Donald W. Winnicott was a well-known British pediatrician and psychoanalyst whose contribution constituted a major development in the psychoanalytic theory and technique. “Holding” can be considered one of most important concepts of Winnicott related to the psychoanalytic frame. Winnicott first mentioned ‘holding’ as a crucial feature of the mother-baby relationship, but it is also one of the duties that a psychoanalyst should take on in the psychoanalytic setting. The later interpretations of Winnicott show us that holding is actually an equivalent of the maternal function of the psychoanalytic frame.
Not only Winnicott’s theories, but also his practices were highly interesting. It is well known that he emphasized the importance of the “environmental mother” and especially with regressed patients, developed interventions which suited the needs of the patient; such as, touching and giving blankets.
1. TWO-BODY AND THREE-BODY RELATIONSHIP
While defining the needs of children under age five, Winnicott differentiates the three-body relationship that the family has from the two-body relationship of the child and the mother. Winnicott indicates that the two-body relationship denotes the direct relationship between the mother and the baby. In this relationship, the good enough mother avoids impingements, and provides the needs of the baby as soon as possible and in a proper way. Also the mother introduces the external world to the baby. If the mother is healthy and not anxious, depressed, confused or reserved, there are a number of opportunities for the healthy development of personality of the baby to flourish (Winnicott, 1954).
Winnicott describes the child in a three-body relationship by claiming that the child loves one of his or her parents while hating the other. Winnicott states that hatred is expressed directly and the basis of this hatred depends on the primitive love (Winnicott, 1954). Some patients and case examples indicate that if the frame and rules didn’t exist, analysis may turn into merely an affectionate relationship with the analyst – the analyst mother without necessary boundaries (Winnicott, 1954).
If we draw a parallel between the two-body relationship and the relationship of an analyst/mother and an analysand/child, the father can be thought of as the ‘frame’ that holds the paternal function and therefore enables the three-body relationship to continue where hate can also be worked through (Winnicott, 1954).
2. THE ROLE OF THE ANALYST: “HATE IN THE COUNTERTRANSFERENCE”, 1949
According to Winnicott (1949):
“An analyst has to display all the patience and tolerance and reliability of a mother devoted to her infant, has to recognize the patient’s wishes as needs, has to put aside other interests in order to be available and to be punctual, and objective, and has to seem to want to give what is really only given because of the patient’s needs” (p. 356).
While working with psychotic patients, compared to analysis with neurotic patients, maintaining the ‘ordinary environment’ is much more important than interpreting. For instance, a couch, comfort and cosiness can symbolize the motherly love for the neurotic patient. As for the psychotic patient, these are concrete ways of the analystshowing his/her love physically to the patient. Due to an inability to symbolize, these patients may perceive the couch itself as the lap or the womb of the analyst (Winnicott, 1949). Therefore, we can assume that the stability and maintenance of the physical environmental conditions which can be thought of as aspects of the “frame” are important in work with such patients.
One of the difficulties in working with psychotic patients is that some of these patients develop an extremely negative transference towards the analyst, which may lead to a negative countertransference on the analyst’s part, including the hate of the analyst.
Even though analysts may have negative countertransferential feelings, ideally, these are latent feelings and the analyst does not act out on them. For the analyst, holding the negative feelings and not expressing them immediately is also a part of the holding function.. Especially, while working with psychotic patients, it may become very difficult not to act out on the feeling of hatred. The only way to do this is to be aware of these feelings. However, Winnicott (1949) states that this hatred should not be withheld until the end of the analysis. The timing of the expression of the negative feelings is very important. Nevertheless, if the analyst does not show what he did not show to the patient in the beginning of the analysis, it means that the analysis is not over. The analyst should show his holding capacity of negative feelings towards the patient in the relationship. If this is not showed, the infant analysand cannot know what she owes to the mother analyst (Winnicott, 1949).
Winnicott (1960) describes “holding” as the condition of support associated with the maternal function of the analyst. He states that ‘holding’ not only means the physical holding of the infant by the mother, but also means holding the infant and supporting it in every situation in life. Externally it can be interpreted as physical holding, yet it is a psychological process that can be defined by the mother’s empathy and awareness.
According to Winnicott (1960), the level of dependency of the infant on the mother changes as the personality grows. In the holding phase, which is the beginning of the emergence of the ego, the infant highly depends on the mother’s auxiliary ego. The infant’s journey starts from ‘Absolute Dependence’, to ‘Relative Dependence’, to ‘Towards Independence’, which is also a journey from pleasure principle to reality principle, and a journey from autoerotism with self to object relations in the external world. In ‘Absolute Dependence’ phase, the baby has no idea about the mother’s care and it has no control over what is good or bad. It just either takes advantage of what is being done or suffers from it. In ‘Relative Dependence’ phase, the baby has a full awareness of its own needs and details of the mother care. In ‘Towards Independence’ phase, the infant is developed enough to live without actual care as the care given by the good enough mother is internalized. It is important to note that, in the psychoanalytic treatment, the unconscious material of these phases could be experienced again by the patient through the transference relationship with the analyst (Winnicott, 1960).
For Winnicott, one of the essential features of care is the satisfying holding. False holding leads to the sensation of being fragmented, sensation of falling forever, mistrust of external reality and other psychotic anxieties in the infant (Winnicott, 1960). The patient who is extremely reliant on the analyst has identification with the child, and just like a mother, the analyst functions as the auxiliary ego. The practice in analysis resembles the natural process between the mother and the child (Winnicott, 1960).
To conclude, psychoanalytic frame acts as a holding environment and functions as the holding capacity of the mother in the analytic process. As Winnicott (1986) put it:
“Whenever we understand a patient in a deep way and show that we do so by a correct and well-timed interpretation we are in fact holding the patient, and taking part in a relationship in which the patient is in some degree regressed and dependent.” (p. 192)
4. PSYCHOANALYTIC SETTING AND REGRESSION
The understanding and managing of regressive situations are crucial in Winnicott’s work. Freud and other analysts claim that regression can be observed in all psychiatric illnesses and transference relationships. By regression, they mean the regression of the libido to the early phases of the development, which are manifested within phantasies and wishes. However, Winnicott emphasizes the need factor in the regressive situation (Kahn, 1986).
According to Winnicott, the analytic setting enables regression by providing the necessary holding and support to the patient. The regression of the patient in an analytic setting means that the patient is re-experiencing the early phase of the dependence. During the treatment, the patient becomes regressed and dependent on the analyst. Thus, s/he has an opportunity to grow up again in good enough conditions of the psychoanalytic setting. That way, the ‘true self’ finds an opportunity to develop. ‘True self’ is defined as a sense of integrity, connected wholeness, spontaneity, creativity and the feeling of being real. On the other hand, ‘false self’ develops when the infant adapts to the mother when the mother reflects her own defences to the infant rather than to reflect the infant’s actual mood. In that kind of care, ‘false self’ functions to hide the true self. This results in a diminished capacity for symbol use and lessened quality of life (Winnicott, 1960). ‘ For Winnicott, regression is a part of the cure and it works in a psychologically healthy person (Winnicott, 1955). Winnicott states that instead of interpreting; techniques which include accompanying, understanding and not interfering facilitate regression. The analyst neither comments nor supports to make the patient regress, yet enables the regression process to keep on going (Winnicott, 1954/55).
5. MARGARET LITTLE CASE: AN EXTRAORDINARY FRAME
The sessions of Margaret Little and Winnicott are told by Winnicott himself in Little’s writings (1981). Even though one person’s testimony is not enough, this case can present us important information regarding all other works of Winnicott (Etchegoyen, 2005).
Margaret Little was analysed by Ella Sharpe between the years 1940 and 1947, during which she decided to join the British Psychoanalytical Society and became a member. After her first analyst’s death in 1949, Little started analysis with Winnicott. In one of the very early sessions, Little broke a vase full of flowers. Winnicott thereupon left the room and came back towards the end of the session. In the next session, Little saw that a very similar vase with flowers was placed in the room. A couple of days later, Winnicott revealed to Little that the vase had been very important to him. When they talked about this event after the end of the session, Winnicott confessed that he had made a technical mistake by leaving the room (Little, 1981). In another situation, Little held Winnicott’s hands and did not let them go. (Little, 1981).Once, while Little was talking about her mother negatively, Winnicott pointed out to her that she hated her mother. Winnicott had extended sessions with Little by ninety minutes, and they all ended with a cup of coffee and cakes (Little, 1981).
In her writings, Little indicates that Winnicott’s letting her hold his hands and touching, letting her invite him to a dinner and telling her that she hates her mother are actually the obvious reflections of his holding technique (Little, 1981).
In 1953, Winnicott suspected that Little may commit suicide and persuaded her to be hospitalized. In this five-weeks of hospitalization, Winnicott was on a holiday; however, he kept communicating with the patient. Little commented on her being hospitalized as experiencing the regression that she had to face with. After she left the hospital, analysis went on with the classical technique (Little, 1981).
Winnicott states that the patients have to wait for the regression process until the analyst is ready for it as the analyst is responsible for managing the regression process (Little, 1981). According to Winnicott, this indicates that regression needs to happen under adult supervision, and it is not something that randomly happens (Etchegoyen, 2005).
Allowing for physical contact, extending the length of the sessions, and Winnicott’s approach to regression are aspects of his technique which differentiate it from the classical Freudian technique.