By Joel Kanter

Date Posted: Monday, 15 June 2009

Joel Kanter is a social worker near Washington, DC. He is the Editor in Chief of the online journal, “Beyond the Couch” , at www.beyondthecouch.org and the editor of “Face to Face with Children: The Life and Work of Clare Winnicott”. at www.clarewinnicott.net . Joel writes about the influence of Clare Winnicott on therapeutic work with children and young people.

Contact : Joel Kanter, MSW, LCSW-C, 8811 Colesville Road, #104 Silver Spring,Maryland 20910,USA

Email: joel.kanter@gmail.com

Clare and Donald Winnicott: Play, Holding and the Transitional Participant

 

While the work of Donald Winnicott is well-known to psychoanalysts, most are unaware of his professional collaboration with his second wife, Clare Britton, a pioneering social worker analyzed by Melanie Klein who worked in child welfare, academia, government service, and psychoanalysis over the course of a remarkable career. Known today largely for her accomplishments in compiling and editing her husband’s papers, Clare Britton Winnicott was a creative, talented social worker and analyst who expanded her husband’s horizons, collaborating with him in exploring the interface between the psyche and environment.
These qualities quickly impressed Donald Winnicott when they began working together with evacuated children in 1941 and a lively professional collaboration eventually evolved into a more personal relationship. In response to this warttime experience and his collaboration with Clare, Donald’s approach to treating children and his scholarly contributions evolved dramatically. As Rodman (2003) noted, “during this relationship, which would continue the rest of his life, he became an entirely new kind of thinker and writer about the psychoanalytic understanding of human life” (p. 8).

Similarly, in a 1946 letter to Clare, Donald wrote “my work is really quite a lot associated with you. Your effect on me is to make me keen and productive and this is all the more awful—because when I am cut off from you I feel paralysed for all action and originality” (Kanter, 2004, p. 252). Rodman offered several hypotheses about the nature of her impact: that Clare was reminiscent of Donald’s transitional object, that she “made herself available to be re-created in the image of his desires and needs”, and that she “provided him with near-perfect ‘mirroring’” (p. 103).

However, apart from the impact of their personal relationship, Clare and Donald’s 30 year professional collaboration has been largely overlooked by Winnicott’s biographers (Phillips, 1988; Kahr, 1996; Rodman, 2003). While many are familiar with Clare’s role as Donald’s literary executor, information about her distinguished professional career and intellectual contributions has only recently become accessible to interested scholars (Holman, 2001; Kanter, 2000, 2004). In this paper, I will briefly review Clare’s professional career before discussing her professional collaboration with Donald and several of her important contributions.

 

Clare Britton Winnicott: A Biographical Outline

Born in 1906 in the north of England, Clare Britton grew up as the oldest of four siblings in the home of a community-minded Baptist minister. After some early years working in YWCA’s and youth ministries, Clare completed the Social Science Course at the London School of Economics in 1938 before taking her first formal social work position with troubled youth in a depression-ravaged Welsh town. After several years of witnessing extreme poverty firsthand, she returned to the London School of Economics where she completed the Mental Health Course under wartime circumstances in Cambridge in 1941. She then spent the War working in Oxfordshire supervising five hostels or group residences for troubled evacuees who were unable to cope with routine placements in family homes. In this work, she worked alongside Donald Winnicott who served as a psychiatric consultant to this project on a one day per week basis.
Clare and Donald’s creative work with children during the War became known throughout Great Britain and they emerged as leaders in a postwar movement to transform children’s services. They coauthored two articles about the Oxfordshire experience (Winnicott and Britton, 1944, 1947) and Clare was the sole author of a third (Britton, 1945), the first of over two dozen publications she would author during her career. After offering joint testimony to the Curtis Commission, the precursor of the 1948 Children’s Act which established a child welfare system throughout England, Clare was appointed head of a new course in Child Care at the London School of Economics. In this position, which she held from 1947 to 1958, she trained a cadre of professional social workers in the emerging field of child care.
In 1949, Clare began a personal psychoanalysis with W. Clifford Scott, the first British analyst formally trained by Melanie Klein. When he moved to Canada several years later, she began an analysis with Melanie Klein herself; most likely, Donald played a direct role in this referral. In 1956, she entered formal psychoanalytic training at the British Psycho-Analytical Society; her clinical supervisors included Michael Balint, Herbert Rosenfeld and Hanna Segal. Her analysis with Klein was a difficult experience; Clare found Klein distant and impersonal and, at one point, stormed out of analysis after Klein offered a long-winded interpretation of a personally significant dream.
Clare was disappointed both with Kleinian technique and the Kleinian faction at the Society. But with Donald serving as President of the Society, Clare coped with the intolerance of dissent within the Kleinian group by remaining largely silent in her classes and compliantly submitting to supervision by orthodox Kleinians. Hanna Segal, in fact, was convinced that Clare was a committed Kleinian who concealed disagreements with her husband in order to preserve marital tranquility (Kanter 2004). However, Segal was unaware that Clare directly expressed her concerns about Kleinian practice in a talk at a social work conference entitled “The Development of Insight” (C. Winnicott, 1959). And at the same time, Donald was critiquing Klein’s Envy and Gratitude in a social work journal (D. Winnicott, 1959). Undoubtedly, both Clare and Donald shared a comparable degree of ambivalence vis a vis Kleinian theory and Klein herself.

In 1964, Clare’s professional career changed dramatically as she was appointed Director of Child Care Studies at the Home Office. In this position, she was responsible for the government’s initiatives in training child care officers and administrators throughout the nation. Effectively lobbying for dramatic budget increases, she established programs that trained thousands of workers. For her distinguished government service, she was awarded the Order of the British Empire (O.B.E.) in 1971.
1971 was a difficult year for Clare. Donald died in January. Soon after, facing retirement age, she retired from the Home Office as a governmental reorganization merged her beloved Children’s Department into a generic Department of Social Services. Still grieving, she returned to the London School of Economics to lead its Social Work Department. Expecting a comfortable tenure as a respected leader, she found herself embroiled in the intense generational and professional conflicts of that era. Elders were no longer respected, casework was challenged by community organization, and psychoanalytic theories were dismissed.

Unable to cope with these tensions, Clare moved on to a quieter life as an analyst and psychotherapist. Besides teaching and supervising therapists, Clare also organized the Winnicott Publications Committee to organize, edit and publish Donald’s voluminous writings. After suffering repeated operations for melanoma, she finally succumbed to this illness in 1984.

 

Oxfordshire

Clare and Donald’s work with evacuated children in Oxfordshire was the defining experience of their careers. Besides meeting each other, their respective professional talents emerged at a time when Great Britain was undergoing a dramatic change in both its cultural understanding of childhood and its governmental child welfare programs (Holman, 1995, 1998, 2001).
Over six million people were evacuated from England’s cities to the countryside during the early years of the War, especially after the Blitz in September 1940. Families agonized about these separations; should they put their child’s physical safety ahead of their psychological needs for attachment? Fathers were off in the military and mothers were pressed into employment. Even with the massive evacuations, nearly 8000 children were killed in Great Britain (Holman, 1995).
These urban evacuees were often unwelcome in middle-class homes which were required to accept these children. Many brought psychological problems with them from their homes; even more developed difficulties when faced with long periods of parental separation and, in some instances, parental death. Throughout England, rudimentary social work services were created to serve the needs of these children. When home placements failed, hostels were established that could provide special care.

Unlike many of her fellow graduates from the London School of Economics’ prestigious Mental Health Course (including the Kleinian analyst, Betty Joseph), Clare deliberately avoided employment in child guidance clinics or mental hospitals. She “wanted to be in the thick of social work, not stuck away in a clinic” (Kanter, 2004, p.15).
On completion of the Mental Health Course in 1941, Clare began working with evacuated children in Oxfordshire, an assignment that changed the course of her life:

I was sent to work in the Oxfordshire evacuation scheme, one day a week, by the person who was running my office. It was only a one day a week assignment, to work with Dr. Winnicott who was coming down once a week to be a consultant to the hostels which were set up for difficult children. The children who couldn’t be kept in an ordinary billet were put into hostels… there were five hostels with difficult kids in. And I was told to go and work there once a week and sort things out. I think the person who was my boss then actually briefed me by saying, “There’s a difficult doctor working in that area. He comes down once a week. He doesn’t believe in social work because he likes to do it all himself. But it’s really in quite a mess and you must go and straighten the whole thing up.” That’s what I was told. So I did; I turned up one Friday to the hostel where he was visiting, and listened, wondering where I could come in and what I could do in this situation. And I think one of the things that I did achieve, fairly soon, was to help the staff in the hostels to make use of his expertise, his knowledge, in a way that they were not able to do. They used to say, “He comes down and talks to the children. He plays his pipe to them and we like him very much, but he doesn’t ever tell us what to do.” So I said, “Well let’s never ask him what to do. Let’s do the best we can in the present situation and then when he comes again tell him what we did and see if he’s got any comment to make on it, and if we can therefore learn something from what we did.” And that’s how it really evolved. And he always said, “You gave me a role and turned the job into a professional job.” (Kanter, 2004, 128-129).

Soon Clare was working full-time in Oxfordshire, caring for over 80 children scattered among five hostels. Donald visited on Fridays to consult with these hostels, but their jointly authored 1944 article “The Problem of Homeless Children” explicitly stated that “in practice”, the psychiatric social worker controlled “the whole of the work” and is the “one individual at the centre of the scheme” (Winnicott and Britton, 1944, p. 100-101). Clare provided continuity to the hostels as staff came and went, played a key role in the placement and transfer of children, consulted regularly with hostel staff, and was the only person who knew “each child at every stage”.

The article explicitly stated that Donald’s role was limited to weekly consultation with the hostel staff, occasional interviews with difficult children and the provision of medical authority in problematic situations.
Years later, Clare reflected on their collaboration:

I saw my first task as that of trying to evolve a method of working so that all of us, including Winnicott, could make the best possible use of his weekly visits. The staff living in the hostels were taking the full impact of the children’s confusion and despair and the resultant behavior problems. The staff were demanding to be told what to do and it took time for them to accept that Winnicott would not, and in fact could not, take on that role, because he was not available and involved in the day-to-day living situation… Gradually it was recognized that all of us must take responsibility for doing the best we could with the individual children in the situations that arose from day to day. Then we would think about what we did and discuss it with Winnicott as honestly as we could… These sessions with him were the highlight of the week and were invaluable learning experiences for us all including Winnicott… His comments were nearly always in the form of questions which widened the discussion and never violated the vulnerability of individual members. After these sessions, Winnicott and I would try to work out what was going on from the mass of detail that had been given to us, and we would form some tentative theories about it. (C. Winnicott, 1984, p. 2-3)

Both these recollections and the jointly authored articles clearly delineate Clare’s leadership role in directing the hostel scheme and Donald’s secondary role as a consultant; in no way could this relationship be described as clinical supervision.

Clare’s autonomous creativity emerges in several recollections of her wartime work. One simple intervention involved locating the parents of the evacuees:

I think one thing I had learned was that the children who were in touch with their parents, whose parents wrote and visited, were in a much better state than the children who never heard anything from anybody. So one of the things I did there was to ask permission to go up to London and to try and find the parents whose addresses we’d got; of the children who’d never heard from them… I spent several days whenever I could get the day, up in London and I was allocated a W.V.S. driver and we went round to the addresses we’d got, and we did find a lot of the parents. Often we found a completely bombed down finished road, and sometimes we could locate the parent in the rest center, but not always. And some were killed. Some were killed. ….what I did there was try and make a link between the parents and actually I got such a name for it that every time I appeared into a hostel they would rush up and say, “Miss have you seen my mum?” When did you see my mum last?” And it was quite hard for them when I had to say, “I can’t see your mum every week. Only every now and again.” But it did awaken some parents to their own responsibilities in regard to the children. Because I could say, “Look he’s missing you terribly. What about a note? Give me something to take to him.” Or something like this. So I did work very hard to make links between home. And I think that was very much encouraged by Dr. Winnicott (Kanter, 2004, 129-130).

Clare also recalled her work with an abused adolescent:

“I took her to one of the hostels and we had a terrific job to get her to settle. But fortunately the couple in charge really worked hard with her. They wanted a lot of support. She stole the woman’s ring immediately. The ring was found and we discussed. I said, ‘Could you lend her your ring on Sundays?’ and say to her, ‘It’s very precious to me but you could have it one day a week.’ Anyway we all went through hell. One way and another, and she emerged. Her mother used to come down to take her out. She’d get completely drunk in Henley, and the police would bring Carrie home, back to the hostel. This went on repeatedly. It always happened like that. The police knew her very well. And I remember Carrie showing me a parcel she’d had from her mum. She was thrilled, and it was half a pound of grapes brought from a barrow, and simply wrapped in a piece of paper, all soaking wet. It’s a wonder they ever got there, but they’d come from her mum. There was something there. We all struggled with this mum and it was very hard work. We got very disappointed and, you know. But fortunately the mother one Christmas Eve was in a pub brawl and died. Fell and actually died. Then we all wondered what was going to happen to Carrie now. She said to the cook, who was a great friend of hers, “Can I come and sleep in your room?” And they let her. She moved her bed into that room. She slept there about a week and then went back to the others. And she did a lot of other things. She really had a regression, and the staff let her do it. She bought a baby’s bottle, filled it with milk and went to sleep sucking it. And they let her do it. They were frightened stiff doing it, but they did let her do it. That didn’t last long and anyway we got her through and at last it was time for her to leave school. We got her a job with some friends of the hostel staff on a farm. She was one of these kids who like every other girl is mad on horses and animals, and we got her a job on a farm where she could go for her half days back to this group, all beautifully settled”(Kanter, 2004, 140-141).

By the end of the War, Clare’s capacity to integrate theory and practice was evident in the following presentation about the Oxfordshire scheme:

All children who come into a hostel have one very important thing in common, that is the failure of their own homes or foster homes to tolerate them and their difficulties any longer. For all these children the critical point of breakdown has been reached, and they have known the frightening experience of “things having gone too far”. Help has been sought, and decisions made, and life as they have known it disintegrates. The point of breakdown may have been reached early or late in the child’s experience. The home may have disintegrated quickly at his first efforts to prove its worth, or it may have stood a great deal up to that point and given much that the child needs. Each child has come a different way to the point of breakdown, and each story with its inextricable tangle of cause and effect is peculiarly the child’s own, however similar symptoms and behaviour difficulties may appear… Of course, the important thing for the hostel is—at what point in the child’s emotional experience did the break occur. If it came early, and the actual physical break is merely the climax to a series of failures—then the hostel has not only to start from scratch, but to be able to deal with the failure as well. If the actual break occurs later in a child’s experience, then the hostel must help the child to rediscover what is good in the past, after meeting and dealing with his experience of failure. For some children, therefore, the actual break from home may be the last act of a tragedy, while for others it may even be a sign of growth and new hope. But at whatever stage the children come into the hostel, and however relieved and hopeful they may appear that action has at last been taken, we know that they come straight from the scene of conflict; and bring with them a deep sense of failure and guilt, which must eventually be reached if they are to be helped. In fact, it seems that the important function of the hostel is to help the child eventually to reconstruct the past however bad or good it has been. And after a prolonged stay in a hostel this can, and does, happen for many of them. But before this point is reached, there is much suffering and difficulty to be endured by the child and the hostel staff. The first stage is reached when the children are sure enough of the hostel to transfer their home difficulties into hostel life, thus “saving” their own homes and enabling them to construct a perfect home in phantasy—on a totally unreal level. Those of us who have worked in hostels are all familiar with these wonderful homes which even the child from the worst background can create, and will often actually run away to find. If the hostel can stand firm and allow the children to work through this stage, then gradually real relationships with hostel staff can be formed, and slowly the child can build up ideas of home based on real experiences in the hostel (Britton, 1946, 30-31).
In all of the above passages, themes emerge that are highlighted in Donald’s later publications: transitional objects, acceptance of countertransference responses, play inhibitions, therapeutic regression, the antisocial tendency, the holding environment, and therapeutic consultation. While Donald certainly acquainted Clare with psychoanalytic concepts, Clare brought her own creative powers to the work in Oxfordshire, using aspects of this theory in a practice setting quite different than the analytic consulting room.

 

Post-War Collaboration

From 1947 through 1958, Clare directed the Child Care Course at the London School of Economics which trained a generation of social workers, many of whom assumed positions of leadership in England’s emerging child welfare system. The curriculum which Clare designed included classes in child development, pediatrics, legal issues in child welfare, and sociology. Clare taught a core class entitled “Care of the Deprived Child”. Donald, too, taught in this program since its inception, offering 10 lectures annually in a class entitled “The Inter-relation of Physical and Psychological Aspects of Development”; in 1955, he began offering an additional 5 lectures on “Adult Personality Patterns”.

In 1958, the Child Care Course was merged into a generic Applied Social Studies Course over the repeated protests of Clare. The demise of the Child Care Course had a special impact on Clare and Donald; this Course allowed them to directly continue a professional collaboration which had begun in Oxfordshire.

When the Child Care Course was ended in 1958, Donald continued to give 14 lectures in the Mental Health Course and 10 in the Applied Social Studies Course until the year before his death in 1971. In contrast, Donald was only allowed to teach 3 classes annually at the British Psycho-Analytic Society.

Donald and Clare also frequently traveled together across Great Britain lecturing and teaching at dozens of meetings of social work agencies and organizations. They played a notable role in the formation and development of the Association of Child Care Officers (ACCO). The initial meeting of this group in 1948 was convened by some of Clare’s first students at LSE and Donald soon volunteered the use of his consulting room at Paddington Green Hospital for ACCO’s committee meetings.

 

Impact on Donald Winnicott

Teasing out Clare and Donald’s contributions to one another is an impossible task. Kay McDougall, a social work colleague at the London School of Economics and Pearl King, Past-President of the British Psycho-Analytical Society, used exactly the same phrase to describe their interaction: “they sparked each other off”. Similarly, John (Jock) Sutherland, the Medical Director of the Tavistock Clinic, wrote that Clare “had a great natural empathy which filled in with (Donald’s) and they did a great deal for each other” (Kanter, 2004, p. 64).
Throughout Clare’s writings, themes and language commonly associated with Donald’s work emerge repeatedly. In some instances, her references to certain ideas clearly preceded his discussion of similar concepts.

A notable example of this is Clare’s observations of transitional objects. As noted earlier, Clare traveled to London to seek out the parents of the evacuees in the hostels and asked them to prepare a note or “give me something to take to them”. And in her recollection of “Carrie”, Clare specifically noted the significance of a gift of grapes from her abusive mother and the therapeutic use of the hostel parent’s wedding band.

Several years later, in 1950, Clare describes these phenomena in evocative detail:

The moment of uprooting is just when a skilled child-care officer is need to see that what a child clings to in the past is brought with him and accepted in the new environment. ….there are many stories, which now, it is hoped, belong to another era, of children clinging to their own clothes and being given an anesthetic to enable the clothes to be removed, or favourite but filthy teddy-bears and other possessions being taken away and burned, but these did not belong to the past, and something became damaged and lost when the familiar things were taken away. These possessions stood for everything the child brought with him from the past and he could not afford to lose so much…. (C.Britton, 1950, 173-174).

In 1950, Donald referred to his childhood “transition object” in a letter to Clare (C. Winnicott, 1978, p. 252) and in May, 1951, Donald presented his classic paper “Transitional Objects and Transitional Phenomena” to the British Psycho-Analytical Society (D. Winnicott, 1953b).

In the aforementioned 1950 paper, Clare also presents many of the core ideas about delinquency that Donald more fully articulates in his 1956 paper, “The Antisocial Tendency”:

As the child-care officer comes into the lives of these children, she must first be able to sort out the whole situation carefully until she finds the alive bit from which new growth can come. For the alive bit is the thing the child is clinging to as the focus of his feelings. It may be hidden in a memory, or a fantasy, or a habit. It will certainly be at the point of tension. The delinquent act is in many cases an unconscious effort to deal with loss… The depression and grief of a child who has lost a loved parent shows that he is alive and dealing with his loss, and that with help recovery is possible. Perhaps the most difficult children to help are those with nothing alive about them. Here the only thing is to wait and watch for signs of life–encouraging the slightest effort, which may be made perhaps towards the possession of something, or a sudden desire to sit next to somebody special (C. Britton, 1950, 174).
As Donald noted himself, he “avoided the immensely exacting organised antisocial case during the early stages of my career, but in the war became forced to consider this type of disorder through the work I was privileged to do with evacuated children in Oxfordshire” (D. Winnicott, 1988, p. 2).

 

Play

Clare’s first solely authored paper “Children Who Cannot Play”, written and published in 1945, presages Donald’s classic work Playing and Reality (1971a) which discussed the significance of play inhibitions. In this paper, Clare reports on her work with an evacuee:

In the early days of evacuation I met a six-year-old boy who was the most completely cut-off child imaginable. He never spoke of his own accord, and only answered questions reluctantly. For a short time at the beginning he refused food. He was completely docile and inactive, and walked about in a dazed fashion. He was incapable of learning anything in school, and play was out of the question; he simply sat and watched people. It was not surprising to learn that both his parents had been killed in the air-raid shelter from which he has been rescued. Fortunately he was put into a good foster-home, where the foster-mother understood something of what he was going through. She became fond of him, but did not try to force herself on him. She let him go his own way at his own pace. After about eighteen months he began to respond and recover. His first efforts at play were pathetic, and he would look sheepish and give up if anyone noticed him. He played only when alone with the foster-mother, when her own little boy was out with the other children in the village. She would plan these occasions when time allowed, and would sit knitting or reading. He would play with bricks, stopping always when anyone came in. Gradually the play became more complicated, and one day he actually built an air-raid shelter and played out his parents’ death, suddenly asking, “Does it hurt to get killed?” All this time he had been grappling with the experience of his parents’ death, and only when he felt secure enough with his foster-mother, when he had grown new roots in his environment, so to speak, could he face the fact of their death and let them go. This he was able to experience again and again through play till he had accepted it. Of course, this was not the free, happy play of a normal child, there was much anxiety and compulsion in it. The patience and tact of the foster-mother cannot be too highly praised. She helped not only by her fondness for the child but by a passive acceptance of him and his difficulties (Britton, 1945, 118).

 

Holding

Clare emphasizes the concept of “holding” in her 1955 paper “Casework Techniques in the Child Care Services”:

(Social workers provide) “a reliable medium within which people can find themselves or that part of themselves about which they are uncertain. We become, so to speak, a reliable environment, which is what they so much need–reliable in time and place; and we take great trouble to be where we have said we would be at the right time. ….we take deliberate trouble to remember all the details about the client’s life and not to confuse him with other clients. We can “hold” the idea of him in our relationship so that when he sees us he can find that bit of himself again which he has given us. This is conveyed by the way in which we remember details and know exactly were we left him in the last interview. Not only do we hold a consistent idea of the client as a person, but we hold the difficult situation which brought him to us by tolerating it until he either finds a way through it or tolerates it himself. If we can hold the painful experience, recognizing its importance and not turning aside from it as the client relives it with us…., we help him to have the courage to feel its full impact; only as he can do that will his own natural healing processes be liberated. I have deliberately used the word “hold” in what I have been saying, because, while it obviously includes “acceptance” of the client and what he gives us, it also includes what we do with what we accept” (C. Britton, 1955).
Clare elaborated on this concept in her discussion of direct interventions with children:
“the only way to reach these children is that we ourselves should believe in and acknowledge these feelings of badness and deadness, because they are real. We may know that this is not the total truth about them, but at the moment it is. To attempt to cheer them up or get them to snap out of their depression is like a rejection of them… If we can ‘hold’ them as they are in their despair—and understanding is a kind of holding—then there is some chance that they might come to life again” (C. Winnicott, 1964, p. 196).
Clare’s concept of “holding” was intertwined with her wartime appreciation of countertransference responses. Aware of her own insecurities when facing the difficult challenges of the Evacuation, Clare empathized with the helplessness, anxiety and confusion of hostel staff. She understood that such responses were part and parcel of the therapeutic processs. In her first day working in the hostel, she recognized the hostel staff’s confusion and offered a comment that helped them contain their anxiety. Clare understood that she had to “hold” staff and foster parents in order for them to “hold” the children in their care. This certainly foreshadowed Donald’s classic paper “Hate in the Countertransference (1949).

Authorship of this concept of “holding” cannot be established. Although the term “holding” appears intermittently in Donald’s lectures at the Institute for Education and at the London School of Economics (1988), he does not make this concept a central focus of a professional paper until “The Theory of the Parent-Infant Relationship” in 1960. The final sentence of this paper footnotes the word “holding” with the following reference: “Concept of ‘holding’ in case work: Cf. Winnicott, Clare (1954)”. This referred to the aforementioned paper on “Casework Techniques”.

After intensive pre-war experience in child psychoanalysis, Donald rarely treated child patients in psychoanalysis after the war (Kahr, 1996). Instead, his clinical interventions shifted dramatically toward a consultative approach with parents and other caregivers (D. W. Winnicott, 1971b), a method perhaps formally described in his 1955 paper “A Case Managed at Home”. As Susanna Isaacs Elmhirst, a pediatrician and psychoanalyst who worked closely with Donald at Paddington Green Children’s Hospital, noted:
“between (Donald and Clare), they developed (in Oxfordshire) unique experience and skill in devising and supporting environmental changes which nourished the emotional and physical growth of children. Out of this lively mutual co-operation, involving various non-medical and often non-parent, adults, gradually developed Winnicott’s “Monday afternoons” at the Green”(Kahr, 1996, xviii-xix).

Facilitating “holding environments” through these consultations became Donald’s core intervention in working with children.

 

The “Transitional Participant”

Perhaps Clare’s most original and important concept was how social workers and others can serve as what can be called “transitional participants” in the lives of children. Through the reality of their contact with significant persons and experiences in the child’s life, the social worker can help the child maintain contact with positive life experiences which can enhance ongoing intrapsychic and interpersonal relationships. This concept was initially articulated in Clare and Donald’s jointly authored 1944 paper:

“The function of the psychiatric social worker as far as the children are concerned is to give them a sense of continuity throughout the changes to which they are subjected. She is the only person who knows each child at every stage. It is she who first comes to his rescue in the billet in which he is causing a disturbance. She sees him in his school and billet, and then in the hostel, and possibly in more than one hostel. If there is a change in hostel wardens, it is the psychiatric social worker who gives some feeling of stability during the period of change. It is the psychiatric social worker who re-billets the child if and when the time comes. She is also in contact with the child’s home, visiting the parents whenever possible. She is thus able in some degree to gather together the separate threads of the child’s life and to give him the opportunity of preserving something important to him from each stage of his experience.” (Winnicott and Britton, 1944).

However, while Donald’s focus shifted toward the intrapsychic function of inanimate possessions which he labelled “transitional objects”, Clare continued (in the lenghty passage below) to elaborate on this concept of the social worker as a “transitional participant” in their clients lives.

“The social worker…. starts off as a real person concerned with the external events and people in the child’s life. In the course of her work with him, she will attempt to bridge the gap between the external world and his feelings about it and in doing so will enter his inner world too. As a person who can move from one world to another, the social worker can have a special value all her own for the child, and a special kind of relationship to him which is quite different in kind from the value and relationship that a psychotherapist has. (The social worker) can never become entirely the subjective object which the psychotherapist becomes; she is bound to external reality because she is part and parcel of the child’s real world, and often is responsible for maintaining that world. The social worker…is therefore in a strategic position in their lives because she is in touch with a total situation representing a totality of experience. Undoubtedly, a very valuable part of our relationship with children lies in their knowledge that we are also in direct touch with their parents and others who are important to them. Of a time, perhaps, our relationship is the only integrating factor in their world, and we take on a significance which is beyond what we do or say. We make links between places and events and bridge gaps between people which they are unable to bridge for themselves. As we talk about real people and real happenings, feelings about them soon become evident and before we know where we are we have entered the inner world of the individual, and so we bridge another gap, that between fact and fantasy. I remember very clearly in my own experience as a social worker this awareness I so often had that I was bridging gaps between people. It struck me first one day when a mother said to me with incredulity on her face: “You saw Brian yesterday–it doesn’t seem possible.” To her, Brian was more than a matter of miles away–he almost didn’t exist anymore. But as I told her about him, ordinary things, that he was learning to swim, and had lost some more teeth since she’d seen him, gradually her feelings came to life and he existed once more in her inner world. But this could not have happened if I had not really known her child….” (C. Winnicott, 1963, p. 171-172).

Besides focusing on how the social worker can be used by children (and parents) to keep alive positive internal representations of significant others, Clare also described how the worker’s ongoing presence in the child’s life can help to facilitate psychic integration across time and space:

(We would) go over the same ground again and again. It might begin with “Do you remember the day you brought be here in your car?” And we would retrace our steps, going over the events and explanations once more. This was no mere reminiscing, but a desperate effort to add life up, to overcome fears and anxieties, and to achieve a personal integration. In my experience, feelings about home and other important places cluster round the caseworker, so that when the children see her they are not only reminded of home but can be in touch with that part of themselves which has roots in the past and the (outside) world….. (C. Winnicott, 1962, p. 9).

Any parent will immediately recall the “remember when” game that is such a significant component in parent-child interactions. Beyond their fascination with photo albums or home videos–especially when shared by significant others–children (and adults) take great satisfaction in the mutual recollection of memorable shared experiences; these might include vacations, the death of a first pet, birthday parties or even a burnt dinner.

Unlike Donald’s concept of the “transitional object”, Clare “transitional participant” is not a passive recipient of the child’s projections; the social worker actively positions him or herself in the child’s life, making direct contact with an array of significant others and informing all parties of this array of contacts. With the knowledge of this participation, the child is then able to internalize the social worker as an embodiment of this life experience.

This phenomenon of the “transitional participant” has implications for understanding a wide array of human experience beyond social work with children. Consider, for example, the profound psychic impact of a visit after many years from a long-lost relative or an evening at a school reunion or family gathering. The actual presence of such “participants” in one’s life has an emotional resonance that hundreds of hours in analysis or psychotherapy can never replicate. The paradox for the analyst is that the conventional parameters largely preclude such participatory experiences; however, awareness of these phenomena can assist in understanding their subjective significance in their patients’ lives.

 

Conclusion

But while the Winnicotts’ personal relationship may titilate our analytic imaginations, this relationship emerged from Donald’s collegial partnership with a talented and quite brilliant woman with whom he could explore the interplay between the internal and external reality. As Clare noted, “we played with ideas, tossing them about at random with the freedom of knowing that we need not agree, and that we were strong enough not to be hurt by each other” (C. Winnicott 1978, p. 250). Development of our professional selves does not merely emerge from our personal history, be it childhood trauma or adult romance, it also requires an interplay of ideas, exposure to new experiences and ongoing evaluation of clinical practice. All of these factors were evident in the Winnicotts’ relationship.

Decades ahead of colleagues both in social work and psychoanalysis, Clare and Donald used clinical data rarely found in psychoanalysis proper to explore how “facilitating environments” enhance “maturational processes”. This integrative approach challenges us today as many are more comfortable focusing either on the environment or the psyche. Their creative partnership left a rich legacy of clinical observations, hypotheses and techniques which encompass the complex interplay of both inner and outer realities in social work, psychoanalytic practice and everyday life.

 

Footnote

Portions of this article were previously published by the author in “Let’s Never Tell Him What to Do”: Clare Britton’s Transformative Impact on Donald Winnicott. American Imago , 61 (4), December 2004, pp
457-481.

 

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