To Talk with Infants

Using words in psychoanalytic practice with small children

who are not yet able to speak

Johan Norman

 

This paper is a preliminary report of my experiences and thoughts concerning the possibility of developing a technique and practice for psychoanalytical work with infants. Children understand words and verbal language long before they themselves can form and articulate words. Articulating and using words is a matter of motor skills and an ability to handle symbolization, while understanding is a different question. Work with an infant have usually been a work directed towards the infant's mother. In my psychoanalytic work with infants and small children and their mothers, I have found that it is fruitful when I turn directly to the child and formulate in words what I think is going on in the moment of the session, in the child's emotional state, in his inner world, and his special circumstances connected with his mother. I also talk with the mother but I try to keep my main focus on the psychic reality of the infant.

The analyst's verbal expression is a complex phenomenon where the lexical meaning of the words is intertwined with the non-lexical meaning of the words expressed in the analyst's gestures, face, eyes and melody of the voice. The correspondence between the lexical and non-lexical meaning of the words can be achieved only by the analyst's having a genuine wish to search for the hidden truth of the infant's psychic reality and with honesty and sincerity try to find words for it. The 'song-and-dance' of body language and melody of voice is a pre-speech which the analyst is talking while using words. It is the use of words which enables the analyst to genuinely talk the pre-speech which can be understood by the infant. But very early the infant is beginning to grasp elements of the lexical meaning of the words when accompanied by the pre-speech.

With mothers who have great psychic difficulties themselves it is hard work for the infants to handle the specific qualities of the environment constituted by the mother and her psychic reality. The mother's projections on the infant distort the mother's response to the infant. Especially with mothers whose psychotic or borderline psychotic functioning is predominant one aspect of the relationship might be seen as if the infant is an infantile part of the mother's personality which has to be warded off or evacuated from the mother's psyche. I am impressed by how early the infant develops a system of self-punishment to ward off a threat.

If the early disturbances between mother and child survive up to the time when the child acquires a more sophisticated capacity to symbolize and to use language, which often will happen between one and half and two years of age, an infantile part of the child will be left behind, and my thought is that this infantile part of the self will remain unchangeable and be a weak point which may be a port of entry for personality disorder and for later abuse and addiction.

But in my experience the mad part of the relationship is only one of its parts. The interaction in the analytical setting between the child and the analyst has a basic role in the activation of the mother's sane part. It is often possible to find a sane part in the mother and a sane relationship which offers the child a realization of its basic need of experiential resonance, normal communicative projective identification, and security. The infant and preverbal child often quickly accepts the mother's offer to re-establish an object relationship but only on condition that the emotional state of the mother has the distinctly right quality.

Case I: Maria, 18 months of age.

Maria and her mother attend the Infant-Parent Unit in Stockholm. Maria is one year and a half. She is very often hurting herself, and her brother also sometimes bites her. It is my first meeting with Maria. Maria, her mother, and I together with two staff members - a psychologist and a midwife - sit on little stools around a small, low table. I have a few toys in a bag.

Maria looks at each of us. I turn directly to Maria, saying that we don't know each other yet. I tell her my name, going on to speak about my work with the children. In this way the setting is introduced, that I have my attention directed towards Maria and what she might have in her mind; I turn myself directly to Maria, I express my thoughts, using words as means for communication. When I talk Maria looks me straight in the eye, at my face and mouth.

Maria drives some cars on the table. All the cars fall over the edge down on to the floor. My thought is that Maria-parts are falling over the edge, the cars represent Maria, the Maria-parts living unsafe within the mother's world. These are my imaginary conjectures but as I don't know Maria yet I only say to Maria that the cars are falling down on to the floor.

As in all psychoanalysis I have one eye on the evident, visible, conscious, and one eye on the hidden, unconscious, split-off. With this binocular vision I try to get to know the links and the contact barrier which connects or avoids connection between the evident and the hidden.

Maria plays with a little baby doll, shows it to her mother, who comments, "Look! A baby doll--maybe a Maria- doll," and Maria agrees. She puts the doll in a crib where it just exactly fits, taking it up and laying it down again.

I say that Maria wants Maria-baby to lie comfortably and safely.

Maria takes a tiger; she shows it to her mother, who says that it is cute.

My thought is that 'cute' is a misrepresentation of the meaning of tiger in this context: Maria a child hurting herself and bitten by her brother, parts falling over the edge, a baby is searching safety in a crib; a tiger appears and in this context a tiger is rather connected with danger, being unprotected, being bitten.

I say to Maria that Mummy thinks the tiger is cute but Maria knows that the tiger is also dangerous and bites.

Maria growls with the tiger at Maria-baby.

I say that Maria-baby is afraid of the tiger, that the tiger can bite and that hurts.

Maria says "Ooh" and points at her mouth.

I say that her mouth hurts.

Her mother remarks that Maria is getting teeth.

Maria points at her mouth, "Ooh," points at me, at my mouth, says "Ooh."

I tell Maria that I have noticed that she has a black and blue mark on her cheek, and I ask her if her cheek has been hurting.

"Ooh," says Maria, pointing at my cheek.

Her mother explains that Maria's brother bit Maria's cheek, mother is a bit upset when she says it.

My thought is that mother at first is looking only with one eye when she says that Maria is getting teeth -- that is an evident fact -- and avoids seeing with the other eye that Maria is talking about herself as being attacked. Mother's emotions and guilt feelings are warding off her wish to know and her receptivity of Maria's emotions.

Maria says, "Ooh," pointing to her own cheek, her ear and the other cheek.

I say that it hurts when her brother bites Maria's cheek, her ear and the other cheek and that Maria is afraid.

Then there is a shift in the session and the following play will go on for the rest of the session.

Maria climbs up on to a stool which is standing beside her mother and she falls headlong. Her mother grabs Maria just before she hits the floor. I jump with fright, and I still have an uneasy feeling of tension. Mummy takes Maria up into her arms and Maria and Mummy are very lovingly friendly to each other; Maria rumples her hair against Mummy, looking very happy and so does Mummy.

Maria crawls down out of her mother's arms and climbs up on to the stool again. Her mother sees this but doesn't seem to take any notice. Maria falls headlong. There is a last minute rescue and her mother pulls Maria up into her arms where the same scene is played again; mother is soft and warm and Maria is aglow with happiness.

I feel disturbed by my own feelings of fear and tension as well as anger at the mother who is so ignorant and undisturbed and who is on the verge of not rescuing Maria in time. I try to talk with Maria but she is now preoccupied by this game, seeming not to notice what I am saying, but I formulate anyway what I think I know and understand in this situation. I tell Maria that perhaps Maria is telling me that Maria is afraid, that she senses a danger when she falls and then shows us that Mummy must rescue her and give her love.

After a while Maria creeps down from the stool. She comes over to me, showing an interest in my bag of toys. She looks into it, takes all the dolls and lays them on her mother's lap. Maria takes the tiger and puts it back into the bag, looks again at the tiger, takes it out and lays it on Mummy's lap.

I say that Maria is thinking that children are not only nice and happy but also have a tiger-part which is angry and want to bite and kill.

Maria looks into the bag and finds a lion. She hesitates but then the lion also lands on Mummy's lap.

Maria climbs up on to the stool again; standing on the edge of the carpet, the stool is unsteady, and she stands there teetering; I feel how tense and angry I am, afraid that she may fall and hurt herself; it is fear I am feeling and I say something to the effect that Maria is now making us afraid. Maria stretches out one foot to her mother as if to cross over but it is too far and Mummy's lap is full of things. Maria's head is a hair's breadth from the floor before her mother rescues her. This time mother is also afraid.

I say that this time Maria has managed to scare all of us; we are afraid; Mummy is frightened, too, and Maria wants Mummy to be afraid because then Mummy is such a nice Mummy and shows that she likes Maria so very much. I say that Maria has told us that Maria feels frightened and wants Mummy to help her feel safe.

At this point the session is over. Maria helps to pick up the toys and put them into the bag. I was completely exhausted after this session.

The same rescue games continued for some sessions but her mother was now more curious about what it was that caused Maria to continue so stubbornly. The Maria-baby doll which was to lie safely in the crib was now also flung out of the crib. I began to discern the literal meaning in the formulation "Maria has hurt herself," the meaning that "Maria herself hurts herself." Maria hurts herself when she feels angry at her mother and she is excited by the danger.

After some time the attacks turned against the mother. One day a long wooden cane has been left by mistake in the room and Maria now begins to play with it, swinging it around close to her mother so that she has to duck. Maria suddenly begins to rip and tear at a tapestry on the wall in wild rage, taking the cane and striking directly at her mother. Her mother picks up the furious Maria trying to comfort and divert her but she then takes Maria's rage seriously and holds her more firmly. An intensive crying goes on for half an hour with calm moments in between, where it is easier to put things into words. Toward the end of the session the tone of Maria's crying changes; it is no longer as angry and furious but more like an infant's cry -- trembling, helpless, like quiet despair. This will be repeated during many sessions. Maria had a tendency to asthma which disappeared.

Maria's mother said that she had never believed that she would ever be able to manage to stand Maria's crying in the way she now did. It had always provoked in her an unendurable desperation and rage, cutting into her, so that she has tried to distract Maria but often locked Maria or herself in another room or in the bathroom so as not to hear. The analyst's presence brought a third party into the painful vicious circle between Maria and her mother and made it visible that Maria herself had turned against those parts of herself that mother couldn't stand. She had transformed the aggression and danger into excitement, and the pleasurable part of the excitement was shared with the mother. Maria's unbearable experience might also have burdened her body in the form of a tendency to asthma. Mother became very sincere in her wish to take care of Maria and to protect her from danger and to avoid the excitement of danger and aggression. Mother sincerely wished that all the parts of Maria were to be included, the Maria-baby, too, no parts were to be left behind.

Some basic elements of the psychoanalytical encounter with the infant.

I am now for a moment changing perspective away from the narrative and interaction of the analytical situation. I will try to define some of the preconditions for the psychoanalytical encounter between me, the infant and the mother. I have of course more questions than answers: Is it really so that something is going on between me and the infant, or is it rather so that it is an interaction between me and the mother about the infant? How does the understanding and my verbal formulations to the child come to me? How is the connection between the child's inner world and my understanding and formulations? What is the child understanding of what I am saying? I have been looking around in recent literature also outside psychoanalysis and some phenomena have caught my attention; I think that they may be understood as basic elements of the interaction and communication in this analytical setting. I want to point to attention, resonance, projective identification, transference and countertransference as five interrelated basic elements of the psychoanalytical encounter.

First I want to point to attention as a basic element of the human mind. Experimental infant research has shown that the new-born child has a disposition to perceive and pay attention to reality according to categories. The infant has an inborn tendency to pay attention to a human voice, to words, to human face, and there seem to be inborn prototypes for these categories - as to colour and forms. There is also an inborn link between tactile and visual sense impressions so that we can feel with the mouth how it would look, and can see how it would feel in the mouth. The infant pays attention to distinctions in perception.

There are also distinctions connected with language which arouses the infant's attention. A four-day-old child can distinguish between syllables like ba, da, bi. A one-month-old child can distinguish the smallest phonetic contrasts in language and it is possible that the youngest infant discovers all the contrasts in all languages. New-born babies are able to distinguish between one-, two- or three- syllable words. They can make the distinction between syllables like pat and tap. If words with only consonants, which do not exist in any language, are constructed by machine, the child is not able to make a distinction between them. But if a vowel is placed at the beginning and end of words, the child succeeds because then he divides the words up into syllables. Words attract the infant's attention and they can distinguish between words and other sounds. When the child is four days old he can distinguish his mother tongue from other languages, showing a preference for his native language.

I find the research in infant linguistics very interesting and it points to the human ability to make linguistic distinctions from birth. This research has, however, not yet led to any conclusions concerning what the infants understand. In experimental research the situation always has to be kept pure, while the clinical situation is a totality where an endless number of phenomena work together so that an emotional context is created and developed. The youngest infants may grasp primarily something of the non-lexical meaning of the words, while the lexical meaning is understood later.

The child has an attention, a curiosity about the relation between his own sense data and external reality. This relation is one of the topics of epistemology and the infant's attention can be call an epistemological drive, rather than an epistemophilic. All these inborn categories can be understood as preconceptions. The infant is richly endowed with preconceptions and when presented with a materialization which approximates to a preconception the infant's attention is aroused. In a state of reverie the free floating attention will allow the analyst to become aware of a convergence in the narratives towards a shared meaning, a selected fact, and this awareness focuses the attention. Attention to distinctions in perception and meaning is the first basic element of the work: I turn directly to Maria. When I begin to talk to her she looks at me very attentively. Wide-eyed, Maria looks me straight in the eye, also looking at my mouth when I speak. When I become aware of the convergence of my thought that the cars falling over the edge are parts of Maria and of my image of Maria's unsafe life within her mother's world my evenly suspended attention halts for a moment and is focused at the coherence.

The great innate capability the child has pertains only to sense impressions, while emotions, hunger, discomfort and pain experienced by the child have no apparatus of their own for dealing with it and the infant can't understand itself. It is however evident that the infant may activate a mental state of reverie in the parents which involves extremely heightened attention and receptivity to everything that is happening in the child. A basic precondition for reverie is the involuntary, unintentional accord which acts as a channel between people. This may be called primary identification but the connotation of the concept resonance is more adequate. Resonance implies gaps in individual delimitation, a latent accessibility to another person's psyche, a form of primary contact on a very primitive level which is independent of content, words and the other's intention. It is a pre-verbal phenomenon. Resonance and also attention are unintentional but still characterized by intentionality in phenomenological sense that all mental acts imply a direction and a context of meaning.

Resonance is a phenomenon which has a very distinct character, in conformity, for example, with the inherited ability to categorize sense impressions into different colours and shapes such as triangles, circles and crosses. I imagine that resonance is a similar, pre-formed category, a shape, a inborn pre-conception. Resonance is the second basic element of the encounter: In my body I could follow my own effort to counteract Maria's teetering on the stool; in the resonance with Maria it is my own teetering that I am trying to counteract. Possibly my counter effort includes an element of also correcting Maria's wobbliness. It is obvious that Maria perceives this accord; I think I even put it into words.

Resonance will be utilised as the channel for the intentional communication we call projective identification. It is only through resonance that projective identification can have an effect on another person and this is the case in both projective identification in Melanie Klein's sense as defence through actualisation in another person the distortion in phantasy of an object and in Bion's sense as normal communicative link. If the channel for resonance is warded off, the projective identification will lose the role for communicating those experiences that one's own mind is unable to handle. These unmetabolized experiences will be evacuated out of the psyche and lead to an inability to relax the attention toward the external reality. The mother's defensive projective identifications may have built up her own phantasy about the baby as a monster inflicting psychic pain. This may have a double consequence for the baby: Mother may try to ward off the resonance with the baby to avoid pain and the infant will then lose the channel for communicative projective identification of its own mental state. In lack of reciprocity the baby's resonance may atrophy or become overgrown. The overgrown receptivity for resonance will make the infant sensitive to intrusive projective identifications and it will take in the mother's defensively distorted image of the baby. Instead of the mother's resonance, her alpha-function and reverie communicated to the child, who introjects a fragment of a thinking object, the mother's intrusive projective identification will become a building block in the infants internal world.

But it is amazing to notice that infants can't resist when a channel for resonance and normal communicative projective identification is offered and re-established. Projective identification is the third basic element of the encounter: I was afraid that Maria would fall off the stool and hurt herself, and it is obvious that I didn't want that to happen. But it was immediately apparent that alongside this fear of mine based on common sense, there was a fear which was implicit in the rescue game, i. e. the fear a person feels who jumps from a great height and who, for a moment, doesn't know if the hard floor or the rescuing hand will get there first.

When the channel of resonance is opened up and permits the flow of normal communicative projective identification those parts of the self and of the inner world which have been warded off and denied entrance will appear in the transference and counter transference which constitute the fourth and fifth basic elements of the encounter. The counter transference will in this way give the analyst 'food for the mind'.

When the analyst turns directly and talks to the infant many of the infant's preconceptions are meeting an approximation of a realization which arouses the infant's attention. The mobilized attention opens up the experiential channel of resonance which activates projective identification and the flow of transference which will be gathered into the analytical situation and in the counter transference. Together with setting the stage in play and action it provides the analyst with impressions, emotions and thoughts as a matrix for the analyst's imaginative conjectures, thinking, understanding and verbalisation. Implicit in the child's creation of the scene is that the child already has a kind of knowledge about it, quite unconsciously as an organising principle. The impressions provided by the child in coherence with the lexical and the non-lexical meaning of the analyst's words create a context of meaning; this is a totality, which again arouses the child's attention. The analyst's words with their melody in tandem with the facial expression functions as a transformation of the child's own feelings, images and thoughts that the child tries to not know about. As the mother is present the child turns to the mother with an intensified demand which often open up the resonance and reverie in the mother for all qualities of the child, whether they are good or bad.

Case II: Oscar, 5 months of age.

Oscar is five months old when we begin our work. It is very difficult to get him to sleep. Oscar must lie in his mother's arms and she rocks him to sleep. If she then moves carelessly he immediately wakes up and the rocking has to be resumed from the beginning. It takes 2-4 hours every evening before he goes to sleep. The attention Oscar directs to the world around him is very tense. It is difficult to talk to him since his only answer is to look still more attentively and to kick about and jump with his legs. Oscar is so tense that he seems to be laughing but there is sometimes a hint of torment and fear in his facial expression.

One day Oscar is more tired and tense than usual. His mother begins to rock Oscar as he lies in her arms. I ask what she thinks will happen if she doesn't rock Oscar. Well, of course, he wouldn't go to sleep, but now his mother holds him still. I go on talking about how it is to go to sleep, to let go of attention to the world around, that Oscar may be afraid when he reaches that border, a feeling in Oscar which Mummy can relieve by herself capturing that feeling. Suddenly his mother says, "Oh, no, I don't want to." His mother now realises that she is avoiding the issue and that she does not want to hear anything about Oscar's state of mind and she has developed the system of rocking to compensate. But she also realises that it may really not be so dangerous to accept Oscar's feelings. Oscar now goes to sleep peacefully in his mother's arms. We sit talking for awhile.

His mother is going to go upstairs to put Oscar in his crib convinced that he will wake up. It is then I use an image which I formulate for the mother: Oscar does not demand much but what he demands is something which has a very exact quality--like when you tune in a radio to listen to a certain program. If you want to listen to it you can do so only if you tune in the wavelength rather exactly. Otherwise you will hear only static or another program. We went up the stairs accompanied by lots of noise and hubbub. Oscar looked up but went on sleeping, now sucking faster on the pacifier. After this the fear of going to sleep was gone for several weeks.

The resonance is as plain and natural for the child as a triangle, a circle, the colours blue, red, etc. My experience is that infants can not be cheated, but on the other hand it is possible to confuse them. Oscar's mother could say, "I'm with you all the time" and this was true as a concrete, physical reality which Oscar saw. But it was not true as a psychic reality. The mother's sudden outburst...'Oh, no. I don't want to'...was a clear expression of her blocking of a channel for experiential resonance, since this infant's tone in herself frightened her. Oscar then had no resonance-channel for his normal communicative projective identification, since his mother did not want to know about Oscar's primitive fears. When Oscar's mother faced up to Oscar's psychic reality, Oscar could relinquish his tense attention and go to sleep. The effect was immediate as if Oscar had been waiting for this moment.

Oscar slept and when there was noise he sucked more intensively on his pacifier. Instead of directing attention outward and waking up, the disturbance floated into his dream work.

A final comment: The child does not demand very much of the mother, but what the child does demand is something which has a very exact quality.

Abstract

This paper is a preliminary report of my experiences and thoughts concerning the possibility of developing a technique and practice for psychoanalytical work with infants. Children understand words and verbal meaning long before they themselves can form and articulate words. The lexical meaning of the words are intertwined with the non-lexical meaning of the words expressed in the 'song-and-dance' of body language and melody of the voice. The analyst is keeping the main focus on the psychic reality of the child and turn directly to the child. The analyst's words with their melody in tandem with the facial expression functions as a transformation of the child's own feelings, images and thoughts that the child tries to not know about. The attention of the child is mobilised and opens up the experiential channel of resonance which activates projective identification, transference and counter transference. The intensified demands in the infant can open up the resonance and reverie in the mother for all qualities of the child, whether they are good or bad.

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Johan Norman
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