2-1 A curious devotion: Winnicott, hermeneutics, and love in the practice of psychotherapy
D.W. Winnicott’s notion of the good-enough mother is one of those ideas that shook my life and practice. A practical idea—and one whose meaning can be easily grasped by almost anyone hearing it—the concept also arose from Winnicott’s thorough and sophisticated theorizing. Yes, I remember thinking; yes, that’s it! Winnicott helped me understand what it was about the notion of the all-too-perfect, seemingly obsessed mother that I found at worst disturbing and at best short-sighted. I always wondered how the child was to be spared distress, seemingly the mother’s goal, in a life that is riddled with it, and what the cost of her efforts might be. On the other hand, I did not wish to entertain a cynicism that would valorize a mother who sees her child as only one thing to attend to in her busy life, the child’s suffering just another burdensome task. Winnicott’s theorizing of the “good-enough” not only helped me ease my own anxieties, it gave me hope for the ability of humans to interact with each other at all. Abandon your search for perfection, avoid violence, just be good-enough! But of course, it is not so simple.
In this paper I explore Winnicott’s concept of devotion as a way towards the good-enough clinician. Eschewing binary divisions of the therapist as either clever interpreter or stoic witness, interrogator or cheerleader, I wish to propose devotion as perhaps the single most important clinical faculty. I will sidestep the (very well theorized) debates between analytic proponents of a hermeneutics of faith versus a hermeneutics of suspicion, and will instead propose that devotion allows us an avenue for our focused attention and a place for love in the practice of psychotherapy via a hermeneutics of curiosity. This hermeneutics of curiosity, inspired by Winnicott’s hermeneutics of paradox, is one that acknowledges the patient’s limits and holds that of course she is doing her best. At the same time, this practice encourages the patient that, while she does her best, I am here; that I will be here next week, and that there is more yet to be said and done. Using my own work, I will explore devotion as Winnicott defines it, illustrate how I see devotion and paradox as central to my work, and, finally, demonstrate how I find utility in both ends of the hermeneutic spectrum (suspicion and faith), settling a midpoint of curious devotion.
In my clinical work I find myself repeatedly returning, seemingly in endless regress, to that fundamental psychoanalytic concept of ambivalence. I began my clinical work – as I’m sure many young, bright-eyed clinicians do – underestimating or dismissing the unconscious tensions, splits, and instances of ambivalence (what Winnicott might call paradoxes) in the lives of my patients. I thought they wanted help; that they came to me with a problem and here I was to solve it. That, of course, is true. My patients did, and do, want and need help. They come to me with problems and to greater or lesser degrees they want my help solving them—help I am happy to give them. Sometimes, though, they have more or different problems then they first presented. Even trickier, I have sometimes found we can solve a problem only to have it rear up again, or mutate into a slightly different form, forever shifting and one step ahead of my, or my patient’s, ability to ‘solve’ it. Quite unhelpfully, I have found us both often so frustrated, each believing we must be the at-fault party.
I think here of a patient, Christine, who I saw for nearly four years and who found herself over and over having the same abusive romantic relationships with men. They were so nice at first (they were always so nice, at first) and each one, she promised, was certainly different – no, this one didn’t keep guns in the house, this one was different because he didn’t fight in bars like the other, didn’t do drugs, or drink. Yet in the end, they were always the same – a month here, a few weeks there, and soon enough her phone calls would be checked, her whereabouts questioned. Then the insults would start. Then just a push (“he was just really upset”), or a shove, and a kick. Then a punch. Then a rape. The details and the sequence varied, but the result was the same: the repetition was so neat and so complete that we could practically set our calendars to when the latest (inevitably) violent boyfriend would stumble on the scene.
How vexed I was in those early years as I problem solved, strategized, encouraged Christine that she was lovable… and despaired as it happened all over again. I bemoaned that I was an awful clinician who couldn’t even protect my patient from the literal, let alone figurative, blows of life (trying though I was). How terribly frustrated and upset she was as she would tell me, tears streaming down her face, that she really appreciated everything we were doing and the suggestions were all really great and she knew she shouldn’t be with him but…she just couldn’t stop herself.
Slowly, in stops and starts, and dreams and memories, Christine taught me how to be her therapist. As we concluded our treatment, Christine still often got into one-sided and unequal relationships, but at the time of my leaving, it had been nearly a year since her last abusive relationship. What she taught me was that I could not stop her and that so long as I was trying, I could not hear her. As she unfolded a family history of an engulfing and fusing mother and an abandoning and violent father, I saw that I could not help her out of the breakdown that had already occurred so long ago (Winnicott, 1974) by repeating the selfsame conditions of that very breakdown. I could not pretend, as her mother had, to not see the violence in these relationships; to choose to see only a sweet, little girl having some fights with her boyfriend that would soon be over and return the world to being nice and sweet and good. Neither could I be her father, knocking her head against the wall and berating her for doing it once again, demanding that she cut it out and wondering what her problem was.
Christine did not need me to take her problems away, nor did she need me to somehow cleverly interpret or illuminate them for her; instead, she showed me often that she understood her situation quite well. No, what Christine needed from me was not good advice, not a corrective emotional experience, not a still face to throw projections across, but that which she had so missed from her parents, her friends, and virtually every man she ever dated: devotion. She needed someone to listen to her, to believe her, to contain her, and give her space. Christine needed someone who loved her enough to allow her to be.
What is meant by devotion? Here I will characterize the term – which I believe is in keeping with Winnicott’s sense of it – as comprising of two parts: the literal and practical act of being there with the patient, and the devotional act of sitting with ambivalence and refusing to solve the paradox for the client (while also not ignoring the intense suffering she undergoes seeking its solution). While devotion may indeed be one of these ‘big’ terms that “knows more than we do” (Winnicott, 1965), nevertheless I aim to poke at and provoke and play with it a bit. How does one do it and what does it look like?
The line I found in Winncott’s writing that describes this is so small – so tiny in an ocean of text with references to object relations, analytic desire, transference and countertransference – that one could almost miss it. For me, however, this particular line caught the light, and it glinted: “what I really do say however… is that the analyst is in the role of the devoted mother. This is quite different from good mother. In fact, it antedates a splitting of good and bad mother” (cited in Rodman, 2003, p. 156; emphasis added). Thus we begin to know devotion by knowing what it is not: it is not the bad mother (surely this was evident enough all along) but – perhaps surprisingly – it not the good mother either. It is not the doting and long-suffering mother who wishes to remove all suffering from her child, to suffer for her instead, and to save her from the ravages of the world.
Rather, the devoted analyst shows a “primary maternal preoccupation” (Winnicott, 1956) that demonstrates, above all, an interest in and attention to the patient. In this sense, the preoccupation, love, or devotion of the analyst is not so far from the free floating, evenly hovering attention that Freud (1900) first proposed as the proper analytic attitude. We begin to show our patients we are devoted to them, very simply, by offering them treatment, by offering it as consistently and reliably as we can, and by paying attention (really paying attention) to all aspects of their experience in sessions. I believe that the first step on the path towards devotion is to see our patients as neither wonderful, star children nor rotten, lying brats, but to be preoccupied with the task of seeing who exactly they really are (and accepting that they may see themselves, and indeed occupy, both these polarities at different times). We do this by showing them we are here, and we will hear.
For me, showing devotion to my patients enters every aspect of the treatment, including the seemingly banal details like scheduling (though of course psychoanalysis teaches us that nothing is ever banal!). Thus I hold a place for my clients, every week or twice a week, and I make sure that they know the space is there for them. I will always try to reschedule with them should one of us be unable to make an appointment, and if they have other troubles, such as with fees or parking, I do what I can to support them. I show them, through my desire for them to come back, every week, that I am here for them, and that I care about them. I show my clients that I believe the work they are doing is important and I want them to continue. This said, I too have my limits.
I am not the good mother who is able to be reached by her patients day or night. I am not the good mother who will always cancel a date or a dinner with a friend to reschedule a forgotten appointment. I am not the good mother who will meet with my patient any time, or in any place outside of our therapy room. I limit the extent to which my patients may access me, but this does not mean I am not devoted to them, nor that I love them any less. Quite the contrary, in fact, and as Winnicott points out, devotion is not simply being ‘good’ or meeting every demand. Neither, however, am I the bad mother who cancels an appointment just to see what happens or in the supposedly honorable name of “evoking the transference.” I am not the bad mother who distrusts or doubts what her patients say in the interest of “cognitive reframing,” destroying my patient’s experience and supplanting it with my own. I am not the bad mother chiding my patient’s defenses, claiming to know her better than she knows herself.
Rather, I aim to show my clients that I am interested in them, that I am curious about them, and that I am inviting them, through this curious devotion, to share in my interest. I think that in this way I model for my clients – so many of whom come to see themselves as worthless, loveless, and inhuman – that there is something indeed that is curious and beautiful about them, because I always want to hear more. Through something as simple as emphasizing rescheduling, I employ a devotion that I’ve often framed as a twist on the famed One Thousand and One Nights – just one more story, please. With suicidal patients whom I have treated, I have sometimes evoked this technique far more explicitly. I take nothing, even the option of death from my patient, but rather ask that she attend just one more session with me before she cashes in that particular option. In this way, I do not come out and tell her, “I love you and I think you should live” (though there are certainly arguable merits and consequences to doing so), but still, I show her that I am here, I want her to remain here too, and I am interested in her, because she is interesting. I listen to her because she is worth listening to – even if she cancels, cries or acts “crazy.”
I cannot give my patients everything, but I can show them that I am devoted. I can say I am here and if you are lost, we will find you, together. In sessions as well, I cannot always offer an astute interpretation or a just-right question that opens up some new avenue of insight. While I am humbled to have sometimes (often despite myself) been able to help my patients in this way, I often also find myself simply humbled in their presence and in the presence of what they come bearing, which deserves witness.
In these times of uncertainty, however, I am not useless. In these, as in all times, I listen carefully and I follow my patient wherever she goes, even to the dark and frightening places. Here too, I think I have devotion, the devotion of a mother who is not all good, lulling the child to stay at home while she fights the demons, nor that of the mother who is all bad, offering nothing but silence and sending the child off alone to “toughen up.” Rather, the devoted analyst goes with her patient and she stays with her through the session, through the long journey into the night and, we hope, back to the light. The devoted analyst imposes no agenda – even that the patient should be well – allowing her patients to be exactly where they are, even if that is “resistant” or “regressive.”
Thus the analyst displays devotion – sidestepping the pull to occupy either the role of good or bad mother – in some simple, practical ways such as scheduling and listening closely. Yet I think there is a second level to devotion, a more abstract practice of holding and considering paradoxes that constitutes analytic devotion. Winnicott (1956) warns us that we must avoid situated, settled meanings, including the oft bandied about notion of the regressed patient as infantile and needy. As a feminist scholar, I have too often observed the term “borderline” used to dismiss women’s cries for others to see them and women’s expressions of distress – carving up their bodies or making them disappear – interpreted as unacceptable “boundary problems.” The patient’s breakdown is seen as a sign of characterological weakness, or a clinical inconvenience, and it must be stabilized and dismissed before we can even begin ‘real work.’
This rhetoric, so common in our field, is nonetheless violent, preposterous, and somehow so encapsulating of all the worst in the poles of both the good and bad mothers. In wanting to immediately relieve the patient of symptoms, we are the good mothers who take away the suffering of the world. Yet in this same moment, we are also the bad mother who invalidates her child’s experience and denies that her symptoms are a part of her, with much to say. It is absolutely correct that “defenses should receive respect and trust” (Orange, 2011, p. 153), but this means holding the paradox of the defense for the patient. If we quickly try to take the defense away – to reduce the symptom, to end the breakdown – we have failed to hear the patient and we have missed her. We have failed to devote ourselves to her just as she is, preferring our own vision of how she might be.
However, even as we respect, understand, and come to see defenses in context, we know that they are painful for the client. We cannot go to the other end of the spectrum and laud the patient for coming up with such a clever way to cope, without also recognizing that this way has a cost, a cost so high that the patient no longer wants to pay it. Rather, we must show the patient, and the patient’s defenses, devotion – we must listen to them, try to understand them, seek their roots and present day functioning. We do not take these important defenses from the patient, but neither do we look the other way. Instead, we do what the patient and so many others in her life have been unwilling or unable to do: look at her. We must be willingly to fearlessly look, and to accept all of what we see: beautiful and damaged, courageous and defensive, striving and breaking apart, crazy and suffering. To look a defense dead on – to stare down a symptom like cutting, or anorexia, and resist the temptation to interpret or question or normalize it – this is the devotion, the love, of the analyst.
Part of how Winnicott sees the devoted analyst as functioning is in allowing the patient to simply be, even if that being is broken down, insane, regressed, or difficult to bear. While I acknowledge and hope to help with her suffering, I cannot walk the journey for my patient, only with her. There have been times with Christine where I have had to take us aside on our therapeutic journey and tell her that I am concerned for her physical safety and life. However, I stopped demanding or even doggedly encouraging her to leave these relationships. For as long as I refused to accept her as she was – broken down, trying so hard, and yet stuck in a vicious cycle – wanting only for her to get out of it, I could be of no help to her.
Christine needed me to tolerate the paradox that she could not: that she both hated these relationships and could only exist within them. She needed me to tolerate her when she could not. She needed me to affirm that she was playing with fire, while also wondering what it must be like to play such a dangerous game, what the thrill and the glint of it looked like to her. What Christine needed was not an answer, but an “insistence on looking not just for the ‘both sides now’ but for how these both sides work to create and sustain psychological life” (Orange, 2011, p. 156).
In the end, I did not solve Christine’s problems, nor her paradoxes, which in some ways still shone poignant as we ended our time together. I value Christine as a person and a human being who is strong and capable, in need of my presence, my devotion, and my ear perhaps… but not in need of my rescue. Were I to rescue her, I rob her of the chance to see for herself how her relationships really work and why they have come to be this way. Difficult though I admit it is, for both patient and analyst, I follow Winnicott and propose that devotion is shown in asking: “for a paradox to be accepted and tolerated and respected, and for it not to be resolved.” This is not because it is impossible to resolve the paradox, but rather because “it is possible to resolve the paradox, but the price of this is the loss of value of the paradox itself” (Winnicott, 1971, p. xxii, italics added).
Thus, I believe that if there is any rescue to be had, it is the clinician who can be rescued, rescued from dualistic thinking about the patient and saved by embracing a sense of the good-enough clinician via that fundamental sense of devotion. When I read accounts championing the hermeneutics of suspicion or of faith, I find myself often vaguely unsatisfied. On the contrary, perhaps, other times I am all too satisfied. Yes, yes, I think, reading along, only to turn to the opposition and find myself still thinking yes, yes, yes. More than opposed to each other, I find these approaches complimentary, and I suggest that we take the best of each to form a good-enough hermeneutics: a hermeneutics of devotion, of paradox, of love. I reject a hermeneutics that would claim that the patient is not telling the truth, not trying as hard as she could, always unconsciously attempting to trick or get one over on the analyst – this position to me seems like that of a bad and terrifying mother indeed. Yet I also think there is something lost in a hermeneutics that always prizes the patient as doing her best to the point that defenses are not challenged, other sides are not sought, and provocation and confrontation is feared and avoided. This seemingly good mother can leave a patient unchanged – still confused, lost, and in pain.
Rather than these poles and the good and bad mothers, I advocate that we as analysts be thoughtful mothers, curious mothers, and devoted mothers. We must trust and ally ourselves with our patients, but we also must be curious about our patients and encourage them to be curious about themselves. While, indeed, my patient may be doing the best she can, this simply isn’t good enough (good-enough?) for her, and she has come asking my help. I will applaud the work she has done, I will respect her efforts, but I cannot leave her in this valley. I must journey further with her, through the work of treatment. The journey will bring us both to understanding her more, but it will have to be through curiosity, questioning, and provoking that we find our way. This is perhaps the hermeneutics of paradox that Winnicott so beautifully embodied. In this way, we trust and embrace the patient, we act and we ask, but we never lose sight of the fact that “there is always more to learn, that our understandings are never more than partial or tentative” (Orange, 2011, p. 173).
When I first began doing clinical work, I was vexed by the question of a theoretical orientation or clinical position. In early training, it seemed that the questions rained from all sides. How did I view the self? What is my working conceptualization of the healthy human? What does it mean to be well? To be sick? How can one act? How can I do therapy? Who am I to do therapy? What do I mean to do by doing therapy? All these questions hidden under that sneaky little question – “What’s your theoretical orientation?” Years later now, after learning, using and discarding or adopting any number of techniques, orientations and strategies, I’ve found that what utility they have is in bearing that common factor: devotion. What seems to matter the most is simply this: listen, and love.
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