Anxiety and the Not-Knowing Stance: Lessons from Winnicott

A new writing project has happily returned me to the work of pediatrician turned psychoanalyst D. W. Winnicott. While of course I never knew him- he died in 1971 when I was ten years old- his writing resonates deeply. He was among the first to help me make sense of both the distress and powerful moments of change I experience in my work with parents and young children. “Yes, exactly!” I find myself often saying to the words on the page.

That is not to say that I don’t sometimes disagree with Winnicott. Take for example, his famous case of the Piggle. While I had not yet been introduced to the world of infant mental health with its wealth of evidence supporting dyadic work, when I first read it for my studies with the Berkshire Psychoanalytic Institute in the early 2000’s I found it troubling. He treated this young child from the age of two to five without significant involvement of her mother, who for most visits stayed home with her younger sister. In 2014 I attended a fascinating discussion at a meeting of the American Psychoanalytic Association of a paper by Deborah Luepnitz about her work about with the Piggle, whose real name is Gabrielle, as an adult. Her findings confirmed my suspicions of a missed opportunity to repair a real relationship in real time. In an article I wrote about the experience, I attribute the problem to historical context:

“The field of child analysis was born out of adult psychoanalysis. There was, and in some ways continues to be, a need to be considered “true analysis.” Given the centrality of the transference relationship between analyst and patient, bringing the child’s parent into the room for therapy for presents a significant conceptual challenge….Both psychoanalysis and contemporary developmental science are founded in the fundamental human need to make meaning in our lives. I hope each discipline can continue to inform the other in meaningful ways.”

In the next stage of my efforts to integrate these disciplines, I’m looking to explore what Winnicott learned from his experience with adult patients. As a pediatrician who has practiced infant mental health/early relational health for many years, I hear echoes of his core concepts in my work with mothers and babies every day. But as a colleague recently pointed out, I’ve now probably worked with more young children and caregivers than Winnicott.

Not being an analyst myself, my understanding of his work with adults derives primarily from my analysis with a therapist who was himself profoundly influenced by Winnicott. With that relationship over a decade in the past, I wanted to understand my own as well as Winnicott’s experience in more depth. I began by reading a review of his patient Margaret Little’s personal account of her analysis with Winnicott titled Psychotic Anxieties and Containment. I was immediately richly rewarded!

As readers of my work know, I’ve come to see what I name as “playing in the uncertainty” as a critical part of clinical work with infants and parents. Supporting frontline practitioners in cultivating a not-knowing stance is a central aim of my teaching and writing. My new book— coming out in Spring of 2025—opens with the epigraph “To start with, I didn’t know” an opening line of Winnicott’s famous essay “The Ordinary Devoted Mother.” This line following his explanation that in his talks for parents, ” I had no wish to tell people what to do.” But beyond that I had not read any specific reference to the not-knowing stance. That is, until I heard it directly from Little.

The review of her book opens with a discussion of different views of the value of regression in psychoanalysis. Then the author summarizes the failed therapies that preceded Little’s work with Winnicott. She finally found her way to him at the age of 48. The reviewer quotes her description of an early session:

“I curled up tight, completely hidden under the blanket, unable to speak or move. DW was silent until the end of the hour when he said only, ‘I don’t know but I have the feeling that you are shutting me out for some reason.’ This brought relief, for he could admit not knowing, and could allow contradiction if it came.”

This exchange offered an opening into a deep and deeply painful regression that proved to be profoundly healing for Little.

In my role first as a fellow and then as a faculty member of the UMass Chan Medical School Early Relational Health Fellowship I’ve had the privilege to be immersed in contemporary developmental science while engaging in clinical work with infants and caregivers. Both experiences together enhance my understanding of Winnicott. Two interactions concerning his concept of the good-enough mother offer an example. In my opening presentation for the 2022-2024 cohort one of our fellows pushed back against my presentation of Winnicott’s wisdom. She claimed that that he failed to appreciate the social context that neglects and often oppresses new mothers.

One of the hallmarks of our fellowship is that we  encourage students to feel comfortable  disagreeing with faculty. A robust email exchange followed in which she shared her  understanding of the concept of the “good-enough mother” as implying that there was a “right” way to parent. As we worked through misunderstandings, the exchange taught us both new ways of listening. It strengthened our relationship.

But it wasn’t until almost two years later when another colleague made a casual comment about her child’s TV viewing habits that I fully appreciated my student’s perspective. She told me, “I have a hard time following the American Academy of Pediatrics guidelines. Often it doesn’t work for us. But I try to be better.” Then intentionally referencing what she understood of Winnicott, she said she hoped it was “good-enough.”

I wrote back, “Let’s begin with a shared understanding of the true meaning of the term originally described by Winnicott. A common misperception is that some external authority dictates the “right” way and that the “good- enough mother” aims to meet this standard but often misses the mark. What Winnicott refers to as “failures”— what I describe as imperfections— occur not relative to an outside expert but rather in the relationship between infant and caregiver.
 
This misperception, perhaps born of a culture replete with parenting advice, instruction, and tik-tok videos, is in some ways the opposite of Winnicott’s meaning. He recognized the mother as sensing what is right for her child— in keeping with herself, her family, and her larger cultural context— as long as she has a “holding environment” that supports her in proportion to the essential nature of the task.”

It’s been a pleasure to returned to the primary source- rereading— and reading some for the first time—  Winnicott’s selected essays in the book Talking to Parents. In a brilliant section titled “Saying No,”  he identifies the complexity of the experience for parents when they must begin to set limits on their child’s behavior.

In it I found this gem, which I would have liked to share with my student:

“In my work I learn a great deal about the difficulties mothers have when they are not fortunately placed. Perhaps they have big personal difficulties so they can’t fulfill themselves even when they can see the way; or they have husbands who are away and don’t give proper support, who interfere, and who are even jealous; some have no husband  but they still have to bring the baby up. And then there are others who are caught up in adverse conditions, poverty, crowded dwellings, unkind neighbors.” 

Winnicott did not have to contend with many of the current challenges we face, including the relentless influence of social media. But his recognition of the value of not- knowing has great relevance today. We live in a time of enormous, often terrifying uncertainty – the pandemic, climate change, political upheaval. Faced with overwhelming anxiety— both internal and external— people may cling to certainty as a form of protection. But ironically this certainty only serves to make us more disconnected from each other. We miss the opportunity to grow and change by moving through misunderstanding to understanding. That Winnicott’s simple words, “I don’t know” could open the door to profound change for his patient Margaret Little (where other therapists had failed) offers evidence of what I call the superpower of the not-knowing stance. As a counterbalance to the fear that characterizes our world today, it is more important than ever to lean in— or to “listen in” —to not knowing.

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