Mixed heritage, mixed feelings: psychoanalytic parent infant psychotherapy during the coronavirus pandemic

ABSTRACT

This paper is an account of Psychoanalytic Parent Infant Psychotherapy (PPIP) by a white therapist with a mixed heritage family during the coronavirus pandemic. It describes changes to the distant relationship between a mother and her infant son who appears at first to be developing an avoidant, dissociated defensive strategy to ward off painful projections from his traumatised parent. Necessary modifications in treatment due to working remotely contributed to several technical adjustments made. The paper attempts to consider the inclusion of race as a fully integrated aspect of working in a transcultural field, taking into account the ‘ghosts in society’. The specific trauma of racist abuse, with an emphasis on colourism that can be experienced by mixed heritage families is discussed. The key to the improved relationship between child and mother by the end of the Parent Infant Psychotherapy is postulated to have come from reflection on the therapist’s countertransference in regard to racism, that then enabled both therapist and patient/s to recognise and begin to work through experiences, thoughts and fantasies about belonging, heritage and racism.

KEYWORDS:

• Psychoanalytic parent infant psychotherapy
• parent infant psychotherapy
• racism
• mixed heritage

Over the course of the unusual Psychoanalytic Parent Infant Psychotherapy (PPIP) treatment that I will be outlining, baby Zayn was able to move gradually from being unwanted: an alien being, persecutory, bringing nothing but pain; to being seen and felt as a cherished and beautiful child. I hope to show how the necessary modifications in treatment due to working during a pandemic contributed to technical adjustments made, with the aim of undoing repetitions of painful childhood ghosts (Fraiberg et al., 1975).

In thinking more deeply about how to consider the inclusion of race as a fully integrated aspect of working in a transcultural field – where as a White¹ therapist I will often work with families of other backgrounds – it felt timely to reflect on the impact race and racism have had on parent infant relating in this mixed heritage family, taking into account the ‘ghosts in society’ (Ghosh Ippen, 2019). I will also discuss the realisation that I needed to review and consider the way I approached this topic within myself.

I recognised that I had to learn about my own unaddressed areas of unease working with race and racial difference. My initial difficulties in opening the topic, and defending against my own internalised racism, greatly delayed the possibility of being able to help process a racial wound for this mother. This wound threatened to obliterate her capacity to connect with her newborn baby.

Referral

Zayn² was referred for PPIP as follows: ‘Ms D’ told her midwives that she felt no positive connection with her unborn baby and that she would like to feel differently. The referral explained that she had separated from her partner following alleged domestic abuse. I was advised that she was ‘very clever’ and had requested support. The referral stated she had a successful career in a professional environment.

Ms D identified as dual heritage: Black British and from a former colony of the United Kingdom. The father was described by Ms D as White and her baby as ‘mixed heritage’. Both parents were raised predominantly Muslim, although Ms D’s family of origin included multiple cultures, religions, races and heritage from various former British colonies. What I later learnt was that there were intergenerational themes of migration, loss and trauma in the wider family, and in her own childhood Ms D had experienced neglect and emotional abuse.

First meeting

Ms D came to our first appointment when Zayn was three months old. I went to the main entrance of the centre to collect them. Initially, I could not see a mother and baby, so I glanced around searching, and caught the eye of a tall Black woman, looking tired and distracted. I could not see a pram or baby, so slightly confused I checked whether she might be here to see me. She confirmed she was. I asked vaguely: ‘… and Zayn?’ Ms D mumbled: ‘He’s been a little pain today’ and pointed towards a pram that was tucked around the corner near the coat racks.

I misheard this, thinking perhaps she had said – ‘I’m in pain today’. I felt my mind taken up with concern about the practicality of how demanding the walk to the therapy room might be for her. I repeated her words back – questioning: ‘You’re in pain today?’ Ms D corrected me sharply: ‘No. He has been “A little pain” today’. I sensed irritation rising in her, but also in me. I had tried not to hear that she was introducing her three-month-old baby to me as a pain.

I felt chastened and a bit wrong-footed, even stupid as I tried to recover from this exchange. Ordinarily, I would feel empathy for an exhausted first-time parent, clearly struggling with the demands of a tiny baby that might feel relentless. Instead, perhaps mistakenly, I feared this could be a hostile start to our relationship, which took me aback. I directed Ms D, walking silently now through two sets of heavy doors and into the therapy room I had prepared, with a cloth baby mat placed in the centre of the floor, with cushions, and a soft toy. I explained how we remove our shoes here and sit on the floor, so we can all be together with the baby, and I suggested she could place Zayn on the mat if she liked.

Zayn was awake but quiet. Ms D lifted him out and I was struck by how light his skin colour was. His full head of hair was dark brown with wispy loose waves, his eyes large and brown. As they sat down on the floor opposite me, I noticed a stiffness in my posture. I know that such self-awareness can be a helpful way for the PPIP therapist to identify with the baby’s experience and to be open to the more embodied communications that pass between a mother and her baby (Baradon, 2018, p. 4). My unease seemed to be in relation to the introduction we had just had, and the stiff and distant physical handling I was observing. Ms D tried to settle into a cross legged position – perhaps mirroring me – and she raised Zayn in the crook of her arm, angling him strangely outwards and away from her body. I had a fleeting thought that she was going to hand him to me. I felt on high alert, and began to recognise the strange sensation that I know is linked with the dissonance I can experience sometimes when observing unhappy mothers and their babies. I have learnt that the internal confusion I can feel is in response to being with a pair whose interactions are mismatched, lacking congruence. I could faintly perceive Ms D’s wish for help, but with that came a terrible and overwhelming sense of helplessness.

Zayn was quiet in his mother's arms (APOSTROPHE) and looking up and away from her face. His head was slipping backwards, his torso low in the crook of her arms, making his legs lift higher up, and his chin rise, as his neck stretched with the weight of his skull falling back. Tension grew in my head and neck as I saw his body being pulled by gravity in two opposite directions. I had to shift position and began to monitor my growing agitation. One of his tiny feet was trapped in between his mother’s crossed legs. I waited, holding back, observing.

Zayn, still quiet, was staring up at the corner of the ceiling and then tracked his eyes across to gaze at the light. In an assessment I would aim to see if the baby shows any interest in the therapist, but so far, he had not looked towards me even when I spoke to his mother.

Speaking in a singsong motherese, and gently, alert to his need to look away and not wishing to startle him, I said: ‘This might be a strange new place, Zayn- ehh … . with new smells and sounds?’ I waited to see if he would turn towards me; he did not. I carried on: ‘And I’m a new person … Mummy has brought you to meet me, so that she could think about you and her, and how you feel about each other, hmmm? Maybe we can think together here’. Zayn’s eyes flickered but he did not turn to look at either of us. He stared at the light.

I felt sad, and my empathy and concern for them both grew a little now; this was quite marked avoidance. I felt a deep emptiness open between us all. But Ms D said she would like to come weekly, and we agreed on this.

After this powerful meeting I had to work on my own countertransference, as I wondered if I had deliberately misheard Ms D’s opening remark. I recognised that defensively I had been drawn instead to hearing the mother’s pain, and not the anger, or even possible hatred, towards her baby. I began to reflect on the unconscious processes at work in me – not wanting to accept this hostile negative attribution from a Black mother onto her baby, perhaps? I wondered if my own ‘racialised unconscious’, as Knight (2013) calls it, was at work in my disavowal of what I had heard. It was possible that I was defending against my own racist stereotype of seeing her as an ‘angry Black woman’; that perhaps I was unconsciously wanting to be a ‘good and open-minded’ White therapist who did not see my patient in this way. This was a complex but fruitful beginning to my own internal dialogue, as I had much work to do to unpack my relationship with otherness, as, it became clear, did she. Perhaps the gratefulness I had unconsciously anticipated was part of my own projection of the racialised power dynamic between Black patient and White therapist, and maybe in my own pre-transference to her, I had expected a ‘clever, successful and keen patient’, not a hostile one with whom I had felt wrongfooted.

In our second meeting, in a spontaneous way, I attempted to open and address the differences between us and those visible between Ms D and Zayn in terms of their appearance.

Zayn was lying on Ms D’s lap, slumped, unsupported. Their hands were close to one another’s. I placed mine alongside theirs, saying this was his hand, and Mummy’s bigger hand. Talking to Zayn, I commented that we all had different colour skin, he from Mummy, and me from them both. As I spoke, I felt almost immediately self-conscious. Ms D shrugged, and I felt embarrassed, hampered by my clumsiness, inept and perhaps even ashamed of not feeling more at ease with my inclusion of race; I was left thinking I had raised something that felt like a taboo.

My thoughts afterwards were along the lines of needing to be more cautious, more precise, not wanting to get things wrong again. I then realised this might be a role response, or even a projective identification, in that, perhaps, Ms D had been feeling the same way in encountering me.

I reflected later on my focus on skin colour. I wondered if I might have unconsciously used the visual contrast of skin differences – by observing all of our hands – as a proxy to talking about race, and had not sufficiently addressed my own prejudices and unconscious colourism. I had not yet learnt that this topic was going to be intensely layered, and not just about the darkness or lightness of each one of us, but tinged with assumptions about class and education, gender and religion, and all the other differences between her and her son, her and me, and between her baby’s father and her. I also was not yet aware of how loaded with painful, indeed traumatic, memories some of this would be. I needed to do some work for myself, and I began to read, talk and explore the topic – the history of her colonial heritage – and sought specialist supervision.

As we got to know each other, I gradually became aware that Ms D described Zayn exclusively with negative attributions, but these felt muted and minimised, while her language seemed careful and stilted. Zayn was ‘a bit demanding’ or ‘a little overbearing’. This fragile modification seemed odd and inauthentic, and underlined the existence of the opposite deeper rage lurking just below the surface. In these early weeks, I wondered if, just as I had misunderstood her in the first meeting, perhaps she was wary that I might misread her as a dangerous woman, an unfit mother. At the time, I had not realised how through the context of a lifetime of structural racism, perhaps came a need to protect herself through this minimisation of pain or anger. It might have encapsulated her experience and need to prevent the other from perceiving her as angry or distressed. Was this a transference to me as a critical White authority who would immediately feel she was too much, too loud, too Black, too angry? I felt confused, and again needed to work hard to address my own discomfort, my own racial and colonial histories and legacies, which had never been so consciously in my mind before in my work. When I raised her cautiousness with language, saying I had noticed how very careful she was when describing things to me, especially about Zayn, or her family, her state of mind … she laughed in relief and agreed she did do that: ‘I am very careful about my choice of words, you’re right, but … I had not realised.’ She went on to say that she always had ‘feedback to say how “too much” I am … so perhaps I adapted without even realising it?’ She came back to this observation of mine again and again. It felt very meaningful to her in terms of her adaptations to ward off racist stereotypes.

Lockdown

Zayn, his mother, and I only met in person four times. When the pandemic hit, our centre closed, and abruptly a new way of working had to be rapidly established. In those bizarre early weeks of the pandemic, not knowing exactly how to transition to teletherapy, we spoke on the phone at the time of our usual appointment. As the pandemic worsened, it became clear that the virus affected those from Black and other ethnic minority populations in far greater numbers, though it was unclear why. Indeed, members of Ms D’s family became ill, and an elderly relative died. Racist tropes of genetic differences with no scientific basis were aired in the media. A difference in Covid prevalence and outcomes for those in a lower socio-economic context, including health and public transport workers, those living in crowded housing and poverty, became evident. A paper published not long after the lockdowns underscored the intersectional risks that Black women in particular bore the brunt of.

… structural gendered racism is revealed as a root cause of health problems among women of color and therefore has directly impacted the risk of COVID-19 harms in the pandemic … power differentials shaped by racialized and gendered systems, [mean that] women of color occupy disadvantaged positions within households, occupations, and health care institutions, and [that] this disadvantage lays on more and more burdens that wear and tear at their bodies and minds. (Laster Pirtle & Wright, 2021, p. 175)

Once again, I became acutely aware of our differences, me in my spacious home, Ms D and Zayn in a tiny loft studio flat with irritable neighbours who objected to Zayn’s cries that travelled through the thin walls.

Our contact at times was sporadic, interrupted and compromised. We had no explicit frame for the work, due in part to the incredible abruptness of the change, but also my inexperience in working remotely, scrambling with my own home adjustments, and as part of a clinical team that had scattered without appropriate technology or know-how. My only aim was to remain connected at the same time every week. I felt anxious and adrift, not trusting we could maintain the delicate new relationship we had. Once, our telephone session was held as Ms D stood with her pram in line for food, prioritising this due to dwindling essentials, and yet, somehow, we stayed connected.

Ghosts in the nursery

In lockdown, living alone with no support from her extended family, Ms D was beginning to allow us, at times, to recognise the rage inside her. She generally struggled to avoid it, becoming explosive and lashing out verbally in anger at Zayn. Our phone calls were intense, urgent; there was a feeling of barely holding back a tsunami of rage. I was concerned for them both.

PPIP work is usually done in a network (Baradon et al., 2016, p. 71) if there are multiple needs, as there were for the ‘D’ family. I was able to activate this network, and include two other practitioners whom Ms D had previously met in person: a specialist perinatal psychologist to support her own adult mental health, and a community worker offering family support to connect her to activities, such as the new and experimental online baby drop-in play groups. She also began taking anti-depressant medication under the care of her GP. We shared the week of contacts out between us in the network, so that while concern was high, she had at least two calls per week. We tried to hold review meetings online for all of us, Ms D included, at least once every few months.

Zayn was now five months old. From what I could hear, and from Ms D’s reports, he seemed to be becoming withdrawn and at times appeared frustrated and anxious; breastfeeding was now Ms D’s only way to soothe him. In our phone calls, I would hear Zayn in the background making sounds, and when I enquired I was told that he was just complaining. At the same time, I was aware of Ms D complaining about her uncaring, illegally lockdown-defying selfish siblings, her dismissive and critical father, her distant and narcissistic mother. I could not gauge if Zayn’s development was actively being disrupted, but I knew he did not seem to be a lively, curious baby who initiated or actively sought contact. Our few meetings in person had given me a sense that any approach I took would have had to be a very active one in trying to elicit Zayn’s appetite to relate; he had been avoidant of eye contact, and too often and easily had retreated into a state of disconnected distress. I thought that now in this vital period of ‘core self’ development (Stern, 1985) he needed to be actively drawn out into a reciprocal relationship, otherwise he might just give up. My role as an infant therapist was urgently required, but how to reach Zayn?

Hidden child

In one of these phone sessions, Ms D recounted in a flat tone: ‘I lost my mind yesterday … it was all too much’. Zayn had been screaming for hours. This was particularly stressful for them, as Ms D had had a series of strong complaints from her neighbours, all of whom were trying to work from home. She explained that she had had to go in the bathroom (the only room inside their flat that was separate) while Zayn was crying, as she had just needed to scream. I asked about this. She said she had to scream ‘For F***’s Sake!’ I could hear the desperation in her voice, mixed with shame. ‘I felt sorry then, because I wanted to scream at Zayn, and I only didn’t because I went into the bathroom’. She described then feeling calmer – she heard Zayn’s cries and noticed how they had changed to sobs. She immediately went out to him and was able to comfort him. She cried as she told me how she felt guilty for being like her own mother who used to shout at her like this. ‘And the worst thing in the world would be to be like her!’, a mother who had always been drinking and shouting, never once putting her first. I felt it was important to point out to her that she had just told me about the ways in which she had not been like her mother; that she had protected Zayn by not screaming at him, that she had noticed and knew Zayn well enough to hear his sobs as different to his cries, and now was bringing it here to talk through with me, and unpack a bit more. Ms D received this in silence. I could hear Zayn’s little breathy sounds through the telephone, and I asked if she was holding him close now; she said she was. My attempts to speak to Zayn felt futile, but I did say – ‘how upset you must have been, crying and wanting Mum, and then Mummy went away and you heard her shouting, angry … you may have felt you were all alone’.

I was concerned that our phone calls were repeating the experience described in this vignette – of a baby being abandoned. When making any kind of comment or interpretation, I had no sense of how it landed; had it helped, had she felt criticised, or worse? I worried that Zayn could not even hear me on the phone as, when I asked, I was told Ms D was wearing headphones to speak to me. My heart sank, as I felt so blocked from accessing Zayn.

I voiced my worries about Zayn being excluded or shut out and asked about her associations to this. In response, Ms D shared a memory of herself aged five or younger, frequently waking scared in the night. She explained how she would creep down a dark corridor to seek comfort from her mother, but was rejected and punished for waking her. I commented that I knew how much she wanted Zayn not to feel as she had done as a little girl, so alone, so scared; but that it was hard, and they needed some help. After this session, I insisted firmly that I needed to see Zayn online, so I could help and talk to him too. I shared my concern about the way she had actively asked for my help in not repeating the emotional neglect she had had, and we needed to include Zayn in the sessions by video-call, to support them as a pair and ensure this did not happen.

I thought about Ms D in this period as a child (albeit of 40 years) who required some developmental therapy (Hurry, 1998). Her conscious wish to break the cycle of intergenerational emotional abuse was a help to us now, despite the conflict she still had over this.

I chose not to focus so much on the conflict and hatred that her son’s dependency needs might have overwhelmed Ms D with. Nor did I focus on her envy of Zayn, who felt free to make his demands loudly known and had a therapist too. In traditional in-person PPIP work, I might have represented the child’s experience more strongly, by working more directly with the child so that the parent would perhaps hear about his own separate experience of rage or hate, towards the mother in this instance. Rather, my approach with Ms D working remotely focussed on developing her ego strength. This was done by acknowledging that anger was there, while ensuring she felt I had seen that she had harnessed a capacity to reach out for help, and in letting me know how difficult and conflictual it was for her to try and be a different sort of mother to her baby. My hope was that this was as close as I could get to supporting Zayn by proxy, through his mother, as I had to adapt my technique to this new ‘teletherapy’. Our peer discussion group explored this shift in focus and technique, and we felt it was warranted.

The following session was held as a video call for the first time. While I was relieved to see Zayn, and could see his mother was trying to help him engage with me on screen, Zayn was not interested in me. My notes state:

It is painful to watch him, he is quite strong and able to hold himself on all fours for a while in a crawl-ready position, but cannot seem to go anywhere and soon collapses. His head goes down hard on the mat, face first. There is a delay but then he wails and kicks; after this I was not sure if he had given up, he seemed to gaze off to the side. I can’t see his expression onscreen. Ms D looks at me with an air of total resignation. I feel helpless.

I said:

‘it is so hard in this moment to be you Zayn, in your little body, with that heavy head. Stuck with Mummy in your flat all day, with no one else around and me so far away on a screen, stuck in my house’. Talking to Ms D now, I ask: ‘I wonder how we can support Zayn with this feeling?’ Ms D says she wishes he would accept a special toy for comfort, that that would help – ‘but he is so fickle with his toys’. She picks him up now. I repeat the word ‘fickle’, saying that she had used it previously to describe her ex-partner, her family and even her friends – all of whom she has described as being unreliable, changeable, not worthy of her trust. She nods. I say that it might be something we can think about together, for her but also for Zayn. To think about how not to have so many difficulties in learning who is safe to trust. I say that for Zayn, it might start just with trusting Mummy, then a special toy might do, but then with time, the trust can expand outside of this to other people in the world – like them both starting to trust me maybe.

Zayn is holding tight to Ms D, looking into her eyes; this seems new to me – a softer contact. They smile and laugh together and come closer now, face to face, almost touching foreheads. I speak to Zayn, saying so that he can hear: ‘Mummy is trying to help you by talking about how to change, how to find her voice and teach you to be someone who does know how to trust the right people. Mum is helping you learn what trust feels like’. They embrace.

Black lives matter

Beyond Covid, in the summer of 2020 George Floyd was murdered in the USA. The Black Lives Matter (BLM) movement became a huge force for change. People defied lockdown rules, and held vigils, gatherings and marches. I became immersed in reading and thinking more about the experience of living through this, and decided to ask Ms D directly if she wanted to talk about this, or any other aspects of how being a Black British woman right now felt. This approach is one formalised by Davis et al. (2018) in their Multicultural Competency Orientation Framework. The authors describe these times as cultural opportunities, or ‘markers that occur in therapy, in which the client’s cultural beliefs, values, or other aspects of the client’s cultural identity could be explored’ (Davis et al., 2018, p. 92). Ghosh Ippen’s writing about adaptations of the Child-Parent Psychotherapy model references Daniel Stern, by adding that these types of moments are:

diversity related ports of entry … indicating that we may need to grow our capacity as individuals and as a field to recognize and open the door to dialogue about power and privilege, cultural values, experiences of racism, and historical trauma. (Ghosh Ippen, 2019, p. 148)

I hope to demonstrate how opening the door to this authentic enquiry, and introducing an external real-world event (BLM), impacted the treatment in a very rich way. For the first time, Ms D now explained that it was actually due to racist abuse that she had left her partner. He had said he did not want her ‘Black baby’ and had become hostile and aggressive. Davids (2011), writing about the way a Black child may come to view their skin colour as racialised, describes how –

the white person can project psychic dirt interpersonally across the colour divide. This option is not open to the black person who thus has to resort to intrapsychic projection into the skin, once these projections are in place, the white person may interact with the black person as ‘psychically’ dirty and the solutions either to prove they are not dirty … or by projecting one’s blackness into other blacks felt to be blacker … or accept that one is black and dirty. Thus, while the white person can evade a mental problem by projection across the colour line, the black person’s use of skin colour for that purpose is doomed to failure, that is the crux of the black problem. (Davids, 2011, p. 138)

Zayn’s predicted arrival seemed to have elicited this response of ‘dirt’ thrown onto Ms D by her White partner in an intolerable and abusive way.

In my asking her directly about how it felt to be ‘Living while Black’, as the group analyst Guilane Kinouani (2021) calls it, Ms D became immediately deeply engaged; she went on to speak more freely than I had ever heard about how she does not know how to be Black and British, and of mixed heritage. ‘How will Zayn be? He is even more “mixed” than I am – his father White, Muslim. Who will he be? How will he feel with a Black mum when he looks so White?’ The questions came pouring out. I had never seen her so animated.

When I reflected on how careful Ms D had previously been with me, and on her muted quality, I felt some shame for not having offered her this opportunity before. I apologised to her for the way I had clumsily addressed difference, race and diversity in one of our first meetings, by only referencing our different skin colours, and said that I now recognised it was so much more than this. She accepted this, but said she would rather I had said it, clumsy or not. Davis et al. (2018) state that holding an attitude of ‘cultural humility’ means that therapists ‘allow for greater attention to process issues that can either exacerbate or alleviate cultural ruptures. In a similar vein, the therapist can regularly illuminate and reflect upon the interpersonal process of therapy, which might ease cultural discomforts by recognizing that they occur and can be spoken about without negative repercussions’ (Davis et al., 2018, p. 97).

Birth trauma

Ms D then proceeded with great urgency to recall and explain how she wanted to tell me about her humiliating and shocking experience delivering Zayn. Her voice was full of emotion. She said that she had been in terrible pain whilst in labour, and had felt dismissed by the midwives. Then, suddenly, she saw them delivering a white baby (as if it was not happening to her). Zayn had been so WHITE when she’d seen him, newborn - ‘just there, between my legs on the bed! I was shocked, shocked! I had not expected him to be so … White. Then I thought … I can show [Zayn’s father] “look at this! A White baby, Ha!” Not Black at all!’

At the same time as this triumphant ‘Ha!’, she went on to tell me that next, she felt a deep disquiet, a confusion. Her next thought was that this was not her baby, he could not be. ‘How can he be mine?’ She said that now, for the first time - telling me now - she realised this was why she could not bond with Zayn. Seeing a baby that looked nothing like her, so White, and then the waves of shock and shame she felt at her own shock; this was not how mothers should feel! This confirmed for her what she had predicted and suspected; that perhaps she was incapable of being a good mother.

Later, when we reflected together on Zayn’s traumatic delivery and Ms D’s experience of feeling dismissed, we discussed a recently published report that we had both read. Shockingly, it exposed that Black women are up to four times more likely to die in pregnancy and childbirth in the UK than White women (Knight et al., 2021).

Returning to think with her about the time before Zayn was born, I was curious to know what her fantasies about her unborn baby had been. I asked her how she had pictured him in her mind, in pregnancy. She said she had only ever pictured a baby that looked as she did when she was little, with Black skin, dark hair and eyes. She still felt it was shocking how like his father Zayn looked, how very identifiably he seemed to belong to his paternal family, and not hers. She also spoke with sadness about how there was some relief as Zayn may have advantages that she did not have from being lighter, Whiter. She described her confusion as she felt ashamed of this thought, as she knew she should be proud of who she was, her heritage, her Black skin, and all she had achieved.

This ‘confession’ of Ms D’s and our bidirectional acknowledgement of how race had somehow been a taboo topic between us, seemed to be a turning point in releasing some of the persecutory projections onto Zayn. Also acknowledging his belonging – in appearance – more visibly to the father, and allowing this to become more conscious seemed a helpful step. She could now begin to see him in a more reality-based way, as a needy infant, who was full of loving feelings towards his mother, not just punishing, hateful ones. He was not his father, but a separate sentient being in his own right. Moving from a perception of Zayn as a hated child, who had perhaps represented both the unclaimed, infantile vulnerable and denied part of Ms D, and had been a visual reminder of her abusive ex-partner, she was able to now feel concern about him.

Zayn: Black and White?

Now we could move into the next phase of therapy, and Ms D was ready to join me in thinking about how Zayn might feel about himself. We could ask – ‘how can we support or protect him from experiencing the pain of colourism, racist abuse, and racial trauma? Can Zayn have a more integrated sense of his mixed cultural and racial heritage?’

To move on to this integration, Ms D needed us to attend to the pain of childhood memories of traumatic colourism resurfacing. Her parents, after they separated, had both had new White partners. Both parents had hid and denigrated her, and she was acutely aware of being the child with the darkest skin. She was often compared and told she was ‘ugly’ in relation to her new lighter skinned – and therefore presumably more beautiful – half siblings.

Her father had a White Christian partner, and at Christmas she – of all her siblings – was left alone at home, as she was told that her darkness would ‘cause offence’ at her new step-family’s gathering. Recollecting now the pain of this projection of dark badness into her was devastating. Her courage was exceptional, as she continued to talk despite the choking sadness and fury she felt as more memories arose. As a PPIP therapist, I always remained aware of the baby’s presence in the sessions, keeping him firmly in my mind. I attempted always to come back to the importance of Zayn’s life experiences in the here and now. It thus was becoming a conscious aim of ours – indeed, a co-constructed hope – that Zayn should not suffer such discrimination and should avoid an intergenerational pattern repeating in this way.

Zayn was becoming a toddler, and at times Ms D felt pride at his cleverness and precociousness; yet a fear of his aggression was difficult to dispel. This was also, of course, tinged with the memory of his father’s aggressive attacks and racial abuse of them both in pregnancy. Zayn loved to throw objects, and Ms D perceived this as rejection and naughtiness: ‘making a mess’. The spectre of projections onto him, leading to him being perceived as ‘difficult’, had always to be guarded against. Ms D became more able to accept these distinctions as, with my support, she became an astute observer. We were able to reframe the throwing, for example, as a scientific exploration, and she could accept my description of him as a ‘little scientist’ doing gravity experiments or testing her willingness to play. Her intellectual capacities had been incredibly helpful to her, as she had managed to maintain a capacity to learn, and valued this highly. Ms D felt emboldened at work too; her appraisals previously had always emphasised her being insufficiently diplomatic, too outspoken and ‘difficult’. She began to challenge this view now, feeling more able to distinguish her own behaviours and the perceptions of her through a racialised lens, and felt less, rather than more of a need to, as she came to call it: ‘tone herself down’. We could reflect together that this expression contained symbolic importance. The word ‘tone’ was used by her with a dual meaning; ‘to tone down’ refers to making something less offensive, but ‘skin-tone’ was the word Ms D used in relation to describing variations in skin colour. It felt she was becoming more aware of how to integrate her and Zayn’s rich and varied identities and appearance.

Fathers

Around this time, Zayn turned 18 months old, and in a video call, Ms D began telling me about the arrangements with Zayn’s father for child maintenance payments. The topic of any possible contact with him was complex, and Zayn had not yet met him in person. Ms D told me that she did not want Zayn to feel her criticism of his father, despite her anger at him. We thought now about how to talk about him, and I noted aloud how well Zayn listens, learns and remembers things. I said to them: ‘we know you’re listening too Zayn, right now!’

Ms D agreed: she told Zayn with pride, ‘you are so good with puzzles and sometimes’ – she laughed –‘you ask me to leave what I am doing by pulling at my arm and saying Ta!’ She said this proudly and gently, it did not feel like a criticism. I knew she had worked hard to help Zayn learn this word for thank you, ‘Ta’, which they used a lot. We laughed at his resourcefulness; he was able to get what he wants and needs, whilst knowing how mummy likes it when he says Ta. I referenced the pleasure they now took in one another, having fun together. I felt some delight at observing their warmth and smiles, their reciprocity.

Zayn toddled away from the screen to grab a giant bubble wand; it was almost like a sword in a sheath, the wand in a container (which was empty of bubble mix). My notes state:

Zayn wiggles the wand in the container and says in babble: ‘Tiggel tiggel tiggel!’ I make a very impressed face and he tries to ‘tickle’ me on screen with the wand – waggling it at the camera. I move in response, as if he is tickling me, and it feels playful. I see Ms D monitor Zayn closely. She returns to ask me about the father and how to talk to Zayn about him. I say that, if I understood her correctly, what makes this very hard is that she and he had been in love once, until this changed. She nods sadly. I say: ‘and maybe it would be nice for Zayn to know that he had been made in that loving relationship? You had hoped to be a family?’ Zayn is listening intently now; he comes to sit on his mother’s knee to watch me on the screen. Ms D is visibly reflecting on the loss and sadness.

I say to Zayn ‘we are talking about your mummy and daddy who made you’. He intently wiggles the wand loose, and waves it out of the sheath at his mum, who enlivens herself, surprised, noting ‘did you unscrew the lid all by yourself! I didn’t know you could do that’. I say ‘Zayn, it’s fun to play with things that fit inside other things in clever ways and that also make things, like bubbles!’ He repeats ‘Bubbozz’, grinning. I add, ‘maybe you’re wondering now … how was I made Mum? How are babies made?’ Zayn looks at me, then away. Ms D looks a bit shocked and laughs, looking at Zayn who says to the wand: ‘Tiggel tiggel tiggel’, waving it at us both, smiling with much glee. I can’t help laughing, and talk about his daddy loving him, but not living there with him and Mum. We are all sober now, Ms D returns to talking of her wish for Zayn to have a father, to not be let down in the way her own father has continually let her down, and how to help this happen. She says that this remains a huge worry for her. I add that the difference is that Zayn has a mother who can think of his needs, not one who throws him out when things get difficult. Ms D seems moved by this, adding quietly- ‘yes, literally thrown out as a child, with a black bin bag’.

Finding his voice

Imagine now a sturdy, tall, not quite two-year-old, confidently stepping off his scooter on arrival in the clinic waiting room. We were now able to resume in-person appointments due to a drop in Covid cases and an end to the lockdown, though we were all wearing surgical masks. In a very different first appointment to the original one, I was waiting to greet them, and led the way to the room. They looked an attractive pair, Ms D tall and slim, dressed in her office clothes. Zayn all in blue, with an aviator helmet on, carrying a number of little accessories that seemed important to him, and a backpack. The reception team were beaming at them, delighted to see children back in the centre, and particularly impressed with Zayn.

Once we settle to sitting on the floor, I greet them both again, and note Zayn is hovering close to his mother now, and seems a little bit anxious, checking my face, which is masked. I lower the mask and smile, saying, ‘it is me, Michela’. He gives an almost imperceptible nod and settles on the floor cushions, near us both, where I have laid out a play mat with some cups and saucers. Ms D updates me that they have come straight from her workplace and crèche. We had spent many months discussing how to support them with this – the first ever separation for a baby born just pre-pandemic, who had always lived in one room with his mother.

Zayn is carefully rummaging in the backpack he has brought; he pulls out an exercise book. Inside it are photos of all the special people in Zayn’s life, and some notes his carers make of how his day has been. I had not seen it before, though we had talked about it as one of several ideas to help aid Zayn with separation. Ms D says: ‘it’s nice, you want to show Michela?’ On the front of the book, I can see a photo of Zayn, with his name on it. He shows me, and his expansive gestures indicate great pride. I joke, asking mock puzzled: ‘Who’s that?!’ He giggles and points at it with confidence again and I say exaggeratedly, with a smile: ‘Who is it?!’ He beams and says ‘Zaaayn!’ I chuckle and agree ‘Yes, it’s you, it’s Zayn. It’s your book’.

I feel playful and delighted, enjoying his independence, his speech, and joining him in his pride and pleasure. I then notice that his mother’s posture has changed; she appears to have slumped, and as she is also masked, I can’t tell from just her eyes what her expression is, but I become aware of my own exuberance seeming too much in contrast to her. I have a fleeting impression of sadness. I check, asking gently: I wonder what she is thinking?

She chokes up – her speech a bit breathless – and she says: ‘He just, he’s never said his own name before … ’ a sob escapes now, as she gasps: ‘it’s the first time!’ I can see and feel how moved she is, as we share this milestone. She smiles through tears, absorbing my words. I am moved too. I say gently: ‘Your tiny baby has become a little person. It is a big step. Zayn knowing who he is, a proud moment. But also … maybe, a little sad?’ She nods and weeps a little. Zayn looks concerned, he glances at his mother’s face and decides to pat her knee briefly, they have a brief tight hug, then Zayn moves off busily to make the stacking cups into a tower and then knocking some down. I say this is a great game to show us some of the work we had done together, taking steps towards one another to find out who each of them was, building something up together, and then of course, this also meant they had to take some steps apart – all part of Zayn’s growing up.

Being three bodies back in a room together seemed to enable Zayn to take this step of claiming and naming himself. We can speculate, as Isaacs Russell (2015) does, that –

A prime concern with technologically mediated treatment is that the elimination of co-present bodies largely confines the psychoanalytic process to ‘states of mind’ rather than ‘states of being’. It is when one can dwell in a ‘state of being’ that one can take part in the psychoanalytic process of communicating with oneself and the other (Isaacs Russell, 2015, p. 180).

Conclusion

Baradon and Joyce (in Baradon et al., 2016) write that the therapist as ‘a new object’ is one of the aims of parent-infant psychotherapy; offering:

different relational experiences from the disappointing or harmful ones the patient expects to be repeated … Thwarting the transference expectations and introducing new, constructive experiences can be advanced through the mentalizing stance of the therapist, the predictable frame that anchors the therapy and the quality of her presence: curious, engaged, and genuine. (2016, p. 40)

Various theorists have attempted to pin down this extra-therapeutic aspect; whether termed the ‘real relationship’ (Couch, 1999; Greenson, 1967), or as ‘something more’ that is done above and beyond interpretation, such as the co-constructed spontaneity of ‘moments of meeting’ (Stern, 2004), or as child psychotherapists in the Anna Freudian tradition might have put it: the therapist as a ‘new developmental object’. Hurry (1998) writes: ‘the interactions which take place within the therapeutic developmental relationship are essentially similar to those that ordinarily take place between the parents and the infant or child.’ (Hurry, 1998, p. 38). I would argue that at one level the developmental deficits Ms D had from her emotional and racially traumatised childhood required this approach in therapy, and in PPIP work this focus enabled her to then begin to provide this for her son.

The emphasis on reality and external events was also particularly strong in this treatment, and I want to highlight how this is supported in contemporary child psychotherapy. For example, in the new Provisional Diagnostic Profile (Davids et al., 2017), more consideration is given than in the classical original Diagnostic Profile (Freud, 1970) to a wider range of biopsychosocial aspects of the child and family being assessed. The Profile sits in the Anna Freudian tradition of psychoanalytic child psychotherapy as the ultimate assessment tool, and one which has guided therapists in this tradition. Recently revisions have updated this to take: ‘as full an account of the family’s social and cultural context, including race, religion education, class and place of birth. This locates the ultimate intrapsychic understanding of the child firmly within a psychosocial and cultural setting’ (Davids et al., 2017, p. 140).

Equally, this group of authors emphasised the environmental section, broadening it to encompass consideration being taken of ‘the family in its community and cultural context’. The emphasis on the sociocultural context has been underlined in a number of recent books and papers, calling for psychoanalytic practitioners to ‘seriously and consistently engage with cultural competence, and all practitioners to engage with psychoanalytic conceptualizations of social identity.’ (Tummala-Narra, 2015, p. 287).

Alicia Lieberman and colleagues (Lieberman et al., 2015) created the treatment model Child-Parent Psychotherapy (CPP) for young children who have experienced trauma. They have drawn close attention to the changes in theory and practice that may be required to adequately reflect this shift of attention from intrapsychic or interpersonal conflicts, to damage or harm that emerges from historical or racial trauma. Ghosh Ippen has particularly extended the thinking about Adverse Childhood Experiences or ACEs (Felitti et al., 1998), stating: ‘it is clear that we need to look beyond the “ghosts in the nursery” to the “ghosts in society” … [so we] coined the term “atrocious cultural experiences’” (Ghosh Ippen, 2019, p. 145). The CPP approach in working with these families was driven, in their words, by the common phrase, ‘It’s not what’s wrong with you. It’s what happened to you.’ Subsequently, they began to enhance and widen this lens even further, noting it is ‘critical to extend this thinking to cultural groups: “It is not what is wrong with you, but what happened to your people.”’ (Ghosh Ippen, 2019, p. 137, author’s italics).

In transcultural psychoanalysis, it is particularly important to the therapeutic interaction and relationship to acknowledge an even more explicit attendance to the external realities of racial difference. Layton comments that:

clinicians influenced by poststructuralist antiracism walk the fine line between scepticism toward the category of ‘race’ and respect for the fact that the ‘fiction’ of racial difference is nonetheless a traumatic, lived reality, because of the forces of racism and the many possible responses to them. … whether or not it is spoken about, race is always in the room when the dyad is interracial, and the analyst who does not bring it up risks avoiding difficult but likely present material. (Layton, 2006, p. 245)

In the work described with Ms D, the role of the ‘real relationship’, as impacted by real life external ‘Atrocious Cultural Experiences’ (Ghosh Ippen, 2019), has been an important and technically complex additional strand to take into account, that proved intrinsic to the successful treatment of this infant and parent. The introduction of a ‘diversity port of entry’ to discuss race and racial abuse was co-created, and had to be mirrored by my own self-analysis too; my own history includes parents and grandparents with strong direct links to colonial stories, refugees, persecution, unprocessed legacies of class and power, multiple cultures, different religious backgrounds, and my own mixed heritage.

Reflecting together at the end of the therapy, I referred to the time I had introduced the BLM movement for consideration as part of our sessions. Ms D told me she had never before thought or spoken explicitly about her experiences of Blackness/mixedness, or thought of how the impact of her parents’ own internalised racism had also been internalised by her, and she realised she wanted to explore this more. She told me she was going to write a piece for her workplace, outlining the subtle but enduring racism and classism she had encountered there, and also shared that she had joined a grassroots peer group to shape local family services. We thought how her growing ease with this topic would help Zayn find his identity too.

A 2009 study of toddlers’ concepts of race proposed that the ‘failure to examine the context of the infant’s social situation and their conceptualization of “racial” identity may lead to missed opportunities for understanding the developing child … ’ (Njoroge et al., 2009, pp. 553–4). The study found that most parents showed hesitancy to acknowledge or discuss racial or ethnic differences with their infant or young children. This prevailing silence around issues of race and culture, they proposed, ‘may ring loudly for the curious infant, parents tend to underestimate the growing child’s awareness of race and culture but it [was evident that] negative messages are internalized and may impact developmental outcomes’.

Having faced my own hesitancy, a ringing silence might have developed. This failure of mine to adequately address racial trauma initially paralleled Ms D’s own reluctance in finding a way to speak openly with me about her life experiences, and the intergenerational burden of ‘living while Black’. Our finding a language and framework for what had happened to her (and inevitably thinking about what may happen to Zayn in the future) was a delicate, painful task that required trust and safety to develop between us. Transference expectations had to be confounded. By the end of the treatment, we felt able to tolerate and reflect on ruptures in our therapeutic relationship, and to repair these. This appeared to have modelled and strengthened Ms D’s capacity to do so with her son, and even her extended family. Indeed, at the end of the therapy there were new mutually joyful and exploratory, playful interactions between Zayn and Ms D. Curiosity and strength had grown in them both, so they could do more to explore their histories, building their own version of self and of a family, and fostering a developing sense of pride in both their mixed heritage identities. The therapeutic endeavour required us to bear and name the shame, violence and hatred that had been so integral to Ms D’s life and upbringing. Identifying and exploring the intergenerational trauma of racism, personal, familial and societal, making a space for it to be identified, named and processed in a way that did not damage or require traumatic repetition, allowed a space for reciprocity and love to flourish between Zayn and his mother.

Acknowledgments

Thanks especially to Ms D and Zayn.

Thanks to the former AFC PIP team, and particularly Tessa Baradon for supervision. To Gweneth Kirkwood, Coretta Ogbuago and Iris Gibbs, thanks for rich discussions and deeper reflections on race and PPIP over the years.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Notes on contributors

Michela Biseo

Michela Biseo works independently as a child and adolescent psychotherapist, and a psychoanalytic parent infant psychotherapist. For many years she was a consultant psychotherapist and then lead of a funded service for parent infant psychotherapy at the Anna Freud National Centre for Children and Families. She also was lead supervisor on the BPC accredited specialist training for PPIP. She is now a senior tutor at IPCAPA on the Independent Child Psychotherapy training. She teaches and supervises those with a specialist interest or practice in PPIP.

Notes

1. Capitalisation of the words ‘Black’ and ‘White’ will be used following the APA guidelines, 2022 designating racial and ethnic groups as proper nouns. https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/racial-ethnic-minorities#:~:text=Racial%20and%20ethnic%20groups%20are,Hispanic%2C%E2%80%9D%20and%20so%20on.

2. Zayn and Ms D are pseudonyms, and this material has been anonymised to maintain confidentiality. On commencing treatment, Ms D signed a generic clinic consent form, allowing my notes to be anonymously used in supervision, and to train others. In the course of the therapy, Ms D was specifically asked for permission from the therapist to write a paper – she agreed verbally. Permission was then sought in writing after the treatment ended. Ms D wrote:

‘I am so pleased to hear about your work, I of course have no problem with you using us as a case study. I’m especially pleased that our case will be used to enlighten others to issues surrounding race. Therefore, I am only too pleased for you to use our time together as part of your piece to be published.’

After the paper was written, the author wrote to Ms D giving her the opportunity to read it; this offer has not been taken up.