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How Do You Get Where You Want to BeWhen You Don't Know Where You Wantto Be?Dr. Jennifer Johns a ba British Psychoanalytical Societyb Winnicott TrustPublished online: 06 May 2009.

To cite this article: Dr. Jennifer Johns (2009) How Do You Get Where You Want to Be When YouDon't Know Where You Want to Be?, Psychoanalytic Inquiry: A Topical Journal for Mental HealthProfessionals, 29:3, 223-235, DOI: 10.1080/07351690802275154

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How Do You Get Where You Want to Be WhenYou Don’t Know Where You Want to Be?

Jennifer Johns

I tell the story of my own development from the childhood of a psychiatrist’s daughter in wartime Brit-ain, through a brief career in family medicine, to the position of a member of the Independent traditionin British psychoanalysis. As well as having psychoanalysts from different theoretical orientations inmy family, I became confused during my training by the different strands of thought and techniquetaught and promulgated in the British Psychoanalytical Society. For some time after qualification, Itook the lonely path of listening mostly to my patients’ material as the prime source of understandingmental suffering. It was only after a few years that I was satisfied at being able to connect psychoana-lytic theory with what I heard in the consulting room, and following this was further able to exploredifferent strands of psychoanalytic thinking to reach my own position.

From the beginning of life, I always knew that the mind was important, that thinking and the thingsthat I felt mattered. I do not think that I can remember, but I can remember remembering, that I de-cided to become a doctor when I was three, just about the time when I was inoculated in the bottomagainst diphtheria, and also that the determination coincided with a feeling of great affront aboutwhat had happened to me. I must have decided then, without knowing the theory of identificationwith the aggressor, that I preferred the role of doctor to that of patient, and since both my parents,my maternal grandfather, and a great-aunt were medically qualified, it was not such an unusual de-cision. The decision to become a psychoanalyst developed with great difficulty, much later andmore slowly; and the realization that I actually was one arrived quite some years after I hadqualified.

However, being curious about how people as well as things worked, I do remember a conversa-tion with my father when I was quite small, certainly under seven, when he explained to me thatthought, that is, being able to think, depended on having words to think with. Without words, hetold me that there was no thought. Up till that time, the adults in my life had seemed to know ev-erything, but suddenly I found myself disagreeing strongly. I knew that there were thoughts Icould not express or even know about properly because I didn’t know the right words yet, but I washurt and once more affronted that they were being dismissed as not being real thoughts. I think thatwas probably the beginning of a level of scepticism about received knowledge that has both helpedand hindered me ever since.

My father, Tom Main, was a psychiatrist when I was small and became a psychoanalyst onlylater; then he worked at a large mental hospital in the beautiful countryside of Northumberland,

Psychoanalytic Inquiry, 29:223–235, 2009Copyright © Melvin Bornstein, Joseph Lichtenberg, Donald SilverISSN: 0735-1690 print/1940-9133 onlineDOI: 10.1080/07351690802275154

Dr. Jennifer Johns is a Member of the British Psychoanalytical Society and Chair of the Winnicott Trust.

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the northernmost county of England. Ten years before the British National Health Service, suchenormous institutions cared for the chronic, as well as the acute, patients, and also those whoselow level of intelligence precluded an ordinary life. The hospital and grounds—with three farmsand a market garden, orchard, bakery, and so on, where those patients able to manage in a pro-tected community occupied their days—resembled a small, rather eccentric village. The older“burned-out” schizophrenic patients, the chronically depressed and the simple, including Down’ssyndrome patients and others congenitally damaged, were a part of everyday life for the childrenof doctors and nurses who played around the staff houses where we lived. People who looked orbehaved peculiarly were not alarming, just part of life. They tended the farm animals, deliveredthe milk, and did the gardening.

When I was about four, during the Second World War, my father joined the Army, which meantthat we left this closed environment to live in a small town nearby, from where he traveled a lot,and was away for a good deal of time. I particularly remember a letter from North Africa, as it hadbeen heavily censored with black ink on the way, wartime anxiety being such that even a letter to asmall girl might have contained sensitive information. I did not realize it, but he was meeting col-leagues who were to become influential in his future life, and thus eventually in mine: many youngpsychiatrists and psychologists, and importantly the then Major W. R. Bion, and the psychoana-lyst Dr. John Rickman, whose pre-War interests, like his own, included a fascination with thetreatment of mental disorder by psychoanalytic methods, and who were to become eminent in thepsychoanalytic world later. I knew nothing of this, except that when my father and his friendscame home to discuss their ideas, there was an atmosphere of tremendous excitement, even pas-sion. At this stage I must have seen, from a child’s point of view, a group of people in a strangestate, suffering losses of friends and colleagues due to the emergency, but who were elated by theprospect of developing their hard-won thinking in different directions. They seemed to believethey could plan the future of psychiatry in what looked like a time of post-War opportunity, andthat they would be able to use the psychoanalytic thinking that had actually been so useful to themand did eventually lead to the development of Group Therapy and the Therapeutic Community, aswell as new ideas of institutional thinking. At the end of the War, when we lived at Northfield, themilitary hospital in which many of these ideas began, there was enormous excitement about thevisit to the developing therapeutic community by a group of influential and renowned Americanpsychiatrists. Many years later, I discovered that one of the group had been Karl Menninger, wholater devoted an issue of the Bulletin of the Menninger Clinic to the work being done by his Britishcolleagues. My father’s links with American psychiatry led to my being lucky enough to have meta number of well-known analysts during my growing up.

Post-War, my father became Medical Director of the Cassel Hospital, and we moved to Lon-don, where first he, and then my mother, then an anaesthetist, began their own analyses, and latertrained as analysts themselves. For complicated reasons, and perhaps without realizing the fullsignificance, they went into analysis with analysts of different theoretical orientations. This waswithin a few years of the controversial discussions in London, so these different choices, my fatherwith the then Middle Group, my mother with a Kleinian, were significant for each of them, andlater, for me. In any case, as in many marriages following a war when each partner learns to livesomething of a separate life, there were periods when their marriage was stormy, and the discord Iknew about and overheard could include or even begin with heated discussions about psychoana-lytic theory or practice. In addition, my parents’ friends included more and more psychoanalysts,and theoretical differences did not inhibit friendships, so that those dinner parties I attended as a

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growing young person involved much discussion about differences between the groups in the Brit-ish Society, as well as strong feelings about the way the Society was organized at that time. I prob-ably knew more about the divisions in psychoanalytic institutions than about psychoanalyticthinking itself, though I certainly picked up basic concepts about the functioning of the mind andknew about the power of its unconscious aspects and that these were to do with the developmentalhistory of the individual. I knew about the importance of dreams and symbolism, and that therewere unconscious elements and meanings in the stories and plays and poetry that I loved reading.There were other discussions, too; my father would talk about institutional and group dynamics.He was an early member of the Tavistock Institute of Human Relations, interested in their ven-tures, and also in the beginnings of Group analysis; my mother, who became a child psychiatrist,discussed infant development, the work of Melanie Klein and Anna Freud—both knew and valuedeach of them, as well as Winnicott. American psychoanalysts and psychiatrists visited our house. Iparticularly remember David Rosenfeld for his kindness and the way he took an adolescent girllike me seriously, and Bob Knight from Austen Riggs, mostly for his height and friendliness. Astrange man was John Rosen, who frightened me with his enthusiasm about sharing his home withhis psychotic patients.

Probably, the first psychoanalytic reading that I did, without knowing it, was Benjamin Spock.Post-War, my family had expanded with three siblings born close together, and since as a ratherlonely older sister I read everything I could get my hands on, I tried to make sense of these smallbeings and their effect on me and on my parents and read his book of advice avidly. His emphasisthat what happens in development matters and the importance of patience and kindness, his under-standing of the overwhelming nature of childhood terrors as well as excitements, his position oftolerance and his belief in the power of a developmental drive that would most often result inhealth, given a chance, together with the acceptance of unconscious factors in both mother andchild were actually helpful to me in making things comprehensible.

Looking back, I can see that I was soaked in psychoanalytic thinking and that this colored myattitude from as far back as I can remember. Psychoanalysis was not for me a revelation, a person-ally discovered treasure, something that could revolutionize my life, but a sometimes useful wayof explaining people and situations. I knew that there was theory, though I found it difficult to read,and since I didn’t intend to become a psychoanalyst, I didn’t bother.

Later on, at school, all this was a background to a life that I thought was going in another direc-tion. Although more interested in literature, languages, and history than science, I still wanted tobecome a doctor, and therefore had to study sciences despite having little pleasure in them. I did,though, come to love the biological sciences, in particular the classification of species, their evolu-tionary relationships, the individual differences and the study of their evolution in relation to envi-ronmental factors. At that time, ecology was beginning to be taught in schools, and I read Lorenzand Tinbergen on animal behavior eagerly and understood the concept of an environment, or eco-system, as a community maintaining both internal and external balances within wider and stillwider communities. I began to see that just as a cell is a unit part of a tissue, which is part of an or-gan, which is part of a body, a body can be seen as a unit part of a family, which may belong to atribe, which is part of a nation, and so on. Recognizing that it is possible to study life at any levelfrom a cell to a species led to the understanding that it is the checks and balances both within andbetween the various units that make for good or poor functioning. Apart from that, science wastaught so badly at my all-girls’ school that I decided I would probably have to learn chemistry andphysics by heart, rather than understanding enough to pass the necessary exams, so I found myself

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a regular seat in that area of the school library containing large volumes of drama and poetry,where, when my rote learning got too tedious, I could reach out for respite easily. When I shouldhave been revising, I read the romantic poets; the playwrights, including T. S. Eliot, ChristopherFry, Shaw; and, of course, above all, Shakespeare. When, at home, I got interested in what my par-ents read; it was the more biological psychoanalysts that I found and enjoyed, in particular theshort papers of Ferenczi, and some of Balint’s early papers. My father ran Balint seminars, thosegroups of family practitioners with an interest in the psychological factors in illness and the fulltranscripts, carefully transcribed of each recorded meeting, often lay about on his desk, so I readthem too. In retrospect, what was developing was an interest in relationships—in literature as inecology and evolution, as in doctor–patient relationships—which fascinated me; I was determinedthat I would be not only a doctor, but also a good one, and later, despite the absence of any teachingon the subject in medical school, I understood that in addition to learning anatomy, physiology,pathology, etc., it was important to learn about how people worked as people, and obvious that thisincluded their minds. The existence of an unconscious mind was self-evident to me, as was the factthat much physical illness had major psychological aspects.

I tried reading Freud. I was disappointed at first. I wanted to know how people worked and de-veloped into the kinds of people they were in relation to their surroundings, and for instance, in theintroductory lectures I found his descriptions of mental workings dry, and his hypotheses seemedlaborious. In adolescence I wanted clarity and proof, and firm ideas about what to do to make peo-ple better. I believed, naively, in normality, and in cure as a return from a pathological state to thatnormality. The Balint seminar transcripts seemed much more alive than Freud. I could see doctorsstruggling to meet their patients’ thoughts and feelings and use their own inner worlds to under-stand how and why their patients had come to their present situations, and also saw how that un-derstanding alone, without interpretation, subtly altered the doctors’ attitudes towards their pa-tients, who responded in turn. Long before actually coming into contact with any patient, I beganto see that understanding was a powerful, and also a potentially dangerous, weapon. However cor-rect, it could sometimes be unwelcome to the patient, who, after all, had not asked for it overtly,and sometimes I read how an overenthusiastic doctor would almost bludgeon his patient with it,eliciting flight, or rage, which would then puzzle or alarm the well-meaning doctor. Those reportsthat showed, in an understated way, that the doctor’s increased awareness of the patient’s situation,internal and external, might be enough to act as catalyst for change, were the most moving, themost human.

In adolescence, I also became aware that I wanted an analysis for myself. There were many rea-sons, the most overwhelming being a level of anxiety that I knew was unnecessarily high, butseemed unstoppable, and that I felt must be connected with frequent upper respiratory tract infec-tions. During my medical studies, just at the beginning of the clinical years when I first had to dealwith death and began to attend the post-mortem examinations of people I had actually known aspatients, I went through a period of acute anxiety and insomnia, and had difficulty keepingpersecutory fantasies from overwhelming me. I went for a few sessions to see Enid Balint, wholater became my analyst, and learned enough about the projection of my own hostilities and mur-derousness to be able to complete my medical studies and registration. At that time, my parentsdid offer to pay for treatment, and to find me someone to see, but since psychoanalysis was a worldthat seemed to belong to and be owned by them, I was determined that when I had an analysis, itmust be my own, and that I must arrange and pay for it myself. I did not, at that time, envisage be-coming an analyst myself, and as a young doctor was excited by most clinical disciplines, particu-

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larly paediatrics and obstetrics, and I began to study further. However, in a fit of rebellion at whatseemed to me to be the stifling culture in hospital medicine—where I saw that men got the bestjobs, working for one consultant got you further than working for another, and progress dependedon who you knew—I decided that, rather than submit myself to this way of doing things, I wouldenter general practice, when I could work in my own way and make my own mistakes while beingable to study how people dealt with illness in their own environment, rather than the rarefied oneof the hospital. I also knew by then that the need for my own analysis was becoming urgent andthat in general practice I was much more likely to be able to earn my analyst’s fees and organizethe necessary timetable for regular sessions than working shifts as a junior doctor. Since at thattime I had no intention of becoming an analyst myself, I did not consider a career in psychiatry,which might have, in the event, proved useful, but at that time was very oriented towards physicaltreatments, with a disdain bordering on contempt for anything psychoanalytical. It seemed to methat the contact with the emotional life of patients that I was most interested in would be moreavailable and rewarding in the family practice that I joined, and in retrospect I think I did learnmore about how ordinary families lived and functioned from seeing them in their own environ-ment and being part of that environment than I might have done in hospital-based psychiatry, farremoved from ordinary life.

The choice of analyst for someone whose parents are analysts is never simple. With parents indifferent groups in the British Society in the ’60s, it seemed impossible. Not only did my parentsseem to know personally everyone they admired, but they each seemed to have strong feelings foror against every other analyst—and these opinions differed between them. In addition to that,quite a number of London analysts had worked with my father at the Cassel Hospital. I have heardhim described as charismatic, and I know that there were those who were utterly bowled over byhim, but he could also be confrontational, at times scathingly contemptuous, and there were thosewho never forgave him. As his daughter, although I loved him dearly, I had observed and experi-enced both of these extremes, of course, and knew that he was a difficult man to be neutral about,so I preferred not to consult anyone who might have been in close professional contact with him.My mother was capable of contempt too, in a quiet way, and her scorn was capable of destroyingthe reputation of anyone she felt to be inadequate, or in any way dishonest. In retrospect, I havewondered if some of my anxiety about my choices was not overly paranoid, but as I have learnedmore about the ubiquity and strength of countertransference, I still feel my caution wasappropriate.

There is also the question of love and difference, and choice of analyst brought up somethinglike the question I had anguished over as a small child when asking myself which parent I lovedbest. So that, as well as anxiety about making a choice that would be acceptable to my parents aswell as suitable for me, questions of love and loyalty, superseded any questions I might have hadabout psychoanalytic orientation. In the end, after a brief attempt at seeing someone else hadturned out unsatisfactorily, I went back to Enid Balint, who found me a vacancy fairly soon at atime I could manage. With her, the edge came off the anxiety, I felt understood, and though shewas not medical herself, she certainly valued those aspects of medical experience that I did, andwas in touch, presumably through her experience with groups of doctors, with the particular diffi-culties that lead doctors to behave in the ways they do.

When recently I found myself passing the house in which most of my analysis happened, Ifound myself thinking, “I left something there. Something I did not need.” From having beenslightly anxious and in a hurry, I found myself relaxing internally, and feeling at once grateful and

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sad that the person who had helped me get rid of those particular parts of myself no longer exists. Ihave not found it necessary to consult another analyst, though, of course, there have been mo-ments in my life during which I have considered that option very seriously, and sometimes evenenvy those who have had more than one personal experience of analysis, but for me Enid was cer-tainly more than “good enough.”

Michael Parsons has written about his experience of having been in supervision with EnidBalint, his analyst having said “Supervision with Enid is a rather particular sort of experience”(quoted in the Introduction to Enid’s book Before I Was I). He felt that, rather than being told howto frame an interpretation or relate what he was observing with theory, although both of those hap-pened, what he especially gained from her was something about how to be with an analytic pa-tient. On reading this, I recognised the reciprocal of it—that I had had an analyst who had beenwith me, and that, although there were interpretations I remembered, it had been the being with,that undoubted attention and reliable concern for me, that had helped me shed whatever it was thatmade me so intolerably tense and unforgiving of myself. She was undoubtedly the major influenceon my analytic formation.

When it was suggested that I give some thoughts about the ways in which I had become the ana-lyst I am, I had some difficulty. I found myself both wanting to answer, and wanting to avoid, myown question of what I got from her—what identifications, to what extent I had copied her, whatof her might have crept into me, what valuable aspects of her I had failed to internalize—in fact,another version of what one might or might not have got from one’s parents, and the extent ofone’s awareness of this, and pleasure or displeasure that one has not, in fact, invented oneself, thatawful blow to the remnants of infantile omnipotence. What of me, of my style, is Enid? And ifsome is, what do I feel about it? I can remember a patient, some years ago, who told me that shegot very alarmed whenever I suddenly got quite emphatic, and said “Look!” before embarking onan interpretation I felt convinced about. I immediately recognized that Enid had sometimes donethat, and was unsure whether or not to be pleased that I had unconsciously adopted her style. Onthe other hand, I was unequivocally pleased when that same patient, who was a psychotherapist intraining and had had some difficulty with supervisors she had chosen through idealization butfound problematic, went to a fellow analysand of Enid’s and reported on it saying with some relief“It’s like coming home!” The thought that both analysands might have gained some style in com-mon from Enid and that that style might be helpful was good.

What I think I got from her was an intense belief in the importance of the patient’s unique expe-rience, of their perception—this was not to be dismissed. I learned respect for the patient’s point ofview, no matter how misguided I might find it. It has been gained by means of struggle and pain,and to dismiss it lightly is to ignore the effort spent in gaining it. Respect for defenses—they haveto be dismantled with care, gently, carefully, but relentlessly—and with proper acknowledgmentand mourning for the loss of the defense and for the recognition that however appropriate those de-fenses were in the time and place of their setting up, they have become superfluous and inappro-priate today. Understanding of the history of development, together with a recognition of today’scircumstances and their differences. And the sadness that goes with the recognition of loss. Ahope that old, brittle, and inappropriate mechanisms of self-protection can be replaced by moreflexible, and adaptive ways of responding in relationships. And above all, patience—to wait, andwait, for the moment when a patient is ready, or has gained courage, or has been able to opensomething previously closed, and to see whether that patient needs the analyst just to be there, orto say something, or to make an interpretation.

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It was after two years of analysis, by that time married with one baby, that I made the decisionthat psychoanalysis was what I wanted to do. I applied for analytic training and was accepted bythe Institute of Psychoanalysis in London. My husband, a psychiatrist, was also accepted to train,but he was in analysis with a senior Kleinian, so we were in danger of repeating the family pattern.During the training, Freud again became and has remained important, and I began to value hiscourage, his careful exploration and his way of expressing ideas. The grand controversy in Britishpsycho-analysis meant that Melanie Klein’s thought was also emphasized in our training, and itbecame very clear, early on in the training, which of my peers were in Kleinian training, which fol-lowed Anna Freud, which were in the Middle Group, and so on. I found the differences confusing,though they were amicably discussed, and there was no personal animosity amongst us, thoughdiscussion of differences became heated and took up an enormous amount of time and energy. Inow think that the confusion arising from the theoretical splits and resulting loyalties may havebeen at least partly responsible for the fact that out of twelve candidates who all qualified, onlyfive remained in analytic practice in Britain and none of those became training analysts; four re-turned to their own countries or emigrated further; and three found different careers in psychiatry.The difference in the composition of the group from today’s candidates is notable too. Of twelve,only two were women, only three were not medically qualified, only four from other countries. Sofar as the groups were concerned, only one was an Anna Freud candidate, four were in Kleiniananalysis, and the remaining eight of us with analysts from the predominant Middle or IndependentGroup. Psychoanalysis in Britain then, thirty years ago, was typically studied and practiced byBritish-born, medically qualified male Independents. Not so now.

During the training, the principal influences on my work were, apart from my analyst, my su-pervisors. I had asked Donald Winnicott to be my first supervisor on the advice of my analyst, whotold me that he was probably not a good choice for a first supervisor, but that I should get some ex-perience of his thinking while he was still available. He was, by that time, very frail, and likely todie soon, which he did, a year later. Although he was warm and acutely attentive, and recognizedmy patient’s difficulties together with my difficulties in recognizing them, in retrospect, I think theadvice that he would have made a better supervisor had I had more experience was good. He wasalways surprising, and obviously enjoyed being so; he always had a different view from the one Ihad expected. He would never answer a question simply and directly, which is what I longed for,but would use an oblique approach that could take days to settle in my mind and become useful.One day I lamented to him that I was bad at attribution, that although I knew what I thought in rela-tion to my patient’s way of being and its origins, I could not for the life of me relate this to any ofthe particular theorists about whose ideas I was being taught. He said, and I was about equally re-assured and disturbed by it, that it didn’t matter, because if you had had a thought, if a thought hadcome to your mind, then it was yours, it was part of you, and it was okay to use it even if someoneelse had had it before. He clearly wanted me to make things my own in order to be able to use themauthentically, but at the time I wanted clear answers. There were many other things that he saidthat remained in my mind, often as a puzzle, and even now I remember and wonder, which I thinkmust have been his intention. After Winnicott died, I went to Peter Hildebrand for supervision,again a very clear mind.

On the other hand, in formal teaching I preferred the open-endedness of those teachers who en-couraged speculation rather than certainty, and I suspected many of those who spoke with author-ity. This is one of my own characteristics, and I recognize that I have both gained and lost by it.The impressive ones were those such as Michael Balint, though as my analyst’s husband he was

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somewhat daunting, but I was relieved by some of the things he said. I liked the way he forbadenotes when speaking about a patient, since he believed that one remembered more freshly withoutthe processing that goes on when one writes supervision notes. I liked the way he emphasized theimportance of the analytic setting, and also discouraged questioning a patient, saying, “If you askquestions, all you get is answers.” One of the clearest teachers was Joe Sandler, and I envied amind that could make such sense of what bewildered me. A series of clinical seminars led by himand Hannah Segal was memorable, if only for the moment when each of them had agreed about apatient’s psychopathology and Joe said kindly, “Well, of course, you’re not a real Kleinian!”

During the training itself, I became confused and often felt that I would never be able to makesense of all the different ideas and ways of looking at clinical phenomena that we were presentedwith. I found the certainty that some teachers and fellow students seemed to possess alarming andfeared that either I was too stupid or too damaged to be able to see as clearly as they did, or thatthese other people were limited in not being able to see the other possibilities that I felt were pres-ent. I wanted more discussion of the terms and language used, and became bewildered when theywere used differently by different people. I wished I had trained in psychiatry, because I felt thatthen I might have been more at home with the nomenclature, though I was confused by the obvi-ous difference in the use of identical words; the difference in the use of the term “psychotic” bypsychiatrists and psychoanalysts is an example. I became alarmed in clinical seminars when, attimes, it seemed to be the analyst leading the patient, and not the other way round, as was happen-ing in my own analysis. I was in the difficult situation of wanting certainty, of being frightened bymy own lack of it, of envying those people who seemed to have it and looked safer than I felt, yetbeing very suspicious of it, and sometimes seeing occasions when a trainee analyst in love with atheory would apply it willy-nilly and, it seemed to me, confuse and alarm his or her patient.

I qualified later than most of my peers, largely on account of having a second baby during mytraining, but was still under 35—again rather early, by today’s standards in Britain, at least. Therewas, then, a dilemma—I was qualified as a psychoanalyst; I had a commitment to my low-feetraining patients, but I was still enjoying my work as a part-time family doctor, which includedon-call night-time duties, and I had two small children and knew I wanted a third. There was alsothe need to pay back a considerable debt accumulated during the time that both of us had been intraining. What to do? There was clearly no flood of paying analytic patients; I was exhausted andconfused by the training; I wanted to see more of my little ones. I felt I should not be so confusedand wondered whether I was any good. I had also, to pay my way during training, taken on apart-time obstetric job in a London teaching hospital, and become a trainer of doctors working infamily planning clinics. I had decisions to make, and made most of them by default. I gave up theobstetric and contraceptive work, and reduced the family practitioner work, and waited to seewhether psychoanalytic work would materialize. It was very slow. Gradually, patient by patient, itbuilt up. Colleagues began to telephone, tentatively exploring whether I was actually seeing psy-choanalytic patients. For a while, there seemed to be a perception among them that I had returnedto family practice, which may have occurred because I hardly ever came to Society meetings, be-ing both involved in my children’s development and “recovering” from the intensity of the train-ing experience and my confusion about my theoretical base.

However, eventually some colleagues began to refer patients, and I gave up my work as a fam-ily doctor, rather reluctantly, as I had enjoyed the experience of being part of a community, evenwhen that community was in a deprived working class area of South London known at that timefor unemployment and gang violence. I had been part of an era of social change in that area, when

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Georgian and Victorian slums were torn down and replaced by massive and uniform concreteblocks of flats, and families who had lived on top of each other with outside toilet facilities and ratswere moved to separate hygienic flats, often miles apart with good plumbing, but a loss of neigh-bourliness and sense of community. The sense of social disruption was palpable, and, since then,the violence and drug use in that area has increased and the blocks that were greeted with joy 35years ago are now condemned. It had been possible to observe, very clearly, the effects of thesewell-intentioned but insensitive social upheavals on both families and individuals, and to try tomake some sense of it for those disappointed and angry patients who came with depression andbewilderment afterwards. But I had now begun my career as a psychoanalyst and, for a few yearswhile the children were young, I saw patients in the mornings during their school hours only. Theonly remnant now of that young doctor I once was is an interest in psychosomatics, especially eyeproblems.

The internal muddle of my training days continued, although at first after qualifying I tried hardto make sense of things and find where I belonged in relation to the different traditions of psycho-analysis. I really wanted to be able to speak two languages, and be fluent in Kleinian as well as thetradition I had been trained in. I discovered the Group of Independent Psychoanalysts and enjoyedtheir meetings, where I listened to people like John Klauber and Adam Limentani, while also go-ing to scientific meetings especially when the speakers were such people as Bion and Rosenfeld,whom I very much wanted to understand, but I became more confused. I then joined a committeein the Society and began to discover more about my colleagues and that, apart from the positionsthey took up in scientific meetings, they actually spoke in very similar ways.

Then I made a decision, which was partly an active one, and partly rather passive, since I wasfed up with my muddle and with the politics of the British Society, but also wanted to be at homewith my growing family. I decided that the best way to solve my dilemma and confusion would beto learn psychoanalysis from my patients, trying to get back to basic principles of understandingthe unconscious and trust my own observations, and for several years I went to few meetings. Iworked rather quietly at home, learning to accept psychotherapy cases and turning them into psy-choanalytic ones. I had qualified as an analyst, and that in the days when you were asked on apply-ing whether you had experience in psychotherapy, and if so, that was a black mark; you werespoiled as a potential analyst. But as soon as I qualified, people began to ring me up asking if I hada psychotherapy vacancy. I hadn’t trained in psychotherapy but waiting for analytic patientsproved fruitless, so I abandoned some of my idealization and took on patients when they were re-ferred, and learned from them. Most were very disturbed and a few were alarming. Analytic pa-tients developed out of the ones I was sent, slowly. I listened to them, and began to develop a wayof working without belonging to a seminar, going to lectures regularly, or listening to papers, buttrying to see what it was that they were trying to communicate. I learned a lot from my husband,Marcus Johns, who has always had a deep interest in early development and who introduced me tothe work of Bower and Trevarthen and eventually Stern. He also talked about the very disturbedchildren he was seeing at the Tavistock Clinic, and I read. I had some concern about possibly de-veloping into a wild analyst, and my various superegos persecuted me a bit. What I did would notnowadays be allowed in terms of Continued Professional Development. I don’t recommend it as away of finding one’s own voice. It shut out all the other warring voices, which was a relief, but pro-fessionally I was rather lonely.

After about seven years, I was invited to join a peer-group seminar by a colleague and found,keeping fairly quiet at first, listening and watching, that what I thought and did was quite accept-

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able, even helpful. Then John Klauber accepted me for a short series of seminars that I enjoyedeven more, valuing his sensitive insights and practical compassion. Rather tentatively, I began tojoin in and go to other meetings, and decided to join the course leading to full membership of theSociety. However, the group differences were even more stark than they had been during my train-ing, and this, I found, threw me back into my painful confusion about the theoretical/politicalsplits and various identifications and disidentifications I found I had, and after about a year Idropped out, again full of doubt.

I did not then go into such a retreat as before, but maintained connection with my colleagues,and joined the staff of a psychotherapy clinic to do assessments for psychotherapy, as well as agroup that studied the work of Matte-Blanco and included Eric Rayner and Margaret Arden. I en-joyed those meetings as a new way (to me) of looking at the unconscious and its workings, thoughI felt that the developmental aspect was less emphasized than I wanted it to be. I foundMatte-Blanco’s emphasis on the characteristics of unconscious functioning refreshing. My ownreading also included Stern, Mahler, Wright, as well as rereading Winnicott. The meetings at theBritish Society were of wide interest, and I found the programs compelling. As an example, my di-ary for the autumn of 1987 tells me that I went to hear Anne-Marie Sandler, Clifford Scott, PatrickCasement, a memorial for Herbert Rosenfeld, the Jungian Louis Zinkin, Robert Wallerstein,Neville Symington, and Harold Stewart—all food for thought.

I took on the task of persuading my father to publish at least some of his papers. When finallyhe agreed, it was on the proviso that I should do most of the editorial work, so that I came to knowhis psychoanalytic thinking better than I had, recognized its sources (he was supervised by bothAnna Freud and Melanie Klein) and saw how much he had influenced me, as well as recognizingthat much of my mother’s thinking, particularly about children and development (she had becomea child psychiatrist and, in addition to her Kleinian training, had studied with Winnicott) was alsopresent in my mind. It was no wonder that I had found the splits in the psychoanalytic world pain-ful. The book, The Ailment, and Other Psychoanalytic Essays by Tom Main, was published in1989 by Free Association Books. My father was already ill by that time, and died the followingyear. That work had been intensive for me both in an internal as well as an external sense, and fol-lowing that, I felt I could become engaged with the institution again. Pearl King, who has been akind of godmother to me, introduced me to the Archives of the Society; at first I helped by goingthrough some papers and sorting them for cataloguing by computer; the history of British psycho-analysis began to become clearer. I then joined another ongoing peer-group seminar and the com-mittee of The Group of Independent Psychoanalysts, which needed an Hon Sec. I was asked towrite things and give some papers. I found myself writing about Winnicott’s thinking, and readingKit Bollas’s work, although I found his style a bit too “American” at first.

Then the Independents, whose chair was then Earl Hopper, were approached by a group ofAmerican self-psychologists in the hope that some rapport and cooperation between the BritishIndependents and self-psychology might be possible. In preparation, I began to read some of thework they had produced and found it intriguing, particularly in so far as it related to some of thetheorists that interested me—Fairbairn, Winnicott, Balint. A simple beginning was with HowardBacal and Ken Newman’s book Theories of Object Relations:Bridges to Self Psychology (1990),and I then went on to read Ernest Wolf’s Treating the Self: Elements of Clinical Self Psychology(1988), before attempting Kohut himself. The first meeting in what became a short series hap-pened in London and resulted in lively discussion; a crude summary might be that the Brits foundthe self-psychologists knowledgable and enthusiastic, but somewhat evangelical and, to our mind,

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naively optimistic; the Americans found us much too occupied with problems to do with aggres-sion and destructiveness, and much too pessimistic. It was agreed that although each self-psychol-ogist defined his difference in relation to the mainstream in terms of an ego-psychologist who met-aphorically sat on his shoulder, the British Independents had a similar relationship with theirKleinian counterparts. Interesting meetings followed in Chicago and again in London, and al-though there emerged no real consensus or ongoing movement, I learned respect for a differentpoint of view, and took a much greater interest in Fairbairn than I had before, his ideas, in particu-lar, appearing in each group’s use of them. I found the self-psychologists’picture of early develop-ment sympathetic, especially in comparison to the Kleinian one, with its emphasis on the child’sstruggle with its own instinctual drives. Their picture of development, although using differentlanguage and introducing some new concepts, agreed with my own view of the child as part of arelationship and being influenced by, as well as influencing, that relationship from the beginning.

One shift in my thinking that occurred as a result of these meetings was an interest in the impor-tance of shame as a powerful element in the development of psychopathology. I had been strug-gling with Kleinian thinking and although the development of guilt in the depressive positionmade some sense to me, I felt that an understanding of the effects of shame made more sense ofsome patients’ distress.

It was at about this time that, together with Ray Shepherd and Helen Taylor Robinson, I workedon the final group of Winnicott’s hitherto unpublished papers, which came out under the titleThinking About Children in 1996. This meant gaining a deeper appreciation of Winnicott than Ihad had before, especially his understanding of children. I was also invited to join the 1952 Club, agroup of colleagues, mostly but not all from the Independent tradition, who gather monthly to dis-cuss papers in preparation, or to listen to guest speakers, and this gave the opportunity for more in-formal discussion than is possible in the wider forum of the British Society. When I joined, theolder members included not only Pearl King, but also Marion Milner, Charles Rycroft, and JohnPadel, all of whom I came to admire and respect, and whose contributions also made me reflect onmy internal psychoanalytic constructions and practice.

By this time, some of my internal muddles about where I belonged in psychoanalysis weremore or less sorting themselves out. I knew that I valued much of Melanie Klein’s thinking aboutearly infancy—one can’t be a British analyst and ignore her work—but I have always agreed withthe importance of Winnicott’s concept of early ego-integration as described in his key paper,“Primitive emotional development” (1945). The concept that the work of the earliest stage of de-velopment includes phases of unintegration requiring integrative shifts, to my mind, places themechanisms of splitting that Klein describes in context and makes sense of them and the thinkingthat follows. Although I agree with Klein about the importance of envy, I do not find the concept ofdeath instinct, in itself, useful; in fact, I have sometimes described it as a “cop-out,” since accep-tance of it can lead to the suspension of further curiosity. When it comes to explaining aggression,I find myself agreeing with Fairbairn and Balint that it is usually frustration that gives rise to theinborn potential for the development of aggression.

I have become very aware, recently, how much psychoanalysis owes to Sandor Ferenczi andhave been rereading his work, which I had half-forgotten.

My approach is, I realize, invariably a developmental one, and I regard the reconstruction ofperceived history as a vital aspect of clinical work. What happens in the reported everyday life ofmy patient matters, both in its own right and in the significance it always has to the unconsciouslife of the patient, as does the transference and what is happening between me and my patient,

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again on both levels. It is those elements, as well as the contribution of the patient’s past history asremembered both consciously and in the unconscious, even in the body, that need to be under-stood. The psychoanalytic setting invites regression, and its management and meaning will al-ways be part of the work. I find the concept of the repetition compulsion essential.

Technically, I try to interpret rarely, and try to find those conditions, or that climate in the con-sulting room that will allow the patient to explore for themselves. Most often, I interpret whentransference issues are to the fore, or near consciousness, though I do not always interpret thetransference; I find sometimes that my understanding of it without comment is enough for the pa-tient to find the interpretation for themselves. I am not afraid of speculation, so long as the patientis in a frame of mind to understand that it is speculation. Acute anxiety, or a regressive state, espe-cially if it is near to a paranoid anxiety, may allow the patient to misinterpret speculation either asmy certainty or as my being as bewildered as he or she is.

I do believe in starting slowly, in waiting to learn about my patient, in following the patient’sagenda, except when it is clear that something is being avoided or evaded; and even then I prefer tobe able to have some idea about the reason for the defense and what is being defended against. Topoint out that a defense is being utilized without any explanation or attempt at one being madeabout its origins and the original or present meanings of it seems to me like an unwarranted attack;to do so will usually be a reenactment or can even be a retraumatisation. The early stages of ananalysis I do compare to an analytic version of Winnicott’s concept of maternal holding: a beingthere in a receptive and attentive way that can allow the patient to relax and begin to dare to ex-plore. Just as a new baby, still curled up from the experience of being in a womb that latterly hasconstricted his movements, gradually uncurls over the first days and weeks before finally stretch-ing out and reaching for the wider world, a patient may lie on the couch inhibited in the explora-tion of the analytic space, and may need both time and the awareness of not being alone before be-ing able to explore the ways of using that space. It is when the inhibition is too severe and thepatient is unable to experience that he or she is not alone or under attack that different tactics areneeded, and that may mean even greater patience. Such patients may have experienced previousenvironments or relationships as too impinging, and cannot find within themselves any way ofsearching, at any level, for what they need, since there is no previous experience or memory of it tobe reached.

Finally, when considering the development of a psychoanalyst, it might be interesting to thinkabout the pain of differences and also of separation in relation to owning oneself as a psychoana-lyst. In infant development, we study a baby’s increasing capacity to separate and differentiatehimself, aware that it is a strain on him that we have to dose carefully, but that there is also a pull, aneed for separation and individuation. We are aware of the two opposing needs and the tension be-tween them, and how this is affected by the actual needs of the mother, and what she needs fromher baby, how she perceives and responds to the infant’s needs, and the tension between her ownneeds for fusion or separation. The parallel theme in considering the process of becoming oneselfas an analyst—finding one’s own voice—is to recognize the ambivalence of the newly qualifiedanalyst about becoming independent and autonomous. There will be the wish to belong, stayclose, identify with one’s own analyst or group to be safe together with a fear of rejection shouldone stray or be thought to be disloyal; and also the wish to strike out and think one’s own thoughtsand forget both what one owes and who one owes it to. Together with these conflicting wishes willbe the concomitant fears of loneliness and isolation, the guilt at what may be seen as disloyalty, orthe fear of being swallowed up, of being cloned as a member of X group, of losing individuality

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and autonomy. The wish to be loved may accompany the fear that one has to give up autonomy inorder to get love. There is a danger within psychoanalytic establishments with their, it seems, inev-itable struggles and splits that the various groupings within the establishments, serving their de-fensive functions, may come to enact the role of the narcissistically damaged mother who de-mands loyalty and that the infant share her point of view if he or she is to be accepted and loved.Those who find independent points of view do so at the expense of loneliness and isolation. I thinkwe can draw another parallel. Freud pointed out that it is important for children to be able to for-give their parents. That is impossible unless the fear of disappointing them and the guilt at the wishto be different from them is somehow worked through, and that, in my opinion, will depend notonly on the child’s courage and pride in its autonomy, but also on the parents’ joy in the separate-ness and autonomy of their child.

Maturing as an analyst I take to be not only the process of self-analysis, but that of finding one’sown voice. It is a process of gaining independence and authenticity, for owning oneself in one’swork, and that means also the processes involved in dealing with some of the identifications thathave been part of one’s journey so far, relinquishing or adapting or making them one’s own. Thejourney of analytic training, we all know, is only just begun when we achieve qualification; per-haps there is an argument to say that it is never finished. But there is a point at which it is possibleto say, “I am myself when with a patient.” Toward the end of her life my analyst, Enid Balint toldme that when she was newly qualified, Anna Freud had said to her that it took five years before ananalytic style was established firmly. Enid then said that she believed it had taken her ten. I know ittook me even longer.

REFERENCES

Bacal, H., & K. Newman. (1990), Theories of Object Relations: Bridges to Self Psychology. New York: Columbia Univer-sity Press.

Balint, E. (1993), Before I Was I, Psychoanalysis and the Imagination. London: Free Association Books.Balint, M. (1957), The Doctor, His Patient, and the Illness. London: Pitman.Fairbairn, W. R. D. (1952), Psychoanalytic Studies of the Personality. London: Routledge.Freud, S. (1933), New Introductory Lectures on Psychoanalysis. Standard Edition, 22: 5–182. London: Hogarth Press,

1964.Klauber, J. (1981), Difficulties in the Psychoanalytic Encounter. London: Free Association Books.Kohut, H. (1977), Restoration of the Self. New York: International University Press.Limentani, A. (1989), Between Freud and Klein. London: Free Association Books.Main, T. F. (1989), The Ailment and Other Psychoanalytic Essays. London: Free Association Books.Matte-Blanco, I. (1975), The Unconscious as Infinite Sets: An Essay in Bi-Logic. London: Duckworth.Parsons, M. (1993), Introduction. In Before I Was I, Psychoanalysis and the Imagination. London: Free Association

Books.Rayner, E. (1991), The Independent Mind in British Psychoanalysis. Northvale, NJ: Aronson.Stern, D. (1985), The Interpersonal World of the Infant. New York: Basic Books.Winnicott, D. W. (1945), Primitive emotional development. In Collected Papers: Through Paediatrics to Psychoanalysis.

London: Tavistock, 1958, pp. 145–156.—————. (1996), Thinking About Children. London: Karnac Books.Wolf, E. (1988), Treating the Self: Elements of Clinical Self Psychology. New York: Guilford.

88 Nightingale LaneLondon SW12 8NRjennifer@mjjohns.com

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