Attachment-informed interventions with the perinatal population

With growing attention being paid to perinatal mood and anxiety disorders (PMADs) in both medical and mental health settings, there is a need for further elaboration on meaningful and impactful treatments with this population. This article outlines some of the unique stressors and psychological states that come with pregnancy and parenting a newborn and infant. The concepts and experiences discussed include: primary maternal preoccupation (Winnicott, 1956), parental ambivalence, major changes to the physical body, and reorganisation of attachment representations and current family dynamics. Clinical material from therapy sessions with patients at a specialised perinatal centre is included in the discussion of using an approach informed by attachment theory (Bowlby, 1988).

‘Hopelessly devoted to you’: An examination of Winnicott’s concept of primary maternal preoccupation in the identity and practice of male group analysts

The rationale for this study is to explore whether or not the Winnicottian concept of primary maternal preoccupation fits into the identities and features in what male group analysts reflect on and resonate with upon ‘giving birth to’ and conducting a group. A qualitative, individual case-study approach was employed to attempt to discover and understand how male group analysts make sense of Winnicott’s fundamental concept. Wondering and thinking about how a male group analyst ‘holds’ both the maternal and paternal function in a group is also being thought about to ascertain the impact of these features on clinical practice. Exploring the concept of primary maternal preoccupation lends towards a strong focus on the relationship between mother and baby, mirrored in and seen as a metaphor for the relationship between the group analyst and the group members. Doron argues that in disclosing her depth of feeling towards the changing group membership in the group she was conducting, she identified strongly with the state of primary maternal preoccupation. This study will explore the range of feelings associated with the primary maternal preoccupation male group analysts associate with. Three qualified group analysts with five years’ minimum post-qualification experience, with whom there were no boundary issues, were interviewed in a semi-structured interview format to ascertain and develop this understanding. A phenomenological research method was chosen to analyse the collated data from the three individual interviews. Following completion of the three interviews, the participants’ texts were analysed resulting in five overall themes being developed. Potential wider scopes and application of the question, potential clinical implications of the topic under discussion and the potential for developing a theoretical discussion in group analysis on what might be coined ‘paternal preoccupation’ were illuminated and discussed.

The Collected Works of D. W. Winnicott

Volume 5, introduced by Jennifer and Marcus Johns, covers the years 1955–1959, an extremely productive period of Winnicott’s work in broadcasting, social work, child psychiatry and psychoanalysis. His two Tavistock publications, The Child and the Family, and The Child and the Outside World; and his first collection of essays, Through Paediatrics to Psychoanalysis, were published during this time. In 1955 he married Clare Britton, with whom he had been working during the previous decade, and in 1956 he became President of the British Psychoanalytical Society. It was in this capacity that many of the large number of letters in this volume were composed, relating to the work of his analytical colleagues and the integration of the different training and theoretical groups within the BPAS.Included in this volume are important papers covering diverse areas of Winnicott’s work, including ‘The Anti-social Tendency’, ‘Primary Maternal Preoccupation’, ‘The Mother’s Contribution to Society’, ‘The Capacity to be Alone’, and responses to Klein’s 1957 book Envy and Gratitude.

A DEFENSIVE “STAND-BY REACTION” AT CRITICAL MOMENTS OF THE REPRODUCTIVE LIFE CYCLE

Investigation about the psychological experiences of the reproductive life cycle showed that in critical moments special reactions may happen. These reactions seem to be defensive in nature, are set in motion in order to promote some kind of emotional protection and are performed in two opposite directions: a) a decreasing of the contact with aggressive impulses and b) an increasing of the use of rationalization and denial of frustrating situations. Examples of those rearrangements were observed at samples of: 1) pregnant women in obstetric high-risk consultation, 2) infertile couples waiting for infertility consultations and 3) pregnant women waiting for amniocentesis results. These data seem to be in accordance with the classical psychological points of view: a) gestation should be considered as a period of protection, b) during pregnancy a “primary maternal preoccupation” (Winnicot, 1958) emerges leading to the mobilization of all resources available for pregnant women and c) along gestational development psychological changes show how flexible maternal functioning may become. What was not expected is that in the absence of pregnancy, infertile couples should behave very similarly to what it is observed when pregnancy is in danger or when medical problems about the mother’s or the baby’s health arise in the horizon. Due to its “freezing” consequences upon emotional development we propose that this kind of reaction will be designated as “stand-by reaction”. Keywords: pregnancy, psychological development, defense mechanisms, infertile couples, stand-by reaction.

The Neonate and His Mother

In this paper, Winnicott describes some elements of the psychology of the newborn. He distinguishes the difference between a mother’s psychology and that of her infant's, and also ascribes to the mother the capacity for primary maternal preoccupation (his term) for identifying with her infant. He gives importance both to the concept of the proper ‘holding’ physically and emotionally of the newborn and to the environmental provision that the infant needs. The beginnings of the personality, and the difficulties inherent in failures of early provision leading to serious mental illness are also discussed. Detailed examples from his clinical cases are given.

Introduction to Volume 5

Volume 5 concerns Winnicott’s writing at the height of his career, between 1955-1959, in which his thinking and his personal and professional life are put into a broad historical context, from Winnicott’s medical education and discovery of Freud to his double career in paediatrics and psychoanalysis. The introduction to this volume covers this period of great social and political change, including discussion of papers and letters relating to the conflicts within the British psychoanalytic world, in particular with Melanie Klein (whose monograph Envy and Gratitude was published in this period), as well as John Bowlby and Anna Freud. A range of papers, reflecting the wide scope of his audiences during this period, are discussed, including ‘The Anti-Social Tendency’, ‘Primary Maternal Preoccupation’, ‘The Capacity to be Alone’, and the book publication of ‘Transitional Objects and Transitional Phenomena’.