A Good Doctor

I

“I’m getting bigger and bigger. I’m going to be three. How old are you?” asks Gabrielle, nicknamed Piggle, who has been brought down from Oxford to London to see the great psychoanalyst, Dr. Winnicott. He tells her: “I’m sixty-eight.” Piggle says she’d like him to live nearer.

A year or so later, on another of her infrequent visits, she chatters, while playing by herself, about how long the train was. He (sensing she is dealing with the absence that implies death) tells her that the long distance is like the long time since she last saw him. And then:

He: Piggle is taking a long time to find out if I am alive.

She: When will your birthday be? I want to give you some presents.

He: What about my death day?

She: We will see what we can get for you. Mummy wrote a letter to France; it takes three hours, quite a day to get there.

He: If I were dead, it would take longer still.

She: You would not open it because you would be dead. It’s terrible.

Winnicott died in 1971. Opening The Piggle—the recently published “account” of his work with Gabrielle—will be for many, as it was for me, like opening the notebooks of someone you wish had been your teacher. There is much new interest in Winnicott since his death, here and in France. In England, Winnicott’s BBC talks (published by Penguin Books as The Child, the Family, and the Outside World), remarkable for their uncondescending simplicity, had made him a widely esteemed authority on infancy. Winnicott stood in the public imagination as an unpretentious defender of the dignity of caring for babies. But he had begun to have an international reputation by the early 1960s. He had discovered, so to speak, the significance of the teddy bear in the mental life of children: his term “transitional objects” was widely used to designate the class of which teddy bears and “security blankets” are the prime examples. He had also, from early on, been interested in the schizoid personality, and had put into circulation the notion of the “false self,” which R.D. Laing elaborated and popularized.

Teddy bears and false selves sound a whimsical combination, and might seem to place Winnicott and what he called the “area of transitional phenomena” somewhere in the English nursery tradition of Never-Never-Lands, Looking Glass worlds, and Learscapes. It was the other way around. Winnicott was concerned with how it is we come to feel more—or less—alive, whole, and real. He saw the teddy bear as marking a step in being able to find the world meaningful. The “false self” is a kind of opposite to the teddy bear. The social persona is a “false self” in so far as it arises out of mere compliance with parental demands that don’t make sense, where parents need to impose a reality that fails to overlap with the very young child’s personal sense of meaning.

The precision of Winnicott’s concern with the ways we are engaged in, or subtly cut off from, our process of living, shows in his first psychoanalytic paper (1935). He made a point there of distinguishing between two types of inner experience then covered by the term “fantasy”: (1) inner life which is predicated on the experience of relationships; (2) the cloudy or scatty pseudo inwardness which serves to blot out the actuality of relationships, the very possibility of presence or absence.¹

So Winnicott was, perhaps, the first psychoanalyst to deal with whimsy, but he did so as its critic, in so far as it represented a waste of spirit. If his contribution was particularly English, it was that he brought to psychoanalysis a sense of the commonplace. He appreciated the ordinariness of the remarkable process of communication set up between “the ordinary devoted mother” and the infant. And to a rare degree he was able to see the ordinariness of the special situation that is psychoanalysis. His relaxed manner as an analyst, and the reputed ineffableness of what he had to teach, had to do with the fact that he could treat the psychoanalytic hour as a slice of life, albeit one in which he had a special job to do.

Winnicott is widely recognized as one of the most original and gifted contributors to our sense of what psychoanalysis is and how to do it—but one difficult to paraphrase or codify. He liked it so, and left it so, by means of speaking plain English. He was remarkable for his avoidance of jargon. His sentences ambled on with a well-bred unassumingness. Certainly it took some mild intransigence to go on speaking English throughout a life in psychoanalytic society. Colleagues—transatlantic ones especially—were sometimes irritated, and complained that Winnicott was hard to understand because he spoke an idiosyncratic language. It was often as if he were playing—for he was generally gently playful—at being the sort of reliable and modest fellow who dealt only in particulars.

I felt I entirely knew, and liked, the man when I recently came across the incident of his beginning a lecture on communication to the San Francisco Psychoanalytic Society in this way:

Starting from no fixed place I soon came, while preparing this paper for a foreign society, to staking a claim, to my surprise, to the right not to communicate. This was a protest from the core of me to the frightening fantasy of being infinitely exploited. In another language this would be the fantasy of being eaten or swallowed up. In the language of this paper it is the fantasy of being found….

A friend of mine had Winnicott as a supervisor when she and I were both studying child psychoanalysis in London. It was in the middle 1960s (about the time he treated Piggle), and I already had a notion of Winnicott as a gentle man who had remained very much his own person in the midst of doctrinal disputes, and who had something valuable and personal to teach, but no one could tell you what it was. My friend’s patient was an extremely withdrawn little boy. He spent his once-a-week therapy hour silently arranging a complicated doll house tableau, a different one each time, inside a cardboard carton where she couldn’t watch his work. He did, however, leave it set up, so she could look at it afterward. Each week I was keen to hear what Winnicott had said to do. Each week, for quite a while, it was the same. She was simply to be there; to let the boy know she understood he was leaving a communication for her, and that she would receive it. Those instructions, and my friend’s patience, puzzled me, for I had just learned (training at a different school) to suppose that the critically effective part of therapy was the giving of interpretations.

Winnicott dealt in those implicit aspects of therapy which don’t have to do with what the analyst says but with how he says it—and with what it may mean to the patient for the analyst to say nothing at all. This is why he has become one of the few authors that beginning clinicians feel they must read. But it wasn’t always easy to see what he was about. He tended to bring intangibles to one’s attention as if he were presenting homely facts, by relating naturalistic observations from his pediatric practice. He’d begun as a pediatrician, and throughout his career as a psychoanalyst remained in pediatrics as a psychological consultant at Paddington Green Children’s Hospital, in a working-class district of London.

One characteristic observation: if, in the pediatrician’s office, an attractively shiny object is placed within reach of an infant between the ages of six and fourteen months, most infants will reach for it and then pause, for a longish moment of hesitation. They seem to go through an inner struggle, and may look to the mother for a cue. If she offers none, but peacefully lets the infant get on with it, the hesitation is usually overcome. The infant reaches with fuller—and salivating—resolve, and begins to play with the object, showing a new self-confidence. It is as if, in that pause, the infant had “accepted the reality of [its] desire.” Having watched infants variously do this for twenty years, Winnicott wrote a long, interesting, and speculative paper about it in 1941, at the end of which he not entirely mischievously suggested that psychoanalysts try regarding their own interpretations as glittering objects, and so learn how their patient responds to the world’s offerings.

Schizoid people tend to feel embarrassed or threatened by their impulses. They seem subtly split off from all desire, as if the moment of hesitation keeps arising, and it is difficult for them to experience desire as their own. The infant, as Winnicott imagined it, can make the stirrings of desire part of what he called the “ongoing-sense-of-beingness,” which is the foundation of a sense of self, if that “ongoing-sense-of-beingness,” doesn’t keep getting disrupted. Maternal care provides a “holding environment” which allows the infant to relax and sense what is going on in himself, and to gather up his fragments of experience. The psychoanalytic situation, Winnicott proposed, also does or can provide a “holding environment.” Winnicott’s notion that in the relaxation of the therapy hour the patient can get in touch with his inner experience in a fresh way is like Freud’s notion of the relaxed attention of free association, but takes it further.

Another way of putting it: Winnicott was concerned with those aspects of the therapeutic relationship which, in fact, constitute an actual relationship. It is, of course, a delicate matter to point out that all sorts of immediate and, well, real things are happening during a psychoanalytic hour. An hour of fully attentive concern from someone who, as thoroughly as possible, is not frightened of you, and who does not wish to use you for his own satisfaction, implicitly offers, as Winnicott saw it, the possibility of a new start for people whose earliest experiences of relationships had been disturbing.

The way Winnicott found to bring this out was, again, oddly matter of fact. He simply described the psychoanalytic situation that Freud had designed, but he did so with a kind of pseudo naïveté, so as to reveal what it had in common with the situation of the infant or young child in the care of its mother. “The analyst would be reliably there, on time, alive, breathing. For the limited period of time prearranged the analyst would keep awake and become preoccupied with the patient….”

One last characteristically Winnicottian image: the young child playing “alone in the presence of the mother”—play that starts at the point when parents say, with relief, of a toddler: “He can play by himself,” meaning, “if I am somewhere around.” This commonplace situation, Winnicott noted, is a step in the development of “the capacity to be alone,” by which he meant solitude in a positive sense: how much we can still feel like ourselves when others aren’t around. The young child can have a nascent experience of safely being alone exactly because an adult is near—and not intrusive. The child who can play alone in a satisfying way has an ongoing sense of self; this in turn is sustained by an ongoing sense of relatedness to an adult felt as “there.” So having a lively private world depends on a sense of being related to another. Winnicott liked to point to these “paradoxes.”

Now try transposing “alone in the presence of the mother” onto the situation of the patient in the presence of the analyst. Suppose the patient is someone for whom aloneness means emptiness and panic. In such cases, Winnicott remarked, falling silent may not be a resistance to the talking cure. It may be the first time that person has dared or been able to experience being alone safely, because of the presence of another.²

II

Little Piggle is not an extreme case. The account of her sessions with Winnicott is as much a sampling of a very young child’s growth as it is a study in pathology. Readers, especially professional therapists, are likely to feel uncertain at times about how disturbed little Piggle is. This is because it was Winnicott’s gift to be able to see illness as a form of health. And Piggle does eventually thrive. A delight of the book—it lends a kind of elegiac radiance—is that we see Piggle refracted through Winnicott’s sensibility. So we watch a very young child growing under the gaze of an old man for whom she is virtually an illustration of the interests of a lifetime. But when we first meet Piggle, in a phase where early states of mind and madness seem quite close, she does seem disturbed.

Piggle, at two year, four months, is persecuted by a “black mummy” who lives in her tummy, and by a “babacar,” which, as she tells her real mother, “is taking blackness from me to you, and then I am frightened of you.’ She scratches her own face at night, and can’t sleep for fear of the black mummy. This started after her baby sister was born, when also there was some unspecified strain in her parents’ marriage. By day, Piggle seems changed, not herself, listless, unable to play, and “spurious”; she talks in an artificial voice, and indeed insists she is not Piggle, but the mother or the baby. And she seems to suffer, as her father writes, “from what used to be called a sense of sin.”

“Tell me about the babacar,” Piggle pleads cryptically, and her mother becomes involved—as does her father—in earnest nightly talks about these black things, which, evidently because of the mother’s anxieties, don’t help. Piggle’s mother, who adopts a rather Winnicottian tone and vocabulary in her letters to Winnicott, tells Piggle that there is a Dr. Winnicott, hopefully billed as someone who “understands about babacars and black mummies”; she’ll write him a letter. “Take me to Dr. Winnicott,” says Piggle, who seems to have picked up her mother’s well-founded faith.

This information comes from the mother’s letters, published in The Piggle. From them we guess she is brilliant, distantly anxious, trying to be composed, seeing herself in Piggle, and, to our benefit, hyper-alert. She reports all Piggle’s interim remarks on Dr. Winnicott. The father can be made out only dimly; likewise the marriage and its effects on Piggle. Winnicott seems to have filled the role of a supplementary father who carried out what the young father could do only incompletely in the situation: help the mother to separate from Gabrielle by helping her feel less frightened of her own or Piggle’s supposed badness.

Winnicott kept a running transcript of his sessions with Piggle—only sixteen in all, since he lived far away, at longish and irregular intervals, a month or several months apart, during the period when Piggle was from 2.4 to five years old. He tried to see her “on demand,” when Piggle seemed most keenly to be asking to see him. These hours are narrated in full, with much dialogue transcribed verbatim, in an extraordinarily natural voice, namely Winnicott’s, which conveys many of his on-the-spot perceptions and choices.

After each session we get the list Winnicott jotted down for himself of what he took to be the main developments and some further reflections. A marginal gloss—scattered, brief, occasionally cryptic phrases—runs alongside the scenes. Excerpts of letters from Piggle’s parents, and a few from Winnicott to them, fill in the intervals. So we are shown, not told. The psychoanalyst’s thoughts appear merely as an element in the situation, which is of course always the case, often forgotten or obscured.

The effect is exhilarating. The Piggle seems, on first reading, like a notebook, sketchy, with the properties of late works: spontaneous brush strokes and lots of bare canvas showing through. I was surprised at how much it let me enter Winnicott’s working sensibility, to re-create the play of his attention, the quality of his responses. He comes to life (as does Piggle of course) so clearly that anyone who studies the book will afterward have his or her “own” Winnicott as a teacher from whom he can continue to learn.

It is not simply Winnicott’s candor—which is, anyhow, quite understated—that allows us to enter into his work, although few glimpses of therapeutic scenes have the immediacy of Winnicott’s. And few case histories include much of the therapist’s reciprocal process of making sense of the situation, though Freud invented the genre by doing, inter alia, just that, in his fashion. Winnicott is as present in these scenes as Piggle. He left himself in the account so we could learn how he went about what he did. But he is also there because he so much saw therapy as a two-person situation, in which the interplay between patient and therapist is both the main event and the carrier of healing.

The gaps, also, help us. Shuttling between text and margin (it’s a bit like reading a script with the director’s notes) we find the marginalia need to be read as signals of Winnicott’s apprehensions at each given point—not as prescribing what this or that material invariably means. Readers then can, and often will wish to, ask themselves: where was he getting this from? What was he seeing—e.g., what must have been Piggle’s mood and manner? To follow, play by play, the communication between Piggle and Winnicott takes some imaginative work, and it is well worth it. Any clinician curious enough to make the effort will come out not only with his own living Winnicott but will discover where what he does overlaps with Winnicott’s approach—and may gain a new appreciation of what is alive and what not-so-alive in his own work. The gaps, mostly, were left wittingly, and characteristically: “I have added comments, but not enough—it is hoped—to prevent the reader from developing a personal view of the material and its evolution.” Similarly, Winnicott used to warn that too much “clever interpretation” from the analyst could “rob” the patient of the opportunity of self-discovery.

Winnicott came increasingly to see the psychoanalyst’s task as that of a facilitator, rather than an uncoverer. He considered the therapeutic hour as a setting in which the patient could work his way through to some discovery, given the right medium in which to do so—this being the analyst’s way of being with him. The discovery would involve for the patient some fuller experience of himself which occurred then and there in the hour. Young children would work their way through to such a discovery in play. In his book on how he did diagnostic interviews with children in such a way that the consultation also served as therapy, Winnicott wrote: “The significant moment is the one in which the child surprises himself or herself.”

Winnicott respected what he liked to call “muddles”—the periods of nonsense, when a patient rambles. “Muddles” could be a “resting state” out of which a statement would emerge; the analyst must not be too keen to find sense and impose order where there is none, out of his own need to be on the job. What is being communicated, just then, is the state of muddle itself. In The Piggle, Winnicott points out the muddles, and notes, “I let this be so.”

The Piggle reveals Winnicott working from the plausible conviction that little Piggle herself has come each time with the intention of doing a piece of work. In each session, he notes the point where he feels the key discovery-communication emerges. “This was the work she had come for.” “Now I could give her the interpretation she had come for.” There has been a tendency to praise Winnicott’s remarkable clinical skill, and at the same time backhandedly to diminish his results by attributing them to his intuitiveness. But the point, surely, is that children—and other patients—arrived at what they did in sessions with Winnicott not just because he intuited what they meant with such alacrity but because he tacitly conveyed his trust that they would arrive somewhere.

Winnicott feels, and we feel with him, that in playing Piggle is communicating in some sense knowingly. He “interprets” not so much to translate her play into words as to let her know he has understood. Interpretation, in his hands, often becomes mainly another means of doing what can also be done without words. He trusted that patients were becoming aware of what they were expressing, as they went along, simply because of the analyst’s “mirroring” attention. Such trust, fortunately, tends to be a self-fulfilling prophecy. This trust shows in the wording of his interpretations: “You were frightened to find you wanted to…” (my italics). The right medium for discovery includes an unfrightened readiness on the part of the analyst to acknowledge it as soon as it emerges—Winnicott’s guideline for when to interpret. It will be seen that this sort of analyst is not so much asking himself: What does this mean? as: What is the patient experiencing, and when shall I confirm it?

Winnicott’s kind of psychoanalysis doesn’t look markedly unusual. His work makes explicit what other analysts do without quite realizing it. He gives, from the start, ordinary “interpretations.” Session two: Piggle asks if he knows about the babacar. He tries little questions (baby’s car?); she won’t say. “I then interpreted. I took a risk. I said: ‘It’s the mother’s inside where the baby is born from.’ She looked relieved and said, ‘Yes, the black inside.”‘

And, as is usual, they play. But at first, Piggle cannot play, except for rudimentary toy arrangements. She keeps filling a bucket with toys until it spills; she has the toy animals feeding. So Winnicott ventures: “Winnicott is the Piggle’s baby…very greedy…it’s eaten so much that it’s sick.” Piggle agrees. They settle in further together, she making faces, he imitating, communicating about the pleasures of eating. Soon he starts really playing for her. Having left the room for a moment, Piggle returns “and found me still sitting among the toys, near the bucket which was overfilled, and ‘being sick over the floor the whole time.”‘

Piggle asks solemnly if she may have just one toy, and we hold our breath, wondering what she makes of the spectacle of the “vomiting” Winnicott. He takes her solemn restraint as a cue that he is to continue to represent its opposite: greediness. And so, he elides it into a game. “Winnicott very greedy baby; want all the toys.” She takes this up, stiff and frightened, but with a glimmer of pleasure, reporting to her father in the waiting room about the greedy Winnicott baby.

Catching on that Piggle is now being the mother, Winnicott goes on playing that he is “Piggle’s greedy baby” of whom Piggle is (as she seems to be) frightened. It is deft that he knows to play Piggle’s baby rather than Piggle herself. She responds by playing that she is an infinite series of new babies being born. The Winnicott baby naturally says he wants to be the only baby. Soon Piggle lets Winnicott know that he is now representing herself. He feels that through the playing, she has begun to re-experience her lost self, and so to let it reappear. (This is an especially Winnicottian perception.) She goes on being born, and soon announces, with relief, “I am just born. And it wasn’t black inside.” This takes place remarkably early; session two.

The black mummy gradually fades to a dream, as Piggle, through play, finds her feelings less frightening and can acknowledge them as her own. Throughout, Winnicott monitors and tracks Piggle’s emergence as a separate person. His eye for this seems almost uncanny. One day, when she is two years ten months old, he knows to greet Piggle at the door by her real name, “Hullo, Gabrielle.” Afterward, she reports, pleased, “I wanted to tell Dr. Winnicott that my name is Gabrielle, but he knew it already.”

As they play various parts, turn and turn about (mother wanting to be “daddy’s little girl,” and being jealous of Piggle, Piggle jealous of the baby with mother), we see Winnicott registering what is occurring in a special way. Piggle is learning to see herself as one among three or four, to locate herself with respect to the idea of older and younger, and to understand that others also have feelings like hers. These are all steps out of the egocentricity of early childhood.

When Winnicott observes and plays with Piggle he feels growth is occurring in front of his eyes: her play is not merely a sign that she has taken these steps. It is through the imaginary identifications of play that she learns to make them: play actually helps. This observation is, I think, original. Or rather, it must be what countless child-watchers have sensed, but none has conveyed it in print.

If Piggle had been seen more frequently, wouldn’t she have given Winnicott more trouble? Wouldn’t he have had to take up more directly her anger at him for their separations? As he’s said elsewhere, in more intensive work the waters soon get muddier. So I can’t agree that the work with Piggle is in every way equivalent to a psychoanalysis. But it is an invaluable demonstration of a psychoanalytic approach that is relaxed but not sloppy, and marvelously alive.

What is special about Winnicott is his sense that being able to play creatively, and to share a common world through play, is healing. That is why he is able—no mean feat—to be spontaneous and to be a psychoanalyst at the same time. He makes us appreciate what it means for the psychoanalyst to be in a state in which he can play. The peculiar freedom of mind (which Freud tried to indicate by speaking of free-floating attention) that would be the most desirable state to be in when doing psychoanalysis could be defined as readiness to play.

If the analyst’s readiness to play is diminished, it is likely a sign that he is to a degree caught in responding to the patient in the ways the patient elicits and has learned to expect from others. It isn’t easy, of course, to stay potentially playful with someone who cannot play. But consider what implicit messages are given to a child about himself by someone else’s readiness to play with him. Winnicott makes us think: aren’t those messages exactly what we would hope the medium of psychoanalysis would deliver, along with any particular interpretations? He puts it more modestly in The Piggle: “It is not possible for a child of this age to get the meaning out of a game unless first of all the game is played and enjoyed…. The analyst always allows the enjoyment to become established before the content of the play is used for interpretation.”

If a person feels unreal, how real does he need his psychoanalyst to be? Winnicott was always interested in this question, which has nowadays become what young therapists most want to discuss. Speaking of patients who present “a false self,” he remarked, “In one case, my work with him really began when I made clear to him that I recognized his nonexistence.” That remark, with its easy-going subtlety and paradoxicality, is very characteristic, and very useful. If the psychoanalyst sees his task as “recognizing,” he will be in a better position to find, with a schizoid person, a good middle ground between being a blank screen and being too personal. The analyst acknowledges that he has had a real and personal experience, of really recognizing something.

Winnicott would let adult patients know they had had a real effect on him. But he was always tremendously scrupulous about how he conveyed this, making it clear that the effect the patient evoked was safely contained, tolerated, and “held” in Winnicott’s conscious experiencing of it. He’d also make clear that he wasn’t merely reacting, but using his response as a source of information; his response was helping him to “recognize” something in the patient. His formula would, roughly, be: “What you’ve said has made me experience x, and from that I recognize that you are feeling y.”

This would be especially helpful for people who because of distorted reactions from others in early life don’t expect to get through to others, or have trouble reading others’ responses. Winnicott’s approach is different from a standard interpretation in which the analyst simply puts forth his own ideas and observations. Winnicott felt that for a schizoid person that type of “objective” remark could be merely an intrusive imposition which didn’t leave the person room in which to have his own experience of himself. Clearly Winnicott was not pretending to be a blank screen: blank-faced mothers do not have a wholesome effect. But his approach was in essence “psychoanalytic.” It was specifically different from methods in which the therapist makes a point of saying what he feels.

Children need to feel reflected in someone else, and understood. But they also need to come up against the reality of the parent as another person, if they are to become separate individuals. Winnicott was, in various ways, always concerned with how much the patient needs to come up against the reality of the analyst as a separate person. “I think I interpret mainly to show the limits of my understanding,” he remarked late in life. Piggle at one point defensively “tidies away” blackness, and has nothing to tell about the babacar. So we find Winnicott, quondam babacar expert, proclaiming his ignorance, exclaiming, “I don’t know about babacars.”

Coming up against otherness might mean, also, learning that one’s therapist is not invulnerable, but has had to make real efforts to deal with one’s demands or rage. “If a patient seeks objective or justified hate, he must be able to reach it, else he cannot feel he can reach objective love.” That was written in 1948. A treatment is incomplete, Winnicott said then, if, at the end, the therapist cannot in some sense let the patient know what he “did unbeknown for the patient, whilst he was ill, in the early stages,” before the patient could see the therapist as a separate person. We see Winnicott doing this at the end of Piggle, as he playfully but staunchly lets her know he is glad to have his independence back too.

In the model of the psychoanalyst as a blank screen, the patient is meant to learn, as the family therapist Jay Haley sourly but not wrongly put it, that all his old games will not work. Winnicott turns this inside out. For him, “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 to a state of being able to play” (italics in original).

There is much discussion in contemporary psychoanalysis about how to work with people who seem unable to experience others as fully real and separate. Should the analyst first accept being used as a part of the patient’s world? Or should he keep trying, like an alert and sympathetic referee, to tell the patient what the patient is doing? The Piggle can be read as a graceful demonstration that it is possible both to join someone else’s world, and to speak up about it. Indeed, Winnicott’s opening line is, “Bring teddy over here. I want to show him the toys.” And, in a sense, he lets Piggle use him as a kind of teddy bear.³

Like a teddy bear, he obligingly accepts and plays out her imaginings. And like a teddy, he is at once a separate being and someone who belongs inside her sense of “omnipotent” participatory communion with the world. Like a teddy, he lets her project onto him, and find in him, her own capacity for appreciation and love of life as it was before fear and disillusion set in.

Winnicott called teddies “transitional,” because from the infant’s point of view they are at once subjectively and objectively real. Or rather, that is how we’d describe what they are for the infant—who is in transition toward being able to make that distinction. Winnicott’s originality lay in trying to re-create the quality of the infant’s own experience. His point was that our sense of the realness of the world, and of the realness of others, depends, paradoxically, on our having been allowed to bathe in that state in which the other seems also like another part of us, almost a creation of our own capacity for consciousness. The early “overlap” between the infant’s subjectivity and the objective reality of the mother is the earliest example of what Winnicott meant by a “transitional area.” Having a teddy was a sign that this early form of experience had been able to occur. Where care of the infant was disruptive, that experience would have been difficult to sustain.

In the ninth session, when Gabrielle is three years and four months old, there is a moment during which “the whole quality of the session altered.” Sucking on a tiny blue plastic cup, Gabrielle has an experience of bliss. “The incident…seemed to be a place where Gabrielle discovered the lost good mother along with her own [lost] orgastic capacity….” Winnicott’s apprehension feels credible because the moment of bliss occurs in the middle of some intricate and delicate work on the black mummy. Just before, Gabrielle tells how the black mummy tried to usurp her bed and got shot. This is a dream, and Winnicott, feeling she is ready for this, lets her know it’s dreaming. Just after, Gabrielle reflects, “I loved her very much…. The black mummy is my bad mummy. I liked the black mummy.” The delusional black mummy was a way of holding on to some of the connection with the lost subjective good mummy: that’s what Winnicott sees in this.

Five months and two visits later, Gabrielle looks at Winnicott through the blue plastic cup and tells him he has become blue. Of this, he notes, “Implying the transfer of her feelings about the cup to the whole of me.” It’s understandable why he took it as such if one fills in the emotional tone of the scene.

At the start of life, when being a part of all there is and being a self are not yet separate, there is, nonetheless, Winnicott felt, something that deserves to be called “relatedness.” Because he saw it that way, Winnicott was able to be singularly unprudish about “narcissism.”⁴ This early relatedness, he ventured, might be “the matrix of transference.” It was for him the substratum of all therapeutic work, something which nearly everyone who enters therapy can rediscover to some degree in the relation to the therapist. That everyone, however subtly and invisibly, did this when offered a fresh start was not something Winnicott wished away.

At the end, Gabrielle tells a dream: “I saw Dr. Winnicott in the pool in his garden. So I dived in. Daddy saw me in the pool hugging and kissing Dr. Winnicott, so he dived in too. Then mummy dived in, then Susan [her sister]…. There were fishes and everything. It was a dry wet water. We all came out and walked in the garden…. It was a good dream.”

Winnicott at once perceives the dream as a summing up of their work: all Gabrielle’s relationships rinsed in the waters of what he calls transference—the “positive relationship to the subjective figure of the analyst.” He is so delighted that with tender aplomb he says something of which the last part is perhaps over her head.

“The pool is here in this room, where everything has happened and where everything imaginatively can happen.”

“I’m swimming,” says Gabrielle happily, who must have got his intent. And soon after, touching on an old leitmotif, she says that everything looks blue. She is looking through two of the blue cups she had once blissfully sucked; it gives her, she says, the feeling she is swimming under water.

But just before this, Gabrielle, with pleasure, twists up a toy man made of pipecleaners. As she does so, Winnicott, understanding she has come for this visit so as to “finish off” with the treatment, cries “Ow! Ow!”

Gabrielle: Now there’s nothing left. It’s all twisted up…, so you can’t cry. I am throwing you right away. Nobody loves you…. Everybody hates you.

Winnicott (in the course of this game): So the Winnicott you invented was all yours and he’s now finished with, and no one else can ever have him.

Gabrielle: Nobody will ever see you again. Are you a doctor?

Winnicott: Yes, I am a doctor and I could be Susan’s doctor, but the Winnicott that you invented is finished forever.

Gabrielle: I made you.

As she constructs a sticky collage kite as a present for her sister (which he construes, silently, as his memorial), she intimates again that she came to finish with him before her fifth birthday. Winnicott lets himself say, “I’d like to get finished with you, too, so that I could be all the other Winnicotts and not have to be this special treatment Winnicott invented by you.”