Doing Things Differently

The Influence of Donald Meltzer on Psychoanalytic Theory and Practice

Margaret Cohen, Maggie Cohen, Alberto Hahn, Margaret Cohen, Maggie Cohen, Alberto Hahn

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429912887
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Doing Things Differently celebrates the work of Donald Meltzer, who was such a lively force in the training of child psychotherapists at the Tavistock Clinic for many years. The book represents the harvest of Meltzer's thinking and teaching, and covers such topics as dimensionality in primitive states of mind, dreaming, supervision, and the claustrum.

Chapter One
Doing things differently: an appreciation of Donald Meltzer’s contribution

Margaret Rustin

The title of this chapter is intended to draw attention to aspects of Donald Meltzer’s ways of working which characterized his practice as a psychoanalyst and which, I think, are important in appreciating his originality. Of course, such observations arise from one’s own particular perspective and may not be in accord with the recollections or understanding of others, and it is obvious that doing things differently—which I am interpreting, in part, as Meltzer’s characteristic commitment to doing things in his own way—means that there will be conflicting views about whether such differences have a good outcome. This chapter is not going to address the institutional conflicts that were part of the historical picture—in fact, I am sure that I am quite ignorant of much of this history. Instead, I hope to describe things that I have observed both in the years of some personal contact with Meltzer and in reading his books and papers over time, things that have struck me as enlightening and interesting, or sometimes maddening and frustrating features of his work, and which arise from his personal style as a writer and analyst. Perhaps, also, I am going to be doing something rather different from other writers who address his ideas, since their focus is more usually on his clinical contributions.

The themes I want to follow are these: the central relevance of child analysis and the unity of child and adult analysis; the value of working in a clinical group with colleagues; the revision of psychoanalytic theory; joint research and writing projects; his discovery of infant observation; the commitment to a wider psychoanalytic culture; and the particular contribution to the Tavistock child psychotherapy training. As you can see, there are overlapping areas implied in this selection, and this is inevitable. I shall use examples from particular books and papers to try to demonstrate what I am getting at.

Let me start with a word about the British psychoanalytic context in which Meltzer was working during and following his years of analysis with Melanie Klein. This was a time when the discoveries of child analysis were greatly valued and when the interest in early mental development was closely linked to psychoanalytic research into serious mental illness. Child analysis and the efforts to analyse schizophrenic and other seriously disturbed patients by W. R. Bion, Herbert Rosenfeld, and Hanna Segal, among others, were taking place simultaneously, and, in some instances, analysts were involved in both these areas. It was also a time when the post-war development of the NHS gave hope that psychoanalytic ideas could influence community mental health in major ways, and the establishment of the Tavistock Child Psychotherapy training in 1948 was part of this. There were strong links between the group of mainly Kleinian analysts who were also trained as child analysts—for example, Isobel Menzies, Eleanor Wedeles, Doreen Weddell, and Athol Hughes—and the Tavistock training. Meltzer’s lifelong interest in the continuities of psychic life, and his confidence that analytic techniques could encompass work with disturbed young children and the full range of adolescent and adult pathologies, grew very naturally from this fertile period of psychoanalytic exploration and simultaneous ambitious engagement with new institutional developments.

His unusual talent for and interest in theory-building combined with his original clinical imagination made for the powerful integration of theory and practice seen in The Psychoanalytical Process (1967). One of the particular features of his writing is that whereas the more standard form of communication in psychoanalysis is via individual scientific papers, and of course he wrote many such papers, it also came naturally to Meltzer to write books. Of course, these were sometimes based on a lecture series, but the fact is that a book-length piece of writing takes in a much wider horizon; this appealed to him, I think, because it involved following things through. Just as an analysis has a beginning, middle, and end, and requires substantial time for its development, so writing or reading a book is a process in time.

The Psychoanalytical Process is exemplary in rooting the ideas presented in clinical detail, and the chapter that describes the process in an individual session with a 4½-year-old girl seen in analysis from the age of 3 is a very powerful example of Meltzer’s approach. The case was presented for detailed discussion in a seminar of child analysts and psychotherapists (reminding us, incidentally, of how closely these two groups worked together at that time), and the clinical material is presented in a carefully descriptive form, recording all the child’s activities, verbalizations, facial expressions and so on, but, strikingly, including nothing at all about the countertransference impact on the analyst. Indeed, Meltzer is explicit in stating that he “leaves problems of countertransference aside as private to the supervisee”. I think this method, even though it is clearly different from contemporary practice, where a group discussion of the clinician’s feelings about the patient, and indeed contributions from other group members about their own emotional reaction, would be expected, draws attention to a fundamental idea underlying Meltzer’s conception of psychoanalysis. This is that if the therapist is truly to be working at the appropriate depth to deal with the infantile transference, an analytic process also has to be ongoing for him or her, either in the form of continuing personal analysis or in the self-analysis that has to be the outcome of a good-enough analytic experience. The model of training as a psychoanalytic therapist which is based on personal analysis, clinical experience, and intensive supervision is thus seen also as the necessary cornerstone of an ongoing professional life. I think it is important to remind ourselves of this, because although professional bodies now demand evidence of continuing professional development (CPD) as part of continuing fitness to practise, the question of what this really requires of us is a serious one. The tremendous intensity of the training years is often seen as exhaustingly demanding, something from which people can crave a rest even if they are simultaneously aware of how much the quality of their clinical work is linked to that intensity. The Psychoanalytical Process makes a strong case that this level of engagement is integral to the capacity to continue to work psychoanalytically.

Meltzer uses the clinical material presented to clarify what he thought actually constituted psychoanalysis. From the patient’s perspective, it is a question of the evolution of the unconscious in the context of the availability of a transference relationship. From the analyst, the contribution required is the provision and maintenance of the setting (that is, the psychoanalytic setting in the sense just discussed about the dedicated state of mind of the therapist in relation to the task) and a steady commitment to “working through”, Freud’s profound conceptual contribution to understanding the idea of process in psychoanalysis (1914g). Meltzer emphasizes that an adequate setting depends on “devotion” to the psychoanalytic method together with curiosity (a lively dose of the epistemophilic instinct, one might say) and argues that these two factors together sustain the tolerance of mental pain required of the psychoanalytic therapist. His discussion of “working through” differentiates two aspects of this process. The first is to do with the attempt to build up insight in the patient, which involves understanding the difference between infantile and adult modes of experience and acknowledging the distinctions between internal and external reality. The second concerns the modification of anxiety, following Klein’s central emphasis on the interpretation of infantile anxieties, which Meltzer develops in the direction of the aim of psychoanalytic therapy being the growth of introjective identification with a thinking analytic mind, which can support the patient and prevent regression. This would be his understanding of what might constitute the “resilience” so beloved in contemporary discourse.

In The Psychoanalytical Process, Meltzer’s conviction in the continuity and coherence of child and adult analysis is particularly vivid, and the developmental nature and function of analytic work is the central point. What is also impressive in the notes included in the appendices are the areas of theoretical work which he is exploring at the time and the hints of those to come. At this time, his thinking is, naturally, linked not only to Freud, Karl Abraham, Klein, and other predecessors, but also to his contemporary colleagues—Bion, Rosenfeld, Segal, Esther Bick, Roger Money-Kyrle, Betty Joseph, and Sidney Klein—whose work he cites in ways that illustrate the lively intellectual group-life of the Kleinians in that period. It also suggests just how much was lost when the dialogue between Meltzer and many of this talented generation of analysts came to a halt.

The enormous task he then took on to draw together his theoretical understanding of the Kleinian clinical approach and its roots in Freud’s clinical papers, and to take his readers on into Bion’s thinking, also marked the period in which his contribution to the Tavistock training was at its height. I remember rather clearly Mattie Harris speaking of her recognition of the gap between the clinical teaching offered to those of my generation in the late 1960s and the theoretical curriculum that accompanied that. When I enquired, truly puzzled about this, why we did not read Klein’s Narrative of a Child Analysis (1961), she said something that amounted to “You wait!” The strengthening of the theory teaching that Meltzer’s systematic lectures provided cannot be overestimated, and of course it massively influenced the curriculum of the observation course, the shape of which was gradually developing during the 1970s, as well as the theory teaching within the child psychotherapy training. What was so important about this for child psychotherapy was the way in which clinical practice was so clearly a present preoccupation in theory teaching done in this way, and the to-and-fro between child and adult analysis and theory and practice gave new potential for clinical experience in work with children to be theorized. I think we can be confident that the significant theoretical contributions later made by child psychotherapists—including, for example, Gianna Williams (1997), Maria Rhode (2013), and Ricky Emanuel (2001, 2012), who all shared this experience—grew from these roots.

Such possibilities were also closely linked to the impact of Bick’s method of infant observation upon clinical practice (1964, 1968). The naturalistic observation of very early states of non-integration, the theory of the centrality of growth of a psychic skin, and the elaboration of second-skin defences were an important part of the work being done with autistic children by Meltzer and the group with which he worked so closely—presented in Explorations in Autism (Meltzer, Bremner, Hoxter, Weddell, & Wittenberg, 1972a, 1975)—and was also the background to Frances Tustin’s work (Tustin, 1981). Just as in The Psychoanalytical Process the seminar group studying child analytic cases was the site for discovery, so in the autism book the shared discussion of the cases followed in such detail by the group was the heart of the project. Meltzer’s capacity for theoretical writing was nourished by this contact with a rich range of cases which allowed him to delineate, again on a developmental model, the very particular forms of failed and alternative mental development which characterized autistic states of mind.

Meltzer’s published work is full of creative collaborations—with Esther Bick, with Meg Harris Williams, with generations of analysts and child psychotherapy supervisees in England, Italy, Spain, and beyond, and with Mattie Harris. It is to a lengthy research paper (Meltzer, 1976b) written in conjunction with her that I want to turn to provide an example of why these co-operative efforts are so important.

The Paris-based OECD, a UN body, commissioned a report in the 1970s that would offer a psychoanalytically based theoretical model of the links between child, family, and community and serve as a basis for social-psychological research and, indeed, clinical research about forms of intervention (Meltzer, 1976b). The report has not been used as fully as its intent warrants, and it is not an easy document to digest, but I think the differentiation it describes between typologies of family culture remains provocative and enlightening.

The first section of the report outlines the central position of the concept of mental pain in psychoanalytic discourse: “Whose pain is it?” they write. This, of course, is the question we usually start with in any new referral, allied to the question of “Why now?” An elegant exposition of basic concepts—anxiety in its various forms, self, part-object, combined object, omnipotent phantasy, mechanisms of defence, and so on—follows. Because of the importance of Bion’s definition of “learning from experience” and the crucial value given by Meltzer and Harris to such learning, there is a careful account of different, more limited or distorted and disturbed forms of learning. The life-space model is then introduced, with reference to the contribution of temperament, internal objects, adult and infantile elements in the personality, and family organization. Use is made of Bion’s distinction between basic assumption and more reality-based “work-group” functioning, and of his 1970 description of the difference between commensal, symbiotic, parasitic, and paranoid orientations to define the nature of the links between family and community (Bion, 1961, 1970). Familiar themes such as the matter of relationship to time appear: timelessness, oscillating and circular time, which all undermine the awareness of linear time.

The breadth of application of these and many more familiar building blocks in thinking about family and community cultures is what is so striking in this report. One can imagine what a challenge it presented to the policymakers and researchers to whom it was, in part, directed; despite clear accounts in the report of unconscious phantasy, transference, and countertransference, without personal experience of psychoanalysis it is hard to imagine that they could grasp all these complexities. However, for clinicians there is a cornucopia of ideas. Meltzer’s naturally theoretical psychoanalytic thinking and philosophical interests marry with Harris’s literary background, her experience of infant observation, and her vast range of clinical experience with children and families at the Tavistock. The evocative finesse of the writing reminds us of their shared breadth of experience as both child and adult analysts. This conjunction is what makes for such a compelling shared focus on the internal and external world.

When they wrote this report, family therapy in the UK was just starting to develop. It would be a major but intellectually fascinating project to explore whether the ideas they proffer about family functioning might map onto the totally different discourses of family therapy in some ways, or whether the psychoanalytic recognition of the centrality of the unconscious makes for quite divergent perspectives. One could make a similar suggestion about the more recent but psychoanalytically much closer discipline of couple psychotherapy. Has this benefited from this earlier work? In James Fisher’s writing about work with couples, we have an excellent example of the potential for imaginative integration (Fisher, 1999).

There is not space here for a full presentation of their typology of family cultures, but to remind us or whet the appetites of those unfamiliar with the report, I will pick out some examples. The structures described are being tested against the crucial functions that Meltzer and Harris ascribe to the family. These are set out as pairs:

• » promoting love / promulgating hate
• » promoting hope / sowing despair
• » containing depressive pain / emanating (spreading) persecutory anxiety
• » supporting thought, thinking / creating confusion.

The atmosphere evoked by each of these phrases also suggests to me that these categories are helpful and accurate descriptions we can use in pinpointing the valency of a clinical session. They refer to phenomena we can observe in the transference and countertransference and can also perceive in what we learn of our patients’ internal and external experience, from lively dream material at one end of the spectrum to the most prosaic of sessions at the other.

The fundamental question is whether the family organization is promoting the development of each of its members according to their respective needs and potentials, and the same question can be asked of the wider community’s relationship to the families within it. One can see that the model therefore has wide implications at a political level. For example, it could be said that recent and, tragically, ongoing events in Greece and, indeed, elsewhere in Europe confirm that austerity conditions imposed upon a society cause unacceptable levels of damage to family and individual development. As I find myself moving between the applicability of these ideas to both the analytic session and our experience as citizens, I think I am demonstrating why this paper has meant a lot to me.

The forms of family that Meltzer and Harris denote are:

• » couple families, which Meltzer and Harris believe promote development through containment of dependence and anxiety;
• » matriarchal or patriarchal families;
• » gang families, in which, they suggest, negative identifications are predominant;
• » reversed families (meaning when family values are in defiant opposition to more stable community values).

All of these non–couple-based families, in different ways, fail in the fundamental task of “bringing up” the children and supporting the growth of adult states of mind.

Holding these different family structures in mind may also enrich our work with parents. The importance of working with parents is much more readily acknowledged nowadays, including in the formal research literature, than it was before the 1970s. I give one example to indicate these possibilities.

I am thinking of a couple I heard about whose clever 7-year-old son, Adam, the older of two children, had considerable difficulties. He was offered individual therapy in the light of his striking immaturity, his extreme intolerance of his sister’s very existence, and his own awareness of and longing for help in dealing with his paralysing anxiety when faced with any kind of choice.

As I heard, in supervision, about these parents, I could see that, although they were intellectually committed to talking things over together and to sharing responsibility for their children, both practically and emotionally, they did not really manage to come together in a way that contained their son’s massive infantile outbursts. Neither they, nor he, felt that they could cope with his level of dependence and unpredictable waves of anxiety, and he would become wholly despairing in his collapsed melt-downs. They felt humiliated and persecuted by this repeated scenario, particularly when it was enacted in full public view, and also very angry when they felt it was aimed at their efforts to provide good experiences for him and resulted in these being spoilt.

At the beginning of the work, the father viewed the sessions not as involving thinking about his own contribution to the unhappy family situation, but as oriented to the therapist’s conveying his understanding of their son. This was allied to the implication that it was the mother’s upset that should be attended to: she was the one who could not cope with Adam, whereas he could come in and calm things down. Mother’s difficult family background, in contrast to his own, was suggested as the reason for her vulnerability to becoming overwhelmed, and she agreed with this. Gradually, this somewhat grandiose paternalistic stance—the patriarchal family, as described by Meltzer and Harris, including the harshly scathing and belittling scolding of Adam, and the denigration of his wife—began to show cracks. The criticism of the other adults in Adam’s life who were not felt to be good enough at their jobs—including his teacher, cricket coach, and babysitter—gave way to a realization that these others were offering the boy a great deal of support and that the view of things that only he as the father of the family really knew what was what and could be relied upon was a distorted one. At this point the work with the couple felt quite different, in that both now seemed more on a level with each other and both were able to voice their worries and despondency about their frequent failures to contain the children. As the unbalanced dynamic between mother and father shifted, it was also interesting to note that the younger sister began to feature differently, not only as the victim of her brother’s aggression and greed for space, but as having her own difficulties in being so easily able to set him up to be in the wrong.

The transference manifestation of all this was an initial idealization of their th...

Table of contents

• Cover
• Half Title
• Series Page
• Title
• Copyright
• CONTENTS
• SERIES EDITORS’ PREFACE
• ABOUT THE EDITORS AND CONTRIBUTORS
• Introduction
• 1 Doing things differently: an appreciation of Donald Meltzer’s contribution
• 2 The relevance of Donald Meltzer’s concept of nipple-penis confusion to selective mutism and the capacity to produce language
• 3 Point–line–surface–space: on Donald Meltzer’s concept of one- and two-dimensional mental functioning in autistic states
• 4 Autism reconsidered
• 5 Dimensionality, identity, and security: finding a home through psychoanalysis
• 6 The isolated adolescent
• 7 Supervision as a space for the co-creation of imaginative conjectures
• 8 Keeping tension close to the limit: from latency towards development
• 9 Donald Meltzer’s supervision of psychotherapy with a psychotic child
• 10 The second life of dreaming
• 11 On having ideas: the aesthetic object and O
• 12 Degrees of entrapment: living and dying in the claustrum
• 13 Trapped in a claustrum world: the proleptic imagination and James Joyce’s Ulysses
• 14 A mind of one’s own: therapy with a patient contending with excessive intrusive identification and claustrum phenomena
• 15 Battered women lose their minds
• Concluding thoughts on the nature of psychoanalytic activity
• REFERENCES
• INDEX