My Youngest Co-Analyst: the Baby in The Consulting Room

My Experience with Babies in The Consulting Room

Over the years I have discovered it is the rare patient who is a new parent (male or female, analytic or psychotherapeutic) who doesn’t bring in the baby at least once or twice for me to meet. During my early years as a candidate and as a young analyst I responded awkwardly to the introduction of such an important guest. I would feel as if I were transgressing an inviolate analytic rule. Though I would always enjoy meeting the baby, it felt like a guilty pleasure. Today, after two decades of having the privilege of meeting these young visitors, my ideas about babies in the consulting room have changed. I would like to present a brief vignette that permanently altered my understanding of the possibilities for my patient, for the baby, and for analysis when babies enter our consulting room ¹ .

Case Presentation: Debbie

Debbie, thirty-five, had been in analysis with me five days a week for twelve years, difficult years subjectively speaking, yet very beneficial ones as well. According to Debbie, analysis was her last chance to have a normal life. And I tended to concur.

I remember Debbie’s first appointment. She arrived in a near panic, her world falling apart. She told me she had just learned that her mother had had a first child, whom she had given up for adoption, a fact no one in the family, including her father, knew anything about. Her mother was delighted to have reconnected with her oldest child and wanted everyone to meet her and to include her as part of the family. Debbie refused. Her mother accused Debbie of attempting to ruin their reunion. Frightened and confused, Debbie ran away for several days.

In our opening sessions Debbie described an enmeshed relationship with her “cold evil Hollywood mother who could have walked out of a soap opera.” In fact, she stated, “My mother is more evil, because she is real and not a character from a soap opera.” She continued: “I am used to getting bits from my mother, but now it’s barely molecules.” According to Debbie, there had never been any space for her. It was all and always about mother. Debbie’s needs constantly came last, she explained. And yet, as so often occurs with such intense deprivation and disappointment, there was no one in Debbie’s life who mattered to her except for this cold, depriving mother. Debbie described a life in which she had never been touched or held, figuratively or literally, by another person. No substitute, no teacher, no friend, no person, could ever make up for the love denied her. If it was not her mother, it could be no one. And it was no one. Debbie chose to live in her parents’ home for fear that were she to leave, no one would notice her absence. Her distress at not being noticed was reinforced, she claimed, during her adolescence, when she lost over a third of her body weight and neither her parents nor her teachers cared enough to intervene.

Debbie’s life was one of abject isolation, except for me. It was no wonder she had frogs for pets and worked at a job where she related solely to numbers. Notwithstanding her isolation, her wish for connection was always present, but at a tremendous cost. Early in the analysis, Debbie reported the following dream. “I was flying to meet a man. I was excited about the prospect of a new type of life. Halfway through the flight, the airplane struck turbulence and began to shake violently. I feared the plane would break apart into a million pieces, not able to endure the stress. Suddenly the plane landed safely, but I was too shaken and worn out to reach out to the man who was there waiting for me. I walked away trembling, never to connect to him.” The transference implication of the dream was poignant.

Debbie’s analysis with me went through many stages. First I was the sanctuary Debbie had been searching for, but as time passed I became, as she would lament, the cold, uncaring evil mother. Most of Debbie’s meaningful life since the time she was a child took place in her elaborate fantasy world. And she wanted no one, including me, to interrupt it.

After a decade of intense analytic work often characterized by her fury and rage at me for not being available in the way she wanted, Debbie came to a personal insight after an enactment in which she stole my rug from my waiting room. “I’m addicted to hating you,” she told me, “like I was addicted to cigarettes. If I am going to get better, I have to give up my hatred of you.” And miraculously, with this insight Debbie began to get better. Our alliance shifted. For the first time Debbie began to trust me. And with this trust, she dared to change. First Debbie changed careers. She chose a field that allowed her to connect with children, helping her heal the frightened, fragmented little girl inside. Each step forward was met with terror. But instead of retreating into angry fantasy the way she always had in the past, Debbie let me help her master her fears. Sometimes I helped her with interpretations; at other times by talking to her the way a mother might talk to an anxious daughter who was trying to step out into the world.

I will now condense many years of hard-won analytic work into one sentence. Debbie found the courage to date, met a man, and married. Life was developing the way she always dreamt it would. After two painful miscarriages, Debbie delivered a healthy baby girl.

A week after the birth, however, Debbie fell into a deep postpartum depression. Over the phone she asked if she could bring her husband to session with her. It was an unusual request from a patient who coveted the special analytic bond we shared. I heard the desperation in her voice. I knew she was reaching out for my help. I made a quick judgment call that I needed to respond in action to what could be an escalating crisis. During her pregnancy Debbie had protected herself by a retreat into denial. In her fantasy, she would need no help. I would make interpretations around her dependency conflicts mostly to make myself feel like I was doing something. I knew we might have to wait until the baby was born for reality to set in. And now that it had, Debbie was in a panic.

The next day the two arrived at my office. Her husband was a very kind man, though naturally a bit overwhelmed by his wife’s decline. He had never known her to be so regressed. He was trying to be practical, wanting Debbie to breast-feed, but she was refusing. He wasn’t listening to her. She cried out in exasperation, “I don’t want to kill my baby, but I want to give him away. I just want to give him away.” Naturally, those words “I don’t want to kill my baby,” were powerful and frightening to hear. I wasn’t entirely certain whether Debbie was psychotic, though I doubted it. I wondered about her conflicts around aggression toward her child, toward her husband. I speculated to myself whether this was an unconscious identification with her mother, who had given her firstborn up for adoption. Though the questions were many, what I knew for sure was that Debbie’s pain was intense and disorganizing. She and I agreed she needed to see her psychopharmacologist, but her husband thought an antidepressant would interfere with her ability to safely breast-feed the baby. I concurred, but explained to him that the baby needed more than breast milk. His child deserved a mother who was emotionally available. We could ensure that the baby had a nutritious formula, but we had to work to help Debbie regain her equilibrium and be available to their child.

In despair, Debbie turned to me sobbing: “Tell my husband, this is how I used to be. He didn’t know me when I was like this. Tell him this is who I was.” I replied, “It wouldn’t be true.” I continued: “You used to be alone in the world, without love. You now have a husband who cares about you and a beautiful baby. You are suffering from postpartum depression. We will help you deal with it.” What I didn’t add was that it was notable that Debbie’s fear did not turn into rage, as it always had in the past. This time she was saddened, distraught by her fear that she wouldn’t be able to provide for her infant. We all agreed she would see her psychopharmacologist and then return immediately to treatment with me.

The next day Debbie brought in her infant. Because of everything we had been through, she trusted me. The session was gut-wrenching, yet relieving. Debbie did not want to kill her baby. She was frightened for the baby, not because of her aggression, but because of her own sense of inadequacy to know what to do to help her infant survive. I felt for my patient, who seemed so unprepared to be a mother. I was also heartbroken for this innocent neonate, fearing her future if her mother could not learn to connect with her.

On the spot I reconceptualized our relationship. The boundaries of our work changed (Zalusky 2008). No longer were we two. There were now the three of us in the room. I felt in part responsible for the situation, believing that without the analysis Debbie would never had become a mother. I remembered Freud (1915), writing in “Observations on Transference-Love,” “It would be just as though, after summoning up a spirit from the underworld by cunning spells, one were to send him down again without having asked him a single question” (p. 164). Having been influenced by the attachment literature and the importance of psychic resonance between mother and infant (Beebe 2005), I chose to work with mother and child. I felt that without intervention my patient would be at risk of repeating with her infant the damage caused by her own mother’s unresolved mourning. Maternal unresolved mourning often is linked to disorganized attachment and childhood psychopathology (Lyons-Ruth 1998).

Using what I knew about Debbie from her many years of analysis, about her difficult childhood and infant development, I helped her connect to her daughter. I reminded her through interpretations that her baby was not the mother who did not notice her. Then I would point out concretely the ways I saw the baby trying to make contact with her. I helped Debbie find her child’s eyes, searching for her, locking her gaze onto Debbie’s. I helped her know she was not invisible to her infant, the way she used to feel with the rest of the world. She was the most important person in this little person’s life. She had difficulty grasping her own importance to anyone. But slowly she began to know that her baby needed her.

Debbie would keep repeating how tiny her infant was. She would tell me she couldn’t wait until the baby was bigger, until she could sit. Her daughter seemed so fragile to her. Debbie was frightened she couldn’t take care of this little bitty person.

I also let her know that though I understood how inadequate, and possibly destructive, she felt, she actually was doing many things right. Her baby was thriving physically. She also seemed to be quite content. Hearing me say that gave Debbie such pleasure because she knew it was true. Her daughter was big. She loved to eat and to smile. In a “Mommy and Me” class Debbie attended, there was a little infant who was not growing.

We both knew she was blessed with a child who was adorable, good-natured, forgiving with a sweet disposition. Our work reinforced the belief that Debbie could be a different kind of mother to her child than her mother had been to her. At times when the baby was inconsolable and would cry during the session, Debbie would worry that she and the baby were bothering me. Then she would panic that the baby’s screeching cry would disrupt my associate and his patient in the next office. I knew Debbie felt her messy feelings were a burden that no one in her family or elsewhere could bear. I would say, “We know babies cry to communicate their distress and sometimes they get overwhelmed.” Then I would add, “I wonder what’s bothering her?” Debbie and I would engage together in trying to understand what was causing her baby’s distress and then tried to help the infant feel better.

As time went on, Debbie grew more confident as a caregiver. She still brought the baby to session, but the child would sleep, eat, or look around the room. When she would cry, Debbie, seamlessly, would take out the formula, prepare it, and feed her. One day while Debbie was reporting a dream, the baby started to fuss. Debbie stopped and attended to her child’s needs. Then, with the same effortlessness, Debbie returned to her dream. Today baby and mother are quite attuned to each other. It is obvious they adore one another. When the child was eighteen months, Debbie stopped bringing her to session. As she explained, an infant exploring the world was too distracting. Debbie felt confident enough about her mothering and was able to return to her analysis. She then had a second child, who came to her sessions, but rarely. It was remarkable how empathic she would be when her son was in distress. No longer would she worry he was bothering my office mate or me. She would attend to her son. Six months ago Debbie terminated her fifteen-year analysis. In one of our last sessions, Debbie laughingly referred to her daughter as my youngest patient. I told her I would prefer to think of her as my youngest co-analyst. Debbie is no longer the same woman. She seems happy and confident. We all changed. Our boundaries shifted and so did our work. The fluidity of our work helped her become less rigid, less worried about obeying rules. Like every good patient, she helped me with the same.