ANGELS IN THE NURSERY: (PART ONE) ABSTRACT and REFERENCES

ALICIA F. LIEBERMAN, ELENA PADRO´ N, PATRICIA VAN HORN, AND WILLIAM W. HARRIS

San Francisco General Hospital and University of California, San Francisco

ABSTRACT: Fraiberg and her colleagues (1975) introduced the metaphor “ghosts in the nursery” to de- scribe the ways in which parents, by reenacting with their small children scenes from the parents’ own unremembered early relational experiences of helplessness and fear, transmit child maltreatment from one generation to the next. In this article, we propose that angels in the nursery — care-receiving experiences characterized by intense shared affect between parent and child in which the child feels nearly perfectly understood, accepted, and loved — provide the child with a core sense of security and self-worth that can be drawn upon when the child becomes a parent to interrupt the cycle of maltreatment. We argue that uncovering angels as growth-promoting forces in the lives of traumatized parents is as vital to the work of psychotherapy as is the interpretation and exorcizing of ghosts. Using clinical case material, we demonstrate the ways in which early benevolent experiences with caregivers can protect against even overwhelming trauma, and examine the reemergence of these benevolent ﬁgures in consciousness as an instrument of therapeutic change. Finally, we examine the implications of the concept of “angels in the nursery” for research and clinical intervention.

RESUMEN: Fraiberg y sus colegas (1975) introdujeron la meta´fora “fantasmas en la habitacio´ n” para describir las maneras en que los padres transmiten el maltratamiento infantil de una generacio´ n a la otra, por medio de poner en escena, con sus nin˜ os pequen˜ os, situaciones de sus propias -si bien no recordadas- experiencias de miedo y falta de ayuda en sus tempranas relaciones en sus tempranas relaciones. En este ensayo, proponemos que “a´ngeles en la habitacio´ n,” experiencias del cuidado recibido, caracterizadas por un intenso y compartido afecto entre padre o madre e infante, en las cuales el infante se siente casi perfectamente comprendido, aceptado y amado, proveen a e´ste con un sentido central de seguridad y autovalor al que se puede recurrir cuando el infante se convierte en padre o madre, con el ﬁn de interrumpir el ciclo de maltratamiento. Sostenemos que dejar al descubierto “a´ngeles” como una fuerza que promueve el crecimiento en las vidas de padres o madres traumatizados es tan vital para el trabajo de la sicoterapia como la interpretacio´ n y el exorcismo de “fantasmas.” Por medio del uso de material de casos cl´ınicos, demostramos las maneras por medio de las cuales las tempranas experiencias benevolentes con quienes nos prestaban el cuidado pueden proteger aun contra el trauma abrumador. Tambie´n examinamos la reaparicio´ n de estas ima´genes benevolentes en la conciencia como un instrumento de cambio terape´utico.

Support for the writing of this article was provided by the Coydog Foundation. Direct correspondence to: Alicia F. Lieberman, San Francisco General Hospital, Building 20, Suite 2100,1001 Potrero Avenue, San Francisco, CA 94110; e-mail: Alicia_lieberman@sfgh.org.

INFANT MENTAL HEALTH JOURNAL, Vol. 26(6), 504–520 (2005)

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/imhj.20071

Finalmente, examinamos las implicaciones del concepto de “a´ngeles en la habitacio´ n” en cuanto a la investigacio´ n y la intervencio´ n cl´ınica.

RE´ SUME´ : Fraiberg et ses colle`gues (1975) ont e´te´ les premiers a` pre´senter la me´taphore “fantoˆ mes dans la chambre d’enfant» pour de´crire les manie`res dont les parents, en reproduisant avec leurs enfants en bas aˆge des sce`nes de leurs propres expe´riences inconscientes relationnelles d’impuissance et de peur, transmettent un mauvais traitement d’une ge´ne´ration a` l’autre. Dans cet article, nous proposons que les anges dans la chambre d’enfant, des expe´riences de mode de soin caracte´rise´es par un affect intense partage´ entre le parent et l’enfant durant lequel l’enfant se sent presque parfaitement compris, accepte´, aime´, offre a` l’enfant un sens fondamental de se´curite´ et d’estime de soi qui peut eˆtre retrouve´ lorsque l’enfant devient parent, pour interrompre le cycle de mauvais traitement. Nous pensons que le fait de de´couvrir ces anges en tant que forces de promotion de croissance dans les vies de parents traumatise´s est tout aussi crucial pour le travail de psychothe´rapie que l’est l’interpre´tation et l’exorcisme des fan- toˆ mes. En utilisant des cas cliniques, nous de´montrons les manie`res dont de bonnes expe´riences pre´coces avec des modes de soin peuvent offrir une protection contre les traumas, meˆmes les plus accablants, et nous examinons la re´apparition de ces eˆtres bienveillants dans la conscience comme un instrument de changement the´rapeutique. Enﬁn, nous examinons les implications du concept d’«anges dans la chambre d’enfant» pour les recherches et l’intervention clinique.

ZUSAMMENFASSUNG: Fraiberg und Kollegen haben 1975 die Metapher: Geister im Kinderzimmer ein- gefu¨ hrt, um die Art zu beschreiben in der Eltern – indem sie mit ihren kleinen Kindern Szenen der Hilﬂosigkeit und der Angst wieder inszenieren – , die aus den nicht erinnerten fru¨ hen Beziehungserfah- rungen stammen, Misshandlung von einer Generation zur na¨chsten weitergeben. In dieser Arbeit schlagen wir den Engel im Kinderzimmer vor: Betreuungserfahrungen, die sich durch intensiv gemeinsam em- pfundene Gefu¨ hle zwischen Eltern und Kind auszeichnen bei denen sich das Kind fast ideal verstanden, akzeptiert und geliebt fu¨ hlt. Dies gibt dem Kind ein grundlegendes Gefu¨ hl der Sicherheit und Selbstwert auf das zuru¨ ckgegriffen werden kann, wenn das Kind selbst Eltern wird, um den Zyklus der Misshandlung zu unterbrechen. Wir behaupten, dass die Entdeckung von Engeln als Wachstumsfaktoren im Leben traumatisierter Eltern ebenso in der psychotherapeutischen Arbeit lebenswichtig ist, als die Interpretation und das Exorzieren von Geistern. Durch Verwendung von Fallgeschichten demonstrieren wir den Weg in dem fru¨ he, hilfreiche Erfahrungen mit Bezugspersonen sogar gegen ein u¨ berwa¨ltigendes Trauma schu¨ tzen ko¨ nnen und u¨ berpru¨ fen das Wiederauftreten dieser hilfreichen Figuren im Bewusstsein als ein Instrument der therapeutischen Vera¨nderung. Zuletzt untersuchen wir das Konzept der „Engeln im Kin- derzimmer“ im Hinblick auf Forschung und klinische Intervention.

*** * ***

REFERENCES

Ainsworth, M.D.S., Blehar, M.C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum.

Beebe, B., & Lachman, F.M. (2003). Infant research and adult treatment: Co-constructing interactions.

Hillsdale, NJ: Analytic Press.

Bion, W.R. (1962). Learning from experience. London: Heinemann.

Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. New York: Basic Books.

Cicchetti, D., & Barnett, D. (1991). Attachment organization in maltreated preschoolers. Development

& Psychopathology, 3, 397 – 411.

Cicchetti, D., & Tucker, D. (1994). Development and self-regulatory structures of the mind. Development

& Psychopathology, 6, 533 – 549.

Clark, T. (1971). “Bugs ate this lake clean.” The Paris Review, Winter, 41.

Dennett, D. (1978). Brainstorms: Philosophical essays on mind and psychology. Montgomery, VT: Brad- ford.

Fairbairn, W.R.D. (1954). An object relations theory of the personality. New York: Basic Books. Fonagy, P., Gergely, G., Jurist, E.L., & Target, M. (2002). Affect regulation, mentalization, and the

development of self. New York: Other Press.

Fonagy, P., Target, M., Steele, M., & Steele, H. (1997). The development of violence and crime as it relates to the security of attachment. In J.D. Osofsky (Ed.), Children in a violent society (pp. 150 – 177). New York: Guilford Press.

Fraiberg, S. (Ed.). (1980). Clinical studies in infant mental health. New York: Basic Books.

Fraiberg, S., Adelson, E., & Shapiro, V. (1975). Ghosts in the nursery: A psychoanalytic approach to the problem of impaired infant – mother relationships. Journal of the American Academy of Child Psy- chiatry, 14, 387 – 421.

Freud, A. (1936/1966). The ego and the mechanisms of defense. The writings of Anna Freud (Vol. II).

New York: International Universities Press.

Freud, S. (1923/1966). The ego and the id. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (pp. 12 – 66). London: Hogarth Press.

George, C., Kaplan, N., & Main, M. (1996). Adult attachment interview protocol (3rd ed.). Unpublished manuscript, University of California, Berkeley.

Harris, W.W. (2004, February). Interventions for children exposed to violence [Discussion]. Johnson & Johnson Pediatric Institute Round Table, Puerto Rico.

Hartmann, H. (1939). Ego psychology and the problem of adaptation. New York: International Univer- sities Press.

Heller, S., Larrieu, J., D’Imperio, R., & Boris, N. (1999). Research on resilience to child maltreatment: Empirical considerations. Child Abuse and Neglect, 23, 321 – 338.

Kernberg, O. (1976). Object relations theory and clinical psychoanalysis. New York: Aronson. Klein, M. (1932). The psycho-analysis of children. London: Hogarth Press.

Kohut, H. (1971). The analysis of the self. New York: International Universities Press.

Lieberman, A.F. (1997). Toddlers’ internalization of maternal attributions as a factor in quality of at- tachment. In L. Atkinson & K. Zucker (Eds.), Attachment and psychopathology (pp. 277 – 299). New York: Guilford Press.

Lieberman, A.F. (2000). Negative parental attributions: Effects on toddlers’ sense of self. Psychoanalytic Inquiry, 19, 737 – 757.

Lieberman, A.F. (2004). Child – parent psychotherapy: A relationship-based approach to the treatment of mental health disorders in infancy and early childhood. In A.J. Sameroff, S.C. McDonough, & K.L. Rosenblum (Eds.), Treating parent – infant relationship problems (pp. 97 – 122). New York: Guilford Press.

Lieberman, A.F., Compton, N., Van Horn, P., & Ghosh-Ippen, C. (2003). Losing a parent to death: Treatment of traumatic bereavement in infancy and early childhood. Washington, DC: Zero to Three Press.

Lieberman, A.F., & Van Horn, P. (1998). Attachment, trauma, and domestic violence: Implications for child custody. Child and Adolescent Psychiatric Clinics of North America, 7, 423 – 444.

Luthar, S.S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, 543 – 562.

Mahler, M., & McDevitt, J.B. (1982). Thoughts on the emergence of the sense of self, with particular emphasis on the body self. Journal of the American Psychoanalytic Association, 30, 827 – 848.

Mahler, M., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant. New York: Basic Books.

Marmar, C.K., Foy, D., Kagan, B., & Pynoos, R.S. (1993). An integrated approach for treating posttrau- matic stress. In R.S. Pynoos (Ed.), Posttraumatic stress disorder: A clinical review (pp. 239 – 272). Lutherville, MD: Sidran Press.

Masten, A.S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227 – 238.

Murray, J. (Ed.). (1971). Oxford English dictionary [Compact ed.]. Glasgow, Scotland: Oxford University Press.

Osofsky, J.D. (2004). Young children and trauma: Intervention and treatment. New York: Guilford Press. Osofsky, J.D., Hammer, J.H., Freeman, N., & Rovaris, J.M. (2004). How law enforcement and mental health professionals can partner to help traumatized children. In J.D. Osofsky (Ed.), Young children and trauma: Intervention and treatment (pp. 285 – 390). New York: Guilford Press.

Osofsky, J.D., & Lederman, C. (2004). Healing the child in juvenile court. In J.D. Osofsky (Ed.), Young children and trauma: Intervention and treatment (pp. 221 – 241). New York: Guilford Press.

Osofsky, J.D., & Thompson, M.D. (2000). Adaptive and maladaptive parenting: Perspectives on risk and protective factors. In J. Shonkoff & S. Meisels (Eds.), Handbook of early childhood intervention (pp. 54 – 75). Cambridge, England: Cambridge University Press.

Pynoos, R.S. (1997, June). The transgenerational repercussions of traumatic expectations. Paper presented at the John F. Kennedy Lectureship, Southern Florida Psychiatric Society, University of Miami School of Medicine, Miami.

Pynoos, R.S., & Steinberg, A.M. (2004, February). Recovery of children and adolescents after exposure to violence: A developmental ecological framework. Paper presented at the Johnson & Johnson Pediatric Institute Round Table, Puerto Rico.

Pynoos, R.S., Steinberg, A.M., & Piacentini, J.C. (1999). A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders. Biological Psychiatry, 46, 1542 –1554.

Sameroff, A.J., McDonough, S.C., & Rosenblum, K.L. (2004). Treating parent – infant relationship prob- lems. New York: Guilford Press.

Shonkoff, J.P., & Phillips, D.A. (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.

Silverman, R., & Lieberman, A.F. (1999). Negative maternal attributions, projective identiﬁcation, and the intergenerational transmission of violent relational patterns. Psychoanalytic Dialogues, 9, 161 –187.

Slade, A., Aber, J.L., Berger, B., Bresgi, I., & Kaplan, M. (2003). The parent development interview.

Unpublished manuscript, City University of New York, New York City.

Slade, A., Belsky, J., Aber, J.L., & Phelps, J.L. (1999). Mothers’ representations of their relationships with their toddlers: Links to adult attachment and observed mothering. Developmental Psychology, 35, 611 – 619.

Smyke, A.T., Wajda-Johnson, V., & Zeanah, C.H. (2004). Working with traumatized infants and toddlers in the child welfare system. In J.D. Osofsky (Ed.), Young children and trauma: Intervention and treatment (pp. 260 – 284). New York: Guilford Press.

Sroufe, L.A., & Waters, E. (1977). Attachment as an organizational construct. Child Development, 48, 1194 – 1199.

Stern, D.N. (1985). The interpersonal world of the infant. New York: Basic Books.

Stern, D.N. (1995). The motherhood constellation: A uniﬁed view of parent – infant psychotherapy. New York: Basic Books.

Tronick, E. (1998). Dyadically expanded states of consciousness and the process of therapeutic change. Infant Mental Health Journal, 19, 290 – 299.

van der Kolk, B.A. (2003). The neurobiology of childhood trauma and abuse. Child and Adolescent Clinics of North America, 12, 293 – 317.

Van Horn, P., & Hitchens, D.J. (2004). Partnerships for young children in court: How judges shape collaborations serving traumatized children. In J.D. Osofsky (Ed.), Young children and trauma: Intervention and treatment (pp. 242 – 259). New York: Guilford Press.

Winnicott, D.W. (1965). The maturational processes and the facilitating environment. London: Hogarth Press.

Winnicott, D.W. (1971). Playing and reality. London: Tavistock.

Zeanah, C.H., Benoit, D., & Barton, M. (1993). Working model of the child interview. Unpublished manuscript, Brown University School of Medicine, Providence, RI.