The Kleinian Baby: 30 Years On….

What I hope to show in this paper is that any theoretical clinical orientation is not a fixed structure. Rather, it is a dynamic living process, learned, reflected on, re-thought, added to, modified, and developed over time. This invitation to me, by the Editor of our Journal, Christine Vickers, to revisit an article that I wrote 30 years ago, entitled, ‘The Kleinian Baby”, offers me an opportunity to put this process into practice.

So, what has become of The Kleinian Baby, in my eyes now that she has reached the milestone of 30 years? Firstly, The Kleinian baby has changed her name.

In her case, my view is that she has now become the Object Relations Baby. This name change is due, in part, to her large extended family. Her family lives all over the world, not only in Great Britain, but in Europe, South America, and even in China, and, of course, here in Australia. Interestingly, in the United States, the work of Melanie Klein was viewed with scepticism until a pioneer Los Angeles Psychoanalyst, Dr Bernard Brandshaft, successfully lured Wilfred Bion to migrate from London to Los Angeles. There, Bion created what has become a flourishing Kleinian enclave in the previously hostile Psychoanalytic Institute in Los Angeles.

Wilfred Bion is certainly one of the “children” or followers of Melanie Klein, playing a central role in the growth, development, and extension of Kleinian theory into a more diverse Object Relations Theory, extending the concepts developed by Melanie Klein into such fields as group dynamics and group pathology, the structures underlying function and dysfunction in groups, as well examining the pathology of individual psychotic patients. Among the other notable Kleinian Psychoanalysts and Psychoanalytic Psychotherapists are Suzanne Isaacs, Herbert Rosenfeld, Donald Meltzer, Martha Harris, Elizabeth Spillius, Betty Joseph, Anne Alvarez, Edna O’Shaughnessy, Margaret Rustin, Isca Wittenberg, Joan Symington, and most notably, Esther Bick, who pioneered the method of Psychoanalytically Oriented Infant Observation, to train Child Psychotherapists at the Tavistock Clinic in London. The Esther Bick Method of Infant Observation is now in use and applied to deeply understand and therapeutically assist babies and their mothers, children — and adults, world-wide.

The Kleinian Method, while adhering to its original theory of the development of the mind, has evolved and grown new ideas, and this is a measure of its health. The concept of the Kleinian Baby is no longer isolated or viewed with scepticism, as I am old enough to recall Kleinian theory could be, in certain circles, 40 or 50 years ago, even by esteemed professionals, working alongside us at the Tavistock Clinic. On the contrary, the theory of the Kleinian Baby has been embraced and developed by “her” community, her multicultural village, with interest and pride in their creative branches and extensions, as she intermarried and procreated. What began as Kleinian Theory, and has developed and enlarged into Object Relations Theory, has successfully and significantly continued to contribute to the development of areas such as Infant Psychotherapy, as well as Group Psychotherapy and Organisational Dynamics.

The concepts which Melanie Klein first described in her theoretical and clinical writings had their origins in her clinical observations, derived from her therapeutic work with her child patients in the playroom and with her adult patients in the consulting room. As I wrote in my original paper in 1992, “Melanie Klein had a profound belief in the internal world.” As Klein understood the mind, she granted it much more activity than Freud is thought to have had. As I wrote then, “Klein held that through observation, one is given the opportunity to see a live, pulsating world of primitive phantasy, partly conscious phantasy, much of it unconscious phantasy, of which the individual baby himself may be deeply unaware. However, through observation the presence of such phantasy can be postulated, deduced, or constructed from careful observation of all communications, verbal and non-verbal, symbolism, symbolic representation, activity or the absence of activity, body movement and play, in its widest definition: That is, both the overt and the covert communication.” As Klein came to understand the mind, she held that activity, innate instinctual knowledge, begins literally from the beginning of life. She saw that in the young baby’s inner emotional world, their initial emotional experience as both very intense, and fragmented and fantastic, in the original sense of the word. Before they experience their primary objects, (parents or carers), as whole and continuous, they are experienced as Part-Objects, and early in the baby’s life the part objects are experienced as a phantasy. The phantasy represents the object as it is experienced, and, in turn, the phantasy affects the perception of the object. The good mother, or more accurately the breast, gives nurture and through the nurture, gives the baby intense pleasure. When the baby finds the breast absent, the breast may turn bad and persecuting in the baby’s mind and may even be felt to be attacking the baby. (Here, we might speculate, we find what might be understood as the roots of Attachment Theory, the understanding of the very roots of the emotional experience of attachment and loss, which accompanies us all of our lives. These early primitive experiences are central to Klein’s understanding of early infant emotional development and has become part of mainstream psychoanalytic language. In this regard, the operation of Projective Identification, and the correspondingly, the mother’s containing function, is a vital mode of communication between the baby and mother couple. The concepts of Projective Identification and containment have been, and continue to be, more clearly elucidated by later theorists, including Bion, especially through his ideas of the function of Alpha and Beta elements, which originate between mother and baby and are vital in infancy. The mother processes the baby’s fragmented sensory experiences and makes them bearable for the baby. As I understand Bion’s theory, he believes that thinking begins with things that cannot be thought. These he called Beta Elements. He suggests that the baby can only begin its psychic life in relationship with that of her or his mother or primary carer, who makes the unthought thinkable, digestible, and capable of being metabolised by the infant. The process of containment between mother and baby therefore initiates psychic growth and development. In normal or “good enough” bonding and development, the mother or the primary carer holds the baby, both physically and emotionally, recognises the baby’s needs, and helps the baby to feel contained and secure.

The acceptance of, as well as the extension and application of such concepts as these, and others, to describe and elucidate Klein’s view of the growth and development of mind, which I wrote about in my brief paper, “The Kleinian Baby”, 30 years ago, is only one example of the fact that fertile ideas change — indeed, they metamorphose. I recall Donald Meltzer saying that in his view, psychoanalysis is not a science, but an art. I would add, it is an art which needs to be not only learned, but nurtured, and deepened over a professional lifetime. Psychoanalysis also, of course, touches on other fields, including the field of philosophy, and on the questions and issues that it raises, including ethics and the truth. It would have been very interesting to have a discussion with Dr Meltzer about his comments, both regarding art and truth, because of the developments in the science of neurobiology of the brain. It provides a window into the development, function, and plasticity of the brain.

To truly understand what a baby needs to thrive, both physically and emotionally, one now needs to embrace science to include the complementary functions of the relationship between the mind and the brain. Are they, in a sense, two sides of a coin? And if so, what do they tell us? Does the “art” of psychoanalysis require, even demand, a partnership with the pure science of the study of the development and functioning of the brain? Each has implications for the other. For instance, what are the emotional implications of the scientific evidence that a baby in utero can hear, and that specialist audiologists are able to test, in the last trimester of the pregnancy, whether the baby’s hearing is normal or abnormal. The newborn baby can recognise the mother’s voice which they heard during the pregnancy. Other scientific studies have demonstrated that newborn babies recognise and prefer songs that their mother sang in the later stages of their pregnancy. Such research now validates Klein’s beliefs that the baby has perceptions, and fragmented experiences and emotions literally from the beginning of its life, and even before birth.

In my earlier paper I wrote that Klein linked her observations to her deep belief, that a basic tenant is that every impulse has an object and that it is innate instinctual knowledge that links the impulse to an object. We see evidence of this at birth, when a mammal is born and seeks the object on which its immediate survival depends, and that is the mother’s teat. Klein postulated that the human Infant has an intuitive grasp (literally), which links the baby’s impulse to suck with the object it requires to survive, namely the nipple on the breast.

At this point I want to appear to digress and state that as Melanie Klein herself had followers, she herself was, of course, a follower of earlier Psychoanalysts, of course including the founder of Psychoanalysis, Sigmund Freud. She and Freud, and Freud’s daughter, Anna, were immersed in the same milieu. Klein came to London in 1926, and Freud, fleeing the Nazis, lived there for the last year of his life, from 1938 to 1939.

It is said that Freud and Klein’s views diverged, and indeed Klein saw the emotional life of the baby as far more intense and primitive than Freud, but in this context, I would like to quote Sigmund Freud, writing in one of his last essays. In 1939, in London, the year of his death, Freud wrote “An Outline of Psychoanalysis.” In that Essay, in Chapter 7, entitled, “Psychoanalytic Work” he wrote:

“A child’s first erotic object is the mother’s breast that nourishes it; love has its origin in attachment to the satisfied need for nourishment. There is not doubt that, to begin with, the child does not distinguish between the breast and its own body; when the breast has to be separated from the body and shifted to the ‘outside’ because the child so often finds it absent, it carries with it as an ‘object’ a part of the original narcissistic libidinal cathexis. This first object is later completed into the person of the child’s mother, who not only nourishes it but also looks after it and thus arouses in it a number of other physical sensations, pleasurable and unpleasurable. By her care of the child’s body, she becomes its first seducer. In these two relations lies the root of a mother’s importance, unique, without parallel, established unalterably for a whole lifetime as the first and strongest love object and the prototype of all later love-relations –for both sexes……And forever long it is fed at its mother’s breast, it will always be left with a conviction after it has been weaned that its feeding was too short and too little.” (Pgs. 188-189)

In this tender quote by Sigmund Freud, we see that the roots of what is regarded as the Kleinian concept of “part objects”, poignantly appear in this piece of Freud’s late writing. In the thought Freud expresses that, “The first object (the breast) is later completed into the person of the child’s mother…”, one might wonder if Freud was possibly influenced by Klein. Or did Freud too, at the end of his life and his original, long, and brilliant contribution to the practice that he pioneered, recognise the place of passionate love in the earliest emotional life of the baby, and the baby’s passionate attachment to the mother? In this quote, there certainly is a coherent overlap in their view of the inner world of the baby and the child.

So, at this point I have touched on Klein’s contribution in the context of her and her followers. They have expanded and developed her insights, derived from her clinical observations, and validated some of her ideas that science, particularly neurobiology of the brain has contributed to our understanding.

What might I further offer in this request made to me to revisit my short paper from 1992? My perspective derives from my clinical work from 1971 to 2014, including the last 30 years since I wrote “The Kleinian baby”. While I retired from my clinical practice with patients in 2014, at the age of 70, I continue to practice as a clinical supervisor and teacher.

It is my work with patients, both children and adults, and my teaching of Infant Observation over more than 40 years that informs my views.

In my clinical work with children and adults, my view is that while the description and understanding of these earliest structures of the mind are vital, the successful working through of the Depressive Position is crucial. Herein lies our capacity to really know the other. The Depressive Position requires the baby, child, or adult’s capacity to work through earlier feelings of envy and hate and make reparation for our imagined or real attacks on others. The Depressive state of mind underlies the capacities to love, to develop tolerance, nurture relationships which are whole and trusting; the Depressive Position allows us to develop empathy, compassion, tolerance, and the capacity to work through early feelings of envy and hate and make reparation for our imagined or real attacks.

These fundamental emotional developments, or, conversely, emotional disturbances, are rooted in, and a function of, a very deep relationship with a primary object. This is the model which expresses itself in the Kleinian terminology of “Object Relations”. While the origins of this terminology may be rooted in the wish for the theory to sound “scientific”, which was in fashion at the time, I think, the “Object” in the term “Object Relations Theory” refers to the baby’s mother. Its actual meaning is about a significant other, and in this theory, it is this fundamental structure on which the therapeutic psychoanalytic relationship is based. When difficulties arise for a child or adult, and psychoanalytic psychotherapy or psychoanalysis is undertaken, the successful work of the therapy, the development, healing, or recovery, is deeply dependent on the relationship between the patient and the analyst or therapist. This form of therapeutic dependence, the patient’s transference, and the therapist’s use of their countertransference reactions and emotions, in the context of the treatment, is akin to the dependence of child or baby on their care-giver’s attunement – it operates, not at an ego level, but at the level of the meeting of two unconscious minds. Crucially, the Transference Countertransference Relationship is the fundamental tool of change between patient and therapist. It is the first and necessary element in establishing and maintaining a therapeutic working alliance. Hence, the terminology, “Gathering the Transference” is used by Donald Meltzer in his book, “The Psychoanalytic Process”, referring to the beginning stage of the analytic process.

Moving back to one of the newer “relations” of the Kleinian Baby, namely the scientific field of the development of the brain, the interrelated fields of Neurobiology and Neuropsychology, these fields now show the effect that secure attachment can have on the very structure of the brain, in infancy and childhood. In parallel, it is demonstrated that the secure attachment that a patient and analytic therapist establish over time, through long term and careful psychoanalytic psychotherapy work in the transference, may also cause mind-brain changes.

As Allan Schore, one of the most well-known proponents of Developmental Neuroscience and Neurobiology, explains, the genetic factors with which an individual is born are no longer understood as a fixed, or “given”. The actual fundamental structures of the brain are continually being formed and developing at least in the first 2 years of life. Rather, they are continually forming and changing. The brain is a living organism.

The trajectory of attachment is established by the relationship between the baby and the caregiver and reinforced and securely established by an interactive process in the physical and emotional on-going care of the baby by a continuous attachment to a primary caregiver. ( Schore 1994)

Continuous care enables emotionally enriched experiences for the baby. Or, in the language of Developmental Neuroscience, research demonstrates that cells that fire together grow together. The hormones between the parent or caregiver stimulate each other. And mutually regulate each other. A good secure attachment relationship directly affects genome development. And cells that are not reinforced die. This science demonstrates that the mother, or primary carer and baby are connected at both micro and macro levels. This dynamic is not only reflected in scientific research in other areas but encompassed by wide reaching scientific research in the area of Quantum physics, showing that all living elements have connections and effects from each other, at far from obvious levels. So too do the caregiver and the baby couple. And at a further parallel connection, so too does the therapeutic relationship. The crucial tool of change in the psychoanalytic therapy process, between the analytic therapist and the patient, whether child or adult, is the work in the transference and countertransference where these miro and macro phenomenon operate.

This pioneering research confirms the earlier clinical observations of the effects of separation and loss of significant others in infancy and childhood. The ensuing trauma for the baby or child has been vividly studied and recorded at the Hampstead Nurseries during WW2, as well as on film by James and Joyce Robertson, in the 1960’s, in their work at the Anna Freud Centre, and of course by the work of John Bowlby on Attachment and Loss at the Tavistock Clinic.

Attachment Theory is essentially a regulatory theory. At its core, it is about how the mother helps the baby regulate emotion. This to-and-fro regulation takes place not at a conscious level but at level of the autonomic nervous system. The mother’s autonomic nervous system regulates the baby’s autonomic nervous system. These repeated and ongoing mother-infant based attachment communications (to express the dynamic in research language!) are essential because such communications, (feelings, expressed outwardly as reassurance, mirroring, comforting, etc.), directly affect the development of the brain, which we now know is on-going in the first year, of life, and into the second year, of life. Allan Schore’s integration of neuroscience with attachment theory ( Schore 1994) confirms Klein’s clinical observations that the baby is object seeking from birth, or even before birth, when we reflect on Alessandra Piontelli’s ground-breaking ultrasound intrauterine baby observations in her book, “From Fetus to Child: An Observational and Psychoanalytic Study” ( Piontelli 1992).

An example of the positively developing establishment of this transitional object in the baby’s mind was given by Sigmund Freud, in his story of the toddler and the spool. Freud related that his daughter, Sophie, was a very present and caring mother to her young son. One day she went out for a short time. She said goodbye, leaving him in the care of his grandfather. The toddler stood in his cot, playing with a spool, to which was attached a long string. Freud observed his grandson, and his play in his mother’s absence. Holding onto the string, he repeatedly tossed the spool out of the cot, saying “fort”, meaning “gone”, and, pulling it back into the cot, he exclaimed, “Da”, which means “Back”. He had a symbol, the spool, and was actively coping with his beloved mother’s absence and his wish for and fantasy of controlling her return!

The scientific discoveries concerning the development of the brain in infancy weave in beautifully and validate with the psychoanalytic thoughts of the post-Kleinian theorists, including Hannah Segal and Wilfred Bion, and others, whose work gave particular focus to the crucial developmental step of symbol formation. Until this crucial step is established, the baby needs the mother’s visceral body. Until there is a symbol in the baby’s mind, the baby requires the presence of the literal object, the literal body, which it only recently left. To illustrate this development, which is linked intrinsically to the establishment of the mother as a whole object in the baby’s mind, one might think of the crucial step of the meaning of Donald Winnicott’s “Transitional Object”, and what it implies regarding the internal world of the baby. It may imply that the baby has begun to internalise the mother or caregiver and is now perhaps beginning the process of being equipped to carry her or him in their mind, expressed by the teddy, the blanket, or whatever is chosen to represent (symbolise) the loved object. The baby has developed the capacity to hold on, remember, connect in their mind, to the mother. They are in the process of developing an internal mother. This takes time. Initially this development is fragile, and a more secure development of this capacity is dependent on many factors, not least of which may be the combination of be the baby’s environment and its innate temperament. Capacities are fragile and if not nurtured, may be lost, or shattered.

At the other end of the spectrum of attachment, Frances Tustin, in her writings about autism, differentiates between primary autism and secondary autism. She postulates that secondary autism may be triggered by what is perceived by the infant as an emotional rupture. Emotional ruptures in the fabric of the baby or child’s development may, of course, occur for a variety of reasons, but abrupt separations from the baby or child’s primary caregiver, may be one of those causes. I have certainly seen children or adults as patients in my clinical practice for whom such ruptures have affected their capacity to have committed, trusting and loving relationships later in life. (Tustin 1986)

In conclusion, I have been asked to “revisit” my paper written thirty years ago. In the process, I have come to realise the congruity of the development of Melanie Klein’s original ideas into what has grown and morphed into Object Relations Theory, which, in turn, has both taken from, influenced, and enriched other theoretical systems, including attachment theory, and the understanding of group dynamics. Klein’s concepts derived from observation and her clinical work with children and adults. In her writings, she described the live, pulsating internal emotional world of the infant’s mind, intense, fragmented but discernible through observation. While controversial at the time, and still viewed with scepticism, many of her basic tenants and clinical conclusions are now confirmed and validated through objective neuroscientific research of the neurobiology of the brain, and its development, before birth, and through early infancy, demonstrating the neurologically competent infant.

Addendum
I wish to begin my addendum with a quote from Anna Freud. I am indebted to my colleague Fiona Lacy, for drawing this quote to my attention.

When Anna Freud was asked by a young person what the personal qualities of a future psychoanalyst ought to be, she replied : “If you want to be a real psychoanalyst you have to have a great love of the truth, scientific truth as well as personal truth, and you have to place this appreciation of truth higher than any discomfort at meeting unpleasant facts, whether they belong to the world outside or to your own inner person.”

While it is well documented that Anna Freud and Melanie Klein disagreed on some fundamental aspects regarding the development of the mind and its psychopathology and treatment, such as the use of transference in the treatment of children, there were also broad areas of agreement between them.

Martha Harris, who was the Organising Tutor of the Child Psychotherapy Training at the Tavistock Clinic, following Esther Bick, was my teacher and mentor, along with many other grateful students. Martha Harris taught not by theory but by practice. What she gave was truly both “pure and applied”, as mathematicians say, and we, her students, imbibed. If we have imbibed the findings about which I have written in this paper, and we do not shun the truth, neither internal nor external, do not “turn a blind eye”, as John Steiner wrote, how can we not advocate on behalf of babies, children, and their primary carers, to share what we understand from all the developments in our enlarged and enlarging field?

The issue I wish to raise in this Addendum relates both to the implications of scientific truth and our inner truth as clinicians. It concerns the implications that my paper raises regarding both the clinical and theoretical groundings of Object Relations Theory, concerning the development of the mind, as well as the scientific research findings regarding the neurobiological development of the brain.

I question whether we, as clinicians, have a responsibility to be the spokesperson and actively advocate by all means available to us, regarding the optimal or “good enough” provision of care for the developing emotional needs of the baby, as well as the primary carer-baby couple? As psychoanalytic psychotherapists, we have privileged access regarding unconscious processes, and with that, it could be argued, comes not only the ethical responsibilities in the consulting room but also societal responsibilities regarding the needs of infants and their carers.

Donald Winnicott said that a “successful infant needs to succeed in enthralling his mother”. He asserted that the mother needs to fall in love with her baby. But falling in love and staying in love requires time and space.

It is an appropriate dilemma to consider of the pressures on primary carers in today’s society. As well as external social and economic pressures there is the issue of adults in positions of influence understanding the emotional life, psychological growth, and emotional needs of the infant. In this regard, I am reminded of Hannah Segal, writing in her book, Introduction to the Work of Melanie Klein, ( Segal 1964) to the effect that thinking about the phases of development in which the psychological phenomena are most remote from our adult experience is most difficult not only to study, but also to comprehend. Adults can be sceptical or even blind to considering the experiences of the baby or the young child. Many adults can easily convince themselves that the baby or young child “won’t remember”, will not “notice”, or if they do notice, the baby or child surely won’t understand. As we know, all too well as clinicians, while adults can deny, and babies and young children may repress negative experiences and trauma, that does not mean that these experiences do not adversely affect them. This is very relevant to thinking objectively and constructively about what might be our obligation as professionals to advocate, prioritising for babies and young children’s needs, so they can develop secure attachments which we understand are mandatory to their capacity to build lasting, loving and committed relationships.

So, what might our “advocating” look like? My reply is that we have only to look to the past, where we find long, and at times effective advocating for change.

In preparation for the Blitz, in which England expected high levels of casualties, the government implemented the highly organised policy to “evacuate” children living in densely populated cities, which would be bombed by the Germans, into “safe” rural settings. The unaccompanied children were sent to villages and farms to be billeted with government selected addresses. It was a logistic exercise with the admirable purpose of saving the lives of many children. (Interestingly, the very first patient that I ever treated at the Tavistock Clinic as a trainee child psychotherapist was a very disturbed little boy whose father had been evacuated to a farm, alone, as a young child. He spent the war years there. After the war ended, as a young teenager, he was apprenticed to a tailor and never returned to live in his family home in East London. He was a very damaged man.)

Anna Freud advocated on behalf of the children in her adopted home of Britain. She wrote to the Home Office, asserting that her work with children clearly demonstrated that the children were more traumatised by the separation from their families than they were by the bombing, and that they were emotionally better off going through the war at home with their families than out of contact with their families in the care of strangers. While not all already-evacuated children were reunited with their families, amazingly, the Home Office reversed their policy, and discontinued the evacuations. It is a poignant example to show that as professionals, we too can effectively advocate, using clinical and scientific knowledge to support our viewpoint.

Today, parents and primary caregivers face a dilemma as to when or whether to return to the paid workforce, and what options are available to them, including the choice not to work. If staying at home with a baby is not an option, they may be assisted by information from professionals to understand what factors to consider in securing the best care for their infants or young child, when returning to the workforce. Childcare is certainly a political issue, in terms of the rights and needs of women to return to work. Under pressure, this may overshadow the awareness of or acknowledgement around the baby’s needs. The value of parental worth, or the value of both the hard work and positive pleasure involved in the care of a young baby or child, can be lost by conflicting societal and economic pressures. Often the rights to paid employment is hotly debated without regard to the rights or, more accurately, the optimal needs of the baby or child regarding the structure and quality of the care.

Many families now live with pressing economic and societal pressures and aspirations, including lower paid workers, or casual workers, who have very limited or no paid maternity or paternity leave and have no option other than to return to work and place their children and young baby in day-care. In these cases, can we as clinicians, advocate regarding the optimal quality training and pay of the child-care workers? In this regard, I recall an anecdote of the effect of James Robertson’s film, “A Child Goes to Hospital”, made and shown in England in the 1960’s. The film followed a young child admitted to a paediatric ward for an elective procedure without a parent being allowed to stay with her. The film showed the distress that a baby or a young child may have when separated from their parent or carer, and not offered a viable substitute parent figure to whom they can turn during the absence of the parent or familiar carer. The widely shown film led to very helpful re-structuring of the nurses’ role on paediatric wards of hospitals in England. The structure of their work was changed, away from “task-oriented nursing” to “case-oriented nursing”. That is, the nurse, on his or her eight-hour shift, was assigned a baby or child which they fully cared for, rather than the previous structure, in which one nurse would do all the bottles, another nurse doing all the baths, etc, which fragmented the care that the individual babies or young children experienced, while separated from their parents, and ill in hospital.

Could we, with our training and knowledge, advocate for this structure of “child oriented care” to be established as standard practice in Child Care Centres, so that each baby or child was offered the same primary carer for the time they were there. In this way, they would be offered the vital component of continuity of care. And, maybe that person, caring for the same babies on most days, could hopefully, get to know them as individuals. This reliable relationship with the primary carer would help the individual baby or child to thrive, and perhaps even give them an experience of feeling that she or he is “enthralling”.

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