When Daughter Becomes Mother:

Inferences from Multiple Dyadic

ParentChild Groups
LEON HOF F MAN, M.D.
In this paper, I describe hownewmothers can be preoccupied with their
mothers and can replay their relationship with them transferentially
with professionals and nannies, who become surrogates for their moth-
ers. Newmothers need affirmation fromtheir mothers and frommother
surrogates because, in their new role, they experience a sense of help-
lessness and anxiety and have difficulty tolerating aggression, ambiva-
lence, and conflict. Sterns motherhood constellation and good
grandmother transference are useful constructs for understanding how
to best approach and help new mothers and their babies. Fromobserva-
tions in multiple dyadic parentchild groups at the Pacella Parent Child
Center, I have distilled two factors that help new mothers address their
anxietiesthe bonds these mothers make with one another and their
transferential bond with the group leader and other professionals at the
center. I critically discuss and compare theoretical inferences derived
from individual psychoanalytic or psychotherapeutic work (as exem-
plified by Balsams work) with the inferences derived from Sterns
dyadic model and with inferences derived from psychoanalytically in-
formed group situations. I consider the implications of the ubiquity of
ambivalence conflicts, especially around aggression.
629
Leon Hoffman, M.D. is Director, Pacella Parent Child Center; Training and Su-
pervising Analyst, New York Psychoanalytic Society and Institute; Assistant Lec-
turer, Mt. Sinai School of Medicine.
Many ideas in this paper germinated in staff discussions at the Pacella Parent
Child Center. I am grateful to the staff for its work with the mothers and babies/tod-
dlers and for their input. I particularly thank Patricia A. Nachman, Marlene
Nunberg, Alice Rosenman, Mary Sickles, and Lissa Weinstein for their assistance.
The child wants everything the omnipotent and all-possessing
mother has in order to do everything the mother does; and a
mother is above all the possessor of a baby.
Brunswick (1940)
The Mothers Mother
JANE, A SUCCESSFUL PROFESSIONAL WOMAN IN HER MID-30S, CAME TO
see us shortly before her first baby was due. She described her state
throughout her pregnancy and contrasted it with her state before the
pregnancy. During her successful career and marriage, she always
maintained a safe psychological distance between herself and her
mother, carefully weighing how much to confide in her mother, to
manifestly avoid feeling ruled by her mothers judgment. Although
she made what she considered to be independent decisions, her
mothers voice, as with so many women, stayed within her, at times
conscious and at other times unconscious, as the voice of her con-
science by which she evaluated her actions. With her pregnancy,
however, this conscious state of quasi-independence seemingly
evaporated and caused her a great deal of distress. In her profession
and even in her marriage, she could allow herself to feel independent
of her mother. Now, on the brink of motherhood, there was no ques-
tion for Jane that she was entering her mothers realm. She worried
what kind of mother she would besimilar to or different from her
mother. Each new stage of pregnancy was accompanied by anxiety
about whether her mother would approve of her actions.
Janes preoccupation with her own mother during her pregnancy is
typical of many new mothers. Pregnancy and, later, the new baby re-
awaken or intensify in the new mother her feelings about her own
mother. The new mother may feel conflicted and ambivalent toward
her own mother or may feel that she needs her own mother to help her
with the baby as well as provide for her own needs. The new mother
may aspire to be a better mother than her own mother or may fear that
she could never be as good a mother as her mother was or is. These
general observations have been discussed by many authors (e.g.,
Stern, 1995; Cramer, 1997; Balsam, 1996, 2000). Preoccupations
about their own mothers also occur in older first-time mothers
whose own mothers may be too old, too far away, or dead. In fact, as a
630 LEON HOFFMAN
result of newer fertility technologies, the number of older first-time
mothers has increased.
It is beyond the scope of this paper to review and integrate the
enormous literature regarding mothers and daughters. Certainly, all
authors agree that the tie between mother and daughter is central
throughout all phases of a little girls development (Tyson, 1991).
The little girl and mother, unlike mother and son, have the same
body (Bernstein, 1983), and mothers treat daughters differently from
sons starting at the earliest moments of life (Elise, 1991). The idea of
daughters longing for her mother is central in many contributions
(Dahl, 1989; Elise, 1998, 2000). One result of this motherdaughter
connection is that superego development is affected by the little girls
wish to please and retain the love of the idealized same-sex love ob-
ject (Tyson, 1994, p. 457). In sum, as Dahl (1995) wrote, the hall-
mark of adult female psychic organization lies in the daughters
capacity to permit continuing reverberations within herself of the
representations of the tie to the mother in her ongoing intrapsychic
dialogue with her mother (p. 202).
The Motherhood Constellation
Although many authors have highlighted the various themes and con-
flicts that occur with motherhood, I must underscore the importance
of Daniel Sterns (1995) seminal contribution of the concept of the
motherhood constellation (see especially pp. 171190).
1
Sterns
contribution is novel in that it emphasizes the appearance of a new
psychic organization in the new mother. Stern acknowledged that
sociocultural forces are important in the emergence of this organiza-
tion and stated that the motherhood constellation does not occur in all
women; it may be a permanent, transitory, or a permanently evocable
state in the woman (p. 174).
WHEN DAUGHTER BECOMES MOTHER 631
1
Sterns ideas derived from dyadic observations are comparable with but, be-
cause of their dyadic (in fact, triadic) frame of reference, different from the older
ideas of Winnicott (1956; 1963, p. 343), who coined the term maternal preoccupa-
tion, and from the detailed studies of Bibring et al. (1961a, b) and Anthony and
Benedek (1970).
By conceptualizing a normalization of the new mothers state
(i.e., as a new psychic organization), Stern (1995) made an im-
portant contribution to psychoanalytic theory. By creating a vo-
cabulary for a normal state, he eliminated the need for concepts
such as developmental crisis (Bibring et al., 1961a) and the
inevitable regression occasioned by pregnancy and motherhood
(Pines, 1982, p. 311). Blos (1985, 1999) and Parens (1999) simi-
larly described the importance of normalizing the theoretical un-
derstanding of the experience of new motherhood. Parens (1999)
wrote, Rather, might there not be in the woman a normal psycho-
biological developmental process that comes with having a baby,
an adaptive process perhaps that influences the experience of preg-
nancy and of becoming a mother? (p. 26).
Stern (1995) noted that the motherhood constellation concerns
three different but related preoccupations and discourses, which are
carried out internally and externally: the mothers discourse with
her own mother, especially with her own mother-as-mother-to-her-
as-a-child; her discourse with herself, especially with herself-as-
mother; and her discourse with her baby (p. 172).
Stern (1995) maintained that the new mother is less concerned
with her father (and oedipal themes), with her husband (as husband
and sexual partner), and with her work and is more concerned with
her mother, with women, with her baby, and with growth and devel-
opment. Stern emphasized the emergence of a new psychic triad
(mothers mothermotherbaby) and maintained that when a woman
becomes a mother . . . several related themes emerge (p. 173): life
growth (concern for the growth and development of her baby), pri-
mary relatedness (emotional engagement with her baby), supporting
matrix (ensuring that support systems develop for her baby), and
identity reorganization (transformation of her self-identity to permit
and facilitate these functions).
Stern (1995) called these four themes and their related tasks the
motherhood constellation. In light of the motherhood constella-
tion, Stern described a variety of clinical implications, specifi-
cally the nature of the therapeutic alliance and the transference and
countertransference configurations that occur in work with moth-
ers and their babies (pp. 185190). He emphasized how a mother
desires to be valued, supported, aided, taught, and appreciated by
632 LEON HOFFMAN
a maternal figure (p. 186). These desires can be intensified and fo-
cused on a therapist. Stern called this bond the good grandmother
transference.
2
A Multiple Dyadic Model: Helping and
Understanding Mothers in ParentChild Groups at
the Pacella Parent Child Center
3
Mothers come to our parentchild groups to learn more about parent-
ing, to understand developmental events, and to learn how to under-
stand their children and interact more effectively with them. They
come to us with worries about themselves, their children, and their
parenting skills, but they do not identify themselves as patients. Of
note, a significant number of the mothers we have encountered are in
their own psychotherapy or psychoanalysis, which, appropriately, in
our opinion, is usually kept private and distinct from work with us.
The great majority of mothers who come to our groups, in essence,
say, as Balsams (2000) psychoanalytic patient did, I want to keep
this apart from analysis (I discuss Balsams patient later). Whether
in their own individual treatment or not, mothers do not come to our
groups for therapy.
WHEN DAUGHTER BECOMES MOTHER 633
2
This termis interesting in that it is similar to the evolutionary biology concept of
grandmother hypothesis, first proposed by Williams (1957). In foraging societies,
young women taking care of babies need an older woman, not just their own moth-
ers, to take care of the older children while the men are off hunting or engaged in
other activities. According to this theory, menopause (cessation of childbirth with
continued functioning) may be one factor that allowed hominids to expand their
range of mobility as well as their intelligence. In other words, a young womens
need for an older woman to help her care for her children seems to be an ancient phe-
nomenon. (See Angiers, 1999, Woman: An Intimate Geography.)
3
I must acknowledge the contributions of Sackler Lefcourt (1997, 2003a, b), the
psychoanalytically oriented clinician who has had the most extensive experience
working clinically with dyads of parents and zero- to three-year-olds over the past
two decades (in contrast with analysts and developmentalists, who focus on re-
search data). Other psychoanalytically oriented parentchild group work includes
that of Heinicke, Carlin, and Given (1994), and Paul and Thomsom-Salo (1997).
Sterns (1995) model provides an invaluable framework for the
general understanding of our experience working with mothers and
their babies, even though his theoretical construction was derived
mainly fromdyadic work with mothers and babies. He did not focus on
the interactions and mutually reinforcing interactions that occur in
groups of mothers with their babies, though he did discuss a new
mothers need for a supportive matrix (pp. 177180). In our setting,
we try to integrate the supportive interactional and transferential fac-
tors with Sterns central theoretical construction of the psychic triad of
mothers mothermotherbaby. In essence, a central aimof our parent
child groups is to help each new mother make the transition from feel-
ing only like a daughter, who is helpless in meeting the needs of her
child, to feeling like a competent mother herself.
By coming to the center week after week, many new mothers, par-
ticularly those who feel lonely and isolated, develop a sense of family
and community that allows them to share their concerns and worries
with one another and with the group leader. The mothers express con-
cern about their mothering capacities and may not feel entitled to enter
the mothering role. They may feel anxious and helpless about their ca-
pacities to mother their children and may believe that their own moth-
ers or nannies or professionals would do a much better job with the
baby. In the groups, we observe complex and multifaceted transferen-
tial interactions. Many new mothers often express and reexperience
the importance of their relationships with their own mothers or with
mothers they had wished for. For example, new mothers assume that
someone else (a professional, a book author, their own mother, a
nanny) knows her baby and its needs better than they do and knows
howto be a mother better. Thus, they may ask many how-to questions:
How do I _______?
The Bonding of New Mothers with One Another
4
and
Their Relationship with the Group Leader
5
Two powerfully mutative group factors help each new mother make
the transition from seeing herself only as daughter (and thus helpless
634 LEON HOFFMAN
4
As we learn more about brain functioning, we can imagine that neurophysio-
logic and neurochemical factors affect the powerful bonding that occurs among new
vis--vis her own child) to seeing herself as the mother (and thus com-
petent): the bonds the mothers formwith one another in the group and
the transferential bond with the group leader. Implicitly and often ex-
plicitly, one can infer the important operation of the mothers mother
behind these two factors.
In the parentchild groups, mothers often become friends and sup-
port one another. They may meet outside the group regularly. They
compare what is discussed in the groups with what they read in
parenting and development books, what their friends say, what their
pediatricians tell them, and, most important, what their own mothers
tell them. Many comment that group discussions about individual sit-
uations are far superior to the seemingly cookbook approaches to
development found in many how-to books and lectures.
The glue that binds the mothers to one another is their relation-
ship with the program coordinator, who speaks with each mother
who comes into the center, and the group leader, the central ongoing
helpful resource. The group leader needs to balance his or her focus
on answering specific questions about development with the need to
foster discussion that allows parents to find the approach best suited
to themselves and their children. Although group leaders work
uniquely, there are several universal themes.
WHEN DAUGHTER BECOMES MOTHER 635
mothers and between mothers and babies. Exploration of these ideas is beyond the
scope of this paper. As scientific knowledge expands, of course, such findings must
be taken into consideration in the evolution and further development of psychoana-
lytic (mind) theories. I am grateful to Maurice Preter, M.D. for calling my attention,
during the March 29, 2001 Journal of the American Psychoanalytic Association
netcast, to the work of McClintock and colleagues. They demonstrated the presence
of a chemical signal for the synchronization of ovulation (carried by pheromones) in
rats (McClintock and Adler, 1978) and later in humans (K. Stern and McClintock,
1998). Pheromones are airborne chemical signals that are released by an individual
into the environment and which affect the physiology or behaviour of other members
of the same species (K. Stern and McClintock, 1998, p. 177). These investigators have
continued to study and discuss, in a very sophisticated way, the effects and potential
theoretical ramifications of a variety of social chemosignals (McClintock et al., 2001).
5
Although the great majority of our group leaders have been women, the findings
described in this paper apply equally to the groups led by three male group leaders.
Do men doing this work need to possess feminine or maternal qualities? This is
a question that perhaps can be studied analytically and empirically. Stern (2003) as-
serted that only women can work effectively with new mothers. Our experience
does not bear this out.
As new mothers can easily feel criticized, especially by their own
mothers or by mother surrogates (e.g., professionals, nannies), a ma-
jor aim at the center has been to normalize the inevitable conflicts
mothers express about their mothering. Common concerns include
Should I breast-feed all the time, or can I offer a replacement bottle?
How often should I feed my baby? My mother tells me to _______
(cf. Friedman, 1996).
Over and over, the group leaders communicate to the mothers that,
even though they may feel bombarded with information and advice
from a variety of sourcesparticularly their own mothers but also
their pediatricians and the many experts who are in essence mother
surrogatesthey, as the mothers for their babies, are the only ones in
a position to make the best decision for themselves, their children,
and their families. In other words, group leaders and the other staff try
to empower the mothers in their mothering role (so that the mothers
can synthesize information and use it effectively) rather than promote
the mothers dependence on the group leaders and staff as their new
omniscient maternal substitutes who are the only ones who know the
right and wrong ways for them to mother their children.
Self-Critical Representations and the
Positive Transference
Our many observations of the importance of the positive transfer-
ence to the center as a whole as well as to the group leader corrobo-
rate Sterns conception of the good grandmother transference.
Certainly, a mothers implicit and explicit transferential reactions
to the group leader are reminiscent of her relationship with her own
mother or with a wished-for version of a mother. As illustrated in the
following example, new mothers require the group leader to repre-
sent a benign superego imago to counteract their own self-critical
representations.
In one parentchild group, the mothers discussed how many of
their husbands did not appreciate the mental energy (as well as the
physical burdens) involved in taking care of their toddlers. They felt
easily criticized by the husbands. Some women complained about
their own mothers, and the topic of their own mothers generated
much animated discussion. Some women said that, at one time or an-
other, their own mothers disparaged their child-rearing decisions.
636 LEON HOFFMAN
For example, some of these grandmothers felt that the toddlers
mother was too lenient, and others felt that the childs mother was too
rigidly strict. In the group, on the other hand, the mothers felt vali-
dated about their positions as mothers to their children and felt com-
fortable discussing the difficulties they faced in child rearing. In so
many words, the group and the group leader helped the mothers to
feel that their job as mothers to their children was the most important
job in world and that they could be competent and not always com-
pare themselves unfavorably in relation to their own mothers.
With their own mothers and with their husbands, they felt they
should do it this way or that wayfeelings in dramatic con-
trast with those experienced in the group as they spoke with one an-
other and with the group leader.
The approach at the center fosters positive transferences and cer-
tainly is in agreement with Sterns (1995) idea that a commonality
of most parentinfant psychotherapies is the way they use a positive
therapeutic alliance and positive transference (p. 159). However,
we have also learned that it is important that therapists and group
leaders remain aware of the subtle emergence of potential irremedi-
able disruptions to the positive therapeutic regard (p. 159) that is
important for new mothers. Thus, a key technical aspect in working
with parentchild groups involves dealing with the complicated
transferences that inevitably occur when conflicted issues begin ris-
ing to the surface (Sherkow, 2002).
The Group Leader with Multiple Dyads:
Not a Therapist, Not an Omniscient Critical Mother,
but More Than a Good Grandmother
An important thrust of our work follows a path similar to that of
Sackler Lefcourt (1997, 2003a, b), who described the central ele-
ments in her work with parents and babies: developmental help,
support, education, and interpretation. Sackler Lefcourt actively
addressed unconscious conflict, unresolved trauma, and mental rep-
resentations derived from the parents own past as they emerge in
the current parentchild relationship. This model was first expli-
cated by Fraiberg, Adelson, and Shapiro (1975). Sackler Lefcourt
(personal communication) did not distinguish, as we do, between
WHEN DAUGHTER BECOMES MOTHER 637
individualized parentinfant dyadic psychotherapy and the work in a
group with many dyads. Much as in our approach, Sackler Lefcourts
(2003b) goal in parentchild work is affirming the importance of
mothering, acknowledging its inherent stresses, and recognizing the
processes by which a woman shifts from a primary position of, I am
my mothers daughter, to I am the mother of my child.
We always have to remind ourselves that the work in the parent
child groups is not just dyadic work. The different motherchild dyads
help and learn fromone another. It is important for the leader to bear in
mind that his or her interventions toward one mother are in actuality
addressed (either directly or indirectly) to the other mothers. Com-
ments made by a group leader to one parent may be mentioned later by
another parent. As a result, the mothers have an impact on one another,
and an intervention directed toward one always has an impact on at
least one other mother. These multiple effects of the leaders interven-
tions (intended or unintended) contribute to the power of the work but
also may provoke unintended negative consequences.
Self-Criticism and Criticism from Mothers Mother
We have observed how important it is to help mothers to feel in
charge. For example, when mothers cannot control their toddlers,
they feel incompetent as mothers, particularly in comparison with
their own mothers. The children may feel increasingly anxious be-
cause they do not have the assurance that their mother can protect
them from their own aggression, and a maladaptive cycle may be
quickly established. The mothers feel increasingly guilt-ridden and
experience themselves as creating the difficulties in their children.
The following vignette illustrates an approach in which we try to help
the mothers to understand their children while attenuating their
self-punitive behavior, derived from both internalized and actual im-
ages of their own mothers.
In one group, Nancy, a very successful professional, was consid-
ered by the other group members as the ideal mother, someone who
took time from her busy work life both to attend the parentchild
groups and to tend to her toddler in many ways. Nancy expressed a
great deal of concern about her toddlers demanding behavior. Dur-
ing discussions, she seemed uninterested in trying to understand why
638 LEON HOFFMAN
her child could feel so unsatisfied. At one point during a group ses-
sion, the child became very demanding about a bigger toy, and the
leader asked Nancy casually, What do you think about that? Think-
ing about that question helped Nancy to understand that there was
meaning to her childs behavior.
Another mother, Jane, discussed howin the past she had a difficult
time understanding the connection between her daughters lack of
language and her screaming whenever she felt frustrated. Jane felt
mortified that she had not made that connection before.
A third mother, Betty, was depressed because of her fathers re-
cent death. She worried about the impact of her depressed feelings
on her child.
Afourth mother, Mary, who was divorced, was concerned because
her not yet three-year-old occasionally stayed overnight with the fa-
ther, despite the childs protestations. Mary castigated herself for not
insisting that the overnight visits to the fathers house be curtailed.
A discussion ensued about the impact on children of the stresses
the mothers felt and how difficult it was for all of them to see their
children in distress. Some wondered how their own mothers, in con-
trast, could have successfully dealt with all these issues.
A fifth mother, Dawn, pregnant with her second child, interjected
that she became so frustrated that she simply told her child that in a
fewdays the child would be moving into her own room(i.e., out of the
parents bed). Dawn was terrified about her upcoming delivery be-
cause the idea of two young children overwhelmed her.
The group leader understood that this group of mothers was very
anxious because of intense self-criticism. In a joking way, she said,
In difficult times, all of us sometimes muddle along, because the
choices as to how to act are very difficult for us to make.
On reflection, the group leader realized that she was concerned
that an intervention could lead the group to experience her as a disap-
proving grandmother (they had talked many times about their own
critical mothers). Her joking style, though, was usefulit communi-
cated, instead, that she was a benign superego figure (good grand-
mother) who empathized with their anxieties but was not omniscient.
She implied that making decisions was also difficult for her. She may
very well have represented their wished-for mother figure, who lis-
tened to them and did not merely instruct them on how to raise their
children. Clearly, sharing affects in the groups has a soothing effect.
WHEN DAUGHTER BECOMES MOTHER 639
Moreover, the leaders affect sharing may have special meaning for
the dyadsmeaning that may not be expressed or even conscious.
In a parallel-process way, the group leader, just like the mothers in
the group, was self-critical when reporting the intervention to her col-
leagueseven though her joking comment had been followed by
Janes talking enthusiastically about recent changes in her daughter
(Jane being the mother who criticized herself for not understanding
the meaning of her daughters tantrums) and by Janes telling the ad-
ministrator how helpful the group had been for Jane and her child.
As this vignette illustrates, the group leader tries to understand the
most predominant affect in the group and to make tactful interven-
tions to encourage group cohesion and amelioration of severe self-
critical introjects in order to further the mothers sense of themselves
as competent mothers with their children. Unlike the critical grand-
mothers, the group leaders listen and help the mothers understand
that there is meaning to the childs behavior.
This group leader provided two interventions: she stimulated the
mothers to try to understand that there was meaning to their chil-
drens behavior, and she showed that she herself was not omniscient,
unlike their fantasied critical all-knowing mothers. The latter inter-
vention promoted development of powerful positive transferences
toward her, of which she was aware but did not interpret.
A sign of a well-functioning group is its members empathy for
one another.
6
In this group, for example, the mothers always found
something in their lives that could stimulate fantasies of themselves
as bad mothers toward their children (or, as they often voiced, not
as good as their own mothers). Their empathy for one another, in-
cluding their communications that they understood one another, was
always extremely helpful.
The group leaders acceptance of the many varieties of develop-
ment and parenting styles helps mothers to accept their conflicted and
ambivalent feelings and to understand the universality of such feel-
ings (including ambivalence about their own feelings and about their
children). By acknowledging their own conflicted feelings, mothers
can master their conflicts rather than deny or become overwhelmed
by them because they are so frightening. Mothers can then feel more
640 LEON HOFFMAN
6
See Hoffman (2003) for another detailed exchange in a parentchild group.
in charge of their own feelings and more competent about their mater-
nal skills. They are then more effective in promoting their childrens
development (Hoffman, 2003).
The Nanny as the Mothers Mother Surrogate
We have observed many women who, though extremely successful
and competent, particularly in their interactions with superiors and
subordinates in their professional lives, have had much difficulty in
managing their lives with their children, including their relationships
with caregivers and nannies. It is important for the group leader to
keep in mind the transference relationship of the mother to the care-
giver. As with the transference relationship with the group leader and
the early childhood staff, understanding the mothers transference
can help one to see more clearly a source of difficulties and thus to
help her interact with her child and caregiver more effectively.
Another group of mothers, mainly successful professionals, of-
ten spoke about the conflicts of living in two worldsthe world of
work and the world of the childand about their difficulties in re-
solving issues with nannies. Their often conflict-filled interactions
with nannies contrasted with their more neutral interpersonal inter-
actions at work.
At one time, one mother, Lois, complained about her childs
sleep problem. The group leader interjected in a quizzical tone,
What sleep problem? Lois responded, Maybe you were right the
other week, when you said she wanted to be with me. The group
spoke about the difficulties in getting ready to go to work in the morn-
ings, as the toddlers wanted to be with themand not the nannies. Lois,
however, was convinced that her nanny was much more competent in
taking care of her child than Lois was. On one hand, Lois wanted to be
home rather than at work, but, on the other hand, she resented that her
having a child impeded her professional progress.
Another mother, Joyce, spoke about her anxiety on leaving for
work and about her feeling very uncomfortable with her child at that
point. The group leader said, Yes, but you seem so comfortable
when you play with him down on the floor.
A third mother, Beverly, blurted out that her boss called to ask her
when she would be coming back to work from maternity leave. She
WHEN DAUGHTER BECOMES MOTHER 641
did not want to think about that, even though she knew she would be
going back to work soon. In group, she concluded that her mother
would have been home all the time. Thats the only way to be a
mother. Pam said to Beverly that her child would respect her more
because she did not stop working. In a forlorn way, Helen, the only
nonworking mother in this group, said, People treat me like I am an
idiot because I am a full-time mother.
The group leader added that, when it comes to what to do for them-
selves and their children, sometimes no decision feels quite right.
Among the many issues explored by this group, the central themes
were the mothers comparison with their own mothers and the dis-
placement of expertise onto the nannies. Much as Cancelmo and
Bandini (1999) did, we have often observed mothers intense con-
flicted relationships with their childrens caregivers. Many of these
mothers imbue the caregivers with attributes of the grandmother
transference (though not always the good grandmother), the care-
giver being a stand-in for the mothers mother, who knows the right
answer. At other times, the caregiver is the equivalent of or is per-
ceived by the mother as her own jealous mother who feels she is the
only one who knows how to be maternal and thus wants to take over
the child rearing. Over the years, we have learned how useful it is to
help mothers understand that, when a caregiver is hired, the relation-
ship is rarely simply that of employeremployee.
Similarly, in our child care environment, the interactions among
the children and mothers with the staff are not just those of parents
with professionals. In these interactions, mothers, particularly vul-
nerable mothers, may react to the staff in a variety of waysobse-
quious and subservient, imperious and demanding, and every
permutation in betweenreminiscent of the transferences between
mothers and child caretakers. To make informed choices of inter-
vention, the group leader must remain aware of the inevitable multi-
ple transferences that signal their arrival subliminally.
The leader for this particular group of mainly professional women
conducted sessions in his own style. Yet, his interventions in the
group (e.g., Sometimes no decision feels quite right) were similar
to the interventions used by the group leader of the overtly anxious
women (e.g., In difficult times, all of us sometimes muddle along,
because the choices as to howto act are very difficult for us to make).
Both leaders acknowledged a lack of omniscience and emphasized
642 LEON HOFFMAN
the universality and ubiquity of conflict. These responses fostered
positive transference feelings and reinforced in the mothers a sense of
the positive aspects of child rearing. By understanding the transfer-
ence, we can maximize our supportive interventions. In needing to
maintain clear boundaries between our psychoeducational work and
psychotherapy, we try to avoid (or at least minimize) transference in-
terpretations.
7
Comparison of Working Transference Models
Our work with mothers and their babies and toddlers affirms the im-
pression that understanding that mothers have a strong need to be val-
ued, supported, aided, taught, and appreciated by an older maternal
figure is crucial in working with new mothers and their babies. Thus,
it is no wonder that, as in the various parentchild examples provided
here, the groups relationship with the group leadera psychoana-
lyst, a figure that provides appreciation and understandingis a cen-
tral helpful tool.
It is important to emphasize, however, that the work in groups of
mothers and babies is very different from focusing on an individual
within a transferential therapeutic relationship, particularly when the
analyst or therapist is attuned to providing interpretations of the
meaning of manifest content.
8
(The major interventions in our groups
are also very different from the interpretative work with single dyads
who enter treatment for a specific parentinfant problem. In the latter
WHEN DAUGHTER BECOMES MOTHER 643
7
With each group, the leader needs to learn and relearn how to address conflicts
among the parents and negative feelings toward him or her. As the groups are not
therapy, however, the leader must think about how to manage and control the inevi-
table transference fantasies, particularly negative transferences, some of which
may be very difficult to address in this psychoeducational setting. Sherkow (2002)
described her experience with a long-standing group in which, after a long period of
idealization, the members began to test her a great deal: The unleashing of aggres-
sion toward me signaled the need for real transference interpretation about their dis-
appointment in their own mothers, and their competition with them, idealization or
denigration of them, as the case may be.
8
Balsam (2004) used a felicitous phrase for the interventions provided in these
groups: upward interpretations.
situations, interpretations of the mothers repetitive identifications
or counteridentifications for herself and for her baby with objects
from her own past occur with much greater frequency and very early
in the therapeutic relationship.
9
)
In an individual psychotherapy or psychoanalysis, both analyst
and patient focus on the individuals psychology as a person, as
an autonomous individual. From the patients personal historical
perspective, the treatment promotes an understanding of that indi-
vidual as someone (either male or female) who has or had a mother
who may be considered good or good-enough or bad or not so bad.
Obviously, most often a mother is remembered as being sometimes
gratifying and other times frustrating. Whether the analysand is
male or female, the understanding of mother is understood from the
subjective perspective of the child or adult and the various permuta-
tions and conflicts over an ongoing or past relationship with her and
the transferential replacements and enactments with spouse, chil-
dren, teachers, and so forth.
In an individual psychotherapeutic treatment with a new mother,
in addition to her subjective memories and experiences from child-
hood, issues related to her new child are understood in terms of tradi-
tional dynamic oedipal, preoedipal, and relational understandings
and in terms of what Stern has described as coming to terms with her
new psychic organization.
Mothers are different from fathers. For example, it may seem
self-evident that the subjective experience of working mothers who
have to leave their crying child when they go to work is qualitatively
different from the subjective experience of most fathers. Wilkinson
et al. (1996) and Waldman (2003) detailed such subjective experi-
ences in their descriptions of therapists and analysts who are new
mothers. These mothers internal conflicts show how their psychol-
ogy is very different from that of fathers.
10
644 LEON HOFFMAN
9
Stern (2003) remarked on the ubiquity of such early interpretations in mother
infant dyadic psychotherapeutic work.
10
Compare Bernsteins (1983) distinction between womens and mens superego
contents: For example, given two contents, I should prepare dinner for my chil-
dren, and I should work for a professional paper, male and female responses
would be very different. Men in Western culture would have no conflict in this area;
the commitment to work is fixed, dominant, and supersedes most other contents. For
Rosemary Balsams (2000) description of her analytic work with
new mothers provides examples of the technical generalizations and
consequent theoretical ideas derived from an analytic approachin
contrast with those derived from a dyadic approach:
The baby in the therapists office has many meanings. My pref-
erences as an analyst [italics added] is to prioritize an attempt to
preserve space for the patient to explore these many meanings,
if at all possible. With the mothers wish to show the baby, the
therapist is privileged to be included in the mutual sharing of the
wonder of the gift of new life. Countertransference and reactive
proud feelings of being an analytic grandmother may well
surface, but may not need to dominate the scene [p. 471].
In other words, Balsam highlighted the fact that the primary
agenda in a psychoanalytic treatment is understanding the patients
subjective experience of maternity and her relationship to her baby
and the variety of meanings for the mother, who is the primary patient
and the subject of examination. This is in contrast with dyadic work,
in which there is not just one patient or person in the room. Balsam
followed Loewalds (1982) idea that, in a psychotherapeutic relation-
ship, the baby acts as a transitional object between the therapist and
patient, and between the patient and the outside world (Balsam,
2000, p. 470).
When Balsams (2000) patient breast-fed her baby in the analysts
office, the patient seemed to understand the difference between a
dyadic motherchild situation with a therapist and analytic work. The
patient said, I just need to sit over here. I hope you dont mind. I
couldnt imagine sitting on the couch and feeding him. I want to keep
this apart from analysis. [She laughed.] I dont want to mess it up. . . .
This is not about breast-feeding. Ive been very comfortable with it
(p. 473). Stern might argue that Balsams patient is like the mothers
he described who tolerated traditional psychodynamic interpreta-
tions . . . without giving them too much weight, in order to benefit
WHEN DAUGHTER BECOMES MOTHER 645
women, the relative strengths of the two contents are not so fixed, but vary accord-
ing to the situation. Women are more likely to experience conflict in choosing
which of the contents will be given dominance; and they are far more likely to expe-
rience guilt (no matter what their choice) (p. 189).
from the other aspects of the therapeutic relationship (Stern, 1995,
pp. 172173).
Balsams patient had been in treatment for three years for chronic
marital conflict. Throughout the analytic work, the analyst had used
analytic techniques to help the patient understand the genesis of her
conflicts. Within that overall framework of treatment, Balsam of-
fered us one way of understanding the patients manifest content.
Balsam understood that the patient needed to defensively keep her
breast-feeding in the analytic office outside the analytic work. In-
stead, the patient spoke about issues of messiness in relation to her
mother. Balsams idea was that the patient was not willing to associ-
ate to the breast-feeding at the moment because she wanted to avoid a
regression in relation to the analyst. Balsam(2000) wrote that the pa-
tient needed to ward off a regressive transference state in favor of
her participation with the transitional object, the baby. The direc-
tion of her thought took us instead forward into the current active
scene of the (presumably) anal struggle between the patients own
mother and herself as daughter (p. 474).
Throughout her communication, Balsam (2000) argued against
Sterns assertion that the mental health field has misunderstood the
new mothers mental state and her special needs. Balsam maintained
that Stern exaggerated when he theorized that a new mother develops
a mind-set fundamentally different from what she had before.
Balsam, like Loewald and others, clearly understood that therapy
is not the same two-person event with a small baby in the room (Bal-
sam, 2000, p. 486, quoting Loewald, 1982). Sterns (1995) conclu-
sion that a new mother develops a fundamentally different psychic
constellation in essence underscores that this new mental state is not
a defensive construction (pp. 171172). Balsam (2000) similarly ob-
served a new mental preoccupation for the new mother: The fore-
front of the patients mind (appropriately) was largely occupied by
her interactions with the baby, while an unconscious, interactive
presence of childhood experience with her own mother was enacted
in the office (p. 485).
However, and in contrast with Stern, Balsam (2000) noted that de-
fensive operations may be involved when a newmother in psychother-
apeutic treatment focuses on her baby and wishes that her analyst will
become the good grandmother. Balsam maintained that the sche-
matically perceived, all-admiring, or unexamined, all-protective,
646 LEON HOFFMAN
presence of the analyst or therapist may provide a benign constancy to
soothe a more hidden tumultuous inner world one so active in its
progressive regression that it must stay in the here and now, as yet un-
able to find verbal expression (p. 486).
In essence, Balsam does not disagree with Sterns idea that, in
working with new mothers, the psychoanalyst must appreciate the
depth of the involvement of the new mother with her new baby and
with images of her own mother. Stern maintains that the old constel-
lations are left behind and superseded, whereas Balsam maintains
that the old constellations are pushed away defensively (whether
temporarily or permanently is unclear).
That new psychic organization or, as Stern said, that new psychic
triad (mothers mothermotherbaby) is accentuated in the here and
now in dyadic and multiple dyadic work because mother, baby, and
therapist/group leader are in the same room occupied by their copart-
ners in the work (Blos, 1985). Whereas the psychic triad is estab-
lished and enacted in dyadic work, the unit of observation expands
exponentially (not just a single mother, not just a single dyad) in a
multiple dyadic setting such as ours (the Pacella Parent Child Cen-
ter). Thus, multiple transferences abound, positive and negative, in-
cluding sibling transferences, and the group leader is a stand-in for
mothers mothermost often the good grandmother, but not always.
The Field of Observation
As I previously discussed (Hoffman, 2003), it is important to attempt
to integrate
11
inferences derived from psychoanalytic data and those
derived from psychoanalytically informed observations. From the ob-
servations discussed herein, it seems clear that the field of observation
is an important source for the varying conceptualizations of a mothers
mind. The nature of the instrument of observation is different. Sterns
(1995) theoretical construction arises out of dyadic observations of
mothers with their infants, whereas Balsams (2000) comes from psy-
choanalytic work with individual patients. In an analytic situation, the
observer (the analyst) is very much attuned to subtle and not so subtle
WHEN DAUGHTER BECOMES MOTHER 647
11
These ideas follow Mahler and McDevitt (1968).
defensive or associative shifts as a patients attention shifts from one
topic to anotheror fromherself to her baby or vice versa. With her
patient, Balsam attempted a gentle interpretation but respected the pa-
tients avoidance (The gentle reminder about her previously ex-
pressed fear of breast-feeding did not result in any willingness to
associate, p. 474). In dyadic, or multiple dyadic work, it is highly un-
likely that, when a basic dyadic function (breast-feeding) is proceed-
ing successfully, one would remind the mother of her previous anxiety.
In a psychoanalysis or psychoanalytic psychotherapy, the subject
of investigation is a participant in the two-person treatment. One of
the aims of the work is to understand the unconscious and precon-
scious determinants of the patients subjective experience. In such an
enterprise, careful attention is given to defensive shifts, both subtle
and more overt ones. In a dyadic therapy, three people are in the
room, and the unit of observation is the motherbaby dyad. In a group
setting, the unit of observation expands greatly to include the interac-
tions and mutual influences of the various group members.
Both Stern and Balsam agree that, when working with new moth-
ers, the psychoanalyst must appreciate the depth of the involvement
of the new mother with her new baby and with images of and feel-
ings about her own mother. Stern maintains that the old constella-
tions are left behind and superseded, whereas, through Balsams
lens of observation, the old constellations seem also to be (perhaps
at times primarily) pushed away defensively (whether temporarily
or permanently is unclear).
In our setting of working with multiple dyads simultaneously, we
observe not only the bond to the group leader (the good grandmother
transference) but also the bond that forms among the new mothers
themselves. The latter bond is a very powerful force that helps moth-
ers experience themselves as more confident with the parenting of
their children. The power of this bond seems crucial to us and to other
observers of groups of mothers of babies and toddlers in groups. In a
situation in which only an individual or a single dyad is studied, the
power of the bond among new mothers can be inferred only from the
individual mothers report. By understanding such differences in the
nature of the observational tools, we can understand why exploration
of this bond is virtually absent from the analytic literature, which
takes the one-to-one in-depth relationship as its focus.
648 LEON HOFFMAN
Discussion and Theoretical Implications
Given the virtually universal ongoing preoccupation of new mothers
with their own mothers, it seems quaint to read Bibring et al.s
(1961a) conclusion that, from their experience, when a daughter be-
comes a parent she is released fromher infantile bondage to her own
mother (p. 21). To the contrary, a daughter is far frombeing released
from her bondage to her own mother when she becomes a mother
herself. Our observationsconsistent with those who have written
howthe motherdaughter bond reverberates throughout the life cycle
of every womanlead us to conclude that this shift in a woman from
the daughter role to the mother role requires a great deal of psychic
work. An important thrust of our work is to help women make the at
times seemingly impossible shift from a self-concept primarily as
daughter to one primarily as mother.
In our parentchild group work, we foster positive transferences.
Although we agree with Sterns emphasis on the power of positive
transferences in motherinfant work, we have also learned that thera-
pists and group leaders must remain aware of the subtle emergence of
potential irremediable disruptions. Thus, a key technical aspect in
working with parentchild groups involves dealing with the compli-
cated transferences that inevitably occur when conflicted issues be-
gin rising to the surface, particularly negative transferences.
Balsams (2000) interventions with her patient seem to indicate
that Balsamagrees with the technical necessity that the maintenance
of a positive transference is desirable during the reign of the mother-
hood constellation (Stern, 1995, p. 188).
There is no doubt that it is critical for therapists of new mothers to
unequivocally accept positive transferences. I agree, however, with
Balsams (2000) assertion that this does not imply giving free rein to
total action on the part of therapist without understanding the individ-
ual complexities (p. 469). But, to my mind, there is a more important
area to be addressed. From a theoretical perspective, how can we in-
tegrate the conception of a newpsychic structure with the observation
that defensive shifts are prominent when using the lens of psycho-
analysis? This question needs further investigation.
What are the theoretical ramifications of Sterns (1995) idea that a
more active technique with mothers of babies focuses more on assets,
WHEN DAUGHTER BECOMES MOTHER 649
capacities, and strength than on pathology and conflicts (p. 187)? I
would argue that Sterns construction seems to equate pathology with
conflict. To the mothers in our groups, we communicate that conflict
is ubiquitous and that we need to master conflict, not eradicate it.
12
In
contrast with Sterns (in my mind, extremely important) normalization
of the mental state of a new mother, his theoretical construction seems
to pathologize conflict, as mothers themselves often do. It does not do
justice to the data of our observations that conflict in mothers is in fact
ubiquitous.
In earlier work (Hoffman, 1996, 1999), I described how conflicts
over aggression, leading to inhibition of activity, prevent women
from achieving a sense of agency outside the home. More recently
(Hoffman, 2003), I highlighted the inhibitory role of conflicts over
aggressionwithin mothers toward their young babies and toddlers
and within the children toward the mothersin womens sense of
competence as mothers and in their child rearing. In the latter work, I
considered an integration of the three trends in the psychoanalytic lit-
erature on womens psychology: (1) attempts to understand the con-
flicts women experience in their desires for advancement in the social
field outside the home, (2) attempts to understand psychoanalytically
the subjective experience of pregnancy and maternity in womens
psychology, and (3) the growing body of literature on mothers and
mothering in dyadic situations with babies and toddlers.
13
In this
communication, I highlight the transferential connections between
their own mothers and the group leaders (and other caretakers).
New mothers often feel unsure of themselves as mothers and thus
come to believe that they cannot trust their own perceptions and can-
not act on their own convictions. Rather than believing that over time
only they can become the real experts for their children, they may
650 LEON HOFFMAN
12
Beverly Stoute, MD was the first to use this felicitous phrasing in our group.
13
In trying to understand the various trends in the psychoanalytic literature on
women, we need to consider the zeitgeist in psychoanalytically oriented feminist
theories of the last third of 20th century. This literature was very much influenced
by Chodorows (1978) emphasis on mothers communicating to daughters how to
become a woman, which means being a mother, a caretaker. Recently, Chodorow
(2003) stated how early feminist psychoanalytic work, including her own, inap-
propriately, and inaccurately, den[ied] the centrality of bodily and biopsychosocial
experience to gender (p. 1183).
retain the feeling that only other people, particularly professional
experts, know the right answers. These experts can often be seen
as mother surrogates. Other mothers are convinced that they are not
real mothers and that only their own mothers are. Thus, they con-
stantly seek advice and try to find the right way to parent in an at-
tempt to perfect their child rearing and their children.
At our center, the transferential power of professionals is evident
in the mothers reactions to the psychoanalysts who are group lead-
ers. The leaders are often viewed in an idealized wayas omniscient,
all-powerful, all-protective mother surrogates. At other times, how-
ever, they may be devalued, covertly or overtly, and negative trans-
ferences may become intense.
Stern (1995) maintained that, during the mother constellation,
negative transferences and treatment dangers arise when the therapist
is unable to respond appropriately to a mothers wishes and needs,
either on personal grounds or because the therapist is adhering to a
therapeutic framework appropriate to psychoneurosis but not to the
motherhood constellation (p. 186).
Often, in our parentchild groups, concrete issues come up for dis-
cussion. Parents ask, Should I do it this wayor that way? The
group leader tries to foster the parents discussing such particular is-
sue themselves, so that particular parents can make the best decision
for themselves and for their particular baby at a particular time. As
the vignettes presented here indicate, we communicate to the parents
that, regardless of the issue to be resolved, conflict is inevitable. In
other words, conflict cannot be eradicated, and a solution for one
motherbaby dyad may be very different from the solution for
another dyad.
In our staff discussions, we often wonder, in parallel fashion,
Should I do it this wayor that way? Or, What is the best way to
handle such and such a situation? In essence, newgroup leaders, like
new parents, wonder if there is one right way to act. In essence, the
senior staff at our center (as those in any supervisory position) are the
staffs good grandmothers.
The group leaders are cognizant of the need to communicate to the
mothers that they understand them, particularly their feeling states.
Nevertheless, as Stern maintains occurs, there have been times when
a group leaders difficulty in understanding and empathizing with a
mothers needs has had a negative impact on the mothers.
WHEN DAUGHTER BECOMES MOTHER 651
In our experience, however, one observation is extremely com-
mon in all our groupsthe theme of aggression; the anxiety, guilt,
and shame about aggressive fantasies; and the profound difficulties
mothers have in dealing with their own anger and their childrens
anger. As a result, mothers may be unable to tolerate conflicted and
ambivalent feelings in themselves or in their children.
As this theme is ubiquitous in our mothers, it leads me to question
the universal validity of Sterns (1995) model, which I would call a
frustrationaggression model, and his seemingly resultant singular
focus on the therapists mishandling of the mother constellation as
the source of a new mothers aggression. It seems to me that there is a
deficiency in Sterns frustrationaggression model and in his conclu-
sion that, after a therapist accepts the concept of the good grand-
mother transference, a better treatment ensues (pp. 186187).
The data from our multiple dyadic groups support the conclusion
that the motherhood constellation and the good grandmother trans-
ference are in fact valuable theoretical constructs. However, ambiva-
lence conflicts, particularly over aggression, are ubiquitous and
inevitable. Mothers need help accepting ambivalence (about them-
selves, about their mothers, about their children). A ubiquitous fan-
tasy is that the professional is a good grandmotherthe professional
is an idealized mother or a wished-for mother. Aprofessional must be
cognizant that idealization of her or his status as the good grand-
mother may, sooner or later, succumb to deidealization with resultant
aggression.
Conclusion
In this communication, I highlight how new mothers can be very pre-
occupied with their own mothers and can replay the relationship with
their mothers in a transferential way with professionals and nannies
who can become surrogates for their own mothers. Newmothers need
affirmation from their own mothers and the mother surrogates be-
cause, in their new roles as mothers, they experience a sense of help-
lessness and anxiety and have difficulty tolerating aggression,
ambivalence, and conflict. Sterns concepts of the motherhood con-
stellation and the good grandmother transference are useful in trying
to understand how to best approach and help new mothers and their
babies. From observations in multiple dyadic parentchild groups at
652 LEON HOFFMAN
the Pacella Parent Child Center, I have distilled two factors that help
new mothers address their anxietiesthe bonds these mothers make
with one another and the transferential bond to the group leader and
other professionals at the center. Here I critically discuss and com-
pare theoretical inferences derived from individual psychoanalytic
or psychotherapeutic work (as exemplified by the work of Balsam)
with the inferences derived fromSterns dyadic model and with infer-
ences derived from psychoanalytically informed group situations. I
consider the implications of the ubiquity of ambivalence conflicts,
especially around aggression.
Epilogue
Psychoanalysts follow a tradition, begun by Freud, of looking to my-
thology to generate hypotheses about mental functioning and to pro-
vide corroborating examples and a narrative frame for their own pet
theories. Holtzman and Kulish (2000) extensively explored how the
myth of Demeter and Persephone (vs. the myth of Oedipus) is a better
metaphor for womens struggles with their passions: it has female
protagonists and speaks to the intensity of the motherdaughter
bond (summary of White, Kulish, and Holtzmans discussion during
the May 13, 2001 Journal of the American Psychoanalytic Associa-
tion netcast).
In the myth, the goddess Demeter expresses her fury toward some
of the male gods for Hadess abduction of her daughter, Persephone.
Her fury is so intense that it puts the entire land under a blight. Spring
(i.e., new life) returns only after mother and daughter are reunited.
Persephones only active action is rather tame. She walks with
other young girls in the fields and picks flowers, and that is when
Hades abducts her. Obviously absent fromthe myth are Persephones
desire to leave her mother and her anger over her mothers prohibit-
ing her from staying with Hades year-round.
Demeters powerful affective reaction suggests that she experi-
ences the loss of her daughter as a threat to herselfreminiscent of
Furmans (1994, 1996) idea that a mother feels a threat to her own
body integrity with the inevitable loss of a child during development.
Tyson (1991, 1996) wrote how the DemeterPersephone story re-
flects the profound motherdaughter bond, a mothers plight in los-
ing her daughter, and a girls conflict over object choice.
WHEN DAUGHTER BECOMES MOTHER 653
Our experience shows that, because of a variety of conflicts, many
new mothers are concerned about their potential adequacy as mothers.
They feel very anxious and unsure about actively assuming their new
roles as mothers to their babies versus continuing only as daughters to
their own mothers and needing to be told what to do (and, thus, be
given permission) by their mothers or mother surrogates. Therefore, it
might be useful to consider adding to Holtzman and Kulishs reading
of the DemeterPersephone myth the idea that this myth may in fact in-
clude a representation of the fantasy that only older mothers (not
daughters becoming mothers) are allowed to be active and aggressive.
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