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.
