Winnicott and 'Good Enough' Couple Therapy

Reflections of a couple therapist

Claire Rabin

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317815266
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Claire Rabin innovatively applies the Winnicottian theory of the 'good enough mother' to couple therapy, redirecting attention to the therapeutic relationship and the therapist's self-awareness regardless of the methods used. Using this lens, even the therapist's mistakes become an opportunity for repairing both the therapeutic relationship and the partners' own personal maturity.

The intensity and pressure of couple therapy can make each case a test of the therapist's competence. The need for neutrality constitutes on-going pressure on the therapist and the proliferation of therapeutic methods can cause confusion about which might be most useful in each situation. Applying theory effectively is easier said than done within the context of the powerful emotions unleashed in sessions, which can result in a catastrophic atmosphere. These factors can make it hard for therapists to utilise their own skills and knowledge within sessions of couple therapy.

The book explores how therapists and couples can unintentionally further 'false selves' without realising how the very tools of change may counter authenticity. Featuring interviews with an international range of couple therapists and case studies from the author's own experiences, the key aspects of the 'good enough' concept are elaborated. Rabin shows how these ideas can strengthen therapists' sense of security and safety in using their lived experience and intuition.

Winnicott and Good Enough Couple Therapy is the ideal book for clinicians seeking an overarching framework for working with couples or families, as well as those concerned with the importance of the client-helper relationship.

1 Winnicott and I

Why look to Winnicott for help in treating couples?

Before examining this basic question, I want to share the ambivalence that arose in me while writing this book. I believe Winnicott would have been delighted with this self-disclosure: Winnicott was the champion of the ‘real self’ and knew about the anxiety that any creative expression entails. He firmly believed in self-reflection and awareness by the therapist, more than techniques or tools for changing other people.

Why am I ambivalent about applying Winnicott to couple therapy?

First of all, I am not a psychoanalyst, although I did an analysis of my own. Initially, I studied a course on Winnicott and family therapy at the Seattle Family Therapy Institute under Rusty Palmer, but over the past three years I have continued to study him on my own. Thus a lot of this book arises from my own self-reflection. Also, I am primarily a couple therapist, but Winnicott did not write about couple therapy. My inner critic warns me about criticism from both sides. Those who use primarily psychoanalytic methods might see me as a naïve interloper. Therapists doing couple therapy might rightly ask why we need another method when couple therapy is inundated with new methods each year.

I believe that couple therapy has lost out by not recognizing the value of Winnicott’s ideas. Some of his ideas were incorporated into modern couples object relations. But there are few books or articles that apply Winnicott’s ideas to couples. Winnicott presented a series of ideas gleaned from watching mothers and babies. People told me that they have a hard time with his idiosyncratic language, paradoxes and rather strange oblique statements. Often those who know of Winnicott have not read his papers but utilize the many secondary explanations that try to explain what Winnicott really meant.

For me stepping out into a new direction in couple therapy invites anxiety of all kinds and certainly ambivalence about my knowing enough to do this. There is a strong pull in me to understand Winnicott as applied to couples. But there is also a fear of not being ‘good enough’ to be able to pull this off.

Winnicott believed deeply in ambivalence. When he wrote about mothers, he was vivid in his description of how ambivalent a mother is. He connected this to the ambivalence of the therapist. He wrote that however much the therapist loves his patients, he cannot avoid hating them and fearing them. His writing is full of paradoxical and contradictory thinking. From everything I have read, it seems he rebelled against the psychoanalysis of his times but also invested much energy and creativity to reach into the psychoanalytic world and change it. He was a child and adult psychoanalyst who also had (through his second wife Clare) a strong affinity for social work. His writings are replete with his own unique ways of using language, a way that allowed paradoxes and contradictions to enliven the reading. He believed that the state of ambivalence marks maturity. If that is true, than I have certainly reached my own maturity!

Looking back on my personal and professional experiences, I have come to appreciate factors that helped and hindered my development. One of the discoveries I made is that Winnicott’s ideas provide a mirror through which I have been able to make sense of these experiences. Talking to other therapists about their work, I have found that they have wrestled with similar concerns, notably what it means to be good enough as a therapist. The pressure to be ‘good enough’ is in the work: the problem of feeling bad about oneself in the work (especially when feeling hateful towards couples), the uncertainties resulting from becoming involved in the couple’s affective field, the value of therapy in creating a special kind of space for the partners and so on. Gathering together the seminal ideas that Winnicott introduced about the role of mothers in infant development, and his application of these to therapeutic practice, related directly to concerns that I have had, and those of the therapists I interviewed. So I shall summarize these ideas, illustrate them appropriately, and then apply them to couple therapy, again providing illustrative vignettes of the therapeutic process that relate to his ideas.

As such this book marks a significant development in my professional and personal movement towards maturity as I reach the age of 65. As Winnicott criticized his colleagues out of intense concern and caring, I will allow myself here to criticize the tendency in couple therapy to overemphasize positive thinking and the teaching of so-called constructive communication skills. Using Winnicott’s ideas I want to bring back the therapist and the therapeutic relationship to the center of the process of work with couples.

This is certainly not to say that the methods of creating change in couples available today have no use. Rather this is an appeal to return to the roots of the therapeutic environment as the basic medium for change. Infancy is about as basic as we get, although as I show later there are now psychologists dealing with ‘gestational’ psychology of the fetus. Like an educated parent, the most sophisticated intervention will fail if the holding environment is not firmly in place. For example, I remember watching a mother teach her one-year-old toddler words by flash cards. I was instinctively turned off by this seemingly advanced training. Twenty years later I heard that the son had a nervous breakdown when he tried to leave home.

We can use Winnicott’s ideas to bring back the interaction between the therapist and the couple as central to the therapy process. From this good enough holding relationship we can then move to utilizing different methods available today. There are enough tools and methods. We need an umbrella concept to hold all of these. Good enough couple therapy is offered here as a generic set of related concepts that can hold the therapist who is trying to make sense of both the complexity of the couple and the complexity of the field of couple therapy. I need something more concrete to find my way through the over 300 methods available today to couple therapists.

Winnicott versus goal-centered treatment

Winnicott eschewed techniques, tools and ‘how to’ prescriptions in his work. He did not like his trainees to ask him what to do. He mostly asked questions. He was a social constructivist before there was a name for this. He had ideas about health and maturity but was also firm in his support for patience and allowing our clients to proceed at their own rate. He positioned himself alongside the greatest psychoanalysts, such as Melanie Klein, Anna Freud, Marion Milner and others carrying on the traditions of Freud. As opposed to the current bent toward clear goals and even protocols for treatment of couples, Winnicott brings us back to the basics.

The good enough mother is a metaphor that can be used to understand the process going on between the couple therapist and the couple, and between the couple. We can use his ideas to view therapy like an infant at play. Winnicott’s ideas can be woven throughout therapy, with a couple using different methods just as a mother would offer the infant different foods and toys.

In the family and couple therapy literature he is more like Murray Bowen, who advocated patient reconstruction of family of origin issues (Brown and Wright, 2010). While his ideas centered on the mother–infant attachment, reflected today in Emotion Focused Therapy, he was clearly not interested in mapping out stages of treatment, as promoted by Susan Johnson’s work (Johnson and Whiffen, 2003). On the contrary, he viewed each infant as unique, and so therapy based on this model cannot have a protocol for every couple.

Winnicott dazzles with the richness of his ideas. He was often paradoxical, which very much fits couple interactions as well as interactions of babies and mothers. For example, in writing about Winnicott’s thinking on play and fantasy, Tuber (2008) gives an example of Winnicott’s unique style of thinking: Winnicott explains how the baby solves his own potential loneliness by creating mental symbols of his mother, allowing the infant to hold his own mother in his mind and solving his predicament of knowing too early how alone he is.

This idea could also be said about couples, who struggle with awareness and imagination, fantasies of togetherness and being alone. Winnicott’s writings are filled with such paradoxical thinking. Thus his papers can be read and re-read over and over, and the paradoxical manner of thinking lights up different associations on each reading. His writings are so rich that books have been written to help people navigate his special use of language (Abrams, 1996).

I don’t think I am alone. Sometimes when I mentioned to people I was writing about Winnicott we would share a smile, as if we both knew a secret and wonderful genius who was so much himself, so real and yet so hard to reach. He was one of a kind, unique, obscure and deep.

A ‘relational’ professional identity

This book will show that being good enough for our couples helps them be good enough for each other. It will make the case that aiming for ‘good enough’ is better than aiming for a perfect record, trying to help everyone all the time with every problem. By having less perfectionist goals we are freed from performance anxiety, which can get in the way of sincere connection and clear thinking. Hamady wrote:

Performance anxiety is an elephant-in-the-room sized issue for everyone who spends time on any kind of a stage. Its management is the subject of a thousand books, workshops and programs that teach how to deal with and mitigate its effects … how to ride its wave rather than have it come crashing down upon you. Yet only a fundamental shift in how performance anxiety is perceived will allow you to overcome and indeed, transcend it. This shift begins by considering how the majority of us view stage fright: as a barrier between a performer and an audience. That performance anxiety is a barrier is not news to most of you. But what may come as a surprise is that its status as such only exists when another much larger barrier is already in place: the perception of the performance as a performance, rather than as a communion, a conversation and a connection.

(2010, p.10)

Therapy as connection not performance

What are the steps toward reducing viewing the therapy role as a performance and staying with the connection, communication and conversation, which is the essence of therapy? These are the resources that lead to becoming a ‘good enough’ couple therapist.

In the time I set aside to write this book, I have gone through a period of deep reflection. I have come to view theoretical tools as fundamentally intertwined with the people who taught them to me. I have come to see these people as mentors rather than teachers. I was a therapist searching for a theory. The people I met on the way helped me self-define and become reflexive. Theories contradict each other and focus on different aspects of life (emotional, behavioral, cognitive, body, brain, etc.), and in choosing a theory we make choices about what we believe and who we are.

In preparing this book I interviewed therapists in five different cultures. When I began to write, I realized this project was becoming a journey back through time and the book was going to be about being and becoming a couple therapist using Winnicott’s ideas as an umbrella for other theories. As I reflected on my own development, an intense curiosity about other couple therapists and their experiences ignited in me. As I started to develop the idea of ‘good enough couple therapy’, I wondered how others would react to this idea. I wondered if it made sense to them and in what way it might help them. I was well rewarded, because the therapists were mostly focused on their own inner worlds and the connections they made with couples. Few really focused on what has been the center of couple therapy – different theories and methods. Rather, therapists need help in dealing with the volatile turbulence of couples and couple therapy.

The role of theory

A theory is far more than a theoretical construction of reality. It goes beyond abstraction of concepts from the details of life. It means more than whose professional company feels right and whose does not.

It is the choice of theory that is a basic and fundamental professional action and activity. It is the ongoing choice of how to view the world and what sense to make of clients’ and one’s own reality. If we see theory in terms of our choices, like all our choices we would expect our professional choice of theories to change over time. We would expect to see the development of the ‘self’ of the therapist grow and become increasingly articulated over the years through these theoretical models and the different colleagues and teachers who taught these theories. When do we ever really feel like an expert inside? Often couples expect us to present ourselves like a medical doctor treating a disease. Deep down we know that the medical metaphor doesn’t fit therapy. But what metaphor does? I am offering the idea of the good enough therapist as an alternative to the expert therapist.

Choice of theory

We become what we choose. Our choice of methods reflects where we are at the time, and thus would be expected to change as we change. It would not be an exaggeration to say that there has been an explosion of material to guide couple therapists. Some of this intensive effort to help couples comes from rising divorce rates, and some from the research showing the importance of good couple relationships for partners’ mental health and for the mental health of children. Thirty years ago couple therapists did not have much choice in methods they used for guiding couples. There were a few different approaches, but nothing like the options that became available from the beginning of the new millennium. The types of therapies continue to increase.¹

Making the choice of methods is easier when the goals are reasonable and attainable. Thus the idea of the ‘good enough’ therapist doing ‘good enough therapy’. Having supervised many trainees and advanced family/couple therapists, I know that deep down many ‘experts’ feel some confusion when faced with the diverse choice of methods. Some therapists chose according to what they think they would like to have if they were in couple therapy. Some have seen good results for certain methods and thus tend to return over and over to the same tools. Others have been exposed to certain theories in their training programs.

An interesting study of choice of methods shows that beginners who don’t have a clear notion of what theory to use are more effective and liked better by their clients than advanced therapists who choose one method and stick to it. Lambert and Barley’s (2001) research shows surprising results. As therapists became better at techniques and theory with increasing experience, they became worse at interpersonal joining abilities! Clients might be impressed by the technique, but the relationship between the client and the therapy suffers the more the therapist knows – or thinks he/she should know.

The good enough therapist is self-confident but willing to change direction.

Mira, aged 35, came to therapy for help. Married for one year and now three months pregnant she was desperately unhappy with her husband. She came alone and talked confidently about wanting a divorce. She felt she had made a bad choice and was sure she wanted to change that. Yet over time in therapy it seemed that she was not really that sure. She then asked me to invite her husband into the sessions to see what really was needed; a new therapy or a divorce. When her husband Don came to a session, Mira and I had already contracted that she and not the marriage was my client. She did not want to automatically move into couple sessions; they had had couple therapy and it had not helped. She did not feel safe in the therapy because she found out that Don was secretly taping the session. Yet she still hesitated about the divorce and wanted Don to attend one session, for me to get a feel for what was going on. I had believed we had agreed that she would observe most of the session and I would interact with Don.

As I interviewed Don about how he saw things, I learned much that could help me help Mira come to a decision. But as I interviewed him on how he viewed the situation, I saw Mira getting more and more upset. I felt I was doing what she had asked for, to get to know Don and to talk with her after meeting him. I even thought I was doing a good job!

After half an hour, Mira exploded with anger at me and him. She went into a rather long diatribe about Don using the session to make his agend...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• Acknowledgments
• 1. Winnicott and I
• 2. My personal and professional journey and the connection between the two
• 3. How therapists view good enough therapy: the interviews
• 4. The process of good enough in therapy with couples
• 5. Hate and aggression in couple therapy
• 6. Transitional objects, transitional space, potential space, and couple therapy
• 7. Countertransference in couple therapy
• 8. The self of the therapist
• 9. Internal family systems therapy: the next step
• 10. Summary
• References
• Index