The article reviewed here is ‘Metapsychological and Clinical Aspects of Regression within the Psycho-Analytic Set-up’ by Donald Winnicott which was originally read out to the British Psycho-Analytical Society in 1954. Winnicott begins
‘The study of the place of regression in analytic work is one of the tasks Freud left us to carry out‘
Winnicott firstly distinguishes between treatment and technique in analysis stating that even with good technique the treatment may be unsuccessful while even with poor technique there can be a successful therapeutic outcome. Winnicott then divides the therapy patients into three groups. In the first group are those people who’s personality has fully developed. In the second group, the personality has developed but not fully. He qualifies this by saying
‘that analysis has to do with the first events that belong to and inherently and immediately follow not only the achievement of wholeness but also the coming together of love and hate and the dawning recognition of dependence….this is the analysis of the stage of concern, or of what has come to be known as the ‘depressive position’…..in…the depressive position, we are dealing with the mother-child relationship especially around the time that weaning becomes a meaningful term‘
The third category of patients are those in which the therapist must
‘deal with the early stages of emotional development before and up to the establishment of the personality as an entity, before the achievement of space-time unit status‘
Winnicott then describes the impact that the analysis of one case in particular had on him. This case involved regression and is described in another of his papers (‘Mind and it’s Relation to the Psyche-Soma‘). He distinguishes between the common use of regression and that used in psycho-analysis
‘When we speak of regression in psycho-analysis we imply the existence of an ego organization and a threat of chaos‘
He goes onto suggest that a healthy defence in the developing person is the ability to defend against ‘environmental failure’ by a ‘freezing of the failure situation’ in the hope that the challenge can be successfully met at a future point. Along the way Winnicott argues for a clear sequence of events during development. He goes on to say that the ‘freezing of failure’ can also be thought of as ‘fixation points in the emotional development of the individual’ more familiar to Freud’s original psychoanalytic theory. He distinguishes between ‘healthy’ responses which are referenced by the individual and the unhealthy responses above. He makes an arbitrary distinction between psychoneurosis and psychosis arguing that the psychoanalyst is needed in the former but not the latter. Winnicott goes on to suggest that Freud had ‘granted the early mothering situation’ in his analysis without realising it – a suggestion he has made in at least one other paper. He looks closely at Freud’s works and divides them up into those focusing on psychoanalytic technique and the others focusing on the setting. He then suggests that Freud’s reliability and rules for behaving recreate the early mothering environment and thereby encourage regression. However he adds that ‘psychotic illness is related to environmental failure at early stage of the emotional development of the individual’ – a rather broad generalisation which can be argued against on many grounds particularly as only a few exceptions to this are needed for invalidation. Winnicott then emphasises the importance of acting out in sessions
‘There is nothing more surprising both to the patient and to the analyst than the revelations that occur in these moments of acting out‘
before going on to discuss the relationship of regression to dependence and saying that
‘There are no reasons why an analyst should want a patient to regress, except grossly pathological reasons…..the idea of psycho-analysis as an art must gradually give way to a study of environmental adaptation relative to patients’ regression‘
He finishes with a discussion of reassurance in classical psycho-analysis asking the question ‘what can be said of an analyst’s inability to reassure?’ along the way – reiterating his earlier point about the reassuring environment facilitating regression.
I thought Winnicott’s article contained a number of interesting points particularly those in which he reflected on the nature of the therapeutic relationship within psychoanalysis. However Winnicott’s language would benefit from being transformed into one that is more easily translated into empirical research.
Donald Winnicott. Metapsychological and Clinical Aspects of Regression within the Psycho-Analytical Set-Up’. Chapter XXII. in D.W.Winnicott. Through Paediatrics to Psycho-Analysis. With an introduction by M.Masud R.Khan. The International Psycho-Analytical Library. Edited by M.Masud.R.Khan. The Hogarth Press and The Institute of Psycho-analysis. 1978.
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