Playing the Unconscious

Psychoanalytic Interviews with Children Using Winnicott's Squiggle Technique

Michael Gunter

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9780367325961
• eBook ISBN:
  9780429917363
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book offers a most interesting view of the application of the Winnicott squiggle game outside the context of therapeutic consultations. It concentrates on describing the inner mechanisms for coping which came to light in the psychoanalytical squiggle interviews with the children.

CHAPTER ONE
Introduction: practice and theory of the squiggle game

The idea of writing a book on the Winnicott squiggle game in therapeutic work with children has been in my mind for a long time and is rooted in many experiences. One such is the realisation, still surprising to me even after so many years, that the squiggle game does indeed enable us in most cases to make contact with a child with particular ease. In most cases, if the child takes up my suggestion, an intense dialogue develops in one way or another, which gives an insight into his or her inner situation. And even in cases where the child is consciously very reserved and in which the talk emerging from the squiggle game seems to be unproductive, the pictures offer a chance to start talking about precisely why he or she shows such reserve.

Naturally, squiggles are not a magical all-purpose psychotherapeutic tool. There are cases in which I don’t know much more about the child and his or her conflicts and subjective view of things after our conversation than I had already been told by the parents. It would also be a mistake to suppose that the ease with which children make contact through squiggles is carried over into virtually effortless diagnostic and therapeutic work. It is important to set up the psychotherapeutic interview situation to be playful in character, which is incidentally fun for both therapist and child. The squiggle game makes this easier because it generates a playful atmosphere, which nevertheless has a very serious side. Results emerge from a genuinely therapeutic form of work; however, this can be extremely taxing. I am sometimes even tempted to avoid an encounter as intense as the squiggle game produces, and simply have a friendly conversation with the child.

Lest there be any misunderstanding, let me point out right at the start that these case studies describe the events as they happened. Most of them I have given in full; only in one or two cases have I abridged the account because the material was so voluminous. The same goes for the pictures: with very few exceptions, I have included the whole sequence, that is to say those I made out of the children’s squiggles as well as those which I consider far more important: the pictures the children made out of mine. It was possible to reconstruct the interviews in such detail either because I made notes on the pages we were using for the squiggles and then wrote them up in detail straight after the session, or because a younger colleague sat in on the sessions and noted everything practically verbatim. Nevertheless, the case studies offered here and the associated insights into clinical practice, technical points of treatment and theory are naturally the result of a process of reflection which occurred when I revisited them whilst preparing the material for publication. This also means that some of the interpretations that seem so obvious after the event did not cross my mind at all during the interview. It is surprising how blind one can be during the session. The way things went was often determined not so much by conscious insight on my part as by intuition and by the fact that I had a theory of the emotional development of the child “in my bones”, as Winnicott aptly termed the basis of this work. In psychoanalytical terms, this form of intuition is communication from unconscious to unconscious, and it is precisely this form of communication that joins conscious communication in the squiggle interviews and makes them so fascinating and therapeutically effective.

Some of the insights took on a clear form in the course of the interview, and I offered the child my interpretation. Some first crystallized after our conversation, although on re-reading it is clear that they played a significant role in our communication. Yet others only began to stand out clearly enough for me to feel I had really grasped them while I was working through the material. We should not be daunted by the mass of material and layers of possible meanings that are presented. In the session itself we should hold back and be sparing with interpretations. These often do not help the child to feel understood and are sometimes more likely to inhibit the flow of communication. It is possible that some of these interpretations may be more helpful to the therapist, giving him a firm footing from which he can focus and structure a confusing mass of material. Even this is legitimate, but it should not be confused with allowing the child to reach an insight and feel understood. Nevertheless, interpretations which address an identifiable conflict in the child are sometimes very important, and I am convinced that they have a therapeutic effect if the child feels emotionally understood. The squiggle game does not differ here from other techniques of psychoanalytically oriented psychotherapy which also assume that intellectual insight alone cannot have any effect. I find it impossible to define exactly when I would consider interpretations appropriate and when they should be avoided if at all possible. It is my belief that in the end it is a question of clinical experience and of assessing the whole clinical situation.

In his book on squiggle interviews, Winnicott (1971a) stressed how important it is to be ready to withdraw our comments at all times if a child reacts to an interpretation with rejection or apparently doesn’t react at all. He felt it was important to allow the child a chance to correct the therapist. Even an interpretation which is correct in itself will not be taken in by the child if it is given at the wrong moment or in the wrong way. A dogmatic interpretation will in his opinion allow the child only two possible options: to accept what has been said as propaganda, or to reject the interpretation, the therapist and the whole set-up. In this respect it is important in these conversations to let ourselves be led by the child, and I often let two or three pictures go by, waiting until I am really sure that the child wishes to enter into a relationship with me, rather than give an interpretation too early, as this might trigger subservience or withdrawal.

In mentioning Winnicott I have already named the author of my second and obviously most decisive inspiration to write this book, which I have long had in mind. It is his incomparable book Therapeutic Consultations in Child Psychiatry on the use of psychoanalysis in child psychiatry, published in England in 1971 and reprinted in 1996. In this book and in a few other publications on the subject, Winnicott refers to his technique as the squiggle game. His general characterization of what psychotherapy is, formulated in his book Playing and Reality (1971b), could also serve as a leitmotif for this book:

Psychotherapy takes place in the overlap of two areas of playing: that of the patient and that of the therapist. Psychotherapy has to do with two people playing together. The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play.

[p. 38]

The stress on playfulness is a thread running through the whole of Therapeutic Consultations in Child Psychiatry, which consists in essence of twenty case studies interwoven with Winnicott’s commentaries. Winnicott pays great attention in the squiggle game, as in his other psychoanalytical work, to offering a space within which the potential for play in the child’s psyche can unfold. In his essay “The Squiggle Game” (1968), he writes: “The principle is that psychotherapy is done in an overlap of the area of play of the child and the area of play of the adult or therapist. The squiggle game is one example of the way in which such play may be facilitated.”

This is not the place to review the book in all its facets and richness of thought, but I would like to mention at least a few aspects which are important to me. The first great advantage of the book is that with the help of the squiggles and near-verbatim dialogues we can follow exactly what actually happened in the session even without being able to look at formal transcripts. The chance to gain a detailed insight into the working style of an analyst is a rarity in the psychoanalytical literature, which alone makes his work one of the most important books on psychoanalysis. It is fascinating to read, and although focused on playful communication, the text is never simply a one-to-one copy of what happened, but is informed throughout with thoughts on the dynamics and genesis of the patient’s illness and problems, and complemented with comments on theory and techniques in treatment. In this way his book is a treasure trove for the child psychotherapist, child psychiatrist, educational consultant and child analyst.

After a brief introduction, Winnicott begins his description of his first case with the simple explanation of the squiggle game that he gives to his patient: “I shut my eyes and go like this on the paper and you turn it into something, and then it’s your turn and you do something and I turn it into something. . .” (1971a, p. 12)—and already both are engrossed. Winnicott stresses repeatedly how important it is to create an atmosphere in which the child can feel free enough. He lets the child know, for example, that the game he wants to play has no rules. He asks the child to show him if his squiggle looks like anything in particular or if he or she can make anything out of it. Then the child will do the same for him and he will see if he can make anything out of the child’s squiggle (1968). Sometimes I find it also makes sense, especially with older, slightly inhibited children who might see the whole thing in terms of performance requirements as in art classes at school, to tell them it’s not a question of drawing a beautiful picture, just to allay any fears they might have.

The therapist’s task is a double one: on the one hand to let himself be drawn into the game with the child, and on the other hand to provide a holding framework. This is what Winnicott means when he writes in his essay that he understands the squiggle game better than the children do. It is his task, and he knows how, to create the framework for “the child’s own discovery of what was already there in herself” (1968, p. 316; cf. 1971a, p. 62). But, he adds, the children are better at drawing. They depict what it’s all about. Both the unfolding of the game and the holding framework are essential parts of a successful therapeutic dialogue. In this the therapist must above all be able to “provide a natural, freely moving human relationship within the professional setting while the patient gradually surprises himself by the production of ideas and feelings that have not been previously integrated into the total personality. Perhaps the main work done is of the nature of integration, made possible by the reliance on the human but professional relationship—a form of ‘holding’.” (1968, p. 299) The development of the game and the freedom and involvement with which the therapist adds his contribution to the game are of critical importance in making it work. In contrast to a physical examination or a psychological test, a procedure of this kind evokes no feeling of inferiority. Winnicott emphasized on many occasions the importance of child and therapist meeting on an equal footing in game and conversation. He was also rather reluctant to describe the technique. He was worried that

someone will be likely to begin to re-write what I describe as if it were a set technique with rules and regulations. Then the whole value of the procedure would be lost. If I describe what I do there is a very real danger that others will take it and form it into something that corresponds to a Thematic Apperception Test. The difference between this and a T.A.T. is firstly that it is not a test, and secondly that the consultant contributes from his own ingenuity almost as much as the child does ... Naturally, the consultant’s contribution drops out, because it is the child, not the consultant, who is communicating distress.

[1968, p. 301]

Winnicott points out that “it is necessary for the consultant to be ready to learn rather than to be eager to pounce on the material with interpretations!” (Winnicott 1968, p. 300)—and it is precisely this approach which produces such good results.

It was his intention, he wrote, to present examples for communication with children. In this respect he makes it clear that it would be wrong for someone to learn how to use the game and think that this equipped them to conduct therapy.

The squiggle game is simply one way of getting into contact with a child. What happens in the game and in the whole course of the interview depends on the use made of the child’s experience, including the material that presents itself. In order to use the mutual experience one must have in one’s bones a theory of the emotional development of the child and of the relationship of the child to the environmental factors.

[1971a, p. 3]

However, Winnicott also built on the great advance of trust that children are able to give at these particular moments, which he would almost describe as sacred. If these moments were wasted, then the child’s belief that he or she was understood would be destroyed. Children often told him that they had dreamt about him the night before a consultation. In these dreams their own ideas and expectations appeared, but so did those of their parents and of their environment. He was amused to be told that he was the very person they had dreamt about. In this way the therapist becomes the subjective object for the child and these wishes, expectations and fears are projected onto him.

The counterpart on the therapist’s side is the holding environment (Winnicott, 1954), which he provides and which is a fundamental element of every psychoanalytical treatment. It is derived from the maternal holding function which is central to the early development of a child (Winnicott, 1960). At a very early level of psychical development, and expressed in different terms (Bion, 1962), this has to do with the therapist’s containing function, which is derived from the mother’s dreamlike empathy with her child (reverie). Through projective identification the child can project into the mother a part of his or her psyche which contains unbearable feelings and which he or she experiences as a bad inner object. These feelings undergo such changes when the child is at the “good breast” that they become bearable when the object is re-introjected (Klein, 1946, 1957).

Winnicott is convinced that the child is expressing the current problems, emotional conflicts or fields of tension which are dominating his or her life at the time. Alongside the conscious ones, preconscious and unconscious aspects of the child’s personality and conflicts are also depicted. However, the material only becomes specific and highly interesting because the child begins to feel that he or she will be understood and may achieve communication at a significant level. As he shows above all in his theory of antisocial tendencies (1984), Winnicott always understands the patient’s symptoms also as a desperate hope that his or her communications will be understood after all (Abram, 1996).

The basis for this specialised work is the theory that a patient—child or adult—will bring to the first interview a certain amount of capacity to believe in getting help and to trust the one who offers help. What is needed from the helper is a strictly professional setting in which the patient is free to explore the exceptional opportunity that the consultation provides for communication. The patient’s communication with the psychiatrist will have reference to the specific emotional tendencies which have a current form and which have roots that go back into the past or deep into the structure of the patient’s personality and of his personal inner reality.

[Winnicott, 1968 p. 299]

The squiggle game is often satisfying in itself, he writes:

It is then like a “found object”, for instance a stone or piece of old wood that a sculptor may find and set up as a kind of expression, without needing work. This appeals to lazy boys and girls, and throws a light on the meaning of laziness. Any work done spoils what starts off as an idealised object. It may be felt by the artist that the paper or the canvas is too beautiful, it must not be spoiled. Potentially, it is a masterpiece.

[ibid., p. 302]

It is probably due in part to this idealized side of the experience that a deep understanding develops so quickly between therapist and child. However, this is also what makes it seem inadvisable to work with this technique for a number of hours. After a few sessions “all the problems of transference and of resistance begin to appear and the treatment must now be dealt with along ordinary psychoanalytic lines” (Winnicott 1971a, p. 10). Nevertheless, it is also this spontaneous, impulsive movement of the found object that frightens certain children because it is connected to the unorganized, mad parts of the self (Farhi, 2001). Winnicott points out that squiggles are uninhibited in that no limits are set, and some children find this lack of restraint naughty. For this reason it was up to him to ensure integration, but this should never go so far as to deny the chaos in any way. Naturally the children also show integrative moves, as can be seen in a number of examples in this book. For instance it can often be observed towards the end of a session, when I indicate that each of us is going to draw one more picture. Some children are then visibly anxious to reconstruct their defences and draw a picture that allows them to leave the chaos behind in the session.

Winnicott himself describes squiggle games with children between five and thirteen years of age. There seem to be two exceptions among his cases: Cecil (case 14) is noted as being 21 months old, but that was the first time Winnicott saw him; in fact he was eight when Winnicott played the squiggle game with him. The case of 30-year-old Ms X (case 18) is introduced with the comment that there is no fundamental difference between a conversation with a child and one with a parent except that with adults and older children the exchange of pictures serves no useful purpose. Winnicott therefore conducts the interview with this mother without recourse to drawing.

The children and adolescents described in detail in this book were between seven and sixteen years of age when I saw them. The squiggle technique can in fact be used successfully with children of five and even four, as the example of Paul later in this chapter shows. At the other end of the age spectrum, it has been my experience—particularly with psychiatric patients who are severely ill, right up to adulthood—that the use of the squiggle game can sometimes break the ice, and there can suddenly be a lively exchange where previously the atmosphere had been marked by the patient’s distinct withdrawal. I have not been able to collect any systematic experience in the use of the squiggle game with adults so far—my experience is limited to single instances—but in the meantime I am convinced that this kind of first contact can be very helpful with older teenagers and adults. The lower age limit is not absolute, but is largely determined by the fact that as a rule it makes more sense actually to play with very young children of two or three, and allow the psychical content to unfold within the framework of child’s play. The squiggles made by these very young children are often repetitive, showing little variation, or the children lose interest fairly quickly and want to turn to something else.

A third source of interest in the writing of this book lies in my longstanding preoccupation with concepts of art therapy (Günter, 1989, 1990, 1993, 1995). Since the fundamental work of Anna Freud (1927) and Melanie Klein (1932) it has been beyond dispute that as a rule, psychoanalytical work with children is possible only by involving their play and what they create, since in such young children there can be very little reliance on verbal association. Freud described phantasy and children’s play as a Zwischenreich, an intermediate realm between outer and inner rea...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• FOREWORD
• 1 Introduction: practice and theory of the squiggle game
• 2 Gifts from an angel: will there be rescue from danger?
• 3 Whale, camel or giraffe with a balloon of a tummy?
• 4 Of pirates and their treasures: the child analyst as archaeologist and treasure hunter
• 5 Deep impact: "They are all nutcases"
• 6 A lion and a broken comb: problematic identification with the father after a traumatic previous history
• 7 The oh-so-good angel and the sock
• 8 The rattlesnake with a knot in its tail
• 9 How do sea monsters help against bed-wetting?
• 10 The king's castle, the mother's rucksack. The wish for the Other on facing death
• 11 Ghosts, babies and Chinese porcelain cups. Fear, fragility and the wish to be beautiful
• 12 Scribbling as an activity done together: squiggle pictures as tangible objects in the outside world
• 13 The rift in the earth and the king's wicked son. The threatening experience of psychosis
• 14 Psychoanalytical access to children under extreme stress: squiggle interviews in research
• REFERENCES
• LIST OF ILLUSTRATIONS
• INDEX