when daughter become mother.pdf

8/11/2019 when daughter become mother.pdf

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When Daughter Becomes Mother:Inferences from Multiple DyadicParentChild Groups

L E O N H O F F M A N , M . D .

In this paper, I describe how new mothers can be preoccupied with their

mothers and can replay their relationship with them transferentially

with professionals and nannies, who become surrogates for their moth-

ers. New mothers need affirmation from their mothers and from mother

surrogates because, in their new role, they experience a sense of help-lessness and anxiety and have difficulty tolerating aggression, ambiva-

lence, and conflict. Sterns motherhood constellation and good

grandmother transference are useful constructs for understanding how

to best approach and help new mothers and their babies. From observa-

tions in multiple dyadic parentchild groups at the Pacella Parent Child

Center, I have distilled two factors that help new mothers address their

anxietiesthe bonds these mothers make with one another and their

transferential bond with the group leader and other professionals at the

center. I critically discuss and compare theoretical inferences derivedfrom individual psychoanalytic or psychotherapeutic work (as exem-

plified by Balsams work) with the inferences derived from Sterns

dyadic model and with inferences derived from psychoanalytically in-

formed group situations. I consider the implications of the ubiquity of

ambivalence conflicts, especially around aggression.

Leon Hoffman, M.D. is Director, Pacella Parent Child Center; Training and Su-

pervising Analyst, New York Psy choanalytic Society and Institute; Assistant Lec-

turer, Mt. Sinai School of Medicine.

Many ideas in this paper germinated in staff discussions at the Pacella Parent


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The child wants everything the omnipotent and all-possessing

mother has in order to do everything the mother does; and amother is above all the possessor of a baby.

Brunswick (1940)

The Mothers Mother

JANE, A SUCCESSFUL PROFESSIONAL WOMAN IN HER MID-30S, CAME TO

see us shortly before her first baby was due. She described her state

throughout her pregnancy and contrasted it with her state before the

pregnancy. During her successful career and marriage, she always

maintained a safe psychological distance between herself and her

mother, carefully weighing how much to confide in her mother, to

manifestly avoid feeling ruled by her mothers judgment. Although

she made what she considered to be independent decisions, her

mothers voice, as with so many women, stayed within her, at times

conscious and at other times unconscious, as the voice of her con-

science by which she evaluated her actions. With her pregnancy,however, this conscious state of quasi-independence seemingly

evaporated and caused her a great deal of distress. In her profession

and even in her marriage, she could allow herself to feel independent

of her mother. Now, on the brink of motherhood, there was no ques-

tion for Jane that she was entering her mothers realm. She worried

what kind of mother she would besimilar to or different from her

mother. Each new stage of pregnancy was accompanied by anxiety

about whether her mother would approve of her actions.Janes preoccupation with her own mother during her pregnancy is

typical of many new mothers. Pregnancy and, later, the new baby re-

awaken or intensify in the new mother her feelings about her own

mother. The new mother may feel conflicted and ambivalent toward

her own mother or may feel that she needs her own mother to help her

with the baby as well as provide for her own needs. The new mother

may aspire to be a better mother than her own mother or may fear that

she could never be as good a mother as her mother was or is. These

general observations have been discussed by many authors (e.g.,

Stern 1995; Cramer 1997; Balsam 1996 2000) Preoccupations

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result of newer fertility technologies, the number of older first-time

mothers has increased.It is beyond the scope of this paper to review and integrate the

enormous literature regarding mothers and daughters. Certainly, all

authors agree that the tie between mother and daughter is central

throughout all phases of a little girls development (Tyson, 1991).

The little girl and mother, unlike mother and son, have the same

body (Bernstein, 1983), and mothers treat daughters differently from

sons starting at the earliest moments of life (Elise, 1991). The idea of

daughters longing for her mother is central in many contributions

(Dahl, 1989; Elise, 1998, 2000). One result of this motherdaughter

connection is that superego development is affected by the little girls

wish to please and retain the love of the idealized same-sex love ob-

ject (Tyson, 1994, p. 457). In sum, as Dahl (1995) wrote, the hall-

mark of adult female psychic organization lies in the daughters

capacity to permit continuing reverberations within herself of the

representations of the tie to the mother in her ongoing intrapsychic

dialogue with her mother (p. 202).

The Motherhood Constellation

Although many authors have highlighted the various themes and con-

flicts that occur with motherhood, I must underscore the importance

of Daniel Sterns (1995) seminal contribution of the concept of the

motherhood constellation (see especially pp. 171190).1 Sterns

contribution is novel in that it emphasizes the appearance of a newpsychic organization in the new mother. Stern acknowledged that

sociocultural forces are important in the emergence of this organiza-

tion and stated that the motherhood constellation does not occur in all

women; it may be a permanent, transitory, or a permanently evocable

state in the woman (p. 174).

WHEN DAUGHTER BECOMES MOTHER 631

1

Sterns ideas derived from dyadic observations are comparable with but, be-cause of their dyadic (in fact, triadic) frame of reference, different from the older

id f Wi i (1956 1963 343) h i d h l


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By conceptualizing a normalization of the new mothers state

(i.e., as a new psychic organization), Stern (1995) made an im-portant contribution to psychoanalytic theory. By creating a vo-

cabulary for a normal state, he eliminated the need for concepts

such as developmental crisis (Bibring et al., 1961a) and the

inevitable regression occasioned by pregnancy and motherhood

(Pines, 1982, p. 311). Blos (1985, 1999) and Parens (1999) simi-

larly described the importance of normalizing the theoretical un-

derstanding of the experience of new motherhood. Parens (1999)

wrote, Rather, might there not be in the woman a normal psycho-

biological developmental process that comes with having a baby,

an adaptive process perhaps that influences the experience of preg-

nancy and of becoming a mother? (p. 26).

Stern (1995) noted that the motherhood constellation concerns

three different but related preoccupations and discourses, which are

carried out internally and externally: the mothers discourse with

her own mother, especially with her own mother-as-mother-to-her-

as-a-child; her discourse with herself, especially with herself-as-

mother; and her discourse with her baby (p. 172).Stern (1995) maintained that the new mother is less concerned

with her father (and oedipal themes), with her husband (as husband

and sexual partner), and with her work and is more concerned with

her mother, with women, with her baby, and with growth and devel-

opment. Stern emphasized the emergence of a new psychic triad

(mothers mothermotherbaby) and maintained that when a woman

becomes a mother . . . several related themes emerge (p. 173): life

growth (concern for the growth and development of her baby), pri-mary relatedness(emotional engagement with her baby),supporting

matrix (ensuring that support systems develop for her baby), and

identity reorganization(transformation of her self-identity to permit

and facilitate these functions).

Stern (1995) called these four themes and their related tasks the

motherhood constellation. In light of the motherhood constella-

tion, Stern described a variety of clinical implications, specifi-

cally the nature of the therapeutic alliance and the transference and

countertransference configurations that occur in work with moth-

ers and their babies (pp 185190) He emphasized how a mother

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a maternal figure (p. 186). These desires can be intensified and fo-

cused on a therapist. Stern called this bond the good grandmothertransference. 2

A Multiple Dyadic Model: Helping and

Understanding Mothers in ParentChild Groups at

the Pacella Parent Child Center3

Mothers come to our parentchild groups to learn more about parent-

ing, to understand developmental events, and to learn how to under-

stand their children and interact more effectively with them. They

come to us with worries about themselves, their children, and their

parenting skills, but they do not identify themselves as patients. Of

note, a significant number of the mothers we have encountered are in

their own psychotherapy or psychoanalysis, which, appropriately, in

our opinion, is usually kept private and distinct from work with us.

The great majority of mothers who come to our groups, in essence,

say, as Balsams (2000) psychoanalytic patient did, I want to keepthis apart from analysis (I discuss Balsams patient later). Whether

in their own individual treatment or not, mothers do not come to our

groups for therapy.


2This term is interesting in that it is similar to the evolutionary biology concept of

grandmother hypothesis, first proposed by Williams (1957). In foraging societies,young women taking care of babies need an older woman, not just their own moth-

ers, to take care of the older children while the men are off hunting or engaged in

other activities. According to this theory, menopause (cessation of childbirth with

continued functioning) may be one factor that allowed hominids to expand their

range of mobility as well as their intelligence. In other words, a young womens

need for an older woman to help her care for her children seems to be an ancient phe-

nomenon. (See Angiers, 1999,Woman: An Intimate Geography.)3I must acknowledge the contributions of Sackler Lefcourt (1997, 2003a, b), the

psychoanalytically oriented clinician who has had the most extensive experience

working clinically with dyads of parents and zero- to three-year-olds over the pasttwo decades (in contrast with analysts and developmentalists, who focus on re-

h d t ) Oth h l ti ll i t d t hild k i l d


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Sterns (1995) model provides an invaluable framework for the

general understanding of our experience working with mothers andtheir babies, even though his theoretical construction was derived

mainly from dyadic work with mothers and babies. He did not focus on

the interactions and mutually reinforcing interactions that occur in

groups of mothers with their babies, though he did discuss a new

mothers need for a supportive matrix (pp. 177180). In our setting,

we try to integrate the supportive interactional and transferential fac-

tors with Sterns central theoretical construction of the psychic triad of

mothers mothermotherbaby. In essence, a central aim of our parent

child groups is to help each new mother make the transition from feel-

ing only like a daughter, who is helpless in meeting the needs of her

child, to feeling like a competent mother herself.

By coming to the center week after week, many new mothers, par-

ticularly those who feel lonely and isolated, develop a sense of family

and community that allows them to share their concerns and worries

with one another and with the group leader. The mothers express con-

cern about their mothering capacities and may not feel entitled to enter

the mothering role. They may feel anxious and helpless about their ca-pacities to mother their children and may believe that their own moth-

ers or nannies or professionals would do a much better job with the

baby. In the groups, we observe complex and multifaceted transferen-

tial interactions. Many new mothers often express and reexperience

the importance of their relationships with their own mothers or with

mothers they had wished for. For example, new mothers assume that

someone else (a professional, a book author, their own mother, a

nanny) knows her baby and its needs better than they do and knowshow to be a mother better. Thus, they may ask many how-to questions:

How do I _______?

The Bonding of New Mothers with One Another4 and

Their Relationship with the Group Leader5

Two powerfully mutative group factors help each new mother make

the transition from seeing herself only as daughter (and thus helpless

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vis--vis her own child) to seeing herself as the mother (and thus com-

petent): the bonds the mothers form with one another in the group andthe transferential bond with the group leader. Implicitly and often ex-

plicitly, one can infer the important operation of the mothers mother

behind these two factors.

In the parentchild groups, mothers often become friends and sup-

port one another. They may meet outside the group regularly. They

compare what is discussed in the groups with what they read in

parenting and development books, what their friends say, what their

pediatricians tell them, and, most important, what their own mothers

tell them. Many comment that group discussions about individual sit-

uations are far superior to the seemingly cookbook approaches to

development found in many how-to books and lectures.

The glue that binds the mothers to one another is their relation-

ship with the program coordinator, who speaks with each mother

who comes into the center, and the group leader, the central ongoing

helpful resource. The group leader needs to balance his or her focus

on answering specific questions about development with the need to

foster discussion that allows parents to find the approach best suitedto themselves and their children. Although group leaders work

uniquely, there are several universal themes.


mothers and between mothers and babies. Exploration of these ideas is beyond the

scope of this paper. As scientific knowledge expands, of course, such findings must

be taken into consideration in the evolution and further development of psychoana-

lytic (mind) theories. I am grateful to Maurice Preter, M.D. for calling my attention,

during the March 29, 2001 Journal of the American Psychoanalytic Association

netcast, to the work of McClintock and colleagues. They demonstrated the presence

of a chemical signal for the synchronization of ovulation (carried by pheromones) in

rats (McClintock and Adler, 1978) and later in humans (K. Stern and McClintock,

1998). Pheromones are airborne chemical signals that are released by an individual

into the environment and which affect the physiology or behaviour of other members

of the same species (K. Stern and McClintock, 1998, p. 177). These investigators have

continued to study and discuss, in a very sophisticated way, the effects and potential

theoretical ramifications of a variety of social chemosignals (McClintock et al., 2001).5

Although the great majority of our group leaders have been women, the findingsdescribed in this paper apply equally to the groups led by three male group leaders.

Do men doing this work need to possess feminine or maternal qualities? This is


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As new mothers can easily feel criticized, especially by their own

mothers or by mother surrogates (e.g., professionals, nannies), a ma-jor aim at the center has been to normalize the inevitable conflicts

mothers express about their mothering. Common concerns include

Should I breast-feed all the time, or can I offer a replacement bottle?

How often should I feed my baby? My mother tells me to _______

(cf. Friedman, 1996).

Over and over, the group leaders communicate to the mothers that,

even though they may feel bombarded with information and advice

from a variety of sourcesparticularly their own mothers but also

their pediatricians and the many experts who are in essence mother

surrogatesthey, as the mothers fortheirbabies, are the only ones in

a position to make the best decision for themselves, their children,

and their families. In other words, group leaders and the other staff try

to empower the mothers in their mothering role (so that the mothers

can synthesize information and use it effectively) rather than promote

the mothers dependence on the group leaders and staff as their new

omniscient maternal substitutes who are the only ones who know the

right and wrong ways for them to mother their children.

Self-Critical Representations and the

Positive Transference

Our many observations of the importance of the positive transfer-

ence to the center as a whole as well as to the group leader corrobo-

rate Sterns conception of the good grandmother transference.

Certainly, a mothers implicit and explicit transferential reactionsto the group leader are reminiscent of her relationship with her own

mother or with a wished-for version of a mother. As illustrated in the

following example, new mothers require the group leader to repre-

sent a benign superego imago to counteract their own self-critical

representations.

In one parentchild group, the mothers discussed how many of

their husbands did not appreciate the mental energy (as well as the

physical burdens) involved in taking care of their toddlers. They felt

easily criticized by the husbands. Some women complained about

their own mothers and the topic of their own mothers generated

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For example, some of these grandmothers felt that the toddlers

mother was too lenient, and others felt that the childs mother was toorigidly strict. In the group, on the other hand, the mothers felt vali-

dated about their positions as mothers to their children and felt com-

fortable discussing the difficulties they faced in child rearing. In so

many words, the group and the group leader helped the mothers to

feel that their job as mothers to their children was the most important

job in world and that they could be competent and not always com-

pare themselves unfavorably in relation to their own mothers.

With their own mothers and with their husbands, they felt they

should do it this way or that wayfeelings in dramatic con-

trast with those experienced in the group as they spoke with one an-

other and with the group leader.

The approach at the center fosters positive transferences and cer-

tainly is in agreement with Sterns (1995) idea that a commonality

of most parentinfant psychotherapies is the way they use a positive

therapeutic alliance and positive transference (p. 159). However,

we have also learned that it is important that therapists and group

leaders remain aware of the subtle emergence of potential irremedi-able disruptions to the positive therapeutic regard (p. 159) that is

important for new mothers. Thus, a key technical aspect in working

with parentchild groups involves dealing with the complicated

transferences that inevitably occur when conflicted issues begin ris-

ing to the surface (Sherkow, 2002).

The Group Leader with Multiple Dyads:Not a Therapist, Not an Omniscient Critical Mother,

but More Than a Good Grandmother

An important thrust of our work follows a path similar to that of

Sackler Lefcourt (1997, 2003a, b), who described the central ele-

ments in her work with parents and babies: developmental help,

support, education, and interpretation. Sackler Lefcourt actively

addressed unconscious conflict, unresolved trauma, and mental rep-

resentations derived from the parents own past as they emerge in

the current parentchild relationship This model was first expli-



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individualized parentinfant dyadic psychotherapy and the work in a

group with many dyads. Much as in our approach, Sackler Lefcourts(2003b) goal in parentchild work is affirming the importance of

mothering, acknowledging its inherent stresses, and recognizing the

processes by which a woman shifts from a primary position of, I am

my mothers daughter, to I am the mother of my child.

We always have to remind ourselves that the work in the parent

child groups is not just dyadic work. The different motherchild dyads

help and learn from one another. It is important for the leader to bear in

mind that his or her interventions toward one mother are in actuality

addressed (either directly or indirectly) to the other mothers. Com-

ments made by a group leader to one parent may be mentioned later by

another parent. As a result, the mothers have an impact on one another,

and an intervention directed toward one always has an impact on at

least one other mother. These multiple effects of the leaders interven-

tions (intended or unintended) contribute to the power of the work but

also may provoke unintended negative consequences.

Self-Criticism and Criticism from Mothers Mother

We have observed how important it is to help mothers to feel in

charge. For example, when mothers cannot control their toddlers,

they feel incompetent as mothers, particularly in comparison with

their own mothers. The children may feel increasingly anxious be-

cause they do not have the assurance that their mother can protect

them from their own aggression, and a maladaptive cycle may bequickly established. The mothers feel increasingly guilt-ridden and

experience themselves as creating the difficulties in their children.

The following vignette illustrates an approach in which we try to help

the mothers to understand their children while attenuating their

self-punitive behavior, derived from both internalized and actual im-

ages of their own mothers.

In one group, Nancy, a very successful professional, was consid-

ered by the other group members as the ideal mother, someone who

took time from her busy work life both to attend the parentchild

groups and to tend to her toddler in many ways Nancy expressed a

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her child could feel so unsatisfied. At one point during a group ses-

sion, the child became very demanding about a bigger toy, and theleader asked Nancy casually, What do you think about that? Think-

ing about that question helped Nancy to understand that there was

meaning to her childs behavior.

Another mother, Jane, discussed how in the past she had a difficult

time understanding the connection between her daughters lack of

language and her screaming whenever she felt frustrated. Jane felt

mortified that she had not made that connection before.

A third mother, Betty, was depressed because of her fathers re-

cent death. She worried about the impact of her depressed feelings

on her child.

A fourth mother, Mary, who was divorced, was concerned because

her not yet three-year-old occasionally stayed overnight with the fa-

ther, despite the childs protestations. Mary castigated herself for not

insisting that the overnight visits to the fathers house be curtailed.

A discussion ensued about the impact on children of the stresses

the mothers felt and how difficult it was for all of them to see their

children in distress. Some wondered how their own mothers, in con-trast, could have successfully dealt with all these issues.

A fifth mother, Dawn, pregnant with her second child, interjected

that she became so frustrated that she simply told her child that in a

few days the child would be moving into her own room (i.e., out of the

parents bed). Dawn was terrified about her upcoming delivery be-

cause the idea of two young children overwhelmed her.

The group leader understood that this group of mothers was very

anxious because of intense self-criticism. In a joking way, she said,In difficult times, all of us sometimes muddle along, because the

choices as to how to act are very difficult for us to make.

On reflection, the group leader realized that she was concerned

that an intervention could lead the group to experience her as a disap-

proving grandmother (they had talked many times about their own

critical mothers). Her joking style, though, was usefulit communi-

cated, instead, that she was a benign superego figure (good grand-

mother) who empathized with their anxieties but was not omniscient.

She implied that making decisions was also difficult for her. She may

very well have represented their wished-for mother figure who lis-



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Moreover, the leaders affect sharing may have special meaning for

the dyadsmeaning that may not be expressed or even conscious.In a parallel-process way, the group leader, just like the mothers in

the group, was self-critical when reporting the intervention to her col-

leagueseven though her joking comment had been followed by

Janes talking enthusiastically about recent changes in her daughter

(Jane being the mother who criticized herself for not understanding

the meaning of her daughters tantrums) and by Janes telling the ad-

ministrator how helpful the group had been for Jane and her child.

As this vignette illustrates, the group leader tries to understand the

most predominant affect in the group and to make tactful interven-

tions to encourage group cohesion and amelioration of severe self-

critical introjects in order to further the mothers sense of themselves

as competent mothers with their children. Unlike the critical grand-

mothers, the group leaders listen and help the mothers understand

that there is meaning to the childs behavior.

This group leader provided two interventions: she stimulated the

mothers to try to understand that there was meaning to their chil-

drens behavior, and she showed that she herself was not omniscient,unlike their fantasied critical all-knowing mothers. The latter inter-

vention promoted development of powerful positive transferences

toward her, of which she was aware but did not interpret.

A sign of a well-functioning group is its members empathy for

one another.6 In this group, for example, the mothers always found

something in their lives that could stimulate fantasies of themselves

as bad mothers toward their children (or, as they often voiced, not

as good as their own mothers). Their empathy for one another, in-cluding their communications that they understood one another, was

always extremely helpful.

The group leaders acceptance of the many varieties of develop-

ment and parenting styles helps mothers to accept their conflicted and

ambivalent feelings and to understand the universality of such feel-

ings (including ambivalence about their own feelings and about their

children). By acknowledging their own conflicted feelings, mothers

can master their conflicts rather than deny or become overwhelmed

by them because they are so frightening. Mothers can then feel more

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in charge of their own feelings and more competent about their mater-

nal skills. They are then more effective in promoting their childrensdevelopment (Hoffman, 2003).

The Nanny as the Mothers Mother Surrogate

We have observed many women who, though extremely successful

and competent, particularly in their interactions with superiors and

subordinates in their professional lives, have had much difficulty in

managing their lives with their children, including their relationships

with caregivers and nannies. It is important for the group leader to

keep in mind the transference relationship of the mother to the care-

giver. As with the transference relationship with the group leader and

the early childhood staff, understanding the mothers transference

can help one to see more clearly a source of difficulties and thus to

help her interact with her child and caregiver more effectively.

Another group of mothers, mainly successful professionals, of-

ten spoke about the conflicts of living in two worldsthe world ofwork and the world of the childand about their difficulties in re-

solving issues with nannies. Their often conflict-filled interactions

with nannies contrasted with their more neutral interpersonal inter-

actions at work.

At one time, one mother, Lois, complained about her childs

sleep problem. The group leader interjected in a quizzical tone,

What sleep problem? Lois responded, Maybe you were right the

other week, when you said she wanted to be with me. The groupspoke about the difficulties in getting ready to go to work in the morn-

ings, as the toddlers wanted to be with them and not the nannies. Lois,

however, was convinced that her nanny was much more competent in

taking care of her child than Lois was. On one hand, Lois wanted to be

home rather than at work, but, on the other hand, she resented that her

having a child impeded her professional progress.

Another mother, Joyce, spoke about her anxiety on leaving for

work and about her feeling very uncomfortable with her child at that

point. The group leader said, Yes, but you seem so comfortable

when you play with him down on the floor



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did not want to think about that, even though she knew she would be

going back to work soon. In group, she concluded that her motherwould have been home all the time. Thats the only way to be a

mother. Pam said to Beverly that her child would respect her more

because she did not stop working. In a forlorn way, Helen, the only

nonworking mother in this group, said, People treat me like I am an

idiot because I am a full-time mother.

The group leader added that, when it comes to what to do for them-

selves and their children, sometimes no decision feels quite right.

Among the many issues explored by this group, the central themes

were the mothers comparison with their own mothers and the dis-

placement of expertise onto the nannies. Much as Cancelmo and

Bandini (1999) did, we have often observed mothers intense con-

flicted relationships with their childrens caregivers. Many of these

mothers imbue the caregivers with attributes of the grandmother

transference (though not always the good grandmother), the care-

giver being a stand-in for the mothers mother, who knows the right

answer. At other times, the caregiver is the equivalent of or is per-

ceived by the mother as her own jealous mother who feels she is theonly one who knows how to be maternal and thus wants to take over

the child rearing. Over the years, we have learned how useful it is to

help mothers understand that, when a caregiver is hired, the relation-

ship is rarely simply that of employeremployee.

Similarly, in our child care environment, the interactions among

the children and mothers with the staff are not just those of parents

with professionals. In these interactions, mothers, particularly vul-

nerable mothers, may react to the staff in a variety of waysobse-quious and subservient, imperious and demanding, and every

permutation in betweenreminiscent of the transferences between

mothers and child caretakers. To make informed choices of inter-

vention, the group leader must remain aware of the inevitable multi-

ple transferences that signal their arrival subliminally.

The leader for this particular group of mainly professional women

conducted sessions in his own style. Yet, his interventions in the

group (e.g., Sometimes no decision feels quite right) were similar

to the interventions used by the group leader of the overtly anxious

women (e g In difficult times all of us sometimes muddle along

642 LEON HOFFMAN


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the universality and ubiquity of conflict. These responses fostered

positive transference feelings and reinforced in the mothers a sense ofthe positive aspects of child rearing. By understanding the transfer-

ence, we can maximize our supportive interventions. In needing to

maintain clear boundaries between our psychoeducational work and

psychotherapy, we try to avoid (or at least minimize) transference in-

terpretations. 7

Comparison of Working Transference Models

Our work with mothers and their babies and toddlers affirms the im-

pression that understanding that mothers have a strong need to be val-

ued, supported, aided, taught, and appreciated by an older maternal

figure is crucial in working with new mothers and their babies. Thus,

it is no wonder that, as in the various parentchild examples provided

here, the groups relationship with the group leadera psychoana-

lyst, a figure that provides appreciation and understandingis a cen-

tral helpful tool.It is important to emphasize, however, that the work in groups of

mothers and babies is very different from focusing on an individual

within a transferential therapeutic relationship, particularly when the

analyst or therapist is attuned to providing interpretations of the

meaning of manifest content.8 (The major interventions in our groups

are also very different from the interpretative work with single dyads

who enter treatment for a specific parentinfant problem. In the latter


7With each group, the leader needs to learn and relearn how to address conflicts

among the parents and negative feelings toward him or her. As the groups are not

therapy, however, the leader must think about how to manage and control the inevi-

table transference fantasies, particularly negative transferences, some of which

may be very difficult to address in this psychoeducational setting. Sherkow (2002)

described her experience with a long-standing group in which, after a long period of

idealization, the members began to test her a great deal: The unleashing of aggres-

sion toward me signaled the need for real transference interpretation about their dis-appointment in their own mothers, and their competition with them, idealization or

d i i f h h b


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situations, interpretations of the mothers repetitive identifications

or counteridentifications for herself and for her baby with objectsfrom her own past occur with much greater frequency and very early

in the therapeutic relationship.9)

In an individual psychotherapy or psychoanalysis, both analyst

and patient focus on the individuals psychology as a person, as

an autonomous individual. From the patients personal historical

perspective, the treatment promotes an understanding of that indi-

vidual as someone (either male or female) who has or had a mother

who may be considered good or good-enough or bad or not so bad.

Obviously, most often a mother is remembered as being sometimes

gratifying and other times frustrating. Whether the analysand is

male or female, the understanding of mother is understood from the

subjective perspective of the child or adult and the various permuta-

tions and conflicts over an ongoing or past relationship with her and

the transferential replacements and enactments with spouse, chil-

dren, teachers, and so forth.

In an individual psychotherapeutic treatment with a new mother,

in addition to her subjective memories and experiences from child-hood, issues related to her new child are understood in terms of tradi-

tional dynamic oedipal, preoedipal, and relational understandings

and in terms of what Stern has described as coming to terms with her

new psychic organization.

Mothers are different from fathers. For example, it may seem

self-evident that the subjective experience of working mothers who

have to leave their crying child when they go to work is qualitatively

different from the subjective experience of most fathers. Wilkinsonet al. (1996) and Waldman (2003) detailed such subjective experi-

ences in their descriptions of therapists and analysts who are new

mothers. These mothers internal conflicts show how their psychol-

ogy is very different from that of fathers.10

644 LEON HOFFMAN

9Stern (2003) remarked on the ubiquity of such early interpretations in mother

infant dyadic psychotherapeutic work.10

Compare Bernsteins (1983) distinction between womens and mens superego

contents: For example, given two contents, I should prepare dinner for my chil -


17/29

Rosemary Balsams (2000) description of her analytic work with

new mothers provides examples of the technical generalizations andconsequent theoretical ideas derived from an analytic approachin

contrast with those derived from a dyadic approach:

The baby in the therapists office has many meanings. My pref-

erences as an analyst[italics added] is to prioritize an attempt to

preserve space for the patient to explore these many meanings,

if at all possible. With the mothers wish to show the baby, the

therapist is privileged to be included in the mutual sharing of the

wonder of the gift of new life. Countertransference and reactive

proud feelings of being an analytic grandmother may well

surface, but may not need to dominate the scene [p. 471].

In other words, Balsam highlighted the fact that the primary

agenda in a psychoanalytic treatment is understanding the patients

subjective experience of maternity and her relationship to her baby

and the variety of meanings for the mother, who is the primary patient

and the subject of examination. This is in contrast with dyadic work,in which there is not just one patient or person in the room. Balsam

followed Loewalds (1982) idea that, in a psychotherapeutic relation-

ship, the baby acts as a transitional object between the therapist and

patient, and between the patient and the outside world (Balsam,

2000, p. 470).

When Balsams (2000) patient breast-fed her baby in the analysts

office, the patient seemed to understand the difference between a

dyadic motherchild situation with a therapist and analytic work. Thepatient said, I just need to sit over here. I hope you dont mind. I

couldnt imagine sitting on the couch and feeding him. I want to keep

this apart from analysis. [She laughed.] I dont want to mess it up. . . .

This is not about breast-feeding. Ive been very comfortable with it

(p. 473). Stern might argue that Balsams patient is like the mothers

he described who tolerated traditional psychodynamic interpreta-

tions . . . without giving them too much weight, in order to benefit


women, the relative strengths of the two contents are not so fixed, but vary accord-


18/29

from the other aspects of the therapeutic relationship (Stern, 1995,

pp. 172173).Balsams patient had been in treatment for three years for chronic

marital conflict. Throughout the analytic work, the analyst had used

analytic techniques to help the patient understand the genesis of her

conflicts. Within that overall framework of treatment, Balsam of-

fered us one way of understanding the patients manifest content.

Balsam understood that the patient needed to defensively keep her

breast-feeding in the analytic office outside the analytic work. In-

stead, the patient spoke about issues of messiness in relation to her

mother. Balsams idea was that the patient was not willing to associ-

ate to the breast-feeding at the moment because she wanted to avoid a

regression in relation to the analyst. Balsam (2000) wrote that the pa-

tient needed to ward off a regressive transference state in favor of

her participation with the transitional object, the baby. The direc-

tion of her thought took us instead forward into the current active

scene of the (presumably) anal struggle between the patients own

mother and herself as daughter (p. 474).

Throughout her communication, Balsam (2000) argued againstSterns assertion that the mental health field has misunderstood the

new mothers mental state and her special needs. Balsam maintained

that Stern exaggerated when he theorized that a new mother develops

a mind-set fundamentally different from what she had before.

Balsam, like Loewald and others, clearly understood that therapy

is not the same two-person event with a small baby in the room (Bal-

sam, 2000, p. 486, quoting Loewald, 1982). Sterns (1995) conclu-

sion that a new mother develops a fundamentally different psychicconstellation in essence underscores that this new mental state isnot

a defensive construction(pp. 171172). Balsam (2000) similarly ob-

served a new mental preoccupation for the new mother: The fore-

front of the patients mind (appropriately) was largely occupied by

her interactions with the baby, while an unconscious, interactive

presence of childhood experience with her own mother was enacted

in the office (p. 485).

However, and in contrast with Stern, Balsam (2000) noted that de-

fensive operations may be involved when a new mother in psychother-

apeutic treatment focuses on her baby and wishes that her analyst will

646 LEON HOFFMAN


19/29

presence of the analyst or therapist may provide a benign constancy to

soothe a more hidden tumultuous inner world one so active in itsprogressive regression that it must stay in the here and now, as yet un-

able to find verbal expression (p. 486).

In essence, Balsam does not disagree with Sterns idea that, in

working with new mothers, the psychoanalyst must appreciate the

depth of the involvement of the new mother with her new baby and

with images of her own mother. Stern maintains that the old constel-

lations are left behind and superseded, whereas Balsam maintains

that the old constellations are pushed away defensively (whether

temporarily or permanently is unclear).

That new psychic organization or, as Stern said, that new psychic

triad (mothers mothermotherbaby) is accentuated in the here and

now in dyadic and multiple dyadic work because mother, baby, and

therapist/group leader are in the same room occupied by their copart-

ners in the work (Blos, 1985). Whereas the psychic triad is estab-

lished and enacted in dyadic work, the unit of observation expands

exponentially (not just a single mother, not just a single dyad) in a

multiple dyadic setting such as ours (the Pacella Parent Child Cen-ter). Thus, multiple transferences abound, positive and negative, in-

cluding sibling transferences, and the group leader is a stand-in for

mothers mothermost often the good grandmother, but not always.

The Field of Observation

As I previously discussed (Hoffman, 2003), it is important to attemptto integrate11 inferences derived from psychoanalytic data and those

derived from psychoanalytically informed observations. From the ob-

servations discussed herein, it seems clear that thefield of observation

is an important source for the varying conceptualizations of a mothers

mind. The nature of the instrument of observation is different. Sterns

(1995) theoretical construction arises out of dyadic observations of

mothers with their infants, whereas Balsams (2000) comes from psy-

choanalytic work with individual patients. In an analytic situation, the

observer (the analyst) is very much attuned to subtle and not so subtle



20/29

defensive or associative shifts as a patients attention shifts from one

topic to anotheror from herself to her baby or vice versa. With herpatient, Balsam attempted a gentle interpretation but respected the pa-

tients avoidance (The gentle reminder about her previously ex-

pressed fear of breast-feeding did not result in any willingness to

associate, p. 474). In dyadic, or multiple dyadic work, it is highly un-

likely that, when a basic dyadic function (breast-feeding) is proceed-

ing successfully, one would remind the mother of her previous anxiety.

In a psychoanalysis or psychoanalytic psychotherapy, the subject

of investigation is a participant in the two-person treatment. One of

the aims of the work is to understand the unconscious and precon-

scious determinants of the patients subjective experience. In such an

enterprise, careful attention is given to defensive shifts, both subtle

and more overt ones. In a dyadic therapy, three people are in the

room, and the unit of observation is the motherbaby dyad. In a group

setting, the unit of observation expands greatly to include the interac-

tions and mutual influences of the various group members.

Both Stern and Balsam agree that, when working with new moth-

ers, the psychoanalyst must appreciate the depth of the involvementof the new mother with her new baby and with images of and feel-

ings about her own mother. Stern maintains that the old constella-

tions are left behind and superseded, whereas, through Balsams

lens of observation, the old constellations seem also to be (perhaps

at times primarily) pushed away defensively (whether temporarily

or permanently is unclear).

In our setting of working with multiple dyads simultaneously, we

observe not only the bond to the group leader (the good grandmothertransference) but also the bond that forms among the new mothers

themselves. The latter bond is a very powerful force that helps moth-

ers experience themselves as more confident with the parenting of

their children. The power of this bond seems crucial to us and to other

observers of groups of mothers of babies and toddlers in groups. In a

situation in which only an individual or a single dyad is studied, the

power of the bond among new mothers can be inferred only from the

individual mothers report. By understanding such differences in the

nature of the observational tools, we can understand why exploration

of this bond is virtually absent from the analytic literature which

648 LEON HOFFMAN


21/29

Discussion and Theoretical Implications

Given the virtually universal ongoing preoccupation of new mothers

with their own mothers, it seems quaint to read Bibring et al.s

(1961a) conclusion that, from their experience, when a daughter be-

comes a parent she is released from her infantile bondage to her own

mother (p. 21). To the contrary, a daughter is far from being released

from her bondage to her own mother when she becomes a mother

herself. Our observationsconsistent with those who have written

how the motherdaughter bond reverberates throughout the life cycle

of every womanlead us to conclude that this shift in a woman from

the daughter role to the mother role requires a great deal of psychic

work. An important thrust of our work is to help women make the at

times seemingly impossible shift from a self-concept primarily as

daughter to one primarily as mother.

In our parentchild group work, we foster positive transferences.

Although we agree with Sterns emphasis on the power of positive

transferences in motherinfant work, we have also learned that thera-

pists and group leaders must remain aware of the subtle emergence ofpotential irremediable disruptions. Thus, a key technical aspect in

working with parentchild groups involves dealing with the compli-

cated transferences that inevitably occur when conflicted issues be-

gin rising to the surface, particularly negative transferences.

Balsams (2000) interventions with her patient seem to indicate

that Balsam agrees with the technical necessity that the maintenance

of a positive transference is desirable during the reign of the mother-

hood constellation (Stern, 1995, p. 188).There is no doubt that it is critical for therapists of new mothers to

unequivocally accept positive transferences. I agree, however, with

Balsams (2000) assertion that this does not imply giving free rein to

total action on the part of therapist without understanding the individ-

ual complexities (p. 469). But, to my mind, there is a more important

area to be addressed. From a theoretical perspective,how can we in-

tegrate the conception of a newpsychic structure with the observation

that defensive shifts are prominent when using the lens of psycho-

analysis? This question needs further investigation.

What are the theoretical ramifications of Sterns (1995) idea that a



22/29

capacities, and strength than on pathology and conflicts (p. 187)? I

would argue that Sterns construction seems to equate pathology withconflict. To the mothers in our groups, we communicate that conflict

is ubiquitous and that we need to master conflict, not eradicate it.12 In

contrast with Sterns (in my mind, extremely important) normalization

of the mental state of a new mother, his theoretical construction seems

to pathologize conflict, as mothers themselves often do. It does not do

justice to the data of our observations that conflict in mothers is in fact

ubiquitous.

In earlier work (Hoffman, 1996, 1999), I described how conflicts

over aggression, leading to inhibition of activity, prevent women

from achieving a sense of agency outside the home. More recently

(Hoffman, 2003), I highlighted the inhibitory role of conflicts over

aggressionwithin mothers toward their young babies and toddlers

and within the children toward the mothersin womens sense of

competence as mothers and in their child rearing. In the latter work, I

considered an integration of the three trends in the psychoanalytic lit-

erature on womens psychology: (1) attempts to understand the con-

flicts women experience in their desires for advancement in the socialfield outside the home, (2) attempts to understand psychoanalytically

the subjective experience of pregnancy and maternity in womens

psychology, and (3) the growing body of literature on mothers and

mothering in dyadic situations with babies and toddlers.13 In this

communication, I highlight the transferential connections between

their own mothers and the group leaders (and other caretakers).

New mothers often feel unsure of themselves as mothers and thus

come to believe that they cannot trust their own perceptions and can-not act on their own convictions. Rather than believing that over time

only they can become the real experts for their children, they may

650 LEON HOFFMAN

12Beverly Stoute, MD was the first to use this felicitous phrasing in our group.

13In trying to understand the various trends in the psychoanalytic literature on

women, we need to consider the zeitgeist in psychoanalytically oriented feminist

theories of the last third of 20th century. This literature was very much influenced

by Chodorows (1978) emphasis on mothers communicating to daughters how tobecome a woman, which means being a mother, a caretaker. Recently, Chodorow


23/29

retain the feeling that only other people, particularly professional

experts, know the right answers. These experts can often be seenas mother surrogates. Other mothers are convinced that they are not

real mothers and that only their own mothers are. Thus, they con-

stantly seek advice and try to find the right way to parent in an at-

tempt to perfect their child rearing and their children.

At our center, the transferential power of professionals is evident

in the mothers reactions to the psychoanalysts who are group lead-

ers. The leaders are often viewed in an idealized wayas omniscient,

all-powerful, all-protective mother surrogates. At other times, how-

ever, they may be devalued, covertly or overtly, and negative trans-

ferences may become intense.

Stern (1995) maintained that, during the mother constellation,

negative transferences and treatment dangers arise when the therapist

is unable to respond appropriately to a mothers wishes and needs,

either on personal grounds or because the therapist is adhering to a

therapeutic framework appropriate to psychoneurosis but not to the

motherhood constellation (p. 186).

Often, in our parentchild groups, concrete issues come up for dis-cussion. Parents ask, Should I do it this wayor that way? The

group leader tries to foster the parents discussing such particular is-

sue themselves, so that particular parents can make the best decision

for themselves and for their particular baby at a particular time. As

the vignettes presented here indicate, we communicate to the parents

that, regardless of the issue to be resolved, conflict is inevitable. In

other words, conflict cannot be eradicated, and a solution for one

motherbaby dyad may be very different from the solution foranother dyad.

In our staff discussions, we often wonder, in parallel fashion,

Should I do it this wayor that way? Or, What is the best way to

handle such and such a situation? In essence, new group leaders, like

new parents, wonder if there is one right way to act. In essence, the

senior staff at our center (as those in any supervisory position) are the

staffs good grandmothers.

The group leaders are cognizant of the need to communicate to the

mothers that they understand them, particularly their feeling states.

Nevertheless as Stern maintains occurs there have been times when



24/29

In our experience, however, one observation is extremely com-

mon in all our groupsthe theme of aggression; the anxiety, guilt,and shame about aggressive fantasies; and the profound difficulties

mothers have in dealing with their own anger and their childrens

anger. As a result, mothers may be unable to tolerate conflicted and

ambivalent feelings in themselves or in their children.

As this theme is ubiquitous in our mothers, it leads me to question

the universal validity of Sterns (1995) model, which I would call a

frustrationaggression model, and his seemingly resultant singular

focus on the therapists mishandling of the mother constellation as

the source of a new mothers aggression. It seems to me that there is a

deficiency in Sterns frustrationaggression model and in his conclu-

sion that, after a therapist accepts the concept of the good grand-

mother transference, a better treatment ensues (pp. 186187).

The data from our multiple dyadic groups support the conclusion

that the motherhood constellation and the good grandmother trans-

ference are in fact valuable theoretical constructs. However, ambiva-

lence conflicts, particularly over aggression, are ubiquitous and

inevitable. Mothers need help accepting ambivalence (about them-selves, about their mothers, about their children). A ubiquitous fan-

tasy is that the professional is a good grandmotherthe professional

is an idealized mother or a wished-for mother. A professional must be

cognizant that idealization of her or his status as the good grand-

mother may, sooner or later, succumb to deidealization with resultant

aggression.

Conclusion

In this communication, I highlight how new mothers can be very pre-

occupied with their own mothers and can replay the relationship with

their mothers in a transferential way with professionals and nannies

who can become surrogates for their own mothers. New mothers need

affirmation from their own mothers and the mother surrogates be-

cause, in their new roles as mothers, they experience a sense of help-

lessness and anxiety and have difficulty tolerating aggression,

ambivalence, and conflict. Sterns concepts of the motherhood con-

stellation and the good grandmother transference are useful in trying

652 LEON HOFFMAN


25/29

the Pacella Parent Child Center, I have distilled two factors that help

new mothers address their anxietiesthe bonds these mothers makewith one another and the transferential bond to the group leader and

other professionals at the center. Here I critically discuss and com-

pare theoretical inferences derived from individual psychoanalytic

or psychotherapeutic work (as exemplified by the work of Balsam)

with the inferences derived from Sterns dyadic model and with infer-

ences derived from psychoanalytically informed group situations. I

consider the implications of the ubiquity of ambivalence conflicts,

especially around aggression.

Epilogue

Psychoanalysts follow a tradition, begun by Freud, of looking to my-

thology to generate hypotheses about mental functioning and to pro-

vide corroborating examples and a narrative frame for their own pet

theories. Holtzman and Kulish (2000) extensively explored how the

myth of Demeter and Persephone (vs. the myth of Oedipus) is a better

metaphor for womens struggles with their passions: it has femaleprotagonists and speaks to the intensity of the motherdaughter

bond (summary of White, Kulish, and Holtzmans discussion during

the May 13, 2001Journal of the American Psychoanalytic Associa-

tion netcast).

In the myth, the goddess Demeter expresses her fury toward some

of the male gods for Hadess abduction of her daughter, Persephone.

Her fury is so intense that it puts the entire land under a blight. Spring

(i.e., new life) returns only after mother and daughter are reunited.Persephones only active action is rather tame. She walks with

other young girls in the fields and picks flowers, and that is when

Hades abducts her. Obviously absent from the myth are Persephones

desire to leave her mother and her anger over her mothers prohibit-

ing her from staying with Hades year-round.

Demeters powerful affective reaction suggests that she experi-

ences the loss of her daughter as a threat to herselfreminiscent of

Furmans (1994, 1996) idea that a mother feels a threat to her own

body integrity with the inevitable loss of a child during development.

Tyson (1991 1996) wrote how the DemeterPersephone story re-



26/29

Our experience shows that, because of a variety of conflicts, many

new mothers are concerned about their potential adequacy as mothers.They feel very anxious and unsure about actively assuming their new

roles as mothers to their babies versus continuing only as daughters to

their own mothers and needing to be told what to do (and, thus, be

given permission) by their mothers or mother surrogates. Therefore, it

might be useful to consider adding to Holtzman and Kulishs reading

of the DemeterPersephone myth the idea that this myth may in fact in-

clude a representation of the fantasy that only older mothers (not

daughters becoming mothers) are allowed to be active and aggressive.

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