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Alpert, A. (1967). Prenursery Project—Indications and Counterindications for Therapeutic Intervention in the Prenursery Via the Mother. Psychoanal. St. Child, 22:139-155.

(1967). Psychoanalytic Study of the Child, 22:139-155

Contributions to Normal and Pathological Development

Prenursery Project—Indications and Counterindications for Therapeutic Intervention in the Prenursery Via the Mother

Augusta Alpert, Ph.D.

SUMMARY

In this short paper I have raised more questions than can be answered in our present state of competence. This has led me to make some suggestions for further study:

1. How to assess the mother's potentialities as an instrument in the treatment of her two- to three-year-old. This involves an assessment of her own developmental progression, of the rigidity of her fixation, especially with respect to her sexual identification; her ability to tolerate therapeutic intervention. Some of these are also referred to by Annie Katan (1959). At the present time we are still

guided mostly by clinical intuition. Mahler's charting of the separation-individuation process for the child has also shed light on the mother's fixation points. These need to be studied specifically before an informed selection of a mother for therapeutic purposes—her own and her young child's—can be made.

2. How to recognize and localize the nature of interference with the child's developmental progression, and gauge such interference in its short- and long-range implications. We need an extension of Mahler's subphases together with Anna Freud's Profile of "developmental lines" for the third year of life, as well as a "timetable," if there is one, of the unfolding of constitutional, endogenous pathology before we can have the "orderly sequence of childhood disorders" aimed at by A. Freud and Nagera (1966). Additional clinical sensitivity is required to differentiate between pathological behavior which reflects imitation of the mother, and/or identification with the mother, and/or reaction to the mother and her handling. To quote Anna Freud (1966b): "We agree wholeheartedly with him [Hartmann] that the whole subject of diagnostic categorization needs reformulation so far as childhood pathology is concerned." I should like to add only that this reformulation should go hand in hand with the inextricably related topic of therapeutic choice.

3. The need to develop plastic therapeutic interventions for under-threes related to deficits in mothering during the separation-individuation phase, such intervention to be applied as close to the subphase affected as possible. It is questionable whether such early, preverbal deficits can be made up when the child is old enough to be analyzed. While it is also questionable, at this time, whether they can be made up by earlier intervention, my experience with corrective object relations prejudices me in favor trying.

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