Essay: Applying theories of John Bowlby / Donald Winnicott / Daniel Stern to observational case study

DANIEL STERN
Daniel Stern spent his career examining how the infant develops a sense of self and he did this by bringing together two concepts: The observed infant is a result of clinical observations made between mother and baby, recorded and analysed by Stern and others. The clinical infant is a reconstruction of an adult’s memory of their life as an infant, mostly realised through therapeutic work. Brought together Stern is able to draw inferences of what their infancy was like during those first few years, and having an appreciation of these two concepts enables the psychotherapist to help the child make more sense of their earlier ‘life narratives’ (1985: 15 – 17).
Stern believes that the infant organises experiences with its Mother, leading to ‘intersubjective relatedness’ (1985: 27-28). This is how the infant not only learns to relate to its mother as a separate being but focuses on the quality of that relationship. Those every day moments that occur between mother and baby – being fed, playing a game of peek-a-boo or simply being held – are significant in how we develop that sense of self and crucial if the infant is going to develop it’s own subjective experiences (1985: 3).
The toddler observations I have undertaken have given me an insight into this process as I witness personalities taking shape and how conflict is dealt with. In these examples, Charlie who is three years and four months, deals with being hit repeatedly by another toddler in a calm, controlled way, whereas Lee, who is five months younger, reacts very differently when another boy pushes him on the floor.
Charlie says ‘I don’t like it Jonathan’ followed by ‘stop’. Interestingly Jonathan hasn’t made Charlie cry and she isn’t asking for any help. She is trying to deal with it herself and she isn’t retaliating by hitting back
(Rose, 2016: 23/30).
Lee bursts into tears and runs to one of the teachers…She picks him up and gives him a cuddle…the teacher carries Lee over to Oscar and tells him that he hurt Lee…Oscar strokes his head and Lee runs off, happy
(Rose, 2016: 4/30).
What experiences have Lee and Charlie had with their primary caregiver that makes them deal with conflict in very different ways? Stern proposes four “domains of relatedness” (1985: 31-32) that assist in the formation of the sense of self. These are not phases of development but interrelated layers emerging over the first two years, complimenting one another (ibid.). The first domain, the emergent self, lasts until the second month. This is like an awakening, a realisation that ‘I am alive’ and with that comes a gradual awareness of the world through lived experiences (1985: 37 – 38).
Next is the domain of the core self and experiencing for the first time what it’s like interacting with another individual who’s able to regulate our physiological needs. The mother might be making funny faces when her baby smiles, soothing when it starts to fret or talking to it when it shows interest in a toy or her breast (Stern, 1985: 100 – 102). The infant learns to symbolise these interactions turning them into “lived episodes” that can be recalled when necessary (1985: 110). Stern calls these “Representations of Interactions that have been Generalised” (1985: 97).
“Whenever a RIG is activated, it packs some of the wallop of the originally lived experience in the form of an active memory” (Stern, 1985: 110).
This forms the heart of what it means to be with a self-regulating other and if that person is absent then “the infant encounters an evoked companion” (Stern, 1985: 111). This is a coping mechanism, a way for the infant to evoke what it’s like being with their mother (ibid.). Stern describes how the absent caregiver can be recalled once the caregiver has infused objects such as toys, almost liked it has personified them (1985: 122).
I can see the “evoked companion” (Stern, 1985: 111) coming alive whilst observing Lee. On this occasion he was enjoying playing with a ball that he brought into the nursery until he was told to put it back in his bag,
Lee doesn’t like this and says ‘No’ and his happy face changes to one of sadness. Abi says ‘ok you can play with the ball for 5 more minutes and then you’re going to have to put it away’. Lee’s face crumbles again and he stands there holding his ball gazing around the room. Is he thinking about the potential loss to an object that holds some significance from the weekend? Then something interesting happens. Lee runs up to one of the staff members and says ‘bag’ and she says ‘that’s it, go and put the ball away’ and Lee runs out of the room to his ball away (Rose, 2016: 13/30).
Lee is identifying with the imbued object, in this case the football and what it represents to him when considering the ‘evoked companion’ (Stern, 1985: 111). Putting the ball away seems to represent a loss, but he’s able to reconcile this, realising that the essence of what it stands for will continue even if it’s inside his bag.
Stern’s third stage is the sense of a subjective self that sees the infant developing needs, likes and dislikes and realising these experiences are sharable with others. This might be as simple as ‘I want you to give me that toy’ or, ‘I’m crying because my nappy is wet’. The quality of Mother’s interactions dictate whether or not the baby feels understood. Stern calls this “affect attunment” (1985: 138 – 139), meaning how the Mother lets her baby know that she is feeling something very similar to her child. This sharing of affective states is crucial. Imagine a baby smiling at his Mother but she is struggling with depression and finding it hard to “imitate the infant’s (happy) facial expressions and gestures, and the baby would see her doing this” (ibid.). If this lack of attunment was repeated over a period of time, one can see how the attitudes and psychological health of the mother can have a huge impact on the baby’s sense of self before he has even learnt to speak (ibid.).
The fourth stage is the discovery of language and the verbal self and with this domain comes a divide; as the infant learns to use words to disguise his true feelings and thoughts (Stern, 1985: 162-163). The older we get, the more this split deepens, as our thoughts take over and so much is left unsaid. This leads to so many of the conflicts we see in adult relationships. It’s important to keep this in mind when working therapeutically with children; giving consideration to all that is left unsaid. The infant taught that it’s not appropriate to share thoughts and feelings may feel the same way in therapy. By nurturing the child’s true self and what makes them unique we can offer them a safe space to express themselves, which maybe expressed through play.
Each domain of self; emergent, core, intersubjective and verbal is continued throughout life and keeping each stage in mind when working therapeutically with a child may help them find a “narrative point of origin” (Stern, 1985: 262). By this I mean that there is likely to be a link between what the client experiences in the present and the way they must have felt as an infant. We can theorise what sense of self has been affected and needs addressing. For instance an adolescent feeling like they are not understood may have its routes in “intersubjective relatedness” (1985: 27). Ultimately each phase is a “sensitive period” (1985: 273) for the infant and its crucial to remain attuned to their impact in life (1985: 256 – 264).
DONALD WINNICOTT
Donald Winnicott started his career as a paediatrician but in the Second World War he got involved in setting up homes for traumatised children whose foster placements had broken down. This led to him becoming more interested in psychotherapy and he was introduced to Melanie Klein who was making great waves of her own analysing children. As a child psychoanalyst, Winnicott was a passionate believer in play; indeed this is where his theories come alive, “It is play that is the universal, and that belongs to health” (1971: 41), and through these observations one begins to understanding the type of relationship the child has with their parents. For any psychotherapist, this is key, but in order to understand why a child may find it difficult to play, it is necessary to go back to their earliest experiences.
‘’There is no such thing as a baby” (1958, p.99) said Winnicott, meaning that where there’s a baby there is always a maternal adult. And so begins the journey of what Winnicott calls the “good enough mother” (1971: 10). This is the mother able to create an illusion of oneness with her baby, able to adapt to its needs, which makes him feel safe and omnipotent. One way this happens is via the breast, the baby becomes hungry and the breast appears. “It is, as it were under the baby’s magical control” (1971: 11).
However not even the “good enough mother” (Winnicott, 1971: 10-11) is able to be there all the time and therefore the baby must learn to cope with feelings of frustration and separation; in other words disillusion (ibid.). The weaning process is a form of separation, but from the breast. Arguably weaning is a difficult adjustment for a number of babies, which perhaps adds weight to Winnicott’s concept. In fact he reminds us “If illusion-disillusionment has gone astray the infant cannot get to so normal a thing as weaning” (1971: 13).
However, not every child is breast-fed, indeed Winnicott reminds us that being fed by bottle doesn’t equate to being a bad mother (1971: 11). What I’m able to take away from the concept of “illusion – disillusion” (1971: 13) is the baby’s perception of how its Mother is able to attune to it’s every need, both physically and mentally giving the illusion “that what the infant creates really exists” (1971: 12).
What would happen if the mother were unable to foster the illusion of omnipotence, perhaps through difficulty relating to her baby? Winnicott is quite clear about the problems this can cause with his reminder that “there is no health for the human being who has not been started off well enough by the mother” (1971: 11).
How else might the infant cope with feelings of separation from its Mother? Winnicott believed that an infant’s babbling, it’s fingers inside it’s mouth through to the relationship they have with cherished toys or blankets were key in understanding how the infant copes with feelings of separation. Transitional phenomena is a way of evoking a representation of mother in her absence, an acknowledgement that he is going through a state of transition (1971:14).
“The transitional phenomena represent the early stages of the use of illusion, without which there is no meaning for the human being in the idea of a relationship with an object that is perceived by others as external to that being (Winnicott, 1971: 11).
In an observation carried out with Charlie I saw her sucking her thumb but with her spare hand she caressed her ear repeatedly,
Charlie takes her seat on the computer bench and puts her thumb inside her mouth and slouches onto the desk pushing her bum out…She sits back up and this time she’s sucking on her finger. Another toddler is in distress and won’t stop crying. Charlie stares at the crying toddler. I look for a reaction from Charlie but I don’t get one, she has a blank look on her face. As the crying toddler wanders away Charlie goes back to self-soothing and sucks on her thumb. With her spare hand she caresses her ear, a movement that I see her doing repeatedly today (Rose, 2016: 24/30).
It could be said that Charlie’s use of the transitional phenomena is a way of evoking the feelings she has about feeling separated from her mother as she begins to come to terms with the outside world.
From the transitional phenomenon comes the concept of transitional objects, which may be a blanket or soft toy. The parent respects the right of their child to make the object their own and it is not challenged (Winnicott, 1971: 4).
“The object represents the infant’s transition from a state of being merged with the mother to a state of being in relation to the mother as something outside and separate” (Winnicott, 1971, 14).
My own transitional object illustrates why Winnicott’s theory resonates so much. A red bear stayed with me as I grew from baby to child and despite holes appearing in its body and it’s eyes falling out, I recall nursing it with bandages, not wanting to give it up. I kept it in a bedside cupboard and it was only when I entered adolescence that I was able to say goodbye. As Winnicott says, “it becomes not so much forgotten as relegated to limbo” (1971: 5) I now wonder if covering the bear in plasters represented how I felt about earlier losses I experienced or was it representing the hurt I was feeling at being alone in hospital? In fact Winnicott reminds us that just prior to loss, or when feelings of anxiety are prominent, we may see exaggerated use of the transitional object. (1971: 15). I was able to experience the bear as a transition between my imagination and all that the outside world entails; something Winnicott argued is essential for good mental health in later life along with a sense of creative satisfaction,
“Throughout life (it) is retained in the intense experiencing that belongs to the arts and to religion and to imaginative living, and to creative scientific work” (Winnicott, 1971: 14).
Winnicott’s theories cement the power of play through the relationships children have symbolically with objects, whether physical or something less tangible. Being aware of this in the therapeutic environment is valuable. My experience of experiential work has shown me the power of play and what we unknowingly project through our imagination. Children may act out their own anxieties through play, consciously or otherwise highlighting the importance of being attuned to what they may be trying to convey. I feel excited about the possibilities of play and what can be achieved between therapist and child. As Winnicott himself said, “Psychotherapy has to do with two people playing together” (1971: 38).
JOHN BOWLBY
All newborns, whether human or animal appear to be born with some innate bonding mechanism, relying on our birth mother to ensure our emotional and physical needs are met and to protect us from danger. It is in a way a form of survival. This forms the crux of Bowlby’s work on attachment, which grew out of his work with emotionally disturbed children. Making a connection between how these children coped being taken from their mothers at such a young age and any subsequent neurosis in later life formed the basis for his theories of attachment behaviour.
Bowlby proposed that the roots of any satisfying relationship must start at the beginning, between mother and baby; the infant must feel safe, secure and protected in order for a secure attachment (1979: 23) to take place. Many of our negative and positive personality traits about how we relate to others are linked to our earliest attachment experiences (1979: 127), and they are just as likely to get played out in the therapeutic relationship, hence the importance of understanding its significance and context in child development.
Examples of dysfunctional behaviour that can result in attachment issues in children include the caregiver being persistently unresponsive, rejecting or threatening. Childhood loss or trauma such as bereavement or extended absences from the attachment figure can also cause a child and adult “to live in a constant state of anxiety lest he lose his attachment figure” (Bowlby, 1979: 137).
Mary Ainsworth developed The Strange Situation test (Ainsworth et al, 1978: 32) as a way of classifying attachment behaviour. In essence the test involves an infant spending time in a room with its mother or a stranger. When the Mother returns to the room, the way the infant copes with the reunion is observed leading to four potential classification types being diagnosed for the infant. The four attachment styles are secure, avoidant, resistant and disorganised, and each of them reflects the quality of the relationship between mother and infant, indicating potential attachment concerns in later life (Ainsworth et al, 1978: 120 – 124).
In this example from a toddler observation, Lee gets upset when another toddler takes away some crockery he was playing with. His decision to seek help followed by his prompt recovery from distress, point towards a secure organised attachment style (Bowlby, 1979: 23),
Lee tries to pull the cups back but she won’t hand them over…Lee stands up now, crying…seeking comfort from an adult. One of the nursery staff takes his hand and pulls him closer. She explains to the others that Lee was playing with them first. I see her rubbing his back comforting him and he begins to relax. I noticed that Lee is now starring into space, his eyes wandering around the room. It takes less then a minute for his mood to improve as his affect changes from one of sadness to happiness. He runs over to the other side of the room, spying a tower of Lego bricks being built (Rose, 2016: 7/30).
Lee has demonstrated that he has a positive expectation of how he expects others to help him when things go wrong, in this case the nursery staff. This has been built from the start by his relationship with his primary care giver (Bowlby, 1979: 8). It is this internal working model (1969: 81) that’s hardwired into our brains from birth and thus learnt and then acted out in an unconscious way throughout life. A toddler without a secure attachment might not have been able to recover as quickly as Lee. They might have appeared angry or remained quiet or moody, or perhaps acted out by breaking something or hurting someone.
The internal working model (Bowlby, 1969: 80 – 81) is an important concept because it acts like a blue print of how we see ourselves and relate to others. A good internal working model (ibid.) grows out of a consistent and loving relationship with our primary caregiver, where we deem ourselves worthy of love and this impacts on future relationships. The insecurely attached child has a very different type of internal working model (ibid.); they may be wary of others or think they are not good enough or unworthy of love.
Out of the secure attachment (Bowlby, 1979: 23) comes a “secure base” (1979: 132), a form of exploratory behaviour. A secure child will happily explore their environment if their attachment figures whereabouts are known. This assists in strengthening the attachment and as the child matures they are able to play independently without constant reassurance from the attachment figure (1979: 132).
“Human beings of all ages are happiest and able to deploy their talents to best advantage when they are confident that, standing behind them, there are one or more trusted persons who will come to their aid should difficulties arise” (Bowlby, 1979: 103).
The idea of the “secure base” (Bowlby, 1979: 132) can be seen in the following example observing Lee compared with another toddler, who showed signs of insecure attachment behaviour,
Lee runs back to the Lego table and sits down playing with the car he built earlier. He is sat on his own and I’m struck with how content he is and how comfortable he appears doing his own thing. I contrast this with a new toddler at the nursery who concerns me; he wanders around always distressed and crying, wanting his mother and babbling. I wonder what’s wrong with as his behaviour seems concerning (Rose, 2016: 19/30).
Lee shows signs of having developed a “secure base” (Bowlby, 1979: 132), playing without always needing an adult close by. The only time he seeks help or comfort is in times of conflict or if he’s hurt. In later life Lee should feel confident about his relationships and how he relates to the world. The other toddler is seen to rely on the staff a lot more and as he gets older he may be distrustful of others and question whether he will be happy and secure.