The featured paper is ‘Withdrawal and Regression’ by Donald Winnicott originally published in 1954. Winnicott tells us that he has met several adult patients who regressed during analysis and recounts one case in particular in which there was transient regression. Winnicott is explicit about the terms and thus
‘By withdrawal in this paper I mean momentary detachment from a waking relationship with external reality, this detachment being sometimes of the nature of brief sleep. By regression I mean regression to dependence’
He chooses a patient – a doctor – that he refers to as ‘schizoid-depressive’ who came to him because he wasn’t able to ‘make original remarks although he can join very intelligently in serious conversation originated by other people’ and also experienced an ‘inability to be impulsive’. The patient is described as being engrossed in the analysis but at times withdrawing with ‘unexpected’ results.
The patient had ‘curled up and rolled over the back of the couch’. Reading between the lines it is difficult to avoid supposing that Winnicott was interpreting his patient’s behaviours in terms of the foetus. Thus in his interpretation of a hand gesture that his patient made, Winnicott asks his patient
‘In speaking of yourself as curled up and moving round, you are at the same time implying something which naturally you are not describing since you are not aware of it; you imply the existence of a medium’
Furthermore when the patient’s wife becomes pregnant
‘this made it very easy for him to link his curled-up state in the medium with the idea of a foetus in the womb’
After a discussion of the cost of the sessions with his mother, the patient in the next session was
‘able to get at his criticisms of me and to express his suspicion that I was a swindler’.
Winnicott then writes that after a ‘very rich period of analysis’ that he interpreted the patient’s wandering thoughts as a movement ‘away from my lap’. It was a little difficult for me to follow Winnicott’s reasoning at this point but he drew parallels between his lap, the couch and a regressed state. There follows a dream analysis and an interpretation of a headache as the need to hold the head in a certain position. Winnicott draws all of this together to suggest that if a patient withdraws during a session, if possible converting this into a regression is preferable as here, there is the possibility of useful intervention. While this is an interesting conclusion, this must be speculation at this point as he is using a single case study. However, Winnicott himself in his paraphrasing uses leading questions within the session and the phrasing of his interpretation to the patient may well have an influence on the patient’s responses particularly when he emphasises that the patient is not ‘aware of it’ (the existence of a medium). There are many implications for the above but it is important to compare with contemporary practice.
Donald Winnicott. Withdrawal and Regression. . In Through Paediatrics to Psycho-Analysis. London. The Hogarth Press and the Institute of Psycho-Analysis. 1978. pp255-261.
Steps To Treatment (STT)
STT = Steps To Treatment. An estimate of the number of steps between the results and translation into practice i.e. treatment. This is an opinion.
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