The International Journal of Psychoanalysis

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The International Journal of Psychoanalysis

Welcome to the message board of the IJPA Internet Discussion Group

The latest Psychoanalytic Controversy on Winnicott's clinical innovations in the analysis of adults, is now available for discussion. The position papers are available to read at the links below:

Introduction to the controversy by Rachel Blass
Commentary by Michael Eigen
Commentary by Jan Abram
Commentary by Vincenzo Bonaminio

Responses to the position papers were published in volume 94 issue 1 of the journal: click on the links below to read them.

link On Winnicott's clinical innovations in the analysis of adults: Responses to the controversy by Rachel Blass
link Response by Michael Eigen
link Response by Jan Abram
link Response by Vincenzo Bonaminio
link Response by Charles Hanly
link Response by Daniel Widlocher

To submit your own contribution to the discussion of these pieces, email ijpa@psychoanalysis.org.uk. Contributions will be posted below.

Contributions received so far:

From Peter L. Rudnytsky

I am honored to participate in this Online Discussion Group arising from the cluster of papers on Winnicott’s Clinical Innovations, and wish to offer a few remarks that I recognize may be provocative but, I hope, also constructive. I would like to start by saying that I think it is artificial to isolate Winnicott’s clinical contributions from his theoretical framework. What we are really talking about is Winnicott’s entire conception of psychoanalysis.

But the essential questions posed by this symposium remain unaffected by the expansion of our focus. And here is where I am moved to register some agreements but also some protests.

In her introduction to the three original papers, Rachel Blass formulates the issue as a choice between those, on the one hand, who view Winnicott as “working within conventional analytic frameworks and developing them,” a “relatively limited” appraisal of his achievement but one that allows him “to remain within the mainstream of analytic thinking of Freud and Klein,” and those, on the other hand, who regard his approach as “radical and revolutionary,” but one which “takes us beyond the very boundaries of the psychoanalytic.”

In my view, this is a flawed—indeed, prejudicial—way of setting our agenda, for it presumes that if Winnicott is revolutionary he must no longer be psychoanalytic . A more accurate way of putting it, in my estimation, would be to say that especially the later Winnicott gives us a vision of psychoanalysis that, while preserving an emphasis on infantile experience and unconscious processes, differs radically from that of Freud and Klein, and thereby takes us beyond the boundaries of classical psychoanalysis into something far more “rich and strange.” I am, accordingly, in agreement with Vincenzo Bonamino when he writes that Winnicott describes “a horizon of clinical conceptualization quite apart from the psychoanalysis of the time,” a perspective that “is rotated by 180 degrees with respect to the traditional one, previously taken for granted.”

As with Rachel Blass’s introduction, I am in equal measure grateful to, and dismayed by, Charles Hanly, when he writes in his response: “If Freud and Klein affirm the primacy of interpretation of the dynamic psychic unconscious in the analytic cure, as I believe they do, the answer would have to be that Winnicott’s view is not consistent with a traditional view of psychoanalysis.” Professor Hanly concludes, “In treating affect responsiveness, corrective emotional experience, empathy and the like as curative of neurosis, independent of accompanying interpretations, it is my impression that the ‘Winnicottian turn’, like the Alexandrian, Kohutian and relational turns, pushes psychoanalysis in the direction of supportive psychotherapy.”

With Professor Hanly’s first statement I am in full agreement: “Winnicott’s view is not consistent with a traditional view of psychoanalysis.” He is, in other words, correct in highlighting the need to choose between alternative conceptions, instead of too readily assimilating Winnicott to his classical precursors. (Thus, when Jan Abram quotes Winnicott himself as saying, in 1954, that his own ideas “are only valuable as a growth of ordinary Freudian psychoanalytic theory,” I regard this as—to borrow Habermas’s term—a “self-misunderstanding” on Winnicott’s part, in contrast to his observation to Harry Guntrip: “We differ from Freud. He was for curing symptoms. We’re concerned with living persons, whole living and loving.”) But in his second statement, Professor Hanly, like Professor Blass, arouses my misgivings by equating “traditional psychoanalysis” with psychoanalysis tout court, instead of appreciating that the problem lies in the overly narrow definition of psychoanalysis in the Freud-Klein tradition, from which Winnicott struggled to emancipate himself .

I cannot forbear mentioning in this connection Hanna Segal’s paper, “Reflections on Truth, Tradition, and the Psychoanalytic Tradition of Truth,” published in the Fall 2006 issue of American Imago (of which I was then the editor), guest-edited by Rachel Blass. In that paper, Dr. Segal wrote that the Middle Group in the British Society “developed a new model of the mind, deriving from Ferenczi and developed by Balint, Winnicott, and, later in the United States, by Kohut,” which, in clinical practice, “considered the personal influences of the analyst—e.g., his support, advice, and comfort—to be integral to the analytic process,” and these “changes in technique were of a kind that rendered them essentially nonanalytic.”

These assertions aroused extreme indignation in many members of the British Society, and in a subsequent issue I published one letter of rebuttal with fifty signatories and a second more sympathetic letter signed by four people. Dr. Segal apologized for any unintended offense, but restated her position without using the term “nonanalytic .”

I can’t help being struck by how the current contributions of both Professor Hanly and Professor Blass once again maintain that an acceptance of the “Winnicottian turn” perforce “takes us beyond the very boundaries of the psychoanalytic” and “pushes psychoanalysis in the direction of supportive psychotherapy .”

It would take too long to explain in detail why I think this view is mistaken, and why I think the Freud-Klein conception of psychoanalysis has held us back in ways that the “new model of the mind” offered by the alternative lineage delineated by Hanna Segal—including Ferenczi, Winnicott, Balint, and Kohut—has sought to rectify, while preserving what is of value in the classical tradition. Suffice it to say that I have reflected on these issues in a series of books, including, most recently, Rescuing Psychoanalysis from Freud and Other Essays in Re-Vision (Karnac, 2012 ).

Let me close by drawing attention to a forthcoming paper by James W. Anderson, “How D. W. Winnicott Conducted Psychoanalysis,” slated to appear in Psychoanalytic Psychology. During the 1980s, Dr. Anderson interviewed six analysands of Winnicott: Margaret Little, Masud Khan, Marion Milner, Enid Balint, Rosemary Dinnage, and one male patient who wished to remain anonymous. I think all participants in this colloquium will find this paper of great interest. Dr. Anderson quotes Rosemary Dinnage as saying, “With every other analyst the misery of analysis to me has been the way they don’t understand. When you get to the vital thing, somehow they’re dreaming or they tell you it means something else,” while both Enid Balint and the anonymous Mr. B. said of Winnicott in almost identical words, “He let me be. That is the most exceptional thing he did.”

Dr. Anderson concludes by remarking that Winnicott had “two lengthy analyses, one with James Strachey, the other with Joan Riviere; both he deemed to be failures,” and he sought in his own clinical work to develop a “form of treatment that would have helped him in ways that Strachey’s classical approach and Riviere’s Kleinian approach did not.” In consonance with Margaret Little’s reflection that Winnicott’s typical intervention “was not an ‘interpretation,’ but it has interpretative effect,” Dr. Anderson sums up what he learned from speaking with Winnicott’s analysands: “He put aside interpretation, that is, interpretation of the classical kind that focused on the unconscious, and he participated with the patient in a joint effort to understand what had happened in childhood and what feelings, often buried or dissociated, were attached to the disappointments, traumas, and inadequate parenting the patient had undergone. Through his humanness, his understanding, and his non-intrusiveness, he enabled patients, as more than one of them described it, ‘to be.’ Within that atmosphere, the true self can come out of hiding, and patients have a chance to resume their growth and to develop a life that feels real.”

If this is not psychoanalysis, then maybe it should be!

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From Rachel Blass

The present controversy does not presuppose that what is not traditional in Winnicott is unanalytic; nor does it assume that one must choose between traditional analytic approaches and something other than analysis. Rather, as I wrote in my introduction, it sets out from the recognition that alongside those who, to varying degrees, regard Winnicott’s contributions as developments within traditional psychoanalysis, there are those who view it (or some aspects of it) to be radical and not in line with traditional analysis. These analysts (including Winnicott himself) at points see Winnicott as going beyond the bounds of analysis. The question then arises as to what makes Winnicott’s contributions in this radical sense analytic. As I explained, underlying the different evaluations of Winnicott’s contributions and their analytic nature are different implicit understandings of the essence of psychoanalysis.

To enrich the exchange on these on these matters I invited Peter Rudnytsky and others to join the online discussion. In his comments, Peter sides with those who take a strong radical view of Winnicott, one which he thinks (counter to Jan Abram’s view) cannot be readily assimilated with traditional psychoanalysis. At the same time he maintains that Winnicott’s radical contributions are analytic in nature. However, he does not further elaborate his view of Winnicott’s contributions or why he regards them as analytic. This is unfortunate because this is precisely what is needed in order to advance dialogue and understanding on this controversial issue. Especially needed are clear statements about the essence of the psychoanalytical – e.g., if, as Peter describes, Winnicott offers a perspective that “is rotated by 180 degrees with respect to the traditional one” what warrants referring to both as psychoanalysis? Is there a meaningful link between the two? How might someone holding such a view of Winnicott define psychoanalysis and what would this definition exclude?

Having such a dialogue on issues that go to the very heart of our convictions about the nature, boundaries and essence of psychoanalysis is not an easy task. And yet, this is what the Controversy Section is inviting. I hope that in the ensuing contributions to the present exchange mere passionate assertions and protests regarding how we must or must not think about Winnicott will be put aside in order to meaningfully engage in this challenging discourse.

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From Adela Abella

Rachel Blass raises the question of whether Winnicott’s clinical and theoretical contributions overstep the boundaries of psychoanalysis (Blass, 2012). Are Winnicott’s innovations congruent with what we consider psychoanalysis is? Or must they be deemed as “something else” (Winnicott, 1962)? To frame the problem in these terms is to ask for a definition of the essence of psychoanalysis. I would prefer a slightly modified angle of questioning: what is the heuristic value of Winnicott's contributions? What sort of problems, amongst those we consider central to the cure, do they help to solve? Or, on the contrary, do his contributions create new problems?

I will focus my comments on the thorny issue of the analyst willing to act as a good mother and therefore refraining from interpreting (Blass, 2013; Hanly, 2013). The rationale for this retreat would be that interpretations are supposed to prevent the patient from regression and thus run the risk of cutting off access to the patient’s most archaic layers. In my opinion, this question –whether the analyst should, at certain particularly regressive moments, refrain from interpreting and rely solely on intimate presence and the sharing of experience- is one of the main points of conflict concerning Winnicott’s contributions.

As for the underlying idea – I mean, that it is precisely this archaic level that demands to be addressed and worked through for a psychoanalysis to be really meaningful- I think that, presently, there is a large agreement in the psychoanalytical field concerning this issue. The discrepancies amongst the various psychoanalytical cultures lie in the way each one of them understands and names this archaic level: pregenital functioning, traumatic core, psychotic part of the personality, narcissistic organisation,…

It has been emphasized (Abram, 2012; Bonaminio, 2013) that Winnicott developed his ideas in close (and complex) relationship with Kleinian thinking. The question is: what does Winnicott mean by interpretation? Does he mean verbalizing the transference? Or is he referring to the fact of putting into words whatever the analyst does understand? When Winnicott dismisses the usefulness of interpretations, is he reacting to interpretations as they were made at that time by Kleinians: going directly to the deepest anxiety, which was often supposed to be of a destructive nature, and which were frequently formulated in terms of partial objects? It should be noted that such bold, deep, chirurgical interpretations seem to have been quite customary in the early days of psychoanalysis: suffice it to remember Freud’s interpretations to the Rat Man.

With the passage of time, things have evolved and presently all psychoanalysts strive to connect as closely as possible with what the patient is experiencing at each moment of the cure, here and now, and try to convey their understanding in ways that may be acceptable. This is true of psychoanalysts inspired by Klein, Bion, Winnicott, those belonging to the French school, etc. The fact that the listening and understanding of each psychoanalyst is colored by his theoretical allegiance does not alter this general trend. We have all become more cautious. In my opinion, speaking with a patient about what she is very precisely feeling and thinking in a given moment may be felt by the patient as a proof that the analyst is listening to her with the attentiveness that a good mother might show towards her baby. Words do not necessary impede communication and intimacy, as is sometimes feared (Bonaminio, 2013): on the contrary, they can convey closeness and empathy with the greatest efficacy. Il all depends on which words are chosen, at what moment and in which way things are said. Sometimes we are to speak, at other times it is better to remain silent. Be that as it may, silence is not always and necessarily the best and more empathic response to a patient.

It might be argued that the question is not just silence but the special silence of an analyst who is trying to act as a good mother and who wants to express his entire acceptance and foster the patient’s contact with his archaic experiences by abstaining from interpretations. What to say about this particular aim: performing as a good mother? Which feelings or unconscious fantasies may this wish convey? Is the analyst sharing with her patient a blissful moment of communication? Is he accepting a healthy aggression? Is he being seduced into denying feelings of destructiveness? Or, on his own side, is he enacting his personal need to be seen and to see himself as a good analyst? And, in any case, how does the patient experience each of these possibilities and what does he do with them?

A brief clinical vignette might be useful. During a period of her analysis where we were crossing through deep swirling waters, a patient starts a session by telling me that she thinks I kept her a bit longer during the precedent hour. She had felt these extra-minutes as a warm gift and felt moved and grateful. She goes on elaborating on her painful feelings of abandonment, her intense longing for a loving mother and expresses strong feelings of rage with touching authenticity. Towards the end of the hour, she tells me that, while coming to my office (which is located in my house) on her bicycle, she had found herself pedaling behind a young girl who seemed to manage hills with no apparent effort. She thought this girl was my daughter. “I felt that she had just crushed me, I felt old and ugly. I feel the tears in my eyes, I don’t know why. In fact she has all the qualities, she can have everything she wants because she is your daughter and me, I am a sort of…. the cuckoo that puts his egg in others’ nest, it is not the same size, it is not his mother who takes care of him, it is a large egg, a kind of big shit that one goes to put in another’s place… and the legitimate eggs will be destroyed by the baby cuckoo.”

I was deeply moved by the intensity of her sadness and her despair and was surprised to hear myself saying: “but it is welcomed to the nest!” My patient answered with words which conveyed, apparently, the reassuring feeling of being understood through an intimate communication: “Yes, I think it must be welcome, given the fact that it survives… It is funny, my husband likes kidding about you, he speaks of you as my mum. I feel that if I think just about my wish to have a mother or to have you as my mother, I can only cry.”

The important question is, for me, the following: how did this patient feel my unusual and strongly emotional reaction at a more deep level? I think we can find the beginning of a response in the way she started the following hour. She was furious with her mother: she had gone out with her husband and left her baby with her mother for the night. “We had asked her to change his diapers. When we arrived in the morning, we realised that she had not done so, she had left him soaking all night long in his shit. She said she had no reason to think she should have changed him, she said we had not told her, she does not listen. Was she pleased to leave him soaking in his shit? I wanted to phone her and to shout that at her but I did not dare (she cries), I felt guilty, she was certainly so happy about spending an afternoon with him and happy also to be able to help me, I cannot spoil that but I fear that she might harm my baby seriously.”

She then added: “When you said that the cuckoo was welcomed, it was like that extra time you gave me, so kind and generous. But the more you are nice the more I feel like a shit, I am not your daughter, I have no right to it. And I fear that you will be furious with me if I tell you all that, if I spoil your pleasure in being kind and warm-hearted towards me.”

My patient taught me some very important things that day. I had not intentionally tried to act as a warm-hearted mother: my accepting and reassuring words were triggered by her extremely moving despair which was probably intensified by the unsettling effect of the fantasy of my daughter being killed. I was trying to reassure my patient but probably still more myself. The important point is that my patient felt my good mother’s words as a refusal to listen to her bad feelings. My failure to address her destructive fantasies obliged her to carry them alone, by herself. I had left her soaking in her own shit. Furthermore, she felt guilty about spoiling the pleasure and self-contentment she supposed I obtained from being a good mother. I guess Winnicott would have called this exploiting the patient. She was longing for a good mother but, at that moment, a good mother would had been the one capable of finding words for her shit in such a way as to share it with her. Had I done this, she would have felt deeply, and not only superficially, reassured. Moreover, she taught me that a patient longing for a good mother may feel deeply guilty if she needs to express her aggression to an analyst who is performing this role very precisely.

It might be argued that, in this particular case, we were confronted not with a healthy aggression but with a destructive one, which demanded to be interpreted in terms of drives and unconscious fantasies (Eigen, 2012). Maybe, but can we really differentiate so sharply between these two sorts of aggression, which are easy to distinguish at a theoretical level but much less at a clinical one? And can we expect that an analyst might shift between interpretive listening and a good-mother stance and be able to follow the minute oscillations of any patient in each hour, all this under the fire of the patient’s transference? Dare we say that such an analyst would run a great risk of confounding the acceptance of a need of his patient with the gratification of a personal need?

To sum up, in my opinion it may be useful to think in terms of a good mother as one of the fantasies a patient may have concerning her analyst, alongside others including a bad mother, an absent mother, a seducing mother, a perfect mother, a dead or mad mother etc. It is certainly also a fantasy the analyst may have concerning himself (in response to his patient or for personal reasons). Nevertheless, if the analyst sees the good mother as an ideal which should guide his listening this might create more problems than it solves. Using a paradox, as Winniccott taught us to do, it is possible that a good analyst should renounce the attempt to perform either as a good (gratifying) mother or as a bad (interpreting) one. It is possible that a good analyst would be the one who is able to remain an analyst, listening and communicating to his patient what he has understood – a listening which may sometimes be felt by the patient as coming from a good transferential mother-.

References
Abram J (2012). On Winnicott's clinical innovations in the analysis of adults. Int J Psychoanal 93:1461-73.
Blass RB (2012). On Winnicott's clinical innovations in the analysis of adults: Introduction. Int J Psychoanal 93:1439-48.
Blass RB (2013). On Winnicott's clinical innovations in the analysis of adults: Response to the controversy. Int J Psychoanal 94:117-118.
Bonaminio V (2013). On Winnicott's clinical innovations in the analysis of adults: Response. Int J Psychoanal 94:124-127.
Eigen M (2012). On Winnicott's clinical innovations in the analysis of adults: Introduction. Int J Psychoanal 93:1449-59
Hanly C (2013). On Winnicott's clinical innovations in the analysis of adults: Response. Int J Psychoanal 94:128-130.
Winnicott D W (1962). The aims of psychoanalytical Treatment. In The maturational Processes and Facilitating Environment. London: Hogarth Press, 1976, pp. 111-118.

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From Christopher Bollas

I would like to add, very briefly, that I quite agree with Vincenzo Bonaminio's point that Winnicott's writing needs to be seen within the context of the British Psychoanalytical Society. Many will know how many letters he wrote to members of the Klein group, but equally, he was constantly trying to speak to them in person and at scientific meetings.
His clinical theories derive from his own unique integration of Freud and Klein but he departs clearly from Klein and yet wishes Kleinian analysts to know why he disagrees with them. He was also in dialogue (by letter, implicitly in his writings) with Anna Freud whom he held in high regard.

The other member of the British Society who shared a similar history and was also in dialogue with the Klein group was Bion. In so many ways their clinical innovations have to be seen as integrating Freud and Klein and yet, rather like Kohut, assuming the Freudian tradition but not making that explicit in their writings. Indeed, Lacan, Winnicott, and Bion all developed somewhat enigmatic forms of writing as well as idiosyncratic theories that may in the future be looked upon as shifts in mid century psychoanalysis collectively aimed as unconscious forms that developed new and vital ways to rethink psychoanalysis. As to the ways in which what they did was or was not classical psychoanalysis; well, I think on reflection so-called classical psychoanalysis will have been found never to have existed in the first place.

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From Abbot A. Bronstein

I am very glad to be included in this discussion of Winnicott’s work and the clinical significance of his far reaching and influential writings.

In a recent AAW section, I wrote a short piece on ideas of what constitutes the analyst’s work in the consulting room. Rachel Blass in her introduction states a similar series of questions, which I think swirl around most discussions about analysis and the ‘offense’ many analysts seem to take when analysis is discussed, whether in private or in International meetings. When there is a discussion of differences we all too often either smooth over or reject the comments as amounting to a statement that “that is not analysis” - a common non-starter for a discussion amongst analysts.

Yet, I did not think this was what Blass was suggesting as some other discussants claim. She was framing the dilemma, as I hoped I had done, in my recent attempt to open a discussion on the differences and controversies in our field.

It may be suggested that, in part, what underlies the differences between these opposing views are different definitions of the boundaries of psychoanalysis. That is, in discussing the nature of Winnicott’s contribution the question at stake is not only what did Winnicott add, but where do his additions stand in relation to what one considers as essential to psychoanalysis.

The three papers each in their own way tried to address what they felt was the clinical relevance of the divergence of Winnicott from ‘classical’ technique. Michael Eigen focuses on the ideas of aloneness, madness and the essential paper on the use of the object, interestingly not on the transitional object and mind, illusion, phantasy. Michael’s emphasis on the use of the object needs to be understood as a theory that implies a clinical approach. Survival is central; madness and aloneness are also states to be survived. They are developmental achievements, as is a transitional space, but the central question is how do they translate into practice.

Winnicott and Kohut’s personal sense of their own analyses and their intention to provide for themselves and for their patients what their analysts didn’t provide for them in the analysis, forms a basis for some of their shifts in technique. In his account of the two analyses of Mr Z, Kohut didn’t reveal the disturbing secret that Z was him. In essence this misleading truth doesn’t negate the theory, but Kohut, like Winnicott, is stating that his own self-analysis provided something another couldn’t or didn’t, which evolved into a theory of self objects, empathy etc. Winnicott's complaints about what wasn’t provided him were similar. This could in both cases be the way great original minds work, but it also says something about their views of analysis. Segal, Meltzer, Joseph and Bion and others analyzed and supervised by Klein didn’t depart so completely from the talking cure, becoming more dependent on the relationship to bring about the cure. This realization on Winnicott’s part may be part of his genius, but it also seemed to give rise to a regret and grievance about analysis that raises serious questions about our technique and theory. Some, myself included, do not feel the changes in technique that are implied by Winnicott’s shift away from interpretation to action are warranted. As Eigen states, ‘‘the therapist functions as a kind of holding environment creating an emotional atmosphere that facilitates coming through’’.

But also, as Abram describes, psychoanalysis was in his bones. After a ten year analysis with James Strachey (1923 -1933), who was the General Editor of The Standard Edition of the Complete Psychological Works of Sigmund Freud, it is hardly surprising that Winnicott said he always felt that ‘‘Freud was in his bones’’ and he protested that any original ideas he may have ‘‘are only valuable as a growth of ordinary Freudian psychoanalytic theory…and would make no sense at all if planted on a world that had not been prepared for it by Freud’’ (Winnicott, 1954, in Rodman, 1987, p. 75). A close reading of Winnicott’s texts shows how, throughout his life and work, he was continually in the process of finding and using Freudian objects and ‘‘creating the object’’ (Winnicott, 1969).

Abram points out how Winnicott himself distinguished analysis from other forms of treatment, in a sensible and hopefully rigorously applied fashion. In conditions where the patient is outside of the neurotic range of pathology and in the borderline psychotic range, as Winnicott describes in his paper on the Use of the Object, Winnicott states that he ‘‘changes into being a psychoanalyst’’ who will ‘‘meet the needs’’ of that ‘‘special case’’. And while he describes this as ‘‘non-analytic work’’ he asserts that it is ‘‘usually best done by an analyst who is well versed in the standard psychoanalytic technique’’ (ibid p. 169). ‘‘The analyst in a ‘standard analysis’ functions like the good enough mother with her new born baby whose ego needs are supported by the m/other’s ego’’. However can this be done, can the methods be mixed and if so what is the cost? Here I would essentially agree with Blass’ question as posed. What do we lose and does analysis stop recognizing that it also has limits to what it can accomplish? It is omniscient and omnipotent to think we can replace ‘bad enough mothering’ with good enough mothering and that we know what it means to be good enough, given the pressures of the unconscious to repeat and re-form objects in the mind’s own image of things. Can analysis cure, and what do we mean by this? What are the goals, and don’t they need to be thoughtfully argued and discussed?

As with Kohut, I believe this aspect of Winnicott has come to be used as a justification for clinicians at times ‘giving up on psychoanalysis’, turning to other methods, medications, analysis by kindness etc, when that was not the intent of either theorist in my readings. Kohut spoke of the tyranny of empathy, Winnicott of the destructiveness of hate and love, but these appear mostly forgotten in the manner in which non analytic intervention (not focused on the mind and “thinking” in its broadest sense) is employed. The danger of the rationalizations produced by clinicians for why a patient needs this or that activity, like the feeding of the cakes Eigen mentions, gives rise to an anything goes attitude in which science is dismissed. Like Abram, I would suggest that this is something that Winnicott himself might have been very troubled by, at least earlier in his development. Abram describes this as a phase of acting out and links it to role responsiveness. But that concept by Sandler and its link to projective identification, are not the same in my reading. One is intentional while the other is what one finds oneself engaged in. One is an unconscious enactment in today’s lingo while the other is a planned intervention, stemming from what seems to me a more omniscient view of what a patient needs from her objects!

Abram, like Rudnytsky, in essence questions whether this is not an advancement in analytic thinking and practice and asks why shouldn’t it be if it is not! Again the question isn’t one of orthodoxy but one of understanding what analysis can do, the goals and how these goals may be achieved. Claiming that our goals are achieved is one of the dangers of our field, whether from Freudian, Kleinians, Kohutians or those following in Winnicott’s footprints. My concern is that once stated it seems to become fact beyond questioning.

Without attempting to defend Blass, I felt she was being more neutral in her description than Rudnytsky describes. But the issue Blass raises both have to do with how we do define psychoanalysis as a treatment and a science. Are their limits? Is it diminishing another’s viewpoint or the seriousness of their argument, to say something is supportive of a defense or non-analytic? Blass is writing as an academic as well as an analyst. She is pushing us to examine what we are saying and its implications. This is not always a nice thing to be pressed to do, but is exactly what we need to do to further our own thinking as analysts in a field that does not seem to allow much discussion.

Can we define what we mean by analysis? Is it a treatment that focuses on resistance and transference, however we define them? Probably not any more. But can we give general descriptions of the mind, the unconscious process of thinking, the role of the unconscious in symptoms and character and the ‘talking cure’ aspects of the treatment? One might give drugs but is that analysis? One can do phone treatments but can we call that analysis? If we give advice is that analysis because we are analysts? What constitutes something mutative and brings about psychic unconscious and internal change in the internal world? Is that what I believe we mean by psychoanalysis? If I am nice to a patient and explain things about their life they may feel much better, but should that be considered analysis? One analyst once said to me that what he does is analysis because he is an analyst! I was startled to think that is how we might define analysis. Shouldn’t we be able to think that there are analytic and non-analytic and even anti analytic ways of intervening and that they result in different outcomes? What Segal was describing in her essay was that Winnicott had moved away from using and understanding of the transference as it manifested itself in the analysis, as the things he felt were central to the analyst’s stance and way of working. This is the core of what Strachey and Glover spoke about regarding suggestion. Although we might today say that all interpretations contain suggestions they are directed to different goals.

I want to make a few comments on Bonaminio’s paper, which I thought raised some very controversial issues that are difficult to discuss. Bonaminio states ‘‘The analyst’s response—his striving to be real and alive for the patient—gives a unique imprint to the analysis of depression.’’ The issue stressed seems to be the concept of ‘real’. I fear that this is subject to massive misunderstanding and distortion and hence can become very dangerous within the clinical setting. Analysts can surely be false or fraudulent, but being what is called real is far more complex. It is being thoughtful, patient, empathic, or is it being aroused and angry and showing that to a patient? Bonaminio further states that for Winnicott the patient is the point of departure of psychoanalysis: analysis is a practical task and if there is no patient there is no analysis. But then he states what seems to this reader a contradiction: “Winnicott’s perspective is rotated by 180 degrees with respect to the traditional one, previously taken for granted. According to him, analysis is possible only if the analyst is capable of working out his own depression in the course of his relationship with the patient. He must work toward resolution of his own psychic challenges in order to create a place inside himself from which to receive the patient’s experience of depression. The analysis starts with the patient, but paradoxically it is first the analyst who has to create a place inside himself to allow analysis to start.” This sounds good but how this is translated into clinical practice seems to me complex and perhaps even very risky. I would like this spelled out much more clearly within a clinical setting in order to avoid the misunderstanding that the patient is treating the analyst. Although seemingly farfetched I have heard analysts describe this phenomenon.

A very good distinction is made between Bion’s thinking analyst and Winnicott’s breathing analyst. It speaks to a different view of the way an analyst may work that seems replayed in the way each of these two analysts think analysis progresses. But are these overlapping views and if not, does Winnicott’s view not extend to interpretation, to the talking cure and to the way thinking and language is used to organize the mind and the body via shifts in the internal world? If not, are we thinking of different views of analytic / psychic change? My reading and understanding is that here interpretation for both Winnicott and Bion, moves away from the realm of the analyst’s pretence of omnipotently knowing everything about the patient’s unconscious feelings, drives, and desires. Instead, the analyst recognizes the limits of his understanding and presents himself to the patient as a real object that can be used for the patient’s benefit. For Winnicott, to quote him through Bonaminio, ‘‘I have always felt that an important function of the interpretation is the establishment of the limits of the analyst’s understanding’’ (1963b, p. 189). But the implication is that unlike Bion, Winnicott would become ‘real’ and that would complete something that can’t be done with interpretation and goes beyond that. I’m not sure any analyst would disagree that there is more than interpretation needed for change. This may be the implication of Bonaminio’s circularity concept. But the role of consciousness and the ability to change things consciously seems implied. My impression was that this is the role of associations also for Winnicott and that the unconscious response, the shift in thoughts and phantasies gives evidence to the analyst of the ‘science’ Winnicott believed in about psychoanalysis.

This section on interpretation by Bonaminio is the most interesting to my mind. It brings infant-mother observations to bear on the analyst-patient matrix. Yet it doesn’t equate them as often seems to be the case in clinical case descriptions today. A complex idea is then reduced to a way to act with patients. But Winnicott was, I thought, describing a much more complex interaction in the process of ‘giving back’. However, this comes up against other statements by DW that seem to simplify what I’ve always understood as a very complex theory of the mind. Sadly straw men are argued by all sides in these analytic discussions which lead to troubling conclusions. All analysts seem to do this, which stops real and vibrant discussion. But a real discussion of what one does and its value and meaning is left to a quasi-religious adherence to what Klein, Freud, Winnicott or Kohut or Lacan did, which is felt to be right because they did it. The examples that Abram, Eigen or Bonaminio give of Winnicott’s thoughtful interventions read differently to me. I’m a bit startled and confused by the examples. But this is what we need to discuss. To this analyst’s ear, they don’t show the brilliance of Winnicott’s thinking in a context of developing and contrasting of ideas. The holding environment, like container-contained, have become excuses too often for shifts in technique that are not supported by the data itself. One too often hears analysts say “A patient needed that, and I know so from his or her history, so I did it.” Multiple functions of associations, unconscious ideas, symptoms with meaning and transference are all discarded. I remember a clinician once remarking that the blanket he provided his patients in his unheated flat was just like Winnicott’s use of a blanket! I would be certain Winnicott wouldn’t have liked that as a reason to do anything!

We must beware of the overly simplistic uses of Winnicott’s ideas along with all the others as well. This controversy of what is analysis remains and should be discussed and I think the efforts to bring forth these controversies in a section like this with 3 thoughtful papers continues the effort we need to prevent ourselves from being closed off from other viewpoints.

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From Anne Alvarez

I am pleased to be invited to take part in this discussion, although I do not work with adults. Rachel Blass, in her response to Peter Rudnytsky’s contribution, suggested that he did not further elaborate why he regards Winnicott’s contributions as analytic. I wish to offer some suggestions which may address some of the technical and theoretical issues involved in  whether Winnicott’s   `  techniques were pushing psychoanalysis in the direction of supportive therapy .I think some ideas from a post - Kleinian/Bionian   - and developmentally informed  - perspective may shed some light on this issue.
 In my work as a supervisor of Child and Adolescent Psychotherapists, I have often seen situations where a trainee  has had a child patient with a history of neglect come in to the session showing a gash on his knee. The therapist feels he or she needs to find the symbolic meaning in this, and may offer an interpretation about sad or lonely feelings about a coming break from treatment. The therapists have often said that they felt they should suppress their natural sympathetic response which might have taken the form of an `Oh dear that looks like it must have hurt!’  Yet where the child  has been deprived of opportunities to feel understood by drug- addled or mentally ill parents,   he may not be equipped with sufficient ego function to see the metaphorical and symbolic links between a hurt knee and hurt feelings. Indeed, he may never have played with ideas. But he may recognize sympathy when he gets it, even where he was  not expecting it. Although I am not a Winnicottian, I think it takes years to become a skilled analyst or a psychoanalytic therapist, and I would prefer that our students offer some Winnicottian humanity at such moments rather than suppress it. As Adela Abella said, it need not be a question of giving up on interpretation – it is a question of which words to use.  I believe there is a way of using one’s maternal or parental countertransference  sensitively and respectfully which need not lead to collusion or seduction or  to the  feeding of narcissism. For example, the therapist might have said something like , `Well, I had better notice that that really looks like it hurts!’ Having contained that experience, we might be then able to hitch a lift into the transference , thusly, `And on top of all that, you and I have to say good bye today for a week- it feels a bit much all in one day.’

To link this technical point with theory, the arousal of a parental countertransference may of course lead to the kind of over-reaction described by Adela Abello,   where, for example,  the patient  is nowhere near ready to believe in sympathy. But at other moments , where the patient’s  attempt at a projective identification is weak , but nevertheless contains a kind of question put to the object,  it may offer an opportunity  which can lead to the building up of a belief  in good objects and  even  an idea that the child himself could be likeable and matter to someone. I believe this can be done psychoanalytically where it is addressing the kind of  deficit in the internal object which can lead to the development of  chronic states of despair.

One adolescent girl who was living in a residential home, abandoned by her birth family, and rejected by several foster families, showed her therapist a picture of someone she said was her uncle. The therapist suspected it was someone related to one of the foster families, and said, very sensitively, that her patient wanted her to believe that that was her uncle, but that they both probably knew that it was not, and how sad that was.  Another way, however, of looking at this incident, is that the girl , not only wished that her therapist would - but needed her therapist to-  be able to visualize her as a person who could one day be fosterable and  find a family who would keep her, and also find a  way of becoming a person who people would want to keep. Both  indeed eventually did happen.  There are ways of responding to such a projective identification that need not involve the making of false promises.  You wish I would adopt you is different from you feel I should be adopting you, but the latter can be ego strengthening and need not  involve collusion.Bion suggested that not all dreams are defensive  or denying of reality, that in certain dreams  the dreamer  could be working on and through something, and he and his inner world could change in the dream. (1979)The same could be said of phantasy, which can contain elements of hope of, belief in, and even intention toward, the possibility of change. Winnicott’s suggestion that we respect (analytically) the paradox contained in the use of transitional objects is  a very similar idea.

The desire to feel liked by one’s therapist need not be a narcissistic defence: it may express a genuine need. That is, instead of omnipotence and narcissism, it may signal a longing for  a sense of potency, agency and self-respect. These latter states of mind are not defences against shame, they are ways of overcoming shame. I am using the concept of `overcoming’ here, which I believe  is one of Klein’s greatest pieces of meta-theory. She insisted that reparation was not a defence against guilt, but an overcoming of guilt.(Klein, 1937) In the same way, I think we need a similar  meta- concept for ways of dealing wlth the shame, terror and persecution of the paranoid- schizoid position. Some processes are defensive, but others overcome. Feeling safe need not be a defence against fear, it may involve an overcoming of fear.(Alvarez, 1992)

Therefore, is it really only supportive psychotherapy that should address these issues? If the patient  has, as well as damaged objects in  his internal world, objects with considerable deficits, is this not the task of analysis too?
This leads to an important theoretical issue concerning the preconditions for attaining the developments of the depressive position. Klein(1952) and Segal(1964) stressed that it was only when love was stronger than hate could the  integrations of the depressive position take place. I believe that an important implication for technique is that tiny increments or faint signals of hope or belief, of liking or trust, sometimes need to be accepted in their own right, and not seen as defensive against something negative. The latter approach may lead to attempts to foster  a premature integration and can interfere with the building up of the good. The life instinct is sometimes used as a defence against the death instinct, but not always. It has its own fund and sources of energy. It is important here to distinguish between ideal and idealized objects. Where the external and internal world has been bleak , empty or dangerous, or all three, new experiences of  an ideal object, however fleeting, may need  recognizing. There has been much attention paid in America to the nature of deficits in the self,(Kohut.1977) but we need to attend also to deficits in the internal objects. With children who have suffered severe emotional neglect, too much concentration on negative transferences may lead to inattention to faint signals of the positive, and perpetuate despair and withdrawal.

A further  theoretical point: I  am suggesting that the respect for  positive or empathic experiences  need not be seen as anti-analytic.(Alvarez,2012) Freud and Bion stressed that it was frustration that led to contact with reality and thinking,(  Freud, 1920 Bion, 1962) but it is evident from naturalistic infant observation, (Rustin) and  developmental research,(Stern, 1985) that babies attend carefully to pleasing, interesting changes in the faces of  their mothers and fathers – that is,  it is clear that the present object stimulates thought just as much as the absent  or frustrating one does. ( Alvarez  1992,2012)Many deprived children  are astonished to discover that a therapist can understand them, or remember things about them – they may ask,` How did you know that, are you a mindreader or something?’ My point is that  such children,( and also, normal infants)are stimulated  by and curious about, this experience – they are not lulled by it into  a symbiotic  mindless state. If the experience is new and interesting, however positive, it need not be dull.   I think that Freud’s and Bion’s gratification/frustration dualism is too simplistic.

I do not know whether this adds anything to the discussion of Winnicott’s work with adults, but it is a way of approaching some of these issues from a post Kleinian/Bionian perspective which relates developmental needs to the psychoanalytic theories of  growth, learning, and of conditions for contact with reality.

References.
Alvarez, A  (1992) Live company: Psychoanalytic psychotherapy with autistic, borderline, deprived and abused children, London and New York: Routledge
 Alvarez, A. (2012) The Thinking Heart: Three levels of Psychoanalytic Therapy with Disturbed Children.  London and New York: Routledge
.Bion, W. R..- (1962) Learning from Experience, London: Heinemann
          Bion, W,R. (1979) Seminars , London Meltzer/Harris household.
       Freud, S.  (1920) Beyond the pleasure principle, Standard Edition 18, London: Hogarth            (1966).
Klein. M. (1937) ‘Love, Guilt and Reparation’. In The Writings of Melanie Klein, Volume 1 (1975) London: Hogarth.
the ------ (1952) 'Some theoretical conclusions regarding the  emotional life of the infant'. In The Writings of Melanie Klein, Volume III Melanie Klein: Envy and Gratitude and Other Works (1975) London: Hogarth
Kohut, H. (1977) The Restoration of the Self, New York: International University Press
Miller. L. Rustin, M,Rustin, M., Shuttleworth, J.(1989) Closely Observed Infants.London: Duckworth.
Segal, H. (1964) Introduction to the Work of Melanie Klein, London: Heinemann.
Stern, D. (1985) The Interpersonal World of the Infant, New York: Basic Books
Winnicott, D. W. - (1953) ‘Transitional objects and transitional phenomena: a study of the first not-me possession’, International Journal of Psychoanalysis, 34: 89-97.

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