Ghosts & Angels in the Nursery:

The Early Roots of Love and Fear

A Conversation with Dr. Alicia Lieberman and Dr. David Oppenheim

This program was made possible by The Koret Foundation; Dr. Anita Friedman

A very special thanks to Jewish Family and Children's Services of San Francisco

Introductory Comments – David Oppenheim, PhD

This interview was filmed in 2019 in the library of Jewish Family and Children's Services in San Francisco as part of a collaborative project between the Child Trauma Research Program at UCSF and the Center for the Study of Child Development at the University of Haifa. As background for our conversation we (Alicia Lieberman and David Oppenheim) had been viewing a film from the 1970s made by Selma Fraiberg, one of the founders of the field of Infant Mental Health. In the film she describes the Child Development Project at the Department of Psychiatry in the University of Michigan in which many foundational ideas in Infant Mental Health, including the concept of Ghosts in the Nursery (Fraiberg, Adelson, & Shapiro, 1975), were developed and elaborated.

In the film Fraiberg illustrates therapeutic work with mothers and infants using brief vignettes of 7 infants. She opens each vignette with the statement that names the baby and declares the baby "has a problem". The cases Fraiberg chose are striking in that they cover problems that stem from all aspects of the infant and his or her environment: problems that stem from infant vulnerabilities or disabilities (pre-term infant, blind infant), problems that stem from a mismatch between a healthy (yet active baby) and a mother experiencing depression, issues related to economic hardship and single parenting, teen pregnancy, and, of course, the "Ghosts in the Nursery": The intergenerational transmission of trauma and abandonment. Throughout the case illustration Fraiberg's compassion and empathy to the mothers are evident as is the optimism regarding the opportunities opened by early intervention. She also strongly stresses the healing potential of new, supportive, and empathic relationships and the belief in the powerful preventive effects of early mother-infant work: Preventing these early relationship disturbances from becoming entrenched child and adult psychopathology.

An additional focus for our reflections involved the volume Selma Fraiberg edited titled " Clinical Studies in Infant Mental Health " which was published in 1980. We enjoyed looking at the book and to see how relevant it is still today. When read from today's perspective it was also evident, however, that issues of child trauma are less directly treated in the book. This became an important theme in our conversation.

Alicia Lieberman was trained by Fraiberg and part of our conversation involved how foundational Fraiberg's contributions still are today, more than 40 years after they were written. We started our conversation with the notion of Ghosts in the Nursery, the evocative metaphor Fraiberg used to describe the intergenerational transmission of trauma and how early painful scenes from the parent's past are re-enacted with the infant. Most importantly this understanding leads the way to an in-depth, therapeutic intervention with the parent that uses the relationship between the parent and the therapist as a secure base for exploring how painful past experiences color and distort the parent's perceptions of the baby.

Our discussion moved on to how Alicia's work built upon Ghosts in the Nursery but also expanded the model. This involved working with older preschoolers, not only infants, going beyond the trauma in the mother's past to include current trauma to which the child (and often the parent as well) were exposed. Alicia emphasizes two important additions: First is "Speaking the Unspeakable" with an emphasis on putting into words overwhelming and frightening traumatic experiences. In this context an interesting link with Bowlby's ideas regarding open and coherent communication about traumatic events is formed. She also emphasizes "Angels in the Nursery", positive memories of moments of safety, love, connection that can serve as an antidote to the scary and flooding "ghost" memories.

Imagining what Fraiberg might have been thinking about the current status of Infant Mental Health Alicia talks about both the positive and the negative: How thrilled Fraiberg would have been to see how IMH developed into a mature discipline with thousands of therapists all over the globe inspired by Infant-Parent Psychotherapy. Alicia also points out how shocked Fraiberg would have been to see that despite everything we know today about the damage caused by early trauma and the importance of supporting families so that they can create the conditions for optimal early development, society still fails so many infants and their families with tremendous individual, societal, and global costs.