Theory As Maternal Environment

Theory as Maternal Environment: Using Winnicott to Explore the Beginning Psychotherapist’s Relationship to Theory Allison Wenglin Belger, Psy.D. Many well-known psychoanalytic theorists and veteran analysts speak of working with patients in a manner free from intellectual constraints and predetermined theoretical inclinations to allow for greater spontaneity, aliveness, and realness in the consulting room. Arguably, this becomes possible only after a beginning stage during which theory has been made use of and internalized to such an extent that the analyst’s own subjectivity as an analyst has developed. Only with an internalized theoretical sensitivity and the development of a creative, subjective “therapistself” can one practice ostensibly free from theoretical notions in the moment-to-moment interactions with patients. In illustrating the ways in which theory facilitates the development of the trainee, the present discussion draws upon the work of Winnicott, whose developmental theory highlights the environmental functions provided to the infant before and during the emergence of subjectivity. While Winnicott’s emphasis is on the real mother and her attunement to her infant, my emphasis is on the analogous functions that a beginning therapist’s relationship to theory can provide in the service of developing a new kind of subjectivity — that of the self-as-therapist. The beginner’s relationship to theory has critical ramifications for developing the capacity to tolerate, and develop within, his role as therapist. As an object relationship, the therapist’s relation to theory is not an interpersonal one and is thus not subject to the same aspects of humanness inherent in relations between people. However, the experience of the trainee in relation to theory and the functions that theory can provide can be one of attunement or misattunement. In Winnicott’s terms, the trainee’s relationship to the environment of theory can be considered “good-enough” or “not good-enough” as an important facilitator of development. Like the mother, theory is both external (a real object existing outside of the subject) and internal (an object represented intrapsychically). Theory can provide a holding environment akin to that provided by the mother and act as a transitional object in ways made possible by its holding functions. Further, like the mother’s care that enables the infant to develop a potential space in which subjectivity and objectivity thrive, a relationship to theory can similarly provide an internal mental space in which the trainee can grapple with the clinical field. A healthy relationship to theory, then, enables the therapist in training to inhabit his role in meaningful and genuine ways, providing him with a capacity to “play” and to be uniquely creative and generative as a provider for his patients. At the same time, however, just as some maternal environments do not meet the needs of the developing infant, certain ways of relating to theory do not facilitate optimal development in the training clinician. The development of such capacities as engaging in Winnicott’s transitional realm, developing and thriving within potential space, playing, and creating can be thwarted by “not good-enough” relationships to theory. In such cases, what might be called a False-Self relation to theory develops; potential space is foreclosed and compliant knowing reigns, or theory is rejected outright.

Theory as Holding Environment Winnicott’s theory of normative development emphasizes the holding environment provided to the infant in the earliest stages of life. This holding involves both physical and psychological aspects and leads to the infant’s egointegration, his capacity for object relating, and eventually his capacity for object usage. When Winnicott writes about the holding environment, he is describing a stage of development in which the infant and mother are one unit, as yet undifferentiated in the infant’s psyche. It is the mother’s total attunement to her infant based on her empathy that comprises the holding function and enables the infant’s ego to become integrated and his instincts to be satisfied (Winnicott, 1960/1965d). A crucial aspect of the holding function is that it allows the infant to be totally unaware of his need for a separate person: It is axiomatic in these matters of maternal care of the holding variety that when things go well the infant has no means of knowing what is being properly provided and what is being prevented. (Winnicott, 1960/1965d, p.52) In much the same way, the therapist in training has a need for a holding environment of his own that provides a similar “illusion of safety and protection” as he develops his subjectivity in a new way in relation to the patients in his care (Modell, 1993, p. 276). Initially, theory serves such a function through its availability for total introjection by the trainee. Through taking in theory, the trainee cultivates within himself a mental space similar to that provided the infant through the initial mother-infant union. Green (1997) targets this aspect of the holding function in his discussion of Winnicott’s ideas: What is of the greatest importance is the introjected construction of a framing structure...analogous to the mother’s arms in holding. This framing structure can tolerate the absence of representation because it holds the psychic space... (p.1081, italics in original) While the introjected mother is the framing structure creating and holding the psychic space of the infant, theory is the framing structure serving similar functions in the trainee. Ogden (1986) equates the holding environment with “the infant’s psychological matrix” (p. 181) in which meaning develops as subjectivity emerges. First, though, separateness goes unrecognized and the infant thrives on the “ego-

support” of the mother. During this stage, the infant is not yet prepared to acknowledge separateness or the recognition of his need for an external object. The therapist in training initially makes use of theory in a somewhat undifferentiated way. In the earliest stage of his development, he thrives on the ideas of others without fully recognizing the necessity of his reliance on these external sources. The demands placed on the trainee are so intense and potentially threatening that he finds himself, mostly unconsciously, making use of theory in such protective ways that he is spared knowing how he would experience his new role without the holding that theory provides. It is this protection from experiencing a “lack of theory” that is critical and ensured by the availability of theory in the earliest phases of the trainee’s development. Through his early introjection of theory, the trainee finds within himself a mental space in which clinical encounters can be processed without being overly threatening. Housed in this mental space is his barely emerging sense of himself as a therapist and the foundation for a new subjectivity that will develop as the trainee’s relationship to theory moves along a continuum, a trajectory similar to that of the infant as he separates from the mother-infant unit during the initial development of subjectivity. Schafer (1983) captures the essence of the holding functions of theory: In working and developing within a tradition, one is not left with the impossible job of making oneself up totally. There is a sense of authenticity that comes from working within a form, a form that is a set of constraints as well as opportunities. You would be engaged in living out a rather simple-minded, romantically individualistic fantasy to think that you could simply make yourself up from moment to moment; you would be disregarding the necessarily interpersonal matrix of learning and adaptation. (p. 286) Though it would be an “individualistic fantasy to think that ... [the trainee] could simply make ... [himself] up from moment to moment” without a relationship to the ideas of others, I believe that during the earliest stage of development as a clinician, this type of fantasy may be both developmentally appropriate and all that is possible. The infant first has an omnipotent, merged relationship to the mother-environment, and the trainee initially relies heavily on the holding provided by theory. During this initial period of reliance on theory, the trainee experiences it as an intensely powerful internal device that allows him the feeling of “knowing” something about his new role. This guidance, although defensive in extremes later in development, initially provides necessary grounding and security. If this intense, almost omnipotent, reliance on theory were not to develop over time, it would be considered problematic, indeed fantastical or delusional in extreme cases. With time and experience, the trainee’s relationship to theory changes in ways similar to the infant’s relationship to the maternal environment. With the foundation provided by his early, almost magical, relation to theory, the trainee can make use of it in ways in which his own subjectivity is expressed and his need for external ideas is both recognized and de-intensified.

Theory as Transitional Object Leading to Potential Space I shall not give an historical survey and show the development of my ideas from the theories of others, because my mind does not work that way. 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. Perhaps this is as good a method as any. (Winnicott 1945/1975b, p. 145) In his characteristically playful way, Winnicott describes here how he goes about developing his theoretical ideas, alluding to one of his central ideas on human development — what he calls the area of “transitional phenomena.” Transitional phenomena take place in an intermediate area of functioning in which inner and outer, subjective and objective, creativity and objective discovery — among other paradoxical pairs — live simultaneously. To Winnicott, the process of taking in and generating theory becomes one of simultaneous creation and discovery. Much like the infant in the earliest transitional realm of interplay between inner fantasy and outer reality, Winnicott, as a theorist, takes in what he has been given by others (other clinicians and his patients) and creates ideas of his own, making use of his subjective experience in the world, especially as an analyst. Only later, if at all, does he “interest” himself in the source of his ideas, perhaps because it is difficult to define such origins when they are part of the admixture of internal subjectivity and external sources. Goldman (1993) picks up on Winnicott’s engagement with theory, saying: Even theory was somewhat of a transitional phenomenon for him, offering him concepts that he then reinvented in accordance with his own sensibilities. (p. xii) In this vein, the beginning psychotherapist who makes use of theory in a healthy and productive way is appropriately engaging in the transitional realm. Theory becomes a transitional object whose function is, in part, to anchor and hold the therapist throughout the challenges of his work, much like the baby’s toy provides comfort in his early task of facing an external reality, a fundamental part of which is his separateness from mother. When the therapist makes use of theory in his work, the details of who generated the ideas and who is making use of them (or creating them at any given moment) must not be sought; the developing clinician requires the paradox of creation and discovery in order to be present in the room with patients. This presence is one inhabited by both subjectivity and objectivity, a pairing made possible partly by the transitional relationship to theory that enables the therapist to inhabit his newfound (or “newfinding”) subjectivity. Such a subjectivity makes demands that are exceedingly

different from those involved with his way of being in the world prior to the endeavor in which he now finds himself. Winnicott (1951/1971f) notes the mother’s acceptant role in relation to the infant’s transitional object, saying: Of the transitional object it can be said that it is a matter of agreement between us and the baby that we will never ask the question: “Did you conceive of this or was it presented to you from without?” The important point is that no decision on this point is expected. The question is not to be formulated. (p. 12) In relation to our developing subject, then, we must not ask of the trainee: “Was that idea yours or was it waiting to be found and made use of by you?” To do so would undermine the function of the transitional object that theory plays in this case. In this way, the trainee develops within himself a confidence in his capacity to think about and manage the clinical encounter, all the while supported by his engagement with the ideas of others. Here is the interplay between his own subjectivity and what we might call “objectivity.” To the therapist learning them, theoretical writings are external and objective in the sense that they are taken in as “objectively perceivable” objects. Winnicott (1948/1975c) writes that “...unless ideas can be subjective they cannot be objectively perceived” (p. 95). Along these lines, Winnicott (1967/1971c) also notes: The interplay between originality and the acceptance of tradition as the basis for inventiveness seems to me to be just one more example, and a very exciting one, of the interplay between separateness and union. (p. 99) It is the infant’s task to cope with the reality of separateness — of having an inside in relation to an outside — and to negotiate “the strain inherent in objective perception” (Winnicott, 1951/1971f, p. 13). It is the beginning therapist’s task to manage his own inner and outer realities in addition to those of his patients. This, too, is a strain involving objective perception as well as subjective apperception on the part of the therapist who must manage his endeavor at least partly through a relationship to theory that, like the child’s not-me possession, provides the therapist with an experience of confidence in a piece of the outside world that is actually also alive in his inner world. This daunting task of managing clinical engagement, then, is one made ever more tolerable and productive through a relationship to theory that is immediately supportive and ultimately generative. Like the healthy infant’s relationship to the maternal environment and, increasingly, to transitional objects symbolizing this provision, the trainee’s healthy relationship to theory undergoes developmental change along its course. In one of Winnicott’s (1963/1965c) essays devoted to dependency in infancy, he distinguishes three types of dependency: absolute dependence, relative dependence, and towards independence. When dependence is absolute, the infant is unable to make use of the mother’s momentary absences in meaningful ways and is psychically unable to know about his need for her (partly because she is still experienced as a part of the infant and not a separate entity). As the infant develops, however, with the proper foundation provided by a goodenough mother in the period of absolute dependence, he becomes able to “know in his mind that mother is necessary” (Winnicott, 1963/1965c, p. 88, italics in original). The capacity for symbolic functioning emerges from this phase of development through the infant’s gradual recognition first of his need for the mother, and later of his desire for what she, and the rest of the external world, has to offer to him. In order for the infant to develop in these ways during relative dependency, he must first have been provided with a fully attuned mother who met his needs so thoroughly that her separateness, and therefore his need for her, initially went unrecognized. With this foundation internalized, the infant is able to rely on the mother for increasingly long moments during which she is not actually present, i.e., moving toward dependence. Instead, she is present in the infant’s psyche, a presence often represented by a transitional object. In a somewhat analogous way, the therapist in training usually begins at a stage of relative dependence,1 relying heavily on his understanding of theory as a provision of internal space that keeps him company while he engages with patients. While intuitive and social capacities, as well as myriad other conscious and unconscious happenings, are on the scene, the therapist in training (in health) would likely experience himself as markedly less confident and less able to provide a holding function of his own for the patients in his care without some theoretical scaffolding as well. Using theory this way prevents him from having to rely solely on his own subjective (internal) reactions to patients and his idiosyncratic understanding of human functioning. Instead, he is comforted in knowing that though he needs help from the outside world where theory resides, he has managed to internalize important aspects of the provision, thereby enabling him to inhabit both his own subjectivity and objectively perceived ideas while in the room with patients. During this period of the trainee’s relative dependence on theory, its function as a transitional object manifests. Like the infant who is able to make use of a “Not-Me” possession to stand in for the maternal environment, the therapist in training cultivates an engagement with theory. This tangible, external body of writings and collection of ideas connects the vulnerable trainee to a more stable, external “mother-environment” that is reliable and present. Theory, itself, provides a reliable, real, external object that similarly enables the fledgling clinician to internalize a confident, knowledgeable, well-equipped internal representation of himself-as-theory.2 As the infant must have internalized the mother in fantasy, always having the real mother to hold him in the process of renouncing the omnipotently controlled internal object, so, too, must the beginning clinician be able to rely on the holding functions of theory in order to renounce it as an omnipotent, magical internal device. Theory can be thought of as an omnipotent device in that, at first, the trainee can, internally, have the “idea” that theoretical concepts make him all-knowing, fully equipped for the endeavor in which he is engaged. In this way, he is momentarily relieved of

the otherwise overwhelming recognition of all that he needs in his new role. However, in order to have an ongoing, healthy relationship to theory, the trainee must eventually find a way to recognize it as a separate set of ideas, existing in reality outside of himself, but still able to provide him with the psychic and intellectual sustenance that he needs. Recognizing this need and renouncing the omnipotent relation to theory requires the “faith” that Ogden (1986) describes when the infant releases omnipotent control of the object, and it is this process that happens when theory becomes a real, flexible agent within the subject that is therapist. Part of this process can be likened to the movement Winnicott (1969/1971g) describes between object relating and object usage. He sees object relating as an earlier, less advanced form of connecting to subjective objects primarily through projective mechanisms. In contrast, object usage involves the recognition of the object as separate from the self and beyond omnipotent control, comprised of more than projected aspects of the subject. Usage implies relating to external reality and involves the destruction and survival of the subjectively perceived object. The survival of the object in the face of this destruction (in fantasy) enables the infant to make use of it in reality. Much as the infant’s relation to transitional objects paves the way for object usage in general and for the capacity to take in “not-me” qualities in objects, so does the training therapist’s early relation to theory make possible the eventual use of the ideas of others through the taking in of the “not-me.” In both cases, these “not-me” qualities ultimately become aspects of “me-ness.” Winnicott’s (1969/1971g) summary of his ideas on object usage distill this point: The object is always being destroyed. This destruction becomes the unconscious backcloth for love of a real object; that is, an object outside the area of the subject’s omnipotent control.... The destructiveness, plus the object’s survival of the destruction, places the object outside the area of objects set up by the subject’s projective mental mechanisms. In this way a world of shared reality is created which the subject can use and which can feed back other-than-me substance into the subject. (p. 94) For the developing clinician, the initial relationship to theory — in which theoretical ideas are by necessity taken in so completely and with so little distinction between the objective and subjective qualities of those ideas — gives way to a usage of theory in which the ideas of others find a life inside the mind of the therapist. The destruction, in this case, might be expressed through the developing therapist’s repudiation of theory and/or grappling with theoretical notions to such an extent that their externality and separateness are made more tangible to the clinician. Quickly, though, this externality loses clarity as the theoretical notions in question, particularly those that resonate with the trainee, find expression in his work as “other-than-me substance in the subject” who has now made use of theory as an object. In line with Winnicott’s notions about transitional phenomena as used by the infant, the trainee must eventually be able to navigate an ever-loosening attachment to theory. This does not mean that the trainee must renounce theory outright, nor does it mean that the relationship to theory and the content that has been taken in becomes forgotten or repressed. Instead, it becomes internalized to such an extent that its form changes and its functions dissipate within the mind of the therapist who is now in a position of making use of theory in a less conscious, more abstract, less definable way. An understanding of this process is helped along through Winnicott’s (1951/1971f) own description of one of the qualities of a transitional object: Its fate is to be gradually decathected, so that in the course of years it becomes not so much forgotten as relegated to limbo. By this I mean that in health the transitional object does not “go inside” nor does the feeling about it necessarily undergo repression. It is not forgotten and it is not mourned. It loses meaning, and this is because the transitional phenomena have become diffused, have become spread out over the whole intermediate territory between “inner psychic reality” and “the external world as perceived by two persons in common,” that is to say, over the whole cultural field. (p. 5) This process of decathexis of the transitional object enables the infant to maintain an internal space more freely than if the object required an ongoing, concrete, consciously accessible life in the infant’s psyche. In much the same way, the therapist in training cultivates an internal mental space born out of his initially tangible, conscious, verbalizable application and use of theory. This space becomes potential space, an area within the therapist’s psyche that houses the now amorphous theoretical concepts. Along these lines, Deri (1978) notes: ... the good transitional object can transcend its original meaning by metamorphosing into broad, intermediate transitional space, where symbol-laden cultural activities and creative, imaginative living takes place. (p. 53) Winnicott (1963/1965c) speaks to this notion of the diffuse internalization of theoretical concepts within the more advanced clinician when he notes that theory: ... is in our bones, so to speak. We take it for granted, and we look to other aspects of growth ... (p. 83) Coltart (1992) similarly highlights this line of thinking: Much of our hard-won theory and conceptualizing becomes gradually metabolized into our own being so that eventually we hardly know, when we think, decide and speak, from whence it comes. There is nothing wrong with this — indeed, I see it as an aim for young therapists still earnestly acquiring the wherewithal of their trade. (p. 188) It is in this way that the trainee is continually moving towards independence, Winnicott’s third category of dependency inherent in the human condition.

Theory as Facilitator of the Capacity to Be Alone One aspect of the move towards independence that Winnicott highlights is that of the capacity to be alone. Winnicott (1958/1965a) posits that an individual’s ability to be alone “is one of the most important signs of maturity in emotional development” (p. 29). According to him, developing a mature capacity to be alone rests on the infant’s experience of being alone “in the presence of mother” (p. 30, italics in original). Here Winnicott addresses the paradoxical notion that for an infant to experience moments of being alone, moments in which his personal impulses can be felt in a relaxed state without pressure to respond, he is actually engaged in an ongoing, internal relationship to “the mother or mother substitute who is in fact reliably present even if represented for the moment by a cot or a pram or the general atmosphere of the immediate environment” (p. 30). While the mature form of being alone is reached first through the safety of the presence of the actual mother and later through transitional representations of her, Winnicott (1958/1965a) says that eventually: ... the individual introjects the ego-supportive mother and in this way becomes able to be alone without frequent reference to the mother or mother symbol. (p. 32) The capacity to be alone similarly applies to the psychotherapist in training who makes use of theory to find ways of inhabiting himself as a therapist in the room with patients. With the introjection of the support provided by theory, the therapist becomes able “to be alone” in the sense that he is, in concrete ways, by himself in his work. While it is true that the clinician is alone, unaccompanied by supervisors and colleagues, it is also true that he is not alone; inside him exists a “belief in a benign environment” (Winnicott, 1958/1965a, p. 32) that enables him to make use of the potential space growing in his psyche. Within this space he will find ways to negotiate clinical encounters, to enjoy an interplay between internal and external, between fantasy and reality. Drawing on Winnicott’s ideas about the capacity to be alone, Tarachau (1963) emphasizes the loss and loneliness experienced by the therapist when he makes interpretations and thus separates himself from the patient, an experience involving object loss for both parties. Tarachau asserts that the therapist tolerates this loneliness in much the same way as does the infant; he accesses “company” internally. One aspect of such company is his internalized theory-as-object that provides him the internal sustenance to manage the loss inherent in being alone in this sense. He is alone in the presence of theory much like the infant who is “alone in the presence of mother.” The fledgling therapist’s ability to make use of theory in this supportive way enables him to feel grounded in the potentially ungrounding endeavor in which he is engaged. Over time, the therapist no longer needs a concrete representation of theory in order to find the internal subjective space in which he works “alone.” Winnicott’s (1958/1965a) own summary of the development of the infant’s capacity to be alone simplifies this process: Gradually, the ego-supportive environment is introjected and built into the individual’s personality, so that there comes about a capacity to actually be alone. Even so, theoretically, there is always someone present, someone who is equated ultimately and unconsciously with the mother, the person who, in the early days and weeks, was temporarily identified with her infant, and for the time being was interested in nothing else but the care of her own infant. (p. 36) Deri (1978) addresses the result of the child’s (trainee’s) internalization of the mother’s (theory’s) holding environment: It is [within an] instinctually unexcited, tension-free state in which the child enjoys playing alone in the presence of his mother. Here the mother “holds” the child safely, not in her arms, but within the securely “holding intermediate space” that she has created for the playing child. In this space the child can play safely, trusting his own creativity, the usability of objects for symbolic play and the durable dependability of the mother, even if she must leave for periods of time. (p. 55) Like Winnicott’s healthy subject who makes use of this internalized holding environment to find meaning in his aliveness, eventually the trainee will be able to “play” as a therapist, the goal of this work in Winnicott’s view, indeed the essence of a healthy subjective existence at all.

True-Self Relationship to Theory and the Capacity for Play and Creativity The general principle seems to me to be valid that psychotherapy is done in the overlap of the two play areas, that of the patient and that of the therapist. If the therapist cannot play, then he is not suitable for this work. (Winnicott, 1971e, p. 54, italics in original) Winnicott saw playing as an outgrowth of the development of a capacity within an individual to inhabit the potential space originating between mother and infant. It is in this space, through play, that a person can “live creatively” in

an expression of his True Self (Winnicott, 1971a, p. 71). For Winnicott, one aspect of the development of a capacity for creative play is the provision of “summation” of relaxation and play experiences. He says that this: … summation or reverberation depends on there being a certain quantity of reflecting back to the individual on the part of the trusted therapist (or friend) who has taken the (indirect) communication. In these highly specialized conditions the individual can come together and exist as a unit, not as a defence against anxiety but as an expression of I AM, I am alive, I am myself ... From this position everything is creative. (1971e, p. 56) As Winnicott points out, in order to encourage patients’ play and creativity, the therapist, himself, must make use of his own playing and creativity in relation to the material of patients. This task demands of the therapist — especially in the formative stages of being in that role — an enhanced attunement to his own relaxation and communicative playing. Because theory provides a sense of holding and groundedness and a background of “not-me-ness” against which the trainee safely finds “me-ness,” it enables him to “relax” in the room and to make himself available for the presence of another being. In Winnicott’s terms, the trainee’s “True-Self use of theory” allows his “personal impulse” to be expressed and the essence of himself as a therapist to flourish. The trainee’s play — his communications through interpretations, gestures, reflections, etc.— is made possible by a reflecting function that, in this case, is provided by theory. Along these lines, theory serves a reflecting function for the developing clinician whose own ideas (actually an amalgam of internal and external concepts) find reflection in those presented in the writings of others. In line with Winnicott’s (1967/1971d) idea that the baby sees himself in his mother’s eyes, the therapist sees himself, his ideas, in the writings of others. During his readings, the trainee, who has in mind his own sense of his work and his ideas about human functioning, finds in the world reflections on his thoughts — writings that overlap with his own thinking, as well as writings that differ from his own thinking. In this way, the trainee confronts both similarity and difference, finding not only separateness but also communication through theory. Something important and powerful occurs when the trainee finds in theory a reflective function through which he then becomes able to play with — and communicate through — his own (now enlivened) ideas about his patients. In Winnicott’s (1971e) words: The searching can come only from desultory formless functioning, or perhaps from rudimentary playing, as if in a neutral zone. It is only here, in this unintegrated state of the personality, that that which we describe as creative can appear. This if reflected back, but only if reflected back, becomes part of the organized individual personality, and eventually this in summation makes the individual to be, to be found; and eventually enables himself or herself to postulate the existence of the self. (p. 64, italics in original) For the beginning therapist, something akin to “desultory formless functioning” or “rudimentary playing” happens when he encounters theory. One aspect of his engagement with the ideas of others, representative of the ongoing, historical, external field predating his work, is like the unintegrated state of a developing subject in infancy (or in adulthood as a patient) wherein the self can emerge through its encounters with something “Other” that reflects back to the subject something “Me.” Ogden (1986) elaborates Winnicott’s notions, saying that when the infant sees himself reflected in the mother’s eyes, …this constitutes an interpersonal dialectic wherein “I-ness” and otherness create one another and are preserved by the other. The mother creates the infant and the infant creates the mother ... Meaning accrues from difference. (p. 209) Thus, it is the evolution of the infant-as-subject through his encounters with the separate mother that leads to his meaningful existence in the world. Similarly, the evolution of the therapist-as-subject is facilitated by encounters with separateness in the form of theory. Finding one’s self through interactions with an external provision is at the core of Winnicott’s thinking. The reflective function enabling self discovery is the heart of his “facilitating environment.” Theory provides this facilitating environment for the trainee. In this vein, in his discussion of Winnicott’s own theoretical writings, Ogden (2001) suggests that: … [his] writing works ... in large measure by means of its power to understand (to correctly interpret the unconscious of) the reader. Perhaps all good writing ... to a significant degree, works in this way. (p. 306) And, perhaps all good theory does as well. Symington (1996) expresses a similar idea in his criticism of the intellectualization of the training process of analytic therapists: We all require an inner searching activity so that our knowledge becomes assimilated to our emotional self in such a way that each reflects the other. It is only then that our knowledge becomes the possession of the true self and only then that knowledge finds its true function — the enlargement of the mind. (p. 20) Both Ogden and Symington are talking about that intermediate area of experience, an area between subjectivity and objectivity, me and not-me, internal and external, in which ongoing engagement is Winnicott’s foundation of creative, alive, and meaningful selfhood. It is this place in which the beginning therapist finds his own identity as a therapist and in which he develops a new capacity for creativity and play in relation to others who depend on his facilitation of their own development. Winnicott’s (1967/1971d) discussion of the infant’s experience of being real is exactly what the training therapist seeks and needs, and, in health, finds partly through his use of theory:

Feeling real is more than existing: it is finding a way to exist as oneself, and to relate to objects as oneself, and to have a self into which to retreat for relaxation. (p. 117) This statement captures important elements of the burgeoning subject who is the therapist in training. Khan (1972), writing about Winnicott’s own capacity to make use of both theory and the “real” experience with patients, speaks to this aspect of healthy development of subjectivity in the therapist: He was a clinician endowed with a complex sensibility, and over the years he had actualized in himself a mercurial intellectuality that informed all his clinical work. However, he also cultivated in himself the generous discipline of letting the patient’s psychic reality find its mood and character in the analytic space. (p. 14) It is this interplay between the ideas of Winnicott as clinician and the internal life of the patient that is made possible by his sophisticated use of theory; he makes use of theoretical notions in order to find space within himself where he can house the experience of his patients. In Winnicott’s terms, our trainee in health cultivates the potential space in which therapeutic attunement occurs by relating to the environment of theory. The result is a capacity for real experience, for play and creativity, and for the ongoing enrichment of experience made possible by the coexistence of internal and external. Winnicott (1967/1971c) extends these ideas on playing and creativity into the arena he calls “cultural experience.” His idea is that, with a well-developed capacity for play and creativity, the individual is on his way to inhabiting “what life itself is about” (p. 98). The individual is available for contributing to, and taking from, the cultural field, and in this way experiencing meaning in his life. He writes: In using the word culture I am thinking of the inherited tradition. I am thinking of something that is in the common pool of humanity, into which individuals and groups of people may contribute, and from which we may all draw if we have somewhere to put what we find. (p. 99, italics in original) When the training therapist engages with theoretical ideas put forth by others, he finds meaning in his role as a participant in a longstanding tradition of psychoanalytic practice. This meaning enriches his sense of himself as a therapist and enlivens his being in this confusing, challenging, and often threatening role.

False-Self Relationship to Theory The focus of this discussion so far has been on the healthy ways in which “good-enough” relationships to theory can serve developmental needs for the analytic psychotherapist in training. Based on Winnicott’s concept of False Self personalities, this section will explore alternative possibilities — relationships to theory in which healthy engagement is lacking and compliant reactivity dominates, or in which theory is rejected outright. Winnicott (1960/1965d) describes the False Self as a split off part of an individual who, for a variety of reasons, is unable to express his True Self, his “personal impulse.” In Winnicott’s view, this False Self functions as the reactive protector of the true core of the individual in an environmental context in which impingements and neglect, rather than attunements, have dominated the developmental field. The False Self is reactive instead of proactive and responsive instead of generative or creative. This part of the personality is highly attuned to the needs of others, surviving by inhabiting what is a purportedly meaningful existence. Unfortunately, such an attempt at meaningful aliveness is undermined by the very nature of the False Self — the compliant way of relating in the world. For individuals in whom a False Self predominates, there is minimal possibility for developing potential space and almost no capacity for creativity and play. Indeed, the genuine subjectivity of the individual is thwarted if not completely shut down. Similarly, there are versions of training clinicians’ engagements with theory that could be considered “false-self relationships to theory.” In contrast to healthy “true-self relationships to theory,” in which holding and transitional functions are served and potential space abounds, false-self relationships to theory foreclose potential space and inhibit healthy development of the therapist-as-subject. Despite managing a true-self existence as a subjective individual in his personal life,3 when faced with the daunting task of becoming an analytic therapist, the trainee may find it difficult to cultivate and express a similar manifestation of his essential self in his professional role. This difficulty is often pronounced in relation to theory, in part because it is an aspect of the external environment that can be readily used for defensive purposes. Further, even in the best of circumstances, it is quite a task to make use of an external body of work without denuding one’s own internal resources of their vitality when faced with overwhelming demands on one’s being. Some of these demands pull for instantaneous, exacting therapeutic action. Speaking to this element of analytic work, Wheelis (1958) notes: ... the analyst — he who, of all people, is least disposed to magic —becomes the object of the most intense and continuous demand for magical performance. (p. 229) Under sometimes intense pressure from patients to feel certain feelings, to think certain thoughts, or to be certain ways, the trainee consciously and unconsciously seeks a source of grounding and containment that will alleviate some of the tensions imposed upon him. Along these lines, in discussing the work of the French psychoanalyst, Francois Roustang, Bacon (1995) underscores the pressure that patients exert upon analysts to know, to be the “One Who Knows,” in Roustang’s words (p. 35). Likewise, Schafer (1983) describes such pressures when he says: “Sitting in the analyst’s chair, it can be very difficult to acknowledge that one just doesn’t understand” (p. 288).

In the face of these and other forces, especially in the early stages of one’s training, the possibilities for misusing theory abound as the demand for knowledge intensifies. Theory has the potential to “hold” the trainee through these difficult times, to be a source of ideas that are simultaneously created and found, and eventually to be fodder for “play” in the presence of patients. However, theory can also be used in ways that interfere with the healthy development of the therapist and ultimately the patients who come to see him. Symington (1996) writes: In their unconscious, patients sense whether interpretations have been arrived at through internal struggle and resolution or whether it is just being passed on from master to pupil and pupil to patient. (p. 21) Roustang, quoted in Bacon (1995), speaks to the problematic use of knowledge under the pressure to be knowledgeable within the analytic dyad: An analyst who knows is not an analyst for he confines the analysand to his knowledge and thus prevents him from gaining access to what he has “never heard before.” ... If one does not succeed in permanently rejecting the “knowing” in order to return to “the supposed to know” as a working hypothesis, and in expelling “prestige” in order to concentrate on “function” then analysis will be unquestionably perverted. For the drama of the social, communal organization of psychoanalysts is produced by confusing the supposed to know with the knowing, by confusing function with prestige. (p. 35) This “perversion” of the analytic endeavor to which Roustang refers is the core of a false-self use of theory. Instead of making room for subjective and objective states to coexist and instead of facilitating the exploration of patients’ desires for therapists to “know,” this type of relationship to theory forecloses such possibilities and deadens the therapeutic potential. Much like the fate of potential space in an individual with a False Self personality, the analytic space in such cases suffers, collapsing into lifeless rigidity. We can see, then, that, like the False-Self subject in the earliest phases of life, the trainee engaging in a false-self relation to theory is reactionary and compliant with respect to ideas. Often occurring unconsciously, such a relationship to theory evolves under the unique pressures of becoming a therapist. In these cases, theory is not used as a way of engaging in a dialogue with others or of finding reflection and elaboration of one’s own ideas. Instead, theory becomes a doctrine that the trainee takes in compliantly, swallowing whole what are perceived as external sources of knowledge and technique that are then used as guides for behaving “as a therapist.” There is little, if any, room for an interplay between the subjective experience and ideas of the trainee and the writings of others in the field. Likewise, the potential space that in health develops out of transitional uses of theory — in which internal and external enliven each other — collapses under the pressure of knowing, leaving the trainee to operate as a delegate of ideas instead of a “real” presence in working with patients. As Winnicott (1960/1965b) understands the False Self personality to exist as protector of the True Self under threat of annihilation, we can understand a trainee’s false-self relationship to theory as a protective measure designed, mostly unconsciously, to maintain his sense of security in the face of enormous pressures from patients and from within. Like the infant and young child facing impingements that threaten the core of his individuality, the trainee who is unable to make use of the environment of theory in healthy ways takes control by reversing the normative developmental equation. Instead of the environment working around the needs of the growing subject, the growing subject reacts to the environment. In this way, the subject finds cohesion and is sustained structurally through rigid, but predictable, reactions to the environmental pull. The training clinician perceives this pull as a mandate of sorts that dictates how to behave in the presence of patients. In Winnicott’s (1950/1975a) words: The “individual” ... develops as an extension of the shell rather than of the core, and as an extension of the impinging environment. What there is left of a core is hidden away and is difficult to find.... The individual then exists by not being found [italics in original]. The true self is hidden, and what we have to deal with clinically is the complex false self whose function is to keep this true self hidden. (p. 212) For the trainee who develops in this way, the shell is the rigidified use of theory that protects the vulnerabilities of the therapist-self. In such cases, the sense of being real and the opportunity for personal meaning dissipate, with the subject becoming a muted, though functioning, respondent. The trainee who works in this false-self way lacks spontaneity, creativity, and the capacity for play, even as he experiences some sense of cohesion through his rigid implementation of the ideas he reads and hears. Addressing the foreclosure of creativity in the psychoanalyst, Wheelis (1958) writes powerfully about the restrictive nature of dogmatic relations to theory: Of those courses open to ... [the analyst] the least painful is a retreat into dogma. If he takes this path, the cancerous doubts which threaten his vested professional interest are abolished by fiat. A vital relation between theory and practice is one of mobile interaction, each exerting an effect on the other. It calls for skepticism, freedom of inquiry, and tolerance of doubt. It presupposes the freedom to revise theory in the light of experience, and the intuition to look for undiscovered aspects of reality because of the implications of theory. This is lost by him who takes refuge in dogma. Henceforth the criterion of truth is not experience, but the book. The sanctity of psychoanalytic theory and technique is maintained, but at the cost of severing its connection with clinically observed events. As he sees it, his experience matches his theory quite closely; but the matching takes place in his own mind. He simply sees black where he needs to see black, and white where he needs to see white. (pp. 231-232) This quotation captures the essence of a false-self relationship to theory, including not only the compliance, reactivity, and rigidity, but also the elaboration of the intellectual at the expense of the real. In line with Winnicott’s

ideas that those with False Self personalities often rely heavily on their intellectual capacities and even achieve recognition and success in academic endeavors, those with false-self engagements with theory relate to the ideas of others in wholly intellectual ways. Again, the interplay between the ideas of the therapist and the theorists shuts down, with theory dictating the course of analytic encounters. This type of relating to theory is problematic and limiting since it allows no room for the trainee to “not know” about something in the clinical field. Arguably, this capacity to suspend knowing — to welcome ambiguity and tolerate the ongoing emergence of novelty and confusion — is the hallmark of psychoanalytic therapy. Along these lines, in discussing the nature of psychoanalysts as inherently unknowing, indeed purposefully so, Phillips (1996) succinctly addresses the problem of a “false-self relationship to theory” in which such unknowing is denied: “If psychoanalysis is not the means to a personal style, it merely hypnotizes people with a vocabulary.” Ogden’s (1989) discussion of the “fear of not knowing” and the defenses available to one who cannot tolerate “what he feels” is relevant to the defensive false-self relation to theory: The illusion of knowing is achieved through the creation of a wide range of substitute formations that fill the “potential space” in which desire and fear, appetite and fullness, love and hate might otherwise come into being.... In the absence of the capacity to generate potential space, one relies on defensive substitutes for the experience of being alive (such as the False Self personality organization ...). (p. 195) For the beginning therapist who cannot tolerate the pressures to know about the desires of the patient and his own desires in relation to his new role, theory becomes the defensive substitute formation akin to the False Self organization to which Ogden refers. Bacon (1995) similarly targets the misuse of theory as an extension of the wish of analytic clinicians to forego desire in relation to the analytic venture. In discussing the “limitlessness” of psychoanalysts’ theoretical discussions, he offers the following explanation: ... I would like to suggest that this sense of limitlessness is also the expression of a desire that is deeply rooted in psychoanalytic thinking and practice — a desire to end all desire, to wrap everything up and leave no gaps and thus experience no lack. A more despairing way of phrasing this would be to say that it is an attempt to swallow the ocean to prevent ourselves from drowning in the sea of possibilities that our methods and theories so confidently expose. (p. 16) Further, Guntrip (1996) cautions, “We dare not pose as omniscient and omnipotent because we have a theory” (p. 753). Schafer (1983) asserts, “The tension is one that exists between organizing your experience and becoming a slave to it [theory]” (p. 287). And, in a letter to Melanie Klein in 1952, Winnicott, himself, warns that the language of psychoanalysis “must ... be kept alive as there is nothing worse than a dead language” (Rodman, 1987, pp. 3435). To Winnicott, “dead” means not personalized. If theory is not used to reflect and encourage the expression of the therapist’s self, a false-self relation to theory emerges instead, deadening the ideas and the originality of the therapist. Within Winnicott’s framework, there are still other ways this false-self relation to theory often manifests in the vulnerable trainee. For example, Smith (n.d.) writes of “conscious and unconscious identifications with former supervisors, training analysts, teachers, and theorists in the analyst’s mind at work” (p. 1); and Symington (1996) highlights “the need for the psychotherapist to detach himself from a rigid omnipotent imago and not to allow himself to be controlled by it” (p. 1). Similarly, Ogden (1989) writes of an “unconscious identification with an omnipotent internal object” that interferes with the capacity to be one’s self, even to know one’s self, as a therapist: Analytic candidates and other trainees frequently utilize this type of unconscious identification with an omnipotent internal object (such as an idealized version of one’s own analyst). This identification serves as a defense against the anxiety that the candidate does not feel like an analyst with his patients ... the omniscient internal object serves as a substitute formation obscuring an underlying confusion about who one is and who the object is. (p. 206) The emphasis here is on the internal object as a body of ideas — theoretical notions that, unconsciously idealized, become the protector of the spontaneous core of the trainee in much the same way the False Self protects and hides the True Self in Winnicott’s troubled subject early in life. Though the unconscious intent in such a set-up is protective and ameliorative, because of the inability to make use of theory in transitional ways, the outcome is the collapse of potential space and the denuding of the analytic field. In Casement’s (1985) words, ... dogmatic certainty will always constrict an analyst’s capacity to think imaginatively about the patient. It also constricts the analytic space, without which ... patients cannot grow most fully into the richness of their own creative potential. (p. 191) The trainee who engages in such a protective maneuver lacks spontaneity and creativity and practices falsely from a Winnicottian perspective. Of course, there are false-self aspects of relating to theory in which all clinicians engage at times. However, while all trainees, indeed analytic therapists and psychoanalysts of all ranks, succumb from time to time to a dogmatic use of theory, the hope is that most make use of theory in the ways that generate therapeutic aliveness in the presence of patients. Another false-self relationship to theory is when one is actively atheoretical in one’s work. It is healthy to grapple with ideas in the process of integrating them into one’s own subjectivity and of finding one’s self as a therapist. However, an outright rejection of theory and its functions is a kind of false-self relationship to theory where there is an over-reliance on the self in the face of an environment that is not meeting developmental needs.

Rejecting the environment of theory is a trainee’s way of protecting an aspect of himself that experiences any relationship to theory as threatening. In some cases, theory can be thought of as an impingement in the sense that too much theory has been introduced too early for the trainee to integrate it into his experience base. In these cases, the trainee might feel unsettled by the novel and seemingly untenable ideas with which he is presented, and thus become overprotective of his previous ways of thinking and feeling. Another possible reason for rejecting theory outright is that the trainee experiences it as over-intellectualized and not helpful enough with regard to the emotional strains involved in treating patients. Further, the ideas offered in theoretical papers may feel impersonal, not quite capturing the uniqueness of the trainee’s internal experience in the role. Feeling such a lack of attunement from theory in these ways leads some trainees to reject the environment and to over-rely on internal capacities. This is, paradoxically, much like the infant faced with impingements who is forced to “study the object and of all that is possible to see in the object some meaning that ought to be there if only it could be felt” (Winnicott, 1967/1971d, p. 113). Because the personal “meaning” of theory is not experienced, the trainee in this bind paradoxically does away with theory while forcefully recognizing it. This forceful recognition can be thought of as the expression of the vulnerable, desperate part of the trainee that secretly “studies” theory with the hope of finding reflection there. However, the stronger voice of rejection prevails through often loud renunciations, convincing the fragile subject of his ability to function on his own. To this point, commenting on the struggling analyst in training, Wheelis (1958) writes: ... he may make of his doubts a counterdogma and become a professional dissident, expending his creative potential in attacks on the orthodox. (p. 234) The effect of this set-up is that the trainee is ill-equipped to meet the demands of his work in the long run. While momentarily convinced of his independence and abilities, eventually the trainee will find that his capacity for creativity, reflection, and playing as a therapist is undermined in the absence of the holding and transitional functions that theory can provide. Thus, the problem is two-fold: the clinician lacks important and necessary knowledge about human functioning and the analytic endeavor (content deficits); and he is not supported internally by the potential grounding functions provided by engagement with theory (process deficits). Addressing the first of these problems, Winnicott (1971a) notes: While it is the patient who is all the time teaching the analyst, the analyst should be able to know, theoretically, about the matters that concern the deepest or most central features of personality, else he may fail to recognize and to meet new demands on his understanding and technique when at long last the patient is able to bring deeply buried matters into the content of the transference, thereby affording opportunity for mutative interpretation. The analyst, by interpreting, shows how much and how little of the patient’s communication he is able to receive. (p. 72) It is difficult to understand how it is that a beginning therapist whose personal psychic development has progressed in predominately healthy, “true-self” ways might develop this type of relation to the world of theory. However, the type and intensity of the demands involved with becoming an analytic therapist make some people ill-suited for the work in the long-run because of the way the self of the therapist is used, pulled, and prodded. The point here is not to pathologize this lack of fit, but rather to understand how certain ways of using and not using environmental provisions can emerge in people confronted with the sometimes overwhelming challenges of training and practice. This is not to suggest that such people lose their identity and sense of themselves in their lives, reverting to a falseself existence in global ways. On the contrary, the present discussion highlights the developmental needs of a psychotherapist in training and the newfound vulnerabilities in his task of cultivating a sense of himself-as-therapist. For some, working with theory can serve important functions towards the emergence of a therapist-self. For others, given the demands on all aspects of functioning and, perhaps, a poor fit for the work, theory is either used in omnipotent, compliant ways, or is rejected outright because of doubts about its usefulness. In these latter cases in which theory is rejected, the trainee has actually turned inward, using more of himself and less of the environment in facilitative ways. While the dogmatic, omnipotent style and the atheoretical approach seem to fall at opposite ends of a spectrum, they are actually different manifestations of a similar underlying problem, which is that the individual experiences some type of failure with regard to the holding needed in the early stages of his work. In response to this experience, he develops a rigid, fierce way of becoming independent. In the dogmatic approach, he maintains an internal sense of omnipotence, thereby avoiding surrender to (acknowledgement of) the pressures he experiences. In the atheoretical approach, the denial of the need for an environment outside of the self is protective in its design to maintain a similar feeling of being fine on one’s own. In both cases, though, the creative and playful aspects of the analytic endeavor are ultimately impossible.

Conclusion This paper is intended to stimulate our collective thinking about how and to what ends we make use of theory as we develop within our role as therapists. While the analogy between Winnicott’s infant and the therapist in training is not seamless, it nevertheless provides a fruitful way of thinking about the development of a psychoanalytic professional self. A trainee’s engagement with the environment of theory is one of the pivotal aspects of his development within this new and challenging role. Footnotes:

1 Winnicott's first phase of absolute dependence is unique to the beginnings of life. This dependence is so extreme, drawing an analogy between it and a novice psychotherapist is not particularly useful. 2 The term "himself-as-theory" is used here because, at this stage, the therapist has not yet internalized a sense of himself-as-therapist, but, toward this end, he is in the process of introjecting the embodiment of theory. This is akin to describing the infant's internalization of the good-enough maternal environment as internalizing "the infant-asmother." 3 In discussing false self relationships to theory, I am assuming that the trainee has managed to develop and thrive as a True Self in his personal life. In other words, he is not globally restricted to what Winnicott (1971b) describes as a compliant, deadened existence. References: Bacon, R. (1995). Paranoid knowledge. Free Associations, 5:1(33), 10-46. Casement, P. (1985). Learning from the patient. New York: The Guilford Press. Coltart, N. (1992). Slouching towards Bethlehem. New York: The Guilford Press. Deri, S. (1978). Transitional phenomena: Vicissitudes of symbolization and creativity. In A. Grolnick and L. Barkin (Eds.), Between reality and fantasy: Transitional objects and phenomena (pp. 43-60). New York: Jason Aronson, Inc. Goldman, D. (Ed.). (1993). Introduction. In In one’s bones: The clinical genius of Winnicott (pp. xi - xxix). New Jersey: Jason Aronson, Inc. Green, A. (1997). The intuition of the negative in playing and reality. International Journal of Psycho-Analysis, 78:6, 1071-1084. Guntrip, H. (1996). My experience of analysis with Fairbairn and Winnicott. International Journal of PsychoAnalysis, 77, 739-771. Khan, M. M. R. (1972). Introduction. In D. W. Winnicott, Holding and interpretation: Fragment of an analysis (pp. 1-18). New York: Grove Press. Modell, A.H. (1993). The ‘holding environment’ and the therapeutic action of psychoanalysis. In D. Goldman (Ed.), In one’s bones: The clinical genius of Winnicott (pp. 273-290). New Jersey: Jason Aronson, Inc. Ogden, T. (1986). The matrix of the mind. New Jersey: Jason Aronson, Inc. Ogden, T. (1989). The primitive edge of experience. New Jersey: Jason Aronson, Inc. Ogden, T. (2001). Reading Winnicott. Psychoanalytic Quarterly, LXX, 299-323. Phillips. A. (1996). Terrors and experts. Cambridge, Massachusetts: Harvard University Press. Rodman, F. R. (Ed.). (1987). The spontaneous gesture: Selected letters of D. W. Winnicott. Cambridge, Massachusetts: Harvard University Press. Schafer, R. (1983). The analytic attitude. New York: Basic Books, Inc. Smith, H. (n.d.). Hearing voices: The fate of the analyst’s identifications. Unpublished manuscript. Symington, N. (1996). The making of a psychotherapist. London: Karnac Books. Tarachau, S. (1963). An introduction to psychotherapy. New York: International Universities Press. Wheelis, A. (1958). The quest for identity. New York: W.W. Norton and Company, Inc. Winnicott, D. W. (1965a). The capacity to be alone. In The maturational processes and the facilitating environment (pp. 29-36). Connecticut: International Universities Press. (Original work published 1958) Winnicott, D. W. (1965b). Ego distortions in terms of true and false self. In The maturational processes and the facilitating environment (pp. 140-152). Connecticut: International Universities Press. (Original work published 1960) Winnicott, D. W. (1965c). From dependence towards independence in the development of the individual. In The maturational processes and the facilitating environment (pp. 83-92). Connecticut: International Universities Press. (Original work published 1963) Winnicott, D. W. (1965d). The theory of the parent-infant relationship. In The maturational processes and the facilitating environment (p. 37-55). Connecticut: International Universities Press. (Original work published 1960) Winnicott, D. W. (1971a). Creativity and its origins. In Playing and reality (pp. 65-85). New York: Basic Books. Winnicott, D. W. (1971b). Dreaming, fantasying, and living: A case-history describing a primary dissociation. In Playing and reality (pp. 26-37). New York: Basic Books. Winnicott, D. W. (1971c). The location of cultural experience. In Playing and reality (pp. 95-103). New York: Basic Books. (Original work published 1967) Winnicott, D. W. (1971d). Mirror-role of mother and family in child development. In Playing and reality (pp. 111118). New York: Basic Books. (Original work published 1967) Winnicott, D. W. (1971e). Playing: Creative activity and the search for the self. In Playing and reality (pp. 53 - 64). New York: Basic Books. Winnicott, D. W. (1971f). Transitional objects and transitional phenomena. In Playing and reality (pp. 1-25). New York: Basic Books. (Original work published 1951) Winnicott, D. W. (1971g). The use of an object and relating through identifications. In Playing and reality (pp. 8694). New York: Basic Books. (Original work published 1969)

Winnicott, D. W. (1975a). Aggression in relation to emotional development. In Through paediatrics to psychoanalysis: Collected papers (pp. 204-218). New York: Basic Books. (Original work published 1950) Winnicott, D. W. (1975b). Primitive emotional development. In Through paediatrics to psycho-analysis: Collected papers (pp. 145-156). New York: Basic Books. (Original work published 1945) Winnicott, D. W. (1975c). Reparation in respect of mother’s organized defence against depression. In Through paediatrics to psycho-analysis: Collected papers (pp. 91-96). New York: Basic Books. (Original work published 1948) Allison Wenglin Belger, Psy.D. [email protected]

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