Contributions from Analytic Work with Children and Adolescents

"A Girl, Her Mother, and Her Analyst: A Study Of Self And Interactive Regulation In Child Treatment" - summary of paper given by Amy Joelson, LCSW at the 2005 Self Psychology Meeting in Baltimore

Roger J. Segalla, Jr., PhD

In the last five years, writers and theorists with a relational or self psychological orientation to psychoanalysis have contributed to a profoundly important understanding of the ways in which self and mutual regulation impact on the analytic treatment process. Infant observational studies (Beebe & Lachmann, 2002) have provided a model for conceptualizing the moment-to-moment affective interaction between the analyst and her patient and translating this understanding into clinical opportunities to deepen the connection and facilitate therapeutic change. Despite this progress, exploration of the operations of self and mutual regulatory interactions in a triad, especially those operating within the analysis of a child, remain relatively uninvestigated. Amy Joelson's paper: "A Girl, Her Mother, and Her Analyst: A Study Of Self And Interactive Regulation In Child Treatment," provides a unique opportunity to explore these concepts in the context of four year old girl's analysis. Ms. Joelson's very stimulating paper was presented this October to the International Conference on The Psychology of The Self and was followed by a discussion by Dr. Irene Harwood.

Using two "heightened affective moments" (Beebe & Lachmann, 2002), Ms. Joelson described how, after responding to the child's demand that her mother join them in the consultation room, this new child-mother-analyst triad engaged in what would become a fascinating complexity of self and mutual regulatory processes. This triadic analysis clearly provided the child with the safety necessary to express the distress she was experiencing in the midst of her parent's difficult separation. Ms. Joelson's ability to both playfully engage with the child and monitor the regulatory processes unfolding in the room allowed this child to communicate the meaning behind her frequent tantrums and apparent agitation. Sensing she had a partner (Ms. Joelson) that would allow her to safely demonstrate her distress in a way that would not irreparably damage her already fragile mother, this precocious three year old set about "staging" scenarios that depicted feelings (anxiety, despair, anger) that would have otherwise been too dangerous and too complex to communicate verbally. Ms. Joelson's presence between mother and child provided a critically important emotional buffer that allowed this mother and child to play more directly while the more difficult even unspeakable feelings were placed within and held by Ms. Joelson. By pushing away any self-consciousness, or any need to control the process, Ms Joelson allowed herself to be playfully transformed into a frog, a bunny, and a princess. These transformations provided this distressed child the opportunity to work through some very difficult feelings while maintaining her attachment her mother.

Ms. Joelson decision to respond to the child's demand that her mother participate in their session could not have been easy or without second thoughts. What evolved was not a psychoanalytic form of family therapy but a profoundly more complicated process that actually involved a complexity of shifting dyadic configurations (child-analyst, analyst-mother, and child-mother). As an analyst that feels fully occupied trying to attend to the words, actions, and feeling states of a single dyad, I was enormously impressed by Ms. Joelson's ability to stay attuned to the moment to moment events in each of these dyads without becoming so enmeshed (or overwhelmed) that she lost her observational platform. She seemed to do this, at least in part, by implicitly trusting that this sometimes bossy, overbearing three year old had something very important she needed to communicate to her distressed and overwhelmed mother. On her own, this child could only express her distress through the blunt instrument of tantrums. While maintaining a connection, largely unspoken with the mother, Ms. Joelson allowed this child to use her (sometimes quite roughly) as a modulated instrument to demonstrate her unmodulated fear for herself and for her mother. Beyond this critically important communication, the play Ms. Joelson engaged in helped this child connect to and work through feeling states (anger, grief, fear, etc.) that on her own must have felt like unformulated affective storms. By herself she could not have sorted through these feeling states without choosing sides in the unwinnable dilemma created by the reality that her two primary objects were at war.

The first "heightened affective moment" occurred right after Isabel (the child) demanded that her mother join them in the session. Ms. Joelson's decision to allow the mother into the consultation room allowed Isabel to express her profound distress following the previous day's unexpected arrival of Isabel's father and her mother refusal to allow him entry into the home. After Ms. Joelson let a doll slip out of her hand, Isabel screamed at her analyst "you let my daddy go," "you let him slip away." As this interaction continued to play out Ms. Joelson recognized that the mother was silently crying, leaving Ms. Joelson torn between the need to attend to child and the need to attend to the mother. What followed was shifting regulatory process in which Ms. Joelson allowed the child to use her as the object of her fury, this enabled her to down-regulate enough to express feelings that had only been expressed as tantrums the day before. The mother's crying was soon followed by a period of interactive regulation that marked the emergence of an elaborately structured triangular transference that became critical to exploring the disruptive dynamics generated in Isabel's family.

In the second "heightened affective moment" which Ms. Joelson labels, "The Mother Laughs," marked the beginning of a period of transformation in the triad. The play between Isabel and her analyst (who threw off her self-consciousness to become a hungry frog) changed the affective tone in the room (signaled by the mother's laughter) and released the triad from the tension created by trauma unfolding symbolically in the transference/countertransference. Ms. Joelson used this transformation and the spontaneous emergence of "Princess Lily and Bunny" to communicate more directly with Isabel, and shape the play so that she (Ms. Joelson) could guide Isabel through previously unsolvable dilemmas, like being mad at people you love.

Ms. Joelson's paper demonstrates in two richly illustrated scenarios the application of relational concepts of self and mutual regulation, three way social referencing, and moments of meeting. These concepts that have been used to describe psychoanalytic dyads can also be usefully employed to guide our understanding of complex dynamics of a psychoanalytic triads. The paper also demonstrates the use of concepts like spontaneity, interactive "sloppiness" and "wearing the attribution." These are techniques, which can serve to open up the analytic space and allow an unfolding of critical dynamic tensions. The insights this paper provides into triadic process also lend invaluable guidance for those of us who use a psychoanalytic model to treat couples. While this summary of Amy Joelson's paper "A Girl, Her Mother, and Her Analyst: A Study Of Self And Interactive Regulation In Child Treatment" is too short to do the paper real justice, I hope the reader will recognize the contributions this engaging paper makes to our understanding of self and mutual regulatory concepts when applied to triads.

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