The Forgotten Appointment: Mismatch-Repair and Therapeutic Change

My pediatrics practice offers evidence for the healing power of repair. When years ago I shifted from asking questions and giving advice to creating a safe space for simply listening, I saw families move from anger and disconnection, sometimes through deep sadness, and then to moments of reconnection. A young child would spontaneously run into their mother’s arms to receive a hug. Often, I felt a tingling in my arms, and my eyes filled with tears in the presence of rediscovered joy and love. I’ve come to understand the repair itself as responsible for the healing and growth I witness again and again as I support families through this process.

D.W. Winnicott drew upon his experience as both a pediatrician and psychoanalyst to build his developmental theories, including the idea of the “good-enough mother,” a concept that lies at the root of the repair theory of development. While I have studied psychoanalysis as a scholar with the Berkshire Psychoanalytic Institute, I am not a psychoanalyst. However, my personal analysis gave me an experience of the power of repair that deeply informs my thinking and clinical work. In this post I experiment with sharing a little bit of that story.

My therapy ended ten years ago. I now recognize that its enduring impact on my emotional wellbeing lies not primarily in the story I told in words but in the countless moments of moving from misunderstanding to understanding strung together over time. The microscopic mismatches in interactions contained in the office space, the larger disruptions of days between appointments and vacations, as well as some massive ruptures, including the forgotten appointment, and their subsequent repair, all contributed to the process. They changed the nature of my sense of self and my relationships with people close to me.

Winnicott described how his patients would “regress to dependence” in their relationship with him, offering him a window into their early life experience. At the time I began therapy at the age of 40 I appeared to have a well-functioning life, with a good marriage, a successful career, and two healthy young children. Yet from the very first session, I struggled to hold myself together between appointments. I could behave as others around me expected, but inside I felt like I was falling apart. When I entered his office, I immediately felt safe and whole. A video I use when I teach about repair theory shows a father comforting his newborn daughter, helping her to become still and calm simply by speaking to her. The image resonates for me.

The forgotten appointment occurred several years into our work together. It was early on a Friday morning, and he had rescheduled from our original time because he was running a conference. We had discussed the change several days prior at an appointment that he had also rescheduled because he had been away at another conference. That morning as I took the familiar drive past sheep farms through rolling hills, I imagined our upcoming conversation. My mind was already in that safe space of his office. But I arrived to discover a locked door. In retrospect, I see it represented a mismatch of the magnitude seen in the still-face experiment. I struggled to make meaning of the situation. My first reaction was terror. Maybe he had died.

Winnicott used the lovely phrase going on being to capture the way we hold on to a coherent sense of self in the face of stress and disruption, an experience that develops in the earliest interactions between a parent and infant. He formulated the idea in terms of actual minutes. He described how when the mother is away for “x + y minutes” the baby can hold on to her image. But when she is gone for “x + y + z minutes,” the baby is unable to hold on to that image, and from the infant’s perspective, it is as if she no longer exists. This experience of “x + y + z” can produce in the baby an “unthinkable anxiety” that he himself no longer exists.

That phrase could apply to my state of mind as I made a concerted effort to behave normally while I waited to hear from my therapist. My sense of “going on being” faltered as minute after minute passed and I had no idea what had happened. When after what felt like an eternity but was actually a few of hours, he called to apologize, my terror turned quickly into rage. How could you forget me! The relationship felt “good-enough” for me to unleash my full fury. Rather than smooth things over, we got into the mess, navigating the conflict to repair our relationship and move forward.

For many years I attributed the significance of this interaction to the narrative. I learned that the conference to which he had traveled the week before was about the Holocaust, and that the morning of the forgotten appointment he was interviewing a Holocaust survivor. My father is a Holocaust survivor, though I had rarely up to that point in my therapy spoken about that history. But now over 15 years later, I see the meaning not primarily in the explanation of the forgotten appointment, but in the repair of this real relationship in real time.

In a developmental process over time, the repeated moving from feeling disconnected and alone to calm and safe became part of my sense of myself. I can draw on the memory- the bodily sense of wholeness- in an instant, no words required. I can be fully present in a difficult experience, whether my own internal struggles or in relationship with another person, knowing that there will come a time when it ends, and healing will happen. In those countless moments of mismatch and repair, I discovered hope.

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