Jackson and Gardner’s recent clinical vignettes opened discussion about clinical observations in IP.net
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This piece intends to open thought and discussion on how the analyst’s movements in response to the child — “countermovement,” can be used in treatment. I suggest several types of analyst responsive movements: facilitating interaction, re-enactments, and elaborately child-directed vignettes. This piece is overly long for IP.net. I hope that you can savor it over several courses of this meal.
The Analyst’s Countermovement in Child Work: Embodied Countertransference and the Present Moment
Nathan Szajnberg, MD
Movement – body, gesture, facial expressions – is a major component of child work. Children move: around the office, on a chair, use the couch as a stage, draw. And children’s faces express increasingly complex feelings after the first year of life (Darwin, 1998; Ekman, 2003; Szajnberg, unpublished). Movement was a subject of a panel at the recent American Psychoanalytic, chaired by Karen Gilmore (APsaA, Jan 14, 2012).
Embedded in action, there is play, drawing, talk — the more representational aspect of our work. Our task, to a significant extent, is to re-present these actions into felt words. We are translators or transformers: we engage in the more classical physics definition of sublimation – transforming, elevating the substance from one state (movement) to higher states (mental representations, including words) by using interpretations with proper content, timing and affect. Mayes and Cohen said of play, “An essential, daily, child analytic task is to find (and understand) the substitutes for verbal communication that will adequately convey to both child and analyst the essential nature of the child’s developmentally stagnating conflicts.” (Mayes and Cohen, 1994, p. 1235). How can we articulate a developmental model of action — movement development — comparable to our more sophisticated models of speech and language development (Shapiro, 1979; Szajnberg, 1985)?
Klein and Anna Freud, despite profound differences, recognized that children’s play and drawing function as free association, create a setting comparable to adult analysis, with proper “listening” technique by the analyst, (Klein, 1984; Sandler, Kennedy, Tyson, 1980), even as the role of play was multiply redefined, such as the balance between play and interpretation (Downey, 1987). We can say more about this “listening” technique in child work. We move, occasionally in response to the child: a change in facial expression (e.g. sadness, surprise, joy), or a gesture, or body shift or movement, or muscle tension/relaxation. Children watch, even when they appear not to listen.
Little written about the child’s movement evoking analyst’s countermovement. Glenn’s Child Analysis and Therapy (1978) does not discuss child movement, let alone the analyst’s in detail. Sugarman (2009) argues that child analytic process is like adult process, briefly alluding to “technical differences” (Fraiberg, 1967) , without discussing the vis-à-vis setting and movement . This paucity exists despite Hoffer’s thoughtful elaboration on Freud’s concept that our first ego is a body ego (Hoffer, 1950). In contrast, adult psychoanalytic literature has pioneered work on body posture (Reich, 1934) and gesture (Jacobs, 1973; Ogden, 2000), including recent work on the physicality and embodiment of speech (Pinsky, 2008; Vivona, 2010). Anthony (1977, 1982) accented the importance of the “sessile position” in child analytic work (trying to stay in one’s chair), yet sensitively does not preclude the analyst’s initiating movement and gesture when working with a silent child.
Infancy researchers also have elaborated the communicative nature of child movement prior to syntactical speech. Piaget (Piaget, 1952) described the sensorimotor stage as a phase in which knowledge lives in our bodies; a child shows he understands the concept “behind” well before he has the words to say it. Ainsworth, following Bowlby, uses the child’s locomotion to understand the child’s working model of attachment (Ainsworth, Blehar, Waters, and Wall 1978). The Strange Situation a child “tells” us through movement about its mother’s sensitivity in the first year of life. Other examples include Spitz’s observation of the evoked social smile or pre-semantic “No,” (Spitz, 1959); Winnicott’s (1975) spatula (tongue depressor) play; Kestenberg’s esoteric studies of infant tension-flow, elaborating Labanotation (Kestenberg and Sossin, 1979); Beebe and colleagues’ applying movement from mother-infant to adult analysis (Beebe, et. al., 2005); and Stern’s elegant discoveries of attunement or movement memory in infants (Stern, 1985, 2004).
Here, I initiate a discussion and study of the analyst’s responsive movements – countermovement’s – an embodied aspect of countertransference. Articulating our countermovements may initiate greater awareness and systematization for training and treatment. We have in mind as a model what Shapiro (1979) suggested in Clinical Psycholinguistics’ final chapter: adults (including therapists), without consciousness, modify syntax and vocabulary depending on the child’s development age. The adult analytic literature about the analysand’s body experiences on the couch is rich, ranging from what is experienced at erogenous zones (where mucosa meets the outside world) (Freud, 1901) to how we hold (or “armor”) our bodies (Reich, 1934; Deutsch, 1947, 1952) to a vast literature on movement and gesture (Breuer and Freud, 1895), including noting the analysand’s facial expression (Freud, 1901). Only in the last few decades has the adult literature explored and articulated how the analyst responds bodily to material (Jacobs, 1994; Beebe, et. al. 2005; Knoblauch, 2009), although Fenichel (1953) suggested that the analyst’s expressive movements facilitate empathy. Here, we discuss analyst movement in the vis-à-vis of child treatment.
Clinical vignettes describe different categories of countermovements in child work. This will be familiar to those working with children , but will include examples of both “present moment” confirmation or facilitation of process, and more content-oriented exploration of meaning.
Facilitating the connection
In some of the following vignettes, the analyst became aware of the movement only after the fact. In the first case, a diagnostic interview, an observant student asked afterwards why the analyst moved in certain ways at specific moments.
“Shoshi” a six-year old, was drawing a little girl. She explained: the girl didn’t like to be looked at by the sun, whom she then darkened. She began drawing bent slightly over the paper, then rested her head on her left arm as she drew with her right, tongue tip between her lips, concentrating. The analyst realized later that when she began drawing, he sat forward in his chair, almost matching her angle of pose above the paper; then, when she became more engaged in the drawing and rested her head on her arm, the analyst reposed (on reflection, giving her space). But, when she turned one quarter towards him to tell him that the little girl was shy of the sun looking at her, she leaned slightly (perhaps ten degrees) away; the analyst responded with a tilt (not consciously at the moment) in the opposite direction. As she continued her story, the child leaned towards the analyst, finally touching his left shoulder with her right. Again, in retrospect (after the student asked about this pas de deux), did the analyst realize that as the child leaned towards him, he relaxed his previous tilt away, sitting up until she leaned into him, and finally turned vis-à-vis to finish her story.
For the moment, let us consider these countermovements a response both to the child’s movement and her expressed story; the countermovement’s function was to facilitate the child’s comfort, but also (and via) an attunement to her gestural and postural affect
Tapping lightly
Uri, a six-year old boy, had difficulty engaging in the work. He spoke little and when offered a crayon and paper to draw, he sat with the crayon poised above the paper, a mournful cast on his face and whispered into empty space, “ I don’t know how to draw … even a person.” The analyst wordlessly picked up a red crayon and began lightly tapping the paper while glancing sideways at the boy . The tapping produced light dots. The boy looked, then began drawing a story of a boy in his apartment, where his father had a big basement coop for chickens and birds and ducks. This torrent of words complemented the drawing. He elaborated: there was straw on the floor for the birds to build nests. There were different coops so that animals didn’t attack each other. The boy in the story liked helping his father, especially feeding the animals. The coops were several times larger than the boy’s apartment.
Here, the analyst’s approach, following Winnicott’s Squiggle game (1971), was to facilitate the boy’s physical (drawing) communication. Unlike Winnicott, the analyst does not draw and tell a story, as the boy picked up the initiative without further intervention by the analyst.[2] The analyst’s movements were not in response to specific content, but in response to a laconic, apparently uncomfortable child. The analyst did not match the movement’s recalcitrance, rather he fostered an engagement in curiosity, tapping into an inherent felt story wanting to be told.
Swinging Light
“Henry” a four and one half year old in the waiting room with his father for his first visit looks frightened as the analyst enters, squats and welcomes the boy. Henry grabs his father’s arm in terror and tries to drag him out of the chair to the exit. The analyst points outside the window well to his goldfish pond. Henry pauses, sees the fish food and flashlight on the window ledge and watches fish rise to the surface as the analyst offers a pinch of food. The flashlight grabs Henry‘s attention. The analyst picks up the light by its lanyard, turns it on and begins swinging it slowly, pendulously so that its beam sweeps parallel to the oak floorboards, towards and away from the consulting room. The boy watches, head swiveling with the light, then reaches for the lanyard, hand-on-hand, imitating the analyst. After several moments, the analyst rises and walks to the office. The boy, carrying the flashlight, follows.
Body-to-body, then attack
For several months, Henry’s play consists of hiding and finding glass marbles or violent playhouse play consisting of a super baby who launches from the basement, his head smashing through the floors, then the roof, then falling back head first, crashing the roof and the house. Attacks on the baby’s head were a recurrent theme. This baby/house story was punctuated by his running in counterclockwise circles while flapping his hands and repeatedly, excitedly reciting tales of the baby’s head smashing.
In a parent meeting, without revealing details of the clinical work, I described this boy’s concern about body integrity. Afterwards, mother asked to meet alone. She insisted that I not reveal to her husband what she had never told anyone. Henry was her only child. She found him a difficult infant, and became increasingly angry at him. She chose to stay home the first year and regretted the decision. Because of him, she wanted no more children. One day, at sixteen months, she was ascending a spiral staircase holding her son, who was crying inconsolably, both pushing away from her and grabbing her neck. She reached the top of the stairs and flung him across the floor against the cupboards. He sustained a scalp wound, bleeding profusely. She brought him to the Emergency Room, explaining that he had fallen down the stairs. After stitches and overnight observation, he returned home without evident medical sequelae. She feared her own anger at the boy and retained a live-in caretaker thereafter. She said, in contrast, that her two younger nieces were “angels.” She thought her son had something wrong with his brain, that he was so difficult a child, one who needed treatment. I do not claim that this specific event was “remembered” by the boy; yet, his recurrent play had the quality of trauma play (Terr, 1994), and he likely absorbed his mother’s feeling of her antagonism towards him. There is history for both discrete and cumulative trauma (Khan, 1974). He certainly knew that mother favored his nieces, commenting repeatedly on this in session.
Over the second year of treatment, Henry cautiously, progressively approached me. While drawing, he sidled closer. As he told me stories, he looked at me directly. One day, nearing the end of a session, he climbed onto my lap. He took the pencil, with which he had been drawing, and placed its tip gently between my lips. He said this was “milky” and I should drink it. I obliged. He then rested his head on my left shoulder, holding the pencil in his right hand on my lips and observing closely. I found myself softening, reclining with some sense of comfort that this child was at rest in my arms. Suddenly, with his left palm, he slammed the pencil into my mouth, striking the back of my throat. Shocked, I jerked my head back and yanked out the pencil. He leaped off my lap with a look of terror. After moments to collect myself, I said something along these lines: he was showing me that even when something good was happening, he expects to be hurt. This theme now entered and recurred in his dollhouse play over the next months: the baby, a super baby, feeding others, doing super power things, then suddenly rocketing through floors and the roof, then crashing down destroying things with its head. With time, the interpretation began to take hold; anxiety diminished and the head-smashing play was replaced with less body-destructive play. That is, here my countermovements (my relaxation, then my sudden jerk away and subsequent body caution) lent themselves to interpret content of a possibly re-enacted experience.
Being Directed by the Child
“Lily” began treatment at five. She brought suitcases with clothes and costumes to perform various song and dance routines. Later, she brought her boom box to accompany her. She became super-heroes, girls with bodily powers such as erupting volcanically, or shocking electrically, or stretching elastically. She assigned roles to me: being an incompetent boy, or a teenage sitter who never could do his job well. In one extended play over several months, I was to be the baby-sitting teenage brother, who dozed off when he should have been watching over his baby sister (her). She directed me elaborately. She would turn down the floor lamp’s dimmer, telling me to get sleepier and sleepier. Then, I was to awaken with terror as she recited to me the nightmare I was having (Szajnberg, 2010). (Months later, she revealed that she had had this recurrent nightmare for some time, but since beginning our play, it had gone away.) She observed me well: if I did not show enough fear or surprise in my face or gesture, she insisted we start over until I got it right. She tolerated no “faking it” on my part. Her direction of my emotive expression extended into other areas of the work as it continued for the next three years. She was a Stanislavsky method director. She expected me to “match” her inner sense of how “it” (various experiences) felt. If I was “off,” she corrected me crisply.
Noticing one’s physical reactions.
“Sonia” decided that rather than singing and dancing on the floor, the couch was a better stage. Perched high, she went through various routines she had seen on TV. In fact, this was entertaining. But, as she became more enthusiastic, she started using the analytic couch — a Mies van de Rohe, black Napa leather day bed with round bolster — as a trampoline for gymnastic routines. As the bolster would interfere with her routines, she removed it at the beginning of session. Only after a bit, I noticed a sense of tension in my abdominal muscles, then rising irritation with her. (I also noticed after such a session that the leather-wrapped buttons were loosening.) Finally, I recognized that I was more concerned about the well-being of my couch than the content of her session. I told her that she could not do gymnastics on the couch, nor dismantle it for her routines. Her performances continued in a more grounded manner with greater comfort on my part. That is, what father considered “games,” were experienced by her as both seductively exciting and attacks on her body, just as the analyst was “seduced” by her performances, while at the same time, angry at her attacks on his fancy couch.
Sonia‘s reaction was quite matter-of-fact. She resumed her performances on the floor with little ado, although the analyst had hesitated for months, concerned that he would be circumscribing her work. We can understand her reaction in terms of Winnicott’s idea of an honest, yet contained expression of honest hatred in the analyst’s response: if the patient is pulling for this expression and the analyst can metabolize this and present it in a straightforward, yet restrained manner, the patient trusts in the work more deeply (Winnicott, 1974; Giovacchini, 2000). Here the comment by the analyst, that is the putting into the words the building bodily tension, facilitated the working alliance. It could also have been expressed in terms of a re-enactment of the child’s sense of hatred elicited in her father, which he expressed by engaging her in “games” that were highly sexualized. This was explored later in the treatment.
Discussion
Early in my training, I naively asked a supervisor who was renown for his child work, how he got children to use the couch. He responded that with children he insisted only that they stay off the ceiling.
We expect children to move in treatment: it is not only developmentally-appropriate, but also how they tell their (life) stories. But, how do we move in response to children, not only whole body movement, but also gesture, facial expression and our physical responses to material? Anthony suggested in his “sessile position” paper that optimally, over time, the child analyst should be able to remain seated. This fits with the sense that we have greater observing ego available at rest. Movement makes demands on our experiencing ego, at times diminishing the observing ego’s acuity. Yet, children do not always permit us this leisure. The child therapist’s task is to avail himself or herself of whatever observing ego can be called up even as our body is in motion, as our experiencing egos are engaged. Fortunately, there is a continuum from experiencing to observing ego. In this sense, child treatment is more demanding of our observing ego than work with adults on the couch: we are not watched and adults move less.
I concentrate on moving response, countermovements; something that hews closer to the concept of countertransference as it has been developed and expanded since Racker’s (1957) early article, to include our feelings evoked in response to the analysand’s non-verbal communications. “Countermovement” captures a continuum of meaning from the more descriptive (literally, the analyst’s movement in response to the child); to the preconscious movements closer to procedural knowledge or related to the phenomena of mirror neurons; to the more classically unconscious countertransference (the range of analyst’s repressed feelings underlying the manifest movement, that range from feelings that “counter” the analysand’s transference to those that are enactments that may facilitate the work.). Consider how to categorize different types of countermovements. On occasion, this is analogous to affect attunement (a matching of body affect); on other occasions, the analyst hewes closer to Winnicott’s Squiggle game (op. cit.), offering the hope of a dialogue in play (the boy with the crayon frozen mid-air).
For instance, the vignettes of the Shoshi, or Uri boy, or light-swinging boy suggest the analyst’s movement in response to the child’s expressed movement: the shift away, then towards by the girl; the boy’s frozen hesitance, crayon poised in the air; Henry’s fear about leaving his father or entering the office. On reflection, the analyst realized that he responded physically, wordlessly, to facilitate the work, to make the setting less threatening, more comfortable.
Second, the extended vignette of Henry “bottle-feeding” the analyst with a pencil comes closer to our current understanding of non-verbal expression of inner life enactment, which evoke feelings in the analyst (Giovacchini, 2000; Ogden, 2005). This boy may have memory traces of his mother flinging him across the floor, or head smashing, or at least her ongoing resentment of him and expressed belief that his brain was damaged (from birth). His pencil “play” expressed severe ambivalence: on the one hand, he wishes/feels/imagines coming to repose on someone, being fed; on the other hand, he expects “unanticipated” stabbing attacks. The paranoid anxiety comes in the “arms” so to speak of someone who should be comforting him; his look of terror as he leaped off my lap captures visually his expectation of retaliation (and possibly horror/guilt of what he had done) (Klein, 1975). The analyst’s task is to transform the movements (both child’s and his) into symbolic representation including the projected fears and wishes.
Third, and more complex perhaps, is Lily’s theatrical direction of my performance — including that my voice and face express clearly the feelings she wanted me to display: this involves both conscious (her close observation of me and directorial demands) and unconscious (repeating her life experiences, for instance, of how she felt so controlled by her parents; had to put on a good face). This is but one example of many: because we are vis-à-vis, the child can monitor more closely our expressed emotions. Further, because spontaneous emotions are expressed facially (and physiologically) before we become conscious of the emotion (Ekman 2005; Szajnberg, 2010), the child can literally see more transparently the sincerity of the analyst’s emotions. We are on display.
The final example — couch as trampoline — shows a stepwise response to evoked feelings. First the analyst became aware of tightening in his belly, then aware of diffuse irritation that became focused on the child, then aware of being preoccupied with his couch’s survival. Only after this bubbling up of feelings into consciousness did the analyst realize that this child’s entertaining displays had become an irritation to him and “endangered” the integrity of the analytic couch, an extension of his body (certainly of his identity). This dawning awareness may be a characteristic of countertransference with more primitive mental states (Flarsheim, 1975). After months, the child revealed her uncle’s seductive attacking “games”: then the analyst realized her re-enactment as aggressor on the analyst’s body proxy.
These examples of countermovements are not exhaustive. Hopefully, they will elicit further thought and discussion on the range and nature of the analyst’s movements in response to child material and movement.
Movement is complex. It ranges from within body feelings (muscle tightening, relaxing, twitching), to body movement, gesture and facial expression (Jacobs, 1973; 1994; Beebe, et. al., 2005). There are various influences on movement. Culture (and child-rearing that transmits culture (Erikson, 1950)) can express itself in different body orientations: in dance, for instance, movement style may range from the low-to-the-ground, en bloc dance of Athabascan Indians, to the more sinuous fluidity of Indonesian dance, to the stylized upper body, foot-slapping lower body Kathakali dance of Southern India (Lomax, Bartenieff, Pauley, 1968). Gender differentiation in movement may show itself in children as young as three (Birdwhistle, 1968). Cognition is held in the body (Piaget, 1952), as are aspects of self-representation in the first three phases of self development (Stern, 1985). For both Piaget and Stern earlier developmental states do not disappear, but remain as levels underlying later stages: what starts in the body, stays in the body. Finally, in addition to discrete affects (such as happy, sad, angry, fear, contempt, disgust), which are expressed universally, we also have the vitality affects (Stern, 1985, 2003), which characterize an individual, even a culture. One might view vitality affects — such as enthusiasm, zest, languor, sobriety, frenetic, calm — as a body version of character.
Stern’s Present Moment concentrates on verbalizations of these experiences, making them also shared experiences. Briefly, his clinical examples are based on his microanalytic interview, which assesses five seconds of experience and graphs this on a timeline with vertical axis of event/feeling/sensation/thought/affect/action . This is highly verbal, but much of its foundation stems from his observations of the ballet between mother and infant. This paper asks us to extend this “present moment” concept to child work. Stern makes a crisp distinction between seeking meaning in psychoanalysis versus his emphasis on (shared) “life verisimilitude.” In this paper, we suggest a continuum between these poles. He argues that “…psychoanalysis is interested in the relationship between pieces of the current experience, past experiences and preformed structures that forge meaningful patterns. The timing between those pieces … is important for psychoanalysis, but not the timing within the individual pieces, especially the present.” (p. 139) He continues later, “…in most psychodynamic treatments, there is a rush toward meaning, leaving he present moment behind. We forget that there is a difference between meaning…and experiencing something more and more deeply.” ((p. 140). Of course, in psychoanalytic work, with an emphasis on the transference, Freud recognized that meaning and experiencing it more deeply need be annealed (Freud, 1905). Stern emphasizes that there is a “problematic relationship between a lived experience…and its later linguistic (re)construction,” something he presented as early as his discussion of the development of selves in childhood and the gap between the first three aspects of self and the linguistic self that develops after the third year (Stern, 1985). He concludes, “the experience of the present moment…aims for life verisimilitude, not meaning.” (p. 141)
View the analyst’s countermovements in response to various aspects of the child’s work; there is a continuum between this experienced verisimilitude (the sense in affect attunement, for instance, when a baby feels, “Yes, you’ve got what I am feeling; you share it.”) and the deeper sense of meaning that comes with meaningful understanding that is infused with feeling.
The analyst’s responsibility is not only to recognize one’s movements, but more so, to distinguish when our movements are in response to the child’s material; a form of bodily countertransference. The analyst’s body ego (Hoffer, 1950) may “dance” with child material. This is not only Stern’s attunement (1985), but also engages our body more fully. The analyst has a responsibility in his self-analysis to know his body, feel it, recognize his movements in order to know when the movements are his own versus his countermovement to the child’s work, the child’s attempt to express something without the words to say it. In a very specific sense, we simply extend Freud’s idea of evenly hovering attention to include not only what we hear, but also how we feel and move in response to the analysand’s associations.
One final point. In most of the vignettes, the analyst became aware of his body movements often after the fact. This “after the fact” sense shares a quality with Nachtraglichkeit, après coup. That is, only after an experience, when there is a following “experience” with greater cognitive capacity or awareness, does the first experience become noticed and understood; there may be more material to infuse greater understanding; there may be more room for the analyst’s balance of observing versus experiencing. This extends Freud’s concept of Nachtraglichkeit, hewing closer to the French development of après coup (LaPlanche, 1999; Birksted-Breen, 2003; Perleberg, 2006). Here, the sense of après coup applies to the analyst’s mental processes making sense of the prior emerging experiences.
Children live closely to their body experiences. In our work with children, we appreciate and meet the challenge to elevate body experience — in this case, movement (our own and theirs)– into symbolic representation, into finding the meaning in our lives as expressed in our bodies. We learn the prosodic dance beneath the words; like music to lyrics, they can be linked.
[1] Like Moliere’s Le Bourgeois Gentilhomme, we may be pleasantly surprised that we have been “speaking prose” these many years about our body movements and never knew it.