Journal of Analytical Psychology, 2004, 49, 143–160

‘Dialectical process’ and ‘constructive

method’: micro-analysis of relational
process in an example from parent–infant
psychotherapy
Judith Woodhead, Bedford, UK

Abstract: Jung defined experience that takes place between therapist and patient as
‘dialectical process’, achieved through ‘constructive method’. Perspectives from attach-
ment theory, neurobiology, cognitive science, systems thinking and infancy research
confirm and extend his view of the centrality of relational process in the development
of self. Interactional experiences are embedded within the history of the primary parent–
infant relationship and structure within the mind implicit patterns of relating. These
patterns influence capacities for managing a whole lifetime of affective relational
experience within the self and with others. This paper shows how parent–infant
psychotherapy seeks to intervene during the formation of disturbed relational patterns.
I offer detailed micro-analysis of the moment-to-moment ‘dialectical process’ that a
mother, her four-month-old infant and myself ‘constructed’ together.

Key words: attachment, cognitive science, constructive method, dialectical process,

infant mental health and research, parent–infant psychotherapy, relational experience,
systems theory, trauma.

I begin with Jung’s words, written in 1927:

We cannot fully understand the psychology of the child, or the adult, if it be
regarded as a subjective concern of the individual alone; for almost more important
than this is his relation to others.

(1954a, para. 80)

In this paper I am concerned with this ‘relation to others’ as central to the

development of self. I am an adult Jungian analyst and I also work with
parents and their babies (from zero to three years) as a member of the
Parent–Infant Project at the Anna Freud Centre, London. The Project began
in 1998 and comprises a team of analysts from different training orienta-
tions. The work, with its emphasis on how infants ‘learn’ about being with
others, has also deepened my insight into the analytic process that arises

0021–8774/2004/4902/143 © 2004, The Society of Analytical Psychology

Published by Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.
144 Judith Woodhead

between my adult patients and myself. I find Jung’s idea of the dialectical
process central to both areas of my work. Jung (1954b, para. 239)
described analytic treatment as ‘an individual dialectical process, in which
the doctor, as a person, participates just as much as the patient’. Although
he was speaking of adult work, his words can also be applied to parent–
infant work that impacts on relationship throughout life. For example,
informed by attachment theory and infancy research we know that the early
infant–parent relationship is the matrix in which a capacity for relatedness is
constructed and that these relational experiences are the starting point for
therapeutic work.
In this paper I am going to portray the multi-layered facets of dialectical
process that became manifest in the relationship between a mother, her baby,
and myself as therapist. I shall also illustrate the constructive method through
which dialectical process can arise. Firstly I should like to introduce you to
Anna, in her twenties, and her first child – four-month old Nadia. I was
the fifth professional to be involved with them – joining the GP (General
Practitioner), the health visitor, Anna’s psychiatrist and her mental health
worker. It was he who referred her to the Project because of his worry about
their lack of smiling and of mutuality. Later in the paper I offer a detailed
account of my work with Anna and Nadia. But first here is a summary of
some major theoretical ideas that informed my approach.

Relational processes and the development of self

The first of these theoretical ideas is about the centrality of relationships.
When I first met Anna she told me that she and her daughter ‘were needing/
wanting support for both of us in our relationship after really hard times’.
I felt there was hope in this expression of need, for she was herself naming the
relationship as in difficulty, in a context of traumatizing external and internal
factors—political, historical, cultural, biological, and psychological. In asking
for help with ‘our’ relationship Anna unknowingly highlighted a feature in this
form of therapeutic work. Neither mother nor infant is viewed as the patient.
The ‘patient’ is the relationship that exists between them. Infant and parent
are viewed as a system.
Winnicott (1957, 1965) was one of the first to view ‘mother–infant’ as a
system—there is no such thing as a baby, only a mother and baby. His work
prefigured that of future dynamic systems’ theorists (initially, Sander 1962),
whose work has current impact on psychoanalytic therapies, especially parent–
infant psychotherapy (Schore 1994; Lichtenberg 1983; Tronick 1989;
Stolorow 1997; Stern et al. 1998; Beebe & Lachmann 2002). The Process of
Change Study Group (Stern et al. 1998) have described in detail the ways in
which an infant ‘learns’ about how to relate with others through the inter-
action between the mother’s mind and the infant’s mind—which creates a
dyadic state of consciousness. As Tronick put it:
Dialectical process and constructive method 145

Each individual, in this case the infant and mother or the patient and therapist, is a
self organizing system that creates his or her own states of consciousness (states of
brain organization), which can be expanded into more coherent and complex states
in collaboration with another self-organizing system.

(Tronick 1998, p. 292)

This echoes Jung’s words describing the therapeutic relationship in which

there is:
an encounter between two irrational factors, that is to say, between two persons
who are not fixed and determinable quantities but who bring with them, besides
their more or less clearly defined fields of consciousness, an indefinitely extended
sphere of non consciousness.

(Jung 1954c, para. 163)

Using this understanding, I was alert from the beginning to the ways in which
Anna and Nadia were co-creating a system in which they related with one
another. When I joined them to create a therapeutic process, a new system was
created within which I also existed—an ‘interactive field’ (Schwartz-Salant
1995). While the dialectical relationship between Anna and Nadia was the object
of my work, my presence brought about a triadic dimension which became
the factor at the core of therapeutic change. The absence of the father in the
therapy was a presence, and made my role as third the more important for the
relational dynamics that Nadia needed to experience for her development.
Therapeutic change in parent–infant psychotherapy depends on new rela-
tional experience within the parent–infant–therapist system, which can
become structured in the mind as a blueprint for relationships throughout life.
We learn from cognitive science and neurobiology of the impact of trauma on
development, described from a Jungian viewpoint by Knox (2001, 2003) and
Wilkinson (2003). Most important is the evidence that there is a separate
implicit memory system, where attachment experiences are encoded and
stored separately from autobiographical memories. These are evident in the
analytic relational process and have long been described in transference and
countertransference theory.
Integrating this knowledge of separate memory systems with psychoanalysis
and systems theory, The Process of Change Study Group (op. cit.) added the
concept of ‘implicit relational knowing’ (Lyons-Ruth 1998, p. 284). They
described this knowledge of how to be with others as pre-verbal, beyond con-
scious awareness, part of implicit memory, and thus not accessible by the
undoing of repression (ibid., p. 285). Their work described the constituents of
relational experience that catalyse the formation of representations. Beebe and
Lachmann (2002, p. 225) suggested that internalization occurs through the
way mother and infant (and in this case, therapist) ‘continuously construct,
elaborate, and represent the emotional regulations, which are simultaneously
interactive and self regulatory. The expectation and representation of the
146 Judith Woodhead

dyadic modes of regulation constitute the internal organization’. In other

words internalization takes place through the experience of the co-constructing
of relationship. Hence the need for my active involvement in this construction
process. Applied to my work with Anna and Nadia, this suggested that the
patterns they were forming with one another were being encoded within
Nadia’s implicit memory, likely to be played out, outside of awareness,
throughout her lifetime. Moreover the urgency of intervening in relational
difficulties was underpinned by research evidence that traumatic experience
may impact on the size of regions of the infant’s brain and on its capacity to
regulate emotion (Teicher 2002; Schore 2001). As we shall see, in the early
part of the therapy Anna begins to provide Nadia with the kind of support
‘that permits the infant to achieve a more complex level of brain organization’
(Tronick 1998, p. 295).
Another key issue for parent–infant psychotherapy is about identifying what
is the fundamental core component in the dialectical process of relating with
others that can structure good and adverse relational memories. Winnicott
described the core component as the existence of the baby in the mother’s
mind, helping the developing infant achieve ‘mutual interrelation’ of psyche
and soma (1949, p. 244). ‘Mentalization’ achieved through ‘reflective func-
tion’ and ‘affect regulation’ (Fonagy et al. 2002) illuminates this process. As
we shall see, Anna and Nadia needed support to be able to build affective
experience together so that Nadia could experience her self in her mother’s
mind, perceived through the nuances of affective meaning in Anna’s responses
to Nadia’s vocal, facial and gestural expressions. Nadia needed to come to
know over time that her mother has a mind, that she herself has a mind that
she can use and develop throughout her life as a basis for understanding both
self and others. This suggests the opposite poles of two minds, the basis for the
to and fro of dialectical process. Dialectical process requires a constructive
method for its development within therapy and I aim to demonstrate this in
the micro-analysis of sequences that arose between Anna, Nadia and myself.
The relationship they were struggling with provided the substance for the rep-
resentations Nadia could form and encode in implicit memory.
Within parent–infant psychotherapy a new environment (the therapist) is
introduced to help mother and infant towards a constructive way of being
together, embodied in ‘affective dialogue’ (Baradon 2002). There is a salient
correspondence between Jung’s constructive method and the approach sug-
gested by Emde and system theorists. First Jung (1960, para. 391): ‘There is
another kind of understanding, which is not analytical reductive by nature,
but synthetic or constructive’. Then Emde (1999, p. 317): ‘We are not just
analysing, reducing, deconstructing and dying. We are integrating, accumulat-
ing, constructing and living’. In parent–infant work, the therapist is indeed
engaging with moment-to-moment lived experiences, which is congruent with
Jung’s emphasis on the analyst’s realness and ‘human quality’ (Jung 1954c,
para. 174). More recently The Process of Change Study Group suggested that
Dialectical process and constructive method 147

the heart of the constructive approach is the creation of ‘real relationship’.

Morgan (1998, p. 326) defines ‘real relationship’ as the here-and-now part of
the therapeutic relationship when ‘the therapist feels a genuineness and imme-
diacy’ in the interaction with the patient. This demands that the therapist joins
in with the patient, fully participant in creating joint experience. The realness
also contains the shared experience of each participant in the therapy; that
forms a joint (but not mutual) history that is unique to them.
In the rest of this paper, those ideas are illustrated through sequences of
clinical material from my work with Anna and Nadia. They show the dialecti-
cal process of the mother-infant relationship, the triadic relationship that
evolved between mother, infant and therapist, and the impact of the therapy
on the construction of new relational experience – a foundation for the forma-
tion of relational representations within Nadia’s implicit memory. The case
material is divided into sequences containing nodal points from the first and
fourth sessions of the weekly therapy. After each sequence there is a narrative
on the therapeutic process that spontaneously arose, while emphasizing that
other narratives could be created. Forming my own narrative could of course
only happen afterwards, in conjunction with viewpoints of colleagues to
whom I grateful.

Case material
First sequence
The trauma of war, loss and separation
In the paragraph below I summarize part of the first session where Anna had
given permission for the sessions to be routinely video recorded. This afforded
the opportunity to analyse in detail sequences of therapeutic work and tran-
scripts. To objectify the clinical work, in the transcripts that follow I refer to
Anna as ‘mother’, Nadia as ‘baby’, and myself as ‘the therapist’.
The therapist and mother are seated on large cushions on the floor in the parent–
infant therapy room. The baby, sixteen weeks old, is sitting near her mother in her
car seat, which is turned away from her mother. In this first session, the baby looks
at times towards this new person, the therapist, and glances fleetingly at her mother
who speaks rapidly and with urgency. For the first twenty minutes of the session all
three are immersed in the trauma expressed within the mother’s narrative. Baby and
therapist hear the mother’s torrent of words, telling of her escape from war, of ter-
rible experiences and their temporary status in England. The therapist asks supportive
questions in order to clarify and explore the mother’s experience, and makes
empathic sounds in response. Traumatic affect fills the room. Mother, baby and
therapist seem subsumed under the weight of the mother’s suffering, disconnected
from one another. The baby makes crying sounds. Next, the mother, speaking very
fast, tells of becoming ill after her baby’s birth, of emergency hospitalizations and
separations from her infant during the first month of her life. She says the baby was
said to have cried continuously (or become still and silent) during her first three
148 Judith Woodhead

months and could not be comforted while her mother cried for her own loss of her
family, country, language, social and political status.

This first sequence set the scene for the therapy sessions that followed. Anna’s
overwhelmed state—experienced also within myself—warned me of her baby’s
likely mental state, filled with traumatic affect. Nadia gained little maternal
response and showed all the classic symptoms of avoidant attachment—pallor,
withdrawal, arching away, and self-comforting. It seemed that she had to
regulate her own emotions, alone in her chair.
In contexts of relational trauma the caregiver, in addition to dysregulating the infant,
withdraws any repair functions, leaving the infant to cope for long periods in an
intensely disruptive psychobiological state that is beyond her immature coping
strategies.

(Schore 2001, p. 209)

I surmised that both mother and baby needed to have the experience of my
mind thinking about their own interacting states. The baby was not alone with
her mother’s emotional narrative; she had my presence and could see and hear
my responses to her mother’s story and their attachment predicament. In view-
ing the video recording later, I found that I tended to speak quickly at first,
mirroring the mother’s speech.
Just as facial mirroring exchanges provide each partner a way of entering into the
other’s affective state, temporal co-ordination provides each partner a way of enter-
ing into the temporal world and feeling state of the other.

(Beebe & Lachmann 2002, p. 106)

Later I spoke more slowly, echoing/affirming Anna’s words and experience, at

a speed that attempted to slow down the fast thinking. I was providing an
experience of a different timing structure. This was embedded in the way
I used language in response to Anna’s narrative, affording mother and baby
a different model of communication and emotional regulation.
Nadia communicated her mental state through unhappy expressions, bodily
squirmings, vocalizations—expressions of the ‘aversive motivational system’
(Lichtenberg 1983). One pronounced bodily movement was especially informa-
tive of the baby’s internal state: she repeatedly arched her back, almost
doubling herself in two. Allan Schore and Miriam Steele (respondents to
a presentation of this material) viewed the arching with deep concern – as a
defensive response to trauma and part of a disorganized attachment pattern.
Knox (1999, p. 525) provides a Jungian perspective on the link between defen-
sive attachment patterns and the formation of complexes. Nadia’s mother’s
past memories and present trauma were, it seems, unwittingly becoming this
baby’s own present, depriving her of her own separate experience. Nadia (and
I) experienced the stream of negative affect through the melodic shape of the
words, the pitch of the sounds, the speed of delivery and her mother’s facial
Dialectical process and constructive method 149

and bodily expressions of stress, including fast breathing. The drawn expres-
sions on Anna’s face seemed to be expressed on Nadia’s face also. ‘The precur-
sor of the mirror is the mother’s face. What does the infant see when he looks
at his mother? He sees himself’ (Winnicott 1957, p. 131). This baby was likely
to see her mother’s preoccupied suffering rather than her (Nadia’s) self. Beebe
and Lachmann (2002, p. 37) describe how ‘the mere perception of emotion in
the partner creates a resonant emotional state in the perceiver; what an infant
perceived on the face of the partner altered his internal state, and the infant
could not escape the face of the partner’. Traumatized by her own affects
Anna was not in a position to be able to provide affect mirroring of her baby’s
mental states. Equation of Nadia’s mental experience with her mother’s
(Fonagy et al. 2002, p. 9) suggests that Nadia is likely to experience her
mother’s traumatic affect as her own. This creates confusion between what
belongs to the self (Nadia) and what belongs to the other (Anna).
While working with the affects arising within Anna’s own personal experi-
ence, I aimed to understand and address the mother’s verbal and non-verbal
ways of relating. I tried to provide and model ‘reflective function’ (ibid.) for the
mother’s thoughts, emotional states, behaviours, attitudes towards her baby.
All the evidence suggested that opportunities for new relational experiences
needed to be provided urgently, due to the baby’s developmental timetable,
effect of trauma on brain structure, and impact of dissociative defences on
the brain which can ‘sever the link between memory systems’ (Pally 2000,
p. 63–4). However, first, the baby needed to be able to enter the session, the
therapist’s mind and the mother’s mind. The next sequence from the first
session portrays how this happened.

Second sequence
Naming the baby
The mother looks towards her baby in the baby-chair and says one word, the baby’s
name, while reaching in her bag for a bottle of milk. The therapist also hears the
name, looks at the infant and asks the mother about the name, its pronunciation, its
abbreviation, and its cultural origins. The mother responds briefly and factually,
affirming the name. She puts the teat of the bottle into the baby’s mouth.

In the specific moment of hearing and asking about the name I (although tech-
nically already knowing the baby’s name) felt I did not know the name, as if
the baby had no personal identity. In this moment the flow of Anna’s narrative
was interrupted. The baby’s self was named as separate from her mother’s self,
and she was given her own place in the room, the therapy and my mind. A
recognition process (Sander 2000, p. 14) had taken place between the three
that could not have taken place without my presence as third person. Nadia
perhaps experienced myself and her mother, two people, speaking for a
moment together (using their minds together) about herself. The interchange
150 Judith Woodhead

between Anna and myself allowed Nadia the possibility of an experience in

which she came to know herself as being known by another, a moment of
awareness shared between the three of us. To return to the sequence:
The baby then cries, struggles, and spits out the teat. The mother replaces the bottle
of milk with one filled with water, and holds it at arm’s length, and the baby sucks a
little. The mother is looking away from the baby, disengaged from the feeding
process, caught in the flow of her own thought and feelings. The therapist says softly
to the baby, ‘Some water – Is that what you might like? haa? You didn’t want to
have milk – it’s water that you would like?’

Here we can see how I began to bring my own self into active engagement
with the infant, showing I have a mind that can think about the baby’s own
mental experience. Asking about the water signified that Nadia’s own
thoughts and feelings are different to mine; otherwise I would not need to ask
the question. My voice and facial demeanour were soft and gentle, and
attuned to the baby’s need for understanding. Witnessed by the mother, Nadia
was shown that she can be talked to and related with in new ways, demon-
strating that she has her own personal needs and wishes and these can be
heard and seen, thought about, named, understood and attended to. Nadia
was beginning to find her way into the session, initially into my mind. Later
her cries and her gestures would slowly start to become part of her mother’s
mind as she became more able to give meaning to communications. This newly
named baby was becoming, and was recognized as, an active participant in the
session, with new agency. I reflect now that naming Nadia was part of giving
birth to her as ‘a psychological self’ at an age when she was beginning to look
socially to the outside world (Bergman 1999, p. 27). With Nadia named as
separate, her mother could then go on to tell of her anxiety at the possible
impact of her thoughts on her baby’s mind.

Third sequence
Murderous thoughts
The mother moves on to tell the therapist rapidly, with high anxiety, of thoughts
that often come into her mind, thoughts she finds acutely disturbing. The thoughts
seem to her to come from nowhere, and overwhelm her mind. The images are of
picking up a knife and harming someone, of using the knife to kill her daughter.
They are thoughts that to her felt as if they entered her mind with their own will and
she can do nothing to keep them at bay except for trying to keep herself busy. Hence
she had accessed the support of a psychiatrist and network.

With both mother and infant in mind, I explored aloud the murderous thoughts,
seeking to clarify them so that I could think about them and their impact on
this mother’s relationship with her daughter.
We see in this part of the sequence how, once the baby had been named,
Anna seemed less preoccupied with her past. Naming marked a shift from her
Dialectical process and constructive method 151

immersion in her own pain to concern for the impact of her own pain on her
daughter who was becoming separately more present. Stern et al. (op. cit.,
p. 303) describes such a shift as ‘moving along’. Mother and baby were taking
a first step towards the goal (expressed at the outset) of developing their
relationship with one another.
As part of the network I seemed to provide ‘a background of safety’
(Sander 1959) and model of emotional regulation for the affects of Anna’s own
complex, including her anxiety, guilt and shame. The theme of the sessions
moved on to feeding experiences that implicitly mediate emotional interaction.
It became clear to me that this baby could not accept a bottle of milk from her
mother and struggled to accept water. As they came to sessions in the morn-
ing, and upset by the feeding experiences at home, Anna often chose to feed
Nadia in my presence. By the fourth session the following sequences evolved.

Fourth sequence
From feeding on the floor to feeding in arms
The mother lays her baby on the mat, and tries to feed her lying down, alternating a
bottle of milk with a bottle of water. She does so mechanically with little attempt to
communicate. (This had occurred in the previous session and the therapist had felt
anxious, unable to intervene, and had consulted with colleagues). The mother tells
the therapist of how often she tries to get milk into Nadia when she is asleep. The
therapist feels confused, puzzled, surprised, shocked. She seeks to explore this with
the mother and clarify her reasons for this kind of feeding. The mother explains that
her baby only takes the bottle lying down, and does not like to be held. The therapist
experiences the feeding on the floor as depriving, frustrating, and hopeless. Trusting
her feeling that such a detached feeding mode is unhelpful to both, tentatively com-
ments: ‘because I think – if I was lying down, and I was trying to have – liquid –
I would find that quite hard’. The mother picks up her baby, her head lagging and
places her stiffly on her knee and gives her the bottle of water. The baby will not or
cannot latch onto it. The therapist contributes: ‘she looks as if she doesn’t . . .’ and
the mother finishes off the sentence with ‘yeah, like she doesn’t like it.’ The mother
then tries again to give her the bottle of milk, and the struggles continue. Her
mother’s vocal tone, facial expression, and way of holding her baby, suggest anger,
despair and a giving up. The therapist feels she herself cannot bear this situation.
Unbearable affect fills the space. A little later their feeding history is described – how
at three weeks, the baby lost the breast she loved, due to her mother’s hospitaliza-
tion. During the story Nadia reaches up and places her hand on the side of her
mother’s breast. Her mother tells of how Nadia was so hungry at that time, and the
therapist asks if Nadia was crying then and is told she was ‘crying, crying’.

In this interaction we can see so much occurring. Feeding experience became

the central ‘port of entry’ (Stern 1995) for exploring the relational difficulties.
I, as therapist, gave a kind of ‘developmental guidance’ (Fraiberg et al. 1975)
that Nadia needed to be fed in arms. I did this because of my impression that
both mother and baby were dissociated in the process of feeding and needed
help to establish attunement. My anxiety was due to concern that both mother
152 Judith Woodhead

and baby would find it difficult to move on from the defensive patterns devel-
oped in the feeding relationship which might become part of the baby’s repre-
sentational world. The mother might feel criticized and find it hard to take in
my words, just as her baby found it hard to take in the milk. I expressed my
thought by putting myself into the baby’s position and saying the words: ‘if
I was lying down . . . ’. I think I was modelling a capacity for empathizing with,
and reflecting on Nadia’s mental experience. At first, feeding in arms was
indeed difficult. A change took place because instead of complete detachment
from one another, the mother was now invited and encouraged to think about
the difficulty and try to understand what was happening from the baby’s point
of view. She took my sentence and completed it, so that a joint thought was
created, a cueing process that could develop between Nadia and Anna.
Addressing the past feeding experience evoked a mother–baby shared past.
I felt this to be new – a discovery that a past they shared could be re-constructed
in the present, the emotions experienced and relational difficulties named. I see
this now as the beginnings of the ‘digestion’ of painful, shared biographical
experience, the loss of the breast connecting up with the immediate present.
I was trying to expand and reframe the explanation of hunger (‘she was crying,
was she?’) – to differentiate somatic (hunger) and emotional responses. The
hand to her mother’s breast suggested Nadia’s own personal experience of the
loss of her mother’s breast. Perhaps semantic expression of their shared loss
allowed new thought to come into being. This occurred in the next sequence
from the same session.

Fifth sequence
She wants it and she doesn’t want it
The baby reaches for the bottles in the bag.
Mother: ‘She wants it – and she doesn’t want it – I don’t know – it’s just . . .’
Therapist: ‘As we said so you must get upset sometimes – and you’re in tears some-
times – and I should think sometimes you get quite angry – don’t you?’
Mother: ‘Yeah – I get angry – what’s happening, you know, and . . .’ She laughs.
Therapist: ‘I bet you do’.
Mother (addressing the baby): ‘And I say this is the milk you know – and I keep
telling her –this is the one that you want’. [She brings the bottle out of the bag and
holds it in front of her.] ‘You want to, but . . . ’
She takes off the lid, her baby is making sounds, and at that moment looks back and
up at her mother and seems for the first time to gain eye contact, her hand reaching
up towards her mother’s face. Her mother looks down at her, also with eye contact.
Therapist (in the moment that the baby looks up) says: ‘Ahh, she’s looking at you’.
Mother (to the baby): ‘It’s the milk, yes’, putting the teat to her baby’s mouth who
pushes it away, pulls it towards, then pushes it away with a look of disgust.
The therapist is thinking about how the looking up at her has gone unnoticed – the
maternal milk is not being given, and the literal milk is again put to her mouth.
Therapist (to mother): ‘She really looked up at you just then, didn’t she?’
The baby is pushing the bottle away and her mother has her head lowered, silent.
Dialectical process and constructive method 153

Therapist: ‘And maybe, I am just wondering, and I may be wrong, whether perhaps
in the early weeks and when you were so ill and having to go to hospital a lot, maybe
you missed out a bit on having that time of her being able to look up at you, the very
early baby–mummy time.’
Mother: ‘Yes – my mother you know – my mother she was with her’.
Therapist: ‘And was able to have some of that time with her’.
Mother: ‘Yeah’, [looking sad].
Therapist: ‘And it means you two missed out a bit, doesn’t it – the two of you
because it was a very hard…’.
Mother: ‘Time for both of us – yeah.’
Therapist: ‘Ill time – hard emotional time’.

It is hard to convey in words the conflict within Nadia that the video of this
sequence portrayed – caught between wanting and not wanting the milk.
I could imagine that the emotional core of the conflict, combined with her
attachment difficulties, could have developed into the constituents of a per-
sonal complex of her own. My engagement with mother and baby was explora-
tory, inviting Anna to join in elaborating possible feelings between her self and
her daughter. Her tone of voice after naming anger at Nadia was affirmatory
and relieved – and it was at this moment, with anger momentarily expressed
and contained, that Nadia looked up at her mother and physically reached up
to touch her face. Anna did look down at her but continued her train of
thought about the milk, sounding exasperated, unable to respond to Nadia’s
invitation to look at her and emotionally engage with her. I needed to name
the look twice, affirming to Nadia the motivational significance (Lichtenberg
1983) of her attachment-seeking and exploratory action. Still the mother hung
her head, perhaps suggesting shame at her anger. Embedded in tentative
language and acknowledging that I may be wrong (i.e., that the mother had
the knowledge), naming all that they had missed out on in their earliest
relationship led to expression of sadness. A new dimension of relational
process could then arise – through a shift from wanting the milk to becoming
able to want mother.

Sixth sequence
She wants you and she doesn’t want you
Mother (looking at her baby): ‘Say what’s wrong?’
Therapist (to mother): ‘It’s almost as though she kind of – and I don’t know if this is
the right kind of way of putting it at all – but kind of wants you – and doesn’t want
you, at the same time; would that be a right way of putting it?’
(Mother lifts Nadia more in and against her, higher up crooked in her arm.)
Therapist: ‘I mean – she wants you lots, in playing and everything – she loves playing
with you – but it is a little bit like she wants you and she doesn’t want you, yeah?
And that’s a hard feeling isn’t it, for both, for both of you’. (Nadia is struggling in
her arms, not wanting the bottle – arching back with cries of protest.)
Mother (to her baby): ‘Are you upset?’ She brings her face round to kiss her and
kisses her twice.
154 Judith Woodhead

Anna directly asked her baby about what was wrong. I felt that Nadia was
caught in her conflict between both wanting and not wanting her mother. To
put the conflict into words felt a relief. The words I used and the ways I used
them felt to be part of real involvement with ‘the human quality’ Jung spoke
of (1954c, para. 174). To speak of how upsetting the conflict was for both
of them seemed to enable Anna to empathize with her daughter and ask her
a direct question about her feelings – ‘are you upset?’ I think this would not
have been a possible question earlier in the work. A movement had taken
place from expression of anger, to sadness, to mutual difficulty, and this
allowed affection to enter with kisses. And then I could ask in the following
sequence, feeling less anxiety, about what would happen if ‘we’ put the
bottle down – ‘we’ suggesting the mutual process occurring between the
three of us.

Seventh sequence
From literal milk to emotional milk
Therapist: ‘What happens without the milk, if we put the milk bottle down – what
happens if you talk to her really closely?’
Mother holds her baby sideways.
Therapist (feeling she is speaking to both of them): ‘Almost kind of looking at each
other, holding her towards you a little bit – ah? – Is that a hard thing to do maybe?’
[The mother is lifting her baby up and round towards her – and the baby’s unhappy
expression and struggle changes into growing pleasure.] ‘Like in this sort of little bit
of looking’.
Mother speaks to her baby softly and smilingly in her language.
Therapist (addressing the mother): ‘She is listening to you, isn’t she?’
Addressing the baby as she looks at the therapist, ‘Are you listening to your mum?’
And a little dialogue between them develops. Nadia again looks at her mother while
her mother is looking to where the baby had been looking – also the baby looks
directly at the therapist who responds by speaking directly to her, ‘Your mum is
really trying to make contact with you, isn’t she?’
Mother (to her baby): ‘What are you looking at?’
A few moments later the baby moves her face round and almost makes a kissing ges-
ture, and her face continues round to face away and her mother follows her gaze. It
seems that the mother is now feeling confident to try being with her baby in this
new, supported, way. The sequence continues:
The baby soon makes many sounds and a ‘ma’ sound while turning more directly
towards her mother’s face. Her mother says softly, ‘yeah’, while the therapist
also says, ‘Yes, it’s your mum you are looking at’. The baby’s sounds increase in
intensity as she brings her hands to hold the sides of her mother’s face and their
mouths come together and noses squash together—a real sensuous experience,
then moving a little round their cheeks squash together. The baby moves away in
her avoidant gesture of withdrawal – while her mother follows her with her gaze,
lovingly. The baby appears to be expressing anxiety about this new closeness and
its safety. She looks towards the therapist, as if to check the process is safe, then
round to her mother again continuing right round to look the other way, while
Dialectical process and constructive method 155

mother follows her intently, synchronized with her movement unlike earlier in
the session. They nuzzle their mouths together. The baby takes a strand of her
mother’s hair and fingers it. She looks to the side of her mother and her mother
looks that way too, and the baby places her hand on her mother’s neck, daring to
explore her mother physically. The mother then picks her baby up to be on a
level with her, facing her. The baby adjusts to the position, initially looking
distant, avoidant, and opening her mouth, perhaps a little yawn. The mother
says (looking directly into her face), her own face lighting up, ‘Whaaah, what a
beautiful girl’. The baby now focuses on her mother and an intimate sequence
unfolds of a few moments. She again says, ‘what a beautiful girl’, as she brings
her face forward and touches the baby’s nose with her nose – twice – and her
mother is involved and smiling. Her mother says, ‘tzik, tzik’ and her baby squeals
pleasurably.
The moment escalates until it becomes a little too much for the baby. She raises
her hands above her head and does her circling away gesture. This time her mother
follows her round to try to engage with her. Her baby circles back round almost
engaging with her mother’s gaze, placing her hand over her mother’s mouth – fingers
almost in her mouth – making a sound. Her mother is responding with a little sound.
The smiles diminish. The baby’s body tone slackens, and her mother moves her
round to sit on her lap, while continuing to look at her face. The baby is regulating
the degree of arousal she can manage, and her mother follows her cue, neither
forcing her to continue the sequence nor abandoning her.

Here we see an important ‘now moment’ (Stern et al. 1998) as communicative

states were synchronized between the three of us. Anna spoke to Nadia in
their own mother tongue; I spoke to Anna about Nadia listening to her, and to
Nadia about listening to her mother – and the dialogue developed between
them while Nadia looked at her mother and also at me. Communication is
multi-sensorial – with touch, sight, and hearing involved. Therapeutic work
centres on this kind of process, whereby the therapist elaborates on what
seems to be happening. The intimate sequence unfolded with release of sensu-
ous passion, activating the sensual sexual motivational system (Lichtenberg
1983). Faces, noses, lips, cheeks, skin, hair, and gazing, nuzzling, touching,
mouthing, tasting, voicing. Perhaps they were making up for missed experi-
ence – one cannot quite know – but they were able to discover a new realm of
intimacy. My presence implicitly supported and I did not need to use words.
Anna and Nadia mirrored each other’s expressions and passion as they
became engaged in an intimate relational process that was, and is, uniquely
their own. Nadia ‘learnt’ that she could safely explore her mother’s face, very
likely leading to change in her expectations and the construction of pre-
symbolic representations. Anna was freed to feel (at least for a few moments)
that she had a beautiful daughter with whom she could be in love, while Nadia
could in those moments find her self, a beautiful little person, in her mother’s
mind.
Then, when Nadia had had sufficient arousal and needed to move on, Anna
adjusted accordingly and helped her to resume a sitting position on her lap
without withdrawing her own supportive attention. In this new relational situ-
ation Nadia was able to communicate how much intimate exploration she
156 Judith Woodhead

wanted and was agent, supported by Anna, in moving to a more comfortable

distance.

Summary
The therapeutic process described in the above sequences illustrates themes
and concepts referred to at the outset. Anna, Nadia, and I created a system in
which new relational experience could arise between the three of us. We saw
in the first sequence how Nadia could get no active positive response from her
overwhelmed mother whose traumatized mind was unavailable for the crea-
tion of a dyadic state of consciousness. Anna required my mind to provide
space for her traumatic affects, creating a new state of consciousness between
the two of us. Then the baby could be named, become more of an individual
little self, and play her full part in contributing to the evolving new intersub-
jective space. I became able to address her directly as if she was understanding
my words (asking about her wish for water, not milk). Anna, perceiving Nadia
as separate, then voiced her concern for the impact of her murderous thoughts
on Nadia’s mind, and could allow these thoughts to be shared, without receiv-
ing censure or panic. Next, feeding difficulty entered the therapeutic process
and their shared feeding history was elaborated and linked with present
difficulty. I addressed the feeding on the floor in terms of how I would find it
difficult to feed lying down. Nadia’s conflict and her mother’s feelings were
put into words, and Nadia risked looking up at her mother. Nadia’s capacity
to internalize new relational experience arose through the co-construction of
moment-to-moment new experience.
We could see change take place in Nadia when she was able to look up at
Anna, stroke her hair, have sensuous pleasure. Anna changed in her capacity
to be with her baby in these moments. I felt emotional warmth and my anxiety
lessened as I experienced their intimacy. New experience arose through fine
tuned responses to one another, accompanied by shared sensory pleasure, and
Anna’s repeated words – ‘what a beautiful girl’. Their needs for pleasurable
experience with one another allowed them to co-ordinate their states in an
expansion of combined consciousness. This could create new expectations
within implicit memory. Nadia could now expect, at times, to be able to have
a face-to-face communication safely with her mother and was learning how to
regulate her own arousal by turning back away from her mother and sitting
back down looking away. With the words ‘what a beautiful girl’ Nadia had
the possibility of seeing her own self in her mother’s mind. In turn, new moves
in their relationship became possible, reflecting how relational process con-
stantly shifts, with representations continually being revised.
New relational experience created for mother, baby and therapist a new
intersubjective environment, an altered experience of relational knowing, a
shift in shared states of consciousness, and possible different brain states. The
feeding difficulties and relational processes were worked and reworked
Dialectical process and constructive method 157

throughout the next year of therapy, responsive to the developmental thrust

and agenda of Nadia’s nascent self.

To conclude
At the end of writing this paper I read for the first time the following:
Explorations which centre on the question of how the unconscious manifests itself in
the here-and-now of therapeutic interaction, with its concomitant emotions, remain
relatively incomplete and undifferentiated. Hence what is lacking most is the micro-
analysis of what is occurring in the intersubjective field . . . this gap . . . is something
more than a few Jungian analysts are aware of today.

(Jacoby 1999, p. 132)

I hope I have contributed by focusing the analytic lens on the creation of rela-
tional process in the work described that arose between a mother, an infant,
and myself, through the development of constructive method that facilitated
dialectical process – in the service of the development of self.

TRANSLATIONS OF ABSTRACT

Jung décrit le vécu de ce qui se passe entre le patient et le thérapeute dans la clinique
comme un ‘processus dialectique’ qui se déroule à travers la ‘méthode constructive’. Les
perspectives données par la théorie de l’attachement, la neurobiologie développemen-
tale, l’approche scientifique cognitive, les recherches sur les systèmes de pensée et sur la
toute première enfance confirment et étendent le fait affirmé par Jung que le processus
relationnel est central.
Les formes d’interactivité se structurent dans les vécus et l’histoire de la relation
primaire entre l’enfant et le parent et sont maintenues dans le psychisme par des
schémas de relations implicites. Ces schémas infléchissent les capacités de gérer les vécus
émotionnels de toute une vie, ceux reliés à la relation au soi et ceux reliés à la relation
aux autres. Cet article décrit comment l’approche psychothérapeutique du parent et
nouveau né ensemble tente une action au moment de la mise en place de ces schémas
pertubés de relation. Est donnée pour cela une micro-analyse détaillée moment par
moment du ‘processus dialectique’ qu’une mère, son bébé de quatre mois et l’auteur ont
construit ensemble.

Jung definierte die klinische Erfahrung, die zwischen Therapeut und Patient stattfindet
als ‘dialektischen Prozess’, der durch die ‘konstruktive Methode’ erreicht wird. Die
Perspektiven der Bindungstheorie, der Entwicklungsneurobiologie, der Kognitionswis-
senschaften, des systemischen Denkens und der Säuglingsforschung bestätigen und
erweitern diese Sichtweise der zentralen Bedeutung des Beziehungsprozesses. Diese
Muster beeinflussen die Fähigkeit, lebenslang die inneren emotionalen Erfahrungen mit
dem Selbst und die Beziehung zum Anderen zu handhaben. Ich zeige in einer detailli-
erten Mikro-Analyse, wie dieser ‘dialektische Prozess’ von einem Augenblick zum
158 Judith Woodhead

anderen von einer Mutter, ihrem vier Monate alten Säugling und mir gemeinsam
‘konstruiert’ wird.

Jung definì l’esperienza clinica che avviene tra terapeuta e paziente come ‘ un processo
dialettico ‘ raggiunto attraverso ‘un metodo costruttivo’. Prospettive provenienti dalla
teoria dell’attaccamento, dalla neurobiologia evolutiva, dalla scienza cognitiva, dal
pensiero sistemico e dalla ricerca sull’infanzia confermano e estendono la sua visione
della centralità del processo relazionale. Le esperienze relazionali sono intrecciate con
la storia della relazione primaria genitore infante e strutturano all’interno della mente
impliciti schemi di relazione. Tali schemi influenzano la capacità di gestire un’intera
vita di esperienze emotive interne all’interno del sé e in relazione agli altri. Questo
lavoro mostra come la psicoterapia genitore-infante cerca di intervenire durante la
formazione di schemi relazionali disturbati. Porto una micro-analisi dettagliata del
‘processo dialettico’ momento per momento, che una madre, il suo bambino di quattro
mesi ed io ‘costruimmo’ insieme.

Jung define a la experiencia clínica que tiene lugar entre terapeuta y paciente como un
‘proceso dialéctico’ que se alcanza por medio de un ‘método constructivo’. Las perspec-
tivas de las teorías apego, de la neurobiología evolutiva, la ciencia cognitiva, sistemas
pensantes, y la investigación sobre la infancia, confirman y extienden su punto de vista
sobre la centralidad del proceso relacional. Las experiencias de interrelación están
basadas en la historia de las relaciones paterno infantiles y estructuradas en las
patrones mentales de relación. Estos patrones influyen en la capacidad para manejar la
totalidad de una vida de experiencias emocionales internas en el self y en la relación
con otros. Este trabajo muestra como la psicoterapia paterno-infantil procura interve-
nir en durante la formación de patrones de relación perturbados. Ofrezco un detallado
mico-análisis del ‘proceso dialéctico’ que momento-a-momento, una madre, su hijo de
cuatro meses de edad y yo ‘construimos’.

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