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First published in 2007 by
Karnac Books Ltd
118 Finchley Road
London NW3 5HT

Copyright © 2008 Lesley Caldwell

Chapter 1 © 2008 Christopher Bollas; Chapter 2 © 2008 Michael Podro;
Chapter 3 © 2008 Claire Pajaczkowska; Chapter 5 © 2008 Alain Vanier;
Chapter 6 © 2008 Thomas Ogden; Chapter 7 © 2008 Vincenzo
Bonaminio; Chapter 8 © 2008 Meira Likierman; Chapter 9 © 2008
Margret Tonnesmann; Chapter 10 © 2008 Julia Borossa;
Chapter 11 © 2008 Ken Wright

The rights of Lesley Caldwell to be identified as author of

this work have been asserted in accordance with §§ 77 and
78 of the Copyright Design and Patents Act 1988.

All rights reserved. No part of this publication may be

reproduced, stored in a retrieval system, or transmitted,
in any form or by means, electronic, mechanical,
photocopying, recording, or otherwise, without the prior
written permission of the publisher.

British Library Cataloguing in Publication Data

A C.I.P for this book is available from the British Library

ISBN-13: 978–1–85575–467–6

Edited, designed, and produced by

Florence Production Ltd, Stoodleigh, Devon
www.florenceproduction.co.uk

www.karnacbooks.com

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7222 CONTENTS
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6 ABOUT THE EDITOR AND CONTRIBUTORS xi
7
8 Introduction 1
9 Lesley Caldwell
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1 1 A theory for the true self 8
2 Christopher Bollas
3
4 2 Destructiveness and play: Klein, Winnicott, Milner 24
5 Michael Podro
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7 3 On humming: reflections on Marion Milner’s contribution
8 to psychoanalysis 33
9 Claire Pajaczkowska
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1 4 Being and sexuality: contribution or confusion? 49
2 Lesley Caldwell
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4 5 Clinical experience with psychotic mothers and their
5 babies 62
6 Alain Vanier
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8 6 On holding and containing, being and dreaming 76
922 Thomas Ogden

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viii CONTENTS

7 The virtues of Anna Freud 97

Vincenzo Bonaminio

8 Donald Winnicott and Melanie Klein: compatible outlooks? 112

Meira Likierman

9 Michael Balint and Donald Winnicott: contributions to

the treatment of severely disturbed patients in the
Independent Tradition 128
Margret Tonnesmann

10 Therapeutic relations: Sándor Ferenczi and the British

Independents 141
Julia Borossa

11 The suppressed madness of sane analysts 165

Ken Wright

INDEX 174

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7222 ACKNOWLEDGEMENTS
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5222 e wish to thank the following for permission to reuse
6 earlier publications:
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9 The editors of the International Journal of Psychoanalysis for their
20 permission to republish:
1 Thomas H. Ogden. On holding and containing, being and dreaming.
2 International Journal of Psychoanalysis, December 2004, 85: 1349–64.
3
4 Christopher Bollas for permission to republish:
5 A Theory of the True Self. In: Christopher Bollas, Forces of Destiny:
6 Psychoanalysis and Human Idiom. London: Free Association Books,
7 1989.
8
9 Extracts from D.W. Winnicott’s works reproduced by arrangement
30 with Mark Patterson and Associates on behalf of the Winnicott
1 Trust, London:
2 Winnicott D.W. Psychoses and Child Care. In: Through Paediatrics to
3 Psycho-Analysis. London: Hogarth Press, 1987.
4 Winnicott D.W. On the contribution of direct child observation to
5 psycho-analysis. 1957. In: The Maturational Processes and Facilitating
6 Environment. Madison, Wisc.: IUP, 1965.
7 Winnicott D.W. The effect of psychotic parents on the emotional
8 development of the child. 1959. In: The Family and Individual
922 Development. London: Routledge, 1999.

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x ACKNOWLEDGEMENTS

Winnicott, D.W. Ego distortion in terms of true and false self. In: The
Maturational Process and the Facilitating Environment. London:
(reprinted by) Karnac Books, 1991.
Winnicott, D.W. Playing and Reality. London: (republished by)
Routledge, 1991.

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Editor
5222
6 Lesley Caldwell is psychoanalyst of the British Psychoanalytic
7 Association (BAP) in private practice. She is the editor of the
8 Winnicott studies monograph series, and was the director of
9 the Squiggle Foundation from 2000–2003. She is an editor for the
20 Winnicott Trust, for whom she is writing a book on Winnicott with
1 Angela Joyce in the New Library of Psychoanalysis teaching series.
2 She is Senior Research Fellow in the Italian department at University
3 College London where she co-directs the seminar series, Rome, the
4 growth of the city.
5
6
Contributors
7
8 Julia Borossa is a Senior Lecturer in Psychoanalysis in the School of
9 Health and Social Science at Middlesex University. She has a PhD
30 in the History and Philosophy of Science and her publications include
1 Sándor Ferenczi: Selected Writings (Penguin, 1999) and Hysteria (Icon,
2 2001). More recent writings on psychoanalysis, politics and culture
3 have appeared in The Journal of European Studies and Lost Childhood
4 and the Language of Exile (edited by Szekacs-Weisz and Ward; Karnac,
5 2005).
6
7 Christopher Bollas is a member of the British Psychoanalytical
8 Society, a patron of the Squiggle Foundation, and the author of many
922 books.

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xii ABOUT THE EDITOR AND CONTRIBUTORS

Vincenzo Bonaminio teaches Dynamic Psychopathology and Child

Psychotherapy in the department of Child and Adolescent Psychiatry
at the University of Rome. He is a practising adult and child psycho-
analyst and a full member of the Italian Psychoanalytic Society. He
teaches on training courses in child and adolescent psychotherapy
for A.S.N.E.-S.I.Ps.I.A. in Rome. He is on the editorial board of
Richard e Piggle.

Meira Likierman is a senior staff member at the Tavistock Clinic in

London, where she teaches psychoanalytic theory to doctoral
students and trainee child psychotherapists. She has published
extensively and lectures widely in universities and on psychotherapy
training courses in the UK, the US and continental Europe. Her book
Melanie Klein: Her Work in Context came out in 2001.

Thomas Ogden is a graduate of the Yale University School of

Medicine and the San Francisco Psychoanalytic Institute. He has
served as an Associate Psychiatrist at the Tavistock Clinic in London,
and is the Co-Founder and Director of the Center for the Advanced
Study of the Psychoses in San Francisco. Dr Ogden is a Supervising
and Personal Analyst at the Psychoanalytic Institute of Northern
California, a member of the Faculty of the San Francisco
Psychoanalytic Institute, and a member of the International
Psychoanalytical Association. He has published seven books, the
most recent of which are This Art of Psychoanalysis: Dreaming Undreamt
Dreams and Interrupted Cries; Conversations at the Frontier of Dreaming;
Reverie and Interpretation: Sensing Something Human; and Subjects
of Analysis. He was awarded the 2004 International Journal of
Psychoanalysis Award for the Most Important Paper of the Year.

Claire Pajaczkowska is Reader in Psychoanalysis and Visual Culture

at Middlesex University. Her recent books include Perversion; Feminist
Visual Culture (with Fiona Carson); and Shame and Sexuality (with
Adrian Rifkin). Her current research is on sublimation, perversity
and the Sublime.

Michael Podro is Emeritus Professor of the History and Theory of

Art at the University of Essex. His books include The Manifold in
Perception (1972), The Critical Historians of Art (1982), and Depiction

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122 (1998); until recently he was Chairman of the Trustees of the Squiggle
2 Foundation.
3
4 Margret Tonnesmann is a psychoanalyst of the British Psycho-
5 analytical Society and a Fellow and senior member of the British
6 Association of Psychotherapists. She was a consultant psychothera-
7222 pist (now retired), and she is a lecturer and seminar leader on Freud
8 and object relations theorists to various institutions in London,
9 Germany and Switzerland. She is in private practice.
10
1 Alain Vanier is a psychoanalyst and psychiatrist, full member of
2 Espace Analytique (France), Professor of Psychopathology and
3 Psychoanalysis at the Université Paris 7-Denis Diderot, and director
4 of the Psychoanalysis and Medicine Research Centre (C.R.P.M.) in
5222 the same university. His most recent books are Lacan (trans. S.
6 Fairfield, New York: Other Press) and Éléments d’introduction à la
7 psychanalyse (Paris: Armand Colin).
8
9 Ken Wright is a psychoanalyst and psychiatrist in private practice.
20 He trained with the Independent Group of the British Psycho-
1 analytical Society, and at the Tavistock clinic and the Maudsley
2 hospital. He is the author of Vision and Separation: Between Mother
3 and Baby (1991) which won the 1992 Mahler Literature Prize. His
4 interests include the development and use of symbols and the
5 relationship between creativity and the life of the self. He is a patron
6 of the Squiggle Foundation.
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A
5222 lthough this collection does not represent a comprehensive
6 engagement with the intellectual history to which Winnicott
7 contributed so significantly, it does propose that using his
8 work to think about themes of importance to practitioners now is
9 also a way of thinking about some of the present preoccupations
20 of psychoanalysis. How certain themes assume an importance
1 and develop at certain times often resonates with debates of the past,
2 and to encounter them in the present almost always offers some-
3 thing new. Theoretical and clinical ideas are produced in particular
4 conditions and in response to, or as part of, a certain intellectual and
5 socio-cultural context; how they have come to be understood and
6 how they have their effect also involves that wider world and its
7 interests.
8 As in a close engagement with any thinker, a close engagement
9 with Winnicott’s work highlights recurring concerns, and in the
30 first five chapters, Christopher Bollas, Michael Podro, Claire
1 Pajaczkowska, Lesley Caldwell and Alain Vanier begin from familiar
2 themes—the true self and how it can be encouraged, the value of
3 art, creativity and the symbolic function, the links between being and
4 sexuality, the institutional care of psychotic mothers. In each case
5 the writer starts from a basic idea which is then used to develop
6 something different. This process, the process of intellectual work in
7 any area, encourages a new (theoretical) object to emerge through
8 the mental and psychological process of destroying, and then
922 restructuring the originating thought, so as to take it further. Such

1
2 INTRODUCTION

a dismantling and restructuring mirrors the process of creativity that

Winnicott himself has written about so convincingly.
In “A Theory for the True Self,” the first chapter of his book Forces
of Destiny (1989), reproduced below, Christopher Bollas wonders how
we, as analysts, can discuss the unknown benefits of our interven-
tions, given that it is “next to impossible to account for what
transpires in a psychoanalysis.” He approaches the experience of an
analysis through his account of the true self, in which he distinguishes
his approach from Winnicott’s linking of the true self with the id.
Bollas proposes the true self as “the idiom of the personality and
therefore the origin of the ego,” the inherited potential of each
person, which initially depends on maternal care for its evolution and
then becomes fundamental to the encounter between personality and
culture that all humans must negotiate and elaborate. Bollas links the
true self and its potential with the potential of any analysis to
generate a new psychic experience through transference states.
The two papers on Marion Milner, a close associate of Winnicott’s
in the British Society and his former patient, take up her approach
to art and creativity, and her interest in the development of the self.
Michael Podro examines the different notions of disruption and
destructiveness informing British psychoanalytic accounts of
creativity and the mind, and links them to modernist concerns with
the decomposition of established modes of representation. For him,
the approach of Klein and later Kleinians limits the way art, whether
made or consumed, has the capacity to extend continually, the range
of mental interests and sensitivities available to the individual.
Milner’s own account of her difficulties with painting describes her
incapacity to overcome the externality of the object she wishes to
paint, an incapacity that derives from the object’s sheer alienness (its
externality) and from the deadness of her own response. She insists
on the aggressive relation with the object required if the artist is
to make it her own; she has to destroy the original, recompose it,
transform it, and thus enable it to be seen and experienced as it is,
in what it can offer and provide. While this may also involve an
internal reorganization involving reparation and guilt, the creation
of a new object in paint depends upon the interrelation of internal
and external thematics. Milner sees this as an extension of the earliest
reciprocity between infant and mother and its continuing availability
to the receptive and constructive capacities of the mind. For Podro

2
 INTRODUCTION 3

122 too, the arts exemplify that creativity of mind that derives from the
2 initial mother-child relation, and what it enables in terms of a sense
3 of self. Claire Pajaczkowska also uses Milner to think about humming
4 as a liminal activity where the self, while being consciously absent,
5 is present as bodily acoustic frame. She, too, is impressed with
6 Milner’s attention to the centrality of feeling and affect in mental life,
7222 and discusses this through the concept of the framed gap and the
8 theory of symbol formation.
9 Lesley Caldwell describes the insights to be gained in looking at
10 records of Winnicott in the consulting room and at his clinical acu-
1 men, but she considers his attempt to develop an idea of difference,
2 based on sexual difference and its manifestation in the transference,
3 less convincing than his discussion of the growth of the self through
4 the encounter with an other—the mother or the analyst—elaborated
5222 through a distinction between being and doing.
6 Alain Vanier’s major influences, Lacan and Dolto, seem to sit easily
7 with what he sees as Winnicott’s fundamental contribution to his
8 own work with psychotic mothers in institutional care. He assumes
9 Winnicott’s sense of mirroring as a supplement to Lacan’s emphasis
20 on misrecognition, but it is through his comprehensive under-
1 standing of Winnicott’s “holding,” and what he regards as its
2 indispensability, that he approaches the place of the institution and
3 his own team in organized care.
4 The papers by Thomas Ogden on Bion, Vincenzo Bonaminio on
5 Anna Freud, Miera Likierman on Klein and Margret Tonnesmann
6 on Balint, explicitly discuss a complementarity between another
7 theorist and Winnicott, while also emphasizing specific differences
8 in their theoretical accounts that argue for differently inflected
9 approaches to some common fundamentals.
30 Ogden, like Vanier, finds “holding” an essential conceptual tool
1 for approaching clinical work. In the paper reproduced here from
2 the International Journal, he sees its complementarity to Bion’s
3 “container-contained” as representing different developmental
4 possibilities, and relating to different understandings of time and its
5 place, both in the growth of the human infant and in the analytic
6 situation. Ogden thinks that different clinical situations call forth
7 these concepts as ideas to be used, but each requires different mental
8 tasks of both analyst and patient. He illustrates this with two pieces
922 of clinical material that show the different needs of the patient and

3
4 INTRODUCTION

what is elicited in the analyst to meet those needs. Ogden develops

his own ideas especially through his consideration of Bion (latterly
so often invoked as to have been rendered almost empty of meaning),
and his emphasis on process. In the case of Winnicott, it is the process
of coming into being through a literal, physical holding that also
represents a mental and psychological necessity; in the case of Bion,
Ogden identifies a dialectical relation between what is involved in
the process of containing, and the process of being contained—an
ongoing reshaping of the mental terrain of life and living, and
dreams and dreaming. This makes of Bion’s formula an active set of
capacities whose impact upon one another constantly reorganizes
what is thought, and what is available to be dreamed and developed
unconsciously, by that thought. It emphasizes the reciprocal relation
between conscious and unconscious thought and how their
interaction may be facilitated. In Ogden’s reading, there is no sense
of hierarchy or preference, of better or worse, but the wish to engage
further with the ideas of two psychoanalytic thinkers.
The place of interpretation forms a continuing question for many
of the papers here. Vincenzo Bonaminio, for example, argues for a
reassessment of Anna Freud as clinician, examining her meticulous
attention to the child as patient, and her insistence that child analysis
is never classical analysis. The considerable differences between her
and Klein over the status of the therapeutic alliance and the stage at
which the transference develops, may profitably be thought about,
Bonaminio suggests, through Winnicott’s statement that their
differences come down to whether the cooperation between patient
and analyst is unconscious or conscious. The status of interpretation
as a technical cornerstone for Anna Freud leads Bonaminio to
emphasize what is at stake for the analyst in interpreting, and its
possible implications for the patient, especially the child patient.
Likierman argues for similarities between Winnicott and Klein in
their accounts of reparation and sees the death drive as a dividing
concept. These are two areas where there is some agreement about
the connections between the two analysts’ work, despite substantial
differences in their accounts of human subjectivity and its origins.
She sees a close convergence between them around the early
existence of “a full superego” in The Observation of Infants in a Set
Situation (Winnicott, 1941), but acknowledges the extent to which
their very different emphases imply that they are speaking about

4
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122 rather different phenomena. She also wonders what is implied for
2 the infant’s own strength as a person by Winnicott’s account of the
3 early incapacity to exist without the mother.
4 Margret Tonnesmann undertakes a detailed account of the
5 approaches of Winnicott and Michael Balint to the issue of regression
6 in analysis, which outlines their differences and argues for its
7222 importance. While both argued for a conceptualization of infantile
8 development in terms of classical theory and object relations, and
9 specified an area—the basic fault, false self—that is organized by a
10 two-person relation situation, where the pre-verbal is paramount
1 and the treatment involves acting out, their accounts of the dynamics
2 of regression in terms of either primary narcissism (Winnicott) or
3 secondary narcissism (Balint) involve different theories of early
4 development. Tonnesmann also proposes that their very different
5222 personalities may well have contributed to further differences in
6 approach. Like the final two papers, this paper also locates the
7 historical importance of serious disputes in psychoanalysis and their
8 continuing relevance for debates about technique, training, and the
9 way individuals view the analytic endeavour.
20 Julia Borossa argues that both Ferenczi and Winnicott are
1 uncomfortable figures for psychoanalytic orthodoxy, but figures
2 whose willingness to pursue the implications of their chosen careers
3 still provides a fundamental reference point for psychoanalytic
4 discourse today. She describes the challenges offered by Ferenczi’s
5 detailed thinking about the interaction of patient and analyst, but
6 she herself questions the demand of training organisations that the
7 analyst must herself be analysed, as implying an identification
8 between analyst and patient that, subsequently, has to be hedged
9 about with restrictions. The requirement to be analysed, that is, to
30 be a patient, and for ongoing education through discussion and
1 supervision with colleagues, is not only the prerequisite of a
2 professional life spent analysing others, it addresses the bases of what
3 constitutes that practice, and the bases of the expertise and training
4 of its members. Borossa writes of Margaret Little’s differing
5 understandings, at the time of the analysis, and retrospectively, in
6 the course of her own analytic career, of the interpretation made
7 by Little’s training analyst, Ella Sharpe, about her patient’s success,
8 and why she made the interpretation she did. In doing so Borossa
922 is describing how and why Little came to recognize her analyst’s own

5
6 INTRODUCTION

involvement in her success, a process of being able to acknowledge

Sharpe’s own ambivalent response to such success and its place in
her interpretation. Perhaps thinking about some of one’s own
interventions, and those of one’s analyst, is a process that necessarily
continues throughout a working life. Writing about either constitutes
yet another reading and evaluation. When Little writes of her later
analysis with Winnicott, her accounts highlight the variety of
motivations inherent in any decision to write and to publish, but most
particularly, to write and publish an account of an analysis, especially
since such a retrospective encounter inevitably depends upon a
different understanding, another narrative about that past situation.
This does not necessarily make either more authentic, or enduringly
true, but it does make them different. Borossa links Little’s difficulties
in getting her account published with the analytic world’s fear of
debating Ferenczi’s standing and the value of his work, this latter a
situation that was in evidence over many decades. Such stifling of
debate has been an unfortunate part of the growth of psychoanalysis,
and, among other things, may relate to the widespread anxieties of
a profession whose work is centrally involved with the unconscious
and its intractability to conscious, rational aims. Nonetheless, such
censoring and demonizing is profoundly anti-psychoanalytic. A
similar regrettable trend may be discerned in recent years around
Winnicott. It has had disastrous results for open discussion among
colleagues, and has impeded the necessary process of evaluating his
work, his decisions about analytic parameters with certain patients,
his behaviour with colleagues and analysands, and some of the
differences between common earlier analytic ways of working (long
sessions, going on holiday with patients, the analysis of one’s own
children, for instance) and ways of working now. The issues raised
theoretically and historically by Borossa are raised personally by Ken
Wright in his assessment of his own practice and his changing
understanding of working psychoanalytically. Wright wonders about
how to be an analyst, about analytic technique, and about how his
work has changed over his career. He anchors his changing approach
to his work in different ways of using theory: his distinction is
between theory, used to facilitate thought and development, and
theory, used defensively to hold the analyst together in the face of
the very difficult demands of analytic work with patients. Wright
describes the style current in the period when he was training, as

6
 INTRODUCTION 7

122 one of prioritizing the interpretation itself, together with an insistence

2 that an interpretation must have a particular structure. In his own
3 case, Wright now believes that despite the very difficult patient he
4 had, the patient’s continual demands were probably justified, and
5 had been exacerbated by the analyst’s superego-focused clinical
6 approach. He suggests that his interest in Winnicott’s accounts of
7222 interpretation and other technical issues, and his own experience,
8 have led to his working in a less regimented way, aimed at providing
9 a holding environment, where the dialogue between patient and
10 analyst proceeds with different assumptions. Wright’s frank
1 assessment of his own previous analytic self seemed to produce a
2 tide of recognition in the large audience in Milan, where he first gave
3 this paper, but it also raises the links between Ferenczi’s active
4 technique, Winnicott’s reorganization of boundaries and his
5222 acceptance of regression (within very clearly defined arenas), and
6 the ongoing need to interrogate one’s own, work so as to understand
7 what is seen to be effective, and why, with any particular patient.
8 An emphasis on the analyst’s freedom has been a theme for many
9 of Wright’s colleagues, but he is clear that his own shifts in his way
20 of being with patients have gained much from Winnicott’s priorities.
1 The ideas presented in these papers give further space to that use
2 of theory from which Wright derives his continuing involvement
3 in the professional field he has chosen. To think about Winnicott in
4 terms of his links with others is to place him firmly in a discursive
5 field of exchange, debate, theoretical and technical challenge, and of
6 procedures and ways of conducting oneself; and then, to use these
7 to examine his influence and effect, and whether they offer insights
8 of relevance today. The papers collected here emphatically suggest
9 that there is much to be gained from reading Winnicott and the other
30 psychoanalytic theorists and clinicians with attention and openness.
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CHAPTER ONE

A theory for the true self

Christopher Bollas

I
t is next to impossible to account for what transpires in a
psychoanalysis. Although clinicians collect vignettes, remember
interpretations that make sense, and isolate important psychic
themes, the sheer unconsciousness of a patient-analyst relationship
makes it a difficult occasion to describe. How do I talk about the
qualities of silence in an hour? How can I describe the mix of tonal
stress and narrative content that constitutes the analysand’s
unconscious emphasis of the emotional reality of a session? How
shall I ever be able to narrate my inner dialogue with myself as I
silently shadow the analysand, agreeing, disagreeing, querying,
wondering, co-imagining? If it is possible for me to state precisely
why I choose a particular interpretation, why in that moment? Why
do I allow clear themes to pass without comment, only to pick up
something else the patient says?
Some people find themselves incapacitated by the question “What
did you get out of your analysis?” Pressed to be specific, often by a
friend who is on the verge of seeking an analyst but still needing
some clear evidence of accomplishment for the considerable
investment of time and money, the friend may want to know details
of what was found out that was previously not known. The reply of
the analysand will often be most unhelpful. “It changed my life.” “I
was very confused and it helped me out.” The unanalysed cannot
be blamed for considering this a mystifying reply.
What does happen in an analysis? How can we discuss the
unknown benefits of our intervention?

8
 A THEORY FOR THE TRUE SELF 9

122 In some respects the history of the psychoanalytic movement can

2 be read as a progressive effort to understand the unique situation
3 that Freud invented and psychoanalysts inherit. Michael Balint’s
4 (1968) works on the nature of the analytic setting and the ordinary
5 regressive features of the process, Milner’s book (1969) on the role
6 of illusion in the transference, and Winnicott’s (1954) ingenious
7222 discoveries of the infant-mother memories latent to the analytic
8 relation typify the spirit of continuing inquiry into the nature of
9 clinical psychoanalysis within, for example, the Independent Group
10 of the British Psychoanalytical Society. Each of these authors believes
1 that the success of an analysis rests not simply on the transformation
2 of unconscious conflicts into conscious awareness, but also on
3 fundamentally new psychic experiences generated by the analytic
4 situation, in particular those sponsored by transference states.
5222 Naturally, some transference experiences are interpreted and cease
6 to be unconscious, but certain uses the analysand makes of the
7 analyst are of a different category of meaning from that represented
8 by the concept of repressed unconscious conflict. When Winnicott
9 introduced the term “true self” to stand for an inherited potential
20 that found its expression in spontaneous action, I think he
1 conceptualized a feature of the analytical relationship (and of life)
2 that had heretofore been untheorized.
3 If we explore the theory of the true self further, I think we may
4 position ourselves to discuss previously unrepresentable features of
5 our clinical work. I refer to that psychic movement that takes place
6 when the analysand is free to use the psychoanalyst as an object
7 through whom to articulate and elaborate his personality idiom. This
8 use of an analyst is difficult to describe, but because I think it is an
9 important part of analytical work, we must try to find a conceptual
30 category to represent this type of psychic movement. Winnicott’s
1 theory of the true self is, in my view, just such a concept through
2 which we may describe something we know about analysis, but have
3 until now been unable to think.
4 Winnicott defined the true self as “the inherited potential which
5 is experiencing a continuity of being, and acquiring in its own way
6 and at its own speed a personal psychic reality and a personal body
7 scheme” (1960, p. 46). The spontaneous gesture was evidence of true
8 self, and Winnicott found its earliest manifestations in the muscle
922 erotism of the foetus. The true self was aliveness itself, and although

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10 CHRISTOPHER BOLLAS

he saw it as an inherited potential, he did little to extend this

understanding of the concept. If we are to provide a theory for the
true self, I think it is important to stress how this core self is the
unique presence of being that each of us is; the idiom of our person-
ality. We are singular complexities of human being—as different in
the make-up of our characters as in our physiognomies; our person
design finds its expression in the discrete living villages (composed
of all those objects we select to cultivate our needs, wishes and
interests) that we create during our lifetime. A genetically biased set
of dispositions, the true self exists before object relating. It is only a
potential, however, because it depends upon maternal care for its
evolution. As its gestural expressions and intersubjective claims are
never free of the other’s interpretation, its evolution depends upon
the mother’s and father’s facilitations. No human being, however, is
only true self. Each inherited disposition meets up with the actual
world and one of the outcomes of this dialectic between personality
idiom and human culture is psychic life.
The psyche is that part of us which represents through self and
object representations the dialectics of true-self negotiation with the
actual world. Conflict is essential to the usefulness of the psyche
which depends, in part, on the healthy balance of forces between the
true self and the actual world. If a mother, for example, forecloses
her infant’s true self, impairing the dialectic of self and other, her
infant will have a diminished psychic capability, as psychic
representations owe much to the freedom of expression guaranteed
by the mother and the father.
To some extent the inherited potential is objectified through self
and object representations in the subject’s internal world although
this is always only a derivative of the true self, much as we know
the unconscious through its derivatives. The idiom of the person is
not, however, a hidden script tucked away in the library of the
unconscious waiting for revelation through the word. It is more a
set of unique person possibilities specific to this individual and
subject in its articulation to the nature of lived experience in the actual
world. The life of the true self is to be found in the person’s
experiencing of the world. The idiom that we are finds its expression
through the choices and uses of objects that are available to it in the
environment. If the mother knows her infant, if she senses his figural
intentions, his gestures expressive of need and desire, she will

10
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122 provide objects (including herself) to serve as experiential elaborators

2 of his personality potential. In this way she assists the struggle to
3 establish self.
4
5
The unthought known
6
7222 That inherited set of dispositions that constitutes the true self is a
8 form of knowledge which has obviously not been thought, even
9 though it is “there” already at work in the life of the neonate who
10 brings this knowledge with him as he perceives, organises,
1 remembers and uses his object world. I have termed this form of
2 knowledge the unthought known (1987) to specify, amongst other
3 things, the dispositional knowledge of the true self. More complex
4 than an animal’s instinct, which is another manifestation of an
5222 unthought knowledge, how much of this knowledge is ever to be
6 employed and brought into the subject’s being depends entirely on
7 the nature of this child’s experience of the mother and the father. If
8 the mother and father have a good intuitive sense of their infant,
9 so that their perception of his needs, presentation of objects for his
20 “use” and representation of the infant (in the face, body gestures
1 and language) are sensitive to his personality idiom, then he will
2 experience the object world as facilitating. When this happens, we
3 have children who take joy in re-presenting themselves, celebrating
4 the arts of transformation because they have experienced
5 transformative mothering and fathering and know from the authority
6 of inner experiencing that latent knowledge can be given its life.
7
8
The primary repressed unconscious
9
30 Perhaps the theory of the true self—as an inherited personality
1 potential—is compatible with Freud’s concept of the primary
2 repressed unconscious. In “The Unconscious”, Freud wrote: “The
3 content of the unconscious may be compared with an aboriginal
4 population in the mind. If inherited mental formations exist in the
5 human being—something analogous to instinct in animals—these
6 constitute the nucleus of the unconscious” (1915, p. 195). These
7 “inherited mental formations” that “constitute the nucleus of the
8 unconscious”—the primary repressed unconscious—may be equiva-
922 lent to the idiom of the true self. Laplanche and Pontalis (1973)

11
12 CHRISTOPHER BOLLAS

understand Freud’s effort to conceptualize inherited schemata: “The

typical phantasies uncovered by the psychoanalysis led Freud to
postulate the existence of unconscious schemata transcending
individual lived experience and supposedly transmitted by heredity;
these he called ‘primal phantasies’” (p. 315).
To be sure, Freud’s view of mental preformation expressed his
adoption of Lamarck’s theory of the genetic transmission of acquired
characteristics, an argument I do not support. Human idiom is the
derivative of a genetically biased disposition, but I do not know what
factors suggest this determination. The experience of each foetus,
inside the womb, will also contribute to the infant’s personality
idiom, as will birth itself. Still, if I see, as do most parents, not only
psychological but personality resemblances between my child and
myself, his wife and members of our families, it is clear to me—in a
most unscientific way—that my child has inherited features of his
ancestral family idiom. But such a transmission need hardly be the
inheritance of acquired traits, as I presume the ancestral idioms are
not acquired but are derivatives of their own genetic history. This
does not speak to the question of the genetic origins of idiom, but
such a consideration is far beyond my capability. For me it is enough
to say that infants, at birth, are in possession of a personality potential
that is in part genetically sponsored and that this true self, over the
course of a lifetime, seeks to express and elaborate this potential
through formations in being and relating.
Freud did not develop his theory of primary repression, and used
it mostly to mark the baseline in the journey of mental contents from
the unconscious, through the preconscious, to consciousness. His
theory of the unconscious was devoted to repression proper: to the
banishment of an idea to the system unconscious. When mentioning
the primary repressed unconscious, he characterized it as the domain
of primary instincts that have a nucleus to them (by virtue of the
repression, not as an intrinsic organization) that attracts conscious
ideas, pulling them into the system unconscious and thus co-
operating with the anti-cathexis exerted by the system preconscious
to sustain repression.
If we substitute the idiom of personality (or true self) for the
instincts1 as the nucleus of the primary repressed unconscious, then
we can argue that the core of unconscious life is a dynamic form that
seeks its being through experience. Winnicott erred, in my view,

12
 A THEORY FOR THE TRUE SELF 13

122 when he linked the true self to the id and the ego to the false self.
2 He intended to emphasize the true self’s representation of instinctual
3 life, but in so doing failed to convey the organization of person that
4 is the character of the true self. If the true self is the idiom of
5 personality, it is therefore the origin of the ego, which is concerned
6 with the processing of life. Naturally instincts are a part of the ego,
7222 and without delving into psychoanalytic metapsychology, I will only
8 add that there is no reason in Freudian theory why we cannot hold
9 that the energy of the instincts is intrinsic to and inseparable from
10 the economics of ego life. But the drives are always organized by the
1 ego, because this true self that bears us is a deep structure which
2 initially processes instincts and subjects according to its idiom.
3 If the ego is synonymous with the true self at birth, then the
4 infant’s negotiation with the mother and father establishes mental
5222 and organizational structures that subsequently become part of
6 the ego, but are not equivalent to the true self. The unthought
7 dispositional knowledge of the true self inaugurates the ego, but
8 increasingly the ego becomes an intermediary between the urges of
9 the true self (to use objects in order to elaborate) and the counter-
20 claims of the actual world. (This distinction is very similar to that
1 made in classical psychoanalysis where the ego is seen as a derivative
2 of the id, increasingly differentiated from the id as it manages the
3 child’s relation to the outside world.) We are still addressing the issue
4 of process and not of mental representation. A part of the ego
5 processes the demands of environmental reality, and its structure
6 changes according to the nature of the interaction with the object
7 world. When this dialectic is thought about, the thinking occurs in
8 the psyche, where that which is thinkable from true self experiencing
9 is represented in the internal world.
30 Perhaps the primary repressed unconscious consists originally of
1 the inherited potential and then those rules for being and relating
2 that are negotiated between the child’s true self and the idiom
3 of maternal care. These rules become ego processes and these
4 procedures are not thought through, even though they become part
5 of the child’s way of being and relating. They are therefore part
6 of the unthought known and join the dispositional knowledge of
7 the true self as essential factors of this form of knowledge. Freud’s
8 letter to Fliess of 6 December 1896 suggests that he knew there were
922 unconscious registrations of experience not unlike theories of being

13
14 CHRISTOPHER BOLLAS

and relating, and he termed them conceptual memories. “Ub

[Unbewusstsein, unconsciousness] is the second registration, arranged
according to other, perhaps causal relations. Ub traces would perhaps
correspond to conceptual memories, equally inaccessible to con-
sciousness” (1896, p. 208).
Rules stored in the primary repressed unconscious differ from the
mental contents that are repressed to the system unconscious. The
secondary repressed unconscious stores thoughts which give rise to other
derived ideas as they seek disguised representation in consciousness.
The primary repressed unconscious stores processes (of self experiencing
and self-other relating) that are operationally determined in the
infant’s , then child’s, negotiation with the mother’s mothering. In
The Shadow of the Object (1967), I argued that through a receptive
frame of mind, a patient evokes news from within the self whereby
new internal objects are created.
Perhaps this is so because the process of knowledge of the
unconscious ego is thought through. That is, that which has never
been thought about but is a useful bit of working knowledge is
mentally processed. Topographically speaking this means that
through a kind of active reception to internal information the
preconscious indicated interest in the unthought ideas that process
both self and other-relating. Perhaps Freud gives us a clue as to how
this can happen through his theory of endopsychic perception—that
mental awareness of “the structural conditions of [our] own mind”
(1913, p. 91). Certain mental representations depict the working of
the ego itself, rather like a cinema projector casting the imagery
of its own internal operations on the screen. It is possible that some
internalized paradigms that are part of the working structure of the
ego find representation in the internal world, a projection of
the workings of the ego.
In my view there are differing moments in analysis when the
patient transforms process knowledge into ideation, through the
representation of dream, daydream or phantasy. This may occur in
a period of self-experiencing during an ordinary regression to
dependence, when through a particular kind of attentiveness and due
to deepening emotional reality, the analysand transforms a scrap of
unthought knowledge into its thinking. Most frequently, however,
it is through the interlocking logics of the patient’s transference, when
both persons psychologically enact a process, that this knowledge is

14
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122 first thought about by the patient. In some respects, then, it is the
2 paradigm potential of the transference-countertransference category
3 that elicits unconscious rules for being and relating, and trans-
4 forms these lived processes into mental representations. Indeed,
5 the analyst’s countertransference is often just such a journey of
6 transformation from the object of the patient’s process to the affective
7222 and ideational representation of the process.
8
9
In-formative object relating
10
1 If unthought knowledge begins with inherited dispositions, the
2 infant will soon know about the laws of interrelating through the
3 relation to the mother, and this then will also become a feature of
4 the unthought known. Such knowledge is composed of all those
5222 “rules” for being and relating conveyed by the mother and father
6 to the infant (then to the child) through operational paradigms
7 rather than primarily through speech or representational thought.
8 In other words, the child learns theories for the management of
9 self and other through the mother’s mothering. As the mother’s
20 transformational idiom alters the infant’s and child’s internal and
1 external world, each transformation becomes a logical paradigm
2 replete with complex assumptions which no infant or child can think
3 out. These are meant to be the rules of this infant-child’s existence,
4 and they are determined by the mother’s presentation of them to her
5 infant, in interaction, of course, with his unique idiom.
6 As infant and mother are mutually in-formative, they act upon
7 each other to establish operational principles derived from inter-
8 relating. Of course, the mother forms an internal object representation
9 of her infant. But she is also in-formed by the infant’s true self, so
30 that her unconscious ego is continuously adapting to her infant. And
1 to a far greater extent the infant is given form(s) by the mother’s logic
2 of caretaking. Object relations during the first years of life are always
3 in-formative, so much so that such conveying of information could
4 be termed in-formative object relating, to identify object relations that
5 sponsor ego structures. In-formative object relating can refer either
6 to the alteration of ego structure or to the contents of psychic life or
7 to both. As the mother transforms the child’s self states, she may
8 induce significant ego alterations, a change in the child’s processing
922 of self and other, that may yield only minimal mental representation

15
16 CHRISTOPHER BOLLAS

in the psyche. In-formative object relating at a later period of psychic

development may result in the child mentally representing attitudes,
actions, and other communications from the parent. This is less
fateful than early in-formative object relating when the child’s
adaptations result in more ego change.

Signs of the true self

A question arises. How does the analyst identify the presence of the
patient’s true self? Unlike the latent thoughts which constitute a
manifest text, or the chain of signifiers that link the freely associated,
or the familiar, if various, constellations of defences, the true self
cannot be easily isolated as an object of study. A latent text, several
signifiers, a network of defences can all be pointed out to a patient.
As the true self is, however, only a potential, it comes into being only
through experience. It does not have an established meaning
(unconscious or otherwise), as its significance is contingent on the
quality of object experience. Yet in the course of a clinical hour, the
analyst can sense when the patient is using him to elaborate an idiom
move, and afterwards it is possible—indeed often quite meaningful—
to indicate how a patient has used one to achieve a self experience.
If the psychoanalyst has reached a decision to allow himself to be
used as an object, then he is in a position to know something of the
nature of such use. He knows the analysand’s true self through
his very particular use of those elements that constitute human
personality. For example, a patient may commence a session in a
light-hearted mood, imitating a relation to one based on a sense of
joy. The patient may need me to facilitate this use of an element (joy)
in relation to an object. Perhaps he will need, as well, my sense of
humour, which I may provide (in Winnicott’s sense of “facilitate”)
by chuckling when the patient tells a joke or makes a wry comment
on life. If the analysand’s comment is amusing, then the analyst’s
reception to amusement is essential to the patient’s use of the analyst
at that moment. This is indicative of true self use of the analyst, where
the patient is using the analyst’s sense of irony, or sense of humour.
If the patient’s comments constituted an effort to be ironic and
amusing, then more likely than not, the communication is evidence
of false self and the analyst’s sense of irony or humour will not be
inspired and therefore not used. Perhaps the analyst’s senses of

16
 A THEORY FOR THE TRUE SELF 17

122 awkwardness or irritation will be evoked by such a false self act and
2 this may complement the patient’s own discomfort.
3 Perhaps a patient becomes highly articulate, evoking the analyst’s
4 capacity to interpret unconscious communications. The analyst then
5 is used for his ability to concentrate and bring his analytic intellect
6 to bear on the task. This could constitute a movement of true self as
7222 it uses the object.
8 On another occasion a patient, perhaps after reporting a dream
9 and its associations, searches for the analyst’s sense of intellectually
10 creative freedom. He inspires the analyst’s free associations. Such
1 associative freedom might be warranted one moment in working on
2 a dream and then not be correct on another occasion when the patient
3 wants the analyst to “hold” the dream and its associations, needing
4 the analyst to be in a quiet and reflective state.
5222 The aim of these reflections is to suggest an important clinical
6 differentiation in the patient’s use of the analyst. True self use of an
7
analyst is the force of idiom finding itself through experiences of the object.
8
Although at times such idiomatic use of the analyst may reveal
9
patterns of personality, the analysand’s aim is not to communicate
20
a child-parent paradigm script but to find experiences to establish
1
true self in life. At other times, however, a patient does indeed create
2
an object relation to convey some rule for being and relating derived
3
from his relation to the mother or father.
4
As I have argued that the ego is the unconscious organizing
5
6 process—the logic of operations—its choices will ultimately reflect
7 both the innate true self (an organization that is its precursor) and
8 the subsequent structures developed out of partnership with the
9 mother and father. Therefore any ego operation in adult life will
30 inevitably be some kind of mix of true self and true self’s negotiation
1 with the world. There is no pure culture of true self, just as there is
2 no unmediated presence of the mother’s structure of caretaking.
3 Clinically, however, we see uses of the analyst substantially more
4 on the side of true self movement which will override our immediate
5 consideration of any related ego structure. The meeting point of the
6 two factors in an analysis (of true self and internalized object
7 relations) is often when true self movement is arrested by some
8 paradigmatic diversion (or distortion) that is represented in the
922 transference.

17
18 CHRISTOPHER BOLLAS

How does the analyst know how to distinguish a true self use of
him from a paradigmatic use? The clue, I think, rests in the internal
information provided in the countertransference. When an analyst
is used to express a paradigm derived from an object relation, he is
coerced into an object relation script and given a certain sustained
identity as an object. He is “set up” to play a part in the completion
of a role that has become an ego operational paradigm. When,
however, this does not occur, when an element is elicited in him to
be used by the patient and then abandoned (with no aim to set the
object up as part of the logic), then in my view this is more likely to
be a true self movement to its experience through the object.
Are these systems of knowledge always distinguishable? I think
not. As the mother operationalizes the infant’s true self into the
infant-mother object relationship, true self becomes part of the
dialectic of interrelating. A true self idiom move will become part of
a relationship. But in the first months of life, a good enough mother
facilitates the infant’s true self, so he experiences object-seeking as
useful. If, on balance, a patient’s use of the analyst is useful, where
transference experience is sought in order to elaborate the core of
the self, then the clinician will not attend to the self-object paradigms
latent in any segment of such use. Only when a pattern establishes
itself, when a complex of uses is repeated, does the analyst shift
attention to consider the laws implied in this category of unthought
knowledge.
It is possible then to say that much of what occurs in an analysis
has not been articulated or thought before. Indeed, it is perfectly
natural that this should be so as until the intervention of psycho-
analysis (as far as I am aware), there was no cultural space for the
articulation of the unthought known in quite this careful manner.
While I think it is possible for the psychoanalyst to understand and
interpret those theories of being and relating that typify an
analysand’s approach to life, it is difficult, in my view, to see the
journey taken by the true self in the analysis. Of course, there are
many times when we sense that we are being used to process
an idiom move, we know that some of our interpretations have a
particular transitional function for the patient but such lucidity,
significant though it is, is a derivative of that deep, silent, profoundly
unconscious movement taken by the true self and effected, with equal
unconsciousness, upon ourselves. We can analyse the rules for being

18
 A THEORY FOR THE TRUE SELF 19

122 and relating when they are recreated in the transference and its
2 countertransference, but we cannot analyse the evolution of the
3 true self. We can facilitate it. We can experience its momentary use
4 of our self. We can identify certain features. But we cannot “see” it
5 all of a piece, in the way that we “see” what unconscious meaning
6 there is that lies hidden in the narrative text. To some extent this is
7222 because it exists only in experience and is contingent upon the
8 nature of experience to trigger idiom moves. Perhaps we need a new
9 point of view in clinical psychoanalysis, close to a form of person
10 anthropology. We would pay acute attention to all the objects
1 selected by a patient and note the use made of each object. The
2 literature, films and music a person selects would be as valued a part
3 of the fieldwork as the dream. Photos of the interior of the
4 analysand’s home, albums chronicling the history of domestic object
5222 choice, dense descriptions of their lovers, friends, enemies might
6
assist us in our effort to track the footsteps of the true self. But I fear
7
we should know only a bit more than we otherwise would were no
8
such effort made, as the choice of object tells us little about the private
9
use of the object. It is possible for an analyst to note how he has (or
20
has not) been used by a patient, and to comment on how a patient’s
1
very particular use of the analyst, at a moment in the session,
2
expressed a feature of this analysand’s true self.
3
Although Winnicott’s theory of an inherited disposition is related
4
5 to Melanie Klein’s theory of instinct (1952) as possessing an innate
6 knowledge of the relation to the object (as for example the relation
7 to the breast), his use of the concept to identify the inner originating
8 source of the spontaneous gesture and my view that the true self
9 exists through the use of an object suggest a different emphasis. The
30 concept of idiom, to specify the unique personality potential of each
1 individual—a potential that is only partly articulated through the
2 experiencing of a lifetime—emphasizes the innate factor as a
3 personality theory rather than simply as universal phylogenetic
4 knowledge. I agree that such phylogenetic knowledge of the breast,
5 perhaps of the face, perhaps of the father, does exist, but it is more
6 accurate to say that such phylogenetic knowledge is only a part of
7 the inherited factor, as I think infants inherit elements of their
8 parents’ personalities by virtue of the genetic transmission of genetic
922 structure.

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20 CHRISTOPHER BOLLAS

To some extent, Bion’s theory of “preconception” (1962) empha-

sizes that need for experience defined by Winnicott as essential to
realization of the true self. Infants are born with innate preconcep-
tions, according to Bion, which, through experience that matches a
preconception, lead to realizations that foster a conception. The true
self is a highly complex idiom of personality preconceptions that
come into realization through experiences in life that resonate with
the preconception. As such, certain experiences in life feel incredibly
valid or important to the person as they seem to register the essence
of the self.
In fact, when an experience arrives to express the true self, the
individual is able to be spontaneous, to be tru(er) in that moment.
The ordinary joy, found by linking a true self preconception with
the object world, is a very special form of pleasure. I think of this
factor as well served by the word jouissance, which is an important
part of Lacan’s (1960) formulation of psychoanalysis. Jouissance is the
subject’s inalienable right to ecstasy, a virtually legal imperative to
pursue desire. Perhaps this is a good definition of the ruthless
pleasure of the human subject to find joy in the choice and use of
the object. Indeed, there is an urge to use objects through which
to articulate—and hence be—the rue self, and I term this the destiny
drive.

Essential aloneness
Something of what Winnicott (1963) means by the isolate that we
are is determined by this true self. Shadowing all object relating is
a fundamental and primary aloneness which is inevitable and
unmovable. And this aloneness is the background of our being;
solitude is the container of self.
In his book Human Nature (1988), Winnicott poses the following
question: “What is the state of the human individual as the being
emerges out of not being? What is the basis of human nature in terms
of individual development? What is the fundamental state to which
every individual, however old and with whatever experiences, can
return in order to start again?” (p. 131). He replies: “A statement of
this condition must involve a paradox. At the start is an essential
aloneness. At the same time this aloneness can only take place under
maximum conditions of dependence” (p. 132).

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 A THEORY FOR THE TRUE SELF 21

122 Essential aloneness is a positive term for Winnicott, an isolation

2 that is supported by a human environment. As this aloneness
3 characterizes the environment out of which being emerges, we carry
4 it with us through life. Before aloneness, according to Winnicott, is
5 “unaliveness”: “the experience of the first awakening gives the
6 human individual the idea that there is a peaceful state of unaliveness
7222 that can be peacefully reached by an extreme of regression” (p. 132).
8 This aloneness is a transitional state between unaliveness and
9 aliveness characterized by dependence and instinctual life. For
10 Winnicott, “the recognition of this inherent human experience of
1 pre-dependent aloneness is of immense significance” (p. 133).
2 Perhaps one day we will discover that we possess existence
3 memories, that our experiences become a part of our being which
4 itself is a form of remembering, and which in turn is available for
5222 transformation into representation through imagination, such as in
6 the dream. If so, foetal experiences become part of our being, and
7 are available for mental elaboration through the imagery of dreams
8 and phantasies which represent it.
9 In the long evolution of the foetus, from its pre-organic history
20 (in the genetic make-up of the parents) to its birth, and then in the
1 dramatically progressive evolution of the infant in those first two
2 years prior to speech, the human being lives a profoundly dependent
3 life, at first literally inside the mother, then inside the postnatal
4 interrelation—and all of this lived before speech. The progression
5 from prenatal essential aloneness to the adult’s capacity to be alone
6 (the action of Winnicott’s “isolate”) testifies to our early self, to the
7 experience of the idiom of the true self, finding its trueness through
8 movement pleasures (prenatal and postnatal) that exist in a pre-
9 cultural category of significance; its subsequent elaborations, through
30 certainly using cultural objects, serve its own pleasure in articulating
1 itself, rather than in understanding and conveying the meaning
2 of the cultural objects used. The true self listens to a Beethoven
3 sonata, goes for a walk, reads the sports section of a newspaper, plays
4 basketball, and daydreams about a holiday—not to know these
5 “objects” and then to cultivate this knowledge into a communication,
6 but to use these objects to yield self experiences. (Of course the use
7 of an object will yield information about it. What we learn from object
8 use becomes immediately available to another category of human
922 experience: the repressed unconscious.)

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22 CHRISTOPHER BOLLAS

In our true self we are essentially alone. Though we negotiate our

ego with the other and though we people our internal world with
selves and others, and though we are spoken to and for by the other
that is speech (Lacan’s theory of the Symbolic) the absolute core of
one’s being is a wordless, imageless solitude. We cannot reach this
true self through insight or introspection. Only by living from this
authorizing idiom do we know something of that person sample that
we are.
In some respects psychoanalysis is a place for the experiencing of
essential aloneness. There is a Waiting for Godot silence to many
analytic hours. The experienced analysand, dispensing with that pre-
sessional foreknowledge typical of the novice patient (who is anxious
to prove worthy of the analyst’s concentration), lingers on the couch,
just waiting. Inside the darkened and mute theatre of the mind he
remembers having had a dream the night before. But he does not
recall the dream. Instead he “sees” the darkness, recalls the psyche-
soma at night, and rests now in the shadows of that non-existence
that we are between the acts of the dream. Or he has a brief sense
of a forgotten memory. He does not recollect the memory, he senses
its unremembered presence. He waits for it to show up, if it will.
This waiting-about mirrors that interval inside the self, as we rest
between psychic registrations, like cinema-goers who see a film clip,
then face a darkened and empty screen. The darkened screen is as
much a part of our life as is the play of images across its illuminated
surface. We are as often waiting in the interiors of silence and dark-
ness as we are informed by the projections of psychic news. There,
in that solitary space, we repeatedly contact that essential aloneness
that launches our idiom into its ephemeral being.

Note
1. I do not propose that instinctual life does not exist. I simply do not give
it that primacy that it holds for Freud. Somatic urges work all the time
upon the mind. The drives of the id do demand expression, a task
performed by the ego. But each person organizes the id differently and
this unique design that each of us is is more fundamental to the choice
and use of an object than the energetic requirements of the soma which
themselves express the idiom of the true self.

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 A THEORY FOR THE TRUE SELF 23

122 References
2
Balint, M. (1968). The Basic Fault: Therapeutic Aspects of Regression. London:
3
Tavistock.
4
Bion, W.R. (1962). Learning from experience. London: Karnac, 1984.
5
Bollas, C. (1987). Shadow of the Object: Analysis of the Unthought Known.
6
London: Free Association Books.
7222
Freud, S. (1887–1902). The origins of psychoanalysis. Letters to Wilhelm Fliess,
8
drafts and notes. E. Mosbacher, J. Strachey (Trans.), M. Bonaparte, A. Freud,
9 E. Kris (Eds.). London: Imago, 1954
10 Freud, S. (1915). The Unconscious. SE 14. London: Hogarth.
1 Laplanche, J. & Pontalis, J.-B. (1973). The Language of Psycho-Analysis. New
2 York: Norton.
3 Milner, M. (1969). The Hands of the Living God. London: Hogarth.
4 Winnicott, D. W. (1954a). Metapsychological and Clinical Aspects of
5222 Regression within the Psycho-Analytical Set-Up. In: Through Paediatrics
6 to Psycho-Analysis. London: Hogarth, 1958.
7 Winnicott, D.W. (1954b). Withdrawal and Regression. In: Through Paediatrics
8 to Psycho-Analysis. London: Hogarth, 1958.
9 Winnicott, D.W. (1960a). Ego distortion in terms of true and false self. In:
20 The Maturational Process and the Facilitating Environment. London: Hogarth,
1 1965 [Karnac, 1990].
2 Winnicott, D.W. (1988). Human Nature. London: Free Association Books.
3
4
5
6
7
8
9
30
1
2
3
4
5
6
7
8
922

23
CHAPTER TWO

Destructiveness and play:

Klein, Winnicott, Milner
Michael Podro

T
hirty years after The Interpretation of Dreams, literary criticism
reabsorbed—reclaimed—Freud’s use of poetics in his analysis
of wit and the dream work; it reclaimed the sense of conflicting
meanings or condensed meanings and their expressive possibilities,
pre-eminently in Britain with William Empson’s Seven Types of
Ambiguity. The core of their shared thought was that the mind, in
making and responding to poetry (to keep to poetry for the moment),
moved between two psychic functions: that which observed rational
stringencies and conventions and, in contrast to it, a regression that
loosened those stringencies, allowing the play of ambiguity,
disrupting conscious and consistent thought to open the way for new
kinds of awareness. One should perhaps still observe that this
“regression” had, as in wit and the dream work, its own structuring
capacity.
Subsequently, in the mid-century, there had been a bifurcation in
psychoanalytic thinking that might be represented by the difference
between two notions of disruption and destructiveness. Melanie
Klein and those under her influence saw the underlying scenario
within mental life as constituted by the fantasies of aggression
towards the loved maternal figure and the struggle to escape the
remorse that this produced; this re-enacted itself as a conflict between
egotistical imperiousness as opposed to a sense of personal limitation
and concern for others. In the literary criticism under Klein’s aegis,
this is taken to be the subject matter or the thematic material of art,
even giving to art the rationale of symbolizing the restitution of the

24
 DESTRUCTIVENESS AND PLAY 25

122 damaged internal object by the integration and harmony of the

2 achieved work (Klein, 1929).
3 In the same period a divergent position emerged. Winnicott,
4 although he did not write directly about aesthetics or art, did write
5 about the mental creativity that he assumed the arts exemplified. His
6 writing was primarily concerned with the development of the initial
7222 mother-infant relation and the consequences of that relation in
8 subsequent life. Integral to this first relationship was the infant’s
9 destructiveness and its need to discover that the object of its
10 aggression could survive its largely fantasized assault; that she—and
1 the infant itself—would not be overwhelmed by its rage. This notion
2 is developed most fully in two papers, Creativity and its Origins and
3 The Use of an Object (Winnicott, 1971). A second strand in his thought
4 is the need to resist premature differentiation between fantasy and
5222 objective reality, to preserve what he called a transitional space: the
6 infant’s, and later the adult’s creativity depended upon leaving
7 space for the play of the mind that did not insist on separating the
8 fictions projected (personal, or shared with others, as in children’s
9 games) from the reality they were projected upon (Winnicott, 1971,
20 passim). The spontaneity of play, together with aggression, is needed
1 for someone to feel fully alive, equally essential for human creativity
2 in ordinary living and in an art. Incompatible with such vitality
3 was the development of the false self, inward compliance with
4 the conventions and expectations of others—family, society, the
5 academy, or accepted taste (Winnicott, 1960). This was to have its
6 counterpart in how the psychodynamic notion of the need for de-
7 composing established modes of representation or composition,
8 converged and interacted with modernist poetics and artistic
9 theory. This is very different from the Kleinian theme of destruc-
30 tion and restitution as something represented or rehearsed in the
1 content of the work of art. I want now to contrast these two values
2 of disruption.
3 In her commentary on the Oresteia, Klein examines each
4 protagonist, tracing the development of their superegos through their
5 imagined relations to each parent (or to one parent in the case of
6 Athene). In central cases she rehearses the conflict of assertive greed
7 or omnipotence on the one hand, and mitigating kindness on the
8 other, the attempt at reparation towards an internalized damaged
922 figure (Klein, 1963). When we turn from Klein’s comments to the

25
26 MICHAEL PODRO

Oresteia itself, we become aware of a dimension that has been

completely—if legitimately—missed out: the way the verse and the
construction of scenes leads us to rehearse the internal doubts and
ambivalence of the protagonists: the Watchman at the beginning
“knowing, but if asked forgetting what can or may be told”; the
chorus trying to grasp what is inaccessible to them, what it is that
the prophetess Cassandra is envisioning; or the interchange of Electra
and Orestes where, in her despair, she does not allow herself to
believe that her brother has returned. To take a more extended
example of imagining internal and external events: the chorus telling
of Agamemnon coming to decide upon the sacrifice of Iphigenia, the
conflict in his mind ended by unreflecting action. What the poetry
elaborates upon is not only Agamemnon’s internal tension and its
abandonment in violence, but the physical and psychological realities
of the event as seen by different protagonists: Iphigenia herself, and
the waiting soldiers who assist in her murder, and also, at almost
the same moment, see what they have done. Klein’s account lacks
any sense of such unfolding of episodes, of intersection of experi-
ences, or the inventiveness by which the basic legend is elaborated
and made resonant in the Athenian context.
But that is, one might argue, largely outside the scope of Klein’s
interest. Her concern was to trace the psychological mechanisms
underlying complex human behaviour and human morality,
showing how a conception of the internal life that had—as she
believed—been developed in earliest infancy could be mapped onto
figures in the Oresteia. Nevertheless, Klein does hold the view that
the work of the artist is a matter of integrating internal life and
making reparation to loved but damaged internal objects. Even if we
accept Klein’s conception of the mind and its development, there
are two problems. Firstly, how literally or narrowly are we to
understand the content of works of art as always symbolizing the
inward reparation towards damaged but loved objects? Secondly,
and much more seriously, how far can we disregard, as she would
seem to do, the capacity of the mind to invent and expand the range
of its interests and sensitivities, altering its internal landscape and
so the scope of its life? Under Klein’s influence there has been a
procrustean tendency to disregard everything that cannot serve as
the symbolization of an internal narrative, and, more specifically, the
narrative Klein had laid down.

26
 DESTRUCTIVENESS AND PLAY 27

122 We see this in a much more sensitized piece of literary criticism.

2 In their commentary on King Lear in their book The Chamber of
3 Maiden Thought, Margot Waddell and Meg Harris Williams describe
4 the final scenes of the play, where Lear comes in carrying the dead
5 Cordelia. The authors comment on Lear’s speech “We two alone
6 will sing like birds i’ the cage . . ./And take upon’s the mystery of
7222 things,/As if we were God’s spies . . .” (V: iii) and the last scene
8 of the play as follows:
9
10 Lear would like to retreat back into Plato’s cave and forever watch
1 the shadows on the wall, secure in his feeling that he is at the
2 heart of the mystery of his mother, and that his good mother
3 Cordelia (his cordial, heart’s elixir) would never be so cruel as
4 to wean him and send him out into the world. But this womblike
5222 security must be shed—imaged in Cordelia’s body becoming
6 “dead as earth”; and Lear’s ultimate heroic effort of imagination,
7 in which he believes he sees the spirit emerging from her lips,
8 enables him finally to relinquish his omnipotent hold on the
9 “daughter” of his inner world of the creative spirit. [p. 37]
20
1 This is suggestive criticism, but the Platonic cave reference seems
2 to reverse the significance of being free of day-to-day winning and
3 losing. More seriously, Lear, seeking to see breath on Cordelia’s lips,
4 is not a heroic effort of imagination, enabling him “to relinquish his
5 omnipotent hold” on the creative spirit, but despair at looking at
6 his dead daughter. To treat this last scene as some kind of spiritual
7 triumph on Lear’s part, rather than playwright and audience facing
8 the sense of her death and Lear’s incapacity to do so, is an evasion.
9 It is also to efface the relation of the audience to the representation
30 of events, their embodied factuality; it is to ignore the battle with
1 external contingency and mortality. The point of disputing this
2 detail in what is a very sophisticated essay is to arrest the collapse
3 of a critical or aesthetic perspective into that of the therapist searching
4 for internal events alone. This example of reading Lear suggests a
5 more general point. The writers’ overall Kleinian view of the human
6 mind may indeed have its affinity with Shakespeare’s without being
7 susceptible to such direct application, such direct reading off. Like
8 old-fashioned moralizing, this curtails the complexity of the play.
922 (A comparably prescriptive reading is given of A Winter’s Tale.)

27
28 MICHAEL PODRO

Marion Milner was in effect responding to Klein and her followers

when she wrote: “Certainly for the analyst, in certain stages in
analysing an artist, the importance of his work of art may be the lost
object that the work recreates: but for the artist as artist, rather than
as patient, and for whoever responds to his work, I think that the
essential point is the new thing he has created, the new bit of the
external world that he has made significant and ‘real’ through
endowing it with form” (Milner, 1950/1957, p.160).
A central aspect of the problem of painting for her personally was
to overcome the sheer externality of the object to be depicted, its
remaining alien to the marks she made on paper; at the same time
the marks she made seemed to her to become inert. The problem
was two-sided: the alienness of the object once she set out to paint
it, and the deadness of the marks she put down on the paper or
canvas:

. . . on looking through some earlier attempts at landscape, I

noticed that the only glimmer of interest came where there was
a transition of colour; for instance, where the yellow lichen on
a barn roof had tempted me into letting the yellows and reds
merge, unprotected by any felt division, so that you could not
say exactly where one colour began and another ended. Also I
noticed that a smear of paint left on the palette after painting,
where white merged into red, blue, brown, was interesting and
alive; whereas the picture painted with the same colours but
carefully separated . . . was dead. [1950/1957, p. 23]

She read in current manuals on painting that to overcome that

externality of the object it was necessary to permeate the subject with
one’s own feeling and so to transfigure it, but it was not something
she could achieve (ibid., p. 36). Such imaginative envelopment of
the subject, when one actually set out to draw it, became deeply
problematic:

Before beginning one could spiritually envelop the object and

feel inspired, transcending space and separateness. But once
begun it was necessary to face the fact of being a body that does
not transcend space as the spirit can. At the moment of having

28
 DESTRUCTIVENESS AND PLAY 29

122 to realise the limits of the body, when beginning to make marks
2 on paper, all the anxieties about separation and losing what one
3 loved could come flooding in. [ibid., p. 57]
4
5 This intimates Milner’s sense of a relation to objects of physical,
6 even sexual, possessiveness. The business of painting involves
7222 absorbing the object into its own procedures and these in turn are
8 felt as an extension of one’s body. If at this point one reached for
9 some set of rules to bring the anxiety and anger under control, “the
10 very reliance on rules” would perhaps “stultify the very thing one
1 was seeking to achieve”. And the very idea of such enveloping might
2 fail partly on account of “that subtle secret possessiveness which,
3 under the guise of loving consideration, can hardly allow the other
4 to be itself at all” (ibid., p. 57). As Milner speculated about her sense
5222 of inhibition and disappointment she came to think of the problem
6 as both a fear of letting go, a fear originating in bodily letting go,
7 and, by the same token, a reactivation of the infant’s anxiety to adapt
8 to social living, as if learning to paint were like bringing instinctual
9 process under control. Milner is not describing technical difficulties
20
but difficulties about the very state of mind that she had invested in
1
the business of painting, even before a mark has been made.
2
Her solution was to make what she called free drawings. This
3
involved making a mark or gesture and letting this suggest to her
4
what to do next, how to respond to what she had already put down
5
by elaborating upon it within the picture. The response was not only
6
a matter of graphic additions but of developing a story, turning the
7
image into imagery, an adaptation of psychoanalytic free association.
8
In the to-and-fro of visual mark and verbal narrative there was no
9
clear consciousness of the priority of one over the other.
30
1 Milner did not, I think, see her free drawing as achieved works
2 of art, but they intimated what it was that the committed artist must
3 be able to do: “To an established painter, who knows that he can
4 successfully bring what he has taken inside himself back to life in
5 the outside world as a painting, there may be less anxiety in this
6 act of spiritual envelopment in order to paint; but for those of us
7 who have no such knowledge it might seem much safer to make
8 the spirit firmly keep itself to itself and not venture out on any
922 enveloping expeditions” (ibid., p. 63). But even if the position of the

29
30 MICHAEL PODRO

established painter is different, we must assume that this risk must

be part of what any artist faces, as she writes, taking up the thought
of Anton Ehrenzweig, “. . . the rhythms by which the ego’s ordinary
common sense consciousness voluntarily seeks its own dissolution
in order that it may make contact with the hidden powers
of unconscious perception” (Milner, 1987, p. 243): the relation of
externality and internality—objectification and what Ehrenzweig
called de-differentiation.
She accedes, with reservations, to Klein’s view of mental life and
says that in the light of it

. . . one of the functions of painting was surely the restoring and

re-creating externally what one had loved and internally
destroyed . . . But there was another aspect of the function of
painting to be considered, the even more primitive one . . .
painting goes deeper in its roots than restoring to immortal life
one’s lost loves, it goes right back to the stage before one had
found a love to lose . . . It was this aspect of the function of art
that became clearer when I considered the method of the free
drawings and the role of this method in realizing, in making real,
the external world . . . making possible a richer relation to the
real world. [1950/1957, p. 67]

She writes later in the book:

what the . . . innovator in art is doing, fundamentally, is not

recreating in the sense of making again what has been lost
(although he is doing this), but creating what is, because he is
creating the power to see it. By continually breaking up the
established familiar patterns . . . he really is creating “nature”
including human nature. [ibid., p. 161]

The break-up of previously established kinds of order will, she

assumes, render us open to suggestions of previously unarticulated
imaginings. It is assumed that those imaginings themselves will
contain traces of primitive aggression that had permeated mental life.
But the very concept of aggression needs the further differentiation
remarked on above: on the one hand the fantasy of aggression
against a loved figure, and corresponding to that the conception of

30
 DESTRUCTIVENESS AND PLAY 31

122 the work of art as symbolizing and itself constituting a way of making
2 (inward) reparation; in this sense the destructiveness is something
3 prior to the working of the artist, something the work of the artist
4 puts right. But the other sense of destructiveness is part of a relation
5 to what is external and is brought about by the artist as artist;
6 overcoming the alienness of the external world as something already
7222 complete. Here Milner’s explicit argument invites expansion. A
8 mode of representation that is already complete appears to the artist
9 as alien because it is complete despite her. It is only by breaking down
10 her subject matter, and that means breaking down the way it has
1 previously been represented, that the relation to the external world
2 can become remade for oneself, become the construction of one’s own
3 thought. This can only be done when one is sufficiently aggressive
4 and not merely receptive. (One recalls here Winnicott’s positive role
5222 for aggression towards the loved object in infant development as
6
opposed to the false self of compliance.) Milner sees in an art’s
7
inventiveness, its reaching out to the external world and receiving
8
back suggestions from it, an extension of the earliest reciprocity
9
between the receptive and constructive capacities of the mind. What
20
makes her contribution to the debate fifty years ago so distinctive
1
and also highly pertinent to the present, is that it makes the relation
2
of internal and external world thematic, and not merely a condition
3
of symbolizing an internal development; and, in doing this, it begins
4
5 to make intelligible the sense of urgency that drives the making of
6 any work of art, the existential urgency springing from the need to
7 be a participant and not a bystander of one’s own world. “To make
8 experience sing”—to take up Rilke’s phrase from Ken Wright—is to
9 remake it.
30
1
2
References
3 Empson, W. (1930). Seven Types of Ambiguity. London: Chatto & Windus.
4 Klein, M. (1929). Infantile anxiety situations reflected in a work of art and
5 in the creative impulse. In: The Writings of Melanie Klein, I: Love, Guilt and
6 Reparation and other works 1921–45. London: Hogarth, 1975.
7 Klein, M. (1963). Some Reflections on the Oresteia. In: The Writings of Melanie
8 Klein, 3: Envy and Gratitude and other works 1946–63. London: Hogarth,
922 1975.

31
32 MICHAEL PODRO

Milner, M. (1950). On Not Being Able to Paint. 2nd ed. London: Heinemann,
1957.
Milner, M. (1987). The Suppressed Madness of Sane Men. London: Routledge.
Williams, M.H. & Waddell, M. (1991). The Chamber of Maiden Thought.
London: Routledge.
Winnicott, D. W. (1958). Through Paediatrics to Psycho-Analysis. London:
Hogarth.
Winnicott, D.W. (1960). Ego distortion in terms of true and false self. In: The
Maturational Process and the Facilitating Environment London: Hogarth,
1965 [Karnac, 1990].
Winnicott, D.W. (1971). Playing and reality. London: Tavistock, 1971.
[Routledge, 1982]
Wright, K. (2000). To make experience sing. In: L. Caldwell (Ed.), Art,
Creativity, Living (pp. 75–96). London: Karnac.

32
122 CHAPTER THREE
2
3
4
5
6
7222 On humming: reflections on
8
9
Marion Milner’s contribution to
10 psychoanalysis
1
2
3
Claire Pajaczkowska
4

T
5222 here is a state of mind in which things are found. It is an
6 experience of finding something that already exists, but which
7 had not yet been discovered. This capacity for finding is
8 something that is made from within. Marion Milner was particularly
9 alive to the dynamic of making and finding, and how this can be
20 experienced as great joy. In this article I discuss Milner’s distinctive
1 contribution to psychoanalysis and show how it might be used today
2 to think about culture as a frame for finding and making objects.
3 Like doodling, humming exists in a space that links inner and
4 outer, subjective and objective realities; the visceral resonance of
5 sound that vibrates through muscle, tissue and bone is also the sound
6 wave that is heard through the ear and reaches out to some external
7 object or other. It is this state of liminality that makes humming so
8 interesting, and Milner’s work offers the means of understanding
9 experiences of liminality and transitional space.
30 Milner—child, adolescent and adult analyst, and author—enjoyed
1 professional and popular recognition. Herbert Read described her
2 work as having the “force of a sudden illumination”. Following her
3 death in 1997, she is particularly remembered for her significant
4 contribution to theories of culture, creativity and the visual arts.
5 As well as being the friend and colleague of Donald Winnicott,
6 Milner was a founder member of the Independent Group of British
7 Psychoanalysts in the 1950s. Her contribution to psychoanalysis
8 is noted by historians Eric Rayner (1991), Gregorio Kohon (1986),
922 D. Goldman (1993) and F.R. Rodman (2003). The distinctive nature

33
34 CLAIRE PAJACZKOWSKA

of the Independent Tradition in British psychoanalysis has been

noted by many, as have its origins in the turbulent years of analytic
debate and disagreement known as the “Controversial Discussions”,
and we find the dynamic of that turbulence in the annotated
essays The Suppressed Madness of Sane Men (Milner, 1987). There
she described her personal and professional development from a
childhood ambition to be a naturalist, to her work as a teacher, to
her brother’s twenty-first birthday gift of Freud’s Introductory Lectures
on Psychoanalysis, which introduced her to psychoanalysis, to training
as an analyst, supervised by Melanie Klein, and finding her own
idiom there. This time of innovation and emergence in the British
Society finds its resonance in the fluid and lucid quality of Milner’s
writings, which have a paradoxical quality of a strength forged by
fire and yet experienced as spontaneous and new by every generation
of readers.
Coming to her work some decades after its first publication, it is
easier to see the themes of longstanding significance which emerge
specifically from the preoccupations of Britain in the 1950s and
1960s. The mood and tone of Milner and her contemporaries writing
in Britain immediately after the war and the profound optimism of
social democratic idealism that infused the public sector is palpable
in the assumption that state organizations such as the National
Health Service and the Local Education Authorities might listen to
the findings of psychoanalysis.
Winnicott’s experience as a paediatrician working in hospitals and
at the Paddington Green Clinic, colleagues working within the Child
Guidance Movement, and Milner’s own research on the education
of girls, all refer to a world in which healthcare professionals saw
themselves as working to rebuild a new, democratic, inclusive society
where the best would be available to all. This provision of the best
for a new future was most transparently represented by the care
given to raising the next generation, so that babies and their mothers,
nursery school children and adolescents all figured centrally as
the symbols of a nation’s hopes. Post-war British social democratic
psychoanalysis suggested that only if individuals were allowed to
reach for themselves the stage that Winnicott called the “capacity
for concern” would the concept of society be anything other than
empty. The distinctive style of Milner and her colleagues managed
to combine imaginative empiricism, social ethics and a deep

34
 ON HUMMING 35

122 understanding of psychoanalysis. It was one of her hopes, expressed

2 in the dedication of her book On Not Being Able to Paint (1950), that
3 her experiences might enable her son and his generation “to reach
4 more rapidly through learning from others” the knowledge that she
5 had acquired slowly through personal experience.
6 One of Milner’s preoccupations that emerges as being of
7222 longstanding significance, is the centrality of feeling and affect in
8 mental life. Rather than being developed as a systematic theory of
9 affect, this preoccupation appears as an intuitive pattern of reference
10 to feeling, and as a capacity for including emotional states within
1 her reckoning of mental life. Amidst the wealth of ideas and writings,
2 I suggest that there are three concepts that show her understanding
3 of the centrality of feelings and the structuring function of affect
4 on thought, knowledge, relationship and representation. These are
5222 her concept of the “framed gap”, her theory of symbol formation,
6 and her clinical interpretations of the emergence of a self from a
7 relationship of shared “twoness”. A more correct way of describing
8 this process in numerical terms would be to say that out of zero, or
9 no number, one, two and three are simultaneously created. How the
20 infant-mother relationship creates self as well as self and other is one
1 of the fundamental questions of post-war British psychoanalysis, but
2 the form Milner and her colleagues give to this question, and her
3 own links to the concept of illusion in symbol formation, constitute
4 a distinctive perspective. Here I introduce these concepts and then
5 show how they may be used today.
6
7
Framing the gap
8
9 The first of the concepts that initially might have seemed inconse-
30 quential and peripheral, but which Milner retrospectively identified
1 as a unifying concept across her clinical and cultural work, is that
2 of the “framed gap”. The analytic process is framed in time by the
3 regularity of sessions, breaks and routines, and also framed by
4 the agreed space of the analytic encounter. Milner extends this
5 understanding of what analysts call the setting to other cultural
6 expressions of this experience of a boundary. She writes of the
7 framed gap provided by the “blank piece of paper” (1987, p. 225),
8 where the blankness of the space allows the emergence of repre-
922 sentational activity from the subject’s own “blankness” or the

35
36 CLAIRE PAJACZKOWSKA

amnesia that protects the ego from the repressed unconscious.

Other frames in culture include the proscenium arch of theatre
framed by the stage and the curtain, a frame that is vestigially
retained in cinema. Art gallery and museum provide architectural
and institutional frames for seeing art and artefacts differently. The
classroom is a frame which, for a specified length of time, separates
one kind of learning experience from another. Dreams, suggests
Milner, are framed in sleep. The frame is a representational
relationship that marks a subject’s ability to change their relationship
to their unconscious through the creation of a third term, or space
that is constructed as “other”. The frame describes an imaginary line
which demarcates an inner from an outer space, and this can be used
as a metaphor for other processes of delineation and demarcation
within the subject. Milner’s most popular description of its liberating
function occurs in her study of the capacity to shift attention in On
Not Being Able to Paint, where she shows how doodling enables her
to disengage her mind from conscious intentionality and thereby
render it receptive to other, less conscious states of experience.
Milner’s concept of the framed gap is recognizable as a variant of
what neo-Freudians would describe as a form of ego functioning, or
as one condition of the “representational world”, and analysts who
use Bion’s theory might liken it to his concept of the container,
or the way that the “alpha function” contains the “beta elements” of
the mind. It is interesting that these concepts were all developed by
the same generation of analysts, but here I want to show how this
concept of the framed gap is integrated into Milner’s understanding
of symbol formation and how both refer to the role of illusion in
mother-infant relationships. I will return to the concept of the framed
gap, particularly when discussing humming as an acoustic equivalent
of doodling.

Symbol formation
This concept was prominent in Milner’s own practice and theory,
and “The Role of Illusion in Symbol Formation”, the paper she
wrote for an issue of the International Journal in honour of Melanie
Klein (1987 [1955]), is, in some ways, a response to the debates that
“framed” psychoanalytic theory at the time. For example, she writes
from the premise that symbolism is something other than regressive

36
 ON HUMMING 37

122 or defensive ego function, as it had been rather narrowly conceived

2 by Ernest Jones’s interpretation of Freud. Milner’s intuition that a
3 symbol extends from unconscious representation to all forms of
4 mental activity, and to all the forms in which the subject interacts
5 with the “outer world”, is an emphasis that she makes a space for
6 by transgressing the analytic canon. She also reframes the discussion
7222 of symbol formation away from the symbol as concept (whether
8 innate or perceived) to focus on the process of its formation as a
9 representation of feeling states, thus dislodging a cerebral concept
10 of representation for an affective one. The symbol is defined as an
1 emotional equivalent of a mental state or experience, rather than in
2 Jones’s sense of a connection of logical equivalence, albeit a logic of
3 the unconscious. For Milner, the presence of the body, as source of
4 the emotions and feelings for which symbolism is equivalent, is very
5222 different from Jones’s conceptual thoughts about the body. He limits
6 his references to the body to the standard Freudian libidinal tropes
7 of oral, anal and phallic, but Milner includes a range of bodily
8 processes such as breathing, speech, song, movement, sensation, as
9 well as more schematic references to “nipple”, “breast”, “anus” and
20 so forth. The paper, although influenced by Klein, is already differing
1 from the Kleinian concept of symbolism, as Milner works from a
2 different understanding of the relation between infant and mother
3 that does not presuppose a repertoire of innate fantasies that exist
4 in the infant’s mind and structure conceptualization.
5 Further innovation in her paper on symbol formation is evident
6 in her choice of the term “illusion” to describe the relation between
7 feeling and symbol. The word “illusion” has a number of connota-
8 tions, including the idea of a kind of magical thinking characteristic
9 of animism and “primitive thought, deception and trickery”. These
30 two connotations are redolent of Jones’s concept of the symbol and
1 the illusory nature of its relation to reality. However, the etymology
2 of illusion lies in the Latin root ludere, to play, and it is this sense,
3 where symbol formation is understood as one component of the
4 relationship within which transitional objects give way to the
5 transitional space of culture through the triangulation of a merged
6 “two-in-oneness”, that Milner brings to her discussion of symbolism.
7 This is different from the Kleinian trajectory of inscribing innate,
8 unconscious symbolic knowledge of a lexicon of phantasy objects that
922 are seen to reappear in children’s play and adult dreams. This view

37
38 CLAIRE PAJACZKOWSKA

is not substantively different from Jones’s. Milner’s concept certainly

includes some aspects of the Kleinian understanding of reparation,
a symbolic response to the subject’s awareness of aggressive attacks
made on the primal object, as necessary components of the psychic
capacity for using a third, symbolic space. However, the revolu-
tionary nature of Milner’s insight lies in how she understands
the process of symbol formation as the means by which a nascent
subjectivity emerges within the psychic field at the same time as the
other, the object, and the outside world. For Milner there is no “inner
world” without the “outer world”, just as for Winnicott there is no
baby without a mother. This relational dimension of subjectivity,
understood as the product of a structure such as play, the ludere of
illusion, is a substantive advance in psychoanalytic theory. Milner
writes:

In psychoanalytic terms, this process of seeking to preserve

experiences can certainly be described in terms of the uncon-
scious attempt to preserve, recreate, restore the lost object, or
rather the lost relation with the object conceived of in terms
of the object. And these experiences can be lost to the inner
life not only because of unconscious aggressive feelings about
separation from the outer object, but also because it is of the
nature of feeling experience to be fleeting. Life goes on at such
a pace that unless these experiences can be incarnated in some
external form, they are inevitably lost to the reflective life. [1987,
p. 227]

The symbol may be partly informed by the processes Klein

described as “reparative”, but is also “relational”, existing quite
differently from the way “internal objects” are conceived by the object
relations school, where the symbol is a re-creation of a lost or
damaged object. Milner’s concept implies a making, for the first time,
of some kind of representational object that did not exist in this form
before, a process belonging to an “earlier” emotional state than that
of the “depressive position” (1987, p. 228).
French structuralist psychoanalysis, such as that of Jacques Lacan,
Maud Mannoni and André Green, was also evolving along these
lines, albeit in a very different tradition. Mannoni’s The Child, His
Illness and the Other (1970) employs a similar notion of the relational

38
 ON HUMMING 39

122 use of object as signifier, and Lacan’s work revolves entirely around
2 this understanding of the centrality of the signifier in the construction
3 of the subject, although he does not have Milner’s facility for intuiting
4 feeling or for understanding the corporeal.
5 The ludic as an undiscovered dimension of the real was undoubt-
6 edly the empire of Donald Winnicott and Marion Milner, and yet
7222 neither they nor their colleagues ever tried to claim “ownership” or
8 mastery of this empire, understanding it as the privilege of childhood
9 and their work as the privilege of perceiving and understanding it.
10
1
E-merging
2
3 The third concept, the emergence of self from not self, or the
4 significance of the “pre-oedipal” to oedipal structures of subjectivity,
5222 is related to the two concepts discussed above. The framed gap is,
6 in a sense, a symbol of the process through which a subject emerges
7 from the state of being merged, but for this to make any sense, there
8 needs to be an understanding of Milner’s emphasis on the process
9 of emergence, which is often described as part of Milner’s clinical
20 practice, but not limited to it. For example, writing about her friend,
1 mentor, analyst and colleague Donald Winnicott for a memorial
2 meeting at the British Psycho-Analytical Society in 1972, Milner said,
3 “During the war I had shown him a cartoon from the New Yorker.
4 It was of two hippopotamuses, their heads emerging from the water,
5 and one saying to the other, ‘I keep thinking it’s Tuesday.’ It was
6 typical of him that he never forgot this joke” (Goldman, 1993, p. 117).
7 Years later, Milner reflected that the shared joke conveys many of
8 the preoccupations of her work throughout her life, “the threshold
9 of consciousness, the surface of the water as the place of submergence
30 or emergence”. Of course Winnicott’s capacity for understanding the
1 wordless dialogues of infants and mothers was the product of
2 decades of systematic observation as hospital paediatrician, not just
3 of the pursuit of the Zen-like “absent-mindedness of reverie”, but
4 Milner also writes of the need for a “space for absent-mindedness”,
5 a kind of thinking that, having mastered realism, can nevertheless
6 disengage from it and enter a space in which thought does not
7 depend on a marked separation between subject and object, or
8 different types of object, such as days of the week. For analysts, the
922 named days of the working week are perhaps even more significant

39
40 CLAIRE PAJACZKOWSKA

than for other workers as the names can signify the “frame” of the
setting that, at times, may be the only demarcation between psychosis
and reality. Following patients as they regress to dependence can
exert pressure or strain on the boundaries of the analytic setting,
which is in place precisely to offer the analyst and analysand protec-
tion from the fear of becoming merged.
The joke and its image also anticipate another aspect of Milner’s
contributions to the theory of art and culture: her concept of a
medium as the third term which enables the co-existence of two
different realities. The meeting of inner and outer worlds in play
takes place through the medium of the toys; the meeting of conscious
and unconscious thoughts in art takes place through the medium
of the materiality of the artwork: narrative, words, song, musical
sound, paint, clay or other material is simultaneously substance and
communication. For Milner, the concept of medium has some of the
meaning of Winnicott’s concept of culture as transitional space, a
third term enabling triangulation and the co-emergence of ideas of
one, two and three.
According to Milner, the state of mind that exists when emergence
is taking place is not only one of mental structuration, such as the
dawn of self consciousness, or the birth of the subject; it is also
one of distinctive emotion and feeling. This she describes as ecstasy,
the emotional experience of sudden discovery of inner space and
limitlessness, and an intense capacity for concentration. She traces
the minute transformations and fluctuations in the quality of
concentration in her child patients as they move through different
predicaments, and intuits a pattern in the quality of concentration.
Interestingly, she does not then classify this quality into different
“types” of, say, libidinal genres, obsessional, hysteric, paranoid, and
so on, but is interested in what the state of mind means to the subject
as a unique experience.
Milner’s work does include references to schizophrenia, especially
in her case study of “Susan”, the young woman Winnicott asked her
to analyse, but the classificatory system of psychoanalysis is also
something Milner wanted to subject to analysis. She writes in 1987
that if she were to write another paper, it would be on the use and
meaning of the word “mad” as it is used colloquially and clinically.
Milner’s concern for exactness in using concepts impelled her to
research the psychoanalytic accounts of mysticism, a discourse in

40
 ON HUMMING 41

122 which the concept of ecstasy is also used. Her essay includes an
2 interesting review of Bion’s writing on the concept of “O”, which is
3 not unlike the idea of the “framed gap”, and she is able to distinguish
4 her thoughts from his on the grounds that whereas Bion equated
5 mysticism with genius, Milner thought that while genius may share
6 some characteristics with mysticism, the two are not synonymous.
7222 In this study she notes her interest in Lao Tzu’s Zen writings, the
8 Tao Te Ching:
9
10 He who knows the masculine and yet keeps to the feminine
1 Will become a channel drawing all the world towards it,
2 And then he can return to the state of infinity,
3 He who knows the white and yet keeps to the black
4 Will become the standard of the world. [Milner, 1987, p. 262]
5222
6 Milner is interested in the mystical Zen ideal of “absolute vacuity”,
7 whether or not this is equivalent to a state of massive denial,
8 and whether Bion’s idea of letting go of “memory and desire” is an
9 appropriate one for the analytic setting. My sense is that the reference
20 to the philosophy of the Far East functions as a way of reframing the
1 Western philosophical tradition’s conception of gender difference.
2 As a way of reframing the constrictive definitions of masculinity and
3 femininity inherent in the Freudian conceptual apparatus, the
4 “otherness” of another culture enables Milner to reconceive gender
5 without having to become confrontational or adversarial in relation
6 to canonical thought. Both Milner and Winnicott went on to make
7 some extraordinarily fertile and generative insights into the primary
8 femininity of creativity, and their thinking about the play of sexual
9 difference in creativity could not have been formulated within the
30 Freudian framework of western binary differentiation.
1 In the references to black and white Milner refers to her
2 analysands’ use of black paint in their art, differentiating between
3 the bad black and the good black. There is a sense in which the colour
4 black connotes death and another boundary or framed absence
5 which is also fertile and generative. There are, she maintains, levels
6 of experience described in mysticism that closely correspond to
7 states of mind encountered in analysis, and that are not adequately
8 described in the scientific literature. The reformulation of femininity
922 beyond the conventions of rather normative, pre-feminist authority

41
42 CLAIRE PAJACZKOWSKA

is powerfully present in her work, and this intuitive “liberation” of

gender from its unimaginative moorings within science is also
implied in her choice of a title for her collected writings, The
Suppressed Madness of Sane Men: Forty-four years of exploring psycho-
analysis. Milner locates herself on the side of exploration rather than
knowledge, on the side of the verb rather than the noun, and always
somewhere in between boundaries. Is it this identification with the
fluidity of liminal states that makes Milner’s work so difficult to
classify and so fresh and contemporary to each new generation that
finds it?
The experience of merging, of e-merging, of being half submerged,
and the experience of being in contact with the conventional
calibration of time (I keep thinking it’s Tuesday) is a good metaphor
for Milner’s psychoanalysis. Following the patient into the real
experience of states of mind that are only half-conscious, whilst
keeping in mind the existence of the submerged depths and the
external realities of time and space, or of science and knowledge, is
characteristic of her work in both clinical practice and cultural
analysis. The technique that most distinguishes her analytic practice,
as reported in her clinical papers, is that of understanding the
analytic setting as the “framed gap” which serves to allow the
patient to encounter the blankness of their own amnesia, or denial
and resistances, so that the repressed or unconscious material may
materialize in a way that is unique to the subject and can then become
integrated into the subject’s own self. While differing from the
Kleinian preference for direct verbalization by the analyst of what
is believed to be unconscious latent content of the transference, and
from Anna Freud’s methods of analysing resistances, Milner was well
aware of her indebtedness to all analytic mentors and precursors,
dedicating her last book to “The British Psycho-Analytical Society,
Warts and All, Gratefully”.
Her interest in the emotional significance of gender (as in the Zen
thoughts on the masculine and feminine) as well as her more
orthodox analytic understanding of the psychic construction of
gender enabled her to navigate the turbulent waters of the contro-
versy between the two maternal mentors, Klein and Freud. Perhaps
the most significant differences between these two lay in their
different concepts of the child. Freud père himself had demonstrated
that the child and the infantile is the core of the unconscious in the

42
 ON HUMMING 43

122 form of the Oedipus complex, infantile sexuality and repressed

2 memories of childhood events and beliefs. Melanie Klein interpreted
3 the child’s play and adult symptoms as if she already knew the
4 content of the infantile mind and the adult unconscious, as if indeed
5 it were a “content” and a psychic reality that must be observed as
6 transference and countertransference. Anna Freud maintained that
7222 the world of childhood was not yet adequately known and that it
8 must be observed, documented and described, carefully and
9 systematically, as well as being inferred from interpretations within
10 clinical practice. That Melanie Klein was a mother and Anna Freud
1 not may have had significance for the perception of the relative status
2 of their knowledge. And the fact that Klein was referred to as
3 “Mrs Klein” and Anna Freud as “Miss Freud” also seemed to arrange
4 these roles in a generational, oedipal dynamic, with Mrs Klein being
5222 elevated to the role of the missing mother to accompany Freud père
6 as totem leaders of the small band of analytic brothers, the forty or
7 so members of the British Society. But for Milner their work was both
8 available as conceptual tools and present as an oedipal predicament
9 that had to be negotiated in finding her own independent voice. In
20 her “Afterthoughts” she notes that omission of references to two
1 books by Anna and Sigmund Freud are “symptoms of the constant
2 struggle both to use the parents’ insights and at the same time to be
3 sensitive to my own experience, to see with my own eyes” (Milner,
4 1987, p. 297). Here we find Milner’s own identification with the
5 oedipal child, an identification and sensitivity which is characteristic
6 of all her clinical and theoretical work. The child, for Milner, is the
7 agent of a kind of thinking and feeling, of understanding, that is
8 neither the oedipal infantile unconscious of the adult nor an
9 empirically quantifiable population to be observed and measured,
30 but a valuable “informant” in play with a “participant observer” who
1 must learn their language in order to understand and enjoy them
2 fully. For Milner the object of psychoanalysis is not to assure the
3 mastery of the ego over the id, not to celebrate the radical alterity of
4 the unconscious, but to learn to love the unconscious, with all the
5 sense of responsibility and care implied in the word “love”.
6 Milner’s comments on the experience of being in supervision with
7 Melanie Klein for a child analysis (her membership paper) are
8 testimony to her awareness of the real differences in technique that
922 became a fully fledged theoretical difference. Milner documents the

43
44 CLAIRE PAJACZKOWSKA

case with the child’s actions and speech, adding Klein’s comments
on the significance of the child’s behaviour. The supervisor’s
comments were directed to the analyst, and they show a single-
minded focus on Klein’s idea of what is taking place in the child’s
unconscious phantasy. This appears, even then, as existing in tension
with Milner’s own intuitive method of following, empathically, the
child’s experience of inner conflicts, and of her changing states of
mind. Not insensitive to Klein’s ideas, Milner, like Winnicott, was
able to integrate an understanding of the significance of early infancy
and the child’s relation to its mother, in reality and in phantasy, as
a central component of her method and her understanding.
There is still a wide readership for her early books On Not Being
Able to Paint (1950) and An Experiment in Leisure (1937), both of which
are written for a wide readership, without explicit reference to
psychoanalytic theory, but with much implicit use of the experience
of being in analysis.
Milner is used today in order to understand creativity as a primary
activity, neither derived from cultural conventions nor sublimated
instincts or unconscious impulses. The understanding of the primacy
of object relations as part of human maturation and psychological
development means that the human need to draw, write, sing, dance
and communicate is seen as something directed to an “other”, but
also—and equally—to a self. In fact the need to communicate is a
product of the space that gradually emerges as being experienced
as a space “in between”, neither self nor not-self. And it is the
formulation of the meaning and significance of this space “in
between” that is characteristic of the contribution of Marion Milner
to the British psychoanalytic tradition. Like Winnicott, there is a
constant recourse to the inner connection of certain kinds of
emotional and psychological truths learned from years of meticulous
clinical work, and a special interest in the space “between” what they
are experiencing in their work and what is written up in “the litera-
ture”. Through reading Milner the reader wonders if it is possible
to speak or write of an experience that is always before and beyond
words, and it is something in the quality of Milner’s writing that
makes this question possible for the reader.
In her most popular book, Milner speculates on the meaning
of not being able to paint and invites readers to recognise the
significance of spontaneously making symbolic or cultural forms for

44
 ON HUMMING 45

122 a relationship to the self. This is analogous to an analytic under-

2 standing of the symptom as “murmuring to itself and hoping to be
3 overheard”. Making, or creating, is an activity that is founded in
4 a primary joyful state of being, and being conscious of being. This
5 primary ec-stasy is a process and activity that is movement out of
6 stillness and stasis.
7222 I suggest that we appreciate humming in the light of Milner’s
8 recognition of the critical importance of the duality of being merged
9 and e-merging. Humming, rather than singing or speaking, is an
10 expression of a state in which the subject, or hummer, is in a sort of
1 “state of grace” that is both mundane and divine. It is an activity
2 that is auto-erotic and object-related, both material and communica-
3 tion. Humming is, I suggest, another example of a framed gap, where
4 the self is allowed to become absent as protagonist by becoming
5222 present as bodily, acoustic frame.
6
There is a moment of exceptional pleasure and concentration when
7
children learn for the first time to read silently, by sounding out the
8
words on the page as sounds within the mind: in the mind’s ear,
9
as it were. This point, at which children become able to master the
20
process of reading as a circuit of taking inside the self a symbol that
1
exists in the outside world, in the book, is also a point at which the
2
child becomes able to find a place for themselves as an active part
3
of a circuit of meaning in a representational world. This mastery of
4
5 a long held ambition to own the mystery of reading is accompanied
6 by an ecstasy of joy and satisfaction. Although this experience
7 is forgotten and reading becomes as mundane as walking and
8 breathing, the memory of that joyous immersion within a circuit of
9 meaning through the silent reproduction of sounds within the mind
30 is something we rediscover in humming. Of course there are other
1 memories also retrieved in humming that predate literacy, such as
2 feeding, kissing, breathing, crying and so on.
3
4
On humming
5
6 The mystery of humming lies in the fact that it makes us both active
7 and passive simultaneously, like the baby with the cotton reel in the
8 Fort-Da game. We lose and we find at the same moment. The mouth
922 emits a resonant hum and it is heard internally through the bones,

45
46 CLAIRE PAJACZKOWSKA

and externally through the ears, as if it arrived from elsewhere. The

elsewhere is also the “within”, the blankness framed by noise.
The ear is an organ of reception that we cannot voluntarily close.
Sounds, transmitted through the materiality of the maternal body,
actively fill the sensory experience from before birth, and may
continue into states of deep unconsciousness. Breathing, too, is an
automatic, involuntary process, and smell can also be sensed through
states of unconsciousness. The ear has, unlike the nose, a particular
part to play in the circuit of sensory perception that connects
sensation to sense and meaning. As language is the prime means of
communication, the ear is endowed with particular social signifi-
cance. Although originally programmed to be used by infants to
locate the source of a mother’s voice in order to track her by eye, the
ears soon articulate their synaesthesia with vocalization and speech.
However, they always retain something of the pre-symbolic sense
with which they began. I have observed babies, during the weaning
phase, humming to the activity of eating finger foods or from a spoon,
as if to add another corporeal dimension to the experience which
was once, sucking noisily at the breast, a more total and engulfing
experience.
Here I want to suggest that humming is the acoustic equivalent
of doodling: when understood in Milner’s sense, it provides a
symbolic equivalent of the emotional aspect of hearing a song or
piece of music. It is a means of setting up a circuit of emitting and
receiving noise simultaneously, connecting inner feeling, physio-
logical resonance and vibration, with the affect of the meaning of the
music, and the external space of sound heard by the ears. From
the inner world of fleeting feeling the hummer can make an envelope
of sound that surrounds and insulates as well as communicating. The
communication is not directed to anyone in particular. The hummer
may be humming to themselves. To the listener, the hummer
indicates being in a state of self-absorption.
Humming is not the tuneful product of a loss that is mourned: it
is not the blues, the visceral cry of the cantor at prayer, the beautiful
song, the siren song of seduction or desire; humming is an expres-
sion of the experience of being at one with oneself. Being merged
through the illusion of relatedness and being e-merging through
the perception of oneself as the origin of sound. In this way the
act of humming is an acoustic way of being in state of “absent

46
 ON HUMMING 47

122 mindedness” a state that Milner thinks is important insofar as it

2 enables another kind of thinking to take place. The relation between
3 the hummer and the mental representation of the memory of singer
4 or music is equivalent to the child play of mimicry and imitation. It
5 is this playful relation that, like the role of illusion in symbol
6 formation, enables the hummer to revisit, and thus, reconfigure, the
7222 boundary between inner and outer. The relation between hummed
8 music and, say, orchestral music is equivalent to the relation between
9 the “illusion of union and the fact of contact” (1950, p. 95). The
10 corporeal resonance of humming also evokes the “fact of contact”
1 and recreates the original maternal envelope within the “illusion of
2 union” that is the hummer’s relation to the original score.
3 Milner relates this kind of “absent mindedness” to what Winnicott
4 called the reverie of primary maternal preoccupation, which is quite
5222 different from phantasy or fantasy. Walkers, swimmers, sportsmen
6
of all kinds, musicians and artists all report a similar, necessary
7
creation of a “framed gap” within which something may be found
8
that is not available for encounter anywhere else. It is this unique-
9
ness of the encounter with oneself as unique that may be being
20
unconsciously sought.
1
It has become commonplace for analysts to acknowledge the
2
transformational value of great art, literature and music, but it is
3
absolutely characteristic of Milner’s idiom that she is able to find the
4
5 transformational value in moments and acts of the most ordinary,
6 everyday kind. There is something about the certainty of the value
7 of what is found, simply by the fact of being found, that guarantees
8 its meaning for the subject. There is an absence of striving.
9 But presence may not be amenable to being sought and it may be
30 simply found. The experience of the self as existing needs to be found,
1 at times, in order to tolerate the burden of existing for others, or being
2 needed; and Marion Milner was able to describe this experience in
3 ways that nobody else had described it before or has described it since.
4 One paradox that tantalizes and frustrates those working within
5 the Independent tradition is that their legacy is one that inspires
6 profound admiration and longing for emulation but does not install
7 orthodoxy or compliance. People cannot become like their mentors
8 by copying them, but by becoming themselves in a way that is
922 always completely unpredictable and new. The originality of self

47
48 CLAIRE PAJACZKOWSKA

and its creativity cannot be sought, it can only be found. And that,
paradoxically, is what Milner was saying.

References
Freud, S. (1917). Introductory Lectures on Psychoanalysis. SE, 16. London,
Hogarth.
Goldman, D. (1993). In: One’s Bones: The Clinical Genius of Winnicott.
Northvale, NJ: Aronson.
Kohon, G. (Ed.) (1986). The British School of Psychoanalysis: The Independent
Tradition. London: Free Associations.
Mannoni, M. (1970). The Child, His Illness and the Other. London: Tavistock.
Milner, M. (1937). An Experiment in Leisure. London: Chatto & Windus.
[Virago, 1988]
Milner, M. (1950). On Not Being Able to Paint. 2nd ed. London: Heinemann,
1957.
Milner, M. (1987) The Suppressed Madness of Sane Men. London: Routledge.
Rayner, E. (1991). The Independent Mind in British Psychoanalysis. London: Free
Associations.
Rodman, F.R. (2003). Winnicott: Life and Work. Cambridge, MA: Perseus
Publishing.

48
122 CHAPTER FOUR
2
3
4
5
6
7222 Being and sexuality: contribution
8
9
or confusion?
10
1 Lesley Caldwell
2
3
4

I
5222 n her early book, Psychoanalysis and Feminism (1974), Mitchell
6 argued for psychoanalysis as a theory able to explain the process
7 whereby men and women come to internalize difference as
8 oppression. In tackling this equivalence she was stating one of the
9 problems facing feminist theorizing of that time and arguing for
20 psychoanalysis as offering a way into why this might be so. In her
1 opening remarks at the Freud Museum conference that celebrated the
2 book’s twentieth anniversary, she said, “What we as feminists asked
3 of Freud’s theory was the same question Freud was asking as a
4 male hysteric: What is a woman? What is the difference between the
5 sexes?” (1995) This was a reasonable and relevant question to ask,
6 especially since it was the one that allowed Freud “to formulate the
7 Oedipus complex and the castration complex as a sort of ‘answer’”.
8 But Mitchell went on to make a distinction between what can be asked
9 as a feminist, an activist, a theorist, and what can be asked as a
30 clinician, a position she identified as involving a technique of listening
1 and hearing in a particular way. Such a practice gives rise to different
2 questions. This discussion of Winnicott and, by extension, the
3 psychoanalytic world we have all inhabited, recognizes the questions
4 that were not, or have not been asked, of and about sexuality as it
5 manifests itself in the consulting room, and in clinical papers and
6 debate, and their implications for practitioners; it offers a tentative
7 engagement with the questions that can and must be asked.
8 In much of Winnicott’s clinical material, especially in The Piggle
922 (1977) and other examples of his work with children, in the extended

49
50 LESLEY CALDWELL

material of Holding and Interpretation (1986)—a privilege to be able

to read such an extended account of a treatment—and in the paper
The split off male and female elements to be found in men and women (1966),
to which we will return below, there is a frankness about bodies,
origins and desire which, taken together, offer a real contribution to
our understanding of the sexuality of the infant and the child, and
to the confused and fluid identifications with and around which
adult sexuality is loosely grouped. But there is little directly about
the sexuality of the mother, or the confused/confusing identifica-
tions produced for her in the engagement with her baby, or the
implications of this relationship for her subsequent life. Of course,
this is not only an absence in Winnicott but one in Freud himself,
and in much contemporary British work. There is work on women;
but work on women as mothers and mothers as women, rather than
work on, say, their relationships with their own mothers and its
effects, is still quite rare.
The meanings of sex in the Oxford English Dictionary all cluster
around division, addressing those terms used to indicate the basic
division of organic beings—whether persons, animals or plants—into
male and female, and the quality of difference it entails. In recent
usage, a more precise notion pertaining to differences in the structure
and function of the reproductive organs and the accompanying
physiological differences consequent on them is recognized. On
these grounds organic beings are distinguished as male or female,
and, in the human species, this distinction is that between man and
woman. The definition of sexuality is given as “the quality of being
sexual or having sex; the possession of sexual powers or capability
of sexual feelings; the recognition of or preoccupation with what is
sexual”; this is a rather bland if clear formulation.
In its original Freudian formulation, one of the interesting things
about psychoanalysis is the attention given to sexuality, and the
extended definition with which it operates. Together with the uncon-
scious, sexuality is fundamental; considerable, if not determining
importance is ascribed to it in the mental life and development of
the individual. And in proposing the existence of infantile sexuality,
Freud proposed a challenge to ways of thinking about the human
subject that is still being absorbed. The Freudian conception of
sexuality is extremely comprehensive. It disagrees with common
psychological accounts of the sexual instinct as a predetermined

50
 BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 51

122 behaviour, typifying a species, having a relatively fixed object (a

2 partner of the opposite sex), and with an obvious aim (the union of
3 genitals in intercourse); and it emphasizes three related areas: the
4 sexual distinction between girls and boys and its establishment
5 round the Oedipus complex and castration, the consequences of
6 this for the individual, and for ideas of masculinity and femininity,
7222 and the importance of conscious and unconscious life. Initially, at
8 least, it does not stress the object.
9 It was Freud’s conviction of the significance of bodily states in the
10 hysteric as symptoms involving a condensation of body and mind
1 that produced psychoanalysis, and the link between mental states
2 and bodily symptoms was also of central interest to Winnicott,
3 whose account of early development makes psychical mechanisms
4 and structures depend upon a growing awareness of the body.
5222 Psychoanalysis emphasizes the body’s significance for the psyche (the
6 ego is first and foremost a bodily ego): the body is understood in
7 relation to both conscious and unconscious experience, and that body
8 is always libidinally invested. There is experience of the body, there
9 is perception of the body, and there is, in Winnicott’s term,
20 apperception of the body, so that the experience of the body is always
1 an experience mediated by unconscious and conscious perceptions
2 about it; but there is no simple reflection of the body in a mental
3 process (Adams, p. 29). For the Winnicottian infant, in the beginning,
4 body and world are undifferentiated and mixed up together, and
5 initial body image and awareness, when it first develops, is not
6 gendered. But bodies are always sexed, in the sense that the social
7 ascription of a sex, based on observation of bodily attributes, precedes
8 the baby’s inhabiting of that sex as gendered, and defined by
9 difference, and precedes the kinds of bodily and emotional care that
30 are increasingly understood (not least because of Winnicott) as
1 fundamental to how being one or other is lived and understood by
2 the boy or girl, woman or man. Psychoanalysis makes pivotal the
3 recognition that the body has to come to be differentiated by gender.
4 In discussing the growing physical capacity that occurs in babies
5 around five to six months, Winnicott focuses especially on its
6 emotional and psychological implications. An awareness of an entity,
7 the self, however rudimentary, is an awareness of its location in a
8 body; that body is both the condition and the boundary of a terrain
922 where feelings and fantasies about instinctual impulses come to be

51
52 LESLEY CALDWELL

understood. Awareness of this involves an awareness of self (and

therefore of other), the beginnings of separateness; all of this emerges
from what has happened in the baby with the mother in the
preceding months. The Winnicottian infant confronts and sustains
instinctual experiences, not from the beginning, but at a time of
his/her ongoing coming together as a differentiated individual.
Infantile sexuality is significant only after the move from unintegra-
tion to integration has been effected. This revision of Freud’s model
constitutes an explicit divergence about the origins and the form
of human individuality and human difficulty; it does not prioritize
sexuality and the difference between the sexes as primary, although
it recognises their centrality. Although Kristeva is scornful of
Winnicott’s notion of a libido as devoid of object or goal, a para-
doxical state of facilitation thus prior to constitution of subject, object
and sign, Winnicott’s extensive interest in the somatic indicators of
psychical states, his willingness to speculate (and to speculate
convincingly) about the facts to be derived from extraordinarily close
observation, evident from the 1940s papers “Primitive emotional
development” (1945 [1958]) and “The observation of infants in a set
situation” (1941 [1958]), does offer a theory of how the infant becomes
a human being. This theory is based on intensive study, which
continued throughout his working life, of what he argues are the
conditions without which the drives can never be accommodated
sufficiently for the subject to begin to live a normal life (with all of
the abnormal, psychoanalytically speaking, that that entails). This
includes first, being, then the existence of body, mind and instinct
as conflictual, in constant articulation with issues of self and other,
with instinctual pressure and with generational awareness. These are
fundamental human problems; they are implied in Winnicott’s
extension of the concerns of psychoanalysis to the family and the
outside world, and explicit in Lévi-Strauss’s reading of the many,
many versions of the Oedipus myth.
Lévi-Strauss’s account of the Oedipus myth is organized around
the inability, for a culture which holds that mankind is autochtho-
nous, to find a satisfactory transition between that explanatory
assumption and the knowledge that human beings are actually born
from the union of man and woman. The problem cannot be solved,
but for Lévi-Strauss, “the myth provides a kind of logical tool which
relates the original problem—born from one or born from two—to

52
 BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 53

122 the derivative problem: born from different or born from the same.”
2 His account insists that not only Sophocles but Freud should be
3 included among all the recorded versions of the Oedipus myth (1977,
4 p. 217). “Although the Freudian problem has ceased to be that of
5 autochthony versus bisexual reproduction, it is still the problem
6 of understanding how one can be born from two: How is it that we
7222 do not have only one procreator, but a mother plus a father?” (ibid.,
8 p. 217) In this chapter, Lévi-Strauss acknowledges the shared
9 problems of human beings and their various attempts to find answers
10 to the unanswerable conditions of their existence.
1 In the bibliography compiled by Harry Karnac, twenty-one
2 volumes of Winnicott’s work, including Rodman’s edition of his
3 collected letters, The Spontaneous Gesture (1987), are listed. There are
4 two titles using psychiatry and clinical disorders and four including
5222 paediatrics and psychoanalysis, that is, six titles that include the
6
fields of professional expertise with which Winnicott was concerned
7
and that elucidate central areas of a research practice focused on
8
consultation and the consulting room. Two mention the outside
9
world, three explicitly link mothers and babies, one mentions parents,
20
five child or children, one home, three family, two development, one
1
deprivation and delinquency. The titles that explicitly mention
2
development link it with the family (The Family and Individual
3
Development [1965a]) and with the combination of environment,
4
5 individual and emotions (The Maturational Processes and the Facilitating
6 Environment: Studies in the Theory of Emotional Development [1965b]).
7 They form the foundations of an interest in development that is both
8 psychoanalytic and social. Then there are two titles calling up the
9 wider field of human existence, Playing and Reality (1971) and Human
30 Nature (1988). While titles do not necessarily denote a specific field,
1 taken together they are indicative, and it is the less technical titles,
2 grouped around “home”, “family” and “outside world”, that allude
3 to the areas Winnicott so stoutly insisted also had their place in
4 psychoanalytic practice and thought. It is easy to underestimate now
5 what was then almost certainly contentious in this extension of
6 psychoanalysis to the domain of everyday life, and his insistence on
7 its appropriateness and its necessity.
8 In the extensive historical, sociological and anthropological
922 scholarship on the “family”, families always involve relationships

53
54 LESLEY CALDWELL

that extend, possibly with different meanings and forms, across the
generations and across the sexes. They always involve more than one
person and imply a series of relationships, though those relations
may have been understood and lived differently in different eras.
Even in the late modern world, where a family may comprise single
sex parents who have adopted a child of the same sex, the intractable
facts of human existence demand that somewhere the biological
contribution of two sexes has been necessary. This further means that
at some time, for any and every child, the question of origins arises,
and of that child’s roots in a world which has preceded it. In the
psychoanalytic literature, and in that of the human and cultural
sciences, origins implicate bodies and bodily processes, but psy-
choanalysis insists upon the psychical implications of this state
of affairs and its centrality for any account of human subjectivity or
personhood. Fantasy, imagination, narrative and myth also provide
ways into wrestling with the big questions of human existence.
In the paper “Creativity and its Origins” (1971), reproduced with
extra clinical material as Chapter 8 of Psycho-Analytic Explorations
(1989), Winnicott sets out a statement about creativity in the section
entitled “The split off male and female elements to be found in men
and women” (my italics throughout):

I suggest that creativity is one of the common denominators

of men and women. In another language however, creativity is
the prerogative of women, and in yet another language it is a
masculine feature.

Here Winnicott mixes, slips between registers: the basic division, sex,
and the ascription of sex to the two classes of humans, male and
female, is indicated first in the heading; then there are the actual
representatives of these two classes of humans, men and women;
then he introduces the adjectival form, masculine. There is no
necessary equivalence between these terms. In the clinical example
he reports, one of startling interest and insight, he further says:
“Something has been reached which is new for me. It has to do with
the way I am dealing with the non-masculine element [another,
different qualifier] of his personality” (p. 73). This is explained by
his interpretation and the exchange that follows.

54
 BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 55

122 DW: “I am listening to a girl. I know perfectly well that you are
2 a man, but I am listening to a girl. I am telling this girl: You
3 are talking about penis envy.”
4
The immediate effect was intellectual acceptance, relief. Then
5
the patient said, “If I were to tell someone about this girl I would
6
be called mad.”
7222
8
Winnicott took it further, which, he says, clinched the matter.
9
10
DW: “It was not you who told this to anyone; it is I who see the
1
girl and hear a girl talking when actually there is a man on my
2
couch. The mad person is myself.”
3
4 The patient replied that he felt sane in a mad environment.
5222
6 Winnicott explains that while this material tallies with work they
7 had already done, he begins thinking about it in a different way. At
8 the following Monday session, the patient reports that he made love
9 with his wife on Friday, and got an infection on Saturday. Winnicott
20 reports that he understood this as an invitation to interpret at the
1 psychosomatic level (an evasion of the psychic structure revealed in
2 the previous session). It is here, and in the following discussion, that
3 the complexity of the mental configuration referred to on the Friday
4 is elaborated.
5
6 “You feel as if you ought to be pleased that here was an
7 interpretation of mine that had released masculine behaviour.
8 The girl that I was talking to, however, does not want the man
9 released, and indeed she is not interested in him. What she
30 wants is full acknowledgment of herself and of her own rights
1 over your body. Her penis envy, especially, includes envy of you
2 as a male.” I went on: “The feeling ill is a protest from the female
3 self, this girl [my italics], because she has always hoped that the
4 analysis would in fact find out that this man, yourself, is and
5 always has been a girl (and “being ill” is a pre-genital pregnancy).
6 The only end to the analysis that this girl can look for is the
7 discovery that in fact you are a girl.” Out of this one could begin
8 to understand his conviction that the analysis could never end.
922 [1971, p. 75]

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56 LESLEY CALDWELL

In the discussion following this interpretation and the patient’s

response to it, Winnicott discusses what he calls a “dissociation”
between “male” and “female” elements, and the greater difficulty of
locating such a dissociation in the healthier patient, because such a
dissociation holds in place “an acceptance of bisexuality as a quality
of the unit or total self”. “Bisexuality,” Freud writes to Fliess in 1899
(1 August), “I am sure you are right about it. And I am accustoming
myself to regarding every sexual act as an event between at least
four individuals” (“The Ego and the Id” [1923], p. 33, footnote 1).
Winnicott then raises some clinical issues about these different
parts of the person, what he calls “male” and “female” “elements”:
that the split off dissociated part, whether male or female, tends to
remain at a certain age—his words “man” and “girl” make this clear;
that for the analyst, there is always the issue of who, or which
one/element/part is being analysed—that is, which elements are
being presented at any one time and why; and the other considera-
tion he identifies is the implications for object relating. The terms
used are “male” and “female”, but he insists that the issue is not
about those central concerns of psychoanalysis, masculine/feminine,
active/passive. The male bit of a man (in this case; but it could
equally be a woman) does both active relating and passive being
related to; there is instinct in both, the drive, for Winnicott as for
Freud, always being masculine/active.
He goes on to make a claim that, in the case described, the pure
female element (again compare the earlier reference to “the female
self, this girl”, which seems quite different) found primary unity with
him as the analyst and this gave the man the feeling of having started
to live, because he had found the basis for “being”, because the pure
female element is related to the breast and the baby becoming the
breast, in the sense that the object is the subject, for Winnicott
the condition on which the emergence of the self who must live in
a world of sexual difference depends.
Since, in his account, the instincts become important, only after
the emergence of that self, the “female element” involves a different,
earlier conception of the relation with the object, an object relating
that is part of “being” and, for Winnicott, non-instinctual. The male
element of any patient approaches the object either in terms of
active relating or of passive being related to, in that the male element
carries the drive, but, it is secondary, developmentally speaking, to

56
 BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 57

122 the female element, which does not seek, because the conditions of
2 seeking (awareness of and desire for the other, absence and loss) are
3 not yet in place; there is no separateness that makes this possible.
4 While this may be a further elaboration of his ongoing interest in the
5 development of the self, the attachment of these states to ideas of
6 “male” and “female” seems to fall into a cultural truism and a further
7222 endorsement of a theory of the need to be able to be before doing.
8 Winnicott seems to be trying to describe two attitudes, two ways
9 of relating to an object—and two ways that exist in sequence: first
10 being, then doing. One can be the object—Winnicott likens this to
1 primary identification—or one can do something for it: one can be
2 absorbed, immersed, or one can use it for some purpose. And the
3 object, of course, can be a person, or indeed a work of art. To call
4 these female and male elements may be neither here nor there:
5222 they do not need to be gendered, perhaps, to be of interest (Phillips,
6 2000, p. 44).
7 The real issue seems to me, here, to be how such an element,
8 whether pure or “contaminated” (but by what?), has played its part
9 in the evolution of the sexuality of the patient, and how this is
20 demonstrated in the ongoing dynamics of transference. With his
1 interpretation of himself as a mad mother, seeing a girl where, biolog-
2 ically and socially, there is a boy, Winnicott captures the complexity
3 of identifications at stake in this man’s first relationship, and their
4 grounding in the mental representatives of confused bodily images
5 developed through the gathering in, introjection and projection of
6 an initial imposition of desire, an unconscious message which, in the
7 world that cuts across both analysis and real life, registers around
8 sexuality, even when that sexual difference is harnessed in relation
9 to a model that proposes a different set of priorities for the neonate.
30 In the case discussed, the confusion of identities, of elements, of
1 the parts of the person called “girl” and “man”, and especially the
2 strength of the girl, and her desire to triumph, seemingly has little
3 to do with being and the female element, and everything, initially, to
4 do with the external and internal environment produced by the
5 mother, a woman who could not, or would not, see a baby boy, and,
6 even more, could not therefore relate to her baby’s early needs. To
7 think further about the implications, for the adult man on the couch,
8 of Winnicott’s recognition of his internalization of the wish of the
922 mother for something that he is not, and the strength of that “girl”,

57
58 LESLEY CALDWELL

and her desire to triumph, does open up a debate about the power
of the mother as caregiver in structuring the unconscious of the child,
and the adult, and its transferential implications.
To recognize the fundamental impact of the parents’ own
unconscious worlds on the child’s development links Winnicott
with Ferenczi and Laplanche, through the consistent, if differently
inflected importance each attributes to the parents’ unconscious
messages and the child’s attempts to make sense of them; this is the
importance, unconsciously, of the parents (in this case the mother)
as sexual. While Ferenczi and Laplanche overtly address the
importance of transgenerational transmission, the mother’s pathol-
ogy, and the impact of the parental unconscious for the possibilities
open to the infant, these issues are also there in Winnicott, as the
bedrock of a seemingly innocuous discussion of home and family.
The famous phrase “there is no such thing as a baby” may have
changed our thinking about babies, but it also invites some consid-
eration about the situation of the other/mother, for whom the
notion that there is no such thing as a baby (without a mother) may
potentially contain all kinds of emotions, many of them anxiety-
provoking and anything but reassuring. Useful and striking though
this idea has been, what it enables in thinking about babies, it may
correspondingly hamper and close down in thinking about mothers
(and by extension, practitioners).
A tentative step might be to say that, if Winnicott’s main concern
with women is with their status as mothers, and perhaps also, with
the implications for them, but more particularly, and certainly, for
their babies, of their immersion in that role, the sexuality of the
mother is overlooked. In the records we have, or at least those that
I know, the analysis of a mother does not appear; women as mothers
do not appear or speak as analytic patients, and women patients do
not discuss this status and its attendant problems—possibly because
they are not mothers. And yet the mother is almost never absent, is
indeed rather doggedly present in most British psychoanalysis.
“In terms of baby and mother’s breast (I am not claiming that the
breast is essential as a vehicle of mother-love) the baby has instinctual
urges and predatory ideas, the mother has a breast and the power
to produce milk and the idea that she would like to be attacked
by a hungry baby.” This statement from “Primitive Emotional

58
 BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 59

122 Development” (1945 [1958], p. 152) constitutes a frank assertion of

2 the essential ambivalence at the heart of the feeding relationship:
3 how, through the propping of the drive upon need, “infantile
4 sexuality attaches itself to one of the vital somatic functions” (Freud,
5 S.E. 7, p.182). The encounter described here is one that sees the
6 mother-child relation in terms of the aggression and sexuality of
7222 reciprocal desire; indeed, a couple of phrases further on, Winnicott
8 speaks of an “excited” infant. The last of the eighteen reasons why
9 mothers hate their babies also implies consequences for both
10 participants of the encounter: “he excites her but frustrates—she
1 mustn’t eat him or trade in sex with him.” While Winnicott develops
2 no further the complexity for both participants, Laplanche insists
3 upon the dialogue of mother and baby as organized round a radical
4 disjunction,
5222
6
. . . an encounter between an individual whose psychosomatic
7
structures are situated predominantly at the level of need, and
8
signifiers emanating from an adult. Those signifiers pertain to the
9
satisfaction of those needs, but they also convey the purely
20
interrogative potential of other messages—and those other
1
messages are sexual. These enigmatic messages set the child a
2
difficult or even impossible task of mastery and symbolisation,
3
and the attempt to perform it inevitably leaves behind uncon-
4
5 scious residues . . . we are not dealing with some vague confusion
6 of tongues, as Ferenczi would have it, but with a highly specific
7 inadequacy of languages. [1987, p. 130]
8
9 Here is a quote, taken almost at random, from Winnicott’s paper
30 “On Transitional Objects and Transitional Phenomena”: “The good
1 enough mother, as I have stated, starts off with an almost complete
2 adaptation to the infant’s need, and as time proceeds she adapts less
3 and less completely, gradually, according to the infant’s growing
4 ability to deal with her failure” (1951 [1958]). From the point of view
5 of the baby’s needs this represents a kind of ideal, but where, and
6 how, does such a complete adaptation fit with the wishes and desires
7 of the mother, who in this instance is described as almost perfectly
8 attuned to her baby? Where, in such an account, is a recognition of
922 the unconscious of the mother, and where is the external social world

59
60 LESLEY CALDWELL

and its demands, not in the sense of the immediate environmental

provision for which, initially, the mother is the primary focus, but
in the sense of the mother’s life, her existence as woman as well as
mother? How, knowing what we do of the unconscious, can such a
statement coexist so unquestioningly with it? Nor do I think this can
be answered by the appeal to the father in the mother’s mind,
though this is also important. Where does such total accountability
(Rose, 2004) leave us as women?
Whatever we are to make of primary maternal preoccupation, the
relation between a level of psychical life and the level of reality at
which the mother cares for her baby could not ever be the same,
something Winnicott acknowledges through the mother’s inevitable
(and necessary) disillusioning of her baby; through the ordinary care
to which Winnicott gives such careful attention, the interrelation of
the sexual in the human, the sexual as part of being, is transmitted
to the baby, the recipient of maternal care, particularly through the
body. Together with much of the British object relations tradition,
what Winnicott states, so much less clearly, are the implications of
the mother’s sexuality, of her desire, of her unconscious, and their
place in shaping the baby and the future adult he or she becomes.
To return to the earlier example of the patient whose mother
saw a child of one sex, a girl, where there was a child of another,
a boy, the mother’s pathology is one structuring consideration;
the other is the man’s continued attachment to it, and possibly the
analyst’s decisions about it. All contribute to how this patient’s
psychopathology has been constructed, transmitted, and continu-
ingly adhered to, in his life, in the present of the analysis, and in the
transference with Winnicott. What seems a continuing absence in
accounts of our work, though probably not in the work of the
consulting room itself, is the absence of the real dilemmas of being
a woman as they may be articulated, not only around the formative
relation with their own mothers, but with the lived experience of
themselves as mothers. How their analysts and therapists respond
to what, for women, impinges on one of the major ways, in our
culture, that being a woman is understood, has ongoing unconscious
implications for women who are mothers and for women who are
not. It also has implications for those clinicians who are available for
use by their patients and their projections in any number of shifting
gender configurations in any particular session.

60
 BEING AND SEXUALITY: CONTRIBUTION OR CONFUSION? 61

122 References
2
Adams, P. (1986). Versions of the Body. m/f, 11–12: 27–34.
3
Freud, S. (1923). The Ego and the Id. S.E., 19. London: Hogarth.
4
Laplanche, J. (1987). New Foundations for Psychoanalysis. Oxford: Basil
5
Blackwell.
6
Lévi-Strauss, C. (1977). The structural study of myth. In: Structural
7222
Anthropology (pp. 206–231). Harmondsworth: Peregrine.
8
Mitchell, J. (1974). Psychoanalysis and Feminism. London: Penguin.
9 Mitchell, J. (1995). Psychoanalysis and Feminism: 20 years on. British Journal
10 of Psychotherapy, 12: 73–77.
1 Phillips. A. (2000). Winnicott’s Hamlet. In: L. Caldwell, Art, Creativity, Living
2 (pp. 31- 48). London: Karnac.
3 Rodman, F.R. (Ed.) (1987). The Spontaneous Gesture: Selected Letters of D.W.
4 Winnicott. London: Karnac.
5222 Rose, J. (2004). On Not Being Able to Sleep. London: Vintage.
6 Winnicott, C., Shepherd, R., & Davis, M. (Eds.) (1989). Psycho-Analytic
7 Explorations. London: Karnac.
8 Winnicott, D.W. (1958). Through Paediatrics to Psycho-Analysis. London:
9 Hogarth, 1975.
20 Winnicott, D.W. (1965a). The Family and Individual Development. London:
1 Tavistock. [Routledge, 2006]
2 Winnicott, D.W. (1965b). The Maturational Process and the Facilitating
3 Environment. London: Hogarth. [Karnac, 1990]
4 Winnicott, D.W. (1966). The split off male and female elements to be found
5 in men and women. In: C.Winnicott, R.Shepherd & M.Davis (Eds.),
6 Psycho-Analytic Explorations. London: Karnac, 1989.
7 Winnicott, D.W. (1971). Playing and reality. London: Tavistock. [Routledge,
8 1982]
9 Winnicott, D.W. (1977) The Piggle: An Account of the Psychoanalytic Treatment
30 of a Little Girl. London: Hogarth.
1 Winnicott, D.W. (1986). Holding and Interpretation. London: Hogarth.
2 Winnicott, D.W. (1988). Human Nature. London: Free Association Books.
3
4
5
6
7
8
922

61
CHAPTER FIVE

Clinical experience with psychotic

mothers and their babies
Alain Vanier

T
he effects of maternal psychosis on babies and on their further
development have been widely studied since Winnicott’s
seminal article, published in 1959, and a number of studies
have contributed useful information (Anthony, 1969; Bourdier, 1972;
David, 1981; Lamour, 1989). In my hospital experience with patients
and their babies, I have been confronted with several questions:
Can an institution play a role in this type of therapy? What are the
effects of the type of psychosis involved? Is it useful, in terms of a
prognosis, to identify the psychic structure? What metapsychological
perspectives are opened up by this type of work?
“Institution” here is not to be understood only administratively
or legally, but rather as a symbolic organization (the “field of speech”,
as Maud Mannoni defined it, referring to José Bleger), a framework
in which the interventions of various protagonists take place and
have their meaning. It is obvious that the operation of the institution
in this sense cannot be reduced to the organization of a group of
health workers. An institution must be produced and a number of
discursive elements define it: utterances, signifiers, and the history
of the institution itself determine the place and actions of the various
protagonists. It cannot be defined merely as the model of the
Freudian crowd.
Both the administrative conditions and the orientation of the care
provided influence clinical practice, and in the service that provides
the focus of this article the psychiatrist was asked to provide a
response in line with the elements of predictability, a forecast which

62
 CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 63

122 could be used to guide a primarily social treatment of the relationship

2 with the patient. But “observation”, the institutional atmosphere
3 and the style of the work are not without consequence for what a
4 practitioner attempts to describe or predict. Ultimately, in this case,
5 the main question consisted of “knowing” whether a benefit could
6 be derived for both child and mother by maintaining the initial
7222 relationship, or whether the link was so easily disturbed and
8 destabilizing for the baby that interrupting it, even abruptly, would
9 be preferable. Expressed in these terms, the question may seem either
10 simplistic or completely theoretical, since it implies that one can
1 decide in advance. In reality, the situation is in a state of flux which
2 involves the observers, and rarely presents itself with such clarity.
3 What does a term like “initial relationship” mean anyway? And what
4 do we mean when we say a “prediction”, since the anxiety of the
5222 staff is such that, in an emergency, what is sought is a decision based
6 on a prediction that a doctor’s expertise would guarantee as accurate.
7 The discussion between Ernst Kris and Anna Freud aside, the idea
8 of predictability should, in this field, be used cautiously.
9 The institution I was involved with is a pre- and post-natal
20 convalescence centre for pregnant women and for mothers in the first
1 two or three months of the postpartum period. Their stay at the centre
2 is always a limited one, and its history is of interest. In the beginning,
3 it was a postnatal care centre, with more of a social than a medical
4 vocation. It treated young women: maids, laundry workers—mostly
5 women from outside Paris who had fallen pregnant, lost their jobs,
6 and were generally down on their luck. The advent of contraception
7 and changes in attitudes gradually transformed its main aims. The
8 women who now come in with their babies are sometimes victims
9 of substance abuse, often living on the fringes of society, or they are
30 psychotics who come from psychiatric services in the Paris area. The
1 centre takes in a diverse population, but what these women have in
2 common is that they have nowhere to go during their pregnancy or
3 when beginning their lives as mothers. The presence of all these
4 down-and-out women has made the centre into the “paddy wagon”
5 of the maternity ward, and this evolution has led to a very important
6 development in the role of psychiatry.
7 Adding to the original task of the centre’s psychiatrists has come
8 at a price. The psychiatrist and the psychologists had initially played
922 a discreet role in following the patient, but it was limited to the

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64 ALAIN VANIER

“orientation and evaluation” of the mother-child relationship. They

were asked for “technical” advice within a multi-disciplinary team.
References to psychoanalysis in such a context brought about a trans-
formation by introducing the idea of another kind of care, decisions
stemming from work with the patient. What was at first a symptom
at the institutional level, the conflict between the institutional
demand for objectification and an approach providing a space for
the subject and speech, condensed around the question of psychotic
mothers and their babies. It was difficult to formalize the latent
objectification in the institutional demand and the resulting tension
did not easily fit into a convenient dialectic.
One of the first observations to be made is that during preg-
nancy—a period which may seem especially difficult—and in the
immediate postpartum period, psychotic mothers usually enter a
relatively calm phase, mostly with no significant increase in delirium.
On the whole, at least in the beginning, it is a phase of pathological
tranquillity, provided that the institution fulfils its role adequately
by providing a sufficiently “containing” influence, even if the term
“containing” does not really elucidate everything in play. Without
generalizing too much, instances of acute tension are most often
quickly resolved.
Although their pregnancies are relatively calm, psychotic women
do not always make the link between pregnancy and the arrival of
a child. When they speak, the child is generally not a factor and is
seldom mentioned. When not simply denied, pregnancy is often
considered an organic disorder; it is acknowledged very late, often
when those around them notice signs of physical change. Paradoxi-
cally, the physical changes are usually accepted quite well, except in
times of crisis. One of our patients, for example, stopped changing
her clothes, stopped washing, and finally decided to wear only one
piece of clothing, yellow pyjamas. She refused to wear anything but
these pyjamas night and day for weeks. One Sunday afternoon, two
days before her scheduled delivery, she showed up at the centre
completely naked, screaming, “Get this thing out of my stomach and
get it over with!” The crisis was quickly resolved by getting her back
into her yellow pyjamas, but she was then unable to step out of
them until after delivery. Her pyjamas helped maintain her physical
unity, acting as a surface enveloping her body at a time when her
physical unity was particularly threatened.

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 CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 65

122 Authors who have dealt with these issues most often recommend
2 a very early separation from the child, given the deadly components
3 of the initial relationship. For Françoise Dolto, however, such mothers
4 have to be given support, and their children should be allowed to
5 see them: “They chose the mother they have. If mother and child hit
6 it off right, they can make do. Who knows if the observed behaviour
7222 isn’t in line with the potential inner development of the child?” What
8 is needed is support for the relationship. But the child also has to be
9 told: “You’re right. What your mother just told you, or just did, isn’t
10 good for you. But she acts like that because she’s sick in her head.”
1 Dolto stresses that although the child should see the mother, these
2 mothers should not be too present for the child because “even in her
3 motor reflexes such a woman mediates a deadly disorder”. That is,
4 the death drives of the psychotic are transmitted directly to the child,
5222 who serves as a continuous boosting mechanism for the mother, so
6 that the danger for the child of a psychotic (or neurotic) mother
7 is that the child may become the mother’s first psychoanalyst or
8 psychotherapist. The child pumps up the mother and very soon
9 becomes hypertonic trying to stimulate the mother who, because of
20 psychosis, depression or medication, is unresponsive and has too still
1 a face.
2 These are mothers who have a difficulty with separation (for
3 example, Winnicott’s Esther), but we can work with them either to
4 tolerate real separation, where the child goes to another institution,
5 or to accept symbolic separation: the baby is not a part of her.
6 The mother and child should be separated, since the mother’s
7 behaviour and care can be very dangerous for her child; but on the
8 other hand, it is just as dangerous for the child not to see its mother.
9 The child should “be told about the abnormality that makes it
30 impossible for it to be left with its mother. For this reason, the person
1 who provides care for the child must be sufficiently maternal to
2 agree to see a woman who, for example, does not acknowledge her
3 child” (Dolto, 1988/1993). These tensions are also reproduced in the
4 practices of the institution because the teams that take care of a
5 mother are not the same as those that take care of a child. There is
6 conflict between parts of the institution deriving from the various
7 identifications of the therapeutic staff.
8 Our work during the very first months after birth recognizes that
922 a stay in an institution can develop the link between the mother and

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the child and allow for the work to be done that makes separation
possible. Separation takes place at several levels. If necessary, it can
be a real separation, or it can be a potential separation, allowing the
mother to tolerate the emergence of a difference, a subjective
recognition of the child inside its initial relationship. Whichever it
is, the separation is part of the link between mother and baby and
should not be confused with a complete break.
Ms H is an African patient sent to us by the home where she was
staying temporarily. She already had a four-year-old in care. She was
being treated on an occasional basis by a psychiatric team and by
the child-care centre which had taken in her older child. Ms H had
just given birth to a baby girl, who arrived with her. She gave the
baby her own first name, which meant that, since the baby had not
been recognized by the father, she bore exactly the same name as
her mother. From the outset, then, there was a confusion with respect
to the chronology of generations. We have been surprised by the
frequency of identical first names, by a familial identification through
first names more generally, which reveals the narcissistic basis of the
relation of mother to child, a narcissistic investment along the lines
of a total double. We could speak of a seamless mirror relationship,
lacking nothing, leaving no room for the recognition of otherness.
Such a mirror relationship is marked by a number of symptoms
involving the gaze.
The family name allows for an inscription in the register of
genealogical succession and thus for the staking out of a symbolic
place. In this respect, the name refers to an origin which could be
mythical, as in the case of the most famous French aristocratic
families. The Lusignan family, for instance, claimed descent from
the fairy Mélusine, the Bourbons from Hercules, and so on. On the
mother’s side, the biological side, there is no real bloodline in the
symbolic sense, the kind that dispels doubt through the bestowal
of a name. However, for the mother, the origin is certain, being
biological, and can be equated to a unicellular being. In the first
instance, we have an origin that can be expressed only as a myth; in
the second, we have a demythicized real. The first name, however,
does not play the same role as the family name. It allows for the
inscription of a different generation.
Just before being hospitalized, Ms H invited her own mother over
from Africa. Her mother returned to Africa once she was admitted,

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 CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 67

122 and once her baby was born, Ms H displayed a very ambivalent
2 relationship with her daughter, not wanting to be separated from
3 her, since this might invalidate her as a mother. From the first
4 meeting, Ms H’s behaviour was very erratic. She would make bizarre
5 statements, stop speaking for no apparent reason, and avoid looking
6 anyone in the eye. She could not look at us when she spoke, nor could
7222 she look at her baby. She would give her baby the bottle with a certain
8 aloofness: the baby would lie on her mother’s bed and the mother
9 would stand next to the bed, staring at the floor. She would give the
10 bottle with her arm stretched out straight, or she would prop the
1 child up with cushions, so she could drink from the bottle by herself.
2 The shutters would be closed and the curtains drawn all the time.
3 Ms H’s comments revealed the beginnings of a surveillance delirium.
4 Her baby would be wrapped naked in blankets. Most of the time,
5222 she would lie on the bed propped up against her mother, or in a crib
6 on the other side of the room. On the first day, the paediatric nurse
7 who took care of the baby wrote: “The baby does not drink much
8 from the bottle and sleeps a lot. I told the mother to watch the bottle
9 and not the baby, which she agreed to do, but she needs me to be
20 there.”
1 Right away, we asked Ms H to leave the child at the nursery. We
2 told her that the child could sometimes be with her in her room, but
3 we also asked her to come to the nursery to take care of her. This
4 meant that there would be a third party present, the paediatric nurse,
5 who could speak to Ms H with the baby present, and speak to the
6 baby with her mother present. To protect her baby from her murder-
7 ous feelings, Ms H began handing the child over more and more
8 often to the paediatric nurses, and the baby soon showed fewer signs
9 of what at first had been cause for concern. During her stay, Ms H
30 gradually began playing with the distance that she had created
1 between herself and her baby, but distance alone could not protect
2 her completely. Something more was needed. If creating a distance
3 had sufficed to regulate the relationship, we would have found
4 ourselves faced with a phobic solution for a problem that is at another
5 level altogether.
6 A month later, the paediatric nurse wrote: “I put the baby in her
7 arms with the baby facing her. She looks at the baby, speaks to her,
8 calls her ‘my honey bun’. The baby, who previously had slept poorly
922 and drunk little, now looks you in the eye and listens when you speak

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to her. Her muscle tone is normal. That day, Ms H was astonished

to see her baby ‘up’, that is, supporting herself on her forearms. She
said, ‘My little baby is changing.’”
After this narcissistic revaluation, Ms H herself underwent a
change and left her baby at the nursery more and more often. She
began letting the hospital personnel take care of the baby, issuing
orders to them as though they were hired help. Luckily, the team
went along with this game, which had a somewhat delirious side to
it. The day the foster family showed up (the decision had been taken
to place the baby in care), Ms H said, “The paediatric nurse will tell
you about my daughter. She’s the one who takes care of her when
I’m not around.” Ms H did have trouble with the development of
her child, and she could not bring herself to change the size of her
baby’s nappies, continuing to use the very smallest size.
In regular discussions with her, it became obvious that the child
was there to settle the question of Ms H’s own position. Her first
baby had arrived at a time when the mother was completely lost,
without any family or institutional moorings. The placement in
foster care of her first child—the word “place” takes on a particular
importance, and she uses it often—allowed Ms H to find her own
place: people to care for her and provide her with guidance, as well
as substantial financial aid. With the second baby, she expected the
same thing to happen: she would find a place for her baby girl, who
bore her own name, and thus would find her own place. Our
discussions and subsequent events pointed to the emergence and the
explanation of the filiation delirium: she was not African, but French,
or wanted to be considered as such, and she hoped to get French
nationality through her daughter. It was a strange construct in which
the delirium, an inversion of filiation whereby she planned to get
her nationality through her daughter, was intermingled with the
likelihood of legal resolution.
The situation changed as the delirium developed. Feeling less
persecuted, Ms H began opening the window and shutters and going
out. Without telling us, she soon found a job (the staff helped her)
working at the unemployment office. Gradually she became like any
mother leaving for work: she would leave her baby each morning
at the nursery, considering it a “day care centre”. At this point she
started imagining, and even went so far as to ask that her daughter
be put in a foster home, but she then disappeared a few days before

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 CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 69

122 this actually happened. She did phone later but seemed to care very
2 little about the proceedings.
3 The second patient, Ms A’s, psychosis was diagnosed not as
4 schizophrenia but as paranoia. Rather than a lengthy description, we
5 will give only a few details of her case.
6 Ms A was over 40 years old, and this was her first baby. Her
7222 pregnancy was unexpected, but she seemed extremely happy about
8 it. She presented a significant persecution delirium, very systematic
9 and rather stable, which revolved around the government adminis-
10 tration where she had been employed. The delirium fed on intuition
1 and interpretations, but we did not observe any hallucinatory states.
2 Her stay at the hospital service, which began long before delivery,
3 took place in a near euphoric atmosphere: the space was well
4 protected; her persecutors could not get in. The future father was
5222 very present but also very odd. He recognized the child before its
6 birth but disappeared for a time when Ms A left the hospital.
7 After giving birth, Ms A no longer felt safe at the hospital. The
8 day after the delivery, she spotted a white truck in the car park.
9 There was no doubt in her mind that the truck belonged to her
20 persecutors, so the centre was not impenetrable and people could
1 get in. She went through a very agitated period in which she called
2 the police and had them come to the hospital and to her parents’
3 place because she felt that they too were in danger; this also related
4 to questioning her filiation. She barricaded herself in her room.
5 Although I was the only one she let in, she still kept up a satisfactory
6 relationship with the staff. She agreed that her baby should be in the
7 nursery as often as possible and even asked for this to be done, while
8 she herself remained barricaded in her room. In her mind, the baby
9 was not threatened by her persecutors.
30 At this point we might do well to consider the idea posited by
1 some authors about the involvement of a child in a delirium. In Ms
2 A’s case, the child was not totally excluded from it, but the danger
3 would appear only after puberty. The little girl stayed at the nursery,
4 and her mother started coming more and more often to take care of
5 her, something she did particularly well. The relationship was not
6 an especially affectionate one, but the care Ms A gave her child was
7 good enough for the child not to present any obvious problems. Ms
8 A explained her lack of affection by saying that she could imagine
922 her child only as a teenager. She began telling us about her numerous

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fears concerning the future of her baby. She was worried about who
her friends would be, about what might happen during after-school
hours. She was worried about substance abuse, possible delinquency,
and, of course, what her persecutors might want to do to her.
Speaking about her baby in the here and now, she said, “She’s like
a toy poodle.” She expressed surprise that there was any point in
talking with her child, but she did it anyway; she was proud of her
baby and loved to show her off to everyone.
In this type of delirium, the child is not so much a double as an
ideal. This supposes that the ideal process, which does not happen
in all types of psychosis, is in place and functioning. The first name
that she chose for the child supports this. Her family name is the
same as that of a very famous actress, and Ms A gave her child
the actress’s first name. The only hitch was that since the father
recognized the child, the duplication of names became impossible.
To counteract this, Ms A said that she planned to have the father’s
name cancelled.
Depending on Ms A’s mood, the hospital provided more or less
adequate protection against her persecutors, whom she saw milling
around outside the entrance, in the car park, and so on. She was very
relieved the day she went to meet a family court judge to request
protection for herself and her daughter, and came back from the
meeting reassured that her child was no longer in jeopardy.
In the cases described briefly above, the institution functioned
as a third party that provided security first and foremost. When the
mother feels endangered, or becomes dangerous for the child, the
institution does indeed offer effective protection, but it also allows
for a possible readjustment of the situation. This starts with a gradual
distancing of the mother and child, but without depriving the mother
of her imagined control, since she can still control the child by issuing
orders to the staff.
But the institution intervenes as a third party on another level.
This third party is missing not only in reality—we are dealing very
often with single mothers, the father being unwilling to recognize
the child—but because of the mother’s pathology. It is precisely this
third element, needed for the structuring of a subject, that the mother
is unable to provide. In a way, the institution’s rules for everyday
life, along with the staff’s presence, provide a basis for something
which can function both as an intermediary and symbolic element

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 CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 71

122 for the child, and as a prosthesis of the ego, a narcissistic support
2 for the mother in the particularly difficult relation she has with her
3 child. Here we see the possibility of a real “holding” of the mother
4 and the child, organized very flexibly in the daily life of the clinic.
5 But the term “holding” does not suffice to account for everything
6 taking place, unless we give “holding” all of Winnicott’s meaning.
7222 Mediation is more than holding, more than what is seen in the ways
8 the child is held.
9 The time spent in the clinic does not necessarily end in separation.
10 Often the clinical environment seems to be a determining factor in
1 the future association of mother and child. The environment is
2 not only the maternal field, it also includes the mother; it is the
3 space within which the relations between the mother and child
4 are organized. Even when such an environment exists, the issue of
5222 separation is still crucial, so our work does not end with actual
6 separation. Sometimes the mother and child can return to the family
7 home, and our work has created a place where the third fundamental
8 element could inform the home environment. The period of
9 separation, that first, archaic attempt, was the determining moment.
20 Our experience shows that for psychotic mothers, birth, properly
1 speaking, does not in itself constitute a break; the actual separation
2 of bodies is not a separation in the symbolic sense.
3 There is a particularly difficult moment to negotiate in the mother-
4 child relationship. Winnicott remarks upon this in a paper in which
5 he talks about Esther. Esther’s mother, a psychotic, was taking care
6 of her child all alone during the first months of her life, and soon
7 started acting strangely. After a sleepless night, she began to wander
8 in a field near a canal, stopping to watch a retired police officer dig
9 a hole. She then headed for the canal and threw her baby into it.
30 Although everything here is of importance, we will not comment on
1 the police officer, but on the baby’s having been thrown, dropped—
2 it is relevant to note that the fact that the baby was “dropped” refers
3 us back to how a baby functions as an object, a special kind of object
4 that Lacan called the “object a”. Winnicott refers to the baby as an
5 object and remarks that if the baby is not held it will fall “infinitely”
6 (Winnicott, 1957). For Lacan, the baby has the status of an “object a”
7 for the mother. This includes separation, provided that the object is
8 phallicized, that is, referred to in terms of a lack. This supposes a
922 third position in the mother-child relation, a position that causes

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Lacan to posit the paradoxical term “pre-oedipal triangle”. Without

such an indexation, the only separation possible is a real one, in
which the object is perceived as a piece of refuse to be thrown away,
since it is a condenser of unlimited deadly jouissance.
It is important to note that Winnicott thought Esther’s mother had
been able to give her baby a start in life, but that the trouble had
started when the child began to separate from her mother. For the
mother, such a separation could be achieved only through an actual
fall. Indeed, in the first months of motherhood, something resembling
an utterance of the demand introduces psychotic mothers to the
difficult question of otherness. Demand can intervene only if the
baby’s screams can be understood, afterwards, as a call (Freud,
1887–1902): that is, if the mother can give these screams the status
of a demand addressed to her. In the perspective introduced by Piera
Aulagnier, “the mother, as a spokesperson, plays a participatory role
from which the ‘spoken shadow’ proceeds, a matrix of the ‘I’, a
witness to the fact that before speaking, the ‘I’ is spoken.” (Vanier,
2000). This anticipatory function is not observable; it is a temporal
opening resulting in a hiatus or gap and an act of violence for the
“I” (Mijolla-Mellor, 1998).
From another point of view, the mother has to assume that there
is a subject in the baby (Vanier, 1995), but a supposition is not a
certitude, rather it is a belief or an act of faith, a reading of this
necessary trustworthiness as continued support of being. Such a
supposition implies a place, that of the Other, where the supposition
can sustain itself. The supposed subject is held by the mother, and
the whole is depicted imaginarily and retroactively by the idea of a
fusion (or, at best, “merging”), of a symbiosis. This is an essential
part of “holding”. It explains how the subject can be already there
in the mother, who imagines it as separated and thus brings it into
existence, since the subject is supposed to know. For the analyst this
sort of position manifests itself in work with autistic children, as
shown in Melanie Klein’s analysis of Dick (Vanier, 1993). To be able
to speak it and speak for it, the mother must suppose that the child
knows (Bergès & Balbo, 1998), and the child’s knowledge would
necessarily imply a subject. Meaning is not produced by the child;
meaning returns to the child only if the mother can provide meaning
as such. It is close to Winnicott’s insistence on “the mother’s role of
giving back the baby’s own self” (1971).

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 CLINICAL EXPERIENCE WITH PSYCHOTIC MOTHERS 73

122 The child as a subject is held by the supposition of the mother,

2 who thereby institutes the child. Provided that the mother supposes
3 knowledge, a knowledge about the object that the child might be
4 demanding, the mother can transform the child’s cry into a call. Since
5 she supposes first of all that there is a demand, the mother can later
6 interpret the cry as having been addressed to her, as a call to her. It
7222 is difficult, therefore, to locate chronologically the idea of a first call
8 that would subsequently be recognized as such by the Other. We
9 find the function of supposed knowledge in transference, at the heart
10 of the analytical relationship and of any one-to-one relationship. In
1 the case of psychosis, it is not knowledge that is erased, but rather
2 the supposition of knowledge. The supposition is what introduces
3 and attests to a third dimension in the dual relationship.
4 On the other hand, the demand supposes another relationship to
5222 the Other, and the possibility of something detachable, something
6
which could circulate as an element of exchange. In the case of some
7
schizophrenic mothers, who encounter difficulties in the identifi-
8
cation relationship with their babies, we note that the child’s nursing
9
is often dependent on the mother’s own feeling of hunger rather than
20
on any signs the child might exhibit. In such a situation, the mother
1
can experience piecemeal division, since she can feel torn by what
2
presents itself as a demand. The fact that an object detaches itself,
3
even partially, supposes the inscription of an initial temporality,
4
5 linked to the dimension of absence.
6 The aim of working with these patients is to enable them to
7 maintain a place in the history of their children and at the same time
8 to allow somehow for the separation to happen, so to speak, from
9 inside the relationship rather than from the outside, in the guise of
30 a doctor’s or a social worker’s decision. But without a formal setting
1 it seems impossible to carry out that task without risking a major
2 catastrophe. This is precisely what we see as the institution’s role.
3 The experience of analysis with adults shows clearly that a
4 paranoid father or mother can function normally, although with
5 some disruptions. With a schizophrenic mother, on the other hand,
6 insofar as she involves the body to a major extent, it seems that the
7 early disturbances in the mother-child relationship are much more
8 damaging. The Other is still present in the case of paranoia, even
922 though its function is not separated. Schizophrenia, however, does

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not include the function of the Other. Unlike paranoia, schizophrenia

divides the body up into drives, organ by organ, because language
itself is never permitted to become an organ. Schizophrenics have
not found a role for the speech that haunts them; language has no
place to go, no organ, even though it has a function. Of course, in
psychoanalysis the field of language does not have a corresponding
organ—this is the meaning of castration. The neurotic gives discourse
a sexual overtone, because even if the organ is ill-fitted for speaking,
it nevertheless does function. Unlike paranoiacs, schizophrenics
cannot construct themselves around an object, which explains why
they have trouble experiencing a delirium. Something has to be found
to play the role of mediator between mother and child: for her, a
corporal container which is not assured, meaning guaranteed for the
child, a possible third element.
This is where the institution can play a role. In addition to its other
functions, the institution also creates an environment regulated by
speech and language, provided that holding is not reduced to mere
maternal behaviour. It is thus possible to avoid global solutions and
prognoses, and instead to approach each case as something that,
according to Winnicott, “needs very careful examination, or in other
words highly skilled casework”. (1959) Along with the indications
provided by the identification of the structure, by the inclusion or
not of the child into the maternal pathology, we can add the valuation
of this subjective supposition by which a mother can promote her
child towards existence.

References
Anthony, E.J. (1969). Clinical evaluation of children with psychotic parents.
American Journal of Psychiatry, 126: 177–184.
Bergès, J. & Balbo, G. (1998). Jeu des places de la mère et de l’enfant. Essai
sur le transitivisme. Ramonville Saint-Agne: Érès.
Bourdier, P. (1972). L’Hypermaturation des enfants de parents malades
mentaux. Revue Française de Psychanalyse, 36/1: 19–42.
David, M. et al. (1981). Danger de la relation précoce entre le nourrisson et
sa mère psychotique, une tentative de réponse. La psychiatrie de l’enfant,
24/1, 151–156.
Dolto, F. (1993). Conversation. Entretien avec C. Mathelin et A. Vanier. In:
L’enfant et la psychanalyse. Paris: Esquisses Psychanalytiques.

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122 Freud, S. (1887–1902). The origins of psychoanalysis. Letters to Wilhelm Fliess,

2 drafts and notes. E. Mosbacher, J. Strachey (Trans.), M. Bonaparte, A. Freud,
3 E. Kris (Eds.). London: Imago, 1954.
4 Lamour, M. (1989). Des nourrissons de parents psychotiques. In: Leibovici
5 S. & Weil-Halpern, F. (Eds.), Psychopathologie du bébé. Paris: PUF.
6 Mijolla-Mellor, S. (1998). Penser la psychose. Une lecture de l’œuvre de Piera
7222 Aulagnier. Paris: Dunod.
8 Vanier, A. (1993). Autisme et théorie. In: Hommage à Frances Tustin. Saint
9 André de Cruzières: Audit.
10 Vanier A. (1995). Contribution à la métapsychologie du temps des processus
1 psychiques. Questions posées par l’observation et la clinique infanto-juvénile.
2 Doctoral thesis (dir.: P. Fedida). Université Paris VII-Denis Diderot,
unpublished.
3
Vanier, A. (2000). Quelques remarques sur le « Je » et le sujet. In: Topique
4
(pp. 133–140). Paris: L’Esprit du Temps.
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Winnicott, D.W. (1957). On the contribution of direct child observation to
6
psycho-analysis. In: The Maturational Process and the Facilitating Environ-
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ment. London: Hogarth, 1965. [Karnac, 1990]
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Winnicott, D.W. (1959). The effect of psychotic parents on the emotional
9
development of the child. In: The family and individual development. London:
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Tavistock, 1965. [Routledge, 2006]
1
Winnicott, D.W. (1971). Playing and reality. London: Tavistock, 1971.
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[Routledge Classics, 2005]
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CHAPTER SIX

On holding and containing,

being and dreaming
Thomas Ogden

W
innicott’s concept of “holding” and Bion’s idea of the
“container-contained”—though often used interchange-
ably in the psychoanalytic literature—to my mind, each
addresses quite different aspects of the same human experience and
involves its own distinctive form of analytic thinking. To blur the
distinction between the two concepts is to risk missing what is most
original and most important to the psychoanalytic perspectives
created by Winnicott and Bion.
I believe that the confusion regarding the concepts of holding and
the container-contained derives to a considerable degree from Bion’s
penchant for using words in a way that invents them anew (Ogden,
2004a). In Bion’s hands, the word “container”—with its benign
connotations of a stable, sturdy delineating function—becomes a
word that denotes the full spectrum of ways of processing experience
from the most destructive and deadening to the most creative and
growth-promoting.
In this paper I delineate what I see as the essential features of the
concepts of holding and the container-contained, and by juxtaposing
the two, illuminate some of the differences between these sets
of ideas. Throughout the discussion, it must be borne in mind that
the concepts of holding and the container-contained stand not in
opposition to one another but as two vantage points from which to
view an emotional experience.

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 ON HOLDING AND CONTAINING, BEING AND DREAMING 77

122 Part I: Holding

2
As is the case for almost all of Winnicott’s seminal contributions, the
3
idea of holding is a deceptively simple one (Ogden, 2001). The word
4
“holding”, as used by Winnicott, is strongly evocative of images of
5
a mother tenderly and firmly cradling her infant in her arms, and
6
when he is in distress, tightly holding him against her chest. Those
7222
psychological/physical states of mother and infant are in fact the
8
essential experiential referents for Winnicott’s metaphor/concept
9
of holding.
10
The importance of the impact of maternal holding on the
1
emotional growth of the infant would be disputed by very few
2
psychoanalysts. However, the significance to psychoanalytic theory
3
of Winnicott’s concept of holding is far more subtle than this broad
4 statement would suggest. Holding, for Winnicott, is an ontological
5222 concept that he uses to explore the specific qualities of the experience
6 of being alive at different developmental stages as well as the
7 changing intrapsychic-interpersonal means by which the sense of
8 continuity of being is sustained over time.
9
20
1 Being in the infant’s time
2 The earliest quality of aliveness generated in the context of a holding
3 experience is aptly termed by Winnicott “going on being” (1956,
4 p. 303), a phrase that is all verb, devoid of a subject. The phrase
5 manages to convey the feeling of the movement of the experience of
6 being alive at a time before the infant has become a subject. The
7 mother’s emotional state entailed in her act of holding the infant in
8 his earliest state of going on being is termed by Winnicott “primary
9 maternal preoccupation”. As is true of the infant’s state of going on
30 being, primary maternal preoccupation is a subjectless state. It must
1 be so because the felt presence of the mother-as-subject would tear
2 the delicate fabric of the infant’s going on being. In primary maternal
3 preoccupation there is no such thing as a mother. The mother “feel[s]
4 herself into the infant’s place” (Winnicott, 1956, p. 304), and in so
5 doing ablates herself not only as the infant experiences her, but also
6 to a large degree as she experiences herself. Such a psychological state
7 is “almost an illness” (p. 302)—”a woman must be healthy in order
8 both to develop this state and to recover from it as the infant releases
922 her” (p. 302).

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78 THOMAS OGDEN

A principal function of the mother’s early psychological and

physical holding includes her insulating the infant in his state of
going on being from the relentless, unalterable otherness of time.
When I speak of the otherness of time, I am referring to the infant’s
experience of “man-made time”: the time of clocks and calendars,
of the four-hour feeding schedule, of day and night, of the mother’s
and the father’s work schedules, of weekends, of the timing of
maturational landmarks spelled out in books on infant development,
and so on. Time in all of these forms is a human invention (even the
idea of day and night) that has nothing to do with the infant’s
experience; time is other to him at a stage when awareness of the
“not-me” is unbearable and disruptive to his continuity of being.
In her earliest holding of the infant, the mother, at great emotional
and physical cost to herself, absorbs the impact of time (e.g. by
foregoing the time she needs for sleep, the time she needs for the
emotional replenishment that is found in being with someone other
than her baby, and the time she needs for making something of her
own that is separate from the infant). In effect, the mother’s earliest
holding involves her entering into the infant’s sense of time, thereby
transforming for the infant the impact of the otherness of time and
creating in its place the illusion of a world in which time is measured
almost entirely in terms of the infant’s physical and psychological
rhythms. Those rhythms include the rhythms of his need for sleep
and for wakefulness, of his need for engagement with others and his
need for isolation, the rhythms of hunger and satiation, the rhythms
of breathing and heartbeat.
The mother’s early holding of the infant represents an abrogation
of herself in her unconscious effort to get out of the infant’s way.
Her unobtrusive presence “provides a setting for the infant’s
constitution to begin to make itself evident, for the developmental
tendencies to start to unfold, and for the infant to experience
spontaneous movement and become the owner of the sensations that
are appropriate to this early phase of life” (Winnicott, 1956, p. 303).
The mother’s risking psychosis in providing selfless “live, human
holding” (Winnicott, 1955, p. 147) allows the infant to take his own
risk in beginning to come together as a self. That earliest moment of
coming together “is a raw moment; the new individual feels infinitely
exposed” (p. 148).

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 ON HOLDING AND CONTAINING, BEING AND DREAMING 79

122 Clinical illustration

2
In the following clinical account, the form of holding just described
3
plays a central role.
4
Ms R startled when I met her in the waiting room for our first
5
session. She said hello without making eye contact, and, in a stiff
6
awkward way, walked from the waiting room into my consulting
7222
8 room. She lay down on the couch without our ever having discussed
9 her using the couch. Ms R turned her head towards the wall (away
10 from me and the little bit of light coming through the closed window
1 blinds). The patient blurted out in clumps of words the fact that
2 she had begun to have panic attacks for which she could find no
3 cause. She told me that she was not able to work or to be a mother
4 to her two adolescent children. Almost in passing, she told me that
5222 her mother had died six months earlier—”she was old and sick and
6 it was for the best”.
7 When I made a comment or asked a question in the early stages
8 of this analysis, the patient startled in the same way she had in the
9 waiting room when we first met. I did not comment on this behaviour
20 and learned quickly to say almost nothing during the sessions. Even
1 the sound of my moving in my chair was experienced by the patient
2 almost as if I had slapped her. It was necessary for me to remain as
3 still and quiet as possible if Ms R was to be able to tolerate being
4 with me. The patient, sensing my stillness (except for the sound and
5 movement of my breathing), relaxed noticeably in the course of the
6 first several sessions and ceased speaking altogether during our
7 meetings for weeks afterwards. I did not experience the need to
8 remain as quiet as I could as the outcome of the patient’s tyrannical
9 rule; rather, being with her reminded me of sitting in my younger
30 son’s bedroom when he was three years old as he fitfully lay in bed
1 trying to fall asleep after having been awoken by a nightmare.
2 Quite the opposite of feeling put upon by Ms R (or by my son), I
3 felt that my presence was like a soothing balm on a burn. While with
4 the patient during a prolonged period of silence, I recalled that when
5 my son began to be able to relax into sleep his rhythm of breathing
6 and my own became one. In my half-sleeping state during one of
7 the nights I sat with him, I dreamt dreams in which my wife and
8 children had disappeared. The dreams felt so real that it took me a
922 bit of time on waking to recognize them as dreams.

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80 THOMAS OGDEN

In retrospect, I believe that during those nights with my son I was

unconsciously becoming at one with him, physically and psychologi-
cally, breathing his rhythm of breathing, dreaming his fears. The
hours spent by his bed remain with me as disturbing, tender expe-
riences. In the session with Ms R, as I recalled that period of sitting
with my younger son, a line from a poem by Seamus Heaney came
to mind: “Never closer the whole rest of our lives” (1984). I felt that
the patient needed of me what my very young son had needed. I
was willing to be used in that way by Ms R when she was able to
take the risk of drawing on me at such a depth.
In the reverie that included the thoughts about my son and the
line from the Heaney poem, I was unconsciously talking to myself
about the experience of selfless holding that Ms R needed. It was as
much a physical experience (for me and, I believe, for her) as it was
a psychological one.

The gathering of bits

As the infant grows, the function of holding changes from that of
safeguarding the fabric of the infant’s going on being to the holding/
sustaining over time of the infant’s more object-related ways of being
alive. One of these later forms of holding involves the provision of
a “place” (a psychological state) in which the infant (or patient) may
gather himself together. Winnicott speaks of:

the very common experience of the patient who proceeds to give

every detail of the weekend and feels contented at the end if
everything has been said, though the analyst feels that no analytic
work has been done. Sometimes we must interpret this as the
patient’s need to be known in all his bits and pieces by one
person, the analyst. To be known means to feel integrated at least
in the person of the analyst. This is the ordinary stuff of infant
life, and an infant who has had no one person to gather his bits
together starts with a handicap in his own self-integrating task,
and perhaps he cannot succeed, or at any rate cannot maintain
integration with confidence. [1945, p. 151]

Here, the earlier, physical/emotional type of holding has given way

to metaphorical holding, the provision of a psychological space that

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 ON HOLDING AND CONTAINING, BEING AND DREAMING 81

122 depends upon the analyst’s being able to tolerate the feeling “that
2 no analytic work has been done”. Winnicott demonstrates in the way
3 he uses language what he has in mind. In saying “Sometimes we
4 must interpret this as the patient’s need to be known in all his bits
5 and pieces by one person, the analyst”, Winnicott is using the word
6 “interpret” to mean not to give verbal interpretations to the patient,
7222 and instead, simply, uninterruptedly to be that human place in which
8 the patient is becoming whole.
9 This type of holding is most importantly an unobtrusive state of
10 “coming together in one place” that has both a psychological and a
1 physical dimension. There is a quiet quality of self and of otherness
2 in this state of being in one place that is not a part of the infant’s
3 earlier experience of “going on being” (while held by the mother in
4 her state of primary maternal preoccupation).
5222
6
Internalization of the holding environment
7
8 The experience of transitional phenomena (Winnicott, 1951) as well
9 as the capacity to be alone (1958) might be thought of as facets
20 of the process of the internalization of the maternal function of
1 holding an emotional situation in time. In transitional phenomena,
2 the situation that is being held involves the creation of “illusory
3 experience” (1951, p. 231) in which there is a suspension of the
4 question “Did you conceive of this or was it presented to you from
5 without? The important point is that no decision on this point is
6 expected. The question is not to be formulated” (pp. 239–40).
7 Winnicott views this third area of experiencing—the area between
8 fantasy and reality—not simply as the root of symbolism, but as
9 “the root of symbolism in time” (p. 234). Time is coming to bear the
30 mark of the external world that lies outside of the child’s control,
1 while at the same time being an extension of the child’s own bodily
2 and psychological rhythms. When the child’s psychological state
3 (whether as a consequence of constitutional make-up and/or trauma)
4 is such that he cannot tolerate the fear evoked by the absence of
5 his mother, the delicate balance of the sense of simultaneously
6 creating and discovering his objects collapses and is replaced by
7 omnipotent fantasy. The latter not only impedes the development of
8 symbolization and the capacity to recognise and make use of external
922 objects, but also involves a refusal to accept the externality of time.

81
82 THOMAS OGDEN

Consequently, the experience of being alive is no longer continuous;

rather, it occurs in disconnected bursts: magic is a series of instan-
taneous phenomena.
The capacity to be alone, like the development of transitional
phenomena, involves an internalization of the environmental mother
holding a situation in time. The most fundamental experience that
underlies the establishment of the capacity to be alone is “that of
being alone as an infant and small child in the presence of the
[environmental] mother” (1958, p. 30). Here, it is the function of the
mother as holding environment (as opposed to the mother as holding
object) that is in the process of being taken over by the infant or child.
This development should not be confused with the achievement of
object constancy or object permanence, both of which involve the
formation of stable mental representations of the mother as object.
Winnicott, in describing the development of the capacity to be alone,
is addressing something more subtle: the taking over of the function
of the maternal holding environment in the form of a child’s creating
the matrix of his mind, an internal holding environment.

Depressive position holding

The nature of Winnicott’s concept of holding that has been implicit
in the forms of holding that I have discussed thus far might be
thought of as emotional precursors of the depressive position as
Winnicott conceives of it. For Winnicott (1954), the depressive
position involves one’s holding for oneself an emotional situation
over time. Once the infant has achieved “unit status” (p. 269), he is
an individual with an inside and an outside. The feeding situation
at this point involves the infant’s or young child’s fear that in the act
of feeding he is depleting his mother (concretely that he is making
a hole in the mother or the breast). (The child has in fact been
depleting the mother all along as a consequence of the physical and
emotional strain involved in her being pregnant with, giving birth
to and caring for him as an infant.) “All the while [during the feed
and the digestive process that follows] the mother is holding the
situation in time” (p. 269).
During the period of digesting the experience of the feed, the
infant or small child is doing the psychological work of recognizing
the toll that his (literal and metaphorical) feed is taking on his (now

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 ON HOLDING AND CONTAINING, BEING AND DREAMING 83

122 increasingly separate) mother. “This [psychic] working-through [of

2 his feeling of having damaged his mother] takes time and the infant
3 can only await the outcome [in a psychological state in which he is],
4 passively surrendered to what is going on inside” (p. 269).
5 Eventually, if the infant or child has been able to do this psycho-
6 logical work, and if the mother has been able to hold the situation
7222 over time, the infant produces a metaphorical (and sometimes
8 also an actual) bowel movement. An infant or a child whose gift is
9 recognized and received by his mother “is now in a position to do
10 something about that [fantasised] hole, the hole in the breast or body
1 [of the mother] . . . The gift gesture may reach to the hole, if the
2 mother plays her part [by holding the situation in time, recognizing
3 the gift as a reparative gesture, and accepting it as such]” (p. 270).
4 Depressive position holding involves the mother’s recognition of
5222 the infant’s “unit status” (his coming into being as a separate person),
6 her being able to tolerate her separateness from him, and psychically
7 to hold (to live with) the truth of her infant’s and her own changing
8 status in relation to one another. She is no longer his entire world,
9 and there is great pain (and also relief) for her in that loss. The
20 emotional situation is creatively destructive in that the infant risks
1 destroying the mother (by making a hole in her) in the act of taking
2 from her what he needs to be able eventually to feed himself (i.e. to
3 become a person separate from her).
4 In depressive position holding, the child is becoming a subject in
5 his own right in the context of a sense of time that is more fully other
6 to himself. The child recognizes that he cannot move people faster
7 than they will move of their own accord, nor can he shrink the
8 time during which he must wait for what he needs or wants.
9 Depressive position holding sustains the individual’s experience of
30 a form of being that is continually transforming itself—an experience
1 of remaining oneself over time and emotional flux in the act of
2 becoming oneself in a form previously unknown, but somehow
3 vaguely sensed.
4
5
Part II: The container-contained
6
7 As is true of Winnicott’s holding, Bion’s (1962a, 1962b, 1971)
8 container-contained is intimately linked with what is most important
922 to his contribution to psychoanalysis. The idea of container-contained

83
84 THOMAS OGDEN

addresses not what we think, but the way we think, that is, how we
process lived experience and what occurs psychically when we are
unable to do psychological work with that experience.

The psychoanalytic function of the personality

Fundamental to Bion’s thinking, and a foundation stone for his
concept of the container-contained, is an idea rarely addressed in
discussions of his work: “the psycho-analytic function of the person-
ality” (1962a, p. 89). In introducing this term, Bion is suggesting
that the human personality is constitutionally equipped with the
potential for a set of mental operations that serves the function of
doing conscious and unconscious psychological work on emotional
experience (a process that issues in psychic growth). Moreover, by
calling these mental operations “psycho-analytic”, Bion is indicating
that this psychological work is achieved by means of that form of
thinking that is definitive of psychoanalysis, that is, the viewing
of experience simultaneously from the vantage points of the
conscious and unconscious mind. The quintessential manifestation
of the psychoanalytic function of the personality is the experience
of dreaming. Dreaming involves a form of psychological work in
which there takes place a generative conversation between pre-
conscious aspects of the mind and disturbing thoughts, feelings and
fantasies that are precluded from, yet pressing towards conscious
awareness (the dynamic unconscious). This is so in every human
being who has achieved the differentiation of the conscious and
unconscious mind regardless of the epoch in which he is living or
the circumstances of his life.
From one perspective, Bion’s proposal of a psychoanalytic
function of the personality is startling. Could he really mean that the
personality system of human beings as self-conscious subjects is
somehow designed to perform the functions described by a late-
19th/early20th century model of the mind? The answer, surprisingly,
is yes: for Bion (1970), psychoanalysis before Freud was a thought
without a thinker, a thought awaiting a thinker to conceive it as a
thought. What we call psychoanalysis is an idea that happened to
be thought by Freud, but had been true of the human psyche for
millennia prior to Freud’s “discovery” (Bion, 1970; Ogden, 2003a).1

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 ON HOLDING AND CONTAINING, BEING AND DREAMING 85

122 Dream-thoughts and dreaming

2
In order to locate Bion’s concept of the container-contained in relation
3
to the larger body of his thinking, it is necessary to understand his
4
conception of the role of dreaming in psychological life (see Ogden,
5
2003b for a clinical and theoretical discussion of Bion’s conception
6
7222 of dreaming). For Bion, dreaming occurs both during sleep and
8 waking life: “Freud [1933] says Aristotle states that a dream is
9 the way the mind works in sleep; I say it is the way it works when
10 awake” (Bion, 1959a, p. 43). Dream-thought is an unconscious
1 thought generated in response to lived emotional experience and
2 constitutes the impetus for the work of dreaming, that is, the impetus
3 for doing unconscious psychological work with unconscious thought
4 derived from lived emotional experience.
5222 Bion’s (1962a) conception of the work of dreaming is the opposite
6 of Freud’s (1900) “dream-work”. The latter refers to that set of
7 mental operations that serves to disguise unconscious dream-
8 thoughts by such means as condensation and displacement. Thus,
9 in derivative/disguised form, unconscious dream-thoughts are made
20 available to consciousness and to secondary-process thinking. By
1 contrast, Bion’s work of dreaming is that set of mental operations
2 that allows conscious lived experience to be altered in such a way
3 that it becomes available to the unconscious for psychological
4 work (dreaming). In short, Freud’s dream-work allows derivatives
5 of the unconscious to become conscious, while Bion’s work of
6 dreaming allows conscious lived experience to become unconscious
7 for the psychological work of generating dream-thoughts and for the
8 dreaming of those thoughts.
9
30 Some tentative definitions
1
2 Thus, basic to Bion’s thinking is the idea that dreaming is the primary
3 form in which we do unconscious psychological work with our lived
4 experience. This perspective, as will be seen, is integral to the concept
5 of the container-contained. I will begin the discussion of that idea
6 by tentatively defining the container and the contained.
7 The “container” is not a thing, but a process. It is the capacity for the
8 unconscious psychological work of dreaming, operating in concert with
922 the capacity for preconscious dreamlike thinking (reverie), and the capacity

85
86 THOMAS OGDEN

for more fully conscious secondary-process thinking. Though all three of

these types of thinking—unconscious dreaming, preconscious reverie
and conscious reflection—are involved in the containing function of
the mind, Bion views the unconscious work of dreaming as the work
that is of primary importance in effecting psychological change and
growth. Bion urges the analyst not to be “prejudiced in favour of a
state of mind in which we are when awake [as compared to the state
of mind in which we are when asleep]” (1978, p. 134). in other words,
for Bion, the state of being awake is vastly overrated.
The “contained”, like the container, is not a static thing but a living
process that in health is continuously expanding and changing. The term
refers to thoughts (in the broadest sense of the word) and feelings that are
in the process of being derived from one’s lived emotional experience. While
conscious and preconscious thoughts and feelings constitute aspects
of the contained, Bion’s notion of the contained places primary
emphasis on unconscious thoughts.
The most elemental of thoughts constituting the contained are the
raw “sense-impressions related to emotional experience” (1962a,
p. 17) which Bion calls “beta-elements” (p. 8). I have found no better
words to describe these nascent thoughts than those used in a poem
by Edgar Allan Poe: β-elements might be thought of as “Unthought-
like thoughts that are the souls of thought” (1848, p. 80).2 These most
basic of thoughts—thoughts unlinkable with one another—constitute
the sole connection between the mind and one’s lived emotional
experience in the world of external reality. These unthought-like
thoughts (β-elements) are transformed by “α-function” (an as yet
unknown set of mental operations) into elements of experience (“α-
elements”) that may be linked in the process of dreaming, thinking
and remembering.

The lineage of the concept of the container-contained

Having begun the discussion of the container-contained by defining
the container and the contained, I will briefly trace the development
of Bion’s ideas concerning the interplay of thoughts and thinking,
of dream-thoughts and dreaming.
In his earliest psychoanalytic work, Experiences in groups (1959b),
Bion introduced the idea that thoughts (shared unconscious “basic
assumptions”) hold the power to destroy the capacity of a group for

86
 ON HOLDING AND CONTAINING, BEING AND DREAMING 87

122 thinking. Bion elaborated the idea that thoughts may destroy the
2 capacity for thinking in his essays that are collected in Second thoughts
3 (1967), most notably in “Attacks on linking” (1959c) and “A theory
4 of thinking” (1962b). There he introduced the idea that in the
5 beginning (of life and of analysis) it takes two people to think. In
6 stark contrast to Winnicott—who is always the paediatrician—for
7222 Bion, his ideas/speculations concerning the psychological events
8 occurring in the mother-infant relationship are merely metaphors—
9 ”signs” (1962a, p. 96) —that he finds useful in constructing a “model”
10 (p. 96) for what occurs at an unconscious level in the analytic
1 relationship.
2 The metaphoric mother-infant relationship that Bion (1962a,
3 1962b) proposes is founded upon his own revision of Klein’s concept
4 of projective identification. The infant projects into the mother (who,
5222 in health, is in a state of reverie) the emotional experience that he
6 is unable to process on his own, given the rudimentary nature of
7 his capacity for α-function. The mother does the unconscious
8 psychological work of dreaming the infant’s unbearable experience
9 and makes it available to him in a form that he is able to utilize in
20 dreaming his own experience.
1 A mother who is unable to be emotionally available to the infant
2 (a mother incapable of reverie) returns to the infant his intolerable
3 thoughts in a form that is stripped of whatever meaning they had
4 previously held. The infant’s projected fears under such circum-
5 stances are returned to him as “nameless dread” (1962a, p. 96). The
6 infant’s or child’s experience of his mother’s inability to contain his
7 projected feeling state is internalized as a form of thinking (more
8 accurately, a reversal of thinking) characterized by attacks on the very
9 process by which meaning is attributed to experience (α-function)
30 and the linking of dream-thoughts in the process of dreaming and
1 thinking (1959c, 1962a, 1962b).
2
3
Relocating the centre of psychoanalytic theory and
4
practice
5
6 When the relationship of container (the capacity for dreaming, both
7 while asleep and awake) and contained (unconscious thoughts
8 derived from lived emotional experience) is of “mutual benefit and
922 without harm to either” (Bion, 1962a, p. 91), growth occurs in both

87
88 THOMAS OGDEN

container and contained. With regard to the container, growth

involves an enhancement of the capacity for dreaming one’s expe-
rience, that is, the capacity for doing (predominantly) unconscious
psychological work. The expansion of the containing capacity in
the analytic setting may take the form of a patient’s beginning to
remember his dreams to which he and the analyst have associa-
tions—associations that feel real and expressive of what is happening
unconsciously in the analytic relationship. For another patient,
expansion of the capacity for dreaming may be reflected in a
diminution of psychosomatic symptomatology or perverse behaviour
in conjunction with an increase in the patient’s capacity to experience
feelings and be curious about them. For still another patient,
enhancement of the containing function may manifest itself in the
cessation of repetitive post-traumatic nightmares (which achieve no
psychological work) (Ogden, 2004b).
The growth of the contained is reflected in the expansion of the
range and depth of thoughts and feelings that one is able to derive
from one’s emotional experience. This growth involves an increase
in the “penetrability” (1962a, p. 93) of one’s thoughts, i.e. a tolerance
“for being in uncertainties, mysteries, doubts, without any irritable
reaching after fact and reason” (Keats, 1817, quoted by Bion, 1970,
p. 125). In other words, the contained grows as it becomes better able
to encompass the full complexity of the emotional situation from
which it derives. One form of the experience of the growth of
the contained involves the patient’s finding that a past experience
takes on emotional significance that it had not previously held. For
example, in the third year of analysis, an analysand felt for the first
time that it was odd, and painful, to “recall” that his parents had not
once visited him during his three-month hospitalization following a
psychotic break while he was in college. (It could reasonably be
argued that the new significance of the remembered event represents
the growth not of the contained but of the container—the capacity
for dreaming the experience. I believe both ways of thinking about
the clinical example are valid: in every instance of psychological
growth there is growth of both the container and the contained.
Moreover, in attempting to differentiate between the container and
the contained in clinical practice, I regularly find that the two stand
in a reversible figure-ground relationship to one another.)

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 ON HOLDING AND CONTAINING, BEING AND DREAMING 89

122 Under pathological circumstances, the container may become

2 destructive to the contained, resulting in a constriction of the range
3 and depth of the thoughts one may think. For instance, the container
4 may drain life from the contained, thus leaving empty husks of what
5 might have become dream-thoughts. For example, pathological
6 containing occurs in analytic work with a patient who renders
7222 meaningless the analyst’s interventions (the contained) by reflexively
8 responding with comments such as: “What good does that do me?”
9 or “Tell me something I don’t already know” or “What psychology
10 book did you get that from?”
1 Another form of pathological containing occurred in the analysis
2 of a schizophrenic patient that I have previously described (Ogden,
3 1980). During an early period of that analysis, the patient imitated
4 everything I said and did, not only repeating my words as I spoke
5222 them, but also replicating my tone of voice, facial expressions and
6
bodily movements. The effect on me was powerful: the imitation
7
served to strip away feelings of realness and “I-ness” from virtually
8
every aspect of my mind and body. The patient was subjecting me
9
to a tyrannizing form of containing that caused me to feel that I was
20
losing my mind and body. Later in the analysis, when a healthier
1
form of containing had been achieved, this pathological containing
2
was understood as a replication (imitation) of the patient’s uncon-
3
scious sense of his mother’s having taken over his mind and body,
4
5 leaving him nothing of his own that felt real and alive.
6 Still another type of pathological containing takes the form of a
7 type of “dreaming” which, like a cancer, seems to fill the dream-space
8 and the analytic space with images and narratives that are unutil-
9 isable for psychological work. Potential dream-thoughts promiscu-
30 ously proliferate until they reach the point of drowning the dreamer
1 (and the analyst) in a sea of meaningless images and narratives.
2 “Dreams” generated in this way include “dreams” that feel like a
3 disconnected stream of images; lengthy “dreams” that fill the entire
4 session in a way that powerfully undermines the potential for reverie
5 and reflective thinking; and a flow of “dreams” dreamt in the course
6 of months or years that elicit no meaningful associations on the part
7 of patient or analyst.
8 Conversely, the contained may overwhelm and destroy the
922 container. For example, a nightmare may be thought of as a dream

89
90 THOMAS OGDEN

in which the dream-thought (the contained) is so disturbing that the

capacity for dreaming (the container) breaks down and the dreamer
awakens in fear (Ogden, 2004b). Similarly, play disruptions represent
instances when unconscious thoughts overwhelm the capacity for
playing.
Bion’s concept of the container-contained expands the focus
of attention in the psychoanalytic setting beyond the exploration of
conflict between sets of thoughts and feelings (e.g. Love and hate
of the oedipal rival; the wish to be at one with one’s mother and the
fear of the loss of one’s identity that that would entail; the wish
and need to become a separate subject and the fear of loneliness and
isolation that that would involve, and so on). In Bion’s hands, the
central concern of psychoanalysis is the dynamic interaction between
on the one hand, thoughts and feelings derived from lived emotional
experience (the contained), and on the other hand, the capacity for
dreaming and thinking those thoughts (the container).
The aim of psychoanalysis from this perspective is not primarily
that of facilitating the resolution of unconscious conflict, but
facilitating the growth of the container-contained. In other words,
the analyst’s task is to create conditions in the analytic setting that
will allow for the mutual growth of the container (the capacity for
dreaming) and the contained (thoughts/feelings derived from lived
experience). As the analysand develops the capacity to generate a
fuller range and depth of thoughts and feelings in response to his
experience (past and present) and to dream those thoughts (to do
unconscious psychological work with them), he no longer needs the
analyst’s help in dreaming his experience. The end of an analysis is
not measured principally by the extent of resolution of unconscious
conflict (which has been brought to life in the transference-
countertransference), but by the degree to which the patient is able
to dream his lived emotional experience on his own.
In sum, container and contained, in health, are fully dependent
on one another: the capacity for dreaming (the container) requires
dream-thoughts; and dream-thoughts (the contained) require the
capacity for dreaming. Without dream-thoughts one has no lived
experience to dream; and without the capacity for dreaming, one can
do no psychological work with one’s emotional experience (and
consequently one is unable to be alive to that experience).

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 ON HOLDING AND CONTAINING, BEING AND DREAMING 91

122 Clinical illustration

2
The following clinical example will serve to illustrate how I use the
3
concept of the container-contained in analytic practice.
4
Ms N regularly began her daily sessions by telling me in great
5
detail about an incident from the previous day in which she had
6
7222 made use of something I had said in recent sessions. She would then
8 pause, waiting for me to tell her that she had made very good use
9 of the insights she had gained from our analytic work. As the patient
10 waited for me to say my lines, I would feel a form of anger that
1 increased over the course of the years we worked together. Even my
2 anger felt not to be of my own making since the patient was well
3 aware of the maddening effect that her controlling scripting had on
4 me. “Scripting” and “feeding me my lines” were metaphors that
5222 Ms N and I had developed to refer to her efforts to expunge her
6 awareness of the separateness of our minds and our lives. The
7 metaphors also referred to the patient’s feeling that her mother had
8 treated her as an extension of herself. Perhaps in an effort to separate
9 from her mother psychically, the patient developed anorexia nervosa
20 in adolescence; the disorder continued to play an important role in
1 her life from that point onward.
2 Ms N used shopping as a way of dissipating feelings of emptiness
3 and loneliness. She would engage saleswomen in expensive clothing
4 stores in a form of theatre. The patient directed a scene in which she
5 would try on clothes and the saleswoman would tell her, in a
6 maternal way, how pretty she looked.
7 In the eighth year of the analysis, Ms N began a session by telling
8 me a dream: “I was in a department store that felt cavernous. A tinny
9 voice from the speaker system was giving orders not only to the staff
30 but also to the customers. There were so many things I wanted to
1 buy. There was a pair of lovely diamond earrings that were displayed
2 in a soft satin-lined box—they looked like two tiny eggs in a bird’s
3 nest. I managed to get out of the store without buying anything.”
4 My first impulse was to react to the dream as still another of the
5 patient’s attempts to get me to say my lines, or failing that, to elicit
6 anger-tinged interpretations from me. But there was something
7 subtly different about the dream and the way the patient told it to
8 me. It felt to me that in the middle of a compulsive repetition of an
922 all too familiar pattern of relatedness, something else obtruded when

91
92 THOMAS OGDEN

Ms N described the earrings. Her voice became less sing-song in tone

and her speech slowed as if gently placing the two tiny eggs in
the bird’s nest. And then, as if that moment of softness had never
occurred, Ms N, in a triumphant manner, “completed” the telling of
the dream: “I managed to get out of the store without buying anything.”
It seemed to me that in this final comment there was a pull for me
to congratulate the patient on her accomplishment. At the same time,
at a more unconscious level, her last statement had the effect of an
announcement of her absolute control over the analytic situation, a
control that would ensure that she would leave my consulting room
no different from the person she was when she entered (having
“managed to get out without buying anything”).
In the few moments during and just after Ms N’s telling me the
dream, I was reminded of having gone shopping with my closest
friend J a few years after we had graduated from college. The two
of us were looking for an engagement ring for him to give to the
woman with whom he was living. Neither of us knew the first thing
about diamonds—or any other kind of jewellery. This “shopping
experience” was one filled with feelings of warmth and closeness,
but at the same time I was aware that there was a way in which I
was participating in an event (the process of J’s getting married) that
I feared would change (or maybe even bring to an end) the friendship
as it had existed up to that point.
Quite unexpectedly, I found myself asking Ms N: “Why didn’t
you buy the earrings that you genuinely found so beautiful?” It took
me a few moments to realize that I was speaking in a way that treated
her dream as an actual event in the world of external reality. I could
hear in my voice that I was not reacting to the provocative aspect
of the patient’s dream with anger of my own. My question was
surprising in still another sense: the things that the patient had
bought in the past had never held any symbolic meaning or aesthetic
value for her—they were mere props in a transference-counter-
transference drama enacted with saleswomen and with me.
The combination of my responding to the dream as an actual event
and the sound of my voice as I asked Ms N why she had not bought
the earrings was not lost to the patient. She paused for almost a
minute—which in itself was highly unusual for her—and then
responded (as if the dream were an actual event) by saying “I don’t
know. The idea never occurred to me.”

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 ON HOLDING AND CONTAINING, BEING AND DREAMING 93

122 Ms N’s long-standing refusal/inability to make use of virtually

2 everything I had to say might be thought of as her use of a form of
3 pathological containing. The “script” from which I was to read my
4 lines (while she directed the play) was the opposite of a kind of
5 thinking that facilitates unconscious psychological work. Nothing
6 original could come of it; no new thought could be generated. Her
7222 pathological containing function to that point had consisted entirely
8 of a form of “dreaming” in which the patient unconsciously denuded
9 herself of human qualities (which she experienced as frailties) such
10 as appetite for food, sexual desire and the need for genuine emotional
1 relatedness to other people.
2 In the dream, the pathological containing function had become
3 the contained—the “tinny” (inhuman) voice from the mechanical
4 “speaker system” that ordered everyone around. My first impulse
5222 had been reflexively to respond to Ms N’s dream as if it were no
6 different from any of a hundred other instances in which she had
7 told me a dream that was not a dream. However, the patient’s tone
8 of voice in telling me the portion of her dream involving the earrings,
9 as well as the content of the imagery of that part of the dream,
20 reflected the fact that she was beginning to be able to contain (i.e. to
1 genuinely dream her emotional experience) which facilitated my own
2 capacity for preconscious waking dreaming (reverie).
3 My reverie of shopping with J for an engagement ring served as
4 a new form of containing that was not hostile to the contained, that
5 is, to the patient as I was experiencing her. My reverie experience,
6 which involved feelings of affection, jealousy and fear of loss, might
7 be thought of as a form of my participating in the dreaming of the
8 patient’s undreamt dream (Ogden, 2004b), that is, my participating
9 in her dreaming her experience in a non-dehumanizing way.
30 My reverie had issued in my asking a question in an unplanned
1 way: “Why didn’t you buy the earrings that you genuinely found
2 so beautiful?” This question reflected the fact that I had not simply
3 participated in dreaming the patient’s formerly undreamable
4 experience, but had momentarily become a figure in the dream that
5 the two of us were dreaming in the session. In addition, the tone of
6 voice with which I spoke to Ms N conveyed the fact that a change
7 had taken place in my own way of experiencing (containing) the
8 patient’s emotional state. The words that I spontaneously spoke were
922 quite the opposite of a set of “lines” (empty words) that had been

93
94 THOMAS OGDEN

extracted from me. Consequently, they could be given to her. (One

cannot give something to someone who is trying to steal the very
thing that one would like to give.) it seems to me in retrospect that
my “asking/popping the question” reflected the fact that I was
unconsciously, for the first time, able to dream (contain) the germ
of a loving oedipal transference-countertransference experience
with the patient.
What I gave to Ms N in asking the question consisted of my
recognizing that her dreaming was of a new sort: interred in the
familiar, unthinking provocation, there was a moment in which
Ms N was actually beginning to engage in authentic unconscious
psychological work. That work involved an unconscious fantasy of
the two of us having beautiful (beloved) babies (the baby birds in
the nest) who would be treated with the greatest tenderness and care.
(Only in writing this paper did I realize that in the course of Ms N’s
telling me her dream, “tinny” had become “tiny”.) My response to
(containing of) the dream as reflected in my question served to
convey a feeling that it may no longer be as necessary for the patient
to reflexively dehumanize her emergent, still very fragile feelings of
love for me.

Concluding comments
At its core, Winnicott’s holding is a conception of the mother’s/
analyst’s role in safeguarding the continuity of the infant’s or child’s
experience of being and becoming over time. Psychological develop-
ment is a process in which the infant or child increasingly takes
on the mother’s function of maintaining the continuity of his
experience of being alive. Maturation, from this perspective, entails
the development of the infant’s or child’s capacity to generate and
maintain for himself a sense of the continuity of his being over time—
time that increasingly reflects a rhythm that is experienced by the
infant or child as outside his control. Common to all forms of holding
of the continuity of one’s own being in time is the sensation-based
emotional state of being gently, sturdily wrapped in the arms of the
mother. In health, that physical/psychological core of holding
remains a constant throughout one’s life.
In contrast, Bion’s container-contained at every turn involves
a dynamic emotional interaction between dream-thoughts (the

94
 ON HOLDING AND CONTAINING, BEING AND DREAMING 95

122 contained) and the capacity for dreaming (the container). Container
2 and contained are fiercely, muscularly in tension with one another,
3 coexisting in an uneasy state of mutual dependence.
4 Winnicott’s holding and Bion’s container-contained represent
5 different analytic vertices from which to view the same analytic
6 experience. Holding is concerned primarily with being and its
7222 relationship to time; the container-contained is centrally concerned
8 with the processing (dreaming) of thoughts derived from lived
9 emotional experience. Together they afford “stereoscopic” depth to
10 the understanding of the emotional experiences that occur in the
1 analytic setting.
2
3
4 Notes
5222 1. I am reminded here of a comment made by Borges regarding
6 proprietorship and chronology of ideas. In a preface to a volume of his
7 poems, Borges wrote: “If in the following pages there is some successful
8 verse or other, may the reader forgive me the audacity of having written
9 it before him. We are all one; our inconsequential minds are much alike,
20 and circumstances so influence us that it is something of an accident that
1 you are the reader and I the writer—the unsure, ardent writer—of my
2 verses” (1964, p. 269).
3 2. I am indebted to Dr Margaret Fulton for drawing my attention to Poe’s
4 poem.
5
6
7 References
8 Bion, W. R. (1959b). Experiences in Groups. London: Tavistock, 1961.
9 Bion, W. R. (1959c). Attacks on linking. In: Second Thoughts. London:
30 Heinemann, 1967.
1 Bion, W. R. (1962a). Learning from Experience. London: Karnac, 1984.
2 Bion, W. R. (1962b). A theory of thinking. In: Second Thoughts. London:
3 Heinemann, 1967.
4 Bion, W. R. (1970). Attention and Interpretation. London: Tavistock.
5 Borges, J.L. (1964). Obra poetica.
6 Freud, S. (1900). The Interpretation of Dreams. SE 4–5.
7 Heaney, S. (1984). Clearances: In Memoriam M.K.H., 1911–1984.
8 Ogden, T. (1980). On the nature of schizophrenic conflict. Int. J. Psycho-Anal.
922 61: 513–533.

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96 THOMAS OGDEN

Ogden, T. (2001). Conversations at the frontier of dreaming. Northvale, N.J.:

Aronson.
Ogden, T. (2003a). What’s true and whose idea was it? Int. J. Psycho-Anal.
84: 593–606.
Ogden, T. (2003b). On not being able to dream. Int. J. Psycho-Anal. 84: 17–30.
Ogden, T. (2004a). An introduction to the reading of Bion. Int. J. Psycho-Anal.
85: 285.
Ogden, T. (2004b). This art of psychoanalysis: Dreaming undreamt dreams
and interrupted cries. Int. J. Psycho-Anal. 85: 857.
Poe, E.A. (1848). To Marie Louise (Shew).
Winnicott, D.W. (1945). Primitive emotional development. In: Through
Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
Winnicott, D. W. (1951). Transitional objects and transitional phenomena: a
study of the first not-me possession. In: Through Paediatrics to Psycho-
Analysis. London: Hogarth, 1958.
Winnicott, D.W. (1954). The depressive position in normal emotional
development. In: Through Paediatrics to Psycho-Analysis. London: Hogarth,
1958.
Winnicott, D.W. (1955). Clinical Varieties of Transference. In: Through
Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
Winnicott, D.W. (1956). Primary maternal preoccupation. In: Through
Paediatrics to Psycho-Analysis. London: Hogarth, 1958.

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122 CHAPTER SEVEN
2
3
4
5
6
7222 The virtues of Anna Freud
8
9
10
Some considerations on the technique of child
1
analysis and the importance of the developmental
2
dimension, based on two of her posthumous
3
papers and a letter: an appreciation of her
4
contribution as “quasi-Winnicottian”
5222
6 Vincenzo Bonaminio
7
8

I
9 n this piece I look at two posthumous and little-known papers
20 by Anna Freud, in order to offer some wider observations of my
1 own on her virtues as a clinician and researcher in the field of
2 child psychoanalysis. Both papers were published in a commemora-
3 tive issue of The Bulletin of the Hampstead Clinic (1983, vol. 6,
4 Part 1) a few months after her death in 1982. Neither has a place in
5 the body of her work that is best known and referred to, but it is my
6 view that they contain, in distilled form, many of the salient features
7 that have marked her contribution to child psychoanalysis and
8 psychoanalysis in general, and that they merit further close attention.
9 The first paper takes the unusual form of an excerpt. In it we find
30 the transcription of some comments she made during a series of
1 seminars on the technique of child analysis, given, together with Ruth
2 Thomas, for her colleagues and students at the Hampstead Child
3 Therapy Clinic in 1965.
4 The reader will notice from the discontinuous flow and truncated
5 formulation of the themes, and the abrupt succession of paragraphs
6 into which they are edited, that these are impromptu remarks on
7 clinical material presented in the seminars, along with observations
8 and requests for clarification made by the participants, most likely
922 by the students. For these reasons it is by no means a text that reads

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98 VINCENZO BONAMINIO

smoothly, and it is a little way from the thoroughness of clinical

argumentation that one finds in Anna Freud’s writings, together with
her conceptual and methodological rigour and intellectual clarity,
qualities so much to be valued whether or not one wholeheartedly
shares her theoretical and technical positions.
It is perhaps this very roughness, to be taken for granted in a text
that was not conceived of for publication, along with the somewhat
oversimplified neatness of many of her statements, that is of interest.
This text allows us to see the living Anna Freud, so to speak, the
leading figure of a particular way of thinking about child analysis,
active in the role of teacher which played such a fundamental part
in her contribution to child psychoanalysis. We see her at work, as
the educator she was, in what could be called her natural environment,
the Hampstead Child Therapy Clinic, a psychoanalytic institution
that was unique in terms of training, research and therapy, founded
by her and developed on the basis of her pioneering experiences at
the Hampstead Nurseries, where help was given to London children
separated from their families because of the war.
This paper dates from the time, between the mid sixties and the
early seventies, when the Hampstead Clinic was Anna Freud. Her
notes plainly evoke the climate of a work group structured and
shaped by the “basic assumption of dependency” (Bion, 1961) on a
“charismatic” leader. If we read her comments carefully, we can grasp
the way she used her position to take what she had drawn from her
clinical experience in psychoanalytic work with children (universally
acknowledged as enormous) and convey it with straightforward
immediacy, without overlong explanations, in an enjoyable manner.
What stands out is her willingness to listen to questions from her
audience, even those that are seemingly the most banal. The thing
is that they are not. This is evident once we return to our memories
of our own lack of sureness when we ourselves were beginning to
tackle psychotherapeutic work with children (although in our work
the lack of sureness is never over, and a good thing too); or if we
think about the disorientation and the need for rules (of course this
cannot be satisfied, but that does not make it any less legitimate) of
those at the start of their training, who ask us point-blank questions
as they embark, anxious and faltering, on their first clinical contact
with their little patients. “Are we allowed to accept gifts from the
child in therapy?” “How are we supposed to interpret them?” “Can

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 THE VIRTUES OF ANNA FREUD 99

122 the child take home the toys from therapy?” “Are we allowed to
2 answer the child’s questions?” These seem to be the questions which
3 stand behind some of the headings in this paper, questions arising
4 from the audience in the seminars, or stemming from day-by-day
5 interaction with trainees in child analysis. There is no doubt that this
6 constant barrage can be embarrassing, but provided one has been
7222 able to create a facilitating environment for the students, such questions
8 have the right to exist.
9 Anna Freud is there with her answers. It is not their content that
10 matters so much as the fact that they indicate the existence of a space
1 in which those questions could be asked. It is certainly possible to
2 disagree with some of her opinions, and from time to time there are
3 hints of an idea of child analysis that harks back to its pedagogical
4 origins, but I don’t think there is one single other piece of writing
5222 from the literature on the techniques of child analysis in which
6
questions of this kind are tackled with so much head-on immediacy
7
and such salutary resourcefulness. At the same time, while “direct”
8
answers to such questions are given, she warns that
9
20
the great danger is . . . to make too many rules . . . [which] block
1
the way . . . You have to use your own judgement . . . and do
2
what you think will bring you nearer to the meaning . . . This
3
means that you are much safer if you have no general answer of
4
5 this kind. And if the answer were printed in a book—that if a
6 patient asks you for play material, always supply it—this wouldn’t
7 be a help, it would be a hindrance to your finding out why it is
8 asked. Whereas if you know that what you want is to know why
9 the patient asks, you will try this and that and the other until you
30 have got the meaning. [1983a, p. 116]
1
2 In my view this is an exceptional piece of psychoanalytic technique
3 in vivo: on one level, we see that Anna Freud says that as a child
4 analyst one has to stick to the concreteness of what the child is asking
5 for, it cannot be bypassed if one wants to “get the meaning”, the two
6 things go hand in hand. On another level, she is herself in the very
7 same position as she is describing to her students. She carefully
8 listens to their questions, picks them up as concretely as they have
922 been asked, allows space for such questions, and at the same time

99
100 VINCENZO BONAMINIO

goes beyond this concreteness in search of the meaning they have

for their students and those who are asking.
As far as the question of training in child analysis is concerned,
we are still in a position historically of genealogical proximity to the
first exponents (Gampel, 1994), but also sufficiently distant to spot
the danger of institutionally-bound procedures turning training into
something repetitive or over-canonical. Thus, while reading these
comments of hers, it does not escape notice that here is the stance of
a pioneer who, in relation to the institution and ideology that had
their origins in herself, nonetheless still tries to keep alive the climate
of debate and discovery of those early days: “I remember the first
time I was confronted with the problem of children taking home toys
that belonged in the analytic hour. When I learned child analysis,
one was in the fortunate position that there was no-one to ask, so there
was no conflict about it; one had to experiment.” And one page before,
she states that more clearly: “Experimenting and guessing are the task
of the analyst—we can’t help that, there are no certainties” (A. Freud,
1983a, p.117; p. 116; my italics).
In statements like these there is a mental attitude that is a long
way from the “scholasticism” and “canonization” to which Anna
Freud’s contribution has been unjustly relegated. Of course, what is
usually regarded as the conservative position she took on classical
psychoanalysis also permeates these observations, but the adjective
“classical” is also to be examined in this context. For Anna Freud,
child analysis was a “new development” of classical psychoanalysis.
I am referring here not to the “classical conceptual model”, based on
the “drives/psychic structures” frame of reference, to which she also
contributed significantly by enlarging and modifying it with her
theory of the centrality of the ego defences. Rather, by saying that
for Anna Freud child analysis was a new development of “classical”
psychoanalysis, I am referring here to the “clinical psychoanalysis”
that is carried out in the consulting room. She writes at the beginning
of this paper under discussion: “I wouldn’t call it classical
psychoanalysis because there never has been anything like a classical
child analysis. There is a classical analysis, and the child analysis is
a modification of it which takes account of the nature of the child”
(1983a, p.115). I am fully aware that in substituting her term
“modification” with “new development” I am biased.

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 THE VIRTUES OF ANNA FREUD 101

122 This would open up the historical Anna Freud/Melanie Klein

2 controversy about child analysis. Without wanting to oversimplify
3 the aspects of this controversy about issues which were central to
4 psychoanalysis at the time—and indeed still are, since some of
5 them are in the foreground of contemporary psychoanalytical
6 debate on clinical technique and theoretical concepts—it is true that
7222 a certain canonization of the two positions as irreconcilably opposite
8 has occurred. If this is taken for granted, it tends to blur some over-
9 lap in their positions in certain clinical areas. This overlap is evident
10 in the developments that have grown out of the original contro-
1 versy which now show a basic agreement between contemporary
2 Kleinians, contemporary Anna Freudians and Winnicottians as far
3 as basic technique is concerned. As I have discussed elsewhere
4 (1993), if we re-examined this historical controversy from the point
5222 of view of the therapeutic alliance (a term and a concept not
6 mentioned as such at the time but which, in my view, was behind
7 the polemics about how to start analysis with children and about
8 how to consider the emergence or not of transference), we would
9 see that Anna Freud’s insistence on the necessity of introducing a
20 preparatory period to solicit the child’s interest in the analytic work
1 and Melanie Klein’s emphasis on the centrality of the transference
2 relationship from the beginning were parallel positions in promoting
3 ante litteram an attention to the dyadic dimension of the work
4 between analyst and analysand, and not so greatly opposed to each
5 other. I think that our contemporary understanding of this dyadic
6 dimension specifically derives from child analysis, although not
7 only from it.
8 Winnicott seems to have picked up the essence of this controversy
9 by smoothing out the sharpest edges of the disagreement. In his
30 1958 paper “Child analysis in the latency period” he affirms his
1 “intermediate” view that
2
3 if one reads these two books [M. Klein’s The psychoanalysis of
4 children (1932) and A. Freud’s The psychoanalytic treatment
5 of children (1946)], each of which is full of infinite richness and
6 indicates vast clinical experience which we can well envy, one
7 can either see similarities or differences. Similarities certainly
8 there are and they concern this matter of the altered technique
922 which is necessary for the latency child . . . In regard to other

101
102 VINCENZO BONAMINIO

differences, and it is this we wish to study, we can note

immediately that Melanie Klein finds it good to interpret the
unconscious conflicts and the transference phenomena as they
arise, and to form a relationship with the child on the relief given
by such interpretations; by contrast Miss Freud tends to build
up a relationship with the child on a conscious level and she
describes how she gets gradually to the work of the analysis with
the conscious co-operation of the patient. The difference is
largely a matter of conscious or unconscious co-operation. [1958,
p.119]

Beyond this digression, what is remarkable for me in reading these

comments by Anna Freud, which are anything but “classical” or
“conservative”, is the priority she made of clinical work with
children: the psychoanalytic situation is the place of child analysis; and it
was the analyst’s contribution to the creation, maintenance and
development of the therapeutic relationship (as we would now call
it) that came first:

This means that in order to continue the analytic contact

undisturbed, or to promote it, one has to maintain a certain
atmosphere of mutual goodwill, basic goodwill, and against that
goodwill the material can be played out. But this atmosphere is
quite easily disturbed by interpretation. How to slip in the
interpretation and still leave that basic atmosphere undisturbed
is perhaps one of the most difficult tasks. [1983a, p.119, my
italics]

Is this not perhaps the most genuine clinical aspect of that

schematization whereby Anna Freud is described only as the flag-
bearer of a somewhat out-of-date technique that was supposed to
be entirely concentrated on the analysis of ego defences? Doesn’t the
above quotation, where she stresses the importance of maintaining
an atmosphere of mutual goodwill, of basic trust between the
analysand and the analyst, of balancing the analyst’s interpretive
activity with leaving that basic atmosphere undisturbed, resemble
Winnicott’s famous statement in “The use of an object” (1969), where
he subtly distinguishes between the analyst’s “making of interpre-
tations” to the patient and “interpretations as such”? He writes:

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 THE VIRTUES OF ANNA FREUD 103

122 . . . it is only in recent years that I have become able to wait and
2 wait for the natural evolution of the transference arising out from
3 the patient’s growing trust in the psychoanalytic technique and
4 setting and to avoid breaking up this natural process by making
5 interpretations. It will be noticed that I am talking about the
6 making of interpretations and not about interpretations as such
7222 . . . It appals me to think how much deep change I have prevented
8 or delayed in patients in a certain classification category by my
9 personal need to interpret. If only we can wait, the patient arrives
10 at understanding creatively and with immense joy, and I now
1 enjoy this joy more than I used to enjoy the sense of having been
2 clever. I think I interpret mainly to let the patient know the limit
3 of my understanding. [1969]
4
5222 This radical shift of accent toward the analyst’s side of the
6 interpretive function is purely Winnicottian: it is Winnicott’s original
7 contribution to the subject, one that has its own internal development
8 starting from his early writings. I have tried to show this elsewhere
9 in discussing his conception of interpretation in psychoanalysis
20 (2001), so I do not mean here that we should make this comparison
1 of Anna Freud’s and Winnicott’s positions too close; differences
2 are to be recognized, and Anna Freud’s classical conception of
3 interpretation is miles away from Winnicott’s. Notwithstanding
4 this, I think we can appreciate a further similarity between them if
5 that genuine clinical attitude towards the patient that I was referring
6 to above, and not a prejudicial schematization, is seen in her
7 contribution to technique.
8 Let us continue to read a few lines more from this paper. As
9 Winnicott considers the risk that the analyst’s “need to interpret”
30 may be “preventing deep change” in the patient, so does Anna Freud
1 when she affirms that
2
3 it is a great danger to get a child accustomed to a constant
4 flow of interpretation, which to him becomes a sort of nagging
5 so that he listens to it as little as to the nagging of a nagging
6 mother. It becomes a sort of translation game . . . Interpretations
7 thrown at the child indiscriminately are a great mistake . . . The
8 interpretation of symbolic material as such is a very doubtful
922 matter anyway, because it is usually meaningless to the child.

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104 VINCENZO BONAMINIO

The symbolic material is revealing to the analyst but meaningless

if translated to the child unless what you have understood fits
into a context which is meaningful to him at the time . . . I think
what one should interpret are experiences, inner experiences
. . . and not words, not images, not single items. [1983a, p. 119,
my italics]

What strikes me in reading sentences like these is Anna Freud’s

insistence on experiences—experiencing in analysis being a
Winnicottian theme—a term which can hardly be found in other,
more systematic papers of hers, and her distinction between what
may be “revealing for the analyst” and what is “meaningful to the
child”. These two dimensions, she implies, do not necessarily
coincide, whereas the analyst’s task is “to be in contact”: she says,
“to be in contact is so important, and to interpret does not always
mean to be in contact” (1983a).
To be clinically in contact first is a further dimension of that
scientific stance, also evident in the scattered observations in this
paper, which makes Anna Freud so widely appreciated and which
runs through all of her work: that is, the necessity—on which she
constantly insisted—to root any kind of conceptualization in the firm
ground of clinical understanding.
In order to emphasize this aspect which is so central to her
scientific approach, I shall make a brief autobiographical digression
which seems worth mentioning in this context. My interest in Anna
Freud’s work goes back to 1972, when I was putting together my
degree dissertation on the psychopathology of borderline-psychotic
children. In the course of my intensive reading I made my first
discovery of the well-known contributions on this subject by two of
her collaborators. Since these contributions made frequent reference
to some “unpublished” writings by Anna Freud, cited as being of
foremost importance on the subject, I decided to write to her and
request more precise bibliographical references. I was very glad that
an opportunity of this kind had come my way as an excuse to write
her a letter. I did not even have the time to work myself up into a
state of expectant trepidation, because within a week I received
a reply which, though curt and formal, was extremely precious, as
may be imagined. I have kept it to this day. Anna Freud thanked me
for my interest in her work but explained that these articles were

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122 non-existent, inasmuch as her colleagues had cited as unpublished

2 papers what were no more than notes and impromptu observations
3 made in the course of clinical discussions. Her closing words in this
4 letter struck me very much at the time, and they still impress me
5 now as an instance, albeit a small one, of her modesty and seriousness
6 of method. She wrote: “The truth is that I never thought I understood
7222 enough about these borderline and psychotic states to do any definite
8 writing about them.”
9 I think it can be said that behind the modesty there is a clear
10 glimpse, even in this letter, of the scientific attitude I was referring
1 to above which runs through all her work: her insistence on basing
2 any kind of conceptualization on a solid knowledge and clinical,
3 almost documentary understanding. This fundamental attitude lies
4 at the heart of a series of virtues that are acknowledged in terms of
5222 her working method and her contribution. This means that what is
6 regarded as “conservative” in her position can also be seen, from
7 another perspective, as an urging to caution in dealing with clinical
8 data, both at the level of how it is understood conceptually and on
9 the reciprocal level of the therapeutic relationship with the patient.
20 Let us turn again to her initial, fairly restrictive position on
1 transference in child analysis, which is in contrast to the decisive leap
2 undertaken in psychoanalytic investigation by Melanie Klein’s
3 revolutionary contribution on the subject. In this paper we find that
4 Anna Freud vindicates her point of view almost with pride when
5 she is among her pupils and in her natural environment: “I don’t
6 think we get a full transference neurosis in child analysis. I have
7 never believed in it. We get something, perhaps, which looks a bit
8 like this, but I have never seen it” (1983a, p.124). This position is quite
9 analogous to the one expressed, albeit in a significantly quieter vein,
30 in “Normality and pathology in childhood” (also dating from 1965).
1 There, acknowledging that she has partially modified her opinions
2 on the subject, she states that she is “still unconvinced” that the
3 so-called transference neurosis in children is similar to that in adult
4 patients. Those expressions, “I am still unconvinced” and “I have
5 never seen it”, speak volumes about her profound clinical honesty
6 and her overall view of things, as well as the coherence with which
7 she proceeded in her formulations on child analysis. As I have
8 stressed in my paper on the concept of child or adolescent therapeutic
922 alliance in child analysis (1993), those clinical developments that have

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been established in psychoanalysis with patients who—unlike

psychoanalytic patients at the outset—were not merely neurotics, but
borderline, psychotic, and especially children, have entailed an
enlargement and a profound revision of the criteria for who might
be analysed, and of the criteria for describing the psychoanalytic
process more generally. The very concept of transference (not to
speak of the counter-transference, which is almost entirely absent
from Anna Freud’s conceptual universe) has become much more
complex and articulated, and yet, as a whole, is interdependent
on the partnership with the analyst in the psychoanalytic situation.
Anna Freud remains unequivocally bound to a traditional view of
transference that one might say is influenced by her transference in
relation to her father.
But if we take a clinical viewpoint rather than one to do with
scholastic canonizations, and consider her statement that the child’s
tendency to regard the analyst as a new object is based on observation
of his or her natural hunger for new experiences, we would agree
that the child’s tendency to exteriorize his or her needs and conflicts
in the clinical situation must be kept in mind, especially when it
comes to interpretations. I have already commented on her insistence
that “to be in contact is important, and to interpret does not always
mean to be in contact” (1983a, p. 119). And again: “Who says that
only interpretation in the transference has any effect? I know Strachey
says it, but there is still the question of whether it is true. What you
are working towards is to get at the child’s real feelings” (ibid., p.120,
my italics).
If we move forward in our reading of this kind of Minima moralia
of child analysis, we discover that Anna Freud warns us with dry
clarity that in clinical work with children, our capacity to stay in
touch with their experiences is more crucial than our capacity for
interpretation, which can indeed become a defensive screen for us
analysts in relation to our little patients. With clinical wisdom, she
tells us that the goal of our work is to reach the child’s true feelings,
and that a spasmodic adherence to interpretations of transference as
the only right ones can amount to making the child feel that his or
her feelings and what he or she is talking about are not true. Could
one disagree nowadays with this clinical teaching of hers?
Again, in another of her many, scattered observations on the
method of child psychoanalysis, Anna Freud remarks that the analyst

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122 ought to be able, every now and then, to take off his or her own
2 psychoanalytic spectacles and take a long-sighted, somewhat
3 distanced view of the clinical material that the child brings to the
4 psychoanalytic relationship, so as to be able to grasp its overall
5 pattern and give it a new, more complex meaning.
6 By analogy, I think that the distance separating us from those
7222 heroic days of the controversial debates and current developments
8 in psychoanalysis offers us an overall view of Anna Freud’s
9 contribution to the psychoanalytic study of children and adolescents.
10 Thus we will inevitably grasp its richness, its articulacy, complexity
1 and rigour, and we will simultaneously see in it the roots of many
2 contemporary trends in psychoanalytic research on the development
3 of the individual. Take, for example, her seminal essay of 1945,
4 “Indications for Child Analysis”. Starting with the title, this paper
5222 should, in my view, be regarded a posteriori as a kind of program-
6
matic declaration of what were to be the subsequent directions of
7
her clinical research. She concludes: “In the foregoing pages an
8
attempt has been made to find indications for the therapeutic use of
9
child analysis not so much in the neurotic manifestations themselves
20
as in the bearing of these manifestations on the maturation processes
1
within the individual child. Emphasis is shifted thereby from the
2
purely clinical aspects of a case to the developmental aspect” (1945,
3
p. 37). Assessing Anna Freud’s psychoanalytic legacy, a paper by
4
Anne-Marie Sandler (1996) focuses in particular on the concept of
5
6 developmental disturbance. This is a clinical topic of considerable
7 relevance and timeliness, one that has its roots in the emphasis Anna
8 Freud always placed on the importance of psychoanalytic diagnostic
9 evaluation.
30 Before dealing briefly with this statement in more general terms,
1 I would like to suggest also reading it in terms more strictly inherent
2 in the therapeutic process with a single child in analysis. The shift
3 in emphasis from the purely clinical aspects to the developmental
4 ones also brings with it the vast subject of adapting analytic technique
5 not only to the various phases of the child’s and adolescent’s
6 development (a classically Anna Freudian topic) but also to the
7 various states of integration of the self and of mental functioning (as
8 we would put it nowadays) with which one might say the child
922 enters into analysis and with which we as analysts are faced.

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We now have extensive clinical documentation on psychoanalytic

work with children who are autistic, psychotic or borderline, which
is to say the entire vast range of serious pathologies. There is no doubt
that this goes directly to the heart of the specific qualities of the
psychotherapeutic function of transformation and change whereby,
within the clinical relationship, the therapist can have the means to
enable the child’s movement towards levels of mental functioning
that are gradually more complex and organized, allowing him or her
eventually to accept interpretation and to develop the process
of working through it. Of course this issue is a great deal more
complicated than such a necessarily summary description can
suggest.
But it is this therapeutic concern which underlies Anna Freud’s
elaboration on technique in child analysis and which can be traced
back to her initial emphasis on what she had envisaged as the
inescapability of an “introductory period”, a stance which justly
engaged her in so many energetic arguments in the controversies
over child analysis. As she can be considered in terms of theoret-
ical position “a radical innovator and a staunch conservative”
(Wallerstein, 1984), so, too, appreciating her contribution in terms of
technique is not to put in parentheses the “embarrassing” pedagog-
ical matrix from which she arrived at child analysis—a matrix,
incidentally, which was always claimed by Anna Freud herself. It
is more a case of looking at it and pinpointing the seeds of her
talent for adapting the clinical tool to the specific needs of the child,
rather than any kind of “non-psychoanalytic” genetic stigma. (Even
today this can still be mentioned in repetitions of the original
controversy which arose in the context of clinical, theoretical and
even methodological priorities that were quite different from those
of the present.) We only have to think of the many and varied
contemporary positions on adolescent analysis that nonetheless
almost unanimously converge when it comes to recognizing the
indispensable need for adapting therapeutic methods to specific
characteristics of this vital stage of the life cycle.
More generally, Anna Freud’s developmental approach (which,
already in the 1945 article quoted above, was so clearly prefigured
in the theoretical terms of the psychoanalytic process with children)
was to lead her, as is well-known, to a progressive outlining of the
diagnostic profile, centred on the concept of development and lines

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122 of development. I maintain that the most significant aspect of the

2 diagnostic profile, as one of the specific features of the Anna Freudian
3 clinical tradition, is the fact of its configuration as a potential clinical
4 working method and clinical reasoning, made available to the
5 therapist beyond, or rather “after” the relationship with the child.
6 As such it is fundamentally a tool with the function of giving balance,
7222 completeness and comparability to the clinical data in terms of
8 differential developmental diagnosis. In this perspective it performs
9 a nodal function for decisions focused on the technical level of
10 differentiated therapeutic interventions, within the broader reference
1 scheme of the psychoanalysis of children and adolescents.
2 Anna Freud’s constant and clinically orientated attention to the
3 developmental aspect is also evinced in a text based on a video
4 recording made in 1981 on the occasion of the 50th anniversary of
5222 the Chicago Institute of Psychoanalysis. As already noted, this
6 originally appeared in the commemorative issue of The Bulletin of the
7 Hampstead Clinic (1983b) and it is one of her last writings. This in
8 itself makes it particularly interesting, but its interest goes much
9 further.
20 “The past revisited”, as the piece is titled, has the flavour of a calm,
1 somewhat detached reflection—at a certain distance, we may say—
2 by someone looking back from the end of her own career as a
3 scientist, and indeed her own life, at the huge amount of work she
4 has done. In doing so, she is also able to identify and point out
5 developments and future directions for research: “If I myself were
6 asked at this late date to embark on such a series of updated lectures
7 [such as the Four Lectures on Psychoanalysis for Teachers and parents
8 (1930)] . . . I think I would attempt to engage the audience’s interest
9 in all the further steps of the humanizing process which mark the
30 child’s path from immaturity to maturity” (1983b, p. 108).
1 A humanizing process—this is a truly striking expression for anyone
2 who had always read Anna Freud “too closely”, by which I mean
3 while putting on the unrelentingly unilateral spectacles of “opposing
4 theoretical positions”. Instead, her work reveals a constant and
5 growing interest in a broader, more all-embracing view, one that
6 includes the socialization of the child, and therefore the influence of
7 object relations in his or her development. In the following paragraph
8 she goes on to note: “It may be the fault of our earlier teaching and
922 its emphasis on the battle with the drives if these others [i.e. the steps

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of the humanising process] . . . are taken all too much for granted as
mere consequences of growth and maturation.”
From this point on, in that dry, immediate style of hers, with that
exemplary clarity of exposition that distinguishes all her work, and
with the essential rigour of her theoretical and clinical thinking, Anna
Freud asks herself, her audience and her readers questions that even
today beneficially disrupt our certainties and what we take for
granted about psychoanalytic knowledge about children: “Is there a
consensus about the age when the developmental steps toward
recognition of danger are finally taken? Or, more meaningfully, how
long does a child advanced in motor skills outstrip his appreciation
of potential damage? What is the relation of this to a boy’s natural
wish for adventure heroism and athletical prowess?” (1983b, p. 111).
It is all the harder to gainsay the relevance of these questions if
we consider them, as I believe we must, not just as pertinent features
of the theory of the development of narcissism and the self as well
as the object relationship, but most of all as live questions which
confront the child or adolescent analyst and therapist in the various
forms whereby transference unfolds and evolves with their patients,
who are first and foremost individuals in the process of development
and change.

References
Bion, W.R. (1961). Experiences in groups and other papers. London: Tavistock.
Bonaminio, V. (1993). Il concetto di alleanza terapeutica nella psicoanalisi
infantile. Richard e Piggle, 1: 75–78.
Bonaminio, V. (2001). Through Winnicott to Winnicott. Notes on manic
defences, withdrawal and regression, and interpretation in Psychoanalytic
explorations. In: M. Bertolini, A. Giannakoulas, M. Hernandez (Eds.),
Squiggles and Spaces: Revisiting the work of D. W. Winnicott, Volume 1.
Philadelphia and London: Whurr.
Freud, A. (1930). Four Lectures on Psychoanalysis for Teachers and parents.
In: The Writings of Anna Freud, I (1922–1935). London: Hogarth, 1974.
Freud, A. (1945). Indications for child analysis. In: The writings of Anna Freud,
IV (1945–1956). London: Hogarth, 1969.
Freud, A. (1965). Normality and pathology in childhood. In: The writings of
Anna Freud, VI (1965). London: Hogarth.
Freud, A. (1983a). Excerpts from Seminars and Meetings: The Technique of
Child Analysis. The Bulletin of the Hampstead Clinic, 6: 115–128.

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122 Freud, A. (1983b). The Past Revisited. The Bulletin of the Hampstead Clinic, 6:
2 107–113.
3 Gampel, Y. (1994). Occhi che sentono e orecchie che vedono. Qualche
4 riflessione sulla formazione nell’analisi infantile. Richard e Piggle, 2: 26–36.
5 Sandler, A.-M. (1996). The psychoanalytic legacy of Anna Freud. The
6 Psychoanalytic Study of the Child, 51: 270–284.
7222 Wallerstein, R.S. (1984). Anna Freud: Radical Innovator and Staunch
8 Conservative. Psychoanalytic Study of the Child, 39: 65–80.
9 Winnicott, D.W. (1958). Child analysis in the latency period. In: The
10 Maturational Process and the Facilitating Environment. London: Hogarth,
1 1965. [Karnac, 1990]
2 Winnicott, D.W. (1969). The use of an object and relating through identi-
fications. In: Playing and reality. London: Tavistock, 1971. [Routledge, 1982]
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CHAPTER EIGHT

Donald Winnicott and Melanie

Klein: compatible outlooks?
Meira Likierman

A
t a heart clinic, in the early days of his career, Winnicott
began to note the response of children to situations of
anxiety: “an anxious child, during a physical examination
in a heart clinic, may have a heart that is thumping, or at times almost
standing still, or the heart may be racing away” (1941, p. 62).
The state thus described suggests that the child fears for its life.
In later works he was to describe what amounts to a fear of
annihilation and its attendant “unthinkable anxiety” (1962, p. 56).
And yet Winnicott’s philosophy of development is known mostly
for its hopeful aspects. For example, it was he who first highlighted
the infant’s resourceful use of the maternal object in the process of
creating and enriching a self. A sense of infantile potency permeates
Winnicott’s writings, intimating human abilities and possibilities in
the course of a troubled existence.
By comparison, Klein’s outlook on the human infant is thought
to be so dark as to lack basic optimism. Conflicted by nature, and
enviously attacking the very nurturing that sustains him, the human
infant is, at times, his own worst enemy. She shows his inner world
as regularly devastated by destructive rages; and ironically, at such
times, when he needs his objects most, he cannot—as Winnicott
seems to suggest—simply make use of them to recover. Projections
may have turned the very objects needed by the infant into perse-
cutors, thus exacerbating his sense of an isolated struggle.
Klein did suggest a more evolved psychic state in the depressive
position, and in her thinking it does bring the life-affirming discovery

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 COMPATIBLE OUTLOOKS? 113

122 of the object’s “wholeness” and otherness, thus introducing the

2 crucial life resource of emotional companionship. However, the
3 discovery of otherness equally ushers in the sadness and mortality
4 entailed in separateness. For Klein, tragedy is a universal scenario
5 inevitably encountered in the inner life of our species. Its implications
6 cannot be evaded in the course of growth.
7222 Critics of Klein have felt that she is an unreasonably harsh theorist
8 of human nature, that she emphasizes destructiveness and pays
9 too little attention to the environment. Apparently, she “blames” the
10 infant. Critics of Winnicott, by comparison, have sometimes been led
1 to assume that he “blames” the parents and ignores internal conflict.
2 The danger of such conclusions lies only partly in the distorting
3 effects of reductive thinking. A more important hazard, which may
4 particularly affect clinical practice, is presented by a potential slip
5222 into judgmental thinking. Invoking the names of Klein or Winnicott
6 to indicate moral disapproval, whether of the mother who is not
7 “good enough” or of the sadistic infant, is un-psychoanalytic. It
8 presents a disregard of Freud’s fundamental dictum of suspending
9 moral judgement in the clinical space. An equal distortion results
20 from the occasional assumption that a “Kleinian” technique needs
1 to be punitive and a “Winnicottian” technique is indulgent.
2 This is not to suggest that there has been an overall failure to grasp
3 or appreciate the theories of Klein and Winnicott. On the contrary,
4 they have each been put to substantial use. But as with all theoretical
5 frameworks, some purely impressionistic elements have existed
6 alongside genuine understanding. These have given rise to a par-
7 ticular polarization that is worth questioning. Is Klein’s only a
8 melancholic, bitter theory, and is Winnicott’s view a simple cheerful
9 alternative that so singularly focuses on consoling abilities and
30 strengths? To a certain degree such impressions are understandable,
1 based, after all, on what are divergent views. Winnicott and Klein
2 certainly disagreed on a number of crucial issues, and yet it is also
3 widely understood that they had important affinities, some of which
4 resulted from historical factors that led to mutual influences.
5 The choice of polarizing their contribution is thus set against
6 another alternative. Just as some outlooks have over-emphasized the
7 differences between Klein and Winnicott, there are others that
8 advocate some kind of integration of them that might be expressed
922 in a clinical eclecticism, for example in the decision to select helpful

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concepts from each and use them within a single framework. Indeed,
the idea of two theories that retain a kinship and are close at source
in spite of their differences can make the prospect of such an
integration encouraging.
But what would such an integration mean? It would clearly
require more than selecting individual concepts from different
frameworks and placing them side by side. A concept wrenched
out of its theoretical context necessarily pulls with it a chain of
other assumptions and premises, and indeed would not make sense
without them. Concepts from different theories are properly
differentiated precisely by their contextual sense. This begins to
complicate the task of eclecticism. In addition, Winnicott did not
merely choose to disagree lightly with one or two Kleinian concepts
without shifting much in the way. In fact, some of his ideas were
intended to offer major challenges that would have required her to
re-adjust her thinking. Therefore, while a simple polarization of two
theories is reductive, so is the notion that an assortment of aspects
from each can be randomly united. While neither a polarization nor
a simple pick-and-mix is a satisfactory alternative, it is possible to
argue for a third option, that of complementarity. Indeed, there are
areas of theory in both Winnicott and Klein that could be drawn on
to create an intermediate, but theoretically and clinically useful area.
An area of this kind does not exclude the presence of both similar
and different aspects of theory; indeed, complementarity also clarifies
areas of thinking that could make mutually compatible additions
to a particular understanding.
This chapter will highlight the compatible area of thinking in Klein
and Winnicott around the concept of reparation. Klein’s definition
gains indispensable dimensions from Winnicott’s theory, both when
he is deliberately using her concept and when he is not. In the
notion of reparation, the theories of Klein and Winnicott reveal a
significant complementarity that has broader implications. This is
because reparation touches on the larger issue of destruction—both
internal and external—in human life, and offers ideas on our means
of responding to it. To highlight this area, there will first be an
overview of both theories with an emphasis on their affinities and
divergences. With such a comparison in mind, it is then possible to
approach the issue of how human beings manage to “repair”, and
to examine the contributions from both theories.

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 COMPATIBLE OUTLOOKS? 115

122 A common element that unites Klein and Winnicott is that

2 neither is offering a moral outlook organized around messages of
3 disapproval or blame, either of the individual or of the environment.
4 Rather, both theories are scientifically conceived views of the human
5 individual as a psycho-biological being, struggling against great
6 odds in the process of growth. The sense of a danger that needs to
7222 be overcome, and of a life-and-death struggle for survival, is focal
8 to both. As psychoanalysts, both Winnicott and Klein ultimately
9 suspend judgement about human nature, and the struggle that they
10 outline is depicted from a morally neutral position that seeks to
1 understand the object of study—the human psyche. In considering
2 their convergences, the significant divergence from Freud that
3 initially unites them in an object relations view is also important.
4
5222
Klein, Winnicott and the divergence from Freud
6
7 Freud’s inquiry into the most disturbing areas of mental life led him
8 to focus on a sexual primitivism that underpins it. He was able to
9 highlight aspects of experience that are difficult, and often impossible
20 to bear. Nonetheless, his theory never reached beyond libido and into
1 the further arena of early emotionality. He thus missed the infant’s
2 crucial innate need for psychic intimacy. The Freudian baby seeks
3 proximity with the mother because she is a means to an end—she
4 provides food and, along with it, libidinal pleasure and a means of
5 discharging drive tensions. This implies that the infant is seeking,
6 and will be satisfied by, what is tangible: for example, maternal milk
7 or else a sensual breast. Nourishment and libidinal pleasure are
8 conspicuous aspects of human experience, and the oral life that
9 provides them ultimately marks out an area that is accessible to self-
30 observation.
1 A much more precarious sense surrounds the idea of an infant
2 who needs, in a fundamental, life-sustaining way, an element as
3 elusive and as invisible as emotional and psychical intimacy from
4 the mother. Both Winnicott and Klein tackled the difficult task
5 of outlining such an area. Both believed that the infant’s need is
6 for the mother’s person, and for a dual, physiological and emotional
7 connection with her. In Winnicott’s thinking, a psychosomatic
8 closeness to the mother begins to give the infant a sense of solid-
922 ity and a rudimentary self-awareness, helping the process of

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“personalization” (1945). Surely, says Winnicott, instinctual,

biological gratification is not everything for the infant: “The
rudiments of an imaginative elaboration of pure body functioning
must be postulated, if it is to be claimed that this new human being
has started to be, and has started to gather experience that can be
called personal” (1962, p. 60).
Klein developed a very similar area of thought in her concept of
unconscious phantasy which equally elaborates body functioning
and represents it psychically. Like Winnicott, Klein suggested that
primal security is dependent upon “the unconscious of the mother
and the child [being] in close relation to each other” (Klein, 1946).
Both Winnicott and Klein had versions of the belief that the
mother’s presence enables the infant to achieve a state of enhanced
cohesion and awareness. Both had theories which suggest a degree
of infantile dependence that is extreme as compared with other
animal species. They share the core idea that the infant is psychically
vulnerable in the face of a harsh reality, but they emphasize
alternative sources for this reality, focusing on external and internal
respectively. These similarities are known, as is the fact that from a
common foundation arose some significant differences.
The divide between Klein and Winnicott is thought to be most
blatantly manifest in their alternative views of the “death instinct”,
generally considered to be Freud’s most controversial concept. It
became indispensable to Klein’s framework, but Winnicott dismissed
it, and is therefore felt to have conceived of a “softer” kind of human
nature.

Klein’s view of the death instinct

In Klein’s thinking infants know about death, as do all living beings.
Death is feared when the breast is unavailable and the infant might
starve. However, death does not come only from the external world.
A destructive drive exists within all human individuals and is active
in the unconscious from birth. While Freud regarded the death
instinct as operating “silently” within the organism, manifesting
only indirectly and in a bound form, Klein took a different view. She
suggested that the death instinct affects the ego directly and can
therefore be available to human experience as an internal threat. It
is thus felt as a force that constantly imperils the early ego’s attempts

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122 at integration and self-regulation. The unconscious threat of

2 annihilation creates a specific manifest tension that is felt as anxiety.
3 And anxiety—a direct result of the death instinct—is thus central for
4 psychoanalytic theory and practice.
5 Klein suggested that the infant deals with the internally felt death
6 instinct in a complex way. First he tries to deflect it by projecting it
7222 elsewhere: “Projection, as Freud described, originates from the
8 deflection of the death instinct outwards, and in my view it helps
9 the ego to overcome anxiety” (1946). The death instinct, directed
10 outwards by the infant, is then attached to the source of external
1 danger—the abandoning breast. This bad object, when re-introjected,
2 becomes an internal, embodied personification of the death instinct.
3 However, some of the death instinct is not projected and disowned,
4 but converted into aggression and sent out as attack, aimed at
5222 destroying the bad object. The depriving breast is thus both feared
6 and attacked, creating acute persecutory anxiety.
7 Later in her life (1957), Klein became more specific about the death
8 instinct. Rather than pointing ambiguously to a generality of sadistic
9 attacks, she suggested that one defining emotion which expresses
20 the death instinct is envy. Envy hits at the root of infantile love
1 for the mother, seeking to destroy the good from which the infant
2 benefits. With envy, Klein drew attention to a strange predicament
3 in the infant. While she believed that he welcomes nurturing and
4 responds to the caring mother with love, she also pointed out that
5 his psyche can, at times, be intolerant of contact with what is life-
6 giving. There is an obstructive activity that can lurk in the midst of
7 pleasure and love, that creates conflict between the tendencies of life
8 and death, and that must be managed in all living states. It is
9 noteworthy that the struggle for Klein was a painful and conflicted
30 one, regarded by her as much more complex than casual sadistic
1 attacks.
2 In spite of this, Winnicott famously rejected both the idea of
3 primary envy and that of the death instinct. Yet by rejecting the death
4 instinct, he was not necessarily ignoring reality, nor placing human
5 nature in a better world. Indeed, he pointed out some conditions that
6 spell the death of experience for the infant. A sober outlook, no less
7 painful in its implications than Klein’s, runs through Winnicott’s
8 work. It assumes the form of two interconnected ideas that became
922 central to him: one is of an environmental interruption of the infant’s

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mental process, something that over time spells psychic annihilation,

and the other is the idea of the mother and infant as comprising a
single mental unit.
Winnicott’s thought that “there is no such thing as an infant”
(1960, p. 39) initially seems to signal something entirely uplifting, in
that it bears the iconic power of mother and child together as an ideal
unit of love. On closer examination, this well known declaration also
implies the possibility of psychic catastrophe. The newborn is not a
unit sufficient unto itself, and what is suggested, among other things,
is a prolonged state of absolute dependence and therefore of untold
potential suffering if needs are not met.
The theories of Winnicott and Klein come very close in their
conception of infantile fragility and anxiety. But Winnicott’s ideas
about anxiety cannot be understood apart from one of his most
original formulations and significant contributions to psychoanalytic
theory. This was his concept of psychic process, and it was initially
formulated in his paper “The observation of infants in a set situation”
(1941), which clarifies his thoughts about the relationship between
mental process and the anxiety that might interrupt it. An under-
standing of this relationship reveals how much Klein and Winnicott
shared in their thinking about anxiety, in what ways they differed,
and what they regarded as an antidote to it.

The observation of infants in a set situation

In this now famous paper, Winnicott draws directly on Klein’s
theory of anxiety. He does so not in the sense of linking anxiety to
the death instinct, but in another, equally significant sense. He
regards anxiety as partly emerging from within, specifically from
a persecutory object that is internal.
At the time of writing this paper, Winnicott had already begun
to pull away from a Kleinian theoretical base. But it was not so much
in his view on anxiety that he differed from Klein as in the factors
that, in his opinion, gave rise to it. These were not understood as
appearing automatically due to the inner workings of the death
instinct. Instead, Winnicott believed that anxiety emerges as a specific
response, and at a time when a most basic capacity of mental life is
first laid down: the capacity to employ mental process.

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122 It is here that Winnicott begins to discuss the importance of

2 allowing the infant “the full course of an experience” (1941, p. 67),
3 something that represents his conception of psychic process. The “full
4 course of an experience” is a mental event, but it is most easily
5 inferred from infantile behaviour in everyday situations. For
6 example, the infant typically takes an interest in new objects, picks
7222 them up, mouths them passionately and sensually, as if incorporating
8 their very essence, then gradually loses interest and abandons them.
9 This complete event should be allowed to take its course, something
10 that Winnicott demonstrated in his “spatula” experiment.
1 Winnicott asked mothers who came for consultations to sit near
2 his desk with their infants on their laps. He placed a shiny metal
3 spatula, a “glittering object” (1941, p. 67) on his desk within easy
4 reach of the infant. The infant would typically contemplate the
5222 spatula, then reach for it and mouth it intensely. After a period of a
6 full sensual exploration, the infant would play at dropping the
7 spatula on the floor. He would then play with it on the floor before
8 finally abandoning it.
9 For Winnicott, the sense of the evolutionary course of an
20 experience, a beginning, middle and end, is bound up with a capacity
1 to extract a full meaning from an event. It also enables what Winnicott
2 would come to describe as a sense of “going along”, “going on
3 being”, and a “continual personal process” (1949, p. 183). It is,
4 therefore, a sense of continuity that reassures the individual that he
5 is still alive and still in charge of his own pace and particular way
6 of experiencing. The individual dictates the pace and course that each
7 experience takes, allowing himself to discover predictable and
8 unpredictable turns of event in a characteristic way. Every life event
9 has a micro-climate of its own, a brief history that is unique to itself
30 and that goes into reinforcing self-awareness.
1 If the infant is allowed to use process to achieve completion, he
2 becomes able to build a sense of what he does with a life experience
3 and how he does it. In fact, being in the world is none other than
4 living through process, as all events have an accompanying mental
5 component that needs to be lived out fully. It is only through this
6 evolving activity that the infant begins to sense a “self”. The process
7 of “realization” (Winnicott, 1945) involves an ability to feel “real”
8 through residing in one’s body, which moves predictably in time and
922 space, hence having the basic orientations of living. The “full course

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of an experience” is thus the process that makes basic mental

orientation, and hence sanity, possible.
Interestingly, Winnicott’s trajectory of the complete experience
allows for an ending that is brought about naturally by the infant.
The infant gets to the point where he feels that he has had enough,
that he has absorbed everything that an experience has to offer, that
the spark has now gone out of it, and even that it has become boring.
It takes courage to allow an experience to die naturally and to face
emptiness, boredom and loss. But this natural subsiding of an
emotion is a part of completion, and the opposite of what Winnicott
came to regard as an “interruption”, which is a “rough intrusion” that
can “snap the thread of the infant’s personal process” (1949, p. 183).
Where would such a “rough intrusion”, an “interruption” come
from? At first Winnicott attributed it to internal factors. His thinking
came from the observation of a more troubled aspect of infant
behaviour with the spatula. The spatula game captured the fact that
life provides good things, “glittering objects” for pleasure, celebration
and discovery. Apparently, all that is required is to notice them, reach
out and grasp, but this is not what actually happens and what
Winnicott observed.
For a start, there were mothers who found the spatula experiment
trying, and were not able to understand the infant’s desires
intuitively. They worried about hygiene, for example, or felt uneasy
with the infant’s dribbling oral sensuality. They were clearly not
receptive to the infant’s unrestrained, animal mouthing with its
connotations of incorporation. But an interfering environment was
by no means the only obstacle in the infant’s way. One of the
important moments noticed by Winnicott in this experiment was the
“moment of hesitation” (1941). When faced with an attractive
“glittering object”, infants who clearly showed intense interest in it
did not reach out at once, but hesitated.
Winnicott suggests that “what we see is the result of the fact that
the infant’s impulse is subjected to control” (1941, p. 62). What is
more, this is not necessarily the mother’s responsibility. Even where
mothers were free with their infants, hesitation occurred. Winnicott
thus raises the possibility that the child inhibits himself, and he
reasons that this can only be due to internal factors. There is in the
infant’s mind an “idea of potential evil or strictness” (1941, p. 60)
that is not dependent on the environment.

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122 In reaching out for a life experience as represented by an attractive

2 object, the infant’s gesture of desire is always threatened at source.
3 The spontaneous gesture is always delayed, and at the moment
4 of delay might never take place. The normal risk-taking necessary
5 for the exploration of the world is conflicted at root. The “evil or
6 strictness” feared by the infant seem to imply a superego in the full
7222 Kleinian sense—it is early, primitive and persecuting. The only
8 addition that Winnicott leaves out is its root in a death instinct.
9 While “the full course of an experience” in this early paper is
10 interrupted because of internal factors, the concept of “interruption”
1 in Winnicott’s later thinking began to assume significant theoretical
2 proportions. It gradually came to be seen as a moment of annihilation
3 representing the death of experience. With this, its internal source
4 began to be played down, or at least not mentioned much, while the
5222 responsibility for interruption slowly moved to the intrusive
6 environment/mother.
7 The “interruption” that Winnicott explores is not the same as a
8 minor delay in carrying out a thought process. It is an occurrence
9 that continually severs the process of meaning-making, leaving the
20 infant cut off from the natural course of his spontaneous desires and
1 intentions, and therefore confused and lost. “Interruption” can
2 manifest as countless intrusions from the mother which happen at
3 a most unseen level of daily minutiae. They represent a continuing
4 misunderstanding of the baby’s communication and a constant
5 severing of it, and a deflection of his signalling and gestures. Later,
6 Winnicott was to emphasize that although the infant can tolerate
7 some impingement from the environment, his “personal ‘going
8 along’ is interrupted by reactions to prolonged impingements” (1949,
9 p. 183). The infant depends on a mother who is able to fit in with
30 the natural rhythms of his psychic process. Such a mother accepts
1 and deals with her consequent hatred of the infant (Winnicott, 1947).
2 Winnicott felt so strongly about the importance of enabling process
3 that he adopted the extreme position of suggesting that “being” is
4 always superior to “reacting”. He believed that “the infant who
5 is disturbed by being forced to react is disturbed out of a sense of
6 being” (1949, p. 185).
7 The mother who inflicts persistent intrusions on the infant’s con-
8 tinuity and “going on being” is also triggering excessive reacting in
922 her infant. Premature over-reacting is burdensome and undermines

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the ability to be at one with the sense of an experience and so build

a strong ego. With too much reacting, any visible ego functioning
can become based on a false structure that has shifted self-awareness
from the internal core to the demands of the environment. An infant
is thus no longer able to identify with, and be orientated by, his own
internal urges, and his all-important “personalization” is under
threat.
In Winnicott’s account, as in Klein’s, there is an explicit acceptance
of infantile annihilation anxiety. So why was it that he did not take
a seemingly small step towards accepting the idea of a death instinct?
It is perhaps in this area that divergences between them cluster
around a very thin dividing line. By refusing the death instinct
Winnicott does not intend to portray a less troubled human nature.
The point that decides the matter for him is a different consideration:
the infant fears annihilation and even knows the terror of
disintegration. He is also capable of destructive aggression, which
is inherent in all motility. Each and every active move or gesture is
fuelled by a degree of aggressive impulse (Winnicott, 1950). Also, in
requiring the mother to adapt herself totally, the infant not only
makes use of her but uses up her living energies. Each infantile desire,
each gesture is also an aggressive demand on the world (1950).
However, so long as the infant is not aware of the meaning of
deliberate killing, and does not link annihilation with hatred, he has
no means of conceiving of the fact that an act is destructive. He does
not experience his own destructiveness as such, and does not even
know initially that he is ruthless. It is this incapacity to conceive of
destructiveness, or rather to attach an active hostile intent to natural
aggression, that led Winnicott to reject the notion of a death instinct.
But then the difference between him and Klein hangs on the
ability of the infant to make particular links between murderousness
and spontaneous aggression rather than on the degree of his
destructiveness or his anxieties of annihilation.
There are other important differences. Although Klein does not
have a comparable concept of mental process, she does have an
idea that is compatible with Winnicott’s idea of an “interruption”.
However, in her thinking, interruption is not visited from without,
but breaks into the infant’s good experience from within himself and
from the internal activity of his death instinct, taking the form of envy
or rage. The early ego is thus threatened with annihilation by “falling

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122 to pieces” (Klein, 1946). The infant feels persecuted by terrors of an

2 internal destructive object, rooted in his destructive drives.
3 Affinities and divergences are also particularly finely balanced in
4 the way that Klein and Winnicott conceive of the infantile means of
5 coping with interruption. Both believe that the actual mother has a
6 crucial role in helping the infant to manage his anxiety. For Winnicott,
7222 as we have seen, this relates to the mother’s ability to understand
8 and support mental process. For Klein it is the mother who rescues
9 the infant from anxiety repeatedly. In his distorted nightmare world
10 of rage and envy, the actual mother restores the child’s well-being.
1 When she appears, the infant’s capacity to test reality enables her
2 good presence to banish internal demons (Klein, 1935). Later, the
3 infant learns to engage in “reparation”, at the same time restoring
4 both his love for the object and his faith in it.
5222 Therefore for Klein, while there is the loss of control of “falling
6 to pieces” under the impact of anxiety, there is also the moment of
7 recovery, and much of it depends on the infant’s emotional potency.
8 A great deal depends on ego strength, first created when infant love
9 enabled an introjection of a loved object that came to form a “core
20 of the ego” (1957, p. 180).
1 In contrast, if Winnicott’s thought is taken to its logical conclusion,
2 it would suggest that a strong and well-introjected love is not a
3 sufficient condition for recovery; or rather, authentic love cannot be
4 constructively expressed and utilized by the infant on his own. When
5 Winnicott explains that “there is no such thing as an infant” (1960,
6 p. 39), he is talking about the prematurity of the infant psyche at
7 birth. This leaves the infant dependent upon the mother in order
8 to comprise a viable unit in the first place. What is implied is a
9 “primitive agony” of being a partial human unit that, without the
30 completing activity of maternal care, would flail about in a state of
1 helpless deficiency. Without the enabling maternal psyche, infantile
2 love may presumably never find a home and never become a
3 resource. The infant depends on a mother who allows the “complete
4 course of an experience”, which alone enables him to discover his
5 personal way of living out his feelings, including his love for the
6 mother.
7 Arguably, the degree of possible helplessness implied in this
8 predicament is as sobering as Klein’s portrayal of helplessness in
922 the face of internal factors. For Klein, intense need to get rid of the

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internally felt death instinct leads to a vicious cycle of anxiety,

projection, aggressive attack and the re-introjection of terror. If there
is insufficient love for the mother, or such love is not reinforced, the
infant does not develop a resilience in the face of his death instinct.
And yet in both Klein and Winnicott there are reinforcing
elements, since both theories are also studies in human strength. It
is mistaken to assume that Klein depicts only gratuitous violence,
and I have already suggested that she had a substantial theory of
the individual’s positive capacities (Likierman, 2001) and that she
placed infantile love for the object, and the reinforcement of such
love by the mother, as the power that enables recovery, reparation
and growth to take place.
At the same time, Klein’s concept of envy does not represent a
simple opposite of Winnicott’s outlook. Her “primary envy” is not
merely an innate malignancy or, as has been thought, some kind of
“original sin”. The infant might well desire to engage with the
mother, but this desire is painfully thwarted from within. Klein’s
formulation of “primary envy” is complex and allows for a compas-
sionate view of the struggling child. She suggested, for example,
that envy is exacerbated when the infant is born with a “weak ego”
(1957) through a variety of factors including a difficult birth or other
traumatizing circumstances. Most important, envy is inevitably
bound up with the basic ability, necessary for survival, to conceive
of something good and desire it. If there were no bitter reaction to
deprivation, and the infant would not notice or mind being deprived,
survival would not be optimized. Whatever the source of envy,
whether it is a “weak ego” or an intolerance of contact with the good,
it culminates in a deep sense of deprivation, of being faced with a
spectacle of goodness that is “so unattainable” (1957, p. 183) because
it is not under infant control.
Klein and Winnicott thus have in common an exploration of
human strengths that are tools to cope with the difficult predicament
of early mental life. How is psychic potency conceived by each of
them? And how does the concept of reparation fit into this outlook?
As suggested, for Winnicott infantile potency is expressed in the
ability to undergo mental process and use it to work over experiences
and recover. But the infant’s mental process is somewhat in the hands
of the mother, who must know not to intrude into it, and provide a
holding environment that enables it. It is in this respect that Klein

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122 provides a complementary aspect, when she introduces thinking

2 about strength that resides in the infant’s person. The infant has
3 specific psychic abilities that are active and constructive, namely the
4 capacity to respond with gratitude and then engage in reparation.
5 This class of reactions signals his ability to build for himself a sense
6 of good quality. Goodness is not passively taken in, it is actively
7222 created and reinforced. Gratitude gives back energetic messages of
8 contentment and the desire for reinforcement, but it is also a form
9 of agency, and puts the infant actively in charge of his experiencing
10 of goodness. Gratitude is his ongoing evaluation of the quality
1 that he receives and his mode of participating in a partnership that
2 creates the good experience. The idea of enjoyment is similarly used
3 by Klein to mark out infantile active participation.
4 Perhaps reparation is the most active and engaging of all the
5222 potent infantile capacities that Klein suggests. In spite of its
6 apparently moralistic connotation, it is not regarded by her as a
7 guilt-ridden, apologetic response to instinctual life, nor, in her
8 thinking, should it be a magical reversal of the effects of damage and
9 destruction, whether wrought by the individual or visited upon him.
20 Reparation is dependent on a moment of tolerating the reality of
1 destruction, facing what has truly gone, and trying to find a way to
2 rebuild what is possible. Reparation is a tool for coping with a
3 difficult, troubled nature, as well as with damage inflicted from
4 external sources.
5 Klein’s concept of reparation is original and impressive in
6 scope, but it is also incomplete in that she does not suggest a psychic
7 process that enables reparation, only describing its outcome. But in
8 Winnicott’s writings, the concept of reparation becomes enhanced.
9 For him, the reparative response to damage, both psychic and
30 external, lies in finding a way to return to individual psychic process.
1 His theory is accepting of the fact that life itself is very incomplete,
2 that damage is suffered all the time, that we have little control over
3 it, and that there is no kind of reparation that restores a situation to
4 what it was before, or “makes it good again” in a complete sense.
5 The only possibility left to a human individual is to restore his own
6 sense of undergoing his experiences, having beginnings, middles and
7 endings in the course of a life that continually interrupts and curtails
8 them. The individual has to recover continually the sense of who he
922 is and how he lives out his own personal going-on-being. If Klein’s

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thinking is added to this picture, it adds not pessimism but an idea

of further strength. In finding his own capacity for gratitude and
reparation, the individual’s sense of potency is reinforced, and he
can reassert his mental process not merely through the re-finding of
it but through allowing the life within him to emerge in the form
of gratitude and enjoyment.
When taking all such factors in the thinking of Klein and Winnicott
into account, it is interesting to note the overall picture that emerges.
Klein’s depiction of a strong infantile reaction to deprivation means
that her thinking plays a central role in the clinical understanding
of internal obstacles. It shows how a degree of innate envy, not
necessarily desired or enjoyed by the individual, can form a
formidable obstacle to even the most loving environment. It is the
infant’s own envy which can impede him, and which is as significant
an obstacle in his life as Winnicott’s environment. At the same time,
Winnicott’s ideas about the enabling mother, who makes process
possible for the infant in the first place, makes sense of external
obstacles to growth.
Psychoanalytic theory is enriched by Winnicott’s thoughts about
the infant and mother unit. However, it is also enriched by an
acceptance that within this unit, active emotional mastery is possible
and comes with the infantile emotional equipment in the form of
gratitude and reparation, as Klein suggested. They put at the infant’s
disposal a means of an active reaction to loss and damage. And
Winnicott’s special contribution was to highlight the only way in
which reparation can be carried out—that is, through resuming the
life and movement of individual psychic process.

References
Klein, M. (1935). A contribution to the psychogenesis of manic-depressive
states. In: The Writings of Melanie Klein, I: Love, Guilt and Reparation and
other works 1921–45. London: Hogarth, 1975.
Klein, M. (1946). Notes on some schizoid mechanisms. In: The Writings of
Melanie Klein, 3: Envy and Gratitude and other works 1946–63. London:
Hogarth, 1975.
Klein, M. (1957). Envy and gratitude. In: The Writings of Melanie Klein, 3: Envy
and Gratitude and other works 1946–63. London: Hogarth, 1975.
Likierman, M. (2001). Melanie Klein: Her Work in Context. London: Continuum.

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122 Winnicott, D.W. (1941). The observation of infants in a set situation. In:
2 Through Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
3 Winnicott, D.W. (1945). Primitive emotional development. In: Through
4 Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
5 Winnicott, D.W. (1947). Hate in the countertransference. In: Through
6 Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
7222 Winnicott, D.W. (1949). Birth memories, Birth Trauma, and Anxiety. In:
8 Through Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
9 Winnicott, D.W. (1950) Aggression in relation to emotional development.
10 In: Through Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
1 Winnicott, D.W. (1960). The theory of the parent-infant relationship. In: The
2 Maturational Process and the Facilitating Environment. London: Hogarth,
1965. [Karnac, 1990]
3
Winnicott, D. W. (1962). Ego integration in child development. In: The
4
Maturational Process and the Facilitating Environment. London: Hogarth,
5222
1965. [Karnac, 1990]
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CHAPTER NINE

Michael Balint and Donald

Winnicott: contributions to the
treatment of severely disturbed
patients in the Independent
Tradition
Margret Tonnesmann

W
hen Michael Balint and Donald Winnicott treated severely
disturbed patients, they both felt that it was necessary to
use particular parameters at certain stages during the
course of psychoanalytic therapy. They held similar assumptions
about the technical changes that became advisable when treating
these patients, and reasoned their case on the basis of their concep-
tualization of infant development. They were in agreement that at
the early stages the facilitating environment makes an essential
contribution to healthy development, and contributes to severe
pathology if it fails. Neither accepted the concept of the death
instinct, but they accepted Freud’s theory of libidinal development
and infantile sexuality with the oedipal phase when the child has
become able to engage in three-cornered interpersonal relations as
a whole person. Conflicts at this stage can lead to psycho-neurotic
disorders in later life that are treated with the classical approach of
interpretation and reconstruction as Freud had devised. However,
they felt that this technique was not sufficient to reach out to those
patients whose illness was due to failures of environmental
adaptation during infant development.
Balint and Winnicott became acquainted with psychoanalytic
thought when they read some of Freud’s publications. Balint wrote:
“After having highly ambivalently criticized The Interpretations of

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122 Dreams and The Psychopathology of Everyday Life, I was, at the age
2 of 21, decisively and definitely conquered for psycho-analysis by the
3 Three Essays on Sexuality and Totem and Taboo. In some form or other
4 these two directions of research—the development of the individual
5 sexual function and the development of human relationships—have
6 remained in the focus of my interest ever since” (Balint, 1952, p. vii).
7222 When Winnicott was a medical student he had to spend three
8 months as an inpatient because of a lung abscess, and a friend lent
9 him a book by Freud.1 He had had in mind to become a GP
10 somewhere in the countryside, but now decided to have an analysis
1 and stay in London. He specialized in paediatrics and started a long
2 analysis with James Strachey (C. Winnicott, 1989).
3 Both Balint and Winnicott argued their conceptualizations of
4 infant development in terms of classical drive theory and the devel-
5222 opment of object relations. Balint makes a strong case for secondary
6 narcissism from the word go. As Harold Stewart has pointed out in
7 his evaluation of Balint’s contributions to psychoanalysis (Stewart,
8 1996), his early publications have a strong biological bias. Balint
9 emphasized that the infant starts off in the womb already intensely
20 related to the non-human environment with soft boundaries with
1 which the embryo lives in a harmonious mix-up. Post-partum, this
2 state is still largely realized for a while as the mother provides
3 conditions for the infant that allow him to exist in a state of primary
4 love, by which Balint means being loved without conditions attached.
5 At the beginning everything is provided for by well adjusted nursing
6 care. But soon the infant has to recognize objects and spaces between
7 objects. If a lack of fit between the infant and the nursing mother
8 because of biological or psychological conditions becomes prominent,
9 a basic fault develops in the mind, and this can give rise to com-
30 pulsive pathological characteristics. Balint has described two of them
1 in detail: there is an ocnophilic characteristic of clinging to objects
2 or seeking free spaces; and one of developing ego skills which he
3 called philobatic. Balint explained his use of the term “basic fault”
4 from its meaning in crystallography, where it denotes a sudden
5 irregularity in the overall structure: “an irregularity which in normal
6 circumstances might lie hidden, but if strains and stresses occur, may
7 lead to a break, profoundly disrupting the overall structure” (Balint,
8 1968). He conceived of the mind in terms of three areas: the basic
922 fault area which is characterized by primitive, exclusively two-object

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relating; the oedipal area which evolves through differentiation and

is characterized by three-cornered whole-person relationships;
and also an area more primitive than the basic fault. This is the
creative area in which there is no object as yet, but objects are in
the process of being created.
Winnicott conceptualized infant development in terms of primary
narcissism. At the beginning the infant lives in an anxiety-free state
of un-integration, a kind of continuation of intra-uterine existence
when physiology and psychology are not yet differentiated. The
infant is merged with mother and lives, as Winnicott says, in total
dependence, as the infant does not know about the dependence.
The ordinary mother relates to her infant in a state of maternal
preoccupation, which is given to her in health and develops during
the last stage of pregnancy. It enables her empathically to understand
her infant’s sensory and emotional experiences, and it assures at the
beginning the aliveness of tissue and the feeling of continuity-of-
going-on-being. Mother holds the infant’s ego and allows the infant
to live in a subjective, undisturbed illusionary world. Everything is
accounted for by projection. When the infant has developed a self
that can experience that he lives in his body and can experience “I
am”, he has a primitive love impulse towards the subjective object:
“I love you so I eat you”. He can now recognize that the mother has
survived the attack, and this gives him the realization of a separate
reality. The infant can now give up the omnipotent control over
the object, relate to a separate object, and thus become aware of
his dependency on mother. Here the facilitating mother has the
important task of giving the infant an experience of her survival, and
she will not retaliate when her infant, let us say, bites the breast. But
she has also now to disillusion her baby and introduce him to the
shared reality world with an intuitive understanding of how much
her baby will tolerate without undue anxieties. If the mother is not
a “good enough” mother, she may fail in facilitating the infant’s
development at the earliest stages and will impinge upon him. The
infant will then develop a premature ego defence, a false self.
The false self is an ego device that will prematurely adapt to the
environment but also protect the true self from further impingements.
But the true self will then remain isolated and cannot feel real.
Balint and Winnicott both felt that patients who seek psycho-
analytic therapy for a basic fault or a false self syndrome need to

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122 regress during the course of therapy. Regression is a generic term

2 and means a return to earlier forms of a developmental process.
3 In clinical psychoanalysis it is seen predominantly as a defence
4 mechanism, for example when under the impact of an oedipal
5 transference there is libidinal regression to early fixation points.
6 Regression is here assumed to be an intra-psychic phenomenon of
7222 defence, worked with during therapy by interpretation.
8 It was Sándor Ferenczi who made use of it as a therapeutic tool.
9 He was the first analyst during the twenties who took severely
10 disturbed patients into analytic treatment and noticed that they
1 regressed during the sessions. They responded badly to Ferenczi’s
2 abstinent analytic approach and accused him of being responsible
3 for their condition, as he was not willing to take responsibility for
4 arousing their longings and desires, but then short-changing them
5222 by just giving interpretations. He became aware that they were
6 repeating childhood traumas which they had suffered when the non-
7 caring parents had over-stimulated or under-stimulated them. He
8 changed his technique and encouraged his patients to feel free so
9 that their tensions were reduced. In this context he became aware of
20 how his emotional responses to his patients were influencing them.
1 He then developed a technique through which he tried to satisfy their
2 wishes, which led to addiction-like cravings that were difficult to
3 handle. All these experiments have been well documented (1988),
4 and Ferenczi had to admit that they had all failed. Satisfying his
5 patients’ cravings also involved close physical contact, and Freud
6 disapproved. Shortly before Ferenczi’s death in 1933, there was an
7 estrangement between them. Balint worked closely with Ferenczi and
8 he told Harold Stewart (Stewart, 1996), who was in supervision with
9 him, that after Ferenczi’s death he had interviewed Ferenczi’s
30 patients. It was not true that Ferenczi had failed with all of them:
1 some had done quite well while others had not benefited. Regression
2 was seen here as an interpersonal phenomenon, namely regression
3 to early developmental levels of object relations.
4 Probably because of Freud’s disapproval, regression as a thera-
5 peutic tool for the treatment of patients whose early mother-infant
6 matrix had been deficient (Balint) or who had suffered impingements
7 in infancy (Winnicott) did not become a prominent device until
8 Balint and Winnicott used it again in London and considerably
922 refined the theoretical, clinical and technical implications. Their

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technical handling of the regression was similar—though not

identical—but their underlying theoretical assumptions of infant
development were different.
They both stressed that the parameters they introduced to meet
the patient’s regression had to be contained within the boundaries
of the analytic setting. Balint described how at a later stage during
analytic therapy of patients suffering from basic fault, the atmosphere
of the session changed. Words might lose their agreed meaning,
and everything the analyst said, or even a gesture, was understood
by the patient as having a special meaning or being of the utmost
importance. The patient was now relating to the analyst in a
primitive, pre-verbal and exclusively two-person relationship. If the
analyst failed to click in, the patient often showed no reaction of anger
or criticism. He reacted instead with an apparently lifeless acceptance
of what was offered. He might complain of feelings of emptiness,
deadness and futility and experience the analyst in a paranoid way
as deliberately behaving maliciously towards the patient. But at the
same time there was an utter determination to get on with it and see
it through. Balint felt that it is this response of the patient that makes
him so appealing to the analyst at this time. These are all signs that
the patient has regressed to the level of the basic fault. The patient
experiences no conflict but a deficiency, and sometimes he even says
that he feels he has been faulted.
If the analyst can now click in, he will understand and respond
to the patient’s demands, which are aimed at being recognized for
his problems related to the basic fault. The patient has regressed
to the primary love level. The atmosphere is “arglos” and guileless,
and the patient has become totally trusting. The patient’s urgent wish
is for something extra, a small request that the analyst will grant
him: an extra session, to be allowed to phone the analyst over the
weekend, or for the analyst to phone the patient, or even small
physical contact like holding the analyst’s hand or finger during
a session. Harold Stewart (1992) maintained that Balint advised
strongly against physical contact and forbade him to engage
in physical contact with his regressed patient when he was in
supervision with him. During the regressed state the patient’s
communication is pre-verbal and hence he resorts to a kind of acting
to which the analyst will respond.

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122 Verbalization and interpretation of such acting out would fail the
2 patient’s pre-verbal state of communication and lead to a repetition
3 of the original trauma that led to the basic fault. It is characteristic
4 of the early primary love relationship that the object cannot be given
5 any consideration. Hence in particular any form of transference
6 interpretation has to be avoided. If the patient can benefit from the
7222 token satisfaction of his urgent needs, he is enabled to find himself,
8 as he often says. He can give up his compulsive, pathological relating
9 to objects, can free himself and find new and better ways of relating.
10 Balint had conceptualized “regression” and “new beginning” in one
1 of his early papers. He used here Haeckel’s biogenetic laws and
2 maintained that new developments in the mind require regression
3 to early primitive modes from which a new beginning, a better way
4 of adaptation can develop. However, some patients cannot make use
5222 of benign regression. It frequently breaks down, and the patient shows
6 signs of desperate clinging to a separate whole object. The regression
7 has now become malignant and is aimed at gratification, with
8 addiction-like states of craving for satisfaction of instinctual demands
9 from the analyst. There are signs of severe hysteria, with genital-
20 orgasmic elements in both the normal and the regressed forms of
1 transference.2 In a short vignette, Balint (1968) showed how after the
2 last analytic session of the week he handled his patient’s demand
3 for an extra session over the weekend. Occasionally the patient had
4 been given an extra session at weekends in the past. It had given
5 him great satisfaction, but it was only rarely that during such an extra
6 session any real analytic work was done. On this occasion the Friday
7 session had passed without any true contact between the patient
8 and his analyst as he had to make the analyst useless. When he was
9 leaving the room, he said that he felt awful and could he have a
30 session sometime over the weekend. Balint judged this request as
1 one aiming at gratification, and considered how he could best
2 respond to the patient’s request. If he made an interpretation pointing
3 out the craving for gratification, the patient would feel even more
4 wretched for having made this demand—if he agreed with his
5 analyst. If he disagreed with him, he would experience the analyst
6 as unkind and cruel, and his tensions in the therapy would increase.
7 An interpretation as the patient’s resistance or as a transference of
8 aggressiveness and hatred from his childhood would have a similar
922 result. If, however, the analyst satisfied the patient’s demand for an

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extra session, regardless of whether he interpreted it as a repetition

of some early frustration prompted by or leading to greediness and
envy, he would turn himself into an omnipotent object and force the
patient into an “ocnophilic” relationship. Balint first recognized and
accepted his patient’s distress so that he could feel his analyst was
with him, but then he said that he did not feel an extra session would
be powerful enough to give him what he expected and perhaps even
needed at this moment, and it would make him small and weak while
his analyst would become big and powerful. The patient left
dissatisfied. Balint had two aims in mind. He wanted to prevent the
development of undesirable relationships, either between someone
let down or frustrated by a harsh and superior authority who knows
better, or between someone weak and in need of support and a
benign and generous authority. Both cases would lead to a rein-
forcement of the inequality between the subject and the mighty
object. Instead he tried to establish a relationship in which neither
the analyst nor the patient would be all-powerful, and a fruitful
collaboration between two people who were not so different in
importance and power could be established. The patient had hardly
ever phoned his analyst, but that evening he did phone, almost in
tears, and said that he did not want anything from him but had to
ring up and let him know how he felt. Balint pointed out that his
response to the original request at the end of the session showed how
a process that had started as a malignant craving for satisfaction
turned into a benign regression for recognition. It also initiated a
changed atmosphere in the analysis.
The object relationship to which patients who have experienced
traumas at the basic fault level regress during therapy is an
interaction between two people that is maintained by mainly non-
verbal means. We speak here of the climate or the milieu of the
session. There are no firm boundaries in this primitive, two-person
relating. There is the harmonious mix-up of primary love and the
ocnophilic and philobatic relating to stable part-objects or even full
objects of the basic fault. During the analysis conditions have to be
created by which they can heal. This means that the patient has to
regress to the developmental level at which the trauma occurred and
led to the lasting deficiency. Only then can the patient discover new
ways of object relating and experience a new beginning.

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 MICHAEL BALINT AND DONALD WINNICOTT 135

122 Balint then poses the question of how the analyst can foster the
2 regression. His discussion centres mainly on what the analyst should
3 avoid: he should avoid becoming a mighty and knowledgeable
4 object for the patient. He warns against making too many transfer-
5 ence interpretations, as this will force the patient into an ocnophilic
6 world, and the patient is then not given enough opportunities to
7222 make his own discoveries. The analyst has to be flexible to adjust
8 to the patient’s needs and alternate between the primary love, the
9 ocnophilic and the philobatic worlds. He has to allow the patient to
10 use him as a kind of primary substance, by which he means to be
1 experienced as indestructible like earth, water, air or fire. He must
2 avoid becoming omnipotent in the patient’s eyes, as this will increase
3 the danger of malignant regression.
4 The analyst has to be unobtrusive and keep in mind that words
5222 have become unreliable. He has to bear with the patient’s regression
6 and not interpret it. He therefore has to accept the acting out during
7 the sessions, and he has to be felt by the patient as just being there.
8 He should not give primary love but just be there and offer the
9 patient the possibility of cathecting him as primary love object.
20 The patient should be given plenty of time to work through the
1 basic fault. This can mean refraining from interpretative work for a
2 longish time. When the basic fault has healed off, the analysis can
3 resume its ordinary course of free association, interpretation and
4 reconstruction. It is then that the therapeutic regression, like all
5 parameters that may occur in an analysis, will have to be worked
6 through. However, Balint makes it clear that for him every analysis
7 should have moments when the patient can regress to primary love
8 and basic fault levels of functioning.
9 Donald Winnicott maintained that patients who have suffered
30 traumatic impingement during infancy and have developed a false
1 self need a therapeutic regression during analytic therapy. At the
2 beginning, these patients will respond with false self adaptation to
3 the therapy, or they will use the care-taking function of the false self
4 and talk about their core emotional self. Winnicott discussed how the
5 false self can be a highly organized and sophisticated ego device that
6 allows for false but effective living. He described patients who had
7 had a satisfactory analysis because their false self adaptation made
8 their analysis a rewarding experience for them and their analysts. But
922 when the analysis was terminated, they found that they were still

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suffering from a sense of futility and emptiness that signified a hidden

true self protected by a false self. They are often regarded as healthy
people in view of their effective living, adaptation and performance,
and Winnicott maintained that some of these patients have had a
careful upbringing, as exposure to impingements during early
infancy does not necessarily imply deprivation during childhood.
When during analytic therapy the patient has gained enough
confidence in the analytic setting, the analyst and the treatment
process, the patient will hand over the false self to the analyst, as
Winnicott said. The patient will then regress to a very vulnerable,
almost defenceless dependence. This is a painful situation as the
dependent state is precarious, and the patient—unlike the infant—
is aware of the risks involved; the infant is not aware of his
dependence. The patient has regressed to the level of functioning of
symbolic realization.
In psychoanalytic therapy the couch is there for the patient’s use
and appears in dreams and phantasies in a variety of ways. For the
regressed patient, the couch is the analyst, the pillows are the breasts
and the analyst is the mother at a certain point. In the ordinary
analysis the patient may have a wish for the analyst to be quiet. The
regressed patient needs quiet. If this need is not met, the patient will
not be angry. Instead, the original failure situation will be reproduced
and his sense of futility remains.
During the period of the patient’s regression, all interpretative
work has to be halted and the analyst has to apply management,
as Winnicott called it. Not only is the patient regressed, but the
analyst also has to take an active part in this primitive two-person
relationship in a holding function. This is often difficult as it may
require a response that does not come easily to the analyst. When
Winnicott was asked by a regressed patient to be still and make no
movement during sessions, it became difficult for him, but from a
dream of his he understood that he had experienced it as having only
one half of a body. The patient can only repeat earliest memories in
actions, as there was no ego at the time of the original failure. They
are unthought thoughts known, as Christopher Bollas (1987) called
them. The analyst will act mainly intuitively to meet the patient’s
need of the moment. But there can be unconscious interference (like
an unconscious negative countertransference) as the analyst has to
respond to the regressed patient as the individual person he is.

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122 If the analyst can meet the regressed patient’s needs, there will
2 still come a time when the analyst makes a mistake. It may only be
3 a small mistake, but at this moment the patient reacts fiercely. He
4 experiences it as a total let-down and becomes very angry indeed.
5 These are the moments when the impingements of the original
6 environmental failure situations are repeated during the analysis.
7222 Winnicott speaks metaphorically of the unfreezing of the early
8 frozen failure situations that are not available to memory but are
9 stored and can therefore be repeated in the acting out. It is important
10 that these mistakes indicating the early failure are discussed and
1 understood by both the patient and the analyst. As the patient is now
2 an adult, he can experience the anger in the here-and-now, but the
3 anger belongs to the original failure situation. Winnicott has
4 described how he once forgot to have certain papers that the patient
5222 had given him put in the right place. The patient was allowed to go
6 straight into the consulting room and saw the mistake. By the time
7 Winnicott joined her she was consumed with rage and wanted to
8 know why it had happened. Had Winnicott forgotten to put the
9 papers in the right place in response to her or had it been something
20 within him that made him react in this way? Winnicott stressed that
1 it is essential to explain the reasons fully to the patient without giving
2 too much personal information away. In this case he actually said
3 to the patient that he was not the tidiest of people. It had happened
4 and presumably would happen again. If she wanted to stay with him
5 in treatment she would have to put up with it.
6 Such failure situations may be repeated via the analyst’s mistakes.
7 Each time they will explain a specific environmental failure that the
8 infant had suffered. In time, the patient will be able to make a move
9 forward towards independence with a true self that can feel real and
30 experience living.
1 Whether the regressed patient can recover at the end of the session
2 and leave depends partly on the degree and organisation of an
3 observer ego. Winnicott maintained that patients who are similar in
4 their immediate clinical aspects may be very different in this respect.
5 Some patients have a strong observing ego but others are unable
6 to recover from the regression during the analytic hour and need
7 nursing care. Winnicott conceived of radical withdrawal during a
8 session as a defence against regression. He described a case when,
922 shortly before his summer holidays, the patient became very cutting

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towards him and finally left the session. He was even doubtful
whether the patient would return, but she came back the next day
and apologized. However, he maintained that when the analyst is
quick enough and can understand the regressive move that is being
defended against by the withdrawal, some analytic work can be
done. Otherwise the withdrawal will function as a defence and the
session is lost for analytic work.
Winnicott always stressed that regressive moves of the patient aim
at progression, and renewed stages of dependence aim at independ-
ence. When they occur during analytic therapy, they can be seen as
signs of the patients’ hope that they will find an environment which
will finally facilitate emotional living for them and free them from
their often crippling sense of futility. The analytic management, how-
ever, has to stay within the analytic setting. At a later stage of the
analysis, when the setting can again support ordinary interpretation
and transference, the parameters of the analytic management have
to be worked through, as Eissler (1953) advised for all parameters that
maintain and do not disrupt the overall process of analytic therapy.
Both Balint and Winnicott argued that patients who have suffered
traumas at the beginning of infancy need to regress during analytic
therapy to pre-verbal functioning in order to communicate the
environmental failure that constituted the defensive ego device of a
basic fault (Balint) or a false self (Winnicott). As they conceptualize
early development differently, Balint in terms of secondary
narcissism and Winnicott in terms of primary narcissism, they
understand the dynamics of the therapeutic regression in terms
of their theoretical assumptions. However, they both emphasize
that the patient has regressed to a primitive two-person relationship
of a pre-verbal nature and communicates by acting out during the
session. To reach the patient, the analyst has to halt all interpretations
and instead has to act in with the patient so that the original traumas
can be activated and repeated. When the analyst no longer functions
within the as-if situation of the transference, this means that the
analyst has to engage with the patient as the person he is. To do so
within the boundaries of the analytic setting is a delicate operation,
and both Balint and Winnicott warn against an analyst undertaking
such therapy without having had enough experience in ordinary
transference analysis with its stable analytic setting. When Balint talks
of being with the patient or just being there and so offering the patient

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122 the opportunity to cathect him as a primary object, or when Winnicott

2 speaks of the analyst’s holding function to meet the patient’s needs,
3 they reason their case in terms of their different understanding of
4 early development.
5 But they were also different personalities, and the question could
6 be asked whether this also played a part in their handling of the
7222 therapeutic regression, when they had to respond by acting in to meet
8 the patient’s acting out. Both warn of the therapeutic regression
9 getting out of hand. For Balint it is the development of a malignant
10 regression that aims at satisfaction of ever-increasing demands for
1 addiction-like instinctual impulses. He warns that the analyst has to
2 avoid being perceived by the patient as a powerful saviour of his
3 predicaments. Stewart (1992) has discussed the development of
4 malignant regression and maintains that some such developments
5222 evolving from benign regression are inevitable, even if they manifest
6 themselves only in a dream. Winnicott described his patients’ anger
7 at the analyst’s mistakes in terms of feeling narcissistically hurt
8 and enraged. In the example I have given, he dealt with the patient’s
9 omnipotence by pointing out his personal limitations and so
20 disillusioning her.
1 Both Balint and Winnicott claim that if given time, patients will
2 spontaneously engage in a progressive move. The basic fault will heal
3 off, and in a state of a New Beginning they will lose their compulsive
4 ways of object relating and experiment with new and better ones.
5 As the patients will be able to start living with their true self engaged,
6 they will lose their compulsive ways of false self compliance.
7 Ordinary analytic work with transference and reconstruction can
8 be resumed, and the parameters of the therapeutic regression can be
9 worked through. A therapeutic regression cannot cure a patient in
30 the way a patient suffering from psychoneurotic symptoms can be
1 cured. But it can free the patient from the crippling sense of futility
2 and emptiness for which he seeks help.
3
4
5
Notes
6 1. Claire Winnicott did not name the book but it is known that it was The
7 Interpretation of Dreams.
8 2. Stewart (1989) has discussed the treatment of several cases of malignant
922 regression and has drawn attention to the absence of clinical case material

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in Balint’s publications. This may lead to the question whether Balint had
Ferenczi’s cases (of which he had detailed knowledge) in mind in his
general description of the clinical picture of malignant regression.

References
Balint, M. (1952). Preface to the First Edition. In: Primary Love and Psycho-
Analytic Technique (2nd. rev. and enlarged ed.). London: Tavistock.
Balint, M. (1968). The Basic Fault: Therapeutic Aspects of Regression. London:
Tavistock.
Bollas, C. (1987). Shadow of the Object: Analysis of the Unthought Known.
London: Free Association Books.
Eissler, K.R. (1953). The Effect of the Structure of the Ego on Psycho-Analytic
Technique. Journal of the American Psychoanalytic Association, 48: 875–882.
Ferenczi, S. (1988). The Clinical Diary of Sándor Ferenczi. J. Dupont (Ed.).
Cambridge, MA: Harvard University Press.
Stewart, H. (1989). Technique at the basic fault and regression. In: Psychic
Experience and Problems of Technique. London: Routledge, 1992.
Stewart, H. (1992). Psychic Experience and Problems of Technique. London:
Routledge.
Stewart, H. (1996). Michael Balint. Object Relations Pure and Applied. London:
Routledge.
Winnicott, C. (1989). D.W.W.: A Reflection. In: C. Winnicott, R. Shepherd,
& M. Davis (Eds.), Psycho-Analytic Explorations. London: Karnac.

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122 CHAPTER TEN
2
3
4
5
6
7222 Therapeutic relations:
8
9
Sándor Ferenczi and the
10 British Independents
1
2
3
Julia Borossa
4

I
5222 n an obituary for Sándor Ferenczi, Michael Balint paid homage
6 to his mentor in the following terms: “If I had to sum up in a
7 single word what our dear departed master had really been,
8 I would simply say: a doctor, a doctor in the most noble, richest
9 meaning of the term” (Balint, 1934). It is a striking, seemingly
20 contradictory homage to pay a man who had chosen to make
1 psychoanalysis rather than medicine his life’s work. Indeed, the
2 tensions, both practical and theoretical, between the medical and the
3 psychoanalytic disciplines are well known and well documented
4 (Casement, 2004). In the 1920s, when the fledgling American
5 Psychoanalytical Society wished to restrict practice to members
6 possessing a medical qualification, Ferenczi fully sided with Freud
7 in opposition to the move (Freud/Ferenczi, 2000). Balint, however,
8 was not referring to such controversies, far ranging though they may
9 be in their consequences for psychoanalysis as a profession. Rather,
30 he was paying homage to Ferenczi’s profound commitment to the
1 act of healing, understood quite simply as the alleviation of suffering
2 first and foremost, which for him extended beyond disciplinary,
3 political, institutional and even theoretical concerns. It is this
4 commitment that lay at the core of Ferenczi’s focus in his writings
5 on the therapeutic relationship, a focus that led him to a number of
6 radical revisions of his own practice and to a sustained critique of
7 what he saw as the power relationship at its core. Accordingly, this
8 paper will concentrate on Ferenczi’s views on technique and the
922 therapeutic interaction, drawing out the conceptual links between

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him and members of the British Independent School, in the expec-

tation that it will allow for a better understanding of the effects of
Winnicott’s own therapeutic attitude. Both Ferenczi and Winnicott
were practitioners widely considered to have had a strong clinical
flair and a willingness to take creative risks. However, this therapeu-
tic attitude, common to both men, sits uneasily within an increasingly
regulated profession practised in a risk-averse environment.

Transference, countertransference and the

professionalization of psychoanalysis
As the historical background to the conceptual dialectic between
transference and countertransference shows, that dialectic was
fundamental to the practice and dissemination of psychoanalysis. In
1911, Freud wrote privately to Jung:

[Neither you nor Pfister] has yet acquired the necessary

objectivity in your practice, that you still get involved, giving a
good deal of yourselves and expecting the patient to give
something in return. Permit me, speaking as the venerable old
master, to say that this technique is invariably ill-advised, and it
is best to remain reserved and purely receptive. We must never
let our poor neurotics drive us crazy. I believe an article on
counter-transference is sorely needed; of course we could not
publish it, we should have to circulate copies among ourselves.
[Freud/Jung, 1974, pp. 252–253]

The lines of advance are clearly drawn for the future institution-
alization of psychoanalysis, and they were understood, at least in
part, on a basic notion of “authority”: of Freud over his disciples, of
analyst over patient. What is also sketched out in the above quotation
is a programme of who may write what for whom and why.
As is well known, Freud viewed countertransference, his term for
the analyst’s transference, much as he did transference itself: as a
resistance which had to be overcome in the course of practising
psychoanalysis, as well as a puzzle that needed to be solved if the
treatment was to proceed in a satisfactory fashion. The following
passage is taken from one of the few pieces in which he treats
the concept in his published writings: “We have become aware of

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122 the countertransference, which arises in him as a result of the

2 patient’s influence on his unconscious feelings, and we are almost
3 inclined to insist that he shall recognize his countertransference in
4 himself and overcome it” (1912b, pp.144–145). To achieve this, Freud
5 argued that potential analysts “should have undergone a psycho-
6 analytic purification” (1912a, p.116). The implication is that only by
7222 being analysed himself was the analyst able to proceed beyond
8 countertransference feelings, and thus be able to do the job. But
9 as in the case of formal training in general, the possibility of a
10 rapprochement between patient and analyst offered by the concept
1 of countertransference would paradoxically lead to a reinforcement
2 of the analyst’s authority, to a rejection of an identification with the
3 patient and to a much clearer demarcation of the roles to be taken
4 up. It is in this context that Freud’s most famous model for the
5222 analyst’s attitude should be read: “[the analyst must be] opaque to
6 his patients and like a mirror, should show them nothing but what
7 is shown to him” (1912a, p. 118). It is in partial consequence of the
8 view of countertransference as an impediment to patient and analyst
9 “knowing their place” that impenetrability is proposed here as an
20 analytic ideal. Moreover it clearly divides the interpersonal space
1 between them.
2 But in the very same essay, Freud then proceeds to reopen that
3 space. He suggests that the analyst “turn his unconscious like a
4 receptive organ towards the transmitting unconscious of the patient”
5 (1912a, p. 115). This passage is very frequently quoted in subsequent
6 writings on the concept of countertransference proper (Heimann,
7 1950; Little, 1951; Kohon, 1986), the authors pointing to it in order
8 to legitimate their own theoretical elaboration, even when it is in the
9 starkest contrast to the substance of Freud’s recommendations.
30 Seldom is it mentioned that the passage was written in the context
1 of an essay which proposed to set out technical guidelines on how
2 to practise and disseminate proper psychoanalysis.
3 Freud goes on to propose another guideline for the proper analytic
4 attitude, one which involves immense conscious control on the part
5 of the therapist, and a markedly unequal relation with the patient.
6 Not only should the doctor be opaque and aloof, but Freud clearly
7 states that “analysts should resist the temptation to put themselves
8 on equal footing with patients by offering them glimpses of their own
922 mental processes” (1912a, p. 118). Any hint of what the analyst really

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felt or thought would constitute a breach of professionalism and lead

to the dreaded charge that what was being practised was suggestion
and not analysis. But as we have already seen, to ensure the proper
kind of professionalism, the analyst is enjoined to undergo analysis.
In other words, this very factor, the recognition of the analyst’s
fallibility and its first tentative theorization as countertransference,
taken together with what was understood as the limited efficacy of
self-analysis in correcting that fallibility, leads the analyst literally to
put himself in the patient’s place. This requirement gave the nascent
profession of psychoanalysis an additional, distinctive characteristic,
as the analyst’s analysis became institutionalized in terms of a
“training analysis”.
Alice and Michael Balint, in one of the earlier essays exploring the
possible uses of countertransference for analysis, put it in the
following terms: “Every advance in psychoanalysis has to be paid
for by an ever-increasing conscious control over the investigation of
emotional life” (Balint & Balint, 1939, p.230). A question insists,
unanswered, through the paper. Is the price of progress too high?
By the time they were writing, psychoanalysis had become a fully
fledged profession, taught at specialized institutes via a tripartite
system of training analysis, seminars and supervised analytic
practice. These held the monopoly in transmitting Freud’s teaching.
In the Balints’ text and others that followed, such as Bernfeld’s
“On the Psychoanalytic Training System”, there is a clear regret for
the idealism of the beginnings, when psychoanalysis was still a
pioneering activity, largely unregulated and considered a true
vocation, almost a magical calling from the unconscious (Bernfeld,
1962; Casement, 2004).
The Independent group of the British Psychoanalytic Society is
strongly associated with the concept of countertransference as well
as with a seemingly pragmatic, anti-theoretical attitude to psycho-
analysis. The name refers to the group of analysts unaligned with
either Anna Freud’s or Melanie Klein’s theoretical positions,
which emerged as a major force on the British psychoanalytic scene
after the Controversial Discussions ended in an uneasy truce. As
Anna Freud and her followers distanced themselves from the rest
of the British Society, forging links instead with American ego-
psychologists such as Kris and Hartman, Klein and her followers
were in effect left to share an institutional space with a group of

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122 colleagues whose work appeared to be, in the context of the highly
2 charged theoretical stakes of the recent debates, eclectic and concil-
3 iatory. But this was a misleading impression: the group emerged in
4 the late 1940s as a powerful political force in British psychoanalysis,
5 whilst paradoxically deriving their cohesiveness and their strength
6 as a group from elusive clinical concerns. Their very existence as a
7222 group depended on the assumption that it was indeed possible to
8 separate out theoretical and clinical truths, and moreover that
9 psychoanalytic truth was to be found in the latter: this is indeed the
10 way that the story of their formation as a group is usually told.
1 Let us take, for example, the following quotations from two key
2 volumes about the group. The first is from an intellectual history of
3 the Independents and the second from an introduction to an
4 anthology of their writings.
5222
6 Independents come together because they are all committed
7 psychoanalysts in the first place, and then not because they
8 espouse any particular theory within it, but simply because they
9 have an attitude in common. This is to evaluate and respect ideas
20 for their truth value no matter whence they come. [Rayner, 1991,
1 p. 9, emphasis mine]
2 They start from a point of theoretical uncertainty with their
3 patients. But what other people see as their handicap is in fact
4 the Independents’ strength. What they have to offer is primarily
5 but not exclusively a professional stance, a professional attitude.
6 [Kohon, 1986, p. 72, emphasis mine]
7
8 However, the question of the true nature and location of
9 psychoanalytic knowledge constitutes a sticking point. Intent on their
30 task of trying to forge a definite group identity for the Independents,
1 the two authors quoted invoke the elusive “truth” of psychoanalytic
2 conviction. In both cases that conviction is twinned with an ethic of
3 professionalism and a privileging of the clinical interaction. However,
4 the complexity of the issue becomes apparent when it is recalled that
5 it is precisely with a conviction imparted by practice that the
6 identities of patient and analyst become almost indistinguishable. It
7 is precisely this coming together of the identities of the two parties
8 of the clinical encounter, in all the complexity involved, which
922 constituted one of Ferenczi’s key areas of interest.

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Donald Winnicott’s dedication of Playing and Reality, “To my

patients who have paid to teach me”, both honours the clinical
encounter and seems to acknowledge an essential ambiguity in the
power relationship between patient and analyst. Winnicott’s uncon-
ventional clinical genius was widely acknowledged by his colleagues
(Goldman, 1994; Khar, 1996; Rodman, 2003). He held important posts
within the institution of the British Society and became a well-
known public figure through radio broadcasts and writings aimed
at a more general audience (Winnicott, 1949; Riley, 1987). But
commentators on Winnicott’s work seem almost unanimous in
stressing his uniqueness, his quasi-maverick position. “Winnicott was
a therapist’s therapist. He helps free up one’s natural therapeutic
verve that too often is squelched by an all too rigid leaning on
arbitrary rules” (Grolnick, 1990, p. 10). “Winnicott, anyway, made it
impossible for us to copy him: he is exemplary as a psychoanalyst
by being inimitable” (Phillips, 1988, p. 17). Winnicott’s disregard for
theoretical tradition is also often invoked, not least by himself: “I shall
not first give an historical survey and show the development of my
ideas from the theories of others . . . What happens is that I gather
this and that, here and there, settle down to clinical experience, form
my own theories and then, last of all, interest myself in looking to
see where I stole what” (Winnicott, 1945, p. 145).
I argue that an inquiry into the work of the Independent group,
the analysts who foregrounded in their self-conception and in their
writings the image of the analyst-at-work, sheds a new light on the
paradox of psychoanalytic knowledge and its distribution between
patient and analyst, pertaining, as Ferenczi saw it, to the dynamic
of power between them. The problem that many analysts from
the Independent group explored in their writings is multifold.
On the one hand, they had to delimit how the subjective nature of
the knowledge that they found in the consulting room could be
addressed, without threatening the fabric of an increasingly regulated
profession by exposing the extent of that very subjectivity. Blurring
the roles of patient and analyst too much, overly insisting on the
similarity of their claim to psychoanalytic knowledge, as Ferenczi
had done, would pose a threat to their own professional identity.
The solution seemed to lie in an outright change of focus.
In a 1992 interview, Nina Coltart, a prominent member the
Independents, described her clinical writings in the following way:

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 THERAPEUTIC RELATIONS 147

122 I write about what it is like to be an analyst . . . But for me what

2 it means—the only thing that I can say about it is that I feel
3 completely fulfilled by it. [I write] about what it’s like sitting in
4 the room, the technical demands, the things which arise, the
5 questions that go on in your mind . . . I am not primarily interested
6 in giving people an intimate picture of what I am like. I am
7222 interested in giving a vivid picture of how I experience being
8 with patients . . . and things I have learnt from that experience.
9 [Coltart, 1992]
10
1
Ferenczi’s clinical preoccupations: the search for truth
2
and healing
3
4 Sándor Ferenczi’s writings on the analyst’s role provide the
5222 transitional link between Freud’s tentative remarks about counter-
6 transference in his papers on technique and the preoccupations
7 of the British Independents. Within the context of psychoanalytic
8 clinical genealogy, Ferenczi is clearly connected to that group: he was
9 Jones’s and Rickman’s analyst as well as Melanie Klein’s before she
20 moved on to Berlin and a second analysis with Karl Abraham.
1 Several of Ferenczi’s analysands (in particular Michael Balint),
2 members of his distinct Budapest school, emigrated to Britain
3 (Haynal, 1988).
4 Ferenczi and Freud started corresponding in 1908. Freud called
5 their exchange “an intimate community of life, feeling and interest”
6 (Freud/Ferenczi, 2000, p. 446) and indeed, over a thousand letters
7 document not only their close friendship but also their collaboration
8 in elaborating some of the foundational concepts of psychoanalysis.
9 The letters carried ideas in process back and forth between Vienna
30 and Budapest, recording moments of inspiration, the spark of new
1 ideas, hopes, anxieties and shared dreams in both the figurative and
2 the literal sense.
3 Ferenczi’s was an idiosyncratic and fertile imagination that led
4 him to a wide range of clinical and theoretical topics. Like Winnicott,
5 Ferenczi was considered to be an analyst’s analyst. Wladimir Granoff,
6 for example, writes:
7
8 If Freud invented psychoanalysis, it was Ferenczi who embodied
922 it . . . He travelled so fast, or rather, if one wishes, he was so

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quickly traversed by psychoanalysis that by the end of his life in

1933, he had already almost completed the journey that the
majority of analysts have only recently started undertaking.
[1974, p. 172–173]

The territory that Granoff refers to is precisely that of the

therapeutic relationship, its arena, its dynamics, its limitations—
Ferenczi’s central concern since one of his first analytic writings,
“Introjection and Transference” (Ferenczi, 1909).
Whereas Freud, at least in published writings, chose to promote
analytic impassivity, an attitude which implied a kind of stoic
patience on the part of the analyst, Ferenczi’s conception of the
analyst’s role was much more interventionist. This was no doubt
related to his conception of psychoanalysis. On his own admission,
Ferenczi had great hopes in the redemptive possibilities that were
latent in the profession he loved:

For years I have been occupied with psychoanalysis from dawn

until dusk, I am a wage earner of this method, it is my craft
and my daily bread. But hardly a day goes by when I don’t—
sometimes in the midst of work—have to stop to admire the
progress in the understanding of sick and healthy humanity. It is
indeed a beautiful invention. [Freud/Ferenczi, 1993, p. 170]

As Ferenczi suggested in some of his published essays (Ferenczi,

1908, 1927) but put much more clearly in his private writings, his
clinical diary (Ferenczi, 1988) or his correspondence, to be true to the
possibilities opened up by psychoanalysis meant that one was under
absolute obligation to a rigorous ethic of truth, with potentially
marvellous transformative powers for society as well as for the
individual:

Once society has gone beyond the infantile, then hitherto

completely unimagined possibilities for social and political life
are opened up. Just think what it would mean if one could tell
everyone the truth, one’s father, teacher, neighbour, and even
the king. All fabricated, imposed authority would go to the devil—
what is rightful would remain natural. [Freud/Ferenczi, 1993,
p. 130]

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 THERAPEUTIC RELATIONS 149

122 An obligation to go to the absolute limits followed from this

2 ethic: “I was shown that much is no compensation for the whole—
3 and according to my psychoanalytic ideal, there are no halfway
4 standards, all consideration for people and conditions disappears
5 beside my ideal of truth (ibid., p. 220).
6 Accordingly, Ferenczi’s attitude to the practice of psychoanalysis
7222 implied a certain ruthlessness in pursuit of his ideal, extracting what
8 he called “truth” from his friends and his patients alike. From 1918
9 to 1926, he developed a practice that became known as the “active
10 technique” (Stanton, 1991). In certain circumstances, Ferenczi argued,
1 it was necessary for the psychoanalyst to intervene directly in the
2 psychoanalytic process, in order to overcome patients’ resistance and
3 free up their psychic energies in order to achieve maximum benefit
4 from the therapeutic encounter. In a series of papers (Ferenczi,
5222 1919a, 1919b, 1921) he showed through extensive clinical examples
6
how this might work to speed up the process of the cure. In doing
7
so, he was proposing a kind of control on the part of the analyst that
8
went far beyond any precedent, such as the one year limit finally set
9
by Freud on his work with the Wolf Man (Freud [1914] 1918).
20
Ferenczi explained that his interventions were useful to release (or
1
increase) the patients’ tensions to the level which was most suitable
2
for free association, the emergence of the true voice of the
3
unconscious and the ultimate progress of the analysis.
4
5 For example, in the case of an extremely anxious hypochon-
6 driac patient, whom Ferenczi acknowledges as “making a very
7 unfavourable impression” (1919a, p. 118), he resorts to spelling out
8 the unacknowledged feelings of ambivalence he perceived she
9 harboured for her sick child, and then sending her home to tend that
30 child.
1
2 While at home she devoted herself again passionately to the love
3 and care of the sick child, and then said triumphantly at the next
4 interview, “you see it is none of it true! I do love only my eldest
5 girl!” and so on. But even in the same interview she had to admit
6 the contrary with bitter tears; corresponding with her impulsively
7 passionate nature there occurred to her sudden compulsive
8 thoughts in which she strangled or hanged this child, or cursed
922 it. [ibid., p.121]

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This unblocked the analysis, which nevertheless proceeded with

difficulty and was marked by the patient’s strong transference
feelings. In another case, Ferenczi urged a patient whose analysis was
stagnating not to cross her legs as she lay on the couch, as this formed
a sort of embryonic masturbatory activity diverting psychic energy
which should have gone into her free association.

I can describe the effect of this measure as nothing less than

staggering . . . Her fantasies resembled the deliria of fever, in
which there cropped up long forgotten memory fragments that
gradually grouped themselves round certain events in her
childhood and permitted the discovery of most important
traumatic causes for her illness. [1919b, p. 152]

This case as well, Ferenczi noted, was marked by strong transference

feelings on the part of the patient. Aware of the problematic nature
of what was at stake in such therapeutic encounters, Ferenczi took
care to distinguish his “active technique” from suggestion, and from
mere “advice-giving”, an authoritarian pedagogy in the manner
of Jung or Adler (Ferenczi, 1921, p. 200–201). But as yet, Ferenczi
merely took note of what was being played out, describing the
patients’ responses as dispassionately as the technical means that he
used to ensure the progress of the treatment.
In these early, technically innovative papers, Ferenczi at first
approached the issue of active therapy with a mixture of caution and
arrogance. “Employ these technical helps with the greatest care,” he
urged, affirming the possibility of a degree of control on the part
of the analyst that Freud would have been more hesitant about,
“and only after a complete mastery of correct psychoanalysis,” he
continued (1921, p. 202). In Developments in Psychoanalysis, co-
authored with Otto Rank, Ferenczi further elaborated his concern
with technical efficacy, aiming specifically to explore the curative
possibilities of repetition through the activation of transference in
the analytic setting. “The moderate, but when necessary, energetic
activity in the analysis consists in the analyst taking on, and to a
certain extent really carrying out those roles which the unconscious
of the patient and his tendency to flight prescribe” (Ferenczi & Rank,
1925, p. 44).

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122 However, in pursuing these questions, Ferenczi was engaging

2 directly with the issue of power relations within psychoanalysis, soon
3 coming to realize their paradoxical nature, and no longer being able
4 to leave the analyst on the more comfortable terrain of neutrality. In
5 a short 1925 paper he signalled a change of direction in technique
6 (1925), setting aside the more authoritarian forms of the active
7222 technique in favour of relaxation exercises, which fostered an
8 “atmosphere of confidence between physician and patient” (1929,
9 p. 285). Elsewhere, he acknowledged that patient and analyst, a priori
10 subject and object of knowledge, are both in fact subjects of the
1 unconscious, under the sway of transferential feelings. Indeed, he
2 pointed out in “The Elasticity of Psychoanalytic Technique” that “the
3 second fundamental rule in psychoanalysis” (following the rule of
4 free association) is “the rule by which anyone who wishes to under-
5222 take analysis must first be analysed himself” (1928, p. 256). As we
6 have seen, this second fundamental rule had indeed already become
7 a requirement at the new training institutes. But what motivated
8 Ferenczi was not regulating a profession but an ethical and philosoph-
9 ical quest. For Ferenczi, a series of difficult but fundamental questions
20 followed on from his recognizing the centrality of the experience of
1 the analysis for patient and analyst alike, questions which he came
2 to tackle directly in the last few years of his life. When, if ever, is the
3 treatment completed? What distinguishes the identity of the analyst
4 from that of the patient? How can analyst and patient best use the
5 analytic interaction, and more specifically transference? What is the
6 responsibility of the analyst? How is he or she accountable?
7 It is commonplace to oppose Freud’s harsh impassivity towards
8 his patients to Ferenczi’s compassion (Dupont, 1988), and certainly
9 it is possible to give a compelling reading of Ferenczi as a caring
30 analyst, transformed and enlightened by his patients, whom he
1 loved. Whilst Ferenczi was a harsh crusader for the truth, he also
2 fully recognized that the process of striving for it involved him as
3 well. In one of his last and best known papers, the controversial
4 “Confusion of Tongues Between Adults and the Child”, Ferenczi
5 attributed a change in his attitude as a therapist to the influence of
6 his patients.
7
8 I started to listen to my patients when in their attacks they called
922 me insensitive, cold, even hard and cruel, when they reproached

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me with being selfish, heartless, conceited, when they shouted

at me “Help! Quick! Don’t let me perish helplessly!”. . . I began
to test my conscience in order to discover whether, despite all
my conscious good intentions, there might after all be some truth
in these accusations. [1933, p. 294]

Ferenczi concluded that the ideal of the impersonal analytic

situation creates a certain effect (frustration, deprivation in the
patient) which is potentially detrimental, abusive, even murderous
(1988, pp. 51–53). Reflecting on the consequences of his practice and
assuming responsibility for his patients’ discomfort in the treatment,
he wrote:

It is my fault (the analyst’s) that the transference has become so

passionate—as passionate, as a result of my coldness. A much
too literal repetition of the father-daughter dependence: promises
(forepleasure, gratifications, leading to expectations) and then
nothing given. [1920, 1932–33, p. 262]

The ends, that is to say, the alleviation of symptoms, are no longer

sufficient to justify the means.
Ferenczi’s preoccupation with the problems of the analytic
relationship culminated in a remarkable document, his clinical diary
from 1932–33. That text charts a working analyst’s meditations
on the limits and the potential of his profession. One theme which
strongly emerges from the text, as indeed from Ferenczi’s corres-
pondence with Freud, is his desire for a virtual and ongoing
therapeutic encounter with his mentor, a sign both of need and of
rivalry. As Judith Dupont puts it, “he endeavours to invent for
his patients what he wanted Freud to invent for him” (Dupont, 1988,
p. xxi). Ferenczi explored ways in which analytic practice could be
stretched, in new directions, to its limits, towards therapeutic success.
It is an endeavour of a piece with his earlier active technique, a
continued affirmation of his idealism about psychoanalysis.
In his diary, Ferenczi took up with considerable emotion the issue
of the guilt of the practitioner, condemned always to fall short of the
magnitude of the ethical and reparative challenge of psychoanalysis.
He saw himself a priori limited by the constraints of the hierarchical
roles imposed on analyst and patient, whilst they might well both

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122 feel like “two equally terrified children” (1988, p. 56). The fascination
2 of this document lies in the unwavering trust in psychoanalysis it
3 reveals, as well as in the clear answer it gives to the question of the
4 identity of the analyst: this identity lies strikingly close to the identity
5 of the patient. Indeed, for Ferenczi, “the best analyst is a patient who
6 has been cured” (1988, p. 115). Alongside more general remarks on
7222 the nature of analytic practice, Ferenczi wove together the narrative
8 of his analytic relationship with four patients—four women, three
9 of whom have been identified: Izette de Forest, Clara Thompson
10 and Elisabeth Severn. The first two, particularly Clara Thompson,
1 subsequently gained prominence as analysts in America (Shapiro,
2 1993, pp. 159–174).
3 But it is the latter, Elisabeth Severn, in the grip of a severe
4 regression for large portions of her treatment with Ferenczi, who
5222 came to occupy more and more of his time and played the central
6
role in the Clinical Diary. She is credited with initiating Ferenczi’s
7
experimentation with “mutual analysis” (Fortune, 1993, pp. 101–120),
8
which he describes in the volume. Ferenczi wrote: “It should be noted
9
in my favour that I accompany my patients to these depths and with
20
the aid of my own complexes can, so to speak, cry with them” (1988,
1
p. 61). As Severn’s analysis became more and more demanding,
2
Ferenczi spent several hours per day with her, relinquishing other
3
patients. But more astonishingly, Ferenczi recorded in the diary how
4
5 he and the patient R.N. (as Severn was known) would take turns on
6 the couch, after she had repeatedly solicited the right to analyse him.
7 She struggled with memories of childhood sexual abuse, whilst he
8 grappled with his feelings of misogyny. The attempt certainly held
9 elements of a utopian move towards realigning analytic power
30 relations, forcing Ferenczi to confront his fears, his awareness of the
1 fragility of his sanity and his sense of control. His fears, in short, of
2 placing himself in the patient’s power. “Why then,” he asks, “should
3 he, the patient place himself blindly in the power of the doctor?”
4 (1988, p. 92) Self-disclosure on one side was met by self-disclosure
5 on the other until Ferenczi, physically and mentally exhausted, but
6 despite his utopian quest still ultimately the one in charge, first
7 reverted to conventional treatment and finally terminated the
8 analysis. Ferenczi died a few months later of pernicious anaemia,
922 whilst Elisabeth Severn recovered sufficiently to write articles and

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154 JULIA BOROSSA

books and practise a form of psychoanalytic psychotherapy, albeit

always outside formal analytic circles.
When Ferenczi’s clinical diary was first published in full, it caused
a fascinated stir in analytic circles, highlighting issues implicit
elsewhere in his work, such as the elasticity of psychoanalytic
technique, the harshness of the power relations involved, the need
for the analyst to pursue the treatment no matter where it led. The
diary shows in writing, and from the analyst’s point of view, how
Ferenczi grappled with the fundamental issues of identity that every
working analyst must confront in the seclusion of his or her
consulting room (“What authorizes me to do what I do?”) and,
crucially, the fundamental principle of the Hippocratic oath (“Am I
really doing no harm?”) even as the profession necessarily diverged
from medicine. Challenged by his patients, Ferenczi finally began to
wonder “whether it would not be natural, and also to the purpose
to be openly a human being with feelings, empathic at times and
frankly exasperated at other times? This would mean abandoning
all ‘technique’ and showing one’s true colours just as is demanded
of the patient” (1988, p. 94).
The diary’s importance lies in the fact that it allows for a story
that could only be tangentially told in official clinical writing.
Ferenczi’s Clinical Diary is literally a text which is self-disclosing. By
contrast, the analysts of the British School, to whose work we will
now return, problematize self-disclosure in their clinical writings. The
Independent Group’s focus on the pragmatic clinical nature of
psychoanalytic knowledge had been facilitated by their particular
institutional position, and they have been associated with the concept
of countertransference. Relating Ferenczi’s changing writings on
technique to their work shows how a more flexible approach to
identities within the therapeutic encounter became increasingly
possible, albeit always within certain institutional limits.

Winnicott and Little: new possibilities in the therapeutic

encounter
Ferenczi’s evocative diary comes from an institutional space which
is completely distinct from that of published clinical writings dealing
with the analyst’s self-disclosure. Psychoanalysts only gradually
(and cautiously) came to write about what was always part of the

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122 scene but deemed to be extraneous to the narrative of the cure.

2 Implicit in Freud’s reservations about countertransference, its usage
3 and its expression was the warning against disclosing too much of
4 the therapeutic relationship. But Ferenczi’s critical perspective on
5 the analyst’s power in the session and willingness to openly use his
6 own emotions for the good of the treatment constituted an alternative
7222 that finally found full expression in a series of key papers by
8 independent psychoanalysts, appearing in the International Journal
9 of Psychoanalysis in the late forties. As previously discussed, analysts
10 belonging to that group openly derived their identity from clinical
1 practice rather than theoretical allegiance. They showed that it was
2 not only legitimate but clinically useful to describe external reality,
3 the material surroundings of the consulting room, what it felt like
4 for them to be an analyst.
5222 Winnicott’s “Hate in the Countertransference” (1947) was the first
6
in an influential series of essays. Its central argument pertains to the
7
necessity of distinguishing between objective countertransference
8
reactions and feelings which are idiosyncratic to a particular analyst,
9
caused by her or his unconscious history. Allowance is made for a
20
reality which is undeniable, testable. Perhaps the most interesting
1
thing about the essay is Winnicott’s choice of “hate” to illustrate his
2
point. He writes that a patient might be objectively hateful, and
3
furthermore that s/he might need to be objectively hated to feel that
4
5 s/he can be objectively loved. He also reminds us of the ways in
6 which analysis does allow for a concrete outlet for the therapist’s
7 hate. For example, this constitutes for Winnicott one important
8 meaning of the fee and of the existence of a set end for the hour. In
9 the main clinical vignette of the paper, concerning a boy he took into
30 his home in an informal fostering situation during the Second World
1 War, he discusses his point of view, namely the feelings of hate
2 engendered in him by the “evolution of the boy’s personality” and
3 the steps he took to “manage” and “interpret” the situation:
4
5 At crises I would take him by bodily strength, without anger or
6 blame, and put him outside the front door . . . The important thing
7 is that each time, just as I put him outside the door, I told him
8 something; I said that what had happened had made me hate
922 him. This was easy because it was so true. [1947, p. 200]

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Paula Heimann’s groundbreaking paper “On Countertransfer-

ence” (1950) followed, and is often hailed as something of a land-
mark. At the time she wrote it, her allegiance was still with Melanie
Klein, but she is usually credited with phrasing the question most
clearly and programmatically (Bollas, 1987, p. 1). Heimann states
that “the analyst’s countertransference is an instrument of research
into the patient’s unconscious” (1950, pp. 81–84). She notes that the
revealing of the analyst’s emotions seemed to arouse great fear and
resistance in the analytic community, and that consequently the
whole issue had been downplayed. In one manner or another,
Ferenczi had repeatedly reflected on the importance of honesty
within the analysis. This view had been at the core of Winnicott’s
aforementioned paper, of which Heimann was well aware. Without
engaging with the reasons the analytic community might have felt
threatened by such moves, she concludes that it is important for the
analyst to keep her countertransference under strict control, but in
order to use it actively in the therapeutic interaction.
The following year, Margaret Little entered the debate with her
paper “Countertransference and the Patient’s Response to It” (1951),
expressing ideas that were strongly resonant with Ferenczi’s latter
views on analytic treatment. Little agrees with Heimann’s central
thesis that countertransference feelings are present in any analysis.
She argues that their recognition is useful, indeed essential, but that
a proper understanding and use of the implications of countertrans-
ference has been hindered by the analyst’s own resistance and fear,
and by the analytic community’s anxieties surrounding direct
personal involvement. She even goes as far as calling her peers’
outlook a “phobic attitude towards the analyst’s own feelings” (1951,
p. 38). Additionally, Little explicitly advises that the analyst should
overcome her reluctance to the extent of admitting countertrans-
ference feelings not only to herself but, under therapeutically
appropriate circumstances, to the patient as well. She goes on to make
a strongly-worded plea for the acceptance of mutuality in the analytic
relationship. The analyst would stand to learn a lot from this, she
points out, since the patient has knowledge to impart, not only about
his or her own unconscious, but about that of the analyst: “. . .
transference and countertransference are not only syntheses by the
patient and analyst acting separately, but, like the analytic work as
a whole, are the result of a joint effort. We often hear of the mirror

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122 which the analyst holds up to the patient, but the patient holds one
2 up to the analyst too” (ibid., p. 37).
3 This represents a change in theoretical perspective vis-à-vis
4 countertransference. But what were the stakes involved for the
5 profession, the reasons for the phobic resistance of Little’s colleagues,
6 and under what conditions, if any, might the full autobiographical
7222 implications of the concept be expressed? To address that question,
8 we need to examine Little’s paper from a slightly different angle. It
9 is introduced by a clinical vignette. “I will begin with a story,” she
10 writes. The story she tells is about a patient who is encouraged by
1 his (male) analyst to make a radio broadcast, in a field which holds
2 some interest for the analyst, on the wake of his mother’s death. Later,
3 during the session following the broadcast, the analyst interprets the
4 patient’s subsequent depression and anxiety as fear of the analyst’s
5222 jealousy. The patient accepts this interpretation, but realizes years
6 later that he had not been allowed to mourn, and the interpretation
7 had been “the correct one at the time for the analyst, who had actually
8 been jealous of him, and that it was the analyst’s unconscious
9 guilt that had led to the giving of an inappropriate interpretation”
20 (ibid., p. 32).
1 There is an interesting discrepancy between this narrative and the
2 one reprinted in Little’s collected papers (1981, amended 1986). The
3 second version’s opening line reads: “I will begin with a true story,
4 from my own experience” (1986, p. 33). Little then proceeds to reveal
5 the autobiographical basis to the story: in fact, she was the patient.
6 The death of her father occurred shortly after she was due to present
7 her membership paper to the British Psychoanalytical Society.
8 Her analyst, Ella Sharpe, encouraged her to go ahead with her
9 presentation anyway, with the aforementioned results. One of the
30 striking aspects of this second version is the possibility of mutual
1 analysis that it hints at, albeit one that became possible only in
2 retrospect. At the time of the interpretation, still in analysis and only
3 just fully qualified, Little complied. It was only much later, a couple
4 of years into her life as a fully fledged analyst, indeed after Ella
5 Sharpe’s death, that she offered her own interpretation of the events,
6 involving her understanding of her analyst’s transference.
7 Little’s use of countertransference in her later paper “R—the
8 analyst’s total response to his patient’s needs” (1957) is more
922 straightforward, and is illustrative of what is to this day a classic

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way of working a countertransferential moment into the narrative

of a patient’s treatment. In that paper’s clinical section, Little speaks
as an analyst of the analyst’s point of view. For instance, she describes
how she dealt with her patient Frieda, who was endangering her life
with her excessively violent reaction of grief for a dead friend, and
whom she could not reach by the conventional analytic reliance on
transference interpretations:

At last I told her how painful her distress was, not only to herself
and to her family, but to me. I said that no one could be near
her in that state without being deeply affected. I felt sorrow with
her, and for her, in her loss. The effect was instantaneous and
very great. Within the hour she became calmer, lay down on the
couch, and cried ordinarily sadly. [1957]

Disguising one’s own experiences as analysand, with a distancing

turn of phrase such as Little’s “a patient” in the 1950 paper, is
probably a common practice among analysts. However, Little’s con-
fession is highly unusual. She followed it up with the publication
of an autobiographical article, “Winnicott working in an area
where psychotic anxieties dominate: a personal account” (1985), and
its sequel “On the value of regression to dependence” (1987), which
detailed her personal history as analysand, particularly as the
analysand of Winnicott. Little openly describes herself as a patient,
moreover, a highly disturbed patient, cared for by Winnicott.
One of the reasons she gives for undertaking this writing is to
provide a record of Winnicott’s practice, especially his work with
adults. “I can best show his work by giving an account of my own
analysis with him—clinical material that has always been recognized
as essential for the development and understanding of theory and
metapsychology, which I am perhaps in the unique position of
being able to supply” (1990, p.19). In other words, Little-as-patient
is taking it upon herself to write the case history that she thinks
Winnicott should have written but never did. It is a similar move to
the one which allowed her to analyse her analyst (albeit covertly) in
the early paper on countertransference.
The implications of Little’s role as Winnicott’s ghost-writer were
serious ones. In a double displacement, Little-the-patient was making
an appearance in the narrative of Little-the-analyst, and moreover,

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122 Little-the-patient was writing for, in the place of her analyst. This
2 unusual case history shows Little playing fast and loose with the roles
3 and voices assigned to patient and analyst by the narrative conven-
4 tions which regulate how the analytic relationship may be portrayed
5 and safeguard the authority and authoritativeness of the analyst
6 as a trained professional working within certain institutional
7222 parameters.
8 In his Clinical Diary, Ferenczi had expressed his theoretical belief
9 in the mutuality of the roles of patient and analyst, and illustrated
10 this belief by writing himself into the position of patient. Ferenczi’s
1 “private” text was made public fifty years after it was written. His
2 work generally has been praised by some as facilitating change in
3 the psychoanalytic institution, but this change was based on a kind
4 of self-recognition, a mark of the institution already having evolved.
5222 “The pieces of a puzzle click together, and a new historical narrative
6 begins to emerge” (Aron & Harris, 1993, p.2). But the diary itself is
7 another matter, and generally considered a research tool, an evocative
8 archival document rather than a viable model for clinical practice or
9 therapeutic attitude. By publishing such an autobiographical piece,
20 Margaret Little was doing something clearly subversive. The
1 narrative of the analytic interaction that she was offering would not
2 appear as an acceptable one, and Little’s autobiographical writings
3 caused a particular consternation in the psychoanalytic community
4 at the very time when Ferenczi’s Clinical Diary was starting to
5 circulate in the English-speaking analytic community. Little’s account
6 of her analysis with Winnicott was turned down by the editors of
7 the International Journal of Psychoanalysis and appeared in Free
8 Associations (Young, 1990). Others thought that it constituted a
9 breach of decorum at best, exhibitionism at worst. One Independent
30 analyst recounts an interesting slip of the typewriter that one of his
1 colleagues made whilst drafting a review of Little’s papers. He had
2 meant to write “Why did she have to go so public?” Instead, it came
3 out as “Why did she have to go so pubic?” (Casement, 1992) There
4 clearly is a complex set of rules in play which make certain texts,
5 certain authorial positions, indeed certain technical positions
6 acceptable and others not. Consider the following condemnation
7 from one of her colleagues: “Margaret Little has always written in a
8 self-revealing way, and I think the paper about her analysis with
922 Winnicott quite frankly was embarrassing. I think it just reeks of what

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didn’t get done . . . It didn’t do anybody a service. I think the

pathology sticks out all over” (Coltart, 1992).
Little’s later writings provoked an undeniable anxiety, reminiscent
of the “phobic reaction” to countertransference that she herself had
referred to in her early paper. The identity of the patient had to be
clearly delimited from that of the analyst, and their mutual roles
regulated. But what is it that is being defended against? The slip of
the pen of Little’s other colleague implies that it might well be
something of an illicit erotic nature which threatens the institution
of psychoanalysis (Borossa, 1997). Winnicott’s own views of the
analyst-at-work incorporate considerably more elusiveness than
either Ferenczi’s or Little’s. As Adam Phillips points out, Winnicott
uses the figure of the artist to illustrate an optimum way of relating
to the world and the Other which may serve as guidance to the
therapeutic relationship as well (1988, p. 151). Winnicott writes: “In
the artist of all kinds one can detect an inherent dilemma, which
belongs to the co-existence of two trends, the urgent need to
communicate and the still more urgent need not to be found. This
might account for the fact that we cannot conceive of the artist’s
coming to an end of the task that occupies his whole nature” (1963,
p. 185).

Conclusion
Countertransference theory, although tentatively developed at first,
began changing the practice of psychoanalysis. The authority of the
analyst was challenged by the gradual acceptance of his or her own
less-than-reliable and imperfectly known and controlled unconscious
as a key factor in the therapy. Analysts were calling for a different
type of relationship with the patient, a seemingly less authoritarian
as well as a less mystifying one. In the theoretical writings which set
the groundwork, from Ferenczi to Little’s early texts and beyond,
the following thematic concerns were also highlighted. External
reality (things, circumstances) could not be bracketed off and had to
be taken into account. The patient’s free associations, her words and
her symptoms, previously thought to be just as coherent as words,
were not the only material at the analyst’s disposal. This meant that
interpretation as understood until then was no longer sufficient. Any
account of the therapeutic encounter could not merely concentrate

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122 on the patient. It also included both the mention of significant

2 incidental elements and the reactions of the analyst in a much more
3 direct way. This last point, the analyst’s stronger presence in the
4 patient’s story, was especially challenging, for it implied a radical
5 instability in the identity of both patient and analyst.
6 Ferenczi’s work shows us that the problem of the power
7222 differential within the psychoanalytic interaction, an unquantifiable
8 element in the remit of psychoanalysis, is a key issue vital to a
9 contemporary engagement with psychoanalysis. His ethics of truth
10 and justice are especially resonant at a historical juncture when
1 psychoanalysis is repeatedly asked to account for itself in the face
2 of increasing government regulation. In this context, the questions
3 which resonate throughout Ferenczi’s writings take on particular
4 urgency. The importance of Ferenczi’s vision for the profession of
5222 psychoanalysis as it enters its second century lies therefore in offering
6 that profession a series of challenges, of dilemmas it must meet. At
7 its inception, psychoanalysis, the science of the unconscious, the art
8 of free association and of a very particular human interaction, held
9 an unprecedented revolutionary and creative appeal. These aspects
20 need safeguarding more than ever.
1 Curiously, the concluding paragraph of The Development of
2 Psychoanalysis makes physician and medicine interchangeable with
3 psychoanalyst and psychoanalysis. Nevertheless it can aptly serve
4 as the final words of this paper as well. “Under the influence of this
5 increase in consciousness the physician, who has developed from the
6 medicine man, sorcerer, charlatan and magic healer, and who at his
7 best often remains somewhat an artist, will develop increasing
8 knowledge of mental mechanisms, and in this sense prove the saying
9 that medicine is the oldest art and the youngest science” (Ferenczi
30 & Rank, 1925, p. 64).
1
2
3 References
4 Aron, L. & Harris, A. (1993). The Legacy of Sándor Ferenczi. Hillsdale, NJ: The
5 Analytic Press.
6 Balint, A. & Balint, M. (1939). On Transference and Countertransference.
7 International Journal of Psychoanalysis 20: 223–230.
8 Balint, M. (1934). Sándor Ferenczi, le médecin. Le Coq-Héron, 98 (1986):
922 66–70.

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Bernfeld, S. (1962). On Psychoanalytic Training. Psychoanalytic Quarterly, 31:

453–482.
Bollas, C. (1987). Shadow of the Object: Analysis of the Unthought Known.
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Borossa, J. (1997). The Migration of Psychoanalysis and the Psychoanalyst
as Migrant. The Oxford Literary Review, 19: 79–104.
Casement, P. (1992). Unpublished interview.
Casement, A. (Ed.) (2004). Who Owns Psychoanalysis? London, Karnac.
Coltart, N. (1992). Unpublished interview.
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122 Freud, S. (1912a). Recommendations to Physicians Seeking to Practice

2 Psychoanalysis. S.E., 12. London: Hogarth.
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4 Freud, S. & Ferenczi, S. (1993). The Correspondence of Sigmund Freud and Sándor
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8 Ferenczi: 1920–1933, Vol. 3. E. Falzeder, E. Brabant & P. Giampieri-Deutsch
9 (Eds.), P.T. Hoffer (Trans.). Cambridge, MA: Harvard University Press.
10 Freud, S. and C. Jung (1974). TheFreud/Jung Letters. W. McGuire (Ed.).
1 London: Routledge.
2 Goldman, D. (1993). In One’s Bones: The Clinical Genius of Winnicott.
Northvale, NJ: Aronson.
3
Granoff, W. (1974). Filiations. Paris: Seuil.
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Grolnick, S. (1990). The Work and Play of Winnicott. London: Aronson.
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Haynal, A. (1988). The Technique at Issue: Controversies in Analysis from Freud
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and Ferenczi to Michael Balint. London: Karnac.
7
Heimann, P. (1950). On Countertransference. International Journal of Psycho-
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analysis, 31: 81–84.
9
Khar, B. (1996). D.W. Winnicott: a Biographical Portrait. London: Karnac.
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Kohon, G. (Ed.) (1986). The British School of Psychoanalysis: The Independent
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Tradition, London: Free Associations.
2
Little, M. (1951). Countertransference and the patient’s response to it.
3 International Journal of Psychoanalysis, 32: 32–40.
4 Little, M. (1957). “R”—the analyst’s total response to his patient’s needs. In:
5 Transference Neurosis and Transference Psychosis: Towards Basic Unity.
6 London: Tavistock, 1986.
7 Little, M. (1985). Winnicott working in areas where psychotic anxieties
8 dominate: a personal record. Free Associations, 3: 9–42.
9 Little, M. (1986). Transference Neurosis and Transference Psychosis: Towards Basic
30 Unity. London: Tavistock.
1 Little, M. (1987). On the Value of Regression to Dependence. Free Associations,
2 10: 7–22.
3 Little, M. (1990). Psychotic anxieties and containment: a personal record of an
4 analysis with Winnicott. Northvale, NJ: Aronson.
5 Phillips, A. (1988). Winnicott, London: Fontana.
6 Rayner, E. (1991). The Independent Mind in British Psychoanalysis. London: Free
7 Associations.
8 Riley, D. (1983). War in the Nursery: Theories of the Child and Mother. London:
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Rodman, F.R. (2003). Winnicott: Life and Work. Cambridge, MA: Perseus
Publishing.
Shapiro, S. (1993). Clara Thompson: Ferenczi’s Messenger with Half a
Message. In: L. Aron & A. Harris, The Legacy of Sándor Ferenczi, Hillsdale,
NJ: The Analytic Press, 1993.
Stanton, M. (1991). Sándor Ferenczi: Reconsidering Active Intervention.
Northvale, NJ: Aronson.
Winnicott, D.W. (1945). Primitive emotional development. In: Through
Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
Winnicott, D.W. (1947). Hate in the countertransference. In: Through
Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
Winnicott, D.W. (1949). Birth memories, Birth Trauma, and Anxiety. In:
Through Paediatrics to Psycho-Analysis. London: Hogarth, 1958.
Winnicott, D.W. (1963). On Communicating and Not Communicating
Leading to a Study of Certain Opposites. In: The Maturational Process and
the Facilitating Environment London: Hogarth, 1965. [Karnac, 1990]
Young, R. M. (1990.) The Analytic Space: Countertransference and Evocative
Knowledge. www.findingstone.com/professionals/monographs/the
analyticspace.htm.

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122 CHAPTER ELEVEN
2
3
4
5
6
7222 The suppressed madness of
8
9
sane analysts
10
1 Ken Wright
2
3
4

I
5222 n 1961, the British psychoanalyst Martin James wrote to Winnicott
6 of “the mixture of fright and misunderstanding [surrounding]
7 your work in some circles. Those with literal or obsessional
8 minded approaches cannot comprehend your allusive and illustra-
9 tive skills, which I find so attractive. I do think that your approach
20 is typically British and totally beyond the comprehension of the
1 Teutonic Hartmann style of theorist” (Rodman, 2003, p. 285).
2 His comments remind us that Winnicott’s ideas were often
3 difficult for his colleagues to understand. Not only were they
4 novel and against the trend, but they were expressed in poetic and
5 unfamiliar language. Winnicott preferred, as he put it, the “flash of
6 insight” to the “painful task of spelling things out” (Rodman, 2003),
7 and if his fellow analysts struggled with these idiosyncratic ways, it
8 seems hardly surprising. However, James’s use of the word “fright”
9 is remarkably strong and raises the possibility that more was at stake
30 than frustration and misunderstanding. It suggests that Winnicott
1 was not just strange and difficult to grasp but also disturbing to his
2 analytic audiences. Reflecting on this, I began to wonder if his
3 disregard of their ways of thinking might have disturbed their sense
4 of security and touched on a latent fear of madness. This idea
5 reopened some earlier thoughts about the relation of an analyst to
6 his theories, and how those theories might help to maintain the
7 analyst’s feeling of sanity.
8 Theories can be used in different ways: while on the one hand
922 they organize ideas about reality, they can also function as a refuge

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from reality. The first use is explicit and object-related; the second is
covert and could be called narcissistic (Wright, 1991). By “object-
related” I refer to the use of theory to know and understand the
object; by “narcissistic” I refer to an unconscious holding function
of theory that may at times underpin the integrity of the self. These
different functions do not necessarily preclude each other, for just
as Bion (1961) envisaged the operation of hidden assumptions within
the work group, so there could be covert narcissistic uses of theory
within a more object-related deployment.
In thinking of how theories function, it has to be remembered they
are symbolic structures, and the way symbols are used will reflect
the psychological needs of the user (Segal, 1986; Wright, 1991).
Normally we think of symbols in their mature, object-related form,
in other words as separated from their objects and thus usable as
tools for exploring reality. Functioning in an object-related way,
theory is a structure of this kind. By contrast, a narcissistically
functioning theory is more primitive—it holds or contains experience
rather than signifying it, and is more concerned with the economy of
the self than with exploration of the object. An early example of such
a primitive structure is Winnicott’s transitional object which supports
the infant’s sense of going on being during the mother’s absence by
containing, or holding on to, a needed experience of the mother
(Winnicott, 1951).
When I refer to a narcissistic use of theory, it is this holding,
containing function that I have in mind. Theory in this mode holds
and contains the analyst’s self, just as the transitional object holds and
contains the infant experience. In this situation, a threat to the
analyst’s theory is a threat to the analyst’s self. When the analyst
defends his theory, he is at this moment protecting the integrity of
his self rather than the scientific content of his theory. In such a case,
we could say that the theory is functioning as a transitional structure—
as a complex symbol that supports the “going on being” (Winnicott,
1962) of the analyst.
This idea has far-reaching implications. Insofar as the analyst’s
theory functions as a holding structure, its use as a tool for exploring
reality is compromised. New observations or new ideas will now
open the door to “unthinkable anxiety”, and “reality” becomes a
threat. It loses its quality of being that separate and interesting object
which the theory was designed to explore, and becomes instead an

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122 unwelcome, discrepant fact. Indeed, insofar as it differs from the

2 theory and cannot be assimilated to it, it becomes a persecutory object
3 that threatens the analyst’s equilibrium.
4 The concept of unthinkable anxiety was introduced by Winnicott
5 in the context of very early infant functioning that constituted a stage
6 of un-integration: “The baby,” he wrote, “is an immature being who
7222 is all the time on the brink of unthinkable anxiety; [but this] unthinkable
8 anxiety is kept away by [the] vitally important function of the mother
9 . . ., her capacity to put herself in the baby’s place and to know what
10 the baby needs” (1962, p.57). This is the mother’s holding function,
1 and I am proposing that psychoanalytic theories may take on a
2 similar aspect for the analyst insofar as he unconsciously needs his
3 theories to hold him.
4 “Holding”, “going on being”, “unthinkable anxiety” and “the un-
5222 integrated state” are all part of Winnicott’s theory of early infant
6 functioning. They belong to a time before the “I” is established, before
7 there is a cohesive ego; in other words, to a time when ego-experience
8 consists of unlinked moments of ego-experience. I think of these
9 unlinked moments as being like islands of meaning that have yet to
20 form a coherent structure. And it follows that between these islands
1 there would be gaps in meaning where a clear sense of orientation
2 would be lacking. We can thus imagine that the infant is in danger
3 of falling through such gaps into unstructured space. “Unthinkable
4 anxiety” is the apprehension of such a catastrophe, of finding oneself
5 in a terrifying place in which nothing can be understood.
6 Quoting Winnicott again: “[If the mother’s] ego-supportive
7 function [can be] taken for granted, the infant does not [feel] a need
8 to integrate” (Winnicott, 1962, p.61)—or we could say “to make sense
9 of things”. The need to integrate—in my terms, “to make sense of
30 things”—is precipitated by a felt break in maternal holding (for
1 example, Winnicott’s x + y + z, where z is the extra time that pushes
2 the baby beyond its level of tolerance [1967a]). The resultant break
3 in the sense of “going on being” provokes emergency reactions: a
4 frantic pulling together of all the bits (premature integration,
5 premature sense-making) and a foreclosing of all spontaneous,
6 natural forms of integration.
7 I will now ask you to shift focus from this detailed examination
8 of Winnicott’s ideas to the analyst sitting in his consulting room.
922 Imagine him as linked on the one hand to the unfolding clinical

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material and on the other hand to his own inner structure of theories.
Into this context we can now put Bion’s advice to the analyst at work
that he put aside memory and desire (1970). The juxtaposition is
interesting, for it now seems clear that Bion is asking the analyst to
tolerate the un-integrated state. He is asking him to relinquish his
hold on theory and remain in a place where meaning is fragmentary
and incomplete. “Don’t close the gap,” he says; don’t make a forced
integration—a panicky organization of the material in terms of
theory or of yesterday’s hypothesis—because that is the window
through which the new can be glimpsed, the “new” being part of
that separate reality that the analyst wants to understand. Bion does
not say, however, what Winnicott possibly implies, that this window
onto reality is also the entry point for unthinkable anxiety: the place,
if you like, through which the “suppressed madness of sane analysts”
may appear.
How the analyst works in this un-integrated area between theory
and reality—whether he remains open or jumps for the closure of
theory—depends on the strength of his own holding structures. If
he is able to take maternal holding for granted, he can step out from
the shelter of his theories. If, on the other hand, his theories have
become a substitute for maternal holding—a kind of false container—
they will be his only refuge from terror and the unstructured void.
Clinically, the consequences are important: the analyst who can take
holding for granted and wait for meaning to emerge will work very
differently from the one who must pull the meanings together in
order to remain intact.
In summary, then, insofar as an analyst’s theory becomes a
substitute for maternal holding, the space of uncertainty between
theory and clinical reality becomes a danger zone. Not knowing
becomes hard to tolerate, and the analyst then falls into premature
knowing in order to escape not knowing. To be adrift in uncertainty
is to feel un-held, so the analyst now hugs his theory close and draws
the whole of reality into its web.
For this analyst, or an analyst in this state, the bulwark against
such feelings is the coherence of his theories and the comprehensive-
ness of his interpretations. If in doubt, he interprets, for this will
contain the patient’s anxiety—or so he thinks, not considering that
his own anxiety may be the problem. From a different perspective,
though, such comprehensive interpretation is not in the patient’s

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 THE SUPPRESSED MADNESS OF SANE ANALYSTS 169

122 interest and takes from him the opportunity to form his own ideas.
2 Pushed into shape by the analyst’s interpretative zeal, he is denied
3 the chance of making integrations of his own, and thus re-experiences
4 an earlier trauma of deficient holding and forced, or premature
5 integration (a kind of false self situation).
6 This overall scenario reminds me of one of my training patients,
7222 and I’m going to give you a very short clinical vignette. The patient
8 was a young man who had suffered significant breaks in the fabric
9 of early holding. He was exceptionally bright and verbal, highly
10 successful in his working life, and I now realize he had dealt with
1 breaks in holding by precisely the kind of premature integration we
2 are discussing. He was a keen amateur musician, and I remember
3 him telling me he was a lover of the legato line. When I asked him
4 what this was, he described how it was a line of music played in a
5222 seamless manner, without any breaks at all. There must not even be
6 a break for breathing, he said; you had to control your breathing in
7 such a way that the music continued to flow.
8 This man’s reaction to analysis—and to my attempts at being an
9 analyst—was stormy in the extreme. I was too anxious to be able to
20 provide him with the holding legato line he so desperately sought.
1 So what did I do? I gave him interpretations, interpretations and
2 more interpretations.
3 I would certainly now do differently. But if I had to defend my
4 actions from those far-off days, I would say that he was a difficult
5 case by any standards and I was a frightened and inexperienced
6 trainee. I felt thrown by the patient’s hostility, and any intuitive
7 capacity for holding that I had would quickly dissipate under
8 fire. Moreover, I was brought up in an analytic atmosphere which
9 overvalued interpretation, so this paper is also about unlearning
30 those early lessons and learning to refrain from interpretation.
1 To give you the flavour of that time, the early 1970s: at the
2 Tavistock Clinic where I did my psychotherapy training, a relatively
3 unknown analyst, Henry Ezriel, told his students that all of their
4 communications to the patient should take the form of an interpre-
5 tation. And they should say nothing at all to the patient until they
6 were clear about each of the three parts that constituted an inter-
7 pretation: the required, the avoided and the catastrophic elements of the
8 patient’s experience. These had to be unravelled from the material
922 in every instance and only then could an interpretation be made.

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170 KEN WRIGHT

Ezriel, as you can imagine, was an extreme case of the interpreting

analyst, though undoubtedly part of a climate in which the analyst
was seen as an interpreter, and expected to retain a certain aloofness
from his patients. When I observed groups through a one way
screen, for example, I often felt the interpretations came from a lofty
height, as though the analyst was in a place apart, from which he
pronounced his truths. And of course I tried to emulate this: in spite
of feeling uncomfortable with it, I too became an interpreting analyst.
Almost certainly I resorted to this tactic with the patient I am
describing, and almost certainly it accounted for some of his rage
and hostility towards me, because he often accused me of not being
a proper human being (in which I now think he was partly right).
Of course the more he raged, the more frightened I became and the
less chance I had of holding him in any better kind of way. In all
probability, I made further interpretations, having also discovered
that formal interpretation offered a good place for the analyst to hide
when he was under fire.
Given all this, you won’t be surprised at how happy I felt when
I first got to grips with Winnicott, and my relief and pleasure when
I read of his writing down interpretations instead of giving them to
the patient. What a relief from the tyranny of interpretation! But the
idea left a gap: if the analyst was not going to interpret, what was
he going to do instead?
Much of Winnicott’s later work can be seen as a working out of
this area. But I think for Winnicott it wasn’t so much a matter
of technique—the notion of technique would have run counter to his
spontaneity. Rather, it was about trying to understand what the
patient needed, and finding appropriate ways of responding (like a
mother, perhaps) to this need. What emerged from his later work
was of course the importance of holding, mirroring and playing. The
need of many (perhaps most) patients was in the pre-verbal area,
and addressing this through interpretation was perhaps like
discussing with an infant the reasons for their crying.
Fifty years on we are in a post-Winnicott and also post-Bion place,
and playing, holding and containing have almost become our new
clichés. Nevertheless, the issues Winnicott raised are still around
and we still argue about interpretation. Whether we interpret; when,
what, and how we interpret are still on the agenda, as are our
expectations of what interpretation can achieve. There are those who

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 THE SUPPRESSED MADNESS OF SANE ANALYSTS 171

122 believe that interpretation itself is the best way of holding and
2 containing, and others who believe it is traumatic and distancing.
3 But Winnicott’s ideas also stay with us—in this context, the idea that
4 the analyst often interprets to satisfy his own need rather than the
5 patient’s (you could call this a narcissistic rather than an object-
6 related use of interpretation). This was certainly what happened with
7222 my training patient: I interpreted in order to hold myself together
8 in the face of overwhelming anxiety. I clung to theory and
9 interpretation, and hugged them close. I had to protect myself from
10 the dangerous reality of my patient and keep him at a distance. And
1 I had to stop myself falling apart. Not surprisingly, I was little use
2 to my patient at these times.
3 Thirty years on I ask myself what I would do now. Would I give
4 my patient a less bumpy ride? And what might I do differently?
5222 From a theoretical perspective, I am sure that I would now try to
6 hold and contain rather than interpret. But what does this actually
7 mean? When I referred earlier to these terms as our new clichés, I
8 was suggesting that we all assume we know what these terms mean
9 but actually fail to examine their practical implications in a nitty-
20 gritty sort of way. In other words, we fall short of spelling out what
1 holding and containing actually mean in a practical, operational
2 sense. This, I believe, is partly to do with the nature of the process.
3 While interpretation is essentially a product of standing back and
4 reflecting, and thus to some extent we can observe what we do and
5 recall what we thought and said, holding and containing involve
6 more intuitive, immediate responses, and so it is harder to revisit
7 them. To do so is like trying to remember the steps you made in an
8 impromptu dance; they were right at the time, but did not conform
9 to known patterns. How do you catch and hold on to such responses
30 that you make on the wing?
1 But we have to start somewhere, and I would describe what I now
2 try and do as increasingly conversational. I am less the analyst who
3 knows and understands it all (the Sherlock Holmes perhaps) and more
4 the helpful and always curious assistant (maybe a kind of Dr
5 Watson). I listen to, and try to engage with, the images and rhythms
6 of the session, and I make fewer interpretations from that “other
7 place”—by which I mean that very separate place where the analyst
8 sits on his own. In my experience, an interpretation often cuts across
922 the emotional flow of the session and brings things to a halt. So I

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172 KEN WRIGHT

now try not to “make interpretations” in this sense but to ride with
the flow, dropping in my observations as and when it feels possible.
Holding and containing involve being with the patient in a way that
interpretation does not. How we speak with the patient, how we
interact, the timbre and rhythm of our exchanges, the way we try
and find “words that touch”, to use a beautiful phrase of Danielle
Quinodoz—all these things are part of the process.
In trying to clarify my thoughts, I have turned to the literature on
infant research, for, unlike psychoanalytic writing, it talks of the
patterns of mother-infant conversation (I am thinking of Trevarthen’s
proto-conversation) and the importance of synchrony and resonance
to infant well-being. Daniel Stern’s work on attunement has also
seemed relevant: attunement is image-based and pre-verbal, and uses
an iconic symbolism of shape, form, tempo and rhythm to mirror
experience and communicate that sharing has been achieved
(Quinodoz, 2003; Stern, 1985; Winnicott, 1967b). These writings have
helped me to realize that holding and containing lie in the prosody
of the session as much as in the content.
Not so interpretation; like the “subtle knife” in Philip Pullman’s
His Dark Materials trilogy, it cuts through from one world to another.
It cuts through and separates the thought, the idea, from lived
experience; but in so doing it risks destroying the life it dissects. By
contrast, holding and containing have more to do with fostering life;
their whole purpose lies in creating the conditions within which
experience can begin to live. I can now better understand Winnicott’s
position: interpretation assumes robustness, a place for experience,
and experience itself, already firmly established. In the absence of
these things, interpretation is impingement, or dogmatic tyranny;
there is not yet anything to interpret, because living experience has
yet to come into being.
I started this paper by considering how theory could be used to
defend the analyst against fear of madness and how its derivative,
interpretation, could be inflated in importance to bolster these
ends. I showed how theory could become a transitional object for
the analyst, thus foreclosing its use as an instrument of clinical
exploration. I suggested that when it is overvalued and used in this
way the patient may suffer abuse from its over-deployment. In the
last part of my paper, I illustrated these ideas through a clinical
vignette and indicated some of the ways they had altered my own

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 THE SUPPRESSED MADNESS OF SANE ANALYSTS 173

122 practice. Finally, I suggested that a more operational analysis of the

2 concept of holding was overdue and could be rewarding, both
3 clinically and theoretically.
4
5
References
6
7222 Bion, W.R. (1961). Experiences in groups and other papers. London: Tavistock.
8 Bion, W. (1970). Attention and Interpretation. London: Tavistock. [Karnac, 1984]
9 Quinodoz, D. (2003). Words that touch. International Journal of Psychoanaysis,
10 84: 1469–85.
1 Rodman, F.R. (2003). Winnicott: Life and Work. Cambridge, MA: Perseus
2 Publishing.
3 Segal, H. (1986). Notes on symbol formation. In: The Work of Hanna Segal:
4 A Kleinian Approach to Clinical Practice (pp. 49–65). London: Free
5222 Associations.
6 Stern, D. (1985). The Interpersonal World of the Infant. New York: Basic.
7 Trevarthen, C. (1979). Communication and cooperation in early infancy: A
8 description of primary intersubjectivity. In: M. Bullowa (Ed.), Before
9 Speech (pp. 321–347). Cambridge: Cambridge University Press.
20 Winnicott, D. W. (1951). Transitional objects and transitional phenomena: a
study of the first not-me possession. In: Through Paediatrics to Psycho-
1
Analysis. London: Hogarth, 1958.
2
Winnicott, D. W. (1962). Ego integration in child development. In: The
3
Maturational Process and the Facilitating Environment. London: Hogarth,
4
1965. [Karnac, 1990]
5
Winnicott, D. W. (1967a). The location of cultural experience. In: Playing and
6
reality. London, Tavistock, 1971. [Routledge, 1982]
7
Winnicott, D. W. (1967b). Mirror role of mother and family in child
8
development. In: Playing and reality. London: Tavistock, 1971. [Routledge,
9
1982]
30
Wright, K. (1991). Vision and Separation: Between Mother and Baby. London:
1 Free Association Books.
2
3
4
5
6
7
8
922

173
INDEX
anxiety 112, 118, 122 see also
Winnicott, unthinkable
anxiety
art 24–32, 33, 36, 40, 41
Aulagnier, Piera 72
awareness 9, 51, 84, 116, 153
new kinds of 24
the “not me” 78
of self 52, 115, 119, 122
Balint, Michael 9, 128–39, 141, 147
basic fault 129, 130, 134, 138,
139
and countertransference 144
new beginning 133, 134, 139
Bion, W.R. 20, 76, 166, 168, 170
container-contained 36, 41,
83–95
bisexuality 56
Bollas, Christopher 136
capacity for concern 34
castration complex 49
child analysis 97–110
childhood 21, 41, 43, 105, 131, 133,
136, 150, 153
174
children
as a double 66
as an ideal 70
Coltart, Nina, 146–7
conflict 10
container-contained 36, 76, 83–95,
170–1
containing the analyst’s self
166–7
Controversial Discussions 34, 144
countertransference 15, 43, 90,
142–7, 154–60
creativity 25, 33, 44, 48, 54
culture 10, 33, 40
day-dreaming see dreaming
de-differentiation 30
dependence 14, 20, 21, 130
Dolto, Françoise 65
drawing 28, 30
dreaming 84, 85–6, 89–90, 93
dreams 14, 17, 21, 22, 24, 36, 37, 79,
85–6, 89–90, 91, 139
drives 13, 52
classical drive theory 129
death 65
 INDEX 175

122 destiny 20 primary repressed unconscious

2 destructiveness 116 11–15
3 urgency in art 31 and transference 142–4
4 and Winnicott 49, 51, 115–16
5 ego 13, 22f, 30, 37, 51, 71, 130
6 alterations 15–16 gender 41–2
7222 defence 130 genetic transmission 12, 19
8 device 130, 135, 138 genetics 12
9 functioning 36 genius 41
10 and the id 13 gestures 9, 10, 11
1 operational paradigm 18 Granoff, Wladimir 147
2 superegos 25 Green, André 38
unconscious 14, 15, 17
3
and Winnicott 12–13 Heimann, Paula 156
4
Ehrenzweig, Ahren 30 holding 71, 76–83, 94–5, 139, 170–2,
5222
Eissler, K.R. 138 173
6
endopsychic perception 14 the analyst’s self 166–7
7
environmental failure 128, 137, 138 internalization of the holding
8
essential aloneness 20–2 environment 81–2
9
humming 33, 45–8
20
facilitation 16
1
false self 12–13, 25, 31, 130, 135, 136, identities, confusion of 57
2
138, 139 Independent Group of the British
3 fantasies see phantasies Psychoanalytical Society 9,
4 Ferenczi, Sándor 58, 59, 131, 141–61 33, 144–6, 154
5 and the active technique 149–50 infant’s personality 12
6 and countertransference 155 infantile sexuality 43, 50, 52, 59,
7 and Freud 147, 151 128
8 mutual analysis 153, 159 inherited dispositions 15, 19
9 search for truth and healing inherited mental formulations 11
30 147–54 inherited potential 10, 11, 13
1 free association 29, 149–51, 161 instinct 11, 12, 13, 19
2 freedom of expression 10 institutions 62
3 Freud, Anna 42, 43, 63, 97–110, 144 role of 73–4
4 Freud, Sigmund 37, 50–1, 56, 72, 84, internal
5 117, 128, 131 damaged objects 25, 26
6 and dreams 24, 85 events 27
7 and Ferenczi 131, 141, 147, 151 life 26
8 Oedipus complex 42–3, 49, 51, interpretation 10, 18, 81, 102–3, 106,
922 53 133, 135, 138, 168, 169–72

175
176 INDEX

Jones, Ernest 37, 38, 147 mothers 24, 50, 58–60, 72, 77, 130
baby’s unit status 83
Klein, Melanie 19, 24–6, 28, 30, 34, maternal care 10, 13, 14, 15
37, 38, 42–4, 72, 101–2, 105, as object 82
112–26, 144, 147, 156 and psychosis 62–74
anxiety 118, 124 mysticism 41
death instinct 116–18, 122, 123,
124 needs 11
envy 117, 122, 124
falling to pieces 122–3 O, concept of 41
projective identification 87 object relations 17, 39, 44, 109, 129,
reparation 114, 123, 125 166
Kris, Ernst 63, 144 in-formative 15–16
object representation 15
Lacan, Jacques 20, 38, 39, 71–2 object-seeking 18
language 11 objects
Lapanche, J. 11, 58, 59 analysts as 106
latent thoughts 16 babies as 71
Lévi-Strauss 52–3 externality of 2
libido 37, 40, 51, 52, 115, 128 finding 33
literary criticism 24 internal damaged 25, 26
Little, Margaret 156–60 making 33
mothers as 82
Mannoni, Maud, 38, 62 relating to 57, 139
memories 22 as signifier 39
conceptual 14 transitional 37, 166
existence 21 use 21
Milner, Marion 9, 28–31, 33–48 Oedipus complex 43, 49, 51
absent-mindedness 39, 46–7 myth 52–3
centrality of feeling 35 pre-oedipal triangle 72
ecstasy 40, 41, 45
emergence of self 35, 39–45 painting 28–30, 44
framed gap 35–6, 39, 42, 45 paranoia 69
illusion 35, 36, 37, 47 parental intuition 11
symbol formation 35, 36–9, parents 13, 15, 17, 19 see also
47 maternal care
Mitchell, J. 49 patient-analyst relationship 8, 17
mortality 27 patient’s use of analyst 17, 18, 19
mother-infant relationship 25, 35, personality idiom 9–15, 19, 20, 22
36, 37, 44, 59, 62–74, 87 moves 16, 19

176
 INDEX 177

122 personality potential 12 and humming 45

2 phantasies 12, 14, 44, 51 and painting 29
3 of aggression 24, 25, 30, 31 Stewart, Harold 129, 131, 132, 139
4 play (children’s) 37, 38, 40, 43, 47, Strachey, James 106, 129
5 90 the Symbolic (Lacan) 22
6 poetry 24
7222 possessiveness 29 theories as a refuge from reality
8 preconception 20 165–6
9 primary love 129, 134 Thomas, Ruth 97
10 primary maternal preoccupation thoughts 13, 14
1 47, 77 disrupting conscious 24
2 primary repressed unconscious latent 16
11–15 unconscious in art 40
3
psychoanalyst as object 9 time 78, 81
4
transference 14–15, 18, 19 , 43, 57,
5222
regression 21, 24, 131, 153 73, 90, 106, 138, 142–7
6
repression 12 states 9
7
reverie see dreaming transformational value
8
rules 14, 15 of art 47
9
of ordinary acts 47
20
Sandler, Anna-Marie 107 transformative parenting 11
1
self transitional space 25, 33
2
emergence of 35, 39–45 culture as 40
3 false 12–13, 25, 31, 130, 135, 136, true self 8–22
4 138, 139 dispositional knowledge of 11,
5 infant’s sense of 72, 78, 119 13
6 management of 15 evolution of 19
7 originality of 47–8 sign of 16–20
8 true see true self
9 separation 65, 66, 71, 83 unaliveness 21
30 sexuality 49–60 unconscious 11–15
1 schizophrenia in art 40
2 and mothering 73 child as the core 42
3 and pathological containing 89 dynamic 84
4 social democratic idealism 34 and Milner 43
5 speech 21, 22 see also language perception 30
6 spontaneity 25 repressed 21
7 states of mind 33, 86 the unthought known 11, 13, 15
8 absent-mindedness 39, 46–7 unthought thoughts unknown
922 during emergence 40 136

177
178 INDEX
Winnicott, D.W. 146
and aggression 25, 31
and Balint 128–39
capacity for concern 34
continual personal process 119
countertransference 155
creativity 25, 41
culture 40
death instinct 117, 128
envy 117
essential aloneness 20–1
Esther 65, 71–2
facilitation 16
and Ferenczi 142, 147
and Anna Freud 101–4
full course on an experience
119–20
going along 119, 121
going on being 77, 119, 125, 130,
166, 167
and holding 71, 76–83, 94–5, 139,
170–1
the analyst’s self 166–7
hesitation 120
178
and the id 12–13
infant-mother memories 9,
12–13
inherited disposition 19
inherited potential 9
interpretation 170–1
interruption 120
and Klein 19, 112–26
and libido 52
and Little 158–60
and Milner 33, 38, 39–41, 44
and mothers 44, 58, 72
observation of infants 118
primary maternal preoccupation
47
realization 119
reparation 114
root of symbolism in time 81
symbolic realization 136
true self 9
unthinkable anxiety 112, 166,
167, 168
wit 24
women 58 see also mothers