I recently had the great privilege to moderate the graduation of what they themselves call the “Covid Cohort” of fellows in the University of Massachusetts Infant-Parent Mental Health program where I am a faculty member. Our first and only in person session occurred on the weekend of March 5th, 2020, days before the world shut down. At the final colloquium of the two-year program -that subsequently occurred entirely online- each present an “integrated learning project” in which they apply theoretical concepts from luminaries in the field.
This class of 28 represent many different disciplines, including Pediatrics, Psychiatry, Clinical Social Work, Nursing, Education, Physical and Occupational Therapy, Mental Health Counseling, Nutrition and Lactation Consultation, Special Education, and Clinical Psychology. They came to the program not only from all over the United States, but all over the world, including Chile, England, Canada, Germany, Greece, Israel, and Bermuda. One fellow from Israel whose final project was development of online groups to meet the needs of parents with young children suddenly stranded at home by the pandemic, described it as “one of the most amazing programs the mental health world has to offer.”
A core theme of the program-the value of embracing the messiness inherent in human relationships-derives from the research of lead faculty Ed Tronick. Immersed in parent-infant relationships through observational research, he discovered that rather than the prevailing notion of graceful “serve and return” interactions, typical relationships are characterized by on average 70 percent mismatch. As long as the majority are repaired, development proceeds in a healthy way. The repair itself fuels growth and change.
Pediatrician turned psychoanalyst D.W. Winnicott captures the same phenomenon in his concept of the “good-enough mother.” For Winnicott, not a researcher in the contemporary sense, his ideas derive from the combined experience of intimate knowledge of parent-infant relationships in his pediatrics practice, and his work as a psychoanalyst where adult patients would in his words “regress to dependence,” using adult language but behaving in relationship with him as in an infant-caregiver relationship.
Both Winnicott and Tronick share a deep appreciation for what goes right. That unique perspective -different from clinical experience primarily with illness or “pathology”-lies at the root of their wisdom. For only be having a deeply felt sense of what goes right can we understand how to facilitate healing when things go wrong.
My development as a clinician and as a human has occurred in relationship with both Tronick and,-in a sense by proxy-Winnicott. While Winnicott died in 1971 when I was ten years old, I had the good fortune to be in therapy as an adult with a psychoanalyst whose work is deeply influenced by Winnicott.
All three voices came together in a recent interaction. Dr. Tronick and I were being interviewed about the book we co-authored, The Power of Discord. In response to a question about dissociation in response to threat, Dr. Tronick explained how the primary strategy when faced with threat is to go to another person. When that fails-when no safe person is available-the feelings of abandonment precipitate the state of dissociation. Not simply an internal physiologic reaction to terror- as with the proverbial mouse in the jaws of a cat-dissociation occurs exactly because of the absence of a safe person.
After the interview I shared with Dr. Tronick how my former therapist Dr. Fromm in his new book Traveling Through Time, in one example of many references to Winnicott, captures the same concept.
“Winnicott brings us into trauma in his “Fear of Breakdown” paper (1974) His description of the person’s suffering goes beyond simple anxiety; rather he describes the “agony” of disintegrating as a person, of being unable to contact reality, of “falling forever.” What has happened to the traumatized person? The Other, on whom we absolutely depend at crucial moments in our lives, has gone missing. Trauma is about the failure of what Winnicott calls the holding environment when it is most needed. The only way for the mind to survive is to leave, to shut down, to dissociate.”
The holding environment, a term that like the “good-enough mother” has found its way into common usage, captures that moment-by-moment interaction in which infant and caregiver get to know each other. Both terms have profound and specific meaning.
Newborn infants have a tremendous capacity to communicate purpose and intention. Their survival depends on it. From their first breath, babies have unique ways of moving and responding to their environment. Their cues can be subtle. Caregivers frequently miss their infant’s signals. Yet healthy development happens exactly because of these missed signals. As parent and infant move through misunderstanding to understanding, their connection deepens. At the same time a baby gets an increasingly clear and hopeful sense that “I am me!”
As I reflect on the two-year fellowship that continued undeterred under these extraordinary circumstances, I see it as a representation of Winnicott meant to convey. Both Winnicott and Tronick’s core concepts-as derived from intimate knowledge of how things go right from the start-have great value throughout life, but especially when things go terribly awry.
In March of 2020, we were all collectively faced with an invisible yet terrifying threat. The group including fellows, faculty, and luminaries held each other over countless messy moments of uncertainty and loss. The result was a profound sense of connection and trust that fueled the explosion of creativity brought forth in their work. The impact will change the lives of infants and families throughout the world for years to come.