The Unwanted Child
by Aaron Lederer, NCPsyA

Abstract
Disorders originating in the first two to three years of life stem from deficiencies in the infant contact with the primary provider, usually the mother.  Clients who carry these early deficits cannot have rewarding, close relationships.  They believe they are unwanted and fundamentally unlovable.  Early in their lives, many of them made certain internal structural adjustments to best survive in their deficient environments.  These adjustments and their consequences are identified and explained, and transactional analysis treatment to obtain the necessary restructuring is outlined.

To have hate where there once was love, to have fear where there once was trust. -- A client
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This paper considers transactional analysis treatment for disorders originating in infancy.  Berne (1961) defined the function of transactional analysis as helping clients put their Adult, uncontaminated, in the executive to obtain symptomatic control and relief.  He asserted that transactional analysis is an advance over psychoanalysis for obtaining these results, but that additional work is required to obtain a cure.  He maintained that cure, or deconfusion of the Child, is to be accomplished through script analysis, which is the substance of psychoanalysis.  He called the process “psychoanalytic cure” (p.172); however, when it comes to clients with problems originating in infancy, Fried (1913/1958) concluded that they do not respond to psychoanalysis, and the analyst who undertakes to treat such a case “cannot fulfill his promise of cure” (p. 124).

Whereas Freud's work emphasized the Oedipal conflict as the origin of neurosis, later writers (Klein, 1945/1975; Rinsely, 1989) recognized that more clients suffer from distress originating from earlier experiences. Little (19900) observed:
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In the course of time, fewer people have sought treatment for neurotic illness, and many more for anxieties of the far less tractable, psychotic type, even though these were not necessarily wholly incapacitating or requiring hospitalization, and this has called for changes in psychoanalytic technique. (p.18)

Such changes have indeed been taking place in the psychoanalytic field with advances such as ego psychology, object relations, self psychology, and Spotnitz's (1993) modern psychoanalysis, although success using these developments usually requires many years of treatment.

Many transactional analysts have developed treatments for child-development problems: early work with permission workshops (Steiner, 1974); reparenting regressive work (Schiff et al., 1975); redecison therapy (Goulding & Goulding, 1979); body work designed to provide corrective experiences for the child (Cassius, 1980), self-reparenting approaches (James, 1981); child-development work (Levin, 1988); and rechilding (Clarkson & Fish, 1988); to name some. In addition, many transactional analysis practitioners recently have turned to modern psychoanalytic advances, and the transactional analysis literature and conferences related to transactional analysis have increasingly included such material.

Clients whose problems originate in infancy do not respond to therapeutic operations such as explanation, confrontation, clarification, and interpretation. They tend to act rather than talk and to create circumstances in their lives that are dangerous to themselves or others, often prompting treatment. They tend to undo progress and are likely to leave therapy just when progress seems most promising. Those who display such characteristics usually fit within the narcissistic-borderline continuum (Adler, 1985) and are often diagnosed as schizophrenic, schizoid, analytically depressed, passive aggressive, psychopathic, impulse disordered, obsessive compulsive, eating disordered, or addictive--the spectrum of disorders originating in infancy. These clients, adamantly ego-syntonic with their Child's adaptations, are the ones we are concerned with in this article. Their psychiatric diagnoses are not considered here to represent classes of illnesses but rather methods of adaptations used by many of them to cope with a common, basic flaw stemming from early deprivation.

In this article, a theory of the unwanted child syndrome is presented that shows how the aforementioned basic flaw brings about a particular splitting of the early Child ego state; how that splits leads to a situation in which the only relationship possible is one founded on hostility and dislike; and how the person's presenting symptoms serve to neutralize an intolerable internal experience that results from these developments. A novel treatment is then presented that corrects the structural distortions and brings to closure the original, early deprivations and their consequent developmental deficiencies.


The Basic Flaw

It is now universally recognized that early pathology develops from failure in the contact between the infant and the primary caregiver, usually the mother. Kohut (1971) wrote that, because of her own narcissistic fixations, a mother's self-absorption may lead her to project her moods and tensions onto the child or to respond inappropriately to his moods, resulting in the child's remaining "fixated on the whole early narcissistic milieu" (p. 66).

Many of our clients in infancy experienced their caretakers as physically or psychologically unavailable. Here are some examples of disruptive attachment histories from my clients:
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At the age of 11 months, a client was left in the hospital for two weeks; another client was given by her mother to a grandmother's temporary care after birth; three clients had siblings born when the clients were younger than two years of age; four clients were born to alcoholic, detached mothers; one client was born prematurely and was incubated for a time; and one, conceived shortly after her parents had adopted a baby, was singled out for rejection and abuse since infancy.

These clients feel unwanted and unloved and believe that they are unlovable. Echoing her early experience, one of these clients said:

I don't like depending on anybody or being beholden to anybody. I can't believe people enjoy me and my company, that I am not a burden. I don't like to depend [on anyone] because I don't trust that anyone is comfortable with giving anything to me.

In his famous study of infants temporarily separated from their mothers, Bowlby (1996,1973) found that if the mourning process and the environment are such that closure cannot be obtained, the infant will detach from its mother.  It will first show distress at having lost the mother and will seek to have her back by any means.  In time, the infant will become increasingly hopeless, withdrawn, and inactive and make no demands.  It will become remote and apathetic toward the mother on her return.  If loss persists, the infant will gradually become self-centered and replace an interest in people with a preoccupation with things such as sweets, food, or toys.

It is reasonable to assume that detachment also results from unresolved emotional abandonment.  This assumption finds reinforcement in Federn’s (1952) posthumously published paper on children’s responses to pain and frustration.  He proposed that “repeated frustration in childhood can result in an impairment. . . When no repair is made--spontaneously, by helpful environment, or by psychoanalysis--coldness and dullness in all object relations are established for life” (italics added) (p.266).

Structurally, the infant’s detachment represents an exclusion by the infant of its internalized mother (P1 in Figure 1).  This blocking off of the experience of “mother” is of such far-reaching consequence to the child’s later development that therapy cannot be effective without first mending it.  I call the exclusion of mother’s representation a basic flaw (not to be confused with Balint’s [1968] basic fault).
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The Split
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If the primary attachment is undisturbed, the growing toddler has enough of an internalized reliable early attachment figure to carry him through the initial exploratory ventures.  Healthy and secure detachment can then lead to increased separation and individuation.   But, lacking a reliable internalized mother, how can the detached toddler believe that he can venture out and survive?  He solves this problem by splitting psychically, allowing one part of the psyche to take charge of and look after the other.  The first part, here called the Tough Kid, “lifts itself up by its own bootstraps," its slogan being, "The hell with them all; I can do it myself." Magid and McKelvey (1987/1988) wrote, in regard to these unattached children, "It is as if a voice inside their heads is saying, 'I trusted you to be there and to take care of me, and you weren't. It hurts so much that I will not trust anyone, ever'" (p. 26). Bowlby (1977) described their quality as "compulsive self-reliance" adopted by the individual to seal his "destiny" of loneliness and to enable him to overcome his self-attributed unlovableness and low personal worth (p. 130). A client expresses this situation to the therapist thus: "Why should I accept you? I don't trust any adults. They are there to do what's good for them. Why will they care about me?"

Serving as a substitute to the excluded, early internal mother image, the Tough Kid, made up to perform a parental function, may structurally be considered P1. But, as will be shown, there is more to the Tough Kid’s content and function.  Once the split has materialized, the Tough Kid assumes the executive.  It envelops and encapsulates the other, vulnerable part, called the Dependent Child (see functional diagram, Figure 2), and stands vigil to protect it from those who offer the greatest threat of abandonment--those with the potential for closeness or nurturing.

(It must be noted that this split is not the same as the splitting defense described in object relations theory.  See the conclusion of this article for further discussion.)

It is easy to detect the split early in treatment.  For example, a teen-age client at her second session, after describing numerous abandonments and betrayals, says, “I don’t want to be dependent on anyone.  I even hate to receive gifts.  I don’t want to be helpless.  I want to be in control and take care of myself.”  When the therapist asks, “Is there a part of you that does want to be taken care of,”  she replies with tears in her eyes, “Oh, yes, there is.  It hasn’t been used for years.  The only place I bring it out is in my poetry."

The Tough Kid mobilizes to cut off the Dependent Child from all contact that risks abandonment.  But being only a split part of a young Child ego state, it is not equipped to substitute for the missing “good-enough” mother.  As a consequence of the Tough Kid’s protection, the Dependent child is deprived of any yearned-for contact.  It remains isolated and despondently lonely.  This condition, discussed widely in the literature, is experienced by the client as an intolerable emptiness.  Hartocollis (1977) described it as a state of chronic boredom, “a sense of longing for something (or someone) that is not merely absent, but nonexistent. . .something that leaves one empty or hungry. . .hopeful in a helpless way” (p. 497).

The Tough Kid undertakes to protect the Dependent Child from these desolate feelings at all costs.  It uses depression or other psychological symptoms and character traits to hide them from awareness, chemical addictions to anesthetize them, or psychosomatic illnesses or behavioral addictions to distract from these feelings.  While the Dependent cChild harbors the feeling of desolate emptiness, it is the Tough Kid that retains the emotional memories of the early separation and protects itself, too, from the pain of these memories with additional methods (discussed in the treatment section of this article).

Revenge
Behind the Child’s detachment lie his unexpressed rage and abandonment grief.  Magid and McKelvey (1987,1988) wrote, “At the core of the unattached is a deep-seated rage.  This rage is suppressed in their psyche. . . .Incomprehensible pain is forever locked in their souls because of the abandonment they felt as infants” (p. 26).

The Tough Kid creates and maintains conflict with its mother, not only to find some outlet for this rage but also to fend her off and to defend itself from its own grief.  It engages its mother in open or hidden behaviors of withholding or spite.  According to Kohut (1972):
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The need for revenge for righting a wrong, for undoing the hurt by whatever means. . .and the unrelenting compulsion in the pursuit of these means. . .gives no rest to those who suffered a narcissistic injury. These are the characteristics of the phenomenon of narcissistic rage. . .and set it apart from other kinds of aggression. (p. 380).

A client described his wish for revenge as follows:

To lose my independence to you and not be wanted is the worst. Then I can't escape. I don't want to stay, but I can't leave. I am helpless because I can't take care of myself. I'm bitter and angry and want to hurt you to cover it all up--that I have no hope to ever be wanted

Detached and unable to look after his own physical needs, the unwanted child must have some control over the mother’s attention.  Lacking reliable attachment, he resorts to second best-contact through hostility.  He cannot make the mother love but can surely make her hate him.  Kirman (1989) wrote, “If we think about it, revenge is a way of holding onto the object while at the same time trying to get back at it.  One has not let go of something if one is planning revenge against it” (p. 90).

The child is not equipped to consider the consequences of his hostility, and these may turn out to be dreadful.  The mother, narcissistically predisposed or unable to tolerate her own anxiety, responds to the child’s hostility with additional punishment or withdrawal (Kohut, 1971).  In response, the child’s desire for revenge increases, leading to further escalation of the mother’s retaliatory responses.  A self-reinforcing loop of mutual punishment, withdrawal, and dislike, open or disguised (Figure 3), ensues.

This feeling/behavior complex becomes the primary emotional contact available to the child and therefore most viscerally significant to him.  A client eloquently described this situation when he said, “Hating is all I have left to keep going in the emptiness.  Giving up hate is like dying, the last piece that connects to life.”  Loneliness, punishment, and revenge become the essence of his attachment.  Rejection, hostility, and hate are the feelings he seeks and strives for, and he assures their availability through his attachment behavior.

Attachment Behavior

Attachment behavior has been defined as the class of behavioral systems aimed at maintaining contact with others, beginning with the mother.  According to Bowlby (1996), the inborn programming of attachment behavior is continuously shaped and modified through experience, and the individual differences in experience lead to different patterns of attachment behavior.  He wrote, “While especially evident during early childhood, attachment behavior is held to characterize human beings from cradle to grave” (Bowlby, 1977, p. 202). The evolving attachment behavior may be considered the early Child’s precursor to the script--the draft on which the script is elaborated--as the script (Berne, 1961) is “a complex set of transactions” that are “adaptations of infantile reactions and experiences” (p. 117).

The presence of attachment behavior in the unwanted child seems to contradict the principle of exclusion.  But the Tough Kid’s exclusion is one way.  The Tough Kid maintains the privilege of excluding its mother, yet its survival requires that it have the mother maintain the tie.  He accomplishes that task through the attachment behavior.

The following excerpt captures the uncovering, in a session, of the detachment, the exclusion and revenge, and the resulting attachment behavior.  The client--a professional woman of pleasant, though at the time vaguely irritating demeanor--had no close friends.  Her marriage was conflict ridden.  She was the mother of a young child, with whom she often struggled

Cl: I want my son to take care of me because I took care of him.  That’s what I did to my mother.  He doesn’t do  it.  I’m angry I do it (cries).  I never understood it before.  I have so much energy behind it when I get angry at him.  It makes sense it comes from something like that.  My mother didn’t yell at me because I caved in so much earlier.

Th:  Did you really cave in?

Cl:  I took care of her feelings on the surface.  On the other hand I didn’t because I just went underground.

Th:  Did you find ways to get back at her from underground?

Cl:  Sure.  I was very good at it.  There was nothing she could put her finger on, that she could tell me not to do.

Th:  And how did she get back at you for that?

Cl:  She. . .acted slightly wounded, so I had to take care of her some more.  Mostly it felt like she got back at me by never giving me what I wanted: the feeling of unconditional love.  After awhile it was hard to tell who was getting back at whom.  It became a way of being.

Th:  What way of being was that?

Cl:  I looked fine on the surface, except neither of us got what we wanted.  No real contact.  I can’t really remember strong feelings about it.  I was numb very early.  Just blank

These clients arrive at therapy with their attachment behavior at the ready.  Soon, as the therapist begins to become significant to the Dependent Child, the Tough Kid will activate the attachment behavior through transactional activities.  The client’s provocation may be open and frank but is more often hidden or disguised.  He is a master at ferreting out others’ vulnerabilities (or gimmicks) and turning these vulnerabilities into mutually tormenting game payoffs.  The more sophisticated players make the torment seem to be the victim’s fault.

In many cases, tormenting is the essence of the unwanted child’s racket or is masked behind a variety of roles, such as playing stupid, helpless, forgetful, confused, Woeful Wrongdoer, or Angry Righteous (Schiff et al., 1975).  Revenge is served by any of the full range of transactional analysis’s pathological transactional activities.


The Adult

Under normal circumstances the Adult evolves in the second year of life to modulate and channel the Child’s striving and impulses according to present reality.  Encountering its own emerging Adult, the Tough Kid assumes a stance toward it characterized by exclusion.  After all, why should the Adult ego state be any different from other adults in the Tough Kid’s’ life?  While excluding the Adult’s influence on it, the dominating Tough Kid may allow it to function in neutral, impersonal matters, but he makes sure to exclude it from the relationship field, both intrapsychic and interpersonal.

While excluding the Adult, the Tough Kid nevertheless exploits it by using it as a conduit through which its attachment behavior flows.  Thus, a client may seem fully rational while engaging the therapist in transactions characterized by blatant hostility (see Figure 4).

The Adult’s contamination by the Child is therefore of a special kind.  It is characterized not by the usual overlap of the Child’s feelings, thoughts, and beliefs from earlier times, but by exclusion, exploitation, and domination of the Adult by the Tough Kid.

Lacking proper Adult functioning, the Tough Kid develops tricks and rules to deal with the demands of the complex world.  But being only a developmentally arrested, splintered relic of early childhood, it is not equipped for proper Adult functioning.  Many tasks that can be accomplished easily by adults are either impossible for the unwanted child or require extraordinary effort.
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The Parent

No mention has been made so far of the Parent (P2) ego state because the split Child is fixated at an age earlier than the beginning of differentiation of the first-order Parent ego state.  As the unwanted child grows, his Parent differentiates according to the historical unfolding of the growing child’s relationship with his caretakers.  These relationships, characterized by the hostility-bound attachment behavior and dominated by the exclusion, define the later client’s Tough Kid intrapsychic relationship with its own Parent (see Figure 5).

Treatment

The structural distortions described earlier are constructed by the child to allow, as best he can, for the treatment of his psychic survival that was presented by the abandonment.  These structural rearrangements and their emotional and behavioral consequences become the life-restricting symptoms the client brings to therapy to resolve.  But because the structural distortions are occasioned by the detachment at the original abandonment, the need to maintain these structural modifications disappears when the basic flaw is mended—the result is cure.

The resolution of the basic flaw lies in the reversal of the emotional processes that led to the infant’s detachment.  As mentioned earlier (Bowlby, 1973), detachment ensues when closure to the abandonment cannot be obtained.  Because detachment is a defense against the intolerable pain of separation, the client must be helped to reenter that pain—with its feelings of rage, sadness,
helplessness, aloneness, and hopelessness—and to arrive at a closure to his abandonment through the verbal expression of those feelings, that is, by fully mourning his early abandonment.

When the basic flaw and the resulting split are mended, the client’s child will be able to, as it must, develop a trusting, dependent attachment with the therapist.  This attachment, if found reliable, will allow the newly integrated Child to acquire the stable internal representation (P1) it needs to safely launch its quest for healthy separation and individuation.

In essence, mending the basic flaw requires mourning, against which the client uses an array of defensive strategies.  It is the Tough Kid who holds the emotional memories that are to be mourned as well as the defenses against them, and it is the Tough Kid who will mourn when these defenses are resolved.  The attachment behavior provides the Tough Kid with a powerful defense against the feelings of grief by giving it an illusion of contact, thereby denying the reality of the separation.  Grieving is also rendered impossible by the presence of first- and second-order exclusions.  Like the infant during the original separation, the excluding Tough Kid is denied proper support for its mourning and is too young to mourn alone.  The Tough Kid also defends itself by sharing in the defenses (described earlier) that it uses to protect the Dependent Child from the feelings of desolation.  Of these defenses, Levin (1993) wrote:

One can’t mourn behind an addiction, a depression, or an acting-out defense.  Addiction, chemical and behavioral, deadens the feelings so that mourning work is impossible, however maudlinly the still-addicted patient might bewail his loss.  Depression similarly is in lieu of mourning—its pathological equivalent—while acting out diverts and takes away from the pain of separation.  Any symptom or characterological defense can serve as a defense against mourning, and that function of the symptom or characterological trait may render it resistant to treatment.  Better to be anxious, phobic, or compulsive than to feel the pain of loss. (p. 273)

Bern’s (1961) premise that patients have a functioning Adult that can be accessed and used therapeutically is a cornerstone of transactional analysis theory and practice.  But when the Tough Kid dominates, it determines the nature and extent of the Adult’s functioning.  At the beginning of treatment, the client’s Adult may be quite accessible; but as soon as the Dependent Child becomes interested in the therapist, the Tough Kid takes over.  It excludes the Adult, neutralizes the therapist’s influence, and, exploiting the therapist’s vulnerabilities, enlists him in the attachment behavior.  The client’s Adult, becoming merely a conduit through which the Tough Kid’s attachment behavior flows, is rendered useless as an ally to the therapist.  In the absence of an uncontaminated, observing Adult, the client is egosyntonic with the Tough Kid, and the client’s cooperation in the therapeutic endeavor abates.

This is when treatment begins.  The client’s attachment behavior should not be challenged but rather supported as a substitute for the missing therapeutic alliance.  But if the attachment behavior is to be kept, then the usual transactional analysis treatment techniques are contraindicated.  Games, rackets, and roles must be preserved to maintain the attachment behavior.  Attempts to decontaminate the Adult will only stimulate the Tough Kid to increase its resistance.  Redecision is premature in the absence of a sufficiently strong integrated Child.  Explanations, interpretations, and confrontations will fall on the Tough Kid’s deaf ears.  Positive stroking should be used selectively, and nurturing must be avoided, as it stimulates the Tough Kid’s opposition.  The therapist must assume a neutral stance.


Auxiliary Adult

Now that the Tough Kid has arrived at its optimal relationship with the therapist and is poised to render further therapy useless, the therapist introduces a new therapeutic element for which the Tough Kid is completely unprepared.  Bypassing the client’s existing Adult, the therapist calls on the client’s psychic resources to bring about a separate Adult entity.  Under the therapist’s supervision, this entity, Trojan-horse fashion, will, for the duration of the treatment, help resolve the Tough Kid’s defenses and will eventually support the Tough Kid’s grieving work.  The therapist disconnects himself from contact with the Child’s split parts and supervises the auxiliary Adult to provide the treatment in ways that the Tough Kid would never permit the therapist to attempt.

To bring forth the auxiliary Adult, the therapist demonstrates the Child’s split to the client and then assigns one chair each to the Tough Kid, the Dependent Child, and the contaminated Adult (TK, DC, and Ao in Figure 6).

A chair is then introduced for the new auxiliary Adult (Ax).  The client is told that, when in that seat, he will, with the therapist’s help, be the one to work with the Child’s two parts.  With this arrangement, the treatment shifts from the interpersonal to the intrapsychic.

The client’s auxiliary Adult is given two tasks.  First and foremost, it is to pay close attention to what is being said by either of the Child’s parts and every so often to repeat to that part what it had said.  Second, it is to deliver to either part any interventions proposed by the therapist.

The auxiliary Adult has had no involvement in the client’s history.  It meets the Child’s split parts for the first time and is not influenced by either Child part or by the Parent.  Its tasks are reality bound, in the present.  It is therefore wholly uncontaminated.  Initially it contains little energy—just enough to fulfill its limited therapeutic functions under the therapist’s directions.  As treatment advances, its allotment of psychic energy will increase, as will its function.

The therapist, the auxiliary Adult, and the Dependent Child are thus aligned with a common goal: to treat the Tough Kid, who is, for the first time, outnumbered (the Parent is not involved in the process).
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The Process

Each therapy session begins and ends with the client in his contaminated Adult (Ao) seat.  At the start of each session the client, in that seat, has ample opportunity to engage the therapist with his attachment behavior.  The therapist must be able to tolerate this often painful contact.  The therapist may also be accused of negligence, such as the client experienced at the hands of his early caretakers.  Without retaliating or withdrawing, the therapist assumes, for therapeutic purpose, that all the accusations against him are correct (Spotnitz, 1993) and fully investigates each accusation with the client (e.g., “How am I being bad, cold, uncaring, etc.?”).

At the first stage of treatment, the Tough Kid uses all the means at its disposal to reject the auxiliary Adult.  Its actions are reminiscent of those of an antibody trying to isolate, engulf, and destroy a foreign object. To all the Tough Kid’s maneuvers, the auxiliary Adult responds simply by restating the Tough Kid’s statements.  Here is an example:

TK: Why should I talk to you? You are a stupid stranger. Where were you when you were really needed?

Th: Switch over and respond.

Ax: You don't want to talk to me. I haven't been any good to you.

TK:  Yeah. . .yeah. I care about what happened with my mom and have nothing  left for anyone else, and if you see that, why would you want to have anything to do with me?

Ax:  You have no feelings for me, so I would not want to have anything to do with you.

The Tough Kid will accuse the auxiliary Adult, too, of the negligent behaviors the client experienced at the hands of his early caretakers.  Through questions suggested by the therapist these accusations, too, will be investigated by the auxiliary Adult.  The therapist will make sure to provide the auxiliary Adult with a steady supply of strokes for its performance to help fuel it with needed energy.

The Tough Kid will attempt to ensnare the auxiliary Adult in the attachment behavior.  To these attempts the auxiliary Adult just keeps repeating what the Tough Kid has said.  These repetitions have a profound effect.  Eissler (1958) wrote that the effect of such repetitions may be equivalent to interpretations.  Each successful restatement signifies to the Tough Kid that its assertions are understood and accepted, thus opening the way to the next, deeper level of expression.  The auxiliary Adult, sharing a common body with both of the Child’s split parts, is able to restate at a level of understanding deeper than the therapist could ever achieve.

In time, with the Tough Kid’s permission, the auxiliary Adult will make occasional contact with the Dependent Child and will continue the contact throughout the treatment.  This contact, too, must be devoid of nurturing or positive stroking.  As with the Tough Kid, the auxiliary Adult’s response will be limited to restatements.

Ax:  How are you?

DC: I feel needy and starved now.  There is no one warm to talk to.

Ax: You feel alone.

DC: Yes.  I want to be open and come out.  I don’t want him (TK) to sabotage my contacts with people and have them go away.  (To TK) You are entitled to be stubborn and sulk, but don’t make people feel terrible, awful, and suffer; you make them hate you and me.  I think you are really hurting and don’t know any other way to make them understand.  I’d rather you tell them and not do it. (Cries.)  I want very badly to make contact with Aaron (the therapist).

Contact with the Dependent Child accentuates the tension between the opposing interests of the Child’s two parts.  This tension provides the driving force to push the process forward to resolution.  Contact with the Dependent Child should be neither too frequent nor too long.  The proper treatment focuses on the Tough Kid, who is accustomed to being at the fore and will not object to attention that is directed at itself.

Given time, the passion in the Tough Kid’s hostility toward the auxiliary Adult subsides, and dependency wishes emerge.  Whereas the Dependent Child’s yearnings are directed toward the therapist, the Tough Kid begins to express longings for its mother and experiences the despair over her absence:

TK:  I wanted my mom to love me.  I don’t want to take any woman that I think is going to be in the way of my mom’s love.  It’s like a distraction, like going sideways.  I’ll have responsibilities and chores, and still I couldn’t solve my mom’s loving me.

Ax:  You don’t want to be distracted from wanting your mother.

TK:  All my frustration is there.  Everything else doesn’t touch it.  Sometimes I feel so crazy.  I want my mom to love me like it was.  I want to tell her everything, how weird everything is, how strange everything seems, how I can’t quite understand.  Always at the edge I can’t understand.  I miss my mom so bad, I want to die.  I want to go back for her.  I yearn for her.  I want it badly.  Nothing I can do does anything at all about it.

Ax:  You miss your mom badly.

TK:  I want to go back there. I missed her so bad.  I couldn’t tell anybody.  I keep wanting her, and yearning for this contact makes me worthless.

With the loosening of the attachment behavior, and with the Tough Kid’s increasing acceptance of the auxiliary Adult, the Tough Kid’s defenses against grief give way, and depression and despair ensue. “ It’s a black pool now, not being wanted.  Floating around. . .not even in any particular pain.  In a black pool, around and around. . .Valley of the dead.  To me it’s a horrible black.”

Given proper responsiveness by the auxiliary Adult through continuous paraphrasing, the depression is transformed into rage:  “I hate you. I hate all of you.  And you always have your reasons.  It all sounds good.  I feel hopeless and I hate you (cries)…I want to make you hurt for that.  You made me hurt, and I want to hurt you back.  I feel helpless with that.”

As the rage is supported by the auxiliary Adult, it eventually subsides and is followed, finally, by mourning:

TK: I don't please you, and I don't have any hope of pleasing. There is no closure to it but grief (cries deeply). A mismatch occurred and what happened to my love? There is no love for me. I lost touch. That grief is in me at the bottom with no place to go. It is there. Where other people have joy, I have grief (cries). I feel hurting in my chest (cries deeply). It's more bitter crying. "Look at the terrible thing that was done to me. You let me love you and you left me. You just threw me away. You got tired and gave up-just threw me away. I was too much for you, and you gave up." I feel helpless. I don't want to go on.

As the grieving progresses toward completion, these changes take place within each part of the ego state:

1. The Auxiliary Adult: Although the auxiliary Adult begins its role as a mere technician, it soon develops emotional responses to the Tough Kid while maintaining its independent observer's ego-dystonic stance. Annoyance is soon replaced by increasingly deeper understanding and empathy toward the Tough Kid. As the Tough Kid's hostility diminishes, the auxiliary Adult on its own initiative assumes increasing investment in the Tough Kid's process, fueled by a shift of psychic energy from the Tough Kid to the auxiliary Adult. This shift of energy is the start of what is to eventually result in the attainment of the integrated Adult described by Erskine (1998): "The healthy ego is one in which the Adult ego state. . .is in charge and has integrated (assimilated) archeopsychic and exteropsychic content and experiences" (p.19).

The auxiliary Adult's responses most often are on the mark. For example, to a quarrelsome utterance by the Tough Kid, the auxiliary Adult voluntarily responds,"I am watching over you. I feel calm. I am here and you can be as distant from me as you want." In response to the Tough Kid's expression of despair: "This is terrible stuff. You don't feel good with it. I feel sad for you." As grieving subsides, the auxiliary Adult, still uncontaminated, becomes sufficiently energized to take on full Adult function

2. The Tough Kid: As its attachment behavior subsides and grief ensues, the Tough Kid's own dependency needs emerge. It begins to show interest in the auxiliary Adult's caretaking potential. For example (TK to AX): "I need someone to lean on so badly. I want to play, explore, be curious, and find my heart. I want to be with you without the layer of worry about how long it's going to last. I feel needy. I want you to take charge of all these things."

The Tough Kid's exclusion of the auxiliary Adult at last collapses, leading to a full acceptance not only of the auxiliary Adult's presence but also its primacy.

TK:  I put you in charge.  I don’t feel I’m playing games with you.  Being in charge of me means that you run my life and leave room for me to be me as long as I am safe.  You are to do what needs to be done, step in when I need help [and] when I do something that’s not good for me.

Ax:  (At the therapist’s suggestion)  So far you’ve had much more energy than I.  Where will I get the energy so I can be fully effective?

TK: I  can give you all the energy I had in my fighting.  It sure was a lot of energy.  It’s tough to say I’ll give you that energy.  It’s tough to give it up.  I want to keep a little so I can say, “I don’t wanna.”  I want to keep enough of that so you could hear me.  I want to keep that reaction.  You can keep the rest.

Increasingly, the Tough Kid experiences the auxiliary Adult as caring, respectful, and affectionate, resulting in a crucial change in the Tough Kid's self-image and identity. Levin (1993) wrote, "The kind of self-love that makes possible a satisfactory and satisfying adult life is only possible if there are memory traces of being thought valuable, estimable, by somebody else: (p.84). As the Tough Kid incorporates these newly acquired feelings, its existential position shifts from the often-disguised "I'm not OK-You're not OK" to a frank "I'm OK-You're OK."

Eventually, the Tough Kid becomes indistinguishable from the Dependent Child, and the two are ready to merge. The merger should be negotiated between and initiated by the two split parts and not be an act of adapted compliance with perceived expectations from the therapist. The split is mended when the two finally merge.

3. The Contaminated Adult: As therapy advances and the Tough Kid's hostility toward the auxiliary Adult subsides, the contaminated Adult parallels this change in its way of relating to the therapist and therapy group members. The contaminated Adult continues to parallel the Tough Kid's evolution in its contacts, becoming softer, more direct, and self-disclosing, until, when the Tough Kid's mourning decays, no trace is left of the attachment behavior, and the contaminated Adult's contact becomes authentic and is accompanied by a deepening self-awareness. The changes culminate with the client, in the contaminated Adult's seat, entering into the same kind of dependent relationship with the therapist that the Tough Kid has entered into with the auxiliary Adult. A client who reached this stage reports:

Ac: I feel unusual. Never felt like this before. I can't describe how I feel. I can only describe what the feeling isn't. It's not that I lost or gave up anything. It's as if all the old strings are there somewhere, but they are loose, not tied together anymore. I don't know how it happened that I let you off the hook, but I did. I really feel very little, as if I don't really know anything. Yet I am sure I can function well outside. It's like I am not quite sure. . .I'd like to be held and rocked, but I don't need you actually to do it. I was always talking about whether you can be trusted. I don't think that anymore. It really doesn't matter to me

The Contaminated Adult, no longer corrupted by the Tough Kid's manipulations, now becomes a vehicle for the expression of the integrated Child's Natural Child longings and responses instead, while still carrying Parent (P2) contaminations.


Outcomes

• The Basic Flaw is resolved. The infant in the client's Child no longer excludes its early Parent (p1). The client therefore no longer experiences the desolate emptiness.

• The client’s integrated Child no longer excludes or dominates its Adult but is in a cooperatively dependent relationship with it instead.

• The client no longer acts out his old symptomatic defenses, namely, chemical and behavioral addictions, depression, and characterological traits.

• The client is no longer invested in the attachment behavior but can relate to intimates in an open, vulnerable manner and is able to recover from hurtful disappointments relatively easily.

• Finally, the client feels lovable and deserving. He is no longer an unwanted child.

Afterward

The client emerges from this treatment with his integrated Child developmentally at infancy and is prepared to revisit and complete subsequent unfinished developmental tasks.  The therapist helps the client’s Child meet its developmental tasks by offering proper responses to presented developmental issues.  Free of the unwanted child syndrome, the client welcomes and thrives on appropriate responses not only from the therapist and group members but also from others in his outside environment.

Remaining treatment is associated with post-infancy problems.  The Parent (P2) is reintroduced, and the usual transactional analysis strategies are used to decontaminate and neutralize its toxic influences.  As the decontamination of the contaminated Adult progresses, uncontaminated early Child components dissolve into the newly integrated Child, and its decontaminated Adult portions merge with the uncontaminated Adult, resulting in the auxiliary Adult being exclusively in the executive.

With that integration the client is cured, as the cause of his symptoms is permanently eradicated through fundamental changes in the structure and dynamics of his personality.


Conclusion

I call this modality treatment of the unwanted child rather than treatment of particular diagnoses.  Use of this treatment should be determined by the internal structural characteristics of the client, not by his diagnosis.

This is an intensive treatment, best provided at a frequency of one or more sessions a week.  Group membership is recommended to provide the client with needed strokes and with opportunities to vent hostility, as well as a place in which he can safely generalize achievements obtained in individual sessions.

This method should be considered an advanced technique to be attempted by experienced clinicians after it has been determined that the client indeed has the structural characteristics of the unwanted child and not a developmental fixation (such as in rapprochement) or a multiple-personality disorder.

The split in the child described in this article should not be mistaken for the defense of splitting as referred to in object-relations theory. According to the object-relations model, mourning is not possible before the splitting defense is relinquished and the depressive position has been worked through (Levin, 1993, p. 261). In the case of the unwanted child, mourning is accomplished by one part of the split Child to make the mending of the split possible. Not all clients using the classic splitting defense have the structural characteristic described here. Conversely, not all who possess these structural characteristics necessarily use the splitting defense.

I have used this treatment for about six years and have applied it at any given time to about a third of my clients. Its development is owed, with gratitude, to those clients who, despite frustrating, slow initial progress, nevertheless remained loyal to the mutual undertaking long enough to benefit from the results of the treatment they helped to develop.

Aaron Lederer is an ITAA Certified Transactional Analyst (clinical) in private practice in Chatham, New Jersey.  The author welcomes contact by clinicians whose interest is aroused by this article.  Please send reprint requests to: Aaron Lederer, 244 Main Street, Chatham, New Jersey 07928, USA


REFERENCES

Adler, G. (1985). Borderline psychopathology and it treatment. New York: Jason Aronson.
Balint, M. (1968).  The basic fault: Therapeutic aspects of regression.  London: Tavistock.
Berne, E. (1961).  Transactional analysis in psychotherapy: A systematic individual and social psychiatry.
     New York: Ballantine Books.
Bowlby, J. (1969).  Attachment and loss: Vol. 1. Attachment.  New York: Basic Books.
Bowlby, J. (1973).  Attachment and loss: Vol. 2. Separation: Anxiety and anger.  New York: Basic Books.
Bowlby, J. (1977).  The making and breaking of affectional bonds: II. Some principles of psychotherapy.
      British Journal of Psychiatry, 130, 421-43.1
Cassius, J.  (1980).  Horizons in bioenergetis: New dimensions in mind/body psychotherapy.
     Memphis, TN:  Promethean Publications.
Little, M.I. (1990).  Psychotic anxieties and containment: A personal record of analysis with Winnicott.
     Northvale, NJ: Jason Aronson.
Magid, K., & McKelvey, C.A. (1988). High risk: Children without conscience.
     New York: Bantam Books. (Original work published 1987).
Rinsely, D. B.  (1989).  Developmental pathogenesis and treatment of borderline and narcissistic
     personalities.  Northvale, NJ: Jason Aronson.
Schiff, J. L., with Schiff, A. W.; Mellor, K.; Schiff, E.; Schiff, S.; Richman, D.; Fishman, J.; Woltz, L.;
     Fishman, C.; and Momb, D. (1975) Cathexis reader: Transactional analysis treatment of psychosis.
     New York: Harper & Row.
Spotnitz, H.  (1993).  A theoretical outline of modern psychoanalysis. Unpublished manuscript.
Steiner, C. M. (1974).  Scripts people live: Transactional analysis of life scripts.  New York: Grove Press.

The Unwanted Child's Narcissistic Defense
by Aaron Lederer, NCPsyA

Abstract
In this article, the narcissistic defense is presented from the perspective of Spotnitz’s (1985) modern psychoanalysis, followed by a description of its second-order structural analysis correlate and a discussion of transactional analysis as a treatment to resolve this defense.
​
Clients suffering from disorders originating in infancy usually do not process their aggressive impulses properly.  This problem is referred to in psychoanalytic writings as the narcissistic defense.  A recent school of psychoanalysis, pioneered by Hyman Spotnitz, M.D. (1969/1985) and his associates in the 1950s and called “modern psychoanalysis,” considers the narcissistic defense to be the cause of, and its resolution the key to the cure of, the full range of pre-oedipal disorders, including schizophrenia. 

Freud (1913/1958) stipulated that in narcissistic disorders, the fixed hostility that develops makes analysis impossible.  Exasperated by their ability to thwart his therapeutic efforts, he once remarked, “Psychotics are a nuisance to psychoanalysis” (Freud cited in Federn, 1952, p. 136).  Indeed, until the early 1940s, there was no effective treatment for schizophrenia and other disturbances originating in infancy.

However, it has been increasingly recognized (Klein, 1935/1975; Rinsley, 1989) that many clients arrive at therapy with unresolved narcissistic fixations of varying degrees.  Fairbairn (1944/1952), for example, wrote that “a sufficiently deep analysis of the oedipus situation invariably reveals that it is built up around the figures of an internal exciting mother and an internal rejecting mother” (p.142), a state that developmentally precedes the depressive position in later infancy (Klein, 1935/1975).

In spite of Freud’s comment about psychotics, psychoanalytic theories and treatment for pre-oedipal disorders have been developing since the early 1940s.  These developments evolved into three schools: object relations, ego psychology, and self psychology.  Another psychoanalytic approach, so-called “modern psychoanalysis” (Spotnitz, 1969/1985), has been growing in a manner reminiscent of the rapid early expansion of transactional analysis and is, at present, being taught in institutes in major cities around the country.  Interest in modern psychoanalysis is seen in other countries, as well.

Central to modern psychoanalytic theory is the concept of the narcissistic defense.  In this article, the narcissistic defense is presented from the modern psychoanalytic perspective.  Then its structural analysis correlate is outlined, and illustrations from sessions are provided.  It is then proposed that the narcissistic defense is carried out by a part of the Child ego state the infant splits off in its quest to survive in its unfavorable environment and that the narcissistic defense is but a specialized function of that split part.  That split, the process that leads to it, and its consequences are described in my article, “The Unwanted Child” (Lederer, 1996).  In that article, transactional analysis treatment is proposed to correct the structural distortions the infant effected by the splitting, a correction that also resolves the narcissistic defense.


The Narcissistic Defense

The narcissistic defense concerns the proclivity of the client to attack his own self to spare others.  Spotnitz (1996/1985) stated that as early as 1948, Nunberg wrote about such a patient:  “In a similar situation the patient said, ‘It seems to me that I am to hit somebody, to tear out somebody’s hair.’ Thereupon he struck his own head with his fist and started to pull out his hair” (p. 48).  Margolis (1994) defined the narcissistic defense as follows:

A defense organized in the narcissistic phase of development by the deprived and frustrated child against his open expression of aggression by turning the aggression inward upon himself. He protects his mother but sacrifices his own ego in the process. (p. 180)

The consequence to the patient, Margolis wrote, is that “his entire character structure and his way of functioning have been organized around the need to maintain this position” (p. 180).  And “the narcissistic defense...is at the root of the narcissistic disorder, in whatever form” (p. 150).

According to Spotnitz (1976/1987): The child who tends to discharge frustration-aggression into his body, for example, is a likely candidate for psychosomatic illness later in life. The highway to depression is paved with frustration-aggression poured characteristically into the superego, which then attacks the ego. If the child does not discharge his impulsivity at all, but lets it accumulate in an emotionally impoverished ego, the corrosive effects of the mobilized frustration-aggression may fragment his ego and push him over the threshold into schizophrenia. This particular pattern of response to unfavorable environmental pressures is what I mean by the narcissistic defense (p. 101)

Accordingly, “Resolving the narcissistic defense and enabling the patient to express his aggressive feelings are major concerns of modern analysis.” (p. 181).  On the outcome of resolving the narcissistic defense, Spotnitz and Meadow (1976) wrote:

When a patient is able to feel his hate impulses rather than his anxiety about them, and when his resistance to discharging them is resolved, it is not the persons for whom he originally felt these destructive urges, but the person conducting treatment who is in the direct line of fire....The key to effective and mutually safe treatment is the activation of these emotional forces in the therapy situation...The more a patient feels his aggressive impulses and expresses them in words charged with genuine emotion, the more aware he becomes of his love impulses and the easier it is for him to act on them unobstructedly in healthful and socially constructive ways (p.42).

Spotnitz and Meadow added, "He also has to be helped to develop new patterns for controlling and regulating the discharge of these impulses" (p.43). Finally, "We need to recognize that the problem is not hate itself, but its expression in harmful ways." (p. 44).

From the preceding it is apparent that self-hatred and self-attack, rather than self-love, are considered by the modern analyst to be the nuclear problem requiring attention in the treatment with some leftover narcissistic fixations, and treatment with most patients begins with this assumption in mind.  As with the three schools mentioned earlier, modern psychoanalytic treatment usually requires many years.


Structural Analysis Correlate

The structural characteristics of the narcissistic defense can be discerned by understanding the function of defense.  Spotnitz (1976/1987, 1976) wrote that the purpose of defense in general is to “prevent the occurrence of some undesirable action through the self, by someone else, or by natural processes (p. 103).  Thus, by definition protective, a defense is parental in function, and its aim is to attend to the Child’s safety.

But since the narcissistic defense originates in infancy, before differentiation of the first-order Parent ego state, the parental function of that defense must reside within the Child ego state as a second-order P1 (see Figure 1) and fulfill a protective function for the infant in the Child (C1).  That function is to save C1 from consequences, perceived as catastrophic, of its impulse to attack the frustrating mother.  The impulse is transferred, probably by the Adult in the Child (A1), to a made-up Parent (P1) that has been split off (C1) and that, in turn, “safely” discharges the impulse back on C1, thereby sparing the mother.

Because the split occurs before the differentiation of either A2 or A2, neither is involved, thereby making the narcissistic defense ego-syntonic with the Child, outside Adult awareness or Parental influence.

Example 1
Keith is a 32 year-old college graduate, a manager at a financial services company.  He was raised by an alcoholic, detached mother and a distant, angry father.  He presented himself in treatment as polite, vaguely irritating, detached, and mechanical.  He was terrified of closeness and had not had any close relationships up to the time he entered therapy.  He revealed that he had been calling himself names and occasionally hitting and punching his own head.  There is no history of physical abuse in his family.

Th: You are telling me about a part that hits and a part that’s being hit.  Which would you like to work with first?

Keith : The part that hits. My head hurts.  I feel like I’m being hit.

Th: Put the hitting part on that chair and ask it to tell you about itself.

P1: (in a strong, angry voice): I’m so angry and upset.  All I want to do is hit myself because that’s all I deserve.  I want to punch myself and hit myself hard and call myself “Stupid!” “Jerk!” “Idiot!” over and over again.  I don’t deserve anything.  I can’t do anything right.  I’m just nothing.  I wish someone would hit me over and over again. That’s what I’m all about.  I’m so stupid.  I can’t get it out how I hate myself.  I’m doing stupid things and just want to stop myself.  I want to take a baseball bat and smack my head.  How nice it could be if I could do that.

Th: How did you get to where you want to hurt yourself?

P1: I get angry.  When I wasn’t taken care of, as soon as I got angry, that’s it.  Who would want to give to someone who is angry?  I remember the anger I felt.  The tense feelings.  But I didn’t have a chance.  I got angry and wanted to hit somebody and couldn’t hit them.  So I hit myself.  It’s easier to hate myself, turn on the anger at myself than to be angry at someone and risk losing them.

Th: Now move to that chair and be the part of you that’s being hit.

C1: I’m scared.  It hurts (cries).  He hits me because I do things wrong.  I don’t want to do anything, and he hits me.  I’m just here...helpless, needy, very scared because I don’t feel protected.  I don’t feel loved.  I don’t feel I can be.  I’m afraid.  I feel empty and alone, uncared for, sad, and the only thing I want is someone to take care of me.

During the month of the treatment described later in this article, Keith entered into a relationship with a woman of good prospect.  Problems surfaced in that relationship that paralleled treatment milestones and were resolved as treatment progressed.  The couple recently married.

Example 2
Gary, a 35-year-old scientist of some achievement, has a manner that is careful and deliberate.  His speech, sad sounding, has low energy.  His thinking tends to be circular.  Although committed to therapy, he feels hopeless about it.  His narcissistic defense revealed itself to be subtle, symbolic, and insidious.

Gary: I just feel...I want something, and when I feel that, I feel like there is a vacuum cleaner inside me waiting to be filled that sucks me in and keeps me from doing anything.  It’s as though a life force is sucked into the vacuum cleaner.  It sucks me in and all that will be left is a hollow shell at the bottom, completely hollow, with no energy at all.  The vacuum cleaner sucks in every fragment of life, any spark of life that’s left.  There doesn’t seem to be anything to change that.

Th: Put the vacuum cleaner on that chair and ask it to tell you about itself.

VC: I’m a vacuum cleaner inside Gary. I move all around, sucking out every bit of life.  These are little sparks I have to vacuum up, like weeds.  I don’t know what they are.   It’s very important not to let them grow wild, or all the brakes will be off, and then he’ll be open to all kinds of disasters.  If the growth gets too wild, it’ll be inconceivable.  I have to keep it very clean and spotless.  Nothing is going to take hold or grow wild.  That’s what I do

In its zeal to absorb all aggression, the split-off vacuum cleaner sweeps up indiscriminately any spark of impulsiveness or spontaneity.  Further work with the vacuum cleaner showed that is does not just contain the accumulated impulsivity but discharges it onto the other part through a stream of humiliating and contemptuous put-downs

Transactional analysts, versed in ego state theory and treatment, can immediately recognize the benefit of understanding the second-order structure of the narcissistic defense.


The Tough Kid

In my article “The Unwanted Child” (Lederer, 1996), which considers transactional analysis treatment for disorders that originate in infancy, I cite research showing that infants whose mothers are excessively frustrating or rejecting detach themselves from their mothers if closure to the infants’ deprived environment cannot be obtained (Bowlby, 1969, 1973; Federn, 1952).  I then stipulate that when such a detachment occurs, it is followed by an internal restructuring that begins with the infant’s excluding its internalized Mother (P1).  I call this exclusion a “basic flaw.”  In the absence of a reliable internal representation of Mother, the infant then splits psychically to produce a made-up substitute.

I further describe how the split (not the same as the splitting defense of object relations theory) bring about unintended, disastrous consequences for the person’s life, not the least of which include stunting subsequent growth and making close, loving relationships impossible.

This P1 substitute functions to protect C! from any possibility of disappointment that may repeat the original pain of separation.  Functionally, it surrounds C1, which I call the Dependent Child, and stands guard over it against any outside contact that has the potential for nurturing or intimacy.  It assumes the executive and excludes not only significant others but also the client’s own Adult from external and intrapsychic contact.

Behind various harmless guises that protective part is as hard as a rock, resolute and resourceful in its deflecting maneuvers.  I call this P1 substitute part the Tough Kid.  I show that both the Tough Kid (TK) and the Dependent Child (DC) (with TK’s permission) are available for contact through chair work.  Studies of the narcissistic defense in sessions reveal that it is but one among several specialized protective functions of the Tough Kid (see Figure 2).

However, the Tough Kid encompasses more than just protective functions.  While the Dependent Child is forever locked in desolate emptiness and loneliness, it is the Tough Kid that carries the intolerably painful emotional memories of the original loss, and it is the Tough Kid that must work these out in treatment.

​
Treatment

Understanding the narcissistic defense as a specialized protective function of the Tough Kid enlarges our perspective on treatment.  The aim of treatment becomes the mending of the “basic flaw.”  When that mending is accomplished, all the protective roles of the Tough Kid become superfluous.  The Tough Kid then rejoins the Dependent Child to return the Child ego to its original, integrated state.  The client can then begin his voyage through the respective, previously incomplete developmental stages toward healthy separation and individuation.

To bring about that mending, the Tough Kid must be helped to reenter the pain of the original separation and to give it full emotional and verbal expression.  The mending is accomplished when the original devastating loss and the agonizing feelings that accompany it are fully recalled, verbalized, and mourned.

But in its protective blocking-off, the Tough Kid makes it incredibly difficult for the therapist to work with it directly.  To bypass this obstacle, the therapist uses a part of the client’s own Adult, designated as the Auxiliary Adult (Ax), to work with both split parts under the therapist’s supervision, making the treatment mostly intrapsychic.  For a full understanding of the theory and treatment of the Tough Kid, the reader is urged to refer to my previous article (Lederer, 1996).

Soon after this treatment was initiated, Keith’s Tough Kid became aware of its role in the narcissistic defense:

TK: I didn’t know I was such a monster.  I feel good it’s out.  I didn’t understand it.  I thought it was all [hitting myself] me.  I feel like a monster.  It’s so right though that he [the Dependent Child] wants to get attention for doing things right instead of wrong.  I don’t know how to do that

A few sessions later rage emerges, directed first at the Auxiliary Adult:

TK: (to Ax): I want to say you are wrong and to fight with you.  I want to beat the shit out of you.  I want to punch you, hit you, scream at you, and throw you out of the fucking window!  I want to push, kick, scream, and punch.  I don’t fucking trust you.  I don’t trust anybody.  Nobody gives a fuck about me.  You don’t give a shit.  Where were you then?  Why are you concerned now?  You don’t care, just like everybody else.

Several sessions later, the Tough Kid’s rage begins to flow toward the original sources of frustration

TK: I'm furious. I want to tell my dad and my parent in general, "Why don't you help me, fucking assholes!" All I want to do is punch somebody. They didn't help me. They weren't there...fucking punch them!...slug them. I hate everybody, my parents, my sister, my brother, my mother-drunk! Look what they fucking did! They weren't there. Why didn't they take care of me! I want to fucking punch somebody. They didn't help me. This is a lot different from hitting myself. I have a headache. I'm still angry. I'm also sad.

Keith reports that he has stopped hitting himself but still attacks himself verbally. He experiences mounting sadness between sessions and frequent bouts of crying. In the sessions the Tough Kid's own dependency needs have emerged

TK: I feel so empty.  I remember wanting to be held and acknowledged and taken care of.
Keith’s Tough Kid is now in the throes of grieving, and in one of the early grieving sessions it indicates that it wants to discuss ceasing its verbal attacks on the Dependent Child.

TK (to Ax):    All I ever wanted was to be loved.  In the last two weeks I feel maybe you are the answer to that.  I’m too afraid of it (cries).  I also want to agree to not telling him [DC] he’s stupid to resist doing that.  If I stop telling him he’s stupid, we’ll get better.

Ax: Should you discuss it with him directly?

TK: I’m scared to, but yes.  (To DC): I can’t help myself (cries).  I just feel it’s [attacking you] the way it should be.

DC: I just want to be better.  I don’t want it to be that way.

TK: (Cries.)  It’s been four weeks that I haven’t hit you.  I try so hard to get better (cries).  I want to get better, too, but what’s going to happen to me?  If I can’t be the angry, interfering, holding-in part, I’ll crumble away.  The things I do give me shape, form, substance.  Without that, what am I going to be?  I’ll be nothing.  I’m not supposed to give up these things.  This is what I’m about.  I’m what Keith is.  I don’t know how to be different and let go.  How am I going to let go about my mother, my father, and my sister?  I’d love to be free.   I don’t know..it terrifies me.  I can see the end, but I don’t know how to get there.  I just want you to understand the struggle.  It’s a hard fight.

DC: I kind of don’t know what to tell you. I just wish you’d stop calling me names and putting me down.  I’m glad to see you are not going to call me names anymore.  I’m sure it’s going to cause you a lot of feelings.  Our goals are the same.  To make progress.  I want to say I was proud of you (cries).  I’m proud of all of us.  We’re making it...and that’s good.  We really are seeing the results.  I can’t imagine going back to not being real.  I’m happy and real.  I want you to keep coming here every week and talking it out.  It’s good.  I want you to get better.  We’re getting help. It’s a good thing.  You just keep talking.  It’s good that you said all this stuff. I’m glad you don’t want to call me names.  It’s hard for you.  You are taking out all your anger at me, and you need to let it out by talking.

TK: You understand.  You are smart and you know.  You are that part that knows things.  You are our feelers.  I bet you can help.

DC: How do you think I can help you?

TK: I don’t know how...just being there. You have good sense about things.  You could help me say things.  You are the confident part that knows. Everyone in the group seems to like us more. We’ll talk again. I like that.

DC: Yeah.  I like it, too. Thanks for the compliments.  Nothing is going to get in our way.

Keith no longer attacks himself. His narcissistic defense is resolved.  He is progressively getting better at expressing his dislikes directly to the sources. His work continues by investing his freed energies in furthering his mourning work.


Conclusion

The significance of the modern analytic view of the narcissistic defense and its implication for the etiology and treatment of the full range of narcissistic disorders should be noted and taken into account.  The purpose of this article is to point the transactional analyst’s attention toward the narcissistic defense, where his understanding in terms of ego state theory and treatment provides a considerable advantage.

The narcissistic defense resolves naturally during the restructuring work.

In my cited article (Lederer, 1996), I call the method of treatment described here treatment of the unwanted child rather than treatment of particular diagnoses.  I caution there that use of that treatment should be determined by the client’s structural characteristics, not by the diagnosis.  This treatment is considered intensive and works best when provided at a frequency of one or more sessions a week.  In addition, group membership is recommended to provide the client with a place to generalize the accomplishments obtained in individual sessions.

Finally, while the modern analyst sets his sights on the aggressive drive as the focus of treatment, the transactional analyst aims to facilitate the expression of mourning, toward which anger and hate are but a necessary step.

Aaron Lederer is a Certified Transactional Analyst (clinical) in private practice in Chatham, New Jersey. The author welcomes contact with clinicians whose interest is aroused by this article. Please send reprint requests to: Aaron Lederer, 244 Main Street, Chatham, New Jersey 07928, USA; home phone: (908) 903-9233; work phone: (201) 635-5215

​
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     New York: Basic Books.
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     In W. R. D. Fairbaim, Psychoanalytic studies of the personality (pp. 82-136). London: Routledge
     and Kegan Paul. (Original work published 1944)
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     psychological works of Sigmund Freud (Vol. 12 pp. 121-144). London: Hogarth Press. 
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     (2nd ed.).  New York: Human Sciences Press.  (Original work published in 1969).
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     character disorders. Northvale, NJ: Jason Aronson.  (Original work published in 1976).
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     Jason Aronson.

The Unwanted Child's Narcissistic Defense Revisited
by Aaron Lederer, NCPsyA

​Abstract
A recent article (Lederer, 1997) discusses a type of client referred to as the “Unwanted Child,” whose injury originated in infancy and who characteristically cannot discharge his aggression toward the source of the frustration.  Instead, these clients attack themselves, sometimes with dire consequences.  This phenomenon is known in the modern psychoanalytic literature as the “narcissistic defense.” This current article proposes that there is an important survival aim to the self-attack: to provide stimulation to the abandoned infant within (C1) and to keep it from deteriorating into marasmus and death.
In two recent papers (Lederer, 1996,1997), I discussed early structural adjustments and their resulting problems as well as proposed treatment for a type of client that makes up a large part of therapists’ practices.  Such clients, whom I refer to as the “Unwanted Child,” suffer from disorders that originated in infancy as a result of “environmental deficiencies” (Winnicott, 1948/1975)—that  is, deficiencies in early contact with mothers/caretakers. An analysis of this defense using transactional analysis theory and references to earlier studies of related developmental problems are contained in the 1996 article.

In my previous articles, I maintained that to account for the needed but insufficiently internalized mother image (P1), the infant psychically splits to create his own mother substitute, a psychic entity that looks after the infant in his exploratory phase.  The caretaking entity, or ego state, which I call the “Tough Kid,” envelops the deprived infant, which I call the “Dependent Child.”  In so doing, the Tough Kid isolates the Dependent Child from contact with others, especially those with the greatest potential for nurturing.  I further maintained (Lederer, 1997) that one of the consequences of the split is that the Dependent Child is unable to discharge its accumulated aggression.  Instead it transfers the aggression to the Tough Kid, who, for its own reasons, is also unable to discharge the aggression toward the source of frustration.  Instead, it discharges the aggression back onto the Dependent Child, thereby creating a self-reinforcing energy loop that modern psychoanalysts refer to as a “narcissistic defense.”

Since the publication of my two earlier papers, further investigation of the narcissistic defense has yielded new material that indicates a crucial survival value to the self-attack.  The Dependent Child, enveloped by the Tough Kid, is totally insulated from outside stimuli.  Its state is analogous to that of Spitz’s (1965) abandoned children:

In the absence of the libidinal object, both drives (libidinal and aggressive) are deprived of their target.  This is what happened to the infants affected with anaclitic depression.  Now the drives hang in mid-air, so to speak.   If we follow the fate of the aggressive drive, we find the infant turning aggression back onto himself, onto the only object remaining. . .Later these infants may actively attack themselves, banging their heads against the side of the cot, hitting their heads with their fists, tearing their hair out by the fistful.  If the deprivation becomes total, the condition turns into hospitalism; deterioration progresses inexorably, leading to marasmus and death. (p. 286)

Largely based on Spitz’s finding, Berne (1964) developed his idea of stimulus hunger, summarized by the colloquialism,“If you are not stroked, your spinal cord will shrivel up” (p. 14).  He maintained that negative strokes will do in the absence of positive ones and are preferred to the deadening state of no strokes.

Client material indicates that the self-attack provides stimulation to the otherwise despondent Dependent Child in an attempt to put off marasmus and death.

In one such case, a client who, when alone, had the habit of cursing and hitting herself, was asked, “What will happen if you don’t attack yourself during this session?” She began to cry and answered

Then I’m all exposed.  Oh, my God. I’m not protected.  Where will I. . .I’ll be all alone, with no one there to protect me.  There is comfort in hitting, in attacking myself.  I can’t live without it.  I’ll burn out if it’s not here, At least then there is someone there.  I have to keep talking so I won’t attack myself. [Lightly taps her fist on her forehead.] I just attacked myself.  I tried. . .this is hard

After a period of treatment according to my (Lederer, 1996) prescription, the client, having acquired the ability to externalize her rage (primarily toward the therapist), gradually reduced her self-attacks.   In a session in which her Dependent Child (C1) was interviewed, it responded to an inquiry as follows:

C1: I feel needy. I want some contact. That's what it feels now. I feel shaky [both legs are agitated, her knees bouncing up and down at an increasingly violent rate]. I have a lot of energy. I feel deprived, jittery. I need to be rocked and calmed down.

Then:

C1: I want to be hit.  It’s the nervous energy I have, a baby not being picked up; that’s how I feel, that emptiness that says, “Hold me.”  I feel the rush [agitation increases], and I could kill; I could kill somebody for not getting what I want.  That’s what I feel right now—that I want to kill somebody for not holding me when I’m not being hit.

Here the Dependent Child feels the intolerable emptiness in the absence of the self-attacks. Its hopeless yearning for proper nurturing immediately evokes the impulse to be hit. In a subsequent session the Dependent Child asked:

C1: If nobody slugs me, how am I going to get attention? If nobody hits me, and I'm not in pain, I can't get attention for just being there.

In another session:

C1: I get nothing. I'm all alone. I feel all exposed. I wish you'd just beat the crap out of me. It's better than nothing. No one cares. I'll wake up and feel the same tomorrow. Nothing I say or do matters. No one cares; no one reacts.

In yet another session:

C1: I'm not getting anything. I'm not getting attacked, I'm not getting loved, I get nothing. I feel like saying, "Here I am, where are you?" I am here [cries].

She continues:

C1: I have very little energy. No one can reach me. I'm sitting on the floor in my room, sitting and staring, just waiting. When will I be found? Sitting and staring. I feel numb. I feel numb.

​Finally, after weeks of largely abstaining from self-attack:

C1: There is jus a little of me over there. I don't matter. I feel like going to sleep. I wish I'd sleep forever.

Then immediately:

C1: I'm no good anyway. I'm just stupid, dumb, an ass. I keep dreaming someone beats me up with a baseball bat.

Here in the absence of the Tough Kid 's attack, marasmus threatens the Dependent Child. To ward off that threat, the Dependent Child stimulates itself, conjuring up being attacked in its imagination and dreams.


Discussion

Adding these new findings to the other characteristics of the Dependent Child/Tough Kid dilemmas discussed earlier (Lederer 1996, 1997), the following overall picture emerges:

The Dependent Child, fixated at infancy, is encapsulated by its “caretaking” Tough Kid and isolated from any contact.  The Dependent Child’s situation becomes analogous to that of the abandoned infants of Spitz’s studies.  As with these infants, the Dependent Child cannot discharge its aggression toward the source of deprivation.  Instead it transfers its aggression to the Tough Kid, which, in turn, discharges the aggression onto the Dependent Child.  This discharge causes pain, if not more serious injury, such as psychosomatic illness, depression, or schizophrenia (Spotnitz, 1985).  Whatever the cost, however, the Tough Kid’s attacks save the Dependent Child from the onset of marasmus and death by virtue of the vigorous stimulation the attacks provide.  Repeatedly, interviews with the Dependent Child of various clients show the Tough Kid’s attacks coincide with the depth of the Dependent Child’s despair; consequently, the Tough Kid provides the Dependent Child with stimuli analogous to nurturing on demand.

I have shown (Lederer, 1996) that the Tough Kid uses some additional means to help lessen the Dependent Child’s desolate emptiness.  The Touch Kid anesthetizes the Dependent Child with drugs and/or distracts it with behavioral addictions, such as compulsive eating, shopping, gambling, work, sex, or other dangerous or exciting activities.


Implications for Treatment

The Unwanted Child arrives at treatment with the following symptoms: The patient is detached, that is, he treats the therapist, at best, as if the therapist were merely a professional, or, at worst, as if the therapist were a nonentity. The client is behaviorally or chemically addicted. He tends to attack himself by milder means, such as biting cuticles, pulling out hair, scratching open a scab, or cursing himself or by harsher means, such as cutting or punching himself (sometimes with the aid of objects such as a paperweight or a telephone) or banging his head against a wall or furniture. Less overt attacks include the client’s assaulting his body with psychosomatic illness, his feelings with depression, or his mind with schizophrenia (Spotnitz, 1985).

These symptoms are provided as a service by the Tough Kid on behalf of the Dependent Child’s psychic survival, and as such, must be maintained and supported until better means are developed to serve the Dependent Child’s needs. Instead of trying to alleviate these symptoms, the therapist must first attend to what I call the basic flaw (Lederer, 1997). This approach involves reversing the original detachment that led to the splitting. When that goal is accomplished and the split is mended, the reintegrated Dependent Child/Tough Kid composite (C1) will be able to accept nurturing from the outside, beginning with the therapist (Lederer, 1996). The client can then voluntarily resolve the physical components of addiction and let go of symptoms that are no longer needed.

Aaron Lederer is an ITAA Certified Transactional Analyst (clinical) in private practice in Chatham, New Jersey.  He is also a certified modern psychoanalyst and is on the faculty of the New Jersey Center for Modern Psychoanalysis.  The author welcomes contact from those whose interest is aroused by this article.  Please send reprint requests to Aaron Lederer, 244 Main Street, Chatham, New Jersey 07928, USA.


REFERENCES

Berne, E. (1964). Games people play: The psychology of human relationships
     New York: Grove Press.
Lederer, A. (1996).  The unwanted child.  Transactional Analysis Journal
     26, 138-150.
Lederer, A (1997).  The unwanted child’s narcissistic defense
     Transactional Analysis Journal, 27, 256-271.
Spitz, R.A. (1965) The first three years of life: A psychoanalytic study of normal and
     deviant development of object relations  New York: International Universities Press.
Spotnitz, H. (1985). Modern psychoanalysis of the schizophrenic patient.
     New York: Human Sciences Press.
Winnicott, D. W. (1975).  Paediatrics and psychiatry. In D. W. Winnicott,
     Collected papers: Through paediatrics to psycho-analysis (pp. 157-173).
     New York: Basic Books. (Original work published 1948).

On the Failure to Attach
by Aaron Lederer, NCPsyA

I was three-years-old when my small family was ambushed by a band of Arabs. My father was killed, and my mother was carried away to a hospital and was not to return for years.  Having physically survived, I was sent to a nearby kibbutz for foster care and was placed with a group of children my age.  Everyone was sympathetic and kind, but I would not be consoled. My world had ended: I had lost my beloved father and mother, and nothing mattered to me.  I was alone in the world.  I mimicked the other kids as I went through the motions of day-to-day living, but, afraid and alienated, I felt estranged from everyone around me.

Three years later, when my mother came back for me, it was too late.  She, too, meant nothing to me.  She was just another person with whom I obediently went to live a different, but equally meaningless, life.  I was still terrified and alone, with no one to confide in.  I tried my best to pretend I was just like other kids, but I wasn’t.  I was so handicapped by my fear and isolation that during grade school I was thought to be retarded, so after the eighth grade I was taken out of school and put to work.

As an adult, I continued to pretend normalcy. With great effort I was able to catch up on my schooling, and obtain a higher education.  I married but was unable to sustain the marriage and a few years later divorced, leaving behind two wonderful sons. In deep despair, I entered psychotherapy and overcame the terrible effects of my unfortunate past.  I remarried and, finally able to function at full capacity, have been leading a good, decent, and productive life since.

During therapy, I became fascinated by the workings of the mind.  I took the necessary training, became a therapist, and devoted the next 25 years, perhaps not surprisingly, to studying and treating the effects on the child of abandonment at infancy.  I soon discovered to my astonishment that, dramatic as my case was, I was luckier than countless millions who, with seemingly less traumatic histories, suffered from the same condition but were injured far more seriously and had no effective therapy to help them.

What made their experiences different and their prospects so hopeless?  They all were injured in their infancy.  I was already three years old at abandonment, and this was a great advantage.


Attachment Deficit

Emotional injury in the first three years can occur as a result of obvious situations.  Here are examples drawn from the early lives of some of my patients:

• One man, as an infant, was separated from his mother and hospitalized for three weeks when he was 11 months old. His mother was allowed only at visiting time.

• One woman was born to an alcoholic, uninterested mother.

• Another woman’s mother lost her husband just before she gave birth and, in her grief, kept her baby emotionally at arm’s length.

• A man born prematurely was placed in an incubator for several weeks.

• One woman was born to a mother overwhelmed with many other small children and a chronically ill, out-of work husband.

​​Not all babies necessarily become damaged because of these kinds of deprivations; we only know of the many who do.  But it doesn’t necessarily take catastrophes to cause permanent emotional injury.  As you will soon read, many suffer even when everything seems to be fine.

Researchers in human attachment who surveyed the American population have found that as many as 40 percent exhibit “insecure attachment style”; that is, they are unable to attain a secure attachment with anyone.  For the sake of convenience, I have been calling this inability “attachment deficit.”  Little known and largely unrecognized by the therapeutic community, attachment deficit is a problem of epidemic proportion in our present culture.

More than half of those with attachment deficit have “avoidant attachment style;” that is, they are uncomfortable being close to others and find it difficult to trust them.  Their overriding world view can be summarized as:  “I don’t need anyone; I can do it all myself!”  The others exhibit “ambivalent attachment style.”  They see other people as being reluctant to get close, are worried that others don’t really care about them, and are often viewed by others as clingy and manipulative.  Their lament is, “nobody cares about me.”

A teenage girl with attachment deficit once said to me, “I don’t like depending or being beholden to anybody.  I can’t believe people enjoy me and my company. I always feel that I’m a burden.”

People with attachment deficit feel unloved and uncared for and believe they are unlovable.  By contrast, those with secure attachment are comfortable depending on others, find it easy to trust and get close to others, and have a strong sense that they belong with others and with their communities.

Adults with attachment deficit may have serious marriage problems, feel empty and lonely, have problem kids, and grapple with other family troubles.  In addition, many also suffer from substance abuse, behavioral addictions, eating disorders, anxiety, and depression.  Some become antisocial; in extreme cases, they may commit violent crimes or even become serial killers. 

Children with secure attachment style are motivated to belong and to cooperate because they want their parents’ approval and are willing to do what is expected of them to receive it. But those with attachment deficit, already feeling unloved and unlovable, have nothing to lose by displeasing parents and other authority figures.  They manifest their attachment deficit in disturbing behaviors, ranging from lethargy to hyperactivity or from clinginess to reclusiveness.  Many are defiant and oppositional, and some are truly uncontrollable and destructive.  These children are often diagnosed as hyperactive, manic-depressive, impulsive, oppositional, or with attention deficit disorder and are medicated to make their behaviors more manageable.  Meanwhile, their core problem attachment deficit remains unknown and goes untreated.

In spite of the enormous number of people affected by this condition and the substantial amount of available research, little is known about attachment deficit among either the general public or the therapeutic community.  Consequently, this condition is usually misdiagnosed and improperly treated.


The Detachment

Almost everyone has heard of the Romanian Orphans Syndrome, the wasting away of infants as a result of insufficient human contact.  This syndrome was not new to researchers.  Dr. Rene Spitz, a noted European early child psychiatrist, found that many infants in orphanages, who also lacked sufficient human contact, eventually wasted away and died.  The “illness” these dying babies suffered from was called marasmus.  A later researcher, Dr. John Bowlby, who dedicated his life’s work to the study of attachment in children, observed, in the 40s, toddlers in English hospitals who were left there for a week or more without their mothers.  He found that many lost all interest in people and became concentrated on sweets and toys instead.  Many of those who did seem friendly toward the medical staff barely acknowledged their mothers upon their mothers’ return--a lack of interest that too often proved permanent.

A dramatic example of such detachment is the case of Ted Kaczynski, the so-called Unabomber.  In an interview, Wanda Kaczynski, the Unabomber’s mother, discussed what she thought was the source of her son’s troubles:

​

INTERVIEWER:  How did this all begin?

MRS. KACZYNSKI:  I used to pick him up out of the crib and he would be bouncing around and he would nuzzle his head in my neck and chortle and gurgle and pull my hair.  He was a bundle of joy.

VOICE OVER:   But when Ted was nine months old, he suffered a painful and dangerous case of hives.  He was hospitalized for a week.

MRS. KACZYNSKI:  In those days they did not allow you to stay with your child.  I remember how he’d grab the bars of the crib in this hospital, and he’d scream and hold out his arms and I’d have to go out the door.  When I finally came back to take him home, what they handed me was not this bounding, joyous baby, but a little rag doll that looked at me, that was slumped over, was completely limp.

VOICE OVER:  Wanda feels that marked the beginning of a lifelong pattern of withdrawal for Ted, a pattern that continued after David was born when Ted was seven.  She remembers Ted as apart, aloof, alone.

INTERVIEWER:  Wasn’t he always going upstairs and closing the door?

MRS. KACZYNSKI:  Yes. And if he heard cars driving up he’d say, “Oh, there is so and so.”  He’d say, “Don’t call me down.  I don’t want to see them.”  He’d go upstairs.

INTERVIEWER: Some of your neighbors have said that they can’t remember that he ever smiled or that he ever laughed.

MRS. KACZYNSKI: Yes, this is true.  He became a very sober sort of child.

The Importance of “Tuning in”

Some of my attachment deficit patients had histories of early abandonments, but many didn’t seem to have an obvious reason for these symptoms.  From the life stories my patients and their families recounted to me, I found that infants often detach from their mothers for subtler reasons: Even if the mother is physically available, the quality of her contact with her infant determines the degree of the infant’s attachment.  A necessary requisite for the infant to securely attach is for the mother to be emotionally available and in tune with the infant.  I am reminded of a mother’s story about being in the shower when she heard her baby girl crying.  The mother soon finished her shower, but by the time she went to the baby, she found her lying silently in her crib with her head turned toward the wall.  Only after some coaxing did the baby become responsive to her again.

From my research and from working with patients, I’ve concluded that each incident of lack of attunement by the mother leads to a bit of temporary detachment by the infant.  An accumulation of these experiences, day in and day out, can lead to a permanent rift.

When the infant detaches from the mother, it doesn’t mean that the mother has ceased to exist for it; the infant is still dependent on the mother for its physical survival.  But once detached, the infant takes its mother for granted and exploits her for its own needs without returning to her much in the way of recognition, affection, or cooperation.  The loving bond is gone; it’s a business deal now.


The Consequences of Detachment

Detachment presents a special problem for the growing infant.  Normally, when infants begin to move away from their mothers, what makes it possible for them to remain away for a while is their growing ability to remember or internalize the mother.  At first, this memory soon begins to fade.  Infants then turn around and rush back to their mothers to “refuel” before venturing out again.  In time, toddlers attain the ability to remember their mothers permanently (this ability is called “object constancy” in psychoanalysis) and can tolerate being away from her for longer and longer periods without undue anxiety.

But the detached infant has not had the chance to internalize the mother. When the mother is out of sight, she is out mind.  So, without having the memory of the mother’s presence, how can the child feel secure enough to begin to move away from her and explore the world?  Insecurely attached toddlers solve this problem in one of two ways:  In the first, they decide, “I don’t need her; I can do it all by myself,” and substituting themselves for the mother, proceed to explore the environment on their own.  These avoidantly attached toddlers must be watched closely, as they are liable to wander, unaware, into dangerous situations or walk away with strangers without even glancing back toward their mothers.  In the second strategy, toddlers cling and whine and refuse to move away from their mothers.  Because of the mothers’ negative reactions to either of these responses, these toddlers form a worldview that they maintain for life that nobody cares for them.  Hence, the pleading motto of the ambivalently attached adult: “Why don’t you love me?”

It is quite common today for many mothers to be absent for long periods of time during the first three years of their children’s lives.  Some mothers put their careers or their personal fulfillment first, while others may have to go to work to help sustain the family, leaving their children with other caregivers.  Whether the absence is necessary and justified or not makes, of course, absolutely no difference to the abandoned infant.  A troubled teen, defiant, uncooperative, friendless, and expelled from school after school, whose mother was away from him for too long for the sake of family survival, and a troubled teen whose mother was away getting beauty treatments, are no different when I see them in my office years later.

But many mothers who do stay with their infants are unable to be sufficiently in tune with them for a variety of reasons.  If there is another baby very close in age, the mother may subconsciously or consciously feel she can attach to only one.  The one she doesn’t choose has a mother who has emotionally abandoned him.  (Of course, when babies are born close together in age, the mother can be aware of this potential pitfall, overcome it, and successfully bond with both the older and younger infant.  The same applies to all the potential pitfalls described in this article.)

Mothers may suffer from postpartum depression or from mental illness, have drug or alcohol addictions, be trapped in harmful marriages, or suffer attachment deficit themselves.  Some failures in attunement may not be the mother’s fault: the infant may suffer from colic or have other painful medical problems or the mother is simply a poor match, having a temperament that is so different from that of the baby.  

Both the self-sufficient toddlers with avoidant attachment style and the clingy ones with ambivalent attachment style grow up to suffer the terrible consequence of detachment from the mother.  Because they failed to internalize their mothers, these infants are left with a void where there should be a sense of their mother’s presence.  The child (and, later, the adult) experiences this void as an intolerable emptiness.  Children soon become compelled to distract themselves from this terrible emptiness by engaging in behaviors that cause great difficulties for those around them, behaviors that often lead to diagnoses of oppositional defiant disorder (ODD), reactive attachment disorder (RAD), and sometimes, erroneously, attention deficit, hyperactivity disorder (ADHD), bipolar disorder, and anxiety, for which they are medicated, often to no avail in the long run.

When these children grow up, the gaping sense of emptiness remains, but they now have a varied way to avoid, distract themselves from, or fill up that void temporarily by medicating themselves with alcohol and other drugs or by engaging in compulsive, self-destructive behaviors.  At the very extreme, some with attachment deficit turn to the distracting excitement of crime or violence.


Six Things All Babies Need

For newborns looking out from their hospital cribs, life has no limits; all things are possible.  But it’s up to their parents to make that happen.  Whether they know it or not, these parents are looking at the chance of a lifetime, a short three-year opportunity to help their babies gain a foundation that will enable them to reach their potential.  Child development and psychological researchers all agree that the first three years of life are the most crucial and that, unless children are given the right kind of experiences at this young age, they will never be able to make the most out of life.  First and most important is for babies to experience the kind of reliable dependency that will enable them to be securely attached; they need to have as strong a bond as possible with one person--the mother.  To accomplish such bonding, babies need six things.

Continuity of experience.  The baby was carried in the mother’s womb and knows the sound and feel of her voice, her body.  If it continues to be cared for properly by the same person until reaching the age of three, when object constancy has been attained, the child will have gained the foundation of reliable dependency from which to begin healthy separation from the mother.  A break in the baby’s continuity of experience, through a surrogate caregiver, for example, will be experienced by the baby as abandonment and can have grave consequences.

Attunement:  Attunement is the ability to sense the inner life of the baby, to experience what they baby experiences, and to respond to the baby accordingly.  Mothers usually have the desire to “be with” or to “join in,” sharing in the baby’s joy, sadness, or discomfort.  When a mother is able to do that, the baby feels complete.  But when attunement is missing, the baby feels alone and uncared for.  Being in tune with a baby is an act of true sacrifice, a sacrifice most mothers are happy to make.  Many mothers, however, are either not willing or not capable of making this sacrifice, as terrible as the consequences to the baby can be.

Touch:  Although it seems like a simple thing, touch is critical to a child’s development.  For a baby who doesn’t yet understand language, touch is how if first knows it exists, that it’s wanted and loved.  Touch is a source of comfort and reassurance in a strange environment.  The baby needs to be held and rocked and talked to and looked at when fed.  It has been scientifically proved again and again that touch helps premature infants grow faster, become calmer, and develop better.  Babies who are massaged daily develop movement early, sleep more soundly, and are less likely to suffer from colic.  Without sufficient touch, children can’t develop properly.

A stable environment:  A stable environment gives the baby the emotional security it needs, especially when it begins to explore.  Stability is accomplished by minimizing change in routine and in the physical arrangements.  It is also accomplished by having a stable emotional climate at home; that is, no scary outbursts of rage or violent fighting among family members and no extreme noises or movements.

Admiration:  T. Berry Brazelton, M.D., a renowned Harvard psychiatrist, said, “I always can tell by eight months which kids expect to succeed and which ones expect to fail.  The ones that expect to fail never hear ‘You’re great! That was wonderful!’ They already have problems like learning or others disabilities.”  The baby needs to see admiration in his mother’s eyes and to hear it in her voice.  Admiration is so important that those who didn’t receive enough of it as infants yearn for it and seek it for the rest of their lives, sometimes in unhealthy ways.  But those who received enough of it, early enough, grow to feel good about themselves and the attitude of others toward them.

Interaction:  The baby isn’t able to communicate verbally, but communication with its environment begins even before birth.  The mother, in advanced pregnancy, can tell the fetus’s mood, and the fetus’s movements often are a reflection of the mother’s mood.  After birth, the baby is able to communicate its states of mind by different kinds of crying, by smiling, or by gurgling, all signals for the mother to understand and respond to.  The mother also, naturally and instinctively, mirrors the baby’s states of mind; thus, by looking at the mother’s face, the baby discovers who he is.


What’s A Mother To Do?

Some researchers have called the urge to have a baby a form of temporary insanity.  The mother must WANT to sacrifice her own needs in favor of the baby’s!  And, as every mother knows, those needs can be overwhelming.

There are optimal conditions under which proper bonding is likely to take place.

The baby should be born to a man and a woman who are fully committed to the marriage and who have had good parenting role models themselves.  Their home must be a home where it is safe to bring the baby.  And ideally, there is a supportive and helpful bunch of relatives, friends, and/or neighbors who provide a safety net in hard times.  The mother must be a permanent presence for the first three years,  no substitute, except occasionally, when necessary.  Even the father cannot replace the mother for a baby.

A baby born to a mother who doesn’t meet some of these requisites is at a risk of joining those 40 percent with attachment deficit.

Of course, it is not always possible for the mother to provide for all the baby’s needs, as when the mother becomes ill.  In such cases, a best substitute should be attempted, such as a willing grandmother or a loving attendant in a day care center, keeping in mind that the baby is at risk, even with the best substitute.  A substitute would be preferable also in cases where the mother is chronically uninterested, depressed, addicted, or too self-centered and immature to put another human being first.

Some mothers fear that if they are too attentive to the baby, the baby will become spoiled.  This could not be further from the truth.  Starting with Dr. John Bowlby, it has been accepted that children become spoiled or overly dependent not because their wants were catered to but because of anxiety over the accessibility and responsiveness of an inconsistent caregiver.


Conclusion

If parents would be aware of the long-term repercussions of their actions, especially during the first three years of their baby’s life, they could save themselves much grief in later years.  Here are quotes from the words of mothers of two patients of mine:

“When we found out I was pregnant, we bought a house so we would have more room.  The mortgage was a big pressure, so I said I would go to work for just one year.  When Sara was born, I knew that in six weeks I would start a new full-time job with a long commute.  Therefore I sort of warned myself, ‘Don’t get too attached.’ Now she is 16 years old, the money I earned is long gone, but I have a commute again.  I’m bringing Sara to you for therapy, trying to undo the effects of my absence.  For the first six weeks, I was emotionally absent, and then for a full year I was absent in every way.  How I regret my foolishness!  If only I had known, we could have stayed in the small apartment!”

And this from the mother of another patient of mine:

“It was the opportunity of a lifetime: two free tickets to Paris, all expenses paid, for two weeks.  The only problem was our 10-month–old son.  My son and I were very close, as a matter of fact; I was still nursing him twice a day.  But my husband convinced me we should go and leave him with either one of two willing and loving grandmothers.  “He’s almost done nursing, anyway!,” and “It’s only two weeks!,” and “Think he can’t survive without you?,” and finally I succumbed.  I cried a lot on the plane but soon snapped out of it and actually enjoyed myself some.  But the worst part was that my little boy was angry at me when we came back and stayed angry for so long I don’t even know when or if he’ll ever forgave me.  He is 30 years old now but unable to relate to people.  Marriage is about as viable a possibility for him as a moonwalk.”

Two weeks or two months, even a year, are brief period of time for an adult who reads clocks and calendars.  But adults need to bear in mind that it is quite different for a baby.  Decisions regarding mother-baby separation during the first three years of life must never be made lightly but rather with consideration of possible long-term consequences.

At every seminar I conduct on attachment deficit, someone, invariably a woman, stands up and asks, “So how long can a mother safely be away from her baby every day? Three hours? Four? A half-hour?”  She tries to pin me down to a specific length of time, some formula which will provide some freedom for the mother while guaranteeing immunity to the baby.  My answer, which is usually less than satisfactory to the questioner, is, “A properly attuned mother will know how long is too long.”

Aaron Lederer is a psychoanalyst and transactional analyst. He is the director of The RAD Consultancy, LLC, a group of therapists advising mothers, nationwide, how to repair the defective attachment of their difficult, antisocial children and allow them to blossom. He has two children and four grandchildren and lives with his wife in Gillette, New Jersey. For more information, contact Aaron Lederer at [email protected].