What Do Mothers Want?

Psychoanalysis
In a New Key
Book Series

Donnel B. Stern, Ph.D., Series Editor

Volume 1
Clinical Values: Emotions
That Guide Psychoanalytic Treatment
Sandra Buechler

Volume 2
What Do Mothers Want?
Developmental Perspectives,
Clinical Challenges
Sheila Feig Brown

Volume 3
Crime and Dissociation:
An Analysis of Violent Narrations
Abby Stein

Volume 4
Wounded by Reality
Ghislaine Boulanger

Copyrighted Material
WHAT DO MOTHERS WANT?
Developmental Perspectives,
Clinical Challenges

edited by

Sheila Feig Brown

THE ANALYTIC PRESS

2005 Hillsdale, NJ London
©2005 by The Analytic Press, Inc., Publishers

All rights reserved. No part of this book may be reproduced or stored in any
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Published by The Analytic Press, Inc., Publishers

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Index by Leonard Rosenbaum, Washington, DC

Library of Congress Cataloging-in-Publication Data

What do mothers want? developmental perspectives, clinical challenges /
edited by Sheila Feig Brown.
p. cm.
Includes bibliographical references and index.
ISBN 0-88163-400-X
1. Motherhood—Psychological aspects—Congresses. 2. Mothers—
Psychology—Congresses. 3. Marginality, Social—Congresses.
I. Brown, Sheila Feig. II. Gloria Friedman Memorial Conference:
William Alanson White Institute.
HQ759.W455 2005
155.6'463—dc22
2005043643

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1
 For
Matthew,
Robin and Benjamin,
Joshua, Alexandra, Ethan and Jesse
Contents

Contributors ix
Acknowledgments xiii
Editor's Introduction xv
SHEILA FEIG BROWN

I. What Mothers Want and Need

1 The Psychic Landscape of Mothers 3

DANIEL N. STERN

2 Loving and Hating Mothers and Daughters: 19

Thoughts on the Role of Their Physicality
ROSEMARY H. BALSAM

3 What Mothers and Babies Need: 37

The Maternal Third and Its Presence in Clinical Work
JESSICA BENJAMIN

4 What Fathers Do and How They Do It 55

JAMES M. HERZOG

5 What Do Mothers and Grandmothers Know and Want? 69

SARA RUDDICK

6 What Is a Mother? 87
Gay and Lesbian Perspectives on Parenting
JACK DRESGHER, DEBORAH F. GLAZER, LEE GRESPI,
AND DAVID SCHWARTZ

7 It's A(p)Parent: 105

New Family Narratives Are Needed
ADRIA E. SCHWARTZ

vii
viii Contents

8 What Does a Mother Want and Need 115

from Her Child's Therapist?
DANIEL GENSLER AND ROBIN SHAFRAN

II. Women's Bodies: Choices and Dilemmas

9 "Too Late": 131

Ambivalence about Motherhood, Choice, and Time
NANCY J. CHODOROW

10 Pregnancy 151
SHARON KOFMAN AND RUTH IMBER

11 Facts and Fantasies about Infertility 171

ALLISON ROSEN

12 Layers upon Layers: 193

The Complicated Terrain of Eating Disorders
and the Mother-Child Relationship
JEAN PETRUCELLI AND CATHERINE STUART

III. Pulling It All Together

13 Listen to My Words: 213

Maternal Life in Colors and Cycles of Time
JANE LAZARRE

14 To Be Partners and Parents: 223

The Challenge for Couples Who Are Parents
CAROLYN PAPE COWAN AND PHILIP A. COWAN

Author Index 249

Subject Index 255
Contributors

Rosemary H. Balsam, M.D. is Training and Supervising Analyst,

Western New England Institute for Psychoanalysis, New Haven, GT;
Associate Clinical Professor of Psychiatry, Yale Medical School; Yale
University Department of Student Health; Book Section Editor, Jour-
nal of the American Psychoanalytic Association; Editorial Boards:
Psychoanalytic Quarterly, American Imago.

Jessica Benjamin, Ph.D. is Faculty, Supervisor, New York Univer-

sity Postdoctoral Program in Psychoanalysis and Psychotherapy;
Founding Board Member, International Association for Relational
Psychoanalysis and Psychotherapy; Author, Bonds of Love; Like
Subjects, Like Objects; Shadow of the Other; Associate Editor, Psy-
choanalytic Dialogues.

Sheila Feig Brown, Ph.D. (ed.) is Supervising Analyst, Teaching

Faculty, and former Fellow, William Alanson White Institute; and
past president, William Alanson White Psychoanalytic Society.

Nancy J. Chodorow, Ph.D. is Faculty, San Francisco Psychoanalytic

Institute; Clinical Faculty, Psychology, Professor of Sociology Emer-
ita, University of California, Berkeley; Author, The Reproduction of
Mothering; Feminism and Psychoanalytic Theory; Femininities,
Masculinities, Sexualities; The Power of Feelings: Personal Mean-
ing in Psychoanalysis, Gender, and Culture; Book Review Editor,
International Journal of Psychoanalysis; Associate Editor, Studies
in Gender and Sexuality.

Carolyn Pape Cowan, Ph.D. is Adjunct Professor of Psychology,

Codirector, Becoming a Family Project, Schoolchildren and Their
Families Projects, University of California, Berkeley; Coeditor,
Fatherhood Today; Coauthor, When Partners Become Parents:
The Big Life Change for Couples; Coeditor, The Family Context of
Parenting in Children's Adaptation to School; Fatherhood Today.

ix
X Contributors

Philip A. Cowan, Ph.D. is Professor of Psychology, Godirector,

Becoming a Family Project, Schoolchildren and Their Families
Projects, University of California, Berkeley; Author, Piaget with
Feeling; Coauthor, When Partners Become Parents; Coeditor, The
Family Context of Parenting in Children's Adaptation to School;
Fatherhood Today.

Lee Crespi, LCSW is Executive Board, Faculty, Supervisor, Psycho-

analytic Psychotherapy Study Center; Board Member, Supervisor,
Gay and Lesbian Affirmative Psychotherapy Division, Institute of
Contemporary Psychotherapy.

Jack Drescher, M.D. is Training and Supervising Analyst, William

Alanson White Institute; Editor, Journal of Gay and Lesbian Psycho-
therapy; Series Editor, The Analytic Press's Bending Psychoanalysis
Book Series; Author, Psychoanalytic Therapy and the Gay Man (TAP,
2001 pbk); Coeditor, Gay and Lesbian Parenting.

Daniel Gensler, Ph.D. is Director, Child and Family Center, Su-

pervising Analyst, William Alanson White Institute; Supervisor,
Derner Institute, Adelphi University; Coauthor, Relational Child
Psychotherapy.

Deborah F. Glazer, Ph.D. is Faculty, Senior Supervisor, Psychoana-

lytic Institute of Postgraduate Center for Mental Health; Coeditor,
Gay and Lesbian Parenting.

James M. Herzog, M.D. is Training and Supervising Analyst, Child

and Adolescent Supervising Analyst, Boston Psychoanalytic Institute;
Supervising Analyst, Sigmund Freud Institute, Zurich, Switzerland;
Author, Father Hunger (TAP, 2001).

Ruth Imber, Ph.D. is Faculty, Training and Supervising Analyst,

William Alanson White Institute; Editorial Board, Contemporary
Psychoanalysis.

Sharon Kofman, Ph.D. is Faculty and Supervising Analyst, William

Alanson White Institute; Faculty, The Parent-Infant Program of
Columbia University Center for Psychoanalytic Training and Re-
search; Faculty, Supervisor, Manhattan Institute for Psychoanalysis.

Jane Lazarre is Author, The Mother Knot; On Loving Men; Beyond

the Whiteness of Whiteness; Wet Earth and Dreams; Some Kind of
Contributors xi

Innocence; The Powers of Charlotte; Worlds Beyond My Control;

Participant, PBS documentary, Race Is/Race Ain't in series Matters
of Race; Faculty, Eugene Lang College, New School University.

Jean Petrucelli, Ph.D. is Cofounder, Codirector, Eating Disorders

and Substance Abuse Service, Faculty, Supervisor of Psychotherapy,
William Alanson White Institute; Coeditor, Hungers and Compul-
sions.

Allison Rosen, Ph.D. is Cofounder, Executive Board, Fertility Pres-

ervation Special Interest Group of American Society of Reproductive
Medicine; Director, Oocyte Program, American Fertility Services;
Medical Advisory Board, Fertile Hope and Sharsheret; former Execu-
tive Director, RESOLVE NYC; Faculty, Supervisor, former Fellow, Wil-
liam Alanson White Institute; Past President, William Alanson White
Psychoanalytic Society; Coeditor, Frozen Dreams: Psychodynamic
Dimensions of Infertility and Assisted Reproduction (TAP, 2005).

Sara Ruddiek, Ph.D. is Author, Maternal Thinking; Coeditor, Mother

Troubles; Working It Out; Between Women.

Adria E. Schwartz, Ph.D. (deceased) was Faculty, Training Analyst,

New York University Postdoctoral Program in Psychoanalysis and
Psychotherapy; Faculty, Supervisor, Institute for Contemporary
Psychotherapy and Psychoanalytic Psychotherapy Study Center;
Editorial Board, Issues in Gender and Sexuality; Author, Sexual
Subjects.

David Schwartz, Ph.D. is on the Editorial Boards, Psychoanalysis,

Culture, and Society; The Journal of Gay and Lesbian Psycho-
therapy.

Robin Shafran, Ph.D. is Supervisor, Child and Family Center, Facul-

ty, Supervisor of Psychotherapy, William Alanson White Institute.

Daniel N. Stern, M.D. is Professeur Ilonoraire, Psychology, Geneva

University, Switzerland; Cornell University Medical School-New York
Hospital; Columbia University Center for Psychoanalysis; Author,
The First Relationship; The Interpersonal World of the Infant; The
Journal of a Baby; The Motherhood Constellation; The Present Mo-
ment in Psychotherapy and Everyday Life; Coauthor, The Birth of
a Mother.
xii Contributors

Catherine Stuart, Ph.D. is Cofounder, Codirector, Eating Disorder

and Substance Abuse Service, Faculty, Training and Supervising
Analyst, William Alanson White Institute; Coeditor, Hungers and
Compulsions.
Acknowledgments

M
y gratitude goes first and foremost to the women of
the Mothers Group at the William Alanson White In-
stitute. The group members included Claire Basescu,
Jill Bellinson, Valentina Harrell, Karen Marisak, Allison Rosen,
and Sarah Stemp. Without their creativity, energy, dedication,
hard work, and support there would never have been a What
Do Mothers Want? Conference and without that conference,
this edited book would never have come into existence. To
Allison Rosen goes my additional appreciation: in her capacity
as President, in 1997, of the William Alanson White Society
of graduates, she invited me to organize a Gloria Friedman
Conference. She gave me the opportunity to honor a colleague
as well as a forum for exploring current considerations about
motherhood.
Along with the women in the Mothers Group, Donna Bassin
was very instrumental in clarifying and deepening my earliest
thinking about a conference and book about mothers. With
exceptional generosity, Donna shared valuable insights she had
learned from her own experiences of successfully chairing a
conference on the same topic and then editing a book of the
presentations from that conference.
I could not have begun or completed this book without
the sensitively balanced combination of maternal and paternal
caring from Donnel Stern, the editor of the book series that
includes What Do Mothers Want? His positive recommendation
of me to Paul Stepansky, Managing Director of The Analytic
Press; his firm belief that I could successfully accomplish our
goals; his patience and kindness shepherding me through both
writing and editing tasks that I had not done before, were key
elements that made this project such a richly rewarding ex-
perience for me.

xiii
xiv Acknowledgments

I am also indebted to Paul Stepansky for his recognition

of the importance of an edited book on mothering that brings
together the different perspectives of a group of prominent
individuals. His staff at The Analytic Press, specifically Eleanor
Kobrin, Nancy Liguori, and Joan Riegel, were all helpful with
the multiple and complex facets of book production.
I am very grateful to others who helped and encouraged
me. Ruth Imber, a wonderful friend, was always available to
discuss ideas, to read yet another draft of my Introduction,
and to give serious consideration to my countless concerns,
both significant and trivial. Robin Sawnie White, my daughter,
offered enthusiastic help with several editorial tasks including
transposing and editing Daniel Stern's keynote address at the
conference to become a chapter for this book. Sarah Ruddick
was most generous and supportive with her useful editing sug-
gestions of my Introduction chapter, suggestions and perspec-
tives that expressed her remarkable wisdom on so many topics.
Sharon Kofman and Stanley Coen were readily available with
important ideas that enriched my considerations about several
aspects of the book. Marsha Winokur offered her thoughtful
and thought-provoking edits of my writing. Jay Greenberg sup-
ported my efforts with immediate and informative responses
to my many requests for references and other information.
Janet Nelson, my first teacher of attachment theory, started me
down a road of professional interest that has led to this book.
Lake Charles, my dear friend and neighbor, has consistently
been there for me with her deep caring, sometimes a cup of
tea, and always a spirit-lifting conversation.
To my family, who graciously put up with years of my
preoccupation with the conference followed immediately by
an edited book, goes my most profound love and appreciation.
Above all, I could not have done it without my husband's help,
support, patience, dinners he cooked, and errands he did in
order that I would not have to during the long gestation that
led to this book.
Editor's Introduction

W hat does a woman want? Over our lifetime, at famil-

iar developmental junctures, we experience myriad
significant possibilities regarding education, jobs and
career, intimate relationships, and motherhood. The choices
we ultimately make and remake are all expressive of our own
psychological and biological realities intersecting with those of
the culture in which we live. Most often, for women in our coun-
try, motherhood is consciously chosen and carefully planned.
But there are also many women whose lives are shaped not
by choice but, rather, by the confines and limitations imposed
by poverty, limited educational opportunities, chronic medical
conditions, or a fractured family life. It is difficult and often
impossible for them, their resources significantly limited, to
choose thoughtfully to become mothers.
This book is about all these women. It is intended to
contribute to our understanding of what is in a woman's heart
and mind when she becomes a mother. What do mothers
want? What do mothers need from their parenting partners,
extended family, friends, colleagues, economic and political
communities, and government-sponsored programs to meet
their vital responsibilties? These are the questions addressed
in the chapters that follow.
The answers come from the multiple perspectives of
prominent writers who have contributed substantially to their
own fields. Their areas of expertise include the subjectivity of
mothers; psychobiological considerations of women; psycho-
analysis and psychotherapy with mothers, parental couples,
and children; child development research; psychological
concerns of heterosexual and homosexual parenting couples;
current feminist, racial, social, and political perspectives. Ad-
ditional important distinctions among the writers that add to
the richness of viewpoints include differences in their marital

XV
xvi Editor's Introduction

status, their parental status, their sexual orientation, and their

gender.
This book is intended for mothers and everyone else inter-
ested in joining in an essential discourse of what mothers want
and need. Most especially, it is for mental health professionals,
educators, and the social and government agencies that help
mothers and their families.
The earlier versions of the chapters of this book were
originally panel presentations or workshops at the Second
Gloria Friedman Memorial Conference of the William Alanson
White Society. The conference, like the book, was called "What
Do Mothers Want?" Both the conference and this book had
many mothers, whose personal experiences of motherhood
contributed to what you are about to read.
Gloria Friedman was a psychoanalyst on the faculty of the
William Alanson White Institute and a colleague and friend
of mine. She died of breast cancer in 1991. Toward the end
of her life, I had the privilege of having conversations with
her that centered almost exclusively on our children and
ourselves as mothers. Because of her expertise at translating
inner experience into spoken language, Gloria offered a special
window into the heart of a dying mother with adult children.
Her words confirmed what has become commonplace as our
culture expands understanding of mothers and motherhood:
making peace with oneself as a mother is always, at any stage
of the life cycle, an extraordinarily difficult challenge.
In 1993, with the purpose of studying aspects of mother-
ing, I brought together a group of psychoanalysts from the
William Alanson White Institute who were also mothers. We
read biographies and autobiographies of mothers and daugh-
ters. We read the literature on attachment, early childhood
development, and related topics. We acknowledged that women
generally, and women professionals in particular, can be com-
petitive with one another and that therefore, beyond the walls
of the group, and even sometimes within the group, it was a
challenge to maintain honesty about personal mothering and
professional experiences. There was always the risk of shame
and humiliation, not only of our mother-selves but also for our
professional-selves. Our mother-selves and our professional-
selves were so bound together that to be evaluated in one was to
Editor's Introduction xvii

have judgment passed on both. But those of us who eventually

formed the core of the group hungered for the opportunity to
share our mothering experiences with other women, especially
as they resonated with our committed, active professional lives
as psychoanalysts.
This hunger enabled us to take risks with one another
and eventually to trust that the group boundaries would be
honored. We came to treasure having a place where we could
safely express our feelings of inadequacy, concerns about our
childrens' "imperfections," conflicts with partners, anxieties
about what our professional colleagues might think of us if
they suspected any difficulties with members of our families,
and so on. We were certainly cognizant that mothers in every
culture experience pressure to measure up to ideals. But as
members of a profession dedicated to helping other mothers
and their families, all of us felt governed and measured by
unspoken, more stringently demanding ideals. We acknowl-
edged that there were pressures we felt from our own histories
of internalized ideals, but we agreed that the most exacting
standards came from our assumptions about our colleagues'
and patients' ideas about us. Were we raising perfect or at least
good-enough children who would reflect our mothering skills
in such a way that would reassure our colleagues and patients
of our professional skills?
When I approached the Mothers' Group with the idea
of doing a conference on mothering that would honor Gloria
Friedman, nobody needed convincing. The conference and
this book could not have been born without every one of the
creative contributions, collective labors, support, and nurturing
that came from the members of that group of women.
The title of the conference, and of this book, is a word-
play on a well-known phrase from a letter Freud wrote to
Marie Bonaparte: "What does a woman want?" (Jones, 1955,
p. 420). Freud and many of his loyal colleagues, and some
psychoanalysts to this day, have been remarkably obtuse
about women as mothers or daughters, even when relevant
information was clearly spelled out for them by their col-
leagues—colleagues who were often daughters, mothers, or
both themselves (Horney, 1924, 1926; Klein, 1928; Deutsch,
1930; Balsam, 2003).
xviii Editor's Introduction

In keeping with the prevailing cultural p e r s p e c t i v e

anchored in the centrality and power of the father, Freud
(e.g., 1908, 1924, 1931) theorized that women were inferior
to men in everything but the caregiving of children, husbands,
fathers, and brothers. Moreover, women's superior caregiving
skills derived from their weaker and less desirable personality
and anatomical characteristics as compared to those of men.
Despite Freud's genius, he never recognized in his writings that
women have a unique biopsychological development and their
own particular subjectivity, all of which are of value and require
study in their own right (Thompson, 1941, 1942, 1943; Rich,
1976, pp 186–217; Chodorow, 1978; Fliegel, 1986, pp. 3–31).
During the years from the end of the 1800s through the
the 1930s, when Freud was developing psychoanalysis, fam-
ily structure reflected a transformation that had occurred in
response to increasing industrialization on both sides of the
Atlantic. Before the Industrial Revolution of the 1800s, women
bore and raised several children while doing their share of
necessary productive labor. The home, which was often the
center of work, was typically communal. By the mid-1800s,
with the growth of technology and factories, the concern for
children's welfare, and the need to maintain patriarchal val-
ues (e.g., men feared that, from an economic point of view,
a working woman might dispense with marriage), the home
became a private place for one family consisting typically of
a father, a mother, and children. Father became the sole pro-
vider, working outside the home; mother became exclusively
responsible for domestic activities, child rearing, and caring
for her husband's physical and emotional needs. Mothers were
blamed for developmental difficulties of their children as well
as any marital problems (Friedan, 1963; Rich, 1976; Chodorow,
1978; Rotundo, 1993).
By the early 20th century, the women's liberation move-
ment 1 had gained enough m o m e n t u m from its beginnings
about 100 years earlier (Wollstonecraft, 1792; Wright, 1829)
to become a powerful, organized challenge to the entrenched
patriarchal society. The struggle for women's suffrage marked
the initial energies of early feminists. After almost a century
of increasingly vigorous campaigning, American women won
the right to vote in 1920. In a second resurgence of energies
Editor's Introduction xix

in the 1950s, prominent feminist writers focused on a redefi-

nition of women's social and economic position (de Beauvoir,
1952; Friedan, 1963). In their search for a new, more indepen-
dent identity for women that had not been available to their
mothers, feminists insisted on the same educational, career,
and economic opportunities as men. Mothering was an accept-
able activity only if it was combined with a career or paid work
outside the home (Friedan, 1963; Mitchell, 1971; Friday, 1977;
Bassin, Honey, and Kaplan, 1994).
Women who chose to be full-time mothers, and even
some part-time mothers, reacted angrily to their denigration
by feminist writers. They refused to be demeaned or margin-
alized by working women (who might have been mothers but
did not primarily identify themselves that way). They insisted
that mothering be valued equally with other lifestyle choices
(Chodorow, 1978; Benjamin, 1988; Bassin et al., 1994).
Their voices had a rapid and profound impact on femi-
nist considerations. By the 1970s, topics of serious study in
the feminist literature included the subjectivity of mothers
(Lazarre, 1976; Rich, 1976; Chodorow, 1978; Benjamin, 1988;
Ruddick, 1989); the variety of representations of motherhood
(Rich, 1976; Chodorow, 1978; Bassin et al., 1994) and the
interactions of gendered bodies with psychological develop-
ment (Gilligan, 1982; Butler, 1990; Chodorow, 1992; Benjamin,
1995)—all crucial dimensions of a woman's life cycle.
In a related area, the feminist movement provoked men's
curiosity to reexamine their own needs and desires as sons,
husbands, fathers, and family providers (Demos, 1982; Ro-
tundo, 1993; Silverstein and Rashbaum, 1994). One result of
the heightened awareness of the subjectivities of men as well
as women is a reevaluation of traditional gender roles. For
example, Ruddick (1994) described the specific nature of ma-
ternal and paternal work: both can be done by men or women
who may be biologically related or unrelated to the child. With
increased awareness of possibilities, it is an opportune time
to reexamine how gender roles are powerfully shaped by our
earliest interactions with caregivers and culture. Only by de-
tailed exploration of our earliest relationships will we come to
understand fully how many mothers and fathers continue, to
this day, to encourage the traditional gender roles that maintain
xx Editor's Introductiom

patriarchal, antifeminist values (Lazarre, 1976; Rich, 1978;

Gilligan, 1982; Olivier, 1989; Silverstein and Rashbaum, 1994;
D'Ercole and Drescher, 2003).
The work of feminists over the past 75 years has been
enhanced by simultaneous dramatic and far-reaching changes
in psychoanalytic theory and practice. Psychoanalysis has
evolved from Freud's classical one-person, drive theory para-
digm to include an interpersonal and relational, two-person
perspective (Greenberg and Mitchell, 1983; Gill, 1994). Psy-
choanalysts, even those who continue to subscribe to more
traditional viewpoints on many issues, are increasingly ac-
knowledging that a useful way "to view psychological reality
is as operating within a relational matrix which encompasses
both intrapsychic and interpersonal realms" (Mitchell, 1988).
A mother can now be viewed as a coparticipant, a cocreator of
relationships with her parental partner and her child, as well
as with her extended family, her community, and her culture.
Certainly at a theoretical level and increasingly at a level of real
experience, mothers are no longer seen as solely responsible
for the developmental outcomes of their children.
Psychoanalytic considerations in recent decades include
the examination of the early life of children, both male and fe-
male, before the Oedipus complex (Mahler, Pine, and Bergman,
1975; Lichtenberg, 1983; Stern, 1985; Benjamin, 1995); the na-
ture of the mother-child attachment (Winnicott, 1947; Bowlby,
1969; Beebe and Lachmann, 1994; Benjamin, 1995; Stern,
1995); and multiple and detailed considerations of maternal
subjectivity and intersubjectivity (Anthony and Benedek,
1970; Chodorow, 1978; Benjamin, 1988; Bassin et al., 1994).
The burgeoning field of infancy and child development
research and theory over the past 25 years has seen investi-
gations in several disciplines related to psychoanalysis. Long-
term followup of developmental studies from many of these
perspectives has extended into adulthood. The findings from
cognitive psychology, child neurology, developmental psychol-
ogy, family therapy research, as well as psychoanalysis and
child development studies in several Western and Eastern
countries are consistent: the primary caregiver is decidedly
significant to a child's emotional, neurological, and cogni-
tive development. Moreover, the quality of adjustment in the
Editor's Introduction xxi

earliest years informs later emotional and social adjustment as

well as academic performance (Goldberg, Muir, and Kerr, 1995;
Cassidy and Shaver, 1999). Consistency of care matters also.
Children do best with only a few primary caregivers during
their preschool years (Hardin and Hardin, 2000).
Having a better grasp of the significance of good child
care has unquestionably made the choices facing a mother
more perplexing than ever. For those who supplement their
own mothering with paid child care, the process of bringing
up children has become very expensive. Nowadays, the care
of one child by one paid adult, or a day-care setting with one
adult for two or three children, is available only to those with
considerable m e a n s . It also appears that if m o t h e r s have
financial support from a source other than their own paid
labor, more of this minority are choosing to become full-time
mothers (Belkin, 2003). They seem to be using wisdom from
feminists of the past half-century to create a satisfying balance
between their youngster's needs and their own parental and
personal needs and desires. They are aware that mothering is
too large a task for one person. These mothers need and want
and ask for support from marital/parental partners, extended
family members, minimal hired help, and contemporaries
who are also mothers (Young-Eisendrath, 1999). Some full-
time mothers view the early child-rearing years as a limited
"time-out" from their work-related lives: they plan for their
reentry into the work force when their children are in school
(Belkin, 2003).
But it is a sad fact that the vast majority of mothers in
the United States are without sufficient economic or social
resources to provide reliably for their children, much less have
the luxury of choosing between quality child care or becom-
ing a full-time mother. Although feminists have accomplished
significant gains for women in the workplace, there continue
to be many obstacles, especially for individuals with mother-
ing responsibilities. Job situations that are sympathetic to the
needs of working parents, for example, flexible working hours,
job sharing, job-sanctioned parental leaves, available day care
at the job site, are rare even for those at the highest levels of
business and professional work. Government-sponsored ser-
vices for children and their primary caregivers are desperately
xxii Editor's Introduction

needed. Yet our government at both the federal and state level,
while espousing the rhetoric of "family values," does little
to provide real economic support; training in child care for
mothers and other caregivers; high-quality, low-cost day care;
medical and psychiatric services; and so on. Given all these
conditions, many mothers confront harsh, often heart-break-
ing realities with regard to the limited opportunities they can
provide their children and themselves.
This volume presents recent thinking on many of those
topics as they affect a woman's desires and needs when she
becomes a mother. All the writers were asked to respond to
the question posed by the title of the book. It seemed to my
editorial sensibilities that the variations and commonalities
in perspectives lent themselves to presentation under three
overarching sections.

SECTION I: WHAT MOTHERS WANT AND NEED

(CHAPTERS 1-8)

Chapters 1 through 8 concern what mothers want and need,

the people from whom they want and need; and the range of
people, including heterosexual women, but not limited to them,
who carry out mothering work.
Daniel Stern begins the book by describing his current
thinking about the organizing motivational systems that in-
form a mother's earliest experiences with her baby. The first
system he considers is one he has begun thinking about only
recently and therefore is not included in The Motherhood
Constellation, Stern's (1995) seminal book on early maternal
experience. It is an organizational story or reality that has to
do with a mother's falling and being in love with her newborn.
Writing in evocative detail about a mother's love for her baby,
he compares it to the inner experiences and behaviors of two
adults as they fall in love. Falling and being in love with her
baby is what a mother desires most profoundly. Stern cautions
that if she does not do so, it is a worrisome sign for the baby's
development. It also indicates a need to be concerned for the
mother's emotional well-being.
Editor's Introduction xxiii

Stern then writes about a second organizing motivational

system of a new mother: her fear about safeguarding the surviv-
al of her newborn. He emphasizes that the new mother's often
overdetermined and excessively protective behavior toward
her baby must be appreciated as normal. It occurs because
nature has provided her with a redundant system to ensure
the survival of our species. With her newborn, the mother will
seek out advice, guidance, and support from women in her im-
mediate family and even female strangers as long as they are
experienced in mothering. Later, she turns to all the members,
both male and female,' of her community and to the commu-
nications media of her culture for helpful information.
Lastly, Stern delineates some therapeutic applications
that emerge from a consideration of the mental organizing
components of the new mother's psychic landscape. He gives
an example of a clinical intervention that is brief and inexpen-
sive yet provides a significant positive impact on mothers and
babies in high-risk populations.
In chapter 2, Rosemary Balsam addresses the situation
in which a mother does not fall in love with her newborn im-
mediately but develops love slowly in the months afterward
as she takes care of her baby's bodily needs. Balsam also con-
siders the problem that arises when maternal love does not
develop at all.
To provide background for her views, she recounts a sig-
nificant but forgotten moment in the history of psychoanalysis.
It is the story of the first female member's presentation to the
Vienna Psychoanalytic Society in 1911. In it, Frau Dr. Marga-
rete Hilferding, whom we can appreciate today as an extremely
courageous and bold pioneer, a feminist, psychoanalyst, and
mother, presented an exploration of pregnancy, childbirth,
and the early months of motherhood. She spoke specifically
of her observation that "there is no innate mother love" but
that it could be acquired through the mother's experiences
of nursing and other physical care of her infant. Such canon-
challenging possibilities were shocking and unacceptable to
her all-male audience of the first generation of psychoanalysts.
A year and a half later, Hilferding resigned from the Vienna
Psychoanalytic Society.
xxiv Editor's Introduction

It is Hilferding's emphasis on the importance of physicality

for the development of mother love that provides a springboard
for Balsam's exploration of the development of love and hatred
between mother and daughter beginning from their earliest
physical interactions with one another.
In chapter 3, Jessica Benjamin focuses on the beginnings
of intersubjectivity between mother and infant that will be
elaborated throughout their lifetime together.
She addresses how a process of mutual recognition of
needs begins between the mother and her baby. The mother
must balance recognition of the child's needs with attention
to her own, thus encouraging mutual respect for one another's
subjectivities—the mother's for the baby's, of course, but also
the baby's for the mother's. This recognition of each other's
subjectivities occurs optimally in such a way that there is
accommodation between the two participants rather than
conflict or the submission of one to the other.
To understand this process fully, Benjamin formulates
what she calls the third as the organizing principle. This third
begins with the infant's first experiences with the caregiving
other. In its earliest form, the third is the nonverbal pattern
of relating that develops around mutual behaviors involving
rhythmicity, most clearly seen in the intricate, ongoing nego-
tiation between mother and infant over sleeping and feeding
schedules. Benjamin notes that the third does not develop in
an ideal, linear manner throughout the life of the dyad but,
rather, moves from mutuality, to breakdown of mutuality, to
repair, in an endless cycle. The development of the third be-
tween mother and infant provides a model of intersubjectivity
for later intimate dyadic relationships including the analytic
relationship between therapist and patient.
In chapter 4, James Herzog investigates the significance
of the father to the mother and child. Father introduces the
first triangular relationship in the infant's life. This triangle,
within a traditional heterosexual marriage, includes the three
familiar dyadic relationships: mother/wife and father/husband;
mother and infant; and father and infant. Herzog's emphasis
is primarily on the father/husband's significance to the wife/
mother: specifically, what does his wife—who has also become
Editor's Introduction XXV

the mother of his infant, want and need from him, her hus-
band, her baby's father—so that she can function at her best
as a mother to their new infant and also as a marital partner
to him? Herzog concludes that to answer this highly important
question both partners must be capable of renegotiating their
marital relationship to include the different and additional
demands, wants, and needs of their new parental partnership.
Such a conversation is vital to the successful functioning of
the adults separately and in their marriage and parenting to-
gether. It is also essential for the child's healthy psychological
development.
To illustrate, Herzog provides two examples of families
in which the children required psychoanalytic intervention
because their parents could not manage to adjust to their new
lives by adding the roles of parents to the old, familiar roles
of marital partners. He suggests that the kinds of parenting
difficulties experienced by the two couples could have been
predicted from the problematic dynamics within their mar-
riages before the arrival of children.
In chapter 5, Sara Ruddick expands the relationships avail-
able to mother and child still further to include grandparents.
Writing from a grandmother's perspective, she focuses first
on what mothers want and need, then on what grandmothers
want for their children-now-parents, grandchildren, and them-
selves.
From her deep understanding of the demands, desires,
inevitable conflicts, and oddity of maternal work (Ruddick,
1989, 1994), Ruddick distills an ideal organizing principle:
that the caregiver must "hold" a child "in personhood," which
means conferring dignity and respect, avoiding humiliation
or shame. Additional topics she explores include the current
status of the "mommy wars" between working mothers and
full-time mothers; the relationship between mothers and their
children's nannies, what they want require from each other,
and the potential for difficulties between them.
What, then, do grandmothers want and need when they
speak for themselves? What do they want to give to their grand-
children and to their own children who are now the parents
of their grandchildren? How do grandparents negotiate the
xxvi Editor's Introduction

complex relationship that depends on a network of relations

to children-now-parents, their children's partners and lovers,
and the grandchildren, whose own personalities and relation-
ships with the generations are increasingly complex? With
all these questions in mind, Ruddick shares with us her first
considerations from a grandmother's perspective.
In chapter 6, Jack Drescher, Deborah Glazer, Lee Crespi,
and David Schwartz present an extensive review of the issues
and the supporting literature about homosexual partners—both
gay and lesbian—when they become parents. To help readers
understand the historical and cultural context of homosexual
parental couples, the authors begin with an overview of the gay
civil rights movement since the Stonewall riots of 1969 to the
present. Nowadays the national political agenda of gay activ-
ists includes pressuring governmental institutions for the legal
rights to marry and to bear, adopt, and raise children. Regard-
less of their limited legal success, more and more homosexuals
are participating in long-term, committed partnerships and
also parenthood.
Although serious consideration of the meanings of parent-
ing is crucial for heterosexual as well as homosexual partners
planning to have children, there are additional and different
areas of potential difficulty for homosexual couples that are
explored in this chapter.
The authors also write about the importance of challenging
long-held beliefs within psychoanalysis. They propose that the
assumptions regarding the traditional nuclear family configura-
tion, gender, and sexuality, as well as such basic concepts as
mother and mothering, need to be reexamined with the goal of
understanding how current views affect the cultural resistance
to homosexual parenting.
In chapter 7, Adria Schwartz explores biological and non-
biological motherhood in lesbian couples. She writes that, for a
lesbian as for a heterosexual woman, being a biological mother
supersedes other dimensions of identity. The biological con-
nection leads to the likelihood that both members of a lesbian
couple will see the birthgiver as the "real" mom.
To provide us with a fuller understanding of the many com-
plex issues that can confront a nonbiological parent/partner in
such couples, Schwartz describes a successful psychotherapy
Editor's Introduction xxvii

with a conflicted and unhappy nonbiological lesbian parent

after the birth of the couple's first child.
Schwartz's chapter provokes thought and offers informa-
tion and hope for any lesbian, gay, or heterosexual parenting
couple coping with the inevitable conflicts that arise when one
parenting partner has a biological relationship to their child
and the other does not.
In chapter 8, Daniel Gensler and Robin Shafran write a
therapist's guide for dealing with what a mother needs when
she seeks treatment for her child. They begin by reflecting
on the mother's complex feelings during her initial contact
by telephone with a potential therapist. This call marks the
mother's acknowledgment of a difficulty or failure that her child
is experiencing, a failure most often in the academic or social
domains. The authors point out that the guilt and defensive-
ness parents feel when making this call, and the threat to their
self-esteem, are to be expected and must be addressed imme-
diately. Also, parents' competitive feelings with the therapist
must be acknowledged as normal. Parents must be reassured
that the therapist is aware and respectful of the boundaries of
his or her relationship with the child. If the therapist does not
respond empathically and supportively to the mother's needs
when she seeks psychotherapy for her youngster, the child's
treatment is likely jeopardized at the outset.

SECTION II: WOMEN'S BODIES:

C H O I C E S AND DILEMMAS (CHAPTERS 9 - 1 2 )

The theme that runs through chapters 9, 10, and 11 is the inter-
action between a woman's relationship with her body and her
reproductive choices. Chapter 12 describes girls' unconscious
use of their bodies to express symptoms stemming from familial
conflicts and cultural demands. Each of these chapters adds to
our understanding of the significance and meaning of a woman's
relationship with her physical body as it shapes her choices of
motherhood, reproduction, and symptom formation.
In chapter 9, Nancy Chodorow provides an excellent sum-
mary of feminist psychoanalytic thought since her landmark
book The Reproduction of Mothering in 1978. She specifically
xxviii Editor's Introduction

elaborates on her most recent emphasis on the centrality of

bodily and biopsychological experience in the the choice to
become a mother.
She examines internal unconscious constellations of
mother-daughter-sibling fantasies and feelings about experi-
ences of physicality as they reverberate within their relation-
ships and lead to ambivalence about motherhood and the
reproductive body. These feelings can be defended against by
focusing on the less anxiety producing reality of problematic
choices between career and motherhood, on the difficulties in
finding a partner who will share in parenting responsibilities,
and so on. But time is passing and a woman's biological clock
is not being acknowledged.
Chodorow offers two clinical examples of psychoanaly-
sis with women who come to realize that they want to bear
children but will never do so because of their own emotional
realities and the choices these realities have generated. By
the time the wish to have children becomes psychologically
disentangled, it is simply too late.
Sharon Kofman and Ruth Imber begin chapter 10 with a
description of pregnancy as a normal developmental crisis. The
emotional and physical destabilization that accompanies this
crisis leads, under optimal circumstances, to an enriched, more
robust, and more complex psychological reorganization. The
nine months of progressive physical and emotional changes
are described in detail and are accompanied by an extensive
review of the pertinent psychoanalytic literature. Although
pregnancy can, and most often does, provide an enriching
contribution to a woman's psychological development, it is
also a time when conflicts and concerns from many differ-
ent eras and areas of her life can be exacerbated. The writers
explore the usefulness of psychotherapy during pregnancy or
immediately after the birth.
As part of their contemplation of issues in psychotherapy
with pregnant women, Kofman and Imber also explore the
transference and countertransference issues that arise when
the therapist is pregnant.
In chapter 11, Allison Rosen focuses on heterosexual
couples who would like to conceive but cannot because of
biological limitations in one or both partners. The couple has
Editor's Introduction xxix

always held on to the belief that their bodies would function

in such a way that they would be able to have a biological
child if this was their desire. When the body betrays this
dream for one or both members, the loss can be devastating
for the couple.
The pain of loss can be minimized for many infertile
couples who, with the aid of advances in medical technology,
can be helped to conceive. When these efforts fail, the couple
may decide to use a surrogate, into whose uterus must be
implanted donor eggs, donor sperm, or both. Within the con-
text of the loss of control that infertility entails, the couple's
meticulous selection of a donor or surrogate who provides the
characteristics they desire for their child can sometimes help
them regain some feeling of control over their destiny.
Rosen also presents a detailed explication of issues, includ-
ing transference and countertransference problems, specific
to psychotherapy with infertile couples.
In c h a p t e r 12, J e a n Petrucelli and C a t h e r i n e Stuart
continue the exploration of the interactions among physical-
ity, emotions, and symptom formation begun by Balsam in
chapter 2. Like Balsam, Petrucelli and Stuart focus on the
m o t h e r - d a u g h t e r dyad but unlike Balsam, who considers
physicality in its broadest sense, the authors of this chapter
spotlight specifically the mutually created interactive behavior
pattern involving mother's feeding and child's eating. They ex-
plain the unique circumstances in which this mother-daughter
interaction involving food can be such that it precipitates the
development of organized, destructive, and highly expressive
disordered eating behavior, including anorexia, bulemia, or
compulsive binge eating in the daughter. The authors point
out that the participation of all family members must be taken
into account inasmuch as they enable and encourage the
system of embedded dysfunction as the daughter matures. In
two case examples, one of an adolescent girl and the second
of a young woman in her 20s, Petrucelli and Stuart describe
the tightly choreographed relational dance between mothers
and daughters that continues to encourage their daughters'
anorexia. The authors' detailed account includes attention
to the complicated transferential and countertransferential
experiences that ensue in the treatment situation.
xxx Editor's Introduction

SECTION III: PULLING IT ALL T O G E T H E R

(CHAPTERS 1 3 - 1 4 )

The concluding section of the book comprises two chapters

written from very different perspectives: the first perspective
is the voice of one mother; the second includes the combined
voices of more than 200 married couples. Both chapters,
illuminating vital and overlapping aspects of a mother's psy-
chic landscape, pull together themes explored at other points
in this book. Both offer essential perspectives and practical
suggestions for what a mother can do on her own and for what
mental health practitioners and governmental agencies must
do to address the wants and needs of mothers.
In chapter 13, Jane Lazarre writes from a perspective
that has been richly informed by her experience as the white
mother of black sons. She insists that our reaction that differ-
ence signifies a threat must be confronted. It is at the heart of
racism. It is at the heart of our interpersonal conflicts. It con-
tributes to the continuation of the myth of the ideal mother.
Just as Lazarre can never be a black mother for her black
sons, much as she may wish to be because of her love for
them, she writes that mothers must take responsibility for
their own and their children's recognition and acceptance of
the inevitable differences, dissonances, and failures that take
place in the mother-child relationship. Mothers must not see
these differences as threatening but, rather, as crucial to their
children's healthy and enriched psychological development;
and they must help their children to see them the same way.
The process of learning, in relationship with our mothers, to
tolerate and, indeed, value our differences from one another,
is the best way to provide children with the kind of template
for adult relatedness that will allow them to live among others
with compassion, forgiveness, and understanding.
In chapter 14, Philip and Carolyn Cowan offer a clinically
informative and useful account of their findings from over 20
years of research with more than 200 married couples. They
have created and evaluated a brief couples group intervention
designed to strengthen a couple's relationship as they pass
through two profound changes in the life of a family: the one
that occurs when the first child is born and the other when
the first child begins school.
Editor's Introduction xxxi

Their results led the Cowans to conclude that the first

thing to consider in answering the question of what mothers
want and need is the quality of the relationship between the
mother and her child(ren)'s father. The authors demonstrated
that, when parents work together to shape their lives to fit
both the children's and their own needs, they report a sense
of greater effectiveness and competency in their relationships
with each other and with their children. Specific to the couples
groups intervention for parents whose first child was start-
ing school, results supported the conclusion that the better
the parental relationship, the more enhanced was the child's
academic/intellectual, social, and emotional development.
The effectiveness of the Cowans's relatively simple, low-
cost, short-term intervention needs to be heeded by mental
health practitioners and appropriate government agencies.
It is an excellent approach for helping mothers, fathers, and
children get what they want and need.
As you read the chapters of this book, each of you will
respond to the different issues and writers according to your
own needs and desires. But whatever your perspective, you will
notice, no doubt, that several chapters affirm a mother's desire
and need for a network of supportive relationships, access to
information about mothering skills, and multiple services from
various private and government sources to help her with her
maternal work. It is apparent to me—from my personal experi-
ences as a mother and grandmother, professional experiences
as a psychoanalyst, and recently from the various enriching
activities involved in putting this book together—that of all the
supportive relationships a mother wants and needs, the one
with an intimate partner-in-parenting is most essential and
ultimately most influential to her.
I have learned that it is irrelevant whether a mother's
parenting partner is male or female, spouse, ex-spouse, rela-
tive, friend or lover. It is the quality of the relationship that is
important. To help the relationship function in her best inter-
ests, a mother must begin with an inner acknowledgment that
her parenting partner has his or her own different concerns
which are of equal significance to hers. She must respect her
partner's differences from her and "hold them in personhood"
(see Ruddick's chapter, this book) in the various negotiations
regarding child care, especially those addressing the inevitably
xxxii Editor's Introduction

difficult balance of nonparenting activities and parenting re-

sponsibilities. Then, a mother must explain and reexplain her
needs and desires to her partner-in-parenting and her partner,
in turn, must risk telling her theirs. If mutual respect, ac-
ceptance, forgiveness, caring, and love are to exist among all
the members of the family the parental relationship—with its
differences, frustrations, and disappointments—must include
both partners' realities.
Herzog, Drescher et al., and Adria Schwartz address these
issues directly in their chapters. The Cowans offer us years
of research data on parenting and an effective intervention
that could well be applied to any parental dyad, not only a
heterosexual married couple, to help them achieve a respectful
negotiated partnership.
In heterosexual parenting couples, mothers need fathers
to be more involved with their children. In fact, at this point
in our cultural history, mothers have to go so far as to invite
fathers into their children's lives and then help make them
more comfortable in what is often a new role for men. It is
certainly a real possibility that many fathers are not interested
in child care to the same degree as mothers. They may pre-
fer the freedom from such emotionally charged conflicts and
difficult responsibilities they are witness to between mother
and child, even though their desire to conceive a child was as
strong as their partner's.
It is also possible that many fathers do not want to share
parenting work equally with mothers for a completely dif-
ferent set of reasons. For example, it is understandable that,
without role models over the past generations, men today may
be afraid that if they try to be more deeply involved, they will
be rejected by their partners and maybe their children. They
may wonder if they are really wanted. They may not have the
confidence that they have the necessary qualities for child
care such as empathy, sensitivity, patience, and restraint of
negative emotions. They may be concerned about appearing
unmanly, effeminate, if they reveal a desire to do maternal
work. No doubt there are many reasons men are reluctant to
participate. Fathers need to explain this to mothers.
Mothers not only have to provide encouragement and
support for fathers, they need to allow them to enter their
Editor's Introduction xxxiii

realm. Mothers must give up some of their mother-power

(Reddy, 1997).
In this book, Lazarre writes movingly that difference signi-
fies a threat. It is important to add that when it comes to rela-
tionships between men and women, similarity has the potential
to signify a threat as well. This threat is well documented in
the workplace, where men may resist welcoming women, who,
given the opportunity, can perform as well as the men do; it
is evident at home where women sometimes resist the notion
that men can do maternal work as well as they can.
If mothers want and need fathers to be more involved
with the children, they must encourage fathers, at least the
fathers who are interested, to appreciate that by their words
and deeds they are pivotal in helping their sons and daughters
understand that men as well as women have dependency needs
and needs to be loved that are gratified within an intimate,
caring relationship. Mothers must support fathers in their ef-
forts to demonstrate that women are not the sole sources of
nourishment, sensitivity, and empathy, just as working mothers
convey that fathers are not the only ones who are interested in
independence and power outside the home (Rich, 1976).
Unless change occurs in fathers and mothers so that simi-
larities are not feared as an adversary's invasion of territory
and differences can be understood as potentially enriching and
negotiable to each partner's satisfaction, we will continue to
perpetuate sexist attitudes in our children just as many of our
parents unwittingly encouraged such attitudes in us during our
childhood. To effect a profoundly meaningful change toward a
more egalitarian society, mothers and fathers together need to
address the issue: that a deep, real, and fully conscious equal-
ity between the sexes must begin in the nursery, not in the
workplace or in the voting booth. Rich (1976), Lazarre (1976),
Chodorow (1978, 1989), Benjamin (1988, 1995), Gilligan
(1982), Olivier (1989), Silverstein and Rashbaum (1994), and
many others have already pointed us in this direction. It remains
a highly significant topic that requires continued exploration.
The resulting enrichment to the marital relationship and
also the separate subjectivities of both mothers and fathers
are obvious. The impact on the children of the family and
ultimately on our culture would be enormous.
xxxiv Editor's Introduction

ENDNOTE
1. The Women's Liberation Movement became known as the Feminist Move-
ment by the 1960s. The change of name is attributed to the emergence of
an influential group of women writing from a feminist perspective about
women's rights. These women referred to themselves and were referred to
as feminists. Currently, the names Feminist Movement, Women's Movement,
Women's Lib, and Women's Liberation Movement are used interchangeably
unless specified otherwise.

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Part I

What Mothers W a n t and Need

Chapter 1

The Psychic Landscape

of Mothers
DANIEL N. STERN

F
irst, I want to say that the question of what women want
is nothing that a man should answer. I am deeply aware
of that. So, instead of answering the question "What do
mothers want?" I am going to address a different question:
"Who are mothers?" from my perspective as a third-party
observer. This perspective has an advantage: I can see mothers
clearly from a certain distance.
I describe mostly first-time mothers but, in a slightly differ-
ent and attenuated form, all of what I have to say also applies
to second- and third-time mothers. It also applies to fathers,
grandparents, or whoever is the primary caregiver. When I
refer to mothers, as I do throughout, it does not matter which
of these people we are talking about: the important thing is
being the primary caregiver.
What I describe as the mother's psychic landscape is not
something that has to be the way it is, not something that
biology or evolution has insisted that it be, not the way that it
is going to be in the future, not the way it is in other cultures.
I am talkimg about what I probably should call the current
mainstream Western narrative about what it is to be a mother
and what is supposed to happen psychically. This particular
mainstream narrative is one that fits very well with aspects
of women's psychology, the biology of the culture, and the
politics, so that it is remarkably stable but not immutable. It

This chapter was adapted from Dr. Stern's spoken text.

3
4 Daniel N. Stern

is important to know what this mainstream Western narrative

is, because if you want to change it—for political, cultural, or
personal reasons—you cannot do it unless you know what is
involved. And I think a lot of people who try to change it do
not really understand deeply what is involved in the psychic
landscape of mothers as we see it now.
It is also important to make clear the notion of mental
organizations. In clinical psychology, certainly among those
writers involved with motivational systems (which means all
the important ones essentially), understanding why people live
as they do absolutely requires the formulation of some kind
of organizing story, or reality. This story helps make coherent
what people think, feel, do, and say. It makes it possible for
people to assemble all the necessary behaviors so they can
get done what it is they want done, whatever that is. Such a
story goes by many names. It can be called a mental organiza-
tion, for instance. Freud called these stories complexes. There
were not many of these, and Freud did not really like the word
(Laplanche and Pontalis, 1967). These organizing motivational
systems are difficult to describe, and my sense is that we all
know that they are there and that we need them, but nobody
knows exactly what they are. That is why I came up with the
phrase "the motherhood constellation" (Stern, 1995). The term
has no historical baggage, and nobody knows what it means. I
do not know exactly what it means either. But it captures the
essence of some kind of mental organization which is at least
semistable. It makes clinical sense. The duration of this mental
organization in a woman's life is variable.

MOTHERS, BABIES, AND LOVERS

So what is the motherhood constellation like? I shall describe

several of its components. The first, and the one I shall spend
the most time describing, I have been thinking about only
recently; it is not in my book on the subject (Stern, 1995). It
has to do with this: most mothers either fall in love with their
babies, or want to, or wish they could, or regret that they have
not. This is a very pervasive situation. It starts in pregnancy
and obviously it continues after birth. Now, when I say falling
1. The Psychic Landscape of Mothers 5

in love, I mean it absolutely literally. It is one of the most

overarching aspects of the mother's psychic landscape, which
makes it very difficult to talk about. We do not know what love
is, and I am certainly not going to try to define it here. But it
is a lot easier to know what falling in love is, and so I will try
to write about that.
One fascinating thing about falling in love is that it is a
mental organizing state. It is not unique to motherhood, obvi-
ously, since most mothers have fallen in love several times in
their lives before they have a baby. And that is very good. They
have sort of oiled the equipment that is necessary to put this
assembly of behaviors in good working order. Or it can happen
for the first time when a woman has a baby.
Falling in love is a special mental organization that brings
together and permeates how people feel about themselves and
the world, what they think, how they feel, what they see, what
they are attentive to. Falling in love pervades the entire per-
ceived world for a period of time. It is one of the most potent
organizers of mental life that we know of.
What is involved? Before I go into that, let me offer an
example to use in comparing mothers and babies: two lovers
at the height of the process of falling in love. In doing this, I
follow William James's (1890) good old dictum. He said, if you
are going to study something difficult like religion, find the
most religious man in the world and go to him during the most
religious holiday. You will find him in the middle of the most
sacred religious act on that day. Watch and see what he is do-
ing at the height of that moment and that is where you start.
If you cannot explain that high point, you are never going to
understand religion, anyway. So you had better start there.
That is why I am starting with lovers who are falling in
love. When you fall in love there is an enormous overevalua-
tion of the other person. Lovers do this all the time: they think
that the person they love is the most beautiful and the most
wonderful, and so on, and so on. So do most mothers. They
think their babies are the most extraordinary creatures on
earth. They really believe it. They act it and they feel it, and
it goes very deep in them.
If your lover thinks that you are better than you are, you
end up being better in some ways. When a mother thinks her
6 Daniel N. Stern

baby is better, smarter, more advanced than he or she really

is, the mother's behavior is pushed into what Vygotsky (1962)
called the zone of proximal development, which means that
she directs her behavior a little in advance of where the baby
actually is developmentally. Doing that helps pull the baby
along. So it turns out to be a necessary and extraordinarily
useful teaching condition to be a little bit ahead of the baby,
not too much ahead, but in that special zone that is achieved
in part by overvaluing who or what the baby is at a given
moment in time.
If, in fact, the mother does not think that her baby is the
most extraordinary creature on earth, that is a bad sign for
the immediate future. Clinically, it is something that makes
you worry.
A second feature of falling in love is the way people look
at each other. This is not a trivial remark. Lovers look at each
other a long time. They can get lost in one another's eyes.
There is a maxim, at least in most cultures, that if a man and
a woman look at each other in the eyes without breaking gaze
and without talking for more than seven seconds straight, they
are either going to fight or make love. And this is roughly true.
The intensity of the arousal is very high. It does not happen
among adults, except between lovers; and it happens between
mothers and babies—and of course between fathers and babies,
too. (Because I am talking about mothers, I am not going to
say "fathers, too" at every opportunity, but in those instances
in which fathers are deeply involved with their babies, you
should understand me as if I have.)
Mothers and babies can look at one another for literally
minutes on end, when, in fact, babies would never direct that
kind of attention to anybody else, nor would a mother gaze
that way at anybody else's face. It is a kind of getting lost in one
another's gaze. It is a kind of soul reading—a plummeting into
the intersubjectivity of the other person, even if one does not
know exactly what is at the bottom of the dive. It also obviously
enhances the intimate contact that leads to bonding. There is
greatly increased arousal in this way of being with another, and
it is tolerated. The intensity of such a gaze may be one of the
things that leads to attachment and to the singularity of the
falling-in-love process. After a couple of months, it is probably
1. The Psychic Landscape of Mothers 7

more important for a baby which person he can look in the

eyes for a long period of time than which person feeds him,
who takes care of him, who spends more time with him. The
gazing I am now talking about is separate from and parallel to
the attachment system.
A third feature of falling in love is that there is a sort of
mental interpenetration or submersion in the other but with-
out any loss of self. The self is never lost in this process. Some
part of knowing that it is you who is doing it stays with you.
Now, whether you are a lover or a mother, you have to get
to know this stranger, who is, at enormous speed, becoming
familiar. The Japanese have a word for a "familiar stranger."
I forget what it is, but it is a wonderful term. This business of
plummeting into the other person and being exquisitely sen-
sitive to what that person may be thinking, feeling, wishing,
intending at any one moment is part of the lovers' situation,
and it makes people extremely attentive and sensitive to one
another. It gives that falling-in-love period a kind of reciprocal
delicacy. It is an extraordinary feeling, and it is exactly what
mothers do with their babies.
Plummeting into another's soul is probably one of the
most serious things that goes on as mother falls in love with
baby. What is at stake is nothing less than intersubjectivity.
We are realizing more and more that intersubjectivity is one
of the major issues and motivational systems in any intimate
relationship having to do with love and attachment (Stern,
2004). It is in play all the time during psychotherapy, which
is an intimate relationship of a kind. Intersubjectivity is the
interpenetration of minds, so that one can say, "I know that
you know that I know," or "I feel that you feel that I feel . . ."
Intersubjectivity can be verbal, it can be nonverbal; it
does not matter. It goes under many names. We talk about
identification with the other, or about emotional contagion,
or about resonance, or about projective identification. There
are many other terms. But we are beginning to realize that the
roots of intersubjectivity are several and that they probably
have a very strong neuroscientific basis.
There is now fascinating work indicating a neurological
basis for knowing what is in another person's mind—baby or
adult. It turns out that we have "mirror neurons" (Gallese,
8 Daniel N. Stern

2001). Very briefly, what they do is this: when I (a baby) reach

for the bottle, a pattern of neurons fires in my brain so that I
can reach it. Near these neurons are mirror neurons that mir-
ror the pattern. But they do not fire and move my arm. They
just send another signal to the rest of the body. That is not
very extraordinary.
What is extraordinary is that if you watch me (the baby,
again) and you are paying attention to me, when I reach for the
bottle, your mirror neurons fire, the very same ones that would
make you do the same gesture (Gallese, 2001). So you know
what it is like to be me. You are inside my body in a virtual
sense. You have participated in the experience of the other. You
are inside the other's skin. This is what is going on between a
mother and a baby, and between lovers, all the time. There is
a constant imagining or being inside the skin or participating
in the other's experience by virtue of these mirror neurons.
We do not know when these neurons kick in for babies, but
they are certainly there with mothers.
There are also "adaptive oscillators," which are essentially
clocks in the body that time what you are doing and what
somebody else is doing (Port and van Gelder, 1995). These
clocks can be reset rapidly to synchronize with another's rate of
movement. This is the kind of thing that goes on in an outfielder
running to catch a baseball that is making an arc through the
sky. He has to time the trajectory of the ball and his own speed
so that he and the ball meet at the right moment. There are two
actions that have to be coordinated and synchronized. Now,
it gets even trickier if the other part of the interaction is not a
ball in the air but another person who you are doing something
with. We see this kind of exquisite coordination between people
all the time. If two people (getting back to falling in love) have
never kissed before, and all of a sudden, unexpectedly, they
throw themselves into a passionate kiss, they very rarely break
their front teeth. There is usually a soft landing. The reason
is that both of them have timed their behavior, and each also
experiences the timing of the other person's behavior, all out
of awareness. So each one is inside the other person's body as
well as in his or her own body.
We have come to view intersubjectivity as one of the
most pervasive aspects of human behavior. We all live in an
1. The Psychic Landscape of Mothers 9

intersubjective matrix, and this is true from the beginning of

life. We are beginning to look at things like early infant imita-
tion (for example, the baby sticking out the tongue when the
experimenter or the mother or father sticks out his or her
tongue) (Meltzoff and Moore, 1977). This is a form of "primary
intersubjectivity" (Trevarthen, 1979).
One of the most striking and remarkable aspects of autism
is that the capacity for intersubjectivity seems to be limited
or absent. Those who suffer from autism do not participate in
the other's experience.
A friend of mine showed me a lovely example of the dif-
ference in the capacity for intersubjectivity between autistic
and nonautistic children. Pretend you are the mom, or the
experimenter. Put your hands up, palms facing out, in patty-
cake position. Most children will then put their palms against
your palms in what seems to be an imitation of the grown-up
gesture. But is it? The infant saw the mother's palms but now
sees the backs of his own hands. The baby is imitating as if he
were the other. Nonautistic children act as if they are doing
the imitation from within the center of the other person, not
from within their own center; and that's what we mean by
other-centered participation.
Autistic children, on the contrary, place the backs of their
hands against the up-raised palms of the adult's so that they
see in themselves exactly what they see in the adult. They are
imitating from their own point of view. There is only partial
intersubjectivity.
Intersubjectivity is not simply a capacity we have. I would
say that it is a major motivational system. It has the same
importance for species survival and for individual survival as
sex and attachment. You cannot live if you do not constantly
search for intersubjective relatedness. There has to be a con-
stant intersubjective orientation going on every minute of the
time when you are with a baby, when you are with a lover, and
when you are in a therapy process.
(Intersubjectivity is a little less acute in therapy than in
the other situations because therapists do not know how to
listen as well as mothers do.)
The fourth feature of falling in love is that there is a
physical symmetry in the movements between the lovers.
10 Daniel N. Stern

If you watch two lovers at a cafe, they trace a dance that is

symmetrical and synchronous in the sense that they go to-
ward each other and then away from one another at the same
moment. Their timing is exquisitely linked, not perfect but
awfully good. You also see this synchronicity with babies and
mothers. They are locked into one another in this way, and
this facilitates bonding.
The fifth factor in falling in love is that you want to be
with the other person, you want to be in his or her presence,
you want to be alongside the other, either touching or at least
within his or her aura, a few feet away, not much more. This
desire for physical closeness is important because it teaches the
mother and the baby how to manipulate and negotiate social
distancing. All the sense of appropriate social distancing that
is necessary to be a human being in social interactions comes
from this source. The basis for social distancing, in other words,
is probably the way people do it in the falling-in-love process.
It is the intimate mode of proxemics.
The sixth feature of falling in love is the desire to touch and
embrace, be close and have physical contact. I am not talking
about sex. I am leaving sex out of this. In fact, I do not think
sex is very important in the mother-baby tie. As you can see,
much of what I am talking about is different from many of the
familiar psychoanalytic traditions.
Lovers touch, they hold hands, they lean against one
another, they stroke one another's face and head. What about
mothers and babies? Now, that's very interesting—they do
the same things. Their touching is completely expectable. You
can see this even with babies in isolettes after they are born.
Let us say a mother has had a C-section or a premature baby
who went right into an isolette. Even those mothers, who have
had no opportunity to spend time with their babies, do exactly
the same things when they see their babies for the first time.
Klaus and Kennel (1976) showed that the first-time mothers
are allowed to touch their babies, most do the same thing.
They start by touching their babies' peripheries. First they
touch their hands or their feet. They do it gently, with their
fingertips, and they slowly work their way toward the center,
touching their babies and stroking them; and as they do that,
their hands flatten out so that they are touching with their
1. The Psychic Landscape of Mothers 11

palms. Slowly, the touching reaches the baby's body and then
the head; or sometimes it is the head first and then the body.
There seems to be a pattern of behavior that most mothers use
in getting to know their babies and making their babies their
own. This is, of course, the way lovers move together when they
first touch—first the periphery with their hands and then they
move toward the center. Again we see that something similar
goes on between lovers and between mothers and babies.
The seventh item about lovers is that they hold the other
person in mind all the time. Now this is an interesting business.
Your lover, or your baby, becomes a preoccupation in the full-
est sense of the word. You see this with lovers, of course, and
you see it with mothers who slowly build up a representation
of their babies this way (Stern, 1985).
This point goes back to the topic of intersubjectivity in a
curious way. I learned just recently that about 50 percent of
children between the ages of five and twelve have an imaginary
companion—a much higher proportion of children than we
thought and much later than we thought (Stern, 2004). Even
these figures are probably a gross underestimation, because
a lot of children, especially boys, will not admit to having an
imaginary friend.
To think of an imaginary companion as a common aspect
of early life is fascinating, though, because it means that you
are frequently conducting mental interactions with a virtual
person with whom you share your thoughts, feelings, and the
like; and you know the other's, too, so that you have a dialogue
about these things. This intense, imaginary dialogue has a very
interesting similarity to what happens at the beginning of fall-
ing in love and in the mother-baby process. It is as if the baby
were prepared by nature (I may be exaggerating a little but not
much) to encounter a virtual other. His mind is constructed
to do business with a virtual other. Then maybe you can just
substitute a real other. And when the baby is not with the real
other, he calls into play the virtual other, an imagined version
of the real other. That is what this preoccupation is about. It is
the constant intersubjective contact, real or virtual, with the
other, whether the baby or the lover.
The eighth factor that the mother-baby process has in
common with falling in love is baby talk and baby face. Outside
12 Daniel N. Stern

of weirdness and pathology, the only other time that adults

talk baby talk is when they fall in love. This is a way of being
together in a wholly different, nonverbal register, which is
clearly marked. And, of course, that is the main way mothers
and babies are together. This kind of relating is an enormous
help to the baby's learning about vocalizations and facial ex-
pressions, which always are exaggerated during baby talk and
baby face (where everything is exaggerated).
The ninth similiarity is that of making a unique world to-
gether. One of the interesting things about lovers is that they
do not share the same world in the beginning. But instead of
one person's taking over the other's world, they create their
own unique world together. It is a small bubble to begin with.
They have, in part, their own language; they have their own
reference system; they have gestures and movements that are
abbreviated to become signals that nobody else knows about.
The use of words is highly singular and unique to the dyad.
This is what mothers and babies do, too, because the result
of the learning of mutually understood signals and words be-
tween a mother and a baby is the creation of a unique universe
between them. This happens even when they adopt something
that is used by everybody in the culture, like words, because
when a baby first learns a word, he does not actually learn it
in the conventional sense. Take, for example, a battery, a black
battery. For the sake of babies, who cannot say "battery," let
us call it "cell." If the mother says "cell" a few times, baby
after awhile will say "cell." And the mother will say "Bravo!"
as if the baby had learned a word. The baby did not learn a
word. The baby learned a sound, and the baby learned that
somehow, somewhere, the sound "cell" is connected to this
particular object. Most essentially, though, the baby learned an
intersubjective reality: he and his mother may as well be the
only people on earth who know that there is a correspondence
between this sound and this object. The word has become
part of the secret, unique world they share. All words begin
that way. And, again, there is a similarity between the world
of babies and mothers and the world of lovers.
The last thing I want to emphasize about falling in love is
altruism. There is this peculiar feeling that you cannot imagine
1. The Psychic Landscape of Mothers 13

living without the other person, a la Romeo and Juliet. I think

there is a lot of this feeling between mother and baby.
Consider that when we talk about the mothering process
and the psychic landscape, either we tend not to talk about
love or falling in love, or we tend to talk about these things as
if everybody knew about them and there was nothing more
to learn or observe. In fact, all the characteristics of love and
falling in love that I have mentioned are crucial clinical issues
in evaluating the extent to which a mother is involved with her
baby and vice versa. We ought not pass over these factors so
quickly and should instead consider them part of our entire
motivational system, a major part of a mother's psychic land-
scape. It is what she wants. If a mother feels she is not loving
well, if she feels inhibited in the way she loves, if she feels she
does not have the repertoire to do it, her problem becomes as
much a preoccupation for her as the fact that she also does
love her baby. The ability to fall in love with the baby is the
cardinal, overriding issue in her psychic landscape during this
time.

T H E MOTHER'S FEARS

The mother's fears begin in full swing as soon as she comes

home with the baby. Every mother really has one main preoc-
cupation when she gets home. Strangely enough, we do not
talk about these fears in our theoretical books or even in our
clinical books. Her sole and completely predominant preoc-
cupation is, "Can I keep my baby alive?" That is all she is
interested in. Here she has this little thing, she does not know
what to do, and she is worried that the baby at any point can
die. "Can I keep my baby alive?" The real questions behind
this question are, "Am I a competent animal? Can I keep the
next generation of the species alive and going?"
Any failure in this area is massive psychologically, a huge
trauma. For this reason, for instance, the mother who has just
come home with the baby will go to the baby's crib three times
a night to make sure the child is breathing. If the husband or
somebody else tries to stop her, her level of anxiety and anguish
14 Daniel N. Stern

will mount to a very high level, and she will usually say, "I'm
going in anyway. I know it's silly but I'm going in." It is why,
when she bathes the baby, certainly in the beginning, she is
worried all the time, not every instant, but all the time in the
back of her mind, that the baby might slip through her soapy
fingers and drown or bang his head against the tub. She worries
that when she is changing the baby and turns her head the
baby could fall off the table and bounce. She is worried that
when the baby is in bed with her, she or her husband could
roll over on the baby and crush the baby or suffocate the baby.
She lives in a world of worries.
One of the reasons that this kind of fear is important to
think through is that psychoanalytic perceptions of it have
been dreadfully destructive and misleading. We all learn that,
if you have great fears and great love at the same time, perhaps
there is a level of ambivalence that is too high. And that may
be true. But it is strategically stupid and wrong to talk about
the ambivalence that way, at least with mothers, because
what is happening is not that the mother is ambivalent at all.
Rather, when nature wants something very badly (and nature
certainly wants the survival of the baby very badly), nature
will build in an enormous amount of redundancy to make sure
the child survives. That means that the mother is wired to be
hypervigilant. And, in fact, with regard to all these fears and
this vigilance, the mother is the victim. She pays evolution's
price by getting little sleep, by putting in too much effort, by
overshooting all the time, and by being fearful nevertheless.
The most constructive and conservative thing a mother can do
is to have these kinds of fears in the beginning and to act on
them. Saying that these fears represent ambivalence, and (as
I did in the beginning of my training or right afterward) that
maybe the mother has some thought that she did not really
want the baby, is destructive to the mother beyond words.
There is also something interesting about looking at this
aspect of the psychic landscape of mothers from the psycho-
logical-theoretical point of view. Our theories of the principal
basic fears that human beings live with concern matters like
our own deaths, isolation, castration, fragmentation, and all
the fears described by Winnicott and others—falling forever
and the like. All these points are unquestionably important.
We throw in some other, more biologically rooted fears, such
1. The Psychic Landscape of Mothers 15

as fear of snakes, thunder, loud noises. But nowhere is it men-

tioned that the greatest fear is that you cannot maintain the
survival of another person. That is not part of our theoretical
list of major fears, and yet that is exactly what mothers live
with. However we view the psychic organization of mothers,
we must take this fear into account in a special way that we
do not do now.
Of interest also about this part of the organization of the
mother that is constructed around fear is that mothers need
experienced older women around them. If they do not have
these older women around, they will fantasize about them or
they will dream about them. They will find them somewhere—if
not in the real world, then in their virtual repertoire. This is
not to be seen as some kind of positive Oedipus complex.
When a woman gets pregnant, one of the first changes she
experiences, even more noticeable after the baby comes, is that
she becomes very interested and involved with other women.
She starts looking at them differently, and she starts thinking
about what they do. Her own mother starts to come into some
prominence. Positive or negative, there is a reevocation of the
nature of the relationship she had with her mother. There is a
corresponding decline of interest in men. She is less interested
in her own father than in her mother, and her interest is not
in her mother as a woman or as a partner to her father, but as
the mother she was when her now grown daughter was a little
girl. These become the major issues, and this is where much
of the energy is being spent.
The Adult Attachment Interview and the corresponding
attachment theory of Main, Kaplan, and Cassidy (1989) have
shown rather convincingly that one of the most important
determinants of how a mother is going to act with regard to
attachment behaviors with her own baby is how she was with
her own mother when she was a little girl. All mothers hate
this idea. It seems to them like a dreadful trap. They feel they
have to do all kinds of things in order to mother differently
from the way their own mothers did. I think the point, in part,
is that the mother's mother becomes a guide, a sort of North
Star. A guide is not a determinant, just a reference point.
Remember, once you know where the North Star is, either
you can steer for it or you can steer south. But you need that
reference point. You may have more than one North Star, and
16 Daniel N. Stern

there may be another constellation that you steer by. It could

be an aunt, a grandmother, a grandfather, an older brother.
But you need it.
In other, more traditional cultures, the idea of the mother
being alone at the time of the birth and immediately after is
relatively rare. Mothers are characteristically surrounded by
other, experienced women, who are not necessarily members
of the family. These other women accompany the mother not
only during the delivery, but also sometimes for months after-
ward. In contrast, a variation of modern culture is that mothers
are essentially alone, or alone with their husbands, during this
early phase after having a baby. It is a bizarre variation, in a
way. What do mothers do? In fact, they recreate the traditional
village form, thanks to all our communications media.
With colleagues Ed Tronick and Katherine Weinberg at
Children's Hospital in Boston, I did a sort of pilot study in
which, after mothers got home, we asked them who visited
them most, and how often; who telephoned them; and so on. It
turned out that the people who visited the new mothers were
mainly older, experienced women. When I say "experienced," I
mean they have had babies, or at least a lot of baby experience
(you do not have to be a mother to have baby experience). First
the new mother will go to the experienced females on her own
side of the family—her own mother, a sister who has a baby,
an aunt or grandmother, and so on. After that, she will go to
women on the father's side.
Men are relatively unrepresented among early visitors.
Usually only the new mother's male friends who are fathers
come to visit during this early phase. Even these experienced
men do not do a great job of it, though. The characteristic pat-
tern is for a man to say all the usual things—"What a darling
baby! How's it doing? How do you feel?" They do all the things
that women do with each other. But then, after about five
minutes, they will say, "Well, let me tell you what's happening
at the office." The man immediately returns to the world and
brings it into the conversation. The new mother does not care
much at that point about these matters, and so her visits with
men are less satisfying for her than her visits with women.
On the average, new mothers establish about 12 contacts
a day with experienced women. In other words, they are recre-
1. The Psychic Landscape of Mothers 17

ating the traditional village pattern that has obtained, appar-

ently, through most of known evolution. But we do nothing to
encourage it, nor do we even really talk about it. At least we
certainly do not talk about it enough.
I talked to a mother once who taught me something im-
portant about this phenomenon. She had stayed in the hospital
longer than usual, about six days after the birth of her first baby.
I asked her, "Well, tell me, who has been the most validating
presence for you now that you have become a mother?" She
laughed and said, "Well, all right. I'll tell you. At seven o'clock
every morning this woman comes in to clean the room and
make the beds. She's about 55. She's a grandmother and she
always comes over to my bed and says, 'Hiya, honey. How'd it
go last night?' and 'How's the baby?' or 'The baby looks pretty
good' or 'How do your breasts feel?' We spend seven or eight
minutes in this kind of talk. The visits from the doctors and
the nurses are important, but if everything is okay they don't
matter much. My husband's visits were essential for keeping
my world structured and alive, but the person who really
validated me as a new mother was this woman. It was she
who said, 'Welcome to the Club.'" This kind of validation was
extremely necessary.

SOME ADDITIONAL CONSIDERATIONS

We are beginning to realize that probably the most potent as

well as the cheapest way to do therapy with parents and babies
at risk is to hire female home visitors who are not professionals,
but who will visit in the home once a week, without fail, for
18 months. These women provide an experienced holding
environment that allows a new mother the kind of validity
and encouragement she needs to explore her own maternal
repertoire. You cannot really teach somebody to be a mother;
all you can do is give her the kind of context in which to ex-
plore herself and better use what she has at that point in her
life. The only situations in which such a holding environment
is not called for are those in which the mother has some kind
of specific inhibition of a relevant sort. Then, of course, more
traditional therapies come into play.
18 Daniel N. Stern

We need to reconsider very deeply, at the theoretical as

well as at the clinical level, the nature of a mother's psychic
landscape. Unless we do this, we will be unable to do effective
therapy with her. And if we want to change what I am calling
the current Western mainstream narrative about what it is to
be a mother, we will have to deal with all the features of what
it is like to be a mother and the way these features seem to be
so deeply involved with other aspects of human existence. We
are used to the idea that what it is to be a mother has clinical
significance, even if we have not been very good at identifying
the most important features of being a mother. It now also has
become a cultural and political necessity, however, to take a
renewed, intensive look at the landscape of mothers.

REFERENCES
Gallese, V. (2001), The shared manifold hypothesis: From mirror neurons
to empathy. J. Consciousness Stud., 8:33-50.
James, W. (1890), Principles of Psychology. New York: Dover, 1972.
Klaus, M. & Kennell, J. (1976), Mother-Infant Bonding. St. Louis: Mosey.
Laplanche, S. & Pontalis, J. B. (1964), The Language of Psychoanalysis,
trans. D. Nicholis-Smith. London: Karnac Books, 1988.
Main, M., Kaplan, N. & Cassidy, J. (1989), Security in infancy, childhood,
and adulthood: A move to the level of representation. In: Growing
Points in Attachment Theory and Research, ed. I. Bretherton & E.
Waters. Monogr. Soc. Res. Child Devel., 50:66–106.
Meltzoff, A. N. & Moore, M. K. (1977), Imitation of facial and manual gestures
by h u m a n neonates. Science, 198:75–78.
Port, R. & van Gelder, T., eds. (1995), Mind as Motion: Explorations in the
Dynamics of Cognition. Cambridge, MA: MIT Press.
Stern, D. N. (1985), The Interpersonal World of the Infant. New York: Basic
Books.
— (1995), The Motherhood Constellation. New York: Basic Books.
— (2004), The Present Moment in Psychotherapy and Everyday Life.
New York: Norton.
Trevarthen, C. (1979), Communication and cooperation in early infancy:
A description of primary intersubjectivity. In: Before Speech, ed. M.
M. Bullava. New York: Cambridge University Press.
Vygotsky, L. S. (1962), Thought and Language, ed. & trans. E. Haufmann
& G. Vakar. Cambridge, MA: MIT Press.
Chanter 2

Loving and Hating

Mothers and Daughters
Thoughts on the Role of
Their Physicality
ROSEMARY H. BALSAM

S
ome female patients have mothers who beat and physi-
cally torture them—the ultimate physical expressions
of hatred—and yet these patients seemingly are bound
to their mothers with such loyalty and love that an analyst can
sometimes go for a year or more before even the first horror
is whispered. The body does not seem to remember even as
it refuses connection with the mind. When the experience
is newly described to the analyst, in the picture frozen in
time, the beating mother alone contains the empowered body
hatred. The child in the scene is helpless and overwhelmed
and often detaches herself from her body. Leonard Shengold
(1989) has written extensively about the psychological vicis-
situdes of this kind of trauma. Most seasoned clinicians have
treated a number of such cases and know what it is like to feel
heartsick for their patients, exasperated in attempts to help
them access even some anger at the attacker of old and feel
frustrated in trying to modify their patients' guilt, dissociation,
and self-criticism.
Here I use the category of daughter/victim of maternal
hatred to contrast with its manifest opposite, that is, daughters
who are emotionally abusive toward their hated mothers, whom
they victimize. (I have not had experience in analysis with
any daughters who have regularly struck their mothers, but

19
20 Rosemary H. Balsam

this can be the case in "elder abuse," when a mother becomes

physically frailer than a violent, strong, young, powerful daugh-
ter/caretaker.) When these angry daughters become patients in
psychotherapy or psychoanalysis, they may report unrelenting
hatred of their mothers during many years of treatment. Yet
their mothers, while maddening in their habits or character,
are not described as having gone to the extremes of physically
beating, torturing, or sexually abusing their daughters. These
contrasting mother-daughter dyads might be understood theo-
retically through many different lenses, but I want to confine
myself to trying to understand some aspects primarily within
the physicality of their relationships.
This is a very complex topic, and I am risking oversimpli-
fication of theory in the interests of focus and space. On the
contemporary sea of plurality of relevant analytic theories,
many ideas can be floated to help understand such duos:
for example, the import of their object relations within such
sadomasochistic bonds; the role of "identification with the ag-
gressor" within an ego psychological frame; the functioning of
self-esteem and undoubted empathic failures in a self-object
framework; the manifestations of avoidant attachment. I am lo-
cating myself here with Loewald (1960), a core image of whose
theory is a mother and infant cocoon, where he believes that
for the infant, the instinctual drives develop simultaneously
and in conjunction with the earliest object ties:

The whole complex dynamic constellation is one of mutual

responsiveness where nothing is introjected by the infant
that is not brought to it by the mother, although brought by
her often unconsciously As the mediating environment
conveys structure and direction to the unfolding psycho-
physical entity... the environment begins to take shape in
the experience of the infant [pp. 237-238].

Turning toward the mother-daughter focus of this chapter,

I locate myself, in addition, close to Chodorow (1978), a
theoretician of gender who early spoke to mutual identifica-
tions between mother and daughter within the female culture
of childbearing and childrearing. In her current work, ac-
knowledging, for example, Loewald in The Power of Feelings
2. Loving and Hating Mothers and Daughters 21

(1999), she explores intrapsychically the subjective sense of

gender. Chodorow "consider[s] personal meaning in terms of
unconscious projective and introjective fantasy" (p. 3). While
against psychoanalytic universalism, she argues that "gender
is individual but also that there are prevalent ingredients,
including culture, anatomy and internal object relations that
most people draw on to animate gender" (p. 4). While each
character in my sexed and gendered mother-daughter plots is
highly individual, at the same time I would like to emphasize
how abidingly reciprocal, from the earliest years, is the interac-
tive entwinement that builds these psychological scenarios of
maternal internalization for daughters (Balsam, 1996, 2000.)
The contrasting mother-daughter couplings that I describe
here seem to me counterintuitive within the primitive crucible
of mutuality and reciprocity that produces the forerunners of
object "shapes" and that creates internalizations. Yet these
daughters are manifestly too opposite to their mothers not to
contemplate that this pattern in and of itself must have some
kind of deep resonance that connects this particular mother
with this particular child. In short, how can a hating mother
produce a child who not only loves her, but also is even ca-
pable of love for others outside the original duo? And how can
a loving mother produce a child who hates her consistently
and pours dislike onto others outside their duo?
One major element that can be underplayed in many
theoretical orientations these days is the body. With relational
and intersubjective correctives emphasizing a two-person
theory, while the analytic field has become thus enriched, it
has become dismissive of "one-person" libido theory. The baby/
body has unfortunately tended to be thrown out with the bath
water of libido theory. For example, when the strict linearity of
Freud's psychosexual phases has been rightfully taken to task,
the body's "orality," "anality," "erogenous zones," and "scopo-
philic instincts" are frequently ignored rather than further
questioned, and have been frankly rejected in their usefulness
or, alternatively, have been coopted to become again useful in
theory building. In the old drive theory, the body per se was
central. Now the relationships are central. So I want to highlight
the corporeal relationships here between mother and daughter
22 Rosemary H. Balsam

and offer them as a special key to understanding how a girl

child's comparative same-sexed body mental representations
of the adult female body may illuminate varying fantasies that
account for certain chronic mother-daughter battles encoded
within these patients' internalizations.

O L D VIENNA

Here I would like to detour into some previously overlooked,

relevant, but prescient themes that were part of a forgotten
presentation that the first woman member of the Vienna Psy-
choanalytic Society offered to the 18 male members on January
11, 1911 (Nunberg and Federn, 1974). The new member was
Frau Dr. Margarete Hilferding. She was part of Dr. Alfred Adler's
entourage who resigned from the society together with him
later that same year as a result of his increasing disagreements
with Freud. The title of the presentation was, "On the Basis
of Mother Love" (p. 113). In essence, Hilferding was talking
about the various interconnections among pregnancy, child-
birth, nursing, maternal aggression, and sexual feelings, and
the earliest benign or malignant attachment between mother
and infant. One wonders if Freud's understanding of women
would have been more vivid and accurate had Hilferding re-
mained over the years to develop her ideas within his circle.
Fresh from family medical practice, she said that evening to
these men, that she had noticed that there were new mothers
who seemed to look forward to the baby during pregnancy, but
after the birth itself, they experienced no mother love.
It is interesting that the title refers to "mother love," but
most of her examination is about where this goes awry. The
main text here is mother anger and hatred. The subtext is love,
which she believed, is often hard won. Her way of putting this
idea rings awkward, as she struggles with integrating some new
Freudian psychoanalytic ideas about the ubiquity of sexual
libido with her clinical and medical observations. Sometime
after the birth, she thought, "psychological factors [develop]
as substitutes for physiological mother love" (p. 113). I believe
that this might today be understood as a maternal variant of a
2. Loving and Hating Mothers and Daughters 23

"false self" reaction (Winnicott, 1960). She saw the "nonexis-

tence of mother love" in a mother's refusal to nurse, in her
desire to give the child away, or in her hostile acts against the
child. Hilferding thought that a special dislike for the child
could develop because the father had deserted. She posited
that the first child often evokes the mother's maximal hostility,
whereas the youngest is often pampered owing to a reversal
of maternal hostility. Hilferding even noted that exaggerated
mother love could be a form of overcompensating for hostility
to a child. (This, we note, was long before "reaction forma-
tion" as a defense was formulated.) She announced boldly that
"there is no innate mother love"—a revolutionary statement
at the time—and that "it is by way of the physical involvement
between mother and child that love is called forth" (p. 114).
In her opinion, the child becomes a "natural sex object for
the mother" (p. 115). "It can be said that the infant's sexual
sensations must find a correlate in corresponding sensations
in the mother," she stated, and "if we assume an oedipal
complex in the child, it finds its origin in sexual excitation
by way of the mother" (p. 115, italics added). Mother love,
she believed, was not innate in any biological sense but could
be acquired through the experiences of nursing and physical
care of the infant.
I include Margarete Hilferding in this discussion because
I am impressed that this woman family doctor, the first female
graduate from the Vienna medical school, emphasized a two-
person theory in a most vivid fashion, as the reciprocity of the
physicality and emotional interchange in this area between
mother and baby. Her insistence on the primordial physicality
of the mutual bond is what I too would like to emphasize for
its lingering mental representations in adult life. I believe that
she was the foremother of this mode of understanding.
Hilferding was ultimately disappointed that, in the discus-
sion afterwards, the men wanted to dwell on the mother's
disembodied mind and digress from a focus on Hilferding's
ideas. They invoked anthropology, expressed opinions about
wicked stepmothers from folk tales, or speculated about the
mother's own early oedipal situation. Paul Federn, for example,
dismissed mothers who hate their offspring as "degenerate"
24 Rosemary H. Balsam

(p. 125), which at that time was a congenital neuropsychiatric

diagnosis. Freud himself delivered Hilferding a blow about her
ability to use his psychoanalytic theory, when he said that
"those explanations that she arrived at before... psychoanaly-
sis are the ones that are the most estimable, being original
and independent" (p. 118). Hilferding had wanted to focus on
a female's experiences of pregnancy, giving birth, and breast-
feeding the infant and point to how these body-based experi-
ences would affect the relationship of the woman to her child.
One wonders what Freud meant by his criticism. For many
reasons, including the men's ways of distancing themselves
from this uncomfortable clinical material and their proclivity
to lecture her, Hilferding certainly felt that she had not been
understood (Balsam, 2003).
Hilferding's ideas were derived from closely observed
obstetrical and midwifely bedside observations, b u t they
were radical ideas for the beginning one-person drive theory
that was psychoanalysis. At that point Hilferding was 40. She
had three-year-old and six-year-old sons (Appignanesi and
Forrester, 1992). She was close to early mothering herself,
which may have lent an authenticity to her argument that
still shines through.
Hilferding's courage in tackling "mother hate" by examin-
ing love with her newly acquired Freudian emphasis on sex
strikes a contemporary analyst as foreshadowing concepts rel-
evant to Freud's (1923) yet-to-be developed structural theory,
in which he designated that "the ego is first and foremost a
bodily ego" (p. 26). She touched on aspects of ambivalence
and aggression in the mother-child bond that theoreticians
are still struggling to articulate. Take, for example, an article
by Holtzman and Kulish (2003) that points to the inhibition
of aggression in women and the chronic lack of theoretic at-
tention to it compared with men.
A mother's sexual experience, for Hilferding, was evoked
in mutual connection with the baby. Her pregnant body's
responsive sensations to fetal movement or her pleasure and
excitement at milk shooting into the breast Hilferding saw
as powerful physical organizers of a mother's mental life. A
woman's sense of loss of a kind of sexual excitement in the
absences of the sensations afforded by pregnancy could render
2. Loving and Hating Mothers and Daughters 25

her affectively empty or flat to her newborn or fuel her rage

and rejection of the infant.

CASE A:
A GIRL'S LOYALTY TO HER HATING MOTHER

Ms. A's was an analysis I supervised. A woman of Greek heritage

in her 30s, she married in the seventh year of analysis. She
was a kind, articulate, and responsible young working woman
who eventually told her analyst stories that put his hair on
end about punishments visited upon her by her mother for,
say, stepping onto the lawn or leaving a dust bunny under the
sofa while doing her cleaning chores. Once, when under inter-
rogation as a late teenager, she confessed to her mother that
she had thought of kissing a boy. The mother shrieked at her
about "sin" and her "vileness," stopped speaking to her, and
made her sleep at night on straw on the kitchen tiles for the
duration of summer school vacation. Brutal beatings with a
belt or fists, slaps, and canings were her daily lot. Yet so much
love emerged about this mother, it was amazing to both analyst
and supervisor.
Ms. A, the only child of separated parents, yearned to be
accepted by her hating mother, who prayed daily to a marble
statue of the Virgin that she kept in an alcove in the hallway.
The force of Ms. A's ability to cling to some better fantasy ver-
sion of this vicious mother, who starved, confined, and beat
her, allowed for a yearning bond to be nurtured in fantasy. No
matter what the mother said or did, the daughter assumed the
insults to be her own fault and roundly deserved. The little girl
was very religious. Longing to be purged of sin and forgiven by
this mother, the representative of the Mother of God on earth,
was an endless quest for my supervisee's patient.
Gradually it may emerge with such a patient that a per-
sistent emotional reserve conceals an unconscious refusal to
become involved fully with the analyst. An unconscious fear of
being beaten or emotionally abused again can manifest itself
tenaciously as it did with Ms. A and can be, with difficulty,
analyzed in the transference. As we know, such patients are
frightened of their own aggression lest they themselves turn
26 Rosemary H. Balsam

into the monster mother. With the limitations she thus imposes
also on regression, the patient unconsciously refuses to accept
any dependency substitute for the mother and thus remains
abidingly loyal. In the paternal transference, some fears that
emerged and became workable were inchoate fears of involve-
ment with a man and retaliatory maternal jealousy. Devotion to
mother was the only tolerable position for Ms. A. To shift this
state meant that she would perceive her mother's behaviors
more objectively and reflectively. This state was too dangerous
to be desired. She preferred to stay as "innocent" as a little
child even as she had managed to inhabit a split state of going
through the motions of some aspects of adult life, like holding a
job and having acquaintances. Ms. A articulated to herself over
many years the inescapable unconscious fantasy addressed to
her mother: "Finally, when I will look after you on your death
bed, when I give my whole life over to look after you, when I
show you how I can repudiate my husband, my children, my
career—and, of course, my analyst—you will finally tell me,
'I've loved you best all along.'" This fantasy was so sweet to
my patient, it was the song of the siren.
The following physical manifestations came alive in the
analysis. Interpretations offered by the analyst were directed in
many ways at how profoundly "unsafe" any element was that
introduced the possibility that Ms. A could be seen by him as
an adult woman. Most important (for the focus of this paper),
the transference involved him as her mother. There were many
dreams, slips of the tongue, or direct associations about how
this or that would have led to a beating or a "time out," which
was more like solitary confinement, or going without meals.
Ms. A dressed in large, baggy shifts, and her hair was plain
and tied back from her face. She never wore makeup. Her nails
were bitten to the quick. She looked at the ground with eyes
downcast. If her therapist smiled at her, she looked distressed
and anxious, for his smile meant that she would be tempted to
"tell all" to him, as she had, at times, felt with school teachers,
and thus betray mother.
Gradually it emerged that mother used to have the girl
sit on a stool to watch her brush her long, black, wavy hair.
Sometimes the daughter combed her mother's hair for her.
2. Loving and Hating Mothers and Daughters 27

She would have the girl paint her nails or apply face masks.
During these beautifying sessions she would tell the girl what
a violent and perverted man her husband was. This was her
explanation for why they had separated. As soon as Ms. A had
her menses, mother administered laxatives, told her she was
sick on "those days," and kept her home from school. If the
patient got out of bed, she would be beaten. The girl lay in bed,
mostly, we thought, dissociated from her body, her feelings,
and her inquisitiveness about what frightening (or exciting)
changes were happening to her body. She claimed to have lost
any feeling of pain in the beatings, although she remembered
the color of her bruises. Her daydreams were of floating in a
warm sea in Paradise.
Mother posed before her in underwear and requested
admiration for her curves, her skin, her glorious hair. Suffice
to say that the analyst helped fill out with Ms. A the vivid
contrasts between her vision of mother as being the perfect,
iconic adult female beauty, the Madonna, and herself as the
"innocent child." Such a creature would enter God's kingdom
without sin. Anger and, of course, sexual feelings were sinful.
So was "knowledge" of any kind—from self-reflection to school
learning, to fantasies of the meaning of carnal knowledge. It
was only in the last years of her analysis that she could take
in and bear the painful knowledge that her mother had been
psychotic from time to time during her upbringing.
By interpretations over many years, the analyst helped
Ms. A recognize that she had options to giving her life over to
mother. But often she would be filled with remorse and say that,
at the bottom of her heart, she was still not sure that she felt
she would be doing the right thing to have a life of her own in
the end. Mother, for all eternity, knew best. Ms. A was amaz-
ingly capable of genuine empathy for her mother and for her
mother's pains while growing up in old Europe. Space precludes
my providing examples or more details of the transference, so
I ask your indulgence in believing my observation that Ms. A
was capable of inspiring respectful and loving ties with others. I
found the manifestations of her forgiveness toward her mother
to be part of a characteristic pattern of giving people the benefit
of the doubt and being stalwart and supportive of others.
28 Rosemary H. Balsam

LOATHING DAUGHTERS: GASES B AND C

These vignettes are about adult daughters who were relentless-

ly critical of their mothers over many, many years of analysis.
The following is a thumbnail sketch of what the analytic
work is like. I characterize the imagined location of the patient
and the analyst in the patient's mind as she tells her bitter story.
The stories are intended to connote objectively mother's bad-
ness. The patient holds herself overly separate. Mother is an
evil outsider to be reported on to a like-minded sympathetic
insider. Analyst and patient join as "we"; mother is "she," "the
other." The almost immediate assumption here is that the self-
assessment of the patient as good insider and therefore "not
like mother" is silently and automatically fused with appar-
ent expectations toward the analyst, also a good insider and
certainly "not like mother." All the badness is placed outside
this intimate dyad and is locked away within mother.
The analyst believes the patient's story of bad mother
care. The analyst may, indeed, actually believe it even more
than the patient does. The good analyst, the good patient, and
the bad mother become frozen in time. The stories quickly
lose freshness. They have been rehearsed over and over with
friends. Until the exploratory treatment, these women have not
been invited to reflect on the meanings of their vituperative
statements. Perhaps this frequently observed social acceptance
echoes a universal interest in stories about the "Bad Mother."
The men of the Vienna Psychoanalytic Society group spoke
similarly of the wicked stepmother when Hilferding talked of
absence of mother love after birth. Nancy Chodorow (1989)
says: "Feminist writings on motherhood assume an all-powerful
mother who, because she is totally responsible for how her
children turn out, is blamed for everything from her daughter's
limitations to the crisis of human existence" (p. 80). The re-
sponse of the culture, therefore, often reflects and compounds
the fixity of the patient's tale. In addition, a competitive woman
listener, retreating to the safety of high ground, may sigh with
relief, "I'm glad she's not my mother."
Ms. B, a health-care graduate student of 25, says over and
over again: "I hate her. I've always hated her. She moans and
groans all the time. She's sick this way and that, nothing but
2. Loving and Hating Mothers and Daughters 29

pains and aches. Why can't she be like other people's mothers?"
Ms. C, a busy suburban mother, says repeatedly: "I have to do
everything for her. She's useless, totally useless. She can't even
balance her checkbook. She can't even cook spaghetti for my
son, and she dresses like a bag lady. When I was two I knew
she was no good. She was a bad cook."
The complaint about Ms. B's mother was, "How dare she
moan!"; about Ms. C's it was, "She's useless." These patients/
daughters were in such a live and constant rage with their
mothers that reporting their mothers' bad behavior to make
an impact on the analyst took precedence over any textured
narrative detail about the mothers' character. Ms. B explained
that she disliked me to comment on what she considered
peripheral parts of her story, because it meant that I did not
believe how badly she had suffered. Ms. C said she feared that I
might exhibit an interest in her mother—some people actually
did—and that undermined her own credibility.
The analyst may pick up extra details for a potentially
fuller picture beyond what the patient consciously wishes the
analyst to focus on. For instance, Ms. B tells how her mother,
the moaner, had a recent fall: "She God damn called up want-
ing to know if her ankle should be X-rayed." How should Ms.
B know what to do for her? "She devotes her whole day to
scolding that I'm not right there. She fell at the Ladies Gar-
den Club meeting." The fixity of Ms. B's complaint shows in
her selectivity in the repetition of her mantra: "She needs me
right there; she's moaning again." Yet the analyst also hears,
"She fell at the Garden Club." So apparently the mother went
without her daughter to a garden club meeting. The daughter/
patient resists registering the meaning of this detail about her
mother's ability to go on outings with people other than her.
Instead she wants me to confirm her mother's neediness and
physical moaning. It may even be painful for Ms. B to view her
mother as separate from her and genuinely physically frail.
After all, if mother is only "moaning" and "needy," perhaps
she is secretly strong and will live forever.
Ms. C tells how useless her mother is for allowing the pasta
to burn downstairs where her hungry grandchild might have
been burned. Ms. C, furious that she had to interrupt balancing
the family checkbook in her study, descended the stairs while
30 Rosemary H. Balsam

yelling that the house would burn down for all mother cared.
She was useless, so neglectful of the poor grandchild. Gould
her mother find no better time to phone her stockbroker than
when the pasta was cooking? Oh yes, the market was collaps-
ing, but the house could have burned down. A neutral listener
might ask, "Useless, in whose terms?" And how could a woman
sophisticated enough to engage a stockbroker in a conversation
about a market crash present herself dressed like a bag lady?
Mother C may not be an open-and-shut case of helpless use-
lessness. Interesting eccentricities about the mother's mental
life were lost in the daughter's selection of complaints.
These patients/daughters reduce their mothers to unidi-
mensional, flat figures. It is as if the rage is so fresh that the urge
is to destroy the mother's individual features. The daughter
does battle repeatedly with the particularly hated feature—the
whining and moaning of Mother B, the uselessness of Mother
C. She sees it everywhere. She reads every innuendo for the
same conclusion. There is nothing new to be learned about this
woman, her mother. Everyone should agree and rally against
her. The transference feelings toward the analyst are often
composed of the opposite. The female analyst is held as an
ideal model, including her choice of clothes, cars, waiting room
magazines, and so on. Her imagined family, career, background
are held to be well-nigh perfect. Unlike the patient, the analyst
is incapable of hate, envy, or malice. As one such patient said
to me, "I suppose you could envy me my Radcliffe education.
But, then, since you went to a British university, the likelihood
is that you never even thought twice about Harvard." Even her
most prized accomplishment did not count. There is one area
that is often markedly different, so different, in fact that it is
remarkable. Physically these patients often reveal that they
feel superior, more beautiful, in spite of how "wonderful" they
find their analysts. In this way, they establish themselves as
"opposite" from the female analyst.

COMPARATIVE BODIES

Mother B and Mother C—unlike Mother A, the child beater—

had managed to evoke and nurture their daughters' highly
2. Loving and Hating Mothers and Daughters 31

positive physical self-assessments. Many times each had

praised her daughter's physical attributes to the skies, repeat-
edly telling her how beautiful she was—more beautiful than
any of a friend's children, more exquisite than any film star.
In other ways that contributed to their daughters' shaky self-
esteem, the mother-daughter relations had been rife with
the daughters' psychological injuries of being misunderstood
emotionally.
To return to the implications for the physical focus: it
seems as if there may be no hatred more clinically vituperative
than that of a person who desperately desires a favorable reflec-
tion but who looks into a cracked mirror. These mothers' sins,
if you will, were that they badly disappointed their daughters
in a physical sense. Let us look for a moment at the mothers'
reactions to their own bodies and appreciate how those reac-
tions reverberated with the daughters' hatred. The daughters'
vivid rejection of Mothers B and C was accompanied by a strong
rejection of their mothers' bodies. This rejection reflected each
mother's own denigrating self-image as a woman while all the
while she worshipped her daughter's body.
Mother B, the moaner, was perceived by her daughter as
"gross, fat, and shapeless." The mother had said about herself,
"Since I married your dad and had you, I went to seed. Nothing
fits. Look at how huge I am—I disgust myself. Never get like me!
My joints are thick and sore, my skin is rough—do you think
I have a hormone problem? Have I a goiter? Feel my throat!
You're as good as a doctor!" My mental picture was of a woman
of size 20-24 at least. Maybe she did have a thyroid problem?
No. She turned out to be a tall, 70-year-old woman, perhaps
size 12 or 14. It became clear, however, how the ugly image had
evolved for the daughter. Mother B had made her daughter, as
a little girl and later as a teenager, massage her joints, inspect
her lumps and bumps, and examine her scalp for dandruff. Ms.
B was horrified by my idea that touching her mother in this
way had evoked her fixed revulsion—in fact, she was "revolted"
all over again by my suggestion. She could not bear to put into
words the strong feelings she had about such body contact.
Instead she railed about her mother's affective tone of voice
and compressed these complaints, omitting all bodily detail,
by using the short-cut phrase, "She's a moaner."
32 Rosemary H. Balsam

There are additional implications here about the child's

attempt to manually soothe the mother, who always spoke of
her own ugliness. Ms. B's horrified reaction was also a coping
mechanism evoked by the memory of homoerotic arousal
invited by her mother and to which her daughter responded
with guilt and shame. Ms. B consequently vowed to be healthy,
well, fit, and a caretaker, a nurse. She would be the opposite of
her mother who greatly admired Ms. B's emphasis on a healthy
appearance.
Mother C, the useless one, was perceived as "manly" by
her daughter. The creak of her heavy footsteps evoked rage and
contempt in the patient. (Though I could always tell when Ms.
C herself arrived for appointments because I heard her heavy
stride in the corridor alongside my office!) The bag-lady cos-
tume included tweed trousers "like an old man's." Mother C had
once said, highlighting her constantly negative view of her own
aging body, "All these women and their meeenopauses—hot
fucking flashes here and hot flashes there. They're so fuck-
ing pampered—never had one me'self. Should throw all their
clothes off and air themselves!" The mother sometimes walked
around naked at home while the daughter visited, her mother's
sagging breasts flopping. Mother C was apparently aggressively
unaware of her daughter's barely concealed disgust and horror
(or else she counterphobically confronted Ms. C's disgust). She
regularly told her daughter she was "a magnificent specimen
of homo sapiens." And Ms. C believed this to be the case.
In the first case example, I indicated how different Ms.
A was physically from her mother. The identifications hold-
ing the body ego ideals of Mss. A, B, and C took the form of
being the opposite of mother, and there were many traces of
how the original internalization had been negotiated. Being
the "opposite" of mother encoded a quantum of the mother's
frequent messages, "You are not like me. You are the opposite
of me." For Ms. B and Ms. C it was, "I am ugly and you are
beautiful." For Ms. A it was, "I am beautiful and you are ugly."
Thus there was a paradoxical obedience to mother in each
patient's conscious aspirations and strivings about herself. Ms.
B saw herself as hyperhealthy and berated mother about her
frailty; Ms. C saw herself as hyperfeminine and berated mother
about her "masculinity." Ms. A, of course, did not berate her
2. Loving and Hating Mothers and Daughters 33

mother but was berated by her for any sign of having a grown-
up female body.
This literal obedience by all the daughters was uncon-
sciously encoded as being "good girls" for mother and doing her
bidding. The unconscious aspects of the echoing similarities
to their mothers were brought to light in all these women in
their analyses. Thus the hyperfeminine Ms. C walked in 3-inch
heels but as if she were striding over the moors in a storm in
Wuthering Heights. Ms. B, the caretaking nurse by profession,
in analysis displayed her own style of "moaning," which was a
psychological variant of the mother's bodily anxious, "What-
can-I-do? Doctor-feel-that" litany. Ms. A, the "innocent" child,
revealed that her initially dissociated daydreams of being in
Paradise were sexy dreams of having a gorgeous female body
like her mother's. As she grew less anxious in analysis, when
she became angry she would frequently thump the couch and
have violent fantasies or give the analyst a "time out" by not
appearing for her sessions. The similarities to mother could
thus be perceived.

CONCLUSION

Margarete Hilferding's legacy from long ago connects with

these contemporary thoughts on mother loving and hating. She
anticipated later work on the powerful sexual and aggressive
emotional bonds that reverberate between mother and child
even from the period of pregnancy. I offer as a bridge Loewald's
(1960) understanding of the origins of the building blocks of
the developing and sustaining ego:

The child, by internalizing aspects of the parent, also internal-

izes the parent's image of the child—an image that is mediated
to the child in the thousand different ways of being handled,
bodily and emotionally... part of what is introjected is the
image of the child as seen, felt, smelled, heard and touched
by the mother... the way it is looked at, talked to, called by
name, recognized and re-recognized [pp. 229-230].

My case materials add information about the mother-daughter

bond especially in the period b e y o n d birth and earliest
34 Rosemary H. Balsam

development—the ongoing rhythm similar to those delineated

by Hilferding early, or by Loewald much later—within the dy-
namic aspects of growing up entwined with a mother. These
mutually responsive exchanges between mother and daughter,
even in cases that appear to have produced markedly different
behaviors and attitudes in adult daughters, on analytic decon-
struction, can exemplify some of the very elements of later
sophisticated variants of the early, powerful incorporation of
the mother's attitudes to her own sexed and gendered body,
and her model of motherly comportment in the world.

REFERENCES

Appagnanesi, L. & Forrester, J. (1992), Freud's Women. New York: Basic

Books.
Balsam, R. (1996), The pregnant mother and the body image of her daughter.
J. Amer. Psychoanal. Assn., 44(suppl.):401–427.
— (2000), T h e m o t h e r within the mother. Psychoanal. Quart.,
69:465-492.
— (2003), Women of the Wednesday Society: The presentations of Drs.
Hilferding, Spielrein, and Hug-Hellmuth. Imago, 60:303–341.
Chodorow, N. (1978), The Reproduction of Mothering: Psychoanalysis and
the Sociology of Gender. Berkeley: University of California Press.
— (1989), Feminism and Psychoanalytic Theory. New Haven, CT:
Yale University Press.
— (1999), The Power of Feelings: Personal Meaning in Psychoanalysis,
Gender, and Culture. New Haven, CT: Yale University Press.
Freud, S. (1923), The ego and the id. Standard Edition, 19:12–66. London:
Hogarth Press, 1961.
Holtzman, D. & Kulish, N. (2003), The feminization of the female oedipal
complex: Part II: Aggression reconsidered. J. Amer. Psychoanal. Assn.,
51:1127–1153.
Loewald, H. (1960), On the therapeutic action of psychoanalysis. In: Papers
on Psychoanalysis. New Haven, CT: Yale University Press, 1980, pp.
221–257.
Nunberg, E. & Federn, P., eds. (1974), Minutes of the Vienna Psychoana-
lytic Society, Vol 3: 1910–1911. New York: International Universities
Press.
Shengold, L. (1989), Soul Murder: The Effects of Childhood Abuse and
Deprivation. New Haven, CT: Yale University Press.
2. Loving and Hating Mothers and Daughters 35

Winnicott, D. (1960), Ego distortion in terms of true and false self. In: The
Maturational Processes and the Facilitating Environment: Studies in
the Theory of Emotional Development. London: Hogarth Press, 1965,
pp.140–152.
Chanter 3

What Mothers and Babies Need

The Maternal Third and
Its Presence in Clinical Work
JESSICA BENJAMIN

T his paper is an elaboration of an idea I have worked

on for many years, the idea of recognition. In the
past I explored (Benjamin, 1988, 1995a,b) both the
path human beings follow in developing the capacity for mutual
exchange of recognition and the effects of that exchange, or
lack of it, which we observe in clinical practice. In this paper
I present ideas on what I call thirdness, a quality of the inter-
subjective exchange that is relevant to the recognition process.
What I mean by thirdness is the quality of relatedness that is
associated with two partners sharing an orientation to a third
principle or perspective that lends the relationship a sense of
mental space and mutual accommodation. I show how the qual-
ity of thirdness is present in the mother-child relation and why
that is so significant for intersubjectivity. I build on a distinc-
tion that has informed all my work on recognition (Benjamin,
1988, 1995a,b, 2004): that between mutual recognition and
the breakdown into complementary twoness, in which there
is a struggle of wills or accommodation that requires submis-
sion or compliance. I have consistently highlighted the way in
which intersubjective development involves ongoing processes
of destruction and recognition, of breakdown and restoration
of recognition, rather than positing an ideal development of
mutual recognition.

37
38 Jessica Benjamin

The idea of the third is central to understanding the work-

ings of intersubjectivity from the beginning of life. I have come
to believe that even in the earliest relationship of infant and
mother (as I refer to the primary caretaker), it is the presence
of a third that makes the relationship a source of recognition
and mutual development. By "third" I do not mean another
person, or necessarily a thing, but some organizing principle
that allows for accommodation and exchange of recognizing
responses. By thirdness I mean the quality that arises when
this principle is working and the deep law of mutual accom-
modation is being at least partially fulfilled. The idea of the
third, or thirdness, is closely related to that of potential space
or transitional experience in Winnicott's (1971) thinking and
the idea of triangular space in Ogden (1994), ideas I have dis-
cussed in an earlier work on mothers (Benjamin, 1995b).
Initially, the idea of the third passed into psychoanalysis
through Lacan (1975), who saw the third as that which keeps
the relationship between two persons from collapsing into a
oneness that eliminates difference or a twoness that splits the
differences—the polarized opposition of the power struggle.
Lacan thought that the intersubjective third was constituted
by recognition through speech, and he gave the father the
privileged position of introducing this symbolic space, saving
the child, as it were, from oneness or twoness. In short, the
father was identified with the intervening third (Lacan, 1977),
as was later true in neo-Kleinian thought (Britton, 1988). In
thinking about the oedipal triangle, the father's "No" is seen
as the paradigmatic third, and so the prohibition of incest
(castration, in Lacan's conceptual shorthand) becomes the
model for thirdness. Many other psychoanalytic theorists,
from Loewald to Ghasseguet-Smirgel, have affirmed this idea
of the father as a principle of separation. I have emphasized
(Benjamin, 1988, 1995) that it is first and foremost the mother
herself, as the infant grows, who must represent this by having
her own personal relation to a third. While this third might,
at times, be represented by the father, the essential thing is
the mother's own desire for an other, a partner who may or
may not be the father. Crucial also is that the mother's desire
should be founded in her ability to accept having her own aims
separate from those of her child.
3. What Mothers and Babies Need 39

I (Benjamin, 1995a) also emphasized the intersubjective

postulate that the child develops through recognizing the
mother's independent aims and subjectivity, stressing the im-
portance of this for gender relations, for acknowledging women
as subjects. I have tried to show how the notion of the father
as creator of symbolic space denies the recognition and space
already present in the maternal dyad. In this paper I elaborate
further my contention that thirdness begins in the m o t h e r -
infant dyad (or any caregiver-infant dyad but we are using
the mother concept here) and develops through experiences
in which the mother holds in tension her subjectivity/desire
and the needs of the child, her awareness of the situation and
empathic appreciation of the child's experience.
The deeper problem with the oedipal view, especially
Lacan's equation of the maternal dyad with imaginary twoness,
is that it misses the early origins of the third. The thirdness
of speech is, as he thought (Lacan, 1975), an antidote to the
complementarity in which your reality erases my reality or vice
versa—where only one reality is possible. But the equation of
this third with symbolic speech picks up midway in the action,
losing the original dialogue between mother and infant that
now plays a major part in our cinematic view of early develop-
ment. Infancy researchers have shown us how recognition is
more than verbal speech, how this speech must be founded in
earlier non-verbal experiences in which mother and child com-
municate kinetically, vocally and visually. In doing so, the two
partners necessarily orient to a pattern, a direction of effects,
a choreography that communicates intention and forms the
expectation of sharing a pattern, a dance, with another person.
This dialogue organizes early experiences of disruption and
repair in which the reliability of a shared pattern is forged in
the crucible of mutual regulation and recognition.
There are, therefore, two elements involved here: the
third in the mother's mind (which Lacan and others have
equated with the father or with mother's desire), and what I
would call the nascent, or primordial, third—the principle of
the earliest exchange of gestures between mother and child, in
the relationship that has been called oneness. I consider this
early exchange to be a form of thirdness, containing its most
rudimentary element. I call the principle of affective resonance
40 Jessica Benjamin

and mutual accommodation that underlies it "the one in the

third." I use this term to describe the origins of the third in
the element of oneness or union that informs even the earliest
forms of lawful, mutually regulating interaction. Any successful
exchange of gestures must have this element that accompanies
the "speech," the music that supports the words. But the prin-
ciple is not just that of "oneness" because the coming together
is necessarily mediated by a rule or pattern or set of expectan-
cies—the third. This third, this rule, pattern or expectancy, is
something that both subjects cocreate, both can modify, both
can experience as taking on objective existence. The subject's
desire and expectation of being matched correlates with the
partner's intent which, when expressed, becomes an object of
awareness—"is this partner trying to align with m e ? " (Beebe
et al., 2003). In my view, matching need not be complete to
be effective because, indeed, the intent can be discerned even
in its imperfectly realized expression.
Sander (2002), the psychoanalytic infancy researcher
whose early work on recognition was important for me and
many colleagues, writes about the nascent third, what we
can also call the primordial or energetic third, in terms of the
principle of rhythmicity. He discusses rhythmicity as one of
the two fundamental principles of all human interaction (the
other is specificity). Rhythmicity is a fundamental form of the
third, and rhythmic experiences help constitute the capacity
for thirdness. What we are describing is the principle underly-
ing the creation of shared patterns, which constitutes the basis
for coherence in interaction between persons as between the
internal parts of the organism. I have extrapolated from this
the suggestion that (Benjamin, 2002) rhythm itself constitutes
the primal experience of patterning, something we see when
focusing on the breath.
One of the changes in our view of development brought
about by infancy research was the notion of symmetry or mu-
tual regulation (Beebe and Lachmann, 2002). This view could
be especially documented by the observation of mutual play,
in which it is apparent that the two-way exchange is based on
both partners aligning to a direction or trajectory of escalating
and de-escalating arousal. Analysis of face-to-face play revealed
the inadequacy of describing mutuality in terms of reacting to
3. What Mothers and Babies Need 41

one's partner, what I call twoness. If we think in terms of one

person reacting to the other, one active the other passive, one
leading the other following, the cocreated third disappears.
Reactive twoness is actually the characteristic of negative
interaction patterns and should be distinguished from turn-
taking based on mutually regulating and accommodating play.
Researchers describe how adult and infant align with a third,
a cocreated rhythm that is not reducible to action-reaction.
Action-reaction is thus, in my view, characteristic of comple-
mentary twoness, the one-way direction of effects, reflecting
the absence of rhythm. By contrast, the rhythmic symmetry of
thirdness reflects a shared subjective phenomenon, in which
the reciprocity of two active partners in two-way interaction
is visible.
In attuned play, the rhythmicity of the interaction requires
and creates the recognition of patterns. The experience of
thirdness is akin to following a shared theme in musical im-
provisation. The third that both partners follow is a rhythmic
structure or play with intensity of stimulation, which both si-
multaneously create and surrender to. As I have said elsewhere
(Benjamin, 2004), such cocreation is like transitional experi-
ence in having the paradoxical quality of being invented and
discovered. To the question, who created this rhythm, You or
I? the paradoxical answer is: both and neither. It is impossible
and unnecessary to say who has created the pattern because,
unlike in verbal speech, in music and dance we can receive
and transmit information at the same time.
Sander's most important early study focused on the com-
plex interpersonal rhythm of the feeding interaction, revealing
a primordial form of thirdness. He showed how neonates fed on
demand adapted rapidly, within two weeks, to feeding in the
day and sleeping at night, while those fed on a regular 4-hour
schedule did not adapt. This finding illustrated brilliantly how
the attunement of the significant other, her ability to recognize
and accommodate to the rhythm of the baby, is a condition
for cocreating a working system. Thus, as the caregiver ac-
commodates, so does the baby. The dyad starts to cohere into
a pattern. The baby's innate adaptive capacities seem to be
brought forth not by the complementary structure in which
one dictates, the other complies—but as a mirroring response
42 Jessica Benjamin

to the accommodation of the other. The basis for synchrony,

then, seems to be an in-built tendency to respond symmetri-
cally, to match and mirror, to respond in kind. This principle
of matching seems essential to all nonverbal interaction that,
Beebe and Lachmann (2002) have argued, remains constant
throughout life.
Once a coherent dyadic system gets going, it seems to
move naturally in the direction of orienting to a deeper "law"
of reality, in this case, the law of night and day. As in the es-
tablishment of a feeding rhythm, the adult's accommodation
allows the system to achieve something like a rhythm of its
own that has a quality of lawfulness, attunement to some
deeper structure.
There is another dimension to the third that is also im-
portant in understanding what I am referring to as lawfulness.
I want to differentiate the primordial or energetic third that
we observe in early interaction from the third in the mother's
mind (or other caregiver). I call the former "the third in the
one." In other words, it is the interpolation of thirdness into
the relationship we traditionally thought of as oneness. This
third is centrally located in the mother's ability to hold in ten-
sion her needs with those of the baby and to tell the difference
between them—at least some of the time. I have illustrated
the importance of this third by describing the dilemma of the
mother who fulfills the role of being the accommodating other,
the one who has to wake up night after night to nurse her baby.
Up to a point, the mother identifies with her baby's needs; she
feels a sense of oneness with his or her needs, and thus sat-
isfaction in filling them. But at a certain point of exhaustion,
the problem of twoness arises. Her quite possibly desperate
need for sleep conflicts with the baby's need to be fed. Here
we have profound asymmetry. Many a mother has come to
understand the fantasy of infanticide in this kill or be killed
moment. As the illusion of oneness between the mother's and
the baby's needs is shattered, a complementary twoness can
arise in which the mother experiences herself unconsciously
as submitting or self-abnegating. It is here that a mother needs
the third in her mind to transcend the breakdown into two-
ness. This third is the understanding of necessity, such that
3. What Mothers and Babies Need 43

the conflict between needs is resolved as surrender to reality

rather than as submission to a tyrannical demand. Rather than
feeling "I am being done to," the mother feels "I am doing what
must be done."
But it is important not to rest with this idea of "doing what
we must." Don't we need to distinguish this "third in the one"
from the simple principle we have long known as superego,
which informs the mother that it is her duty to forgo sleep? How
do we prevent the third in the one from degenerating into mere
duty and self-denial? The degeneration is prevented by the fact
that at other moments, mother and baby are in synch—that
is, mother's actions then include elements of the one in the
third: the identificatory oneness of feeling her child's urgency
and relief, and her pleasure and joy in connection. This bal-
ance of oneness and thirdness requires the capacity to bridge
the gap in experience between asymmetrical partners, without
losing sight of how those capacities and consciousness are so
evidently different. Indeed, to some degree, an at least intui-
tive knowledge of this asymmetry and difference is required
to make the accommodation possible.
I proffer an example, written by a father (which helps to
remind us that "mothering" is a category that can transcend
gender and even throw it into question), Stephen Mitchell,
whose death was a great loss to our psychoanalytic community.
Mitchell (1993) underscored the distinction between submis-
sion to duty and surrender to the third, what I am calling the
third in the one.
When my older daughter was about two or so, I remember
my excitement at the prospect of taking walks with her, given
her new ambulatory skills and her intense interest in being
outdoors. However, I soon found these walks agonizingly slow.
My idea of a walk entailed brisk movement along a road or
path. Her idea was quite different. The implications of this
difference hit me one day when we encountered a fallen tree
on the side of the road... the rest of the "walk" was spent
exploring the fungal and insect life on, under, and around
the tree. I remember my sudden realization that these walks
would be no fun for me, merely a parental duty, if I held on to
my idea of walks. As I was able to give that up and surrender
44 Jessica Benjamin

to my daughter's rhythm and focus, a different type of experi-

ence opened up to me If I had simply restrained myself out
of duty, I would have experienced the walk as a compliance.
But I was able to become my daughter's version of a good
companion and to find in that another way for me to be that
took on great personal meaning for me [p. 147].

The reason I consider this story important is that we

often lack criteria for distinguishing an inauthentic posture
of submission to another's demand from a position in which
we are able to respect another's need even though it conflicts
with or fails to match our own need in that instance. The prin-
ciple of the third allows us to step out of a sense that we are
submitting or being coerced into a position in which we not
only projectively identify with the one we are giving to (after
all, we could also identify with the one who is forcing us to
give something) but also experience pleasure in being received.
The mother whose baby nurses with noisy satisfaction and
chortles with glee at her milk feels well received. Her milk
is being appreciated, she has something important to give to
this new life, and so her baby's enthusiasm constitutes a form
of recognition. In reflecting on what will create happiness in
his child, Mitchell portrays a similar experience, in which he
is transformed by the pleasure of his child. This intention to
connect and the resulting accommodation to the needs of the
other form one emotionally enriching version of what I would
call the moral third, the connection to a larger principle of
necessity, Tightness, and goodness. This is a particular form
of the third in the one. The parent accepts the necessity of
asymmetry, accommodating to the other as a way of generat-
ing thirdness, and is transformed by the experience of opening
to mutual pleasure. This, of course, is what therapists do in a
hundred different ways, every day.
My point here is not only to say that the space of third-
ness opens up through parental accommodation to the child's
rhythm, "stopping to watch the fungus grow." We also need to
find a way to distinguish accommodation from submission, the
more so because in contemporary literature on parenting and
psychoanalytic literature on the analyst's empathy there are
3. What Mothers and Babies Need 45

certain tendencies toward idealization of parental adaptation

that demand further questioning. A whole tendency in cur-
rent baby-rearing literature suggests that a mother who keeps
her child next to her body constantly can avoid all comple-
mentary conflicts and breakdowns by nonstop satisfaction of
baby's needs. Such thinking bypasses the question of how the
child can grow up to be a subject who can feel the difference
between making tyrannical demands on mother as a pure
object of need and the engagement in a reciprocal emotional
exchange. In the clinical situation, likewise, the question arises
as to how we distinguish necessary accommodation and sur-
render to the other's rhythm from an ideal of "pure empathy,"
merger or oneness which can tend toward inauthenticity and
the denial of self.
How would such self-denial manifest itself clinically? An
overvaluation of empathy over awareness of necessary differ-
ence could ignore the patient's deeply felt need to be sure that
he is not coercing the therapist in a way that "destroys the
object" (Winnicott, 1971) so that there is no one there to recog-
nize him. Then too, the patient needs to experience that he is
not exacting some restitution for early suffering that bypasses
the reality of loss. He might also be longing for a barely known,
only suspected freedom—the one that results when neither
the patient nor the therapist plays the part of his anxious or
controlling internal objects.
How, then, do we distinguish compliance or submission
from acceptance of difference, recognition of the other's sepa-
rate subjectivity? Some of our traditional theorizing misses
this difference, as does the term oneness. In a critique of
object relations theory, of Balint's idea of primary love, Lacan
(1975) said that if the intersubjective third were not there
from the beginning, if the mother-baby couple were simply
oneness—then the mother could begin by allowing the baby
to devour her but end by devouring the baby. Indeed, he said
there would be nothing to stop her, when she was starving, from
doing as the Aborigines do (Lacan cited Alice Balint as having
made this astonishing claim), turning the tables and eating the
baby. Thus I have been trying to show how the traditionally
maternal experience of "oneness" should include the third in
46 Jessica Benjamin

the one, the parental ability to contain and suspend her or his
immediate need without denying the difference. In an effort to
solve the problem of asymmetry with patients whose affective
vulnerability requires the therapist to exercise considerable
restraint of her own reactivity, Slochower (1996) has argued
for a version of containing in which we consciously bear the
knowledge of pain that results from giving over to the patient
who cannot bear our subjectivity. In this way, we remain
clear about the difference between satisfying the patient and
satisfying ourselves, avoiding the collusion and collapse of
the patient's nascent efforts toward autonomy which might
otherwise result.
Another crucial aspect of the third in the one is the
mother's knowledge that infant distress is natural and ephem-
eral, so that she is able to bear and soothe her child's distress
without dissolving into anxious oneness with it. In infancy
research, as Fonagy et al. have emphasized, we see how the
mother who is able to demonstrate empathy with the baby's
negative emotion yet shows by a marker (e.g., exaggeration)
that this is not her own fear or pain or distress is far better
able to soothe her baby. Fonagy et al. (2002) cites the work
of Gergely, who proposes that mothers are driven to saliently
m a r k their affect-mirroring displays to differentiate them
from realistic emotional expressions, typically by producing
an exaggerated version of the emotion in question. Whereas a
genuine expression of anxiety or distress on the mother's part
would be alarming, this facial mirroring communicates, "I un-
derstand and recognize you." Such behavior is, I would argue,
proto-symbolic, already indicating the difference between the
representation and the thing itself. It is inherently reflexive,
expressing the mother's knowledge of difference, and like the
representation of necessity in her mind, it suggests the pres-
ence of a regulating "third in the one." This knowledge, like
the ability to project the child's future development, which
Loewald (1951) cites as a parental function in his paper on
therapeutic action, helps create the symbolic space of third-
ness. The mother's ability to maintain both attunement and
awareness of the fact that this distress will pass establishes a
tension between empathic oneness and the observing function
often associated with the third. The full experience of thirdness
3. What Mothers and Babies Need 47

requires not merely this observational position (as in Britton,

1988; Aron, 1995), but the identificatory and affective currents
of the one in the third.
On the other side, the analyst can only soothe or regulate
the patient by maintaining some of the differentiation I am
allocating to the third in the one. Indeed, when the patient is
severely unregulated, it is unlikely that the analyst will main-
tain this position; rather it is something she will constantly
lose and regain (Schore, 2003) and often require the patient's
cooperation in regaining. She cannot simply maintain an
"all-empathic" stance of an "all-giving" mother, an endless
supplier of goodness and empathy, without deceiving herself
about inevitable lapses, moments of dissociation, discomfort
with elements of projective identification, and so on. If she and
the patient comply in utterly smoothing over these inevitable
bumps or potholes (Bromberg, 2000), her empathy will begin
to seem inauthentic, a mere imitation rather than a complex
process of disruption and repair. And if she does not eventually
convey the third in the one to the patient, if she appears to be
able to give endlessly without a hitch, the patient will feel that
because of what the analyst has given her, the analyst owns
her. In other words, the patient will feel she must suppress
her differences, spare the analyst, participate in a pseudo-
mutuality. It is crucial to hold the tension between authenticity
and empathy so that we as analysts are able to shift between
expressing and withholding our subjectivity, rather than as-
suming that self-expression is inevitably hurtful or disruptive to
the process. In this way we can distinguish between empathy
as a source of goodness and avoidance of necessary conflict
and collision (see Aron, 1999).
Acceptance of polarizing choices between one's own sub-
jectivity and the other's needs seems to me the best way for
the mother, or the analyst, to reproduce a "kill or be killed"
complementarity. Either the mother or the baby has to die.
In this constellation the analyst, like a mother, may feel that
her separate aims, her being a person with her own needs,
will kill the patient. She cannot reflect with any clarity on the
difference between holding the frame in a way that facilitates
the emergence of the patient's agency and withholding in self-
gratifying obedience to an ideal of "being the analyst," the one
48 Jessica Benjamin

who cures and helps, who has no needs of her own. The analyst
who is unconsciously guided by the system of complementarity
in which one person's needs always require the other's sub-
mission or self-abnegation will not be able to help her patient
with the problems of guilt, feelings of destructiveness, fear of
separation.
In theory, at least, we have to be cognizant of the positive
aspects of the shared recognition of subjectivity that occur in
the therapeutic relationship. This recognition occurs not, as
some critics (see Orange, 2002) of relational analysis have
claimed, through the patient's approaching the analyst's sub-
jectivity as if this were a symmetrical relation in which the
analyst had to make herself known in the same way the patient
does. Rather, it occurs through the patient's recognizing him-
or herself in the analyst's struggle to formulate and feel along
with him, in other words, in the analyst's mode of revealing
the internal third to help create a shared third.
We hope that what the patient comes to discover in the
analyst's mind, then, is the way the analyst makes use of her
separate subjectivity to know and relate. So, for instance, when
the analyst is empathic, this empathy is experienced as coming
from an outside other—in other words, as Winnicott (1971)
said, it is "not m e " nourishment, milk coming from an outside
breast, not from something under my omnipotent control. In
this case, it makes it valuable to the patient who can then think
"Ah, this means that there is somebody out there from whom
I can get something and on whom I can lean." Gradually, this
experience also comes to mean to the patient "now there is
somebody out there whom I can connect to. There is an outside
world that is a possible source of goodness, that can be loved."
In this way, the patient discovers her or his own loving self.
Thus I want to stress that our efforts entail a complex bal-
ance between the two interdependent structures of dynamic
interaction—the one in the third and the third in the one.
We need the third in the one because "oneness" is danger-
ous without the third. But—and I want to emphasize that the
other side of this tension is just as important, the side missed
by oedipal theory—we also need the one in the third—the
nascent or primordial experience of thirdness, of union and
3. What Mothers and Babies Need 49

resonance. Aron and I (Aron and Benjamin, 1999) have talked

about how, without the nascent kind of thirdness, the more
elaborate forms of self-observation based on triangular rela-
tions, those usually identified with the oedipal, become mere
simulacra of the third. They revolve around idealization and
submission to a person or ideal.
One of the most common difficulties in psychotherapy is
the patient who uses symbolic functions and self-observation
punitively, so that the third—often identified with the critical
paternal authority—becomes a false self function. It functions
as a mask for self-punishment and thereby becomes a generator
of shame rather than insight. To link this to my previous point,
this appearance may relate to the way in which parental anxi-
ety devolves into critical scrutiny as a child gets older. What
should be a reflexive, observing third that allows for distance
between mother's ideal perfect child and her real child becomes
punitive scrutiny or anxious worry. For instance, the mother
becomes preoccupied with the child's performance as evidence
of her own adequacy as a mother. In turn, this scrutiny and
anxiety become internalized by the child as a critical observing
function. Rather than using self-observation productively, as
a true internal third, children who have grown up in this way
tend to experience the third as a self-defeating, undermining
criticism. Thus the analyst's observation, or third, does not
contribute to a shared intersubjective process of reflective
dialogue but becomes a manifestation of a persecutory other.
Analysts, too, have their unique way of conflating the
submission to ideals with self-observation, which commonly
enough results in self-blame and shame for not being a "real
analyst." One of the reasons I consider the relational turn
so helpful is that it has encouraged clinicians, even when we
think we are following the rules, to look at how enactments
occur right under our very noses, despite our best conscious
intentions—because we are far from transparent to ourselves
and we are engaged in deep, often murky unconscious com-
munication with our patients. Therefore, our capacity for self-
criticism and awareness is better served by the compassionate
acceptance of what is than the preoccupation with what ought
to be. The ability to observe without a rush to judgment is, I
50 Jessica Benjamin

believe, more likely to enhance our sense of responsibility for

correction, our ability to repair what goes awry.
Thus I want to emphasize a crucial distinction between
the observing function that develops in the space of thirdness
and the self-scrutiny that develops without the music of the
third in the one. In the triangular situation, unless there is al-
ready space in the dyad, the third person who enters becomes
a persecutory invader rather than an instigator of symbolic
functioning. The observer can even be experienced as a tor-
mentor. For the symbolic third to be a true third requires the
confident expectation of accommodation and identification,
that is, the internalization of early reciprocal patterning based
on recognition.
In my opinion, distinguishing this facsimile of the third
from intersubjective thirdness helps us to understand one of
the subtle but profound difficulties that arose from the bias
toward the oedipal father as the principle of the third. This
bias can be found in the contemporary neo-Kleinian idea that
the patient experiences himself as being shut out from the
analyst's link to thinking, where thinking is seen as a represen-
tation of the mother's link to father. In other words, the issue
becomes that of being shut out from the parental couple and
enviously attacking it, an attack on the third. What is thereby
missed is the way in which therapist and patient have failed,
as most likely mother and child failed, to create a shared third
in which the patient can experience the maternal analyst's
mind as the one in the third, as neither invading nor shutting
him out. In my view it is crucial to see that the etiology of this
failure—which may well manifest as a power struggle in which
one person's reality is pitted against the other, in which each
seems to annihilate the other—cannot be attributed primarily
to a lack of relation to a literal paternal third or a hatred of
the analyst's thinking as if it represented a hated father (see
Feldman, 1993). The patient's childhood experience of being
shut out or excluded needs to be seen foremost as reflecting a
mother-child couple in which there were significant difficulties
in creating a shared third.
I am suggesting, as Cooper (2000) has in a different con-
text, that what has been understood as the maternal function
3. What Mothers and Babies Need 51

of containment really needs to be grasped as a mutual process.

This mutuality begins with the one in the third, without which
the third in the one, that is, observation, insight, thinking and
differentiating of all kinds will be experienced as distancing
or alienating rather than helpful. It reflects an early failure
to establish a shared third, to create a system of mutual rec-
ognition and containment that can survive breakdown and be
repaired. In the absence of a shared third, one is often unable
to regulate her or his level of tension. As clinicians, we see how
the patient strives to dampen this hyperarousal by the use of
an overly critical form of self-observation. This mode of coping
with failures in regulation tension or excess further disrupts the
process of mutual accommodation, further compromises the
experience of shared thirdness, that is, of finding a rhythm of
mutual regulation. In this situation the analyst often dissoci-
ates and falls into complicity with self-reproach which poses
as insight. When the analyst, reacting to the patient's disregu-
lation, tries to re-regulate herself by adopting the position of
observation without recreating affective accommodation, the
effect of insight (as Spezzano [1993, 1996], Bromberg [2000],
and Schore [2003] have detailed) is to further dissociation for
both participants and perhaps lead to alarming protest on the
patient's part. Quite often, when such cases are brought to us in
supervision, we see how a confiictual and coercive principle of
twoness takes over, a pattern of reactivity in which one person
must give over to the other. Therapist and patient recreate the
original difficulties the patient experienced in building a third-
ness based on shared recognition and the mother's asymmetri-
cal accommodation. The original lack of a moral third, which
allows the mother to balance connection and independence
in her stance toward the child, is replayed in the analyst's in-
ability to keep hold of her or his own mind.
To sum up: The nascent presymbolic thirdness, which I
also think of as the energetic or primordial third, lays down
the foundation for the later interpersonal symbolic third, the
dimension of recognizing meaning and negotiating differences
through speech. Without the nascent or primordial third; dia-
logue becomes a mere simulacrum of thirdness. Likewise, the
energetic, rhythmic aspect of the nascent third should inform
52 Jessica Benjamin

the moral third, it is the music of universal laws and meaning. I

suggest that the moral third, the "law" of respect for difference,
develops out of this early deep structure of accommodation to
otherness. In ways we do not always recognize, this lawfulness
permeates our experiences of goodness and provides the big
container for the smaller thirds that we struggle to build in our
relationships.
Over and over, most recently in Islamic fundamental-
ism, we see how readily ideas of a universal creative principle
degenerate into ideals of obedience to a punitive omniscient
power. This may be, at least in part, the result of the fact that
the principle of maternal accommodation becomes tainted for
the child growing into a society where women are denigrated
and oppressed. Maternal accommodation is then confused
with submission.
The creation of the shared third, with its containing and
recognizing function, allows us to continually rediscover our-
selves in the other, the other in ourselves, and the difference
between them. In a sense, as Stern (1985) proposed in his
discussion of intersubjectivity, the great discovery is that there
are other minds out there. Eventually, in the developmental
process as in the therapeutic one, we might hope to discover
that there is somebody out there who sees the world differently
(see Hoffman, 2002). "Reality does not have to be defined by
either only you or only me, because maybe there are different
things in the world than I knew about." So the separate yet
recognizing subjectivity of the mother or analyst becomes a
vehicle for the most precious thing, which is love coming from
an other person. If there is actually recognition coming from
another person, then what I experience exists—it is not just
my fantasy world. Thus a patient can actually love the outside
world, as opposed to finding the outside world only disturbing,
frightening, or empty. It is thus that we confirm the value and
the lovability of the world and our own sense that we have the
capacity to love. This confirmation ultimately becomes the
basis of the moral third in the one, the connection to principles
of accommodating and living with others in a universe that is
"lawful enough."
3. What Mothers and Babies Need 53

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chological Association, New York City, April.
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Hillsdale, NJ: The Analytic Press.
— Sorter, D., Rustin, J. & Knoblauch, S. (2003), Forms of intersubjec-
tivity in infant research: A comparison of Meltzoff, Trevarthen, and
Stern. Psychoanal. Dial., 13:777–804.
Benjamin, J. (1988), The Bonds of Love: Psychoanalysis, Feminism, and
the Problem of Domination. New York: Pantheon.
— (1995a), Recognition and destruction: An outline of intersubjectiv-
ity. In: Like Subjects, Love Objects. New Haven, CT: Yale University
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— (1995b), The omnipotent mother, fantasy and reality. In: Like Sub-
jects, Love Objects. New Haven, CT: Yale University Press.
— (2002), The rhythm of recognition: Comments on the work of Louis
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— (2004), Beyond doer and done-to: An intersubjective view of third-
ness. Psychoanal. Quart., 73:5–46.
Britton, R. (1988), The missing link: Parental sexuality in the Oedipus
complex. In: The Contemporary Kleinians of London, ed. R. Shafer.
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Bromberg, P. (2000), Potholes on the royal road—or is it an abyss? Contemp.
Psychoanal., 36:5–28.
Cooper, S. (2000), Mutual containment in the analytic situation. Psycho-
anal. Dial., 10:169–194.
Feldman, M. (1993), The dynamics of reassurance. In: The Contemporary
Kleinians of London, ed. R. Shafer. Madison, CT: International Univer-
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Fonagy, P., Gergely, G., Jurist, E. & Target, M. (2002), Affect Regulation, Men-
talization and the Development of the Self. New York: Other Books.
Hoffman, I. (2002), Forging difference out of similarity. Paper presented
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Association for Relational Psychoanalysis and Psychotherapy, New
York, January 19.
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J. Forrester. New York: Norton, 1991.
— (1977), Ecrits: A Selection, trans. A. Sheridan. New York: Norton.
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Loewald, H. (1951), Papers on Psychoanalysis. New Haven, CT: Yale Uni-

versity Press.
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Books.
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Orange, D. (2002), There is no outside: Empathy and authenticity in the
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Sander, L. (2002), Thinking differently: Principles of process in living systems
and the specificity of being known. Psychoanal. Dial., 12:11–42.
Schore, A. N. (2003), Affect Regulation and the Repair of the Self. New
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Chanter 4

What Fathers Do and

How They Do It
JAMES M. HERZOG

I should like to advance the hypothesis that mothers ask

fathers to cocreate a psychological space with them in
which it is possible for a child to be himself or herself with
some modicum of protection from projections, unconscious
conflicts, or unresolved traumatic residua. If uncontained and
untitrated, these are likely to prove deleterious and deform a
child's development. Such desetayage, or skewing, as described
by Braunschweig and Fain (1981), among others, often results
from unrecognized strain in the adult-adult relationship. This
strain compromises the father's capacity to help his wife to
modulate and manage internal stirrings that can interfere
with her capacity to see her child and her husband for who
they are.
I propose that the father is admirably suited to assist his
wife if he employs what I call the paternal principle. I extend
Ghasseguet-Smirgel's (1985) postulation of the universal law
in which the father stands for the reality of generational and
gender differences to say that the paternal principle involves
affirming the reality of diversity and difference. It is my thesis
that the father must actively maintain a stance favoring hetero-
geneity and individual difference in the presence of powerful
factors that militate against this essential reality. He serves
this function once a family has been started by reminding the
mother of their sexual relationship and coparticipation in the
experience and management of excitement even at a time

55
56 James M. Herzog

when there are powerful forces at work that favor the diminu-
tion of these essentials and press for a less diverse caretaking
surround.
I call the push for homogeneity—the mother's wish that
the father be more maternal than paternal, more like a second
mother than like a father—the "Mr. Rogers" preference. This
pressure often contains a wish or even a decree promulgating
the suspension of adult sexuality. In the face of this important
dynamic, the father is called on to remain grounded in his adult
sexuality and beckon his wife to join him in that realm even
as she may experience dramatic shifts in her own libidinal life
and her perception of her husband's instinctual endowment.
This groundedness of the father and his capacity to manage the
mother's need for both a second mother and a father/spouse,
even while she may think that she needs only the former and is
currently not interested in the latter, is, I suggest, a hallmark
of good-enough masculinity and paternity.
A man's caretaking line of development predisposes him
to need and want to maintain the sexual and the aggressive
components of "spousing" and caregiving even when the pres-
sure for nurturance and support is necessarily present and
paramount. In so positing, I emphasize the cooperative nature
of a parentogenic alliance forged by a man and a woman who
love each other and the advantage that accrues to the child
from having two parents whose caretaking lines of development
are distinguished one from the other by virtue of gender.
While stressing the hoped-for developmental harmony that
exists between spouses as they together embark on building a
family, I am, of course, as a psychoanalyst, aware that conflict
is omnipresent and activated by the very same forces and op-
portunities that also allow for cooperative parenting. Esther
Thelen's (1995) use of chaos theory seems highly relevant.
Each change, each challenge affords the opportunity for re-
organization under the influence of newly emerging attractor
states. The probability of a more functional change in course is
always dogged by the possibility of the resurgence of regressive
and unresolved earlier conflicts, insults, and traumata.
There is a body of very important neuropsychological
data emerging that speaks to an infant's need for the mother
to become less perfectly attuned to him or her at around three
4. What Fathers Do and How They Do It 57

months of age. Doing so appears to facilitate the maturation

of the prefrontal cortex and its evolving circuitry with regard
to emotional responsivity and regulation (L. Mayes, 2003,
personal communication). Hitherto, in the face of "primary
maternal preoccupation" (Winnicott, 1958), the amygdala has
been the crucial processing element and its limbic reverbera-
tions paramount. Now a preference has revolved for appreciat-
ing difference and involving reasoning in the process.
It is exactly at this point that the father's request that the
mother return to their bed and to their conjugal excitement
becomes critical. He helps the mother to be less perfectly
attuned to the baby by inviting her to split her attunement
between the maternal and the spousal parts of herself. Simulta-
neously, he is available to the baby in his preferred interactive
play mode, which Eleanor Herzog and I have called disruptive
attunement in contradistinction to the mother's homeostatic
attunement (Herzog, 2001). Once again, it needs to be clearly
stated that this best of all scenarios is often honored in the
breach. Individual life histories, roused as they always are
from whatever ways in which they have been resting, join the
fray at each point of transition and psychobiological change
and challenge.
The relationship between maternal attunement and the
love the mother feels for the baby and sexual excitement and
the love the mother feels for the father is a complex and var-
iegated phenomenon. Laplanche (1999), Stein (1998), and
Fonagy and Target (2003), among others, have posited that
sexual excitement in the infant arises in response to uncon-
scious maternal seduction and misattunement, which creates
an introjectible self-representation in the form of alienness,
which then constitutes the arousing and elusive other. Fonagy
has compared this process with the development of borderline
phenomena.
The astonishing part of these formulations is their dyadic
emphasis to the exclusion of the father and of triadic reality.
A father optimally is already cavorting with his infant in his
particular mode (disruptive attunement) as well as trying to
interact in a more maternal mode, and he is also beckoning
his wife to direct her sexuality toward him. All this is regarded
in some distinct and vital way by the child, with regard to
58 James M. Herzog

both how it goes smoothly and how it encounters profound

and derailing resistances and fixations. The self-with-mother-
and-father-together representation comprises all of these nego-
tiations between the parents and the unconscious processes
that they entail within the parents.

CASE ILLUSTRATIONS

Nick

Following the well-known principle that pathophysiology am-

plifies and thus serves as a window on physiology, let me tell
you about a 10-year-old analysand of mine whom I call Nick.
To begin with a description of Nick's parents, his father
is a distinguished diplomat in his mid 50s. Nick's mother, an
educator who has become a gynecologist, requests that I treat
her son and perhaps her husband as well. In the first meeting
with the parents, I observe that father almost always accedes
to his wife's direction and, within the first 12 minutes, I learn
that mother has devised a strict regimen of treatment for her
husband's chronic anal pruritis. Father takes nine sitz baths a
day and ejaculates by masturbating every morning and every
evening. Father acknowledges, with hard-to-define affect, that
he is the cleanest man in the greater Boston area and that
he probably has less available semen than any man his age.
Mother says that she has the problem of his persistent itch
well in hand. I note that she has devised a treatment for her
husband's external itch and, perhaps, also his internal one. I
keep my observation to myself, but notice that I shift somewhat
uncomfortably in my seat.
Mother then begins to speak about her depression and a
familial history of bipolar illness. I notice that father visibly
relaxes. It is as if he has been released from the hot seat, or,
more accurately, hot bath. I observe that I am hearing about
mother's power and something about the diminution of drive
and resource in the father. I also wonder if physical intimacy
between the parents and shared sexuality between them has
been transformed into this parody of a doctor-patient relation-
ship. I hypothesize that the spent father and the prescribing
4. What Fathers Do and How They Do It 59

mother may have dramatically impinged on their son's capacity

to regulate himself and to interact with others.
Here is the material Nick elaborates when he and I meet
together. Keep in mind the questions, what do mothers want
from fathers and how do these wants and their negotiation bear
on the child's evolving psyche, whether the mother's wants
and the father's stance are within the nomothetic range or
distinctly idiopathic.
Texarkana Tranny, the he/she librarian, says, "Sonny,
do you need a h a n d ? " and when the boy says "Yes," thinking
that he will get help finding a book, she rams her dick into
his unsuspecting butt. She looks, I am told, something like a
grandmother, her hair all up in a bun, her waist tightly cinched,
her legs covered in a long skirt. But that is all a disguise. She
is really a guy in girl's clothing. No one suspects because of
her outfit. She does it in action, while concealing her doing-it
mode by both generational and gender covers. She is really
mean and she knows how to do just what she wants to do.
Meanwhile, Tex, her alter ego, is alone in his shack and
hums Tumbling Tumbleweed while thinking of stopping being
just a lonely cowpoke and opening up his own meat-processing
operation and providing juicy cheeseburgers for all the hungry
children of the world. He wears blue jeans, boots, a rawhide
shirt, and a big leather belt. Just looking at him, you can tell
that he is a guy, the same on the outside as on the inside. But
this turns out to not be quite right either. Tex's costume might
as well be a nightshirt or a pair of pajamas, as he is perpetually
asleep. Tex just dreams. He is full of words and actually gets
nothing done. Not a single cow has been slaughtered, not a
single cheeseburger consumed as a result of his endeavors.
I learn a lot about Tex and his fondness for singing Don't
Fence Me In. He is overwhelmed and consequently underactive.
It is, in fact, absurd that he wears a big leather belt, because he
could never use it, either to discipline or to keep his pants up,
because there is probably nothing underneath them anyway.
All efforts to understand Tranny or to police her continuous
assaults on young boys who like to read are resisted, and I am
told just to play the game. She is very irritable and, as anyone
can plainly see, she is also very dangerous. Importantly, she is
60 James M. Herzog

not really a she. For my part, even in the face of instruction to

the contrary, I insist on a wishing to prevent Tranny's attacks.
Initially, I am not so motivated to wake up Tex. I wonder about
my countertransference and about my role-responsivity with
regard to what I assume to be Nick's intrapsychic and interac-
tive dilemma.
This material comes in the second year of the analysis of
a now 10-year-old boy whose presenting complaints involved
depression and a seeming compromise of his immune system.
There had been no mention in the initial consultation about
Nick's anger or his problem with aggression.
Nick and I explored the world of baby lobsters and their
perilous early days. When thrown off the tail of their mother,
they drift helplessly upward, prey for many hungry mouths,
until fewer than four out of every thousand survive until the
first molt and they can, with the aid of increased gravity, de-
scend back to the relative safety of the ocean bottom. There
is no paternal-lobster presence to guarantee the safety of the
helplessly adrift little crustaceans. They do not have a "how
to do it guide," a way to control the action. They are also not
equipped with words. These little ones are on their own with
neither a paternal nor a maternal structuring or holding sur-
round. I inquire whether mother and father lobsters have an
interesting relationship. I am told that when the mother lobster
slaps her tail, she not only dislodges the babies but also ban-
ishes the father. He flees, never to return, "if he knows what's
good for him," Nick tells me.
Our next area of exploration involves penguins and their
exposure to the hunting practices of leopard seals and the
even more clever Orca killer whales. Leopard seals wait for
penguins to leave the safety of an ice floe and descend into the
water where they can be killed and consumed. Orca whales,
in contrast, rock the penguins' ice floe, throwing the terrified
birds into the water and thence into the waiting jaws of the
whales.
In this play, we focus on the cooperation between the
hunting whales. Nick wonders if they are a couple, that is, a
mother and a father, or if they are both male or both female.
We also note a strategy of the parent penguins that involves
throwing a baby off the ice slab into the water. If he is eaten,
4. What Fathers Do and How They Do It 61

then the penguins know the leopard seals are present and
the rest of the penguin group remains on the ice; if he swims
without being attacked, then all can enter the water. Again we
note the lack of protection and the plight of the young. But we
have advanced in this play beyond what we encountered with
the lobsters. Because now, at least in the hunters, the idea of
the parental couple has been joined, the idea of two together
affecting a third, although here it is to eat the third rather than
to rear him. What an important image of the family is being
developed!
Finally, before we became immersed in the escapades of
Texarkana Tranny, the action-oriented transsomething sexual
assailant, and Tex, the ruminating but particularly ineffec-
tive cowpoke, we were absorbed with the construction of a
strange home. It had been built on unstable landfill and so it
kept collapsing. The question of how a foundation might be
constructed if its underpinnings would not support it or serve
as a reliable anchor perplexed Nick and perturbed both of
us. Mother Earth herself needed to possess a certain reliable
structure if she was to support that which emanates from her
or was built on her.
In my role as analyst, I was asked to comment on this
strange phenomenon and render a judgment as to whether
the building would ultimately stand or collapse. At first, I felt
unable to issue such a verdict or even to know what the prog-
nosis might be. But then, aided by the fact that my patient was
just ten years old and by the fact that I am a child analyst, I
was able to say, "Some lobsters do grow up and some penguins
live to be parents themselves. We shall learn together what
maximizes the chances of those outcomes. Sometimes things
are even more complicated. Guys wear dresses and do hurtful
and bad things; others don't seem to be able to do anything
at all, except croon again and again. We have to find out why
Tranny behaves so badly and what it means. It is not her outfit,
I think, but that she hurts the little boys who ask for her help,
and we must also learn why Tex is so stuck. All these things
will help us know how the building is constructed and what is
required in its foundation."
I made these comments in the displacement which Nick
used to discuss familial and intrapsychic guardians; they were
62 James M. Herzog

not transposed to his actual interactive reality, which we were

also learning about in concomitant family meetings.
Nick responded to my attempted formulation by telling
me that he thought that Mother Earth couldn't do it alone.
"That's why there is a God," he said. I asked for a clarification
and Nick answered to the effect that there are earthquakes
and all sort of instabilities of the earth unless there is a strong
other presence that can harness these forces and keep things
stable enough so that building can occur. But he wasn't done
yet. Mother Earth had to acknowledge and value the existence
of God the Father. Were she agnostic or too arrogant, nothing
could ensue. We began a long and amazing geological-psycho-
logical exploration of Mother Earth and her strange tendency
to want God the Father to be just like her, a "second Mother
Earth," was Nick's way of putting it. "You can see," he told
me, "that just won't do. There has to be a Mother Earth and a
Father God for this thing to work. They are different, not the
same. That is what is required for a house to be built, for the
ground not to give way."
Nick was trying to make sense of a situation in which two
difficult events had occurred that skewed his development in
a monumental way. His mother, for reasons that, I am sure,
were profound and painful, required his father to stay in the
Mr. Rogers, second-mother mode. His father, for equally com-
pelling reasons, acquiesced or found such a position tolerable
or necessary. The second event, which followed from the first,
was that maternal attunement was not balanced by the spousal
comanagement of excitement and subsequently Nick's capaci-
ties to modulate amygdaloid control of his emotional reactivity
and regulation with prefrontal processing was delayed or de-
railed. His subsequent problems with aggression and relating
were likely related to both phenomena. I do not think it is too
farfetched to suggest that his immune system irregularities
were also related.
It is interesting to look for the equational meanings be-
tween the lobster and the penguin dilemmas, Texarkana Tranny
and Mother Earth, and the actual details of the anal soaking
and bidiurnal ejaculations. It seems that Nick in some way
recognized that his dad was getting it up the ass even if he did
4. What Fathers Do and How They Do It 63

not know of the specific gynecologic-proctologic procedures

that were being employed.

Colleen

Colleen is five years old and has been in analysis with me for
a year. She is the only child of her 40-something mother and
50-year-old father. Her conceptional history matters in that
the parents, both professionals, postponed their family until
mother was well established in her career. Getting pregnant
turned out to be a long and arduous matter, and, when con-
ception finally occurred after multiple hormonal primings and
ovulatory tweakings, there were four fetuses in utero. Painful
counseling and deliberation resulted in the removal of three of
the fetuses and Colleen alone was left to develop. Two of the
other fetuses were female and one was male.
After Colleen's birth, mother developed a psychotic de-
pression, in the throes of which she tried to smother her
baby. The child was bruised and agitated but otherwise was
pronounced to be well, and mother was hospitalized for several
weeks. This event occurred when Colleen was seven weeks old.
It was necessary for the father to take a leave of absence from
his work and care for Colleen for much of her first year while
mother was hospitalized. He had the help of a Guatamalan
nanny who had taken care of other children and in his opinion
functioned adequately, although he always felt that he needed
to remain at home to oversee her ministrations. This seemed
to be a direct response to his wife's decompensation and her
attempted murder of Colleen.
Mother is now in an intensive psychotherapy and father
is in an analysis. The marriage has suffered majorly from the
gestational trauma and from the postpuerperal events. Father
is ever more removed from the family, seemingly never able to
make the transition from presiding mother to lover, husband,
and father. The couple has no sexual relationship, and mother
assumes that her husband now has another lover or lovers; she
states ruefully that he could never go without sex for more than
24 hours at a time. Sadly, she relates that her husband resists
64 James M. Herzog

all her entreaties to rejoin her and her daughter and forgive
her for her illness and what transpired.
Colleen was referred to me by father's analyst after trouble
had emerged in her preschool. Colleen found it difficult to
separate from her mother because she loved her so much and
when finally ensconced in the school would strike out at her
female teachers.
In our play, Colleen presides over an aviary and zoological
garden that is threatened by the arrival of several predatory
falcons. We are interested together in the plight of the sparrows
and rodents now that their place on the food chain has become
perilous, but the real interest focuses on the falcons. Colleen
describes in exquisite detail the way in which the father falcon
hunts and the mother falcon stays at home to care for her
young.
The narrative departs significantly from ornithological
reality, but it tells us something about Colleen's evolving in-
scape. We learn that Flora, the mother falcon, is beautiful and
caring. She keeps the young warm and safe and prechews the
birds and rats that father brings home. We become interested
in the experience of the little falcons. They are always referred
to as "the young," which obscures the actual number of off-
spring. Is there one? Are there several? Eventually, we focus
on little Flora, who is the daughter falcon honored to share
her mother's name. She will eat only food that her mother
has already masticated. Little Flora says she likes food best
that has been in two mouths. I wonder if this is her mother's
mouth and her father's. "No," Colleen responds, "it is in her
mother's mouth and in her own." The father falcon, we are to
learn, does not play a significant role in this enjoyable eating
even though he procures the food. "He eats with some other
bird," Flora announces through Colleen's commentary.
Events in the falconry become more complicated. Big
Flora is preoccupied and often careless. Sometimes she bites
little Flora when transferring partially chewed sparrow. She
flaps her wings, and little Flora falls from the nest and is badly
bruised. The father is now nowhere to be seen. Little Flora's
devotion to big Flora is unabated. In fact, she appears to find
her mother's maltreatment a fecund surround for ever-growing
4. What Fathers Do and How They Do It 65

love of mother. We discover that big Flora wants to hurt little

Flora. She likes to feed live prey to her daughter, especially
if the soon-to-be-food is still screaming and bleeding. Little
Flora expresses an ardent wish to be just like her mother and
a growing fear that she may not succeed in this most urgent
and compelling wish.
We resolve to understand more about all these develop-
ments. Colleen says that she too wonders whether little Flora
has or had siblings and where the father falcon has gone. She
says that she has detected that I am curious about little Flora's
devotion to her mother in the face of all the bad things that
are happening to her at her mother's beak and wings. She tells
me that it may be dangerous for me to be interested in such
matters. After all, what do I know about raptors? She wonders
if perhaps I know a lot. Maybe even hawks frequent my back
yard.
After voicing this concern about the availability of mascu-
line, paternal expertise and presence, she tells me that she
thinks she knows why Little Flora loves her mother so much.
I ask why? Colleen tells me that at least Flora's mother doesn't
use her killing talons on her. She is alive, not dead. That is
a reason to love one's mother. One must be very careful of a
mother's killing tendencies, particularly if there is no protecting
and modulating father present. How true and how prescient,
I think, and what a perilous constriction of a little falcon's or
a little girl's play space.
Colleen is telling us yet more about a variant of what
mothers want from fathers and what ensues when it is not
forthcoming. I assume that her mother wanted much from her
father that would have been holding and stabilizing and that
her postpartum psychosis and father's psychology prevented
these developments from occurring. In their absence, the little
girl constructed her own explanations of the order and disorder
of the universe and elaborated their structural consequences
in her inscape. Her capacities to regulate her aggression and
evolve triadic intrapsychic structures are similarly burdened
and have, as an added dimension, the omnipresent fear that
separation from mother will provoke a lethal response.
66 James M. Herzog

I have presented two quite different scenarios exemplifying

both wish fulfilled and wish putatively thwarted. Nick's mother
effected what she wanted and his father complied. Colleen's
mother could not bring about what she wanted and needed.
The little girl was barraged by the translations of preconcep-
tual events and postpartum psychiatric illness that populated
her anamnesis.
Both Nick and Colleen, with very different histories and
psychologies, show us something about the complex ways in
which the sequellae of suboptimal mother-father interactions
unfold. Each case is about the ways in which what mothers
want from fathers unfolds or devolves. In both cases, the issue
revolves around the separation between the sexual lover or
adequately aggressive male and the nonsexual man who can
entertain the child, that is, be Mr. Rogers without constituting
a danger in the sexual or aggressive realm.
There are many reasons that the mother may wish her
husband to remain in the second-mother mode. This choice
involves complicated intrapsychic operations in the mother.
She must not only abrogate her own impulses (infanticidal and
infantiphilic) in this regard but both project them and then ex-
punge them from the entrusted partially male other. Mr. Rogers,
a truly nice man, is also, in this construction, a penisless and
fistless man, mother and father. There is a normative aspect to
this split in the maternal ego that constitutes a major challenge
in a marriage and must be met by a corresponding development
in the man's psychology, a development that melds caretaking
and the management of excitement. Here a man must call on
elements of his own caretaking line of development that allow
him to be both maternal and paternal, both perfectly safe and
capable of exciting. As his own caretaking line of development
is forged from sexual and aggressive conflicts and their resolu-
tions at various stages and from an amalgam of maternal and
paternal identifications, it is within the realm of expectability
for a man to take on these two seemingly disparate tasks. He
can be the lover and excitement beckoner for his wife, when
they are alone together, and he can be Mr. Rogers-like, a
mother-father combination with his child and also for his wife
when they are with the child. The capacity to be both is vital
4. What Fathers Do and How They Do It 67

for the mother so that she too can be both and thus maintain
her adult sexuality even as she participates in the primary ma-
ternal preoccupation (Winnicott, 1958) necessary to minister
optimally to her child's needs.
As we see in the clinical material there are multiple rea-
sons—circumstantial, historical, and interactive—that may
occasion both maternal derailment and paternal failure in this
regard. Such deviations skew the caretaking milieu in which
the child develops and favor maternal deviations and behavioral
alterations as well as inadequate or distorted responses from
the father in all these endeavors.

CONCLUSION

In all intimate relationships, there is a pull for convergence

and sameness, even as there may be a need for continued in-
dividuality and difference. How two people, mother and father,
become more similar and how sexuality as the medium for play
allows a safe-enough place for difference and the heterogene-
ity that characterized each partner before the marital process
started to pull for homogenization is, perhaps, a universal story
of the marital relationship. Sexuality, with its limbic roots, is
the natural venue for the declaration of difference and innate
aspects of the self, both biologically and psychologically, to
express itself. As such, with its own versions of dominance,
hierarchy, partnership, and mutually orchestrated cycles of
excitement and repose, it allows for the press toward sameness
to be countered in a critical way in the most fundamental play
mode. In the absence of such a well-enough functioning sys-
tem, the need to manage these issues takes other less favorable
forms. I have tried to show through the unique experiences of
Nick and Colleen how two of these less favorable forms pres-
ent. Good-enough adaptations of the mother-father negotiation
and coconstruction of a safe-enough milieu for their offspring
abound. We clinicians are in a unique position to elaborate a
nosology of pathology and a template for health and optimal
development.
68 James M. Herzog

REFERENCES
Braunschweig, D. & Fain, M. (1981), Bloc-notes et lanternes magiques. Rev.
Franç. Psychanal., 45:105–226.
Chasseguet-Smirgel, J. (1985), The Ego Ideal: A Psychoanalytic Essay on
the Malady of the Ideal. New York: Norton.
Fonagy, P. & Target, M. (2003), Putting sex back into psychoanalysis. Un-
published ms.
Herzog, J. M. (2001), Father Hunger. Hillsdale, NJ: The Analytic Press.
Laplanche, J. (1999), Essays on Otherness. New York: Routledge.
Stein, R. (1998), The poignant, the excessive, and the enigmatic in sexual-
ity. Internat. J. Psychoanal., 79:259–268.
Thelen, E. (1995), Motor development: A new synthesis. Amer. Psychology.,
February:79-95.
Winnicott, D. W. (1958), The capacity to be alone. In: The Maturadonal
Processes and the Facilitating Environment: Studies in the Theory
of Emotional Development. Madison, CT: International Universities
Press, 1965, pp. 158–165.
Chanter 5

What Do Mothers and

Grandmothers Know and Want?
SARA RUDDIGK

W hen I was asked to consider the question, What Do

Mothers Want? I playfully replied, What Do Grand-
mothers Want? I then decided to take my question
seriously. I would speak first about mothers, as I have often
done, then consider the desires and thoughts of grandmothers.
As it turned out, I could not simply add grandmothers to the
family scene. In the presence of grandmothers on the page,
I became self-consciously aware of the particular genera-
tional position from which I write. I am only now beginning
to understand the new ways of thinking this shift of focus may
provoke. 1

GRANDMOTHERS AND MOTHERS

Grandmothers are mothers; they stand in a biological or adop-

tive maternal relationship to at least one child who has become
a parent. (Children/parents I call them—an awkward phrase
but I have found no substitute.) The status of "grandmother"
differs across cultures. In my cultural circles, grandmothers
bring a history of mothering to their relationship with their
children who have become parents. This relationship takes
many forms over time but is nonetheless usually recognizable
as maternal.
When a grandmother writes about mothering, she can
unwittingly or consciously feel and think as the daughter she
will always be. A grandmother can also speak "as a mother."

69
70 Sara Ruddick

Perhaps she is the primary mothering person in a child's life;

or she may be trapped by the grievances and pleasures of her
mothering past. What would it mean for a grandmother delib-
erately to adopt a grandmother's perspective as distinct from a
daughter's or a mother's? In the idiom of this book, how would
someone ask what a mother wants if the mother in question
were also the questioner's child?
The beginning of an answer occurs to me. To be a grand-
mother or a mother is already, by the meaning of the words, to
be related to children. But, unlike a mother, a grandmother is
immediately related to at least two sets of children, two genera-
tions. The doubling of children—grandchildren and children/
parents—situates a grandmother within a net of relationships.
She can extract a grandson, extract a daughter, but to speak
of either of them she must speak of both. This artificially ab-
stracted dyad is itself entwined with other relationships that
are familial because of biological lineage, adoption kinships,
and "adopted" friends.
Because of their doubled children, grandmothers may
become particularly sensitive to generational positioning, their
own and others'; grandmothers are able, and likely, to speak
in a generational voice. Generational voices can be moralistic,
condescending, alive with a sense of their greater strength. This
sense of superiority is most likely expressed by people in the
"prime of life," whether speaking of the old or young. But a
grandmother, or someone of the grandparent generation, can
also write, as she can act, intrusively and arrogantly. In this es-
say I am just beginning to create for myself a generational voice
that acknowledges temporal distance, speaks with restraint
and respect, but does not get so bogged down in its efforts to
be good that it misses the pleasure of grandchildren.

WHAT DO MOTHERS WANT?

A mother wants to keep her children safe, to protect them

from illness, accident, and violence. She wants to foster their
capacities for joy; train them to behave in ways acceptable
to her social group or to groups whose approval she desires;
help them to do well in school; teach them the techniques and
5. What Do Mothers and Grandmothers Know and Want? 71

value of friendship. Different parents express different aims in

different words. In some cultures there are no schools; where
there are schools, individual mothers may want nothing to
do with the schooling their culture offers. Any list, including
mine, will quickly reveal the relative security, and the oppres-
sion or privilege of the list maker. Nonetheless, amidst these
varieties, in most cultures of mothering, it is part of "being a
mother" to want for your children what you believe are the
goods of life.
Women who are mothers also have so-called independent
aims and desires—independent, that is, of their children's
needs. A m o t h e r may, for example, want to read a book
throughout the afternoon, quit a demeaning job although her
children depend on the money she earns, or leave the chil-
dren asleep in the house for a rendezvous with her lover. A
"career" and "chosen work of one's own," as contrasted with
jobs justified by family needs, are socially respectable symbols
of extramaternal desire. A career has requirements that are at
best indifferent to a mother's aims. Chosen work, any work a
mother feels compelled to do, including organizing or writing
on behalf of children, invites her to set standards and to value
her time according to the priorities of her project.
On their best days, some mothers may give themselves
over wholly to their children. They experience children's
pleasures as their own and children's mastery as empowering.
Other mothers, on their best days, feel as if they can stride
across the world's stage and act out their ambitions with nary
a tear or sigh for their children back at home. But a mother
who has some freedom to imagine and some hope of acting on
her imaginings will likely find herself desiring what she herself
believes a mother should not desire. Conflict between maternal
and nonmaternal desires is characteristic of women who are
mothers, not an unexpected trouble that befalls them.
Whatever goods a mother desires for her children, her
efforts to provide them is "work." A few decades ago it was
crucial to mothers that their work be recognized as a demand-
ing activity in which they might refuse to engage and for which
they should be credited. A stronger identification of mothering
as a particular kind of work had other welcome effects, such
as dismantling the link between mothering or fathering and
72 Sara Ruddick

heterosexuality. Whoever took it as his or her responsibility to

care for children could be seen as doing a mother's work.
Amidst these progressive changes, or at least progressive
wordplay, gender has remained remarkably "unbending" (Wil-
liams, 2000). Men may participate more actively in child care,
their participation may be more eagerly noted, and fathers may
more often become primary parents. Nonetheless, for many
layered reasons, women still do a disproportionate amount of
the work of caring for children. At the same time, more women
want to engage in careers that have been steadily raising the
standards of "productivity." Mothers with careers, or with
demanding jobs that impose careerlike measures of progress,
are faced with hard choices.
One response to mothers' difficult choices is to blame
feminism. Another, with eerily appropriate rhetoric, divides
mothers into "warring" camps: mothers who "stay at home"
and mothers who "work outside the h o m e . " The ensuing
"Mommy Wars" then deploy minimaternal identities that are
abstracted from the economic, familial, sexual, and social
priorities that frame a mother's life. A third response, toward
which I am veering, is to deny the division, and perhaps even
the difficulties in balancing maternal and other work. Mothers
are not, as I hear them, so intolerant of each other as the catchy
idea of Wars suggests. Nor are they as liable as their elders to
overestimate what can be chosen and controlled, either for
their children or for themselves. Yet, as often as I am struck by
the willingness of older women to pass judgment on the lives
of mothers they barely know, I am also surprised and silenced
by the sensitivity and defensive pride of mothers when the
subject of "work" arises.
A fourth response, toward which I also veer, is to mock the
mothers who suffer the burden of choice. There is a consider-
able range in the economic situation of mothers who "balance
home and work." But anyone with a serious and troubling
choice about how and when to earn money is more fortunate
than most parents. If these economically fortunate mothers
are sufficiently trusting to speak aloud about their conflicts,
they will almost certainly be reminded that most parents must
work at jobs that eat up time with their children and sometimes
leave them frantic for their safety.
5. What Do Mothers and Grandmothers Know and Want? 73

Sometimes mothers themselves seem almost to invite

mockery. For example, The New York Times printed a mother's
confession. Jenny Rosenstrach (2004) obsessively and competi-
tively records the "quality time" her children spend with her
or with her and her husband and compares it with quality time
the children spend with their nanny. With anticipatory relief,
Jenny marks the first day of nursery school. On that day a
number of hours that had been assigned to the nanny will be
taken over by the school. The mother does not acquire points,
but the nanny loses them. Although Jenny Rosenstrach's self-
mocking story seems to invite our mocking, The New York
Times (2004) printed seven serious letters that responded
variously to modern mothers' plight.
Jenny Rosenstrach's story raises the "Nanny Question,"
which is often an adjunct to the "Mommy Wars." This par-
ticular mode of employment of one woman by another (as it
is usually put, even though the father is often also employing)
probably affects a small number of the nation's mothers. Many
mothers have only the help they get from their partners and
friends. Other helpers are at least as often relatives as strang-
ers—younger siblings, grandparents, grown children of friends
who are members of the household for a short or long stay.
But nannies have attracted the attention of social critics,
feminists, and mothers who employ them (e.g., Romero, 1992,
1997; Wrigley, 1995; Nedelsky, 1999; Tronto, 2002 ; Nichols,
2004).
Nannies are most visible when they are truly terrible, or
are terribly exploited, or are employed by nominees for public
office. Because of the spotlight on famous employers, more nan-
nies may have what all deserve: good wages, clear job descrip-
tions, social security, health insurance, vacation time, reliable
expectations about the tenure of their employment, and the
freedom and ability to leave when they desire. But, so I am
told, some mothers who are ordinary "good citizens" willfully
pay low wages with no benefits to women who are powerless
because of their immigration status and our immigration laws
to claim what is their due.
Feminists often respond to the Nanny Question by arguing
that mothers should not employ other women privately to do
child care, but should turn to public, or at least collective,
74 Sara Ruddick

day-care centers or else do the work themselves. When Julia

Hanigsberg and I (1999) wrote the introduction to Mother
Troubles and her daughter and my granddaughter were in day
care, we tacitly endorsed a No-Nanny position. I am now struck
by two other aspects of this discussion: the degree to which
justice is described in individualist language and the elusive
character of mothering work whoever does it.
Nannies—who are also often mothers themselves—need
policies and laws that give them the power to claim what is
their due. Perhaps it is less obvious that mothers who are
employers also need laws that both require and support their
efforts to be just, laws that set standards of decency and re-
spect to which anyone must adhere. I can still be surprised at
the varieties and persistence of mother-blaming, the ways that
cultures represent mothers as not only silly and "bad" but as
responsible for the evils in their societies (Ladd-Taylor and
Umansky, 1998). I am surprised, too, by the ways mothers are
excused or excuse themselves from the requirements of justice.
Justice is a cooperative endeavor, not one that individuals do
alone unless they are very wealthy or saints. I hear a moral
loneliness and self-preoccupation in some mothers' efforts to
be good in a society where winning is what counts and cheating
is acceptable. I also see a willingness of some fortunate proud
mothers to take what they can get of public goods and other
peoples' lives, which should not surprise me but does.
Mothers are "hot," talked about and talking, inspiring
books like this one, and paragraphs like those I have just put
down. Yet the work at the center of mothering, the work that
children demand and mothers do, remains elusive, whoever
does it. Nannies, when and insofar as they care for children,
are mothering persons doing a mother's work. Not surprisingly,
we often hear little about their work once the conditions of
their contractual arrangements are spelled out. Eva Kittay's
(1999) memoir of her relationship with her daughter Sesha, a
child severely mentally impaired, is unusual in the attention it
gives to a caregiver's self-understanding. Kittay takes the title of
her essay from her caregiver's reflections on her relationship,
which is also her work, with Sesha: "Not My Way, Sesha, but
Your Way, Slowly." This respectful listening to a caregiver's
reflections need not, and in that memoir does not, minimize
5. What Do Mothers and Grandmothers Know and Want? 75

the complexities of intimate relational paid work in a social

context structured by differences in power and control.
Mothering work is an odd mix: hands-on intimacy, manage-
rial organization of household projects, training and educating
in skills and values, fighting on children's behalf, and teach-
ing them how to fight with each other without serious injury,
mental or physical. Sometimes working well means following a
child's mind and attention—"not my way but your way, slowly."
Sometimes it means "my way, and in a hurry." And sometimes
it is their way, as teachers, counselors, doctors, priests, and
rabbis decide. Each way has its excesses. Each involves revi-
sion, mistrust and trust, of "them," yourself, your child.
A mothering person listens and watches. Work, play, dis-
aster, and household routines run together. As if on holiday
from adult duties, a mother talks energetically with other moth-
ers in the playground only to be interrupted when her child
falls hard, on concrete. A mother and her one-year-old walk
out on a beautiful day but before long are struggling: when can
he be carried, ride in the stroller, or walk and run on his own,
but never into the street? There is too much time—children
play contentedly, needing only half a mother's attention, but
still leaving her too little attentive time for projects of her own.
Or there is no time at all—no silent time, no time even to read
the newspaper without a one-year-old trying to find pictures
of cars and name then.
I am telling true enough stories. This is what the work of
mothering looks like as I remember it and as I have seen it
from roughly, the mid-1930s on, as it was done, for the most
part, in cities and suburbs of the United States, in conditions
of financial comfort, peace at home, and war abroad.
This work is no less demanding if an employee, friend,
grandparent, or mother does it. But, of course it matters who
does the work, and this adds to its oddity. Mothering is done
within and through particular relationships. The quality of the
relationships not only affects the work; it is, for some mothering
persons, one of the work's most important aims. If a morning
walk with his grandmother estranges a child from his mother, if
a mother's lunchtime rituals estrange her daughter from friends
she enjoys and needs, then that day's work has gone awry.
Mothering relationships are inherently intimate, messy
76 Sara Ruddick

as intimacy is messy. Just how intimate, and how useful and

necessary the intimacy, is a subject of intensely felt disagree-
ment among mothers. For some critics, an ideal of attentive,
focused mothering is the legacy of an antifeminist, feminine
mystique, at best a time-consuming hobby some women are
free to pursue. For others, a child's desire for the attentive,
focused love of his mother, along with a mother's desire for
her child's responsive recognition of her, form the core of the
messy, intimate relationships in which we become and value
the persons we are.
In the midst of her odd work, so little noticed, so hotly dis-
cussed, a mother may see little connection between her efforts
and her child's temporary happiness, let alone his long-term
well-being. One way of bringing sense and order to the work is
to articulate ideals by which mothers might be governed within
the processes of their days, irrespective of long-term outcomes.
These ideals could govern the work of mothering persons no
matter what their biological or adoptive relation to the chil-
dren they care for. But I have in mind especially mothers who
are intensely vested in the well-being of particular children to
whom they are related biologically or by adoption.
I speak of ideals with some reluctance. The Shadow of the
Bad Mother already haunts the days and dreams of too many
ordinary mothers; too many judges and experts are ready to
mark maternal failure. Yet ideals can provide a kind of comfort,
give an order and moral sense to work that is always changing,
always unfinished. I chose one among many ideals for political
reasons of my own. Were I again actively mothering, I would
hope for occasions when mothers could formulate together the
ideals by which they would then be governed.
The ideal I chose arises out of the "nature" of children's
relationships with those who care for them. Children come
to consciousness in relationships where they are utterly de-
pendent on caregivers. These same children often respond to
care in ways that are frustrating if not enraging: wailing no
matter what is given them, running into the street, biting the
neighbor's child, dropping out of school From the begin-
ning, children are vulnerable to assault not just by bullies and
sadists but by exhausted, angry people who love them. Very
5. What Do Mothers and Grandmothers Know and Want? 77

early on they are also vulnerable to humiliation, to being made

ashamed.
The converse of assaulting and humiliating is "holding
someone in personhood" (Nelson, 2002), "conferring dignity"
on them (Kittay, in press). Nelson describes her family's care
for her mentally impaired younger sister who died at 18 months
of a neural tube disorder: "Each of us in the family I dare say,
saw Carla in a slightly different light. Acting out of our various
conceptions of who she was, we made a place for her among
us, treating her according to how we saw her, and in so treating
her, making her even more that person we saw" (p. 32).
In this family, mothering keeps in personhood a child who
might otherwise, for lack of mental capacity, have been seen
as, and would have therefore become, a lesser, nonperson sort
of being, cast aside.
In a similar spirit, Kittay (in press), taking as an example
the dignity of her severely mentally impaired daughter, Sesha,
has written about treating a patient or child with dignity:
"Dignity is a feature that must be perceived in order to be.
For dignity is a call upon another to recognize our intrinsic
worth. That call requires a response, a witnessing In our
relationships of care, we witness, recognize—and so confer
that dignity in another."
A child's dignity must be seen and conferred before it can
become assuredly hers. The child "calls upon another" who
is caring for her, and whose power over her is immense. She
pleads that she not be violated or shamed, not cast aside or
excluded, however enraging, alluring, disappointing, or tire-
some she may just now be. The other who cares hears her call,
recognizes a person meant to be treasured and confers upon
her the freedom from humiliation and assault that dignity
requires.

In a pique of anger, a three-year-old throws milk in his mother's

face. She hits him or she does not. In either case, what he has
done is unacceptable; this is not an occasion for interpretation.
But she may restrain herself from further assaulting and hu-
miliating out of a perception of her child as someone not to
be violated, not to be made ashamed. And as she sees him,
78 Sara Ruddick

so he is. She is aware of a deep restraint, that runs under her

occasional slap and scream. She is able to bring this restraint
to her work most days during this time of her life and his. But
she will be learning and relearning it in the years to come. A
mother is not born but, rather, becomes unwilling to humiliate,
unwilling to cling to righteous rage, to continue assault past its
moment of anger. She becomes unwilling to make her child's
body a site of pain and shame. She learns the habits of protect-
ing the dignity she has conferred. This foundational restraint
could be given many names—respect for dignity and holding
in personhood are two.

WHAT D O GRANDMOTHERS WANT?

Although there is a vast and contentious literature on mothers,

if there is a literature on grandmothers I do not know of it. In-
stead of reading, then, I conducted "interviews." I began with a
quasi-formal interview with Helen Cohn, the mother of a friend.
Helen was in ill health in her 80s. Her one grandchild was 11
at the time of the interview. Helen's intelligent self-disclosure
set the course of my thinking about grandmothers. Eventually
I casually questioned every dinner partner, cab driver, hair
cutter, and grandparent I came across. I also watched and lis-
tened to grandparents I was close to, including my husband,
and remembered my parents and others of their generation.
Grandparents seem hard wired for loving grandchildren,
even when the timing and circumstances of birth are initially
discouraging. I have no words for the sweet, hopeful passion
that grandchildren seem so often to evoke. Traveling through
my memories, I selected one story from each of my grand-
children to include here. In the end, however, I forswore the
familiar genre of grandparent stories. Instead I studied aspects
of grandparent relationships that are more complex.
From my small sample I have learned that the grandparent
relationship is at least triangular. No matter how close a grand-
parent and grandchild become, there is another person, the
grandparent's child, the grandchild's parent, who is included
in fantasy, memory, future relations, and ongoing negotia-
tions. The child/parent brings along others—other families,
5. What Do Mothers and Grandmothers Know and Want? 79

the other grandmother(s), and, of course, the child's other

parent if there is one.
Grandparents do a parent's work, more or less. Doing more
are many grandmothers who are the principal mothering per-
sons in their grandchildren's lives. Those who do less includes
some grandparents who are indifferent to their grandchildren
and many who would want to share the work but cannot be-
cause of geographical distance; fragile, if not fractured, relations
with the grandchild's parents; or ill health. Between primary
responsibility and no help at all are many intermediate stops:
"taking the children" for occasional weekends and on special
trips, contracting in for regular child-care days, living with the
children/parents and helping them. Sentimentally, and in real-
ity, grandparent/grandchild outings and rituals incorporated
into child care lessen its burdens while also creating distinct
pleasures. Not so sentimentally, "women who take care of
grandchildren for more than nine hours a week allegedly face
a significantly higher risk of heart disease" (O'Neil, 2003).
However young a grandmother, she is three generations
removed from her grandchild. (She may, of course, be inter-
mediate between great and great-great grandchildren on one
side and children/parents on the other.) Grandparents need
not be old: they may not turn 70 until their grandchildren are
middle aged. People in their 70s and 80s are in varieties of
good and ill health. On the other hand, in my circles where
women can control their fertility and receive adequate health
care, a child's first experience of terminal aging or death is still
apt to be of a grandparent or someone close to her family of a
grandparent's generation.
Kathleen Woodward (1990) writes that grandmothers
help us "find our way out of this Freudian world limited to two
generations, one from which older women are missing" (pp.
150–151). They give us a sense of a life span and also the sense
of a life cycle. The most celebratory of grandparents I spoke to
mixed the thrill of a new life with an awareness of loss. Helen
Cohn (2002, personal communication) was explicit:

My granddaughter is the light of my life; from her I get the

daily pleasure of an 11-year-old's energy and spirit. But with
that is an ongoing sadness—you will not know her when she
80 Sara Ruddick

is 20, you will not see her even begin to live her life. And
[she repeated] I have the daily pleasure that this 11-year-old
exists, and an ongoing sadness that I will never know her as
she is grown up. You must not let the sadness take away from
the pleasure. You have no choice but to accept the sadness;
or you will lose the pleasure, lose the child.

What, then, do grandmothers want? A grandmother wants

to have strong, stable relationships with her children. If she
does not tell you this, she recognizes the desire as soon as you
mention it. Her tales of her children are mixes of gratitude,
worry, light-hearted criticism, rage, and loving complaint.
She sometimes feels impotent before the collective power of
her children/parents and their entourage. At other times she
is aware of the continued power of a mother to hurt. But she
depends utterly on the mutual goodwill between herself and
her children/parents.
A grandmother wants to be pleased with her children's/
p a r e n t s ' care of her grandchildren, however she and her
grandchildren's parents may disagree about details. To watch
one's children at work and play as parents, caring with skill
and imagination, is one of the great pleasures of being a grand-
parent. The correlative sorrow is seeing grandchildren cause
children/parents pain by their unhappiness or illness or other
circumstances beyond the children's/parents' control. Between
great pleasure and great sorrow is the question every grand-
mother recognized, whatever words she used: Should we, can
we intervene?
Grandparents in my social circles, now in their late 50s
or older, have known illness, loss, and death. In this context,
grandparents need and want experiences that allow them to
remain curious, appreciative, and attached to the world that
will survive them. Pamela Daniels (2003, personal communica-
tion) spoke of this kind of enlivening experience: "All this loss
and death I think, among other things, that grandmothers
deeply want a new experience of love and fullness when their
years and their awareness have, in the nature of things, afforded
them ample exposure to and knowledge of grief and loss."
Grandparents and older parents allegedly say they do not
want to become burdens to their children as they age. (No
5. What Do Mothers and Grandmothers Know and Want? 81

one actually said that to me.) Whatever they say they want,
grandparents often do become ill and frightened. Then they
want all the help that they can usefully receive. The last gift a
parent can give her or his children is an example of failing and
dying well. I received such a gift and have only recently seen
it given by a young grandfather who died at 62. I have heard
many grandparents of my own and my mother's generation
talk to each other and their children/parents about wanting
to give that gift.
If the birth of grandchildren symbolizes renewal and con-
tinuation, the death of parents or grandparents can symbolize
care given and received. Dying well, as I have witnessed it,
requires the efforts of friends and children, supplemented by
trained medical assistants. Too often a well-knit network of care
is insufficiently sustained by "health-care providers." Stories
of unnecessary suffering abound, and one hopes that reform is
underway. It is astonishing and profoundly morally disgusting
when such care depends on cash, class, or fee for service.
In our interviews, I requested that Helen Cohn ask her
friends what they as grandparents wanted. Helen told me that
she and the grandparents she knew wanted to give something
special to their grandchildren, something that expresses their
values, their interests, themselves. They might have almost
no relationship with their grandchildren, but they knew, and
could say quickly in response to questions, what they would
give if they could.
I was surprised and heartened by the persistence of the de-
sire to "express yourself," to give something that is "distinctly
yours"; heartened by the belief of grandparents in their 80s
and in ill health that they had something distinctively theirs to
give. Since my first conversation with Helen Cohn I have seen
grandparents taking pleasure in the self-expression she spoke
of. Children/parents often live a tightly woven, densely packed
life that makes it difficult always to be ready to receive what
their parents want to give. But I have seen children/parents
welcoming what their parents give their children, that is, what
the grandparents give the grandchildren. These children/par-
ents sustain their parents' belief that there is something special
about them that their grandchildren should get.
82 Sara Ruddick

SAFETY AND SADNESS

I have written this paper, from first word to last, in the midst
of a war waged by the government of my country. Military vio-
lence has been on my mind even when I have kept it behind
my lines. Assault, humiliation, and domination are acts of
war, creating enemies where there were none. "Conferring
dignity" and "holding someone in personhood" are ideals of
nonviolence. Mothers fight. We fight among ourselves, fight with
our children, fight on our children's behalf. Whenever I look
at mothers fighting, I try to see ways of making and keeping
peace. I have done this before, have done it here.
When, for the first time, I turned my mind to grand-
mothers, I knew in advance that I would be looking for habits
of mind and desire that could undermine the allure of military
thinking. Even before our first interview, I hoped that Helen
Cohn would offer me some good antiwar lines. But it was only
when I asked directly about war that she volunteered: "No
grandmother would want her grandchildren to go to war. They
might get hurt. It would be unsafe." We both knew that grand-
parents—grandfathers mostly—were fighting and planning
wars. Her remark sounded simple, as she never does. I quote it
as one does the quaint sayings of old women, grandmothers.
But Helen had it exactly right. Safety, the desire to protect,
the fear that "they might get hurt," is at the center of mother-
ing. Some mothers and more grandmothers may be indifferent,
too distant, or too weak to protect. But for the most part, as
Helen said, grandmothers do not want their grandchildren to
get hurt. And war, as we used to say, is dangerous for children
and other living things.
The desire for safety is not in itself an instrument of peace.
Keeping children safe may mean keeping them away from
"others" who would contaminate, corrupt, or demean them.
If there are, as was reported, "security moms" (and security
grandmoms?) who depend on the arms of strong leaders, it
may be safety they are looking for.
When I turned to grandparents, I hoped to identify some
elements of their thinking and relationships that might point
to inclusive, open conceptions of safety and nonviolent strate-
gies of protection. It proved too easy to transfer insights from
5. What Do Mothers and Grandmothers Know and Want? 83

the domestic to the military context—to consider the uses of

sentimental abstraction in each for example. Learning from
generational experience would take time, many conversations,
another paper. To conclude this chapter, let me turn from word
to image to describe as best I can a postcard I have on my desk
and the feelings it evokes.
The postcard was sent to me by Duane Cady, a friend,
philosopher, and pacifist. The card is titled "Iraqi children."
On one side there is a black-and-white photograph of children
who entirely fill the card. The photograph was taken by Ibrahim
Abdil-Mu'id Ramey, director of the Peace and Disarmament
program at the Fellowship of Reconciliation, when he was on
a visit to assess the effects of sanctions that followed the first
Gulf War. The children in the photograph are boys and girls,
early adolescents. They are not "cute," nor, evidently, political:
they are just waving and smiling. On the reverse side of the
card is the line: "In the dictionary of nonviolence, there is no
enemy. Mohandas Gandhi."
Since this picture was taken, many of these children, es-
pecially the boys, will have acquired light weapons, have shot
and been shot at. Some will have picked up cluster bombs that
exploded in their hands. Some of these children are likely dead.
If I imagine, grimly, that these smiling children are, though
safe when photographed, now maimed, killed, or turned into
killers, what do I, a citizen of the country who attacked them,
feel when I look at their smiling faces?
These smiling children could make me tearful, and they
have. But the tears, though temporarily comforting, do not ex-
press the feelings that this card prompted. I might feel ashamed.
But shame is a self-preoccupying emotion, which, at least for
me, easily turns aggressive. (I must admit that I searched for an
alternative to "attacked" in the previous paragraph and could
hardly bring myself to leave out the quotation marks.)
But if I wanted to induce or suffer shame, or to strength-
en my own or a reader's horror of war, I could have looked
at pictures of "dead bodies and ruined houses," to use the
phrase Virginia Woolf (1938) recurrently invoked in her clas-
sic pacifist and feminist polemic, Three Guineas. There are
many photographs from Iraq I could chose from, some now
notorious. The photo I have shows ordinary, amused, curious
84 Sara Ruddick

boys and girls crowding to be photographed by a stranger. If

their smiles point hauntingly to the violence that will befall
their city, this is only because we know, as they do not, the
trouble that is coming.
The p h o t o g r a p h does b e a r a message, a m e t a p h o r :
Gandhi's dictionary of nonviolence, which has no entry for
"enemy"—although it has many entries for wrongs and injus-
tices that must be resisted nonviolently. If I had had Gandhi's
dictionary with me as I wrote, and if I had found myself speech-
less without "enemies," I could have kept beside me poems
and images that would remind me of terrible and vicious acts
that no one excuses. But Gandhi's dictionary has gone missing;
there are entries for "enemy" in any dictionary I consult. Mili-
tary violence needs enemies, seeks enemies. Once you have
enemies, some of them will likely look like these children.
But even without Gandhi's dictionary, when I look at the
picture I still see these kids, smiling and waving, their utterly
ordinary happiness and trust caught forever by a friendly
photographer. It is this picture of ordinary happiness and
trust taken for granted, this picture that will not be destroyed,
that allows me to see clearly and sharply, and to feel in anger
and sorrow, what it is that violence destroys and will destroy
again.

ENDNOTE

1. For the most part, following the editor's terminology, I speak of mothers
rather than of parents or mothers and fathers, of grandmothers rather
than grandparents. But I am deliberately inconsistent. I do not want to
excuse or exclude men from any parental relations. Nor do I want to
deny the real differences of brain, spirit, and body, history and fantasy
that make for sexual difference among adults, including parents. I speak
more evenhandedly of grandparents or grandmothers. Grandparents
have lived in male or female bodies. Grandmothers will likely suffer the
inequities and prejudices distinctive to women in their social and ethnic
circumstances. But grandparents are aligned and divided by difference
more marked than sexual difference, which sometimes seem to make
no difference at all.
5. What Do Mothers and Grandmothers Know and Want? 85

REFERENCES
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Contemporary Maternal Dilemmas. Boston, MA: Beacon Press.
Kittay, E. F. (1999), Love's Labor: Essays on Women, Equality, and Depen-
dency. New York: Routledge.
— (in press), Equality, dependency and disability. In: Perspectives
on Equality: The Second Seamus Heaney Lecture, ed. M. Lyons & F.
Waldron. Dublin, IR: Liffey Press.
Ladd-Taylor, M. & Umansky, L., eds. (1998), "Bad" Mothers: The Politics of
Blame in Twentieth-Century America. New York: New York University
Press.
Nedelsky, J. (1999), Mother Troubles: Rethinking Contemporary Maternal
Dilemmas. Boston, MA: Beacon Press.
Nelson, H. L. (2002), What child is this? Hastings Center Report, 32:29-
38.
Nichols, M. (2004), Nannies around the world. Women's Rev. Books, Janu-
ary, pp. 12-13.
O'Neil, J. (2003), Vital signs: At risk—Grandmom's little health risk. The
New York Times, November 4.
Romero, M. (1992), Maid in the U.S.A. New York: Routledge.
— (1997), Who takes care of the maid's children? In: Feminism and
Families, ed. H. Lindemann Nelson. New York: Routledge.
Rosenstrach, J. (2004), Mom vs. nanny: The time trials. The New York
Times, September 9.
The New York Times (2004), Mother and child: A spreadsheet (7 letters).
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Tronto, J. (2002), The "nanny" question in feminism. Hypatia: J. Feminist
Philos., 34–51.
Williams, J. (2000), Unbending Gender: Why Family and Work Conflict
and What to Do About It. New York: Oxford University Press.
Woodward, K. (1999), Inventing generational models: Psychoanalysis, femi-
nism, literature. In: Figuring Age: Women, Bodies, Generations, ed. K.
Woodward. Bloomington: Indiana University Press, pp. 150–151.
Woolf, V. (1938), Three Guineas. London: Harcourt, Brace & World.
Wrigley, J. (1995), Other People's Children. New York: Basic Books.
Chanter 6

What Is a Mother?
Gay and Lesbian
Perspectives on Parenting
JACK DRESCHER
DEBORAH F. GLAZER
LEE CRESPI
DAVID SCHWARTZ

I watched many of my heterosexual friends disappear into

their child-rearing caves during my 20s and 30s. I began to
see a similar thing happen to gay and lesbian friends when I
reached my 40s. I was not entirely prepared or comfortable
with this state of affairs. When I learned that the Chelsea
apartment above mine was to be bought by two men who had
a two-year-old, I nostalgically longed for a time when living
in a gay neighborhood meant not having to put up with the
noise of children in the apartment above.
Jack Drescher, The Circle of Liberation

HISTORY

C
ultural change can be disorienting. Following the 1969
Stonewall riots in New York City, the politics of the
gay liberation movement were antiestablishment,
antimilitary, and antiinstitutional (Duberman, 1994). Free-
dom from oppression meant getting away from conventional,
heterosexual beliefs about what constituted acceptable forms
of sexuality. In what would later come to be regarded as the
pre-AIDS era, many gay writers preached in favor of either a
subversive or a revolutionary gay sexuality. Theirs was a cry

87
88 Jack Drescher, Deborah F. Glazer, Lee Crespi, and David Schwartz

for increased freedom of sexual expression, regardless of how

much it discomfited the heterosexual majority. Post-Stonewall
gay liberationists argued that gay men and lesbians would not
get their rights by trying to act like heterosexuals. They argued
that the overtly sexual gay man did not have to be a denigrated,
heterosexual stereotype; instead he could wear his sexuality
as a gay badge of honor (Rechy, 1977). This became a defin-
ing moment in an era in which calling people "promiscuous"
meant they were having more sex than you were.
Tragically, the liberatory sexual philosophy of the 1970s
did not anticipate the devastation to be wrought by the AIDS
epidemic that followed in the next decade. Furthermore, the
bottle-throwing drag queens at the Stonewall could hardly have
imagined that, in the 35 years that ensued after their historical
uprising, the movement for gay and lesbian civil rights would be
fiercely fought around such establishment issues as the delivery
of adequate health care (Shilts, 1987), the right to serve in the
military (Shilts, 1993), the right to get married (Sullivan, 1997),
and the right to bear, adopt, and, care for children (Glazer and
Drescher, 2001; D'Ercole and Drescher, 2004).
In retrospect, however, the revolution succeeded in ways
the early firebrands never imagined. Although gay liberation
did not bring about a radical rethinking of acceptable forms of
open sexual expression among the heterosexual majority, it did
sow the seeds of a gay consciousness among subsequent genera-
tions. However, men and women raised in the post-Stonewall
era shaped the meanings of being gay or lesbian to suit their
own generational needs. By doing so, they went back to the
future: by the late 1980s, gay and lesbian political goals came to
resemble those of the polite, homophile movement of the 1950s
and early 60s that the Stonewall riots had supplanted (Bayer,
1981). Instead of in-your-face radicalism, the goal once again
was to fit into mainstream society. Increasingly shedding the
old cloak of invisibility, gay men and lesbians began to speak
with a more conservative voice. In the process, they began to
ask not only for a place at the table (Bawer, 1993), but also, as
in today's marriage debate, a place at the head table.
To social conservatives, same-sex marriage seems a
completely radical idea. In fact, the quest for marriage rights
6. What Is a Mother? 89

actually represents a growing conservative trend in gay cul-

ture. In any event, the pursuit of same-sex marriage has led
to a national dialogue about what civil rights gays and lesbians
can extract from the heterosexual majority and has fostered
a conversation within the gay community itself about defini-
tions of gay identity.
As same-sex marriage and gay and lesbian parenting are
part of a social agenda to normalize homosexuality, the issues
surrounding same-sex marriage are linked to gay and lesbian
parenting. Not surprisingly, the early activists of the movement
did not particularly concern themselves with the raising of
children. On the contrary, liberation politics were aligned with
a growing ecology movement and concerns about overpopula-
tion. Seen from this perspective, heterosexuals were sometimes
denigratingly referred to as "breeders" who conspicuously con-
sumed the world's limited resources whereas nonreproductive
homosexuality was considered "environmentally friendly." Gay
and lesbian parents were former breeders who had produced
children in the failed heterosexual marriages that preceded
their coming out.
Times change. Today family values have taken root and
are flourishing in the gay and lesbian community. Many gay
and lesbian couples now ask each other how they feel about
having children before they make long-term commitments.
Ironically, just as early gay writers put their literary energies
into exalting their revolutionary sexplay, some of today's most
articulate gay writers have become doting, middle-class parents
who write about the thrill of changing their babies' diapers
(Green, 1999).

PSYCHOSOCIAL ISSUES

Gay men and women are increasingly seeking the option of

becoming parents. The availability of new reproductive techno-
logies, surrogate mothers, and donor sperm and the increased
acceptance of gay men and lesbians by adoption agencies and
courts are changing the cultural landscape (Mamo, 2004). In
this gender-bending environment, lesbian mothers and gay
90 Jack Drescher, Deborah F. Glazer, Lee Crespi, and David Schwartz

fathers are entering territory previously uncharted by tradi-

tional psychoanalysis.
In preparation for entering this new territory of parent-
hood, many lesbian and gay parents tend toward extensive self-
examination. Doing so makes them especially well equipped
and prepared to be parents (Baran and Pannor, 1989). Never-
theless, even with all the preparation in the world, the decision
to pursue parenthood can evoke many changes in the experi-
ence of self.1 For example, the pursuit of parenthood can be
particularly poignant for a lesbian whose earlier coming-out
experiences and self-definitions as a lesbian excluded any
possibility of motherhood. Gay or lesbian parents may need
to address questions their children face about the nature of
their birth. They may also need to cope with discrimination
against their children and against themselves. Prior family
experience may not provide a model to help gay and lesbian
parents respond to the social pressures placed on those who
live in alternative family configurations.
Some gay men and lesbians grieve their ability to procreate
through traditional means. Crespi (1995) recounts a mourn-
ing process that a lesbian may experience in acknowledging
the desire to make a family with someone with whom she
cannot conceive a child. This mourning may resemble the
grief experienced by infertile heterosexual couples or those
who are unable to reproduce by conventional means. Unre-
solved mourning prevents some women from having children
in their lesbian relationships; others may experience a sense
of inadequacy and fraudulence in their identity as mothers,
their mothering not having been attained through traditional
heterosexual means. Again, this kind of mourning may be true
for gay male and heterosexual couples relying on reproductive
technologies as well.
If both women in a lesbian relationship have an intense
desire to mother, unique conflicts may arise. The first struggle
may occur with the selection of which partner is to conceive
or who will conceive first. In some lesbian couples, one woman
may have her egg fertilized in vitro with donor sperm and then
implanted in her partner for gestation. This approach may
not only reduce some of the competitive feelings surrounding
6. What Is a Mother? 91

giving birth, it may also provide greater legal attachments to

both parents.
Competitiveness can also be found in gay male couples
deciding which partner will inseminate a surrogate. Some gay
couples may attempt to resolve this issue by having a surrogate
fertilized by the sperm of both of them. In this way, unless ge-
netic testing is done, each partner can feel that he is the "real
father." As often happens in birth and adoption situations, one
parent may be erroneously identified as the "real mother" or
"real father." The nonbiological/nonlegal parent may have to
cope with unexpected feelings of anger and rejection instead
of the hoped-for joy and excitement.
During the pregnancy or the wait for an adoptive child,
much preparatory work is done to reconfigure the new fam-
ily and find each member's internally r e s o n a n t role. For
many lesbian couples, for example, this process may unfold
smoothly, as each woman finds herself gravitating toward the
role that suits her disposition and resonates with her own pa-
rental identifications. If these roles are complementary, each
partner can accommodate the other in a fluid and mutually
supportive way.
Another concern for some lesbians, particularly when
considering donor insemination (DI), is whether the biological
mother will, a priori, have a stronger bond with the child. In
interviews with lesbian couples, Crespi (2001) found that
the comother—when actively and fully engaged in caregiv-
ing—had the potential for an equal or even stronger bond. In
some cases, the biological mother returned to work to a more
demanding schedule, leaving her partner the opportunity to
spend more time with the child. In other cases, the nonbirth-
mother's personality style propelled her to take a more active
role, either because she was less anxious or temperamentally
more attracted to caring for an infant.
Nursing a baby may also foster competitive feelings. Nurs-
ing can often signal the identity of the "real mother" to the
outside world. At home, a sense of inauthenticity or inadequacy
may develop in the nonbirth mother who is unable to soothe
their baby as satisfactorily as the nursing partner. 2
When both partners were able to take a more or less
92 Jack Drescher, Deborah F. Glazer, Lee Crespi, and David Schwartz

equal role in most daily routines, the child appeared to bond

relatively equally to both. When preferences were shown, they
alternated and shifted over time, as would typically be expected
during the stages of child development. In these families, when
competitive feelings arose, they were usually transient and
were mitigated by a capacity for emotional identification by
each woman with her partner's experience, as well as by the
inevitable shifting of preferences within the child.
When one partner assumed the primary nurturing role,
whether the biological or the coparent, the child showed a
clear preference for that parent. This phenomenon has also
been observed in heterosexual families with primary nurturing
fathers, in which even breast-fed babies demonstrated a de-
cided preference and stronger bond for the father (Pruet,
1983). "[T]he child's response to either p a r e n t . . . i s more a
function of the nature of the parent-child interaction than of a
biological predisposition" (Kotelchuck, 1976, p. 343). However,
when the primary nurturer is also the biological parent, there
is more of a potential for feelings of exclusion to arise and for
the nonbiological parent to feel peripheral.
When one of the partners in a couple had a biological role
in conceiving their child, the nonbiological, noncaregiving
lesbian mother or gay father can find herself or himself in an
awkward position. For example, the nonbiological parent may,
in fact, have no legal standing in relation to the child. 3 Neither
legally nor biologically related, nor the primary nurturer of the
child, that parent must invent an altogether original social role
in relationship to the child and to the nurturing parent-child
dyad. Furthermore, this must be done with few socially defined
constructs that legitimize the parent's status in the family. He
or she, probably having no role models with whom to identify,
receives little direction or reinforcement from the social milieu
which often does not recognize such individuals as parents at
all (Tasker and Golombok, 1997).
A woman's strong desire to mother may often be accom-
panied by an equally strong sense of entitlement to be the
primary parent (Crawford, 1987). This need may derive from
an identification with her own mother and an internal psy-
chological representation of mother that does not allow for a
6. What Is a Mother? 93

secondary position in relation to the child. As women are often

socialized to be the primary nurturers, it may be difficult to
organize one's feelings of exclusion or rejection when the child
shows a strong preference for one parent over the other. This
difficulty may also arise, however, in gay male couples where
the child prefers one partner, despite the more conventional
social construct of father as secondary parent.
Psychoanalysis has historically defined the role of the
father in the early years of a child's life as supporting and
protecting the mother-child dyad (Winnicott, 1956). Or the
role of father is to foster exploration and disentangle the child
from the symbiotic tie to the mother (Mahler, Pine, and Berg-
man, 1966). In families where the father is the primary care-
taker (Pruet, 1983), however, these fathers have the ability to
nurture and bond as deeply as mothers as a consequence of
their having had strong positive identifications with their own
nurturing mothers.
Similarly, if a lesbian mother is able to call on a positive
identification with her own father, she may be able to assume a
role of supporter, stimulator, and mediator in a nonconflictual
way. However, a lesbian who has disidentified with her mother
(Schwartz, 1998) but is conflicted about identifying with her
father may have difficulty defining her role as parent. She may
feel that she is failing as a woman if she is not the primary
nurturer. This feeling will be compounded if she has previously
tried and been unable to conceive. She may feel her identity
threatened by being perceived as being in the traditional father
role. If her relationship to her father is conflicted, she might
lack a positive internal model with whom she can identify.
As there are still so few, if any, archetypes in the culture that
support a woman in the role of coparent or a man as primary
nurturer, those who find themselves in these roles may have
few places to turn for validation and confirmation.
It should be noted that biological mothers are not entirely
free of the stressors involved in navigating the dynamics of the
lesbian-mother relationship. The birth mother may experi-
ence powerful, often ego-dystonic feelings of competition if
she envies the freedom of the nonbirth mother to go out in the
world while she remains home tending the baby. A new lesbian
94 Jack Drescher, Deborah F. Glazer, Lee Crespi, and David Schwartz

mother may often be unpleasantly surprised to find herself in

precisely the kind of domestic situation from which she had
previously believed her lesbian identity had freed her.
More problematic than competition between the two
parents—and potentially more destructive—is what could be
understood as a dyadic versus triadic problem. This problem
may arise when one (or both) partner has a strong unresolved
need for a two-person relationship that interferes with the
ability to enter into a three-person relationship. This inability
may be the result of an overly symbiotic tie to the partners's
own mother, which was never sufficiently resolved (Mahler et
al., 1966). Conversely, insufficient nurturing from one's own
mother may leave a person in a state of ongoing object hunger.
A child's entrance into the couple's dynamics can sometimes
reactivate early dyadic needs and destabilize the couple's
bond, resulting in a painful exclusion of one partner. This may
manifest itself in a variety of ways. For example, either partner
may become overly critical of the other's parenting and try to
control all situations involving the child.
Dyadic problems, however, are not unique to lesbian-
and gay-parented families. They are also seen in heterosexual
couples in which the mother becomes overly involved with
the children or the father finds himself on the periphery of the
family. Conventional social constructs, however, may allow a
father to organize this situation in ways that make this more
tolerable (retreating to a men's club, for example), although
such a "solution" may result in a greater distance between the
heterosexual couple.
Gay and lesbian parents may face increased demands in
reconciling the multiple self-representations related to gender,
object choice, and motherhood. In the heterosexual commu-
nity, a lesbian- or gay-headed family can often be viewed as
anomalous or even deviant, and these mothers and fathers
may face rejection and homophobia. In some lesbians and gay
men, such reactions can reawaken feelings of difference and
unrelatedness experienced during the childhood, adolescence,
and coming-out phases. These feelings in turn, can lead to a
striving for invisibility, a self-protective stance used to ward
off feared attacks and rejection in heterosexist and homopho-
bic environments. Nevertheless, disclosure of a lesbian or gay
6. What Is a Mother? 95

parent's identity can occur in situations where the parent feels

unsafe and would prefer invisibility—for example, on a bus
or elevator when a small child decides to introduce her two
mothers or two fathers to every stranger within earshot.
The first research on children born to mothers of lesbians
who left their heterosexual marriages is now almost a quarter
of a century old (Kirkpatrick, Smith, and Roy, 1981). There has
been a growing amount of research on the children raised in
gay and lesbian households since that time (Kirkpatrick, 1996;
Patterson and Chan, 1996). However, the new generation of
children born to and raised by "out" lesbian mothers and gay
fathers is not yet old enough to allow for a fuller understanding
of the intrapsychic and developmental influences of alternative
family configurations. Lesbian mothers and gay fathers will
inevitably have to address questions their children face about
the nature of their birth and will experience increased stress in
coping with a type of family life for which they have no model.
They may also have to cope with discrimination against their
children. As a child becomes increasingly involved in the world
outside the home, the psychological stressors on the parent
may increase. Having one's child face bias or rejection may
cause the lesbian mother or gay father to reexperience the trau-
mas of their own childhood recognition of same-sex longings
and the coming-out experiences they faced in adolescence and
young adulthood. Nevertheless, increasing social acceptance is
helping lesbians and gay men expand their experience in their
roles as women and men, moving beyond what it meant to be
lesbian or gay in previous generations. As lesbian mothers and
gay fathers become more visible, they will increasingly enter
into the realm of psychoanalytic inquiry. The question remains
whether psychoanalysis is yet up to the task of making sense
of their experiences.

DECONSTRUCTING M O T H E R

Same-sex parents—as well as a growing number of hetero-

sexual, single-parent households—inevitably raise the ques-
tion, "What is a mother?" More than half a century ago, one
of psychoanalysis' most innovative thinkers approached the
96 Jack Drescher, Deborah F. Glazer, Lee Crespi, and David Schwartz

q u e s t i o n indirectly, a t t e m p t i n g to a n s w e r i n s t e a d t h e q u e s t i o n
of w h a t is a b a b y :

"There is no such thing as a baby." I was alarmed to hear

myself utter these words and tried to justify myself by point-
ing out that if you show me a baby you could certainly show
me also someone caring for the baby, or at least a pram with
someone's eyes and ears glued to it. One sees a "nursing
couple."
In a quieter way today I would say that before object
relationships the state of affairs is this: that the unit is not
the individual, the unit is an environment-individual set-up.
The center of gravity of the being does not start off in the
individual. It is in the total set-up. By good-enough child
care, technique, holding, and general management the shell
becomes gradually taken over and the kernel (which has
looked all the time like a human baby to us) can begin to be
an individual [Winnicott, 1952, p. 99].

Half a century later, a children's television show, The

Rugrats, picks up where Winnicott left off. In the show's
Mother's Day special, several children explain what a mother
is to Chuckie, a toddler whose mother died: "A mother loves
you, and feeds you, and takes care of you." In a moment of
postmodern insight, Chuckie excitedly realizes he too has a
mother and happily proclaims that it is his father!
So what is a mother? With few exceptions (Glazer and
Drescher, 2001; D'Ercole and Drescher, 2004), psychoanalysts
rarely come at this question from a gay and lesbian perspective.
It is worth considering the meanings of the absence of gay and
lesbian perspectives from the psychoanalytic canon, for not
only are there political implications, there are theoretical and
clinical ramifications as well. Many analytic formulations are
rooted in developmental theories based on family constella-
tions of the 19th century. This inevitably leads some analysts
to pathologize efforts by gay men and lesbians to parent while
others resort to Procrustean, heterosexual formulations in ef-
forts to make sense of these families (Schwartz, 2004). For the
most part, however, heterosexual psychoanalysts have ignored
the theoretical challenges raised by the growing number of gay
and lesbian parents and their families.
6. What Is a Mother? 97

An exception is the increasing number of openly gay and

lesbian analysts who have tried to make sense, in general,
of gay and lesbian lives in a deconstructive way (O'Connor
and Ryan, 1993; Schwartz, 1993, 1995, 1996; Domenici and
Lesser, 1995; Magee and Miller, 1997; Schwartz, 1998; Dre-
scher, 1998; Lesser and Schoenberg, 1999; Drescher, D'Ercole,
and Schoenberg, 2003; D'Ercole and Drescher, 2004). 4 While
their work does not necessarily offer specific answers to the
question "What is a mother?" they nevertheless raise many
other questions regarding psychoanalysis' problematic sanc-
tification of mother.
For instance, how have the concepts of mother and moth-
ering functioned in psychoanalysis, particularly in their inter-
play with gender, sexuality, and ethics? What are the position,
use, and function of the concept of mother within psycho-
analysis? How, in the tradition of Foucault (1978), would one
denaturalize mother or show how the category's persistently
superordinate position and impact in psychoanalytic theory
are a function of other forces besides their correspondence
with any sort of scientific or even psychological truth? How is
one to understand the politics of mother? How can one under-
stand the extraordinary power and privilege of mother and of
the risk of anyone's questioning its nature?
Obviously, mother is no ordinary concept to deconstruct.
Instead, like certain other psychoanalytic shibboleths (e.g.,
femininity-masculinity), but perhaps even more so, mother's
range of implication is great and diverse; when one presses
against it, one touches on much more than is immediately
evident. In psychoanalytic culture, probably even more than
in other intellectual environments, mother can be seen as en-
compassing the personal, the theoretical, the clinical, and the
political. In one way or another, everyone exists in powerful
relation to the authority of multiple mothers: as children to
our own mothers, as analysts to our patients' internalizations
of their mothers, and in the transferential sway of cultural
maternal imagery.
As one deconstructs mother, aspects of the concept, both
qualitative and formal, begin to come into relief. On the formal
side is mother's ubiquity apart from its denotative function.
Mother can be a passionate interjection, part of an obscenity,
98 Jack Drescher, Deborah F. Glazer, Lee Crespi, and David Schwartz

a superlative modifier; it may play a role in an insulting tirade.

But more important is its very specific qualitative aspect, for
this aspect, in subtle ways, establishes some of the limits on
what can and cannot be said of mother. Mother is a being and
mode of relatedness that simultaneously signifies vulnerability,
authority, fecundity, femininity, safety, nurturance, power,
generosity, and specific types of wisdom, among other things.
Mother requires respect, love, awe, veneration, protection,
and humility. To begin to question even recent accretions
to this ever-growing signifying edifice is to take aim at an
institution that is at once the not-to-be-questioned authority
and an exposed woman. Anyone who would question her is
simultaneously arrogant and brutal, foolishly irreverent, and
without a heart.
After all, a deconstruction of a concept or institution (ar-
ticulation of its latent and unspoken origins and functions) is
usually, in some sense, a demotion of that concept or institu-
tion. The deconstructionist's goal is to disrupt unwarranted dis-
cursive hegemonies or harmful regimes, both intellectual and
institutional. Thus, from a queer perspective, deconstructing
mother means taking on its taken-for-granted, privileged status
struck in certain areas of political concern, in particular with
respect to the status of women, the idealization of heterosexual-
ity and natalism. Consequently, in deconstructing mother, its
demotion is necessarily also part of the agenda, and significant
anxiety cannot be far behind. 5

CONCLUSION

The anxiety associated with the deconstructive demotion of

mother may, in fact, underlie some of the cultural resistance
to gay and lesbian parenting. As the category of mother is a
naturalizing or essentializing cultural trend, then for some the
very existence of gay and lesbian parents threatens the socially
constructed "natural order" of human sexuality. 6 How can it
be "natural" to have two mothers or no biological mother?
In religions, the arbiter of what is natural is either a deity
or a collection of writings purported to represent the deity's
will. In science, the determination of what is natural often rests
6. What Is a Mother? 99

on an anthropomorphic view of evolution or of evolutionary

processes that "expect" human beings to behave the way nature
intended. In psychoanalysis, it is not quite clear to whom one
should turn for a working definition of nature. One hundred
years ago, Freud (1905) unashamedly tried to link his own
psychological view of human sexuality's natural order to the
biological theories of his time.

The final outcome of the sexual development lies in what is

known as the normal sexual life of the adult, in which the
pursuit of pleasure comes under the sway of the reproductive
function and in which the component instincts, under the
primacy of a single erotogenic zone, form a firm organization
directed towards a sexual aim attached to some extraneous
sexual object [p. 197].

Many in today's psychoanalytic world no longer subscribe

to Freud's sexual theories. Yet, even among interpersonal and
relational analysts, heterosexual models of reproduction and of
nuclear families continue to serve as compelling cultural narra-
tives, just as they did for Freud. As we have shown, constructs
based on traditional heterosexual modes of reproduction often
affect the way the gay and lesbian couples perceive themselves,
their intimate relationships, and their families. Inevitably, these
constructs will also affect the way psychoanalysts perceive gay
and lesbian parents. Reproductive technologies, however, are
creating a new kind of sexual revolution and a gender revolu-
tion. Psychoanalysts need to consider the impact these changes
will have on their own theories and practices.
The very human resistance to letting go the familiar, es-
pecially the familiar associated with order, clarity, and some
modicum of certainty, will slow psychoanalysts' efforts to
honestly examine such concepts. Such an exploration may
require that psychoanalysis turn its unique investigative instru-
ments on the fundamental assumptions behind the prevalent
ideologies of gender, sexuality, family, and political economy.
Doing so may lead to the discovery that some forces inimi-
cal to human growth are embedded even in some cherished
psychoanalytic concepts, like mother, that have been taken-
for-granted. Nevertheless, an explicit commitment toincluding
100 Jack Drescher, Deborah F. Glazer, Lee Crespi, and David Schwartz

a specifically psychoanalytic scrutiny of our most basic as-

sumptions (especially those that appear most innocent) may
go some distance toward limiting and reversing the damage
unquestioned axioms may do.

ENDNOTES

1. For example, Winnicott (1956) wrote of the regressive nature of becoming

a mother. A mother-to-be experiences a loosening of her defenses (Blos,
1985), which can bring about a repetition of developmental issues and
an opportunity for her to revisit and resolve earlier conflicts, particularly
with her own mother (Benedek, 1959). For some, the mothering experi-
ence may be growth enhancing and reparative (Glazer, 1998).
2. In the Crespi (2001) study, when breastfeeding could be alternated
with bottle-feeding, the partner was able to share greatly in the early
feeding experience, thus enhancing a sense of maternal adequacy and
authenticity.
3. The feelings generated by the absence of a legal relationship may also
hold true in same-sex couples who have adopted a child in a state that
does not allow second-parent adoptions.
4. Gay and lesbian analysts, of course, are not the first to deconstruct
psychoanalytic notions of motherhood. They follow or work in parallel
with the tradition of queer theorists (Butler, 1990; Sedgwick, 1990) and
feminist psychoanalysts (Chodorow, 1978; Dimen, 1991; Goldner, 1991;
Harris, 1991).
5. One of the authors (Schwartz) locates his own early deconstruction of
mothering to teaching psychology undergraduates at Brooklyn College
in 1973, when he emphasized that there were no data to suggest that
the biological mother made a unique contribution to child rearing that
could not be provided otherwise, for example, by an adoptive parent, an
extended-family member, or someone employed for the purpose. At the
time he was concerned with conservative attacks on efforts to support
working mothers economically and psychologically. Not surprisingly,
student reactions were very anxious and mixed, leaning to the right.
Some male students responded with mock seriousness; they objected to
Schwartz's effort to "take away" their beloved mothers.
6. That which is natural is given greater hierarchical value than that which
is "unnatural." For example, in contemporary culture, the natural is a
highly prized category used to market commodities. To call something
natural is another way of saying that it is good, or at least to claim that
it is better than something that is not natural. Thus, saying people are
"born gay" is another way of saying it is a natural occurrence, rather
6. What Is a Mother? 101

than a moral failing. In our culture, a belief in the goodness of nature is

a very old one that permeates almost all levels of discourse.

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Chanter 7

It's A(p)Parent
New Family Narratives Are Needed
ADRIA E. SCHWARTZ

A
s I think of him, I first met Josh when he arrived in
my office with Vicki in what appeared to be a green
oxygen tank filled with frozen sperm, packed in dry
ice. Vicki, my patient, inseminated her partner Margaret that
afternoon. Josh was born nine months later. He is now seven
years old and plays the cello. He has a baby brother, Andrew,
who has the same donor, but who was birthed by Vicki. Each
boy has two moms, but in some ways Josh is Margaret's and
Andrew is Vicki's—not necessarily in the minds of the boys,
but in the minds of the moms. In relation to her nonbiological
son, each has trouble feeling that she is the "real mom."
I ask us all to rethink the ways in which we theorize fami-
lies, given the degendering of parenthood that has occurred
in the postmodern family, and given the obsolescence of the
universal oedipal triangle as the structure for determining
gender, sexual orientation, and other allegedly fixed aspects
of identity.
We now recognize that gender and sexuality are not unitary
identities but function on a continuum of change and modu-
lation, figure and ground. Relational theorists have helped us
to understand that internalizations are variegated and multi-
leveled in relation to development. It is the qualitative relation
to these objects that is internalized, not the objects themselves.

Dr. Schwartz died in January 2003. The manuscript she had used for her What
Do Mothers Want? conference presentation was prepared as a chapter for this
book by Rima Shore.

105
106 Adria E. Schwartz

Multiple aspects of self in relation to various parenting experi-

ences emerge for all of us, and come to hold sway in different
developmental periods.
Our earliest internal representations, Stern (1989, 1991)
has suggested, are of relational patterns, cumulative interactive
histories with significant others: a series of repeated interactive
events that are mutually derived and subjectively constructed.
These representations are a function of objective events and
subjective experiences alike. Developing relational theory,
then, allows for the possibility of a system of caretaking fig-
ures whose gender, sexual orientation, or biological relation
to their offspring may not be taken for granted. This is the
foundation of our new family narratives.
Feminist anthropologist Ellen Lewin (1993) did a landmark
study comparing lesbian and heterosexually identified single
mothers. Lewin concluded that being both a lesbian and a
mother challenges the tendency, in American culture, to con-
flate "woman" and "mother" and define lesbians as neither.
Thus, claiming the identity of lesbian mother may be construed
as an instance of resistance to prevailing sexual politics.
By becoming mothers, lesbians join heterosexual women
in a particular organization of identity that partakes of a more
mainstream gender ideology. The notion that motherhood
supersedes other dimensions of identity is shared by lesbians
and heterosexuals. Becoming a "lesbian mother" sometimes
enables women to gain a certain status in our gender system,
but it may also further embed them in traditional gender ide-
ology. In same-sex parented families, vestiges of traditional
gender ideology may, in turn, give rise to problems in the form
of strong competition between lesbian mothers. In such cases,
insecurities abound about who is (or is capable of being) the
"real mom."
I raise this issue not because it is endemic to same-sex
parented families or indicative of pathology; rather, I raise it
to illustrate the ways that we can begin to think meaningfully
about what goes on in our new families and how we might be
better able to listen to and understand new family narratives
without the straitjacket of old paradigms.
This particular problem arises in families composed of two
7. It's A(p)Parent 107

lesbian-identified mothers, where one is the "bio" mother and

the other is not. There are some situations where both mothers
can claim to be the biological mother (where one partner do-
nates an egg to the other and the child is conceived through
in-vitro fertilization), but the numbers are still too small to
allow meaningful clinical impressions about the relationships
between these parents.
In families where "real mom" difficulties arise, one parent
gives birth to, and most likely nurses, a child; the other parent
is left to contend with feelings of envy, exclusion, and insecu-
rity about her child's attachment. When both women have an
intense desire to conceive, or one woman is unable to conceive,
these issues may be compounded.
I have come to question whether there is a fundamental
dyadic situation established through the birthing and nurs-
ing relationship, where the nonbiological, nonnursing mom
becomes a "third," gaining importance later in development
but holding a different psychic space in the family early on—a
space determined by position as well as by personality (Armel-
ini, 2001). Is there an intrinsic validity to the coparent's feel-
ings of envy and exclusion? What might be the consequences
of such feelings for the dyad and for the triad?
I have worked with a number of couples in which the non-
nursing moms consistently complained of feeling excluded from
the primary dyad. They expressed distress at having the baby
or toddler or three- or four-year-old reject them at times when
certain forms of comforting were required. They complained
of never really being able to "get in" in the same way that the
birthing/nursing mom can. How are we to understand this?
Josh's family is representative of these families: two
lesbian-identified moms, each the bio mom of one of two boys
who are biologically related to each other by virtue of sharing
the same donor. Each mother wants very much to fulfill her
biological potential to mother—her "essential" motherhood.
But, in some way, these women were caught in a net of tradi-
tional gender ideology that could admit only one "real mom,"
leaving the coparent fearing for her place in the family.
After Josh was born, Vicki wanted very much to use a
breast pump to facilitate a sympathetic lactation so that she
108 Adria E. Schwartz

could share both the nursing responsibilities and the nursing

experience. Margaret was initially ambivalent and later became
adamant in her disapproval of the project.
While denying that nursing Josh would significantly affect
the quality of the mother-son bond, Margaret simultaneously
"confessed" that "deep down" she believed that a child can
have only one "real" mother, and she was going to be it. Vicki
(according to Margaret) had the brilliant career, one with which
she, Margaret, could never successfully compete, despite her
own substantial accomplishments. Essential motherhood was
the one thing Margaret could claim to be and have. Despite what
Margaret believed intellectually, emotionally she was not able
to relinquish the primary maternal field or share it equally with
Vicki. Moreover, although she acknowledged that her exclusive
nursing might make a difference in earliest infancy, Margaret
promised that ultimately they would share parenting equally,
just as they had shared in selecting the criteria for donor selec-
tion, the insemination process, and Josh's last name.
Vicki capitulated to Margaret's wishes reluctantly but
without much resistance. Why?
Since entering psychoanalysis, Vicki had struggled with
a feeling that she was not a "real girl." In my experience, les-
bians who have grown up feeling "not-female like mother,"
deidentified with their mothers, have a difficult time envisaging
themselves carrying and birthing a baby. I have written about
this partial identification in greater detail elsewhere (Schwartz,
1998).
Vicki did not fight more effectively for equal participation
in the nursing process because of her unconscious conviction
that she could not be a "real mom." How could she be a "real
mom" if she was not a "real girl"? 1 As Josh developed, Vicki
faded more and more into the background whenever she was
asked to by Margaret or Josh.
Vicki was an artist who worked both at home and as a
consultant outside the home. Margaret was a part-time aca-
demic, also working both at home and outside. They had no
regular working hours. Josh quickly learned that, by strongly
exercising his preferences for which mom was to do what and
when, he could exercise control over what must have appeared
to him as the random comings and goings of his moms. Given
7. It's A(p)Parent 109

Margaret's desire to be the preferred mother and Vicki's inse-

curities about her ability to be a mother at all, Josh was able
to control his moms in a way that was, of course, a loss for
the three of them. Vicki became increasingly estranged and
critical of Margaret's parenting. In response, Margaret grew
angry, resentful, and withholding of affection from Vicki. Josh
grew ever more controlling.
The relationships between mothers and son became more
and more skewed as Josh expressed frequent and strong prefer-
ences for Mommy Margaret over Mommy Vicki—at bedtime,
bath time, on the way to preschool. Vicki was profoundly upset
at these moments. But how could it be otherwise when Vicki
so often colluded with the asymmetry?
It is not uncommon, of course, for fathers to feel excluded
from the mother-infant dyad. A father might experience deep
feelings of abandonment by his spouse, with transferential
resonances. Feeling excluded from the mother-infant dyad,
he might experience rivalrous rage and feelings of worth-
lessness (Donna Bassin, personal communication). But in
heterosexually identified families, putative moms and dads
less often compete directly as parents. The months of earliest
infancy are often ceded to mothers, especially nursing moms,
and fathers do not really move closer until the child becomes
a toddler (Armelini, 2001). That situation is changing now as
more fathers become involved earlier; but, for the most part,
competition between heterosexual parents is often mitigated
by a culture that expects mothers and fathers to have different
gender-based relationships with their children.
When both partners in a lesbian couple wish to birth a
child, there is the obvious issue of who is to become pregnant
first. Aside from such practical considerations as age, or whose
career might be better able to accommodate a pregnancy and
maternity leave, these decisions often involve complex un-
conscious identifications that may either facilitate or impede
progress toward pregnancy.
Vicki, in the aforementioned couple, wanted very much
to birth a baby. Margaret, however, "went first" ostensibly
because she was already in her mid-30s and older than Vicki.
But it was also the case that Vicki could not imagine actually
being pregnant and bringing a child to term. Long before she
110 Adria E. Schwartz

ever seriously contemplated becoming a mother, she had

recurrent dreams of babies who were hairy and deformed.
At the time, these dreams seemed to represent her sense of
deformity and monstrousness (Vicki as the abject object of
her parents' physical and emotional abuse). But, in part, they
were also a reflection of her internalized homophobia (Butler,
1995; Herek, 1998).
When Vicki first came into analysis, despite being a promi-
nent "out" artist and recognized professionally as such, she
claimed actually to "hate lesbians" and assumed that there was
something essentially wrong, a developmental arrest perhaps,
when one deviated from a normal heterosexual course. She had
no real desire to change her sexuality but seemed resigned to
her baseline defect with the unconscious presumption that she
would ultimately be punished, most likely by dying from AIDS.
Vicki's dreams took on additional meaning as she confronted
her desires to become a mother.
Vicki's conviction that she was "not a real girl," her dei-
dentification with her mother-as-female, coupled with an inter-
nalized homophobia, increased her narcissistic vulnerabilities
and seriously eroded her confidence as a mother.
At one point during Vicki's analysis, however, as the work
progressed from issues of her internalized self-hatred to her
increasingly ambivalent feelings of being "not-female like
mother," Vicki announced playfully, after seeing the film Ju-
nior, "If Arnold Schwarzenegger can become pregnant, I guess
I can too." She had decided that she would indeed become
pregnant, bear a child, and provide a sibling for Josh.
Vicki has done just that, choosing the same unknown do-
nor so that Josh has a biologically related sibling. This practice
has become more common as lesbian and gay parents feel
entitled to create larger families and seek to bind their fami-
lies biologically in a world that still holds completely chosen
families suspect.
After a devastating miscarriage, Vicki has birthed a son
who nurses voraciously and smiles constantly, and whose
love provides much needed reassurance to Vicki that she can
be a "real mom" and a good mom at that. Vicki still struggles
with feelings of illegitimacy. She lives in constant dread that
something awful will befall one or both of her children by way
7. It's A(p)Parent 111

of illness, accident, or malevolence. She has had these fears

for Josh, but the fears have increased exponentially with the
birth of her second son. Many parents worry that they can-
not protect their children from life's dangers, especially in
these times of seemingly unbridled terror and aggression. In
this case, however, analysis has revealed that Vicki's fears are
due to lingering doubts about whether she and Margaret, as
lesbians, are truly entitled to the happy family that they seem
to have created.
To return to our "real mom" problem: It seems plausible to
me that there may be different forms of attachment, representa-
tion, and internalization in infants who nurse exclusively with
one parent, compared with infants who are fed more equally
by two parents. Issues of asymmetry in early attachment and,
consequently, issues of jealousy, envy, exclusion, and competi-
tion might arise more frequently in lesbian couples where there
is one bio/nursing mom than surface in lesbian couples where
the nursing experience is more equally shared.
Competition between lesbian moms can begin here and
extend through middle and late childhood, with the nonbio
mom feeling always a little less than, and not quite equal to,
the bio mom in the child's eyes. When this asymmetry exists,
how the two mothers handle it depends in part on the internal-
ized maternal representations carried by each, as well as on
the conscious and unconscious ground of their partnership.
In Vicki and Margaret's family, their partnership was es-
sentially sound, loving, and aspiring toward a fundamental
noneompetitiveness and equality. Their difficulties arose out
of their insecurities around mothering: in the case of one,
insecurity about competence and legitimacy based on early
identifications; and, in the other, insecurity about the possibil-
ity that mothering can be authentically shared given its casing
within a traditional gender ideology.
It is incumbent on us as clinicians and theoreticians to
reconfigure the psychic family. We must recognize the limi-
tations of the once-foundational oedipal triangle, so that we
may more accurately represent families as they exist today.
The relational intersubjective approach has helped us to be-
come aware of the impact of parental subjectivities and the
subjectivities of the multiple significant caretakers involved
112 Adria E. Schwartz

with today's families. Each parent/caretaker is a parent in her

particularity. Difference need not be read hierarchically within
the developmental spectrum.
Our new family narratives reveal multiple internal pa-
rental relations changing over time in tune with changing
developmental needs, changing family dynamics, and a chang-
ing culture. Triangles have become obsolete in their shape,
dimensionality, and stasis.
Given that there is an absent biological parent in same-
sex parented families, the primary constellation consists of a
minimum of four people rather than three. In lesbian-parented
families, the absent biological parent is the sperm donor. In
gay-male-parented families, it is the biological mother, at the
least. In these families, as in adoptive families, the biological
parents carry the child's genetic history, a shadow of something
difficult to see. Put a spotlight on it and it disappears, yet its
presence lingers evanescently. What of significant psychologi-
cal import is carried in the shadow of the absent parent(s)—the
"donut" as a friend's child used to refer to her sperm donor?
The sperm donor, as shadow member of a family, carries the
ambiguity of a donut: in looking at the hole it is unclear whether
there is or is not something missing. There are, after all, many
different kinds of donuts.
How will these shadow people live inside Josh and his
cohort as they grow into adulthood? Clinical data await the
time when greater numbers of children and families using alter-
native forms of conception, or adopted children from differently
configured families, enter the psychoanalytic arena. 2
Gay- and lesbian-parented families have been in the
vanguard of changing family narratives and have changed
cultural norms as well as psychological understandings of the
reconceptualization and degendering of parenthood. We clini-
cians and theorists need to recognize these new families and
deal with clinical issues as they arise, while recognizing that
these issues will change as narratives of new families continue
to evolve.
7. It's A(p)Parent 113

ENDNOTES
1. For an interesting case of a lesbian struggling with infertility coupled with
her feelings of not being a "real woman" see Bassin (2001).
2. In a survey of the literature published in 1990, Paul Brinich found only
one report of the psychoanalytic treatment of an adult adoptee (Bern-
stein, 1983) where the adoption was the focus. Most reports focus on
children or adolescents. Similarly we have no clinical psychoanalytic
data on children of alternatively configured families.

REFERENCES
Armelini, M. (2001), The father as function, environment and object.
Squiggles and Spaces: Revisiting the Work of D. W. Winnicott, Vol.
2, ed. M. Bertolini, A. Giannakoulas & M. Hernandes. London: Whurr,
pp. 37–46.
Bassin, D. (2001), An analysis of infertility. Stud. Gender Sexual., 2 5 : 6 3 -
82.
Bernstein, S. B. (1983), Treatment preparatory to psychoanalysis. J. Amer.
Psychoanal. Assn. 31:363–390.
Brinich, P. M. (1990), Adoption from the inside out: A psychoanalytic per-
s p e c t i v e . In: The Psychology of Adoption, ed. D. B r o d z i n s k y &
M. Schechter. New York: Oxford University Press, pp. 42–61.
Butler, J. (1995), Melancholy gender-refused identifications. Psychoanal.
Dial., 5:165–180.
Herek, G. M. (1998), Stigma and Sexual Orientation: Understanding
Prejudice against Lesbians, Gay Men, and Bisexuals. Thousand Oaks,
CA: Sage.
Lewin, E. (1993), Lesbian Mothers: Accounts of Gender in American Cul-
ture. Ithaca, NY: Cornell University Press.
Schwartz, A. E. (1998), Sexual Subjects: Lesbians, Gender and Psycho-
analysis. New York: Routledge.
Stern, D. N. (1989), The representations of relational patterns: Developmen-
tal considerations. In: Relational Disturbances in Early Childhood, ed.
A. Sameroff & R. Emde. New York: Basic Books.
— (1991), Maternal representations: A clinical and subjective phenom-
enological view. Inf. Mental Health J., 12:174–186.
Chanter 8

What Does a Mother

Want and Need From
Her Child's Therapist?
DANIEL GENSLER
ROBIN SHAFRAN

The phone rings in a therapist's office one morning. Mrs. P is

on the line. She is looking for a therapist for her son, Steven.
The psychologist at his school has given her the therapist's
name. Does the therapist have time to see him?
In the course of the conversation, the therapist obtains
some basic information about Steven—how old he is, what
grade he is in, the ostensible reason for the referral—that
is, why the school believes this child would benefit from
treatment. The therapist learns, also, that, although Steven's
mother shares some of the school psychologist's concerns and
has a few of her own, she is more worried about the fact that
the school is worried. The anxiety in her voice is palpable.
This is her child, and now she is afraid that something is
wrong, perhaps even seriously wrong. She and the therapist
make an appointment for her to come in, with her husband.
The meeting with Steven will be scheduled at that time,
should the three of them agree that it makes sense.

W
ho is the patient? Whose needs must be addressed,
whose ability to function evaluated, whose anxiety
alleviated? Whether child therapists think rela-tion-
ally or along more classical lines, the answer to those questions
will likely be, "Steven, the child whose difficulties precipitated

115
116 Daniel Gensler and Robin Shafran

the call." However, child therapists are also aware that, unless
they address parental concerns, their success is likely to be
significantly compromised.

HISTORY O F INCLUDING MOTHERS

IN CHILD THERAPY

Child therapists have not always been concerned with parents.

The fundamentals of child treatment from a psychodynamic
perspective were first formulated by Melanie Klein (1932)
and Anna Freud (1946). During the 1930s and 1940s, psycho-
pathology was conceptualized as a product of internal psychic
conflict. Child treatment, following the adult model, relied on
the development of an intense, private relationship between
patient and analyst and the use of interpretation as the pri-
mary vehicle for symptom relief (O'Brien, 1992). Klein limited
her contact with the parents of her patients to the absolute
minimum, just enough to ensure that the treatment could
continue unimpeded. In the Kleinian tradition, classically
trained analysts also minimized their contact with parents of
their child patients; those analysts believed that of primary
importance was the child's internalized experience. Little
credence was given to the analyst's ability to affect the child's
relational environment.
In contrast to Klein, Anna Freud stayed in regular contact
with her patients' parents in order to obtain information and to
provide guidance. She also maintained regular contact with the
children's teachers. While working from a classical perspective,
Freud clearly acknowledged that children lived with significant
adults and contact between those adults and the analyst would
benefit the child patient. Information could be shared and
the child's life enhanced. Nonetheless, that the parents them-
selves might have any need or desire simply did not enter the
mix. Work with parents was still considered "extra-analytic"
(Sandler, Kennedy, and Tyson, 1980) or "secondary" (Glenn,
Sabot, and Bernstein, 1978).
8. What Does a Mother Want and Need from Her Child's Therapist? 117

A RELATIONAL APPROACH
TO INCLUDING MOTHERS

Contemporary child therapists are more likely to consider the

needs of the significant adults in the lives of their child patients.
The most common models of treatment tend to focus not on the
child alone, but on treating the child and parents from within
the matrix of relations that develop among them. Children are
understood most fully as living in these relationships, and so
parental cooperation, even collaboration, increases the likeli-
hood of therapeutic success. In fact, there is a growing number
of child therapists who work exclusively with parents; they
believe this to be the most productive way to effect change
in a family system (Pantone, 2000; Jacobs and Wachs, 2002).
Therapists who continue to work predominantly with child
patients recognize that their patients' parents require thought
and attention, as well. 1
The relational view of child treatment emphasizes "an un-
derstanding of the complex intersubjective nature of the family
constellation and the ways in which manifest problems reflect
an intricate system of internal representations and projections"
(Jacobs and Wachs, 2002). Child therapists working within
the relational perspective recognize that a mother bringing
her child to therapy, while not the identified patient, enters
the consulting room with a variety of expectations, concerns,
and anxieties that must be acknowledged and managed. Parent
contact is considered an integral part of the ongoing therapy,
not an irritating sidebar requiring grudging accommodation.
Sullivan (1954), discussing the psychiatric interview,
made the point that each client must get something out of each
interview with the psychiatrist. In the particular situation of
child treatment, this axiom extends to the mothers of patients
as well. Child therapists need to attend to the needs and wants
of mothers for several reasons. On the most superficial level,
mothers are consumers, and if they are not recognized and
responded to as such, they will take their business and their
children elsewhere. Some mothers may view the child thera-
pist in much the same way as they view a soccer coach, piano
teacher, or math tutor. Their children may be given over to the
118 Daniel Gensler and Robin Shafran

therapist for the length of the session, but there is little inter-
est or wish for involvement on the part of the parent (Altman
et al., 2002). In such situations, the therapist needs to work
unobtrusively and respectfully with what the mother wants
or is aware of as her need, and also with her unattended or
unarticulated need. If the therapist is successful in this regard,
maternal involvement will increase as the mother finds herself
understood in a way she had not anticipated.

M O T H E R S ' CONSCIOUS AND UNCONSCIOUS

WISHES REGARDING CHILD THERAPY

In the best of situations, those in which mother is a willing

participant, her wishes regarding her child's therapist are often
conflicting. Some wishes are conscious, and some are not.
Additionally, maternal wishes may be adaptive (such as the
wish to be helped to be a better parent), defensive or avoid-
ant (such as the wish for the therapist to collude so that the
mother does not have to acknowledge a difficulty), or, more
likely, blends of both. Over the course of therapy, both the
balances between conscious and unconscious wishes and the
nature of the conflicted wishes may change.
A mother's conscious, articulated wishes and needs will
differ from her unarticulated needs. These unarticulated
needs are inferred by the therapist through interaction with
the mother and the child, from theory, and from professional
experience. What is inferred may not be validated immediately
by the mother, although later it may be shown to be true. In
a common trap at the start of a child's therapy, the therapist
may think less about a mother's conscious wishes and focus
instead on his own determination of what is required. He may
reframe the mother's report of the child's presenting problems
into a formulation of what needs to occur if symptoms are to
resolve and development proceed smoothly. Focusing on what
the therapist thinks that mother and child need can potentially
exclude some very real maternal concerns. In such situations,
the opportunity is missed to join the mother in her subjec-
tive wishes in relation to the therapist. Mothers want many
things from their children's therapists, and, to the extent a
8. What Does a Mother Want and Need from Her Child's Therapist? 119

therapist is able to articulate and acknowledge those wishes,

the therapeutic alliance with the mother is enhanced. Should
the therapist miss, minimize, or deliberately ignore maternal
needs or reactions, a potentially fruitful collaborative experi-
ence may be lost. Ideally, the therapist tries to integrate the
mother's subjective wishes within a total formulation of what
needs to happen for the child to improve.
Such integration may not go smoothly when the mother's
conscious wishes are focused and urgent. The mother, particu-
larly at the inception of treatment, wants to be reassured that
her child will be helped and the problems fixed. One mother,
filled with anxiety and self-blame about her 10-year-old's dif-
ficulties, said, "Just promise me that she is going to be okay,
that she will grow up and get married and have children."
Although the therapist felt confident enough to provide some
reassurance that the woman's daughter would ultimately feel
stronger and better about herself, the husband and babies were
more than she felt able to guarantee.
Consciously, mothers wish for help for their children
through symptom reduction and enhanced functioning. Simul-
taneously there can be a host of less conscious wishes. For
example, unconsciously a mother may want to be parented
herself, while also needing the therapist not to expose her
unarticulated wish that she herself could be the child whose
needs would come first. Another mother, seeking support in
tolerating the knowledge that her child is suffering, may hope
that the therapist will help her to keep her image of her own
mothering free from indictment or blame. She may want the
therapist to validate an explanation she has for her child's
problems (e.g., that the child's problems are medical or temper-
amental or constitutional) and to validate her own proposed
solution (e.g., medication). Simultaneously she may want the
therapist not to confront her on the contribution of her own
behavior in creating or maintaining her child's problems, not
to ask her to do more or to be different. For an extended pe-
riod, she may need the therapist to validate her vacillating or
ambivalent positions, without exposing the ambivalence or
contradiction.
Maternal feelings, whether conscious or unconscious,
must be recognized and taken seriously. Feelings of shame,
120 Daniel Gensler and Robin Shafran

guilt, self-blame, and sad resignation are common responses

to the recognition that a child is struggling, and such reactions
must be acknowledged and responded to with compassion.
Consciously or not, a mother wants a therapist who treats
her gently in this regard and does not directly challenge her
competence as a parent.
Mothers have other unconscious needs of their child's
therapist. A mother may need the child's therapist to allow
her to continue to hide from anxiety, humiliation, and rage
that she might otherwise have to face and feel and deal with.
Another mother may have a wish, most likely unarticulated and
even unformulated, to project onto the therapist her own love
for her child, in order to protect that love. In this way, should
the mother lose touch with her love and find herself only able
to rage at her child, there is someone (the therapist) who can
protect both the child and her love for him.
Another unconscious wish is that the therapist not inter-
fere with the mother's projections regarding her child. For
instance, if a mother sees her child as a powerful person and
then identifies with the child's power and control, she may
feel stronger and more powerful herself, perhaps undoing her
own very painful feeling of helplessness. Unfortunately, such
a dynamic may encourage the child to feel entitled to be in
charge and potentially to claim so much control that conflicts
result at school and at home. Mother may experience conflict-
ing wishes in such a situation and hope that the therapist will
not confront her, while she simultaneously wishes that the
therapist will help her change and feel her own strength. In
such a scenario, both mother and child benefit as the mother
learns to feel that she is able to take charge and her child no
longer feels obligated to be strong for his mother.
Child therapists often find themselves in the difficult posi-
tion of voicing concern about something that the Mother is
saying or doing to the child and having that concern ignored.
If the inappropriate behavior meets the reporting standard for
abuse, the therapist is legally obligated to make a report to the
authorities. Fortunately, this situation does not occur with
great frequency. More often, difficulties stem from a conflict
between the therapist's view of what needs to be addressed
to facilitate the child's progress and the mother's ambivalent
8. What Does a Mother Want and Need from Her Child's Therapist? 121

wish not to confront a problem that her child faces. Such situ-
ations are not reflective of abuse; rather, they are indicative
of the mother's resistance to facing the reality of her child's
situation. The therapist must carefully return to the reason
the mother brought the child into therapy, attempting to draw
on the professional alliance with the mother and its goal of
ameliorating the child's presenting problems. This effort is
intended to overcome the mother's unconscious wish not to
deal with some part of her own behavior that can be interfer-
ing with their shared goal.
Maternal wishes and needs change as the therapist's
relation with the mother and the child deepens, as the child
develops, and as chance events occur for the therapist or the
mother over time. In time-limited treatment, there is less
opportunity for the adult-adult collaborative experience to
be as meaningful for the mother as when treatment occurs
over months or years. As mother and therapist get to know
one another and as mother experiences the respect that her
child's therapist accords the mother-child relationship, and as
she finds that her input is valued, the mother's investment in
the treatment is likely to increase. In contrast, if the mother's
experience with her child's therapist in any way mirrors the
rejections and exclusions she has experienced elsewhere, the
child's treatment will be in jeopardy.

Let us return to Mrs. P, who has come to consult about her

son with the intention of starting him in treatment. Nine-
year-old Steven is the identified patient and is the starting
point of the conversation. It soon becomes clear that Mrs. P
has concerns of her own. Will Steven be all right? What has
she done to "make" him this way? Who is going to "find out"
that her son is so troubled, that she has done so "badly" as a
parent that he needs a therapist? Does the school psycholo-
gist think badly of her, and is the therapist going to think
badly of her? Feelings of shame, guilt, and blame predominate
in the session. These are her feelings, although the topic of
conversation is Steven.

Mrs. P's responses are not at all uncommon. She has sought
help for her son despite how uncomfortable she feels about
doing so. Spiegel (1989), articulating the interpersonal view,
122 Daniel Gensler and Robin Shafran

considers child psychopathology to be "a result of difficulties

in interpersonal relationships, most often a reflection of par-
enting" (p. 49). He believes that "on some level, the parents
are likely to be aware of this, feel guilty and defensive, and
therefore find it difficult to make the initial contact" (p. 49).
The job of the therapist entails dealing with that difficulty so
that the child's treatment can go forward without undue dam-
age to parental self-esteem.

MATERNAL HELPLESSNESS AND EMPOWERMENT

Mothers who feel guilty and ashamed need to be helped to un-

derstand that they alone are not responsible for their children's
problems. Often economic, sociological, family, medical, or
developmental factors operate beyond a mother's control
(Birch, 1993). Children are faced with struggles and challenges
despite their parents' best efforts to shield and protect them.
Furthermore, children vary in how difficult they are, and
some would present difficulties despite the most loving and
competent parenting. For some mothers, truly accepting this
information is a tremendous relief. For others, it is a mixed
blessing. After all, if a mother has created a child's problem,
perhaps she can fix it. If it happened despite her best efforts
and is truly beyond her control, maternal feelings of helpless-
ness and despair can result.
For mothers who find the closed door of the playroom a
painful and rejecting experience, the therapist's task has an
additional dimension. These parents must be reassured that
the therapist will not become "more special" than they are,
that they are still the "experts" on their own children, despite
their seeking the therapist's expertise. They need a good sense
of what actually happens when the therapist is alone with their
children. Therapy needs to be demystified, or the risk increases
that mothers' competitive or jealous feelings will intrude into
the treatment (Glenn et al., 1978).
Jacobs and Wachs (2002), speaking to a related issue,
make the point that in individual treatment the alliance that
develops between the child and his therapist "often unwittingly
serves to exclude and vilify the patient's parents" (p. 4). Child
8. What Does a Mother Want and Need from Her Child's Therapist? 123

therapists must be watchful that this does not occur, and they
must be mindful of any tendency to join the child in blaming
the significant adults in his life for his difficulties. Similarly,
therapists must be alert to their own anger at a mother for fail-
ing her child. Such occurrences could strengthen the therapist's
identification with the child at the expense of a more reasoned
assessment of the family's situation. Mothers need not to be
judged excessively. And they need their children's therapists to
help them tolerate the tension between being both a participant
and an outsider in their children's treatment.
For older children, a new complication arises, since chil-
dren who can describe and complain are able to portray their
parents in ways very different than their parents might portray
themselves. A mother's need to feel that her point of view is
valid, to feel in control and competent with her child, can come
into conflict with her child's definition of their relationship.
Here it becomes the therapist's task to help the mother accept
a goal of increased communication and mutual understand-
ing within her family. A mother's accurate understanding of
her child's point of view, which may be different from hers,
provides an empathic atmosphere that is healing for the child
and also helps the mother to be the parent she wants to be
(Paul, 1970).
Regardless of the age of the child in treatment, the constel-
lation of mother's wishes and needs from her child's therapist
and the conditions that she requires to allow therapy to pro-
ceed, are similar—the development of trust, respect for the
mix of adaptive and avoidant needs, the need for gentleness
and compassion, and so forth.

MATERNAL EXPECTATIONS AND CONFIDENCE

Bruch (1948) described how parents' often unrealistic expecta-

tions of the psychotherapist may reflect their own limitations
as parents. Their inflated notions of the therapist's power to
change their child can reflect their own unreasonable expec-
tations for the child, thus concealing the trouble they have
accepting the child's limits or coming to terms with the dis-
crepancies between who the child is becoming and who they
124 Daniel Gensler and Robin Shafran

wished the child would become. In this situation, some mothers

may want the therapist to collude with their expectations so
as not to expose their own trouble with being more accepting.
They may need assistance to develop more realistic views of
their own strengths and weaknesses, just as they need help in
viewing their children more realistically.
At the same time, it is important that maternal feelings
of self-doubt and helplessness are identified and, to the extent
possible, ameliorated by helping the mother become more
certain and effective in her parenting. As a mother is helped
to feel more effective, the likelihood is increased that she will
become more attuned to and better able to meet the needs of
her children. A mother's commitment to her child's therapy
is strengthened as her need for a viable connection with the
therapist is recognized and worked with and she finds herself
feeling better about her own mothering. All this happens while
the child remains the identified patient.
As the relationship between mother and therapist deepens
and the treatment alliance strengthens, maternal compli-
ance with the therapist and interest in the therapist's advice
and guidance may increase as well. Such compliance can be
complicated. Complying with the therapist's advice can simply
represent a hopeful experiment in fulfilling the wish to become
a more ideal parent. But compliance can also derive from a
mother's wish to please the therapist without considering her
own perhaps contradictory wishes and feelings. The mother
may then find herself in a situation where, in effect, she must
choose between her desire for approval and her fidelity to her
own complexity as she parents her child.

M O T H E R S ' NEEDS F O R THEIR CHILDREN

AND FOR THEMSELVES

In addition to a mother's needs and wants relating directly

to the well-being of the child—and this category includes the
need to assuage feelings of guilt and shame—are the needs and
desires which relate more specifically to the mother herself,
to her own relational experiences and patterns of living in the
interpersonal world.
8. What Does a Mather Want and Need from Her Child's Therapist? 125

In the first conversation, Mrs. P let the therapist know how

important the opinions and judgments of others were to her
sense of herself as a competent and effective mother. She was
worried that the school was concerned about her son, and she
subordinated her own observations and intimate knowledge
of her son to what the "experts" had conveyed. This was a
woman who had difficulty holding on to a sense of her own
competence and agency. She had not yet learned to rely on
her own perceptions and judgments, despite considerable
successes in many aspects of her life. Although she was talk-
ing about treatment for her son, her need for affirmation, for
reassurance of her own worth, came through.
Once her son's therapy was underway and Mrs. P and
the therapist were meeting on a more or less monthly basis,
it became even more clear that Mrs. P had some needs of her
own that she was hoping to have met in the course of these
parent sessions. She had suffered, since her own childhood,
the effects of an alternately intrusive and hypercritical or
extremely remote mother. Conversations regarding Steven's
progress, and strategies for increasing family harmony, pro-
vided the backdrop for Mrs. P to experience nonjudgmental,
supportive involvement from a new maternal object of her
own—her son's therapist. This use of the therapist supported
her son Steven's therapy, since her desire to remain in the
therapist's good favor assured her cooperation. However, it
had attendant risks—that Mrs. P might become competitive
with her son, resent the attention the therapist paid him, and
grow to feel that once again she was the less desirable sibling.
That scenario would be a most unfortunate repetition of the
dynamics in her own family of origin.

The opportunity to engage in a collaborative relationship

around a third party, the child, offers a mother an opportunity
to meet a need for intimacy and therapeutic engagement with-
out declaring that she herself has such needs or desires. She
does not have to admit directly that she herself is suffering.
Demons from her own past may emerge within the context
of conversation about her child. The need to work out a vari-
ety of issues, such as competition, disappointment with her
spouse, or a wish to be reparented herself, can contribute to
her willingness or hesitation to join in collaborative work with
the therapist.
126 Daniel Gensler and Robin Shafran

As the mother experiences the support offered by her

child's therapist, her ability to look more honestly at herself
may improve her own sense of well-being as well as that of
her child. If her child's therapist recognizes and acknowledges
that the child's mother is more than a mother, that she fills
other roles and has other needs, the mother's vision of herself
may expand as well. Chethik (1989) referred to the "transfer-
ence parenting" that can occur in work with mothers who get
support from their children's therapist so that they, in turn,
can better support the child and the therapy. Chethik also
described how this kind of work can provide actual psycho-
therapy for one "sector" of the mother's life, that area of her
identity and functioning involved in parenting.

LIMITS AND T H E E F F E C T O F CHANGE

IN RESPONDING T O M O T H E R S ' NEEDS

There are limits to the child therapist's ability and opportunity

to satisfy maternal needs and wishes. When the mother makes
many phone calls and seems to require a great deal of response
and involvement from the therapist, the therapist will set limits
just as she would with any adult patient. Availability is limited
by the therapist's need for privacy, as well as the importance
of not participating in a sadomasochistic relation with the
parent. A therapist also has to be able to retain a role as the
child's advocate, rather than being primarily an advocate for
the parent (Altman et al., 2002). When it appears that mother's
desperation for contact with the therapist arises out of her
own unaddressed anxiety or dependent needs, the therapist
encourages her to enter into her own psychotherapy. Whether
the mother does so or not, it is inevitable that her fundamental
way of relating will emerge in the developing threesome of
therapist, child, and parent. Parent sessions are essentially
relational experiences that, when effective, alter the mother's
experience of herself in relation to the therapist, to her spouse,
and, of course to her child.
In conventionally structured child treatment, therapists
usually meet with parents only once every few weeks. This
8. What Does a Mother Want and Need from Her Child's Therapist? 127

contact may be supplemented by a few minutes at the begin-

ning or end of the child's session or, more frequently, on the
phone. Because of this limited opportunity for contact, child
therapists often fulfill maternal wishes only indirectly, through
the effect of the therapy on the child. Of course, the more
frequent the contact, the more directly maternal needs can
be communicated and the better able the therapist will be to
address her concerns.
Both the therapist's personality and chance events that
occur in the therapy with that therapist contribute to the
unique coloring of a parent-therapist relationship. This color-
ing differs with different participants, although the outcomes
may look very much the same. Individual therapists make
different decisions about maternal needs, both expressed and
inferred. Therefore the course of a successful therapy, through
which the child improves and the mother feels more empathic,
competent, and happy in the maternal role, varies with differ-
ent therapists. The occurrence of chance events—a therapist's
pregnancy, an encounter outside of the therapy session, a slip
of the tongue, the way the therapist negotiates requests, gifts, or
self-disclosure—influences the course of treatment as well.

CONCLUSION

Child therapists expect to fill multiple roles, at least symboli-

cally, in the lives of the children they treat. Therapists need
to be aware that they may also fill multiple roles in the lives of
their child patients' parents—therapist to the parent's child,
therapist to the mother, advisor, hired help, cheerleader,
friend, and parent. Child therapists try to help mothers with
their need to feel good about themselves and their mothering
skills; their wish to acknowledge and resolve feelings of guilt,
shame, anger, and resentment; and their inclination to avoid
or deny such uncomfortable responses to their children. These
are the normal feelings and wishes that come with bringing a
child to therapy. To the extent that the therapist succeeds in
responding to these wishes of the mothers who bring in their
children, both the child and parent are well served.
128 Daniel Gensler and Robin Shafran

ENDNOTE
1. This discussion applies to fathers and other primary caregivers, as well
as to mothers. The critical ingredient is that the parenting person be
concerned about the child's welfare and be involved with meetings with
the child's therapist.

REFERENCES
Altman, N., Briggs, R., Frankel, J., Gensler, D. & Pantone, P. (2002), Rela-
tional Child Psychotherapy. New York: Other Press.
Birch, M. (1993), Who's holding the environment? Issues of parents of trau-
matized children. Newsletter, Section 2 (Childhood and Adolescence) of
Division 39 (Psychoanalysis), 2:14-16, 20. Washington, DC: American
Psychological Association.
Bruch, H. (1948), The role of the parent in psychotherapy with children.
Psychiatry, 11:169–175.
Chethik, M. (1989), Techniques of Child Therapy: Psychodynamic Strate-
gies. New York: Guilford Press.
Freud, A. (1946), The Psychoanalytic Treatment of Children. New York:
International Universities Press.
Glenn, J., Sabot, L. & Bernstein, I. (1978), The role of the parent in child
analysis. In: Child Analysis and Therapy, ed. J. Glenn. Northvale, NJ:
Aronson.
Jacobs, L. & Wachs, C. (2002), Parent Therapy: A Relational Alternative
to Working with Children. Northvale, NJ: Aronson.
Klein, M. (1932), The Psycho-Analysis of Children. New York: Free Press,
1975.
O'Brien, J. D. (1992), Introduction. In: Psychotherapies with Children and
Adolescents, ed. J. D. O'Brien, D. J. Pilowsky & O. W. Lewis. Northvale,
NJ: Aronson.
Pantone, P. (2000), Treating the parental relationship as the identified pa-
tient in child psychotherapy. J. Infant Child & Adolesc. Psychother.,
1:19–38.
Paul, N. L. (1970), Parental empathy. In: Parenthood: Its Psychology and
Psychopathology, ed. E. J. Anthony & T. Benedek. Boston: Little
Brown.
Sandler, J., Kennedy, H. & Tyson, R. L. (1980), The Technique of Child
Analysis: Discussions with Anna Freud. Cambridge, MA: Harvard
University Press.
Spiegel, S. (1989), An Interpersonal Approach to Child Therapy. New York:
Columbia University Press.
Sullivan, H. S. (1954), The Psychiatric Interview. New York: Norton.
Part II

W o m e n ' s Bodies:

Choices and Dilemmas

Chanter 9

"Too Late"
Ambivalence about Motherhood,
Choice, and Time
NANCY J. C H O D O R O W

I n this chapter I delineate a particular manifestation of the

nonreproduction of mothering: how a constellation of un-
conscious mother-daughter-sibling fantasies, anchored
by a deadened aggression against both self and object, can
destabilize and undermine fertility and maternality. Partly be-
cause, as I discovered somewhat after the fact, these fantasies
may coexist in the same person with (not obviously related)
experiences of time's standing still, women with this particular
fantasy constellation may put off thinking about motherhood
or even not notice their own age advantage. These women's
internal conflicts and fantasies about having children and
about time's standing still encounter external changes. These
changes have occured in gender roles and family patterns; in
the culture's interpretation of biology, aging, and time; and in
the actual biological constraints of aging.
When internal and external rationales to postpone coin-
cide, a clinician sees painful crises, in which the wish to have
children becomes psychologically disentangled—when it is
simply too late. I am thinking here, then, not only of women
who have used various feminist or career-driven reasons for
delaying motherhood and then found themselves up against
the fertility clock, but also of women who have actively sabo-
taged their fertility and for whom time plays a particularly

Reprinted with permission, J. Araer. Psychoanal. Assn., 51:1181–1198.

131
132 Nancy J. Chodorow

potent role in their psychology and the progress of their treat-

ment—hence, again too late. I am not making a sharp distinc-
tion between the experience and treatment of the reproductive
body—more directly, bodily—centered wishes and conflicts
about being pregnant or fertile—on one hand, and the experi-
ence of maternality—the maternal sense of self, or the relation
to the child—on the other. I believe, however, that the kinds
of psychological phenomena I discuss here will affect both in
specific ways for different clinical individuals. 1
The patients who concern me here have, like me, had to
recognize that, although they now very much want to bear
children, they will never do so. They must also recognize that
not having children is a consequence of their own psychic reali-
ties and the behaviors that these realities generated. Our role
as analysts is to mitigate psychological suffering and promote
self-understanding and self-acceptance. Yet we are drawn to
case reports with fairy tale endings: "When we terminated,
Mrs. A was enjoying her work, was sexually responsive to her
husband, and was pregnant." In one important respect, such
an external fairy tale ending cannot happen for the women I
am discussing, as we recognize the biological clock and the
ending of possibility; but my experience has been that it is
particularly difficult for these women to mitigate their guilt
and self-blame. The challenge, then, is to help a woman in this
situation to get beyond feeling that her lack of motherhood is
her fault and that she has damaged not only herself but oth-
ers in the process. For the analyst, perhaps particularly if the
analyst is a woman whose maternal identity is powerful and
who really does feel, deeply and profoundly, that there is no
substitute for motherhood (I refer to myself), there are also
strong countertransference feelings: it is difficult not to agree
with the patient that on some level there is something absolute
and irretrievable in her situation.
My clinical observations here reflect my previous theo-
retical work. I (1978) have argued that women's mothering is
typically generated and reproduced through their internal ob-
ject world, especially through preoedipal and oedipal layerings
of the mother-daughter relationship. Later, I (1999) claimed
that projective and introjective filterings of culture are always
9. Ambivalence about Motherhood, Choice, and Time 133

inextricably implicated in, and help to create, psychological

gender. Although we can separate out the intrapsychic from
the cultural as theoretical categories, we cannot do so in in-
dividual, lived clinical reality. In those writings, I also claim
that affective constellations and fantasies that do not seem
directly related to subjective gender enter into individualized
animations of gender. In what follows, I describe a specific way
that the internal mother-daughter world filters both culture
and the body, and I document how a particular psychological
phenomenon, not ostensibly gender related—the experience
of time—affects directly gendered experiences like mother-
hood or its absence. Having myself discovered this relationship
only quite late in (or after) these treatments, I suggest that it
behooves us to pay particular attention clinically to the ways
that such nongender-related phenomena affect gender.
Finally, I address a difficulty found in early feminist
psychoanalytic work like The Reproduction of Mothering
(Chodorow, 1978). Appropriately, both in the 1970s and
today, this work challenged psychoanalytically and culturally
normative views of femininity, including motherhood, that
were rooted in generalizations and universalizations about
the necessary sequelae of living in a female body. But it did
so by inappropriately, and inaccurately, denying the central-
ity of bodily and biopsychological experience to gender. As I
recognize in later writing (1999), certain bodily, genital, and
reproductive configurations and potentialities universally
demand psychological elaboration, even as this psychological
elaboration will be clinically individual. More specifically, I
document my claim that "biological mothering is itself specifi-
cally cast intrapsychically partially in terms of this internal,
bodily imaged mother-daughter world Pregnancy, child-
birth, the felt reproductive drive [are] filtered through the
prism of the intrapsychic and intersubjective reproduction of
mothering" (p. xiv). For the women whom I discuss here, there
is an intrapsychic conflation of attacks on the maternal womb
and on their own womb and reproductive possibilities: looking
at their internal, object-relational experience of maternality
and its difficulties "allows us to see biological experience in
psychologically more accurate ways" (p. xiv).
134 Nancy J. Chodorow

MOTHERING IN PSYCHOANALYTIC T H O U G H T

Although classical psychoanalysis made pregnancy and moth-

erhood lesser features of women's development than genital
experience and difference, those experiences are from the
beginning, central, to women's psychosexual, self-, and ob-
ject-relational development. They also constitute adult devel-
opmental phases or psychosocial crises (see Benedek, 1956,
1959, 1960; Kestenberg, 1956, 1976; Bibring, 1959; Bibring et
al., 1961; Chodorow, 1978; Notman and Lester, 1988; Langer,
1992; Pines, 1993; Raphael-Leff, 1993; Bassin, Honey, and
Kaplan, 1994; Balsam, 1996; de Marneffe, 2004). Motherhood
begins internally in the conflictual, intense cauldron of child-
hood sexuality and object relations. It is overdetermined, filled
with fantasy, and complex: any woman's desire for children,
whether immediately fulfilled, fulfilled belatedly, or never ful-
filled, contains layers of affect and meaning. Having children,
just as not having children, can be freely chosen or patho-
logically driven, mired in conflict or relatively conflict free.
Each of these choices can have multiple meanings; with any
of these choices, we hope for a certain amount of secondary
autonomy—a predominance of elements that have come to be
independent of these originary conflicts. But, if motherhood
were not filled with so many different meanings and motives,
we would not expect a mother to have a maternal identity and
the special sense of herself in relation to her children that al-
lows her to mother.
Just as with all developmental theories, however (for
example, we now distinguish a consolidation of erotism and
object choice as developmental necessities from normative
heterosexuality), we need to be careful to distinguish the in-
evitable internal working with or through of the developmental
challenge of bodily reproductivity and generativity from any as-
sumption of a normative psychological or behavioral outcome.
Accordingly, in considering the nonreproduction of mothering,
I am not suggesting that it is the destiny of all women to bear
or raise children, nor that it is more pathological to choose not
to be a mother than to choose motherhood. Moreover, although
all women (and men) give fantasy and dynamic meaning to
their reproductive selves, bodies, and object relations, and
9. Ambivalence about Motherhood, Choice, and Time 135

although there are prevalent developmental patterns within

this, these facts do not vitiate clinical individuality or preclude
potentially infinite individual variation in these meanings and
patterns (Chodorow, 1999). I consider particular patterns of
relationship to fertility and maternality and particular women,
not to fertility and maternality in general.
The dynamic and relational constellation that I describe
as leading to "too-lateness," for example, differs from that
described by Bergmann (1985), who also found in a number
of patients a culturally and psychologically generated delay of
motherhood (one that I recognize in other patients) centered
on a precociously sexualized dyadic relationship to the father
and a symbiotic relation to the mother.
Finally, although motherhood has usually one central
meaning of generativity for women, generativity for both sexes
means more than parenting one's own biological children (Erik-
son, 1950). It can involve many kinds of creative and caring
activities, or activities that foster the next generation or the
environment. Such activities directly express the parental
components of generativity and sublimate the biological repro-
ductive components and felt drives. Just as I have emphasized
that I am not beginning from the position that motherhood is
the natural destiny of all women, or that the decision not to
have children is by definition pathological or problematic, I also
note that the too-lateness I am considering is about regretted
delaying, which may or may not result in infertility. In these
older women who find that it is too late, I am not suggesting
that infertility—when this, rather than lack of a reproductive
partner or menopause seems central—is a sign of continued
internal conflict about pregnancy. Psychoanalysis has been
more likely to investigate infertility than delay (for an excep-
tion, see Bergmann, 1985), and, although it can still fruitfully
explore and treat cases of psychogenic sterility and infertility
(Pines, 1993; Leuzinger-Bohleber, 2001), I agree with Apfel and
Keylor (2002) that "it is time to retire the term 'psychogenic
infertility' as simplistic and anachronistic" (p. 100). (Apfel and
Keylor also point out that "assisted reproductive technologies
offer a more direct route to parenthood" [p. 85] than analysis.)
I am taking at face value my patients' current wishes to have,
or to have had, children.
136 Nancy J. Chodorow

CULTURAL CONTEXTS AND

PSYCHOLOGICAL DEFENSES

In the last half century, we have seen remarkable changes in the

family and work lives of privileged women. Numbers of women
and men choose not to have children, and women are typically
older at the time of first birth. Professional women especially,
often including our patients and colleagues, do not have chil-
dren until their midthirties, their 40s, and even, occasionally,
their early 50s. For many persons, and even for "society," "the
family" seems to have moved from being a necessity to being
an option. In the United States, work is for the main part orga-
nized without regard for parenthood, yet one reads articles and
op-ed columns in which writers argue that workplaces actually
discriminate against nonparents when they give pregnancy
leave, allow part-time work for mothers, or enable mothers
to leave work on time. The implicit attitude seems to be not
that all of us need children to be born and well cared for, but
rather that having children is a personal preference of some
indulgent persons who should not be coddled. And although
"the family" is not an option from the child's point of view, in
the United States at least, policies from welfare regulations to
pregnancy-leave benefits and workplace requirements seem to
assume that children do not need mothering, that somehow a
caretaker or caretakers will be found.
Most of us favor those changes that have enabled women
to engage in fulfilling and remunerative work (many of us
are those women!), and, as the question of "choice"—fam-
ily life as an option—also comes up around women's right to
abortion, most of us are firmly in favor of this right. Because
of these beliefs, it may be difficult for us to recognize some of
the potential psychic concomitants of the general growth of
"choice"—not just the choice to keep or not keep a pregnancy,
but our current cultural belief (one that I certainly share) that,
for an individual woman, having children should be a choice
rather than an assumed destiny. These concomitants are more
likely to arise today than formerly, when it was simply assumed
that most women would marry and have children; as much
passive role acceptance as active psychological capabilities
was required to achieve these ends.
9. Ambivalence about Motherhood, Choice, and Time 137

For contemporary women, including the patients I am

considering, a variety of culturally supported beliefs have pro-
vided conscious rationalizations for attitudes to motherhood.
First, these women may agree with a widespread notion—which
certainly, in the United States at least, has much external re-
ality to support it—that motherhood and professional life are
incompatible for women, that the demands of modern profes-
sions for total commitment and a 60-hour work week assume
a wife/mother in the home or two high-powered professionals
without children. For many women, supported by some strands
of feminist ideology, the cost-benefit analysis goes one way:
what are the costs of motherhood to a high-powered career,
rather than the costs of a career to motherhood?
In a personally felt appropriation of a cultural and feminist
critique, patients report observing their mothers' entrapment,
passivity, suffering, and subservience to their fathers, as well as
their mothers' inability—from the daughters' point of view "be-
cause of the children"—to assert themselves or leave the mar-
riage. Generated from this observation of trapped mothers and
from feminist ideology among some younger women—women
who have not yet reached the too-late stage but who might,
unless they pay attention to their personal uses of cultural
defenses—is an insistence (for which, I ruefully find, my own
early work provides fuel) that they will not have children un-
less their partner promises to do half the caretaking. In other
manifestations of this appropriation of cultural tropes as de-
fenses, divergent conflicts about work, on one hand (too much
involvement, fears of failure, fears of success), and motherhood
on the other (on one side, the pull toward total envelopment
in relation to a child, fantasies of triumph over one's mother,
and fantasies of bountiful wombs and breasts; on the other,
fears of regressive merger, of oedipal triumph, and of bodily
depletion and deformity) converge into the single conscious
conflict: career versus motherhood. (I have adapted the terms
divergent and convergent conflict from Kris, 1984, 1985.)
Thus, our current cultural climate, and perhaps feminism
itself, stressing the incompatibility of career and mother-
hood, provide a cover for internal conflicts and fears, enabling
women to mask conflicts and ambivalence about motherhood
by turning those conflicts into ones between motherhood and
138 Nancy J. Chodorow

career. If we are lucky, women come to us early enough to

examine the function of such beliefs in keeping deeper fears
of motherhood and pregnancy from surfacing. That way a real
choice can be made. But for women for whom it is too late,
this is not possible. Culturally infused defenses thin out, so
that psychological fears and conflicts are seen to have affected
reproductive potentialities more directly.

T H E EXPERIENCE O F TIME

Motherhood is in conscious and unconscious fantasy first and

foremost a gendered bodily, object-relational, and cultural ex-
perience for women. But gender also gains personal meaning
and is constructed from phenomena that are not ostensibly
gendered. In the patients I am considering, this nongendered
phenomenon involves a relation to time that itself has implicit
cultural as well as psychological underpinnings. Many cultural
commentators have noted the contemporary cult of youthful-
ness and the flight from aging; indeed, these trends have been
supported by astounding changes in longevity and health. As
people change careers in their fifties, as men remarry in their
sixties and father children, as fertility treatments allow women
to become pregnant in their forties and fifties, we can come to
be fooled by time. For women, these biocultural changes can
contribute to the fantasy that there is no biological clock.
The relationship among time, change, and gender is also
intrapsychic. Building on Nietzsche, the psychoanalytic cul-
tural critic Norman O. Brown (1959) theorized that the denial
of death and fantasies of immortality generate morbid neurotic
transformations, a deadened culture, and a constant striving
for change, rather than the capacity to live life fully in the
present. In a more clinical vein, several analysts have explored
the contradiction between, on one hand, the necessarily slow
unfolding of an analysis, taking the analytic dyad out of ordi-
nary time and recognizing the timelessness of the unconscious,
and, on the other, the necessity of acknowledging that time
is, in fact, passing as an analysis progresses—that aging, life
lived in the present, and mortality are really before us as we
work (Hoffman, 1998; Buechler, 1999; Cooper, 2000). Arlow
9. Ambivalence about Motherhood, Choice, and Time 139

(1984) describes how variations in the sense of time and time-

lessness can, in some instances, access moments of eternity
but, in others, lead to a paralyzing inability to make any life
choices—from writing down an appointment on a calendar to
applying to college or planning a family—that imply a future
to be planned for or years to be counted. For women for whom
it is too late, I also discovered that, quite apart from their cur-
rent recognition of this too-lateness, time has in unconscious
fantasy stood still. Analyzing this unconscious attitude toward
time, then, becomes a primary route into understanding the
psychology of the too-late nonreproduction of mothering.
Time has, perhaps, a characteristic resonance for women.
Kristeva (1979) claims that "women's time"—time from the
unconscious point of view of motherhood and reproduction—is
both cyclical and eternal. She is referring both to the cyclicity
of the menstrual cycle and women's place in the cycle of genera-
tions and to the monumental, out-of-ordinary-time-and-space
tied to nature rather than culture, a sense of pregnancy, and
involvement with a baby. This cyclical-eternal sense is to the
time dimension what the oceanic feeling or primary oneness
is to fusion in the dimension of space. Women's time is part of
the earliest experience and sedimenting of being, for the child
and for the mother, who in relation to her child draws from
her own experience of being mothered; it is part of what many
women bring to maternality. (Arlow, 1984, describes a musi-
cian who, feeling penetrated by light and transformed during
a Christmas Eve performance, feels briefly a sense of being
outside of time and part of eternity, merging with her music,
her mother, her father, and an imagined Madonna pregnancy.)
Kristeva (1979) contrasts women's time with the linear and
teleological time of history, society, and politics.
A distortion, or perversion, of woman's time, I think,
figures into the timelessness, or time-standing-still, psychic
phenomenon of women for whom it is too late (Chasseguet-
Smirgel, 1985, describes the relationships among creativity,
perversion, and the acceptance or nonacceptance of reality).
Because of the rooting of the internal mother-child relation in
early unconscious fantasies of destruction rather than in gen-
erativity, the timelessness of the early mother-child bond that a
woman takes with her into her own reproduction of mothering
140 Nancy J. Chodorow

has acquired a deadened and imploded quality, rather than that

of an emerging chrysalis. Cyclical time, rather than being active
and in movement, becomes stopped or repetitively circular;
monumental, eternal time freezes. The psychological clock
stops as age and time stand still, time is repetitive or circular,
and the biological clock is eliminated. To return to culture, my
speculation is that this unconscious sense of time-standing-still
is potential in any time and place, but it may be more likely
in a culture like ours, with its emphasis on youth, no aging,
longer lives, later fertility, and a family life cycle, that seems
to have no fixed routine and to be a voluntary rather than a
taken-for-granted option.

T H E CLINICAL PICTURE

A variety of behaviors may express the u n d e r m i n i n g of

fertility. Women may have multiple abortions or take sexual
risks—having had multiple partners since their teens, not
protecting themselves, or not attending to uterine or vaginal
symptoms. One case of very early menopause must certainly
have been an unfortunate biological anomaly, but the patient
herself attributed it to rage at her mother and at herself—to
her wanting to destroy her own uterus. Women who undermine
fertility may also tend to avoid or inhibit generativity. They
may choose jobs that masochistically punish and traumatize
rather than fulfill them—sometimes extremely demoralizing
jobs that involve working with ravaged and destroyed people.
They may describe creative blocks. One woman in her early
50s described the sibling envy, rage at her mother, and multiple
abortions that I have found to characterize other women who
have sabotaged their fertility, but she had always consciously
not wanted children. Yet she wrestled with a huge writing block,
and she found it entrapping to keep a datebook and to write
down changes of appointment.
We are in classical Klein territory here, specifically Klein's
description of early hatred of the mother and the wish to de-
stroy the mother's insides. Klein claimed that fantasies of the
mother's insides include other babies as well as milk and the
paternal penis, but this claim has not, I think, been enough at-
9. Ambivalence about Motherhood, Choice, and Time 141

tended to in our case reports. My too-late patients feel that they

had not enough of mother because there were several siblings
and mother was depressed, downtrodden, submissive, and tired
from taking care of so many children. The patients come to
recognize their belief that they destroyed their mother, quite
bodily, with greed or envy, but they also discover and elaborate
on an implacable envy of siblings and memories of wishing to
destroy them. Conscious memories of exaggerated adoring and
protecting of siblings, we discover, veil this wish to destroy;
in another logic, the sibs' desperate need for protection and
adoration was the result of the potential for destruction by the
patients themselves. Consequently, there is ongoing anger at
the mother and a fear of having destroyed, as well as a desire
to destroy her, but siblings especially loom large.
At the same time, I have not found the fear of maternal
retaliation for destructive fantasies that Klein also describes:
the mother is already too tired and weakened, not just by the
patient but by her maternal life, to retaliate. Accordingly, the
patient has to take her deserved destruction upon herself, and
a kind of deadening anger, whose origins seem to lie in the
mother-child-sibling realm, becomes central in the psyche.
This is not a volatile or active rage but, rather, an imploded,
leaden, relentless self-destructiveness. The woman has dead-
ened both self and object; the object includes her own, and
in fantasy her mother's, uterus. The affects and fantasies that
have gone into disrupting this bodily and relational generativity
seem to go to the earliest mother-child relation and to a core
of deadening and deadened anger that has been turned both
outward and against the self and the reproductive and sexual
body. Destructive wishes against the mother and against the
self become conflated.
These developmental outcomes, set in early childhood, run
up against, or alongside, a lack of recognition of the reality of
time, a denial of time's passing. In unconscious fantasy, time
has stood still. Both treatment and life are more or less main-
tenance operations rather than progressions. The patient may
for some time believe that she does not deserve to improve
but can only hold things steady and not be totally miserable.
Patients talk about "keeping things timeless" and "running in
place." They may be surprised at or deny their own age, and
142 Nancy J. Chodorow

time may form a psychic retreat, represented not in physico-

spatial images of being in a castle, fortress, or otherwise walled
off, but in talk about rolling back the clock or doing things
over. Photos capturing particular childhood moments that
resonate with conflicts with siblings and mother are fixed in
the imagination as screen memories.
This sense of time's standing still, progressing cyclically
rather than linearly, proves a formidable resistance. It may
be a quiet and not immediately noticeable resistance, a tacit
assumption that manifests only indirectly in that the treat-
ment does not progress. Whether analyzed or not, the denial
of time's passing is also unremitting and relentless, since one
of its functions is to deny the harm the patient believes she
has done by rolling back the clock to a time before siblings
became damaged or mothers died or became depressed and
hopeless. In the case of S, one of the cases discussed later, time
as a psychic retreat was endlessly discussed and analyzed,
which finally enabled termination. But it was not until after-
ward, when I was writing this paper and considering especially
the other case, J, whose sabotage of her fertility was so much
more virulent than S's but for whom the denial of time was
less elaborated, that I recognized the close connection in this
case and others among keeping things timeless, denying age,
and acknowledging the biological clock.

CLINICAL EXAMPLES

To make more vivid the clinical picture of the psychological

filtering of biological fertility and maternality through the inter-
nal mother-daughter psyche and through time and timeless-
ness, I describe in what follows two women, one of whom was
largely unable to resolve her personal sense of too-lateness,
and the other who was able to achieve such resolution. J was
in her early 40s when she came to treatment. She had been liv-
ing with the same man for four years and had hoped, she said,
to have children with him, but she had not gotten pregnant.
She was the oldest of five children, three spaced fewer than
two years apart, followed by a gap of five years, then another
closely spaced two. J reported having from earliest childhood
9. Ambivalence about Motherhood, Choice, and Time 143

a total adoration and protectiveness of her two immediately

younger siblings and tremendous guilt that their lives had been
harder than hers. She talked about her siblings in a way that
bespoke frantically keeping her jealousy of them at bay. Her
parents had been separated off-and-on for four years when an
accidental pregnancy returned her father to the home. Shortly
after the last child was born, her mother, again pregnant, had
a miscarriage with severe hemorrhaging and was rushed off
to the hospital for a hysterectomy, leaving J to take care of all
her younger siblings. J, terrified that her mother would die,
was also relieved that there would be no more babies and felt
confirmed in her perception of her father's brutal maltreat-
ment of her mother and the family. To her ostensible relief,
her parents divorced shortly afterward.
J, who currently reported desperately wanting a family,
described having had six abortions between the ages of 20 and
30 (six representing the number of children that her mother
would have had but for the hemorrhaging and hysterectomy). 2
As we reconstructed things, there had been in these pregnan-
cies a drivenness acquired either through brief one-night stands
or with boyfriends whose even slight hesitation she used as a
reason not to sustain the pregnancy. J had gotten pregnant,
it seemed, almost so she could have an abortion. When she
decided in her mid-30s that she wanted to have children and
with this intention became involved with a man, J chose a di-
vorced man with a checkered paternal history, one who never
saw his children. They began immediately to try to get preg-
nant but with no success, and as J turned 40 she began to look
into fertility treatments. I say began, because she looked with
only a surface acknowledgment of her biological clock. J took
her time finding doctors, had trouble getting her boyfriend to
join her for appointments, and did not want to tell either him
or the doctors about her abortion history. In treatment, her
several abortions were a constant source of self-punishment, a
constant reminder that she had only herself to blame for ruin-
ing her chances to become a mother and for destroying these
potential babies. J was quite sure that through her abortions
she had destroyed her capacity to get pregnant, and given her
age and reproductive history, this seemed a realistic belief.
Uncovering the self-attacking, in addition to the sibling-
144 Nancy J. Chodorow

attacking, reasons for J's abortions was the work of a long

treatment. Before J began with me, she had been in analysis
in another city for many years. She aborted that progressing
treatment by finding a job that required her to move. During
our work together, J often came late or had to leave early for
meetings. Indeed, part of her denial of time was to have three
places to be, including with me, at literally the same time.
J also occupied her hours with trivia from work—all, as she
began to see, to keep feelings at bay.
As she reached her mid-forties, J had given up, recognizing
that she would never be a biological mother; it was, in fact, too
late. She had neither the resources, the stable relationship,
nor, it seemed, the biological capacity to become pregnant. We
became more aware of her unconscious commitment to time's
standing still or not existing, and of her need for time not to
exist, because to recognize that time moves forward would be to
acknowledge the reality of too late. Fertility, getting pregnant,
came to be understood as meaning not only, or even mainly,
becoming a mother, but also making reparation and undoing
the damage she had done to self, siblings, and mother. When
J reached the too-late time, she felt that she could never undo
this damage, never get over her sadness, guilt, and anger at the
destructiveness she had wreaked. She had not protected, but
had destroyed, her younger siblings, had wanted to destroy
them, had destroyed her own potential children and her own
reproductive capacities.
J finally drifted out of treatment. When we discussed what
it would mean to terminate rather than to end—to see her life
as the life she had lived or to feel compassion for herself—J
said that if that is what termination would take, then she could
not finish treatment. She will always feel regret and will never
accept what she has done with her life. Also, to try to accept
herself would take time, and then she would be even older.
At some point, J announced that she had begun looking into
adopting. Even though this effort accorded with her tendency
to act to get away from feelings, nonetheless it promised at
first to resolve, in some fashion at least, the actual childless
outcome of her painful conflicts. This search itself, however,
took on the same timelessness and did not seem to progress. J
9. Ambivalence about Motherhood, Choice, and Time 145

had, over the course of time, become less virulently self-criti-

cal about her abortions, but she could not, it seemed, attain a
successful mourning of her lost fertility.
A second woman, S, for whom it was also too late, was able
to resolve her internal feelings differently after a long analysis.
Like J, S came from a large family, six children rather than five,
of whom she was the youngest. S had always felt that there was
never enough to go around; her siblings had taken everything
from her mother already, so that by the time S was born, her
mother was old, tired, depleted, and unable to give. Several of
her siblings were successful adults, but, like J, S felt that her
own destructive envy had been the cause of incapacity in those
who were not. S had the same imploded anger at her mother
for being unavailable, and a relentlessly self-punitive sense
that her mother's exhaustion was her fault—her own birth
and feeding, specifically, had been responsible. As an adult, S
had exposed herself many times to sexually transmitted dis-
eases through risky and unprotected sex. Since she had never
become pregnant, she speculated that she must have ruined
her fertility. Like J, but perhaps with more unconscious and
conscious elaboration, S also kept her analysis and life timeless;
she thought of herself as a young girl or young woman and for
many years did not allow our relationship to shift and develop.
Unlike J, for whom each friend's pregnancy was another painful
blow, S simply did not notice that her friends were marrying
and getting pregnant, or, if she noticed, she thought that she
herself was not old enough to have children.
Investigation of this narcissistic cocoon of time's standing
still in the analysis, and of her need that time stand still so as
to keep her destructiveness from happening, freed S to accept
that, among other things, her nonfertihty might be a result of
those needs. She was able to achieve both a sublimation of her
generativity and a successful mourning. In her late 40s she
met a widower with two college-aged children—children of an
appropriate age for her to have been their biological mother.
As she finished her analysis she was able to accept, without
self-punitiveness, the life she had lived as hers, and she found
herself engaging in generative nesting—remodeling a house,
taking great pleasure in creating a beautiful flower garden, and
146 Nancy J. Chodorow

learning how to relate to her new stepchildren. As she put it, "I
have regrets, but I can't change the choices I made. I'll never
have children, and I have to go on with things. I can't redo my
childhood. I can't undo my age, or my choices to be single for
so long. There's no going back on it."

REFLECTIONS AND CONCLUSIONS

Although one resolved successfully and one did not, both cases
exhibited very similar dynamics regarding both the turning
inward of deadening aggression against the reproductive body
in the context of anger at the mother and siblings and the de-
nial of time's passing. The different resolutions would take us
into other areas of treatment and psyche, but I want to reflect
on a few elements in these two women and their treatments.
Although not being able to get pregnant and become a mother
were for S arenas of sadness, mourning, and anger at herself,
her presenting concerns were not so centrally on the question
of motherhood and fertility as were J's. Yet frozen time—the
denial of time's passing—was a central theme. By contrast, J's
main presenting concern was her horror and guilt over her
abortions, and her incapacity to get pregnant or have a child.
J's deadening and destruction (psychological as well as physi-
cal) of her maternal insides seemed more vociferous and ab-
solute. The fantasy of time's not passing was not so elaborated
or obvious—until after I was writing this paper, our analysis
of the denial of time had been more tied to the immediate
transferential present of her not getting to sessions.
The differences in these cases are probably a matter of
clinical individuality, although we could also speculate that the
actual fact of pregnancy, getting pregnant, having or not having
abortions, and an immediate reaction to the maternal uterus
might be more prevalent in older daughters of large families,
who have watched their mothers' subsequent pregnancies, than
in youngest daughters. It may also be that these differences in
emphasis help to explain what seems, after the fact of discovery,
to have been a blindness on my part, especially in the case of S,
to the close connection between, on one hand, time's standing
still or repetitively cycling nowhere as a psychic retreat (even
9. Ambivalence about Motherhood, Choice, and Time 147

in the context of understanding the relation of the denial of

time to endless unresolved mourning and self-blame), and, on
the other, the virulence of the attacks on the internal mother-
self and putting off pregnancy and motherhood.
As the psychanalytic literature describes, it can be ex-
tremely painful and sad (for both patient and analyst) when
a woman has trouble conceiving. In the "too-late" cases of
the nonreproduction of mothering that I am describing, this
circumstance is made more painful by the woman's sense that
she herself is at fault, not just for reasons of hormonal hap-
penstance or having put off getting pregnant, but because of
virulent antifertility forces within. I have explored the (some-
times mutually constructed) defenses and resistances that
enter treatment around time and timelessness, and the rela-
tion of particular family experiences to unconscious feelings
about motherhood and a woman's reproductive body. A denial
of time's passing intertwines with delayed motherhood.
I have examined internal constellations of fantasy and
feeling that lead to ambivalence about motherhood and the re-
productive body or active sabotaging of bodily internal mother,
siblings, self, and (her own) babies. I have suggested that the
internal constellations that lead to not having children meet
a shifting culture in which conflicts in relation to motherhood
are obscured by many cultural tropes and social trends. These
include a view of motherhood as an active choice for women, a
statistical rise in maternal age, and medical advances that make
possible prolonged fertility, fetal monitoring, and increased
longevity. Such tropes and trends can be further potentiated by
feminist claims for women's careers and for shared parenting.
Finally, less visibly but perhaps more insidiously, they include
a meshing of women's time with a culture that denies biological
aging and implies that all things are possible.
Just as, when working with physically ill patients or pa-
tients dealing with bereavement, we can work only within the
absolute reality of death but cannot make death disappear, so,
I think, we need to accept that there may be a sense that there
is no possible substitute for women who very much want, but
cannot have, children. Recognition of this reality, perhaps par-
ticularly with women who have denied the reality of time and
for whom it is too late, may help us to help them to mitigate
148 Nancy J. Chodorow

the virulent self-punishment and deadening of all creativity

and generativity that can result—to accept their lives with
integrity rather than despair. And, if we recognize the ways
in which almost embodied but not ostensibly gender-related
unconscious fantasies of frozen time have both underpinned
and obscured the putting off of motherhood and kept treatment
from moving forward, we can also be more attuned to looking
for manifestations of this particular psychic retreat earlier in
treatment. Perhaps then we will be able to analyze it before
it is too late.

ENDNOTES

1. I use the terms clinical individual and clinical individuality to emphasize

that our generalizations and universalizations always depend on our
observation of particular, unique individuals (see Chodorow, 1999).
2. Pines (1993, pp. 103-113) describes a similar patient whose "planned
abortions" (p. 107) and inability to stay pregnant were symptoms of a
deeper need to remain empty, dead, and entangled with a destructively
fused relationship with her mother.

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Chanter 10

Pregnancy
SHARON KOFMAN
RUTH IMBER

H
istorically, insufficient attention has been paid to the
complexity of female development. Until women be-
gan to study and write about themselves in greater
numbers, we had to rely on what was often a limited and inad-
equate male perspective on femininity. As our understanding
of female experience has expanded, pregnancy has emerged as
an important focus of research and clinical attention. Here we
examine this transformational event in a woman's life from a
contemporary, psychoanalytically informed perspective. There
is broad agreement that this is a time of intense emotional
upheaval and psychological reorganization characteristic of all
"normal developmental crises" (Bibring, 1959). Just as adoles-
cence is a time of preparation for young adulthood, pregnancy
can be seen as preparation for motherhood (Cohen and Slade,
2000). Contemporary forms of family creation and technologi-
cal advances in fertility intervention add new dimensions to
this life phase.
Many psychoanalytic writers have studied pregnancy
over the last several decades and excellent summaries exist
(Raphael-Leff, 1995, 1996; Lester and Notman, 1986, 1988;
Cohen and Slade, 2000). They agree that the period of gesta-
tion is a time of destabilization and psychic disequilibrium,
leading, optimally, to an enriched, more robust, and complex
psychological organization. Profound change occurs across
many dimensions: "From the level of the body to the level of
intimate relationships, family relationships and societal rela-
tionships to the level of self-definition and identity formation,

151
152 Sharon Kofman and Ruth Imber

the woman's sense of herself and her relationships changes

dramatically by the time she gives birth" (Cohen and Slade,
2000, p. 21).
Psychologically, pregnancy is characterized by emotional
upheaval, vulnerability, and lability; a radical disruption of
basic physiological processes along with a complex reorganiza-
tion of the body image (Raphael-Leff, 1996); and a fluidity of
defensive functioning (Goldberger, 1991). There is a degree of
"normal" ambivalence as well as regressive tendencies (Trad,
1991), such as increased dependency wishes, the blurring of
boundaries, heightened access to primary-process thinking;
and the revival of earlier wishes, conflicts and identifications
(Notman and Lester, 1988). Additionally, there are shifts in self-
esteem, as well as greater self-absorption and preoccupation
with the body and its rapid changes and novel sensations.
Pregnancy has repeatedly been observed to be a period of
deep fulfillment and satisfaction for many women. Goldberger
(1991) understands this, in part, as the pregnant woman's sense
that she has accomplished something of value, "completely ef-
fortlessly, by just being" (p. 221). Goldberger and others (e.g.,
Leon, 1990; Raphael-Leff, 1995) have attributed the state of
contentment while pregnant variously to the confirmation of
fertility, goodness, and creativity that the state of pregnancy
represents; its affirmation of the marriage and the continuity
of generations; and the woman's intimate access and connec-
tion to the mysteries of life and immortality. For some women,
becoming pregnant offers the possibility of a new beginning
and a chance to repair the past and set things "right" (Bradley,
2000). The blissful experience associated with the fantasy of
a symbiotic return to the womb and the identification with
maternal omnipotence have also been noted by many writers
(Lester and Notman, 1986; Leon, 1990). Other authors (e.g.,
Bibring, 1959; Benedek, 1970) have emphasized the woman's
pleasure in attaining a long-sought adult status and consolidat-
ing an integral aspect of feminine and sexual identity. She has
finally fulfilled a cultural, familial mandate.
In contrast to a conventional view of pregnancy as a physi-
cal process that can be taken for granted, many contemporary
thinkers have focused attention on what Raphael-Leff (1995)
calls the "inside-stories" of pregnancy, with emphasis on the
10. Pregnancy 153

woman's subjective experience of the pregnancy process.

Contemporary writers have expanded our understanding of
pregnancy into new areas: the intrapsychic modifications of
representations of the self and of the child (Stern, 1991, 1995);
the development of reflective awareness (Slade, 2002, 2003);
maternal styles (Raphael-Leff, 1986, 1991); and predominant
states of mind (Mayes, 2002) that accompany the transition
to parenthood. Another new focus of interest attends to the
uniquely gendered aspects of the experience of pregnancy.
Raphael-Leff (1996) has noted that the biology of pregnancy
augments awareness of the difference between the genders
in fundamental ways within heterosexual couples. Various
authors have addressed the complex impacts of gender on the
changing partner interaction, as new definitions of self and
other come to the fore for both men and women in heterosexual
and homosexual partnerships (e.g., Cowan and Cowan, 1992;
Cohen and Slade, 2000; D'Ercole and Drescher, 2004).
Mayes (2002) asks the important question, "What allows
adults to psychologically care for their c h i l d r e n ? . . . How do
parents make room in their minds for their new baby and their
new role?" (p. 5). In this special area of study the emphasis is
on the emergence of the maternal as an attitude, a constellation
of feelings, and a set of capacities (see Leckman and Mayes,
1999; Chodorow, 2000). One such capacity is intersubjective
understanding and communication (Slade, 2002, 2003).
The confirmation of pregnancy is understood to initiate
a range of feelings associated with the reality of the event.
The developmental challenges specific to pregnancy and the
preparation for parenthood unfold across the three trimesters
of pregnancy and are reconfigured by childbirth and the early
mothering experience (Lester and Notman, 1986; Cohen and
Slade, 2000). It is important to appreciate the diversity of ad-
aptations and varying depths of engagement that characterize
different women over the course of a pregnancy. Raphael-Leff
(1986, 1996) proposes a useful metaphor. She suggests that
individual women can be seen as varying along a continuum
of their "permeabilty" or "psychological immunity" to the
psychic issues pregnancy presents.
We emphasize the experience of a first pregnancy to high-
light basic issues. Naturally, such factors as whether or not the
154 Sharon Kofman and Ruth Imber

pregnancy was planned, the woman's age, her marital status,

and the partner's gender will all shape not only how the rev-
elation of the pregnancy is experienced by a woman but also
her feelings in the months that follow. If she has a history of
infertility, miscarriage, or other complications of pregnancy,
joyful feelings may be tempered by fears of loss and, frequently,
anxiety in connection with prenatal testing (Covington and
Burns, 1999). Cohen and Slade (2000) have identified the
impact of inadequate social and marital support, limited finan-
cial resources, and the woman's psychological immaturity as
potential sources of initial anxiety and ambivalence. Generally
speaking, according to those authors, in the first trimester the
pregnant woman is reacting to and assimilating the novel physi-
cal sensations and symptoms that are occurring. The baby is
still pretty much an abstraction. Her orientation is primarily
narcissistic, as the baby is experienced as an extension, or an
additional part, of herself (Ammaniti et al., 1992).
The baby becomes recognized as a real and live presence
with the aid of ultrasonography (Piontelli, 1992, 2000) and
with the quickening (usually during the fourth or fifth month),
which marks the beginning of the second trimester. She can
now feel the baby's separate and distinct reality, in most cir-
cumstances a thrilling and reassuring experience. The expan-
sion of the belly and the accompanying weight gain, resulting
in the inevitability of "going public" with the pregnancy during
this phase, are emotionally charged and potentially conflictual
events.
The palpable presence and sensations of another being
inside her instigates profound internal transformations over
the next months. Turning inward, the expectant mother begins
to revise her sense of her boundaries and separateness. As
Raphael-Leff (1996) describes, "she can no longer maintain
an illusion of being a monadic individual" (p. 374). Birksted-
Breen (2000) elaborates how, in unconscious fantasies and in
dreams, the pregnant woman continually reworks her emo-
tional experience of the baby's "insideness" or "outsideness" to
herself and the connection she makes between herself and the
baby. We have noted in our patients' clinical material uncon-
scious themes of inclusion versus exclusion, retention versus
expulsion, closeness versus distance, and domination versus
10. Pregnancy 155

surrender in our patients' clinical material. These themes have

been identified by other analysts (Cohen, 1988) as well.
Fluctuations in self-esteem and abandonment anxieties
associated with the dislocations of pregnancy are also com-
mon during this time. A woman may need more support and
reassurance from her partner that she is still loved and desired
despite the changes occurring to her body. If her partner can
delight in her changing physical shape and "bond" with the
unborn baby, the pregnant woman will be helped to feel af-
firmed and proud of what is happening inside her.
A maternal stance typically described as "motherliness"
also becomes increasingly evident in the second trimester
(Lester and Notman, 1986). The feelings of movement and
life inside are presumed to rekindle a deepened identification
with the mother and fetus on a physical and psychological
level. Memories of the mother's earliest experience are reacti-
vated in the present. Researchers tell us that daydreams and
fantasies about the baby are often evoked at this time. If all
goes well, tender wishes to care for and nurture the baby also
emerge into consciousness (Lester and Notman, 1986). Mayes
and Cohen (2002) and Slade (2002) believe that the transition
to parenthood is underpinned by the mother (and father's)
ability to "create a space in their mind of the child they expect
to love" (Mayes and Cohen, 2002, pp. 40-41). These authors
and others (e.g., Stern, 1995; Cohen and Slade, 2000; Slade,
2002) underscore that the mother's developing attachment to
her baby is facilitated by imagining the baby, its temperament,
physical characteristics, and personality. Her immersion in
reveries about the baby and her imagined "self-in-relation"
(Chodorow, 1978) intensify as the pregnancy unfolds.
For women who are self-absorbed as a result of a his-
tory of trauma, current marital conflict, or stress from other
external realities (including the enduring impact of infertility
techniques and medical procedures) the opportunity to "attend
to their own minds and body communications" (Pines, 1990)
is frequently diminished. From a clinical standpoint, we are
aware that excessive ambivalence and defensive strategies, and
a lack of support will result in different narratives.
The third trimester is usually occupied with preparation
for the delivery. Unresolved issues relevant to the adequacy of
156 Sharon Kofman and Ruth Imber

a woman's support network come to the fore. Infant specialists

(e.g., Beebe and Lachmann, 2002) have vastly illuminated our
understanding of the subjective and intersubjective processes
characteristic of early caregiving experiences. Optimally, in
late pregnancy, the mother-to-be enters a unique mental state
of heightened sensitivity and "primary maternal preoccupa-
tion" with the baby, which extends into the perinatal period
(Winnicott, 1956).
Over the course of the pregnancy, the mother-to-be reor-
ganizes and transforms her identity in fundamental ways: from
daughter to mother, from wife to parent, from one generation
to another (Stern, 1995). Various authors have delineated
the processes by which she reworks her relationship to her
mother and partner, internally and externally, as she assumes
responsibility for the care of a helpless infant. She becomes pro-
foundly identified with her baby's needs. Her focus of attention
almost exclusively concerns the safety and emotional needs of
the infant. Her concerns to become a good mother are evolv-
ing under the dominance of the "motherhood constellation"
(Stern, 1995). This process is facilitated by the revival of iden-
tifications with her own mother and memories of experiences
with her mother as well as with alternative maternal figures
and resources (relatives, friends, siblings, teachers, mentors,
including "nurturing" men) across her life history.
Although pregnancy can, and most often does, provide
an enriching positive contribution to a woman's psychological
development, Goldberger (1991) and others (e.g., Cohen and
Slade, 2000; Piontelli, 2000) point out that it should not be
viewed simply as a period of uncomplicated calm. It is also a
time of the ubiquity of conflicts (Goldberger, 1991). Let us
highlight a few of the most typical of these.
Some of a woman's conflicts and concerns stem from
early childhood fantasies and misunderstandings regarding
procreation. We have in mind such fears as there will be no
room for the mother's organs once the baby fills up her "inner
space," or the fantasy that the baby will "suck" the life out of
the mother, or the idea that the mother's "bad" feelings may
cause the baby to die. A woman who anticipates becoming a
mother may irrationally fear being punished for successfully
10. Pregnancy 157

competing with her own mother, or for replacing or surpass-

ing her.
Many women have spent years pursuing careers that
have brought them much satisfaction and formed an impor-
tant part of their adult identity. The prospect of motherhood
may threaten this aspect of their sense of self. How much free
time will she have for herself, for her other children and, of
course, for her partner once a baby arrives? These concerns
may be especially acute for women whose own mothers were
not themselves happy with their lives either because they
were frustrated with being full-time, stay-at-home women, or
because they were never able to achieve a satisfying balance
between career and the maternal role. It is only in the last three
or four decades that women have had the freedom to combine
a domestic role with one that takes them into the larger world.
It is easy to understand how precarious this balancing act may
seem even now (see Moulton, 1977, 1985, for an elaboration of
this issue). Even with the most liberated and supportive spouse
or partner there will be what we would call "role strain." For
instance, even a woman who loves her job will occasionally
experience guilt about the time it takes away from her child.
Conversely, no matter how much a woman loves her child and
the role of mothering, there are bound to be times when she
resents the sacrifices she may be required to make at work to
be a good-enough mother.
One of our patients, a professional dancer, struggled for
several years with her realization that if she chose to have a
family it would, in all likelihood, mark the end of her life as a
performer. She was very invested in her lithe body and dreaded
the changes to her figure that bearing a child would cause.
Indeed, when she did opt for children and was pregnant with
her first child, her fear of becoming just like her overweight,
unhappy, and very angry mother was a central issue in her
psychoanalysis. Her pursuit of a career in dance had been
understood, when she began treatment, as having been moti-
vated, in part, by a strong disidentification with her mother.
Such a need to differentiate from mother while simultaneously
reestablishing a primary connection with her by becoming a
mother often creates intense ambivalence and turmoil.
158 Sharon Kofrnan and Ruth Imber

Other women may have trouble with the increased de-

pendence that they have on their husbands or partners. Often
this change requires a psychological shift when they become
mothers and sometimes even before they give birth, for in-
stance, if they are put on bed rest or if they find they are un-
able to function at full throttle. This dependence can be both
emotional and financial. If she is working less, or not at all,
a woman may suddenly experience herself in the position of
the subordinate in subtle power issues. The hand that rocks
the cradle may not be as powerful as the hand that fills the
checking account. Even a woman who continues to hold her
own financially faces the reality that she now must count on
her partner to both nurture and coparent in ways she may not
have needed before becoming pregnant or having a child. If she
has seen her own parents collaborate in a harmonious way in
her family of origin, she may have little trouble allowing herself
to need her husband's greater support. For some women who
are more ambivalent about their marriage or their role there
may be a sudden realization that they are far less free to leave
the relationship should they so desire. This recognition can be
quite disturbing if emotional commitment is threatening.
Although couples often say that they will share the job of
parenting 50/50, pregnancy is undeniable evidence that some
things will not be equitable. The woman may resent the burden
of bearing the baby and may fear the ordeal of actually giving
birth. She may fear the pain of delivery or have fantasies that
her body will be damaged or even that she will die in childbirth.
These feelings may alternate with a sense of pride and power in
what her body can do that a man's cannot. If, as is increasingly
the case with older women who have had fertility treatments,
the woman is expecting twins, or even triplets, all these feel-
ings will be heightened by the reality that such pregnancies
are more complicated and have greater associated risks.

PSYCHOTHERAPY WITH T H E PREGNANT PATIENT

For many women who are unable to envision themselves as

mothers, or for whom the anticipation of parenting has a darker
10. Pregnajicy 159

side (Spielman, 2002), psychotherapy presents an opportunity

to "redefine the representational landscape" (Stern, 1991).
Clinical listening in the treatment situation is enriched by
the therapist's attunement to the self-other relational configu-
rations that come into play perinatally, especially in relation
to the pregnant woman's mother. If her mother, for example,
was experienced as degraded, absent, depriving, rejecting,
preoccupied with other babies, perfectionistic, parentifying,
depressed, or abusive, this will shape the pregnant woman's
feelings about mothering a child of her own (Cohen and Slade,
2000). Clinical holding often entails an accepting context
and tolerance for regressive, little-girl longings and angry,
disappointed feelings (Trad, 1990; Bradley, 2002) that need
expression to effect a genuine reintegration of past and pres-
ent. In the transference relationship to the female therapist,
interpersonal issues relevant to female closeness and mutual-
ity, curiosity, and comparative or competitive preoccupations
are likely to emerge.
Many women feel ashamed to acknowledge distress and
difficulties in coping. We have learned that, in subtle or in more
pronounced ways, many women are burdened by unwanted
bad or inadequate perceptions and feelings about themselves,
which emerge with special relevance in anticipation of parent-
ing. A dream reported in the literature (Trad, 1990) illustrates
a pregnant woman's recovery of a not-me, "broken doll" aspect
of self in the course of treatment.

The dreamer finds herself in the basement of an old tum-

bledown house that looks familiar to her. "She began looking
for something that will help her identify the house as the one
she had lived in. Finally, on a high shelf half-hidden by boxes
and debris, she saw her old doll, which was torn, dirty and
missing a leg. When she tried to reach for the doll, she felt
pain in her abdomen. She felt a shoving from behind and
looked around to see a doctor pushing her from behind and
her husband pulling on her hands in front, trying to get her to
leave the basement. She kept telling them she couldn't leave
without the doll, but they didn't hear me" [p. 351].

There are many possible interpretations to this dream. We are in

agreement with Trad (1990) that the dream reflects the patient's
160 Sharon Kofman and Ruth Imber

self-reorganization in the "treatment womb." Experiencing her-

self as a broken and inanimate doll, she seems to be voicing
that some vital part went unrecognized and, unless repaired,
is at risk for reenactment in her relationship to her child.
The postpartum period is often a time when some of the
issues we have been discussing continue to be worked through
and resolved. Another dream reported by one of our patients
after she had given birth illustrates her sense of vulnerability
and her concerns about being a "good-enough" mother. The
dream illustrates the crucial role of the pregnant woman's in-
ternalized representation of maternal support in determining
maternal confidence. The intense affects reported here are
common to the postpartum experience and are often short
lived, especially with the benefit of therapeutic containment.
In the dream, the woman is pregnant, on a bicycle, and
aware of controlling her balance while navigating downhill. She
notices that she is wearing white pants. She passes a group of
male skinheads and steers away from them. Suddenly a strong,
big woman who crosses her path knocks her off her bike. She
exclaims, "Don't you see I'm pregnant?" Then she is at home.
She has bought a fish tank with a fish in it. The fish is jumping
in and out of the water. The tank springs a leak and she, alone
in the room, watches, helplessly as the water from the tank
seeps slowly onto the floor.
As we worked with the dream it became clear that many
of the anxieties experienced during the pregnancy were free
only to emerge after this woman's baby had been safely born
and was healthy.
Let us now consider how therapist and patient respond to
the imagined and future baby as a presence in the consulting
room in diverse transference-countertransference relational
configurations (Stack, 1987; Goldberger, 1991; Raphael-Leff,
1996). The baby may be experienced as an envied sibling,
competing in the transference for the mother's supplies. Or,
for women with a history of parentification and maternal role
reversal, the baby may be anticipated with apprehension and
resentment as a reedition of a demanding parent. Disentangling
the fantasied aspects of these projections by exploring the
mother's emotions, fears, and enactments in the transference
can open up space for the actual baby to be seen as a new
10. Pregnancy 161

person outside the mother (see Fraiberg, 1980; Lieberman,

1983; Stack, 1987; Cramer, 1997; Slade, 2002).
A therapist may encounter a variety of her own personal
reactions when working with a pregnant patient. Some of
these experiences may rightly be termed countertransference,
in the narrow sense, as when the patient is fearful and seeks
guidance or mothering from the therapist and the therapist in
turn, responds with maternal reassurance and advice instead
of attempting to understand what may underlie the patient's
concerns. We believe that a pregnant patient will often need
some additional support and "mothering" from her therapist.
Such support does not have to interfere with the simultane-
ous exploration of the patient's inner world. Empathic male
analysts can certainly provide this "mothering." Providing
support, however, can become problematic if it is based on
an overidentification with the patient's needs and anxieties.
Such overidentification can lead the therapist to take the
patient's concerns or attitudes at face value rather than ana-
lyzing them.
Other reactions in the therapist, however, may be stimu-
lated not by the patient's transference but, rather, by the
pregnancy itself. An older female analyst may, for instance,
be envious of a younger woman's ability to be pregnant. This
envy may arise whether or not the analyst has children of her
own. Any analyst may find himself or herself struggling with
revived maternal transferences to a pregnant patient. Some of
us may have our own unresolved issues about what it means to
be a mother, and these issues can interfere with our ability to
hear the whole range of our patients' feelings. If, for example,
we overidealize motherhood, we may be unwilling to allow a
patient to express her resentment toward her unborn child.
Mrs. A was a divorcee with two school-age sons when she
met and married a man who did not yet have any children of
his own and who very much wanted at least one child. She
agreed that they would have a third child together. He was a
loving stepfather and devoted husband who deeply enjoyed
family life. As Mrs. A approached 40, her husband began to
press her to become pregnant. It became clear that, as the
actuality of having "to start all over again" with a new baby
grew more real, her resentment and fear increased as well.
162 Sharon Kofrnan and Ruth Imber

She simply did not want to give up her figure, her freedom,
or her uninterrupted night's sleep to deal once again with an
infant. Perhaps, too, there was the less conscious fear that a
new baby would become her rival for her husband's love and
attention or that he would be less involved with the children
of her first marriage once he had a child of his own. She con-
sciously feared that a new baby would distress her two sons,
who had finally begun to adjust to postdivorce life. She felt
guilty about having to admit to herself and her analyst that,
much as she loved her two children, she did not love the idea
of carrying or being the mother of a third. Her analyst found
herself at moments identified with Mrs. A's new husband and
had to manage her view of her patient as betraying his trust
since she had promised him she would have his child.
It is important that analysts take care not to impose their
personal beliefs and values on the patient even in subtle ways.
Male analysts especially may need to guard against viewing a
woman who chafes at, or actively rejects, the traditional role
of devoted, full-time, loving mother as somehow being an un-
natural woman. While much is made today about the effect of
the "real" aspects of the analyst, we have found that the gen-
der or parental status of the analyst is a less important factor
than are psychological maturity and freedom from stereotypic
assumptions in determining the success of treatment with a
pregnant woman. The capacity for empathy, tolerance for
uncertainty, and ability to contain anxiety and negative affect
are far more significant attributes in helping a woman weather
this developmental period.
We have learned that the therapeutic option of psycho-
tropic medication as an adjunct to psychotherapy in the treat-
ment of the pregnant patient always requires an informed and
thoughtful stance on the part of the therapist. We believe that
the decision to continue, discontinue, or initiate medication
during pregnancy should follow careful consideration with the
patient of the benefits and potential risks in her individual
case. The risks of going on or off a medication may be psy-
chological as well as physical, short- or longer-term. Keeping
up to date on current research findings is strongly advised,
as is consultation with an expert psychopharmacologist. The
psychodynamic meanings of the request for medication and
10. Pregnancy 163

the implications of medication for the treatment relationship

should also be explored.

T H E PREGNANT THERAPIST

As women have entered the field of psychotherapy in ever-

greater numbers, the pregnant therapist has become a common
occurrence. The same could be said for many occupations as
women increasingly work both before and after motherhood.
The pregnant therapist in some ways faces a special challenge,
for it is her emotional responsiveness, coupled with her intel-
lectual ability, that is her stock in trade. Even as she must cope
with all the physical and emotional changes that pregnancy
presents, she must also deal openly and effectively with the
various and often intense reactions that her patients will have
to this "intrusion in the analytic space" (Fenster, Phillips, and
Rapoport, 1986). However, it is precisely at times of heightened
emotional vulnerability such as during pregnancy that a thera-
pist may be least able to maintain her "emotional balance" in
the face of powerful transference pressures. By now there is an
extensive literature (Fenster et al., 1986; Imber, 1995; Bassen,
1998; Fallon and Brabender, 2003) on the topic of the pregnant
therapist or psychoanalyst that supports the idea that her job
during this developmental phase is inevitably complicated in
various ways. This is especially true for a first pregnancy, as it
is this one that will confront a woman with the most dramatic
"normal maturational crises" (Bibring, 1959).
Although the myth of the completely anonymous therapist
has by now been laid to rest, there are many aspects of her
personal life that she would not disclose to her patients in the
normal course of events regardless of her theoretical orien-
tation. Her pregnancy, however, ensures that something highly
personal will be revealed to her patients. It is usually undeni-
able evidence that she is sexually active and that she has an
ongoing intimate relationship with a partner. In addition, just
as a patient's unborn baby is a presence in the treatment room
during the patient's pregnancy, so, too, when the therapist is
pregnant a third person can be said to have joined the dyad
(Goldberger et al., 2003).
164 Sharon Kofman and Ruth Imber

In a therapy treatment where the primary focus has been

on the patient and his or her fantasy life, things are bound to
change. Now the therapist's life and future plans will become
a focus (McGarty, 1988). When will she stop working and for
how long? What practical arrangements will she make for her
patients in her absence? Will there be disruptions to her normal
work schedule during the pregnancy? How will she and her
patient cope with the possibility that she will not be able to
continue her practice until the expected due date? Although
this is obviously a "special event" in any treatment (Weiss,
1975), Fenster and her colleagues (1986) cite numerous refer-
ences to therapists trying to act as though their pregnancy were
just "business as usual" (Lax, 1969; Benedek, 1973; Baum and
Herring, 1975; Schwartz, 1975; Titus-Maxfield and Maxfield,
1979; Phillips, 1982). The reasons for this defensive posture
may include fear of the patient's intense transference reac-
tions, especially angry, aggressive ones (Lax, 1969; Naparstek,
1976; Bassen, 1988; Imber, 1990); guilt about abandoning or
excluding the patient (Lax, 1969; Fenster et al., 1986; Bassen,
1988; Imber, 1990), and a fear of being seen as inadequate or
unprofessional (McGarty, 1988; Fallon and Brabender, 2003)
especially in comparison with male colleagues.
In an early paper on the pregnant therapist, Nadelson
et al. (1974) suggested that, owing to her heightened sense
of vulnerability, the pregnant therapist might be especially
unwilling to perceive and deal with negative, hostile, or ag-
gressive feelings in her patients. Their conclusion has been
confirmed by subsequent authors (Bassen, 1988; Imber, 1990,
1995; Goldberger et al., 2003). It is understandable that at a
time when the therapist may be filled with excitement and
joyful expectation about her unborn child it will be difficult
to listen to a patient's fantasy or wish that the baby will die or
be deformed or that the therapist is betraying the patient by
turning her loving attention to this unborn rival. One patient
expressed well the sense of outrage that his therapist's "sur-
prise" evoked. He angrily demanded, "How could you do this
without asking my permission?" Another patient, whose anger
was more out of awareness, joked to her analyst, "You'll never
be able to cross Broadway in one traffic light again."
10. Pregnancy 165

A related problem the pregnant therapist may encounter is

the envy of patients who themselves desire to become mothers
but who, for one reason or another, may not be able to do so.
Mrs. C had entered treatment because she was having an affair
with a married man and was thinking of leaving her husband,
with whom she had not been able to conceive a baby after try-
ing for several years. The therapist, now in her second trimes-
ter, had finally begun to wear maternity clothes when Mrs. C
came for her first session of the week. She immediately noticed
the change in her therapist's wardrobe but needed to disavow
the obvious meaning. She sat down and asked the therapist if
she was trying to get a reaction from Mrs. C by "dressing up as
though" the therapist were pregnant. The therapist gently told
Mrs. C that, in fact, she was pregnant and that this might be
a very difficult fact for Mrs. C to take in. The patient resorted
to denial: "No, it's fine. It doesn't matter." Despite the effort to
work on her response over the next several months when the
therapist returned from her two-month maternity leave, Mrs.
C chose not to return to treatment. Instead, she suggested that
she would be glad to meet the therapist somewhere for a cup of
coffee. But, she said, she could not return to being a patient.
One important question a therapist must confront is how
and when to tell her patients about the pregnancy. Some pa-
tients will ignore or deny the pregnancy for as long as possible,
whereas others may be exquisitely sensitive to bodily changes
in their therapist and guess the reason quite early. Mrs. C had
warded off her awareness of her therapist's condition for as long
as she could. Other patients had already guessed even before
the therapist began to wear maternity clothes. While usually
a therapist will follow the patient's lead in discussing themes
in treatment, this is a situation where the therapist will have
to take the lead if the patient does not present some hints of
having consciously perceived what is happening.
Often the patient may register the pregnancy only "sub-
liminally" (Stuart, 1997). If the therapist is not overly anxious
and defensive, she may hear veiled references to the pregnancy
in dreams or in displaced associations. One difficulty with
evaluating if Mrs. C had registered the pregnancy was that her
sessions were often filled with references to babies and her
166 Sharon Kofman and Ruth Imber

anger at her husband for not being able to give her one. Recall
that this was the very problem that brought her into therapy
long before her therapist became pregnant. Some therapists
may be so preoccupied with their own physical state and be
so eager to share it that they will hear or imagine references
to it when none exists (Baum and Herring, 1975; Fallon and
Brabender, 2003).
In their recommendations for the supervision of analytic
candidates, Goldberger et al. (2003) suggest that, if the patient
has not yet guessed, he should be told by the end of the second
trimester so that there will be enough time to work on all the
issues that are stimulated. They point out that, if the patient is
informed too early (i.e., in the first trimester, when the major-
ity of miscarriages occur), there is a risk that the analyst will
have to deal with her own loss while working with the patient's
reactions to the pregnancy. In addition, if the patient is told
too early there is no possibility of noting how the patient's
material evolves spontaneously. We think this is good advice
for any therapist in or out of training.
A pregnant therapist will have to wrestle with her self-
absorption and withdrawal, as she becomes preoccupied with
changes occurring both physically and intrapsychically. The
literature suggests that both the therapist and the patient may
prefer to deny the significance of what is happening for as long
as possible (Lax, 1969; Bassen, 1988). If they do not give in to
this temptation, the therapist's pregnancy can be an incredibly
useful opportunity for a patient to explore conflicts and issues
he or she might otherwise not access, such as separation and
loss, sibling rivalry, mother-infant themes, and the like.
Bassen's (1988) interviews with 18 analysts who had com-
pleted pregnancies supports the observation that this can be a
very productive time in treatment. Because the therapist must
undergo and manage all the same stresses and challenges that
pregnancy presents to all women, it is probably most desirable
for her to have a supervisor with whom she can consult during
this time especially if she is not in her own analysis. While we
have known women who felt that during their pregnancies they
had received excellent support and supervision from male su-
pervisors (often older men with children of their own), there is
10. Pregnancy 167

some indication that many women seek out female supervisors

at this time (Fenster et al., 1986) perhaps in the belief that a
woman will better understand the experience. The therapist
will usually be more sensitive to the supervisor's criticism and
in need of support for her physical and emotional experiences
during pregnancy (Baum and Herring, 1975; Fenster et al.,
1986).

CONCLUSION

Our intention in this chapter is to convey the power of the ex-

perience of pregnancy for the woman's sense of self and other.
The physical experience of pregnancy is paralleled by profound
changes intrapsychically. Each woman's personal psychology
and life situation will shape her own conscious and unconscious
experience of the pregnancy and its characteristic anxieties,
fantasies, and symptoms. We also want to highlight the role of
the pregnancy in the emerging relationship to the baby.
It is no longer unusual for either a patient or an analyst
to be pregnant during treatment. We hope that the attention
given here to the pregnant woman's internal life—her hopes,
fears, and states of mind—will contribute to a richer under-
standing of the meaning of pregnancy in the dyadic treatment
situation.

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Chapter 11

Facts and Fantasies

about Infertility
ALLISON ROSEN

M ost women do not know the dangers of delaying child

bearing. A woman's age is the biggest barrier to natur-
ally occurring conception or success with fertility
treatment. Because of misinformation and a lack of informa-
tion, one in five women in the United States delays childbearing
until age 35, when fertility rapidly begins to decline. As psy-
choanalysts and psychotherapists, we are caught in a web of
analytic proscriptions, prescriptions, and taboos about impos-
ing our personal agendas on patients. After all, our patients
come to us for help with a variety of problems, not necessarily
to discuss their childbearing plans. Yet, if we do not bear in
mind the realities of "the biological clock," we may collude
with their denial of the realities of childbearing and cause
irreparable harm. If they are not yet considering childbearing,
how do we bring up such a profoundly delicate topic? If our
patients have been diagnosed with infertility, how do we best
help them? How do we conceptualize our role when patients
are faced with extended infertility treatment and must decide
when "enough is enough" or grapple with the complicated
decisions surrounding the use of donor gametes or adoption?
How do we negotiate our biases when they are very different
from our patients'? What are the common transference and
countertransference themes associated with infertility? What
can infertility and reproduction teach us about ourselves?

171
172 Allison Rosen

CULTURAL C O N T E X T

Parenting and childbearing have changed radically over the

course of history. Consistently, the more education and power
women have in their societies, the fewer children they bear
(Sen and Snow, 1994). In the United States, the priority we
give to our families, community, and professional lives is easily
seen in the transformation of family, work, careers, and birth-
rate from the past to the present. For instance, during Colonial
times (1700s), women did not work outside the home for wages.
Typically, they married by age 20, had six or seven children,
had their last child at 38, and died, on the average, at 50 (Frie-
denberg, 1998). For the most part, Colonial women did not live
to see their last child married. The concept of becoming an
"empty nester" or even a grandparent was foreign to them.
During the 1970s, with the social changes instituted by
the women's liberation movement, women began to examine
the impact of motherhood on their self-fulfillment, careers,
and role in society. Perhaps the most critical examination of
motherhood during this period was Adrienne Rich's (1977)
popular book, Of Woman Born: Motherhood as Experience
and Institution. She believed that motherhood served as a
patriarchal institution imposed on women "which aims at
ensuring t h a t . . . all women shall remain under male control"
(pp. 280–281). During this time, women were urged to develop
careers and share parenthood (with its trials and tribulations)
with their husbands. Women flooded into the labor market. In
1970, 40% of married mothers worked outside the home; in
1984, 59% of married mothers worked. In 1970, only 24% of
mothers with children one year old or younger worked outside
the home; in 1984, 46.8% of mothers with children under one
worked (Hayge, 1986, p. 43).
The changes instituted during the women's movement
transformed society. By the 1990s, the traditional, nuclear
family of working father, homemaker mother, and (at least)
one child accounted for only 7% of all United States households
(Moen, 2001). Now, in the 21st century, women are marrying
later and delaying childbearing to establish their careers. The
majority of women no longer give birth in their early 20s. The
first-baby rate for women in their 30s and 40s has quadrupled
11. Facts and Fantasies about Infertility 173

since the 1970s. More than 60% of wives are working for pay
and almost two-thirds of mothers of preschoolers and, even
more strikingly, married mothers of children under age 1, are
in the work force (Moen, 2001).
Strikingly, census data reveal that childlessness has dou-
bled in the past 20 years. One in five women between ages 40
and 44 is childless (Gibbs, 2002). This increase in childlessness
is primarily due to women's wish to establish themselves in
their careers before bearing children and a lack of information
about the risks to their childbearing capacity if they delay. 1
In fact, in a recent survey, 86% of women falsely believed that
they could get pregnant in their 40s with fertility treatment
(Hewlett, 2004). Hewlett (2002) looked at the relationship
between career and child bearing and found that 55% of high-
achieving women under thirty-five years of age are childless
and 49% of high achieving women in corporate America are
childless at age 40. According to Hewlett, only 14% planned
to be childless.
This situation is unfair to women. Basically, the more fi-
nancially successful a woman is, the less likely she is to have
a partner or children (Hewlett, 2004). Men do not experience
the same gap between what they want and what they have
in relation to child bearing: 79% of men want children; 75%
have them (Hewlett, 2004). Unfortunately, the majority of
women who have postponed children into their 40s because
they married late in life or attempted to establish themselves
occupationally will likely remain childless without medical
intervention and use of donated eggs (Sauer and Paulson,
1992; Sauer, 1998).

Infertility Facts

Infertility affects 6.1 million people in the United States, ap-

proximately 10% of the reproductive-age population. The rate is
much higher in older women. For a woman at age 20, the risk
of miscarriage is about 9%; it doubles by age 35, then doubles
again by the time the woman reaches her early 40s (Scott et
al., 2002). This decline ensues because at 42 years, 90% of a
woman's eggs are abnormal; she has only a 7.8% chance of
174 Allison Rosen

having a baby without using donor eggs. Only .1% of babies in

the United States are born to women 45 years of age or older
(Scott et al., 2002).
At age 37, half of all couples will be infertile (i.e., be unable
to conceive after one year of actively trying to bear children);
approximately 90% of all couples will be infertile by age 42
(Scott et al., 2002). The limiting factor for success of infertility
treatment for both men and women is usually determined
by the woman's age and the quality of her eggs.2 Abnormal
eggs (oocytes) cannot be fixed. Egg quality and a decrease in
ovarian reserve are the prime problems in achieving pregnancy.
With help, a woman can carry a pregnancy much later than
she can become pregnant (e.g., with donated oocytes). Until
recently, only embryos could be safely frozen. (Embryos are
created through assisted reproductive technology using in
vitro fertilization by combining male and female gametes.)
Eggs and ovarian tissue are difficult to freeze. Approximately
65 live births have occurred from frozen eggs in fewer than
10 centers in the world (FPSIG, 2003). However, elective egg
freezing or egg banking to delay child bearing will be available
in the near future as an option for younger women (typically,
under 35) who can afford it.

Infertility Myths

Women often falsely assume that their general health is a

good predictor of fertility. They may take very good care of
themselves in the belief that health, appearance, and "looking
young" are indices of their capacity to bear children. Changes
in menstrual cycle typically do not accompany the initial de-
cline in egg quality that ushers in the inability to achieve and
carry a pregnancy. Hence, women may be unaware that their
time is running out. Their regular gynecologists, not wanting
to rush their patients into such an important decision, may
falsely reassure them. The media engender the myth that
women can delay childbearing; the same media do not reveal
that many babies born to highly visible women in their 40s
are born through the use of donor eggs. Many couples lie about
their use of donated eggs or sperm (Golombok et al., 2002).
11. Facts and Fantasies about Infertility 175

More than one million people seek infertility treatment

and 30,000 babies are born each year to couples using assisted
reproductive technologies (Gibbs, 2002). The Centers for Dis-
ease Control and Prevention reported in 1998 7065 transfers
using donor eggs. Of the one in ten couples in this country
that experience infertility, it is estimated that between 11%
and 25% will pursue adoption (Mosher and Bachrach, 1996;
Winter, 1997).

WHEN AND H O W DO WE BRING UP T H E SUBJECT?

Given that the first measurable decline in fertility for a woman

begins at 27 years, I believe it is imperative for the psychothera-
pist to have reproduction at the back of her mind. If a patient
has not mentioned childbearing fears, hopes, and dreams and is
in her 30s, I raise the issue. I am not trying to steer the patient
into bearing a child; instead, I am curious about the absence
of thought and/or preparation about the topic. In a long-term
treatment, the therapist usually knows the patient's reasons
for denial. Despite the fact that broaching the subject can have
deleterious unseen consequences on the treatment, I would
rather err on the side of attending to denial.
Too often, I have been the consultant on cases where child-
bearing has been lost because both the patient and therapist
avoided (or did not know) biological reality. Discussion can
spark many interesting and informative reactions. Attach-
ment issues, oedipal rivalry, lack of a partner, poor partner
relationship, and career needs are common obstacles in the
path toward parenting. If a woman has been unable to find
someone to share her life and is aware of the biological reality
of her fading reproductive capacity, she may suffer additional
shame, identity issues and despair. ("Why can't I find a m a n ?
What's wrong with me? Am I incapable of intimacy? You just
don't understand The men out there are losers. I've tried
everything.") She may not want to marry someone simply to
obtain sperm, but time pressure exerts its toll and ravages the
dating experience. Hoping "to have it all," many women de-
cide to risk infertility in order to find someone to love. Some
establish a "cut-off date" and then decide to use sperm donors
176 Allison Rosen

and become single mothers. In so doing, they hope to retain

the option of finding a partner when they are under less time
pressure. Others worry that men will not love them with the
"excess baggage" of children.

THE DIAGNOSIS

Patients who are newly diagnosed with infertility usually suffer

more than they would have anticipated prior to diagnosis.
Physicians and the personnel treating them may not see the
degree of pain that the therapist does. Most patients wish to
appear to their physicians as good candidates for parenthood
(Josephs, 2004). In contrast, in a trusting therapeutic relation-
ship, the infertility patient "lets down" and shows his or her
pain. The strong affects may frighten both the patient and the
therapist.
Returning from a rival sister-in-law's baby shower, an
infertile woman said:

When I came home all I could think of was killing the baby.
I would kill the baby and smear his blood all over the walls.
Then I would kill myself. John tried to comfort me, telling me
to "calm down." Nothing would relieve the pain. I cried all
night, despite his telling me to come to bed. I didn't tell him
about wanting to kill the baby. I didn't want to scare him.

PSYCHOLOGICAL CHALLENGES OF INFERTILITY

While every infertility patient suffers a unique and painful

journey, they share similar psychological challenges. Research
tells us that infertility entails depression, feelings of shame,
and a loss of hope (Dennerstein and Morse, 1988; Downey et
al., 1989; Stotland, 1990; Berg and Wilson, 1991; Burns, 1993;
Greenfeld and Walther, 1993; Rosenthal, 1993; Applegarth,
1996). Marital and sexual satisfaction may suffer. One's sense
of control, including one's health and well-being and belief in
the fairness of life, are often destroyed along with one's self-
esteem (Dickstein, 1990).
11. Facts and Fantasies about Infertility 177

Each failed treatment cycle in an individual's or couple's

reproductive journey is experienced as a profound loss (Green-
feld, Diamond, and DeCherney, 1988). Upcoming events
become times of fragile hope or potential dread marred by
miscarriages and despair. ("I will be pregnant on our anni-
versary. By Christmas, we'll have the baby.") The pain can be
unbearable. In fact, infertility is experienced with the same
emotional distress as a diagnosis of cancer or AIDS (Domar,
Zuttermeister, and Friedman, 1993). 3 An infertile couple loses
the child of their dreams, the fantasized child that will complete
their life and fulfill important emotional needs, as well as the
emotional needs and destinies of their families. Men frequently
turn to work or other outside activities for comfort. Women
often seek emotional support outside their marriages, from
other women or female family members. Women often feel
responsible for the couple's infertility, whether or not they
actually are responsible (Newton and Houle, 1993).
I believe that one of the most significant losses that in-
fertility entails is the loss of one's prior notions of self. The
stress of infertility and its attendant narcissistic injuries may
lead to rage reactions and other regressive responses. Thus, in
self-psychological terms, the narcissistic pain of "infertility is
experienced as an injury to self-cohesion, leading to anxiety,
fragmentation and archaic forms of self-organization" (Burns
and Covington, 1999, p. 10). In interpersonal terms, the trauma
of infertility can lead to the emergence of dissociated aspects
of self and earlier modes of organizing experience, as well as
an altered perception of one's interpersonal relationships. Each
month, each cycle leads to a painful, unbearable hope, followed
by a distorted self, an unfamiliar, angry, despairing self, born of
the repeated loss of the couple's beloved child. Magical thinking
is common. Relationship patterns from earlier times emerge.
Envy of one's fertile "sisters" may rear its green head; one may
feel cut off and alienated. Strong affects, rippling through the
patient's life, permeate all intimate relationships and deplete
the person's family and community reservoir of support.
In summary, infertility thwarts one's life dreams, sense
of meaning, sexual functioning, and spontaneity. It interferes
with love, self-esteem, sense of control, and security in one's
178 Allison Rosen

body and in the world. It destroys financial resources. Many

infertility patients behave and feel quite differently than usual
during their distress, and this difference influences their sense
of self, personal relationships, daily functioning, and goals. In
my experience, infertility patients may lie or feel jealousy and
hatred. They may be consumed with self, indifferent to the
world, disconnected from family and friends, contemptuous of
their spouses (who don't understand), bitter, and paralyzed in
other aspects of life. Only one thing matters—pregnancy and a
baby. To someone else (e.g., a friend or colleague or therapist),
the desire may seem driven and compulsive. Not only do infer-
tility patients lose their offspring, they may feel as if they are
losing their minds and comfortable notions of self. Their place
in the world, as well as their safety in past relationships, disap-
pears. With this narrowing of focus and emergence of earlier
modes of organization, the pursuit of parenthood becomes the
necessary cure if they are to feel normal again, and all efforts
are expended in this direction.

CLINICAL VIGNETTE: INFERTILITY IS NEVER

SIMPLY ABOUT BIOLOGY

Michael and Ruth consulted me because they were contem-

plating divorce. In addition to their other troubles, they could
not come to an agreement about what to do with their frozen
embryos. Ruth was 45 years old. They had been trying to
have children for seven years, beginning immediately after
they married, when they were in their late 30s. Michael was
the only son of Holocaust survivors. Most of his family had
been killed during the war, and his parents died before he met
Ruth. In contrast, Ruth came from a large, close-knit, Ameri-
can-born Jewish family. She married Michael in the hope of
building a family similar to the family she knew. Having just
lost her mother and feeling life's fragility and the importance of
emotional connection, she hoped to become a mother herself.
Michael reported that he often was angry because he felt that
their lives revolved around Ruth's family. He wanted a family
of his own.
After several years of invasive medical treatments, Michael
11. Facts and Fantasies about Infertility 179

and Ruth decided to use donor eggs because of the low prob-
ability of Ruth's conceiving with her own eggs. The first cycle
using the donor eggs was a failure. Ruth felt so upset she could
not consider going forward. She felt "done in," her body and
psyche battered and violated. (However, seven embryos re-
mained, cryopreserved following the first donor egg transfer.)
Michael began going to synagogue to pray for Ruth to change
her mind and use their frozen embryos. He did not care if
she did not want to go on trying to have children after they
used up the frozen embryos, but he could not abide that the
embryos were sitting in the freezer. To Michael, they were
like his parents in the concentration camp, destroyed for no
purpose, trapped in the freezer instead of the fires.
Ruth hated Michael's religious choices. She felt that his
newly found religious observance in an orthodox shul, which
separated men and women, betrayed her feminist values. She
refused to attend and refused to pray. She felt that Michael
had made his life a concentration camp by continually watch-
ing television shows about the Holocaust. And Ruth felt alone
when Michael traveled on business. She feared Michael would
not be able to be present to parent a child. She decided that
they could remain child free, in fact, should remain child free,
given their hateful feelings toward one another. Neither felt
understood by the other.
This case highlights several important issues. Since their
late marriage, Michael and Ruth had gone through long-term
infertility treatment. They each arrived at the decision to stop
treatment at a different time (a not unusual outcome). The
embryos had different emotional meaning for each of them. To
Michael, they represented genetic continuity with his Jewish
heritage and proof that the Nazis were defeated. The intensity
of Michael's rage toward Ruth partially reflected the emotional
despair and rage of a son toward the Nazis, life destroyers,
who had attempted to kill his parents and their offspring. His
embryos represented his past and future family.
For Ruth, the embryos were a potential threat to her health
and well-being. She could not become the idealized mother she
had lost. Unable to achieve a pregnancy, Ruth felt ashamed,
her feminine identity wounded. She was usually proud, but
her self-esteem was shattered, and she resented needing her
180 Allison Rosen

husband's approval; she hated feeling dependent on Michael for

validation of her femininity and self-worth. She hated him for
defining children as necessary for meaning in life. She hated
him for defining as of core importance to him the only thing
she could not do—bear a child.
They could not talk to each other without fighting. Each
felt alone in the marriage, trapped in an empty relationship
with a hostile partner. Ruth retreated to her family for emo-
tional succor, where she felt safe. Michael felt abandoned by
his wife, bereft of support for his strong desire for his own
family, roots, and intimacy. Ruth and Michael felt controlled
and dominated by the other's powerful needs (a common oc-
currence in infertility).
Ruth and Michael decided to use a gestational carrier (a
woman to bear the embryo conceived with the donor eggs and
Michael's sperm). Ruth threw herself into the process. She
wished to find a gestational carrier through her own efforts
rather than employ the services available to help her find one.
She resented Michael's lack of involvement in the process
although she felt proud of her emerging resourcefulness. She
spent long hours alone on the Internet, searching for gesta-
tional carriers. After she found one, both Michael and Ruth felt
optimistic. Ruth's ability to choose a gestational carrier helped
repair her damaged sense of self and feeling of lack of control.
Implantation of the selected gestational carrier with Michael
and Ruth's frozen embryos failed. They decided to find a new
donor and create new embryos. Simultaneously, they decided
to explore adoption as a possible route to parenting.

PSYCHOTHERAPY WITH INFERTILITY PATIENTS

Michael and Ruth illustrate some of the essential tasks of

psychotherapy:

• Establish the meaning and personal significance of infertility,

pregnancy, and child bearing for each partner, the couple,
and their families.
• Confront the reality of infertility and necessary medical
treatments (e.g., finances, physical effects, often dehuman-
izing medical treatment).
11. Facts and Fantasies about Infertility 181

• Build a support network to sustain relationships with family

members, friends, and others.
• Demonstrate how infertility influences self-image, sense of
competence, and communication.
• Outline the interpersonal interaction (how each provoked
the other to feel angry, isolated, unloved and a burden).
• Analyze patterns in the couple's relationship (e.g., distanc-
ing, flooding, and withdrawal).
• Explore emerging new options (taking a "vacation" from
infertility treatment, ending treatment, adoption, and so
on).

As psychoanalysts, we are interested in the meaning our

patients give to their experiences. Infertility had narrowed the
possibilities of meaning and the possibilities for happiness for
Michael and Ruth. Similarly, I felt constricted and worried as
I treated them. I felt frustrated that much of the therapy con-
sisted of pragmatic details of the medical treatment as Michael
and Ruth squabbled. Michael could not communicate without
rage, and his angry tirades influenced my ability to stay con-
nected to both of them. I wanted to yell back at Michael, to
lecture him, to subdue him. Instead, I often felt frozen—both in
the way I acted and in my capacity to generate meaning or new
possibilities. Ruth's lonely vigil as she looked for a gestational
carrier, her isolation, at Michael insistence, from her family,
saddened me. I struggled to avoid a similar passive retreat.
Contemporary relational and interpersonal authors stress
that our sense of who we are, our sense of agency, is the out-
come of complex developmental processes in which our indi-
vidual psyches emerge from the "relational, social, linguistic
matrix" we are born into (Mitchell, 2000, p. 59). Mitchell out-
lined four interactional dimensions or basic modes of organiz-
ing experience that occur during development: presymbolic
relational fields of reciprocal influence, intense affect across
personal boundaries, experience organized into self-other
configurations and mutually recognized self-reflective persons.
These modes represent increasingly sophisticated levels of
development that coexist with each other (p. 59).
Under the stress of infertility treatment, earlier modes of
organizing experience emerge in the therapeutic dyad or couple
treatment. In this case, Michael needed to be known, to have
182 Allison Rosen

his desire to create a child affirmed. Under the threat of an-

nihilation of his "babies," he attempted to dominate Ruth and
the therapy. During this period of our work, I felt submissive
(frozen, isolated, imprisoned within myself), and yet I wished
to assert my will. I wanted to become the "expert," the prob-
lem solver, and thereby circumvent the pain of loss that each
had endured (and my own loss of autonomy). I found myself
wanting to urge them to explore adoption prematurely. What
we were able to accomplish, instead, was the working through
of the mutual meaning of their experiences. Rather than al-
lowing presymbolic enactments, rage, and narcissistic needs
to dominate our interactions, we slowed down. Ultimately,
Michael and Ruth had to integrate love and loss, connected-
ness and autonomy, similarity and difference.

O u r Anticipation of t h e F u t u r e Influences
O u r Sense of Self

Loewald (1972) and Ogden (1989) describe time as the basic

fabric of the psyche. Why? Memory, by traversing the lattice
of internalized interactions, makes self-reflective personal
experience possible. In this view, the present is enriched by
our associative connections to the past. However, the present
is also profoundly tied to how we anticipate our future. In
our internal world, our future is built from the intertwining of
memories of the past with the present; our fantasies about the
future (time capsules from the past) partially determine our
feelings and sense of self in the present.
I am suggesting that infertility and, more generally, par-
enting involve a softening of self-other boundaries and access
to earlier modes of emotional experience. We fantasize about
our potential children (if we are infertile), and these fantasies
enrich (or may diminish) our sense of self. For instance, we
hope our children represent the best in our loved ones and
ourselves. (In contrast, we may also fantasize that our children
will manifest our worst, some hidden defect we are ashamed
of, thus lowering our confidence.) With these fantasies, we are
connecting through time to our past, present, and future. When
11. Facts and Fantasies about Infertility 183

we are actually parents, we are able to intuit our infant's needs

because we can partially reexperience their needs. In general,
our felt personal meaning and self-esteem is affected by this
fluidity of organizational modes and fluidity through time.
Infertility patients are trapped in time. The death of their
dreams makes them feel as if they have lost a part of them-
selves. The loss of their dreams may awaken actual earlier
losses. Since for infertility patients, the present is vivid and
painfully uncertain, and the future, while hoped for, presages
either unbearable pain or ecstatic bliss, treatment itself may
seem caught in a narrow time frame. Waiting the two weeks for
the results of an IVF transfer may be agonizing. Other salient
and difficult issues arising in infertility treatment are the ability
to tolerate flexible boundaries of self and nonself. ("Can I love
a child who is not genetically mine? Can I love my child? How
will my family feel?") It highlights similarity and difference.
("I feel different from everyone else.")
These dimensions—time, earlier relational patterns, the
abiliity to tolerate flexible self- and nonself-boundaries, and
the capacity to tolerate similarity and difference—powerfully
affect the infertility experience. Often these dimensions emerge
as dialectical poles in the therapist-patient dyad. Therapists
often feel the tug to polarize these dimensions interpersonally
containing one part and dissociating the other. For instance,
during the period when Michael was unable to find a balance be-
tween his own needs and those of others, I felt the pull to judge
("Can he be a good father?"), thus emphasizing our difference.
When a patient feels mistrustful, hopeless, dependent,
and outside conventional experience, the therapist may feel
the pressure of strong rescuing/maternal fantasies and wish
to reassure the patient about the future. ("You will be able to
have a baby or adopt one, don't worry." "We all suffer. Consider
instead the many ways that infertility is a gift.") In contrast,
rather than reassuring or reframing the infertility experience,
psychoanalytic therapist-patient dyads need to explore mutu-
ally their dense layering of affective and cognitive experience.
Given the often dehumanizing nature of medical intervention,
the relationship emerges as a potent force to contain the rav-
ages unearthed by infertility.
184 Allison Rosen

D o n o r Sperm and Egg as an A t t e m p t

t o Reclaim Self and Sense of Agency

The donor gamete selection process is an option that highlights

the important decisions and psychological processes faced by
infertility patients. When using egg or sperm donation, couples
must consciously decide which qualities they want in their
donor. Thus the process becomes one of creating children
by conscious (and unconscious) design. Most of us are not
comfortable with this eugenics-like act; we prefer children
to emerge from the murky wisdom of Mother Nature. (In this
respect, I guess most of us are mystics; we prefer mystery, the
unseen hand.) Infertility patients have often suffered invasive
treatment, loss of control, shame, fragmentation of their former
sense of themselves, narcissistic-like, regressive responses,
boundary ambiguity, and so on—and then they are asked to
decide about their donors.
Many couples start the selection process shyly, flirting with
their desires. Most eventually conclude that since others are
carefully selecting donors, why not also avail themselves of the
opportunity to do so? Most couples, however, do not feel com-
fortable talking to a stranger about their deepest needs. They
feel guilty, very politically incorrect. As they begin to relax
into the process, they list the qualities they desire: "I want a
donor who is tall/short, intelligent, thin, athletic, sweet, happy,
a donor with thin legs or with my blood type." With encourage-
ment, they differentiate and elaborate the qualities they would
like in a donor. As one infertility couple requested, "Gould
you find a donor who likes to shop?" During this particular
interview, I quipped—somewhat ironically, I thought—"You
mean you want a donor who has the shopping gene?" "Yes,"
the couple replied in unison. While shopping is probably not
genetically inherited, the young, hopeful mother in this couple
was selecting qualities in a donor that would allow her to at-
tach to the donor and the developing fetus/child. As Stern and
Bruschweiler-Stern (1998) point out, every mother "mentally
constructs the baby of her hopes and dreams.... Mothers also
extend their imaginations to include what the baby will be like
at one year, as a school girl, and as an adult" (p. 34).
11. Facts and Fantasies about Infertility 185

While the emotional p r e p a r a t i o n for pregnancy and

childbirth that infertility patients go through is similar to the
emotional preparation of other people, there is one large dif-
ference. Infertility patients must actually select the qualities
and characteristics they believe they want in their children
from the looks, behavior, and personality of their ovum-donor
cohort. The process is not one of fantasy alone. They are imagi-
natively creating a baby with whom they can identify and are
specifying the qualities they can love in another. Elucidating
the difficulty of her choice, one patient, an African-American,
single, professional who planned to use donor sperm and donor
egg for conception, asked, "How is this different from creating a
slave?" Her question startled me. I believe that this patient was
sensitive to the power relations in the donor-selection process.
She drew from her cultural heritage and felt she was engaging
in purposeful breeding. She emphasized power and control, the
use of another person for one's desires, emotional or otherwise,
as an aspect of her mental preparation for pregnancy.
In general, infertility patients want donors to be perfect,
idealized notions of themselves. They usually select qualities
they view as important in the parent who is losing his or her
genetic input. They assume the fetus will be of the same sex
as the donor. (In other words, donor egg couples believe they
will have a female child; donor sperm couples fantasize a boy.)
Couples want donors who are equal or superior to them intel-
lectually, as indicated by colleges attended and SAT scores,
and who have an appearance and interests similar to theirs.
These couples do not want donors who have promiscuous sex
or reproductive traumas. They want donors who are altruistic,
who donate because of their wish to help another. They do not
want vain, narcissistic or greedy donors. They do not want
donors who have psychopathology or who are fat.
One patient, who wished to recruit her own donor, found
a donor who looked like her and had similar interests, IQ, and
religion. This donor was attending Harvard and would donate
her eggs for $30,000. The patient felt repulsed by what she
perceived as the donor's base, business-like manner and greed.
These qualities were similar to those of the patient's father,
who put business above family and had ignored the patient's
186 Allison Rosen

needs throughout her life. In other words, this patient reacted

to this donor and potential fetus as she would her father. Ad-
ditionally, these qualities may have represented dissociated
or defended-against aspects of herself. Though money was not
an object for this infertility patient, she resoundingly rejected
this donor. The donor offered to reduce her price by half. The
recipient patient felt only contempt for this offer. Negotiation,
money, and business do not mix with our softer notions of
babies and nurturing. In addition, this patient was attempting
to heal a long-held narcissistic injury ("My father preferred
business to me").
Another couple, for whom appearance was very important,
and who planned to lie to their families and friends about their
use of an egg donor (and who, therefore, wanted a close physical
resemblance), felt particularly vulnerable when they could not
cajole a picture of the donor from their anonymous donor egg
program: "I wouldn't buy a car unseen. You are asking me to
spend $30,000 and I can't even see the goods. You are selling
eggs! Why can't I see what I'm buying?" (This man wanted a
donor more attractive than his wife.) "I want her to look like
Debra Winger. My wife used to before she gained 50 pounds. I
would be satisfied with a Jewish-looking Christie Brinkley, but
my wife wouldn't. Debra Winger would be okay."
To outsiders, donor selection may seem, at times, to be
a selfish, narcissistic enterprise. However, I believe that, by
finding a donor with whom they can identify and who is an
idealized, sexless, version of themselves, infertility patients are
emotionally repairing their damaged sense of self—a self that
may have emerged during infertility treatment. Additionally, I
believe they are trying to resolve on a personal level contradic-
tory cultural pressures that may emerge for the first time as the
consequence of a particular path they have chosen. ("Why did I
wait so long to have a baby? Why didn't someone tell me of the
risks?") Within the context of the loss of control that infertility
entails, donor selection may afford a slight measure of control.
Shameful aspects of self that were born during infertility can
be whisked away. Donors are perceived as calm, kind, upbeat,
loving people—attractive, neurosis-free people.
11. Facts and Fantasies about Infertility 187

GOUNTERTRANSFERENGE

What are the effects of infertility patients' psychological sequel-

ae—loss of control, desperation, and pain—on their providers
in the reproductive community and, more specifically, on the
mental health providers treating them? The reparative efforts
of infertility patients when choosing donors are similar to the
reparative efforts of the providers treating them. Although the
specific form of the reparations varies, with some providers
focusing on loss of control and others on idealized versions
of themselves, the process is in many ways the same. Psy-
chotherapists may also become aware of their own paths not
taken and feel shame; forbidden desires or unsavory defenses
may emerge. (As one therapist who became depressed when
treating an infertility patient lamented, "Why did I choose not
to have children?")
Other therapists wishing to reassure and help establish a
working alliance may disclose their own infertility experience
and their capacity to resolve the strong emotions induced by
the experience. Implicitly, such disclosures may represent
the therapist's desire to present an idealized version of herself
("I know what you're experiencing, I experienced it too, and
I overcame the strong feelings and can use my experiences
to help you"). The therapist may be assuming an identity of
experience (which may be a true assumption), rather than
exploring the meaning for a patient and may be feeling power-
ful in the face of the patient's despair. Infertility touches us all:
it touches the lives of our patients, colleagues, families, and
friends, and often we must travel its difficult path ourselves.
One survey found that 52% of respondents who specialized in
infertility counseling had experienced infertility, and almost
three quarters (71%) started working in the field after diagnosis
(Covington and Marosek, 1999).
When we are treating infertility patients, our own un-
explored fantasies and dreams may emerge, stirred from
experiencing the strong emotions induced by our patients. One
therapist, long past childbearing, reported having fantasies of
creating the "perfect" girl from donor gametes. (She became
188 Allison Rosen

aware, in the process, of the wish to have a female child.)

Another therapist described a dream that a big black snake
bit her to paralyze her and make her food for baby snakes
so that the baby snakes could eat her. The baby snakes were
devouring her, and she was powerless to stop them. In my
experience, common therapist defenses are wishing to have
control or even omnipotence ("I helped this patient have a
baby. Without me, she wouldn't have been able to do it.");
encouraging empowerment while neglecting a patient's feeling
of helplessness; detaching from a patient's strong affect; ignor-
ing the medical reality of the patient; or ignoring the relevant
personal meaning for the patient.

CONCLUSION

Infertility can teach us about ourselves. When we face uncer-

tainty, despair, loss of control, and vulnerability, we attempt
to repair the effects on our psyches by envisioning a better
self or a better future. We become attached to this future, to
our fetuses, our unborn children, to our hopes and dreams to
maintain emotional equilibrium. While we are used to the idea
that we remember the past through the filter of the present, I
am suggesting that we also evaluate the present and experience
ourselves in the context of the future. Undone dreams, our
failures as humans, may never be rectified in our lifetimes. But
we can invest in our fantasies about our children. Infertility,
the donor selection process, and our choices, can reveal to us
our areas of narcissistic vulnerability. Our children represent
the hoped for best in us and our hopes and dreams for a better
world. Reproductive medicine is a lens through which we can
assess our cultural and personal values and the discrepancy
between who we are and who we hope to become.

ENDNOTES

1. In fact, out of 12,524 respondents to a fertility awareness survey on

a women's website, only one person answered all questions correctly
(Gibbs, 2002).
11. Facts and Fantasies about Infertility 189

2. With the advent of intracytoplasmic sperm injection (IGSI), most in-

fertility that is due to male factor can be treated by inserting a single
sperm into a woman's egg that has been harvested using a traditional
IVF protocol.
3. Technological advances may usher in more grief. For instance, sonogra-
phy provides a lens into the uterus. Parents can see the developing baby
long before any external changes mark pregnancy. With genetic testing
the genetic makeup and sex of the baby can be learned. The pictures
and fantasies created by this technology facilitate the parents' attaching
to a baby—a person—rather than a fetus (Covington, 1999, p. 231) and
early pregnancy loss means the loss of a potentially beloved member of
one's family.

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Chapter 12

Layers upon Layers

The Complicated Terrain of
Eating Disorders and the
Mother-Child Relationship
JEAN PETRUGELLI
CATHERINE STUART

A nyone with an eating disorder assuredly has had prob-

lematic relationships within the family of origin, both
during the course of his or her development and in
current family interactions. Whether one is a parent dealing
with an eating-disordered child or a therapist working with
this child and his or her family, relationships will inevitably
be fraught with issues of control, questions regarding interven-
tion, and anxieties that permeate the very physical being of
each person involved. These often overwhelming anxieties,
struggles for intra- and interpersonal control, awareness—and
disavowal—of one's presence vis-a-vis the other shift seamlessly
back and forth in any relationship. There are few arenas in
which these kinds of issues are more urgent than in relation-
ships where concerns about anorexia, bulimia, or compulsive
binge eating prevail.
Although all family members always powerfully affect each
other, this chapter focuses primarily on mother-daughter rela-
tionships in which the daughter suffers from an eating disorder.
It is a situation in which mothers are severely challenged in
negotiating the inevitably fragile dyadic connection.
The clinician finds that mother and daughter, from their
earliest experiences together, have been immersed in a pattern

193
194 Jean Petrucelli and Catherine Stuart

of behaviors focused on the disordered eating. The mother has

tried to stop the daughter's bingeing, or has attempted to coerce
the anorexic to eat. The mother's every word is measured to
achieve a desired effect. Brisman (2002b) saliently states, "Lan-
guage is not merely a means of communicating but is an action
in and of itself, something to be complied with—or rebelled
against. Thus, for example, 'Are you hungry?' is not a question
borne of curiosity, but a demand to eat, or not eat, as the case
may be." Within this kind of mother-child bond, one often
sees a narrowed, albeit secure, interpersonal structure. Here,
the daughter looks outside herself to define who she should be,
how she should feel. In a misguided quest to help, the mother
becomes the arbiter of the daughter's experience and thereby
cements a dynamic in which the eating-disordered young
woman is inadvertently discouraged from feeling the anxiety
of taking responsibility for her own life. The daughter becomes
dependent on the mother for direction and then thwarts that
direction in an attempt at embracing her own life.
In psychotherapy, allowing the daughter/patient to experi-
ence the anxiety that occurs when one deals with the unknown
becomes a new path of growth. The therapist's role must ul-
timately be that of a collaborator in the patient's integration
of the various parts of her self-experience, a role similar in
important respects to the role of effective parents in the lives
of their children. First, patient and therapist must become
aware together of the important themes in the patient's life.
Second, patient and therapist must give voice to the patient's
unnamed parts, that is, the bulimic, anorexic, or binge-eating
self. Last, the two must weave together a new understanding
and configuration of the patient's experience that, after the
patient leaves treatment, can serve a holding function for the
patient by allowing her to understand and tolerate experience
that was intolerable before treatment.
What mothers and therapists can and cannot do to traverse
this complex terrain successfully is discussed in this chapter
through the use of two clinical case examples. The vignettes
highlight the role of anxiety, dissociation, disowned feelings,
and enmeshment between mothers and daughters. Close atten-
tion is paid to the transference-countertransference configura-
tions as they are enacted during the initial consultation and as
12. Layers upon Layers 195

they unfold in the treatment. The first vignette highlights an

enactment that was immediately evident in the initial phase
of the treatment, the microcosm of the deeply felt affects and
behaviors involved in the interactions between mother and
daughter. This enactment required the therapist to join the
mother in a highly significant interaction impacting on the
future of the treatment. The nature of the therapist's coun-
tertransference reactions is examined to understand the re-
sulting enlistment of the mother's support for the subsequent
psychotherapy for her eating-disordered daughter. Behaviors
that show up in the early stages of treatment need to be exam-
ined with the goal of considering new alternative behaviors.
This kind of clinical inquiry can set the stage for the therapist
to address and help the mother and other significant family
members relinquish a misguided position of control and re-
establish themselves as observers and supportive participants
in the daughter's establishment of self.
The second clinical vignette describes the treatment of
a 26-year-old woman who embodied her mother's disowned
and projected feelings of vulnerability and defectiveness. This
case illustrates the familiar pattern of an anorexic patient who
hides her vulnerabilities and anxieties. The treatment required
family intervention in addition to individual treatment.
The two vignettes, with their emphasis on the m o t h e r -
daughter relationship, share a similar theme with respect to
the role of anxiety and the disownment of affect. In both cases,
the treatment ultimately required understanding the partici-
pation of various family members in supporting the system of
embedded dysfunction.

T H E CASE O F LORI, HER MOM, AND ME

I (JP) was referred a 14-year-old girl, suffering from anorexia,

and her mother. Lori, a slender, athletic-looking girl with long
blonde hair, braces, and an adorable smile, entered my office
with her mother, an attractive, well-dressed, tall, thin woman
in her mid 50s. As they both sat down, I said I would like to
talk with them together for a few moments before talking with
Lori alone. The mother's anxiety was palpable. She talked
196 Jean Petrucelli and Catherine Stuart

rapidly, rambling, making no eye contact and keeping her head

slightly tilted toward her daughter. She perched at the edge of
her chair, in contrast to her daughter, who sat placidly on the
couch. Lori's mother seemed about to jump out of her skin.
Her daughter kept smiling complacently, shifting her gaze back
and forth from her mother to me.
The mother spoke for 15 minutes about her divorce,
which was in process at that time, and her family's concerns
about it. The whole time she displayed unbridled anxiety. I
then asked if she was always this anxious, to which she replied
in a robotic fashion, "I am anxious and dyslexic and I lose
my train of thought when I look at someone when I speak to
them. Therefore I am not making eye contact with you and
if I don't concentrate I lose the thoughts in my head." Lori
smiled. It seemed that Lori was watching to see if I was doing
it right. Was Lori the usual recipient of this anxiety? I could
not help but wonder, was this to be my "job"? Was I the "new"
container?
Was Lori's mother anxious in response to me and my
intrusion into the airtight connection between her and her
daughter? Was she concerned that I might threaten their bond,
their need for each other as a "couple"? My potential involve-
ment, requested as a professional consultation, might seem
to the mother like an alien force that could crash through the
structure they had built and ruin it.
I wondered if I was slightly distracted in response to the
level of mother's anxiety and if that would affect my ability
to get a feel for Lori as I attempted to contain her mother's
overwhelming sense of chaos. This chaos came across in both
the mother's style of relating and the content of her story. The
mother recounted that she was in the midst of an ugly divorce,
that her husband had an affair and was now with the other
woman, that Lori had just been hospitalized with anorexia
for a month, and that Lori and her two siblings had changed
schools. Lori's "job," she being the only daughter with two
brothers, was primarily to console and listen to her mother.
Lori's mother stated that she now knew Lori's doing this was
not a "good thing," and she was working on creating better
boundaries, "but it was hard."
12. Layers upon Layers 197

In response to the mother's anxiety, I found myself expe-

riencing a wave of calm. I pondered whether Lori's nonanxious
stance was a response to the experience of having somebody
else (me) deal with her mother. Or was Lori's smile and calm
demeanor representative of a well-honed adaptive dissociated
stance? Did the content of her mother's story and her style of
relating allow Lori not to experience the usual nervousness one
feels on an initial visit? Were her dissociative defenses serving
to regulate relatedness to others? And what role was food, or
lack of it playing in all this?
I had to focus on the question of Lori's steadily being
barraged or intruded on by the mother's anxiety. How had it
affected Lori's ability to take care of herself? I suspected that
Lori's sense of self had become totally subordinated to the need
to respond to the mother. I began to w o n d e r . . .
How does Lori begin to formulate her own experience of
the outside and her internal world, especially in the face of
(family) trauma? How does a chronic diet of feeling out of con-
trol impact so profoundly on appetite or desire? If one decides
to lose one's appetite in advance of actually knowing what one
feels and inhibits the desire to eat, is there an illusion of safety
against the possibility of the unpredictable?
Lori restricts her own emotional responses in the face of
her mother's overwhelming level of chaos and anxiety. In this
way Lori is very much like other eating-disordered patients:
she quietly takes care of the "other" (in this case, mother) with
an outward compliance that, paradoxically, depends on main-
taining unchallengeable total control over the symbolic other
by restricting her own food. Lori has learned to deny her body
food when she is hungry. She has learned to "push down" her
own body's emotional reactions and not trust her body's inter-
nal food messages. She experiences her body's responses as if
they came from an alien other. In the consultation, I became
aware of "pushing down" my own feelings of being "upset or
distracted" in the face of the mother's overwhelming state of
neediness. I wondered, though, how a chronic diet of mother's
overinvolvement and father's underinvolvement had impacted
on Lori's instinctive abilities to experience how she feels.
Knowing how one feels, recognizing physiological hunger
198 Jean Petrucelli and Catherine Stuart

and satiation, involves being able to differentiate between

internal control (feelings) and external control (influences).
Internal control means that eating habits are guided by the
body's instinctive physiological hunger and fullness signals
rather than by emotional hunger. External control means that
our eating habits are guided by willpower, discipline, guilt, the
clock, society's eating rules, our emotions, and environmental
cues. An eating disorder is never simply a matter of self-control,
although the issue of control is played out in a variety of ways.
When one has a need for too much external control, the instinc-
tive cues that allow one to know what one feels are overridden
(pushed down) and one learns not to respect one's own eating
signals. When the external influences become overwhelming,
it often becomes impossible to formulate one's affective state,
delay the response, and digest or process the experience.
For Lori, her parents' impending divorce, her own chang-
ing schools, and her mother's high anxiety were all forms of
external chaos creating internal conflict. Lori, in the presence
of her mother, maintained the façade of the happy, silent,
compliant child, while feeling sad, confused, and worried. In
her mother's absence, she conveyed her inner turmoil in cau-
tious, verbal descriptions of just how difficult her life had felt
of late. She said she appreciated learning how to talk about
her feelings in the hospital and was afraid she was going to
"forget" how to do this.
How does one learn how to not forget and stay "conscious"
of the unbearable? Historically, Lori had adapted to the good-
girl role and went underground, smiling sweetly, hiding a
chaotic and turbulent inner life. Eating-disordered patients,
in general, can be thought of as making a botched attempt to
self-regulate the outside chaos by internally going underground.
By staying "unaware," they attempt to maintain the illusion of
safety: "As long as I don't know, it won't hurt me." This ability
to escape awareness allows them to experience a temporary
cognitive narrowing by means of which the integration of the
whole picture is lost. Lori, for example, attempted to reduce her
internal chaos by limiting her desire for food and concretely
limiting and simplifying her choices of food.
For eating disordered patients, the experience of desire
or even wanting to want feels intolerable or out of control.
12. Layers upon Layers 199

Brisman (2002a) has insightfully noted, that, on closer ex-

amination with eating-disordered patients, "the point is not
this patient's wanting, but more precisely their insistence on
not wanting" (p. 335). For them, to feel desire is to become
flooded with shame.
Shame is an emotion that manifests in the desire to hide,
to disappear, or even to die because one fears that the self is
empty, bad, and inferior. A person ashamed feels as though
nothing can be done about it, because shame is linked to a
sense of being, not something one is doing. If one believes that
one cannot do anything about feeling that there is something
wrong with who one is, then it makes sense that one would try
to protect oneself from being exposed. Lori expressed shame
around her restriction of food, especially because, she told me,
she knows she is not "fat" and does not understand why she
did not want to eat prior to the hospitalization.
Two days after the consultation, I received a phone call
from Lori's mother. She said in her anxious voice, "Lori liked
you very much and told me that she had really opened up and
talked more than she ever had But I have to ask you, because
I'm a nurse, and when her father meets you, because he'll want
to meet you and see you and you'll have to convince h i m . . . And
when I saw y o u . . . and it's like what the internist asked me
about me" [the build up continued] You're so t h i n . . . Do you
or have you had an eating disorder?"
Now, when this question comes up in the course of a
treatment, and it inevitably does with my eating-disordered
patients, I explore their fantasies of what would it mean to
them if I did have an eating disorder and what would it mean
to them if I didn't. The complexities of responses are always
rich and meaningful and reveal some aspect of the work pre-
viously unknown and not yet shared between us. Seldom, if
ever, have I felt the need to answer the question directly—until
this phone call.
"Well," I said, "First of all, not every thin person has an
eating disorder. After all it's about one's dysfunctional relation-
ship to food, not body shape or size." I was responding very
defensively and with too much personal information. In my
disorganized moment, I rambled, "I'm an athlete and believe
in helping people develop a healthy relationship with food,
200 Jean Petrucelli and Catherine Stuart

and genetics plays a huge role. Then we have to factor in me-

t a b o l i s m . . . . " I knew this was not a typical response from me.
It signaled that I was participating in some enactment with
Lori's mother.
Just as Lori seemed to have been derailed by her mother's
anxiety, was I also responding to that overwhelming affect?
Did I, like Lori, feel the need to calm her mother—in my case,
with direct answers? As a mother and an analyst, I could both
hold her concern and her desire to get her daughter into a
good treatment, while simultaneously knowing that she was
erroneously equating competency with body size. But why did
I respond so defensively and with so much information?
On one level, I realized that I was experiencing anew the
need to quiet her anxiety. After all, with her question to me,
the mother brought everybody into the room with her: her
husband, her internist, her nursing profession. I had to respond
to a team. With one question she had taken the one-on-one
collaborative aspect out of our exchange.
On another level, this episode made me wonder what
messages we therapists impart to the parents of a child with
an eating disorder. How do we contain our own anxiety, and
what effect do our ways of coping have on the ways we contain
the anxiety of the other or the patient in the room? When do
we feel that we have to do something to contain a mother's
anxiety, and when do we allow a mother's feelings to unfold?
In the case of Lori, I felt I had to do something to contain her
mother's anxiety.
When I was on the phone with Lori's mother, one of the
things that happened was that I became involved with her in
such a way that I unwittingly started to talk her language, by
which I mean her anxiety-laden speech. Retrospectively it is
easy to say that whatever happened worked because, indeed,
the mother was reassured. (Her response being, "Oh, I'm con-
vinced that I want her to work with you.") But maybe what
became clear with this mother was that fusing with her, merging
with her, in essence talking "her language" in this uncontained
sort of peripheral way actually made her feel understood and
less threatened. Perhaps if I had just answered her question
with a yes or no her anxiety would have remained unabated.
Was my "defensive rambling" a way to calm her so that she
12. Layers upon Layers 201

would not interfere with her daughter's treatment? If I had

answered her question simply, would that kind of a response
in some way have caused her to feel more shut out? Was Lori's
mother anxious in the consultation because she feared the in-
volvement of the "other" (in this case, me), someone who could
create a potential wedge between her and her daughter?
As clinicians, we are always dealing with the varying levels
of intrusiveness, involvement, and relatedness of the parents.
We must ask ourselves how we deal with the mothers in the
room—and the fact that mothers are always in the room even
when they are not physically present. After the phone conver-
sation with Lori's mother, I received phone messages from her
once a week. She was having trouble leaving my room.
In general, if we are anxious about something or our pa-
tients are anxious, what messages do we give them? How do
we help our patients modulate their anxiety so that it does not
become overwhelming, while at the same time we recognize
that a certain level of anxiety is necessary for the patient to
remain motivated to work through the problem? We need to
stay mindful of how this dynamic plays out with food.
In Lori's chaotic family, the rules and structure were mal-
leable, confusing, and unpredictable. As a result, she learned
to depend on herself, not on the stability of the family. Food
could be used to calm anxiety, or the refusal to eat could be
used to create the illusion of feeling stronger.
In the therapeutic arena, the therapist must both recognize
and respect the adaptive solutions, that is, the eating disorder,
as the patient's attempt to survive the unbearable and in so
doing maintain a connection to that part of themselves. This
dilemma becomes far more complex when the overinvolved
parent or the underinvolved parent, flip sides of the same dys-
regulated coin, have not yet learned that an eating disorder is
a sign that family rules and patterns and parental communica-
tions are being questioned. The attempt to use food intake and
weight control to solve unseen emotional conflicts and shifting
states of anxiety has little to do with food or weight.
Lori and I have just begun our work together. Our last
session left me optimistic. Given the difficulties surrounding
her capacity to make choices, I was elated when in parting she
sheepishly giggled, "I can't decide if you remind me more of
202 Jean Petrucelli and Catherine Stuart

Cher or Morticia." I thought, "How wonderful. At least she's

trying to decide and thinking for herself."

T H E CASE O F NANCY

Nancy was different from the other members of her family.

Her parents, siblings, aunts, uncles, and cousins were intel-
lectually gifted, professionally accomplished, physically robust,
and athletic. Nancy was born prematurely and developed mild
learning disorders. She was a small child with artistic interests
and anxiety in social situations. By age 26, her problems
were severe and she had had three treatments for anorexia,
including two inpatient hospital stays and outpatient cogni-
tive behavior therapy. Nancy improved with each treatment
but was not able to reach the goals of being physically healthy
and able to function effectively as an adult. She did not work
or attend school. Her most recent therapy ended when her
weight dropped below the number she and her therapist had
agreed on. Nancy and her parents discussed her treatment and
agreed that the emphasis needed to shift from a narrow focus
on behavior toward a treatment that focused on promoting
understanding and a change in motivation.
Nancy and I (CS) met twice a week for a month. During
these individual sessions, Nancy seemed eager to please and
delighted to have adult companionship. She had body image
problems and reported feelings of deep insecurity. I never saw
her as anxious or depressed. She seemed content to use the
sessions for emotional contact and had to be encouraged to
talk about problems.
Nancy did not want to change her eating habits and was
certain that her extreme diet and the surrounding rituals
were protecting her from obesity. She talked about her eating
disorder and her feelings about her body. Although she had
never been overweight, she described herself as a "compulsive
overeater in disguise" and explained that everyone in her fam-
ily was obese and had ridiculous ideas about food. Her parents
believed that every meal needed to be complete and inclusive.
A protein, a carbohydrate, and vegetables or fruit were neces-
sary components. Nancy joked about how each relative had
12. Layers upon Layers 203

a different but seemingly equal problem with food and body

image. Her mother spent hours worrying about how an outfit
looked with a particular pair of shoes and her father ate every-
thing in sight. Nancy's light-hearted rendering of the family
dynamics covered her fear that there is no hope for her; every
relative was doomed to overeating and poor body image. Her
irreverence covered her rage that there was no reasonable role
model or structure for her to use as a guide.
After a few weeks, we agreed to have a family meeting.
When her parents entered the consulting room, the atmosphere
changed. The emotional charge was intense. Nancy chose a seat
as far away from her parents as possible. I noticed the contrast
between the parents and their child. Nancy was petite with dark
hair and eyes. Her parents were taller and bordered on obese,
with attendant health problems. Her parents began discussing
their worries about their daughter. Her father, John, focused
on her lack of appropriate engagement in any productive en-
deavor. Her mother, Joan, expressed her concern regarding
Nancy's refusal to eat, as well as her lying. While I reflected on
the experience, I noticed the lack of agreement between the
parents about Nancy's problem and the feeling of desperation.
At this point Nancy interrupted their report. Her parents had
referred to her by a "pet name" she despised, feeling it signified
her status as an infant in their eyes. Her father readily agreed
and apologized; her mother acquiesced, saying that if it was
that important, she would stop, but she did not see any harm
in calling Nancy by the pet name. I experienced her mother
as pitying Nancy, as well as having a sense of helplessness.
Both parents pressured Naney to change and Nancy quietly
and firmly resisted.
I saw my goals during this first family session. The intense
pressure from her parents needed to be redirected. They
needed help containing their anxiety about their daughter. We
talked about the family dynamics. When Nancy made choices
that were not healthy, the entire family mobilized. We agreed
that all their efforts to make Nancy change exacerbated the
problem. To break this cycle, Nancy's parents had to step back
and treat her as an adult, with the corresponding rights and
responsibilities.
Thanksgiving was a few weeks away. For the last several
204 Jean Petrucelli and Catherine Stuart

years, Nancy and Joan stayed home, missing the long weekend
and celebration with the extended family. Joan did not want
Nancy to spend the holiday alone, and Nancy could not make
a promise to attend. As we talked about this, Nancy vacillated.
Part of her wanted to accept responsibility and hoped she
would be able to go to her aunt's home, and yet another part of
Nancy wanted the assurance that her mother would keep her
company if she felt too anxious to attend. Everyone understood
the practical aspects of treating Nancy as an adult. The difficult
part was managing the interplay of affects and anxieties that
pervaded the room. If Nancy expressed fear, Joan's anxiety and
her subsequent need to become a rescuer elevated, triggering
anger from John. The focus shifted away from Nancy, who felt
upset by the tension between her parents. It was easy to see
how her eating disorder flourished within the family. We ex-
plored these tensions, and by the end of the session, all agreed
that Joan and John would go to the celebration whether or not
Nancy joined them. Nancy accepted this solution, stating that
it made sense: if she wanted to be treated as an adult, she had
to accept the consequences of her choices. Joan was upset; she
felt that Nancy should not be alone on Thanksgiving. I asked
Joan to notice how she was not allowing Nancy to be an adult,
to make a choice and bear the accompanying feelings.
In our individual sessions, Nancy talked about the changes
we were making in the family dynamics and the cycle of feelings
she was experiencing with the changes. Her initial response was
anxiety in anticipation of a change. By the time the change oc-
curred, she felt mastery, often doing more than had been asked.
She reported the changes to me with pride. Her demeanor with
me had always been casual and at times chatty. I realized that
she wanted me to know her as an adult. She did not want a
relationship that echoed the parent-child relationship she had
with her parents. In that paradigm she felt defective, and she
was not willing to accept that role anymore.
As the therapy evolved, Nancy made progress in every
aspect of her life. She enrolled in classes and applied for a job.
She talked about her desires to move forward and the things
that were holding her back. She had a complicated schedule
that included hours devoted to shopping for the only foods
she would eat and hours for two periods of exercise each day.
12. Layers upon Layers 205

As she moved forward, her parents (in particular, her mother)

undermined her efforts. Her mother nagged her and tried to
force her to eat. Her mother was not able to keep any of the
limits we asked her to set. Nancy and I agreed that I would
meet with her mother for a few sessions to help her understand
the obvious problem.
During the sessions with Joan, her story unfolded. She
was a mother who had been disappointed and worried about
her daughter since birth. Born prematurely she was fragile
from the start. Nancy's older siblings were hearty, robust, and
intellectually gifted. Joan could not imagine a life for Nancy.
Everyone in Joan's family, from grandparents through siblings
and cousins, had graduate degrees and professional careers.
In Joan's eyes, Nancy was not equipped to deal with school
or work. She wanted to protect Nancy from feeling hurt and
inadequate. Nancy was allowed to miss school for the slightest
ailment and eventually missed most of her high school. As a
result, she was isolated from her peers.
It was during these years that her eating behavior became
disordered. In an attempt to feel less social anxiety, Nancy be-
gan dieting to be like her peers. While she was conscious of that
motivation, the pattern of avoidance and evoking sympathy
from her parents became more deeply entrenched. Instead of
helping her relate to her peers, her dieting resulted in more
loneliness and separation, as well as further enmeshment with
her mother. Her father became a more distant figure to her
as she and her mother embraced their struggle. Joan's view of
Nancy was totally different from the view I had of her. Joan's
protective view of her daughter did not reflect the capable
woman I was getting to know. When I listened to Joan, however,
it was easy to feel compassion for her and believe that Nancy
was fragile and inept.
When Nancy seemed seriously ill, her mother would drive
her to various grocery stores in search of the perfect peach.
Nancy would not eat anything else, and her mother felt she had
no choice but to find that peach. When Nancy took massive
amounts of laxatives, her mother paid for them. Once, Nancy
was caught shoplifting to obtain the desired medicine. Her
mother believed it was her duty to make sure that Nancy did
not have to suffer the consequences of her behavior. Joan
206 Jean Petrucelli and Catherine Stuart

related her stories with a "What's a mother to do?" expression

on her face. She felt that her daughter's life depended on her
assistance. She worried that Nancy had a mental illness that
made it impossible for her to cope. Mother and daughter were
perfect dance partners—Joan followed the intricate moves
of Nancy's eating disorder. Every dangerous move by Nancy
resulted in a complementary move by Joan designed to buffer
Nancy from pain. Conversely, on one level, Nancy responded
to Joan's leads by being strong and defiant: "I will not eat." At
another level, not eating made her the child who needed life
support.
The fabric of their relationship comprised interactions
focused on Nancy's eating, as though nothing else were worthy
of conversation. There were hidden messages in their interac-
tions. Nancy experienced her parents as saying, "You are not
like us. You are small and weak." In defense, she retorted, "I
don't want to be like you, I want to be the opposite. I will make
myself smaller and smaller. I am strong and I can defy you and
your attempts to make me be like you."
Instead of directing her life on the basis of her internal
needs and desires, Nancy formed an identity in reaction to her
mother. Her mother was desperate to change Nancy's behavior,
both the eating and the dishonesty. In her efforts to change
Nancy, Joan undermined her confidence and attempts to act
as an adult. Joan treated her like an invalid, and, behaviorally,
Nancy acquiesced by living in a regressed state; she seldom
even changed from pajamas. When she ventured out, she ex-
pressed a more mature state, dressing in skirts or dresses and
high heels. She looked and behaved like a young professional
woman.
As our work progressed, Nancy gained weight while telling
her parents, internist, and me that she ate only nonfat yogurt.
She started menstruating and was distressed by this develop-
ment. Nancy was terrified that eating in a healthy way would
result in the family problem of obesity. She was aware that her
parents' idea of wholesome was unreasonable, thus promoting
Nancy's longstanding mistrust of authority figures. I chose to
stay on the sidelines with regard to food and exercise as long
as her internist reported that Nancy was healthy.
During our sessions, I had to refrain from the pull to
12. Layers upon Layers 207

be intrusive and ask about the paradox that she was gain-
ing weight while eating fewer than 600 calories a day. Nancy
needed privacy, and I had indicated I would not be surprised or
disappointed if she needed to conceal things from me. Nancy
vacillated in her self-concept. When she was at home, she was
anxious, corresponding to the image her mother held. Nancy
played out her conflict of wanting to be her mother's daughter,
feeling protected and safe, and yet wanting to separate and
have a life for herself through food. Her refusal to eat allowed
her to defy her mother and at the same time kept her too weak
to separate.
Nancy's concerns about body size had many meanings. By
being thin, she was different from her parents in a positive way.
During high school she desperately wanted to be like her peers.
While developing her sense of self, she did not experience her
parents as a positive mirroring presence. When Nancy looked
to them to see who she was in their eyes, the reflection was
disappointing. She was different from them, both mentally and
physically. Nancy could not find a way to receive validation
and admiration by being like them. She found love in their
expressions of sympathy. When she rebelled, she tried to be
their opposite—smaller and delicate. Among her peers, thin-
ness was valued. In that world, her parents' body sizes were
devalued and this discredited their wisdom. "If they are so
smart, why do they have health problems related to life-style
choices?" she wondered.
From that vantage point, Nancy looked at them with dis-
gust over their obesity. Ironically and defensively, this was a
psychological identification with them. She was critical of them
for their weight and health concerns. Nancy's disgust about fat
easily turned into self-loathing. When she experienced herself
as fat, she could not bear being seen outside her home, and
would not get dressed. This issue unfolded between us over
time.
Could Nancy be like me? Could she expect validation
and admiration from me? As our relationship deepened, there
were times when I felt tempted to worry about her and we
talked about how we were recreating the family dynamics in
our relationship. When Joan's mother became ill, and both
parents left to help her, Nancy did well. She told me about
208 Jean Petrucelli and Catherine Stuart

her new responsibilities in taking care of the house, the pet,

and herself. Nancy stopped taking calls from her mother, who
called several times a day to remind Nancy of something she
needed to do. Nancy was enraged at the lack of validation of
her competence.
During our sessions, Nancy continued the p a t t e r n of
being caught up with her parents—what they wanted, their
anxieties and concerns—and she avoided her own life. Nancy
talked about her parents' weight problems and her belief that,
despite their intelligence, their advice was suspect. Eventu-
ally she was able to express her anxiety regarding her ability
to trust anyone, therapists included, when they attempted to
take care of her. As she experienced these anxieties and came
into contact with her felt experience of wanting control over
others, Nancy was able to understand the way these concerns
were blocking her growth. She could see that she was like her
mother in some ways and different from her in others.
We talked about the meaning of size, and she spoke about
the various descriptions of people in novels. In her own writing,
she experimented with creating female characters of different
sizes. She talked about her body and mine, and I answered her
questions about my ideas regarding food, exercise, and body
size. With me, she tentatively learned that she could challenge
and criticize and that I could respect her wishes.
While Nancy was improving, she enrolled in college, and
the reports from her internist indicated that she was gaining
weight. Nancy herself continued to report that her eating be-
havior had not changed. I believe Nancy had substituted not
talking about eating for her prior refusal to eat. Since I have
encouraged this family to believe that everyone has a right
to privacy and autonomy about eating, I did not inquire. Her
improvements were her own. When we had family sessions I
reinforced Nancy's rights to privacy about what she ate and
helped contain Joan's anxieties about her daughter. As Nancy
became more separate and competent, it was apparent that
the changes were difficult for Joan, perhaps because they
diminished her intimate, regressive contact with her daughter.
Nancy's father, on the other hand, delighted in the changes; he
enjoyed a new and more adult relationship with Nancy.
12. Layers upon Layers 209

SUMMARY

The process of disentangling parents from their child's struggle

with food is multifaceted. It involves recognizing the coexis-
tence of varying needs and how they manifest in dysfunctional
behavioral patterns. Take, for example, the way Lori served
as the container for her mother's anxiety. Lori's "caretaking"
of her mother occurred, in part, because of father's unavail-
ability for her and for her mother. Lori's mother relied on Lori.
To Lori (or any child, for that matter) an anxious mother was
clearly better than no mother at all. This "exchange" of roles
resulted in Lori's inhibition of her own anxiety. In the case of
Nancy, her mother saw Nancy's differences from her as evi-
dence of weakness. In her efforts to protect her daughter from
pain and anxiety, Nancy's mother doomed Nancy to remain a
child. Both created a cycle in which each reinforced the other's
destructive patterns.
The psychological influence parents have on their children
is unquestionably complex and profound. Historically, the
mother has been blamed as the sole cause of psychopathology,
a way of thinking that obscured the multitude of other factors
that are also important in determining eating disorders: inter-
personal, intrapsychic, neurobiological, familial and cultural
(Rabinor, 1993). Nonetheless, the mother remains terribly
important in these cases. A deeper and more complex under-
standing of the role of the mother-daughter relationship in the
genesis and maintenance of an eating disorder is needed if the
relationship is to become a source of strength and growth for
the daughter.
In order for the relationship to take on this new role, the
therapist must allow the patient to experience the anxiety that
accompanies conflicting needs and the anxiety that occurs
with things unfamiliar. The broader experience that occurs
as a result of the acceptance of anxiety creates the possibility
of new patterns of relatedness. These new patterns may arise
between mother and daughter, patient and therapist, and pa-
tient and food.
The reconfiguration of these relationships is complex.
The patient must somehow learn to hold on to her experience
210 Jean Petrucelli and Catherine Stuart

of desire in the face of competing needs. She must accept

similarities and differences between herself and her parents
without relinquishing her own desire; and her parents often
have to learn how to do the same thing. Because the mother
and daughter may play reciprocal roles in relatedness that stifle
the daughter's desire, the connection and love between the
two can involve suffering. In a world that reinforces the idea
that interpersonal connectedness means powerlessness and
dependence, the eating-disordered daughter tries to become
powerful and autonomous, but all she achieves is "pseudo-
independence." In the anorexic patient, the dilemma is that
interpersonal connectedness and dependence are collapsed
(they are experienced as the same thing); the collapsed experi-
ence is then constructed as the opposite of autonomy rather
than as an important and necessary complement to it.
The work of the treatment involves facilitating the patient's
access to the multifaceted aspects of herself or himself. The
interaction between parent and child needs to be taken out
of the realm where only one aspect of each person is being
expressed. The treatment must change this state of affairs to
allow the experience of anxiety to unfold, thereby changing the
meaning of the old patterns of relatedness and creating new
ones. By inquiring about what and how the patient wants, the
therapist encourages the naming of previously unintegrated
aspects of the patient's experience and thereby fosters the
individuation that is necessary for the child. With this hope, a
new road can be forged, one that allows a healthy and different
form of expression.

REFERENCES

Brisman, J. (2002a), Wanting. Gontemp. Psychoanal., 38:329–343.

— (2002b), When helping hurts: Untethering the motherly tie. Paper
presented at conference "What Do Mothers Want?" Nightingale-
Bamford School.
Rabinor, J. R. (1993), Mothers, daughters, and eating disorders: Honoring
the mother-daughter relationship. In: Feminist Perspectives on Eating
Disorders, ed. P. Fallon et al. New York: Guilford Press, pp. 272–286.
Part III

Pulling It All Together

Chanter 13

Listen to My Words
Maternal Life in Colors
and Cycles of Time
JANE LAZARRE

have heard this phrase, "Listen to my words," spoken over

I and over by a friend of mine to her two young children

whenever they are slipping out of control, into the knots of
anger, desire, and anxiety in which children (as well as grown-
ups) are often entangled. My friend, the mother, puts her hands
softly and firmly on her child's shoulders and says, Listen to
my words. Sometimes—not always of course—it works. The
child quiets down, and the situation can be clarified or diffused.
Often, but in particular with mothers, we don't listen to what
is being said to us, but, rather, in each new generation with
new discourses, we anticipate and impose meanings.
For me the story of motherhood began over 30 years ago,
and, in my continuing attempt to record its many complexities,
I often have to listen closely to my own words, what I actually
said before the voices of critique set in. The large knot of feel-
ings I called "the mother knot" in my first book is, of course,
entwined in complicated and often inseparable ways with the
daughter knot. Daughterly feelings seep and flow into every
relationship between women and those we love—partners,
friends, therapists, and our own children. Many people, espe-
cially women, identify with their mothers, and then long for
the mother of childhood, or of their childhood fantasies and
dreams. I identified with a mother who was lost to death when
I was seven, whom I was always refinding and losing again,
who, in the end, I saw would never be found.

213
214 Jane Lazarre

A number of years ago, I decided to try to locate and visit

my mother's childhood home in Norwalk, Connecticut. I had
never gone there; I had kept her photograph significantly ab-
sent from my collection of photographs on shelves and walls in
my living room; since her death, I had tried to keep her voice
and story from my consciousness except in the extremities of
idealization and rage. But life experience, including my own
bout with breast cancer, which she had died of over 40 years
before, had made me ready to revisit old, stacked, and stuck
feelings about her. My husband drove, and Khary, my younger
son, who was then about 25 years old, sat in the front seat next
to him. I was alone in the back seat, free to think and dream
as I had once done as a little girl right after she died, my face
directly in the wind from the opened window, singing the songs
I remembered her singing to me. Only a few blocks after Exit 14
on the Merritt Parkway, down a hill and to the left, we were in
Norwalk, then quickly in South Norwalk, on South Main Street,
and we began to look for number 47, where my grandparents
had lived when their children were small. A wide street cut
through what looked more like an old-fashioned village than
a modern urban center. On one side of the street were small
industrial buildings typical of early 20th century architecture.
On the other side, a small red brick apartment house, number
51, then another, number 49, then a large parking lot where
number 47 should have been.
I stood in the emptiness of that large space, my knees
weakening, feeling as alone as I had ever been, when Khary
leaped out of the car, jogged over, and put his arm around me.
Meanwhile, my husband walked to the back of the lot where
an apparently unlived-in yellow wood frame house was hidden
behind numbers 49 and 5 1 . We followed him, walked around
it several times, but could find no number on its doors.
At the far edge of the asphalt was a narrow border of trees
and behind the trees an old railroad track. I began picturing
my mother, my Aunt Fran, my mother's eldest sister, and their
other siblings, seeing them in the brown tinted colors of an old
photograph I have. My mother is wearing a jacket with large
round buttons over a short skirt. Ankle-high boots and thick
white leggings cover her feet and legs. You can see the folds
13. Listen to My Words 215

where the leggings gather at the knees. The dark border of a

round tam reaches almost to her eyes. Her face is very clear, her
eyes small and dark, her wide mouth suggesting my own, my
older son Adam's, and now his daughter's, my granddaughter's,
as well. Recalling the photograph I have framed above my desk,
I mentally transfer the child to the path that runs alongside
the railroad track. She is standing there with her brother and
Fran. Despite the shadows of maternal preference for herself,
paternal preference for her sister—a story that has come
down through the generations—despite the anger toward her
father she must sometimes feel, admiration mixing with the
fear that somehow she has proven herself to be inadequate in
the judgment of this reputedly harsh and selfish man; despite
what she knows is her older sister's justifiable anger at her for
being her mother's guilty favorite and for reasons as mysteri-
ous as the reasons for her father's dislike; despite it all, she
eagerly grips her sister's hand. The train is rumbling by. They
hear its whistle. It is heading for New York City, which seems
as far away to her as Paris, the elegant place she's read about in
books. In the sensuous excitement of the sound of the whistle
and the rapid, loud passing of the long black train, she imagines
both places, New York, Paris, and she feels certain she will get
there some day.
I become aware of the story I am constructing when I
accidentally bite my tongue. I am furious at my grandfather,
who was dead long before I was born, for his ruthless rejection
of his younger daughter. What arrogance, I think, recalling
the piercing eyes in the photograph my aunt gave me of her
beloved "Papa." How could he not have loved the beautiful
child with her wide lips and dark eyes, dressed in her loose
leggings and dark tam? How complex it must have been for my
mother, the favorite of my grandmother, whom I knew when I
was growing up to be a frightened, insecure, and angry woman.
How lonely it must have been for my mother, how chronically
angry and culpable she must have felt. I had heard stories all
my life from my aunt about her adoration of her father and,
into her 90s, her hatred for her mother, but now, for the first
time, I am imagining my mother's emotions—my mother as a
daughter, as a little girl.
216 Jane Lazarre

Angrily, I kick some stones across the lot. "What's wrong?"

my son asks, and I confess my anger at my grandfather for
causing my mother such pain.
Then he asks in a purposely innocent tone, "Hasn't he
been dead a long time?"
My own bitterness wells up with such sour taste I nearly
spit. But it is my father's face, not my grandfather's, filling my
head. I am very young, and he is criticizing me for eating too
much, dressing too sloppily, spending too much time staring
at paintings or blank walls. I am seven, and he is telling me
my mother is dead, his arms reaching out for me. But he is
weeping, shaking with sobs, and I resist him, run to my aunt.
I am scared of him, of his pain, that he will never love me in
the way I long to be loved.
I return to the present, the parking lot, and my son and
realize my husband has gone off to explore the rest of the street.
Khary puts his arm around my shoulder and, standing on South
Main Street where number 47 used to be, I tell him how the
image of my mother as a lonely and unhappy child recalled my
own childhood unhappiness for me. "Don't cry, Mom," he says
gently, and so I realize I am crying. 1 wipe my eyes and listen
to my son, a grown man accompanying his mother on a search
for a piece of her past. "You're not that little girl, Mommy," I
am told by my son, the good psychologist, his now rarely used
endearing name for me reminding me of years of history and
so confirming perfectly the truth of what he says.
Pointing to the old railroad tracks behind the lot, I tell him
about the other image, of my mother as an excited little girl,
watching trains. His eyes light up, then fill with tears. "Yeah,"
he says softly, looking out toward the tracks. "She must have
stood right there, filled with dreams. She must have watched
the train come around that bend and pass by fast, heading for
the city." He laughs, wipes his eyes and points to his father,
who is coming toward us, his arms filled with old maps of the
city, a book on "Historic Norwalk," and four lovely white tiles,
each with a green leaf design, which he has bought in a gift
shop and which we will inlay on a shelf in our kitchen, next
to the stove.
I have taught m a n y writing classes in which daugh-
ters, writing about their mothers, try as hard as they can to
13. Listen to My Words 217

penetrate that tightly webbed and misted point of view. I have

taught courses about mothers and daughters in literature and
have noted the images of angelic or demonic mothers that fill
so many novels, even some novels I love. A young male student
whom I had mentored for three years once said to a class after
completing one of my books, "I always wondered why Jane was
so interested in mothers and daughters. She has sons. Then I
read one of her books and realized she is a daughter too."
In the preface to the 1997 Duke University Press edition
of my first memoir, The Mother Knot, I told this story:

Several years ago, I was teaching an undergraduate course

called "Voices of Mothers and Daughters in Novels by Wom-
en." We had read Jane Eyre, which introduced the great
themes and classic motifs of the daughter's journey toward
self-realization. And then we came to Kate Chopin's The
Awakening, one of the first novels in English to be written
by a mother who takes a mother's point of view as the subject
of a literary work. When it was first published, many critics
and reviewers found the heroine, Edna, to be unloving and
selfish, an unnatural mother, and I had learned over years of
teaching the novel that contemporary generations of students
often felt the same. So before we began this story of a woman
trying to chart a path to herself, struggling to become an art-
ist, loving her children but unwilling or unable to "turn over
her soul to them," I asked my students to close their eyes
and think about "the good mother."
As they sat there, ruminating silently, I asked a few
widely spaced questions: What is she like? How does she
act? What do we need from her? Then I asked them to open
their eyes and write down some of what had come to them.
As they read out the qualities of "the good mother," I wrote
them on the blackboard until it was filled with overlapping,
crowded text, long sentences and single words: She is giv-
ing and caring. Unselfish. A model of independence, but she
needs her children's love deeply. Highly disciplined. A disci-
plinarian, but she understands the need for fun. Reliable, yet
childlike. Tells you right from wrong, but is never intrusive.
Emotionally connected, but she can be mysterious—she has
her own life! As they called out the phrases while I wrote, my
students understood the pattern emerging and rolled their
eyes at their own surprising beliefs.
218 Jane Lazarre

I asked them to close their eyes again. Now imagine, I

said, that you are not daughters and sons but mothers. You are
yourself, but you have just been told you are having a baby.
The room filled with gasps and groans. Eyes snapped opened.
They felt terrified, they said, of the impossible expectations.
They were only human, after all. They felt inadequate. Even
in an imaginary, passing moment, they already felt classic
maternal guilt.
Now the silence of the moment was mine. I looked
around the room at these men and women young enough to be
my children, and I understood that the story of mothers from
their own point of view will never be told for the last time,
will never once and for all alter the deepest structures of our
feelings. As long as we have children and raise them—both
badly and well, as we must—the story of the mother in her
own voice will have to be told and retold. We will have to
break the silence and break it again as we try to become real
for our children and, at the same time, come more fully to
understand our society and ourselves [pp. xv–xvi].

What do mothers want? As long as we take care not to

fall into the trap of generalizing about mothers, as if we were
all the same in personality, character, temperament, and need,
one part of the answer is really no great mystery: For people
to remember, or learn, that we are daughters too, foolish
rather than wise at times, sometimes weak when we would
so love to be strong, moved by desire and self-doubt at every
age just as when we were girls, unable to fix things at times,
and at times—as much as we would love to do so—unable to
provide.
What do I want personally as a mother? That's a story too
long to relate here. But I will tell you one that is connected to
it like two dreams in the same night, or two related chapters
in a book. Gloria Friedman was my therapist for many years.
When I attended her funeral, I listened, with tears running
down my cheeks, when a younger woman patient said, "Gloria
was the mother I never had." For me, Gloria was a soul mate
of sorts, a cherished listener and wise teacher, but not the
mother I never had. I once thought my father was the mother
I never had. For a long time, and often to this day, I think my
husband is the mother I never had. I have one sister and three
13. Listen to My Words 219

dear women friends who take turns being and failing to be the
mother I never had. In what Toni Morrison (1992) has called
the "deep story" (p. v) of my psychic life, my male analyst
is sometimes the mother I never had. But, of course, all this
reaches toward a truth I have somehow known for 52 years.
No one is the mother I never had; or, my mother is the mother
I had for seven years, and she is irreplaceable. Compensation
is possible, wonderful compensation, but not replacement. In
coming to understand this truth, I have become, I hope, a wiser
mother over the years—because I have come to see that not
even my children are the mother I never had.
Indeed, I am the mother now, even in some ways the
mother I never had, carrying with me the fears and capaci-
ties of my daughter-self. One writer whom I greatly admire,
Sara Ruddick (1989), has said this about being a mother: "To
give birth is to create a life that cannot be kept safe, whose
unfolding cannot be controlled and whose eventual death is
certain In a world beyond one's control to be humble is to
have a profound sense of the limits of one's actions and of the
unpredictability of one's work" (p. 72).
I welcomed these rare honest words, which signified not
only a general truth about the experience of being a mother,
but, for me, a more particular truth. My sons are Black. They
are grown men now, one with a child of his own, but the life
experience of being the white mother of Black sons continues
to reflect some of the deepest themes of motherhood for me:
the creative potential of a shifting identity; the passionate wish
to protect one's children and, often, the impossibility of do-
ing so; the way the meanings of motherhood are constructed
by the wider world; the need for empathy which is ultimately
connected to the ability—and desire—to listen to someone
else's words.
When I look back on all my attempts to write about this
enthralling and emblematic theme, one scene from my mem-
oir about being the white mother of Black sons stands out for
me.

It is 1992, and my younger son is 18, a freshman in college.

Although he attends a largely white institution, there are
enough black students for him to choose a black social world.
220 Jane Lazarre

He loves his friends, black Americans, Caribbean and African

students, several of them, like him, with one white parent
who nevertheless define themselves, as he does, as Black. I
am slowly introduced to their perspective on identity. Black
Americans have been so-called mixed since the days of slav-
ery, and many still are. Frederick Douglass, the great Ameri-
can writer and orator, had a white father, as did many slaves
over 14 generations, so that what we call "mixedness" has
always been a part of Black life. Like Douglass, my son tells
me, he does not qualify his blackness. Political and personal
life are separated neatly only in academic abstractions. As a
feminist, a teacher of feminist and race studies, as a woman,
I know this: the straight, unblurred line between collective
and personal stories is an illusion of privilege.
"I am black," Khary explains to me repeatedly during
that first year away from home when he has to find and take
his place in his own world. "I have a Jewish mother, but I
am not 'biracial.' That term is meaningless to me. I reject
the identity of the tragic mulatto." He goes on to explain his
beliefs and feelings in detail, and when I say, "I understand,"
he tells me carefully, gently, "I don't think you do, Mom. You
can't understand this completely because you're white."
At first I am stunned, by his vehemence and by the idea.
Like most mothers, I have strongly identified with my chil-
dren. Like other writers of my generation, I have used the
experience of motherhood to try to comprehend the essential
human conflict between devotion to others and obligations
to the self, the lifelong tension between the need for clear
boundaries and boundless intimacy. I have experienced dif-
ficulty but also real reparation in mothering children myself,
and now, standing in a darkened hallway facing my son, I feel
exiled from my not-yet-grown child.
Fierce possessiveness lies at the heart of motherhood
right alongside the more reasonable need to see one's chil-
dren become themselves, and now this emotion rises up and
chokes me, obliterating vocabulary. I cannot find words to
express my feelings, or my feelings are too threatening for
me to find easy language. They are mine fields lining oppo-
site sides of the road of my motherhood of this beloved son.
What is this whiteness that threatens to separate me from
my own child? Why haven't I seen it lurking, hunkering
down, encircling me in some irresistible fog? I want to say
the thing that will be most helpful to him, offer some care-
13. Listen to My Words 221

fully designed, unspontaneous permission for him to discover

his own road, even if that means leaving me behind. On the
other hand, I want to cry out, don't leave me, as he cried to
me when I walked out of day care centers, away from baby
sitters, out of his first classroom in public school. And always,
this double truth, as unresolvable as in any other passion,
the paradox: she is me/not me; he is mine/not mine [Lazarre,
pp. 24–25].

And so I move, back and forth and never in neat sequence,

between the interior world and the world in which my sons,
now my granddaughter, and other children live—a world that in
addition to sharp pleasure and sustained joy includes, increas-
ingly now, violence, racism, and war. I close with a passage writ-
ten by the great American writer who understood the wounds
of racism better than anyone, James Baldwin (1955):

When one slapped one's child in anger the recoil in the heart
reverberated through heaven and became a part of the pain
of the universe. [But] it was the Lord who knew of the impos-
sibility every parent in that room faced: how to prepare the
child for the day when the child would be despised and how
to create in the child—by what means?—a stronger antidote
to this poison than one had found for oneself [p. 106].

As the white mother of Black sons, I had to learn that,

in addition to the dangers and injustices all children face,
my children faced a particular injustice—the force of racism,
dangerous to their spirits and their bodies, a force I initially
knew very little about, and therefore a force I had to learn to
understand. Over time, making my way through a thick fog of
denial I came to call "the whiteness of whiteness" I became
a student again, learning from my children, our Black family,
and from books, about an American history and tragedy that
I, like most white Americans, comprehended only in a shallow
and too general way.
What do mothers want? Compassion for all the human
feeling this most profound varied and complex life experience
gives rise to; for social institutions and significant others,
including therapists, including our children, to listen to our
words: not to interpret too quickly; not to reduce one thing to
222 Jane Lazarre

another; to remember the link we ignore at our peril, between

our precious personal lives and our endangered world.

REFERENCES

Baldwin, J. (1955), Notes of a Native Son. Boston, MA: Beacon Press.

Lazarre, J. (1996), Beyond the Whiteness of Whiteness: Memoir of a White
Mother of Black Sons. Durham, NC: Duke University Press.
— (1997), The Mother Knot. Durham, NC: Duke University Press.
Morrison, T. (1992), Playing in the Dark. Cambridge, MA: Harvard Uni-
versity Press.
Ruddick, S. (1989), Maternal Thinking. Boston, MA: Beacon Press.
Chapter 14

To Be Partners and Parents

The Challenge for Couples
Who Are Parents
CAROLYN PAPE COWAN
PHILIP A. COWAN

A
s researchers who have spent many years studying
couple relationships early in the family-making per-
iod of life, it was with some trepidation that we ac-
cepted the invitation to contribute to this volume. First, we
were not certain that there is a single, coherent answer to the
question, "What do mothers want?" It seems to us that differ-
ent mothers want different things. Second, we were convinced
that the question of what mothers want and need cannot be
answered without consideration of what their partners want
and need. A question about mothers' lives inevitably raises
issues about the quality of the relationships they have estab-
lished with their children's fathers, regardless of whether they
are living together, married, or divorced.
The information we present here is based on findings from
two longitudinal intervention studies of 200 couples with young
children, studies that included a randomized clinical trial design
to evaluate the effects of interventions for expectant parents
or parents with young children, and videotaped observations
of mother-child, father-child, and couple interaction (Cowan
and Cowan, 2000; Cowan et al., 2005). Before we discuss the
results of our studies and our answers to the question, "What
do mothers want?" we begin with an anecdote from a single
"case." We posed the question to one of our daughters, who

223
224 Carolyn Pope Cowan and Philip A. Cowan

at the time we asked was a wife, a professor, and the mother

of a nine-year-old and a six-year-old. She responded quickly,
"I want one hour of peace and quiet!"
This chapter attempts to unpack the reasons why many
mothers and fathers of young children, whom they love dearly,
summarize their situation with a simple, poignant plea for some
relief. To begin, we describe results of our own and others' stud-
ies of new parents to demonstrate why this goal is so difficult
to achieve. In the second part, we present the results of two
preventive interventions, both using a couples group format,
to illustrate what can be done to alleviate some of the stresses
and strains of the early childrearing years in ways that have the
potential to meet the needs of parents and their children.
In the course of these studies we learned two important
lessons that help to place what mothers want in the context
of the larger social systems in which they find themselves.
First, in two-parent families with young children, the quality
of the relationship between the parents plays a central role in
shaping children's intellectual, social, and emotional devel-
opment. Second, that contemporary American families are
struggling to meet the challenges of normative transitions in
the early family-making years cannot be blamed on the families
themselves. There are almost no societal supports, and many
societal barriers, that make it difficult for women and men to
create the kind of families in which individuals and relation-
ships are nurtured in ways that make sense to them.

NORMATIVE FAMILY TRANSITIONS CREATE STRESS

Why are the early years of child rearing so stressful? We have

described elsewhere (Cowan and Cowan, 2003) how normative
change creates challenges that even the most well-functioning
women and men must struggle to manage. Transitions, by
bringing to light processes usually hidden, enable us to see
more clearly both individual and family strategies for coping
with new and unexpected events. For new parents, sleepless-
ness, lack of time for replenishment, and significant changes
in relationships with parents, partners, and friends, all require

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14. To Be Partners and Parents 225

some readjustment. These changes challenge parents to find

new coping strategies when old ones are not sufficiently helpful.
For many, they also stimulate the reawakening of long-buried,
unresolved individual and relationship issues, which can be
accompanied by anxiety, depression, or irritability—discom-
bobulating for many and frightening for some. Transitions lead
to different results in different families. At the same time that
transitions create conditions for growth by stimulating the de-
velopment of new skills, they increase the risks for dysfunction
if the individuals and families find themselves without adequate
resources to deal with the changes in their circumstances.
Our studies of couples' transition to parenthood and the
first child's transition to school grew out of our own lives. We
had moved from Canada to California as young parents with
very young careers. By the mid-1960s, we were parents of
an infant, a three-year-old, and a five-year-old. As it slowly
dawned on us that there was a surprising amount of strain in
our relationship as a couple, we became even more alarmed
to find ourselves surrounded by couples undergoing serious
marital strain, separation, and divorce. In the early 1970s, we
designed a study to figure out more systematically what was
happening to all of us and to see if we could help. This very
brief personal background is, of course, a short version of a
much longer story.

T W O LONGITUDINAL, PREVENTIVE
INTERVENTION STUDIES

Design of t h e Studies

The "Becoming a Family Project," in which we studied the

transition to parenthood, followed couples from pregnancy
to their first child's completion of kindergarten. On entering
the study, of the 96 couples, 72 were in their third trimester
of pregnancy and 24 had not yet decided whether to have a
baby. We recruited the latter couples so that we would not fall
into the trap of attributing any changes we found in the new
parents to their having had a baby rather than to other events
226 Carolyn Pape Cowan and Philip A. Cowan

unfolding over time. One-third of the randomly selected ex-

pectant couples were invited to participate in a couples group
led by a male-female team of mental health professionals. The
groups met weekly for six months during the three months
before and the three months after the babies were born. All
the couples in the study—with or without babies and with or
without the couples group intervention—were followed and
assessed individually over the next six and a half years, which
for the parents corresponded to the period from late pregnancy
until the children's completion of kindergarten.
In the second study, the "School Children and Their Fami-
lies Project," we recruited a new set of 100 couples whose first
child was four to four-and-a-half years old. This study is con-
tinuing as we write; the children are now in high school. In this
study, two-thirds of the parents were randomly selected and
offered an opportunity to participate in a couples group led by
male-female teams of mental health professionals. The couples
groups in this study met weekly for four months in the year
before their children entered kindergarten. Let us emphasize
that, in both intervention studies, couples did not know that
there would be an intervention until after they had completed
an initial interview with one of our staff couples. In line with
our goal of preventive intervention, we sought couples who
were not (yet) in enough distress to have actively sought help
for themselves or their child. (We describe the couples groups
and the results of the intervention later in the chapter.)
The couples in the two studies were remarkably similar.
The participants who responded lived in 27 different towns
and cities in northern California. Eighty-five percent described
themselves as European American and 15 percent as Asian
American, African American, or Hispanic American. The ma-
jority were working class and middle class, along with some
who would be classified as upper middle class. There was a
range of incomes in both studies; 15 percent of the participants
earned below the median income for two-parent families in
northern California.

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14. To Be Partners and Parents 227

A FAMILY SYSTEMS DEVELOPMENTAL MODEL

In our view, to understand what is happening in one aspect of

family life—what mothers want, for example—it is necessary to
examine adaptation in five domains or aspects of family life:

1. Individual characteristics of fathers, mothers, and chil-

dren;
2. Three-generational factors, specifically, both parents' early
experiences of relationships in their families of origin;
3. Qualities of the parent-child relationships;
4. Factors outside thefamily, including support from others in
the family's social network and life stressors in the context
of kin, friends, neighborhood, workplace, and government
policies; and
5. Qualities of the relationship between the parents as a
couple.

We place the couple relationship last to emphasize its central

importance. Virginia Satir (1972) was the first of many family
therapists to describe couples as "architects" of the family,
their reactions to events in the other four domains shaping
whether or not risks and actual distress result in longer term
maladaptation. Our working hypothesis, now supported by data
from our own study and those of many other investigators, is
that (a) data from each of these five aspects of family life pro-
vide unique information about how individuals and families
cope with challenge, and (b) a combination of information
from assessments in each domain provides a more adequate
understanding of each individual family member's adaptation
than does information from any one of the domains alone.
Extending Erikson's (1980) idea of developmental tasks
from descriptions of the individual to the level of family, we
suggest that there is a unique developmental task associated
with each of these aspects of family life. Specifically, coping
with the transitional changes of becoming a family and meet-
ing the challenges of the early family-making years, we see
five major "projects." The first is the necessity of reshaping
one's identity and inner balance, which is no small task. The
228 Carolyn Pape Cowan and Philip A. Cowan

second is reconsidering and reconstructing relationships with

parents and kin—a considerable challenge for many men and
women. The third is establishing a nurturant relationship with
the child, a relationship welcomed by many men and women,
but anxiety-provoking for many others. The fourth is coping
with pressures from outside the family, which we find almost all
new parents must confront. The fifth—reorganizing the couple
relationship as the family of two becomes three or more—is
perhaps the greatest, most unexpected challenge of all.

Reshaping Identity

One of the ways we examined changes in identity during the

transition to parenthood is with an instrument we call "The
Pie." Participants were presented with a page containing a
large circle about 4.5 inches in diameter and asked to list the
major aspects of themselves beside it (e.g., parent, partner,
lover, worker, friend). They were asked to divide The Pie into
sections depending on how large each of those aspects of self
feels, not how much time they spend doing it. For the women,
the mother or parent piece of The Pie began at about 10 per-
cent of the circle during the last trimester of pregnancy and
expanded until it occupied more than one-third of the circle
when their first babies were eight months old. This represents
an average score: for some mothers the piece labeled parent
took up two-thirds of the circle. At the same time, the piece
labeled worker got smaller from late pregnancy to 18 months
postpartum. Even when the women returned to work, they
tended to be out of the home around 20 hours a week or less.
The most thought-provoking finding, and one that we had not
predicted, is that the piece labeled partner or lover also grew
smaller during this transition to parenthood period.
What about the men? The men's piece of The Pie that they
called father or parent began at approximately five percent of
the circle, which quadrupled in size after the baby was born.
Nevertheless, men's identity as a father remained substantially
smaller than the women's sense of self as a mother. In contrast
to new mothers, fathers' identity as worker basically remained
14. To Be Partners and Parents 229

the same size as it was during pregnancy, and the piece labeled
partner or lover grew slightly smaller during the transition to
parenthood period. That is, if we assume, as The Pie exercise
does, that there is a limit to one's psychological investment,
these new mothers and fathers documented some significant
and different changes in their sense of self, but for both men
and women the partner/lover aspect of self was squeezed during
the transition to parenthood. Remarkably similar results came
from parents in a German study of the transition to parenthood
that used The Pie (Schneewind, 1983). The finding that men
and women change in different ways or to different degrees as
they become parents is a recurrent theme in all our findings
and has implications for their relationships as couples.

Reworking T h r e e - G e n e r a t i o n a l Relationships

The impending and actual birth of a baby has the potential to

arouse issues from women's and men's past, some memories
otherwise long forgotten or repressed. We (Cowan and Cowan,
2000) and others (e.g., Anthony and Benedek, 1970) have
described an intrapsychic disequilibrium that requires some
interpersonal reorganization for men and women as they enter
a new generation, begin to take on a new sense of self, and
renegotiate relationships with significant attachment figures,
especially parents and in-laws. Feelings of longing for nurtur-
ance and disappointment at not receiving it get reawakened.
This reawakening often plays out in issues about whose parents
will come to visit or help first. Discussions about what to do
with parents' gratuitous advice about handling new infants
often leads to nervousness or conflict between the two adult
generations—and between the new parent partners.
In both studies, many new parents described attempts
to reach out to their parents with news of the pregnancy
or the baby's birth, only to experience familiar patterns of
criticism, dismissal, or pulling away. Despite the expectation
that these patterns might persist, when they did, they never
failed to surprise and disappoint the new parents. In many
instances, the generations found themselves engaged in a
230 Carolyn Pape Cowan and Philip A. Cowan

dance of connection, disconnection, and often reconnection.

Consistent with the theory of transition as both a danger and
an opportunity, this dance resulted in new closeness for some
families and painful disappointments, even estrangements, for
others. These generational dynamics had implications for the
relationship between the new parents.

Creating a Relationship with the Child

There is truth to the current cliche that one must discover how
a new baby "works" without the benefit of an owner's manual.
How does a parent learn to pick up the infant's mysterious
signals? Daniel Stern (1995) eloquently describes the delicate
negotiations involved in the establishment of intersubjectivity
between parent and child (see also Benjamin, this volume).
Other developmental researchers point out that men and
women tend to use different styles in establishing different
kinds of relationships with their children (Parke, 1996; Pruett,
2000). Fathers are typically a bit more rough and tumble with
their babies, perhaps especially with boys. Mothers and fathers
must learn to manage their reactions to those differences.
Some are able to regard them in a "We're each contributing
wonderful, unique things to our child's development" mode,
whereas others experience them as "I'm upset because my
spouse is doing things the wrong way." These reactions affect
the atmosphere of the parents' relationship as a couple, which,
of course, contributes to the atmosphere in which the infant
is developing.

Coping with Life Stresses and Enlisting Social Support

After the baby's birth, men's and women's connections with

the world outside the family change, sometimes in similar
ways, sometimes quite differently. One item that stood out in
both our studies is the overwhelming lack of societal support
reported by parents of babies and young children. Quandaries
concerning the balance between family and work increase for
both men and women. Friendship networks shrink as new
14. To Be Partners and Parents 231

parents begin to relate more to other parents and less to child-

less friends and coworkers, some of whom are not as enthralled
as the parents are with the baby's every move. These shifts are
often experienced as unexpected losses despite the gains of new
friends. Many contemporary parents are rearing children far
from the potential support of kin, in isolated dwellings where
their neighbors are at work and not available.
Workplace support is extremely limited for American
mothers and fathers, who have no universal paid leave and only
12 weeks of unpaid leave if they want to secure their return to
the same position. For those who choose to or must continue to
work during their children's infancy, the dearth of high quality,
affordable child care makes parenting very stressful. Services
for new parents are practically nonexistent, except for a few
experimental home-visiting programs for low-income mothers
in a few parts of the United States. If mental health services
are available at all, only those in serious difficulty seem to
find them and, then, not until their ineffective strategies have
become entrenched and difficult to modify. Those who decry
the decay of "family values" have not incorporated support for
upholding these values in American social institutions.

Reorganizing t h e Couple Relationship

Because there are changes in each new parent's sense of self,

and in relationships with parents, in-laws, coworkers, friends,
and children, and because of the physical and psychological
demands of caring for newborn infants and young children, it
seems inevitable that the relationship between the parents will
undergo change. These readjustments are especially challeng-
ing given the biological and psychosocial shaping of different
roles for mothers and fathers, which seems to propel men and
women into different worlds.
We are all aware that for the last 40 years, especially with
the rise of the women's movement, there has been an ideology
of encouraging egalitarianism in family arrangements. Our re-
sults suggest that the reality for modern couples is closer to a
slightly modified traditionalism. Modern fathers do more house-
work and hands-on child care than their fathers did, but much
232 Carolyn Pape Cowan and Philip A. Cowan

less than contemporary mothers do. Men and women move

into more traditional roles than they had before their babies
were born and more gender-linked roles than they expected,
regardless of whether or not the mothers work full time. This
finding comes not only from our study, but from studies of par-
ents in many Western industrialized societies (e.g., Bernardes,
1997). In our studies, new parents reported increased conflict
in the period between pregnancy and 18 months postpartum,
and "who does what?" issues top the list.
Summarizing what happens to the quality of couples' re-
lationships, we relied on widely used measures like the Locke-
Wallace Short Marital Adjustment Test (Locke and Wallace,
1959). Repeated measures using this or similar assessment
tools to examine partners' marital adjustment or satisfaction
with their couple relationship over time reveal that marital
adjustment and satisfaction decline from pregnancy through
the early child rearing years (Shapiro, Gottman, and Garrere,
2000). Correlated with the decline in the quality of the couple
relationship is not the amount of conflict, but, rather, the
widening gap between husbands' and wives' roles and their
perceptions of their life as a family (Cowan et al., 1985). In
our study, the divorce rate for new parents was 15 percent in
parents without intervention by the time the first child was
three years old, and, for parents with and without intervention,
20 percent by the time the children were in the first year of ele-
mentary school. Although 20 percent may seem low, consider
that this figure represents almost half the divorces expected
in United States marriages over time.
Let us be clear that our findings show that we cannot
blame babies for the state of their parents' marital happiness
or adjustment once partners become parents. There is a great
deal of consistency in marital adjustment or satisfaction over
time: couples who feel very positive about their relation-
ship before the baby arrives are the ones doing best later on,
whereas those who are unhappy with their relationship in the
prebaby phase are likely to be in even greater distress two
years later. The transition to parenthood, then, tends to have
its most negative effects on the fault lines that already exist in
the couple relationship terrain.
14. To Be Partners and Parents 233

IMPLICATIONS O F FAMILY RELATIONSHIP

QUALITY FOR CHILDREN'S DEVELOPMENT
AND ADAPTATION T O S C H O O L

If we were to end the family-making story at this point, it would

seem reasonable to ask, "What has all this got to do with what
mothers want?" As indicated by the title of this chapter, our
answer is that mothers want to be caring parents and partners,
and they are determined to provide a family environment in
which their children can develop to their fullest potential. What
we and others (Cox, Paley, and Harter, 2001) have shown in
studies over the last two decades is that the parents' level of
adaptation in each of the five domains of family life we have
been describing contributes to their ability to accomplish these
central life goals.
The information that we summarize briefly here comes
from interviews with parents and children over time, question-
naires completed by mothers and fathers at home, observations
of couples and of parents and children working and play-
ing together during visits to our project, and ratings of the
children's behavior in their classrooms by their teachers from
kindergarten through grade four. Because the children in our
studies lived in 27 different cities and towns, they attended
90 different California schools—public, private, and parochial.
We asked their kindergarten, first-, and fourth-grade teachers
to describe every child in the classroom on a 110-item check-
list, the Child Adaptive Behavior Inventory (Cowan, Cowan,
and Heming, 1995), without giving them the identities of the
children participating in our studies.
Our staff also administered an individual achievement
test to each child at home along with the Berkeley Puppet In-
terview (Measelle et al., 1998), which was designed to assess
children's positive or negative evaluation of themselves and
their relationships. We were interested in how well the family
factors we had assessed in the year before the children entered
kindergarten explained variation in their adaptation to school.
Adaptation and maladaptation were viewed in terms of the
children's social competence and difficulties, their aggressive
behaviors; their depressed, shy, and withdrawn behaviors;
234 Carolyn Pape Cowan and Philip A. Cowan

their academic competence or difficulty; and their sense of

well-being or distress as they made the transition to elementary
school and set out on their academic careers.
Let us start with the most obvious family relationship
that can affect children's adaptation to school—the quality
of a child's relationship with his or her mother and father.
Families visit our project playroom and for about 40 minutes
each, mother and father engage separately in a number of tasks
with their child. Our teams of two observers rate the behavior
of the parents on a number of scales. When either mother or
father uses an authoritative style (Baumrind, 1980)—that is,
when they are warm and responsive, but also structure tasks,
set reasonable limits for a child of that age, and respect the
child's autonomy—the child does better at school in kindergar-
ten and first grade as measured by academic achievement tests
and by teachers' ratings of social competence, and behavior
problems. Despite the typical emphasis on mothers' parent-
ing in most studies and clinical practice, we find that fathers'
parenting style is as important as mothers' style in predicting
how children adapt to school.
Many researchers have found that there is spillover from
the quality of the couple relationship to the tenor of the
parent-child relationships (Cummings and Davies, 1994; Cox
et al., 2001). When the couple cannot resolve their conflicts,
or when there is a tense, freezing atmosphere between the
parents, the parent-child relationship tends to lose effective-
ness, and the child tends to show signs of poorer adjustment
in school—socially, academically, and behaviorally. Especially
when daughters blame themselves for their parents' conflict,
they are much more likely to be seen by their teachers as
depressed. In another example of the gendered nature of
marital conflict, maritally dissatisfied fathers of daughters tend
to treat their daughters the way they treat their wives—with
irritability and aggression; but fathers of sons appear to be
more compartmentalized in the spillover of marital conflict to
their parenting. This difference in favor of boys does not hold
for mothers and sons. Thus, when parents are distressed as a
couple, daughters are more at risk.
Our five-domain approach suggests that, in addition to
parent-child and couple relationships, the three-generational
14. To Be Partners and Parents 235

transmission of family patterns also plays a role in how children

fare in the early years of school. In our studies, we were not
able to observe grandparents interacting with their children
and grandchildren. Instead, we interviewed each of our study
parents using the Adult Attachment Interview (Main, Kaplan,
and Cassidy, 1985). This 60- to 90-minute interview asks par-
ents to reflect on their early and current relationships with
their mothers and fathers (the grandparents of the children),
to give five adjectives that describe each of those relationships,
and to offer examples to illustrate the adjectives they chose.
Based on the pattern of coding, the interviewed person is de-
scribed as having either a secure state of mind or an insecure
state of mind regarding parent-child relationships. Insecure
parental strategies may consist of dismissing the importance
of such relationships or of expressing anxiety, anger, or both
during the interview in ways that disrupt the coherence of the
narrative.
In each of our studies, we found that, when a mother or
a father has an insecure working model of attachment, he or
she is more likely to be involved in a high-conflict marriage
and to be less authoritative in interactions with the children
during visits to our project. We also found that, if the father's
narrative reflects a secure working model of relationships but
the mother's does not, his style tends to provide a buffer for
the risk of repeating relationship distress across generations;
the parents' marital interaction in these couples looks pro-
ductive, and the mothers' parenting appears to be as effective
as that of mothers with a secure model of relationships. One
provocative finding is that the reverse is not true; when moth-
ers have a secure working model but their husbands do not,
the mother's security fails to buffer the couple or the children
from the consequences of the father's negative perspective
on his early upbringing. His interactions with his partner and
child are not effective.
To complete our brief summary of the contributions to
children's adaptation of the five aspects of life we assessed in
their parents: we found that mothers' and fathers' descriptions
of their well-being or distress as individuals, and the stressors
and supports they experienced in relationships with others,
contributed uniquely to explaining variations in the children's
236 Carolyn Pape Cowan and Philip A. Cowan

social, academic, and emotional adjustment to kindergarten

and first grade.
Three conclusions can be drawn from results of our own
and others' studies of the key family factors associated with
children's development. First, each of the five domains of family
life makes a unique and important contribution to children's
adaptation. Being an effective parent predicts an important
amount of the variation in how children meet the academic and
social challenges of school. But how the parents resolve their
real-life conflicts and problems as a couple also plays a part.
Over and above these two domains, the pattern of relationship
transmission from grandparent to parent to child contributes
to whether the children seem able to concentrate, learn new
material, and get along with other children at school. Parents'
adjustment and life stress as individuals also contribute to the
family systemic picture of how children fare during the transi-
tion to elementary school. Of course, some of these links arise
from the fact that parents and children share a set of genes,
but others are related to the dynamics of their relationships
and the psychodynamics of each individual.
These findings illustrate why we want to reframe the
question of what mothers want. Much of the discussion of
this topic refers to what women want and need to be "good-
enough" parents and reasonably well-functioning individuals.
Our results suggest that a central ingredient in achieving this
goal is the kind of relationship that mothers establish with the
fathers of their children. We should emphasize that, although
our discussion here has focused on heterosexual, two-parent
families, there is ample evidence that this conclusion applies
to divorced couples (Hetherington and Kelly, 2002), and that
single mothers and their children also benefit from good rela-
tionships with the children's biological fathers (Carlson and
McLanahan, 2002). The literature on gay and lesbian families
tends to focus on parenting (Patterson, 1995), but we expect
similar links to emerge between the quality of the couple's re-
lationship and the parent-child relationships in these families
as well (see Schwartz's and Drescher et al.'s chapters in this
volume for supporting evidence).
The data also reveal that it is possible to identify individu-
als and family relationships that are at risk for future distress.
14. To Be Partners and Parents 237

The question is, what can be done to reduce the probability

that the risks will result in maladaptation? That is, what can be
done to help mothers come closer to their hopes and dreams
of parenthood?

PREVENTIVE INTERVENTION
FOR EXPECTANT PARENTS
Here we focus on our systematic evaluation of interventions
designed to strengthen the relationship between the parents
during their transition to first-time parenthood. In 1979, when
we first designed the "Becoming a Family Project" for couples
who would give birth in the early 1980s, there was suggestive
evidence in the literature that couple relationships might
be vulnerable to strain during the transition to parenthood
(LeMasters, 1957), but there were no longitudinal studies of
partners becoming parents and no reports of programs for
couples that might make a difference to their adjustment as
individuals, as couples, or as parents. After conducting a small
pilot study, we succeeded in obtaining funding for a larger inter-
vention study. We offered randomly chosen couples coming
into the study an opportunity to participate in couples groups
with clinically trained staff couples as leaders. Each group
contained a staff couple and four or five couples expecting
a baby around the same time. They met for two hours every
week for six months—the last three months of pregnancy and
the first three months of parenthood.
Although this volume focuses primarily on mothers, let
us emphasize why we included both mothers and fathers in
our intervention groups. Our design was based on assumptions
and findings illustrated in the first part of this chapter: (a) that
the marriages of partners becoming parents were vulnerable to
strain during the transition to first-time parenthood, even for
two-parent families in fairly advantaged circumstances; (b) that
well-functioning couple relationships could help break nega-
tive intergenerational cycles; and (c) that children's successful
development would be related not simply to the quality of the
mother-child relationship but to the quality of the relationship
between the parents as a couple.
238 Carolyn Pape Cowan and Philip A. Cowan

Because the families in our two studies were very similar,

we have combined the data on family risk to give an overall
picture of the stressors for couples early in the family-mak-
ing period. At some point between pregnancy and the first
child's entrance to high school, 25 percent of the mothers and
fathers had scores on the Center for Epidemiological Studies
in Depression Scale (CES-D) (Radloff, 1977) that were above
the clinical cutoff, which means that they were reporting
many of the same symptoms as those people with diagnoses
of clinical depression. Furthermore, at some point in the six
years we followed them, 50 percent of the parents described
their relationships as couples in ways that suggested serious
strain in their marriages, including the 20 percent who ended
their marriage.
In both studies, 20 percent of the mothers and fathers,
while describing the quality of their relationships with their
parents when they were young children, spontaneously talked
about a history of alcohol- or substance-abuse problems in
their parents. Two percent of the parents in our studies re-
ceived psychiatric diagnoses and more received diagnoses of
serious physical illness in the first two years after their babies
were born. Finally, 10 percent of the children in both stud-
ies had been identified by their teachers, parents, or health
professionals as having problems serious enough to warrant
further assessment or intervention. Thus, in this "nonclini-
cal" sample of families with considerable advantages, most of
whom had not sought therapy, there were multiple indicators
of significant levels of stress and distress. Given that these
women and men were entering periods of expected change and
adjustment, we view this as an ideal time to mount a preven-
tive intervention.

The Couples Groups

The couples groups we offered in both studies were simi-

lar. The transition-to-parenthood groups met weekly for six
months, and the transition-to-school groups met weekly for
four months. Each group included four orfivemember couples

Copyrighted Material
14. To Be Partners and Parents 239

and a staff couple. The format of the groups was similar in

both studies, although the content issues were a little different
since we were working with expectant parents in one project
and preschoolers' parents in the other. The male-female staff
couples in the two studies were all trained in working with
couple or family relationships. They were psychologists, social
workers, and marriage and family counselors with varied levels
of experience.
In the last three months of the transition-to-parenthood
groups, the babies became part of the group. Consequently,
there were some disjointed discussions, with the distractions
of babies crying, burping, and being diapered, and parents
taking an intense interest in each other's babies so that our
discussions were disrupted regularly. The advantage of hav-
ing this "living family laboratory," as some referred to it, was
that it represented a graphic replay of exactly what was going
on in the couples' lives at home and thus provided fodder for
vivid discussion. Having both parents and babies in the room
simplified the leaders' task of noting that new mothers and
fathers had little opportunity to finish any conversations about
what was happening to them. Because it was not practical to
manage this level of complexity with parents and preschool-
ers in the same room, the transition-to-school groups were for
parents only.
In couples groups, we try to do a number of things to
create a therapeutic environment, although we do not view
the groups as providing couples therapy. First and foremost,
we attempt to create a safe setting in which men and women
can share their hopes, concerns, and impasses about family
issues. One metaphorical way of thinking about the group in
attachment-theory terms is that the group setting provides a
"secure base" in which partners are more likely to share their
experiences during an anxiety-provoking transition, to draw
on one another and the staff couple for information and sup-
port, and to try new ways of working together to satisfy the
needs of both partners, especially when their relationships feel
vulnerable. When the partners are able to serve as resources
for each other, they are better able to create what Byng-Hall
240 Carolyn Pape Cowan and Philip A. Cowan

(1999) calls a secure family base that facilitates the develop-

ment of parents and children.
The unique feature of the groups, in contrast to the
mothers' groups that seem increasingly common in middle-
class communities, is that both partners are in the room. This
gives us a chance to work on the relationship between the
partners, to help them build on their strengths as individuals
and as a couple, and to manage conflicts and solve problems
more effectively—basically to move closer to being the kinds
of parents and partners they dream of being.
We must emphasize that the groups were not created to
provide couples therapy. Nor would we consider them to be
psychoeducational classes or didactic workshops in which
the leaders teach a specific set of communication or parent-
ing skills. Our approach combines a family systems focus on
five central developmental tasks of family life, with a focus
on intrapsychic process, and so considerable time is spent on
dynamic issues that include reflection on attachment issues
and the three-generational aspects of marriage and parent-
hood. We work to help the group members acknowledge their
needs, make their personal pictures of ideal relationships
more explicit and conscious, and recognize and think about
how patterns from their families of origin led to their passions
about what they are determined to repeat or change in their
new families. We recognize that breaking the cycle of negative
intergenerational relationships is extremely difficult work.
Our hope is that by helping mothers and fathers make small
changes that feel more satisfying to both partners, their sense
of competence and satisfaction will over time have cascading
effects on relationships with their children and other important
people in their lives.
In addition to active work helping each m o t h e r and
father move their actual and ideal circumstances closer to
one another's, the power of the group appears to stem from
the recognition that "we're all in the same boat." Listening
to other couples struggle through similar issues in ways that
seldom happen in their social lives, all the participants have
opportunities to see that they are not the only ones who are
having differences and finding it difficult or stressful to make
adjustments.
14. To Be Partners and Parents 241

E F F E C T S O F T H E COUPLES GROUP INTERVENTIONS

Becoming a Family

Fathers who had been in one of our couples groups during

their transition to parenthood described themselves as more
psychologically involved with their babies in the first two
years than did fathers without the intervention. Mothers who
had been in a couples group started thinking of themselves as
students and workers again in the second year of parenthood,
in contrast to mothers in the comparison group, who were
almost totally focused on their role as parents (showing much
larger parent/mother pieces of The Pie). Mothers who had
participated in a couples group were happier with the "who
does what" of their lives, the couple's arrangements to divide
the care of their home, their family decisions, and the care of
their children. Noteworthy about this finding about satisfac-
tion with their role arrangements is that there was no statis-
tically significant difference between the two sets of couples
in the actual arrangements they described. Nevertheless, the
mothers who had talked about these issues for six months in
a couples group were less unhappy or more satisfied with their
role arrangements as a couple than were their no-intervention
counterparts. We think that their discovery that almost every-
one in the group was struggling in similar ways helped them
attribute their strain to the transition rather than to some fault
or obstinacy of their partners.
The fathers and mothers from the couples groups re-
mained relatively satisfied with their relationships as couples
all the way from pregnancy through their children's entrance
to elementary school (Schulz, Cowan, and Cowan, 2004). This
result suggests that the consistent finding of more than 20
studies (Cowan and Cowan, 1995), that marital satisfaction
declines in the early years of parenthood, applies primarily to
couples without intervention.
There were no separations or divorces for the first three
years of parenthood in any of the couples who had been in a
couples group, whereas 15 percent of the couples who had
had a baby but no intervention were already separating or
divorcing. Nevertheless, by the time the children in the study
242 Carolyn Pape Cowan and Philip A. Cowan

reached kindergarten, 20 percent of the couples were separated

or divorced, regardless of participation in a couples group. The
intervention appeared to do two things: for couples who stayed
together, it kept their marital satisfaction stable throughout the
preschool years; for those who eventually ended their marriage,
it delayed divorce until late in the preschool period.
Although we have no systematic data, it is our impres-
sion that it is unrealistic for a 6-month intervention—even an
intensive one like ours—to have long-lasting effects for every-
one without some kind of "booster" intervention. In follow-up
interviews, some of the couples suggested that they needed
a "refresher course" for coping as partners as they faced the
challenges of new family and work situations like the birth
of a second or third baby, the loss of a job, relocation, or an
unexpected serious illness.

School Children and Their Families

The findings that we report now are from a second set of 100
families followed from their children's preschool to the end
of grade four, when the children were 9½ to 10 years old. As
the parents entered the study, we offered one set of couples,
randomly chosen, participation in a couples group that met
weekly for 16 weeks as they prepared for their first child's
transition to kindergarten. We contrasted that intensive inter-
vention by offering parents the opportunity to ask for a yearly
consultation with the staff couple who conducted the initial
interview—in the last preschool year and in the kindergarten
and first-grade years. We found that most of the couples who
were offered consultation did not take advantage of the yearly
offer, so our contrasts are mostly between parents who partici-
pated in a couples group for 16 weeks and parents who received
no special help. As in the first study, none of our recruitment
materials mentioned the interventions; participating couples
heard about the interventions at the end of the Initial Interview,
when they had talked with a staff couple and been told more
about the overall study.
In this second study we added an important level of com-
plexity to the design of the couples groups. The semistructured

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14. To Be Partners and Parents 243

groups followed a set agenda for half of each meeting, and

parents were invited to bring any personal issue to work on
in the other half of the evening. We asked the leaders of some
groups to focus during the open-ended part of the evening on
the relationship between the parents (Couple Focused) and
leaders of other groups to focus on the relationships between
parents and children (Parenting Focused). For example, if a
couple was having a struggle getting their four-year-old to go to
bed, and he tended to have a tantrum around their insistence,
in the groups that emphasized a Couple Focus, the leaders
might ask, "How do the two of you manage when you are try-
ing to work on a challenge like this? What do the two of you
do when you differ?" In the groups that emphasized a Parent-
ing Focus, the leaders might ask, "What is each of you trying
to accomplish with your son when you're trying to get him to
bed? What are you trying to convey to him? What have you
tried that has worked and what hasn't worked?" We used this
difference in emphasis in the way real-life topics were pursued
to see whether it made any difference in the long run if we
focused on either of these two central family relationships.
We also wanted to test hypotheses about quality of marriage
spilling over to quality of parenting and vice versa.
In this intervention study, we found effects of the interven-
tion on the parents and on the children's adaptation to school.
In the Parenting-Focused groups in which the leaders focused
on the parent-child relationships during the open-ended part
of the evenings, when we observed them with their children
in the year after, the mothers' and fathers' parenting styles
were more authoritative if they had participated in a couples
group—more effective than they had been before the children
entered kindergarten and more than the styles of parents who
had had no intervention. The children of the Parenting-Focused
group reported more positive adjustment to school in respond-
ing to the Berkeley Puppet Interview than did the children of
the nonintervention couples, and the teachers described the
children of the former group as less shy, less withdrawn, and
less depressed in first and fourth grade than were children of
parents with no intervention.
In the Couple-Focused groups in which we had focused on
the relationship between the parents during the open-ended part
244 Carolyn Pape Cowan and Philip A. Cowan

of the evenings, the mothers' self-esteem went up according

to their self-reports during the transition to school years; the
fathers and mothers alike reported less conflict and volatility
as a couple after participating in the groups, and we observed
less marital conflict between the spouses in our playroom as
they worked and played with their child in the year after the
groups ended (less than before the intervention and less than
the couples with no intervention). Noteworthy here is that
the parenting of mothers and fathers in the Couple-Focused
intervention also improved over time. The children of those
parents had higher achievement scores at the end of kin-
dergarten and were rated by teachers as lower in aggressive,
oppositional behavior than the children of parents with no in-
tervention. These results suggest that a group with a Parenting
Focus led to improvements in parenting but not in marriage,
but a group with a Couples Focus led to improvements in both
marital and parent-child interaction.
In summary, by focusing on challenges for mothers as
well as fathers during the early stages of family-making and
helping them recognize patterns from their families of origin,
deal constructively with the expression of powerful emotions,
and resolve some of their ongoing differences to both partners'
satisfaction, preventive interventions can have long-term ef-
fects on mothers, fathers, and children.

IMPLICATIONS FOR THERAPISTS

Our project was intended to be preventive by enabling inter-

vention early as key family relationships were developing. We
think that the findings have implications for therapists who
help distressed mothers and fathers.

1. We hope that the results of these two intensive intervention

studies will encourage therapists working with mothers dur-
ing the early family-making years to reframe some of their
interventions in the context of family systems in transition.
In this way they may avoid interpreting all individual, intra-
psychic, or couple distress as indicators of pathology. The
systemic view suggests that therapists treating new mothers
14. To Be Partners and Parents 245

might facilitate their clients' adaptation by focusing some

attention on challenges in the couple and parent-child re-
lationships, and by working on intergenerational issues in
clients' families of origin.
2. Individual and couples therapists can be helpful to women,
men, and couples who are becoming parents or who are
parents of young children by helping them to reframe and
normalize their experiences. Therapists may not be in a
position to provide the "we're all in the same boat" discov-
eries that participation in a couples group seems to do, but
they can inform clients about the normal and expectable
stresses of the early child rearing period through direct
information or references to readings.
3. Therapists who treat adult clients may also play an active
preventive role in children's development. If therapy helps
to alleviate individual distress and reduce negative transac-
tions between patients and their partners, parents, children,
and coworkers, the patients' children may also reap benefits
in their academic, social, and emotional development.
4. For those planning interventions with women and men in
the early child rearing years, including parenting classes,
it may be helpful to know that parenting may more likely
be altered by improvements in the couple relationship, but
improvements in parenting effectiveness may not alleviate
distress between the parents.

As we return to the question, "What do mothers want?"

we come back to the quandaries that result from the fact that
contemporary parents are, in a sense, new pioneers. We have
heard what mothers want from hundreds of mothers. They
want to be the best parents they can be, to manage a nourish-
ing relationship with a partner, to balance being a partner and
a parent, to establish satisfying relationships with their own
parents, and to be involved in work that is meaningful. And
they want an hour of peace and quiet.
Finally, a piece of practical advice that follows from our
research findings: in what is often a frantic attempt to balance
all these demands, mothers and fathers are often tempted to
put their relationships on hold while they respond to the im-
mediate needs of their children. This is especially true when
246 Carolyn Pape Cowan and Philip A. Cowan

both parents work outside the home and feel guilty about tak-
ing more time away from the child to replenish themselves.
While we are not advocating that parents disregard their
children's needs, our intervention results suggest that some
time devoted to nurturing the parents' relationship as a couple
can have marked and long-lasting benefits for children. This
does not mean that couples must have romantic dinners out or
weekends away. It does mean that 10 minutes a day to check
in with each other—not simply about what needs doing at
work, at home, or with the child—can have important payoffs
in the long run for their own and their children's well-being.
The couples group interventions we mounted with clinically
trained staff provided two hours a week over a few months
during which the couples could talk about and work on their
family issues and predicaments. In both studies, the groups
made a difference to some couples in how their relationship as
partners fared, the style in which they related to their children,
and their children's academic, social, and emotional adaptation
in the early elementary school years.
There is a New Yorker cartoon by Maslin that captures our
ideas about intervention with couples. Two couples are chat-
ting in an immense living room, and one asks the other, "The
work being done on your marriage, are you having it done or
are you doing it yourselves?" Our idea is that, if couples can
get a little help "having it done" as they embark on important
family transitions, they will probably be better at "doing it
themselves" over the following years. Our hypothesis, as yet
untested, is that if mothers can have some time each week to
focus on their relationships with the fathers of their children,
they might find that their reality comes a little closer to what
they want.

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Author Index
A Bergh, R, 173–174, 191
Ablow, J. C., 223, 232, 233, 247
Altaian, N., 118, 126, 128
Ammaniti, M., 154, 167
Anthony, E. J., xxi, xxxv, 229, 246
Apfel, R. J., 135, 148
Appagnanesi, L., 24, 34
Applegarth, L., 176, 189
Arlow, J. A., 138–139, 148
Armelini, M., 107, 109, 113
Aron, L., 47, 49, 53
Arons, E., 164, 169
B Brabender, V., 163, 164, 166, 168
Bachrach, C , 175, 190
Baldwin, J., 221, 222
Balsam, R. II., xviii, xxxv, 21, 24,
34, 134, 148
Baran, A., 90, 101
Bassen, C. R., 163, 164, 166, 167
Bassin, D., xx, xxxv, 109, 113n1,
113, 134, 148
Baum, E., 164, 166, 167, 167
Baumgartnere, E., 154, 167
Baumrind, D., 234, 246
Bawer, B., 88, 101
Bayer, R., 88, 101
Beebe, B. B., xxi, xxxv, 40, 42, 53,
156, 167
Belkin, L., xxii, xxxv
Benedek, T., xxi, xxxv, 100n1, 101,
134, 148, 152, 164, 167–168, 229,
246
Benjamin, J., xx, xxi, xxxiv, xxxv,
37–41, 49, 53, 230
Berg, B., 176, 189
Bergman, A., xxi, xxxvii, 93, 94,
102
Bergmann, M. V., 135, 148
Bernardes, J., 232, 246
Bernstein, I., 116, 122, 128
Bernstein, S. B., 113n2, 113
Bibring, G., 134, 149, 151, 152, 163,
168
Birch, M., 122, 128
Birksted-Breen, D., 154, 168
Blos, P., 100n1, 101
Bowlby, J., xxi, xxxv
Bradley, E., 152, 159, 168
Braunschweig, D., 55, 68
Brewaeys, A., 174, 190
Briggs, R., 118, 126, 128
Brinich, P. M., 113n2, 113
Brisman, J., 194, 199, 210
Britton, R., 38, 47, 53
Bromberg, P. M., 47, 51, 53
Brown, N. O., 138, 149
Bruch, H., 123, 128
Bruschweiler-Stern, N., 184, 191
Buechler, S., 138, 149
Burns, L. H., 154, 168, 176, 177,
189
Butler, J., xx, xxxv, 100n4, 101,
110, 113
Byng-Hall, J., 239–240, 247
C
Candelori, C., 154, 167
Carlson, M., 236, 247
Garrere, S., 232, 248
250
Cassidy, J., xxi, xxxv, 15, 18, 235, 247
Chan, R., 95, 102
Chasseguet-Smirgel, J., 55, 68, 139,
149
Chethik, M., 126, 128
Chodorow, N. J., xvi, xviii–xxi,
xxviii, xxxiv, xxxv–xxxvi, 20–21,
28, 34, 100n4, 101, 132–135,
148n1, 149, 153, 155, 168
Cohen, D. J., 155, 169
Cohen, L., 151–156, 159, 168
Cohn, H., 78–82
Cook, R., 174, 190
Cooper, S. H., 50, 53, 138, 149
Covington, S. N., 154, 168, 177,
187, 189, 189n3, 189
Cowan, C. P., 153, 168, 223, 224,
229, 232–233, 241, 247, 248
Cowan, P. A., 153, 168, 223, 224,
229, 232–233, 241, 247, 248
Cox, M. J., 233, 234, 247
Cramer, B., 161, 168
Crawford, S., 92, 101
Crespi, L., 90, 91, 100n2, 101
Cummings, E. M., 234, 247
D G
Daniels, P., 80
Davies, P., 234, 247
de Beauvoir, S., xix, xxxvi
de Marneffe, D., 134, 149
DeCherney, A., 177,190
Demos, J., xx, xxxvi
Dennerstein, L., 176, 189
D'Ercole, A., xx, xxxvi, 88, 96–97,
101, 153, 168
Deutsch, H., xviii, xxxvi
Diamond, M, 177, 190
Dickstein, L., 176, 189
Dimen, M., 100n4, 101
Domar, A., 177, 189
Domenici, T., 97, 101
Downey, J. I., 176, 190
Drescher, J., xx, xxxvi, 87–88,
96–97, 101, 102, 153, 168, 236
Drews, M., 173–174, 191
Duberman, M., 87, 102
Author Index
Dwyer, T., 134, 149
E
Erikson, E. H., 135, 149, 227, 247
F
Fain, M., 55, 68
Fallon, A. E., 163, 164, 166, 168
Federn, P., 22–24, 34
Feldman, J., 164, 169
Feldman, M., 50, 53
Fenster, S., 163, 164, 167, 168
Fliegel, Z. O., xviii, xix, xxxvi
Fonagy, P., 46, 53, 57, 68
Forrester, J., 24, 34
Foucault, M., 97, 102
Fraiberg, S., 161, 168
Frankel, J., 118, 126, 128
Freud, A., xviii, xxxvi, 116, 128
Freud, S., 34, 99, 102
Friday, N., xx, xxxvi
Friedan, B., xix, xx, xxxvi
Friedenberg, Z., 172, 190
Friedman, G., xvi
Friedman, R., 177, 189
Gallese, V., 7–8, 18
Gensler, D., 118, 126, 128
Gergely, G., 46, 53
Giavazzi, M., 174, 190
Gibbs, N., 173, 175, 188n1, 290
Gill, M. M., xxi, xxxvi
Gilligan, C , xx, xxxiv, xxxvi
Gillman, R., 163, 164, 166, 168
Glazer, D. F., 88, 96, 100n1, 102
Glenn, J., 116, 122, 128
Goldberg, S., xxi, xxxvi
Goldberger, M., 152, 156, 160, 163,
164, 166, 168
Goldner, V., 100n4, 102
Golombok, S., 92, 103, 174, 190
Gottman, J. M., 232, 248
Green, J., 89, 102
Greenberg, J. R., xxi, xxxvi
Greenfeld, D., 176, 177, 190
Guerra, D., 174, 190
Author Index
H Kotelchuck, M., 92, 102
Hannigsberg, J. E., 74, 85
Hardin, D. H., xxi, xxxvi
Hardin, H. T., xxi, xxxvi
Harris, A., 100n4, 102
Harter, K., 233, 234, 247
Hayge, H., 172, 190
Heming, G., 233, 247
Herek, G. M., 110, 113
Herring, C., 164, 166, 167, 167
Herzog, J. M., 57, 68
Hetherington, E. M., 236, 247
Hewlett, S., 173, 190
Hilferding, M., xxiv, 22–24, 28, 33
Hoffman, I. Z., 52, 53, 138, 149
Holtzman, D., 24, 34
Honey, M., xx, xxxv, 134, 148
Horney, K., xviii, xxxvi-xxxvii
Houle, M., 177, 190
Huntington, D., 134, 149
I 155, 269
Imber, R. R., 163, 164, 168–169
J Lewin, E., 106, 113
Jacobs, L., 117, 122, 128
James, W., 5, 18
Johnson, V. K., 223, 232, 247
Jones, E., xviii, xxxvii
Josephs, L., 176, 190
Jurist, E., 46, 53
K MacGallum, F., 174, 190
Kaplan, M. M., xx, xxxv, 134, 148
Kaplan, N., 15, 18, 235, 247
Kelly, J., 236, 247
Kennedy, H., 116, 128
Kennell, J., 10, 28
Kerr, J., xxi, xxxvi
Kestenberg, J. S., 134, 149
Keylor, R. G., 135, 148
Kirkpatrick, M., 95, 102
Kittay, E. F., 74, 77, 85
Klaus, M., 10, 18
Klein, M., xviii, xxxvii, 116, 128,
140–141
Knoblauch, S., 40, 53
251
Kris, A. O., 137, 249
Kristeva, J., 139, 149
Kulish, N., 24, 34
L
Lacan, J., 38, 39, 45, 53
Lachmann, F. M., xxi, xxxv, 40, 42,
53, 156, 267
Ladd-Taylor, M., 74, 85
Langer, M., 134, 249
Laplanche, J., 57, 68
Laplanche, S., 4, 18
Lax, R., 164, 166, 169
Lazarre, J., xx, xxxiv, xxxvii, 217–
221, 222
Leckman, J. R, 153, 169
LeMasters, E. E., 237, 247
Leon, I. G., 152, 169
Lesser, R. C., 97, 101, 102
Lester, E. R, 134, 249, 151–153,
Leuzinger-Bohleber, M., 135, 149
Levinson, N., 163, 164, 166, 168
Lichtenberg, J. D., xxi, xxxvii
Lieberman, A., 161, 169
Locke, H. J., 232, 247
Loewald, H. W., 20, 33, 34, 46, 54,
182, 190
M
Magee, M., 97, 102
Mahler, M. S., xxi, xxxvii, 93, 94,
102
Main, M., 15, 28, 235, 247
Mamo, L., 89, 102
Marosek, K., 187, 189
Maxfield, R., 164, 170
Mayes, L. C., 57, 153, 155, 169
McGarty, M., 164, 169
McKinney, J., 176, 190
McLanahan, S. S., 236, 247
Measelle, J., 223, 232, 233, 247
Meltzoff, A. N., 9, 18
Miller, D., 97, 102
252
Mitchell, J., xx, xxxvii
Mitchell, S. A., xxi, xxxvi, xxxvii,
43–44, 54, 181, 190
Moen, P., 172, 173, 190
Moore, M. K., 9, 18
Morrison, T., 219, 222
Morse, C., 176, 189
Mosher, W., 175, 190
Moulton, R., 157, 169
Muir, R., xxi, xxxvi
N Reddy, M. T., xxxiv, xxxvii
Nadelson, C., 164, 169
Naparstek, B., 164, 169
Nedelsky, J., 73, 85
Nelson, H. L., 77, 85
Newton, C., 177, 190
Nichols, M., 73, 85
Notman, M. T., 134, 149, 151–153,
155, 163–164, 166, 168–169
Nunberg, E., 22–24, 34
O Rustin, J., 40, 53
O'Brien, J. D., 116, 128
O'Connor, N., 97, 102
Ogden, T. H., 38, 54, 182, 190
Olivier, C., xx, xxxiv, xxxvii
O'Neil, J., 79, 85
Orange, D. M., 48, 54
P Sauer, M., 173, 191
Paley, B., 233, 234, 247
Pannor, R., 90, 101
Pantone, P., 117, 118, 126, 128
Parke, R. D., 230, 248
Patterson, G. J., 95, 102, 236, 248
Paul, N. L., 123, 128
Paulson, R., 173, 191
Perruchini, P., 154, 167
Phillips, S., 163–164, 167, 168,
169
Pine, F., xxi, xxxvii, 93, 94, 102
Pines, D., 134, 135, 148n2, 149,
155, 169
Piontelli, A., 154, 156, 169–170
Pola, M., 154, 167
Pontalis, J.-B., 4, 18
Author Index
Port, R., 8, 18
Pruett, K. D., 92, 93, 102, 230, 248
R
Rabinor, J. R., 209, 210
Radloff, L. S., 238, 248
Raphael-Leff, J., 134, 149, 151–154,
160, 170
Rapoport, E., 163, 164, 167, 168
Rashbaum, B., xx, xxxiv, xxxvii
Rechy, J., 88, 103
Rich, A., xviii, xix, xx, xxxiv, xxxvii,
172, 190
Romero, M., 73, 85
Rosenstrach, J., 73, 85
Rosenthal, M., 176, 191
Rotundo, E. A., xix, xx, xxxvii
Roy, R., 95, 102
Ruddick, S., xx, xxvi, xxxvii, 74, 85,
219, 222
Rust, J., 174, 190
Ryan, J., 97, 102
S
Sabot, L., 116, 122, 128
Sander, L., 40, 41, 54
Sandler, J., 116, 128
Satir, V., 227, 248
Schneewind, K. A., 229, 248
Schoenberg, E., 97, 101, 102
Schore, A. N., 47, 51, 54
Schulz, M. S., 241, 248
Schwartz, A. E., 93, 96, 97, 103,
108, 113, 236
Schwartz, D., 97, 100n5, 103
Schwartz, M. C., 164, 170
Scott, R., 173–174, 191
Sedgwick, E., 100n4, 103
Seelig, B., 163, 164, 166, 168
Sen, G., 172, 191
Shapiro, A. F., 232, 248
Shaver, P. R., xxi, xxxv
Shaw, R., 163, 164, 166, 168
Shengold, L., 19, 34, 35
Author Index
Shilts, R., 88, 103
Silverstein, O., xx, xxxiv, xxxvii
Slade, A., 151–156, 159, 161, 168,
170
Slochower, J. A., 46, 54
Slowey, M., 173–174, 191
Smith, C., 95, 102
Snow, R., 172, 191
Sorter, D., 40, 53
Spezzano, C., 51, 54
Spiegel, S., 121–122, 128
Spielman, E., 159, 170
Stack, J. M., 160, 161, 170
Stein, R., 57, 68
Stern, D. N., xxi, xxiii, xxxvii, 4, 7,
11, 18, 52, 54, 106, 113, 153, 155,
156, 159, 170, 184, 191, 230, 248
Stotland, N., 176, 191
Stuart, J., 165, 270
Sullivan, A., 88, 103
Sullivan, H. S., 117, 128
T Woolf, V., 83, 85
Tambelli, R., 154, 167
Target, M., 46, 53, 57, 68
Tasker, F., 92, 103
Thelen, E., 56, 68
Thompson, C., xviii, xix, xxxvii
Titus-Maxfield, M., 164, 170
Trad, P. V., 152, 159, 170
Trevarthen, C., 9, 18
Tronto, J., 73, 85
Tyson, R. L., 116, 128
253
U
Umansky, L., 74, 85
V
Valenstein, A., 134, 149
van Gelder, T., 8, 18
Vygotsky, L. S., 6, 18
W
Waehs, C., 117, 122, 128
Wallace, K. M., 232, 247
Walther, V., 176, 190
Weiss, S. S., 164, 170
Williams, J., 72, 85
Wilson, J., 176, 189
Winnicott, D. W., xxi, xxxvii–
xxxviii, 23, 35, 38, 45, 48, 54, 67,
68, 93, 96, 100n1, 103, 156, 170
Winter, C., 175, 191
Wollstonecraft, M., xix, xxxviii
Woodward, K., 79, 85
Wright, F., xix, xxxviii
Wrigley, J., 73, 85
Y
Yingling, S., 176, 190
Young-Eisendrath, P., xxii, xxxviii
Z
Zampino, F., 154, 167
Zuttermeister, P., 177, 189
Subject Index

A "Becoming a Family Project," 237

abortions, 143 couples groups interventions,
accommodation, 37, 38, 40–45, 50, 238–240
51, 54 effects of, 241–244
vs. submission, 44. See also design, 225–226
surrender implications for therapists,
adaptive oscillators, 8 244–246
affective resonance, 39–40 biological clock, 138–140. See also
agency, sense of, 184–187. See also mothering, reproduction
eating disorders and nonreproduetion of;
aggression, 82. See also hating timelessness
mothers; hatred of mothers bodies, comparative
aging, 138–140. See also infertility; of mother and daughter, 30–34
mothering, reproduction breast-feeding. See nursing
and nonreproduetion of;
timclessness C
AIDS, 87–88 caregiving skills, xviii
altruism, 12–13 cases
ambivalence about motherhood, 14, Colleen, 63–67
131–133, 137–138. See also J, 142–146
mothering Lori, 194–202, 209
anorexia, 210. See also cases, Lori, Michael and Ruth, 178–182
Nancy; eating disorders Mrs. A, 161–162
attachment styles and attachment Mrs. C, 165
theory, 15–16, 235 Mrs. P, 121–122, 125
attunement, 41–42 Ms. A, 25–27, 32–33
paternal vs. maternal, 57 Ms. B, 28–33
authenticity vs. empathy, 47. See Ms. C, 29–33
also therapist, subjectivity of Nancy, 194–195, 202–209
authoritative parenting style, 234, 235 Nick, 58–63, 66, 67
autism, 9 S, 142, 145, 146
Vicki, Margaret, and Josh, 105,
B 107–111
baby talk and baby face, 11–12 chaos theory, 56
"bad mother," 28, 76. See also child abuse, 19, 27
hatred of mothers child analysis, 116
256
child care, xxii, 73–74
child development research, xxi
child therapists, 115–116, 127
maternal compliance with, 124
child therapy
importance of addressing parental
concerns in, 115–116
including mothers in
history of, 116
relational approach to, 117–118
limits and effect of chance in
responding to mothers' needs,
126–127
maternal expectations and
confidence, 123–124
maternal helplessness and
empowerment, 122–123
mothers' conscious and
unconscious wishes regarding,
118–122
mothers' needs for their children
and themselves, 124–126
childlessness. See infertility;
mothering, reproduction and
nonreproduction of
"choice" to become mother or not.
See mothering, reproduction
and nonreproduction of
communication signals between
mother and infant, unique, 12
complexes, 4
containment, 46, 50–52. See also
holding
countertransference. See also cases,
Lori, Nancy; eating disorders;
infertility patients; pregnant
therapists
with pregnant patients, 161
restraint of, 46
couple relationship(s), xxxii–xxxv,
67, 232. See also family
relationship quality; father-
mother interactions
couple- vs. parenting-focused,
243–244
reorganizing, during transition to
parenthood, 57–58, 66–67,
Subject Index
90–95, 153, 157, 158, 161–
162, 221–232. See also cases,
Colleen, Nick
couples groups interventions,
238–244
couples therapy, 244–246
cross-cultural comparisons, 16–17
cultural contexts and fertility,
172–175
and psychoanalytic defenses, 136–
138. See also timelessness
cultural influences on family
structure, xviii, xix
D
daughter/victim of maternal hatred,
19–20, 23–24
daughters. See also eating disorders
abusive toward their hated
mothers, 19–20
loathing, 28–30
denial
of self, 45
of therapist's pregnancy, 165–166
of time's passing. See timelessness
dignity, 76
treating child with, 76–77
disruptive attunement, 57
donor eggs, 89, 91, 179
as attempt to regain self and sense
of agency, 184–187
donor insemination (DI), 91
donor sperm, 89–91, 105, 107, 112
as attempt to regain self and sense
of agency, 184–187
drive theory, 21
E
eating disorders and mother-child
relationship, 193–195, 209–
210
clinical vignettes, 195–209
eggs, donor. See donor eggs
elder abuse, 20
empathy, 44–48. See also
intersubjectivity
types of, 47
Subject Index
enactments. See cases, Lori;
countertransference
envy
of mothers, 141
of pregnant therapist, 165
eye contact, 6
F fertility. See also infertility;
false self, 23, 49
"familiar stranger," 7
family. See also gay and lesbian
parents
becoming a, 241–242
extended, support from, 16
family life, domains/aspects of, 227,
236
family narratives, need for new,
105–112
family relationship quality, 56–58,
90–91. See also couple
relationship(s)
and child's development and
school adaptation, 233–237
family systems developmental
model, 227–232, 240
family transitions, normative, 66–
67, 221–232. See also cases,
Colleen, Nick
create stress, 57–58, 90–95, 153,
157, 158, 161-162, 224–225.
See also family narratives
developmental tasks and
challenges, 227–232
father-mother interactions, 57,
66–67. See also "Becoming
a Family Project"; couple
relationship(s); father(s), case
illustrations
father(s), xxxiii–xxxv, 55–58
case illustrations, 58–67
feeling excluded, 109
functions, 55–56, 93
identity, 228–229
lack of support for new mothers, 16
mothers' relations with,
xxxii–xxxv. See also couple
relationship(s)
257
as the third, 38, 39
feminism
mothering and, xix–xxi, 137
psychoanalysis and, xx–xxi
feminist movement, xix–xxi. See
also women's liberation
movement
mothering; specific topics
mourning the loss of. See
mothering, reproduction and
nonreproduction of
undermining of, 140–142
when and how therapists bring up
the subject, 175–176
Freud, S.
failure to recognize uniqueness of
female psychology, xviii, xix
lack of understanding of women,
xviii
viewed women as inferior, xviii–xix
fundamentalism, Islamic, 52
G
gay and lesbian parents, 98–100
children raised by, 95
competitive feelings, 90–93, 111.
See also lesbian mothers,
"real mom" problem
deconstructing mother, 95–98
difficulty entering three-person
relationship, 94
history, 87–89
and need for new family
narratives, 105–112
parental roles, 91–93
psychosocial issues, 89–95
and same-sex marriage, 88–89
gay men and lesbians. See also
lesbian couples
grief over inability to procreate
through traditional means, 90
use of donor sperm and surrogates,
89–91, 105, 107, 112
gender
culture and, 132–133
subjective sense of, 21
258
gender roles, 72, 231–232. See
also gay and lesbian parents,
parental roles
generational patterns. See three-
generational relationships;
transgenerational patterns
gestational carriers, use of, 180. See
also gay men and lesbians,
use of donor sperm and
surrogates
grandmothers, 78–80
mothers and, 69–70
safety and sadness, 82–84
what they want, 80–81
grandparent relationship, as
triangular, 78
H essential tasks of, 180–181
hating mothers, 19–20, 23–24
a girl's loyalty to her, 25–27
hatred of mothers. See also
daughters, loathing
destructive fantasies and, 140–141
holding, clinical, 47, 159. See also
containment
holding environment, 17
holding someone in personhood,
77–78, 82
homeostatic attunement, 57
homophobia, 94–95
internalized, 110
homosexual parents. See gay and
lesbian parents
hypervigilance, 14
I lesbian mothers, 106–107. See also
idealization of loved ones, 5–6
identity. See also self-
representations
reshaping, during transition to
parenthood, 228–229
imaginary companions, 11
Industrial Revolution, xix
infant research, xxi
infanticidal fantasies, 42
infertility, 171, 188. See also
cases, J; cultural contexts
Subject Index
and fertility; fertility;
mothering, reproduction and
nonreproduction of
diagnosis of, 176
is never simply about biology
(clinical vignette), 178–182
psychological challenges of,
176–178
infertility facts and statistics,
172–174
infertility myths, 174–175
infertility patients
anticipation of future and sense of
self, 182–183
psychotherapy with, 181–186
countertransference, 175,
187–188
intergenerational patterns, 15–16
intersubjective third, 38–39, 45, 49,
50. See also third
intersubjectivity, 7–9, 11, 21. See
also therapist, subjectivity of
interventions. See also couples
groups interventions
for mothers at home, 16–17
intimacy, 7–9, 75–76
desire for, 10
Islamic fundamentalism, 52
L
lesbian couples. See also gay men
and lesbians
in which both partners wish to
birth a child, 109–110
gay and lesbian parents
gender identity, 110
identity, 106
"real mom" problem, 106–112
libido theory, 21
life stresses, coping with, 230–231
"listen to my words," 213, 221–222
love
falling in
features of, 5–13
with infant, 4–13
Subject Index
mother, 22–23
absence of, 23
lovers. See also couple
relationship(s)
mothers, babies, and, 4–13
M deconstructing, 95–98
marital relationship. See couple
relationship(s)
marital satisfaction and happiness,
232, 240
matching, 41–42
maternal life and colors and cycles
of time, 213–221
maternal preoccupation, primary,
67, 156
maternal third. See thirdness
maternal work, 71–76
mental organizations, 4, 5
mirror neurons, 7–8
mirroring, 41–42, 46
Mommy Wars, 72
mother-daughter relationships,
19–22, 33–34
comparative bodies, 30–34
Mother Knot, The (Lazarre), 213,
217–218
Mother Troubles (Hanigsberg &
Ruddick), 74
motherhood, xx, xxii–xxiii
motherhood constellation, 4, 156
components, 4–6
mothering. See also specific topics
in psychoanalytic thought, 134–135
reproduction and nonreproduction
of, 131–135, 146–148. See
also fertility; infertility
clinical examples, 142–146
the clinical picture, 140–142
cultural contexts and
psychoanalytic defenses,
136–138. See also
timelessness
and the experience of time,
138–140
"motherliness," 155
mother(s). See also specific topics
259
becoming vs. not becoming a. See
mothering
changes in women when they
become, 15
concept of, within psychoanalysis,
97
difficult choices faced by, 72
fears, 13–17
fighting, 82
full-time, xxii
independent aims and desires, 71
maternal vs. nonmaternal desires, 71
meanings and connotations of the
term, 97–98
needs for their children and
themselves, 124–126
psychic landscape, 3, 13, 14, 18
what they want, 70–78, 218–219,
221–224, 233, 245
mother's desire, as the third, 39
mourning the loss of fertility. See
mothering, reproduction and
nonreproduction of
Mr. Rogers preference, 56
mutual accommodation, 40, 51. See
also accommodation
mutual recognition, 37
mutual regulation, 40–41
mutuality of containment, 51
N
"Nanny Question," 73–74
neurobiology of intimacy, 7–8
neuropsychological development of
infant, 56–57
nursing, 44, 91, 92, 107, 108
O
object representations, 105–106, 154
oedipal theory, 23, 48–50, 111
oneness, 38–40, 42, 43, 45–46, 48–
49. See also under third
P
parent-child relationship, creating,
230
260
paternal principle, 55
patriarchal culture, xviii, xix
peace and nonviolence, 82–84
physical contact, desire for, 10–11
play, 41, 42
postpartum period, 160
potential space, 38
pregnancy, 167
conceptions of and perspectives
on, 152–153
conceptions of one's baby during,
154
experience of and psychological
meanings of, 152–154
psychological shifts and
transformations during,
151–160
pregnant patients
on medication, 162–163
psychotherapy with, 158–163
age and gender of therapist, 161,
162
imagined/future baby as
presence in consulting room,
160–161
therapists' reactions, 161
recovery of "broken doll" aspect of
self, 159–160
resentment toward unborn child,
161–162
pregnant therapists, 163–167
informing patients about
pregnancy, 166
supervision and supervisors of,
166–167
preventive interventions for
expectant parents. See
"Becoming a Family Project";
"School Children and Their
Families Project"
R another's demands, 43–45, 52
racial issues, 219–222
recognition, 37, 39, 48, 52
mutual, 37
vs. breakdown into
complementary twoness, 37
Subject Index
regressive nature of becoming a
mother, 100n1
relational theory, 21, 106. See also
under child therapy, including
mothers in; two-person theory
Reproduction of Mothering, The
(Chodorow), 133
resonance, affective, 39–40
restraint of reactivity, 46, 77–78
rhythmicity, 40–42
role strain, 157
S
safety, concern for children's, 82–84
school, children's adaptation to
family relationship quality and,
233–237, 242–244
"School Children and Their Families
Project," 243–244
study design, 226, 242–243
self-denial, 45
self-representations, 105–106.
See also identity; infertility;
pregnancy, psychological
shifts and transformations
during
anticipation of future and sense of
self, 182–183
sexes, equality between the, xxxiv
sexuality, 67
in mother-infant relationship, 23,
24
of mothers, 57
social support, 16–17
enlisting, 230–231
speech, thirdness of, 39
Stonewall riots, 88
subjectivity. See intersubjectivity;
therapist, subjectivity of
superego, 43, 49–50
surrender to reality vs. submission to
symbolic speech, 39
symmetry, 40
symmetry/synchronicity in
movements, 9–10
synchrony, 41–42
Subject Index 261

T "transference parenting," 126

therapist, subjectivity of, 47–48. See transgenerational patterns,
also authenticity vs. empathy; 15–16, 236. See also three-
countertransference; generational relationships
intersubjectivity transitional experience, 38
patients who cannot bear, 46 triadic relationships, 50, 55–58, 67.
third, xxv, 107 See also oedipal theory; third;
as false self function, 49 thirdness
moral, 44, 51, 52 difficulty entering, 94
nascent/primordial/energetic, two-person theory, 21, 23
39–41, 49 twoness, 37–42
observing function, self-scrutiny,
and, 49–50 V
in the one, 42–43, 46 Vienna Psychoanalytic Society, 22,
one in the, 40 28
thirdness, 37–52 violence and nonviolence, 82–84
defined, 37, 38
three-generational relationships, W
240. See also William Alanson White Institute,
transgenerational patterns Mothers' Group at, xvii–xviii
reworking, 229–230 women's liberation movement, xix–
time xxi, 172. See also feminism
cycles of, 213–221 "women's time," 139. See also
experience of, 138–140, 182–183 mothering, reproduction and
timelessness, sense of, 139–147, nonreproduction of; time
183
touch, desire for, 10–11 Z
transference, 159 zone of proximal development, 6
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