Abstract
The point at which analyst, mother, and baby actually meet in the consulting room has a long prehistory. They are familiars. Patient and analyst have been in the room together with a baby in mind before conception, and with the baby alive and often visibly kicking from the inside for several months before it actually arrives in the room. The paradox of a baby who is there and not there, dreamed into life (in the Bionian sense) by analyst and patient while still just a representation in their minds, poses questions that are centrally important in how we conceive of analysis. I am thinking in particular of the role of unconscious communication between analyst and analysand as they jointly prefigure the baby and the astonishing experience of becoming a mother. The analytic dyad has become an analytic triad, and by the time the baby is actually brought into the consulting room as a separate person, he or she already exists as a shared object. The baby’s arrival in the consulting room then signals a new phase in the analysis, and that is the transformation of shared maternal reverie into actual roles: mother, baby, and analyst.
As you may have picked up on by now, analysis during pregnancy and the postpartum period is, in my view, a privileged piece in an ongoing analysis; pregnancy and the introduction of the baby into the analysis as both a fantastic construction and a real object constitutes a singular experience for patient and analyst alike. Far from an awkward parameter, from this vantage point babies in the consulting room are a vital aspect of the patient’s transition into “mother,” and the analyst’s transition to a relationship with both the patient and her child, who, in addition to being a real baby, will always be an object in the analyst’s mind in relation to the mother.
This point of view, or this experience of analyzing, is a far cry from the historical practice of recommending that a pregnant analysand drop out for the duration of her pregnancy, or certainly before the last tri-mester, with the rationale that she would be “narcissistically preoccupied” and unable or unwilling to do the work of analysis. This position was based largely on an influential and widely cited study conducted by Bibring (1959; Bibring et al. 1961), “The Psychological Processes in Pregnancy and the Earliest Mother-Child Relationship.” Significantly, while the study was conducted from a developmental point of view via interviews and observation, the language and the rhetoric employed were psychoanalytic, with the investigators commenting authoritatively on the “distribution of object libido and narcissistic libido” during the course of the pregnancy and early postpartum periods. The finding that there were “marked regressive shifts” during pregnancy contributed to the official view that analysis during pregnancy was contraindicated. That what seems so patently to have been a retreat from analysis based on pseudoscientific data masquerading as fact was taken as a real directive almost defies belief as we revisit it today. The same might be said of the recommendation historically that the patient not make any major life decisions or changes during the course of analysis. The net result was that for a quarter-century pregnancy and the postpartum period were largely kept out of the consulting room. In going back to the Bibring study, it seemed to me that it was singularly important, for reasons we can only speculate about, to keep pregnancy and babies outside of analysis. It also raises the question of the analyst’s countertransference motivation in discharging a pregnant analysand. This remains an essential consideration as we now ponder babies in the consulting room as significantly more than extraanalytic social time. In truth, what could be more immediate and important in the life of a pregnant analysand than the psychic sequelae of gestation and birth, with all the attendant fantasies and anxieties? What could be more important than a baby? On the other hand, and perhaps most relevant for our consideration, is the question of how (or even if ) the analyst continues to do something called “analyzing” as the baby enters the consulting room. It raises the fundamental question of the scope of our practice as analysts.
Notably, Freud’s evocative metaphor of the “navel” of the dream, the point at which the dream is attached to the deep unconscious, is an image of pregnancy and the baby’s prenatal attachment to the mother. First the fetus and then the developing baby attaches itself physically and psychically to the mother in a way that is both conscious and profoundly unconscious in the mother’s mind. It is at once representable—descriptions, sonograms, movement, kicking—and unrepresentable. It is always at an important level miraculous. The impulse to bring a baby into the consulting room has many facets, but there is always the wish/need to show the analyst a fantasy made real—proof of a miracle. There is also the analyst’s wish to see that proof.
As I write this I realize that I have to veer off into personal disclosure here, which will partly explain the drift of my remarks so far. Every analyst is different, and working with a different unconscious instrument. None of us can generalize, or beyond that theorize, without acknowledging the deeply subjective nature of what we do and why we do it. For reasons that are still mostly beyond my awareness, I have been interested in pregnancy and fascinated by babies for as long as I can remember. I wrote my doctoral dissertation on the subject; I know my views to be overdetermined, and I am solely responsible for their content. A colleague of mine, when she heard that I would be part of a panel on babies in the consulting room, burst out, “But Jane, you would pay people to bring babies into your office!”
Case Presentation
With this caveat in mind, I will tell you about a patient I will call Ani, and her long arc in analysis through an almost unbearable period of infertility into pregnancy and the birth of a baby who, in her mind, saved her sanity, redeemed her as a person, and now, at almost three, represents life itself and her rightful place in it. It is my conviction at this point that far from constituting an “interruption” of our analytic work, this baby and the new object relationships he has engendered have made analysis possible.
This baby, I realize, also has a place in my psychic life, as do the young children of all my patients, most of whom I have been introduced to at one time or another. Significantly, every woman who has ever had a baby while in analysis with me has brought him or her into the office. The analyst’s relation with the patient’s objects was the subject of a panel at the American Psychoanalytic Association Meeting in June 2010; the June 2011 panel on which I presented an earlier version of this paper is, in my mind, a sequel.
Ani had been in analysis for about a year and a half when she got married in her late thirties and started trying to get pregnant. Time was pressing, and after several months she turned to ART, already plagued by the conviction that she could never become pregnant and have a child, and that perhaps this was for the best because she would surely be a terrible and toxic mother, as she felt her mother had been. After her first miscarriage early on, she got up off the couch, feeling unable to cope with the feelings of hopelessness, apprehension, and ultimately rage “in analysis” proper—that is, on the couch. She felt that I had tacitly misrepresented analysis as a process that might help her recognize and acknowledge what was good in her life, and had gone so far as to suggest that she had been lucky in getting pregnant immediately the first time. She now felt that she had been sold a bill of “goods,” and it was all going horribly wrong. There was nothing to analyze, she thought; this is just how it is. After another two miscarriages she was told by her fertility doctor that she “would be more likely to be struck by lightning” than to carry a baby to term. The seemingly nonchalant yet final manner in which this edict was handed down understandably enraged her, and the treatment almost broke down completely in the ensuing turbulence. There was nothing, in her view, to understand or to analyze, including her impulse to foreclose on her entire life and career in the face of not getting pregnant. (I have written elsewhere [Kite 2007] about the uncommon misery of infertility as the frustration of a pressing instinctual wish, often accompanied by near psychotic depression.) All I could add with Ani at this point was that the infertility edict was in fact just one man’s opinion, and she was tempted to allow it to ruin her life.
As she pulled out of the acute crisis, Ani embarked on a stringently healthy diet and fertility regimen advertised by a Chinese medicine physician and supported in internet fertility chat rooms as a way to detoxify the body and ultimately get pregnant. This organized and focused her, and gave her some small hope. It is of note here that I too was hopeful, though my efforts to voice this were strenuously rebuffed. There was no analyzing her iron determination to focus only on her desire to get pregnant. The comments of anyone in an allegedly “helping” profession were worse than useless; they were nonsense. Ani and I were in a kind of grim existential gridlock here where I could only bear witness to her pain.
After four months on the regimen and feeling very well physically, she became pregnant without any exogenous fertility treatment. Still doubtful that this could be for real, Ani and I proceeded gingerly through a healthy pregnancy that continued to feel literally unbelievable, and she gave birth to a healthy baby boy. She brought Ian into the office shortly after he was born—living proof, though still in important ways an unbelievable object. “Who is he? Did I produce this baby?” were very real questions, which didn’t yield readily to “proof” in the form of extensive video documentation. I was thrilled and relieved to see this baby. He was definitely for real.
Ani brought Ian frequently in the first three months. Typically he slept beside her in his infant seat, and occasionally she nursed him when he was fussy. Our conversations at this point centered around the predictable trials and joys of early motherhood. We spoke in each hour about sleeping, eating, soothing, and fussing. Each of these things raised the question of whether she was doing something the “right” way or not. Needing to do things “right” was intimately tied to Ani’s fears that she would be bad, or “lose it” as a mother, as her own overwhelmed mother had done. Things between us often felt fragile in a different way at this point, as necessarily personal views entered our work. During this phase I did feel pulled to share some of my own experience in caring for babies, without implicitly suggesting that there was a “right” way to do something. This turned out to be a terminally tricky area, however, as there was a thin line between Ani’s dim view of official “psychoanalytic” notions and potentially misguided personal advice. They could be one and the same. It became clear at this point that her toxic negative transferences to me as an analyst persisted beneath what I increasingly experienced as our shared pleasure in her baby, serving as a defense against any reliable positive feeling, any real attachment, between us.
As time went by and Ian became more mobile, his visits to the office stopped, and were replaced with i-phone videos and pictures. It seemed important to keep him with us in this way, tracking every step, delighting in his new words and abilities and talking about fears and anxieties concerning him. We also talked about Ani’s new terror that if anything happened to him she would want to kill herself, as her fears of being either unwittingly careless or somehow incompetent as a mother herself or mistakenly relying on somebody who might prove unreliable got the upper hand. In fact, it was my impression that Ani was doing just fine, and that she had communicated this to me in a way that I could receive and process, and implicitly reflect back to her. For my part, I had to realize that I was captivated by this little person, and that my interest came through in a frank way. I loved seeing the videos and watching his development, I appreciated Ani’s signature sense of humor as it emerged in relation to him, and I looked forward to hearing about him. I was charmed. During an interval when the pictures and videos were fewer, I “saw” him in a dream, standing and smiling. This dream also signaled to me, however, that perhaps it was I who was using our shared delight in Ian to shield us temporarily from Ani’s negative transferences to me and to psychoanalysis. By this point, more often than not we were having fun. I was catching a break.
Ian’s most recent visit to the office was about a year ago, at twenty-three months, at a time when Ani had begun to worry about aggression and punishment. Ian had recently rushed out of a room at home and knocked a valuable vase off a table before it could be rescued. His father had been angry, while Ani maintained that it was a huge mistake to have left a valuable breakable object in harm’s way. Mindful that Ian would be coming in, I had more or less child-proofed my office, bringing in a few toys and placing breakable objects out of reach. During the visit he was curious and active, but also quite responsive to Ani’s verbal and nonverbal cues about what it was okay to do. At one point I noticed Ian going up to a table with a small rose-filled vase on it. I realized in a split second that I had miscalculated his height, and that he could probably reach the vase but not manage to get it down safely with the roses in it. In a single moment I thought, “Can I get to him in time? Am I now the unthinking parent setting him up to break something?” In this long moment Ani crossed the room and carefully took the vase, not to put it out of reach, but to hold it for him as he smelled the flowers. He was delighted. I was impressed. In this moment I felt that both Ani and I could see her mothering naturally, even onstage at her analyst’s office. Later she asked me what I thought, and I said I thought she was doing a great job.
There were, and are, many opportunities to analyze the not-so-good job that Ani feels she is doing, in the context of a very active and headstrong little boy. The tone of this has shifted, however, to small glitches in a reliably good mothering experience. We have moved on. I think that it has been important for Ani to know that I think that she is doing well as a mother. We have found that having this shared feeling ultimately didn’t prejudice other important transferences, some of them intensely negative. The “bedrock” of this analysis is still there, accompanied but not overshadowed by the fact that she now knows herself to be a good mother with a delightful child. What I initially recognized as the protective function for both of us of our active involvement with Ian has I think gradually given way to Ani’s building up a good mothering object internally. I understand this object as a representation of both of us together as good enough mothers, and this in turn has quietly built a platform for ongoing analytic work. During this interval Ani resumed using the couch, and has begun to face some of her deepest disappointments and betrayals, past and present. There is the feeling that there is much at stake now; the baby in the consulting room has made it clear that analysis is a serious business involving more than one person.
What does it mean to introduce another actual person into an analysis? It is probably clear by now that in my view, rather than acting as a “parameter,” a bit of extraanalytic social time, analyzing a mother and baby together broadens and deepens what we call analysis. The “baby” (I am thinking of Winnicott here, and his famous dictum that there is “no such thing as a baby”) is not brought in as a separate object. The mother brings a part of her own psyche, which has already become a “third” in the room during her pregnancy; the baby is both a shared object and a new object for analyst and patient. It is also true and important that the baby as constructed in the analyst’s mind is both separate and part of a dyad. Even though patient and analyst “dream up” the baby together, unconsciously and intersubjectively, it is ultimately the real baby that is important. Analyst and patient stay in contact through the baby as he is brought into view, over and over, during pregnancy, in the consulting room, and ultimately via extended conversations and anecdotes. In this way the baby becomes the demand made on the mind for work.
Objections can be raised along the familiar lines that it’s too gratifying, too supportive—in short, that it’s not analysis with the baby in the consulting room. This is the familiar split between phenomenology and theory, experience and its role in analysis. Analysis is inherently conscious and unconscious for both patient and analyst; character plays a role. It is this analyst and this patient with this baby. We can’t generalize. I’m tempted to say here, in the same spirit as Winnicott, that there is no such thing as a “patient,” and certainly no such thing as “a patient” and “a baby” as singular entities.
Having said all of this however, there is also inevitably the work of recognizing the baby as a separate object, and the need to help the mother release the illusion of omnipotent control and omnipotent responsibility. To this end, I would like to give Ian the last word here, as he has rapidly become a thoughtful, curious, and amusing boy, much like his mother, to whom he recently offered the following interpretation. Struggling about how quickly to wean him, aware of her own reluctance at this juncture and hoping for some definitive signal one way or the other from the increasingly verbal Ian, Ani asked him whether he was still getting milk during his less frequent nursing times. “Yes,” he answered. Ani persevered with “And what does it taste like?” “Dessert!” Ian responded.
As Ani and I discussed this presentation, and Ian’s comment about nursing, she sent me a postscript: “I also read this as how he has continued to remind me of life’s sweetness, and in that sense he is like dessert to me, I suppose.”
Footnotes
Acknowledgements
The author acknowledges Ilse K. Jawetz for her countless unspoken contributions to this text over the last thirty-five years.
Training and Supervising Analyst, PINE Psychoanalytic Center.