Academic journal article The Journal of Rehabilitation

The Psychoanalytic Theories of D.W. Winnicott as Applied to Rehabilitation

Academic journal article The Journal of Rehabilitation

The Psychoanalytic Theories of D.W. Winnicott as Applied to Rehabilitation

Article excerpt

The contributions of D.W. Winnicott, a prominent member of the British object relations school of psychoanalysis, are related to disability adjustment and rehabilitation processes in this paper. Specifically discussed are Winnicott's views on the therapeutic holding environment, good-enough mothering, the true and false self, environmental impingement, transitional objects, and countertransference. Recommendations are offered for using these concepts to better understand and facilitate adjustment to disability.

To most individuals the word psychoanalysis conjures up images of Sigmund Freud, the couch, infantile sexuality, Freudian slips, the tripartite structure of personality, dream analysis, transference, and toilet training. However, Freudian analysis, albeit the most visible, is only one of several approaches to psychoanalysis currently in use. In fact, the theories and techniques in psychoanalysis are seemingly as diverse as those of counseling and psychotherapy in general.

One way to make sense out of this diversity is to classify the theories of psychoanalysis into four basic categories: (1) orthodox or classical analysis, (2) ego psychology, (3) self psychology, and (4) object relations (Pine, 1985). An alternative approach is offered by Greenberg and Mitchell (1983), who argue that psychoanalytic theory can be reduced essentially to two major schools of thought-one based on drive/structure theory and the other based on relational/structure theory. The drive/structure model is best illustrated by the work of Sigmund Freud (1953-1974) and Anna Freud (1964-1981) and their disciples (Arlow & Brenner, 1964; Brenner, 1973; Fenichel, 1945), and the relational/structure model by the work of Melanie Klein (1964; 1975), W.R.D. Fairbairn (1952), D.W. Winnicott (1965; 1971; 1975) and Harry Guntrip (1961; 1969; 1971). Although some theorists [e.g., Heinz Kohut (1971; 1975; 1984) and Otto Kemberg (1975; 1976; 1980)] have attempted to mix the two models, the models themselves are based on fundamentally different conceptions of human nature, development and pathology. Specifically, the drive/structure theories emphasize the primacy of the drives (instincts), the role of libido and aggression, intrapsychic conflict, and the central importance of the Oedipal period. Relational/structure theories, on the other hand, emphasize the importance of pre-Oedipal development, self-object fusion and separation issues, self-cohesiveness, and the very early relationships between children and their primary caretakers.

These conceptual differences have implications, not only for patients who are believed to be suitable for psychoanalytic interventions, but also in terms of the specific techniques utilized in the treatment. For example, drive/structure analysts tend to limit their practice to patients who are relatively high functioning (e.g., neurotics) and to rely primarily on techniques such as free association, dream analysis, interpretation of transference and resistance, and the "neutral" therapeutic stance. Relational/structure analysts frequently treat patients who are more severely disturbed (e.g., persons with borderline or narcissistic personality disorders) and rely primarily on therapeutic techniques such as empathy, recognition and use of the real relationship, counter-transference interpretations, interpretations based on issues related to self-object fusion and separation, and the creation of what D.W. Winnicott (1965) has called a therapeutic "holding environment."

In a recent article titled "Freud and Disability," Cubbage and Thomas (1989) provided an assessment of Freud's theories and therapy as these relate to the psychology of disability and various rehabilitation interventions. Among some of the major concepts discussed in this paper were: castration anxiety, fear of loss of love, the death instinct, and the role of the defense mechanisms (especially denial). The purpose of the present paper is to extend this line of inquiry by discussing the writings of Donald W. …

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