JOU RN AL O F C H ILD PSYCH O TH ERA PY VO L .

27 NO 3 2001 257–271

1
2
3
The early appearance and 4
5
intergenerational transmission of maternal 6
traumatic experiences in the context of 7
8
mother-infant interaction 9
1011
1
2
E. MÖ H L E R , F. RE S C H , A. CI E R P K A AND 3
4
M. CI E R P K A 5
Heidelberg, Germany 6
7
8
9
Abstract The paper describes the case of a girl of 8 weeks, referred by her mother because of ‘intolerable
2011
hysterical attacks’ triggering maternal impulses of abuse. Maternal perception of her infant was distorted
1
to the extent that the mother was re-experiencing encounters with her own intrusive and traumatizing
2
mother in the face of her screaming child. She also perceived the infant’s motor impulses as physical attacks
3
on herself and expressed intense anxieties about her daughter’s future aggressive potential.
4
The infant was viewed by her mother as extraordinarily and dangerously greedy. Even neutral infan-
5
tile vocalizations were perceived as manipulating and sadistic. She tried to ward off these anxieties by
6
employing a rigid scheme of rules and obsessively controlling the father’s and grandmother’s interaction
7
with the child. The mother feared being overwhelmed by the infant’s needs if she were to yield to them
8
in a exible way.
9
The mother’s background of early neglect and trauma is described, in the light of recent literature
3011
about the early intergenerational transmission of traumatic experiences, in order to demonstrate possible
1
treatment modalities and the need to consider both protective and risk factors.
2
3
Keywords Child abuse; mother-child relationship; mothers; parenting.
4
5
Introduction 6
7
Mothers exposed to physical or sexual maltreatment in childhood very frequently
8
enact the intergenerational ‘cycle of abuse’ either by maltreating their children or by
9
becoming the victim and turning the child into the perpetrator (Ratzke and Cierpka,
4011
1991; Famularo et al., 1992). The prevalence of a history of sexual abuse among
1
young women is described as being around 13–25 per cent (Kessler et al., 1995;
2
Goodman et al., 1998). The Ž gures for physical abuse range from about 13 to 40
3
per cent (Kessler et al., 995; Goodman et al., 1998).
4
5
6
Journal of Child Psychotherapy
ISSN 0075-417X print/ISSN 1469-9370 online © 2001 Association of Child Psychotherapists
http://www.tandf.co.uk/journals
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 258 E . M Ö H LER ET A L .

1 The abuse can have multiple psychopathological consequences: depression, anxiety

2 disorders, obsessive-compulsive disorder, conversion disorder, self-mutilation and
3 substance abuse. Impairment of affective regulation (Ogata et al., 1990; Paris and
4 Zweig-Frank, 1992; Paris et al., 1994; Resch et al., 1998) and dissociative disorders
5 (Brunner et al., 2000; Chu and Dill, 1990; Kirby et al., 1993) are some of the most
6 frequent problems associated with abuse-related trauma.
7 Any type of trauma may be followed by post-traumatic stress disorder with  ash-
8 backs, hypervigilance, sleep disorders, etc. A generalized psychophysiological
9 hyperreactivity is also described for traumatized patients, including increased heart-
1011 rate reactivity to acoustic stimuli (Shalev et al., 2000) or decreased habituation of
1 reactivity to acoustic stimuli (Metzger et al., 1999). There are, however, few studies
2 about the in uence of a maternal history of abuse on her reactions to her newborn
3 child. One study examined mothers with a history of abuse and found maternal
4 hyperreactivity to infant stimuli (Casanova et al., 1994). Also, it has been found that
5 abused mothers rarely identify their infants’ emotional signals correctly (Kropp and
6 Haynes, 1987) and their empathic responsivity and affective reactivity have been
7 shown to be lowered (Milner et al., 1995).
8 While the intergenerational transmission of sexual, physical or emotional violence
9 and abuse is established and frequently described as a statistical phenomenon, the
2011 mechanisms of this transmission need to be further elucidated. Cierpka and Cierpka
1 (1997) propose that a general disturbance of empathy keeps former victims of violence
2 from taking the child’s perspective, thereby impairing parental perception of the
3 child’s needs. At the same time a defective superego leads to a loss of intrapsychic
4 structure, causing defective intrafamilial boundaries.
5 The background and development of early relational disturbance caused by a
6 maternal history of abuse are as yet very poorly understood. The observation and
7 analysis of mother-infant interaction in at-risk dyads can and should be applied as
8 a useful tool to identify early risk factors (Briggs, 1997). Such analysis of abused
9 mothers’ behaviour and attitudes towards their own infants may contribute to the
3011 prevention and treatment of pervasive and severe interactional disturbances.
1 In another approach the literature on the interactional characteristics of abusive
2 mothers may be used in order to Ž nd a connection with the speciŽ c behaviour of
3 abused mothers, thereby identifying important risk factors in the latter for actual
4 acting out of their former abusive experiences. Bauer and Twentyman (1985) found
5 a general hyperarousal and hyperreactivity of abusive mothers, especially when they
6 were interacting with their children. In a prospective study, Engfer and Gavranidou
7 (1987) describe less maternal sensitivity in the neonatal period in mothers who were
8 later found to abuse their infants.
9 Changes in reactivity and sensitivity could potentially be related to the psychophys-
4011 iological alterations known to occur in post-traumatic stress disorder. Empirically,
1 emotional and physiological hyperreactivity to infant stimuli can be found in abusing
2 as well as abused mothers, indicating the possible psychophysiological roots of trans-
3 mission (Casanova et al., 1992, 1994). Attachment theory stresses the fact that insecure
4 attachment is frequently described in the context of intrafamilial abuse and a connec-
51111 tion to psychophysiological alterations is also proposed. Many abused children

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 TRA N SM ISSIO N O F M A TERN AL TRA U M AT IC EXPER IE NC ES 259

demonstrate signs of disorganized attachment towards the perpetrator, showing a 1

chaotic and erratic reaction pattern. Adults with a history of abuse can be found to 2
manifest similar attachment patterns in the Adult Attachment Interview and the reac- 3
tions of abused mothers to their infants can be predicted by these parameters (Main 4
and Goldwyn, 1984). Crittenden (1981) investigated mothers with a history of abuse 5
and found them very frequently to show signs of enmeshed attachment (E) espe- 6
cially to the abusive parent, characterized by intense anger and longing for acceptance 7
at the same time. 8
Our article focuses primarily on yet another aspect of intergenerational transmis- 9
sion. Steele and Pollock (1968) were the Ž rst to mention the importance of projective 1011
mechanisms in the interaction of abused parents and their infants. They proposed a 1
mechanism involving the projection of negative self-representations onto the child, 2
leading to rejection or further abuse. 3
According to Brazelton and Cramer (1991) and Dornes (1993) parents tend to 4
project unconscious material of their own past onto their infant, especially during 5
the Ž rst months of life, unconsciously shaping the formation of the infant’s self. 6
Hinde (1976) stated that parental interpretation of the infant’s behaviour is charac- 7
terized by a ‘constant overestimation of the intentional element’. The contents of 8
parental projections are dependent on the parents’ own history. The so-called ‘ghosts 9
in the nursery’ (Fraiberg et al., 1980) are parental representations and introjected 2011
objects modulating the parent-infant dialogue. As parental fantasies about the child 1
frequently originate in unresolved relational patterns in the parental history, some 2
authors call this phenomenon ‘the return to the neurosis of the child’ (Kreisler and 3
Cramer, 1981). The infant represents an aspect of the parental unconscious. Lacking 4
pronounced personal characteristics or differentiated intentions a new-born child can 5
be shaped and formed by the parents’ fantasy. 6
The developmental signiŽ cance of this process will be determined by the parents’ 7
reactions to these projected attributions of meaning of infant behaviour (Cramer, 8
1986). According to Dornes (2000), there is no such thing as the ‘true self’ as every 9
parent immediately modiŽ es the infant’s personality by reacting to the infant as it 3011
is imagined to be by the parent. In the course of this process, the infant will even- 1
tually identify with the parents’ projections to a signiŽ cant degree. These projective 2
mechanisms might be postulated to be especially detrimental to mother–infant inter- 3
actions, and consequently to the infant itself, when the projections are of a violent 4
and intrusive nature (Rabain-Jamin, 1984). 5
This article describes the reactions, attitudes and interactional characteristics of a 6
young mother with a history of abuse, illustrating projective mechanisms in the trans- 7
mission of a ‘potential for violence’. This young woman was able introspectively to 8
observe and communicate her own experiences and emotions. We found this very 9
helpful in understanding some of the intrapsychic factors that can modulate and 4011
in uence abused women’s interactions and relationship with their infants. We shall 1
discuss some of the insights gained in relation to the prognosis, prevention and 2
therapy of infant maltreatment. 3
The psychosocial signiŽ cance of these issues is highlighted by the crucial question 4
of whether the intergenerational transmission of violent experiences is an inescapable 5
6

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 260 E . M Ö H LER ET A L .

1 fate or a preventable constellation, as discussed by Fraiberg (1980) and Fonagy et al.

2 (1991). Oliver (1993) states that one third of abused parents do not maltreat their
3 children. Conversely, a parental history of abuse is not a mandatory condition for
4 sexual or physical infant maltreatment. Some authors (Croghan and Miell, 1999;
5 Cadzow et al., 1999) have stressed the importance of maternal postnatal depression
6 or psychosocial factors when determining the risk of abuse.
7 Clearly, parental abusive impulses and actions towards their own children have to
8 be viewed in the context of a pathogenic vulnerability model (Resch, 1999), since
9 risk factors need to be weighed against the existence of protective elements. According
1011 to Egeland et al. (1988), the transmission of abusive experiences can be prevented
1 by a supportive marital relationship. Similarly, the cycle of abuse can be interrupted
2 by the integration, as opposed to the dissociation, of the traumatizing events (Egeland
3 and Susman-Stillman, 1996). Psychosocial support in general has also been found to
4 be protective for at-risk dyads (Bishop and Leadbeater, 1999). The interdependence
5 of intrapsychic and psychosocial risk factors and protective factors is illustrated by
6 the case report presented below with particular reference to the clinical application
7 of scientiŽ c background information.
8
9
Case report
2011
1 Mrs L called the Parent–Infant Programme1 for an ‘emergency appointment’. Her
2 daughter Alicia was 8 weeks old. Very tense and agitated, Mrs L talked about her
3 problems with Alicia. According to maternal report, Alicia was crying three to eight
4 hours per day, culminating in ‘hysterical attacks’. She was sleeping for only Ž ve to
5 six hours per night and was being treated by the paediatrician with a homeopathic
6 medication. The mother found the sleeping problem to be signiŽ cantly improved by
7 the medication with Alicia sleeping ten hours per night without waking.
8 During the Ž rst interview Mrs L. reported intense fears of hurting her child. Her
9 impulse to hit or beat Alicia was at times so strong that she could barely control it.
3011 A week previously, during a screaming attack, Mrs L had forced Alicia’s mouth shut,
1 at the same time feeling horriŽ ed by her own actions and consciously keeping the
2 baby’s nose free for breathing. Usually she tried to direct her rage away from her
3 child by screaming herself, hitting or kicking the walls or the kitchen door, which
4 she Ž nally destroyed.
5 At times these outbursts failed to provide her with sufŽ cient relief, and she revealed
6 that on one occasion she had dropped Alicia onto her bed from about Ž ve inches
7 above. Immediately afterwards she had had intense feelings of guilt and remorse and
8 had taken Alicia into her arms.
9 She was extremely worried about what she called her ‘potential for violence’. At
4011 the same time she admitted being frightened by her daughter’s ‘potential for violence’,
1 describing her as kicking against her breasts twice during nappy changes. Mrs L saw
2 this as a deliberate act by her daughter aimed at violently hurting her. She had
3 responded faster than she could think, or control herself, by ‘instinctively slapping
4 her back’ and she complained about intense pains resulting from Alicia’s actions.
51111 Similarly, she felt attacked by her daughter when Alicia ‘hit her lower jaw’. She felt

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 TRA N SM ISSIO N O F M A TERN AL TRA U M AT IC EXPER IE NC ES 261

threatened by Alicia’s growth, because she feared not being able to control Alicia’s 1
‘aggression’ once she gained in height and strength. She felt that Alicia’s ‘violence’ 2
might be aimed speciŽ cally at herself. 3
Mrs L stated that her relatives did not understand her feelings. Her husband and 4
her mother-in-law were very reproachful to her for not showing enough affection 5
towards Alicia. She blamed this additional experience of rejection and loss of approval 6
on her daughter. She felt unsupported while at the same time mistrusting any offer 7
of help, especially concerning child care. She was worried that any kind of affection 8
shown to Alicia by her husband or mother-in-law would irreversibly spoil the girl. 9
In order to keep her daughter’s potential ‘greed’ in check she had developed a 1011
computer Ž le with a timetable for Alicia and laid down rules on how to treat her. 1
She very strictly enforced these rules, such as not attending to her when she was 2
crying, and she tried to control her husband’s and her mother-in-law’s interactions 3
with Alicia, such that she was never, in fact, able to take her mind off the child and 4
relax, when she could have had the chance of doing so. 5
She adhered rigidly to a time schedule and expected the same of her husband and 6
mother-in law. ‘Violations’ of her rules would cause Mrs L. to ‘lose control’ and to 7
act out her rage by destroying things. When asked what she felt in those situations, 8
apart from rage, she revealed intense anxiety about Alicia’s development. ‘Giving in’ 9
to her needs in a  exible way, it was feared, could encourage Alicia’s greed to a point 2011
where it might be dangerous and overwhelming for Mrs L. She felt the desperate 1
need to teach her daughter ‘social adaptation’ in order to control her ‘potential for 2
violence’. On one occasion when she had experienced her child’s hunger cries as 3
‘greedy’, she had given Alicia hot milk in her bottle in order to teach her the ‘logical 4
consequences of her greediness’. 5
During this Ž rst interview the mother appeared very tense and agitated. Heightened 6
arousal and unstable affect were evident throughout the session. Mrs L was not 7
working at this time. She had interrupted her nurse training after a patient had ‘acci- 8
dentally almost broken her lower jaw’. Before and during the pregnancy she had 9
worked in a bakery. Her husband was a technical engineer who worked about eleven 3011
hours per day. Mrs L described him as very unavailable and overly dependent on his 1
mother. Her mother-in-law was still working as a nurse. She had left her husband 2
and was living with a female friend. Mrs L felt that her mother-in-law would always 3
side with her husband, leaving her lonely and misunderstood. According to Mrs L, 4
Alicia would smile radiantly at her father and grandmother, a reaction that she 5
perceived as a deliberate provocation, since Alicia never smiled at her (the latter could 6
be conŽ rmed in the sessions). 7
When asked about her own family of origin Mrs L Ž rst talked about her mother, 8
who had beaten her with various instruments throughout her childhood. Recalling 9
those episodes of maltreatment she remembered her mother ‘screaming hysterically’ 4011
when hitting or kicking her. Neither her father, her teachers nor the neighbours had 1
ever come to stop the abuse, apart from on one occasion when she described her 2
father virtually saving her life. Her mother had pursued her with a knife, trying to 3
open the door of the bathroom where Mrs L had locked herself in. She reported 4
this as the only time her father had actually intervened and stood up to her mother. 5
6

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 262 E . M Ö H LER ET A L .

1 Mrs L talked about these experiences of terror and pain with a  at affect pointing
2 to a high degree of dissociation. She was also extremely ambivalent in relation to her
3 mother, who had died a few years previously. She regretted that her mother had
4 never seen Alicia. Later she was able to appreciate that her regret stemmed from an
5 intense – because never fulŽ lled – longing for acceptance by her mother. She reported
6 having received some basic care and attention, but never any praise or conŽ rmation.
7 She described her father as an alcoholic who was barely managing to work and
8 had no energy left for the family. Her father was still alive and had undergone
9 therapy. Apparently he had stopped drinking, but conveyed to his daughter that he
1011 had no true understanding of, or interest in, a small child like Alicia. Mrs L felt
1 grateful for his ‘honesty’.
2 Alicia’s early development was difŽ cult. Mrs L was ambivalent when she learnt
3 about her pregnancy, which had occurred during an antibiotic treatment that had
4 interfered with her birth control medication. But since Mr and Mrs L had planned
5 to have a child the following year anyway, Mrs L decided to keep the child. The
6 pregnancy was uncomplicated at Ž rst, but towards the last trimester Mrs L devel-
7 oped severe pain in her pelvis. She felt that her gynaecologist did not take her seriously
8 enough since he declined when she ‘desperately’ asked for a Caesarean section.
9 When the membranes ruptured at 38 weeks a breech position was detected and
2011 a Caesarean section had to be performed. Postnatally, Alicia was diagnosed with a
1 humerus fracture that needed surgical treatment. For two weeks afterwards the infant
2 was not supposed to be lifted, so Mrs L felt that nursing was impossible. In addi-
3 tion, Alicia had a re ux that made it more difŽ cult to provide adequate nutrition
4 for her.
5 These perinatal and postnatal complications had, in Mrs L’s own eyes, severely
6 impaired the mother–infant relationship. She remembered feeling totally unprepared
7 for discharge after two weeks, and feeling overwhelmed with uncertainty when arriving
8 home with her daughter. At this time she already felt alone and unsupported in the
9 task that lay ahead of her. Alicia, after being rather quiet and easy in the hospital,
3011 cried excessively in her new surroundings to the extent that she developed a hernia.
1 The re ux itself turned out to additionally aggravate Alicia’s screaming. Mrs L
2 was proud to have invented a recipe for thickening Alicia’s formula, thereby mastering
3 the re ux problem. Physical examination of the infant revealed no abnormalities apart
4 from the hernia that was mentioned by her mother. From a developmental point of
5 view Alicia turned out to be a normally reactive infant with an adequate stimulus
6 sensitivity and age-appropriate capacities of smiling and limited head control. No
7 hyperreactivity or excessive crying could be detected. On the contrary, Alicia proved
8 to be very capable of self-regulation. According to her mother, the screaming occurred
9 only in her presence. In our clinical examinations and throughout the therapy sessions
4011 Alicia was so remarkably quiet that she might have been described as showing ‘compul-
1 sive compliance’ (Crittenden et al., 1988).
2 Mother–infant interaction was characterized by Mrs L’s marked but exclusively
3 negative reactions to infant signals. Mutuality of interaction could rarely be observed,
4 as Mrs L never encouraged the child to become engaged in play. When the mother
51111 was asked to play with her, or when Alicia needed to be dressed, etc., maternal

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 TRA N SM ISSIO N O F M A TERN AL TRA U M AT IC EXPER IE NC ES 263

reactions were mainly negative. There was no modulation of intonation as in typical 1

infant-directed speech. Mrs L talked to the child as she would to an adult: ‘Don’t 2
get started right now, please’, etc. Also it was very evident that Alicia avoided eye 3
contact with her mother by turning her head as far away as possible in all situations 4
where there was a chance of interaction. During these interactional sequences Mrs 5
L appeared very tense, rigid and in exible, always struggling to keep Alicia at a 6
distance, such that there was minimal physical contact. On the rare occasions that 7
Alicia voiced some discontent Mrs L pointedly turned away from her. Each time she 8
held her and Alicia moved her arms and legs, she told her harshly not to hit her. 9
A more detailed exploration revealed that Mrs L became extremely distressed espe- 1011
cially when Alicia’s screaming became ‘hysterical’. When the therapists mentioned that 1
she had used the same vocabulary to describe her mother Mrs L verbalized her fear that 2
Alicia was exactly like her mother. Sometimes she virtually saw her mother yelling at 3
her when she held her crying infant. It was at these particular moments that she was 4
most afraid of losing control. She seemed to feel victimized by her child and she talked 5
of feeling completely helpless and powerless against being tortured by Alicia. 6
Mrs L was obviously projecting her own aggressive-intrusive representation of her 7
mother onto Alicia. This led to a severely distorted perception of her 2-month-old 8
baby as violent and sadistic. Interaction with Alicia was severely impaired since Mrs 9
L responded to her perception of the girl as a perpetrator with intense aggression, 2011
to the point where maltreatment had to be feared. 1
Less obvious was Mrs L’s rage toward her own mother. She sometimes protected 2
her image by idealizing her, especially when comparing her with her mother-in-law, 3
who turned out to be the target for Mrs L’s hatred and disappointment. Mrs L kept 4
coming back to talking about the many ways her mother-in-law disappointed, hurt 5
or rejected her, while on the other hand perceiving her as intrusive. She often spoke 6
about how much she needed her mother-in-law’s help and called her lazy. This under- 7
lined her oral tendencies that also became very manifest in the transference – however 8
they could never be verbalized or experienced consciously by Mrs L. She seemed to 9
defend against her own intense oral neediness by projecting it onto the child as she 3011
again and again described Alicia as being so greedy and never satisŽ ed. Alicia’s greed 1
was as frightening to Mrs L as her own orality. She worried that Alicia might totally 2
suck her dry, obviously re-experiencing her own traumatic experiences of being over- 3
whelmed and defenceless. At the same time Alicia was viewed by her mother as 4
potentially overpowering and violating her boundaries, according to her own projec- 5
tively distorted perceptions. 6
In the course of the counselling sessions Alicia’s mother mentioned that she had 7
felt extremely relieved at being allowed to talk about her anger and anxiety in the 8
Ž rst interview without feeling judged or criticized for what she was saying. During 9
the following sessions Mrs L was receptive and hungry for positive feedback, for 4011
example when being complimented for managing the re ux problem and for Ž nding 1
the initiative to contact the Parent–Infant Programme. She was very sensitive and 2
easily offended but managed after a few sessions to trust enough in the therapists to 3
ask for advice, which she did in a very child-like manner. She could barely get enough 4
appointments and showed a high degree of compliance. 5
6

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 264 E . M Ö H LER ET A L .

1 As early as the second session, one week later, an improvement in mother–infant

2 interaction was noted and reported by Mrs L. The diaries that had been handed out
3 to her in the Ž rst session were painstakingly Ž lled in with long remarks about her
4 feelings, and this had apparently helped her to release some of her urgent emotions.
5 Occasionally she had noted positive moments with her daughter and it was apparent
6 that she at least now made attempts at communicating with Alicia. But there had
7 still been several moments of desperation, when Alicia’s screaming had caused Mrs
8 L to withdraw to the living room in order not to hurt her.
9 While being able to modulate her hatred against Alicia, Mrs L seemed to turn
1011 even more angrily against her mother-in-law. When the latter had cancelled a baby-
1 sitting appointment Mrs L had had a violent Ž t. Usually, Mrs L’s husband and her
2 mother-in-law protected themselves against her outbursts by more or less surren-
3 dering to Mrs L’s regimen. Both tried to follow Mrs L’s catalogue of rules for Alicia,
4 but Mr L admitted that he was not always able to carry out his wife’s orders completely.
5 He took Alicia in his arms when she was crying, and for this had to face his
6 wife’s anger and criticism. This had a predictable negative impact on the marital
7 relationship.
8 When this triadic interaction problem was discussed carefully, Mrs L was Ž nally
9 able to ventilate feelings of envy when seeing her husband interacting so easily with
2011 Alicia. Again she insisted on her fears that Alicia would be spoiled by being carried
1 around or talked to in a nice way. This would, in her eyes, aggravate Alicia’s greed
2 and need for attention, rendering the girl even more overpowering.
3 Mr L turned out to be a very sensitive and understanding husband, who was able
4 to re ect on his wife’s experiences and actions and see the connection to her past.
5 At the same time he was very concerned about the well-being of his child. He reported
6 having left his work several times in a hurry when Mrs L called him to support her.
7 The marital relationship was surprisingly stable with Mr L fully aware of his wife’s
8 problems. At the same time Mrs L seemed to feel that Alicia was intruding into the
9 couple’s relationship with her needs. Especially when her husband played with Alicia
3011 – in a very competent and sensitive way – her anger against Alicia tended to grow,
1 a phenomenon that she was Ž nally able to put into words.
2 In the presence of her husband Mrs L constantly idealized her own mother, regret-
3 ting that Alicia had never met her grandmother. She insisted that her own mother
4 was more caring and interested in her than her husband. Mrs L’s ambivalence was
5 very explicit, and it was not possible for her to integrate the caring and the violent
6 sides of her mother, indicating her borderline structure.
7 The treatment, involving counselling sessions with two of the authors (E. Möhler
8 and A. Cierpka), consisted of four sessions, each lasting about seventy-Ž ve minutes,
9 including a break of about ten minutes that was used by the therapists for a discus-
4011 sion of the next steps with the re ecting team. The Ž rst session had revealed Mrs
1 L’s very positive response to the ‘holding’ aspects of the therapy (Winnicott, 1965a,
2 1965b), which took her oral needs and narcissistic vulnerabilities into consideration.
3 This ‘holding’ seemed to enable her to develop a (limited) capacity to relate posi-
4 tively to Alicia. Mrs L called the therapist several times in between appointments
51111 obviously to renew and test her experience of being held. She indirectly asked for

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 TRA N SM ISSIO N O F M A TERN AL TRA U M AT IC EXPER IE NC ES 265

conŽ rmation and praise and it seemed as if she was able to share some of the posi- 1
tive attention she received with her daughter. This is congruent with Papousek’s 2
(1998) Ž ndings suggesting that ‘mothering of the mother’ is required in many cases 3
in order to enable her to develop her own intuitive maternal competencies. The latter 4
are crucial for infant development. This is why we found it necessary to be very 5
responsive to Mrs L’s oral and narcissistic needs. We anticipated that this might lead 6
to an amelioration of the mother–infant relationship, as it was believed that partial 7
need fulŽ lment might lessen the defence against these impulses. With a reduction of 8
the need to ascribe massive greed and longing for attention to her daughter, Mrs L 9
might become able to see Alicia’s appropriate infantile expressions for what they were. 1011
The ‘ghosts in the nursery’ of Alicia L could be detected and fought only by 1
revealing to Mrs L the projective mechanisms that were at work. This major focus 2
of the parent-infant therapy required patience and caution. Mrs L needed to be 3
shown again and again that her perceptions of Alicia were actually those of her violent 4
mother, who was the original target of her hatred and aggression. When she was 5
able to realize that Alicia had no sadistic and intrusive impulses and motives for her 6
behaviour, Mrs L slowly became able to open up to a true contact with her ‘real’ 7
daughter. We also helped Mrs L to see that the way she sought to control Alicia 8
through all her rules could be understood as a response to the way she had felt trau- 9
matized by violations of her own boundaries and that she was desperately trying to 2011
prevent a repetition of this by keeping everything tightly under control. 1
Information on developmental psychology turned out to be necessary and helpful 2
to Mrs L, as she had not known until then that Alicia’s cognitive ability was too 3
limited for her to work out manipulating schemes or sadistic plans of action. This 4
signiŽ cantly reduced Mrs L’s fear of her ‘overpowering infant’. At the same time, 5
Mrs L could be calmed and reassured about Alicia’s physical and mental state. Alicia 6
was developing very well, adequately cared for physically and well nourished. With 7
Alicia as the source of reward and compliments for Mrs L she was able to like her 8
daughter better. 9
However, the severity of the relational disturbance and the extent of mother’s 3011
psychopathology required individual psychotherapy that could not be offered within 1
the Parent–Infant Programme. Mrs L did not Ž nd a therapist easily, though, in part 2
due to her own mistrust, but also due to the very negative countertransference feel- 3
ings that she evoked. 4
The situation described here confronts physicians and therapists with the need for 5
very careful observation to take account of any real danger to the infant. The respon- 6
sibility for Alicia staying with her mother was Ž nally taken on by the therapists, who 7
were in uenced by the knowledge that Alicia’s father was sensitive, re ective, avail- 8
able and not abusive. He tried to buffer his wife’s intense emotions, being able to 9
interfere in tense situations without escalating them. Nevertheless Mrs L was constantly 4011
disappointed in her husband, probably projecting her experiences with her father 1
onto him. Mr L was, however, able to understand and to tolerate this. In addition, 2
Alicia proved to be in very good contact with her father. 3
Nevertheless, intense psychosocial support needed to be provided. According to 4
Brayden and co-workers (1992), the risk of child maltreatment can be signiŽ cantly 5
6

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 266 E . M Ö H LER ET A L .

1 lowered by reducing the time span that mother and infant are exposed to each other.
2 Mrs L required some assistance to help her justify the need for a family helper, since in
3 her husband’s eyes this was not urgent. Although he was being sympathetic, compas-
4 sionate and supportive toward his wife, he needed time and help to understand the
5 extent of his wife’s psychopathology, and that this involved a real danger to the infant.
6 Mr L agreed when he realized that his wife’s distress needed to be taken very seriously.
7 Mrs L preferred an extra-familial source of support, since this made it easier for her to
8 trust that the nanny would adhere to ‘the rules’. This signiŽ cantly reduced the level of
9 aggression that resulted from the frustrations of feeling dependent on, and disappoint-
1011 ed by, her mother-in-law, and the consequent re-experiencing of the initial rejection by
1 her own mother. Since, up to that point, frustration was always turned against Alicia it
2 was important to lessen this source of negative emotion.
3 Nonetheless, there still remained a need for intensive treatment and support for
4 the mother-infant dyad, as well as for the mother herself. Future developmental steps
5 could be a source of new con icts. We therefore recommended that the family stay
6 in contact with the Parent–Infant Programme. Mrs L called frequently and once
7 made another appointment. She cancelled it again, stating that she had solved the
8 problem herself. (Clearly she had been testing whether the therapists were still there
9 for her.) The feeling of being able to receive help at any time was thought to help
2011 lessen Mrs L’s anxiety about Alicia’s future development.
1
2
Discussion
3
4 This case report is presented in order to demonstrate different aspects and mecha-
5 nisms of the intergenerational transmission of abuse. Additionally it elucidates the
6 web of risk and protective factors that need to be considered when trying to inter-
7 rupt the cycle of abuse.
8 The following levels of relational disturbance could be found in this mother-infant
9 dyad:
3011
1 1 Mrs L clearly showed signs of hyperarousal and emotional hyperreactivity in rela-
2 tion to Alicia’s signals, as described for abusive as well as for abused mothers
3 (Casanova et al., 1992, 1994).
4 2 Like other infants, Alicia served as a target for maternal projections, with the conse-
5 quent detrimental effect on the mother–child relationship resulting from the
6 projected content. The ‘ghost’ in her nursery was the Ž gure of a violent, aggres-
7 sive and abusive grandmother who shaped Mrs L’s perception of Alicia. The girl
8 was consequently viewed by her mother as sadistic, manipulative, greedy and over-
9 whelming. Alicia’s appropriate infantile mode of expression was answered with
4011 inappropriate maternal aggression.
1
2 This aggression was also triggered by intense anxiety about losing control and being
3 overpowered by Alicia. This was probably due in part to maternal hyperreactivity
4 and defective affect regulation. This anxiety became explicit in Mrs L’s worries that
51111 within two years Alicia might be so strong that she would not be able to manage

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 TRA N SM ISSIO N O F M A TERN AL TRA U M AT IC EXPER IE NC ES 267

her any more. These fears were rationalized by the mother’s opinion that Alicia had 1
inherited the ‘potential for violence’ of her grandmother. The mother saw powerful 2
and dangerous forces in her daughter, possibly also projecting her own aggressive 3
impulses into her. 4
At the same time, Mrs L’s strong narcissistic need for conŽ rmation and accep- 5
tance demonstrated the fragility of her self-concept and conŽ dence, a phenomenon 6
that is also frequently noted in the literature on abusive mothers (Cierpka and Cierpka, 7
1997; Brayden et al., 1992). Her intense bids for attention from the therapists or 8
from her husband indicate a history of emotional neglect in addition to physical 9
abuse. Mrs L’s oral neediness made her view Alicia as a rival in the struggle for the 1011
care and attention of other adults. At the same time, Mrs L defensively projected 1
her own strong neediness on to Alicia, so that normal infantile expressions and reac- 2
tions were interpreted by the mother as massive greed. 3
This distorted perception of infant expressions underlines the central disturbance 4
of empathy as a frequently reported consequence of abusive experiences. Appropriate 5
infantile needs could not be perceived as such by Mrs L because she had constantly 6
to defend herself against her own infantile impulses. This helped to explain the back- 7
ground to Mrs L’s ‘rule system’ for Alicia, which can be regarded as a typical 8
abuse-related trait. Crittenden (1981) found abusive mothers to be much more 9
controlling in play interactions with their infants than a control-group. Even in 2011
primates control and rigidity of interaction is correlated with infant abuse by the 1
mother (Troisi and D’Amato, 1984). 2
This case enables us to speculate about the possible background to this pheno- 3
menon. Mrs L’s excessive control was obviously needed in order to keep her own strong 4
and threatening impulses and needs in check, while at the same time preventing feared 5
potential violations of her own boundaries. She seems to have tried to compensate for 6
a lack of internal structure by implementing a rigid external scheme of rules. Her over- 7
control of her husband’s and her mother-in-law’s interactions with Alicia indicates that 8
Mrs L’s own strong maltreatment impulses had been projected onto these family mem- 9
bers as a defence mechanism. At the same time, Mrs L was subtly acting out her aggres- 3011
sive impulses by disregarding her infant’s emotional need for attention and affective 1
responsivity. Her rigid scheme of rules allowed her to rationalize her own inability to 2
respond to Alicia at a spontaneous emotional level. 3
The attachment disorder illustrated by this case also reveals yet another aspect of 4
abuse-related interactional disturbance. Mrs L’s strong tendency constantly to test 5
the availability of her husband, mother-in-law and therapists led to a permanent re- 6
enactment of disappointment by attachment Ž gures. At the same time Mrs L struggled 7
very hard ‘to do the right thing’ and to be ‘a good girl’ receiving praise and posi- 8
tive attention. According to Crittenden et al. (1991), this combination of permanent 9
frustration, aggression and struggle for acceptance is typical of the enmeshed attach- 4011
ment frequently found in abusive mothers. (Mrs L’s tendency to call the therapists 1
outside the sessions also re-enacted the boundary violations in her own history.) 2
The prognosis for the mother–daughter relationship is poor, given the pervasive 3
nature of the relationship disturbance on all the levels discussed above. Neverthe- 4
less, Mrs L’s initiative in contacting the Parent–Infant Programme can be seen as a 5
6

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 268 E . M Ö H LER ET A L .

1 resource, as can, especially, her considerable openness for re ection on her own
2 potential for abuse and its background. Shocking as they might be to hear, the frequent
3 verbalizations of aggressive impulses should be seen as functionally protective. On
4 the one hand, they served as a release for violent impulses and on the other they
5 could be used and integrated into the therapy. Nevertheless, the lack of assumption of
6 responsibility for her own impulses and actions could only slowly be modiŽ ed. On
7 rare occasions, Mrs L was able to see her own role and pathology as they became evi-
8 dent to her in moments of ‘loss of control’. However, over long periods of time she
9 perceived the situation to be the ‘fault’ of her husband or mother-in-law. This
1011 helped her to idealize her own family of origin and to stabilize her self-concept, but it
1 interfered with her openness to a change of perspective and to questioning her own
2 interactional style.
3 The case report presented here describes the interaction of a traumatized mother
4 with her infant, taking intrapsychic risk factors into consideration in order to clarify
5 the mechanisms of the intergenerational transmission of abusive experiences from
6 mother to infant. The altered reactivity and responsivity of abused mothers frequently
7 described in the literature could be conŽ rmed in the case of Mrs L’s interaction with
8 her daughter Alicia. The considerable signiŽ cance of projective mechanisms is also
9 underlined, suggesting the need for future research. Especially in the case of dyads
2011 where abuse is involved, the signiŽ ance of projective mechanisms as against
1 psychophysiological, attachment or other factors as described above should be quan-
2 tiŽ ed in order to elucidate the intergenerational transmission of violence. The
3 development of – highly needed – preventive tools depends on a more thorough
4 understanding of the mechanisms involved.
5 On a more subtle level, this example illustrates how abuse-related alteration of
6 maternal interactional capacities can cause infant emotional maltreatment. We suggest
7 taking these subtle forms of maltreatment into consideration, especially when esti-
8 mating the risk of a mother with a history of maltreatment passing on her experiences
9 of abuse to her child.
3011 The example of Mrs L also demonstrates the importance of protective factors. Mrs
1 L was in a non-abusive marital relationship and had entered treatment at her own
2 initiative, indicating that she was able to enter supportive relationships despite her
3 multiple traumas. For the success of therapy in this case, ‘containment’ of Mrs L’s
4 needs turned out to be important. However, this also underlined the need for including
5 the partner in the therapy in order to make the abused woman’s striving for accep-
6 tance, her narcissistic vulnerability and her mistrust of relationships understandable
7 to the husband. This contributed to stabilizing Mrs L’s emotions as well as the
8 marriage. The course of therapy chosen was only justiŽ able by establishing, at the
9 same time, psychosocial support and control. Mrs L’s narcissistic vulnerability required
4011 a very cautious and sensitive strategy of implementation.
1 In our case the consequences of a maternal history of abuse consisted of over-con-
2 trol, rigidity, emotional coldness and aggressive impulses towards the infant. Aspects of
3 the underlying dynamics are strikingly illustrated by Mrs L’s description of her daugh-
4 ter as a ‘reincarnation’ of her mother. The empirical analysis of speciŽ c interactional
51111 risk factors and their background could make a signiŽ cant contribution to a better

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 TRA N SM ISSIO N O F M A TERN AL TRA U M AT IC EXPER IE NC ES 269

understanding of the intergenerational transmission of abuse. IdentiŽ cation of the 1

‘transmitters’ is crucial for the effective implementation of preventive strategies. 2
3
Dr. med Eva Möhler, Prof. Dr. med Franz Resch, 4
Abt Kinder- und Jugendpsychiatrie, 5
Blumenstr.8, 6
69115 Heidelberg 7
Germany 8
9
1011
Acknowledgement 1
2
This article was Ž rst published in Praxis der Kinderpsychologie und Kinderpsychiatrie
3
(2000) 49: 550–62, and is reprinted with permission.
4
5
6
Note 7
8
1 The Parent–Infant Programme at Heidelberg University Clinic is provided through the
interdisciplinary collaboration of the Department of Psychosomatic Co-operation Research 9
and Family Therapy (Prof. Dr. med M. Cierpka), the Department of Child and Adolescent 2011
Psychiatry (Prof. Dr. med F. Resch), an analytical child and adolescent psychotherapist 1
(A. Cierpka) as well as the Department of Neonatology (Prof. Dr. med O. Linderkamp). 2
The Ž rst interview of mothers with very young infants usually includes a thorough devel- 3
opmental and neurological examination of the child. 4
5
6
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