The Bernard L. Pacella, MD Parent Child Center

This "guide to navigating the parent-caregiver relationship" by Joseph Cancelmo and Carol Bandini is quite fascinating.

The areas I want to touch on involve the mutual transferences between parent and caregiver. This struck me as the most novel contribution by these authors because, to my knowledge, this kind of discussion has not been done previously. (Clearly it is a value that these authors are both analysts.)

I think that these are critical concepts because it can help us understand what goes on between parent and caregiver and some of the obstacles that can occur and which cannot be helped if one only addresses them by dealing with the objective reality.

For example, at The Pacella Parent Child Center we have seen over and over again how mothers who are extremely successful and competent, particularly in their interpersonal and professional interactions with either superiors or subordinates, have a great deal of difficulty in managing their relationship to their children's caregiver. If one thinks of a transference relationship to the caregiver, one can understand more clearly a source of this difficulty and thus be able to help both parent and caregiver deal with the interaction more effectively.

Another example of this transferential problem is reflected in another current book, "Woman: An intimate Geography," by Natalie Angier. In that book, Ms. Angier speaks of the role of the grandmother (or the post-menopausal older woman) as far back as early society:"Young women needed older women;" "The original division of labor was between child bearing women and post menopausal women."

In other words, this "grandmother hypothesis" (which accounts for the allowance of the hominids to expand their range and their intelligence) maintains that young women who were taking care of babies needed older women (not just their own mothers) to take care of the older children (while the men were off hunting, etc.).

One doesn't have to stretch the imagination to see how in our own age, with family dispersion, the absence of these older women in the community of the young women necessitates them to find such women "for hire."

Here's an example from Cancelmo and Bandini, which reflects this transferential relationship from the mother to the caregiver:

"Many parents may forget to thank the caregiver for her work simply because it is taken for granted. This is often not the neglect of a callous employer. It is expected that care will be provided — not unlike what children come to expect when they receive good-enough care. The situation is loaded for forgetfulness to happen. Parents must work to become aware of how the caregiver's role can often stir up such dependency feelings. Of course, there may also be more personal, individual reasons why parents consistently disregard the caregiver and her value to the family" (page 56).

"We found that difficulties arise when mothers place unrealistic expectations on the caregiver, or expect her to do without basic needs, as they at times feel they have to do. The mother must have a clear idea of what she is hiring this person to do. Is she hiring the person to be a mother to her (that is, take care of her in a maternal way)? This is something that she may not recognize as an employer, but longs for nonetheless. Or the mother may not want to perform such a function for the caregiver….For the vast majority of parents these unconscious tugs to identify with their children, to be taken care of, to have the attention their children receive often go unnoticed and unspoken. Who can blame exhausted parents for wanting such help from their caregivers not only for their children but also for themselves? Yet always they must balance this need with the reality of the caregiver as an employee, remembering it is only as if she were a member of the family. This realization helps assure that the caregiver's needs are met, so that she may be willing to go the extra mile when she can." (pp. 105-106).

The mother of the child may also represent a transference object to the caregiver:"Through her protagonist Lucy, a nanny, Jamaica Kincaid captures the intensity of feeling that exists in the relationship between caregivers and mothers. Lucy tells us that her employer, Mariah, the mother of the children in her charge, can, in the best and the worst of times, remind her of her own mother. Kincaid captures the subtle truth that feelings from our past relationship with our own parents or caregivers can come alive when caring for young children." (page 113).

These transference reactions may, of course, lead to unexpected, complicated, and unfortunate interactions. Various types of parent-caregiver relationships include:

The hands-on, directive parent who hires a relatively passive and compliant younger caregiver.
A young parent who hires an older, typically maternal figure to take charge and direct.
A working mother who sees her child's caregiver as her contemporary; another working mom (page 113).

All of these issues are important to keep in mind when working, particularly with mothers in the early post partum state. In that state, the mother's needs are particularly acute and the needs for a "grandmother" type are critical. So when such a person is "hired," the relationship no longer becomes just an employer-employee relationship.

Similarly, in a child-care environment like the Pacella Parent Child Center, the mother's relationship to the staff is not the same as a parent with a professional. It is a relationship in which the mother, particularly one who is vulnerable (either as a result of realistic issues or internal issues), may react to the staff in a variety of ways: they may want the staff to be compliant, or to be dominant and all-knowing, or they may want the staff to be a collaborative partner, reminiscent of the transference descriptions between a mother and the child caretaker.

The difficulties in dealing successfully with these situations may rely on understanding the transference (NOT interpreting it, because neither the parent nor the caretaker is in analytic treatment). By understanding the transference, we can try to maximize our supportive interventions.