Babies in the Consulting Room

In each of the three cases presented in this section, we can see the interplay of two forces. On one hand, there is what Daphne de Marneffe (2004) has called “maternal desire”—a wish to have and care for children, which may vary in intensity and expression from one woman to the next. For some, maternal desire has the kind of urgency we might associate with a drive, and its thwarting—for example, by infertility—may be a psychological catastrophe; Jane Kite (2007) has written beautifully about this elsewhere. On the other hand, there are feelings of uncertainty and ambivalence about mothering, and toward children. In every mother, there are fears of what Barbara Almond (2010) has called “the monster within”—an assortment of feelings that may range from ordinary resentment in a “good enough” mother to more pernicious excesses of hostility. In some women, fears of that monster may be muted; in others, they are quite pronounced. Proscriptions against the expression of maternal ambivalence also may vary in strength from one patient—and one analyst—to the next.

In analytic treatment surrounding a baby’s presence in the consulting room, we might expect to see strands of maternal desire and maternal ambivalence—arising from both patient and analyst—intertwine. The analyst, then, must work to help a patient develop her better mothering angels, while allowing the “monster within” to have its say. One possible strategy is for the analyst to take refuge in her own, best mothering self, noticing and fostering all that is good in the patient’s relationship with her child. The analyst might in fact make a deliberate effort to provide a benign, maternal holding environment, enacting the role of what Daniel Stern (1995) has identified as the “good grandmother.” This approach has both adherents and detractors. Rosemary Balsam (2000), for one, agrees with Stern’s observations about the developmental needs of mothers, but disagrees with his treatment recommendations: “The transference . . . to the analyst as a wished-for, benign presence—representing a split-off, all-good mother (which may, of course, conceal the dreaded all-malignant mother)—seems to me to be as potentially analyzable as any other transference, either at the time of the experience or later” (p. 468). Similarly, in “Treating Patients Who Are Parents,” Ruth Imber (2010) notes that the “good grandparent transference and countertransference” can be of great therapeutic use when discerned and understood, but can also “mask negative feelings and fantasies” (p. 489). Idealization, as we all know, has great developmental utility (necessity, even); but it also has great potential as a mode of defense.

It is not only the patient who may feel need of an idealized mother when she brings her baby to treatment; less obviously, the analyst may be inclined to idealize the patient-as-mother. As Lynne Zeavin reminds us, shared pleasure in the baby might be put to defensive use, allowing both patient and analyst to avoid difficulty between them, and within themselves; if we dwell too exclusively on the positive, we may miss important analytic opportunities. Zeavin’s technical approach proceeds from this concern, and perhaps also from a theoretical perspective that alerts her to her function as a container for what her patient cannot yet tolerate. ¹ And as Kite reminds us, negative transferences don’t just go away. They persist, and they call for analysis—even when the analytic dyad can rejoice together in the patient’s new baby.

Kite observes that our June 2011 panel might be understood as a sequel to a panel presented a year earlier, on the place of the patient’s objects in the analyst’s imagination. ² Participants in that panel considered whether it is possible, or even desirable, to avoid mingling our own imaginings with our patients’ internal objects. Many analysts steadfastly avoid contact with patients’ families and friends; most of us try not to be complacent in accepting either our patients’ representations or our own views of others in their lives. Instead we remind ourselves that objects in our patients’ accounts—and in our imaginings—may differ from the real people they represent. This observation may help us address an interesting question that Kite raises: Why might it ever have seemed important to keep our patients’ babies out of the consulting room? When a patient brings her baby to treatment, the analyst confronts two real people where there would otherwise be mere representations—imagined renderings of both the patient’s baby and the patient-as-mother. Might this encounter with two real objects once have seemed—and might it still seem—like an interference with the shared work of bringing imagined, internal objects to the full light of consciousness?

As both Kite and Zeavin point out, the fetus precedes the actual baby into the consulting room and is accompanied, during the pregnancy, by a retinue of imagined objects: the patient’s and analyst’s imaginings of the mother-to-be and the baby-to-be. As Kite reminds us, the gestating baby is largely an imagined object. Though we may catch glimpses of older children—in photos, and sometimes in the flesh—those too old to lie, sit, or toddle through their mothers’ sessions return to the realm of the imagined, for the analyst. But briefly—when the actual baby comes into analysis—both the patient’s and the analyst’s imaginings are rendered in flesh. The baby is a dream—a shared dream—come true. Perhaps this helps explain why two of these papers include the author’s dream of her patient’s baby—and also why those dreams, and contact with our patients’ babies, can feel transgressive.

Each of the three cases in this section highlights the importance of the analyst’s flexibility in adjusting the nature and aims of treatment around the baby’s presence in analytic hours:

It is perhaps both a strength and a limitation of this collection of cases that each features a woman analyst and a woman patient. Holding gender constant allows us to consider variations in clinical presentation and technical response without concern about the possible confounding influence of gender difference. However, our focus on female dyads does not allow us to consider what happens when male analysts treat mothers who bring their infant to analysis, or when analysts of either gender treat fathers with their infant in tow. Collectively, those of us on the June 2011 panel and in our audience have had limited experience with new fathers who bring the baby to analytic sessions. Is this in part because men do not feel they would be welcome with their baby? Might analysts of new fathers be alert to their possible desire to bring the baby along?

To carry this line of inquiry a bit further: if convinced of the possible benefit—to any new parent—of analytic hours with a baby present, what might we make of the patient, male or female, who never brings a new baby to treatment? To maintain solo attendance at all one’s analytic hours, in the early months of an infant’s life, takes considerable effort. What might motivate a new parent to keep the baby out of analysis? And what about the experience of the analyst who sees a patient through an entire pregnancy (the patient’s, or perhaps a wife’s or partner’s) yet never meets the baby? Might this situation engender feelings of exclusion and jealousy—countertransference reactions of potential use in understanding the patient?

Another shared feature of the three cases presented here also helps to deepen our exploration, yet limits its breadth, raising questions we cannot address directly. Each of these three patients expresses some experience of marked difficulty or anxiety around mothering. Perhaps such cases are especially suited to illustrate the opportunities and challenges of analytic work with the baby present. But is our sample representative in this way? That is to say, are patients likely to bring their baby to treatment only if in the throes of some heightened conflict around motherhood? Or has it become commonplace—even for patients who are quite comfortable as mothers—to bring their babies to treatment? If so, do those sanguine mothers’ sessions-with-baby seem any less central to the action of analysis than those presented in the three cases at hand? We think the highly selective focus of these three papers is of use in launching the study of a widespread but largely unexamined feature of clinical practice. Parent-infant-analyst triads different from those captured here are also of interest, and we hope other authors will follow this publication with related contributions of their own.