Margaret Little's book "Psychotic Anxieties and Containment: A Personal Record of an Analysis With Winnicott" is an excellent psychoanalytic work "from the couch" of one of the greatest psychoanalysts. It's mostly telling the story of her analysis with Dr Winnikot, whose work with adults is little known with theoretical reflections. Well, it is how it should be done -- experience, integrate and reflex. Then comes sharing. And, to the best of my belief, everyone can benefit from this courage sharing.
Containing just as a mother does
Margaret Little has shared clinical material from behind the door of Dr Winnicot's room, which belonged to her experience of psychotic anxiety, held in and destroyed her since childhood. And D.W. (as she called him in the book) applied a carefully containing approach to cure her. They have been working together extensively while meeting in the most active phase of the therapy up to seven times per week for 1.5 hours each session. Here is how she describes the settings for one of the depressive episodes during the therapy:
''Early in the analysis, after a severe attack of gastroenteritis (which I recognized later was a flare-up of the coeliac condition). I went on feeling very ill and exhausted physically and deeply depressed. I was not able to go for my sessions. D.W. came to me at home - five, six and sometimes seven days a week for ninety minutes each day for about three months. During most of those sessions, I simply lay there crying, held by him. He put no pressure on me, listened to my complaints and shoved that he recognized my distress and could bear with it.''(p. 52)
During the sessions, she describes she felt that DW was her mother, as if it was real, which, of course, was a projection mastered by the D.W. approach. During the sessions, D.W. allowed her to be a child and cared for her as if her life depended on him. He was holding her hands for hours, sometimes falling asleep. Onece even admitted her to the psychiatric hospital during his vacations to ensure she would not commit suicide. He regularly wrote and spoke to her during her time in the hospital. He allowed her to live through childhood again, get into deep regression and break the traumatic bond with her mother.
"The experience of being "mothered" is truly mutative in that it resolves the anxiety concerning survival and identity by providing reassurance and continuity of being. Awareness of being real, recognition of what is inner or outer, ability to fantasize and to distinguish fantasy from reality, to symbolize, to relate to others in a way that was previously impossible, and to mature, first to the "depressive position" (Klein 1935) or "stage of concern" (Winnicott, 1950, 1963a), and later to the oedipal level, follow as in normal development, helped on by whatever maturity had been achieved before." (p.90)
The book argues that the analyst's ability to provide a safe, secure and containing environment is crucial in helping patients to work through their psychological problems and ultimately recover.
Annihilation and regression to dependence
One of the key concepts explored in the book is the notion of the psychotic part of the personality in every human being and the scary feeling of annihilation caused by intense and overwhelming emotions that threatens one's sense of self and existence. She suggests that the analyst's role is to help the patient to contain these emotions and to integrate them into their sense of self which pens space for the patient's regression to dependence. The latest refers to a patient's willingness to rely on the therapist for safety, support and guidance:
"Regression to dependence is a healing process that originates not in the analyst but in that part of the analysand, his "true self", which can still hope for a reversal of the original failure, through finding in the analyst enough adaptation to his needs. "Treatment" is needed, rather than technique"; and intuitive behaviour and management, not verbal interpretation. But it is not easy, for it involves the analysand in a frightening return to the earliest unintegrated state. There is the risk of repeated annihilation by stimuli to which he has to react physically (startle reflex), and with forced integration, against which he has no defence and which he cannot comprehend; of being let fall while helpless, there being no boundarY or Control.'' (p. 88)
Little argues that this regression can be a healthy and necessary part of the therapeutic process, as it allows the patient to explore and work through their anxieties in a safe and containing environment.
A personal touch
The contribution of the work is outstanding because we can look at the struggles one prominent psychoanalytic went through. And her experience, at least for me, is an excellent example of any human suffering and must be allowed to do so, even if the person herself is a mental health professional. Dr Little worked almost all the time while in therapy with D.W., accepting analysants. Probably it was hard for her to write this book, not just because of the D.W. legacy she was writing for but because of the personal story she shared. As Dr Little wrote:
''...existence is justified by allowing the right to it to others'' (p.33)
Overall, Margaret Little's "Psychotic Anxieties and Containment: A Personal Record of an Analysis With Winnicott" in an accessible and clear way, describes the analyst's role in containing the patient's anxieties and overwhelming emotions. The book is easy to read and is a great resource for psychoanalysts, mental health professionals, and anyone interested in psychology.
And it is important to remember:
''There are analysts who apparently believe that every session ought to be painful, but while D.W. was fully aware that analysis could only work for someone who really suffered, he believed in the value of a relationship that could also be encouraging and enjoyable.'' (p.63)