Editor Laurence Spurling Editorial Committee Jan Abram Sheila Ernst Nina Farhi Rosie Parker Val Richards Rachel Sievers Margaret Walters Lindsay Wells Gillian Wilce Editorial Consultants Christopher Bollas John Davis Juliet Mitchell Adam Phillips Jacqueline Rose Anthony Rudolf Andrew Samuels Published for The Squiggle Foundation (Registered Charity No. 283858) 11 North Square, London NW 11 7AB by Karnac Books 58 Gloucester Road London SW7 4QY Copyright 0 1996 by The Squiggle Foundation All rights reserved. No part of this book may be reproduced, in any form, by any process or technique, without the prior written perhiission of the publisher. A CIP catalog record for this book is available from the British Library. ISSN: 0267-3 142 ISBN: 1-85575-13 1-3 CONTENTS Editorial 1 The Application of Group Analysis in the Childbearing Year: The Function of Holding by Jessica James 3 Lullabies and Rhymes in the Emotional Life of Children by Renata Gaddini 28 A Historical Analysis of Winnicott’s “The Use of an Object” by Laurel Samuels 41 Winnicott and Transference: The Knife-edge of Belief by Laurence Spurling 51 . . . A First Approach to Clinical Work Taken by the Hand of Winnicott by Carolina Castro 62 An Anthology of Poems collated by Anthony Rudolf 71 Winnicott Bookshelf 82 Correspondence 94 Contributors to this issue 96 ISSN: 0267-3142 ISBN: 1-85575-131-3 Printed in Great Britain by BPCC Wheatoris Ltd. Exeter EDITORIAL This volume begins with two papers on the theme of holding. Jessica James, in her paper "The Application of Group Analysis in the Childbearing Year: the function of holding", uses her experience as a group conductor of parents with new-born infants, and as a birth attend- ant, to show that in order for the mother to be able to hold her infant she herself needs to feel held by a parental figure. Professor Renata Gaddini's paper on "Lullabies and Rhymes in the Emotional Life of Children" looks at an aspect of holding through the mother's singing of lullabies and other songs to her infant. Her paper draws on and follows on from an earlier paper, "The Precursors of Transitional Objects and Phenomena", pub- lished in Winnicott Studies, volume 1, 1985. The two following papers attempt to throw more light on Winnicott's thinking on the use of an object and on the transference. Laurel Samuels, in her paper "A Historical Analysis of Winnicott's 'The Use of an Ob- ject"', investigates the circumstances, and the effect on Winnicott himself, of his first public account of his concept of the use of an object, at a lecture given to the New York Psychoanalytic Society in 1968. My own paper. "Wimicott and Transference: the knife-edge of belief', takes an historical and critical look at the concept of transference, and attempts to flesh out what is distinctive in Winnicott's understanding of transfer- ence. The two final contributions are intended to mark the fact that Winnicott Studies is changing from a journal to a series of books (described below), which means that this is the last volume of Winnicott Studies in its present . form. In her paper "A First Approach to clinical work . . taken by the hand of Winnicott", Carolina Castro attempts to tell two stories: of her clinical work with a young boy, and of her own work in turning Winnicott into a form of mentor and inspiration for her, rather as she became for her client. Winnicott Studies was always intended as a spur for readers to use their own imagination and critical sensibility in order to allow themselves to be "taken by the hand of Winnicott", wherever that might take them. This volume ends with an anthology of poems, collected for us by Anthony Rudolf. Winnicott was, I think, distrustful of technical and ab- stract language for the description and understanding of human life, although he was obliged to use it himself. He held creative artists in high 2 Editorial esteem, believing they could often express much of what he wanted to say about human development better than he could himself, and several of his papers detail how he came upon some of his ideas out of a prolonged dialogue with, say, a series of paintings or a particular poem. It thus seems fitting to end with a contribution which is not in the usual aca- demic style of the journal, but which hopefully complements it in its direct appeal to the imagination of the reader. As I have said, this is the last volume of Winnicott Studies in its present format, and also the last with myself as editor. The journal is in the process of being transformed into book form, with individual volumes being published with papers on specific themes bearing directly or indi- rectly on Winnicott's work. The new editor is Val Richards, with Gillian Wilce as assistant editor. It only remains for me to wish them well, and to thank the editorial committee and editorial consultants to the journal, and all those in the Squiggle Foundation, as well as all those who have con- tributed to the journal, for their hard work and dedication which have made Winnicott Studies possible. THE APPLICATION OF GROUP ANALYSIS IN THE CHILD-BEARING YEAR: THE FUNCTION OF HOLDING Jessica James INTRODUCTION Child-Birth as Linked to All Phases of Child-Bearing In this paper I am looking at how women and their partners may be helped to use the transformations of pregnancy and childbirth to prepare for looking after a small baby and being a parent. Significantly there is no word to describe the totality of this phase and in our culture they tend to be regarded separately. Breen (1985) shares this view. I see them as inex- tricably linked and as a powerful period with enormous potential for growth and change. I shall call this phase the child-bearing year, to cover the woman's responses to pregnancy, to childbirth, to the early months of motherhood. In pregnancy there tends to be a focus on the birth as an isolated event with little relation to any of the other experiences and of enormous dread, foreboding and fear "to be survived". I want to discuss the possibility that the labour is, in fact, not isolated but the most intense, regressive metaphor for the holding needed by the labouring woman, akin to that which the new baby also requires. Birth Attending and Analytic Practice I have developed my ideas through experience and practice as a birth attendant. A birth attendant, as I see it, is distinct from other persons caring for a labouring woman in that she has some professional detach- ment and expertise, is there solely to support the woman through the intense experience of labour and has no medical responsibility. I intend to draw on my experiences in this field in the first section. I will be sug- gesting that the importance of child-bearing stands at the centre of all analytic practice. At the heart of the analytic experience lies a recreation 4 Jessica James of our most regressive infantile needs for attention to the non-verbal, metaphorical experiences of "being with" and "being held". The analytic clients' own history will be lived through and regarded retrospectively and suppositiously. I am seeking to develop a practice and a range of ideas to help practically with the primary and fundamental experience of birth. In this way, I am applying and interchanging the concepts of ana- lytic practice with child-bearing, so as to formulate an approach which recognises the emotional significance of the phases and their potential for prevention and well-being. Groups in a Life Transition The second section will describe how groups offered during the child- bearing year can provide the opportunity to recognize and mark this life change, so that both men and women can live it, not just survive it and become able to tolerate and allow the rollercoaster of emotions that preg- nancy, child-birth and a new baby bring. Women, sometimes men, come to child-birth preparation groups hav- ing never been to groups before. Overtly these groups have a potential for intimacy which is, perhaps, the benign mother group perceived in posi- tive non-conflictual terms that Sheidlinger (1974) suggests. Covertly they may also have a more therapeutic potential that involves acknowledging the painful, conflictual elements of change, adaptation and threats of en- gulfment. In joining these groups there isn't the stigma of having failed that psychotherapy suggests to so many people; in fact there are over- tones of success. in our society becoming a parent represents the joyous and romanticised notions of the "family" and "motherhood". Yet whilst having a baby can mean fulfilment and normality, just below the surface also lie more ambivalent feelings and doubts. For women, in particular, there lies the fear of never being herself again, of losing the self she knows, being a mother rather than a woman and a major change to her body, self image and life-style. For men there are also changes, especially if he wants to become an involved rather than a distant father. In our society most women and men have little or no experience of babies before they get pregnant and tend to be separate from their families of origin and extended family support. There is an acknowledged need for support through this life crisis and such groups replace the rituals and structure of women's shared lives together which are a part of some societies that we regard as primitive. They provide an opportunity for mourning the loss of the past life and preparing for the new life. They have enormous therapeu- tic potential at a time when people feel churned up, open and available to their inner worlds. As such they are an opportunity to find the baby inside The Function of Holding 5 each other and, by bringing it into the open, going some way to having it attended to and understood. As Skynner (1983) writes: . . . there is nearly always care and affection available if people ask for it . . . it's their attitude that stops them receiving affection as their baby is shut away behind that tightly held-down screen. Being a parent and joining a group to prepare for birth is a socially ac- ceptable way for people going through a life crisis to develop alongside their babies. THE BIRTH EXPERIENCE I am going to start by describing the experience of women in labour because it is in this context that one can see most accurately how her regression and need for holding enables, at a later stage, her ability to empathise with her baby. They highlight the mechanisms that operate throughout the child-bearing year. In this section I want to examine how the labour itself provides an intensive, regressive experience comparable to the new baby's. I have developed in my role as a birth attendant, in hearing stories of labours and in my work preparing for child-birth, an increasing awareness of the link between the labouring woman's needs with the baby's. In my reading of psychoanalytic literature this has been borne out, in descriptions of mother-baby interactions, as well as the analogies of the importance of the environment and non-verbal cues pro- vided by the analytic situation. I want to suggest that child-birth may be an opportunity for women to identify with a re-experience being a baby as a preparation for motherhood. Winnicott (Davis and Wallbridge, 1981, p, 94) writes of this: In the weeks before and after the birth of the baby, the mother and baby share certain experiences. These strengthen the mother's identification with the baby and result in the "experience of mutuality"-the birth itself . . . is the feeling of being in the grip of something external, so that one is . . helpless there is a very clear relation here between what the baby experiences in being confined, as it is called. There comes a state in the labour in which, in health, a mother has to resign herself to a process almost exactly comparable to the infant's experience at the same time. The Body in Labour Somatic Regression During the child-bearing yeas a woman's body will undergo enormous changes which will attract her own and others attention. Different women 6 Jessica James will cope with this according to their attitude to their bodies and their own previous history. Somatic expressions of emotional pain are common and compouaded by the medical care she receives which tends to empha- sise the nuances of her physicality. Since our very first self-awareness in infancy is somatic and our first ego is a body ego, a woman's intense awareness of her body at this time will generate regressive and infantile feelings (Raphael-Leff 199 1). Attending to a woman in labour involves constant contact with her body on the most basic level. Her excremental functions, body tempera- ture, emission of fluids, needs for nourishment, energy levels are to the fore along with her contracting uterus. Responding on a physical level involves mopping up, soothing, providing containers, changing clothes, feeding and giving drinks, rocking and breathing together. One woman, in the late stages of labour, felt the need to sit on the loo. We walked slowly towards it with my arms around her shoulders. We stopped for contractions and stood with her leaning against the wall. with me holding her hips, swaying and breathing deeply together, then we proceeded to the toilet. Before we got there, she felt sick and I found a bowl in which she vomited. At the toilet she sat on it but lost the need to go. She became very cold and we walked back to the labour room, dealing with the contractions in the same way against the wall. In between con- tractions I found a blanket to put round and woolly socks to put on. Amniotic fluid was dripping from her vagina, which seemed distressing to her and I helped to mop it up; the midwife found a clean towel and pants. She started to feel like pushing, the midwife cleaned away faeces. The labouring woman leant over my shoulders and bore down. She felt hot, I helped to take off everything she wore. In between contractions I sponged down her face with a cold sponge. One time I didn't cool the sponge and she directed me to do so . . . Doing the Thinking for Her These minute by minute, moment by moment, details of attention to her physical needs, in this instance, are like those required by a small baby. Although a woman obviously has the potential to give verbal explana- tions of what she wants, in fact it is a hindrance and effort to have to find the words. To articulate with words involves denying her regressive expe- rience and above all what she wants is to have someone linked into her non-verbal cues and to do the thinking for her. With attention paid to her bodily requirements in this way, she gets confirmation that her body is healthy, doing the right things, is not shocking nor repugnant to others. The Function of Holding Many women feel contempt for their body, estranged from its functions and processes, often generated by the way their body was regarded and treated when they were young. The experience of birth (along with the whole child-bearing period although birth as the most intense manifesta- tion) may be an opportunity to re-introject positive feelings about her body, which she may or may not have received from her early experi- ences. Skin Communication The childbirth provides a normal, developmental phase for women to re- experience bodily, soothing contact. Pines D. (1980) describes patients who have found psychosomatic solutions to psychic pain with skin disor- ders requiring physical contact through touching and soothing where verbal communication is blocked. She calls this "skin communication". She suggests that the skin as a medium for physical contact represents a boundary of self and non-self. In cases where the mother has handled the baby through its skin in a non-containing, negative and anxious way, this results in the baby's affects finding expression through disorders of the skin. The stroking massaging skin to skin contact of childbirth given by a containing, confident attendant can be seen as analogous to that which may be transmitted as a source of pleasure and intimacy between mother and baby. The labouring woman can internalise this experience and not have to re-seek it through psychosomatic expressions later. Breathing in Labour Breathing, also a bodily experience, is a powerful part of the labour and a direct link with the baby as well. We could say that breathing together in labour is a dyadic song without words. The contact made is through talc- ing the sound and feel of the breath, playing with it by finding a rhythm together, sometimes making slight alterations to pitch, tune or level of sound, but always as a response to the labouring woman's own creation. So I have found myself in labours getting into all sorts of rhythms and sounds of breathing, sometimes with a sense of desperation, at other times quite tuneful. The kind of breathing that I encourage women to use is deep belly breathing, that babies do naturally when they are born. The stomach of a baby expands and contracts with their breath as the oxygen flows in and the lungs fill completely and deeply. This is lost as we grow up and become hurried, tense and shallow with our breath.