1
The Case of Margaret Little

THE WORDS OF THE ARTIST AND PSYCHOANALYST MARGARET LITTLE CONvey a problematic uncertainty to her sense of existence and a difficulty sustaining a subjective position in the world that is echoed by many patients—the complaint of "not having a life." Little (1985) described what Kohut would later call a pathology of the self, a self for whom, in her terms, "anxieties concerning existence, survival, or identity" (p. 15) predominate. Little's first analyst in the late 1930s had observed that she seemed to doubt her own right to existence. Modell was to address this issue in a groundbreaking paper of 1965, "On Having the Right to a Life." He was here building on "Winnicott, who was to become Margaret Little's third analyst, by returning to a study of the effects of disturbances in the earliest object relations. Modell described patients whose inability to accept successes and pleasures in their lives betrayed a powerful antiself dynamic, a basic guilt in establishing themselves as separate individuals from the maternal object. Separation for them meant unconsciously a destructive attack on the mother, from whom something valuable was being wrenched, perhaps analogous to Klein's notions about infantile envy. Modell did not limit his analysis to serious psychopathological states, but suggested that such guilts and fears formed a part of many patients' conflicts.

Although Little might have said that her problems were not about "having a right," but about having any existence at all (in fact, she did say something quite similar), the two questions are linked. Having a right to a separate self means renouncing the oneness of a mother-child dyad or, what amounts to the same thing in a Lacanian framework, renouncing the possibility of satisfying the Other's desire and moving toward an assumption of one's own (separate) desire.¹ This passage was exactly what Little was unable to complete, unable to experience a second, psychic birth as a separate, desiring self. The important British psychologist and theorist, Harry Guntrip, was to seek out Winnicott for reasons quite similar to her's after an impasse in his first analytic experiences. For these two damaged individuals, something had gone awry in early life experience which they could not name; something was missing for which words were just beginning to be found when they first consulted him. Perhaps they demonstrate, in ways that go beyond their particular circumstances, the widening gap in the postmodern subject between desire and intersubjective identity caused by a tearing of the social fabric into which individual subjectivity is knit. The Lacanian social theorist, Žižek (1994), argues that the destabilization of traditional values and ideologies during the postwar period carried to an extreme the monadic isolation of the bourgeois self in European societies. For many vulnerable persons, psychoanalysis as a social institution—during these fecund years of its history— offered the possibility of repair or restitution of a damaged or alienated self. Guntrip's saga is exemplary in this respect. His quest for personal meaning led him from a protestant Christian calling as a minister toward psychoanalysis as a vehicle for restoration of the pure, natural self he sought. His French contemporary, the philosopher Louis Althusser, initially inspired by Lacan, turned to analysis for very similar reasons, experiencing a lack of personal existence that haunted his life. His disillusionment with the Catholic faith and communist ideology that had organized his intellectual and emotional life and his unremitting search for a set of viable ideals are vividly portrayed in his autobiographical writings, which I discuss in chapter 6. The theme of self-restoration was, of course, explicitly taken up by Kohut, who in many ways echoed the liberating post-Freudian zeal of Guntrip in an American setting. There was passion as well in Lacan's commitment to probing the secrets of the human subject. Like Kohut and Guntrip, he rejected the mechanistic model of ego psychology, defending a more dynamic depiction of psychic life that he found in Freud.² Perhaps Freud could explore the mechanisms of the mind during an earlier, more stable era without immediately bringing into question the secure identity of the European bourgeois evoked by Žižek. Winnicott's interests were in many ways parallel to Lacan's, particularly his attention to the origins of self within the mother-child relationship, and it was the application of his ideas to patients like Margaret Little and Guntrip that aroused so much interest³ in his writings.

Little (1985) writes of her first session with her second analyst, Ella Freeman Sharpe, that she lay rigid on the couch, unable to speak or move. Later she began to scream. After sitting her up, Sharpe interpreted her fear as a kind of castration anxiety resulting from a rivalry for the affections of Little's previous male analyst, whom she also knew. Little disagreed, arguing that her fear was one of "utter destruction, being bodily dismembered . .. wiped out" (p. 14). Later, she was to make a misattunement of this type by Dr. Sharpe the centerpiece of her important article on countertransference (Little, 1951). There are similiarities in her description of Sharpe to Guntrip's (1975) well-known account of his first analysis with Fairbairn. In both cases, a dedicated and caring analyst behaved rather rigidly and silently, sticking to oedipal interpretations. Of course, Fairbairn went much further in the direction Guntrip sought and was already breaking with analytic orthodoxy. In some ways he was ahead of Winnicott.⁴ Both analysts no doubt helped their difficult and challenging patients considerably, but a residue was left, a fundamental untouched residue that led both eventually to the couch of D. W. Winnicott. Little was later to diagnose her relationship to Sharpe as a transference psychosis based on earliest infancy. This situation was certainly repeated and even fostered in her subsequent analysis with Winnicott, who believed that regression was necessary and was prepared to accept it. She once again lay silent in their first session, where Winnicott commented that she was shutting him out for some reason, a true object relations interpretation of the experience of self with other. Modell (1980) would elaborate this phenomenon in his paper, "Affects and Their Non-Communication," in which he observed the defensive need of certain patients to shut the analyst out to protect a vulnerable self against a repetition of traumatic early maternal failure. Green (1975) had offered an analogous hypothesis, in which he spoke of an impossible attempt to abandon relations with objects, leading to a "negative hallucination of the self" (p. 55), like Little's belief in her nonexistence. Guntrip may have accomplished the same result of distancing his analyst by his pressured talking during the sessions. These tactics of noncommunication suggest an underlying fantasy of a powerful, uncaring or dangerous, devouring mother, who must be shut out at all cost.

Little's account of her treatments brings out two of the important dimensions of the emergence of subjective life in infancy emphasized by Andre Green—the problematics of presence (her frightening quasihallucination of Sharpe as a kind of spider), evoking the danger of being devoured or destroyed by the object, and of absence (feeling out of contact with Winnicott), threatening psychic annihilation by another who might not respond to what was most important to her. She desperately needed an object, not for pleasure, but for recognition and presence, yet feared being destroyed by misunderstanding or impingement. Modell (1990), describing a group of patients similar to Little, wrote that closeness can threaten the existence of the self, whereas distance may lead to deadness. Modell (1980) had observed that the fear of destruction by the failure of an empathic response may be met by a sort of nonrelatedness, inducing a reciprocal coldness in the analyst. Although his emphasis here was on the patient's anxiety and defensive maneuvers in the context of internal object relations, Modell's formulation was on the way to the two-person psychology that he was later to advocate. Now we would say that exploration of the analyst's unwitting or unconscious participation in this type of situation is an essential element of an effective treatment, not because it creates the patient's problem, but because it provides the road to understanding and reconstruction of a basic developmental and structural failure in which the analyst has inevitably been (re)playing a part.

In his scathing critique of analytic models of transference, Lacan (1958) mocked the metaphor of distance used by object relations analysts as implying a simplistic version of the two person psychology, in which the symbolic dimension of subjectivity is slighted in favor of an imaginary "real" relationship—"ripening the Object in the hot house of a confined situation" (p. 245). To my way of thinking, Winnicott is more enlightening here than Lacan, as he addresses the symbolic "maternal provision" and its failures. Winnicott may have overemphasized the maternal aspects of the patient's relationship to the Other (the analyst in the transference, the primordial mother, the symbolic order), whereas Lacan mistrusted the traumatic potential of maternal overpresence, which became the cornerstone of his theory of anxiety (see Harari, 2001). Rudnytsky has cleverly contrasted the difference between the two by suggesting the term "name of the mother" as Winnicott's equivalent of the important Lacanian concept nom du pere (name of the father). Their disjunction on this point carried over to their respective conceptions of therapeutic action. Winnicott developed a model of regressive reliving of a damaging infantile situation and did not hesitate to establish his own active holding presence, whereas Lacan looked more toward making a decisive cut in the infantile dyad, allowing the patient to emerge as a differentiated subject of desire. As Eigen (1981) wrote, both shared the goal of enabling the subject to persevere in the difficult task of human existence.

Rudnytsky (1991) has further polarized Winnicott from Lacan by highlighting their different conceptions of self. Although his analysis of their complex and not always consistent ideas is nuanced, he comes down on the side of an "essentialist," core self as truer to human experience than the fissured and divided subject of Lacan and the postmoderns. He faults Lacanian theory for rupturing the wholeness that characterizes healthy personal experience (thus supporting Guntrip's position) and for replacing it with an inherently unstable and alienated self. Although acknowledging the fuzziness of Winnicott's notion of a "true self," Rudnytsky argues that it provides a more solid foundation for a renewed psychoanalysis, and he presents the image of a happy, self-realized Winnicott as a better model than the more tormented subject of Lacan. In my view, something is lacking in this picture, which seems more of an affirmation of one side of a duality than a complete theory, and is unfair to the complexity of both thinkers. Although Winnicott is certainly the more appealing psychoanalyst from what we know of their work, I believe that his buoyant optimism and belief in health, cited by Rudnytsky, needs balancing by the tragic vision of Freud and the structuralist antihumanism of Lacan. For this reason, I support Rudnytsky's other stated wish of "having Winnicott with Lacan" (p. 85).

The different emphases of Lacan and Winnicott are fairly clear and colored their clinical technique, where the comparisons are not necessarily in Lacan's favor. In general, he was critical of the analyst's departing from her formal role as support for, but not an active agent of, the transference, for which he advocated a traditional analytic position. Although he attacked the atomistic or essentialist model of an interiorized subject to be uncovered or liberated by the enlightened analyst (for example, by being raised to the level of genital object relations, already biologically inscribed in his or her destiny) and argued that the unconscious was not like a buried crypt to be excavated in treatment but a "transpersonal" construct (a term used in the "Rome Discourse" of 1953), Lacan's writings support an abstinent transference model quite unlike Winnicott's. His discussions of technique present a classic view of the analyst as providing a mirror, one if anything more austere than Freud's, reflecting the patient's own messages in a kind of dialectical operation. This use of the mirror metaphor further differentiated him from Winnicott and, later on, Kohut. Winnicott emphasized the infant's gaining a sense of his existence in the mother's eyes, enabling him to begin to perceive actively, whereas, for Kohut, mirroring meant a process of attunement by the parent to the child (or analyst to patient). In both versions, there was implicit recognition of the affective communication involved. In this regard, the role of affect was relegated entirely by Lacan to the imaginary transference⁵ as a deception or lure to be overcome. Using his clever (but almost incomprehensible) analogy of psychoanalysis to a bridge game, Lacan (1958) spoke of the affective elements in the transference as belonging to the analyst's position as the "dummy" (le mort or "the dead one," in French), using phrases like "the passive face of death" (p. 220).⁶ He observed repeatedly the important function of frustration in mobilizing the patient's demands (behind demand, of course, the key element of desire), referring to the "terrible temptation" (p. 257) of the analyst to respond and contrasting analysis with the warmth of the ordinary human relationship.⁷

Although he may have implicitly accepted the framing and holding functions of an analysis, Lacan presents these more as an effect of the structure and setup of treatment than a product of the behavior of the analyst. A tendency to idealize the psychoanalytic situation as intrinsically therapeutic was also present in ego psychology and continues to play a part in contemporary psychoanalysis as well. In North America, what Green characterized as a maternalization of practice may account for the unquestioned assumption of its beneficent nature, as demonstrated by participants in the American Psychoanalytic Association's focus groups, who saw themselves as empathic, engaged helpers, working to "support the individual in his or her struggle to become the whole self" (Zacharias, 2002, p. 5). Lacan's emphasis on structure over process is illustrated by his invention of many schematic models, of which the schema L is notable, the point of which was to show the displacement of the analyst from any pretended role as subject of a "real" relationship into her necessary positions as object for the patient (as the dummy) and to the place she occupies of the Other. This was why he referred to the "pretended analytic situation," because it was not for him a true intersubjective situation.⁸ The analyst, for Lacan, avoids all traps of responsiveness that might support the ego and its imaginary transference, with the aim of taking the patient through his transference fantasies to the assumption of his own desire. To this end, the analyst accepts the essentially deceptive and even magical role of incarnating the symbolic Other, which will call forth the unconscious desire of the subject.⁹

Lacan's structural interpretation seems in many ways to support the classical, "objective" interpretive tradition, much as Freud advocated. One has only to read the accounts of his former patients offered by Roudinesco (1993), as well his own discussions of technique in which the "dialectical" returning of the patient's own message by the analyst was highlighted, to infer that the well-analyzed analyst can correctly read the patient's communications, respond to the important signifiers, and arrive at the correct designation of the ultimate interpretation, the tu es cela (thou art that; Lacan, 1949, p. 7). His controversial technique of punctuating (interrupting) sessions at the right moment seemed to imply an analogous capacity¹⁰ for accurate judgment of when to intervene. While in theory the short sessions could have the impact of marking a point of intensity or of particular importance in the process—especially if the patient were prepared for such surprises—in practice, Lacan shortened the time to unjustifiably brief periods of only a few minutes, especially in his later years.¹¹ Contemporary Lacanians who practice the "scansion" of the analysand's discourse with this theory in mind obviously make conscientious efforts to exercise their power judiciously, and, as a general rule, tend to use sessions of 25 to 30 minutes.¹²

There is an irony in this description of Lacan's practice. The excesses of "classic" psychoanalytic treatment in the direction of an assumed impersonality, commitment to some version of an objective or nonpersonally implicated functioning of the analyst, and avoidance of responsibility for the evolution of the transference relationship (already strenuously criticized by Ferenczi, 1933) have come to be identified with the mechanistic deviation of ego psychology from the vitality of an actively constructed, intersubjective encounter. As I have noted, it was certainly against this type of analysis, with its positivist ambitions, that Winnicott and Lacan were reacting in the late 1940s. Although few today would support any similar model of the analyst as presiding over an "untouched surgical field," it seems to me that psychoanalysts are still far from resolving or fully conceptualizing the tension between the classical doctor-patient (or, as Lacan scoffed, "shepherd-flock" paradigm) and the evolving relational and intersubjective model. In the former, the patient brings his troubled past, symptoms, and cumbersome ego for treatment; whereas in the latter, two subjects co-create a new, transformative experience. Again, something seems wrong with the exclusive choice of either of these alternatives, as polemicized by the different schools. So Lacan should not be singled out in this respect, even if, by seeming to incarnate, in Borch-Jacobsen's (1990) phrase, an "absolute master," he may have helped to perpetuate a mystifying and shamanistic style of psychoanalysis.¹³

At the same time, there is clearly another text in Lacan's writings and lectures that undercuts the mastery of the analyst and that, moreover, provides important theoretical substance for an alternative model of the transference. One could say the same of Freud, of course, and, no doubt, there were historical reasons embedded in their epochs that explain why the revolutionary aspects of psychoanalysis as a liberating practice were grafted onto a version of paternal authoritarianism, only now slowly fading. Both men were freer and more spontaneous with their patients, more prone to enter into "enactments," which (in the best case) offer material to be used creatively to further the process, than a cursory reading might suggest. But Lacan went further than the scandalous freedom of speech and action often reported of him¹⁴ by offering novel ways of conceptualizing the analytic relationship and by presenting a less constrained and socially repressive role for the analyst. In this regard, his discussion of countertransference in Seminar VIII (1960-1961) was ahead of its time by insisting that this phenomenon, beginning to be reevaluated contemporaneously by Paula Heimann and others, was an inevitable consequence of transference. The transference, he argued, depends on a speaking relation with another subject that, inevitably, incites unconscious desire, however well-analyzed the analyst. In fact, "the better the analyst is analysed, the more likely that he will be frankly in love or in a state of aversion and repulsion" (Lacan, 1960-1961, p. 224). In these passages, he acknowledged that something must be there for the patient besides the empty analytic mirror. Thus, in another of his cryptic but memorable parables, Lacan (1964) observed, "It is not enough that the analyst should support the function of Tiresias. He must also, as Apollinaire tells us, have breasts" (p. 270). Exploration of this avenue was bypassed, however, in favor of an emphasis on the ethics of the analyst's desire, which seems to amount to a desire for "absolute difference" (p. 276), a putative accomplishment of successful training analyses (and for him, there seem to be no other).¹⁵ This ethic implicitly recognizes that the analyst cannot know the desire of the other and therefore is never in a position of knowledge from which to correctly interpret the unconscious of his patient. The metaphor of sustaining difference against the inevitable pressures of countertransference and the undeveloped notion of a "transpersonal" unconscious (Lacan, 1955), involving the interplay of two desires, capture for me the richness of Lacan's vision missing from Rudnytsky's critical evaluation.

In thinking about Lacan the analyst, particularly in developing his conception of the encounter of two subjects in analysis, it seems inevitable to wonder about his own analysis and his own desires to become an analyst. To a point that may have become excessive, no one today would discuss a case without reference to the previous analyst and his or her limitations. With all due reservations, this approach to Lacan's own classical analysis with Rudolph Loewenstein, the alleged failure of which is commonly attributed to Lacan himself, may at least situate his departure from the orthodoxy of the period in the context of analysis as it was then understood and practiced.¹⁶ My hypothesis is that this training analysis left a traumatic residue influencing his own subsequent practice. There are indications, supported by Roudinesco (1993; Derrida and Roudinesco, 2001), that Lacan himself may have suffered early damage from an impoverished and rigid object environment, which left him with a vulnerability toward (and tendency to repeat) certain injurious experiences in later life.¹⁷ Such a constellation may have been restaged in his several years-long training analysis of 1932-1938. Loewenstein, newly minted from the Berlin Institute, was a young man Lacan's age when he took him on as his patient, and it seems obvious that he lacked the seasoning and brilliance that a mature Winnicott was able to bring to bear on Margaret Little and Harry Guntrip. The fact that Loewenstein, a creative thinker and appreciated clinician in the heyday of post-war ego psychology in America, was to devote his researches to the development of the ego as an organ of adaptation, while Lacan turned toward the coming to be of the subject is doubtless significant. Thus, Lacan translated Freud's (1933) famous dictum, "Where Id was, there Ego shall be" (p. 80), as, "Where it was ... it is my duty that I must come into being" (Lacan, 1955, pp. 128-129). It is surprising that no one has yet attempted to link Lacan's innovations with his own unsuccessful analytic experience, drawn like most of us to repair his unresolved problems, which may have passed unaddressed in the training analyses of the time.

According to Phillips (1988), Winnicott himself may have had a "dead mother"—at least a depressed one whom he sought to heal. Although his second wife, Clare, paints a picture of a happy, secure childhood, there are indications that all was not rosy. Phillips cites a late poem by Winnicott about his mother that includes the lines, "Mother below is weeping, weeping, weeping. Thus I knew her. Once, stretched out on her lap as now on a dead tree ..." (p.21). His wife did observe that a deliberate effort was made not to spoil him, which may have deprived Winnicott "of some of the intimacy and closeness he needed" (p. 22). Winnicott wrote that after a youthful injury, he decided to become a doctor himself to avoid depending on physicians in the future, and Clare observed that he only became angry when he was ill. Possibly his choice of a second analysis with a Kleinian, Joan Riviere, after 10 years with James Strachey, was related to an unanalyzed piece of this early problem of vulnerable passivity, which he was to address so brilliantly in this work with Guntrip. Riviere (cited in Phillips, 1988) wrote that the analyst's concern was not "adaptation to the real world" but "the imaginings of the childish mind" (p. 43).

A creative imperative to escape the restrictiveness of a stereotypic, oedipally focused psychoanalysis, congealed in the structures of a declining patriarchal order, may have motivated both Lacan and Winnicott to take new directions. A similar aversion to the biologizing and reductionistic tendencies of ego psychology may have contributed to Modell's innovations in his version of a two-person psychology—for example, his advocacy of the crucial importance of the communication of affects in the dyad. Lacan saw this avenue as headed toward the dead end of an idealized intersubjectivity that ignores the presence of the symbolic order from which each subjectivity is suspended, but, as I have noted, his recognition of the intrication of two unconsciouses in analysis seems to point to another issue, one which, I believe, Modell and others have taken. In homage to Merleau-Ponty, Green (1973) observed that "affect is the signifier of the flesh and the flesh of the signifier" (p. 332). In Lacanian terms, it is the expression of the real in the play of two subjectivities. For me, the issue of the communication of affect raised by Modell is the crux of psychoanalytic therapy and is central to my approach in this book. It was certainly neglected by Lacan (or seen as derivative) and lacks development by Kohut, although both have something to teach us about affect. Although in some sense implicit in all of his writings, Winnicott also failed to say much on the subject. Of all the analysts with whom I will be dealing, only Modell and Green have systematically addressed the problem of affect in psychoanalytic theory, notably its signifying and communicating functions.

A central problem in this regard has been that psychoanalysts have tended to associate affect with the Id, with biology, and with a form of drive discharge, rather than seeing it as a symbolic activity. Thus they could aspire to an objective evaluation of the drive tensions. From my perspective, "having a life," the embodied feeling of personal existence, depends on the capacity to express affect in a form that can be communicated within a framework of shared meanings and social conventions that link the subject to others. I see the functions designated by the term ego ideal to be crucial to this process. The difficulty addressed by Green is that affect displays the features of force, intensity, and somatic arousal noted by Freud and seems to partake of something primal, biological, and preverbal in the infant-mother relationship, along the lines investigated by innovative researchers such as Daniel Stern (1985). At the same time, affect is intersubjective, structured, and communicative, as Stern also rightly insists. In speaking of these early life transactions between infant and mother, Stern infers a continuum of emotional expression ranging from pure discharge to highly patterned (learned) sequences that carry symbolic meaning. The latter view has been developed independantly by a number of anthropologists whom I discuss. These authors stress the cultural construction of affect, which implies both a particular form of self organization (a specific narrative of the self) and a familiar scene of action (a social paradigm). The transmission of cultural values and models, which Freud located in the parental superegos, then serves the function of structuring affect representations. When these symbolic links are lacking, affect remains uncommunicated or miscommunicated as flatness and deadness, or the obverse, as disruptive overflow.

There are many examples of disruptive affective discharge in Little's account. Once, in her despair that Winnicott could not understand her incommunicable feelings, she smashed a cherished vase, driving her analyst temporarily from the room. Later he admitted he had been hurt but thought that the act had been useful. Winnicott apparently did not interpret that the smashing of the vase might be an expression both of one pole of her experience in the transference (being destroyed or destroying) and of her self-state (as fragmented). Such an incident is not generally conducive to brilliant insights by any clinician, and Winnicott was in any event not too inclined to emphasize interpretation. Physical holding and attentive observation often took the place of verbal interventions with Little, perhaps brilliantly, as she clearly did not have the words at this point. The oscillation between explosion and silence is a familiar problem with many patients, as described by Green. I illustrate this with two extended case examples in chapter 4. Winnicott learned that, in fact, Margaret Little had been discouraged in childhood from expressing feelings. When he asked her why, she only cried silently. He recognized this as a failure in the mother-child holding and was able to reconstruct with her the damaging interactions with her mother, very much as he did with Guntrip. One might say that he was participatory (sometimes in rather intrusive ways, like meddling with Little's vacation plans by telephoning her friend), but did not analyze his participation, except as supplying a need. Today we might criticize him for this failure to explore his countertransference participation, despite the sensitivity of his intuition.

Little (1985) recounts an important series of events in her analysis after she had broken her ankle on a vacation trip to Scotland, following an "explosion" of anger toward her mother for the first time. Winnicott interpreted the accident as a suicidal reaction to separation from him, apparently having forgotten the important angry episode that preceded it. In her associations to this incident, Little referred to an illness around age five when she entered a febrile delirium, clinging desperately to her mother who, Winnicott interpreted, "would not let you die." Little amends this by saying, "she would not let me choose whether to live or die" (p. 31) Soon afterward, Winnicott himself took this role by insisting that she be hospitalized during his vacation, which she calls a repetition of his earlier reaction to her smashing the vase when he left her alone in the room. Her story suggests an odd confusion between intrusion (excess of presence) and abandonment (absence), restaging her infantile experience in the transference. The report reads as if Winnicott were attempting to supply a missing experience of good mothering, rather than to interpret the actuality of transference. Once admitted to the hospital, Little described undergoing a psychotic regression, at least one characterized by rages and childlike behavior, where she could again lose control, but in a safe environment. Upon discharge, she read her poems and recounted her hospital experiences to Winnicott "much as a child would tell its mother" (p. 84). Here the reparenting analogy was explicit.

In the terminal phase of her analysis, which followed closely upon release from the hospital, Little did receive an important interpretation to the effect that her fear of annihilation referred to an event that had already happened. Much as he was to describe in his paper, "Fear of Breakdown," Winnicott (1973) told her that she had already been psychically annihilated and was now reliving that experience. She agreed, saying that she had never been a person in her own right, only an appendage of someone else. Again, none of this was dealt with directly in terms of the analyst's role in the transference, at least according to Little's narration. Modell (1991) raised the important question, "whose reality is it?" in psychoanalysis, as there is always a danger of the well-meaning analyst imposing her own beliefs, goals, and values on the patient (which is why Lacan stressed "absolute difference"). The assessment of regressive phenomena is one important area in which this reality question can arise. Modell's position is that a patient can symbolically actualize a past relationship while preserving its "as if" character, different from the prototype. Transference is a new construction. Winnicott dealt with regression as though it were a true temporal return to an earlier state. In his short paper on countertransference (Winnicott, 1960), he differentiated neurotic patients toward whom the analyst maintains a symbolic distance—"the gap between the subjective object and the object objectively perceived"—and psychotic patients, who need to regress to a state of absolute dependency on the analyst. The analyst then responds to the patient's presumably real needs. Although Little is quite clear that for her the experience of her analyst as a "real" (that is, objective and separate) person was crucial to her recovery, she does not see him as a second mother. She felt privileged to have known and learned from Winnicott as an analysand and as a colleague in the British Psychoanalytic Society, and she reports that she came to accept what he could not give her of her frustrated infantile wishes.

Whether or not Winnicott did interpret the transference-countertransference enactments, including the possible effects of his own destructiveness, about which he wrote, it seems inescapable that some form of repetition of an earlier situation was a major dynamic of the analysis. As with Guntrip, he appears to have interpreted what the mother actually did or did not do, and he offered a substitute relationship in which earlier failures could be reexperienced and reworked. For these analysands, whose subjective cohesion and vitality were seriously compromised, he provided a holding frame and pointed to failures of environmental provision at the earliest phases of life. Probably, however, he also did something more and something less. Certainly he retained his place as a separate subject ("the desire of the analyst"), for example, telling Little his feelings about her poetry and artwork, whether he liked them or not. He was not necessarily empathic in the sense of attempting to achieve the patient's point of view, and he was not overly cautious in asserting his subjective reality. This stance would certainly have been approved of by Lacan, who insisted on noncompliance with patients' wishes for confirmation of their feelings in the transference. He would also have endorsed Winnicott's freedom to be himself and break with orthodoxy so that his patient might eventually rediscover her own desire as a separate subject. Although Lacan might have (hypocritically) condemned nonverbal interventions, which he himself was not too loathe to carry out, he would have been gratified to learn that it was some of the things Winnicott said that stuck with Margaret Little. Neither analyst apparently ever spoke much in the here and now of transference (although the evidence is incomplete on this point), perhaps in Winnicott's case because he did not feel that transference regression was an "as if" phenomenon that could be interpreted symbolically, especially in terms of his own participation. At the time both these men were trained (and the situation still persists to a great extent), all transference was viewed as a regressive product belonging to the patient, to be interpreted from outside by the analyst. Lacan realized that this type of objectifying interpretation was damaging (it was one of the breaks with orthodoxy for which he was severely criticized by the International Psychoanalytic Association's investigators [Roudinesco, 1986]), and he understood that the interaction (the intersubjectivity) was the crucial dimension of analytic practice. Unfortunately his own limitations may have prevented him from applying these theoretical innovations to clinical work, and he failed to offer the case material for others to learn from what Winnicott proffered.

It is of considerable interest to read Margaret Little's own published ideas about the countertransference, which were innovative and even revolutionary. In her 1951 article, published in the International Journal of Psychoanalysis while she was in treatment with Winnicott, she spoke about the constructive and necessary effects of the countertransference. She wrote that countertransference was not an obstacle to be analyzed but a predictable repetition by the analyst of an earlier relational position lived through in childhood by the patient. She advocated that the analyst communicate her experience, even if negative, as a means of shedding light on the past, which could then be reconstructed in the transference situation. The patient, she observed, lives her transference entirely in the present, while the analyst can potentially separate from this configuration and also see its origins. Psychoanalysis, she argued, creates a reverberating mirror situation for both participants based on transference, but over time, the images can become "clearer for both," as the analyst is able to reveal her subjectivity to the patient. Little also warned against the dangers of the analyst interpreting out of an unconscious countertransference, providing an extended example, which we can now see was derived from her first analysis with Sharpe. She attributed Sharpe's oedipal rivalry interpretation entirely to an unacknowledged countertransference. One wonders, however, whether this constructive use of the analyst's private experience was something Little missed in Winnicott as well. Perhaps his open style of interacting went part of the way for her in satisfying this therapeutic principle.

Lacan, as we have seen, was also interested in the countertransference, and, in fact, commented on Little's paper in his first seminar on technique (1953-1954). Unfortunately, rather than develop those aspects of her formulation that must have resonated with his own ideas, Lacan badly misinterpreted her position, attributing to Little a radical recentering of analysis in the hie et nunc (here and now). Although not as scornful as he could be about analytic authors, he did use Little as a representative of a misguided tendency he found in "the British school" to speak "ego to ego" (p. 32) with the patient. He also confused the anecdote about Sharpe's erroneous interpretation, first asserting that it was correct and then attributing it to Little herself with a candidate. Later, in a chapter once again taking up this theme, Lacan (1960-1961) described analysis as a relationship between two unconsciouses and distanced himself from the traditional view of the countertransference as a neurotic vestige. Two years later in his unpublished seminar on anxiety (1962-1963; see Harari, 2001), Lacan returned to the issue, reiterating his distorted reading of the hic et nunc theme. In some ways, both Winnicott and Lacan equivocated on the countertransference, Winnicott bracketing off the regressive phenomena in treatment of psychotics from the customary interpreting position of the analyst and Lacan still reiterating old saws about the well-analyzed analyst avoiding mistakes. Little saw more deeply, no doubt because of her own painful personal experiences, and helped initiate a paradigm change that we are still digesting.

All in all, one comes away from Little's moving account of her treatment with Winnicott with the impression of an enormously gifted analyst who had a grasp of the earliest building blocks of subjective organization (the mirror, transitional space, maternal preoccupation) and who was not afraid to cross boundaries and participate in a relationship. What, finally, may have helped her discover herself as a real person, existing in her own right? In my own clinical experience, which obviously is in no way comparable in depth or variety, the analytic holding environment and the benign role of a nurturant analyst, about which Winnicott taught us, have always seemed the basic foundation of all treatments. Beyond this, I share Rudnytsky's admiration for the way he was able to convey, if not always speak about, his own participation as an individual with her, distinct from his position as a "subjective object" created by her in the transference. Conversely, I have found transgressing boundaries to be uncomfortable and not necessarily useful (I refer to active interventions in patients' lives, touching, and other Winnicottian behaviors, of which, again, my own experience is much more limited). Winnicott is an inspiration, but not always a guide, and I miss a more elaborated theory, above all a theory of the "self" or subject. As Phillips (1988) notes, Winnicott's notions of the true self have essentialist connotations of an inborn core of a mystical nature.

In what follows, I take a closer look at the concepts of self and subject, attempting to relate the kinds of clinical phenomena addressed by Winnicott to broader themes. Probably, in the end, we will never know what made the difference for Margaret Little, yet with the help of Kohut, Modell, Green, and, of course, Lacan, I believe we can come much closer to understanding what is involved in the peculiar process of "having a life" and what had been missing for her that he was able to reestablish.

¹The entire subject of separation leading to the second birth of the human subject is circumnavigated again and again by Lacan, for example, in "The Subversion of the Subject and the Dialectic of Desire" (1960) and in Seminar IV (1956-1957). That is, it is approached indirectly and often through the negative. Van Haute (2002) has attempted to translate these passages into a more "experience near" and user friendly manner (see pp. 104-119).

²Kohut (1977) mentioned Lacan with others as overlapping with his own interests.

³Rudnytsky's (1991) comparative study of Kohut, Lacan, and Winnicott deals with many issues touched on in this chapter.

⁴See Winnicott and Khan's (1953) review of Fairbairn, in which the lonely Scotsman was tarred with the accusation of departing from Freudian theory.

⁵Lacan went so far as to suggest suppression of the term affective from analytic vocabulary in Seminar I (1953-1954, p. 281). Borch-Jacobsen (1990) noted the absence of Freud's emphasis on the affective basis of the transference, as well as on the primary mother-infant relationship in Lacan's work (see pp. 77-93).

⁶The dummy analogy was discussed in "The Direction of the Treatment and the Principles of Its Power" (Lacan, 1958), as well as in Seminar VIII (1960-1961), in which it was diagramed.

⁷In Lacan (1958), a highly calculated strategy of the treatment was presented.

⁸The full quote is "indicating by this [pretended] some reference to the effort of these recent years in analysis to organise, around the the notion of a situation, what happens in analytic treatment. The word pretended is there best to say that I oppose myself, at least in a corrective position ... to this attempt. I do not think that one may say of analysis, purely and simply, that there is a situation. If there is one ... it is a false situation" [seminar of 16 November 1960; my translation].

⁹There are many versions of schema L, of which one pertaining to the transference was presented in Seminar VIII (Lacan, 1960-1961) and a fuller development was given in Seminar II (Lacan, 1954-1955). In this schema, Lacan depicted the interplay of the imaginary relation of the ego in the transference with its unconscious symbolic dimension. For more on the sorcery of the symbolic position assumed by the analyst, see Borch-Jacobsen (1990, pp. 190-201), where he underlined the essentially fictive nature of the symbol and of the patient's personal myth, received from the Other, which, for him, covers the emptiness of a being whose truest desire is for death. He concluded that Lacan aimed for the reinsertion of a confused subject into an arbitrary symbolic order via the recognition of signifiers of his own unconscious desire, which is essentially meaningless.

¹⁰One can pick up these indications of analytic mastery in Lacan's Seminar I (1953-1954), Seminar XI (1964), and in Ecrits (1966), especially in "Direction of the Treatment" (1958). Much of Lacan's discussion of other analysts' work (see, e.g., his remarks on the case written up by Kris in "Direction of the Treatment") suggested a tone of certainty that would seem to directly contradict his own teaching.

11There are some scandalous and funny anecdotes recounted in Allouch's (1984) compendium. For example, an analysand sighed after a few moments, "I don't have anything to say." Lacan's amused response: "Mais oui! Ça arrive. A demain cher" (Of course, that happens. See you tomorrow). Or the anaiysand beginning, "I dreamt that ..." interrupted by Lacan saying, "That's very good. See you tomorrow."

¹²I have discussed this problem informally with a number of Lacanians, notably the late Jacques Hassoun and, more recently, Andre Michels (both Parisian analysts). On one hand, the example of Lacan was followed, perhaps somewhat uncritically, by many of his students, just as Freud's has been. On a more theoretical level, Lacanians have concerns about emotional dependence on the analyst and on the tendency to regression by analysands, which raise interesting questions. Of course, many influenced by Lacan do not use the short sessions in their practices.

¹³For similar critiques of Lacan playing the part of master see Roustang (1986) and Althusser (1985a).

¹⁴Roudinesco (1993) gives examples. See also the anecdotes gathered by Allouch (1984) and Clement (1981).

¹⁵This formula is highlighted at the end of Seminar XI (Lacan, 1964). The entire discussion of countertransference in Seminar VIII (Lacan, 1960-1961) revolved around papers of Kleinian analysts, which seemed to evoke in Lacan an avuncular smile of tolerance for a kind of erroneous thinking (object relations) that has stumbled across a distorted truth.

¹⁶Roudinesco (1986, pp. 117-122) discusses this chapter of Lacan's history in her study of psychoanalysis in France and, more incisively, in her biography of Lacan (1993, pp. 70-74), where she cites interviews of colleagues and associates, as well as the biography of Marie Bonaparte by Bertin. For example, she recounts an incident described by Lacan in which he told his analyst about an incident in which he was driving his car in a tunnel toward a large oncoming truck, which ultimately gave way. Lacan allegedly understood this as a transference phenomenon about which Loewenstein failed to comment. In addition to the weight given this story by Lacan himself as describing a mortal Hegelian struggle with his analyst, the imagery of the tunnel also seems suggestive of Roudinesco's thesis of Lacan's damaged childhood.

¹⁷In addition to her accounts in the biography, Roudinesco uses the phrase "the psychic cruelty which marked the childhood of Lacan" (p. 299) in her fascinating dialogue with Jacques Derrida, De quoi demain (Derrida and Roudinesco, 2001).