Can we draw parallels with our clients’
relationships with us – as did Winnicott (2002)? Both therapists and mothers can
communicate reliability to the patient/ child, which facilitates growth. Both are working toward helping an individual reach their inherited potential. Caregivers and therapists need to have ability/ capacity/resources to provide a good enough holding environment. I have worked in a specialist
personality-disorder service for over a decade, and we have come to understand the origins of the distress of our clients as often arising from early attachment traumas where the child has been deprived of what is essential for secure emotional and relational development. They have NOT: • Experienced protection from neglect, danger, abuse;
• Been held in mind so that they know they are safe and the world is a good place where relationships can be trusted and separation can be managed;
• Received love and aff ection – “Mother’s attention acting like a mental skin, holding the diff erent parts of the baby’s internal world together” (Johanna Bick, 1968);
• Felt themselves to be someone special; • Had experiences of being understood – caregivers thinking about what the baby’s needs are – emotional, physical, cognitive – and responding appropriately to those needs;
• Been given space to be and to discover – caregivers knowing when to respond and when not to;
• Been part of interactional patterns of reciprocity – “The intense two-way flow of communication, or dance, between a mother and her infant, initiating and regulating contact, enhancing the growing relationship, and shaping the development of the infant’s sense of self” (Brazelton & Greenspan, 2000);
• Experienced containment – “The process undertaken by the mother of receiving her infant’s intense feelings, containing and making sense of them so the infant feels understood” (Bion, 1962);
• Experienced having a secure base: “He is content to move away, as long as he knows that she is there. He can even leave the room on his own initiative and his aplomb in doing so is sometimes in sharp contrast to the consternation when his secure base gets up and moves away” (Ainsworth, 1967).
Context 170, August 2020 My daughter becoming an “ordinary devoted mother” Without opportunity to repair, deprived
infants may become adults who oscillate between intense dependence and fusion, and intense pseudo-independence. There is little or no possibility for them to have a sense of healthy connection and intimacy co-existing with a healthy individuated sense of an autonomous self. There has been serious consequence to them of experiencing inadequate care. It is with these adults that as professionals we are tasked with providing what was missing for them as children to repair the early developmental trauma and subsequent resulting damage to their security in themselves, with others, and in their worlds. Drawing again on Winnicott’s
contributions (2002), it is helpful to explore his concept of the “good enough” caregiver.
“The ordinary devoted mother – by
devoted I simply mean devoted; machines cannot do this job.” “Good enough care: good enough
mothers are human and imperfect – wholly dedicated and humanly unreliable – this is essential to fostering independence.” “Human beings fail and fail” – the good
enough caregiver provides a balance which both satisfies the child and pushes them towards independence. He suggested that a baby has a task
of learning the “me” and the “not me”. Distraction of the caregiver to attend to his or her own needs or worlds is necessary to provide a route to this learning. Also necessary is the healthy triad. “Not me” must come in a safe and timely manner – not too early – and there must be a third party who can provide
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The good enough family therapist: We may choose to be family therapists but not necessarily in circumstances of our choosing
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