HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals


  • Katia CharalabakiPsychiatrist, Family Psychotherapist, coordinating director of Family Therapy Unit of Attica Psychiatric Hospital
  • capacity for symbolization
  • Demeter-Persephone mother-daughter
  • projections
  • differentiation process
  • role of the therapist
  • intergenerational transfer
  • ambivalence
  • merged relationships

_This article is based on a presentation given October 2010 in Paris, at the 7th Congress of EFTA _


Mother-daughter family therapy during conjoint sessions is of a special interest, since it provides a chance for various issues regarding differentiation between the two of them to be explored, especially if the father is absent. The common psychotherapeutic sessions enable the creation of the necessary psychic space between them, in order each of them to be able to recognize the separate existence of the other. In the therapeutic system the therapist (even the female one) is in the role of a "symbolic father", who facilitates the process of differentiation by easing the finding of new meanings in their relationship. The myth of Demeter and Persephone highlights some important features of the mother-daughter relationship.

**Key- words: ** Demeter-Persephone mother-daughter, differentiation process, intergenerational transfer, ambivalence, merged relationships, capacity for symbolization, projections, role of the therapist

And sleep came to her again, deep and continuous. She
_dreamt them as she were living all her past life. What was extraordinary was that _
she dreamt the
continuation of her own dreams of the past day. She no longer dreamt her marriage or her dowry but her
_childbed, and she seemed to have her three girls all at once, Delcharo, Amersa _
and Krinio, all small, all the
_same age, like triplets. The three of them were helped up to stand before her and _
they wanted petting
_and cuddling and kissing. But suddenly their faces were transformed, they were _
no longer her three
_daughters. They took on all the characteristics of the three girls who were _
drowned, and suddenly they
were hanging like a necklace round her neck.

Alexandros Papadiamantis ‘The Murderess’, trs. by Peter Levi

The aim of this presentation is to focus on some particular issues of mother- daughter conjoint family psychotherapy and understand the role of the therapist as a third party, whose symbolic presence encourages the differentiation process and enhances both mother’s and daughter’s recognition as separate individualities. The myth of Demeter and Persephone presents some analogies that highlight important issues of mother-daughter’s relationship.

The myth of Demeter and Persephone

(Holtzman and Kulish, 2000)

According to the Homeric hymn, Core/Persephone, the young daughter of Demeter (goddess of fertility) and Zeus, is gathering flowers with other young girls. As Core plucks a particularly beautiful narcissus that has attracted her, the earth opens suddenly and she is abducted by Hades (Pluto), god of the Underworld, with the permission of Zeus. When Core next appears, she is with Hades in the underworld. Demeter descends from Olympus and frantically searches the earth for her daughter. In her fury and pain she causes famine and drought to spread over the earth. This catastrophe forces Zeus to persuade Hades to release Persephone (after her descent to the underworld, Core has been renamed to Persephone). However, before going on land she has eaten some pomegranate seeds and is now bound to Hades. A compromise is worked out among the gods, whereby Persephone spends one third of the year with Hades and two thirds with her mother.

Clinical Vignette

Doretta, 18 years old, lives with her mother (her parents divorced when she was three). Her father lives in another city and has rare, if any, contacts with his daughter. The relationship with her mother is very close, highly conflictual, their quarrels often ending up in physical violence. Doretta has repeated her last year in high school, is isolated, doesn't have any friends, hardly leaves the house and is in a permanent state of anxiety. She is afraid that something disastrous is going to happen, that she will die. However, the most severe of Doretta's symptoms is the way she eats. Every meal becomes an ordeal, a ritual of self-torture: she takes her plate and sits on the floor in a corner, alone. In order to swallow every bite she presses her neck, pulls and roots out tufts of hair, pinches her body which is bruised all over. Her difficulty to swallow sometimes leads her to spit bites in handkerchiefs and drawers. When her difficulty of swallowing becomes unbearable Doretta asks for her mother's help, begging her to rescue her from all this suffering, or resorting to cursing and hitting. It must be noted that she has no preoccupation with her weight and her vomiting is not provoked, so this is not seen as an eating disorder). The family history is briefly as follows: a quick and reckless marriage of parents, mainly because of mother's longing to leave her parental home and, especially, to get away from her strict, even harsh mother. After the parents’ divorce the father disappears and ceases to support Doretta and mother financially, so mother and daughter live on mother's salary from her work as housekeeper. During the first conjoint sessions in therapy, central issues emerge such as closeness between them, upside-down hierarchy (“who is the leader”, “who is leader of himself” ), fears of separation once Doretta graduated and went to study in another city, and also the ambivalent-compulsive way they deal with nurturing. Despite both women’s hard efforts to resolve the problems, it is obvious that they seek magic solutions. At the very first session Doretta draws a powerful, cloaked magician with a shiny wand who will take away her horrible symptoms.

Basic themes in Mother-Daughter Conjoint Family Psychotherapy

Femininity and motherhood as intergenerational transfer experience across three generations

The transgenerational approaches in family therapy hold that many of the problems of current families reflect unresolved emotional issues from their families of origin, which pass from generation to generation through the process of transgenerational transfer. The ways in which family members create relationships, manage intimacy, resolve or avoid the conflict, maintain or do not maintain distances and boundaries may often reflect, to a greater or lesser extent, previous family patterns. In this sense, in order to understand the problems of the present, therapists and families need to examine them in an intergenerational, historical context (Goldenberg et al., 1999). Every mother has been a daughter and every daughter is likely to become a mother. According to Jung, every mother contains her daughter and every daughter contains her mother; every woman extends to the past through her mother and to the future through her daughter (Jung et al., 1969).

Stern (1995) believes that a pregnant woman is introduced to a new and unique psychological organization called “motherhood constellation”. This is about three intersecting aspects of being a woman, which are in constant dialogue with one another: the dialogue of a pregnant woman with her mother of her childhood (how she experienced her mother in the maternal role), the dialogue with herself as mother of her own child, and the dialogue with the child itself.

_In the myth under consideration, there is a characteristic transgenerational transfer in the difficulty that seems to exist in accepting the husband and the concept of marriage in three generations. More specifically, it states that Rhea (Demeter’s mother and Persephone's grandmother) did not want to marry Cronus because she preferred to be with her sisters and take care of her mother. In other words she did not want to lose the 'girlish' happiness; she wanted to enjoy the daylight which she was deprived of for so many years because of her cruel father, Uranus (a fact repeated later through the descent of Persephone into the underworld!). Eventually she was persuaded by her mother Gaia to get married. Gaia, in order to console her beloved Cronus, who was madly in love with Rhea, promised him that he would have her. So she summoned her daughter and told her that she was destined to marry Cronus and become the first of the Titanides, queen of the World. Rhea, who was always obedient to her mother, tearfully agrees to marry Cronus. _

_Demeter, daughter of Cronus and Rhea, shared her siblings’ fate and ended up in the stomach of her father (thus also missing the daylight, like her mother and daughter) until Zeus released them. Pursued by many gods from an early age because of her beauty and her other qualities, Demeter resisted everyone who yearned to seduce her. Eventually Zeus, disguised as a bull, managed to trick her into having intercourse with him. The fruit of their union was Persephone, the beloved daughter to whom Demeter devoted herself completely. _
_Persephone, finally, is supposedly abducted by Hades, her father’s brother, meaning that she has no desire or responsibility for her mating with her future husband. Yet when she is with him she ‘forgets herself’ and eats the pomegranate seeds, and is thus able —and compelled— to keep returning to the Underworld and her husband. _

Going back to Doretta’s story, the narrative of family history reveals several references associated with the concept of food across three generations. It seems that the experience of motherhood, directly connected to the concept of food, passes down from maternal grandmother to mother, and from mother to daughter and rekindles fears, anxieties and conflicts associated with the primary sense of care by the maternal grandmother. In a session mother speaks about Doretta’s father. M: “Doretta’s father did not believe she was really his daughter, so when we divorced he refused to pay alimony [the Greek word for which is the same as nourishment]. He is quite rich, and if Doretta were to look after him in his old age he might “give her a treat”. Mother describes her own childhood as follows: M: “I was severely beaten by my mother. Even during my meals I was beaten. One day my grandfather said to my mother: “Why do you give her this kind of bread? This is bitter bread you are feeding her”. D: “If some day the door opened and my father came in, I would tell him all the things I could not swallow all these years”.

_The issue of "food" and its constant interconnection with mother–daughter relations permeates the entire myth of Demeter and Persephone. First of all, Demeter herself is the goddess of fertility on earth. “Great nurse, all-bounteous” is called by the Orphic Hymn “to Ceres (Demeter Eleusinian) “the fumigation from storax.” Moreover, the Orphic Hymn to Persephone calls her “O, vernal queen… Whose holy form in budding fruits we view”. However, as the myth unfolds in the Homeric Hymn "To Demeter”, which is the main source of the myth, "eating disorders" keep recurring: Demeter, having heard of the abduction of her daughter, after a long wandering comes to Eleusis "Unsmiling, not partaking of food or drink" (v 200); when hosted at Metaneira’s home disguised as a wet-nurse, Demeter "...ordered her [Metaneira] to mix some barley and water with delicate pennyroyal, and to give her that potion to drink” (vv 209-10); threatening with a desolate and barren earth that will not bear fruits, Demeter persuades Zeus to return Persephone to her: "She said that she would never go to fragrant Olympus, that she would never send up the harvest of the earth, until she saw with her own eyes her daughter, the one with the beautiful looks" (vv 317-8). Using exactly the same argument, Hermes, messenger of Zeus, forces Hades to liberate her: "For she [Demeter] is performing a mighty deed, to destroy the tribes of earth-born humans, causing them to be without menos, by hiding the Seed underground—and she is destroying the tîmai of the immortal gods." (vv 351-4). Hades also resorts to a "food" trick to preserve his wife’s bond to his kingdom: "But he [Hades] gave her, stealthily, the honey-sweet berry of the pomegranate to eat, not wishing her to stay all the time over there, at the side of her honourable mother, the dark-robed Demeter" (vv 371-4). And the solution—two thirds of the time with her mother, one third with her husband—was rewarded with the "restoration" of human sustenance: “Straightaway make the harvest grow, that life-bringer for humans. So he spoke, and Demeter, she with the beautiful garlands in her hair, did not disobey. _ Straightaway she sent up the harvest from the land with its rich clods of earth. And all the wide earth with leaves and blossoms was laden."(vv 469-471).

Both the myth and the clinical vignette show that the way mother experienced the primary emotional bond between herself and her own mother influences and shapes the relationship with her daughter. Mother acts as the "guardian" of a tradition she continues without realizing it (Kramer, 1999). Since her experience is described as traumatic, it seems that Doretta’s symptoms and treatment can serve as an opportunity to renegotiate the same unresolved issues in the relation to her own mother. As motherhood is associated with the primary story that every woman carries, it makes her a carrier of unfulfilled desires, idealizations, disappointments, struggles, remediation attempts and repetitions. A deep communication passes from mother to daughter, ensuring the transmission of old teachings processed by previous generations. The daughter, in turn, assimilates and appropriates the cultural heritage of her ancestors and will become a carrier of the family culture and memory (Cramer, 1999). A central theme that emerges is whether the story which is transferred from mother to daughter promotes autonomy and development or, conversely, the unresolved traumas are perpetuated in subsequent generations.

_ **Ambivalence ** _

The mother-daughter relationship is extremely important and complex, and generates intense and conflicting emotions together with the need and dependence. Mother fulfills a unique function, at once providing proximity and cultivating a distance, while she bears the additional load of being able to withstand and contain the ambivalence (Hendrika Freud, 2010). Similarly, mother’s recognition of her own ambivalent feelings towards the baby is a painful process that makes her feel threat and guilt at the same time, as the baby is dependent on her (Parker, 1997).

Among other things, the myth of Demeter and Persephone deals with divided loyalties: closeness to mother is interrupted by a sex drive. Thus Persephone eats the pomegranate seeds (“:forgetting" that she was not allowed to do so), but tells her mother that she was forced to eat them. At the beginning of the journey, Persephone, separated from her mother for the first time, feels sad, frightened, anxious and perhaps angry with the man who took her—against her will—away from her mother’s arms and her carefree life. Eventually, she shares herself between loyalty to her mother and the challenge of the contact with the man. While mourning the loss of her childhood paradise, she is preparing for her new life as wife and queen of the underworld. At this stage she may feel guilty towards her mother, because she begins to enjoy the relationship with the man. It is the moment she discovers her sexuality and accepts her femininity. She may now enjoy the relationship with her husband, even if she feels that she betrays the maternal relationship. When Persephone returns to her mother, she is not the child she used to be. She has now gained new experiences that have transformed her into a woman. The myth of Persephone is a symbolic representation of the adventure of inner life which needs to sink into mourning in order to blossom (Kalliteraki, 2008).

In Doretta and her mother’s case, the way they manage care issues is extremely ambivalent and compulsive. Food as a source of pleasure and life involves also torture, suffering, punishment: it does not nurture but destroys. The daughter, having mixed feelings about her mother, partly due to the intense dependence in their relationship (Hendrika, 2010), is experiencing an internal conflict: she loves and at the same time hates her mother, a person to whom she is closely attached and dependent while trying also to differentiate herself and form her own identity. The daughter needs her mother but also struggles to get over her. Mother, on the other hand, deprived and abused by her own mother, is unable to meet the emotional needs of her daughter due to the unhealed trancegenerational trauma. The more frustrating the relationship of the mother with her own mother, the more likely it is for the relationship with her own daughter to be fraught with ambivalence. This is obvious by the daughter’s symptom: Doretta struggles to swallow, trying and at the same time resisting the intake of food.

We are coming to the point of giving meanings to the symptoms.

Doretta’s difficulty in swallowing signifies that daughter and mother were hitherto condemned to eat "bitter bread", the one that Doretta cannot swallow. At the same time, the difficulty in swallowing is Doretta’s a call for help to her mother to relieve her physical stress and metabolize pain; a cry to her mother to become nurse-protector, releasing their relationship from the ghosts of the past.

Perhaps the timing of all this is not accidental: Doretta is on the threshold of adulthood, when she and her mother are dealing with separation issues. In the relationship of a mother with her teenage daughter ambivalence grows even more, as the two parties face different developmental needs and conflicts (Hershberg, 2006). Mother often looks forward to enjoying an intimate connection with her daughter as she moves towards adulthood. Daughter, on the other hand, follows in the footsteps of her mother, adopts her patterns through identification but at the same time seeks paths towards diversity. Mother may feel threatened as she senses that her daughter needs her less and less. The daughter may feel herself torn between conflicting needs: while she craves for her mother’s care and admonishments, she is also fascinated by freedom and the desire for a more independent life.

In this sense, motherhood involves mourning (Bernstein, 2004). It is a delicate balance between engagement and disengagement, between keeping and letting go. Mother is the one who should "always be there" (to pamper, to advise, to listen, to comfort) but at the same time she is the one that has to deal with being "given up". The process of "being there to be abandoned" is perhaps the most difficult aspect of motherhood, and is repeated with each child (Furman, 1996). Mother’s ability of withstanding her daughter’s aggression (often a defense against her own dependence) without feeling threatened by her daughter’s rejection is an important aspect of the symbolic “maternal hug".

_ Types of fusion _

Bowen (1996) describes the family as an emotional system of relationships among members that can range from fusion to differentiation. He proposes the term "undifferentiated family ego mass" to describe the emotional state that is dominant in merged relationships. The merged person lives and defines him/herself through others and experiences confusion regarding the limits of the self. His/her behavior is guided by "reflexive" emotional reactions, thus he/she operates inefficiently even in low stress conditions. In these relations, great effort is made in seeking love and affirmation or attacking the other for not providing them, so there is not much energy left for self-determined activity (Fleming & Anderson, 1986).

Two different types of merged relationships have been described:

First,  symbiotic illusion : it is a narcissistic bond that develops between mother and daughter, and whose function is to keep the fragile sense of the mother’s self unchanged (Hendrika, 2010). Within this bond the process of autonomisation is prohibited, since there is no room for the development of daughter’s differentiation. Mother and daughter do not exist unless they mirror each other in order to define themselves. This is a kind of narcissistic mirroring unlike Winnicot’s mirroring, to which we will refer later. Mother creates an idyllic relationship with her daughter that actually serves to detour the negatively marked emotions (Hendrika, 2010). Any negative feelings of the mother towards her child gives her the scary feeling that she is not a good mother, so she does not allow herself to recognize anything but positive emotions and therefore she has a tendency to idealize, experiencing everything that regards the child through an idyllic perspective. Moreover, she has great difficulty in separating emotionally from her child, whom she needs to meet her own dependency needs, and this exacerbates the fusion. Aggressive emotions are sometimes projected to a third person, often the father, so the mother-daughter duo remains "protected" from any occurrence of differentiation (Hendrika, 2010). Daughter, trying to adapt to the emotional demands of her mother, gives up her own desires and thus tends to develop a false self. But in this way, she participates in the reversal of the role of generations, becoming "mother of her mother".

Second,  conflictual relationships [1] : the more fused and undifferentiated the mother-daughter relationship, the more likely it is for them to engage in uncontrolled emotional reactions and conflicts that end up intensifying the emotional dependency.

In the myth, Demeter and Persephone are presented in an ideal relationship: mother protects her daughter from other gods desiring beautiful Core and tries to preserve her innocence. Essentially, this means that the mother is trying to keep the relationship with her daughter unchanged. Young Core –she is named Persephone after her abduction by Hades– is described as a carefree and innocent inexperienced girl who picks flowers and lives under her mother’s wing. In systemic terms, we could say that Core, fully undifferentiated and fused with her mother, has yet to develop her own identity of self. Not yet named, she is described in relation to her mother, Demeter. As the legend tells us, Persephone’s separation from her mother comes in a violent, abrupt way. She is dragged by Hades into the Underworld, an unknown, dark and threatening place. We might say that the Underworld symbolizes Core’s inner journey of discovering herself away from her mother’s influence and guidance. The descent to the Underworld indicates the ability of penetrating her inner self, her contact with her knots and confusions. It is the time when she is called upon to deal with her internal conflicts and the dark sides of herself.

In Doretta and her mother’s case, the relationship is close and often leads to the use of physical violence. One element that suggests the existence of a close, addictive relationship between the two is the fact that the mother "lives" her daughter’s love affairs as her own, and at some point she describes her daughter’s boyfriend in an idealized way. Conversely, when Doretta creates a peer relationship with a girl, her mother appears extremely threatened and constantly fights with her daughter to put an end to this friendship.

M: "Call me crazy, strange, I don’t know ....this girl hasn’t done anything to me, but I do not want her, I do not, I do not know why .... I do not want my daughter to be with her"

_ The capacity for symbolization and the creation of psychic space _

The capacity for representation and symbolism as well as its absence (expressed in acting out) is influenced by one’s environment. Parents who can contain their children's emotions and are attuned with them tend to have children who can recognize and describe their emotions and are able to resolve conflicts (Holmes, 2009).

Winnicott (1967) emphasized the fundamental role of mother's mirroring in the development of the child's self. Mother’s face is the mirror in which the infant first begins to recognize himself/herself. The baby, as reflected on the face of his/her mother, acquires a symbolic representation of his/her own mental states and that of others, a development that lays the foundation for affect regulation and impulse control (Allen & Fonagy, 2002). The ability to understand and regulate emotions requires two conditions in order to develop: first the mother's facial expression of emotions to be congruent or contingent on the child's feelings, and second a markedness of the mirroring (sometimes the mother's facial expression of emotion is "marked" by exaggeration), whereby the mother is able to express a feeling of the infant while indicating that she is not expressing her own feelings (Gergely & Watson, 1996). Through this process, the mother introduces the child to the "as if" position, in the way of pretend mode, in other words into the world of symbolization (Gergely & Watson, 1999). As the child grows up, through the interactions with mother and other important persons he/she is able to turn his/her raw feelings into symbols (Holmes, 2001). So the child gradually manages to tell a story about himself/herself that connects the inner and outer experience.

For Wright (see Holmes, 2009), the face of the mother is the first symbol. Her face is not part of the child's self, but as she responds to the child's needs she creates a feeling that is closely linked to the child; so the infant begins to see himself/herself in the eyes of the mother and develops his/her inner world. Manolopoulos (2011) says that mother is the first poet whose voice and songs provide metaphors to the infant, linking the sensations of the body with the emergent meaning of the psyche.

According to Bion (1962) mother is an essential component in the development of the child's capacity for mentalization and therefore for thought, through her own capacity for reverie. The mother is the one who "hosts”, "contains" or "connects" the baby's sensory experiences and gives them meaning (Bion, 1978), while she also provides a sense of indissoluble line (Stern, 1985). This activity of the mother introduces the child to the process of internalization and symbolization.

The sensitive and attuned response of the mother is internalized by the child as reflective function (Fonagy et al., 1991) which refers to man's ability to perceive behaviour in terms of needs, feelings, beliefs, goals, purposes and reasons (Allen et al., 2008). Another related concept, introduced by Fonagy as well, is that of mentalization. As others respond to the child's needs and understand his/her internal mental states, he/she can also understand others and accept their version of reality. In this way, he/she can become competent to cope with him/herself and other relationships. Mentalization is a fundamental human capacity of holding mind in mind (Allen et al., 2008). It enables human beings to distinguish inner from outer reality, internal mental processes from interpersonal ones and allow them to give meaning and cope with reality. It summarizes the ability of transforming impulses into feelings, symbolization, mindful thought and meaning making (Fonagy & Vrouva, 2010).

When mother cannot contain her child's feelings, the result will be excessive projective identification or even splitting on the part of the child and a sense of emptiness and lack of meaning, resulting in the subsequent onset of psychopathology (Holmes, 2009). A mirroring of the mother that is not contingent (does not correspond to what the child feels) can result in an empty self which may later lead to a development of narcissistic pathology. When the mirroring is not marked, the mother absorbs and externalizes the child's feelings (without being able to metabolize them) and this can lead the child to feel overwhelmed by his/her distressed emotions and as a result his/her internal experience seems to be matched by his /her external experience. The unmarked mirroring may result in the genesis of borderline pathology (Fonagy et al. 2002).

Traumatized individuals lack a "theory of mind" in the sense that they have difficulty in seeing others as separate beings with their own feelings, intentions and desires and they cannot accurately define their own inner world. The capacity to think reflectively about themselves and their experiences is limited (Fonagy, 1991). The lack of symbolization and fantasy may lead them to acting outs (Zulueta, 2006). As they lack the capacity for emotional processing of their experiences, they are unable to give meanings to their internal and external reality in a consistent and coherent manner.

Going back to the myth of Demeter and Persephone we could observe that Demeter seems to lack the capacity to internalize the loss of her daughter and get on with her mourning. Her life changes as she loses the purpose and the meaning of her life. In her grief and rage for her daughter's abduction, she loses her nurturing abilities and causes the earth to go barren. Since there is no room for symbolism, she turns her hostility into concrete action. She acts in a primitive, reactive and destructive way, condemning earth to poverty and barrenness.

In the case of Doretta, the difficulty in swallowing is so intense that in the fifth session the therapeutic team decides to prescribe antidepressant medication although there was no clear diagnostic indication to do so; also, although this was not an eating disorder, to propose a therapeutic meal during a session (in spite of not using Minuchin’s technique of the therapeutic meal in our practice for a lot of years, even in cases of eating disorders). This can be seen as an instance of the therapist wearing the mantle of the “psychiatrist-magician” who provides a different type of “nurture” than the one suited to their therapeutic setting.

The intake of that first antidepressant pill was typical of the family's mythology around nutrition and food. Doretta, while at school, tries to swallow the pill but cannot.  She is in a state of great anxiety, “her throat is closed”. A teacher rings her mother and says that her daughter is not well. Mother takes Doretta home. There is a scene while mother tries to force Doretta to take the pill. When they finally succeed, she goes back to work. Doretta describes the effect of the pill on her, i.e. “the decisive attitude of her mother”:

D.: “When my mother left, I went and hugged the radiator, and stayed there until I had calmed down. I wanted to be somewhere warm”.

But the “magic” had already taken effect. The symptoms literary “vanish”.  She starts to eat properly, she goes out to a café with schoolmates and enrols in a dance class.

In the next session the therapeutic meal is like a re-feeding ritual. Doretta eats slowly, in a ruminating way, and at the same time takes part in a conversation about food. D: “The other day I ate a chocolate bar at school, and I liked it so much that now I eat one every day”. Mother remembers that two brothers of her own mother could not eat in front of other people: Μ: “Maybe it is our family genes. Anyway, I am so pleased that I managed to help my daughter”.

Over time Doretta blooms like a butterfly. Pretty and composed, she graduates from school, starts studying in a University class and has an affair with a young man. She decides to bid farewell to conjoint sessions and leaves her mother to individual therapy. The following months she sends messages through her mother about how well she is and how she enjoys so many things for the first time. Eight months later the medication is stopped.

Much later, during the next phase of therapy, mother and daughter come together to deal with "leaving home'' issues.  The symptoms have disappeared and the issue is discussed of establishing and maintaining some mental space between them for Doretta to be able to integrate the female part of her being, in other words to be “endowed’ with femininity by her mother.

Doretta's mother says that her daughter asked her for money to have her eyebrows done, but she refused: "It seems useless... I’d be happy to pay for something else." Doretta says she is embarrassed by this conversation: "are we really going to talk about hair now?” The therapist points out that the main issue is Doretta's femininity and to what extent her mother accepts and allows it. Mother remembers that her own mother would not allow her to groom herself or even wear pants, and that she only saw her as a woman only after she had divorced and only thanks to her father’s intervention. At this point Doretta remembers her grandmother telling her that she would pay for things relating to makeup and beauty. In this way the grandmother undermines her daughter (Doretta's mother), "stealing" her role and not allowing Doretta to be “endowed” by her own mother. The therapist observes that the mother was allowed to acquire femininity through her father, while Doretta is in a more difficult position, because the separation with her mother (which means among other things that Doretta can become a woman) has to be accomplished in the absence of the father, with the therapist herself "in the name of the father". On this, mother and daughter readily agree.

_ Projections in mother - daughter relationships _

Parents do not respond in the same way to all children in the family, despite their claims to the contrary. Bowen (see Goldenberg et al, 1999) used the term “family projection process”. This process describes how the parents project their own low level of differentiation onto the most susceptible child, the most emotionally attached to them, the least able to detach him/herself from the family. The projection process take place in every family to some degree, operates within the father-mother-child triangle and is associated with the multigenerational transmission process.  According to Bowen, the intensity of the family projection process depends on two factors, the degree of the parents’ undifferentiation and the level of anxiety the family experiences (Goldenberg et al., 1999). Parents tend to project unconscious material of their own past onto their child, and the child consequently behaves in a way that fits in with the parents’ projections.

Fraiberg (Fraiberg et al., 1975) points out that  "in every nursery there are ghosts. They are the visitors from the unremembered past of the parents, the uninvited guests at the christening" . These ghosts represent unresolved emotional issues from the parents’ past and get into the parent-child relationship. The child thus seems to be inhabited by an ancestor, like a castle haunted by a ghost, and cannot exist outside the parental projection (Lazaratou, 2008). Steele and Pollock (Mohler et al., 2001) were the first to mention the importance of projective mechanisms in the interaction of abused parents and their children. They proposed a mechanism involving the projection of negative self-representations onto the child, leading to rejection or further abuse.

The name Persephone from epic poetry (Persefassa in the tragic authors) is probably of foreign origin, and ancient commentators believed it to derive from the words “fetch and murder" or from the words ptersis (destruction) and touch. Both views mean "the one who causes death, destruction." The name of the young woman initially was Core [=daughter], but after her descent with Hades into the Underworld she became Persephone, i.e. synonymous with destruction. The interesting question is how or by whom the name was changed, since the destruction of the earth was caused by her mother, not by her.

In our therapy, the projections of the mother to Doretta are often obvious. A typical example is when mother blames her daughter. M: "She doesn't take initiative, she doesn't dare to take her life in her hands, she cannot even handle her personal affairs over the phone". D: "Even for personal matters such as renewing my registration at University school, I do not feel good on my own. I prefer to have my mother with me so that I feel stronger. Th: (to the mother) ‘How do you perceive yourself and what are your weaknesses, for which you could draw support from your daughter”? M: "I am strong, I don’t give up and I always look ahead. Whatever happened in the past is the past. " The weak side of the mother, that finds no place in the description of herself, is projected to the daughter who readily conforms to it. This is why Doretta cannot explain why she feels so weak without the presence of her mother On the other hand, the mother’s omnipotence does not seem to be as assertive as her mother herself describes it. For several years Doretta's mother has worked very hard for an employer who underpays her. Although she claims to have other options, she cannot decide either to quit or to demand what she deserves. At some point during therapy, Doretta reveals that one day she stole money from her mother's employer out of an "irresistible impulse". This event is quiet contrary to the profile and values of Doretta, who has otherwise defended her dedication to integrity at great material and psychological cost. It seems once again that Doretta’s mother projected to her daughter her own need to take back what she deserved, and Doretta acted out this need through an impulsive-compulsive theft, collecting “the debt on behalf of her mother".

The role of the father, the role of the therapist

Doretta's mother offers hospitality to her recently divorced brother. This rather obligatory hospitality annoys mother and makes Doretta anxious and dysphoric. She has started spending money compulsively, using her mother’s credit cards.

Doretta calls the therapist and reports feeling anxious; the symptoms have reappeared, she cannot eat and she pleads for medication. “Please do something or I will die. My mother gets angry with me because she thinks that I do it on purpose. No one believes how much I am suffering.” She comes to individual therapy session. D.: “Since my uncle came at home he sleeps in my bedroom”. Th.: “Why doesn't he sleep in your mother’s?” D.:  “Because he doesn't want to”. Th.: “Why don't you sleep in your mother's bedroom?” D.: “Because I don't want to leave my bed. My mother makes me very angry, because when she comes to make the beds she sticks my bed right next to uncle's. I can't eat, I am becoming ugly, nobody will like me anymore”.

The next session is a conjoint one. Neither mother nor daughter say anything about the uncle. It is as if there is complicity to preserve a family secret. But they do report an incident when Doretta in an impulsive way began to beat her mother on the head shouting: “Do something so I can be less skinny, that I can eat, do something that shall not be so ugly, help me to eat”. The therapist helps them open the uncle affair. Doretta talks about uncle and the beds. Mother remains silent, in a Pontius Pilate attitude. The therapist makes an “aggressive” reframing. “A 20 year old girl sleeping in the same bedroom with an uncle of 42—is it possible that she has to be skinny, ugly, and a little bit mad to be safe?” Doretta cries.

In the next session Doretta reports that it was her decision to leave her bed and go into her mother's bedroom. But she is not quite well yet. She has intense somatic symptoms. D: “Since our last meeting I decided to go into my mother's bedroom. I wanted to make a change. It was my own desire. But nothing changed regarding my physical symptoms. I am so sorry about losing my life. And I don't want to make my mother unhappy”. M: “And I feel lost, I don't know what to do to help her”. Th: “So you say that something is happening in your home against your will. But what is that?” M:” Many things. I am overloaded. My daughter is not well. I feel lonely. And my brother is at home and does not want to leave”. D. “But this sacrifice we do for uncle is in our blood. It is an emotional engagement”. Mother agrees. M: “I am doing this for my brother for sentimental reasons. He is so lonely; he has no one to take care of him”. Th: “Is your brother also some sort of company for you?” M: “Now that I got used to him, yes”. D: “I’ve got used to him, too. When he left for a weekend the room felt empty”. Th: “I wonder, what is the role of your uncle's presence amidst this intimacy between you and your mother?” D: “Maybe he was the third person who stood between us”. So, we concluded, now that Doretta slept in her mother's room they had come very close again.

Commenting on the session we could say that the presence of the uncle as a third person did not release the tension of the fusional relationship between mother and daughter; on the contrary, obviously due to his “invasion” of Doretta's room; it exacerbated it. On the other hand the therapist, as a third person, tries to create some psychological space between mother and daughter in order to facilitate their emotional separation. The therapeutic system consists of a triangle where the therapist, although female, plays in the reparatory role of father, whose symbolic presence encourages the recognition of mother and daughter as separate individuals. For this reason, many times during the therapy the therapist was called upon to take the role of the father. In one session, for example, Doretta asked the therapist to see her mother alone "to sort things out between them", just like children who need to feel that their parents agree on issues that concern them. The therapist provides a safe context that promotes a new understanding, reinforcing the mother’s and daughter’s capacity for emotional processing (whereas previously they functioned through projections and acting out). The therapist takes the symbolic position of a “good enough father” (to paraphrase Winnicott), who combines emotional availability with boundaries.

The presence of the father has a number of important implications for the mother -child duo (Marks, 2002). It provides a kind of relief for both mother and child, reinforces the child’s distinct entity and can positively affect his/her ability for symbolization. He is not just a person but represents a role, a function; he/she is the third person who mediates between mother and child and facilitates the separation process.

The father counterbalances the excessive exposure to the mother and at the same time represents for the child the experience of holding an important position in the mind of someone other than his/her mother (Raphael-Leff, 1991).

The father may even correct or compensate for the emotional gaps of the mother. He can offer a second chance for his daughter’s emotional growth. When the parental tasks are shared between mother and father, each with their own contribution to make through their own masculine or feminine approach and their own character, the child benefits from this complementarity. According to Skynner (1987) a determination of the self based on two different persons, mother and father, is done in the same way a boat can find its position from two points on the horizon.

The child internalizes both of his/her parents, a process which protects him/her from being trapped in a dead-end relationship. The primal family triangle provides the child with two links connecting him separately with each parent and brings him against the link between them, which excludes him. In the family triangle the child learns to see him/herself relating with other people, initially his/her parents, sometimes being induced and other times being excluded. A third position then comes into existence from which relationships can be observed and he/she can also envisage being observed. Βritton (1989) calls the emotional freedom of this process a triangular space.

As children learn that parents have their own emotional life from which they are excluded, they realize the separation of generations in the family and become aware that, compared with their parents they will always be children (Heineman, 2006). It is both important and painful to observe and accept the special bond between parents and come to terms with jealousy and fear of exclusion while continuing to feel loved by the parents. Later on they will exclude themselves from the parental couple to develop their own identity and form close relationships outside the family (Charalabaki, 2008).

On the other hand the therapist in the mother-daughter conjoint family therapy functions either as husband to the mother or father to the daughter, depending on circumstances, without the one cancelling out the other.

At certain times in the therapeutic procedure the therapist needs to become a symbolic couple with mother from which the daughter has to be excluded. At other times the therapist creates space for the version of the absent father to be heard, so that the daughter can access aspects of her father's story that were concealed by her mother or were presented from her own point of view.

According to Kristeva (2011), the therapist stands on a ridge, where on the one hand the "maternal position" as satisfaction of needs (Winnicott) and on the other hand the "paternal position" as differentiation, distance and prohibition that produces meaning as well as absurdity are constantly mingled and disconnected.

In the absence of the father, the daughter, if she perceives her mother vulnerable and alone, will try to compensate for her father's absence by assuming greater responsibility for her mother. In such a context of relationships dominated by role reversal and over-involvement, the emotional separation and differentiation of the daughter is constantly postponed. The more immature and narcissistically vulnerable the mother is, the more difficult it will be for her to allow her child to develop beyond her own personal needs and expectations and become a separate individual.

It is important to stress that, when referring to the father's absence we mean not his physical absence but the lack of father’s symbolic function in the family which could facilitate the differentiation of the child.

In the myth of Demeter and Persephone, Zeus, father of Persephone, seems to want the separation between mother and daughter since he allows Hades to seduce his daughter. Moreover, Zeus (along with the other gods) is the one who elaborates and proposes the compromise in the relationship of Demeter and Persephone. In reality he represents Persephone’s capacity of to internalize her relationship with her mother, at the same time maintaining the relationship with her husband. The closeness with her mother remains and the relationship with Hades in the Underworld can be experienced as a source of pleasure, albeit away from her mother’s gaze. After the intervention of Zeus and the final solution he gave, according to which Persephone would stay with her husband for part of the year and remain with her mother the rest of the year, Demeter seems able to deal more creatively with her grief about the loss of her daughter. As she accepts and gives meaning to her sadness regarding the changes that brought about her daughter's abduction by Hades, she allows the relationship to include distance, differentiation, separation.

Like Persephone, all daughters act at turning points in the course of their lives, falling back on their mothers in order to come to terms with that side of their self which resembles their mother and at the same time is different. These landmarks can be marriage, pregnancy, childbirth, menopause, aging and death. Themes of separation and loss can cast a shadow over the most joyful times of a woman’s life. Every new phase in the life cycle means abandoning the previous one. Here Persephone needs to say goodbye to the fusional relationship with her mother in order to become a woman, acquire a name and establish a relationship with a man.


The conjoint family therapy of Doretta and her mother continues. Doretta has gone through brief relapses of depression and conflict with her mother at some difficult turning points in her life like graduation, or the difficulty in her relationships with the opposite sex. The initial food-related symptoms never recurred, and the relapses were always shorter and less intense. The themes that emerged in this therapy enabled us to explore and process theoretical concepts around the "female maternal relationship" and link them to our clinical experience.

We shall conclude with an image (Leslie Dick, 1995). In early May 1992, there was, on the front page of  The Independent   in London, the photograph of a three-month-old baby. Taken in Somalia, before the US intervention there, the picture shows an emaciated woman outside a Red Cross station. Her starving child is being weighed on a crude apparatus—a kind of triangular hammock or sling attached to a set of scales. The woman is looking away and smiling as if the most wonderful thing imaginable has just occurred. The caption explains it all. Apparently, she is smiling because the scales have shown her baby to be under a certain weight, and this means that the feeding centre will take the baby in. She is so happy because the child shall live, even though she may not see her baby again.

"Take her away from me, keep her safe, may I never see her again, may I go away from her, keep her safe from me. For I will damage her, I am her mother.

_Does this make sense? Does this ring a bell? All those women desperately trying to protect their kids—are they like me, terrified of the thing in myself that is capable of destroying everything good, that ravages, wreaks untold damage, leaves disaster behind?" (Leslie Dick, 1995). _

[1] According to literature and our own clinical experience, the families which seek psychotherapeutic help are usually the ones in which conflictual relationships are dominant.


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ARTICLE 4/ ISSUE 1, October 2012

Do not feed the bees

Sotiris Manolopoulos, Psychiatrist-Child Psychiatrist, Psychoanalyst
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