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The Tavistock Model

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This is one of a new two volume edition of Collected Papers of Martha Harris and Esther Bick, which includes some papers not published in the first edition. The companion volume, Adolescence, by Martha Harris and Donald Meltzer, contains those papers by Martha Harris specifically related to adolescence.

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1. The Tavistock Training and Philosophy (1977)

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Martha Harris

This paper covers the main features of Martha Harris's development and consolidation of the psychoanalytic training founded on infant observation that she inherited from Esther Bick in 1960. In particular she instituted the work discussion group, personality development seminars, and the two-part training that also facilitated the dissemination of psychoanalytic knowledge into the wider community, through workers who would not necessarily train to become psychoanalysts themselves. Her distinctive principle was to encourage “self-selection”. She drew on various sources of personal experience—inspiring teachers (Klein, Bick, Bion), work in schools set up together with her husband Roland Harris,2 teaching and organizational skills, and above all, personal self-analytic awareness—being firmly convinced that a psychoanalytic attitude is useful in all emotional situations where infant conflicts are inevitably involved and, unless acknowledged and understood, are liable to undermine the work-group ethos.

 

2. The Individual in the Group: On Learning to Work with the Psychoanalytical Method (1978)

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Martha Harris

This paper explores the “Tavistock philosophy” in more specifically Bionian terms of the tension between the individual and the group as container or constricter, with special reference to Attention and Interpretation (Bion, 1970). The author suggests “transposing into a lower key” the turbulence and uncertainty associated with the “new state of mind”. The baby-observation seminar is a prelude to perceiving the emotions that characterize the psychoanalytic couple; and group learning can aim to be “symbiotic” rather than reinforcing basic assumptions. She discusses her method of “continued self-selection” by students; the usefulness of written work; the place of theories or “models” as “organizational tools”; problems of working in institutions; and the dangers of considering oneself a “spokesman” for some “advanced” psychoanalytic group, as distinct from struggling to learn through introjection—“becoming O”.

This paper attempts to convey some of the ways in which I see Dr Bion's work as raising questions and throwing light upon problems of organizing training in psychoanalytical method and attitudes. His thoughts on this topic are most cogently but, as always, often obliquely stated in Attention and Interpretation. There he pursues further his ideas about the relationship between the container and the contained; the nature of the transformations effected by the quality of their interaction; the subtle proliferation of mythology and lies which in differing degrees obstruct the search for truth. There he continues the preoccupation which runs throughout his writings, with the relationship between the individual and the group, and, as befits a historian, the relationships between different groups.

 

3. Bion's Conception of a Psychoanalytical Attitude (1980)

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Martha Harris

An obituary appreciation of the work of Bion, focussing on the implications of “introducing the patient to himself” and the cultural infancy of thinking processes.

In considering Bion's contribution to clinical work, much could be said of how he used and extended, in his own inimitable way, some of the theories of Freud and of Melanie Klein in so far as he found that they illuminated the observations which he was able to make in the consulting room: thus carrying on the great tradition in psychoanalysis. A number of people have been studying his work at the Tavistock Clinic in the past few years with Donald Meltzer, and this has been expounded in the third volume of The Kleinian Development (1978).

I would like to select what is, for me, the most inspiring and liberating aspect of his conception of psychoanalysis. Although he believed that there is no substitute for undergoing an analytic experience in the sequestered but turbulent milieu of the consulting room, if one is bent upon exploring the mysteries of one's personality, Bion sees the discipline of psychoanalysis for analyst and patient alike, as aspiring to continue that great tradition of thinking in art, science and philosophy, which investigates not only the nature of the world in which we live, of human beings in that world, but also the mind of the observer, the thinker himself.

 

4. The Place of Once-Weekly Treatment in the Equipment of a Psychoanalytically Trained Child Psychotherapist (1971)

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Martha Harris

From the context of the pressures of working in a clinic (and other realities of life), the author evaluates both disadvantages and potential advantages of less intensive therapy with children—many aspects of which apply also to work with adults. This leads to more general considerations: the rhythm of work; the potential for learning for the therapist; the anxieties aroused and defences employed; the place of teamwork; the selection of cases; the goals which are realistically possible by comparison with more intensive therapy; technical matters such as alternative modes of communication to transference interpretation; the roles of observation, family history and theory; and the balancing of personal learning with social obligations.

This brief paper reintroduces a topic which was the focus of the Association's very first study weekend eleven years ago: one with which those of us who work in clinics are continually occupied, and about which after those years of experience we may be in a better position to ask the relevant questions, and to make a few tentative generalizations.

 

5. Growing Points in Psychoanalysis Inspired by the Work of Melanie Klein (1982)

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Martha Harris

This paper, the last to be published by Martha Harris, takes a historical overview of certain key moments in the evolution of Kleinian thinking. These are: Klein's extension of Freud's “projection” into “projective identification” as a result of her observation of children's phantasy worlds; work by her colleagues and students with psychotic adults and by Meltzer on sexual theory, enabling a clear differentiation between narcissistic and object-related modes of mental operation in forming personality structure; Bion's extension of “projective identification” and of Klein's “epistemophilic instinct” in his theory of thinking; and Bick's perception of skin functioning in infants which, together with her colleagues’ and students’ work on autism, enabled a differentiation between two-and three-dimensional states of mind. These apparently different or differently-derived theories integrate into a single model of personality growth. The examples that follow on however emphasize the fact that individuality is varied and surprising and does not necessarily conform to the expectations aroused by any existing model.

 

6. Esther Bick, 1901–1983

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Martha Harris

Martha Harris took over Esther Bick's course at the Tavistock in 1960 and continued to remain good friends and to work closely with her until her death. In a discussion with Meltzer about the difference between genius and talent, she said that she was one of the few who had “a touch of genius”. The following eulogy is the published version of what was felt by those present to be a “wonderful speech” (Elizabeth Spillius, personal communication). The speech transcript has been lost and there appear to have been differences from the published version. Joan Symington, who was present at the memorial occasion, writes:

“What I noticed in Mattie's very moving eulogy (which had many of the audience in tears) was that she said Mrs Bick had been ‘vouchsafed’ exceptionally fine internal objects. The word ‘vouchsafed’ struck me as some quite different way of looking at internal objects. It may link up with Bion's ‘third eye’” (personal communication).

 

7. Child Analysis Today (1962)

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Esther Bick

Esther Bick considers internal and external factors that contribute to the neglect of child analysis, and emphasizes its importance with regard to both the education of the psychoanalyst and to the community, and also its rewards. Two clinical examples are given to illustrate countertransference stresses faced by the child analyst and the heightened dependence on unconscious intuition which helps to clarify contact with the child.

This symposium is in the nature of an historical event—it is the first symposium on child analysis at an International Congress of Psychoanalysis. In May 1927, such a symposium was held before the British Psychoanalytical Society. On that occasion Melanie Klein contrasted the development of child analysis with that of adult analysis, discussing the striking fact that although child analysis had a history of about eighteen years, its fundamental principles had not yet been clearly enunciated; whereas, after a similar period in the history of adult analysis, the basic principles had been laid down, empirically tested, and the fundamental principles of technique firmly established. She went on to discuss why the analysis of children had been so much less fortunate in its development.

 

8. Notes on Infant Observation in Psychoanalytic Training (1964)

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Esther Bick

In this foundational paper, Esther Bick describes the nature and purpose of infant observation seminars, and the technical and emotional difficulties faced by the observer in relation to the family and the seminar group. Several examples are given, including long extracts from an observation of one particular baby, in order to demonstrate how only close attention to detail can make these primal emotional strains observable and illuminate the experience of the observer, and of the mother and baby couple. She also stresses the importance of consecutive observation for gathering scientific data as free as possible from linguistic preconceptions. She concludes that the psychoanalytic validity of the experience lies partly in learning how to observe, and partly in the prototypal relationship to the breast as part-object as being the “basic unit of relationship from which more complex relationships are built”.

Infant observation was introduced into the curriculum of the Institute of Psychoanalysis in London in 1960 as part of the course for first year students. The detailed observational material that I am quoting in this paper is mainly drawn from the work of these students. Infant observation had, in fact, been part of the training course for child psychotherapists at the Tavistock Clinic since 1948 when the course began. We then decided to include in the first non-clinical year some practical experience of infants.

 

9. The Contribution of Observation of Mother–Infant Interaction and Development to the Equipment of a Psychoanalyst or Psychoanalytic Psychotherapist (1976)

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Martha Harris

This paper develops the parallels indicated in Bick's 1964 paper between the infant observer and the psychoanalytic candidate, in terms of emotional turbulence and observational skills. Given that the analytic transference externalizes infantile relationships and desires, the earliest part-object relationships lie hidden in the patient's narratives; and being able to see the continuing internal infant provides the analyst with a metaphorical language for linking the patient with unconscious areas that are otherwise hard to verbalize. Infant observation teaches the analyst that the process of mother and baby “finding each other” cannot be artificially forced. The author considers problems of identifying with a thinking object, and its converse—the dangers of “societal debate” in producing two-dimensional analysts, and the potential constrictions in the analogous roles of supervisor and mother-in-law. Meltzer's “toilet-breast” is related to the decontaminatory function of the mother in thinking (Bion). The nature of transference and the “central truth” of waiting and tolerating pain without recourse to precipitate action is emphasized and the paper concludes with examples of fluctuating part- and whole-object orientation in an infant and an adult of equivalent “analytic age”.

 

10. The Experience of the Skin in Early Object Relations (1968)

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Esther Bick

This classic, highly condensed paper about the conditions that are necessary for Klein's “splitting and idealization” to take place, was read to the 25th International Psychoanalytic Congress in Copenhagen in 1967 and has been extremely influential, especially regarding the understanding of two-dimensional features of personality structure. According to Shirley Hoxter, Bick intended it “as a preliminary communication only but she was never contented with attempts to expand it in later writings.” (Hoxter 1988, p. 103)

The central theme of this brief communication is concerned with the primal function of the skin of the baby and of its primal objects in relation to the most primitive binding together of parts of the personality not as yet differentiated from parts of the body. It can be most readily studied in psychoanalysis in relation to problems of dependence and separation in the transference.

The thesis is that in its most primitive form the parts of the personality are felt to have no binding force amongst themselves and must therefore be held together in a way that is experienced by them passively, by the skin functioning as a boundary. But this internal function of containing the parts of the self is dependent initially on the introjection of an external object, experienced as capable of fulfilling this function. Later, identification with this function of the object supersedes the unintegrated state and gives rise to the fantasy of internal and external spaces. Only then is the stage set for the operation of primal splitting and idealization of self and object as described by Melanie Klein. Until the containing functions have been introjected, the concept of a space within the self cannot arise. Introjection, i.e. construction of an object in an internal space is therefore impaired. In its absence, the function of projective identification will necessarily continue unabated and all the confusions of identity attending it will be manifest.

 

11. Further Considerations on the Function of the Skin in Early Object Relations (1986)

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Esther Bick

This paper, published posthumously with an endnote by Donald Meltzer, draws on both adult and child patients and on infant observation to elaborate on the meaning of the adhesive qualities of second-skin formation in relation to the mother/internal object: including other modes of clinging such as with eyes and ears, or how an infantile difficulty in grasping can take the form in adults of a failure to grasp ideas. Meltzer puts Bick's description of these phenomena in the context of autistic two-dimensionality, Bion's exoskeletal personality, and Money-Kyrle's inquiries into cognitive development.

In 1968 I presented a paper built around clinical experiences and infant observations concerned with the primal function of the skin of the baby and of its primal objects in relation to the most primitive binding together of parts of the personality not as yet differentiated from parts of the body [see previous chapter]. There I described some of the evidence suggesting that in the earliest times the parts of the personality are felt to have no inherent binding force and fall apart unless passively held together, an experience indistinguishable from feeling the body to be held together by the skin. The suggestion was also made that in the event of defective development of this containment function other “secondary skin” devices may arise, in collaboration with particularities of the maternal care, such as muscular or vocal methods. The consequences for personality development were briefly illustrated, with special reference to ego strength, pseudo-independence and tendency to disintegration.

 

12. Some Notes on Maternal Containment in “Good Enough” Mothering (1975)

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Martha Harris

This paper expands Winnicott's “quantitative” definition of a “good enough” mother in qualitative directions, incorporating Bion's concept of maternal reverie, Bick's of the containing skin and the move from unintegrated to integrated states of being, and Meltzer's of two-dimensional states. These concepts are illustrated through two infant observation cases and one analytic case of a mother with a new baby. All are concerned with the nature of “fit” between mother and baby, and with the baby-within-the-mother; with the way reawakened infantile feelings can interfere with reverie; with the complications of mourning (in two cases); with the baby's struggle to introject the good breast whilst partly relying on second-skin support (in one case), and with the mystery of internalization in which (in another case) the thumb can take on the significance not of a mere plaything or transitional object, but rather, become the “agent of an internalized object in advance of the baby's conscious control”.

 

13. A Baby Observation: The Absent Object (1980)

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Martha Harris

An account of how a baby, during his first year, used the observer in tandem with his mother in order to symbolise first the bad object and then the absent object, enabling him to form first an almost hallucinatory and then an internal picture alongside her coming and going.

From quite early on, even a few weeks—as soon as a baby becomes aware of there being a difference between himself and the breast, his mouth and the nipple, himself and the mother—the problem of separation becomes observable. How does the baby let the object go; and how does he deal with this in the mind? Long before a baby is actually weaned from the breast, some sort of weaning process is taking place or failing to take place, with every separation from the mother. In the first baby I have in mind, it is the use of the eyes which is revealing of aspects of this problem. The observer, who had been watching him develop for over a year, had been struck by the different uses that he made of his eyes. This baby was born to a Japanese mother and an Australian father, both of whom were temporary immigrants to London. The observer saw the mother before the baby was born, and found her a very charming, pretty little woman, greatly looking forward to having a baby. But in fact she had a terrible time during her labour, because she was very small and this was a very big baby.

 

14. Towards Learning from Experience in Infancy and Childhood (1978)

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Martha Harris

This paper considers questions at the heart of both psychoanalysis and life: the mysterious nature of introjection; how learning from experience is founded on “experience shared”; the problem of “fit” between mother and baby and the “lacunae” that are its impediment; the nature of “holding” not as mere protection but as enabling the child to have “experiences of himself and of the world in a modulating environment”; the developmental force of “realism”, helped by a “matter of fact response to children's nastier feelings”; above all, the inadequacy of theory by comparison with observed individuality, as in the case examples. The author begins by suggesting that a real awareness of the catastrophes of the wider world can improve our understanding of the anxieties of the young child.

To begin by paraphrasing Hegel: “We learn from history that we do not learn from history.” This probably applies to the history of psychoanalytic societies and other similar bodies, to the history of the human personality as much as it does to the history of nations. And yet the psychoanalytic method of observation and of research has given us an impetus and unique tool to study why it is that we find it so difficult to learn from our personal history. It has given us a basis from which to consider ways in which it may be possible or impossible to hand on to others any of the experience we do acquire. Those of us who are in some position of responsibility for the welfare of others—as parents, educators, administrators for example—must of necessity be concerned with thinking about the conditions which enable individuals to develop and to share the fruits of that development with others.

 

15. Personality Development: Latency (1964)

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Martha Harris

Written for New Society in 1964 as part of a seven-part series by various authors, republished as The Seven Ages of Man, ed. R. R. Sears and S. S. Feldman, in 1973. The sections, intended for the general reader, were: Infancy; Childhood; Adolescence; Young Adult; Prime of Life; Middle Age; and Old Age; each subdivided into the body; personality; and ability. The author focuses on the process by which the latency child, within the context of family and society, acquires his own values and resolves (in Kleinian terms) his natural guilt. For a related New Society series see Chapter 23 below, “The family circle”.

The years from five to twelve were described by Freud as the “latency period”, the part of a child's life when strong infantile sexual impulses are to some extent mastered, and so remain latent till reawakened in the bodily and emotional flowering of adolescence. But the repression of infantile sexuality and the control of primitive aggression is a gradual process, even a painful and reluctant one. And here the child is helped by the mother who wishes him to grow up, who is able to free him; by parents who expect, as his powers develop, increasingly responsible cooperation from him in governing his unruly impulses. He is stimulated by the very frustrations of his situation in the family to explore wider fields.

 

16. The Therapeutic Process in the Psychoanalytic Treatment of the Child (c.1968)

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Martha Harris

The paper begins with a simply phrased introduction to the nature of the transference in the psychoanalytic process with children.2 The limitations of theory are pointed out, by contrast with the practical qualities of toughness and sensitivity that are required by the therapist in order to support the child's own need to understand the reality of their inner world, not merely to avoid pain. The aim is to help the child deal with frustration in a more “realistic” way, both internally and externally, instead of turning away or using the distortions of omnipotence.

As we know, children are referred for treatment for many reasons. In some cases a child's illness may be a symptom of disturbance within the family. By working in a family psychiatry setting we may be able to help him indirectly by influencing parental attitudes. We may nevertheless be left with a child who cannot respond adequately to a better climate, still unable to cope with the frustrations that even the best of environments must necessarily impose, and who may never have been able to make sufficient use of what was offered. Such children like the adults whom they would later become, all suffer from some impairment in their ability to function in the external world and in the inner world of thought, emotion and imagination—an impairment which may be attended with greater or lesser awareness of conflict, dissatisfaction with the self, or of impoverishment in the personality.

 

17. The Complexity of Pain in a Six-Year-Old Child Following Sudden Bereavement (1973)

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Martha Harris

This case demonstrates the efficacy, given appropriate conditions both external, internal and familial, of very brief yet genuinely analytic therapy. Despite the initial impression of defensive anger and guilt, character and circumstances in the case of this young boy were such that seven sessions were sufficient to put in place an internal analytic model of thinking about and mourning the loss of his father: “as if I were a voice that came from inside him”. It is a paper which goes beyond a particular instance to the heart of what psychoanalysis is about—mourning and introjection in the service of sorting confusions and thinking. The task is to follow the child in order to find a level of transference that matches his understanding to the time available. It requires a flexible and penetrating approach to the reality of the situation. The author's special sensitivity in this case has a personal as well as professional basis, since her own husband had suddenly died three years previously.

 

18. Depression and the Depressive Position in an Adolescent Boy (1965)

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Martha Harris

This paper describes an adolescent boy's beginning to move out of depression resulting from a severe superego and manifest as a dampening of affect, into the depressive position in which the power of such projections is reintegrated more creatively and vitality is increased. The discussion refers also to another adolescent case conducted by Dora Lush.

The clinical material in this paper will be centred around a dream, reported by a boy of fifteen and a half years after some three and a half years of analysis. In its context the dream, which was an important and vivid experience for him, typically conveys, I think, the picture of a patient struggling against those aspects of himself that perpetuate depression and inanition. He struggles to be able to face the conflict of ambivalence and the guilt it entails, and to maintain the depressive position—i.e. a state of integration, of responsibility for the conflicting emotions and parts of himself in relation to valued objects.

 

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