The Maturational Processes and the Facilitating Environment, Winnicott (1965)
(1) Psychoanalysis and the Sense of Guilt (1958)
Freud believed that guilt was a type of anxiety in which love and hate coexisted. Guilt, he thought, developed in early childhood in the context of the child’s first three-person (triangular) relationship. In the Oedipal situation, a boy develops sexual desires for his mother, and in hopes of having his mother to himself, he comes to hate his father and long for his death. At the same time, the boy loves and respects his father. And so this ambivalence — both hate and love for his father — results in his first experience of guilt. In time, the boy comes to introject his father, thus giving birth to his superego.
Klein believed that guilt developed before the Oedipal stage in the context of the two-person (mother-child) relationship. She believed that the infant at times feels aggressive, destructive impulses toward its mother. As the infant comes to learn that the mother has survived her aggression, she attempts to make reparations and feels guilt.
Winnicott notes that some people lack the ability to experience guilt. Most such individuals were born with the ability to experience guilt but were deprived “at the early stages of their development the emotional and physical setting which would have enabled a capacity for guilt-sense to have developed.” The crucial stage, Winnicott believes, occurs in the two-person mother-child relationship around the child’s first birthday.
(2) The Capacity to Be Alone (1958)
The capacity to be alone is an important sign of emotional maturity. When Winnicott uses this phrase, he does not mean “actually being alone.” He explains that a person can be “in solitary confinement” and yet still lack the capacity to be alone. Lacking this capacity can cause great suffering while those who have this capacity “may even value solitude as a most precious possession.”
Paradoxically, one develops the capacity to be alone when given the opportunity “of being alone, as an infant and small child, in the presence of mother.” In this two-person relationship, the infant has the opportunity to “discover his own personal life.” When alone with his mother, the infant is able to relax, “to become unintegrated, to flounder, to be in a state in which there is no orientation,” to not worry about external impingements. Such experiences given the infant the ability “to build up a belief in a benign environment.”
In Kleinian terms, this infant learns to introject “the ego-supportive mother.” The mother thus becomes a good internal object, thus allowing the child to “rest contented even in the absence of external objects.”
Winnicott begins by telling us that it is pointless for the analyst to address a patient’s painful past before the patient herself is ready to talk about it. The analyst often needs to wait, sometimes for a long time, for the patient to develop confidence to proceed. This patient is able to develop this confidence when she realizes that the analyst is reliable. The analyst’s reliability is the most important factor in analysis, more important than the analyst’s interpretations, as “the patient did not experience such reliability in the maternal care of infancy.”
Winnicott turns his attention to infancy, a period of complete dependence. The infant has potential, “a tendency towards growth and development.” However, the infant cannot reach her potential without satisfactory maternal care. One aspect of maternal care is holding. Holding refers to physical holding but also the provision of all of the infant’s physical and psychological needs. Holding occurs during the very beginning of the infant’s life, the period in which the infant feels she is merged with her mother.
The most important maternal quality is being responsive or adaptive to the baby’s specific and changing needs. The typical mother begins to identify with her baby during pregnancy, and this identification continues once the baby is born. It is through this identification with the infant that the mother knows what the infant is feeling and “so is able to provide almost exactly what the infant needs in the way of holding and in the provision of an environment generally.”
Some mothers have babies different from themselves, and these others are more likely to misunderstand the needs of their babies. However, even most of these mothers “tend on the whole to know accurately enough what their infants need, and further, they like to provide what is needed. This is the essence of maternal care.”
Given all this, it shouldn’t be surprising that sometimes the student analyst is more effective than the seasoned analyst and that the new mother is more effective than the experienced mother. A seasoned analyst finds it “irksome to go as slowly as the patient is going, and he begins to make interpretations based not on material supplied on that particular day by the patient but on his own accumulated knowledge or his adherence for the time being to a particular group of ideas. This is of no use to the patient.”
When infants receive this type of care, she is able to build “a continuity of being. On the basis of this continuity of being the inherited potential gradually develops into an individual infant. If maternal care is not good enough then the infant does not really come into existence, since there is no continuity of being.”
(4) Ego Integration and Child Development (1962)
The infant is born with an ego, and the strength of her ego depends on the mother’s ability to meet her needs in what Mahler would later refer to as the normal autistic phase and the symbiotic phase. In optimal parenting, the mother is able to meet the infant’s needs so well that she has “a brief experience of omnipotence.”
Winnicott elaborates on the experience of omnipotence. “[T]he baby develops a vague expectation that has origin in an unformulated need. The adaptive mother presents an object or a manipulation that meets the baby's needs, and so the baby begins to need just that which the mother presents. In this way the baby comes to feel confident in being able to create objects and to create the actual world.”
The infant is “an immature being who is all the time on the brink of unthinkable anxiety.” This anxiety is only kept at bay because the mother is anticipating and providing for the infant’s needs as described above. When this good-enough parenting occurs, the infant is able to become integrated. An integrated person recognizes herself as an “I” that persists through time, an “I” that is distinct from others, one’s skin serving as the boundary between self and others.
(5) Providing for the Child in Health and in Crisis (1962)
Winnicott describes the relationship between good-enough parenting and achieving one’s potential: “Emotional development takes place in the individual child if good-enough conditions are provided, and the drive to development comes from within the child. The forces towards living, towards integration of the personality, towards independence, are immensely strong, and with good-enough conditions the child makes progress; when conditions are not good enough these forces are contained within the child, and in one way or another tend to destroy the child.”
He then gives a beautiful example of responsive parenting: “I remember when I was four years old I woke up on Christmas morning and found I possessed a blue cart made in Switzerland, like those that the people there use for bringing home wood. How did my parents know that this was exactly what I wanted? Certainly I did not know that such heavenly carts existed. Of course, they knew because of their capacity to feel my feelings, and they knew about the carts because they had been to Switzerland.”
The responsive mother knows that she must not leave her child for “more minutes, hours, days then the child is able to keep the idea of her alive and friendly.” If she leaves her child for longer than this, she must spoil the child when returning “in order to turn the child back (if it is not too late) to a state in which he or she takes the mother for granted again.”
The mother knows her infant’s needs “through her identification with the infant.” The mother doesn’t need to “make a sort of shopping list of things she must do tomorrow; she feels what is needed at the moment.” In the same way, when we’re taking care of a child, “we do not have to plan the details of what we must provide” but must make sure there is “someone who has time and inclination to know what the child needs.”
(6) The Development of the Capacity for Concern (1963)
The infant needs the mother to play two different roles. The infant at times needs to selfishly use the mother to satisfy her own id-needs; she needs, in Winnicott’s words, an “object-mother.”)The infant also needs her mother to remain empathic so the infant can make reparations for her bad behavior; she needs an “environment-mother.” It is crucial that the infant see that the mother can survive these attacks and moreover that she remains empathic and allows the infant to make reparations.
It is this type of parenting that allows the infant to develop the capacity for concern. To be specific, the infant starts to experience guilt. If the mother does not allow the child to make reparations, “the guilt becomes intolerable, and concern cannot be felt.”
Like the mother, the analyst must play both of these roles, seeing the patient’s destructive side but remaining empathic and open to receiving the patient’s reparations. He tells the story of a female therapist who treated an adolescent girl while also allowing the girl to live with her. In their sessions, the girl began to express her hatred of the therapist. Outside of the sessions, “the girl began to want to help clean the house, to polish the furniture, to be of use.”
(7) From Dependence towards Independence in the Development of the Individual (1963)
Socialization. The healthy adult “is able to identify with society without too great a sacrifice for personal spontaneity.” The mature adult is also able “to attend to his or her personal needs without being antisocial, and indeed, without a failure to take some responsibility for the maintenance or for the modification of society as it is found.” This is to say that independence is not the same thing as isolation. The healthy adult relates to society in such a way that he and society “can be said to be interdependent.”
Stage #1: Absolute Dependence (0 to 6 months). The mother identifies with the infant, and in so doing she is able to be adaptive to the infant’s needs, the infant’s “instinct tensions” as well as her many ego-needs. The infant at this stage lacks awareness of her needs and level of dependence. And so the mother herself must often anticipate them. “I could remind you of the temperature of the bathwater, tested by the mother's elbow; the infant does not know that the water might have been too hot or too cold, but comes to take for granted the body temperature.”
Stage #2: Relative Dependence (6 months to 2 years). The infant now gains awareness of her needs and dependence. Before, the mother’s prolonged absence would adversely affect the infant, but during this second stage, the mother’s prolonged absence is noticed by the infant and results in anxiety. “Gradually the need for the actual mother (in health) becomes fierce and truly terrible, so that mothers do really hate to leave their children, and they sacrifice a great deal rather than cause distress and indeed produce hatred and disillusionment during this phase of special need.”
Stage #3: Towards Independence (beginning at 2 years). The child becomes better equipped to deal with her mother’s absence. This in part happens because she develops the ability to see things from her mother’s perspective. This in turn reduces some of the hatred she had felt when her desires were unmet; for example, now when the mother disappears, the child can understand, for example, that the mother is going out to get some bread but will return soon.
During both toddlerhood and adolescence, the child makes huge strides in socialization.
(8) Morals and Education (1963)
Where do our moral values come from? Some believe that they come from religion, meaning that if we want children to have moral values, then we must instill them with religious beliefs. According to this thinking, religious beliefs are a necessary condition for moral beliefs. Winnicott believes that just the opposite is true, arguing that moral beliefs are a necessary condition for religious beliefs. Put differently if a child already has a moral sense, then religion makes sense to her, but if she doesn’t have a moral sense, then religion “is at best a pedagogue’s gimmick, and at worst a piece of evidence” that her parents lack “confidence in the processes of human nature and are frightened of the unknown.”
And so if we want our children to have moral values, then we’re wasting our time if we focus on teaching them religion. Rather, if we want our children to have moral values, then we need to provide the necessary conditions so that their personal superegos can develop.
Winnicott proceeds to describe the moral development of children. All children have inherited tendencies for maturation, but this maturation can only come about in a good enough environment. Specifically, we all need a mother who has completely identified with us that she knows what we need at any given moment and reliably provides for our needs. When we receive such good and reliable parenting, we’re eventually able to accept belief in a good and reliable god.
He advocates a responsive, balanced approach. Adults certainly need to impart values to children. The child’s “innate moral code has a quality so fierce, so crude, and so crippling,” and so our adult moral code is needed “because it humanizes what for the child is subhuman.” At the same time, we must move at the child’s own pace. For example, we must not shame children for adopting values when they’re not even developmentally capable of holding those values.
He next discusses the development of moral guilt. Between the ages of 6 and 24 months, the infant is at times destructive, and during these times the mother “is repeatedly destroyed or damaged.” He seems to be referencing Klein’s paranoid-schizoid position, describing how the infant will at times regard the mother as a bad object and hate her and at other times regard the mother as a good object and love her. If the mother is able to endure these attacks and remain empathic, the child will integrate these two parts of her mother, achieving Klein’s depressive position, and in turn developing the capacity for guilt, “guilt related to the idea of destruction where love is also operating.” He continues: “It is this anxiety that drives the child towards constructive or actively loving behavior in his limited world, reviving the object, making the loved object better again, rebuilding the damaged thing.”
Many of course have not had these good enough upbringings, and Winnicott understands why moral educators feel the need to indoctrinate such individuals. However, he urges that these educators not subject the healthy to this indoctrination. We must provide each such individual with a facilitating environment in which she can grow her own moral capacity and find her own way of following or not following society’s moral precepts. “By the time the child is growing up towards an adult state the accent is no longer on the moral code that we hand on; the accent has passed over to that more positive thing, the storehouse of man's cultural achievement. And, instead of moral education we introduce to the child the opportunity for being creative that the practice of the arts and the practice of living offers to all those who do not copy and comply but who genuinely grow to a way of personal self-expression.”
(21) Psychiatric Disorder in Terms of Infantile Maturational Processes (1963)
Neurotic Patients. Neurotic patients are treated by uncovering the Oedipus complex. Neurotic patients are the patients whom training analysts should treat.
Psychiatric Patients. We often begin to work with a patient whom we believe to be neurotic only to eventually discover that the patient’s facade is a false self and that they are more deeply disturbed. Such patients do not respond well to classical techniques; such techniques can actually make such patients even more ill: “If the interpretation is incomprehensible then, whatever the reason, the patient feels hopeless, and may feel attacked, destroyed and even annihilated.”
Etiology. The etiology of psychiatric patients precedes the Oedipus complex but goes back to “the two-body relationship, the relationship of the infant to the mother before father or any other third body came to the scene.” He writes that there are three early developmental achievements that such individuals might not have reached: (1) integration, (2) personalization, and (3) relating to objects. Thus, psychiatric patients can (1) become “disintegrated,” (2) lose their ability “to dwell in their bodies” and “to accept their skin-boundary,” and (3) “unable to relate to objects.” Such patients “‘feel unreal’ in relation to the environment and they ‘feel that the environment is unreal.’”
Facilitating Environment. When the infant’s facilitating environment is good enough, then the infant has the chance to meet the above developmental achievements. “The characteristic of the facilitating environment is adaptation, starting almost at 100 per cent and turning in graduated doses towards de-adaptation according to the new developments in the infant which are part of the gradual change towards independence.”
Modification of Technique. There are things that the neurotic takes for granted that became “the cornerstone” of working with psychiatric patients. The neurotic takes the analytic “setting” for granted. What Winnicott seems to mean is that the neurotic trusts the analyst to act in a certain reliable way.
The psychiatric patient lacks this trust. It is essential that the psychiatric patient becomes dependent on the analyst, but this process can take considerable time “because of all the tests that have to be made by the patient who has become wary because of previous experiences.” The psychiatric patient risks becoming dependent not because he fears the analyst will die but rather because he fears “that the analyst will suddenly be unable to believe in the reality and the intensity of the patient's primitive anxiety, a fear of disintegration, or of annihilation, or of falling for ever and ever.”
The analyst must hold the patient. Holding “often takes the form of conveying in words at the appropriate moment something that shows that the analyst knows and understands the deepest anxiety that is being experienced, or that is waiting to be experienced. Occasionally holding must take a physical form, but I think this is only because there is a delay in the analyst's understanding which he can use for verbalizing what is afoot.”
He adds: “There are times when you carry round your child who has earache. Soothing words are no use. Probably there are times when a psychotic patient needs physical holding, but eventually it will be understanding and empathy that will be necessary.”
(22) Hospital Care Supplementing Intensive Psychotherapy in Adolescence (1963)
Adolescence is tough. “Adolescence itself can be a stormy time. Defiance mixed with dependence, even at times extreme dependence, makes the picture of adolescence seem mad and muddled. Parents, who are much needed over this phase, find themselves confused as to their role. They may find themselves paying out dollars to enable their own children to flout them. Or they may find themselves being necessary as people to be wasted, while the adolescent goes for friendship and advice to aunts and uncles and even to strangers.”
He continues: “there is only one cure for adolescence, and this is the passage of time and the passing on of the adolescent into the adult state. We must not try to cure adolescents as if they were suffering from a psychiatric disorder. I have used the phrase ‘adolescent doldrums’ to describe the few years in which each individual has no way out except to wait and to do this without awareness of what is going on. In this phase the child does not know whether he or she is homosexual, heterosexual or narcissistic. There is no established identity, and no certain way of life that shapes the future and makes sense of working for graduation exams. There is not yet a capacity to identify with parent figures without loss of personal identity.
“Then again, the adolescent has a fierce intolerance of the false solution. We contribute something to the adolescent if we as adults offer no false solutions, but if instead we meet the localized challenges and deal with acute needs as they arise. We expect defiant independence to alternate with regression to dependence, and we hold on, playing for time instead of offering distractions and cures.”
(23) Dependency in Infant-Care, in Child-Care, and in the Psycho-Analytic Setting (1963)
Winnicott says he wants to discuss the similarities of the dependence we find in infancy, in early childhood, and in analysis.
Dependence in Analysis. Dependence in analysis, he writes, “has always been known and fully acknowledged, and for instance shows in the reluctance of an analyst to take on a new patient within a month or two of a long summer holiday. The analyst rightly fears that the patient's reaction to the break will involve deep changes that are not yet available for analysis.”
Dependency in Childhood. To illustrate dependence occurring in early childhood, he describes a 20-month-old boy who “reacted badly” when his mother became pregnant and subsequently experienced anxiety. The boy “stopped using the pot and stopped using words, and his forward progress was held up. When the baby was born he was not hostile to the baby, but he wanted to be bathed like the baby. At breast-feeding time he started thumb-sucking, which had not previously been a feature. He made special claims on the parents' indulgence, needing to sleep in their bed for many months. His speaking was delayed.”
Dependency in Infancy. It is essential that the mother adapts to the infant’s changing needs and thus “facilitates the very important maturational developments of the earliest weeks and months.” If the mother fails in this regard, the infant’s development will be severely stunted. He writes that a failure of basic environmental provision (privation) leads to psychosis. When the infant initially experiences basic environmental provision, she is able to develop ego-organization. If the environmental failure occurs after the infant has developed ego-organization (deprivation), she will be unable to “establish an internal environment” and become independent, and the infant will develop an antisocial tendency.
Analysis. Analysis can be a corrective provision (or experience). A patient, for instance, “may for the first time get full attention from another person, limited though it be to the reliably established fifty-minute session; or may for the first time be in contact with someone who is capable of being objective.”
Although a corrective provision might be important, it is “never enough.” “What then is needed for many of our patients to get better? “In the end the patient uses the analyst's failures, often quite small ones, perhaps maneuvered by the patient, or the patient produces delusional transference elements and we have to put up with being in a limited context misunderstood. The operative factor is that the patient now hates the analyst for the failure that originally came as an environmental factor, outside the infant's area of omnipotent control, but that is now staged in the transference.”
“So in the end we succeed by failing — failing the patient's way. This is a long distance from the simple theory of cure by corrective experience. In this way, regression can be in the service of the ego if it is met by the analyst, and turned into a new dependence in which the patient brings the bad external factor into the area of his or her omnipotent control, and the area managed by projection and introjection mechanisms.”
Freud believed that guilt was a type of anxiety in which love and hate coexisted. Guilt, he thought, developed in early childhood in the context of the child’s first three-person (triangular) relationship. In the Oedipal situation, a boy develops sexual desires for his mother, and in hopes of having his mother to himself, he comes to hate his father and long for his death. At the same time, the boy loves and respects his father. And so this ambivalence — both hate and love for his father — results in his first experience of guilt. In time, the boy comes to introject his father, thus giving birth to his superego.
Klein believed that guilt developed before the Oedipal stage in the context of the two-person (mother-child) relationship. She believed that the infant at times feels aggressive, destructive impulses toward its mother. As the infant comes to learn that the mother has survived her aggression, she attempts to make reparations and feels guilt.
Winnicott notes that some people lack the ability to experience guilt. Most such individuals were born with the ability to experience guilt but were deprived “at the early stages of their development the emotional and physical setting which would have enabled a capacity for guilt-sense to have developed.” The crucial stage, Winnicott believes, occurs in the two-person mother-child relationship around the child’s first birthday.
(2) The Capacity to Be Alone (1958)
The capacity to be alone is an important sign of emotional maturity. When Winnicott uses this phrase, he does not mean “actually being alone.” He explains that a person can be “in solitary confinement” and yet still lack the capacity to be alone. Lacking this capacity can cause great suffering while those who have this capacity “may even value solitude as a most precious possession.”
Paradoxically, one develops the capacity to be alone when given the opportunity “of being alone, as an infant and small child, in the presence of mother.” In this two-person relationship, the infant has the opportunity to “discover his own personal life.” When alone with his mother, the infant is able to relax, “to become unintegrated, to flounder, to be in a state in which there is no orientation,” to not worry about external impingements. Such experiences given the infant the ability “to build up a belief in a benign environment.”
In Kleinian terms, this infant learns to introject “the ego-supportive mother.” The mother thus becomes a good internal object, thus allowing the child to “rest contented even in the absence of external objects.”
(3) The Theory of the Parent-Infant Relationship (1960)
Winnicott begins by telling us that it is pointless for the analyst to address a patient’s painful past before the patient herself is ready to talk about it. The analyst often needs to wait, sometimes for a long time, for the patient to develop confidence to proceed. This patient is able to develop this confidence when she realizes that the analyst is reliable. The analyst’s reliability is the most important factor in analysis, more important than the analyst’s interpretations, as “the patient did not experience such reliability in the maternal care of infancy.”
Winnicott turns his attention to infancy, a period of complete dependence. The infant has potential, “a tendency towards growth and development.” However, the infant cannot reach her potential without satisfactory maternal care. One aspect of maternal care is holding. Holding refers to physical holding but also the provision of all of the infant’s physical and psychological needs. Holding occurs during the very beginning of the infant’s life, the period in which the infant feels she is merged with her mother.
The most important maternal quality is being responsive or adaptive to the baby’s specific and changing needs. The typical mother begins to identify with her baby during pregnancy, and this identification continues once the baby is born. It is through this identification with the infant that the mother knows what the infant is feeling and “so is able to provide almost exactly what the infant needs in the way of holding and in the provision of an environment generally.”
Some mothers have babies different from themselves, and these others are more likely to misunderstand the needs of their babies. However, even most of these mothers “tend on the whole to know accurately enough what their infants need, and further, they like to provide what is needed. This is the essence of maternal care.”
Given all this, it shouldn’t be surprising that sometimes the student analyst is more effective than the seasoned analyst and that the new mother is more effective than the experienced mother. A seasoned analyst finds it “irksome to go as slowly as the patient is going, and he begins to make interpretations based not on material supplied on that particular day by the patient but on his own accumulated knowledge or his adherence for the time being to a particular group of ideas. This is of no use to the patient.”
When infants receive this type of care, she is able to build “a continuity of being. On the basis of this continuity of being the inherited potential gradually develops into an individual infant. If maternal care is not good enough then the infant does not really come into existence, since there is no continuity of being.”
(4) Ego Integration and Child Development (1962)
The infant is born with an ego, and the strength of her ego depends on the mother’s ability to meet her needs in what Mahler would later refer to as the normal autistic phase and the symbiotic phase. In optimal parenting, the mother is able to meet the infant’s needs so well that she has “a brief experience of omnipotence.”
Winnicott elaborates on the experience of omnipotence. “[T]he baby develops a vague expectation that has origin in an unformulated need. The adaptive mother presents an object or a manipulation that meets the baby's needs, and so the baby begins to need just that which the mother presents. In this way the baby comes to feel confident in being able to create objects and to create the actual world.”
The infant is “an immature being who is all the time on the brink of unthinkable anxiety.” This anxiety is only kept at bay because the mother is anticipating and providing for the infant’s needs as described above. When this good-enough parenting occurs, the infant is able to become integrated. An integrated person recognizes herself as an “I” that persists through time, an “I” that is distinct from others, one’s skin serving as the boundary between self and others.
(5) Providing for the Child in Health and in Crisis (1962)
Winnicott describes the relationship between good-enough parenting and achieving one’s potential: “Emotional development takes place in the individual child if good-enough conditions are provided, and the drive to development comes from within the child. The forces towards living, towards integration of the personality, towards independence, are immensely strong, and with good-enough conditions the child makes progress; when conditions are not good enough these forces are contained within the child, and in one way or another tend to destroy the child.”
He then gives a beautiful example of responsive parenting: “I remember when I was four years old I woke up on Christmas morning and found I possessed a blue cart made in Switzerland, like those that the people there use for bringing home wood. How did my parents know that this was exactly what I wanted? Certainly I did not know that such heavenly carts existed. Of course, they knew because of their capacity to feel my feelings, and they knew about the carts because they had been to Switzerland.”
The responsive mother knows that she must not leave her child for “more minutes, hours, days then the child is able to keep the idea of her alive and friendly.” If she leaves her child for longer than this, she must spoil the child when returning “in order to turn the child back (if it is not too late) to a state in which he or she takes the mother for granted again.”
The mother knows her infant’s needs “through her identification with the infant.” The mother doesn’t need to “make a sort of shopping list of things she must do tomorrow; she feels what is needed at the moment.” In the same way, when we’re taking care of a child, “we do not have to plan the details of what we must provide” but must make sure there is “someone who has time and inclination to know what the child needs.”
(6) The Development of the Capacity for Concern (1963)
The infant needs the mother to play two different roles. The infant at times needs to selfishly use the mother to satisfy her own id-needs; she needs, in Winnicott’s words, an “object-mother.”)The infant also needs her mother to remain empathic so the infant can make reparations for her bad behavior; she needs an “environment-mother.” It is crucial that the infant see that the mother can survive these attacks and moreover that she remains empathic and allows the infant to make reparations.
It is this type of parenting that allows the infant to develop the capacity for concern. To be specific, the infant starts to experience guilt. If the mother does not allow the child to make reparations, “the guilt becomes intolerable, and concern cannot be felt.”
Like the mother, the analyst must play both of these roles, seeing the patient’s destructive side but remaining empathic and open to receiving the patient’s reparations. He tells the story of a female therapist who treated an adolescent girl while also allowing the girl to live with her. In their sessions, the girl began to express her hatred of the therapist. Outside of the sessions, “the girl began to want to help clean the house, to polish the furniture, to be of use.”
(7) From Dependence towards Independence in the Development of the Individual (1963)
Socialization. The healthy adult “is able to identify with society without too great a sacrifice for personal spontaneity.” The mature adult is also able “to attend to his or her personal needs without being antisocial, and indeed, without a failure to take some responsibility for the maintenance or for the modification of society as it is found.” This is to say that independence is not the same thing as isolation. The healthy adult relates to society in such a way that he and society “can be said to be interdependent.”
Stage #1: Absolute Dependence (0 to 6 months). The mother identifies with the infant, and in so doing she is able to be adaptive to the infant’s needs, the infant’s “instinct tensions” as well as her many ego-needs. The infant at this stage lacks awareness of her needs and level of dependence. And so the mother herself must often anticipate them. “I could remind you of the temperature of the bathwater, tested by the mother's elbow; the infant does not know that the water might have been too hot or too cold, but comes to take for granted the body temperature.”
Stage #2: Relative Dependence (6 months to 2 years). The infant now gains awareness of her needs and dependence. Before, the mother’s prolonged absence would adversely affect the infant, but during this second stage, the mother’s prolonged absence is noticed by the infant and results in anxiety. “Gradually the need for the actual mother (in health) becomes fierce and truly terrible, so that mothers do really hate to leave their children, and they sacrifice a great deal rather than cause distress and indeed produce hatred and disillusionment during this phase of special need.”
Stage #3: Towards Independence (beginning at 2 years). The child becomes better equipped to deal with her mother’s absence. This in part happens because she develops the ability to see things from her mother’s perspective. This in turn reduces some of the hatred she had felt when her desires were unmet; for example, now when the mother disappears, the child can understand, for example, that the mother is going out to get some bread but will return soon.
During both toddlerhood and adolescence, the child makes huge strides in socialization.
(8) Morals and Education (1963)
Where do our moral values come from? Some believe that they come from religion, meaning that if we want children to have moral values, then we must instill them with religious beliefs. According to this thinking, religious beliefs are a necessary condition for moral beliefs. Winnicott believes that just the opposite is true, arguing that moral beliefs are a necessary condition for religious beliefs. Put differently if a child already has a moral sense, then religion makes sense to her, but if she doesn’t have a moral sense, then religion “is at best a pedagogue’s gimmick, and at worst a piece of evidence” that her parents lack “confidence in the processes of human nature and are frightened of the unknown.”
And so if we want our children to have moral values, then we’re wasting our time if we focus on teaching them religion. Rather, if we want our children to have moral values, then we need to provide the necessary conditions so that their personal superegos can develop.
Winnicott proceeds to describe the moral development of children. All children have inherited tendencies for maturation, but this maturation can only come about in a good enough environment. Specifically, we all need a mother who has completely identified with us that she knows what we need at any given moment and reliably provides for our needs. When we receive such good and reliable parenting, we’re eventually able to accept belief in a good and reliable god.
He advocates a responsive, balanced approach. Adults certainly need to impart values to children. The child’s “innate moral code has a quality so fierce, so crude, and so crippling,” and so our adult moral code is needed “because it humanizes what for the child is subhuman.” At the same time, we must move at the child’s own pace. For example, we must not shame children for adopting values when they’re not even developmentally capable of holding those values.
He next discusses the development of moral guilt. Between the ages of 6 and 24 months, the infant is at times destructive, and during these times the mother “is repeatedly destroyed or damaged.” He seems to be referencing Klein’s paranoid-schizoid position, describing how the infant will at times regard the mother as a bad object and hate her and at other times regard the mother as a good object and love her. If the mother is able to endure these attacks and remain empathic, the child will integrate these two parts of her mother, achieving Klein’s depressive position, and in turn developing the capacity for guilt, “guilt related to the idea of destruction where love is also operating.” He continues: “It is this anxiety that drives the child towards constructive or actively loving behavior in his limited world, reviving the object, making the loved object better again, rebuilding the damaged thing.”
Many of course have not had these good enough upbringings, and Winnicott understands why moral educators feel the need to indoctrinate such individuals. However, he urges that these educators not subject the healthy to this indoctrination. We must provide each such individual with a facilitating environment in which she can grow her own moral capacity and find her own way of following or not following society’s moral precepts. “By the time the child is growing up towards an adult state the accent is no longer on the moral code that we hand on; the accent has passed over to that more positive thing, the storehouse of man's cultural achievement. And, instead of moral education we introduce to the child the opportunity for being creative that the practice of the arts and the practice of living offers to all those who do not copy and comply but who genuinely grow to a way of personal self-expression.”
(10) Child Analysis in the Latency Period (1958)
Psychoanalysis of children is the same as psychoanalysis with adults, the only difference being that children play instead of talk. However, he notes that this difference “is almost without significance, and indeed some adults draw or play.”
Significant changes occur once children pass through the Oedipal complex. As Klein wrote, “Unlike the small child, ‘whose lively imagination and acute anxiety enable us to gain an easier insight into its unconscious and make contact there, [latency children] have a very limited imaginative life, in accordance with the strong tendency to repression which is characteristic of their age: while, in comparison with the grown-up person, their ego is still undeveloped and they neither understand that they are ill nor want to be cured, so that they have no incentive to start analysis and no encouragement to go on with it” (The Psycho-analysis of Children).
Whereas Klein focused on interpreting the child’s “unconscious conflicts and transference phenomena as they arise,” Anna Freud preferred to “build up a relationship with the child on a conscious level.” Winnicott sees the merits in both approaches. He adds that what matters the most to patients is “not the accuracy of the interpretation so much as the willingness of the analyst to help, the analyst's capacity to identify with the patient and so to believe in what is needed and to meet the need as soon as the need is indicated verbally or in non-verbal or pre-verbal language.”
(12) Ego Distortion in Terms of True and False Self (1960)
History. The idea of a true self and false self can be found in Freud’s writings, the true self being the part of the self “powered by the instincts (or by what Freud called sexuality, pregenital and genital)” and the false self being the part “that is turned outward and is related to the world.” Winnicott adds that when our ego is built up enough, our id-demands feel like part of the self.
Description. The purpose of the false self is to protect the true self. One’s false self can be extremely severe. An example would be someone who believes that their false self is their real self. Such a person might function well in some areas of life, but they will struggle in their interpersonal relationships, as others will expect a real self and end up disappointed. One’s false self can be less severe. An example here would be someone who presents a false self to others while knowing it’s a false self. This individual might be looking for opportunities to bring out their true self. Even the healthiest individual has a false self. This type of person finds a balance between being authentic and being mannered; he’s not someone who wears his heart on his sleeve. A true self “feels real,” while a false self “results in a feeling unreal or a sense of futility.”
Etiology of the True Self. The mother-infant relationship is the origin of the true self. At times “the infant’s gesture gives expression to a spontaneous impulse.” This gesture is an example of the true self. The good-enough mother responds to the infant’s gesture, causing the infant to feel a sense of omnipotence, to believe in the existence of an “external reality which appears and behaves as by magic.” The infant is thus encouraged to act spontaneously, and in time the infant recognizes that her omnipotence is illusory, “the fact of playing and imagining.”
Etiology of the False Self. The not-good-enough mother does not respond in the same way; this mother does not allow her infant to feel the sense of omnipotence. Whereas the infant of the good-enough mother learns that she can get what she wants and thus receives encouragement to be her spontaneous self, the infant of the not-good-enough mother learns that she can only get what she wants if she complies with her mother’s wants. This second infant then learns to hide her true self and develops a compliant, false self.
Psychoanalysis. When a patient has a false self, the analyst must attempt to access their true self. Winnicott shares that his work really started with one patient when he made it clear to him that he “recognized his non-existence.” When hearing these words, the patient “felt he had been communicated with for the first time.” Winnicott cautions that once an analyst accesses the patient’s true self, the patient will enter a period of extreme dependence.
(14) Counter-Transference (1960)
Good analysis requires much from analysts. Analysts must maintain a professional attitude, meaning that while working they must be an idealized version of themselves. It’s important that analysts have themselves been analyzed because the job at times makes it difficult to maintain this professional attitude. A personal analysis, of course, does not free one from neurosis, but it “increases the stability of character and the maturity of the personality.”
While remaining professional, analysts must also retain “the vulnerability that belongs to a flexible defense organization.” Winnicott shares that he is affected by his patients. While working, “[i]deas and feelings come to mind, but these are well examined and sifted before an interpretation is made.” Just as having a stomach does not usually affect his interpretations, he can be “somewhat stimulated erotically or aggressively” by something the patient has said without having his interpretive work affected.
He adds that the role the analyst plays depends on the diagnosis of the patient. Most patients are neurotic and benefit from classical technique, “with the analyst’s professional attitude in between the patient and the analyst.” However, exceptions must be made for two types of patients. The first exception is the patient who has “an antisocial tendency” and is “permanently reacting to a deprivation.” For such patients, the analyst must correct “the failure of ego-support which altered the course of the patient’s life.” The analyst’s task is to “use what happens in an attempt to get down to a precise statement of deprivation or deprivations, as perceived and felt by the patient as a child.” The analyst in this case is not interpreting the transference.
The second type of patient needing an exception is the individual who needs a regression. These patients can only experience a significant change if they “pass through a phase of infantile dependence.” Each of these patients has a false self that is concealing their true self. If the hidden true self comes out, the patient will break down, “and the analyst will need to be able to play the part of the mother to the patient’s infant. This means giving ego-support in a big way.”
These two types of patients force “a direct relationship of a primitive kind, even to the extent of merging.” The analyst ensures that this happens “in a gradual and orderly manner.” Recovery must also be orderly, except where it is part of the illness that chaos must reign supreme both without and within.” He shares a time in which such a patient hit him. “What I said is not for publication. It was not an interpretation but a reaction to an event. The patient came across the professional white line and got a little bit of the real me, and I think it felt real to her. But a reaction is not counter-transference.”
(15) The Aims of Psycho-Analytical Treatment (1962)
Winnicott defines “standard analysis” as “communicating with the patient from the position in which the transference neurosis (or psychosis) puts me.” While in this position, he represents the reality principle (“it is I who must keep an eye on the clock”), but he also finds himself “a subjective object for the patient.”
He next talks about interpretations. One reason he gives interpretation is so the patient knows he, the analyst, doesn’t understand everything. “In other words, I retain some outside quality by not being quite on the mark — or even by being wrong.”
He’s satisfied with making one interpretation per session. He tries to be economical in his interpretations. “I say one thing, or say one thing in two or three parts. I never use long sentences unless I am very tired. If I am near exhaustion point I begin teaching.”
In the transference, he expects to find “a tendency towards ambivalence” and “away from more primitive mechanisms of splitting, introjection and projections,” etc. He understands that these primitive mechanisms “are universal and that they have positive value, but they are defenses in so far as they weaken the direct tie to the object through instinct, and through love and hate.”
In the first stage of treatment, he provides an ego-support that “corresponds to the ego-support of the mother,” which “makes the infant ego strong and if and only if the mother is able to play her special part at this time.” As the treatment progresses, the patient begins to develop more ego strength. This in turn results in a “loosening up” of the patient’s defenses, which “become more economically employed and deployed, with the result that the individual feels no longer trapped in an illness, but feels free, even if not free from symptoms.”
(16) A Personal View of the Kleinian Contribution (1962)
Ernest Jones was the foundation of psychoanalysis in England, and in 1923 Winnicott went to him for help. Jones referred him to James Strachey, who analyzed Winnicott for ten years.Winnicott was at the time unaware of the contention between Melanie Klein and Anna Freud, and he practiced in relative isolation for the next two to three decades.
(17) Communicating and Not Communicating Leading to a Study of Certain Opposites (1963)
When an infant has a facilitating environment, she is given the experience of omnipotence, and this in turn enables her to perceive her objects subjectively, meaning (I think) that she’s projecting parts of herself into them. In time the infant starts to experience dissatisfactions, and these dissatisfactions change the way she sees these objects; she projects less and starts to perceive these objects objectively, that is, perceive them as they actually are.
When a child does not have a facilitating environment, she develops a split. Half of the split continues to relate to the object subjectively, while the other half split develops a false self and relates to the object objectively. The second split is not engaging in true communication because it does not involve the true self.
Even when a child has a facilitating environment, a type of split still occurs, and one part of the split engages in silent communication. This part corresponds to the true self, and this part “never communicates with the world of perceived objects,” and the individual “knows that it must never be communicated with or be influenced by external reality.” Although it’s true that “healthy persons communicate and enjoy communicating,” it’s also true that “each individual is an isolate, permanently non-communicating, permanently unknown, in fact unfound.”
We can see a good example of the individual as an isolate in adolescence. During this time, as we undergo changes and before we’re ready to become part of the adult community, we strengthen our defenses against being found. “That which is truly personal and which feels real must be defended at all cost, and even if this means a temporary blindness to the value of compromise. Adolescents form aggregates rather than groups, and by looking alike they emphasize the essential loneliness of each individual.”
It is important that analysts allow for non-communication. “We must ask ourselves, does our technique allow for the patient to communicate that he or she is not communicating?” Analysts must be able to understand the difference between a patient’s not communicating and “the distress signal associated with a failure of communication.”
Psychoanalysis of children is the same as psychoanalysis with adults, the only difference being that children play instead of talk. However, he notes that this difference “is almost without significance, and indeed some adults draw or play.”
Significant changes occur once children pass through the Oedipal complex. As Klein wrote, “Unlike the small child, ‘whose lively imagination and acute anxiety enable us to gain an easier insight into its unconscious and make contact there, [latency children] have a very limited imaginative life, in accordance with the strong tendency to repression which is characteristic of their age: while, in comparison with the grown-up person, their ego is still undeveloped and they neither understand that they are ill nor want to be cured, so that they have no incentive to start analysis and no encouragement to go on with it” (The Psycho-analysis of Children).
Whereas Klein focused on interpreting the child’s “unconscious conflicts and transference phenomena as they arise,” Anna Freud preferred to “build up a relationship with the child on a conscious level.” Winnicott sees the merits in both approaches. He adds that what matters the most to patients is “not the accuracy of the interpretation so much as the willingness of the analyst to help, the analyst's capacity to identify with the patient and so to believe in what is needed and to meet the need as soon as the need is indicated verbally or in non-verbal or pre-verbal language.”
Doing analysis with children in the latency period is that “the analyst is considerably helped by the tremendous changes that take place naturally in the child of five, six, or seven years of age. At the time when the early analysis is ending these growths are taking place, facilitated no doubt by the success of the analysis. Any improvement due to analysis is in this way exaggerated by the natural course of events.” Most significantly, children at this age tend to become more socialized, often losing “the wildness and changeability of the pre-latency era” and becoming “more happy in groups.”
(12) Ego Distortion in Terms of True and False Self (1960)
History. The idea of a true self and false self can be found in Freud’s writings, the true self being the part of the self “powered by the instincts (or by what Freud called sexuality, pregenital and genital)” and the false self being the part “that is turned outward and is related to the world.” Winnicott adds that when our ego is built up enough, our id-demands feel like part of the self.
Description. The purpose of the false self is to protect the true self. One’s false self can be extremely severe. An example would be someone who believes that their false self is their real self. Such a person might function well in some areas of life, but they will struggle in their interpersonal relationships, as others will expect a real self and end up disappointed. One’s false self can be less severe. An example here would be someone who presents a false self to others while knowing it’s a false self. This individual might be looking for opportunities to bring out their true self. Even the healthiest individual has a false self. This type of person finds a balance between being authentic and being mannered; he’s not someone who wears his heart on his sleeve. A true self “feels real,” while a false self “results in a feeling unreal or a sense of futility.”
Etiology of the True Self. The mother-infant relationship is the origin of the true self. At times “the infant’s gesture gives expression to a spontaneous impulse.” This gesture is an example of the true self. The good-enough mother responds to the infant’s gesture, causing the infant to feel a sense of omnipotence, to believe in the existence of an “external reality which appears and behaves as by magic.” The infant is thus encouraged to act spontaneously, and in time the infant recognizes that her omnipotence is illusory, “the fact of playing and imagining.”
Etiology of the False Self. The not-good-enough mother does not respond in the same way; this mother does not allow her infant to feel the sense of omnipotence. Whereas the infant of the good-enough mother learns that she can get what she wants and thus receives encouragement to be her spontaneous self, the infant of the not-good-enough mother learns that she can only get what she wants if she complies with her mother’s wants. This second infant then learns to hide her true self and develops a compliant, false self.
Psychoanalysis. When a patient has a false self, the analyst must attempt to access their true self. Winnicott shares that his work really started with one patient when he made it clear to him that he “recognized his non-existence.” When hearing these words, the patient “felt he had been communicated with for the first time.” Winnicott cautions that once an analyst accesses the patient’s true self, the patient will enter a period of extreme dependence.
(14) Counter-Transference (1960)
Good analysis requires much from analysts. Analysts must maintain a professional attitude, meaning that while working they must be an idealized version of themselves. It’s important that analysts have themselves been analyzed because the job at times makes it difficult to maintain this professional attitude. A personal analysis, of course, does not free one from neurosis, but it “increases the stability of character and the maturity of the personality.”
While remaining professional, analysts must also retain “the vulnerability that belongs to a flexible defense organization.” Winnicott shares that he is affected by his patients. While working, “[i]deas and feelings come to mind, but these are well examined and sifted before an interpretation is made.” Just as having a stomach does not usually affect his interpretations, he can be “somewhat stimulated erotically or aggressively” by something the patient has said without having his interpretive work affected.
He adds that the role the analyst plays depends on the diagnosis of the patient. Most patients are neurotic and benefit from classical technique, “with the analyst’s professional attitude in between the patient and the analyst.” However, exceptions must be made for two types of patients. The first exception is the patient who has “an antisocial tendency” and is “permanently reacting to a deprivation.” For such patients, the analyst must correct “the failure of ego-support which altered the course of the patient’s life.” The analyst’s task is to “use what happens in an attempt to get down to a precise statement of deprivation or deprivations, as perceived and felt by the patient as a child.” The analyst in this case is not interpreting the transference.
The second type of patient needing an exception is the individual who needs a regression. These patients can only experience a significant change if they “pass through a phase of infantile dependence.” Each of these patients has a false self that is concealing their true self. If the hidden true self comes out, the patient will break down, “and the analyst will need to be able to play the part of the mother to the patient’s infant. This means giving ego-support in a big way.”
These two types of patients force “a direct relationship of a primitive kind, even to the extent of merging.” The analyst ensures that this happens “in a gradual and orderly manner.” Recovery must also be orderly, except where it is part of the illness that chaos must reign supreme both without and within.” He shares a time in which such a patient hit him. “What I said is not for publication. It was not an interpretation but a reaction to an event. The patient came across the professional white line and got a little bit of the real me, and I think it felt real to her. But a reaction is not counter-transference.”
(15) The Aims of Psycho-Analytical Treatment (1962)
Winnicott defines “standard analysis” as “communicating with the patient from the position in which the transference neurosis (or psychosis) puts me.” While in this position, he represents the reality principle (“it is I who must keep an eye on the clock”), but he also finds himself “a subjective object for the patient.”
He next talks about interpretations. One reason he gives interpretation is so the patient knows he, the analyst, doesn’t understand everything. “In other words, I retain some outside quality by not being quite on the mark — or even by being wrong.”
He’s satisfied with making one interpretation per session. He tries to be economical in his interpretations. “I say one thing, or say one thing in two or three parts. I never use long sentences unless I am very tired. If I am near exhaustion point I begin teaching.”
In the transference, he expects to find “a tendency towards ambivalence” and “away from more primitive mechanisms of splitting, introjection and projections,” etc. He understands that these primitive mechanisms “are universal and that they have positive value, but they are defenses in so far as they weaken the direct tie to the object through instinct, and through love and hate.”
In the first stage of treatment, he provides an ego-support that “corresponds to the ego-support of the mother,” which “makes the infant ego strong and if and only if the mother is able to play her special part at this time.” As the treatment progresses, the patient begins to develop more ego strength. This in turn results in a “loosening up” of the patient’s defenses, which “become more economically employed and deployed, with the result that the individual feels no longer trapped in an illness, but feels free, even if not free from symptoms.”
(16) A Personal View of the Kleinian Contribution (1962)
Ernest Jones was the foundation of psychoanalysis in England, and in 1923 Winnicott went to him for help. Jones referred him to James Strachey, who analyzed Winnicott for ten years.Winnicott was at the time unaware of the contention between Melanie Klein and Anna Freud, and he practiced in relative isolation for the next two to three decades.
His work as a pediatrician gave him reasons to doubt the profession’s preoccupation with the Oedipus complex. For “innumerable case histories” had shown him that “the children who became disturbed” had shown “difficulties in their emotional development in infancy,” years before the Oedipus complex. He began to advance this thesis, and then one day Strachey told him about Klein. He soon began to meet with Klein. “This was difficult for me,” he writes, “because overnight I had changed from being a pioneer into being a student with a pioneer teacher.”
Both he and Klein believed that child analysis should be “exactly like adult analysis.” She used toys with her patients, something he found valuable. She “had a way of making inner psychic reality very real. For her a specific play with the toys was a projection from the child's psychic reality which is localized by the child, localized inside the self and the body.”
He found it especially significant that, while never dismissing the Oedipus complex, she primarily focused on pre-Oedipal events. He considers her writings about the depressive position to be her greatest achievement, ranking it with Freud’s conception of the Oedipus complex. It is an achievement when one achieves the depressive position, and this “implies a high degree of personal integration, and an acceptance of responsibility for all the destructiveness that is bound up with living, with the instinctual life, and with anger at frustration.”
Klein helped him to see that for the “growing baby and child,” arrival at the depressive position is accompanied by “the capacity for concern and to feel guilty.” He elaborates: “Arrival at this stage is associated with ideas of restitution and reparation, and indeed the human individual cannot accept the destructive and aggressive ideas in his or her own nature without experience of reparation, and for this reason the continued presence of the love object is necessary at this stage since only in this way is there opportunity for reparation.”
Winnicott never considered himself a Kleinian and states that he has “never been able to follow anyone else, not even Freud.” For instance, “I simply cannot find value in his idea of a Death Instinct.” Klein, he writes, “has gone deeper and deeper into the mental mechanisms of her patients and then has applied her concepts to the growing baby.” He believes that she has made mistakes “because deeper in psychology does not always mean earlier.” She often erred by pushing “the age at which mental mechanisms appear further and further back.”
He also criticizes Klein’s contention that the baby begins in the schizoid-paranoid position. This contention “seems to ignore the fact that with good-enough mothering the two mechanisms may be relatively unimportant until the ego-organization has made the baby capable of using projection and introjection mechanisms in gaining control over objects.” Without good-enough mothering, “then the result is chaos” and the infant splits objects into “good” and “bad.”
Both he and Klein believed that child analysis should be “exactly like adult analysis.” She used toys with her patients, something he found valuable. She “had a way of making inner psychic reality very real. For her a specific play with the toys was a projection from the child's psychic reality which is localized by the child, localized inside the self and the body.”
He found it especially significant that, while never dismissing the Oedipus complex, she primarily focused on pre-Oedipal events. He considers her writings about the depressive position to be her greatest achievement, ranking it with Freud’s conception of the Oedipus complex. It is an achievement when one achieves the depressive position, and this “implies a high degree of personal integration, and an acceptance of responsibility for all the destructiveness that is bound up with living, with the instinctual life, and with anger at frustration.”
Klein helped him to see that for the “growing baby and child,” arrival at the depressive position is accompanied by “the capacity for concern and to feel guilty.” He elaborates: “Arrival at this stage is associated with ideas of restitution and reparation, and indeed the human individual cannot accept the destructive and aggressive ideas in his or her own nature without experience of reparation, and for this reason the continued presence of the love object is necessary at this stage since only in this way is there opportunity for reparation.”
Winnicott never considered himself a Kleinian and states that he has “never been able to follow anyone else, not even Freud.” For instance, “I simply cannot find value in his idea of a Death Instinct.” Klein, he writes, “has gone deeper and deeper into the mental mechanisms of her patients and then has applied her concepts to the growing baby.” He believes that she has made mistakes “because deeper in psychology does not always mean earlier.” She often erred by pushing “the age at which mental mechanisms appear further and further back.”
He also criticizes Klein’s contention that the baby begins in the schizoid-paranoid position. This contention “seems to ignore the fact that with good-enough mothering the two mechanisms may be relatively unimportant until the ego-organization has made the baby capable of using projection and introjection mechanisms in gaining control over objects.” Without good-enough mothering, “then the result is chaos” and the infant splits objects into “good” and “bad.”
(17) Communicating and Not Communicating Leading to a Study of Certain Opposites (1963)
When an infant has a facilitating environment, she is given the experience of omnipotence, and this in turn enables her to perceive her objects subjectively, meaning (I think) that she’s projecting parts of herself into them. In time the infant starts to experience dissatisfactions, and these dissatisfactions change the way she sees these objects; she projects less and starts to perceive these objects objectively, that is, perceive them as they actually are.
When a child does not have a facilitating environment, she develops a split. Half of the split continues to relate to the object subjectively, while the other half split develops a false self and relates to the object objectively. The second split is not engaging in true communication because it does not involve the true self.
Even when a child has a facilitating environment, a type of split still occurs, and one part of the split engages in silent communication. This part corresponds to the true self, and this part “never communicates with the world of perceived objects,” and the individual “knows that it must never be communicated with or be influenced by external reality.” Although it’s true that “healthy persons communicate and enjoy communicating,” it’s also true that “each individual is an isolate, permanently non-communicating, permanently unknown, in fact unfound.”
We can see a good example of the individual as an isolate in adolescence. During this time, as we undergo changes and before we’re ready to become part of the adult community, we strengthen our defenses against being found. “That which is truly personal and which feels real must be defended at all cost, and even if this means a temporary blindness to the value of compromise. Adolescents form aggregates rather than groups, and by looking alike they emphasize the essential loneliness of each individual.”
It is important that analysts allow for non-communication. “We must ask ourselves, does our technique allow for the patient to communicate that he or she is not communicating?” Analysts must be able to understand the difference between a patient’s not communicating and “the distress signal associated with a failure of communication.”
(21) Psychiatric Disorder in Terms of Infantile Maturational Processes (1963)
Neurotic Patients. Neurotic patients are treated by uncovering the Oedipus complex. Neurotic patients are the patients whom training analysts should treat.
Psychiatric Patients. We often begin to work with a patient whom we believe to be neurotic only to eventually discover that the patient’s facade is a false self and that they are more deeply disturbed. Such patients do not respond well to classical techniques; such techniques can actually make such patients even more ill: “If the interpretation is incomprehensible then, whatever the reason, the patient feels hopeless, and may feel attacked, destroyed and even annihilated.”
Etiology. The etiology of psychiatric patients precedes the Oedipus complex but goes back to “the two-body relationship, the relationship of the infant to the mother before father or any other third body came to the scene.” He writes that there are three early developmental achievements that such individuals might not have reached: (1) integration, (2) personalization, and (3) relating to objects. Thus, psychiatric patients can (1) become “disintegrated,” (2) lose their ability “to dwell in their bodies” and “to accept their skin-boundary,” and (3) “unable to relate to objects.” Such patients “‘feel unreal’ in relation to the environment and they ‘feel that the environment is unreal.’”
Facilitating Environment. When the infant’s facilitating environment is good enough, then the infant has the chance to meet the above developmental achievements. “The characteristic of the facilitating environment is adaptation, starting almost at 100 per cent and turning in graduated doses towards de-adaptation according to the new developments in the infant which are part of the gradual change towards independence.”
Modification of Technique. There are things that the neurotic takes for granted that became “the cornerstone” of working with psychiatric patients. The neurotic takes the analytic “setting” for granted. What Winnicott seems to mean is that the neurotic trusts the analyst to act in a certain reliable way.
The psychiatric patient lacks this trust. It is essential that the psychiatric patient becomes dependent on the analyst, but this process can take considerable time “because of all the tests that have to be made by the patient who has become wary because of previous experiences.” The psychiatric patient risks becoming dependent not because he fears the analyst will die but rather because he fears “that the analyst will suddenly be unable to believe in the reality and the intensity of the patient's primitive anxiety, a fear of disintegration, or of annihilation, or of falling for ever and ever.”
The analyst must hold the patient. Holding “often takes the form of conveying in words at the appropriate moment something that shows that the analyst knows and understands the deepest anxiety that is being experienced, or that is waiting to be experienced. Occasionally holding must take a physical form, but I think this is only because there is a delay in the analyst's understanding which he can use for verbalizing what is afoot.”
He adds: “There are times when you carry round your child who has earache. Soothing words are no use. Probably there are times when a psychotic patient needs physical holding, but eventually it will be understanding and empathy that will be necessary.”
(22) Hospital Care Supplementing Intensive Psychotherapy in Adolescence (1963)
Adolescence is tough. “Adolescence itself can be a stormy time. Defiance mixed with dependence, even at times extreme dependence, makes the picture of adolescence seem mad and muddled. Parents, who are much needed over this phase, find themselves confused as to their role. They may find themselves paying out dollars to enable their own children to flout them. Or they may find themselves being necessary as people to be wasted, while the adolescent goes for friendship and advice to aunts and uncles and even to strangers.”
He continues: “there is only one cure for adolescence, and this is the passage of time and the passing on of the adolescent into the adult state. We must not try to cure adolescents as if they were suffering from a psychiatric disorder. I have used the phrase ‘adolescent doldrums’ to describe the few years in which each individual has no way out except to wait and to do this without awareness of what is going on. In this phase the child does not know whether he or she is homosexual, heterosexual or narcissistic. There is no established identity, and no certain way of life that shapes the future and makes sense of working for graduation exams. There is not yet a capacity to identify with parent figures without loss of personal identity.
“Then again, the adolescent has a fierce intolerance of the false solution. We contribute something to the adolescent if we as adults offer no false solutions, but if instead we meet the localized challenges and deal with acute needs as they arise. We expect defiant independence to alternate with regression to dependence, and we hold on, playing for time instead of offering distractions and cures.”
(23) Dependency in Infant-Care, in Child-Care, and in the Psycho-Analytic Setting (1963)
Winnicott says he wants to discuss the similarities of the dependence we find in infancy, in early childhood, and in analysis.
Dependence in Analysis. Dependence in analysis, he writes, “has always been known and fully acknowledged, and for instance shows in the reluctance of an analyst to take on a new patient within a month or two of a long summer holiday. The analyst rightly fears that the patient's reaction to the break will involve deep changes that are not yet available for analysis.”
Dependency in Childhood. To illustrate dependence occurring in early childhood, he describes a 20-month-old boy who “reacted badly” when his mother became pregnant and subsequently experienced anxiety. The boy “stopped using the pot and stopped using words, and his forward progress was held up. When the baby was born he was not hostile to the baby, but he wanted to be bathed like the baby. At breast-feeding time he started thumb-sucking, which had not previously been a feature. He made special claims on the parents' indulgence, needing to sleep in their bed for many months. His speaking was delayed.”
Dependency in Infancy. It is essential that the mother adapts to the infant’s changing needs and thus “facilitates the very important maturational developments of the earliest weeks and months.” If the mother fails in this regard, the infant’s development will be severely stunted. He writes that a failure of basic environmental provision (privation) leads to psychosis. When the infant initially experiences basic environmental provision, she is able to develop ego-organization. If the environmental failure occurs after the infant has developed ego-organization (deprivation), she will be unable to “establish an internal environment” and become independent, and the infant will develop an antisocial tendency.
Analysis. Analysis can be a corrective provision (or experience). A patient, for instance, “may for the first time get full attention from another person, limited though it be to the reliably established fifty-minute session; or may for the first time be in contact with someone who is capable of being objective.”
Although a corrective provision might be important, it is “never enough.” “What then is needed for many of our patients to get better? “In the end the patient uses the analyst's failures, often quite small ones, perhaps maneuvered by the patient, or the patient produces delusional transference elements and we have to put up with being in a limited context misunderstood. The operative factor is that the patient now hates the analyst for the failure that originally came as an environmental factor, outside the infant's area of omnipotent control, but that is now staged in the transference.”
“So in the end we succeed by failing — failing the patient's way. This is a long distance from the simple theory of cure by corrective experience. In this way, regression can be in the service of the ego if it is met by the analyst, and turned into a new dependence in which the patient brings the bad external factor into the area of his or her omnipotent control, and the area managed by projection and introjection mechanisms.”
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