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Hoffman, R.S. (1982). Prenatal Psychoanalysis: A New Approach to Primary Prevention in Psychiatry. Int. J. Psycho-Anal., 63:88-89.
Psychoanalytic Electronic Publishing: Prenatal Psychoanalysis: A New Approach to Primary Prevention in Psychiatry

(1982). International Journal of Psycho-Analysis, 63:88-89

Prenatal Psychoanalysis: A New Approach to Primary Prevention in Psychiatry1

Robert S. HoffmanAuthor Information

Although it is widely appreciated that the emergence of psychoneurotic symptoms in adult life results from unconscious conflicts deriving from early childhood experiences, little effort has been directed toward primary prevention in this area. A possible approach to early intervention was evaluated by offering intensive psychoanalysis to third trimester foetuses during the two weeks prior to their delivery. Long-term followup was obtained on 46% of the sample (n = 110) at age thirty, via interview and psychometric data. The primary criterion for adequate adult adjustment was an annual gross income exceeding $36, 000.

Factor analysis of the data revealed six therapeutic factors to be correlated with good outcome:

1. Appropriate timing of interpretations, i.e. between contractions.

2. Analysis conducted with the foetus in the horizontal position. This can be achieved by first determining the alignment of the foetus in the uterus via sonography and then positioning the mother so that the foetus lies flat.

3. Thorough working-through of foetal feelings of anticipatory anxiety related to labour and imminent delivery.

4. Development of a full-blown transference neurosis wherein the foetus's behaviour toward the analyst reflects earlier experiences with fellow germ cells in the prezygotic stage.

5. High forceps extraction, which appeared to enhance the effect of deep interpretations by pressing them into the foetal skull at the time of delivery.

6. The necessity that the foetus himself pay for the analytic sessions. Although this was impractical to arrange prior to delivery, it was found equally effective to inform the foetus that he would be billed at the age of 18.

In addition to the above therapeutic manoeuvres, it was found that certain specific aspects of the foetal situation affected the subsequent course of personality development:

1. In several patients, inadequate maternofoetal circulation had a pronounced negative effect, a finding consistent with Melanie Klein's concept of 'good and bad placenta'.

2. Witnessing of the primal scene by the foetus was judged to be highly traumatic, no doubt due to close proximity to the action. This, of course, was predicted by Freud in his classic paper, "Kinderpeepinshtuppe" (1903), in which he noted that such experiences can eventuate in hysterical blindness, tunnel phobias, or plantar warts. Whether these effects are related to heightened Oedipal conflicts or to rhythmic compression of the foetal brain is still unclear.

3. Two sets of twins were followed in the study, and twinship was found to engender a certain degree of sibling rivalry. One twin garroted his brother with the umbilical cord. In the other pair, rivalry appeared to be less of a problem: since the mother had a bicomuate uterus, each twin had his own room.

These data suggest that psychoanalysis need not be delayed until neurotic symptoms emerge in adulthood, since efforts at early intervention in utero can be highly rewarding. Further research


1 Throwaway, J. Psychoanal., 46:4, Dec. 1978.

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would be necessary to confirm these preliminary findings as well as to explore possible extensions of the technique. We are currently evaluating the effect of psychoanalytic therapy upon spermatogonia and primordial ovarian follicles prior to conception.

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Article Citation

Hoffman, R.S. (1982). Prenatal Psychoanalysis: A New Approach to Primary Prevention in Psychiatry1. Int. J. Psycho-Anal., 63:88-89

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