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Regression to Dependence: A Second Opportunity for Ego Integration and Developmental Progression
Reliving early states is now widely recognized as a necessary component in psychotherapy with disturbed patients. Building on the pioneering work of Klein, Ferenczi, Balint, and particularly Winnicott, Dr. Robert Van Sweden shows how to foster the process of experiencing these early states in the analytic setting. With vivid clinical illustrations he demonstrates that regression to that time of early dependence allows the patient to reexperience the mother-infant relationship in the transference, and to reintegrate parts of the self split off during failures in the original dyadic interaction. Dr. Van Sweden, like the pioneers on whose work he builds, believes that in the safety of the analytic setting regression leads to further ego integration and to emotional development. Thus, regression to dependence is ultimately progressive.
In this book Dr. Van Sweden thoroughly reviews theories of regression and then adds his own conceptualizations. He sees patients who are in need of a regression to dependence as most often those with preoedipal rather than oedipal conflicts. Therefore, technique must be altered in a way that involves metaphorically cradling the patient in reexperiencing the first few months of life. Since the patient then often experiences overwhelmingly primitive affects, the therapist must be willing to extend the standard therapeutic frame and be able to survive the patient's projected rage and pain if ego integration is to take place.
This book is divided into four parts. Part One addresses the nature of regression to dependence and introduces the reader to Mrs. R., whose experiences in analysis illustrate the challenges and advantages of applying the theoretical concept of regression in the actual clinical setting. Part Two focuses on the risks and rewards of the regression to dependence, including a review of some analysts' theoretically and clinically based objections to this process. Part Three explores the interactions between analyst and patient that impede ego integration and those that facilitate it. Part Four presents the author's view of the important changes regression to dependence can offer patients and how this approach makes psychoanalysis useful to a wider scope of patients.
In this book Dr. Van Sweden thoroughly reviews theories of regression and then adds his own conceptualizations. He sees patients who are in need of a regression to dependence as most often those with preoedipal rather than oedipal conflicts. Therefore, technique must be altered in a way that involves metaphorically cradling the patient in reexperiencing the first few months of life. Since the patient then often experiences overwhelmingly primitive affects, the therapist must be willing to extend the standard therapeutic frame and be able to survive the patient's projected rage and pain if ego integration is to take place.
This book is divided into four parts. Part One addresses the nature of regression to dependence and introduces the reader to Mrs. R., whose experiences in analysis illustrate the challenges and advantages of applying the theoretical concept of regression in the actual clinical setting. Part Two focuses on the risks and rewards of the regression to dependence, including a review of some analysts' theoretically and clinically based objections to this process. Part Three explores the interactions between analyst and patient that impede ego integration and those that facilitate it. Part Four presents the author's view of the important changes regression to dependence can offer patients and how this approach makes psychoanalysis useful to a wider scope of patients.
228 pages, Hardcover
First published July 7, 1977
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August 17, 2009
Freud focused psychoanalysis on the Oedipal conflict, in which the three-to-five-year-old child, competing with the same-sex parent for the affections of the opposite-sex parent, installs defense mechanisms that will hamper him—cause relationship problems—later in life. Freud assumed that up to the Oedipal age the developing child had had a relatively benign (no pun intended) childhood, with adequate mothering. Thus, he treated mainly adults who suffered from neuroses that could be cured through “talk therapy” that resolved (through insight) the persistent and disruptive Oedipal conflicts. Freud never claimed that psychoanalysis would work with more severely disturbed patients.
However, in their practices some psychoanalysts were faced with “more severely disturbed patients” and had to figure out how to treat them. One such was Melanie Klein, who worked primarily with children. Recognizing that Freudian theory could not account for severely disturbed children who had experienced poor mothering early on, Klein explored in detail what happens in the child’s mind from day one of infancy. This led her to formulate a mother-oriented theory of “object relations”—how the infant reacts internally to the significant people-parts in its life (“objects”—pre-eminently the mother’s breast), and later to whole people (more “objects”), especially the mother. Based on these experiences the baby develops an inner reality, out of which slowly emerges the ego. With healthy mothering, the ego develops properly but with poor mothering it does not. An infant (or later, adult) with a poorly integrated ego does not function effectively—is often “severely disturbed,” and beyond the reach of Freud’s usual methods. Klein’s theory focused less on the reality of the mother-infant experience itself than on the baby’s fantasy-reaction to it. And in treating disturbed children, though she replaced Freud’s free association with play therapy, Klein stuck with the Freudian approach of insight through interpretation.
Enter Donald W. Winnicott. A prominent English pediatrician who later took up psychoanalysis, Winnicott focused not on the child’s fantasies but on its actual relationship with the mother: “Without the mother, there is no child.” The two form a dyad; if the mother is “good enough” in handling the infant, the latter develops an adequate ego; if not, the infant’s ego fails to integrate: to protect itself, the baby “splits off” dangerous emotions (rage, pain) rather than incorporating them in the ego, and constructs a “false self” (usually over-compliant) to shield the underlying “true self” that seems unacceptable to the mother. This leads to a lifelong sense of unreality (because of dealing with the world through the “false self”) and ultimately of futility (“It’s hopeless: my real self will never emerge”). In the most extreme cases (for example, in many schizophrenics), even the sense of “false self” may never fully develop because the split-off emotions emerge as separate pseudo-egos that often operate at cross purposes, giving the impression (and the reality) of a disorganized and incoherent personality.
Van Sweden believes with Winnicott that the only way to integrate the adult patient’s ego is not through “talk therapy” but through “regression-to-dependence”—taking the patient back to the preverbal stage of infancy so that she can re-experience her split-off rage and pain, break down the “false self,” and open up the “true self” while in the presence of the (“good-mother”) therapist. The keys to success: the therapist’s ability to provide a safe and nurturing setting, and his ability to withstand without fear or defensiveness the sometimes ferocious attacks of the patient as the latter releases the hitherto split-off rage and pain. This type of therapy is grueling for both patient and therapist—but according to Winnicott and Van Sweden, it is the only way to get the job done because anything less will not only leave the “false self” intact but quite possibly strengthen it.
Some of Van Sweden’s words:
The concept of regression to dependence means that through the analytic relationship the opportunity is provided for the individual to reexperience the early mother-infant relationship. Further, in this reexperience, the psychic reality that has been unconscious is made conscious. For the first time, the patient is able to feel directly the terror, pain, and rage that resulted from the original maternal failure. These intense emotions are relived in the holding environment provided by the analyst. The patient’s fragmented ego now has the opportunity for integration, through the reworking of his/her previously split-off emotions. Paradoxically, regression to dependence has a significantly progressive role.
In the original experience an infant’s ego is in an unintegrated state, which describes both the infant’s early pre-ego development [and:] the infant’s total dependence upon the mother. Winnicott’s understanding of this state led to his conviction that there is no such thing as an infant separate from its mother.
Glover…describes the primitive ego of the infant in this unintegrated state as made up of “ego nuclei”…which are miniature egos in an undifferentiated organization. I believe it is the interaction between mother and infant that supports the integration of these nuclei into a fully integrated ego.
When the infant cannot integrate into his ego the various maternal impingements, a false-self defensive organization comes into play in order to protect the kernel of the true self’s development. True self/false self is a concept that Winnicott developed to explain what occurs as the result of frequent impingements in the mother-infant relationship. When the impingements become too intrusive and the true self is in danger of being annihilated, the false self, which is built on a defense-compliance basis, comes into being. The net effect for the individual is a sense of inward futility and resignation regarding life…. Winnicott…expands on this development when he says, “In the extreme examples of False Self development, the True Self is so well hidden that spontaneity is not a feature in the infant’s living experience. Compliance is then the main feature, with imitation as a specialty.”
Because the ego was in danger of annihilation as a result of the impingements (intrusion or absence of mother) the “true self” (ego) of the individual needed to be protected. This protection came in the form of a false (compliant) self, which acted as a defensive organization. The net effect for the individual became a sense of futility and resignation to never being happy.
In the present, the individual expresses a longing for the important maternal connection that was not achieved in infancy. He/she often continues to seek for this connection in relationship after relationship. Recognition of the unmet desire, with the accompanying anger and pain, is the essential ingredient in the regression-to-dependence process.
In the normal process of psychological development, ego integration, which includes the resolution of the Oedipus complex, results in the developing child having a firm sense of self and the ability to experience his own identity whether he is alone or involved with others. For those individuals whose mother-infant relationship was impaired, normal ego integration did not occur. Instead, the individual’s sense of self is fractured. These individuals have a limited sense of separateness or identity when they are with others and often feel abandoned and bereft when alone. In order to function in the world, they often must split off their own emotions in an effort to find acceptance from others and a semblance of peace within themselves.
When the infant tried to achieve mastery over the failed maternal environment, he did so…by developing a defensive false-self organization, which enabled him to adapt to this environment. But the false self cannot ever reach the independence of maturity, for as Winnicott…has shown, there was no object (mother) who could offer a shared reality, only one based on a set of projections.
The mother-infant relationship based upon projections deprives the infant of having an object with whom to share his inner developing life. His rage and primitive agony result from the absence of this shared reality. This absence becomes more profound as there is no one to help him carry the rage and pain. Left to his own immature devices, the infant then drowns in his primitive emotions. These feelings are intolerable to the infant, and so the mechanism of the ego splits them off. Adults often report this experience as one of falling into a bottomless pit. It is absolute desolation.
Essential elements of regression-to-dependence (per Winnicott): 1) a safe and nurturing environment, 2) an analyst who is attuned (like a mother) to the patient’s true feelings, 3) a release of anger and frustration by the patient, 4) the patient’s movement toward independence, and 5) a sense of relief in the patient and a growing sense of self.
Winnicott: “The regression represents the…individual’s hope that certain aspects of the environment which failed originally may be relived, with the environment this time succeeding instead of failing.”
The ego of the infant is too immature to be able to gather into its control the anger and pain it experiences. These intense emotions must be split off until a later time when additional ego-support is available.
It is not the analyst making up for what the analysand [patient:] did not receive from his mother that brings integration. It is, instead, the analyst’s recognition of the analysand’s intrusive or depriving experience, and his capacity to contain the analysand’s pain, rage, and terror without being destroyed by it or ending the analysis, that resolves the damage done to the analysand in infancy.
It is essential that the analyst acknowledge the wish of the analysand for the analyst to make up to the patient what he/she did not receive. But the reality is that no one can provide this for the analysand. Once this is recognized, the analysand can feel and express previously repressed emotions of anger and pain.
However, in their practices some psychoanalysts were faced with “more severely disturbed patients” and had to figure out how to treat them. One such was Melanie Klein, who worked primarily with children. Recognizing that Freudian theory could not account for severely disturbed children who had experienced poor mothering early on, Klein explored in detail what happens in the child’s mind from day one of infancy. This led her to formulate a mother-oriented theory of “object relations”—how the infant reacts internally to the significant people-parts in its life (“objects”—pre-eminently the mother’s breast), and later to whole people (more “objects”), especially the mother. Based on these experiences the baby develops an inner reality, out of which slowly emerges the ego. With healthy mothering, the ego develops properly but with poor mothering it does not. An infant (or later, adult) with a poorly integrated ego does not function effectively—is often “severely disturbed,” and beyond the reach of Freud’s usual methods. Klein’s theory focused less on the reality of the mother-infant experience itself than on the baby’s fantasy-reaction to it. And in treating disturbed children, though she replaced Freud’s free association with play therapy, Klein stuck with the Freudian approach of insight through interpretation.
Enter Donald W. Winnicott. A prominent English pediatrician who later took up psychoanalysis, Winnicott focused not on the child’s fantasies but on its actual relationship with the mother: “Without the mother, there is no child.” The two form a dyad; if the mother is “good enough” in handling the infant, the latter develops an adequate ego; if not, the infant’s ego fails to integrate: to protect itself, the baby “splits off” dangerous emotions (rage, pain) rather than incorporating them in the ego, and constructs a “false self” (usually over-compliant) to shield the underlying “true self” that seems unacceptable to the mother. This leads to a lifelong sense of unreality (because of dealing with the world through the “false self”) and ultimately of futility (“It’s hopeless: my real self will never emerge”). In the most extreme cases (for example, in many schizophrenics), even the sense of “false self” may never fully develop because the split-off emotions emerge as separate pseudo-egos that often operate at cross purposes, giving the impression (and the reality) of a disorganized and incoherent personality.
Van Sweden believes with Winnicott that the only way to integrate the adult patient’s ego is not through “talk therapy” but through “regression-to-dependence”—taking the patient back to the preverbal stage of infancy so that she can re-experience her split-off rage and pain, break down the “false self,” and open up the “true self” while in the presence of the (“good-mother”) therapist. The keys to success: the therapist’s ability to provide a safe and nurturing setting, and his ability to withstand without fear or defensiveness the sometimes ferocious attacks of the patient as the latter releases the hitherto split-off rage and pain. This type of therapy is grueling for both patient and therapist—but according to Winnicott and Van Sweden, it is the only way to get the job done because anything less will not only leave the “false self” intact but quite possibly strengthen it.
Some of Van Sweden’s words:
The concept of regression to dependence means that through the analytic relationship the opportunity is provided for the individual to reexperience the early mother-infant relationship. Further, in this reexperience, the psychic reality that has been unconscious is made conscious. For the first time, the patient is able to feel directly the terror, pain, and rage that resulted from the original maternal failure. These intense emotions are relived in the holding environment provided by the analyst. The patient’s fragmented ego now has the opportunity for integration, through the reworking of his/her previously split-off emotions. Paradoxically, regression to dependence has a significantly progressive role.
In the original experience an infant’s ego is in an unintegrated state, which describes both the infant’s early pre-ego development [and:] the infant’s total dependence upon the mother. Winnicott’s understanding of this state led to his conviction that there is no such thing as an infant separate from its mother.
Glover…describes the primitive ego of the infant in this unintegrated state as made up of “ego nuclei”…which are miniature egos in an undifferentiated organization. I believe it is the interaction between mother and infant that supports the integration of these nuclei into a fully integrated ego.
When the infant cannot integrate into his ego the various maternal impingements, a false-self defensive organization comes into play in order to protect the kernel of the true self’s development. True self/false self is a concept that Winnicott developed to explain what occurs as the result of frequent impingements in the mother-infant relationship. When the impingements become too intrusive and the true self is in danger of being annihilated, the false self, which is built on a defense-compliance basis, comes into being. The net effect for the individual is a sense of inward futility and resignation regarding life…. Winnicott…expands on this development when he says, “In the extreme examples of False Self development, the True Self is so well hidden that spontaneity is not a feature in the infant’s living experience. Compliance is then the main feature, with imitation as a specialty.”
Because the ego was in danger of annihilation as a result of the impingements (intrusion or absence of mother) the “true self” (ego) of the individual needed to be protected. This protection came in the form of a false (compliant) self, which acted as a defensive organization. The net effect for the individual became a sense of futility and resignation to never being happy.
In the present, the individual expresses a longing for the important maternal connection that was not achieved in infancy. He/she often continues to seek for this connection in relationship after relationship. Recognition of the unmet desire, with the accompanying anger and pain, is the essential ingredient in the regression-to-dependence process.
In the normal process of psychological development, ego integration, which includes the resolution of the Oedipus complex, results in the developing child having a firm sense of self and the ability to experience his own identity whether he is alone or involved with others. For those individuals whose mother-infant relationship was impaired, normal ego integration did not occur. Instead, the individual’s sense of self is fractured. These individuals have a limited sense of separateness or identity when they are with others and often feel abandoned and bereft when alone. In order to function in the world, they often must split off their own emotions in an effort to find acceptance from others and a semblance of peace within themselves.
When the infant tried to achieve mastery over the failed maternal environment, he did so…by developing a defensive false-self organization, which enabled him to adapt to this environment. But the false self cannot ever reach the independence of maturity, for as Winnicott…has shown, there was no object (mother) who could offer a shared reality, only one based on a set of projections.
The mother-infant relationship based upon projections deprives the infant of having an object with whom to share his inner developing life. His rage and primitive agony result from the absence of this shared reality. This absence becomes more profound as there is no one to help him carry the rage and pain. Left to his own immature devices, the infant then drowns in his primitive emotions. These feelings are intolerable to the infant, and so the mechanism of the ego splits them off. Adults often report this experience as one of falling into a bottomless pit. It is absolute desolation.
Essential elements of regression-to-dependence (per Winnicott): 1) a safe and nurturing environment, 2) an analyst who is attuned (like a mother) to the patient’s true feelings, 3) a release of anger and frustration by the patient, 4) the patient’s movement toward independence, and 5) a sense of relief in the patient and a growing sense of self.
Winnicott: “The regression represents the…individual’s hope that certain aspects of the environment which failed originally may be relived, with the environment this time succeeding instead of failing.”
The ego of the infant is too immature to be able to gather into its control the anger and pain it experiences. These intense emotions must be split off until a later time when additional ego-support is available.
It is not the analyst making up for what the analysand [patient:] did not receive from his mother that brings integration. It is, instead, the analyst’s recognition of the analysand’s intrusive or depriving experience, and his capacity to contain the analysand’s pain, rage, and terror without being destroyed by it or ending the analysis, that resolves the damage done to the analysand in infancy.
It is essential that the analyst acknowledge the wish of the analysand for the analyst to make up to the patient what he/she did not receive. But the reality is that no one can provide this for the analysand. Once this is recognized, the analysand can feel and express previously repressed emotions of anger and pain.
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