Incomplete psychological separation between mother and child, and the symptoms that can emerge from this relative state of undifferentiation, is increasingly appearing in the patients and families I treat as a common element in their histories and present lives. Co-sleeping, extended breast feeding, dependence on the mother for toileting, and marked separation anxiety are not uncommon features in this type of dyad, and often we also see some combination of impulsivity, aggression, low capacity for frustration and empathy, learning problems in school and socially, and so on, which can be organized under the general category of impoverished capacity to independently regulate affects, or feelings. Sometimes, these dyads must be treated therapeutically as a couple in parent-child psychotherapy if separation is not possible or is too traumatic for the child or the mother, a treatment which can evolve into individual therapy for the child, and perhaps also for the mother.

Almost inevitably, enmeshed mother-child dyads have a history of early trauma in either the childs and/or the mothers history. Often I have found that both mother and child experienced trauma (abuse of the mother or the child by a third party, birth trauma, adoption (traumatic loss or separation) medical illness, colic, hospitalization, post-partum depression, etc) in the childs early months and years, and occasionally this experience was a repetition of something the mother experienced in her early years with her own mother (enmeshed mother-child dyads are often passed down generationally and also culturally, i.e. these dyads may be more common in cultures where family enmeshment is the normal expectation. Enmeshment may not necessarily be the result of trauma but perhaps can also be a much sought after cultural value).

In response to this traumatic experience in the childs infancy, the mother and child cling to each other for safety they both feel much better when the other is nearby. Mutual holding physically and psychologically is normal and expected in the early months of an infants life, but due to the trauma, both mother and child experience great difficulty in separating and living more independently when the time arrives when this should normally begin to happen. Co-sleeping (and sometimes prolonged breast feeding) is usually the first sign of this occurrence, which may be followed by intense separation anxiety, clinginess, moodiness or general regressiveness, and struggles with independent toileting, eating, and so on. The most common story is that the child was irritable and intolerable of separation from the start, refused to be put down in the crib, and co-sleeping was easier and soothed the baby at once. Post-partum depression in the mother is sometimes a feature of these cases, and often the child appears to indeed have been born with a temperament that is either difficult to parent or may elicit the mothers need to remain overly close to the child.

These children usually do not get referred for psychotherapy until they begin to attend school, where impulsivity, poor frustration tolerance and capacity for empathy, aggression and separation anxiety can create serious problems for these children in learning and socializing with other children and adults. Incomplete psychological and physical separation couples with aggression and impulsivity so consistently in my experience that I have begun to more seriously contemplate the nature of this relationship
and how one thing leads to the other.

To begin, we can say that, although a feeling of safety in the infant can emerge from being very attached to its mother, when this attachment extends beyond the age when the infant or toddler might normally begin to show signs of differentiating (i.e. by sleeping alone, exploring the environment, separating upon playing with peers or going to daycare/school) the feeling of safety can turn into intense fear and dread in the absence of soothing, protective and regulating mother. We can say that because the child depends so much on the mother to help it with its feelings, that it fails to learn how to manage its own feelings in her absence, and this can only occur in her occasional absence. If the mother is never absent, but always there, the child struggles to become a self that can self-regulate feelings the child remains a self-mother and may find it challenging to fully experience the mother and the self as an autonomous person. The child shares psychological functions with the mother, such as the capacity to internally soothe itself in the face of environmental stress and maintain self control and self-cohesion (keeping it together), but outside of the presence of the mother the child functions at a much lower level, since none of the important psychological qualities it needs are his or hers alone. Mother and child may function very well as one, but not as two.

In summary, affect regulation becomes seriously compromised in the context of an enmeshed mother-child relationship, due to the sharing of vital psychological functions which are not the childs alone. This child never learned how to manage discomfort, frustration, waiting, loneliness, and so on, because the mother was always there to regulate these feelings at once. Impulsive and aggressive acting-out (in particular at school with teachers and peers) is one method children may use to express feelings of discomfort and frustration they could never truly feel or manage independently.

The second point we can make is that empathy derives at the start from the capacity to view the other person as separate from oneself. When a child experiences the mother as part of himself or herself as an extension or auxiliary self the child cannot gain an adequate appreciation of how his or her actions might impact the other, since the other does not technically exist the other is equivalent to him or her.

Empathy derives from first knowing that the other is separate and can empathize with you as a separate self this leads to thinking about and sensing what the other may feel, which leads to guilt, conscience, and so on. Not adequately understanding the mental states of others (nor the self) means you can act on the other without knowing or caring about how that feels. In my experience, this tends to stem from the child not having had someone think about how he or she felt, which could not happen since the mother and child were fused they were one. The mothers experience is the childs and vice versa. This does not mean that the mother is not loving, caring, protective, and so on. It means that the child cannot see her behaviour as hers and her thinking about him as true empathy as long as they are undifferentiated.

There is no empathy as long as there is one thing empathy is born when the concept of twoness is introduced to the infant, and twoness is introduced from the beginning of life when the infant experiences a feeling, need or frustration in the absence of the mother. The missing mother reminds the child that mother is separate and has her own needs, which forces him to empathize with her to recognize her own subjectivity – and to find a way to contain his or her own feelings and frustrations until the mother returns. That the baby’s sense of mother’s goneness is relatively consistent and not too long (i.e. the mother returns in an expected and timely way) is important in ensuring that the baby is not too traumatized and can learn to contain himself (this should be confused with Dr. Ferber’s method of permitting children to “cry it out” in isolation). Undifferentiated dyads may create children with little empathy who struggle to appreciate their own and others feeling states. These children may appear as cruel, ruthless, and generally naive and apparently careless about others feelings and ones impact on them. They may become aggressive and seem not to care and even laugh at the person they hit.

When you combine the failure to empathize, with the deficits in self-regulation mentioned previously, you may see the aggressive impulsivity that is currently so common in the field of childrens mental health, particularly when the child in introduced to school, since school makes demands on children in terms of being able to function independently, tolerate frustration, and so on, which these children struggle with in particular. Naturally there are impulsive and aggressive children who do not share an enmeshed relationship with the mother, but repeatedly when working with less differentiated dyads I have witnessed these similar histories and symptoms, which gave rise to the present contemplation.