Back in the Day: Child Psychoanalytic Emphases in the Yale Longitudinal Study Psychotherapy of “Nancy Miles”
As Linda Mayes and Stephen Lassonde have pointed out in the Introduction, the zeal of the investigators involved in the Yale Longitudinal Study far outweighed their research skills. In this regard their courageous explorations were more analogous to the Lewis and Clark expedition to explore the Pacific West 145 years earlier than they were to man’s landing on the moon twenty years later. But the study has also never been replicated. And by taking the psychoanalytic psychotherapy of “Nancy Miles” as a manageable sample of the data, we can arrive at a new appreciation of the role of siblings and families in the shaping of a child’s development.
“Nancy” was the firstborn daughter of a fractious couple with the surname “Miles.”1 Nancy was offered psychotherapy by an experienced child analyst whom I shall call “Molly” at a frequency that varied between weekly and biweekly over a seven-month period. I would categorize the treatment contact as largely psychodynamic with bits of a cognitive/behavioral approach thrown in. As is the case in everyday human communications, much of the impact of an analysis is based on nonverbal factors. All told, these factors add up to a series of connective emotional experiences that attempt to rework, interpsychically and intrapsychically (that is, both interpersonally and internally), deficient and defective object relations. This model of therapeutic action was based, in a manner that appears now to have been quite limiting, on a participant-observation model rather than a more specifically interactive model. Paradoxically, there was scant interpretation of unconscious wishes, conflicts, and defenses, which so bulwarked Winnicott’s interventions in The Piggle in 1977.2
This volume’s space limitations precluded my including Molly’s original process notes. I am offering the next best thing: my interpretive take on the notes. While Nancy was followed from before birth, her psychotherapy commenced when she was in her fourth year. Among the reasons for treatment were persistent indicators of anxiety and depression over the previous years accompanied by an increasing lag in her cognitive development. In other words she was in increasing psychological pain and her development was flagging. She appeared to be “dying on the vine” as a result of pernicious family influences and somewhat hidden psychological trauma that was only fleetingly apparent to investigators of the Miles family. On reading this material I was struck by the ways in which the raw and undigested data of the life of the Miles family and their struggles to gain economic and marital security came to augment my understanding of Nancy’s communications in her therapeutic play. The study data helped to delineate the area of traumatic, unassimilated, unconscious mentation that Nancy was non-verbally and intuitively attempting to work through with her therapist. As with many children, her unconscious mentation consisted of reactions to experience that had never risen to a level of conscious thought and speech in her everyday life. This latent information about determinants of Nancy’s state of mind tended to get swamped in the welter of day-to-day details. It turned out to be critical in highlighting the regular appearance of Nancy’s older object-related stereotypes, as well as her search for new object relatedness with Molly. I use “old object stereotypes” to denote the frequent, regular attempts to project onto another the early fantasies and psychological attributes of an important other; these include often frustrating or unsatisfactory characteristics of the primary objects, the parents. In the service of mastery, this involves the repetitive projection of a threatening person from current or past experience. The older object repetition and projection, however, can also be of a “good” object with a soothing or idealized nature. In the latter case, the projections may serve to keep anxious dysphoric stereotypes of “helpers,” who are in reality not so helpful, at bay by maintaining the therapist in an idealized “can do no harm” light, cloaking threatening hostility in the supposedly benign garments of a “new object.”
THE THERAPEUTIC ELEMENTS OF PLAY
This case review also sheds light on the process of internalization. How do Nancy’s temperamental givens—such as her internal proclivity for passivity and withdrawal in the world outside her family—interact with external frictions in the process of internalization? A partial answer would be that the tumult of the Miles family, taken in as dysphoria and depression, was both dramatized at home while paradoxically displayed in public as inhibition and depression. Her public persona contained a wish not to be understood. At home Nancy showed her identification with the hostile aggressor in her angry exchanges with her parents and brother. Outside the home, she showed the deadening ravages of those identifications, inhibition and depression. Structurally the medium of play provided a sieve for straining out elusive elements of her id, subego, and super-ego functioning and bringing them into a more synchronous interaction with her ego.
In situations of neglect or psychological assault, we find mother-infant dysregulation or the overstimulation of hostile affect storms that mimic both the parents’ initial conscious or unconscious rage with the child as well as the child’s defensive identification with the aggressor. Additionally in Nancy’s case there was the narcissistic injury brought about by the arrival of a new preferred male replacement child. Primarily she responded to this intrinsically as a loss of place and secondarily as an interpsychic loss of status. The therapeutic action of play permits the child to achieve some semblance of ego wholeness and mastery that is more consonant with his or her developmental level. In Nancy’s instance, Molly’s therapeutic contact facilitated a positive shift in her mood disorder that was manifest in her good-naturedly teasing Molly and sticking out her tongue at her, and in gains in intellectual functioning where she became able to do card naming games. But the treatment seems to have had its limits. The end result may have been that Nancy became able to use the nursery school as a safe haven from her chaotic home environment, or to a lesser degree it may have paradoxically contributed to a neurotic character fixation dominated by social anxiety. But overall, Nancy’s contact with Molly caused a diminishing of significant amounts of anxiety and depression. Molly’s abrupt, unexplained departure, occurring as it did without an opportunity for Nancy to psychologically metabolize it, may have contributed to the persistence in Nancy’s character of a state of shy, quiet withdrawal. In the manner that trauma begets trauma, was Molly’s leaving a retraumatization of Nancy? Did it inadvertently replicate the narcissistic insult that had occurred when Nancy’s mother had shifted her love from Nancy onto brother Eric after his birth? Any feelings of rage at being replaced by a sibling (and a male at that!) were then swamped by regressions to transitional objects (dolls and stuffed animals), muted compliance, and a characterological resistance to being “understood” (resonated with).
THE NATURE OF TRAUMA
In a research meeting when Nancy was ten months and twenty-two days old, Ernst Kris made the comment that outside events rarely constitute major traumata. Years later most clinicians would construe such a statement as stemming from Freud’s ambivalence and confusion about whether his hysterical patients became so because of the distorted and forbidden wishes for the important people in their lives or because of real negative, painful, external experiences. As it turned out, many of them had been subjected to incest, violence, and sexual abuse at the hands of family members and close family friends. Kris’s perspective in questioning the effects of poor childrearing on children reflected that of the field at the time. It underlines how the investigators were blinkered in regard to the role of trauma in child development, making it difficult for them to fully account for what they were garnering and seeing. What we see now was probably also the case then: most therapists are drawn to the work after having experienced mal-parenting in their own early histories, with its traumatic shifts in object preferences and alliances. Nancy’s fall from familial grace with the birth of her brother gives the lie to the idea of trauma being a null factor in child development. As the case information developed, it became clearer that the team slowly and informally shifted its attitude to allow for the greater contribution of external trauma, in the form of the parent’s conflicted feelings toward Nancy and the gender bias of the culture at that time.
THERAPY SESSION 1: COMMENTARY ON THE ELUCIDATION OF LOSS
I will review the transcribed process notes of therapist “Molly,” taking into consideration ancillary information provided by other involved members of the study group. Molly’s manner of capturing the play narrative is notable in terms of what seems to be missing by modern standards. There are few references in the play and personal exchanges to the interactivity of the minds of analyst and child. What thoughts get stimulated and why? In first sessions we routinely allow for unfamiliarity on the part of child and therapist. The immediate references to “Mary” and “Maria” (girls in the nursery) suggest that in addition to Nancy’s prior, at least passing, acquaintance with her therapist Molly, early transference activity is present. The therapist does not engage Nancy by treating the milieu as part of the treatment frame. The basic assumption seems to be that the playroom provides the therapeutic frame. She defers to Nancy’s wish to finish her “baking” project rather than more actively insinuating herself into the play. At such an early stage, it is obviously a choice on the part of the therapist as to whether to join the play or wait on the sidelines, so to speak. But similar deferrals happen in subsequent sessions. The therapist’s style tends toward the sessile. This raises the question of whether this style dovetails unproductively with a character that in Nancy’s case tends toward shy reticence and disengagement. Certainly the analytic standard at the time encouraged silence and watchful passivity on the part of the treater. Did the fishbowl atmosphere of the study contribute to the treaters taking a more laid-back and noncommittal stance? Molly’s approach in these sessions seems more observer than participant. In current circumstances, if our reading of the child so indicated, we might opt to sound out, early on, the child’s willingness to interact with a strange therapist. As it was, Molly merely watched Nancy play.
Nancy’s insistence on finishing her sand bakery project before going to the playroom suggests that she, at times and in certain situations anyway, was not as passive as she often appeared; that she had a mind of her own. Some anxiety may also be involved in her exercise of self-possession when confronted by Molly, a relative stranger. It is of note that Molly spoke with a brogue (this comes through in the word usage and rhythm of the notes). This is not to suggest that an accent would imply a threat, since both Nancy’s grandparents spoke heavily inflected English. It may be quite the opposite, making Molly sound familiar like her grandparents, not foreign. It is notable that after finishing her “baking” Nancy attempted to move away from Molly toward a different play area, rather than to where Molly was stationed to take her. Was Nancy feeling disengaged and averting herself from the therapist in kind? This sort of evasive action might raise a flag in the analyst’s mind as to whether this was a subtle early sign of either independence or ambivalence and anxiety.
Home is definitely on Nancy’s mind as she starts out by stating that she wants to take home the initial perfunctory drawing that she made. Given later events, however, this statement seems to ambiguously subsume the found picture of another child as well. She reemphasizes how much home is on her mind when, following the scribble drawing, she shifts her attention to the doll house. On one level this can be understood as standard early exploratory play, casing the play space and play materials. But then a parapraxis on Nancy’s part signals that the play is emotionally charged. She does not see the bedroom on the upper floor of the doll house. The cascade of emotional errors continues as a baby doll is placed in a “crib.” She becomes aware of her parapraxis and immediately changes the noun to “playpen.” The process continues as the woman doll and baby doll become “Nancy and her baby,” instead of mother or Molly and baby. This is followed by Molly’s first interpretation within the play as she states that the icebox in the doll house is a Frigidaire with no door. This is an interesting choice of words given that “icebox mother” was a common contemporary term employed to denote an etiological object factor for children with autism. Could Molly have been entertaining some similar questions about Nancy’s object relations? In intuitively assigning the category “lost” to the door rather than questioning Nancy further about what may have happened to the door, Molly attempts to both show her understanding of Nancy and to start to frame their contact with contemporary analytic loss theory. Nancy, with a flash of anxiety that may stem from some notion of hers about irreversible bodily damage (castration anxiety to Molly) vehemently denies this. The sexualized and phallocentric term “castration anxiety” has gradually fallen out of usage as a term that connotes female inferiority based on hypothesized genital trauma. It still may be manifest clinically as a specific form of anxiety in males or females where performance anxiety is equated with specific fantasies of genital mutilation that has either occurred or is yet to come. She is emphatic that she wants/prefers the fridge to not have a door. Embedded in this exchange may be the transferential hope/wish/question for Molly as to whether a female can be strong and potent even if genitally different from the “ruling” males; even if her body is lacking a phallic appendage. Is anatomy truly destiny? Or does strength come from some other less obvious sources so that in metaphorical terms it matters not whether the fridge comes with or without a door? In fact without a door we can see into the fridge and view its heretofore hidden mysteries and strengths. This may be an early example of Nancy’s tentative curiosity about the hidden strengths of the intact female body. In any event, Molly’s first interpretation is vigorously denied by Nancy. She wishes that total completeness is possible without a door!
Nancy proceeds to defensively smooth out this anxious moment, which was apparently too much and too quickly about loss. For her, it seems to be about not just the speculative loss of body parts but also the real loss of self-esteem, status, and standing in the family over the previous two years coupled with the loss of love and attention from significant others. She dramatizes this by populating the doll house with a father, cousin, and friend. That none of these figures extended into the dramatic play suggests further the immediate defensive and reparative fantasy function of these figures. The friend doll with a name so close to Molly’s further bolsters speculation that transference developments are looming. Even nowadays the problem with identifying these elements of a treatment process in children is that the therapist is often not prepared to see these elements for what they are. The mindset back in the 1950s and sometimes currently has tended to be that such elements are identifiable and interpretable only much further down the line. The material here suggests that the text of a therapeutic process is determined by what the analyst is ready to see, and when.
While there was a momentary retreat from Molly’s sortie into castration anxiety and loss after the Frigidaire episode, Nancy experienced another “anxious moment” around finding a broken chair with a leg scotch-taped back onto it followed by encountering a doll with a missing sock and shoes. It is important to note that this “large doll” is actually Nancy’s size. Later on she became “Terri,” Nancy’s constant transitionally objectified companion. Terri accompanied Nancy everywhere in the nursery school after Nancy rescued her from the playroom, becoming the successor to Nancy’s original transitional object, a blue blanket. According to the head nursery school teacher, when Nancy froze into neurotic withdrawal, she would often place Terri on one side of her and any available adult on the other. Nancy made a partial restitution in the play by finding the missing shoe and mandating that the doll did not need to wear socks. This play fragment appears to be an attempt by Nancy to break out of the various conflicting conformities about clothes, appearance, and femininity that dogged her. This segued into exploration of the doctor’s kit; a further hint at a preoccupation with restitution and another thrust out from under the shadow of trauma. Molly notes that Nancy liked to carry a suitcase around in the nursery. That might mean that an engaging tie-in comment had been made to Nancy, since many girls of her age carry around parcels. These are often as important for what they may contain in the way of retrieved lost articles as they are for being similar to objects of adult identification and adult power such as satchels, briefcases, and purses. In other words, they reflect early oedipal power issues rather than the later, more popular, oedipal themes deriving from adolescent sexual romance.
At the end of the session, in a coda to her smear art at the beginning, Nancy painted a muddy, apparently overdetermined hue (suggesting feces) that she proceeded to dedicate to her brother. Molly terms him a “newborn,” while in fact at that point Eric was about eighteen months old. Finally she wanted to take three pictures home, including the pink papered one of another child that she had discovered on the easel when she entered the playroom. Her wish/parapraxis was that she had created it. Nancy could be read as having at some level been aware of what she was appropriating from another child patient of Molly’s. The play stage was immediately set for an enactment of her sibling agita; taking something from another of her therapist’s imagined charges and in doing so mastering a rivalry (at least a little bit). Enactments imply the presence of transference. As I mentioned earlier, at the time the existence of transference in child work was being debated. Here, however, as it does with adults, transference manifested itself in the most mundane and everyday of ways. The mention of the brother as the future benefactor of her theft (a reversal), the exploration of the doll house with its broken and/or repaired furniture (capturing Nancy’s own bodily anxiety, diminished mental state, and wish for repair by Molly); all these allusions seem in sum to amount to a bit of transferential compensation from Molly for what she had lost with the arrival of her brother. Molly seemingly thwarts this plea for specialness, for a gift from her. She treats Nancy’s wish perfunctorily as if it were literal, without questioning it. She apparently uses her authority to deny her request and Nancy characteristically submits passively without protest. The defensive and aggressive aspects of this dynamic on Nancy’s part are not addressed by Molly at the time or as a possible response in the notes. Molly handles the matter operationally with the matter-of-fact suggestion that she leave the pink painting in the playroom. In other words, an instrumental, rather than an interpretive action, is taken by the therapist. Technically it is not that such an instrumental intervention is incorrect. At Nancy’s age such an act of authority might be interpreted as dependently gratifying or as firming up the treatment boundaries. With both adults and children now we might handle the answering of a question not with another question, but with an instrumental response, simply answering the question . . . and then following up on the subsequent words or play as though they are part of a free associational response. They usually are. The problem that arises with a command response is that it may be exercised at the expense of increasing insight and self-observation even for a child of Nancy’s age. An opportunity may be lost to investigate the complexities of motivation. Such interventions might have helped to thwart the consolidation of Nancy’s conflict into her later social anxiety. She might have been freed up, rather than, if not tightened up, left in a state of social inhibition.
Throughout the record there are many recorded statements about how special a male baby is in the minds of the extended family members of the Miles clan. Molly infers that Nancy’s discomfort in the first session is not frustration but a reaction to the heat. She assists her in taking off her jacket. Nancy’s drawing attention to her “pretty dress” seems in hindsight loaded with her need to replenish her wounded female narcissism by asking for a complement from Molly. There also seems to be in this comment an ironic attempt to give dresses the same or more value as more masculine items of clothing like trousers or slacks. Several observers have mentioned how conflicted the area of apparel was for Nancy. Her father demanded that she wear slacks or overalls. Her maternal grandmother (who bought all the children’s clothes) insisted that Nancy wear only dresses when she visited. And her mother inevitably wore a dress, even if it turned out to be a somewhat shabby housecoat.
Nancy ends the session on notes of homage, restitution, and revenge toward her brother and new rival, Eric. Molly’s summary statement attributes Nancy’s “defensive reaction to missing objects” to the “castration complex.” This may be accurate but it also tilts toward the archaic. Such a formulation seems to spring more from theoretical knowledge than from a creative discovery of poignant anatomical loss in the hour. It captures only a part of a complex amalgam of many losses, which may be only partially grasped by the anatomically based metaphor of castration anxiety. Certainly the culture of the time was phallocentric and, as mentioned, the overt family standards favored boys. But Nancy’s loss dynamic also seemed to contain elements of depleted self-esteem, unstable object constancy, and a depressive regression to separation anxiety (the latter manifested in her reluctance to leave Molly). In contemporary terms, “castration complex” can be taken to refer to an intrapsychic closed state of developmental affairs for females in the first three-quarters of the twentieth century. It harks back to a time when anatomy was magically conceived as conferring a subordinate destiny and women and girls were in large measure delegated to wearing a gendered cultural and physical straitjacket. They were defined in fixed passive, depressive, masochistic, and envious terms. They were considered to be among life’s losers relative to boys and men with their phallic scepters. Nancy commences her therapeutic exercise, then, expressing through her play actions anxiety, pain, and depression about her gendered fate. She fumbles for a solution in which her brother Eric has not superseded her.
PSYCHOTHERAPY SESSION 2: HOPE FOR AUTONOMY AND INDEPENDENCE
In this session, Nancy, smiling, positive, and expectant in response to Molly’s appearance, announces that her mother is at home. This seems to be a marker for her current state of object constancy. She both conveys an understanding of where her mother is located out of sight, along with her calm expectation that her mother will arrive to pick her up at the end of the morning. The concept of object constancy was a dawning idea at the time, introduced in midcentury by Anna Freud and Hans Loewald, among several others. It is a concept that seems to have been easily accepted in child development but whose place and usage has lagged in the field of adult analysis. For a child of Nancy’s age, object constancy usually possesses a dynamic, fluid quality, waxing and waning depending on degrees of stress and the amount of separation or stability surrounding the primary objects, the parents. In this session there seems to have been a regrouping of her object constancy, enhanced by a smiling positive transference to the reappearing Molly. Her comments about her mother and then her grandmother, Nana, have a free-associational quality. The mention of her sick grandmother, a cause of great anxiety for her mother, Flo, signals Nancy’s own anxiety and confusion about her grandmother’s physical state layered with concerns about her own. There seems also a subtle anxiety as to whether Molly is a doctor who used needles. (At the time, Nancy’s grand mother’s diabetes was being treated with injections of insulin.) The positive emphasis seemed to be twofold: women and mothers can be depended on, and women in need, like grandmother, will be taken care of in their illness, just as Nancy in her distress is being taken care of by Molly. In this session it becomes clearer that the whole nursery school setting, not just the playroom, is being used as a play stage, by Nancy anyway. Nancy with doll and carriage seems a displaced, active dramatization of Nancy’s growing passive dependence on Molly. Again, as she did in finishing up her sand play in the first session, Nancy quietly asserts herself, retrieving her doll and carriage from the threat of appropriation by another child. This time, however, her actions are supported by Molly’s presence, rather than being an anxious reaction to it.
Once in the playroom, Nancy repeats her focus on trying to bring order out of disarray, this time in regard to the shelves of the refrigerator. Her emphasis on the mother doll in the kitchen and the father doll and others upstairs seems an allusion to the layout of the Mileses’ house. Nancy no doubt was troubled on some level by the angry, embittered, and arbitrary demand by her father, Leo, that her mother, Flo, have the kids at the door to greet him upon his arrival home from work. This demand was then double-bound by his impossible and imperious expectation that Flo control the children, allowing him some peace and quiet by keeping them with her while he ascended half a flight to watch TV in the upstairs living room.
There followed a play segment about the uncomfortable place for the driver (no real or rear seat) with the mother and daughter in the back of a toy truck. This seems to resonate with something that Flo complained about bitterly to various home visitors in the course of the study: Leo was the only one who could drive, and he would exercise his power and dominance by refusing to take his wife places on ritual Sunday drives. While many of these conflicts might strike observers as quibbling aspects of the times, there was a vehemence and ferocity to these recurrent conflicts about being housebound, husband-bound, and subject to Leo’s whims and powers that raised their emotional temperature far beyond the ordinary. These were not day-to-day angers, frustrations, and petty vexations. They contained hate of object-destroying, homicidal depth. But back then, the place of positive aggression and negative hostility in the psychology of everyday life was still to be explored and developed. Once again, the play associations are overdetermined; loaded with symbolic and metaphorical meaning. Shifting from the dramatic play of the Sunday ride to the medium of painting, Nancy selects that moment to “tinkle” (the bowdlerized and castrated form of “to urinate” or “pee”). She is at pains to demonstrate that she has available a good deal of what seems to be a mixture of autonomous ego functioning and counterphobic neurotic ego function. Unlike her mother vis-à-vis the car rides, she can take care of urinating without relying on anyone else; she can even flush the toilet standing up, depressing the lever with her foot. That Molly substitutes “tinkle” for urination at that moment raises the question of whether she was defensively missing the rage or at least the opportunity to inquire about the “pissed-offness” accompanying Nancy’s need to pee at that particular moment.
Nancy then mentions the panties given to her by Nana, which also seems to point to several environmental contributors to Nancy’s character development. As noted, Nana, Flo’s mother, was a major financial support to this ambitious but struggling family. This was a fact of life that Leo reacted to with great ambivalence. He was both appreciative and resentful, because part of the price that the family paid for her financial support was that they abided by her very strict expectations about how boys and girls dressed. These, after all, were the days of binary gender assignment. Boys will be boys and girls will be both feminine and losers. The idea of gender as a mosaic mix of biological attributes and both male and female psychological characteristics was still far in the future. Nana bought clothes accordingly. When Nancy and Eric came over to visit her on weekends, it was imperative that Nancy wear a dress, not slacks or jeans, and that her appearance be entirely feminine. Eric similarly had to be wearing masculine garb that accorded with Nana’s old-world standards. This requirement seems to contribute to Nancy’s overemphasis, tinged with anxiety, on the “goodness” of her psychologically degraded feminine appearance in dresses and panties, and their conformity with those of another woman of dominance, Molly, who wore dresses in earth tones.
PLAY SESSION 3: NANCY AS BOSS, SHOWING HER IDENTIFICATION WITH ERIC
In this third session, held two weeks after the second, Molly ended up once again with the formulation that Nancy was struggling with some “activation of the castration complex.” In doing this she seems to be understanding the term castration complex as a neurotically fixated state rather than a possibly transient developmental constellation brought on by her brother’s birth and complicated by cultural/familial emphases that could be resolved by corrective experience, therapeutic play, interpretation, and gender neutrality. The use of just two examples from a session replete with all sorts of information suggests a lack of differentiation by the clinician of what might be usual expectable developmental dynamics as well as a turning away from what potential clinical themes might be discovered that lie beyond the pale. Castration dynamics certainly may be contributing to the clinical picture—consider the missing feet and marbles in the wrong places—but there are other suggestions that Nancy’s frustrations have to do with a sense of lack of wholeness that is perhaps anaclitic in nature, or to the mysteries of sources of power that are hidden or invisible, like vaginas. That she can’t figure out the matching card game points to cognitive blunting: a neurotic proclivity for not understanding too much or not being understood too well. In her attempts to turn passive into active through the play of her imagination, she wants a house of her own with a mother and/or brother at her beck and call. These play themes seem to indicate that Nancy’s psychological dilemmas are richer and more complex, involving narcissistic injury and deflated self-esteem in relation not just to her brother, but to her mother as well. The transference version of this appears in the play when she bosses Molly and orders her around. Her confusion at the start of the session about locating the right playroom seems more salient as one of several subtle indicators that Nancy’s developmental dysphoria has infringed on her cognitive processes. Some children might respond to such ongoing traumatic stressors by becoming danger-activated, hyperalert, and sharply focused on the narrow visual and aural details of their environment. Nancy’s defenses seem to work the other way, to mute and confuse her attention to her surroundings.
Around this time, Ernst Kris noted in a research meeting the interesting and paradoxical phenomenon in which the older child, Nancy, identified with her younger brother Eric and modeled her behavior after his. Is Nancy doing something similar here? With her bossy behavior toward Molly is she showing her identification with the younger but more powerful and favored brother? In another family Eric might become her ally in the family fray instead of another living reminder of her fall from grace. The whole of this session seems bracketed by the presence of another, an interloper, in the room; a proxy for Eric. She can’t initially recognize her room. There are marbles that she infers don’t belong there. There are the absent and otherwise messy paints, consumed and spread around by another. It is as though she senses that intruders have been in her room and that Molly (in the maternal transference) is at some level perceived as responsible for this state of events. The implication is that Molly, like a mother, has shifted her attention to another. Nancy, turning passive into active, takes on a commanding tone toward Molly, much like a master toward a slave. Molly does not question Nancy’s domineering commands that Molly build a house or that she pick up objects that Nancy has dropped. Nor does she probe for the underlying angry affect that is likely impelling these commands. Instead, Molly submits to Nancy’s bidding. Currently, we might be more curious about this assigning of roles. What affect is driving the play? Is it play in the sense of being part of an unfolding psychodrama? Or is it nonplay and thus a particular form of resistance to a child’s version of free association, the play process? Is Nancy turning the tables on the adult and demonstrating to Molly what it is like to be the subservient and passive child, following and identifying with a younger brother? Probably so.
In the layering of meanings in the therapeutic play process, another subtext for the session is Molly’s transformation into a subservient, need-satisfying maternal object who is at daughter Nancy’s beck and call. This could be termed revenge play or turning situations into their opposite; in the least very gratifying and the stuff of Hollywood. This process seems to lead to important links where feeling demoted overlaps with feelings of bodily loss and castration. These overlaps lend themselves to identifications with the aggressor, both in terms of the presenting psychological and physical depictions of the damaged self that has been wrought by the aggressor, and, more deeply, the rage, self-loathing, and violent revenge fantasies that lurk beneath the preoccupation with such a damaged and violated self.
Given the flow of the session, a technical point arises: what about asking (either inside or outside the play) what Nancy makes of Eric’s role as aggressor in her world? Trying to put big marbles into small toys seems like the metaphorical expression that Nancy applies to the shrinking world with little place for her after Eric’s appearance; an impossible wish to return to her solo status in infancy. Alternatively, how can she reverse life events and put Eric back into his mother’s womb or, better yet, kill him? Devouring the cracker that she has assigned to Eric further underlines the forbidden, multifaceted revenge fantasies that crowd her mind. Nancy’s actions of going to the bathroom by herself and flushing the toilet with her foot do not seem to work as defining evidence of a female castration dynamic. It seems more to represent that, at times anyway (perhaps in the company of a powerful, intact woman play partner), she can momentarily escape the culturally defined phallocentrism of the time and act in a relatively conflict-free manner. Then again, in this action sequence, after devouring Eric’s cookie, she may be flushing Eric down the toilet in her quest for mastery, regardless of whatever the cultural proscriptions may be.
PLAY SESSION 4: LIBERATED AGGRESSION FOLLOWED BY RAGE AGAINST TWO MOMMIES
In this session, held one week later, Nancy once again seems somewhat more together. As the session ends, however, hostility erupts and she sounds the discordant notes of rage and affective diathesis. At the start of the session, she is more “there” cognitively and more affectively free than she had shown previously. She exhibits different parts of her mind in a manner that Molly finds perplexing. In this session, Nancy displayed more of the ego qualities that she had briefly flashed when finishing her sand baking in session one, and in retrieving her doll and carriage from another child during the following session. She continues to be more aggressively engaging and interactive with Molly, more spontaneous in her playing and joking. This is the Nancy who has been observed more at home than in public. She savors the absurd with the analyst. Toward the end of the session her attitude morphs into a rageful meeting with Molly and her mother. In it Nancy demonstrates her extremely conflicted ambivalence about being triangulated with her two “mommies” and having to tolerate their having their own relationship apart from her. This may be an oedipal variant that she had previously shorthanded with her comment about her aunt putting a needle into her grandmother (for her diabetes) while she looked on passively.
But Nancy’s tantrum at the end of the session seems to be partly a reaction to various slights by the therapist. At the beginning of their hour together, Molly, apparently following protocol, delays engaging Nancy. After entering the nursery school, she waits for the music to end before escorting Nancy to the playroom. This is followed immediately by Nancy’s report of her grandmother’s being attacked by a needle and her cousin Jay’s violent affront in pushing her off a chair; girls being treated roughly and badly by others. In all this, she seems more cognitively present, clearer about her colors, and better at doing puzzles; all signs of a cognitive resurgence of sorts. A transition point in the session occurs around Nancy’s blurting out “Mommy.” It is an ambiguous exclamation that could refer, as Molly suggests in her note, to Nancy’s thoughts about taking her painting to her mother. Another more proximal alternative is that it could be making explicit the presence of Molly in Nancy’s mind as the increasingly ambivalent mother; an old transference object. Nancy’s insecurity about her appearance reemerges as she trolls for positive comments about her dress. In a telling sequence, she says “pretty dress” and makes an apparent parapraxis after previously getting her colors “right” by calling it “gray” rather than brown. Molly notes that she doesn’t know whether this is something that Nancy says about all her dresses (or the color of her therapist’s hair). That would have been an appropriate question to ask. Instead, she responds concretely as though this almost four-year-old needed an adjustment in her reality testing. She corrects Nancy, stating that the color is brown, not gray. Nancy reacts in a complex manner that is part clarification and part retaliation, but overall, a release from her general regressive passivity. As Molly notes, she turns into a dramatically different child, showing a side of herself that was previously absent in the school setting, but one that other observers had noted at home when she was carousing with Eric and in battlefield mode. A common error would be to see Nancy’s actions at this particular point as regressive, rather than as an escape from regression. This gleeful, instinctual aggressive display may actually be a sign of the presence of a healthy growth potential.
As this sequence continues, Nancy tells a paradoxical joke about snow in summer as though to indicate that Molly did not get her “gray” joke; she turns a dirty poop color into something closer to Snow White. Is she also evincing guilt that in jibing with Molly she is upsetting and reversing the “natural” order of inhibition and regression? The hostile/satirical sequence is elaborated as she sticks her tongue out at Molly. For young girls, sticking out the tongue (and in current times flashing the middle finger) is often an upward symbolic displacement that is both mocking and flaunting. It represents a disparaging display of power that carries in it signals of gendered female potency and sexuality. In the second part of the sequence she laughs uproariously before she falls off her chair. This replicates in play her earlier report of Jay’s shoving her off a chair at home. The sequence continues with another passive into active trope with Nancy throwing the puzzle pieces onto the floor. She does this joyfully, “not violently,” Molly notes. Molly describes here important indicators that she is in the presence of positive aggression.3 My speculation is that Nancy is expressing developmental energies of a relatively nonneurotic, nonhostile nature that were released in the presence of a neutral but supportive analytic observer. In a flash she shows the potential that had impressed earlier investigators, particularly Provence and Coleman, before those qualities became blighted by the type of ongoing family trauma that Ernst Kris termed strain trauma. At the end, in throwing a fit in her mother’s presence, Nancy targets two birds with one transference storm. She expresses an amalgam of long-bottled-up rage at her mother and more recent transferential rage toward Molly. In that era such powerful clinical determinants were still not well worked out, understood, and accepted as part of the child analytic clinical canon.4
MEETING WITH MRS. MILES AND MOLLY: RESISTANCES IGNORED RATHER THAN EXPLORED
In the meeting two weeks later with Mrs. Miles present, Molly once again seems somewhat emotionally oblique and relatively nonexplanatory in her approach to Nancy. This may reflect the style of the time, which was to listen, reflect, occasionally interpret, but not explain. This style may be exaggerated by the considered research posture embodied in the participant-observation model as defined then. After acknowledging Nancy, Molly fraternizes with several other children before opening her lap to Nancy. These days, the therapist would be more drawn to Nancy immediately because of the appeal signaled by her smile and her body English. In doing so the therapist would be acknowledging the heat of Nancy’s attachment and respectfully clarifying right away that this is not a playroom day. The situation is compounded by Nancy’s insistence on a private, confidential relationship with Molly. She is quite clear that she wants a separation of parents from the therapist. This statement begs for an understanding to develop between therapist and child, particularly with a child of her age who seems at times to actively encourage not being understood. There is also some suggestion here of a communication difficulty; that the information from home visits is not getting transmitted to Molly but is going directly to the research meetings or becoming submerged in the files as part of the superfluity of data.
Nancy seems to passively accept going out to the yard. In her submitting to this directive, there is an unfortunate reinforcement of her trends toward compliance. Granted it would have been more difficult to support her active right to, if not veto, at least protest the meeting between Molly and Mrs. Miles. As has been speculated, participation in the study no doubt had an exposing effect on some of the participants, both parents and investigators. There was a heightening of anxieties about parenting, an eliciting of fears of being judged wanting, culminating on one side with parents imbuing the investigators with idealized wisdom that they may not have possessed. Mrs. Miles nervously lights up a cigarette, a habit of hers that is in conflict with her husband’s wishes as well as her own mother’s. (One measure of how members of the Miles family were resolving their differences is that later on Flo states that Leo is not criticizing her for smoking. In fact, to demonstrate his tolerance, he buys her packs of cigarettes without protest.) Flo asks Molly about Nancy’s crying. This is a point of conflict particularly between her old-country mother and the study investigators. Grandmother had asserted whenever given the chance—as when the Miles family moved in with her briefly during this time of treatment contact—that feelings were bad and it was bad for Nancy to express emotion, particularly painful affects. In other words, “Big girls don’t cry.”
Paints and painting at this point are associated with father. Nancy’s painting now seems to be a neurotic activity expressing her conflicts about instinctual discharge, rather than a medium for creative elaborations of her inner life. There are suggestions here that Nancy is at war with both of her parents but that at times this state is quite independent of the parental conflicts. The net result is that, as she ages, Nancy’s neurotic state seems to be at times resonant and at other times more separate from the storms within the family milieu. Her anxious rituals are centered around doing, undoing, and expiation; making a mess and then cleaning it up. The investigators tended to view Nancy in nursery school and in therapy as the castration-complicated victim of a brother-successor. As the material develops over the course of nine sessions, however, there is a growing suggestion that her restraint and containment at school are a reflection of her preferred mode of quiet self-containment in an atmosphere of supportive adults. On her home grounds she is the aggressor, knocking her brother around and hoarding her play money. Her mother’s favoritism toward Eric is expressed ironically in Flo’s conviction that Nancy has plenty of play money to share with her brother. In metaphor-speak this means that Nancy possesses plenty of power, love, and emotional supplies. In retaliation for this real loss of status, however, Nancy rejects her mother’s food, and in the process, her mother and her love. She becomes “disobedient,” running around the table instead of eating. Father’s trying to force her to eat unconsciously increases her passive resistance. Cooking (recall the making of sand cookies in Molly’s first interview) is associated with mother. We could say that at home she is in war mode, reflecting in her behavior the currents and tensions of hostility that course through the family. She gets punished for her admixture of identification with the aggressor and healthy aggression and hostility by being sent to her room. All of this only served to reinforce the mother’s endorsement of Eric. A sleep disturbance ensues. Its secondary gain is that the mother’s punishment is to become the emotional patch on Nancy’s separation anxiety/rage as she ends up sleeping with Nancy to soothe her. It has become clearer over the years that separation anxiety is virtually inseparable from the rage at loss of love or the loved ones’ emotional unavailability. The data gathered here seem to support a broader mindscape in which Nancy tries to maintain Molly as a relatively unambivalent new maternal object. She simultaneously struggles to overcome her deep ambivalence toward her own mother and to restore what Melanie Klein has termed a more stable depressive position. That is, can Nancy be rageful toward her mother and yet remain confident that her rage will not drive her mother further away? Can she remain confident that in spite of her mood her relationship to her mother will remain safe and stable? In this passage, Flo mentions that Nancy has a curtailed interest in her toys. This is the first mention made by the parents of a neurotic phenomenon that had been remarked on at the time of Nancy’s developmental testing at eleven months of age. It is also the same quality that Ernst Kris commented on in a research meeting when she was in her fifth year, when he tentatively tied it in its origins to Nancy’s early tendency to lose the nipple while breast-feeding.
PLAY SESSION 5: GUILT, EXPIATION, AND DARK AND DIRTY FAMILY AFFAIRS
Much of the drama of this session seems to happen at its beginning. Nancy is playing with another child, “Pauline,” whose name resonates closely with “Molly.” Later it is mentioned that Pauline is seeing Al Solnit for child analysis. As I have emphasized here, the difference between child therapies may be only a matter of degree, shading, and frequency of meetings rather than of process per se. This may be particularly so within this study, given the volume of data available to fill in the blanks of a therapy and the possibility of using natural historical observation to compensate for the lesser amount of data arising from a less frequent treatment. A sibling/parent triangle is in place in the nursery school. Molly attempts to negotiate it in real life terms by telling Pauline that she can continue playing with Nancy when she returns. Nancy, however, rejects this suggestion in much the same self-assertive manner that she made Molly wait for her to finish her sand cookies play in the first session. Furthermore, in displacement she acts out a psychodramatic triumph over her sibling, Eric, when she states that she wants to play with Darla, not Pauline, upon her return.
Molly’s narrative is, as usual, clear, precise, and vivid. While the meta-message of the play around arranging the doll house furniture is not forthcoming, through it Nancy indicates a preoccupation with her own housing arrangements. Around this time she became phobic about using the toilet. This manifested itself here obliquely in her preoccupation with toilets in several play sessions. Again, her need to order and structure the doll house, as well as her preoccupation with objects missing, broken, or out of place, could be easily traced back to the anxiety and confusion of her disorderly family as well as her own inner upset state. The prelude to this is her preoccupation with the cat in the box, which ultimately leads associationally to her own pet cat “Blackie,” another reference to home. Nancy’s fantasy play style never strays too far from the memories of actual events. Time and again she shows the limited span of her imagination. Paradoxically, this may make it difficult for Molly both to read her and to appreciate that Nancy is showing her the groundedness and fixity of fantasies characteristic of a child living amid traumatizing circumstances. Her mental stage is set and remains occupied in large part by preoccupation with her own object relations, rather than drive discharge, reminiscence, or fantasies of the future. That Molly at times seems not to “get” Nancy is a probable function of the sort of not knowing of her that her parents display around her at home. They rarely seem to “get” Nancy, bound up as they are in their own transference projections and fantasy identifications. The extensive notes from Laura Codling’s social work home visits during this time are filled with the details of the Mileses’ marital unrest and their frustrated, upwardly mobile social strivings. Flo and Leo were quite unhappy with their life in a split-level house in the suburbs. They both felt, Leo in particular, that they were being harassed by some neighborhood teenagers. I read this, in part, as an externalization of their marital woes. In addition, they were looking for ways to make and save money. One rationalizing solution that they came up with was to move in with Flo’s parents while they put their home up for sale. Flo was also openly missing her proximity to her own parents. She specifically felt that she was losing out in her rivalry with her older sister and her sister’s husband, who lived upstairs in the same building as her parents. Transferentially, this could have influenced Flo’s object parallel shift from her preference for her older child, to the younger son, Eric. This move in with her parents also amounted to a trial separation of sorts. They did this for about a month. Flo and the children slept in one room and supposedly because of space limitations, Leo slept in the attic. When their house did not sell, they reluctantly moved back to the suburbs from the inner city of New Haven. Nancy introduces these changes in her therapy play with associations around Nana’s supposed visit to her house, Nancy’s going for a walk with her, and the possibility that she may stay at Nana’s house.
The references to toilets and their usage in this session may proclaim Nancy’s anxieties about what she may have done to bring about such a dark and dirty state of family affairs. How much guilt needs assuaging in relation to her hostility toward others, whether Pauline or family members? In Nancy’s mind there seems a lot of cleaning up and keeping up of appearances to be done, hence the alternations in the play between washing hands and faces, proper toileting, and bathing. The image of bread on the house coupled with her statement that her mother is feeding her good and nutritious bread and oatmeal, apparently delivered without irony, seems to further back up a sense of rapprochement between the two of them. This is another possible unarticulated effect of the working alliance between Molly and Nancy, especially given the number of interactions between the two that involve feeding and physical contact. She is in an alert and cheerful mood during this session; in a teasing manner, she confuses colors with Molly. Such shifts away from manifest and latent depression would currently warrant a comment from the therapist so as to put these shifts on the record, so to speak, and not to assume that they are obvious to the young child, or to an adult, for that matter. The session also illustrates a partial recovery from the cognitive regression that was a part of the impetus for the initial therapeutic contact. At the end of this session, Nancy is described as falling “lightly” when she is greeted while coming down from the playroom. This may be lighthearted clowning around, a further break in Nancy’s depression, but it may also be a way of signaling goodbye to Molly and dramatizing through body English the dissolution of that day’s play dyad. While I have speculated on the imprint that family climate, competition, and recovery from stress may have left on the play in this session, the normative developmental qualities found here are also important to summarize. At this point, Nancy seems on the way to partial recovery in terms of her mood and cognition and to a partial restitution of her ego functions. This was marked by a decrease in separation anxiety. Her immobile nursery school presence persisted. Through Molly’s ministrations, in an atmosphere of relative peace and quiet, developmental processes have begun to kick back in.
PLAY SESSION 6: DADDY’S GIRL NOW
During this sixth play session, Molly is cued to Nancy’s renewed separation anxiety and estrangement from her mother, and she comments directly on her sadness. Nancy’s mood is probably more akin to a surfacing anaclitic depression, an affective representation of potentially permanent loss, rather than a mournful acceptance of sadness about evanescence, transition, and change. Nancy, at this time, was reluctantly negotiating a shift to her father as her primary object of affection, and away from her mother who, after her earlier mother/infant dalliance with Nancy, was so obviously involved with preferences for Eric that it added to Nancy’s sense of trauma and depression. Her father, by contrast, actively courted Nancy’s favor and affection. By peering out the window, anticipating her father’s arrival, and making other references to him in this session, Nancy signals this growing shift. Toward the end of the session her play about “daddy” and her fantasy of having “two daddies” (probably her original paternal object and Molly in another version of the shifting transference), culminated with a play trio of two birds and the daddy doll, which most likely represent Molly, Nancy, and her father, Leo. Her rage at parental object-related shifts is presumably muted by her separation anxiety and depression, and is wrapped up in a preoccupation with her appearance. Today we might attempt to stimulate even a three-year-old child’s curiosity as to why she is so focused on seeking approval and on compulsively needing to be seen as neat and tidy. The technical challenge would be to get closer to presumed underlying ambivalent feelings and fantasies of hostile aggression as well as the accompanying guilt about hostility toward love objects and “lost” objects. This tack is also suggested by her precise layering of colors on the paper followed by her washing/cleaning gesture of expiation. The emergence of Molly as a new object for Nancy is signaled again by Nancy sitting on Molly’s lap early in the session. It is reinforced later on, when her painting becomes a gift to Molly. Finally, Eric emerges in transferred form, as Jerry in the session; a dominant male and study subject to whom Nancy must acquiesce as both punishment and as proof of her inferiority. The episode begins and ends with Nancy positioning herself in defensive social isolation next to another surrogate parent, Eveline Omwake, the head nursery school teacher. In this way she maintains an imaginary triad.
PLAY SESSION 7: RED SHOES, MAD MOTHERS, AND STICKING OUT TONGUES
The “overture” to this play session contains a very clear description of how the transition from the group play experience in the nursery school to the dyadic situation in the playroom sometimes occurred. First, there is the dilemma of group activity versus individual expression. Does Nancy dance like the others or perform some activity of her own? Almost simultaneously there is the problem of signaling and securing the attachment to the therapist in the presence of the group, many of whom are in treatment, some with the same therapist. (The report suggests, for instance, that Leah, like Nancy, has a therapeutic relationship with Molly.) For Nancy, as in earlier sessions, it is clear that the therapeutic encounter begins as it usually does, unbounded by doors and physical space, with the initial sighting of Molly. She signals her positive transference and working relationship with her therapist when she takes Molly’s hand and insistently, albeit awkwardly, clings to it until she leaves the group and heads upstairs. “You are mine,” she seems to be declaring. Also on display is an apparent conflict of loyalty represented by the dilemma of whether to include or exclude the assistance of another therapist, Al Solnit. Nancy, in her ambivalence, initially rejects him and then later accepts his help in jumping off the stairs, though she still insists on holding Molly’s hand as well as Dr. Solnit’s as she does this.
On arriving in the playroom, Nancy immediately expresses her continuing preoccupation with things broken, missing, or lost. Again, this seems not something to be narrowly or reductively defined as an aspect of castration anxiety. It seems instead to have deeper roots in death anxieties and a deathly dramatization of her need for company and comfort after so many abandonments in a somewhat shattered life. It is part of larger preoccupation with losing and loss; an anxious and depressive mental attitude reflecting losses of love brought on by time and tenuous family circumstances. In this session it is a door off of the sink that she gets Molly to fix. As we have seen, at other times it has been missing and broken chair legs and marbles, or other items that seem not to fit or to be faulty. A further characteristic inhibition of motor aggression, coupled with thwarted aggressive capacities for knowing and acquiring new knowledge, cause her loss of self-esteem. Nancy’s tentativeness and confusion were symptomatic of the damage to her once robust primary tie to her mother; not every child’s fate in such circumstances as it is here. Recall that Flo was thought by Sally Provence to be one of the three most nurturing and connected mothers in the first year of Nancy’s life. Her own temperamental givens toward splitting and internalization highlight a propensity for dealing with frustrations and disappointments by internalizing her rage and hurt, and further complicate her play preoccupations about loss. In the play displacement, Molly as the agent of restitution as both the finder and the healer of lost and broken parts offers Nancy the hope that she may be similarly transformed. Molly will be her therapeutic “Santa Claus” of sorts, bringing her not sleds but security, bodily and psychological intactness, and well-being.
It is after this sequence that Nancy’s anger emerges in its fullest expression, though, in keeping with the times, Molly does not pick up on it and press for further elaboration. It seems that Molly is relying on the technical precepts generally used then, which posited the therapeutic action in the treatment of young children as residing in a benign and supportive play relationship with the therapist, one that made words if not extraneous, at least immaterial, and placed interpretation in a secondary role. The play was the thing. As Erikson pointed out at the time, too many words might overburden play and lead to disruption. Now, to reverse a phrase, we assume that at any age and developmental stage one word might be worth a thousand play pictures (give or take). Interpretative comments couched in the vernacular of the child’s developmental level are understood as furthering self-understanding. They maximize the effectiveness of the therapeutic contact, potentially expanding the conflict-free sphere of ego functioning and facilitating a new object relationship. Being there in that manner satisfies the child’s appetite for new, novel, and refreshing relationships apart from the neurotically laden dynamics of old frozen transference objects and developmentally distorted self/other objects. As Nancy describes it, her mother gets mad at her for getting her shoes dirty (or for not eating or not sleeping, being disobedient, or otherwise acting in a hostile or “bad” fashion). Depending on the sequence, Nancy states that in her anger at her mother she either provokes her or retaliates against her by tromping in the mud and getting mother’s gifted red shoes dirty. Unlike Dorothy’s in the movie version of The Wizard of Oz, her shoes will not provide her with a talisman of magic and safety but will ground her in the despair and self/other punitiveness of her rage. As the play continues, Nancy attempts to undo her transgressions by playing out an omnipotent Prospero fantasy in which she, like Shakespeare’s magician in The Tempest, controls everyone in the house, adding sisters and extra Erics to her assigned doll and mother and father. Her play soothes the helplessness of being little in a habitat of uncontrollable and irascible adults. The slight of the unwanted Eric is relieved as she becomes the one adding sisters and brothers to the family willy-nilly; reinforcements perhaps. It is notable that when she encounters a doll without an arm, even in the midst of these play balms, Nancy experiences a mix of heightened bodily anxiety and excitement accompanied by a pronounced shudder. Molly must once again rescue her by performing her unifying play magic, banishing the specter of permanent separation and loss. The meta-message here seems to be that such impossible aggressive wishes, awakened in the play and confounded by the inhibitions internalized in relation to her mother’s prohibitions of messiness, provide the groundwork for a harsh early superego formation. The clinical manifestation of such early “sphincter morality” is seen in Nancy’s physical immobility and passivity and in her inability to play freely and to extract pleasure from toys and the act of playing.
THERAPY SESSION 8: IS THE TROUBLE INSIDE, OUTSIDE, OR ON THE OTHER SIDE?
In this eighth session, held six weeks later, Nancy once again demonstrates her eager and ardent attachment to Molly. Molly, however, seems rather awkward when it comes to dealing with the strivings for her attention made by her two therapeutic charges, Leah and Nancy. This is all the more notable since it has been well established that one of the root causes of Nancy’s depression has to do with her inability to adapt to a common developmental event, the arrival of a peer who becomes a competitor. Her sibling hatred of Eric and her lost competition with him remain writ large in her actions and play. Current experience with nursery school settings and day care has sensitized and alerted us to the manifold ways in which competitive issues, jealousy, and envy can insinuate themselves into the everyday lives of young children and those who care for them. Of course, it also seems a natural progression from the drama of Leah being left behind to Nancy’s immediate question about the one-sided easel. Why one side rather than two? Molly’s response, that only one child would be painting in the room at any one time, while factual, seems a missed opportunity to remark on Nancy’s continuing sensitivity to people and things absent or missing, particularly rivals. Her preoccupation is highlighted even further by her immediately pointing out that a color is missing from the easel as well; the color red, the color associated with her anger at her mother and her shoes; the color she must blot out in anal-expressive fashion with her “mud” painting. The next sequence in the session involves a misunderstanding of Nancy’s wish to sit down while she pours the red paint. Molly at first thinks that she is indicating that she wants to use the toilet. This seems a further depiction and confirmation in the play of cloaked anal dynamics that drive her red/mud play. Then, of course, she starts her painting activity by making an“N.” This series of painting gestures raises the question of where Nancy is in her ambivalence toward Molly as well as her father.
Nancy’s next play sequence is of falling in the water and peek-a-boo play, ending with her sticking her tongue out at Molly. Molly seems to deflect Nancy’s hostile/teasing, yet erect and sensuous rebuff, when she describes this action as “stretching out her tongue.” This display of potency conveys a relaxed comfort with her aggression and further suggests that departure is in the air. Molly appears and disappears through Nancy’s painting movements with her hands. Nancy then shifts out of the play and moves her attention and thoughts away from Molly with her question about the dormitory going up next door. This leads to her thoughts trending home, to a central oedipal power dynamic where Nancy shares the marital bed with her parents over her mother’s protest and with her father’s support. In her narrative her own libidinal strivings regarding the sleeping arrangements are disavowed. The dog makes her do it. Furthermore, any guilt that she might otherwise be conscious of for going against her mother’s wishes is disavowed. After all, the metaphor of the dog “Mike” knocking her mother down suggests the added strength that Nancy has acquired from Molly that is helping her deal with day-to-day family life. In fantasy she wishfully protects her mother (from herself) by locking Mike up. (Mrs. Miles hated dogs and Mike in particular.) At the end the current positive objects in Nancy’s life are joined as she insists on physical contact with Molly, sitting on her lap while drawing a cutout picture to take along with her painting to her father as a gift. No apparent goodbyes are reported, but nonetheless Nancy departs from Molly as a child who at this juncture seems to have been partially psychologically resuscitated through a combination of physical contact involving feeding and sitting in Molly’s lap, attentiveness if not attunement, and the provision of a therapeutic play environment by Molly, with all its built-in potentials for psychological healing.
PLAY SESSION 9: A QUIET GOODBYE
This story of a treatment contact began with Nancy cooking sand cookies and ends with her pretending to bake a clay birthday cake at Molly’s suggestion. The final play session, which takes place three weeks after the eighth, is highlighted by a strong sense of purpose, if not a sort of rapture, as Nancy immerses herself in an exercise in curiosity that seems to have two parts. Part one has to do with her cold and its treatment by Dr. Coleman, and the second element is Nancy’s subsequent identification with the aggressor in her play. Both Molly and Nancy were absent the previous week; Nancy because of a cold. As she is inspecting the play dishes, Molly suggests a tea party. Nancy, showing rebellion, muted sadism, and high jinx, attacks Molly’s arm and leg with her needle from the doctor’s kit. She delightedly injects Molly not on her bare thigh as she had wished, but through Molly’s skirt. This seems to be a follow up to her sticking her tongue out at Molly in the previous session. The suggestion is that to treat her cold, Nancy received injections from Dr. Coleman. Her report of her own absence from nursery school amounts to one of the longest and clearest day-to-day conversations in her record. Part two consists of her ordering behavior such as naming the potty seat, dressing a “Negro” doll, and finally, training her curiosity on the doctor’s kit and its components. At the end, Nancy makes a play stove in what seems indicative of a growing acceptance of both being a girl and things feminine in the temper of the time.
DISCUSSION
Nancy as subject and Molly as analyst came together on our analytic scene halfway through the history of analysis, which extends somewhat more than a century. We assume and hope that as analysis continues to grow and mature, our understandings of the mind will keep pace. So what did we learn, overall, from the brief contact of this subject and this analyst? Taking Molly’s technique with Nancy as one typical type of therapeutic engagement, we can see that one mode was to present the child with a benign, supportive, interested adult. As noted earlier, implicit in such an approach was the realization that a child or adult could use this interpersonal stimulus to begin to construct a new, novel, hoped-for, “good” object. The relative absence of interpretations and questions in this treatment reminds me of Anna Freud and Sophie Dann’s descriptions of the Bulldogs Bank children as they were revived psychologically after the Holocaust.5 In the process of their recovery from harrowing years in the Theresienstadt concentration camp during World War II, these six children were well cared for physically and attended to emotionally. As an integral part of their recuperative process, their history and actions were never interpreted, and yet they made astonishingly speedy recoveries from their near-death infant experiences. Nancy originated in less dire circumstances. She does her own translating and interpreting of her traumatic experiences with Molly present as a witness and catalyst for her return from cognitive relapse and depression. While we have learned much in the ensuing fifty years about object constancy, how to identify transference in child therapy, object relations, and defenses, it is humbling to return to another day and view therapeutic action at work in another key. This action may not be as informed, efficient, and interactive as we now conceptualize it to be, but it nonetheless sounds a major emphasis: one thoroughgoing relationship with a troubled child, while not providing a complete formula for recovery, offers the basis for reversing regressions and reinstituting growth. Such an approach, however, is a half measure. It addresses object relations dysfunctions but not neurotic internalizations that usually require interpretative words in the context of play enactments to ameliorate. My hunch is that many adult and child analytic treatments of the day were much like that reported by Molly, long on relational dynamics and short on certain types of interpretations that address the character armor that is a secondary effect of trauma at the hands of individuals whose sacred trust should be the protection rather than the exploitation and harm of children. I am aware in making this statement that it flies in the face of much that is reported in the literature of the 1940s, 1950s, and 1960s. But I think that much of the literature was of the nature of window dressing, idealizing the psychoanalytic process as supposedly set down by Freud and glorifying abstinence while, in actuality, minimizing mutative interpretations. In present-day terms, individual treatment for Nancy would ideally be packaged with marital therapy for the parents and/or individual treatments for them, as tolerated. In the Mileses’ case, in the course of the study they received a variety of indirect help for their own troubled psyches and their tormented and tormenting marital relationship. The study involvement probably saved their marriage, at least for the time being. There is certainly no evidence that the study made things worse for either Nancy or her parents. From a therapeutic point of view, it was a qualified success. It remains to be seen how much of the developmental damage that Nancy sustained was “collateral damage,” secondary to her being a witness to warring parents, and how much she was a direct target of their discontents. The former would tend to lead to more transient developmental disturbances, while the latter would signify more permanent character pathology. There seems to have been some of each.
Given the early childhood time frame and the lack of follow-up data, what can we say about Nancy’s future course? Nancy did continue to see a trainee after Molly’s departure but that contact seems to have been static with no evidence of change in either a positive or a negative direction. While predicting future behavior is often a fool’s errand, if temperament is indeed the rudder of development, then Nancy may have gone through life as a quiet, socially reserved individual who, like her parents, saved her pathology largely for home display. But we need to remember that, contrary to the tidy and somewhat romantic analytic notion that development proceeds along regular progressive lines, it is often in fact spontaneous and discontinuous. In this sense it is analogous to what we see in gene variation and transmission. What goes before may or may not be significant in accounting for or contributing to later traumas. It may take more than an infant’s lack of pursuit of a stray nipple while nursing to predict future complex behavioral complexes. Traumas may emerge spontaneously from the cauldron of experience at any age. This assumes that there were no further children, that her parents remained married, and that she continued to cling anxiously to a special status with her father. The study had noted the unusual characteristic that she tended to identify with Eric as the aggressor, rather than visa versa, which would have been the more usual older-child/younger-child dynamic. After a childhood marked by passive traits, a propensity for calm (no dancing please), and submerged guilt, Nancy would reach adolescence and puberty at about the time of the Vietnam era. The conditions of the time, societal unrest, pursuit of peace and freedom in all their different forms, and the escapes provided by illegal medications could have affected her in either of several directions. They might have reinforced her tendency toward passivity, withdrawal, and quietude, or she might have become at risk for significant delinquent acting out. If the early infantile anxiety and depression, only partially resolved in her preoedipal period, reemerged as it so often does in early adolescence, Nancy would have been in for a tumultuous time, careening between breakdown and reintegration.
If we pull back at this point and take a forest rather than a tree view of the data from various sources about Nancy and her family, an interesting possibility emerges. What we may discern in the material is a historical description of “splitting” in Nancy. The discrepancy between her rough defiant behavior at home and her passive, wallflower behavior in nursery school may be better understood if we characterize it as a function of her use of splitting as both a defense and a character trait. In this way she could produce a differentiated display of energies, at certain times containing hostile, death-dealing forces and at others more relaxed, if inhibited energies similar to the libidinal schemes that infused her as an infant. In her therapy with Molly she seems to have shown both modes at various times. Certainly her parents in their relation to each other and their environment were “splitters.” How they shared information was often dominated by splitting phenomena.
Whatever course she took in adolescence, perhaps Nancy’s exposure to psychotherapy would sensitize her to the positive benefits of that option. As we know from experience, however, children who have been in treatment as youngsters may want to leave that option behind them, with the rest of their disparaged childhood, when they reach adolescence. In any event, it is difficult to predict outcomes on the basis of early experience except to say that early modes of character formation tend to persist. While our model of development tends to be linear, we must allow for circumlinear, spiraling ascents to maturity as well as regressive descents during adolescence. With Nancy we hope for the best, all the while remaining alert to the continuing deforming nature of early traumas and their subsequent persistence through the processes of internalization and neurotization.
POSTSCRIPT
I will conclude on an autobiographical note. As an undergraduate at Yale, I participated in a very minor way in this research project. My involvement was a major determinant in my selecting a subsequent career path as a psychoanalyst of adults, adolescents, and children. In September of 1954, I was a scholarship student at Yale College. At the time, each scholarship recipient was required to work fourteen hours a week at a job within the university. I was given the choice of working at the Yale Commons dining hall or at the Child Study Center. This turned out to be a “Hobson’s choice” of sorts—that is, no choice at all. By that time I had developed an appetite for all things psychiatric and psychoanalytic. I had spent the previous two summers working as an orderly on a locked psychiatric ward of a nearby Veterans Administration hospital. At that hospital the acute psychological casualties of the Korean conflict arrived for treatment eighteen hours or so after breaking down on some battlefield near Pusan, for instance, or around the Chosan Reservoir. The psychiatric service was run by analysts on staff or in training, and during those two summers I prevailed upon them to educate me in matters psychiatric and psychoanalytic through a sort of bibliotherapy. The Child Study Center morphed into my sixth unofficial undergraduate course. One of the first papers that I duplicated for the research study group (setting aside a copy for myself) was Winnicott’s magnificent work “Transitional Objects and Transitional Phenomena” from 1953.6 It spoke to me in a way that “knocked my socks off” and led me to the naive impression that the Child Study Center was a Winnicottian outlier. When I returned to the center many years later as a fellow, I realized to my chagrin that the analytic landscape was much more as it should be, individualized and varied, hardly Winnicottian. This did not deter me from writing my first analytic paper on Winnicott’s landmark 1953 paper.7 I was inspired not only by the dynamic stream of analytic thinking that ran through the research notes, but also by the simple sight of a young Sam Ritvo and Al Solnit walking and talking with their young analytic charges as they went to explore the contents of the dog pen in the next yard. Overall, the influence of the center was such that, while upon entering I had hoped that I might become a medical doctor and a psychiatrist, upon leaving for medical school my sole intent was to join the analytic field of Kris and Kris, Provence, Ritvo, Solnit (and Winnicott!).
NOTES
1. Possible identifying data such as individual names, places, and chronological sequences have been altered in the interest of confidentiality. Care has been taken that these alterations do not measurably distort the dynamic picture of Nancy and her family.
2. Donald W. Winnicott, The Piggle: An Account of the Psychoanalytic Treatment of a Little Girl (Madison, CT: International Universities Press, 1977).
3. T. Wayne Downey, “Within the Pleasure Principle: Child Analytic Perspectives on Aggression,” Psychoanalytic Study of the Child 39 (1984): 101–36.
4. Ernst Kris, “Decline and Recovery in the Life of a Three-Year-Old; or, Data on the Mother-Child Relationship,” Psychoanalytic Study of the Child 17 (1962): 175–215.
5. Anna Freud and Sophie Dann, “An Experiment in Group Upbringing,” Psychoanalytic Study of the Child 6 (1951): 127–68.
6. Donald W. Winnicott, “Transitional Objects and Transitional Phenomena—A Study of the First Not-Me Possession,” International Journal of Psycho-Analysis 34 (1953): 89–97.
7. T. Wayne Downey, “Transitional Phenomena in the Analysis of Early Adolescent Males,” Psychoanalytic Study of the Child 33 (1978): 19–46.