in the context of each observation; and the progressive evolution of the entire period under consideration.

At the University College of Literature and Philosophy in Turin, Carla Gallo Barbisio undertook a study project on the mother-child relationship, for which three typical situations had been chosen: one observation on pregnancy and the first week of life of the child, one on the first year of life, and the last one during the third year of life.

The chapter Osservazione della madre durante i mesi della gravidanza e la prima settimana di vita del bambino (Observation of the mother during the months of pregnancy and the first week of life of the child) by Susanna Mazzetti (1993) shows an observation experience conducted during the pregnancy. One reads about a young mother, rather ambivalent towards her pregnancy and filled with anxieties, which are clearly discernible during the preliminary meeting, the story of which definitely ends up becoming a sort of first observation. The mother welcomes the observer with a depressed expression and immediately tells her about the first two months, which she experienced in a traumatic way. The observations after the birth confirmed this initial anxious state, and the baby became the new container for her maternal anxieties. Mazzetti’s work was read with a great deal of interest and widely discussed within the Observatory group, which lingered in particular on the role of the young observer [female], commenting on her identification with the mother, that at times transformed her into blotting paper for the intense emotions that filled the space, reducing the emotional burden, and also a container that fostered the mother’s capacity to convey her fears and guilt and allowed her to talk about her dreams.

INTERNAL MOTHERHOOD IN THE PRELIMINARY INTERVIEWS

Our study group has performed a retrospective investigation which highlighted, during the preliminary interviews, privileged aspects for the observation of the internal motherhood. During these first meetings, one may notice the quality of the anxieties when the time of childbirth approaches and many forewarning signs of the mother-child relationship, and of the mother-child-observer relationship, which is established later on.

As a matter of fact, the preliminary interviews normally take place shortly before the birth, when the caesura represented by the childbirth and the encounter with the real baby are drawing nearer, and it is possible to grasp a particular state of the internal motherhood dominated by the anxieties of the last quarter of pregnancy and by the fear of giving birth. During the pregnancy, a psychic path develops, featuring different stages, each of them with specific psychological tasks, anxieties, and somatic expressions.

Raquel Soifer (1973) identifies various moments to which particular types of anxieties and physical symptoms can be associated: the beginning of the gestation, during which the anxiety derives from the doubts about the reality of conception and one’s own capacities to change and to be able to take care of a child; the stage of the implantation of the embryo, which is unconsciously perceived and triggers persecutory experiences; the perception of the foetal movements with phantasies of an aggressive and dangerous foetus or malformations of the foetus and ensuing Oedipal guilt; the perception of the internal movements of the foetus with anxieties of loss, of being emptied out; the fear of a premature delivery as an anticipation of the feared separation, which becomes transformed into somatic manifestations (such as collapses, cramps, etc.). In the final stage of pregnancy, the fear of giving birth emerges: a difficult separation both from a psychic and a physical point of view. The feeling of loss and separation is combined with the fear of dying in childbirth or that the child might die whilst being born. The death anxieties rotate around dangerous phantasies: of damaging the baby, or about a dangerous child who might cause damage.

Other studies as well confirm these anxieties, which become more intense as the delivery approaches; in particular, Fornari (1981) draws a distinction between separation anxiety, with castration and death phantasies, and genetic anxiety, related to the child’s health. The latter can be referred to as the typical anxiety of every creative process and lays on the recognition of the foetus as a whole object; while separation anxiety appears to be linked to a foetus that is still perceived as a part object.

The alternating of joyful phantasies and agonizing phantasies in regard to possible damage to oneself and the baby-to-be increases the maternal ambivalence and makes the mother particularly in need of support.

Simona has recently come back to Italy after a period...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of Contributors
• List of Figures
• Foreword
• Introduction
• 1 The story has already started: preliminary meetings in the infant observation
• 2 The announcement in pregnancy: annunciation or verdict?
• 3 The Pre-Infant Observation
• 4 Listening to future mothers
• 5 Ultrasound scan and internal processes
• 6 The development of the psychic womb: the weft and the warp
• 7 In the analysis room: pregnancy questions the analytic tool
• 8 Towards motherhood during the analysis, or in a psychoanalytic consultation
• 9 The “times” of maternality
• 10 Having or not having a baby: internal movements searching for new balances
• 11 Being received in consultation
• 12 Training childbirth professionals
• Addendum: The crisis of “internal motherhood” and its impact on the “consultazione partecipata”
• Index