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6-25). Winnicott's clinical experiences in this capacity eventually gave him the raw materials "from which he subsequently built his psychoanalytic theories" (Donald Woods Winnicott 1876-1971-2000).
Winnicott's Influences and Challenges
Winnicott's theories and method were far from unchallenged by his professional peers, however, including several renowned European child psychoanalysts who had first immigrated to London during the war years. Among his chief challengers, and major professional competitors of that period were the likes of Melanie Klein and Anna Freud:
child analyst Melanie Klein, moved to London in 1926 and soon had many followers: Winnicott had further analysis with one of them, Joan Riviere. The Kleinians' belief in the paramount importance, for psychic health, of the first year of a child's life, was shared by Winnicott. But this view diverged somewhat from that of Freud and his daughter Anna (herself a child analyst!) who both came to London in 1938, refugees from the Nazis in Austria. A split within the British Psycho-Analytical
Society was threatened between the orthodox Freudians and the Kleinians; but by the end of World War Two in 1945 a typically British compromise established three more or less amicable groups: the Freudians, the Kleinians and a "Middle" group, to which Winnicott belonged"(Donald Woods Winnicott 1876-1971-2000).
After first moving to London, Melanie Klein was, in the early 1930's, one of Winnicott's original psychoanalytic mentors. Later Winnicott analyzed Klein's son, although he did not do so under her supervision, as she had originally requested that he do (Rodman 1987, p. xiv). Later on in his career, however, Winnicott's professional relationship with his former mentor became frosty. The major source of disagreement between him and Klein had to do with Klein's unwillingness to support Winnicott's view that the "actual mother and her actual behavior" (Rodman, p.xx) were crucial to healthy human development.
While rejecting the principles of peers like Melanie Klein, Winnicott acknowledged that Sigmund Freud had single-handedly created the conditions of possibility for work by all future psychoanalysts, including himself. As Rodman (the Spontaneous Gesture 1987) explains:
The role of external reality was brought into question by discovery that reports of Sexual molestation in childhood usually were the result of Oedipal fantasies rather than actual events. That opened the world of fantasy to careful study and launched
Freud on his great work of demonstrating that a person's instinctual urges and infantile neuroses color and shape the course of life. This point-of-view...[was] regarded as the backbone of psychoanalytic theory...Klein probably represents its apotheosis. By virtually excluding external reality from a formative role in development, her theory achieves the impression that the technique it generates will benefit the patient through shattering insights. Winnicott, firmly rooted in the psychoanalytic tradition but also a practical observer of children and their parents in distress, could bring in external reality as an influence without sacrificing the significance of the child's fantasy life in the process" (p.xx).
Two key differences between Winnicott's approach to psychoanalysis and that of Sigmund Freud himself, however, are (1) the stages of human development on which they mainly focus, and (2) their respective emphases on early instinctual life (in Freud's case) and "relational structure of infant to mother" (in Winnicott's case) (Rodman, the Spontaneous Gesture 1987, p. xxvi). Further, in comparing Melanie Klein's 'internal object', to his own 'transitional object' Winnicott states (Playing and Reality 1950): "The transitional object is not an internal object (which is a mental concept) - it is a possession. Yet it is not (for the infant) an external object either"(p.9),
Moreover, as Rodman (1987) explains, Winnicott focuses on the earliest stages of infancy and childhood, particularly the infant's relationship to its mother, and 'transitional objects' (Winnicott, Playing and Reality 1950, pp. 1-7) as the major keys to all later development, good or bad. Freud, on the other hand, is not nearly as concerned with infancy in and of itself, or with either mother-infant or object relations as indicators of later emotional health. Second, as Rodman (1987) states of Winnicott: "His theory of health is not defined [as is Freud's] by the absence of pathology. He is interested in more than that. He wants to define a healthy life in positive terms"(p.xix).
Winnicott's view of infant-mother, and infant-object relations as pivotal to healthy human development likely sprang from his early clinical work within his initial medical specialty of pediatrics. From there, he became interested in child psychiatry. Rodman (1987) states: "His Wednesday clinics, which gradually evolved from traditional pediatrics to child psychiatry, were part of the continuity of his medical experience, which amounted eventually to about 60,000 cases"(p.xiv). Therefore, "A s a pediatrician with a vast experience he could not help being rooted in the empirical reality of early infant development. This aspect of his knowledge perfectly complemented what he was learning in child analysis and in the process of reconstructing the early life of deeply disturbed adult patients"(p.xx). Further, as Goldman (2002) concurs: "Winnicott, for his part, was never comfortable thinking about development as coming either from the inside out or the outside in. His primary area of interest was the overlap -- what he termed the 'intermediate space -- between internal and external realities."
Winnicott's psychoanalytic theories, methods, approaches, and instincts were unique, for three key reasons. First, he was the only child psychoanalyst among his peers to have practiced pediatrics before turning to child psychiatry as a later specialty. Second, Winnicott alone focuses on infancy as the most crucial stage of life, from which either healthy or unhealthy psychological development in humans springs. Third, he uniquely identifies the mother as the source of an infant's first, most important, object relationship. As Winnicott further explains: "A baby is held and handled satisfactorily, and with this taken for granted is presented an object in such a way that the baby's legitimate experience of omnipotence is not violated. The result can be that the baby is able to use the object, and to feel as if this object is a subjective object, created by the baby...All this belongs to the beginning, and out of all this come the immense complexities that comprise the emotional and mental development of the infant and child" (Mirror-role of mother and family in child development, 2002).
Illustrations and Case Studies
The manner in which Winnicott put his theories into psychoanalytic practice, in his clinical efforts to help developmentally disturbed children and their parents, is evident from various case studies and illustrations offered by Winnicott in Playing and Reality (1950). One such example involved a seven-year-old boy with an unusual attachment to string.
According to his parents, "...the boy had become obsessed with everything to do with string, and in fact whenever they went into a room they were liable to find that he had joined together chairs and tables; that they might find a cushion, for instance, with a chair joining it to the fireplace" (p. 17). The parents, Winnicott adds, were relieved to finally discuss their son's unusual obsession, especially since "...the boy's preoccupation with string was gradually developing a new feature, one that had worried them instead of causing them ordinary concern. He had recently tied a string round his sister's neck (the sister whose birth provided the first separation of this boy from his mother)"(p. 17).
Besides his parents, the family of this boy consisted of two sisters, an older one who was mentally retarded and attended a special school, and a younger sister, whose birth, when the boy was three years and three months of age, had caused his first separation from the mother when she left for hospital to give birth. That separation was followed by another from the mother, when the boy was three years and eleven months (this time, the mother was hospitalized for an operation. Yet another separation from the mother took place when the boy was four years nine months old, this time for two months while the mother, who suffered from serious depression, was treated for it in a mental hospital (Winnicott, Play and Reality 1950, p. 16).
Winnicott summarizes his treatment of this child and his string-obsession symptom in the following way:
explained to the mother that this boy was dealing with a fear of separation, attempting to deny separation by his use of string, as one would deny separation from a friend by using the telephone. She was sceptical [sic], but I told her... I should like her to open up the matter with the boy...developing the theme of separation according to the boy's response.
Moreover, from the moment that she had this conversation with him the string
Play ceased. There was no more joining of objects in the old way...she felt the most important separation to have been his loss of her when she was seriously depressed; it was not just her going away...but her lack of contact with him because of her complete…[continue]
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During the next chapter of this clinical case study dissertation, the Literature Review section, this researcher relates accessed information that contributes a sampling of previous research to begin to enhance the understanding needed to help a patient "grow" not only in therapy, but also in life. CHAPTER II LITERATURE REVIEW The theories and techniques used in psychoanalysis are very diverse; Freudian analysis is only one approach." Thomas and McGinnis, 1991, ¶ 1) Diverse Contentions One
Therapy The object relations theory of the personality developed from the study of the patient-therapist relationship as it relates to the earlier mother-infant dyad. Object relations theory emphasizes the infant's early experiences with its primary caregiver (typically the mother) as the fundamental determinant of the formation of adult personality. The infant's need for attachment is the primary motivating factor in the development of the self. Two schools of Object Relations theorists
dysfunctional behavior that strikes 1 out of 40 or 50 adults and 1 out of 100 children or 2-3% of any population. It can begin at any age, although most commonly in adolescence or early adulthood - from ages 6 to 15 in boys and between 20 and 30 in women -- according to the National Institute for Mental Health. This behavioral affliction is, therefore, more common than schizophrenia