For Heaven’s Sake – be yourself: Margaret Little in therapy with Donald Winnicott

Donald Winnicott

Margaret Little’s account of her analysis with Donald Winnicott is fascinating and for me – inspirational. She went into treatment with him aged 48, and 13 years after first seeking psychiatric help. She had heard DW speak and read his work and felt he was someone who could really help her. In the first session she was once again overwhelmed with terror unable to move or speak. At the end of the hour DW who had remained silent said: ‘I don’t know but I have the feeling that you are shutting me out for some reason.’ This brought relief that he could admit not knowing, and could allow contradiction if it came. But she felt she had been shutting herself in and taking up the smallest amount of space.

In another early session Margaret Little felt in despair about ever getting him to understand anything and wandering around the room attacked a large vase filled with white lilac – trampling on it.

‘In a flash he was gone from the room, but he came back just before the end of the hour. Finding me clearing up the mess, he said ‘I might have expected you to do that [clear up? Or smash?], but later.’ Next day an exact replica had replaced the vase and the lilac, and a few days later he explained that I had destroyed something that he valued.’

It wasn’t referred to again which seems rather strange, but long after finishing treatment when Little asked him for advice about a patient, she was seeing who repeatedly hurt her knowingly and repeatedly, she spoke to DW about having hurt him with this action. ‘He agreed that I had, but added that it had been “useful”.’

Because Little couldn’t speak until she had settled, DW extended the session to last an hour and a half. Taking in the silence and stillness Little describes as a huge contrast to the disturbances of her childhood with her mother’s high-anxiety driven state and a feeling of general hostility from which she felt she had to retreat. DW in the early stages of the work held Little’s two hands clasped between his as she lay beneath a blanket – ‘silent, inert, withdrawn, in panic, rage or tears, asleep and sometimes dreaming.’ This was part of what DW called ‘holding’ and ‘regression to dependence’ – both metaphorically and literally. He was ‘holding the situation’ – taking responsibility, supplying what ego strength a patient could not find in themselves and gradually withdrawing as the patient could take over. In other words, providing the ‘facilitating environment’ where it was safe to be yourself.

(Two asides: 1. I was working in child guidance when a child smashed up a piece of furniture in a session with the child psychotherapist. The therapist immediately replaced it before the next session – this action prompted a discussion in the team about whether the child needed to know the impact of his actions [not to replace it] – or whether the boy needed to see that his actions didn’t lead to destruction and his violent behaviour could be survived [the item was replaced].

    1. In the present day holding a patient’s hands would probably be seen as transgressing the codes of ethics, as it might be misconstrued, and deviates from accepted practice – but DW was developing his ideas and unconstrained by such rules).