Psychanalyse.lu


Jeremy Holmes

(Visiting Professor, Psychoanalysis Unit University College London; Honorary Consultant Psychotherapist, Tavistock Clinic.)


Foreword to: Joel Kanter, Face to Face with Children - The Life and Work of Clare Winnicott
(London, Karnac Books, 2004)

 

This book is primarily about the ways in which psychoanalytically informed social work set out to help troubled children in the middle decades of the previous century. As such it represents an invaluable historical record. But I believe it has much wider contemporary relevance and resonance. Pointing backwards to the rediscovery of lost values, it also has significant links with the very cutting edge of twenty-first century social care.

This is my attempt to describe the impact of social work on the novice psychiatric trainee in the 1970s:

A professorial ward round at a famous postgraduate psychiatric institution. The trembling resident presents the case. The professor interviews the patient, skilfully, but with great detachment. There follows a long and erudite discussion about diagnosis and psychopathology. A conclusion is reached and recorded. The professor departs, accompanied by acolytes. The resident, ward nurse and psychotherapeutically trained social worker remain behind. Silence falls. Then, as though from another world of discourse, the voice of the social worker is heard asking gently, but insistently, “but how shall we set about trying to help—as opposed to categorize, medicalize, diagnose, Procrusteanize—this suffering person?” [Holmes, 1991]

This was my 1970s' introduction to the social worker as a key member of the psychiatric team. In those days the psychiatric social worker was someone who had good training and skills in psychotherapy yet was not incarcerated in a psychoanalytic ivory tower, and she was able to use them, together with her personal strengths and practical wisdom, in the applied setting of the clinic.

The inevitable feminine of the personal pronoun, and the evident gender stereotyping of the Grand Round scenario, are inescapable. In those days the overwhelming majority of British social workers were women, direct descendants of the middle-class “do-gooding” lady almoners of the hospitals and voluntary “Care Committee” workers of the 1930s–1950s. In its preoccupation with child development, and concentration on the emotional and practical needs of those in distress, social work appeared to reinforce at a social level the stereotype of domestic “women's work”, while acquiescently vacating the high ground of doctoring, diagnosis, and academic prestige to men—albeit, as it often happened, “their” men.

Insofar as she is seen as “Winnicott's [D.W.W.] wife”, this is true too of Clare. But Miss Britton (as she was until the age of 45) also illustrates and embodies a very different set of images of social work: a vehicle for the liberation and self-expression of independent-minded women; a valuation of the developmental needs of children as an essential contribution to just, humane, and mature society; a recognition of the emotions as well as the intellect as a touchstone of humanity; a containing and reflective counter-weight to a male world dominated at best by action and exploration, at worst by unspeakable cruelty and destructiveness.

Joel Kanter's sympathetic introductory chapter covers these and other aspects in depth. The comments below should be seen as footnotes to his excellent summary. I shall pick out four themes that seem to me to make Clare's work relevant to contemporary preoccupations: the relations between the sexes, applied psychoanalysis, the nature of professionalism, and the values underlying social care.

Marriage . The first follows immediately from the discussion of gender stereotyping. As doctor, psychoanalytic president, life-and-soul extrovert, much-lauded author, and theorist, D.W.W. seems to embody typical “male” attributes. By contrast, Clare's modest background presence, unflashy teller of apparently everyday stories of conversations with her child clients, not to mention being an unfailing provider of seven o'clock dinner for D.W.W., suggest a womanliness that might be expected of a typical social worker. But, as emerges so clearly in this volume, the reality was somewhat different. D.W.W. was chaotic, intuitive, academically unsystematic, often lacking in common sense, and, in his private life, often a poor judge of men. Clare was organized, efficient, and down to earth, both in her practice and her thinking. She had a distinguished career in her own right and would today almost certainly have achieved a Chair in Social Work at the LSE.

Their successful marriage brought into play “masculine” and “feminine” elements, as well as the grown-up and childlike sides of both of them. They were able to retain separateness and individuality despite—or perhaps as a consequence of—their deep mutual involvement. Clare drew on D.W.W.'s creativity and civilized it into a form that was useable in her everyday dealings with children and those of her students. D.W.W. needed Clare to translate his ideas into practice, to provide the tinder-box where sparks of original thought could be struck, the anvil upon which new ideas could forged. While remaining within a conventional gender division of labour, they were able to express rather than suppress their “shadow” selves.

This suggests a different approach to the deconstruction of gender that has been such a preoccupation of the last two decades of the twentieth century. Feminism rightly asserts vis-à-vis the masculine that “anything you can do I can do just as well (and many things better)”. But behind that there lies a void, leaving the question of the relationship between the sexes still unanswered.

The example of Clare and D.W.W. suggests that “marriage”, if seen—metaphorically as well as literally—as an intercourse of equals, can be a way of breaking down traditional patterns of male authority and female submission. The “issue” of such a marriage (notwithstanding that Clare and D.W.W. were childless) can be both a benignly regressive “harmonious mixup” (to use a phrase coined by D.W.W.'s psychoanalytic contemporary Michael Balint), and a sublimatory sphere in which, through work, culture, and conversation, men and women can exchange their intrinsic attributes without feeling depleted.

Applied psychoanalysis . Both D.W.W. and Clare, before becoming psychoanalysts, had had successful careers in different professions:

D.W.W in paediatrics, Clare of course as a social worker. Perhaps because of this they both had the knack of using psychoanalytic ideas in everyday non-psychoanalytic clinical settings. Clare was clear that engagement, making contact with troubled children, striking up an authentic conversation, and reinforcing their sense of self were all essential tasks to be completed before any formal interpretative work could be usefully done. Like D.W.W., she too knew that children are often best approached indirectly—through a game, conversation during a car journey, comment on a pair of fashionable shoes, or even snuggling up in front of the TV together. For her, “support” and interpretation were not, as held in some psychoanalytic circles, mutually exclusive, but mutually reinforcing. Deep truths can emerge from the ordinary and are often themselves utterly simple. She did not see psychoanalytically informed social work (or, for that matter, psychiatry) as somehow watered down or inferior to the five-times-a-week “real thing”, but, rather, a way of engaging in the everyday lives of ordinary people, but with the added depth and dimension that comes from a psychoanalytic perspective.

The best aspects of the impractical yet invaluable supervision that D.W.W. offered Clare and her fellow social workers with evacuatedand adopted children in the war were carried over into her own supervisory work in training social workers, whose case reports she comments on so beautifully throughout this volume. That perspective, which gives meaning to care work and provides the conditions under which a professional task becomes a creative act, sorely needs to be rediscovered if social work is to regain its attraction for the idealistic young.

Professionalism . This brings me to my third theme: social work as a profession. The LSE was a hotbed in the maelstrom of the early 1970s where students questioned to their very foundations traditional intellectual and social authority. One of the consequences of that and other social change in the last two decades of the twentieth century has been to sweep away traditional social work practice, and especially the casework that lay at the heart of Clare Winnicott's professional identity. Professionals of all sorts are today viewed with suspicion. The rights of the “user”—no longer a “patient” or “client”—reign supreme.

While there is much that was necessary about this seismic cultural shift, for social work it has had unforeseen negative consequences. Rather than becoming agents of social change, manning the barricades alongside their clients, the role of social workers today is if anything more than ever bound up with social control. In the mental health field in the United Kingdom, social work expertise covers risk assessment, intimate knowledge of mental health legislation, and generally acting as a broker for deprofessionalized practical services. The long-term, intimate, subtle, deeply involved developmental experience that casework at its best could offer has become a thing of the past, incomprehensible to the young generation, nostalgically mourned by their elders.

For Clare Winnicott, the professional relationship brought out the best in its practitioners: a relatively unconflictual zone where people could express their love, toughness, intellect, compassion, and humanity in the service of others. At the same time social work practice—if properly nurtured, supported, reflected upon—was a maturational experience for the professional herself. The Clare Winnicott that comes through this in volume embodies the essence of that professionalism. As she writes about her work with children and their carers, she conveys a sense of being instinctively professional (if that is not an oxymoron) —respectful of boundaries, focused on the task in hand, able to muster all necessary knowledge and experience in the service of the client. At the same time she is utterly herself, calm, warm, encouraging, playful, funny, and able to be surprised by what her clients can teach her, and the responses they evoke in herself.

Values. That brings me finally to the values that inform Clare Winni-cott's thinking and to their contemporary relevance. Here too we find her unique blend of common sense and psychoanalytic insight. Her view of the psyche and of social life was essentially dynamic in that she saw both as a resultant of a balance of forces: on the one hand those that tend towards individuation, authenticity, and maturation; on the other, the stress, disruption, and loss that challenge the self with disintegration and false accommodation to a traumatic reality.

She was acutely aware that harmonious relationships could prevail, but that maturity involves being able to cope with discord as well. Nothing is so perfect that it can last for ever. What makes her writings interesting to us today is that, unlike many of her psychoanalytic contemporaries she did not reify any particular psychoanalytic con-struct—such as transference interpretations—as a route towards successful therapy. She was, rather, interested in the psychotherapeutic process , and how it can help people towards authenticity and a sense of self. For her, establishing a therapeutic conversation was what mattered, not what the content of that conversation happened to be. She saw that the moment a child can communicate in words something of his inner world, a foothold has been established. Recovery flows from speaking the truth about feelings and being sensitively heard, not judged, organized, or advised. And, of course, it is the possibility of being heard that is the catalyst that allows the feelings to flow and the words to form.

The voice that comes through these pages is imbued with the values that make a good therapist. It combines authority with modesty, a simplicity that is not afraid to tackle complex or seemingly intractable problems, an authenticity that flows from experience but is informed by the ideas and theories that enable that experience to be reflected upon and digested. Clare Winnicott knew what was good and what was wrong, which were the defences needed to survive in a difficult world, and those that could usefully be discarded. She managed to be both her own woman and a devoted wife to one of the outstanding psychoanalysts of his day. Her harmonious additions bring depth and completeness to the mercurial melodies of her husband.

Clare met D.W.W. while working with orphans and evacuees who were the innocent child victims of war. Today's social work clients are casualties of family breakdown in an increasingly fragmented, ever-changing, regression-inducing, global society. Borderline clients, refugees, and victims of torture need both social work and psychotherapy if they are to survive psychologically, let alone flourish. Clare Winnicott will no doubt continue to be remembered because of whose wife she was. With the help of this volume, however, D.W.W. and Clare's complementarity becomes clearer and shows the way for the much-needed revival of partnership between psychotherapy and social work. Without that mutual support and understanding, the whole pic-ture —the integration that is the hallmark of the authenticity Donald and Clare strove for—will remain for ever elusive.

XHTML 1.0 Transitional