It will come as no surprise to many that the contributions of women to psychotherapy have been heavily weighted toward the study and treatment of children.
“Psychoanalysis was focused on childhood during a time when children were viewed as women’s province,” write Nancy Felipe Russo and Agnes O’Connell in a new book on the history of psychotherapy. “At first this both increased the value of the `women’s sphere’ in society and legitimized women’s participation in psychoanalysis. (Later it also helped blame women, particularly mothers, for society’s ills.).”
These days, the debates over single mothers, day care and similar issues have again brought childhood development and disorders into sharp focus. To get a grip on those topics, it is helpful to trace the impact women have had on understanding of the psychological growth of children-from the efforts of the first women practitioners of Sigmund Freud’s inner circle to his daughter Anna, who extended her father’s ideas, especially regarding children, to the contemporary, sometimes harsh critique of Freudian ideas leveled by feminist therapists and clinicians.
Russo’s and O’Connell’s article appears as one chapter in a hefty volume recently published in conjunction with the 100th anniversary of the American Psychological Association entitled “History of Psychotherapy: A Century of Change” (American Psychological Association, $69.95).
Pioneers such as Marie Bonaparte and Helene Deutsch adhered closely to the traditional Freudian line (earning them the sobriquet of Freud’s “dutiful daughters”), a few significant divergences appeared early.
Even Deutsch, who trained as a physician before working with Freud and who became director of the Vienna Psychoanalytic Institute in 1925, came to believe that penis envy, one of the basic tenets of classical psychoanalytic theory, played only a secondary role in girls’ personality development. More importantly, she believed that girls’ bonds with their mothers are crucial as well, hence Freud’s description of how girls resolve the oedipal attachment-by detaching from the mother and forming a strong attachment to the father-was inaccurate.
Others went further when it came to feminine psychology. Karen Horney “provided a new way of thinking about women,” according to O’Connell, and “emphasized the importance of cultural and societal factors on women’s `inferior position’ and stated her belief that what women envy is not the penis but the superior position of men in society.”
Horney and Clara Thompson began to see interpersonal relationships as central to adjustment and well-being, rather than unseen forces such as the oedipal complex and psychic conflicts between instinctual drives (the id) and the self, or ego.
It was in developing the concept of the ego and in her formative work in child psychotherapy that the youngest child of Sigmund Freud made her biggest impact. Anna Freud summarized her ideas, many of which developed out of her work with children in England during World War II, in such works as “Normality and Pathology in Childhood.”
Said Russo, “(Sigmund) Freud talked about the ego but didn’t develop it as a central aspect; he was more interested in drives and instincts. You could say that Anna Freud was interested in what makes us human-the development of our sense of self, our ego, that strong conscious identity-whereas (her father) was interested in what links us with animals.”
According to Alice Honig, a professor of child development at Syracuse University, Anna Freud also originated what is now a cornerstone for understanding the effect of early childhood experiences. “Anna Freud taught us that magnificent realization,” said Honig, “that children who have been abused or rejected or shamed grow up feeling not just that they’re unworthy, but they identify with the aggressor” as a defense mechanism, thus setting the stage for inflicting the same damage on their own children.
In his book “A History of Psychoanalysis,” Reuben Fine declared that Anna Freud and her contemporary Melanie Klein “may fairly be said to have initiated the psychoanalytic treatment of children.” Both were innovators in the development of play therapy for children, in which observing the free, unstructured play of young children becomes the key to understanding conflicts that the children themselves cannot yet comprehend or verbalize.
Significant differences of approach between the two led to the creation of two distinct “schools” in the 1930s in Europe, where Klein and Freud worked. Klein, for instance, believed that many psychic mechanisms of adults, such as projection and transference, were present even in very young children, whereas Anna Freud did not believe this.
Said Russo, “Klein centered on the relationship with the mother per se and in its own right, as opposed to the father and Freud’s very androcentric, that is, male-oriented conceptualization.
The issue for Klein, Russo said, is that the infant hates the mother who doesn’t satisfy its needs but loves the mother who does, “so there’s a love/hate thing going on, and how you resolve that dynamic between love and hate sets the course of future development.”
Klein’s work is known and used around the world but remains little-known in the U.S., said Russo. “Part of it is just garden-variety sexism and people listen to men more than women, and (thus) women’s contributions become invisible.
“Also, people who stayed in Europe had a different pattern of influence than those who came to the U.S. or went back and forth, and part of it is our ideology of individualism: Klein’s work focused on relationships, and we have been slow to fully appreciate connections between people and how they influence us,” said Russo.
As the field of developmental psychology grew, therapists working with children began to shift their techniques in accordance with new findings on the thinking, emotional and interpersonal shifts of childhood. Some of the most important contributions were made by Margaret S. Mahler. In works such as “The Psychological Birth of the Human Infant,” she studied the process by which an infant assumes its own identity.
Mahler suggested that separation and individuation are the hallmarks of that psychological birth: the realization of separateness from the mother and the development of autonomy. Mahler thoroughly sketched out a four-stage process, the most critical being what she called the “rapprochement” phase, taking place between 15 and 24 months of age.
“If anyone can make you feel the misery and the see-sawing of that period, Mahler’s done it,” said Honig.
Just prior to that toddler phase in a child’s development, she said, “when you first walked gloriously off into the world, you still thought your umbilical cord to mama and papa was totally intact. But now you know you’re separate, and you have a thinking mind, and you’re worried: Can I be off on my own? There’s a tremendous war between wanting to still be a baby at the breast and wanting to be separate.”
How a child manages this phase, Mahler suggested, has crucial implications for his or her behavior throughout life; for instance, the closer the infant-mother attachment to begin with, the more independence and exploratory behavior the child will display eventually.
Mahler’s work thus dovetails with what has come to be known as attachment theory, as originated by the British psychiatrist John Bowlby and developed by American psychologist Mary Ainsworth, professor emeritus at the University of Virginia.
According to Honig, “Bowlby said that there are ethological implications of infant behaviors like crying, calling, hugging, clutching on, smiling; that these all have a Darwinian survival function and are meant to keep mother close to you. What Mary Ainsworth did was specify, with her `strange situation test,’ the quality of the infant-mother attachment.”
In such tests, babies from 12 to 18 months old usually are left alone in a room for a short time with a friendly stranger, then rejoined by their mothers, then left completely alone for a few minutes before mother returns.
“What happens on reunion?” asks Honig. “Either the baby demands to be picked up, settles into your body and accepts comfort, uses you for emotional refueling or what Ainsworth calls the `secure base.’ From there the securely attached infant, and later child, can go forth bravely and meet other people and the challenges of learning and the workaday world.”
But babies whose attachments are insecure, she said, may seem to ignore the mother on her return, or try to wriggle away if picked up in a display of what has been termed “avoidant attachment.”
“And what some people are saying is that with more non-maternal day care we’re seeing more avoidant attachments,” with huge implications for problem behavior in later life, said Honig. “That’s a big fight in America today.”
The work of attachment theorists such as Mary Ainsworth, said Honig, “has brought therapy even further and turned it toward the parent-infant relationship. Because all the play therapy in the world will not help a child if its parent is still totally insensitive to its signals, totally punitive and unavailable.”
In recent years, some researchers have melded attachment and psychoanalytic theories in their therapeutic work with parents and infants.
The late Selma Fraiberg was foremost among them, coining the term “ghosts in the nursery” for the influences of the past that can disrupt a mother’s effectiveness as a caregiver and lead to childhood disorders.
Honig said: “Almost all modern therapists who work with infants and mothers build on the power of what we call `projective identification’: you think of your kid as . . . rotten . . .because your boyfriend left you with the baby; and you also want the baby to give you back the love you may have felt cheated out of as a neglected child.
“And who gave us those defense mechanisms of the ego? Freud, and especially Anna Freud for the identification with the aggressor. So yes, we’re much more sophisticated in our practices, but let’s remember the giants on whose shoulders we’re standing.”
