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Home > Public Resources > Trauma Blog > 2015 - October > Bad Seeds or Misread Needs? Understanding the Impact of Maternal PTSD on the Mother-Infant Relations

Bad Seeds or Misread Needs? Understanding the Impact of Maternal PTSD on the Mother-Infant Relationship

October 27, 2015

Editor’s note:

ISTSS member, Daniel Schechter; MD, a child, adolescent and adult psychiatrist at the University of Geneva, won three international awards this summer for two papers. These papers both discuss how maternal violence-related PTSD can affect the parent-child relationship and child social-emotional development. In the following article, we asked Dr. Schechter to describe his two winning papers briefly and what inspired the intriguing ideas they represent.

Since my first volunteer experience even before I started medical school at a therapeutic nursery, I noted that mothers who had been exposed to maltreatment and violence tended to describe their infants and young children in ways that I would never think to describe a baby or a toddler. “She’s a mean baby…she likes to hit her mommy.” This mother was talking about a 2-month-old infant. She went on, “You see the way she’s holding her fist, that’s the way she held it in my womb and when she was born—she’s a boxer like her dad and she’s going to kill someone someday like he did. She looks all nice and cute now only because she knows you are looking at her.” Then about a 13-month-old “devil”, another mother said, “He’s a sex bomb, he gets his mommy and all the girls to fall at his feet and then he gets what he wants out of them!”

These were all inner-city children and mothers who had been identified as “at-risk” for maltreatment (many having already been maltreated and/or exposed to domestic violence). I asked myself, how could someone, especially the child’s own mother who I would expect to tell me how good-looking, smart and wonderful her baby was, see her baby in those ways? And with that kind of image in the mother’s mind, how would that child grow-up? Would he fulfill her prophecies? Fraiberg, Adelson and Shapiro (1975), of course wrote about how the traumatized parent is haunted by her past and how these “Ghosts in the Nursery” contribute to intergenerational cycles of abuse, violence and related trauma. Alicia Lieberman has extended these ideas further in her papers on negative attributions and the importance of positive past attachments or “Angels in the Nursery” that can mitigate those toxic effects (Lieberman et al., 2005; Lieberman, 1999).

By the time I finished my adult and child psychiatry training, I realized that the question of how traumatic experience in the context of attachment affects a parent’s perception of her child had not been very much studied empirically (Gara et al., 2000). And so, during my research fellowship at Columbia University, I began to tackle this question and develop an experimental intervention using videofeedback (Schechter et al., 2006).

The latter was meant originally to test our hypothesis within a clinical sample of mothers and toddlers referred to an infant mental health clinic, that during stressful parent-child interactions such as a moment of infant distress or of mother-toddler separation, one or more aspects of the interaction might trigger traumatic memory traces (i.e. helpless or rageful states of mind) in the maltreated or violence-exposed parent’s mind that could, in turn, cause the parent to avoid rather than approach the child when the child needs the parent the most. The child’s distress would then increase, and the parent would avoid further, leading to a downward spiral, resulting in mutual dysregulation of emotion and arousal rather than mutual regulation which is essential in early social-emotional development. If we could show that mothers with PTSD related to exposure to maltreatment and/or interpersonal violence indeed statistically had more negative, age-inappropriate descriptors than non-PTSD controls, and that we might change those indicators of distorted maternal perception with a Clinician Assisted Videofeedback Exposure (CAVES) session that would follow a filmed parent-interview with trauma narrative and mother-child interaction sessions, this would support our hypothesis and give hope for better-targeted evidence-based interventions for this population.

Subsequently, we did do such a study within a sample of 77 non-referred mothers and toddlers ages 12-42 months who were recruited from community pediatric clinics. And we found that maternal PTSD, dissociative and depressive symptoms in the context of lifetime maternal exposure to interpersonal violence predicted the degree of negativity of mothers’ attributions towards their toddlers, and also towards themselves and their own primary attachment figures.

These attributions were significantly more negative than those of the non-PTSD comparison group, regardless of whether the latter had been exposed to maltreatment or violence. And most excitingly, we found that after the 3 sessions that included the CAVES, this degree of negativity among the mothers with PTSD and comorbid psychopathology significantly decreased—yet only in reference to the mothers’ children, not towards themselves or their primary attachment figure.

The resulting paper entitled, “Negative and distorted attributions towards child, self, and primary attachment figure, among posttraumatically stressed mothers: What changes with Clinical Assisted Videofeedback Exposure Sessions (CAVES)?” (Schechter et al., 2015) received an Exceptional Contribution to Research Award by the International Psychoanalytical Association’s Biennial Congress in Boston in July, 2015.

These findings also to show that while the “ghosts” play an important role from the mother’s history as predicted by Fraiberg and colleagues, the child’s emotional communication, her distress, and even potentially the child’s physical appearance or gestures in so far as they might resemble to the mother a past perpetrator, can serve as traumatic reminders to a mother with post-traumatic psychopathology.

A “haunted” mother who responds both to traumatic triggers associated with her child or, unpredictably, by any number of other stimuli in her environment, can thus pose difficulties for the child to feel consistently, predictably an emotional connection and sense of security. And so, I worked on this clinical problem in a second paper, entitled “On Traumatically Skewed Intersubjectivity” (Schechter, in press). This paper has been awarded the Hayman Prize for Published Work on Traumatized Children and Adults by the International Psychoanalytical Association and the Charlotte and Norbert Rieger Psychodynamic Psychotherapy Award by the American Academy of Child & Adolescent Psychiatry.

In this paper, I describe my clinical observations—which remain as yet hard to measure empirically, on how children must by the circumstances of their relationship with a traumatized parent enter their parent’s traumatic world so to make sense of that parent’s perceptions and behaviors, and to fulfill their developmental need for intersubjectivity.

The resulting interactions often feel traumatic—such as when a mother in one case that I discuss, throws away all of her child’s teddy bears and pillows after a flashback in which she recalls having been smothered as a child during repeated rapes by her uncle. And yet the traumatic reaction of the mother, as she in agitation and without explanation or warning hurled her daughter’s favorite stuffed animals into the trash bin, can not be thought of or felt by her 17-month-old daughter as “the same trauma” to which the mother’s perceptions and behaviors refer.

This paper discusses how I was able to help this and other mothers of children of various ages take their child’s perspective (and vice versa with respect to the child) as facilitated by my taking both the mother’s and child’s perspectives as an observing third in a psychotherapeutic setting, with positive results for both.

Interestingly, these positive results can be surprisingly rapid to initiate—even if taking a long time to maintain, likely due to the increased plasticity, fast pace of development, the mother’s hope for something new, of being able to do differently with one’s own child than what had been done when the parent was a child.
 

References

Fraiberg, S., Adelson, E., & Shapiro, V (1975). Ghosts in the nursery. A psychoanalytic approach to the problems of impaired infant-mother relationships. Journal of the American Academy of Child & Adolescent Psychiatry, 14(3), 387–421.

Gara, M.A., Allen, L.A., Herzog, E.P., Woolfolk, R.L. (2000). The abused child as parent: the structure and content of physically abused mothers’ perceptions of their babies. Child Abuse and Neglect, 24(5), 627–639.
Lieberman, A.F. (1999). Negative maternal attributions: Effects on toddlers’ sense of self. Psychoanalytic Inquiry, 19, 737–756.

Lieberman, A.F., Padron, E., Van Horn, P., & Harris, W.W. (2005). Angels in the nursery: The intergenerational transmission of benevolent parental influences. Infant Mental Health Journal, 26(6), 504-520.
Schechter, D.S. (in press). On traumatically skewed intersubjectivity. Psychoanalytic Inquiry.

Schechter, D.S., Moser, D.A., Reliford, A., McCaw, J.E., Coates, S.W., Turner, J.B., Rusconi Serpa, S., & Willheim, E. (2015; epub Feb 20, 2014). Negative and distorted attributions towards child, self, and primary attachment figure, among posttraumatically stressed mothers: What changes with Clinical Assisted Videofeedback Exposure Sessions (CAVES) Child Psychiatry and Human Development, 46(1), 10-20.