The Playground of Psychoanalytic Therapy

Jean B. Sanville

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781134879977
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

Building on the foundations of the "independent tradition" of British object relations theory and modern infancy research, Sanville proffers a new understanding of the role of play in the clinical situation. She attends especially to the therapeutic situation as a safe playground, the therapist's playful engagement of the patient, and the patient's emergent ability to embrace playfully the liberating possibilities of psychoanalytic therapy.

CHAPTER 1
Meaning Making and Playing in Infancy

The principle of psychic determinism, often associated with psychoanalysis, has been disturbing to some of us because of its being in drastic contrast to the high value we place on psychic freedom. Readers of Freud often comment on the differences between his theoretical me-tapsychology and his clinical approach. Freud himself seems to have suffered recurrent indecision about whether to conceive of his ideas as natural science, objective, detached, and intellectual or as “an intuitive, receptive mode of relating to others” (Rycroft, 1985, p. 87). Rycroft observed the paradox in traditional thinking. Freud saw the unconscious as “a chaos, a cauldron of seething excitement… which was a slave to the pleasure principle and neglected the reality of the external world,” and yet the effect of analysis was to create personalities that “embrace just those emotional, imaginative elements that its theoretical conception of a rational ego excludes” (p. 122).

It is central to the thesis of this book that not only psychoanalysis but all of the psychodynamically oriented therapies aim at facilitating the unfolding and integration of the imaginative and creative capacities that are potential in every human being. These therapies concern themselves not so much with causes of psychosocial pathology, with unearthing the repressed and hence hidden events, but rather with discovering with patients how they constructed the particular meaning schemes that they did and how they may reorganize these schemes to comprehend more fully both past events and new phenomena. The method of achieving insight is as significant as the outcome; the means are as important as the ends. The approach eschews imposing the therapist’s own meaning schemes but fosters the person’s ability to generate his own scheme.

There seems to be a drive toward meaning in human life, a drive originating in biology and brought to fruition in language and syntax. Human beings are innately symbolizing animals, and psychoanalytic therapies are concerned with the semantic (Fuller, 1985). Such therapies involve narrative process, with the therapist an “assistant autobi-ographer,” constructing with patients meaningful biopsychosocial stories. Therapist and patient weave the most satisfying tales when together they can establish an atmosphere in which playfulness can occur.

For many years that group of British psychoanalysts known as the Independent group, such as Balint, Milner, and Winnicott, have been awarding an important place to play and illusion in human life, and they have been joined more recently by others, such as Bollas and Casement. It is not coincidental that these professionals have been deeply interested also in literature, music, and the arts and have linked play and creativity. Winnicott, a pediatrician, grounded his theories in his observations of innumerable infants and children and their mothers. Winnicott (1971a) defined psychoanalysis as a subspecies of play, “a highly specialized form of playing in the service of communication with oneself and others” (p. 41). Its aim was to restore a “creative relation to the world” (p. 38), as Milner (1952) had declared.

Much of the work consists of building the playground in which playfulness can occur. In this regard, we therapists have much to learn from infants and their parents, but since most of us cannot combine pediatrics with our main professions, we turn, instead, to the observers and researchers of the earliest periods of life. Steeping ourselves in their writings, we find ourselves provoked to revise some former notions about human nature, about how persons develop over time, and perhaps about our approach to psychotherapy. We seem to be on the threshold of what many analytically oriented clinicians regard as a veritable revolution.

There is, for example, more evidence for ego instincts at the beginning rather than for id instincts, and, rather than dominating at the start, the pleasure principle appears to function dialectically with the reality principle (Stern, 1985, pp. 238–39.) So we cannot think of psychic reality and external reality as opposed; each is to some extent constitutive of the other. This interrelationship is best exemplified in play. When the dialectic breaks down, there is pathology—at one extreme, psychosis, in which there is both great rigidity and excessive fluidity, and at the other, what Bollas (1987) calls “normotic” illness and what McDougall (1980) calls the “normopath” persons “out of touch with the subjective world and with the creative approach to fact” (Winnicott, 1971a, p. 78).

At this time in history there seems a convergence between the leanings of the British Independent Tradition (Kohon, 1986) and the ever fresh and surprising discoveries of the developmentalists. There is new respect for playing in human life, as it can lead to creativity in constructing the self (Sanville, 1987a), interpersonal relationships, and even our own facilitating environments. This book will explore some of this convergence and its possible implications for a psychodynamic therapeutic approach.

Not so long ago it was rather glibly assumed that a main goal of psychotherapy was to render the patient reality-oriented, and it was, of course, the analyst or therapist who would be the judge of that. Now we are beginning to credit that which lies beyond the reality principle, to allow for an “intermediate area of experience” (Winnicott, 1971a) in which we do not constantly feel under constraint to determine what is objective or outside reality but in which we can enjoy the inevitable ambiguities involved in a philosophy that acknowledges that what we deem to be reality will always be determined in some measure by the theories we hold as we contemplate the world (Sanville, 1976). So therapists try to respect the subjective factors that lead their patients to construct reality in ways different from their own, and hence therapists become increasingly aware of the subjective factors that have entered into their own judgments and of the effects on the therapeutic dialogue of these differences.

The realm of play allows negotiation of those differences with a degree of pleasure because the meanings of phenomena will include generous portions of the subjective. As Piaget (1951) would put it, play is close to pure assimilation, which “makes for satisfaction of the ego rather than its subordination to reality” (p. 167), in contrast to accommodation, in which one molds oneself to reality. If we assume a continuum between the two; then we note that people whom we see as creative tend to veer closer to the pole of assimilation; they are not primarily conformists to the consensually “real.” In them; imagination is granted considerable free play.

Freud (1908) was most interested in the origins of imagination, and he proposed that the child at play behaves like the creative writer, rearranging the things of his world in a new way and investing his activity with a high degree of emotion. The child takes playing very seriously but also distinguishes it very well from reality. Both the creative writer and the child reap “important consequences” out of this very unreality since “many things which, if they were real, could give no enjoyment, can do so in the play of fantasy, and many excitements which, in themselves, are actually distressing can become a source of pleasure” (p. 144). Although Freud thought that when we grow up we cast aside play, he noted that we may one day find ourselves “in a mental situation which once more undoes the contrast between play and reality”—as when we throw off our sense of heavy burden by humor (pp. 144–145). Moreover, he recognized that we never fully give up pleasures once experienced but form a “substitute or surrogate” (p. 145). Our propensity for constructing fantasies is one of the adult versions. Unlike the play of the child, these, he found, were not easy to observe, especially because adults tend to be ashamed of their daydreams and hide them from others. The only way we know that people fantasy is that “the victims of nervous illness” tell us about them in order to be cured.

Thus, Freud’s speculations about fantasy were gleaned from troubled adults. He even wrote that “a happy person never fantasies, only an unsatisfied one” (p. 146). The motive forces of fantasies were wishes, either ambitious or erotic, often a combination of the two. Fantasies “change with every change in [the daydreamer’s] situation” (p. 146). They reflect an earlier, usually infantile, experience, and current impressions, and they also create a situation relating to the future. So, although Freud attributed fantasy to the “sick” ones, he nevertheless envisioned its having far-reaching and even constructive possibilities.

Perhaps fortunately, none of us is ever completely happy, and so fantasy flourishes, both consciously and unconsciously. Over time, we have redefined the wishes that motivate fantasy. What Freud called ambitious we would say has to do with wanting to develop the potentials of self, and what he called erotic we would say has to do with wanting to connect meaningfully with others in such a way that we minimally sacrifice aspects of our being that we feel to be authentic. From his vantage point, Freud called some behaviors infantile, often with a pejorative note. Today we hear that word as anything but depreciatory. We even find in studying the first years of life why Winnicott (1959–1964) saw the patient’s capacity to regress as an attempt to bring about self-cure (p. 128).

Data from current infant observation and research let us imagine the meaning making that goes on in the so-called preoedipal period of life, with an especial focus on the qualities of those meanings that are generated in play and playfulness. Some of those imaginings seem most relevant to changing ideas about the psychoanalytic enterprise and about those psychotherapies that are based on psychodynamic principles.

MEANING MAKING AND PLAYING AT THE START OF LIFE

During the many decades in which we contented ourselves with hypotheses about growth and development that were constructed—we sometimes said “reconstructed”—from the treatment of adult patients, we affirmed a number of things that have subsequently proven questionable or even false. The infant, far from being buffeted by drives so powerful that they make for violent internal excitement, appears instead to arrive equipped with budding ego capacities. The main characteristic of the human mind, we are told, is its tendency to create order (Bruner, 1977), to categorize experiences into conforming and contrasting patterns, to generate “theories.” The infant immediately becomes a researcher, avidly reaching out for stimulation with all the peremptoriness once attributed to the drives (Stern, 1985, p. 41). Taking an ecological approach (Gibson, 1979), the newborn begins at once an active evaluation of his perceptions and asks, “Is this the same as that? If it’s not, how discrepant is it from what I previously encountered?” (Kegan, Kearsley, and Zelazo, 1978). We observe, in passing, that in later life these questions are crucial for any reparative emotional experience.

Once upon a time we were taught that the infant arrived in a state of “primary narcissism” or “autism” unconnected with the rest of the human world. The baby was assumed to possess a “stimulus barrier” so strong that whatever was outside self was virtually nonexistent (Spitz; 1965b). Of course, when one thinks about it, that kind of narcissism was odd, a narcissism without a self; for the psychological self was not thought to be born with the biological self (Mahler and Furer; 1968) but had to develop later. Now we are accepting the evidence that at birth there are already a sense of self and a sense of the other. Different authors have used different terms to designate this earliest self. Shor and I (1978) wrote of a nascent or evanescent sense of self; Lewis and Brooks-Gunn (1979), of an existential self; Pine (1982), of an experiential self; Emde (1982), of a prerepresentational (affective) self; and Stern (1985), of a sense of emergent self.

There seems consensus that during the first two months of life the infant is actively generating meanings that constitute a “sense of organization in the process of formation,” a sense that will remain active for the rest of life (Stern, 1985, p. 38). Stern conceives of infant experience as global, “sensations, perceptions, actions, cognitions, internal states of motivation and states of consciousness” experienced “directly in terms of intensities, shapes, temporal patterns, vitality affects, categorical affects, and hedonic tones” (p. 67). This “fundamental domain of human subjectivity,” operating for the most part out of awareness, is the domain “concerned with the coming-into-being of organization that is at the heart of creating and learning” (p. 67). Stern’s calling this process of forming perspectives about self and others a “creative act” is in keeping with Winnicott’s (1971a) notion of “primary creativity.” The infant and the person-to-be are equipped to experience as meaningful the process of organization as well as the result, which we could think of as “product,” but a product that is forever unfinished.

Clinical interests propel us toward a very special attention to this sense of emergent self and to the domain of relatedness in which it can occur, for it is the sense that will be evoked whenever the person is in the process of organizing later senses of self, of assimilating what is felt to be meaningful, and of generating new meanings along the way. The richest meaning making, together with the most satisfactory unfolding senses of self and of others, tends to occur out of a paradox: the illusion that one has created this thing, person, or relationship, which had to have been there in the first place, waiting to be found (Winnicott, 1971a). So; like Winnicott, we set forth to find a place for illusion in human life.

No doubt there are meanings that arise out of the constraints of accommodating, in which there is little room for the “me.” We might guess that the patients from whom our previous notions about life’s beginnings were constructed may have had too early and too frequent impingements on their senses of being. The meanings that they organized led them later to seek in analysis or in therapy to emend and update the schemas that they used to evaluate themselves and their social world. Out of the data of their experiences we nearly came to think of infancy itself as pathological, the baby feeling beset from within her own self by drives that threatened to become unmanageable and unable as yet to perceive whatever might be outside.

In the days when drive theory reigned, we termed the first period of life the oral stage and thought that the infant was aroused mainly to satisfy appetites and then became somnolent when gratified. In a wonderful little film, The Amazing Newborn (Hack, 1975), we observe something very different. Providing that the mother has not been drugged to quell her labor pains, the infant will enjoy a rather prolonged state of what is called the “quiet alert” (Wolff, 1959). The infant is less interested in eating than in gazing into the eyes of the mother, who, of course, gazes back lovingly. From time to time the infant averts gaze, looks away—we might guess to process the experience—and then once more joins mother in this visual exchange. This would seem to be evidence of beginning bonding, of building the “domain of emergent relatedness” (Stern, 1985), but also of claiming a private and ever forming self by “digesting,” assimilating to self the experiences with another (Shor and Sanville, 1978).

In the film, we see that when the baby cries, she can be comforted by being picked up and held to the shoulder, from which position daddy is in view. There can be no doubt that this newborn finds meaning and significance in the human face. The film depicts babies being tested as to visual preferences by being put into a contraption in which they are shown patterns of various sorts; they manifest a marked preference for those that resemble the human face. Hearing, as we now know, is well established in the late months in utero, and the newborn can be seen moving in rhythm to the adult voice, arms and legs stretching and contracting with the cadences of the sound. One can see the roots of attunement and empathy in those movements. Although they seem to have no immediate purpose, they reveal the infant’s nascent capacity to resonate with the feelings of other persons.

No wonder, then, that Spitz (1963a), in his later years, came to declare that life begins with dialogue and that “man, when he is deprived of the dialogue from infancy, turns into an empty asocial husk, spiritually dead, a candidate for custodial care” (p. 159).

Realists often inquire how we know what the infant is feeling and thinking. The newborn does arrive already equipped with all the facial expressiveness that we have come to associate with the different affects, and so we may be warranted in assuming the emotions behind the expressiveness. Perhaps, however, reality is not the whole issue. We could posit that the self is born of illusion, that because the mother and father believe that a self is there, they call it into being by their own responsiveness. The parents in the film The Amazing Newborn are clearly of the good-enough kind, which I define as possessing a capacity to assume beyond any real evidence that there is a little person in their new baby. Such parents attribute meanings to the baby’s behavior and bring the baby into the framework of their own meaning systems. As we know, they entertain fantasies as to who this infant is and will become—fantasies that gradually exert their influences on the growing child. These “ghosts in the nursery” may lead to impaired mother-child relationships (Fraiberg, Adelson, and Shapiro, 1975) or perhaps to great things if those fantasies are congruent with the aptitudes and talents in the infant. In any event, we who watch the film or, better still, have an opportunity to be around a wee one, will find ourselves imagining the sense of emergent self evolving out of each encounter of this infant with the social world.

It is worth reflecting on the qualities in a parent that might best foster this sense of emerging in the offspring. Stern (1985) preoccupies himself with the qualities inherent in the infant in the first two months of life and does not elaborate on those in the mother that promote their unfolding. But Winnicott (1963b) wrote of the importance of primary maternal preoccupation. Loving paradox, which is in many ways at the heart of play, he declared this engrossment to be a sort of “normal illness,” which one must be healthy to develop and which one will outgrow in due time.

This primary maternal preoccupation is close to what Michael Balint (1932) calls primary love, in which the mother during this beginning period has, according to the baby’s illusion, no needs or wishes of her own but is simply there for her infant so that the latter may enjoy a state of tranquil well-being. In the stage when the baby is absolutely dependent, the mother can identify, make use of “projective identification” to positive ends, and surmise what the baby is feeling and needing and wanting. She meets the baby’s “ego needs.”

Winnicott, like the current researchers, affirms that the infant’s needs are not confined to instinctual tens...

Table of contents

• Cover
• Half Title
• Full Title
• Copyright
• Dedication
• Acknowledgments
• Contents
• Prelude
• 1 Meaning Making and Playing in Infancy
• 2 A Child Who Cannot Play
• 3 A Child Who Can Play: A Contemporary Little Hans
• 4 The Scene: Space and Time of the Therapeutic Playground
• 5 Playgrounds for Transference and Countertransference
• 6 The Work: Building a Playground with an Unplayful Adult
• 7 Re-railing the Dialogue
• 8 Primary Trauma: Work, Love; and Play Toward Repair
• 9 Dreams as Private Playthings
• 10 The Psychomythology of Everyday Life
• 11 Playing and Interpretation
• 12 Endings and New Beginnings
• 13 The Play of Psychotherapy
• References
• Index