Psychoanalytic Quarterly, LXIX, 2000

THE MOTHER WITHIN THE MOTHER

BY ROSEMARY H. BALSAM, M.D.

This paper describes the subjective experience of internaliza-

tion, focusing on the daughter’s inner world as she encounters
becoming and being a mother. Three case vignettes at three
phases of a woman’s mothering cycle are used to demonstrate
modes of registration and expression of her own internalized
mother as these in turn involve her offspring. Some issues in
analyzing the new mother are raised by the material, as well
as implied questions about how “mothering” behaviors emerge
at later junctures.

The Child is Father of the Man;

And I could wish my days to be
Bound each to each by natural piety…

But for those first affections,

Those shadowy recollections,
Which, be they what they may,
Are yet the fountain light of all our day,
Are yet a master light of all our seeing…

—William Wordsworth, “Ode: Intimations of Immortality

from Recollections of Early Childhood”

INTRODUCTION
Often, it is only when a woman becomes a mother herself that she
experiences the full impact of her own internalized mother. Becom-

465
466 ROSEMARY H. BALSAM

ing a mother is a developmental process, and carries with it positive

and negative effects on a woman’s subjective sense of herself (Benedek
1959; Bibring et al. 1961; Dahl 1999; Deutsch 1945; and many oth-
ers). The topic of the mother’s manifestations of the internalization
of either of her own parents regarding their sex and gender is a vast
area. All of these influences may integrate together seamlessly, and
may even be too subtle for an individual to detect, unless there are
acute troubles that bring them to undeniable attention. I have there-
fore selected for discussion here only a few features and aspects of the
internalization of mothers as shown in their daughters when they, in
turn, become mothers in their own right. I will focus especially on
the new mother in treatment—what it is like for the new mother, the
nursing mother, and who the analyst is to the new mother. In addi-
tion, I address the implications of holding the analytic treatment frame
as far as possible. The importance to the mother of internalization of
experiences, expressed over a lifetime, is illustrated in the second
and third cases.
My vantage point in this piece is the subjective experience of the
discovery in consciousness of a behavior or attitude that struck the
patient and therapist (either at the time or later) as a manifest cre-
ation in the image of the patient’s own mother. Such an emotional
constellation may seem as though it were newly called into service by
the mother/patient at a particular moment in her own mothering of
children, and consequently initially took her by surprise. Another
woman, before having children, may consciously repudiate her mother
or idealize her, seeing the negative or positive characteristics as be-
longing clearly to mother, but gradually becoming aware of her own
apparently identical behaviors emerging in motherhood; or the
woman may not have noticed any maternal influences at all, and the
therapist becomes the first to be privy to observing the change.

NEW MOTHERHOOD

It is reasonable to imagine that a clinician learns most about mater-

nal internalization as it affects contemporary mothering from patients
 THE MOTHER WITHIN THE MOTHER 467
with whom the therapist has worked prior to and during the experi-
ence of pregnancy and delivery, and then in the time of brand-new
motherhood. One would think logically that this could provide a par-
ticularly fresh experiential chance for the analyst to see, hear, and
compare shifts in thoughts, feelings, and behaviors within the before-
and-after experience of mothering that could be subject to the ben-
efits of the patient’s own reflections and observations. Such a process,
however, proves not to be so straightforward.
I have had the privilege of seeing some women in considerable
psychotherapeutic and analytic intensity during these times. Such
patients often bring the baby into the office for one or another rea-
son, so that one has the opportunity to see the interaction about which
one has heard so much. Such sessions, of course, occur more often
with face-to-face therapy patients than in analysis. Most new mothers
have a strong wish for the therapist to admire their babies (Friedman
1996; E. Loewald 1982). According to individual dynamics, some will
experience an even greater “need” or urgent wish for admiration, or
even a need for an overseeing of the baby’s progress in a continuous
way.
No matter what the mother’s internal climate, from the urgency
of many enactments involving the therapist to an expression of mild
wishes toward the analyst in relation to the baby, there seems to me to
be an actually lessened interest in self-reflection among nursing moth-
ers. I have come to regard this as common during this life experi-
ence. Friedman (1996) wondered whether patients who were actively
breast-feeding when in analytic treatment, but who later claimed they
had “forgotten” to discuss breast-feeding in their sessions, were “reti-
cent” because their analysts were reticent, too. Friedman worried about
an analyst’s missing opportunities to explore a mother’s ambivalent
feelings toward the infant, and was also concerned about the engage-
ment of the analyst in what could become an enactment of a variant
of a primal-scene triad, in which mother and baby are a secret couple,
while the analyst colludes and hence becomes left out.
These speculations have merit, but I believe that the “reticence”
may be related mainly to the patient’s level of availability to the open-
ing of hidden meanings while in this phase. Stern (1995) and Stern
468 ROSEMARY H. BALSAM

and Bruschweiler-Stern (1998) observed this phenomenon, too, but

blamed it squarely on the entire mental health field for misunder-
standing and ignoring the new mother and her special mental state.
This is not quite fair with regard to psychoanalysis, as evidenced by
chapter 14, “Pregnancy and Motherhood,” in the annotated bibliog-
raphy of the psychoanalytic literature of female psychology by Schuker
and Levinson (1991). These articles demonstrate a continuing, com-
plex struggle to grasp the subtleties of this time of life.
When I was a candidate in analytic training in the 1970s, there
seemed to be a tacit agreement in the analytic ambiance that preg-
nancy and new motherhood were “inappropriate” times for analysis
because the new baby took up too much of the patient’s internal en-
ergies, leaving nothing for the analysis of transference. I cannot track
down exactly how this common view became a dictum. Certainly,
Deutsch, in the 1940s, and Benedek and Bibring in the 1950s and
’60s, did not hold this opinion, and included these phenomena for
analytic scrutiny. In the 1970s, with the social impact of the feminist
movement, such maxims and other certainties regarding female de-
velopment were energetically opened for reevaluation by those such
as Blum (1976), Kestenberg (1980), Pines (1993), and many others.
Work that involved reporting the experience of pregnant therapists
was begun by Balsam and Balsam (1974), Lax (1969, 1997), and Nadel-
son et al. (1974). Increasingly, analytic thinkers have become open
to seeing and hearing about these experiences with their female pa-
tients.
New motherhood does not seem to me to be a “bad” or “inappro-
priate” time to continue an already-established, ongoing analytic treat-
ment. Like all other epochs, it requires particular attention to what is
happening in the patient’s life, as well as a willingness to work along-
side, but not set against, a patient’s ego defenses in the exploration of
further meanings. The transference at such a time to the analyst as a
wished-for, benign presence—representing a split-off, all-good mother
(which may, of course, conceal the dreaded all-malignant mother)—
seems to me to be as potentially analyzable as any other transference,
either at the time of the experience or later. Stern (1995) identi-
fied this as the “good grandmother” transference in the context of his
 THE MOTHER WITHIN THE MOTHER 469
“motherhood constellation,” and advised that it be “accepted as ap-
propriate.… It does not have to be fought against” (p. 186). I agree
with his observations about patients, but I disagree with his treatment
recommendations to therapists, whom he implies should therefore
feel free to “act out” by making home visits, giving advice, etc., seem-
ingly to give free rein to their own feelings and gratification of the
patients’ requests without respecting the complexity of the interac-
tion.
Many analytic therapists would take a different tack from Stern’s.
For example, E. Loewald (1982) spoke to great subtlety and delicacy
in making individual choices about the conditions under which an-
swering this kind of wish on behalf of an individual patient would
either further the treatment or derail it. In my experience, it is a
matter of the individual mother’s choice as to how she wants to han-
dle treatment should she become pregnant in the course of a long-
term therapy, more than it is the solipsistic choice of the therapist
regarding what is best. What is possible can be worked out together.
If the patient opts to stay in treatment for whatever reason, the pace
of the analysis will be different in this newly maternal state than in the
nonpregnant state. Treatment becomes more languorous regarding
integration or working through, but it is, on the other hand, vividly
experiential. The shared experience can provide much material for
eventual integration if the young mother continues in therapy or analy-
sis well past the weaning stage.
Patients in new motherhood will talk to the therapist a lot about
everyday, current experiences and issues: the evolution of outside re-
lationships, especially with other females who have or have had ba-
bies; their own mothers, alive or dead; in a lesser way, their fathers,
the husband, or significant other; child care joys and trials in the home;
the baby itself; and observations about the baby’s experience. They
do not seem to be given to elaboration on complicated aspects of
their feelings, however, or to the creation of reactive or evoked fanta-
sies emanating from inner autonomy in interaction with the outside
world. Observations about the baby, therefore, are usually viewed as
“real,” rather than as part fantasy due to normal projection. They are
related to and described as “needs.”
470 ROSEMARY H. BALSAM

Perhaps introspection is more possible for a patient who is

troubled by some aspect of the mothering experience and is actively
seeking help for it. E. Loewald (1982) reported four cases in psycho-
analytic psychotherapy, ranging in psychopathology from neurotics
who brought in the baby occasionally, to a borderline patient who
needed continuous, active help with mothering. In these new moth-
ers, Loewald, too, noted the limits of the patients’ interest in or use of
extensive introspection as a helpful direction in approaching their
experiences. She proposed that the baby acts as a transitional object
between the therapist and patient, and between the patient and the
outside world. The sheer (appropriate) vitality of the “me--not me” of
the mother’s experience of the baby may preclude much in the way
of examination of her own fantasies and/or primitive and deep am-
bivalences involved in her own thoughts and interactions with the
baby.
The mother’s mother is manifest in the treatment material of the
new mother in a graphic, concrete, show-and-tell manner. There are
plenty of stories told about the grandmother’s interaction with the
new dyad. The narratives are external. Much actively conscious learn-
ing, observation of the attitudes of the grandmother, and apparently
active and experimental refashioning of the relationship in the present
tense is going on in the environment. The patient’s mother often
comes to life, as described to the analyst, in a newly invigorated way.
Earlier, a consistent, particular picture of a patient’s mother may have
emerged, or she may have been schematized, her presence more viv-
idly detectable within the transference than in current stories. She
was, as far as the patient went, “cold” and “vain,” or “warm” and “ac-
cepting.”
The “cold” remembered mother of the patient’s infancy may be
transformed into what sounds now like a confused and befuddled
new grandmother, awkward with the baby. This observation is a dis-
covery for the patient, and may even call into question the simplicity
of her former notion of “cold.” Yet the patient is more interested in
how to cope with this new version of her mother, and if and when to
trust her mother with the infant, than in taking up questions that
invite self-reflection, such as, “What about your shifts in perception of
 THE MOTHER WITHIN THE MOTHER 471
your mother?” Another “cold” mother may be surprisingly touched
by the birth of a grandchild, telling her daughter that her little grand-
son is the boy she always wanted for herself, and for the first time—to
the patient’s knowledge—expresses envy of her.
A “warm,” sensible-sounding mother may become entranced by
the new baby, besotted, and unable to separate from daughter and
baby, making life difficult for the young mother who may not want to
set boundaries or hurt her feelings. The patient may move from a
formerly comfortable tenderness tempered by distance from the
mother, to a feeling of acute jealousy stirred by her child. These feel-
ings may take her by storm, as though from an outside source, be-
cause they were not permitted in consciousness before. Another
“warm” mother may continue her loving, supportive behavior, easily
encompassing both her daughter and grandchild; the impact of the
new experience stirs up new variants of old moments for further trans-
formations.
The baby in the therapist’s office has many meanings. My prefer-
ence as an analyst is to prioritize an attempt to preserve space for the
patient to explore these many meanings, if at all possible. With the
mother’s wish to show the baby, the therapist is privileged to be in-
cluded in the mutual sharing of the wonder of the gift of new life.
Countertransference and reactive proud feelings of being an “ana-
lytic grandmother” may well surface, but may not need to dominate
the scene.
I have found new mothers to be delighted to show their babies to
me, and that they want me to share in their admiration of them. I
remember this pleasant desire also from my own analysis, when I
showed my analyst a photograph of my kindergartner, and he re-
sponded with admiration and appropriate restraint, but with much
interest. In short, I think that the main wish of the patient/mother
is to receive glowing approval, admiration, and pride from the ana-
lyst in this miraculous production: I should see that this baby is more
special than any baby ever born before or any baby I have ever seen
(including my own, as one patient revealed long after). In compar-
ing the baby to a child’s transitional object, E. Loewald wrote “...the
‘wonderfulness’ of the baby is not to be measured” (1982, p. 400).
472 ROSEMARY H. BALSAM

Deutsch (1945) wrote of the immense triumph over the old moth-
er which the new mother experiences as a natural part of genera-
tional progression. “The queen is dead! Long live the queen!” ex-
presses an attitude that plays a role in the normal perception of this
baby as the best of all babies, and by implication the mother as the
best-ever mother. No matter that the patient’s mother may have been
“good enough”; there is a certitude possessed by the new mother that
she and her baby are “better than good enough,” as one patient as-
serted. This attitude is heightened by an intense and even more des-
perate hope in women who have a predominantly negative view of
their mother’s child-rearing capacities. The counterpart of Freud’s
(1914) characterization of “His Majesty the Baby” is that his mother
is queen of her realm.
If the therapist engages as the patient would like, whether or not
the baby is present, the talk would preferably center around topics
such as the different looks of the baby, feeding too much or too little,
or sleeping too much or too little. When the baby is present, a com-
ment offered from a more analytic stance—for example, about a
patient’s aroused feelings with regard to the baby’s prolonged colicky
attack of the previous night (“You sound worried”)—might result in
the patient talking animatedly to the baby, “Is mom worried about
you, then.… Is that right.… What is that lady over there saying? [Tickle,
tickle.] You look just fine now! Nobody would know what a little devil
you were last night, getting mom and dad out of bed all night long!”
The baby gurgles delightfully and delightedly—naturally.
Somehow, this does not seem the right moment for “the lady
over there” to draw attention to the baby as a mode of distraction and
an aid to the mother’s avoidance of her inner anxiety or her ability
to reflect! The mother looks up and says, “He does look okay now,
doesn’t he? Just like a different baby.” The therapist says, “You had a
rough night.” The patient looks relieved and merely agrees, “We sure
did.” And then she may go on to complain that her husband had
been clumsy or comforting, or to say how great or how awful her
mother’s remedy was. And so it goes.
As an interesting show-and-tell, such sessions may demonstrate to
the analyst intriguing elements of conflicted maternal behavior that
 THE MOTHER WITHIN THE MOTHER 473
the patient had previously referred to as relevant to her interactions
with her own mother. The time to work with such observations and
the transference is usually later, in my experience.

Case 1

Ms. E, the mother of a four-month-old baby boy, came late to her

analytic session. She had been in treatment for three years for chronic
marital problems. Carrying her sleeping baby in her arms, looking
harassed, she explained that her baby-sitter was sick that day and had
not come. She bumped down on the couch breathlessly with the inert
infant on her lap. The baby stirred, opened his eyes, and smiled win-
ningly at her. Then, noticing the strange place (and perhaps her body
tenseness, I assumed), he started to whimper.
“I’ll try feeding him. That way I might be able to talk, because
there was something I really need to talk to you about. Where will I
sit—should I sit on the couch, or should I sit on the chair?” She looked
very nervous and flustered. “Whatever,” I said. (When I am doing
basically analysis, I continue to sit in my analytic chair because I can
also face the therapy chair, although at a greater distance from the
patient.)
Heading for the therapy chair, Ms. E said, “I just need to sit over
here. I hope you don’t mind. I couldn’t imagine sitting on the couch
and feeding him. I want to keep this apart from the analysis. [She
laughed.] I don’t want to mess it up.… This is not about breast-feed-
ing. I’ve been very comfortable with it.” And indeed, she sat in the
chair, opened her canvas bag, proceeded to take out and spread a
huge towel backed with a plastic sheet over her lap, covering the chair
arms as well and stretching down to the floor. Then, in a very compe-
tent and cozy manner, she fed her little boy, holding him tenderly. He
spat up and she clucked and wiped him with another towel. And when
she finished, she wiped her breasts with yet another towel. This be-
havior was patterned and methodical, with sweetness and calm. She
did not comment further about “messing up” the couch or her elabo-
rate towel ritual, which I assumed had sprung into place four months
474 ROSEMARY H. BALSAM

previously, along with her nursing activity. We exchanged some words

about her enjoyment of breast-feeding, and I reminded her of her
earlier concerns about this; she agreed without elaboration that she
had worried in advance.
Ms. E then told me what she had planned to say that day, about
how her mother was insisting on buying new plastic coverlets for her
living room furniture. “I don’t know why. We don’t need it. She thinks
it’s this gift. I hate covers of any kind over furniture! I believe in kids
making a mess. They have to enjoy themselves, and Tom and I see
eye-to-eye on this one. That’s one thing I’ve always said. I certainly
won’t be like her that way—covering up every stick of furniture when
I was a kid in case I’d make a mess! I want to think more here about
how to stand up to her, to put my foot down. It’s my house and I’m
the mother now, and I’ll do what I want to, thank you.”
I think that the reader will readily see here the deep influence of
the patient’s fastidious internal mother in this vignette, now actively
being expressed in the enactment with the towels, and accompanied
in the session by a rather typical emphasis that the new mother/pa-
tient typically places on the here and now, and her wish for advice or
interaction about the practical dialogue with mother, in order to “put
her foot down.” One can also appreciate that the gentle reminder
about her previously expressed fear of breast-feeding did not result
in any willingness to associate. This would probably have invited the
mother’s regression in relation to the analyst, a condition to be warded
off in favor of her participation with the “transitional object,” the baby.
The direction of her thought took us instead forward into the cur-
rent active scene of the (presumably) anal struggle between the
patient’s own mother and herself as daughter.

LATER MOTHERHOOD

The following is a sequence of revelations in the dawning of con-

scious awareness of the patient’s internalized mother, showing up
within the analytic process at a time of more mature motherhood,
when a woman’s capacities for introspection are often more available
 THE MOTHER WITHIN THE MOTHER 475
than in the previous example. (I wish to point out that in the effort to
select, curtail, and present material relating only to my topic, the syn-
copated rhythms of the analysis as a whole have been muted. This is
an inherent problem in presenting a live sequence while also trying
to convey a reconstruction that utilizes understandings gleaned from
the periods before and after the sequence occurred.)

Case 2

Ms. T, a 34-year-old, married teacher with a 5-year-old daughter,

in her second year of analysis, reported the following dream: “I see a
large, wooden doll, painted and shiny in reds and greens, with a ba-
bushka and a shawl—I realize it’s a Russian doll. I pick it up and it
falls in half, and out comes a smaller, identical one, and then out of
the bottom of that one (that’s weird) comes the really small one. That’s
all. Oh, and I remember I was both pleased and somehow embar-
rassed; I add that because I know you’ll ask me if I had any feelings in
the dream.”
Associations led to Russian dolls that Ms. T and her daughter,
Alicia, had seen in a toy shop. She told Alicia that she had never had
dolls when she was little. The five-year-old had been fascinated by
“poor mommy’s” story, wanted the doll, and the mother had bought
it. Ms. T reported a momentary, conscious sense of revenge against
her “mean” mother. She had also noticed that she gloried in Alicia’s
approval: “I can’t believe I’m saying this—I’ve turned her into the
mother I always wanted—someone who would approve of my gift,
play with it, and say thanks! I’ll have to get over that!” The patient
laughed.
They had gone home companionably. At first, Ms. T was pleased
that the child was enjoying the toy, but after a while, she became an-
noyed and eventually “driven mad” by Alicia’s putting the dolls in
and out of each other, opening and closing them. Ms. T was trying to
mark a student’s exam in the living room after supper, before her
daughter’s bedtime, while her husband was out; she could not con-
centrate with the clacking of the doll parts and the little girl’s rhym-
476 ROSEMARY H. BALSAM

ing repetition, “Put-in-his-thumb, and pull-out-a-plum!” Alicia would

laugh and start again, entirely absorbed. Finally, Ms. T exasperatedly
banished the toy, and, irritated, she lifted the child and “whipped her
off to bed” on the dot of 7:00 p.m., Alicia’s usual bedtime. Perfuncto-
rily, Ms. T read her a story, but could not wait to get downstairs for
peace and to get on with her task for school. Alicia went to sleep
obediently. The mother was aware that she was afraid her anger would
get out of control.
“I felt compelled to get rid of her, but compelled to let her stay,”
Ms. T explained. “I threw the doll in the wastebasket. When I cooled
off, I took it out before Alicia got up this morning. There was no
harm done, but I was pretty angry—far angrier than I’ve ever been
with Alicia. I felt she’d abused the privilege of my getting her the doll.
I felt abused by her.”
Now, on the couch, Ms. T gave rein to her fury. Her angry asso-
ciations led to the “opening and closing thing” and to her daughter’s
singing some of the words of “Little Jack Horner.” (Alicia’s father
was called Jack. The child was probably having a joyful sexual fantasy
as she engaged in a quasi-masturbatory way with the dolls; this was
far from the patient’s conscious attention at the time, however.) The
words “sitting in a corner” led Ms. T to think of childhood punish-
ments for bad behavior. The thought of “abuse” came next—“Gosh,
that’s what mother called masturbation! Is this what’s going on? I
can’t believe it. I’m too sophisticated to have guilt about that! All
because of a daughter and a doll that has other dolls inside it?”
She was angry all over again, this time at me in the transference for
her struggle against the temptations to play with words and ideas
which might lead into taboo territory.
Over the following months, we reconstructed the scene between
Ms. T and Alicia, i.e., the sudden outburst of fury at Alicia as it rela-
ted to the underlying desire to “throw away the abuser” (Alicia as a
self-representation of a bad, sexual girl) by banishing the doll,
throwing the doll in the trash (instead of the child), or “whipping”
Alicia off to bed, followed by the reparative, undoing actions of read-
ing her a story and retrieving the doll from the trash. This kind of
scene had likely occurred frequently between little Ms. T and her
 THE MOTHER WITHIN THE MOTHER 477
own mother, and was now repeated in the next generation. Ms. T was
usually very measured in her affects and dealings with the child. Pre-
viously, she had considered this orderliness an aspect of identifica-
tion with her own strict mother; it now occurred to her that perhaps
even her mother, like Ms. T herself, might have struggled against for-
bidden pleasures. The story of the Russian doll imagery thus became
more complicated, alluding to interconnecting, identificatory layers
of patterned prohibition set up against impulse as well as against live-
liness.
Ms. T had grown up as the only child of older parents. They were
staid and religious. Her wish in treatment had been that she would
not be as constricting toward her children as her mother in particu-
lar had been toward her. Ms. T was a depressive character who was
conscientious and reliable, kindly but with a limited appetite for plea-
sure. On the advice of a therapist friend whom she bemusedly ad-
mired because of her easygoing ways, the patient had decided to spend
some of her inheritance after her parents’ death to seek analysis. Ms.
T had internalized the narrow limits of her rigid mother, who in par-
ticular had little time for or sympathy with play. Life was too grim for
a large variety of reasons. This was the first layer of her story.
The patient had started treatment when Alicia was three years
old. She had employed a warm, indulgent, Jamaican baby-sitter, whose
influence, as we discovered later, was supposed to help safeguard the
girl’s capacity for pleasure—because Ms. T had severe doubts about
her own ability to nurture this capacity, although she knew theoreti-
cally that it was “a good thing.” By the time the dream of the Russian
doll was reported in analysis, the patient had established a consistent,
maternal transferential attitude toward me as a disciplinarian, dubi-
ous of “wasted time,” and expecting “results.” In the reported session,
the reader will appreciate that the transference took an opposite turn,
toward me as sensual tempter to play. Ms. T seemed ashamed of her
own childish desires. She herself was “the teacher,” after all. We un-
covered much about her strong childhood desire to be (prematurely)
grown up, at one level to please her white-gloved, proper, unplayful
mother, and at another, more concealed level, to fulfill yearnings to
be more included as a third-equal party in this elderly couple’s or-
478 ROSEMARY H. BALSAM

derly, well-scheduled, adult activities. One could appreciate in this

material hints of a possible hidden oedipal situation.
One day, Ms. T dropped incidentally that she was always left be-
hind at home during her parents’ “monthly visits into the city to have
dinner and attend a concert, the opera, or the ballet.” This revelation
took me by surprise. I began to wonder about the hidden aspects of
this mother, apparently highly disapproving of childhood play as a
“waste of time,” yet a regular at the opera house, where high emotion
and passion reign, and many of the plots and actions are amongst the
silliest and most improbable, playful inventions imaginable! The Rus-
sian doll dream was introduced into the analysis just after this hint of
the mother’s inhibited playfulness had emerged. It symbolized the
patient’s sense of taking off outer layers of her mother to look at the
insides “from the bottom.”
At another time, still working with the doll imagery, Ms. T said, “I
want so badly not to be like mother. But I can’t help it.... Mother
used to get angry in just the same way as I get with Alicia. She’d be
hard, so hard...wooden, really. Maybe that’s another meaning of
‘wooden doll?’.... I don’t know which is harder: showing you my
feelings, or showing her my feelings, or showing Alicia my being out
of control. I feel all anxious. I hate being disturbed like this. It’s you
and this damned analysis that’s making me lose my temper. I’m rest-
less and moving about. Mother used to say, ‘Sit at peace, will you?’ ”
I commented on how nervous she felt being not wooden, not a
wooden doll like her mother. “I can’t believe it’s so hard for me to be
full of feelings,” Ms. T responded. “I am annoyed. It feels like you’re
my mother sometimes, and I’m in here like an embarrassed little girl.
But then I seem to find that my mother had far more feelings than I’d
credited her with. There are layers upon layers: there’s me here as if
in you, and then there’s me inside my mother, and then there’s Alicia
inside me.”
This patient was clearly becoming acquainted with the dimen-
sions of strictness and play, and with the complex internalizations they
represented within her character. In turn, these represented her
mother together with her, and informed her own mothering as well
as her attitudes in the analytic maternal transference.
 THE MOTHER WITHIN THE MOTHER 479
MOTHER CARING FOR MOTHER

Case 3

This example is taken from the opening phase of treatment with

a 61-year-old woman, Ms. N, the mother of grown children, who had
an unexpected experience shortly after beginning therapy: her 92-
year-old mother suddenly fell ill. As she cared for her mother, Ms. N
discovered the insight of being “made in the image” of her mother.
This vignette elaborates the moment of insight itself. Partly due to
the intrigue aroused by this experience, Ms. N later decided to enter
analysis, during which a subsequent working-through process deep-
ened her initially startling awareness.
Ms. N was a loud, jolly, practical, blunt, no-nonsense woman who
volunteered as a nurses’ aide. She came to treatment for mild but
chronic depression, which had begun after her children were grown
and she had been divorced. Her own mother, Ms. F, was a gentle,
dreamy, frail woman who still loved to read romances, was struggling
to remain physically capable, and was keen to preserve her indepen-
dence in her own apartment with her cat. Ms. N and Ms. F had a
mutually respectful relationship.
A few days before the session I will describe, Ms. N’s mother had
dialed 9-1-1, having fallen and broken her hip. Ms. F had undergone
an emergency hip replacement and seemed to be recovering, but was
now in cardiac failure. Ms. N had accompanied her to the hospital
and remained there for the days and nights preceding the session;
she looked exhausted. She told me that her “poor little mother” had
been at first brave, “chattering away” to the doctors, “all full of trust,”
and was an object of admiration and marvel to the emergency room
staff, who “thought she was so cute.” The patient then began to weep.
She apologized, saying that this was not like her.
“The most painful aspect of the whole thing was when she got
some kind of sedation after the operation,” Ms. N continued. The
patient’s face crumpled in agony as she wiped her eyes. “My mother
wept and clung to me like a baby, crying that she was going mad and
she was going to die, and wailing loudly that she wanted out of there.
480 ROSEMARY H. BALSAM

She even cursed the nurses! I didn’t know she knew such words.
She got violent and confused, and was thrashing around and had to
be tied to the bed. I’ve never, ever seen her like that before; she’s
so ladylike and dainty and soft-spoken. She would never carry on
like that. She would be so humiliated if she knew. She does know,
I guess.... I was humiliated by her. I hate myself for saying it.”
The patient wept for a long time. I was thinking how much of a
dainty little doll she had imagined her mother to be, even at ninety-
two years of age—but, perhaps, especially at ninety-two, if she were
shrunken and pale and frail-boned…? I was just getting to know Ms.
N; she had been through many hardships in her life, had survived
wars and floods. She appeared to me to be tough, like a strong gal-
leon that still sailed dependably in high seas, despite accidents and
repairs. She often used profanities in conversation. I was thinking
about how she had managed to create herself in this seafaring image
for me, and how it wove into my own personal life experiences. I was
imagining her mother under the influence of the toxicity of the drug,
cursing “like a sailor”—not unlike my patient? I wondered why Ms. N
was so humiliated by her mother’s disinhibition, why she had appar-
ently not been able to generate any empathy for it, despite the fact
that she herself boasted of being free from “feminine” niceties. I was
surprised to observe that she valued so highly the ladylike accent on
refinement in her mother. I had a sense of not wanting to interrupt
her tears, since I thought that this might have been the first moment
of sufficient quiet for her to manage to grasp and attend to her feel-
ings.
Soon Ms. N began to tell me a dream she had had the previous
night. A pale, angelic girl was alone in her crib. Her hair was blonde,
like a halo. Maybe Ms. N had seen a baby like that in the nursery of
the hospital where she worked? That was all. Her associations then
led to a sudden memory of something that surprised her because she
had not thought about it for years. “Why am I telling you this?” she
wondered. The following story came to light.
When the patient was about three, her parents and she were in a
terrible car accident at night. Her mother was driving. Ms. N had
been asleep in the back seat when the car suddenly bashed into the
 THE MOTHER WITHIN THE MOTHER 481
guardrail of a freeway. Miraculously, she escaped injury, but her par-
ents were hurt and swept off to the hospital. She said, “I was very
confused. I’d no idea where I was or what had happened, but the
policemen were lovely, gave me things to eat and showed me all over
the police station while they sent for my aunt to pick me up. Maybe
they took me to the hospital, too. I thought the nurses were lovely.
My folks were fine. They said how relieved they were that all they
lost was a bunch of metal.”
Ms. N smiled, yet looked at me quizzically. I was quite shocked by
this story, shocked also by the cheerful, upbeat way she told it, with all
the emphasis on how great the police and nurses had been. Knowing
that she was not in the same emotional place that I was, I nevertheless
said, “That must have been terrible.” “Yes,” she agreed. “It was awful
to be in an accident.” I realized that her heart was not in this state-
ment and that she was being polite to me. She went on, “I was a very
sweet child and very trusting. You wouldn’t think I was once so sweet!
They said I didn’t even cry. I just chattered away and knew every-
thing would be fine. I was right, too.”
I pointed out that her bravery as a child in this story—for ex-
ample, her appreciation of the policemen’s help—seemed very simi-
lar to her mother’s reaction in the emergency room when she first
entered the hospital, behaving in a brave way and “chattering,” which
was admired by the staff. The patient was intrigued with the similarity,
which came as a surprise, and felt that this answered her question
about why she had dreamt this dream now. “I don’t usually think of
myself as so like my mother at all. But this is interesting.”
Ms. N added that maybe this memory was also her way of telling
herself there were things to be discovered, and that it referred to the
perils of an interior journey, like a trip on the highway. I was left
contemplating the breathtaking similarity between the patient as a
child and her description of her mother’s current personality charac-
teristics. I felt enlightened to know more about her mother’s reaction
formations, exposed by the sedative’s loosening effect on her ego
defenses. I thought about the patient’s having entrusted me with a
brief glimpse of the psychohistory of her inner world, including her
carefully hidden maternal identification with delicacy, which might,
482 ROSEMARY H. BALSAM

I supposed, have been maintained at a heavy cost to herself had it

endured and been elaborated. Over the years, this identification had
clearly undergone radical modification. Her own internal image of
her frailty was a shock, albeit a pleasant one, after sixty-one years of
seeing herself as predominantly tough and strong.

DISCUSSION

Many book titles bespeak the acknowledged drama of a girl’s identi-

fication with her maternal object—Chernin’s The Woman Who Gave
Birth to Her Mother: Seven Stages of Change in Women’s Lives (1998),
Stern and Bruschweiler-Stern’s The Birth of a Mother: How the Mother-
hood Experience Changes You Forever (1998), and Chodorow’s The Repro-
duction of Mothering: Psychoanalysis and the Sociology of Gender (1978).
Although each writer represents a very different point of view, the
titles suggest that the fantasies and mental processes involved in be-
coming a mother lead many observers to note the repeating pattern
of an adult who “gives birth” to a child, who in turn “gives birth” to
an adult, ad infinitum. Chernin used a quote from Jung to intro-
duce her book: “Every mother contains her daughter in herself and
every daughter her mother, and every woman extends backward into
her mother and forward into her daughter.” This is a recognition in
metaphor of a psychological system of projection, introjection,
reprojection, and reintrojection of certain unconsciously incorporated
and imitated elements of the “m/other,” be they in body or mind.
These internalizations become available to consciousness particularly
when special milestones of the life cycle are reached by the next gen-
eration.
The cases I have presented here include episodes that can be
placed along a lifelong trajectory. Each time a life crisis or new per-
son or situation is encountered, as H. Loewald (1960) theorized, we
encounter the “ghosts” of our past, who seek an opportunity to be-
come embodied in life once more. It is inevitable that a woman will
internally encounter as “remembered present” (to borrow a term from
cognitive science) the intimate actions and attitudes of her primary
 THE MOTHER WITHIN THE MOTHER 483
caretakers as they have imprinted themselves within her. In every
analysis, the patient discovers either overt or hidden beliefs that the
parent’s way of doing things is still the gold standard, even though
more worldly experience will have informed the patient differently.
When this happens, the presence of the “ghost” is vivid and capable
of being superimposed upon the contemporary version of the indi-
vidual. In such major events as pregnancy, childbirth, and certain as-
pects of child care—each of which a woman’s mother once did to and
for her—these life-identical passages most heavily bear the imprint of
the mother. The mother’s illness and death is another such time for
the intensification of internalizations.
I think that the biologically based elements of a woman’s life,
such as the facts of mature body shapes, menstruation, pregnancy,
childbirth, and menopause, carry with them the most conscious and
yet the most unconsciously powerful markers of psychological identi-
fications with the mother. I am aware that a modern feminist reader
may view my remarks as “essentialist,” which is a way of saying that
thinking which includes biology lays down laws based on the inevi-
table biology of a woman. However, I believe that there is a cogent
argument against applying the essentialist label in this case. I agree
that a woman’s capability to give birth and other aspects of her physi-
ological makeup do not necessarily predispose her to primary mas-
ochism, as Deutsch claimed in 1945; such a supposed predisposition
does not accord with clinical experience and serves to tie the deni-
gration of women to a “necessary” biology. This kind of thinking is
“essentialist” (Chodorow 1996).
Feminist writers such as Chodorow, though, have reached an im-
passe concerning the links between female anatomy and physiology
and the gendered inner world of women, an impasse with which I
would like to struggle. Observation of the clinical, and theoretical
demonstration of moments of compelling similarity between the bio-
logically based experiences of mother and daughter, do not require a
deterioration into essentialist thought. Such observation becomes only
a psychological starting point, as used here, for a discussion of the
psychological power of internalization. Such clinical and theoreti-
cal demonstrations need not constitute an explanatory end point.
484 ROSEMARY H. BALSAM

Fluidity follows, and not fixity. Subsequent inner reactions to these

phenomena, when accessed into consciousness, may become altered
and transformed into almost unrecognizable shapes, such as in the
case of Ms. N. Not every aspect of a mother’s characteristics or
regulatory interaction that has been internalized either needs to be
or will be accessed at a given moment. Also, Schafer (1968) reminded
us that “internalization is a matter of degree” (p. 14), and that the
degree of stability of its organization varies. In presenting these
three cases, I have attempted to demonstrate different reactions to
the reexternalization of an ancient internalization, and a sense of the
possibilities for fresh access at different points in the life cycle
at which mother and daughter are reinventing their internal close-
ness.
In regard to the new mother, Stern and Bruschweiler-Stern (1998)
also noted an absence of detailed accounts of the inner world of the
new mother, especially accounts given by women themselves. These
authors’ belief is that the absence of data has to do with the following:
(1) faults in post-Freudian theory developed prior to their own con-
tributions, which, in their book for the lay woman (albeit oversimpli-
fied for the consumer), promise to fill the void caused by “strangely
mute” “health professionals and society at large,” who have not “at-
tended to this intimate psychological experience” (p. 18); and (2) a
feminist caste to emphases in female psychology on “the need for
equality...[in] the workplace, sports, politics—rather than in the more
problematic area of childbearing” (p. 17).
What I consider apt is the observation by Stern and Bruschweiler-
Stern of “how rarely...the experience is described by mothers going
through the process” (1998, p. 17). Surprisingly, though, Stern
(1995) categorized this “motherhood constellation” as an entirely
“new” and “unique” state of being for a woman because, he said, it
brings into operation “the mother’s discourse with her own mother,
especially with her own mother-as-mother-to-her-as-a-child; her
discourse with herself, especially with herself-as-mother; and her
discourse with her baby” (p. 172). But these inner “discourses,” as
Stern himself simultaneously asserted, represent the psychodynam-
ic development of a continuous inner evolution of mother and daugh-
 THE MOTHER WITHIN THE MOTHER 485
ter. It is a contradiction, therefore, to claim that they are entirely
“new.”
Stern added that “the motherhood constellation” pushes to the
background “the Oedipal triads of mother--mother’s mother’s--father
and its new edition of mother--father--baby” (p. 172). This statement
does not warrant a “new” designation either, since psychoanalytic writ-
ings from Deutsch (1945) onward have commonly privileged the pri-
macy of the mother--daughter relationship when it comes to the topic
of motherhood. Stern and Bruschweiler-Stern believed that a woman
“develops a mindset fundamentally different from the one she held
before, and enters into a world of experience not known to non-moth-
ers” (1998, p. 5). This, too, seems exaggerated. Sisters, for example,
have often closely identified with each other’s birth and parenting
experiences. Teenaged big sisters have often taken charge of tiny ba-
bies for overwhelmed mothers. These “mothering” experiences are
related to a woman’s having her own baby. Winnicott’s (1956) de-
scription of and term for this stage, “primary maternal preoccupa-
tion,” has not been improved upon.

Review of Case 1

In conventional analytic terms, Stern’s observations correlate with

a possible defensive split in the functional ego, whether temporary or
more fixed over time (Freud 1938). Ms. E, for example, evidenced
this split as a defense when she fed her baby in an office armchair,
virtually covered by a tent of plastic, while simultaneously decrying
her mother for covering upholstery with plastic to keep mess at bay—
vowing that she would never do such a thing! She was certainly in
discourse with her internalized mother, while also talking to me about
herself, and concerning herself, too, with the immediate welfare of
the infant. The analyst at this moment seemed held in a compart-
ment of wished-for, all-good, and admiring mother, an aspect of the
archaic mother. The forefront of the patient’s mind (appropriately)
was largely occupied by her interactions with the baby, while an un-
conscious, interactive presence of childhood experience with her own
mother was enacted in the office.
486 ROSEMARY H. BALSAM

Such a fresh opportunity to address aspects of the maternal re-

lationship has been discussed by Benedek (1959) and others. It
was Balint (1949) and then Benedek who first used the term “sym-
biosis,” though in a more organic way than in Mahler’s work of the
1950s and ’60s (1952, 1968), where it was spelled out as metaphor
for the interrelation (Moore and Fine 1990). Benedek felt that the
new mother related symbiotically to her infant, and that, internally,
there was a reactivation of the original symbiotic relation with the
internalized mother. Ms. E spoke vigorously about her conscious dis-
identification with her mother and her desire to be entirely dif-
ferent, but analysis demonstrates the frailty of such desperate barri-
ers.
E. Loewald (1982) noted rightly that “therapy is not the same
two-person event with a small baby in the room” (p. 394, italics in
original). The baby becomes both the activator of the mother’s un-
conscious process, and an agent to help ward off the integration,
possibly because of the associated unconscious anxiety. E. Loewald
pointed to the similarity of the infant’s devotion to his or her transi-
tional object and the new mother’s devotion to her baby. “This is a
way station in the baby’s development of object relations.… The
mother too normally makes such a transit during her baby’s early
months from an ‘inner’ perception to an ‘outer’ perception of his
reality” (p. 398). This description of this stage of a mother’s exist-
ence, as well as my own observations, seems to affirm Benedek’s sense
of the “spiraling of interpersonal processes” within the new mother.
The schematically perceived, all-admiring, or unexamined, “all-pro-
tective,” presence of the analyst or therapist may provide a benign
constancy to soothe a more hidden tumultuous inner world—one so
active in its progressive regression that it must stay in the here and
now, as yet unable to find verbal expression.

Review of Case 2

Ms. T was more mature in her motherhood. Her phase involved

working on her increasingly undeniable identification with her
mother. She showed an ability to engage in the analytic process and
 THE MOTHER WITHIN THE MOTHER 487
to bring conflicts home to the interaction with the analyst. She
struggled between forbidden pleasures and their severe prohibi-
tions. She reexternalized her internalized mother into the room.
This process was given much vigor by the simultaneously stimulated
conflicts with her daughter Alicia. Would Ms. T have had such inhi-
bitions to work through had she not had a child? Perhaps. I believe
that the conflicts would have shown themselves, possibly in other
forms, in some situations of intimacy with those whom she could
symbolize as children—people she viewed as needy, dependent on
her, and looking to her for help.
The urgency to work through conflicts varies among patients, of
course, depending on the environmental tolerance and/or how much
these conflicts offend the patient’s best aspirations for him- or her-
self. Similar problems may have come to light with Ms. T’s school
pupils, for example. But the immediacy of her reactivations and her
desire to work out better avenues here were propelled by her ambi-
tions for her daughter as her reactivated self, and also by her own
ambitious mother within her.
The imagery of Russian dolls seems to me a poetic expression of
the intuitive knowledge of internalization. Ms. T’s dream of the doll
is particularly apt to my topic of the importance of interwoven physi-
cality in the interactive drama of gradual internalizations between a
girl and her mother. Ms. T ’s analysis of her daughter’s doll revealed
the following: central curiosities regarding wishes to explore the
mother’s exterior surface and mysterious interior cavity with the hands;
an omnipotent desire for the physical power to take her mother apart
and put her together again; and affective mastery of the symbiotic
fantasy of separating and reuniting. These issues were condensed in
the concrete actions of Alicia, who parted and joined the dolls while
rhyming “thumb-and-pull-out-a-plum.” This behavior suggests an in-
forming fantasy of the search in the body’s interior for something
delicious, hidden from view, good enough to consume, and some-
thing to which there are barriers.
Childhood genital masturbation was the focus of Ms. T’s guilt in
this session, as it had become externalized in a challenging way with
her oedipal-age daughter. The memory of embarrassment at her own
488 ROSEMARY H. BALSAM

masturbation and her parents’ reactions was presented for work in

the transference by including the analyst in the strict parental imago
and using the session’s associative verbal play to express the impact of
comparison with masturbatory pleasure. Ms. T’s desire to confront
the phenomenon and overcome her inhibition was fired by the mo-
tive of freeing her own sense of pleasure, thereby freeing her child’s
pleasures. Pleasure in the body was a part of Ms. T’s aspiration for her
child, and less directly so for herself.
Even in this brief vignette, one can appreciate how such a mater-
nal or superego ideal (Blum 1976) can appear to be a solipsistic ideal
attached to an abstract notion of the ideal mother. In analysis, similar
unconscious aspirations of the mother of the previous generation will
frequently be noted. Here, Ms. T’s mother is certainly remembered
as having been unplayful; yet a paradox was introduced in the revela-
tion about the mother’s passion for the opera, suggesting a coexist-
ent, hidden measure of positive feeling about play. We may here be
dealing with three generations of female bodily pleasure inhibition,
now represented by the behaviors surrounding the dolls within the
doll.
The visual shape of these Russian dolls also expresses the girl
child’s thought experiment about her future body—the bulges of
the breasts and hips and the narrower waist (Balsam 1996). Alicia
graphically demonstrated her fascination with and attraction to both
being like mommy and being better than mommy. (The doll was pur-
chased in the context of the story about mommy always wanting, but
never having, a fine doll like that one.) Female-to-female physical
comparisons and the struggle for superiority would not be surprising
components of further material as it unfolded in the analysis, back-
ward and forward in time between Ms. T’s daughter and her own
mother. The shape and physicality of the female analyst, especially,
often become intermediary foci of attention in sorting out such strands
(Balsam 1996). Thus, each physical component of connection be-
tween daughter and mother becomes subject to the process of inter-
nalization, carrying with it the interpretation of the subject’s attitudes,
which will emerge and be expressed in the future as the situation
arises.
 THE MOTHER WITHIN THE MOTHER 489
Review of Case 3

Finally, in the case of Ms. N, the child becomes not “Father of the
Man” (Wordsworth 1990), but “mother of the woman.” The reversal
of roles in later life seems to call up from the depths for reworking
the earliest encounters and earliest internalized experiences with pri-
mary caretakers. Turrini and Mendell (1995), in their overview of
the literature, pointed to developmental threads—from as early as
the age of eighteen months—in little girls’ behaviors that suggested
the beginnings of caretaking attitudes toward their own mother. For
example, in play designed to “comfort herself when her mother is
away,” the little girl “may be heard to say ‘mama’ and ‘baba’ while
cradling and rocking her doll” (p. 103). Further, “from being soothed
to becoming the soother exemplifies the internalization and estab-
lishment of maternal behavior” (p. 103). Turrini and Mendell also
noted the mother’s role in directing the child to turn hate into love,
thus laying the interactive foundation for ego defensive operations
such as reaction formation. One can see echoes of these processes
still being activated in Ms. N at the age of sixty-one.
Ms. N’s elderly mother, Ms. F, seemed to have a very different
personality from Ms. N, who thought of herself as the opposite of her
timid, romantic mother. She was also very fond of her mother, and
demonstrated well-developed abilities to take care of others; the pa-
tient did not shy away from her mother’s health crisis. These respon-
sible, caregiving behaviors were also consistent with help given to her
own children over the years. Ms. N gave reason to believe that her
mother had been a competent caretaker, so it can be assumed that
these gifts had originated in her early experiences with the now-frail
mother. One can see that the maternal and feminine identifications
involved in the patient’s stable and reliable caretaking abilities stood
quite separate from what she rejected as “feminine wiles.”1

1
This kind of data emphasizes to me the caution with which we should use the
concept of “femininity” in theory building, since we run the risk of conflating too
many qualities of being female under this one umbrella, which may disguise inherent
value judgments that assume how women should be.
490 ROSEMARY H. BALSAM

Seductive and coy female behaviors were indeed a part of Ms. N’s
mother’s femininity. It is an interesting puzzle to wonder how the Ms.
N of the rollicking expletives had emerged from the nest of Ms. F.
What had become of the potential for this mother to offer her daugh-
ter for internalization the “feminine” delicacies which so often bring
social approbation? The crisis in the emergency room seemed to sug-
gest routes toward solving this puzzle. The story of the shocking car
accident, and Ms. N’s probable confusion and terror in being sepa-
rated from her injured parents so suddenly, with all kinds of chaos
going on in the night, point to the role of trauma in the ultimate fate
of the variety of possible internalizations.
The three-year-old Ms. N, by all accounts, was at that time able to
use charm and little-girl seductiveness toward the alien grown-ups,
the policemen and nurses. This suggested a strong imitation of these
aspects of mother. Her apparent friendliness in these immature iden-
tifications was highly adaptive at the time. Yet in her present-day dream,
the child in the crib appeared lifeless, even though “angelic.” The
reference to a halo probably encoded a reference to death in the air,
both on the night of the accident and now at her mother’s bedside.
Mother had “chattered away” in the emergency room, just like little
Ms. N at the police station after the accident—cheerful on the out-
side but alone and afraid on the inside, as suggested by the child
“alone” in the dream. Mother’s fury had been released subsequently
upon the same doctors and nurses who had called her “cute” in the
emergency room!
The present and past were thus blended for Ms. N. The effects of
the early trauma may be postulated to have left little Ms. N much
more wary of presenting her cheery, affable, “feminine” self to the
world. One would need to know much more, but it is tempting to
wonder whether the now-patterned aggressive, cursing, “sailor” mode
had been constructed to retaliate against her mother for her failure
to protect her on the night of the accident. Underground anger could
be detected in her adult tone of brusqueness. Of course, more than
one experience would be required to account for the widespread,
stable structure in these reaction formations, which had given a par-
ticular flavor to her entire character.
 THE MOTHER WITHIN THE MOTHER 491
The surprising aspect that Ms. N revealed to herself and to me at
this time was how alike she and her mother actually were, as revealed
in these moments of acute stress, and that they were especially alike
in their tendencies to create reaction formations. Ms. N’s more alien-
ating claim of being the direct opposite of her mother was only par-
tially accurate. The capacity for tender caretaking could now begin to
be fully owned by Ms. N, without a fear creeping in that if she were to
reveal her tenderness, the world would find her exposed, turn sud-
denly chaotically cruel, and rob her of the dear bond with her be-
loved mother.

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