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Are you a “therapy mom”?
What, perhaps you ask, is a “therapy mom”?
Martha R. Herbert, M.D., Ph.D., of the Harvard Medical School and Massachusetts General Hospital, uses the phrase to describe mothers of autistic children in an article on WebMD (CBS News) about why psychoanalysis should be part of the treatment for autistic children. I rather doubt that my own son, who can talk a little but not well enough to explain his emotions or fears or to tell me what he did at school today, would be a good candidate for this sort of treatment. New York city psychoanalyst Susan P. Sherkow, MD, says that psychoanalysis can help parents understand the “‘meaning of what these children are trying to convey’”:
Psychoanalysts see autistic children four times a week, typically with a parent in the room. They also counsel parents once a week separately to keep them abreast of progress. In a nutshell, the analyst serves as a sensitive translator who attempts to decode what the child is thinking, feeling and doing.
“A major piece is to make sense of what the child is trying to communicate, translate it to the mother, and give her the confidence that she can do it, too,” explains Sherkow, …… who works with autistic children and their families.
“The therapist focuses on the behavior, mood, or emotion of the child and then translates it to the child and waits for a sign that the child feels understood, such as a furtive glance. And from there, the therapist enters the child’s world,” she explains. Sometimes this translation is putting the child’s actions into words, such as saying “you are picking up a cup.”
Herbert (who has spoken and written about environmental causes of autism) suggests that
“Moms are running themselves into the ground and yet they are not really present, so they become part of the process and not part of [sic] solution.”
Parents of children with autism need to relate to the child in whatever state they are in – and this is where psychoanalysis may be helpful, she says.
Psychoanalysts can be sensitive to the inner world of the child. “It’s a skill you can’t package, but it’s wonderful,” Herbert says.
A “therapy mom,” from what Herbert indicates here, would be a mother who is doing so much for her autistic child that she is over-fatigued, “running [herself] into the ground and yet…..not really present,” due to her excessive efforts to help her child (efforts which many of us—including potential “therapy dads”—-do find ourselves doing). While we could all, I supposed, use a bit more sleep, and while I certainly see my husband and myself as playing a key role in the “process” of Charlie’s education, I find Herbert’s suggestion that such parents are “not part of [sic] solution” and that we are somehow not “sensitive to the inner world of the child” extremely puzzling. I’m not always right about what my son is trying to tell me when he wants me to wear a certain shirt, but—due to regular, daily, constant experience and interactions—-what parent does not attempt “to decode what the child is thinking, feeling and doing”?
As for this notion of the “therapy mom”: The term seems to suggest that mothers who are so much involved in helping their child that they are “running themselves into the ground and yet…..not really present” are themselves in need of therapy; that such mothers are themselves in need of some kind of help if they are to start to become part of the “solution.”
And I find it troubling that a professional in the autism field might hold such a view.
Go to you tube: type in “Behaviorally Fragile Autistics” on you tube. This is a most interesting caes of autism, self injurious behavior and seizures. Very complex, but not without hope. There are some very important points seen in videos that would help professionals and anyone working with this unique population. This case has had numerous MRIs. cat scans, genetic work ups, cbcs, etc..all to no avai. According to mom, and evidence she presents in some videos, the child has had extensive medical and behavioral work ups, yet continues to stump the “experts.” It’s seems a case like this truly stumps us, because the fact is this type of autism requires round the clock care, analysis and daily acute and PRN medications to mitigate the self abuse that has plagued this autistic child for severeal years. A most interesting case.
“And I find it troubling that a professional in the autism field might hold such a view.”
———–
And you accuse ME of being peurile!
In reponse to Owl:
Where did you get the idea that Freud’s works are nothing more than remnants in modern psychiatry? Interpretation of Dreams is still required reading for all medical school psychiatry residents. Ninty percent of all modern psychotherapy is still Freud. Recently Aaron Beck admitted this in public, after winning his fancy Lasker Prize in medicine. What’s more, Freud’s book on aphasia is still required reading for neurology residents all over the world.
I think the big problem with Freud is that nobody knows a thing about his theories. The reasons for this are obvious enough. Up until about ten years ago it was illegal in the U.S. for anyone but physicians to practice psychoanalysis. Therefore only physicians were qualified to teach it. Your typical psychology professor is a dunce compared to the old-time psychoanalysts, and such a professor is not qualified to teach Freud to his students. He can present cheap jealous scorn though. That’s why all students go around smirking and giggling at the very mention of the word Freud. Just Read Freud for yourself. All his 23 volumes of callected work are available in paperback.
Anyway, Freud had something to say about autism and schizophrenia. For your information, it was Freud who first saw autism as essentially different from schizophrenia. In schizophrenia, libido is withdrawn from external reality. In autism it is not withdrawn. Instead it is focused on only one aspect of external reality; one’s own body. For this, Freud coined the term “auto-erotism.” Eugen Bleuler first agreed with Freud, but then decided he no longer could accept Freud’s libido theory. Instead he decided that auto-erotism was simply a symptom of schizophrenia and therefore changed the name to “autism.”
This truly aggravated Freud, but there was nothing he could do about it. Bleuler outranked him as the world’s leading psychiatrist at that time.
So, the big question is this: Was Freud right? Is autism distinct from psychosis? Or was Bleuler right. Is autism simply a symptom of psychosis.
I can’t figure out why you find various ideas for research “troubling.” If there is “no known cause and no known cure” for autism, why leave any stone unturned. I thought we were supposed to be concerned primarily about children around here; not their mothers.
Anyway, of all psychoanalysis, the object relationists are are probably best suited for curing autism.
As for your point that psychoanalysis can’t learn too much about the meaning of symptoms; that was Bettelheim’s complaint. However, modern psychoanalysts have been working on that problem just as classical psychoanalysis. If you start out with a deterministic view of things–that EVERYTHING has a meaning–all you have to do is decypher observed behavior. It’s like decoding dead languages. It has been done before.
I’m not inclined to delve too much into this topic either—but it is more “alive” that many of us might think or wish, and I’d rather be informed. At the 2005 conference in Cleveland on autism and the humanities that led to the book on autism and representation from a disabilities studies perspective—one of the keynote speakers was a psychoanalyst from Austria (I think). He spoke a good hour (that’s what it seemed like) about the equivalent of Bionian conceptualisations—–his presentation did not at all fit in with the focus of the conference.
Thanks Kristina,
While I doubt that I am going to delve too deeply into this, sometimes when there is a lot of explanation of internal motives, ideation, etc., I like to find out just plainly what is going on on the outside–as in what they are actually doing.
As owl pointed out, the translation is somewhat dependent on what the observer’s point of reference is.
Cheers.
Regan, I’ve just looked at the summaries so far—will see if I can access more. Shades of play therapy here—–
I’m glad somebody is willing to take a cognitive view to treatment instead of just drugs or conditioning… but I do take psychoanalysis with some grains of salt. I liked how one of the psychoanalists is quoted saying that they could make themselves more useful by staying out of discussing the cause of autism and sticking with how understanding the mind can help… but then again they base their understanding on the remnant of Freud’s ideas. I’m just remembering a Freud reading I did where he was trying to diagnose schizophrenia I think it was as having something to do with masturbation… He completely failed to say anything relevant on the subject. Modern attempts to pin down withdrawing from social interactions as a result of narcissism etc I think will be similarly doomed. Autistic perspective: I wonder why all these people talk so much… psychoanalyctic perspective: the child is attempting to withdraw from properly developing an oedipus complex by self stimulating the latent sexuality by flapping his hands.
1564 days ago
[...] Therapy Moms and Psychoanalysis (for autistic children)Martha R. Herbert, M.D., Ph.D., of the Harvard Medical School and Massachusetts General Hospital, uses the phrase to describe mothers of autistic children in an article on WebMD (CBS News) about why psychoanalysis should be part of the treatment for autistic children. And New York city psychoanalyst Susan P. Sherkow, MD, says that psychoanalysis can help parents understand the “‘meaning of what these children are trying to convey.” [...]
Kristina,
Do you have access to these articles or just the summaries? Our university library does not subscribe. To be square, without reading the full text, it is just gobbledeegook to me, as to the goal of the “watched play” as reciprocal play and the “watched play” as observation to develop mentalization.
———————————–
Review of The Psychoanalytic Study of the Child:Volume 59
http://www.apsa.org/Portals/1/docs/JAPA/541/Ascherman-Bk–pp.337-343.pdf
The volume’s section of clinical contributions opens with Susan P. Sherkow’s development of her concept of “watched” play: She distinguishes the “watched” play of her 2001 paper, a reciprocal play, from “watched play” in which “the young child wants mother to ‘participate’
in his play by quietly observing him” (p. 56). The“watched play state” is related to development, including the capacity for “mentalization” (Fonagy and Target 1998). Sherkow notes, “the child’s growing
ability to mentalize, corresponding to ego development, is a function of an internalization of the mother’s mentalization itself. In the same way, the child’s internalization of ‘watched mother’ in play is an internalization of the patient, focused, watching mother’s cognitive processes, including the ego functions of affect regulation and compensatorystabilization. The internalization of ‘watched play’ and the internalization of mentalization coincide . . . ” (p. 61). While Sherkow’s ideas have obvious relevance to intriguing to consider how her ideas may apply to other clinical work.
FONAGY, P., & TARGET, M. (1998). Mentalization and the changing aims of child psychoanalysis. Psychoanalytic Dialogues 8:87–114
SHERKOW, S. (2001). Reflections on the play state, play interruptions, and the capacity to play alone. Journal of Clinical Psychoanalysis 10:531–542.
I was evaluated by some folks with a rather psychoanalytic mindset when I was four, and some of the stuff they came up with was utterly ridiculous. They gave me an inkblot test and noted that at a certain point, I just started making up “nonsense words” — my dad pretty accurately surmised that this meant I’d “had enough”, but the evaluators still decided to read all kinds of weird stuff into whatever it was I said. And I mean really weird stuff, including insinuations of penis envy. (Did they say that about all females during a certain period of years? I’d wager probably).
One more by Sherkow, “Further Reflections on the “Watched” Play State and the Role of “Watched Play” in Analytic Work” (2004). Psychoanalytic Study of the Child, 59:55-73:
I’m noting the notion of the “watching mother” and Sherkow’s references to the analyst as “translating” the child for the mother.
And here is a summary of a 2004 session, with my emphases in italics:
You mean this:
Working with Children with Autistic Spectrum Disorder:
A Dialogue between Psychoanalysis and Neurobiology
A little more information:
Okay, I was able something in reference to a presentation that just happened at the Jan 18, 2008 Winter Meeting of the American Psychoanalytic Association, which may have been the warmup for the WebMD article,–a discussion led by Drs. Sherkow and Herbert. I have not been able to locate other on the presentation itself yet (which is what I would really like to take a look at). So I stand corrected that Dr. Sherkow has not worked with an autistic child, although the majority of citations that I found had to do with sexual abuse in girls.
“Psychoanalytic Approaches to Working with Children with Autistic Spectrum Disorder: A Dialogue between Psychoanalysis and Neurobiology.”
http://www.medicalnewstoday.com/articles/93574.php
This letter to the NYT
in reply to
“Detecting Autism Early, When There’s Hope”
Jan 3, 2005
http://query.nytimes.com/gst/fullpage.html?res=9504E4DE1239F930A35752C0A9639C8B63&sec=&spon=
“unites ego-psychological formulations with a Bionian conceptualisation of the thought disturbance”….= HURL for me. That wall of jargon must be difficult to see through.
Do you have the links?
Completely not-academic research but this is a post from last year by Autism Diva referencing Herbert.
Kristina,
Thanks for the citation, which I will look at in the full version, just to be fair.
If nothing else, figuring out what
“unites ego-psychological formulations with a Bionian conceptualisation of the thought disturbance.” translates to in plain English will be interesting. I still want to see what the actual outcome is and how that was determined.
Now here’s a question.
Yes, yes, it was Google U–(the regular search engine and Google scholar) and Pubmed, but I was curious about either Dr. Sherkow’s or Dr. Herbert’s qualifications to be making these claims about the need recommendation of, psychotherapy.
It could be me, but I did not find anything worth talking about. Dr. Sherkow, in particular, does not seem to have anything in her own CV to do with a professional knowledge of autism, beyond an account at a conference about someone else’s work with “envy and narcissism” in A, as in one, case study, of an autistic girl. That does not speak well to particular qualities of having special insights in autism that the article claims as necessary.
Dr. Herbert does have a connection, but not in regards to that which she is recommending.
So what is it exactly that makes either of them competent to speak to the need or effectiveness of this except their desire to say so? And again, is this based on any kind of empirical outcome data or is it just something they came up with to try out? I can’t seem to find any research.
I did some searching on PubMed and came up with:
Parks, CE.
J Am Psychoanal Assoc. 2007 Summer;55(3):923-35.
“Psychoanalytic approaches to work with children with severe developmental and biological disorders. Panel report.”
Salomonsson B.
Swedish Psychoanalytical Association, Stockholm, Sweden. bjorn.salomonsson@chello.se
Int J Psychoanal. 2004 Feb;85(Pt 1):117-35. “Some psychoanalytic viewpoints on neuropsychiatric disorders in children.”
The author addresses issues interfacing neuropsychiatry and psychoanalysis. He recommends psychoanalysis for children with Attention Deficit, Hyperactivity Disorder (ADHD) and Dysfunction in Attention and activity control, Motility control and Perception (DAMP). He attributes its low status in neuropsychiatric treatment recommendations partly to the fact that psychoanalysts do not always declare their specific field of investigation. The scientific community then assumes that psychoanalysis aims to comment on issues outside its field of investigation, e.g. on neurobiological aetiology. The community therefore fails to discern the psychoanalyst’s specific task, to help the child express and work through his conscious and unconscious experiences. Clarity on the analyst’s part will improve relations with the scientific community and facilitate a relevant comparison of treatment methods. Another reason for neuropsychiatry’s negative attitude towards analysis is its unwillingness to accept that unconscious conflict influences behaviour. With theoretical and clinical arguments, the author argues that unconscious factors must be taken in to understand and to treat the child. Countertransference, often cumbersome with neuropsychiatric children, becomes easier to handle if the analyst is clear about his field of investigation. If he sees through simplistic formulations on aetiology, countertransference gets even more manageable. Psychoanalysis can result in considerable intellectual and emotional development, as illustrated by work with a latency boy with DAMP, autism and slight mental retardation. In his psychoanalytic theoretical framework of the case, the author unites ego-psychological formulations with a Bionian conceptualisation of the thought disturbance.