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Home Contents Document Winnicott, D.W. (1986). Holding and Interpretation: Fragment of An Analysis. London: The Hogarth Press and the Institute of P..
(1986). The International Psycho-Analytical Library, 115:1-194. London: The Hogarth Press and the Institute of Psycho-Analysis.

Holdingand Interpretation:Fragmentof An Analysis

D. W. Winnicott

Contents
Introduction (by M. Masud R. Khan) Fragment of an Analysis Withdrawal and Regression References 1 19 187 193

Introduction
M. Masud R. Khan
S M! si" months before #r Winnicott$s death in %anuary &'(&) a grou* of young Anglican *riests in+ited him to come to tal, to them. -e acce*ted) and in a casual e"change of con+ersation they told him that what they needed guidance about was how to differentiate between a *erson who see,s their hel* because he is sic, and needs *sychiatric treatment) and one who is ca*able of hel*ing himself through tal,ing with them. .elling this story to me) Winnicott said that he had been ta,en abac, by the awesome sim*licity of their /uestion. -e had *aused a long while) thought and then re*lied0 If a person comes and talks to you and, listening to him, you feel he is boring you, then he is sick, and needs psychiatric treatment. But if he sustains your interest, no matter how grave his distress or conflict, then you can help him alright. I was dee*ly im*ressed by the wisdom of Winnicott$s re*ly) and since then) whene+er I see a *erson in consultation) this statement of his is ne+er out of my mind. Re1reading Winnicott$s 2Fragment of an Analysis3 has brought that /uestion into an e+en shar*er focus for me. We ha+e two accounts of this *atient from Winnicott) one which he recorded in his *a*er 2Withdrawal and Regression3 (Winnicott 1954a) re*roduced in the A**endi" to this +olume)) and the other *resented in 2Fragment of an Analysis3) of which this is the definiti+e te"t.1 It is instructi+e to com*are these accounts in their style) character and content. For my argument it is im*ortant to distinguish between boring and boredom. The Oxford English Dictionary defines the +erbal substanti+e boring as 2the *ractice of annoying and wearying others3) and the noun boredom as 2the state of being bored4 tedium) ennui3. It is my hy*othesis here that boring has the /uality of the 2anti1social tendency3 (Winnicott 1956) and im*lies a demand and a ho*efulness) whereas boredom is an organised and defensi+e mood and a *sychic structure. Similarly feeling bored is a normal state and


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An earlier +ersion was *ublished in Giovacchini (1972).

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different from boring. When I re1searched into Winnicott$s writings for the antecedents of his idea that boring is a sym*tom of *sychiatric sic,ness) I found that one can trace it) though in indirect and ob+erse ways) from his earliest writings. Winnicott (1936) himself has told us that 2careful history1ta,ing has had a *rofound effect on my outloo,.53 .o witness his way of obser+ing infants and children is often +ery re+ealing towards a true understanding of his later so*histicated *sychoanalytical hy*otheses. .he cases *resented in his first boo,) Clinical Notes on Disorders of Childhood (1931)) already establish his distincti+e style and sensibility as a clinician. -e always obser+es the infant and a child as a whole *erson in his given careta,ing en+ironment. .wo cha*ters from that first boo, ha+e been re*ublished in his collection of *a*ers) Through Paediatrics to Psycho-Analysis (1975). What stands out from his case1material in those cha*ters is how Winnicott singles out restlessness and fidgetiness in children for s*ecial obser+ation. .he fidgety child cannot *rocess and master *sychically) through playing, his e"citement and an"iety. -e turns them into beha+ioural 2nuisances3) e.g. tics) fidgetiness) disorders of a**etite) consti*ation etc) as a**eal to the en+ironment. .his *hase of Winnicott$s clinical e"*erience finds its first theoretical statement in his *a*er The Manic Defence (1935). My *ur*ose here will be to find out what are the *sychodynamics of that *sychic state which com*el a *erson to be boring. It is not an accident that) mo+ing from his clinical data from *aediatric wor, with children to analysis of adults) Winnicott should write his first serious analytic *a*er on manic defence) which is an intra1*sychic way of dealing with an"ieties that ha+e their beha+ioural counter*arts) fidgetiness and restlessness) which he had obser+ed in children. Winnicott (1935) *ostulates that he has come 2to com*are e"ternal reality not so much with fantasy as with an inner reality3. .his seemingly casual statement carries a +ital shift in Winnicott$s a**roach to *sychic e"*erience. 6ater he was to see in com*ulsi+e fantasying a negation of *sychic reality0 2fantasying remains an isolated *henomenon absorbing energy but not contributing 7 in to dreaming or to li+ing3 (Winnicott 1971). Winnicott sees in manic defence an attem*t to deny inner reality) a flight to e"ternal reality and an attem*t to maintain 2sus*ended animation3. -e gi+es four clinical sam*les to ma,e his *oint ( Winnicott 1935). .he first is of 8illy) aged fi+e. -e had been referred for restlessness and inability to en9oy what he had ac/uired. In analysis) 8illy$s games were not playing but wild attac,s. As the child$s *ersecutory an"iety lessens) he begins to be able to use material for *laying and e"*ressing concern for the characters of his fantasy. .he second) #a+id (aged eight)) an asocial child) came to analysis for being turned out of school on account of 2se" and la+atory obsession3. In an early session the
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child had remar,ed0 2I ho*e I am not tiring you3) and Winnicott adds that 2the aim to tire me out soon asserted itself3. 8ut alongside there was in this child the need to sa+e the analyst from e"haustion) and he *ro+ided Winnicott with com*ulsory rest *eriods. What became clear was 2that it was he who was becoming e"hausted3. ne can see how clearly tiring and boring are related together) as techni/ues of co*ing with inner stress. .he boring *atient is trying to maintain omni*otent control o+er his inner reality by obsessional o+er1control of language and material. -is narrati+e is a *etrified s*ace where nothing can ha**en. Winnicott$s ne"t case of :harlotte (aged ;<)) who was clinically a de*ressi+e with suicidal fears) gi+es account of how the *atient re*orted a stoc, dream0 2she comes to a railway where

there is a train) but the train never starts. After she had settled into her analysis she had a dream where the train started. Winnicott inter*rets0 2In sim*le language) trains which start to mo+e are liable to accidents.3 .he need in manic defence is to free=e all *ossibility of anything ha**ening. .his is why I am e"tending Winnicott$s conce*t to *ostulate that the *atient who com*els boring narrati+e on us is not letting language and meta*hor elaborate or change his e"*erience. -e creates a s*ace of discourse where both he and the analyst are *aralysed by the techni/ue of the narrati+e as well as its monotonous and re*etiti+e contents. .he fourth case is of an obsessional *atient) Mathilda (aged ;'). When) in a session (from which Winnicott re*orts)) she had brought a >olyfoto of herself (?@ images) for him to loo, at) Winnicott had disco+ered in it the *atient$s wish for 2a denial of her deadness by loo,ing and seeing3) and how the *atient had felt it more real for me to see her photo (a ?@th of her) than for me to see her herself. .he analytic situation (which she has s*ent four years *roclaiming to be the reality for her) now seemed to her for the first time to be unreal) or at least a narcissistic relationshi*) a relationshi* to the analyst that is +aluable to her chiefly for her own relief) a ta,ing without gi+ing) a relationshi* with her own internal ob9ects. She remembered that a day or two before she had suddenly thought) Ahow awful to be really oneself) how terribly lonelyB.3 In these clinical +ignettes we already ha+e the essentials of Winnicott$s a**roach to the *atient. -ere we can already see him /uestioning the authenticity for the *atient of what he or she *roduces or *resents in the analytic situation and relationshi*. From this I would conclude that that which is boring is inherently inauthentic) both for the *atient and the analyst. And yet we ha+e to learn to tolerate this counterfeit discourse in order to hel* the *atient. Fre ! (1895)) in the +ery first case where he totally abandoned hy*notic techni/ues and wor,ed e"clusi+ely with free1association method) had encountered this 2boring factor3) and remar,ed0
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2.he story which FrCulein !lisabeth told of her illness was a wearisome one.53 (my italics). In the conte"t the ne"t im*ortant *a*er by Winnicott i" #e$aration in #e"$ect of Mother%" &r'ani(e! Defence a'ain"t De$re""ion (1948a). -ere Winnicott introduced his conce*t of 2a false re*aration3) which deri+es from 2the *atient$s identification with the mother and the dominating factor is not the *atient$s own guilt but the mother$s organi=ed defence against de*ression and unconscious guilt.3 Winnicott$s wor, here was an attem*t to find some answer to a climate of acrid debate in the 8ritish >sycho1Analytical Society during the *re+ious decade between Melanie Klein and her followers who *laced total em*hasis on unconscious fantasies and others (chiefly !dward Dlo+er) who considered some of the fantasies attributed to the *atient as the sub9ecti+e creations of the analysts themsel+es. Winnicott tried to show how much the mother$s mood can im*inge u*on a young child$s growing *sychic reality and dislocate it from finding its own character. We shall see how later Winnicott was to e"tend this hy*othesis into his conce*ts of the true and false self organi=ation of *ersonality. A more dramatic clinical e"am*le of the intrusi+e effect of mother on a child Winnicott 'ive" in hi" $a$er) Mother%" Ma!ne"" a$$earin' in the *+inica+ Materia+ a" an ,'o-a+ien Factor (1972). Already in his *a*er .ri/itive ,/otiona+ Deve+o$/ent (1945) Winnicott had gi+en a succinct account of how he saw the infant1mother relationshi*0 In terms of baby and mother's breast (I am not claiming that the breast is essential as a vehicle of mother love! the baby has instinctual urges and predatory ideas. "he mother has a breast and the power to produce milk, and the idea that she would like to be attacked by a hungry baby. "hese two phenomena do not come into relation with each other till the mother and child live an experience together. "he mother being mature and physically able has to be the one with tolerance and understanding, so that it is she who produces a situation that may with luck result in the first tie the infant makes with an e#ternal ob$ect, an ob$ect that is e#ternal to the self from the infant's point of view. I think of the process as if two lines came from opposite directions, liable to come near each other. If they overlap there is a moment of illusion % a bit of e#perience which the infant can take as either his hallucination or a thing belonging to e#ternal reality.

In this *a*er we ha+e in rudimentary form all of Winnicott$s later conce*ts) e.g. holding) transitional ob9ect and de*endence. It was on the
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*rimary model of mother 7 infant relationshi* that Winnicott was to elaborate the nature and character of transference and the role of the analytic setting. -e was to em*hasise one *rocess) 2that of the indi+idual$s contact with shared reality) and the de+elo*ment of this from the start of the infant$s life.3 (Winnicott &'?@). Winnicott sees a ha=ard for the analyst in such an underta,ing0 25many treatments of schi=oid ty*es of adolescent fail because they are *lanned on a basis that ignores the child$s ability to Athin, u*B 7 in a way) to create 7 an analyst) a role into which the real analyst can try to fit himself3 (Winnicott &'?@). In his *a*er 28irth Memories) 8irth .rauma) and An"iety3 (&'?') Winnicott states that 2there is e+idence that the *ersonal birth e"*erience is significant) and is held as memory material3 but he insists that there is no such thing as treatment by the analysis of the birth trauma alone. -e recounts certain e*isodes from the analysis of a female *atient Miss -. (aged E<)) and concludes0 2In the +ery close and detailed obser+ation of one case I ha+e been able to satisfy myself that the patient was able to bring to the analytic hour, under certain very speciali ed conditions, a regression of part of the self to an intra!uterine state. What is e+en more significant is Winnicott$s statement0 2It seems to me that it is in relation to the border!line of intolerable reaction phases that the intellect begins to wor" as something distinct from the psyche. It was this differentiation of *recocious intellectual functioning in reaction to im*ingements that was to lead Winnicott to see in fantasying a *athological mental functioning that is a negation of *sychic reality) and of which a certain ty*e of com*ulsi+e free1association is the sym*tom in analytic *rocess. Some +icissitudes of this ty*e of de+elo*mental distortion of mental function Winnicott discusses in his *a*er 2Mind and its Relation to the >syche1Soma3 (&'?'a). .he need in some *atients 2to be relie+ed of the mind activity in order to refind their *sycho1somatic wholeness of being is seen in their demand for !:.. In his *a*er 0n1iet2 0""ociate! 3ith 4n"ec rit2 (1952) Winnicott s*ells out three main ty*es of an"iety resulting from failure in techni/ue of infant1care0 unintegration, becoming a feeling of disintegration& lack of relationship of psyche to soma, becoming a sense of depersonali'ation& also the feeling that the centre of gravity of consciousness transfers from the kernel to the shell, from the individual to the care, the techni(ue. .his memori=ation of the techni/ue that fails I consider to constitute the essence of the techni/ue of the *atient who is boring. Such *atients twist and abuse the analytic *rocess we offer them to im*ose u*on it an arid techni/ue of relating (through discourse in the adult situation) of which
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they ha+e been the +ictim in childhood. 8ehind it) as Winnicott (1952) *oints out) there is an ungras*able fear of madness in them0 "here is a state of affairs in which the fear is of a madness, that is to say a fear of a lack of anxiety at regression to an unintegrated state, to absence of a sense of living in the body, etc. "he fear is that there will be no an#iety, that is to say, that there will be a regression, from which there may be no return. .he tyrannical re*etiti+eness of the boring *atient$s narrati+e congeals this latent 2madness3 into an interminable +erbiage. .he clinical means for dealing with such highly organi=ed mental habits Winnicott discusses in his *a*er Meta$"2cho+o'ica+ an! *+inica+ 0"$ect" of #e're""ion 3ithin the ."2cho0na+2tica+ 5et- $ (1954c). !ssential for Winnicott is the issue of classification and choice of case. -e distinguishes three ty*es of cases. First are those who can o*erate as whole *ersons and whose difficulties are in terms of inter*ersonal relations. .he second are those in whom wholeness of *ersonality is *recariously held. -ere analytic wor, relates to the de+elo*mental stage of concern (cf Winnicott &'F;). .he survival of the analyst Winnicott considers the

dynamic factor in the treatment of these *atients (cf Winnicott &'F;). .he third are those whose analysis must deal with the +ery beginnings of *ersonality formation as a differentiating entity in itself. -ere the em*hasis is on management) and the clinical handling of regression to de*endence in the analytic situation. For Winnicott 2the word regression sim*ly means the re+erse of *rogress3 and there cannot be a simple reversal of progress. .here has to be an ego organi=ation which enables regression to occur. -ence the ca*acity to regress is the result of fa+ourable en+ironmental care in infancy and childhood. It is this *ositi+e as*ect of infant1care in these *atients that) according to Winnicott) engenders in them a belief in the *ossibility of the correction of the original failure) through s*eciali=ed (clinical) en+ironmental *ro+ision) towards new forward emotional de+elo*ment. In the care and treatment of these *atients the em*hasis shifts to the #uality of the analytic situation. ne *assage from Winnicott "tate" (1954c) it lucidly0 It is proper to speak of the patient's wishes, the wish (for instance! to be (uiet. )ith the regressed patient the word wish is incorrect& instead we use the word need. If a regressed patient needs (uiet, then without it nothing can be done at all. If the need is not met the result is not anger, only a reproduction of the environmental failure situation which stopped the processes of self growth. "he individual's capacity
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to *wish+ has become interfered with, and we witness the reappearance of the original cause of a sense of futility. "he regressed patient is near to a reliving of dream and memory situations& an acting out of a dream may be the way the patient discovers what is urgent, and talking about what was acted out follows the action but cannot precede it. .he understanding and management of regressi+e states) e"*licit or cloa,ed) were the *rimary concern of Winnicott$s clinical wor,. Freud and other analysts had established the ubi/uitous *resence of regression in all *sychiatric illnesses and in the transference relationshi*. .heir em*hasis had been largely on regression to more *rimiti+e stages of libido de+elo*ment) with corres*onding fantasies and wishes. Winnicott added to this the em*hasis on the element of need in regressi+e *henomena and states. .hat said) let us return to the *resent clinical material. I am dee*ly indebted and grateful to Mrs :lare Winnicott for ma,ing a+ailable to me the total notes that Winnicott ,e*t on this case. As Winnicott indicates in his brief introductory remar,s to the material *resented here) this *atient had been in analysis with him earlier) during the war. In fact there are three se*arate sets of e"tensi+e notes from three stages of the two analyses of this *atient with Winnicott. From the beginning of the analysis Winnicott had decided to ta,e notes. .he first set of notes belong to the first analysis and are titled 2Fragment from an analysis3. Winnicott had written it u* in a draft form but ne+er *ublished it. What he says there is so re+ealing that I shall /uote his introduction to those notes directly from the ty*escri*t0 In this paper I wish to make use of some rather unusual clinical material. It is difficult to report analytical material. ,irst, there is the immensity of the task of remembering an hour's work and then of writing it down. -econd, there is the (uantity of material and the difficulty there must be in choosing from it. "hird, there is the special difficulty analysts seem to find in recording what they themselves said. .ere, however, all these three difficulties are to some e#tent overcome. /y patient spoke slowly and deliberately, and what he said could be easily recorded& I chose a special moment to make records, one which I knew would be decisive for the analysis& and I actually wrote down what I said whether I was pleased or ashamed of it. In the analysis of a young man of 01 a stage was reached which was
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obviously likely to prove critical. 2fter a long and steady pull the patient and I were reaching the top of a hill and seeing more and more, partly because, as we reached the top, the work itself became less arduous. )e were to cash in on a year's analysis and, in order to learn as much as possible from what was happening, I took down several hours almost verbatim. I think I can say in this case the patient did not know that I was adopting this unusual procedure. 3f course I would not have done it if it would have really mattered a great deal had the patient discovered it. )ithout describing the whole case, I would say that in this analysis the striking feature was the ease with which the patient was in touch with his feelings towards the ob$ects of his inner world and the ease with which he told me about these as long as he felt that I was in this inner world with him. 4oing with this, as might be e#pected, was a stubborn resistance in the form of a dissociation in the patient's personality, so that he in analysis had very little relation to himself in the e#ternal world. "he fragment of analysis which I wish to report marks the period of the breakdown of this resistance. "his analysis was a straightforward one. It had that momentum of its own which is so nice for both analyst and patient. In spite of big interruptions because of the fact that the patient's university was evacuated from 5ondon, the patient had acted as if he knew he needed help, believed that he could get help. /oreover, he did not behave as if he felt % as some patients do % that the analysis would be snatched away at any moment if he did not hurry. I might describe how his analysis started because it throws light on the character of the transference. 3ne day the patient's mother rang me up and said that she was in analysis with -o and so and she had a son aged 01 who wished for analysis for himself. )ould I see him6 I replied 7es, send him at 8 o'clock tomorrow. 2t 8 o'clock the ne#t day the boy came into my room, lay down on the couch and started analysis e#actly as he would do a year or two later. In other words, analysis for him meant something which he already believed in. 2s he left the room he went up to my bookcase and saw two books which he said were in the bookshelves at his home. In this and in every way he showed that he placed in my chair someone who already belonged to his inner world, and it is roughly speaking true to say that I remained an ob$ect of his inner world until the moment which I am about to describe in the first of the analytic hours which I took down verbatim. In other words, up to this point, which was roughly speaking a year, interrupted by evacuation during terms, the patient's relation to me was an e#tremely artificial one unless one understands $ust what was
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happening. "he material was rich and the work done considerable, but it was impossible to reach, for instance, the dynamics of the 3edipus situation. "he period of transition was in fact heralded by the patient's first recognition of the reality of $ealousy in the e#ternal world in the form of a casual statement that he had read something about a thing called the 3edipus comple# and didn't hold with it. 9uring this first half of analysis I made no attempt to force the situation because I knew, from the type of the transference, that it would be absolutely futile to do so, and also because the analysis was steadily progressing so that one could e#pect eventually the development which would throw light on what might be called a resistance or a negative therapeutic reaction. 4oing ahead of the clinical material, in order to give the reader something to catch on to, I would say that the vital change in the analysis came with the analysis of the patient's fear of completing analysis. "here is a number of ways in which an#iety is produced by the idea of completion of a $ob, and with this patient the accent was on one way, namely the disappearance of the hallucinated breast or sub$ective good e#ternal ob$ect at the moment of gratification and cessation of desire. ,or him this was worse than aggression towards the love ob$ect % it annihilated it. :p to this point in the analysis I had been an internali'ed person, and analysis had gone along swimmingly in its own way and within its own limitations. 2fter it, however, the analysis and the patient's life changed. In analysis he became able to relate me to e#ternal phenomena, and to lose his serious dissociation, so that he now brought e#ternal matters into the associations. 2t home he started a new relation to his mother, one based on observation of her real self& and the patient changed from a self satisfied, self centred, la'y young man who dressed in abnormal garments and affected a beard, into a man who wanted a $ob and who eventually took and is holding a responsible war $ob in a factory. /oreover, the 3edipus situation, which had previously been

unreal to him, and which had not been able to be brought into the analysis, now became real to him in the classical manner. .he clinical notes that follow gi+e a +erbatim account from fi+e sessions towards the +ery end of that analysis) which had lasted roughly two years. It had ended because the *atient had become able to ta,e a war 9ob in an engineering firm. .wo themes *reoccu*y the *atient0 fear of ending analysis and it becoming a 2com*lete3 e"*erience4 and the confusion of this
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with the *atient$s dread of 2the +iolently hostile content of satisfaction at the end of the meal) which means annihilation of desire and annihilation of sub9ecti+e breast followed by hostility to *ersisting ob9ecti+e breast3 (Winnicott$s inter*retation to the *atient in one of the sessions). .he acute fear of satisfaction from a good) or rather ideal) feed features *ersistently in the material of the fi+e sessions. ne inter*retation of Winnicott to the *atient in this conte"t is worth /uoting here0 -atisfaction means something more important to you than the blotting out of the breast. It means the loss of desire for it, and at that moment you do not know whether you will ever recover that desire& and in so far as the breast is a sub$ective phenomenon this means that you have no knowledge that the breast will come again. 7ou are at the mercy of your instincts and your capacity for instinctual gratification, unless you recogni'e someone with breasts as ob$ective phenomenon and dependence. .he first analysis had lasted nearly two years) with long holiday brea,s. .he *atient) who had been considered suffering from a schi=o*hrenic1ty*e illness) had made good reco+ery. Some eight years later Winnicott wrote s*ontaneously to the *atient$s mother0 7ou may be surprised to get a letter from me, but I would very much like a note from you about B. I know that on the whole it is not a very good idea to get into touch with past patients, and for that reason I am writing to you and not to B himself. ;evertheless one's work becomes much more interesting if one can follow up cases, and as I remember B's analysis very clearly I have often intended to ask you to let me know about him. I hope you are well and that he is well. .he mother wrote bac, eagerly) and Winnicott as,ed her to see him. I /uote his account of the inter+iew with the mother0 /rs < came to see me at my re(uest, although she was pleased to do this and to give me a report on the family. It was interesting to note that a great change had come over her description of B's home life. In the intervening years /rs < has herself had a long analysis and she now describes herself as having been very ill. In the first interview with me she had said that if any child had ever had a perfect childhood it was B. It was in her own analysis that she discovered that her perfection as a mother had a symptomatic (uality. -he simply had to be perfect, and this allowed for no fle#ibility and
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was derived from very great an#iety in herself. "his une#pected bit of news completely confirms the main conclusion drawn from the analysis of B, since what we une#pectedly found there was that in reliving the very early breast feeding e#perience he felt completely annihilated at the end of a feed and for this reason he had been unable to let himself go in any feeding e#perience. "he subse(uent development of this boy may be said to have been satisfactory. I would say that the only non satisfactory feature from my point of view is that he is a communist, but of course, it is not necessary that membership of this party should be a symptom of illness. In my opinion this is one relic of his need to defend himself against his mother, who in spite of herself rather obviously dislikes these political views of her son. "he main feature of the recovery of this man is that he acknowledges nothing at all from his analysis. I always recognised it to be e#tremely important that no claim for recognition or gratitude whatever should be made. 2 perfect analysis would be $ust as difficult for him as a perfect management of infancy and would annihilate him. .is only possible way is for him to have changed as a result of it, and I now regret having once allowed

myself to stop him in the street to ask him how he was, although this apparently did no harm. .is return to analysis will almost certainly come through the fact that he has now become a medical student, and it is (uite likely that he will come round eventually to wanting to be an analyst. .e would probably be the last person to know this, and it is a point to remember that in his own analysis which must precede his becoming an analyst he will have to arrive at some consciousness of the way in which he was helped in his own analysis. If he is not to be an analyst there is no reason at all why he should ever know. 2fter the end of the analysis he changed and, after changing from an introverted man with indeterminate se# and a big liability to be turned over into homose#uality by a seduction, he suddenly went into an engineering works where he was soon managing other men. .e was able to change his $ob when he found that he had to, but he always knew that engineering was not his interest, it being simply the kind of life he had to lead because of the war. .e was not really well enough to $oin the army, and in any case one would think that his roots in 4reat Britain are not deep enough for him to want to die for the country. 2t the end of the war he was able to reconsider his position and he decided to be a doctor. .e is now married and will soon have a child. 2n important part of his management came through the mother's recovery in her own analysis so that she was able to turn him out of her
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own house. In other words, the analysis in this man did not go far enough to enable him to get away from his mother with her as well as she was at the time when he was under treatment. "he benefit of the double analysis is clear. .is younger sister is fairly straightforward, married, with a family, but his older sister is a schi'ophrenic having analysis and at present being cared for in a hospital. B had retained his very great interest in music and he seems to have found a wife who can understand him and can take the place of his mother without being like the mother. In other words, it seems as if he has not had to find another ill mother, although to some e#tent he has found someone rather like his mother is now she has recovered through having had a long analysis. Gothing seems to ha**en for another four years) though from some notes it a**ears that Winnicott ,e*t in touch with the mother s*asmodically during this *eriod. .he ne"t we hear of this *atient is when he goes +oluntarily to a hos*ital s*ecialising in treatment of neuroses and is an in1*atient there. .he *sychiatrist in charge of him had got in touch with Winnicott and informed him that the *atient) after /ualifying in medicine) had a brea,down and was admitted to that hos*ital. .he *atient himself was resistant to returning to Winnicott for further analysis. A note scribbled in *encil around this time by Winnicott states0 2I heard that the *atient was in a certain hos*ital and I got in touch with the doctors there) ,nowing that the time must ha+e come for the continuation of the analysis. I had ,e*t in touch with the mother. .he *atient had no ca*acity to come and loo, for me.3 From the e"isting corres*ondence it seems that around this time the mother also rang Winnicott and came to see him. .wo days after this consultation) the mother wrote to Winnicott0 2I ha+e 9ust s*o,en to 8 and ga+e him your address and *hone number 7 I do ho*e he comes to see you and is able to start analysis soon.3 .he reason the mother had to gi+e her son Winnicott$s address was that since the first analysis Winnicott had mo+ed to a new address. .he *atient started the analysis a wee, later) while still an in1*atient at the hos*ital. So the second analysis starts some thirteen years after the end of the first. A note in *encil by Winnicott about the beginning of the new analysis is +ery telling0 )hen the analysis restarted it was hardly true to say that he came to see me. =ather it seemed that an observer of life came and talked with me in a rather well arranged rhetoric. )e sometimes talked of the patient. 4radually I would say we have become two nursery maids talking about a boy (the patient!, and in time the nursery maid brought the boy % even the baby % to see me. I got a few glimpses of a real child.
______ - 12 -

At first the *atient came fi+e times a wee, but some four months after starting analysis he was able to lea+e the hos*ital and ta,e u* a medical a**ointment) which necessitated his coming three times only. .his analysis lasted 9ust o+er two years. .here are two sets of notes from this second analysis. .he first set consists of notes

Winnicott wrote retros*ecti+ely about the on1going analysis) and they co+er) by and large) the first si"teen months of the analysis. From the end of this *hase of analysis Winnicott abstracted fi+e e*isodes which he has re*orted in his *a*er With!ra3a+ an! #e're""ion (1954a). .hen there is a ga* of three months) and after that Winnicott ,ee*s a +erbatim record of the sessions of the last si" months of analysis) which are *ublished here. .o end the account of Winnicott$s dealings with this *atient it only remains to be stated that Winnicott again wrote to the *atient) from his own initiati+e) some fourteen years after the termination of his second analysis. I /uote the letter0 7ou may be surprised to hear from me> indeed you may have forgotten me. But the fact is that I would very much like to hear a word from you about yourself, your work, your family. I'm at the age at which one looks back and wonders. I send you my very good wishes. .he *atient answered *rom*tly with a +ery long letter) gi+ing news of himself and his family) and telling Winnicott of the sad death of his mother after a distressing and long illness. -e had fared well in his own wor, and life. Winnicott re*lied to him0 I was so very pleased to get your reply to my letter. "hank you for the trouble you took going over things. I am sorry your mother had an uncomfortable end. -he was indeed a personality. I am impressed by the way you have used your life instead of perpetual psychotherapy. ?erhaps that's what life is. (I might write to you again one day.! In his >reface to the Second !dition of The Gay Science in 1886) Giet=sche wrote0 "his book may need more than one preface, and in the end there will still remain room for doubt whether anyone who had never lived through similar e#periences could be brought closer to the experience of this book by means of prefaces. I feel a similar sentiment faced with the tas, of introducing Winnicott$s e"traordinary +erbatim record of the last si" months of the long1stretched
______ - 13 -

analysis of his *atient. .he +irtue of Winnicott$s clinical narrati+e rests in the fact that its drift is as undecided as its *sychodynamics are o*en1ended. !+en though in his brief introductory remar,s Winnicott frames his account in the conte"t of the #e*ressi+e >osition) the actual e+ents of the 2subtle inter*lay3 (*. &(; below) between him and the *atient are untrammelled by any intrusi+e theoretical *resu**ositions. .his should not be mista,en for naH+etI on Winnicott$s *art. -e was a clinician endowed with a com*le" sensibility) and o+er the years he had actuali=ed in himself a mercurial intellectuality that informed all his clinical wor,. -owe+er) he had also culti+ated in himself the generous disci*line of letting the *atient$s *sychic reality find its mood and character in the analytic s*ace. .herefore each of us) who reads his narrati+e) will turn it into a discourse according to the needs and bias of his own sensibility. I shall discuss it under three headings0 a) the *atient$s way of relating to himself4 b) the *atient$s use of Winnicott4 c) Winnicott$s style of *resenting and dosing himself to this *atient. Winnicott was an indefatigable note1ta,er of his clinical encounters. Where he found the energy and the time is a mystery. All the same) he did not ta,e such e"tensi+e notes on all his *atients. Something about the manner in which this *atient *resented himself and too, hold of the clinical s*ace struc, Winnicott from the +ery beginning. In his first draft notes from the start of the analysis) /uoted abo+e) one hears Winnicott tell that he was im*ressed by 2the ease with which the *atient was in touch with his feelings towards the ob9ects of his inner world3) and that the *atient had little difficulty in +erbali=ing these thoughts) e+en though *onderously. When the *atient starts his second analysis) Winnicott notes0 2Rather it seemed that an obser+er of life came and tal,ed with me.5We sometimes tal,ed of the *atient.3 .his curious and calculated stance of the *atient *ersists right through to the end. ne could argue

that for this *atient nothing e"isted but his thoughts, and that his basic attitude was0 I refuse) therefore $ am. It is this refusal and these thoughts that are the contents of the *er*etual chatter that goes on in his head) and which Winnicott (1971) was to call fantasying. It is this mentation that isolates his sub9ecti+e self from others) and e+en from his own reflecti+e self1 awareness. .owards the outside world he is merely reacti+e. .owards his true self) if one may use that *hrase) he has only a *rotecti+e attitude. -e can ne+er reach it and li+e from it. -ence his com*laints of lac, of s*ontaneity and initiati+e. What established this irre+ocable dissociation in him Winnicott attributes to the 2ideal3 feeding e"*eriences in infancy that robbed the *atient of all initiati+e from need and desire. Instinctual urgency of hunger or lust *ush one towards the ob9ect.
______ - 14 -

.hat is the one ris, he cannot ta,e. -ence he li+ed in the oubliette of that ob9ectless s*ace) which constitutes le terrain interne, of his mentation and self1obser+ation. In it e+ery e"*erience is re*resented by thoughts) but no e"*erience or *erson is internali=ed. .he *atient himself remar,s0 2chatter is tal,ing to no *erson3 (*. &?; below). From the +ery beginning Winnicott was aware that the whole manner of tal,ing and relating in this *atient inherently carried a negati+e thera*eutic reaction. .he *atient gi+es his own diagnosis0 2I ne+er became human. I ha+e missed it3 (*. 'F) and 2.o sum u*) my own *roblem is how to find a struggle that ne+er was3 (*. &FE). Winnicott was not daunted by this. Gor did he set out to cure it. -e allowed for its functioning as the necessary condition for this *atient to exist in life. 8ecause this *atient rarely does more than e"ist. Furthermore) once Winnicott realised that the withdrawn affable mentation of this *atient was not hostile in intent towards him) the analyst) he was challenged by the paradox of this *atient$s total acce*tance of the clinical situation and s*ace) with a *arallel refusal of inter1*ersonal relating and to initiate any *lay from s*ontaneous im*ulse. I ad+isedly use the word *arado". .o ha+e seen it in conflictual terms of ambi+alence would ha+e been a false o+er1sim*lification. It is through sustaining this *arado" for some thirteen years of relating to this *atient (one must not forget that for Winnicott this analysis lasted thirteen years and after4 Winnicott had ,e*t the *atient ali+e in his memory all that time) that Winnicott was able to witness how this *atient relates to himself and what is the character of that self1relating. It was boring!ness, not boredomJ 8oredom is a static) inert *sychic mood. 8oring1ness is an acti+e e"istential stance) maintained through incessant mentation. -ence the eerie and mellow fatigue that we find in this *atient) and which so readily enables him to shift le+els of consciousness at any threat or *ros*ect of true encounter with Winnicott) and drift into slee*. .his 2couch1slee*3 *ro+ided this *atient the truest e"*eriences of himself) and this couch1 slee* is a secret s*ace to which e+en his dreams yield no clues. What monumental ca*acity Winnicott had to contain un,nowing. -e lets it all ha**en. .he *atient frets0 2.he thing is to wa,e u*.5I would li,e to wa,e u*) that is) get u*) go away3 (*. &F@). 8ut that he$ll ne+er achie+e. -e shall stay in the oubliette of his mentation. -ence he can ha+e no aims. Where there is no route) there is no aim. When the *atient raised 2the +ague *roblem of aim3 (*. &F')) Winnicott *rom*tly reminds him that he couldn$t e+en come to Winnicott for his second analysis) and adds0 2I had more or less to go and loo, for you3 (*. &(<). At best this *atient could only reach a *oint where he can be the isolated surround of his .rue Self) but cannot ris, to li+e from it. -ence he bores himself with his techni/ues of self1care and self1cure all life long.
______ - 15 -

When Winnicott had decided to frame this material in terms of the #e*ressi+e >osition) he had good reasons to do so. .he #e*ressi+e >osition connotes an intra1*sychic state) entailing s*ecific affecti+e ca*acities and other ego1functions. It is not an accident) *erha*s) that soon after writing the first account of this *atient$s analysis in his *a*er With!ra3a+ an! #e're""ion (1954a)) the ne"t *a*er by Winnicott should be The De$re""ive .o"tition in 6or/a+ ,/otiona+ Deve+o$/ent (19547). For Winnicott the #e*ressi+e >osition

constitutes an achievement in emotional de+elo*ment. .he crucial *assages in Winnicott$s argument are0 "he child (or adult! who has reached that capacity for interpersonal relationships which characteri'es the toddler stage in health, and for whom ordinary analysis of the infinite variations of triangular human relationships is feasible, has passed through and beyond the depressive position. 3n the other hand, the child (or adult! who is chiefly concerned with the innate problems of personality integration and with the initiation of a relationship with environment is not yet at the depressive position in personal development. In terms of environment& the toddler is in a family situation, working out an instinctual life in interpersonal relationships, and the baby is being held by a mother who adapts to ego needs& in between the two is the infant or small child arriving at the depressive position, being held by the mother, but more than that, being held over a phase of living. It will be noted that a time factor has entered, and the mother holds a situation so that the infant has the chance to work through the conse(uences of instinctual e#periences& as we shall see, the working through is (uite comparable to the digestive process, and is comparably comple#. "he mother holds the situation, and does so over and over again, and at a critical period in the baby's life. "he conse(uence is that something can be done about something. "he mother's techni(ue enables the infant's co e#isting love and hate to be come sorted out and interrelated and gradually brought under control from within in a way that is healthy. .he essential conce*ts for the understanding of this *atient$s use of Winnicott are in the *hrases 2the mother holds a situation and 2the mother$s techni/ue3. If one e"amines carefully this *atient$s transference relationshi*) one feature stands out remar,ably0 the diligence with which he obser+es Winnicott$s techni/ue of analysing and ta,es it into his language immediately. All the way he refuses and negates the ob9ecti+e ob9ect Winnicott) in order to isolate Winnicott$s techni/ue of analysing and ma,e it his own. What he lea+es to Winnicott is the holding of the clinical
______ - 16 -

situation and s*ace. Furthermore) language *ro+ides this *atient with all the barriers he needs to ,ee* Winnicott distanced. Whene+er the clinical *rocess edges him towards mutuality) he falls aslee*. -is +erbal 2demands3 for *hysical contact are merely another ruse of his mind *recociously to usur* an emergent need andKor wish in order to hand it o+er to language) where they then stay *etrified and inert. Winnicott reassures him on this count0 2I would say that a correct inter*retation that is well1timed is a *hysical contact of a ,ind3 (*. &F<). Winnicott senses all the way how *recarious is the inner *rotecti+e shield of this *atient. Any accidental influ" of actuali=ed e"citement in a *hysical mutuality of tenderness or concern could easily ha+e *layed ha+oc with the *er*etual gamesmanshi* of this man$s mental a**aratus. So Winnicott stays in the area of deliberate language as the e"clusi+e mode of usage by this *atient. -ence the *atient ne+er reaches his ca*acity for *laying. It remains a nostalgic *ossibility in his thoughts. Winnicott is *rofoundly aware of the constrictions this *atient has to li+e with. -e tells the *atient that he is 2cluttered u* with re*aration ca*acity3 (*. L')) and this carries an ominous threat for this *atient because 2satisfaction annihilates the ob9ect for him3 (*. ;<). Di+en these limits) the *atient could use Winnicott in a +ery s*eciali=ed and distant way only. -is basic use of Winnicott is to find a *ersonali=ed s*ace where he can s*read out his thoughts and what he has observed of his e"*eriences) and tentati+ely allow for interaction between them. 8ut e+en here sleep is both his refuge and his only e"*erience of de*endence. Winnicott inter*rets after one of his sleeps% 2Mou had a need then to be held with someone else in charge while you sle*t3 (*. &FL). .he *ersistent use that this *atient ma,es of Winnicott is that of a certain reticence in Winnicott. .he *atient ,nows Winnicott ,nows more of him that he e+er inter*rets. .his is one shared secret between them. .he other is Winnicott$s note1ta,ing. Gow I come to the last issue I wish to discuss0 Winnicott$s *resentation and dosage of himself to this *atient. In his *a*er) De+in8 enc2 a" a 5i'n of 9o$e (1973)) discussing the anti1social tendency in a child who may steal a fountain *en from some sho* Winnicott *ostulates0 @it is not the ob$ect that was being sought, and in any case the child is looking for the capacity to find, not

for an object (author's italics!. I belie+e Winnicott sensed from the +ery beginning that this *atient was searching to find a capacity in himself and not a relationshi* with an ob9ect. And this decided Winnicott to set a s*ecific tenor to his relationshi* with this *atient. 6i,e the *atient) he too became *artially an observer of the clinical *rocess. In him it too, the form of ta,ing notes. In another *a*er) The Mother : 4nfant ,1$erience of M t a+it2 (197;)) discussing the experience
______ - 17 -

of mutuality Winnicott states0 2.his mutuality belongs to the mother$s ca*acity to ada*t to the baby$s needs3) and he elaborates it in terms of the clinical *rocess as follows0 2nalysts with a rigid analytic morality that does not allow touch miss a great deal of that which is now being described. 3ne thing they never know, for instance, is that the analyst makes a little twitch whenever he or she goes to sleep for a moment or even wanders over in the mind (as may well happen! to some fantasy of his or her own. "his twitch is the e(uivalent of a failure to hold in terms of mother and baby. "he mind has dropped the patient. I belie+e that one other function the note1ta,ing ser+ed for Winnicott was to ,ee* him awa,e and aware during the *atient$s long *auses or la*ses into slee*) and e+en during the assault of the *atient$s organi=ed dense rhetoric in the sessions) which foreclosed mutuality by its +ery method. .he *rinted narrati+e lends a somewhat false momentum to the +erbal e"change between the *atient and his analyst. .he calculated idiom with which this *atient manufactured his narrati+e was inordinately boring and the *atient is aware of it. Somewhere) /uite unconsciously) Winnicott drew u*on his +ast e"*erience of doodling with children in consultation and used the s*ace of the *a*er to doodle notes. -is way of scribbling notes during the session comes much nearer to doodling than writing. -e scrawled all o+er the *a*er) in all directions and sometimes u*side down. .hus he himself stayed ali+e in somatic attention and his mind ne+er 2dro**ed3 the *atient. Such *atients *ro+o,e a +ery uncanny sort of hate1 res*onse in the counter1transference which com*els the analyst to intrude with inter*retations to ease the tension generated or to la*se into a silence that is more inert and boring than the *atient$s narrati+e. Winnicott also creates a secret s*ace in the area of note1ta,ing that matches the *atient$s secret s*ace in couch1slee*. .hus both are safe with each other) and sur+i+e each other. !ach is aware of the other$s secret and lives with it) without /uestioning it. .he lessons for all clinicians who read this clinical narrati+e are many indeed. >erha*s the most im*ortant one is that one must not try to cure a *atient beyond his need and his *sychic resources to sustain and li+e from that cure.
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SectionCitation
Khan, M.R. !"#$%. &olding and 'nterpretation. Int. ?sycho 2nal. 5ib., !!()!*!"+. ,ondon) -he &ogarth .ress and the 'nstitute of .sycho*/nalysis.

Fragment of an Analysis
.-IS fragment of an analysis is gi+en as an illustration of the de*ressi+e *osition as it can a**ear in the course of an analysis. .he *atient is a man of thirty) married) and with two children. -e had a *eriod of analysis with me during the war) and this had to be bro,en off because of war conditions as soon as he became clinically well enough to wor,. In this first *hase he came in a state of de*ression with a strong homose"ual colouring) but without manifest homose"uality. -e was in a bemused state and rather unreal. -e de+elo*ed little insight although he im*ro+ed clinically so that he could do war wor,. -is +ery good brain enabled him to 9uggle with conce*ts and to *hiloso*hi=e) and in serious con+ersation he was generally thought of as an interesting man

with ideas. -e /ualified in his father$s *rofession) but this did not satisfy him and he soon became a medical student) *robably (unconsciously) retaining thereby his use of myself as a father1figure dis*lacing his real father) who had died. -e married) and in doing so offered a girl who needed it a chance for thera*y through de*endence. -e ho*ed (unconsciously) that in his marriage he was laying down a basis for a thera*y through de*endence for himself) but (as so often ha**ens) when he in turn claimed s*ecial tolerance from his wife he failed to get it. She fortunately refused to be his thera*ist) and it was *artly his recognition of this fact that led him to a new *hase of illness. -e bro,e down at wor, (as a doctor in a hos*ital) and was admitted into an institution himself because of unreality feelings) and a general inability to co*e with wor, and with life. -e was not aware at that time that he was see,ing out his former analyst) and was /uite inca*able of as,ing e+en for analysis) although as it turned out later this is what he was *recisely doing and nothing else would ha+e been of +alue. After about a month of the new analysis he was able to resume wor, as a hos*ital officer. -e was by this time a schi=oid case. -is sister had had a schi=o*hrenic illness treated (with considerable success) by *sychoanalysis. -e came to
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analysis saying that he could not tal, freely) that he had no small tal, or imaginati+e or *lay ca*acity) and that he could not ma,e a s*ontaneous gesture or get e"cited. At first it can be said that he came to analysis and tal,ed. -is s*eech was deliberate and rhetorical. Dradually it became clear that he was listening to con+ersations that were going on within) and re*orting any *arts of these con+ersations that he thought might interest me. In time it could be said that he brought himself to analysis and tal,ed about himself) as a mother or father might bring a child to me and tal, about him. In these early *hases (lasting si" months) I had no chance of direct con+ersation with the child (himself). 1 .he e+olution of the analysis at this stage is described elsewhere. 2 8y a +ery s*ecial route the analysis changed in /uality) so that I became able to deal directly with the child) which was the *atient. .here was a rather definite end to this *hase) and the *atient himself said that he now came himself for treatment) and for the first time felt hopeful. -e was more than e+er conscious of being une"citable and lac,ing in s*ontaneity. -e could scarcely blame his wife for finding him a dull com*anion) unali+e e"ce*t in serious discussion on a to*ic set by someone else. Actual *otency was not disturbed) but he could not ma,e lo+e) and he could not get generally e"cited about se". -e had one child) and has since had a second. In this new *hase the material gradually led u* to a transference neurosis of classical ty*e. .here came a short *hase leading ob+iously to e"citement) oral in /uality. .his e"citement was not e"*erienced) but it led to the wor, described in detail in the case notes that follow. .he case notes refer to the wor, done between the e"citement that arri+ed in the transference but which was not felt) and the experience of the e"citement. .he first sign of the new de+elo*ment was re*orted as a feeling) /uite new) of lo+e for his daughter. .his he felt on the way home from a cinema where he had actually cried. -e had cried tears twice in that wee,) and this seemed to him to be a good omen) as he had been unable either to cry or to laugh) 9ust as he had been unable to lo+e. 8y force of circumstances this man could attend only three times a wee,) but I ha+e allowed this) since the analysis has ob+iously gone with a swing and has e+en been a ra*id one.

&

:f 2:linical Narieties of .ransference3 (Winnicott 1955) and 2!go #istortion in .erms of .rue and False

Self3 (Winnicott &'F<). L In 2Withdrawal and Regression3 (Winnicott 1954a)) re*roduced in the A**endi" to this +olume.
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Thursday,27 January
.atient "he patient said that he had nothing much to report e#cept that he had had a cough. ?robably this was an ordinary cold. It did occur to him, however, to think in terms of "B, and he had been going over in his mind the use he could make of it if it should turn out that he should have to go to a hospital. .e could say to his wife> ;ow here I am@ /nalyst Aarious interpretations were possible here and I chose the following> I said that what was ignored was the relationship of this illness to the analysis. I was thinking in terms of the break it would make in the treatment. I said that I was not at all sure that this rather superficial working out of the conse(uences was the most important part of the an#iety. 2t the same time I dealt with the reality aspect and said that I was going to leave it to him. .e was conscious of the fact that he wanted me to deal with this as material for analysis and he did not want me to take part in actual diagnosing. .atient 2fter my interpretation he said that in fact the idea came at him not as "B, but as cancer of the lung. /nalyst I now had more powerful material to work with and I made the interpretation that he was telling me about suicide. It was as if there was what I called a five percent suicide. I said> I think you have not really had to deal with a suicidal urge in your life, have you6 .atient .e said this was only partially true. .e had threatened suicide with his wife but he had not meant it. "his was not important. 3n the other hand he had at times felt that suicide was part of the make up& in any case he said there was the fact of his sister's two suicide attempts& they were partial suicides and not designed to succeed. ;evertheless, they showed him how real suicide could be, even when not an urge involving the whole personality. .e now linked this up with the barrier that he felt he had to get through to get further. /nalyst I reminded him (and he had forgotten! that he felt that there was a person preventing him from getting through the barrier. .atient .e said he felt the barrier as a wall that he must break down or hit himself against& and he had the sensation of having to be carried bodily over the difficult patch. /nalyst I said that we therefore had evidence that between him and health was suicide and that I must know about this as I must see that he did not die. .atient .e had the idea of various forms of starting life again with things different. .ause. .e spoke about his lateness which had become a feature recently. "his was due to the fact that something new had
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happened& he could have come, setting aside all his work and hanging around for a (uarter of an hour so as to be on time. Instead of that his work had become more important and he now finished things off before coming& with luck he might have been on time. .e put it that the analysis had now become less important than his work in some sense. /nalyst I made an interpretation here, gathering together the material of the past and pointing out that I could see this more easily than he could> first he could only contribute into himself, then he could contribute into the analysis& and now he could contribute to the analysis in his work. I $oined this up with the guilt which underlies the whole of this phase including the suicide. I reminded him that the thing that the analysis was leading up to was e#citement with instinct including eating. "he guilt about the ruthless destruction here was too great e#cept insofar as constructive urges and capacities reveal themselves. 1

Pause.
.atient "he effect of these interpretations was revealed in the ne#t remark when he said in a much more easy way> I now think of the illness in amusing terms& it might be measles, a childhood thing. /nalyst I pointed out that a change had come over him since I had taken away the suicide communication which was hidden in the fantasies about the illness.

.atient ,ollowing this he said that for the first time he felt if opportunity occurred he could use an affair and balance this with his wife's infidelity. /nalyst I pointed out that this indicated a lessening of the dependence elements of his relationship to his wife, these having been gathered into the analysis.

The weekfollowing27 January

.he re*ort of the ne"t three sessions is condensed into the following statement. .atient "he patient reported that before the last session he had in fact slept with the girl friend. "his was after a party. 2ll feeling was damped down. .e said that it might have happened at any time apart from analysis. .e felt no love (potency was not disturbed!. "he whole of this session was toneless and unconsciously designed to make the analyst feel that nothing important was happening.

&

:f 2.he #e+elo*ment of the :a*acity for :oncern3 (Winnicott &'F;).

______ - 22 -

.atient ,ollowing this he reported that he had e#pected a great result. .e had e#pected me to know without being told that he had had an e#perience with e#citement in it. "he information came indirectly at first. /nalyst I pointed out to him that he had so damped down the report of what had happened that I had been unable to make use of it. I was now able to interpret the transference significance of the incident and at first I said that the girl represented himself so that in the affair he as a female had had intercourse with me as a male. .atient .e half accepted this interpretation but he was disappointed because there was no natural evolution belonging to the interpretation. /nalyst "he following day he was depressed and I made a new interpretation, stating that my previous one had obviously been wrong. I said that the girl was the analyst (in the transference neurosis!. .atient "here followed an immediate release of feeling. "he interpretation led to the theme not of erotic e#perience but of dependence. "he analysis now came out of the difficult phase which had lasted throughout the week, and a powerful relationship to me developed which frightened the patient. .atient .is (uestion was> Ban you stand it6 .e spoke about his father in particular among the people from whom he had sought the right to be dependent. .is father could take it up to a certain stage, but then always he would hand him over to his mother. .is mother was of no use, having already failed (i.e. in the patient's infancy!. /nalyst I made another interpretation, which I had to withdraw because I could tell from the effect that it was wrong. I reminded him of the female version of himself that hovered around his male self throughout his childhood, and I e(uated my new position in the transference neurosis with this female shadow self. 2fter withdrawing this I saw the correct interpretation. I said that now at last his thumb had come to mean something again. .e had been a persistent thumb sucker till eleven, and it would seem likely now that he gave it up because he had no one for it to stand for.1 "his interpretation of the thumb was clearly correct, and incidentally it produced an alteration in his very stereotyped hand movements. ,or the first time in the whole of his analysis, without being aware of doing so, he put his left thumb up into the air and brought it towards his mouth.

&

See 2.ransitional

b9ects and .ransitional >henomena3 (Winnicott 1951).

______

- 23 -

Tuesday,8 February
.he doorbell being out of order) he was ,e*t waiting three minutes on the doorste*. .atient .e reported having a formula for starting, and compared it with history taking. ?atients assume that you know more than you do. /nalyst I have to bear in mind that you may have been upset by the waiting. (Aery unusual in the case of this patient.! .atient .e went on with the description of how one gets stuck in history taking between going into great detail or simply satisfying the patient, presumably pretending that one knows as much as one is e#pected to know. -omewhere in the middle of this he had a withdrawal.1 =ecovering from the momentary withdrawal, he managed to report the fantasy belonging to the withdrawal, in which he was very annoyed with a surgeon who stopped midway in an operation. It was not so much that the surgeon was angry with the patient as that the patient was $ust out of luck& he was being operated on when the surgeon went on strike. /nalyst I linked this with the reaction to the weekend following my acceptance of the dependence role. I brought in the bell failure, but this was relatively unimportant& whereas the long breaks linked up directly with his statement at the end of the previous hour that I might not be able to stand his need for an e#treme dependence, such as his living with me. "he effect of this interpretation was very marked& the analysis came alive and remained alive throughout the hour. .atient "he patient spoke of his negativity, how it bores him and makes him depressed. It leaves him high and dry. )hen he gets sleepy he gets annoyed with himself. "his negativity is a challenge. -ometimes speech is not worth the effort. .e feels literally dried up. -leep means lack of emotion. ;othing presents itself. .e then described the contrast between his wife's attitude and his own. .is wife feels things and cannot stand his own intellectual approach to everything and his absence of feelings. .e began to discuss the word love, not its se#ual aspect. .e then spoke about Cones' article in -he 0bserver,2 mentioning especially the child with the button and the way Cones linked this up with cannibalism. I made no interpretation, knowing that he was coming the ne#t day, and that the theme would reappear.

& L

:f 2Withdrawal and Regression3 in the A**endi" to this +olume. 2.he #awn of :onscience3 in The Observer of F February &'EE.
______ - 24 -

Wednesday,9 February
.he *atient came e"cited. .atient I feel better. (Dlation.! .e reported having laughed with people. "here was something new about all this. It was natural. /nalyst I found that he could not remember what happened last time and I gave a summary. In giving this I was unable to remember the content of the withdrawal fantasy and said so. It always helps this man if I am able to remind him of the material of the last hour.! .atient .e said that this liberation brought about by his feeling better made him independent of his wife. .e now had a bargaining weapon with her which he could use, although he felt no vindictiveness against her. .e did not need to beg for sympathy any longer. It used to be nothing but himself, hopeless. /nalyst I said that it seemed to have strengthened his whole personality, his getting a little bit nearer to cannibalism and to instincts. .atient .e said that to make matters better he had had a discussion with a surgeon, very friendly, very satisfactory in result. /nalyst .ere I remembered his withdrawal fantasy and reminded him of it.

.atient .e continued that the surgeon had argued against the idea of an operation in regard to a certain treatment of a patient. "he surgeon understood, but in a sense he had downed tools.

Pause.
/nalyst I interpreted that e#citement was present but well under control because it brings its own an#ieties. .atient .e reported other minor incidents. I can afford to be e#cited. 2 year ago the same things happened but as I could not afford to be e#cited they passed over me. I allowed an intellectual appreciation only. I could not afford to do without my depression. In fact I could not understand how anyone could get e#cited, and I had no conception of feeling competent. ;ow, because of the progress that seems to be maintained here in this treatment, I can let things go. .ause. I do not want to talk about e#citement. /nalyst "he point of e#citement is being e#cited. .atient "here is a risk involved. 7ou look silly. ?eople might laugh if you prattle. ("his word belongs in the analysis to a phase of his early childhood in which it was said that he prattled before he became sullen and withdrawn.! 2nd then you are left holding the baby. (/eaning e#citement.!

Pause.
______ - 25 -

/nalyst I made an interpretation $oining together the prattling and the holding of the baby. 1 .atient ?eople despise adult prattling. I have always beeen serious minded. ;ow I feel that I could prattle naturally outside the analysis. In the analysis I can only be serious even now or I can be e#cited about something. "here is something different about e#citement in its own right. "he danger is that if you are e#cited you lose it. 7ou have it taken away or undermined. /nalyst If you show e#citement it gets bagged. (I might have interpreted the castration an#iety here but refrained.! .atient 7es. 7ou are light hearted and then you become heavy if the e#citement is claimed and considered to be attached to something. It is important to be fancy free, but this can only happen in the absence of a love relationship. I was thinking of this last night. "he relationship to the girl is a fancy free affair. "he relationship to my wife cannot be so. /nalyst I reminded him that he was also talking about masturbation, and he developed the theme as he already was on the point of doing so. .atient "he advantage is that there is no risk taken& no social complications. .e was struck by the une#pected fact that when he was married the need continued, even though this $eopardi'ed his potency. 2t this point there were bell noises& a man was mending the bell. "his caused an interruption, and the patient was surprised to find that he minded. It is usually the other way. 7ou seem to be overworried when there are interruptions and I cannot see that they matter. Cust now, however, with such intimate matters under discussion, I see for the first time the truth of what you have said about the setting of analysis and its importance. /nalyst I linked this up with the theme of dependence.

Thursday,10 February
.atient .e continued to report e#citement, although this was at a low level compared with the elation. /nalyst It appears that you have lived most of your life at a level below par in regard to e#citement, and now when you come even to ordinary e#citability you feel conscious of it. .atient 7es, I find I am able to be gay and lighthearted with less effort. I

&

For the conce*t of 2holding3 see 2.he .heory of the >arent 7 Infant Relationshi*3 ( Winnicott 196;a).
______

- 26 -

used to be able at times but it was always an act. -omething happened today which made me reali'e, however, that caution is needed. "here are still unanswered (uestions to do with work and family. I feel apprehensiveness and guilt at feeling well, and of course at having a secret affair. It would be dangerous to get too e#cited, that is to say, at the e#pense of the future. I cannot afford to ignore what remains to be done. But there is a difference. I can now look forward to a future. In the past it seemed that I had difficulties in the present with no solution, as well as no prosect for the future. "here was no hope of living an ordinary life ever. /y depression was something to do with looking for dependence. I could say that in the dependence and therefore in the depression I was claiming my birthright. /nalyst "he hopelessness about the future and the present therefore turns out to be a hopelessness in the past which you did not know about. )hat you are looking for is your capacity to love, and, without our knowing all the details, we can say that some failure in your early life made you doubt your capacity to love. .atient 2fter agreeing with all this, he said> "here is the task still to be done. /nalyst I made a rather wide interpretation linking up the reality that belonged to his discovering his love of his daughter and reminding him that this followed tears at the cinema. .atient I have always had an intellectual idea of pleasure associated with pain. -imilarly I associate love with sadness. I told somebody this once. It was at a 7outh Blub talk on se#. I said that there was an association between love and sadness, and I was forcibly rebuked and called sadistic. /nalyst I remarked that nevertheless he knew that he was right and that the speaker was wrong. .atient ?erhaps she (the speaker! knew but she found it inconvenient to agree with this point in the setting. /nalyst "here is no need for me to try to answer this because the answer is evolving in your analysis. .atient I was not being sadistic, and this comment was therefore not true. /nalyst .ere I started making a rather more comprehensive interpretation, bringing in the word cannibalism which came from Drnest Cones' article in -he 0bserver.1 .atient .e filled out my remark by saying that he had always recogni'ed that biting was important in love making. /nalyst In the comprehensive interpretation I spoke of this infancy situation

&

See *. L?.
______ - 27 -

which he had missed in some way and which he was needing me to provide in the analysis, speaking of the holding of a situation in time, so that the dependence phenomena could be tested in relation to the instinctual moments and ideas. I happened to say in illustration that an infant might have three nurses in the course of a day in an institution, thus presenting a difficulty in regard to reparation.2 .atient .e picked up the idea of my interpretation (uickly and said> In my case there seemed to be four, because of my four lives % hospital, home, analysis, and the girl. Dverything depends on my being able to describe in the analysis what happens in the other phases. .e then said> But adversely what is happening is that this split in the total situation is giving me more to talk about. In any one of the four places I have a lot to say, whereas usually I feel e#hausted if I say anything and have nothing more to say. /nalyst I spoke first about his need to feel that he was contributing in this analysis and that if he has nothing to say he has often felt awkward and deficient. I said> )e are also talking about one of the origins of conversation in which each individual is integrating all the material of the split off e#periences by talking in one situation about another, there being in health a basic unified pattern. ?reviously all he had been able to find were various e#amples of the original pattern which he was all the time seeking. ;ow in the analysis he had found the pattern and could benefit from being able to split it up.

Pause.
.atient "here is a danger of going too far. 3ne could get confused.

/nalyst 2t first I thought that he meant that my interpretation had been too comple#. .e was referring, however, to the innumerable odd things that he could bring into the analysis, and I was reminded of his having been noted for prattling until a certain age in early childhood when he changed over into being unable to talk e#cept seriously. .atient .e now told me about the fear of a hopeless $umble of bits and pieces, something that he called being too widely split. .e chose to speak about the ward round that he does on "hursdays with 9r <, especially as this always affects the "hursday evening session. I had never been told this fact before. 9r <'s round is never simple. It is always a series of challenges. .e is full of ideas and demands. 2t present there is a new development in that the patient has innumerable ideas of his own and he now stands up to his chief, and they both en$oy the contact. "here was also the matter of a rather difficult

:f 2.he #e+elo*ment of the :a*acity for :oncern3 (Winnicott &'F;).

______ - 28 -

surgeon. .e had written a history of a patient, and had received an amusing letter back thanking him for his very detailed and comprehensive report. "his letter was praise, and it came $ust when the patient was in a mood to receive praise, perhaps for the first time for many years. .e certainly welcomed it. Cust now there seemed to be too much of everything. .e became worried always when there were innumerable bits, and for this reason had developed a techni(ue of generali'ing and thereby simplifying issues. /nalyst "he alternative to an ordering of the material was getting lost in innumerable fragments. It would seem that the patient here was describing his growing ability to tolerate disintegration or unintegration. .atient .e said that these ideas felt like too many children. /nalyst /y $ob as analyst was to help deal with these children and to sort them out and get some sort of order into the management of them. I pointed out that he was cluttered up with reparation capacity when he had not yet found the sadism that would indicate the use of the reparation phenomenon. "he e#citement in relation to me had only been indicated and had not appeared. .atient .e then described the analytic situation as a difficult one for the e#cited patient. 2nalysts are well protected. "hey avoid violation by special mechanisms for protection. "his was especially evident at the Institution, where patients and doctors do not meet e#cept professionally, and appointments are arranged indirectly. "he doctors also are having analysis. It is only possible to hurt them by actual physical violence. 3nce some men tried to break through and succeeded in annoying some of the doctors by deliberate rudeness and were rebuked. 2n analyst ought not to act that way. 3r why do they6 "here are two ideas, he added here. 3ne, I am annoyed that the analysts were not immune to verbal trauma. 2t the same time I am annoyed at their invulnerability. 7ou can only annoy an analyst by not turning up, but that's foolish. /nalyst I said that he had omitted talking about not turning up (I ought to have said playing at, but I left this out!. It was as if he had told me a dream in which he had not turned up, and we could now look into the meaning of this dream. )e could see that it contains sadism for him at the moment and that the sadism leads us to cannibalism. 2s an additional interpretation I said that, in $oining together all the different phases of his life, there was one which was the surgeon's praise. I had been likened to the surgeon in the material of the previous hour, and it was important to him that I should be able to see that I have praised him through the surgeon.
______ - 29 -

.atient .is response to this was that he thought that I ought to be able to show e#citement along with his e#citement. )hy could I not be proud of his achievement6 /nalyst I replied to this that I was indeed e#cited, although perhaps not as e#cited as he would be since I was also not so much in despair during his despair periods. I was in a position to see the thing as a whole. .atient .e continued on the theme of the analyst's ability to be e#cited at progress in patients and I said> /nalyst 7ou can take it from me that I do this kind of work because I think it is the most e#citing thing a doctor can do, and it is certainly better from my point of view when patients are doing well than when they are

not.

Monday,14 February
.atient .e reported that the phase of e#citement had subsided. "he novelty of it was lost. "here were three factors. 3ne of these was that he was tired& another was that the e#citement could not solve all his problems. (I noted the end of a phase of elation.! )hile he was e#cited he had e#pected that his difficulties with his wife, etc., would automatically solve themselves, but he reali'ed now that they were as before. /nalyst I brought in the end of the last hour when he hoped that I would be e#cited too. I pointed out that we were dealing with elation and that it was important to him that I had not shared his elation although I had shared his e#citement. .atient .e said that the change had persisted to some e#tent& for instance, he noticed a lessened need for putting on an act % living in itself had become less of a heavy burden and deliberate activity. .is talking, although still difficult, was now not a permanent problem& it often seemed unimportant that he was not talking like others. .ause. .e said that the end of e#citement brought an#iety because during the e#cited time he had plenty to say in the analysis. ;ow he had nothing again. /nalyst =eally you are letting me know that you have nothing whatever to say. .atient "hat took the lid off. It showed that all I had been saying was of no value whatever. I feel e#posed. .ause. .e reported definitely not wanting to speak. /nalyst .ere I made a comprehensive interpretation, bringing in a previous one in which I linked up the present analysis with the first phase which was completed in the war without his having achieved much insight. I said that satisfaction annihilates the ob$ect for him. .e had
______ - 30 -

obtained some satisfaction last week and now I, as the ob$ect, had become annihilated. .atient "hat makes me think, because I was concerned that the girl friend was no more of interest to me. .e then made a review of his relationship to his wife in the light of this interpretation of mine. .e observed how satisfactions had to some e#tent always led to an#iety associated with annihilation of the ob$ect. /nalyst I made an interpretation concerning the continuation of my interest in the period in which I seemed to be annihilated. .atient .e reported that intellectually he could understand my interest continuing and the continuation of the ob$ect, but there had been an effort re(uired to get to the feeling of the reality of these things. /nalyst I drew attention to his use of frustration which keeps satisfaction incomplete and preserves the ob$ect from annihilation.

Pause.
.atient I now feel we have got down to important things. 5ooking back I am able to recogni'e the reality of this problem. I wonder if this sort of reaction is unusual or uncommon or whether I am like other people. /nalyst I discussed with him the two aspects of this (uestion& firstly, he was talking about a universal phenomenon, and secondly, he was dealing with something which is more important to him than to some people. .atient .ow does this affect the baby having a breast feed6 (.ere he was getting very closely back to the essential features of the first analysis.! /nalyst I now gave him a longer and more detailed description of the two possible reactions, the schi'oid and the depressive (without using those terms!. I spoke in terms of the buttons of the coat pulled at by the child, which was associated in the patient's mind with the word cannibalism. I said that for him when he had got the button the important thing was that he was satisfied, and therefore the button became unimportant (decathected!. "here is another possible reaction, which I mention because it is there in your analysis but you are not yet able to see it. "his would be concerned about the coat that was now devoid of a button, and also concerned about the fate of the button. .atient .e obviously understood what I was saying. .ause. .e said that he had been thinking a great deal over the weekend about which of two e#tremes to follow in his career. 3n the one hand there is the intellect and the

highbrow line of development, with pleasures despised. 2lternatively there is pleasure, which he could make the most important pursuit. In practice the first meant following the advice of his
______ - 31 -

chief, writing up case histories and starting off on a career in medicine based on intellectual attitude. .is chief's whole life is in medicine and on an intellectual plane. .e was tempted to follow this spartan regime but, he said, this would leave himself out of the picture, and the alternative would also be unsatisfactory as he would go out purely for pleasure. .e could drift into some line between the two e#tremes, but drifting would not be satisfactory either. /nalyst I related this to the material at hand. I said that, if his analysis got no further than it had got at present, he was left with e#actly the problem that he had described which belongs to the first of the two reactions (the schi'oid!. I said that it would be possible to talk about the future, and to say that his analysis already did show that he was on the brink of the alternative line of development with concern about the ob$ect. -hould his analysis cover this issue, then a new solution would automatically appear to the main problem of the management of his career. .atient .e said that he wondered how there could be hope of getting at something here in the analysis which had never been before. Is it possible to get at something in one's nature that does not yet e#ist6 .ow can one achieve concern when it has never been there before6 Ban something be created out of nothing6 2lternatively, is there something buried which can be discovered6 /nalyst I said that to some e#tent we might find that he had achieved concern and had lost this capacity through hopelessness in some infantile situation. ;evertheless, it would not seem impossible to make a step in analysis that had never been made before. "hese things depended not only on himself but also on his analyst. .atient )ell, of course the baby has to get at these things for the first time with the mother. /nalyst In the last few minutes we have been talking intellectually and talking about your analysis, and this is rather different from doing analysis. .atient I do feel, however, that it is of positive value to talk about things intellectually. /nalyst (I could not help comparing this state of affairs with that which obtained at the end of the first analysis, when very big changes had occurred in the man's personality and e#ternal relationships, but insight was not a feature.!
______ - 32 -

Tuesday,15 February
.atient I was thinking about the end of yesterday. 7ou said we were talking around the sub$ect. ,or some reason or other this made me laugh. It was really a very marked reaction. I could not help feeling that it was very funny. It was as if we had said, *)e are only pretending to be serious.+ )e were playing round in a lighthearted way. "here was a break in our serious attention to matters, and I laughed and felt very e#cited. /nalyst 7our word *playing+ reminds me that I might have brought in this word *play+ in connection with the ideas around your phrase *fancy free+ in the previous session. 2t the end of last hour you and I were playing together, talking round the sub$ect, and you en$oyed it, and felt the contrast with the usual hard work. .atient "hat reminds me of something from /oliEre. -omeone told a man that he had been speaking prose all his life. .e was ama'ed. .e had been unaware of this fact and it e#cited him. /nalyst I think there is a feeling that we were caught playing together. .atient "he same thing in medicine generally. I can see now how important it is when something lighthearted turns up in the middle of a serious sub$ect. It can be bad taste, but occasionally it is very helpful in the middle of a serious medical discussion to have a little game, a wisecrack of a play on words. I spoke about the two e#tremes> should I undertake very serious work like a hermit or an ascetic, or should I go out for pleasure and avoid everything serious6 "here seems now the possibility of a blend, which is different from seeking a midway path. "he blend includes both e#tremes at the same time. /nalyst "his is the same sub$ect as that of the thumb and your interest in it and your having me for it to stand for.

Pause.
.atient 2 new sub$ect cropped up today. It had to do with the girl friend. I saw her $ust now. /y attitude to her is changing. 3riginally I was only attracted intellectually. ,irstly there was a demonstration of bravado in relation to my wife, and secondly there was a physical e#citement, but this made me worried because I knew that boredom and e#haustion were bound to appear. "oday there was a change. I actually e#perienced warmth of feeling and an interest in what she was doing and saying. I wonder if I might be starting to be in love. "his would be absolutely new. I cannot $udge. It never happened before. I don't want to pin a label onto it. "here is a sharp contrast between my ease with this girl today and my general difficulty which continues with my wife. It is the same with work. "here seems to have
______ - 33 -

arrived a bridge. In relation to the girl, when there is a hiatus, she continues with ideas from her end which my wife can no longer manage. ?robably she used to, but she has given up hope. 2 striking e#ample would be that I phoned this girl for half an hour. "his is absolutely new. I have never phoned anyone for more than three minutes, as there was never anything to say e#cept business arrangements. 2t home there is a great easing of tension, because it no longer matters about my wife and her boy friend. /nalyst I asked about his wife and about how much she knows. .atient ?robably she knows pretty well, but I prefer to make a mystery of it. It would be too cold blooded to open up a frank discussion on the sub$ect. )hoever starts the sub$ect is in a weak position. (Incidentally the *atient is showing that he ,nows that this e*isode with the girl is *art of the analysis and not an attem*t to brea, u* the marriage. -e is always ho*ing that he can get well and that the marriage will mend.) /nalyst I attempted to show that the various separated episodes in his life all came together in the transference. .atient .e went on to speak about the way his wife e#pects him to be dominant, while she likes to be in the dependent position. )ith the girl, neither is dominant. It occurred to him to say that this relationship with the girl is like that of a brother and sister, whereas with his wife the relationship is of father and daughter. 3ccasionally he had this relationship with his younger sister, but they have drifted apart. "he advantage with the girl is that, while providing a relationship of this kind, there is an absence of incest taboo. "hey can help each other. "his provides an e#citing novelty, discovering the possibilities. .ause. .e reported that he was stuck. /nalyst I continued with the theme of the bringing together of all the attitudes in relation to the analyst and the e#periencing of conflicts which are avoided through the acting out in compartments. In speaking of this I referred to masturbation. .atient I was thinking that you were sure to say that this relationship to this girl is something to do with masturbation, partly because masturbation has become very much less compulsive since the relationship started. I thought> *.e will say you are only acting out a fantasy.+ /nalyst I pointed out that the introduction of the word only was important, a word that I had not used. .atient 7es, you would pour cold water on it. /nalyst I dealt with the reality of the masturbation fantasies which formerly we could not find, but which he has discovered in relation to the girl
______ - 34 -

and particularly in the interplay which has turned up and which follows developments in his relation to myself.

Friday,18 February
.atient "he first thing that occurs to me to say is that it was three days ago when I came last. It seems a much longer time. "here was a part of a dream which I had in the morning which I remembered. )hen I woke I was still in it, and then, as I gradually woke further, I $ust remembered it, by which time I became worried because I felt I ought to be horrified, whereas it seemed (uite natural. "he dream was that I had seduced my daughter. ,or a time I lost the memory of this dream and then it came back.

/nalyst I pointed out that this dream followed on his having felt love for her after crying. I asked what he meant by seduced. .atient ?robably I simply mean that I had intercourse with her. I remember now that recently, when she was on my lap, I had some se#ual e#citement, something needing suppression. "his occurred last week during a period of e#citement and during the time when I was having occasional intercourse with the girl friend. It was all part of this same thing, and in this period I was not masturbating. I did not want to. 2lso I was able to suppress it by conscious effort, in preparation for potency. 2ll this reminded the patient of the problem belonging to several years ago, at home, with his wife. .e reported for the first time difficulties in getting e#cited and premature e$aculation. 2t that time he would masturbate to relieve tension in order to get better control. /nalyst I reminded him that he had likened his relationship to his wife to a father % daughter relationship, and that the dream therefore indicated something happening in his relation to his wife. .atient "hat links up with what I was going to say. I have been depressed because I have been seeing the girl friend since the dream and I have been getting fond of her, but I now have found that she has become cold. 2n earlier partner had turned up, so my patient was being pushed out. -he herself had been seduced by her father at si#teen and therefore she hated him. "here is the point that society does not frown on such a seduction as much as it does on incest between son and mother. In anthropology a father % daughter relationship may develop, but not that of mother and son. .e said that in several relationships girls tend to lean on him because he is sympathetic, and the relationship tends to end in a
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father % daughter way. .e feels this as a defect of his personality. .e is not able to be aggressive. /nalyst )hat you are leading up to is that you have not been able to get to your hate of the man in the triangular relationship. .atient "his only comes afterwards. It is not spontaneous. It is an academic point. ;ow there had been an advance and there was danger of it all getting out of hand. .ow would it all end6 .e knew the rival with the girl friend. /nalyst .ere I made a sweeping integration of the four elements which only $oined together in the transference> dependence, instinctual gratification, incestuous dream, the marriage relationship. .atient 2fter this he said that he $ust remembered that many years ago he dreamed of intercourse with a woman, and it now seemed that she could have been his mother. "here was certainly some element of his mother in the woman of the dream. 2ll this came on top of the practical dilemma in regard to the girl. "here are unsatisfactory alternatives> &) com*ete with the man L) retreat ;) terminate the relationshi*. .e recogni'ed all three as unsatisfactory and was angry. -uch ends would only be convenient. 2lso he had been thinking on the way to analysis today, 2 life without se# must be unsatisfactory, even although worries could be avoided in that way. If there were no e#pectations it would not be a life. .e said that, from early on, somehow or other he had ac(uired the idea that intercourse is desirable& something he knew he would want even if he did not need it. /nalyst I pointed out the absence of the father in the dreams. .atient It was here that he told me more of the rival with the girl friend, also a married man with two children. .e felt that it was unsatisfactory in this relationship that these two men were treading in each other's footsteps (identified!. /nalyst I pointed out that the dream about his daughter and the relationship to the girl avoided the strong feelings and the conflicts that would belong to the dream about his mother. .atient .e said that I must remember that for the last few years he had had no feelings at all about his father. "hey were buried and distorted, e#cept that they turned up at one stage of the analysis. (.e associated the loss of feelings about his father with the absence of the father in the dream.!

1innicott, 2. 1. !"34%. 52elin6uency as a 7ign of &ope in /dolescent .sychiatrys '', edited by 7. 8. 9einstein and .. ,. :iovacchini ;ew <ork) =asic =ooks%. 1innicott, 2. 1. !"3(%. -hrough .aediatrics to .sycho*/nalysis > a reissue of 1innicott?s 8ollected .aperss ,ondon) -avistock .ublications, !"(#%, with an introduction by M. Masud R. Khan ,ondon) -he &ogarth .ress@ ;ew <ork) =asic =ooks%. []
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Article Citation [Who Cited This?]

Winnicott, D.W. !"#$%. &olding and 'nterpretation. Int. ?sycho 2nal. 5ib., !!()!*!"+. ,ondon) -he &ogarth .ress and the 'nstitute of .sycho*/nalysis.
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