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Early Childhood Development: The “Good Caretaker” and Self-Soothing

May 31, 2012

From a trauma perspective, a variety of models are pertinent in explaining the risk of PTSD. These include developmental theory, attachment theory, and the resource model.

The resource model is particularly relevant in natural disasters and war violence involving death or disappearance of parents.

Knowledge of early attachment of infants to their caretakers helps us to understand why failed parenting (caretaking) can have a damaging effect on a child’s mood, sense of autonomy, self-agency, sense of self, use of defenses, and outlook towards the world.

The innate experience of the human infant is, by general consensus, unorganized and chaotic. His early environment envelops him, and he is only minimally capable of understanding or transforming it.

Freud’s approach to developmental maturation was predicated around the sequential unfolding of the libidinal stages. According to Freud, the human psychological apparatus is organized around the purpose of lowering drives and tensions, with the predominant role of experiencing pleasure.

However, as the field of developmental psychology evolved, an account of   how the infant differentiates from formlessness into a healthy, autonomous, self-regulating entity became crucial to many developmental theorists (Greenacre, P. “Early Determinants in the Development of the Sense of Identity” Journal of the American Psychoanalytic Association, 1958).

For an individual to achieve inner well-being, he or she needs a healthy supply of sharing and validation by caregivers. In this regard, the first bonding between parent and child begins in the womb.

 A child who grows up in a warm, safe, and nurturing environment is going to carry into adulthood a feeling of security, worth, well-being, and optimism (Kohut, Heinz and Miriam Elson, ed. ”The Kohut Seminars on Self-Psychology.” New York: W.W. Norton, 1987).

A child who receives this will feel more confident and empowered as an adult and will be more effective in personal relationships, interactions at work, and in society in general.

According to Kohut (known by some as the “Father of Self-Psychology”),the infant “self” begins from an amorphous state, has no durable sense of structure, cannot stand alone, and requires the participation of others to maintain a sense of well-being, cohesion and constancy.

Kohut refers to “others” from the infant’s perspective, as not yet separate from the latter’s “self.” In other words, for the infant there is no sharp distinction between the internal world and external world. The infant’s internalized experience of the caretaker becomes part of the infant’s internal sense of self, which Kohut terms the “self-object.”

For Kohut, the ideal situation is when a child is born into an empathic, responsive human milieu. He regards relatedness with others to be as essential for psychological survival as oxygen is for one’s physical survival.

Donald Winnicott, a developmental psychologist who popularized the concept of the “Good Enough Mother,” is in agreement with Kohut regarding the observation that “Disorders of the Self are understood as environmental deficiency diseases” (“The Maturational Process and the Facilitating Environment” International University Press, New York,1956).

According to Winnicott, the caretaker, (ideally the mother), provides the “holding environment” within which the infant develops self-awareness.

Moreover, solidification of the self requires a certain devotion and empathic anticipation of the child`s needs: “When the mother is able to resonate with the baby`s needs, the latter becomes attuned to his own bodily functions and impulses”.

In additional to the holding function of the mother, where she “brings the world to the child”, Winnicott considers the conditions necessary for the child to develop the capacity to tolerate being alone.

Transitional objects help the child to negotiate the gradual shift from the experience of the child totally immersed in the subjective world to a sense of self among other persons (Object Relations in Psychoanalytic Theory, edited by Jay Greenberg and Stephen Mitchell, Harvard University Press, 1983, Chapter 7, page 195).

The relevance of this will be revisited in the article addressing the role of the Trauma Therapist as a transitional figure in the reconstruction of the “damaged self” following trauma.

For Margaret Mahler (another influential developmental theorist), the organizing principal of developmental success is based on whether you received and internalized a nurturing good object, which I sometimes refer to as “good parent” or good “caretaker.”

In order to accomplish this, the parent has to walk through the developmental stages with the child in a sharing and empathic way, paying attention to the child’s bonding cues.

Mature object-relationships require the capacities of balancing this while promoting self-soothing through a process of gradated separation.

In order to accomplish this, the good parent remains only as far as the child can tolerate, and is predictably available for emotional “refueling” upon recall by the child.

In trauma research, “foraging patterns” are used to replicate the physiology of childhood deprivation. Stress hormones are elevated in cubs whose foraging is unpredictable.

This would correspond to a parent who is not available during the critical “rapprochement phase” (Margaret Mahler, Fred Pine, and Anni Bergman “The Psychological Birth of the Human Infant.”: Basic Books, New York, 1975).

Her requirements for optimal mothering bear a striking similarity to Winnicott`s “Good Enough Mother.”

In Mahler’s framework, the mother has to demonstrate a capacity to “move with the child in order to enhance the successful sense of confident autonomy.”

According to Mahler, the failure to adapt to any stress, particularly in the young victim, is the result of the victim failing to receive critical emotional ingredients from his or her mother or other caretakers.

The benchmark of successful development depends on the movement from a symbiotic dependence on the mother to the achievement of a stable individual identity within the world.

Mahler refers to this process as the successful “psychological birth” of the child, or “separation-individuation.”

The successful process of hatching and re-fueling is what Phyllis Greenacre calls the child’s “love affair with the world,” as discussed in her article “Early Physical Determinants in the Development of the Sense of Identity” (Journal of the American Psychoanalytic Association, 1958).

During this process, “receiving” occurs via the successful “internalization” of the “good caretaker”. Resolution of the rapprochement crisis was discussed in 1971 by Mahler as an essential developmental requirement for the prevention of subsequent psychopathology.

It would appear that the process described by Winnicott, in “The Maturational Process and the Facilitating Environment,” is what corresponds with the healthy development of limbic structures such as the hippocampus (Winnicott, D.W. New York: International University Press, 1965).

The capacity to maintain a sense of autonomy and empowerment will later be needed to ward off the predatory behaviors of others.

Extended caretaker failure to provide empathy may lead to deficits ranging from shyness and introversion to serious disorders of the self.

These disorders, which are beyond the scope of this book, are listed as “Cluster B Personality Disorders” on Axis II in the DSM-IV, and are covered at length in the classic book edited by James Masterson and Ralph Klein, “Disorders of the Self: New Therapeutic Horizons”(Brunner/Mazel Inc., 1995).

According to Judith Herman, traumatization is not static (Trauma and Recovery, Basic Books, 1992, See Chapter on “Captivity” pages 86-92).

If critical psychological and material resources are not replaced, the trauma survivor remains vulnerable to ordinary life stressors, hindering further psychological and social growth.

This concept also applies to other settings where caretaking is temporarily delegated to others, such as babysitters, schools, day care centers, or summer camps.

It has been well established that inadequately trained or negligent caretakers can psychologically damage children.

A child that grows up in a warm, safe, and nurturing environment is going to carry into adulthood a feeling of security, worth, well-being, and optimism.

The more nurturance the child received during upbringing, the more confident and empowered he or she will feel as an adult, which will translate into interactions at work and in society at large.

This link between childhood socialization and adult functioning evolves from the organizing principal of Margaret Mahler’s “map of developmental success.”

She refers to the success of this “separation-individuation” process as “the setting for developmental readiness” for pleasure in independent functioning.

The process begins with symbiotic fusion with the mother, followed by the infant’s absorption with its own autonomy, and the availability of the mother to refuel during moments of insecurity when the infant can retreat, until a secure sense of self takes hold.

Mastery of this phase terminates with the successful achievement of the child to organize itself around the parent as an external love object.

Given the close dynamics of such relationships, good caretakers become internalized as good “self-objects.”

These become available for recall during times of psychological trauma.

Successful conclusion of this stage is what enables victims, following a trauma, to attach themselves to surrogate caretakers such as friends and family in order to reawaken latent soothing “self-objects” from childhood.

Kohut, in “Restoration of the Self,” notes that victims assimilate the emotions of their caretakers (New York: International Universities Press, 1977).

This includes the caretaker`s gentleness, tone of voice, mood, and empathic responses.

If a victim successfully internalized the parent as a good “self-object” during childhood, the individual will be far more receptive to being comforted during stress by surrogate caretakers.

The capacity to be soothed when faced with a trauma is also crucial for maintaining one`s inner sense of cohesion and well-being.

The good “self-object” is easily rekindled via bonding with significant others such as spouses, siblings, friends, chaplains, or therapists, who can then function as soothing “transitional objects” during times of crisis.

The power of healing through emotional attachments has been illustrated in combat environments.

In 1947 Kardiner, the author of The Traumatic Neuroses of War, in collaboration with Herbert Spiegel, a military psychiatrist during the Second World War reported that the strongest protection against `overwhelming terror` was the degree of relatedness between the soldier, his fighting unit, and the unit commander (Revised edition, New York: Hoeber,1947).

Carey-Trefzer noted in a study of children during the Battle of Britain that the mental shock of bombing was far more serious when children were under the care of an emotionally unstable parent (Eth and Pynoos, ed. “PTSD in Children” American Psychiatric Press, 1985).

Healing does not take place in a vacuum. Trauma victims need to receive an emotional sense of comfort from anyone with whom they are in a healing relationship.

This allows the victims to share their stories within the supportive matrix of empathic others. Gradually, traumatized patients internalize the sense of safety that they feel within the relationship as becoming part of themselves.

The renowned psychoanalyst Otto Kernberg made the following observation regarding treatment of patients with “disorders of the self” (such as Borderline Personality Disorder):

“The therapist`s empathic attitude has elements in common with the empathy of the `good-enough mother` with her infant (Psychotherapeutic Strategies, New Haven, Yale University Press, 1984).

In trauma recovery, another self-function that is fundamental to healing is that of “sense of agency”.

The annihilation of any sense of self may be the ultimate goal of the predator for his victim.

I have described this in some detail in the article on Stockholm syndrome.

In her chapter titled “A Forgotten History”, Judith Herman notes that “the more powerful the perpetrator, the greater is his prerogative to name and define reality” (Trauma and Recovery, Basic Books, 1992).

In the instance of rape and incest, perpetrators make every attempt to escape accountability, and a very effective tool is to attack the credibility of his victim.

Anything possible is done to silence the victim and rationalize the atrocity, such as “the victim exaggerated” or “brought it upon herself”.

The therapeutic challenge of re-empowering the survivor spans from the individual relationship with the victim to the social and political spectrum.

In the larger social arena, keeping trauma in consciousness is necessary to affirm and protect the victim.

The challenge of re-empowering a victim is quite daunting in cases of repeated abuse leading to a state of learned helplessness experienced as a dreaded and unavoidable fate.

Survivors of childhood abuse may develop a deep self-loathing, directing their negative emotions into self-abuse in the form of self-mutilation or even suicide.

As Herman notes in her chapter titled “a healing relationship”, the first principal of recovery is the empowerment of the victim. “No intervention that takes power away from the survivor can possibly foster recovery”.

 

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