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IV. SETTING AND REGRESSION
The concept of regression is a controversial matter. For some analysts who follow the ego psychology tradition the setting is a condition in which “The immutability of a constant, passive environment forces him [the patient] to adapt, i.e., to regress to infantile levels” (Macalpine, 1950, p. 525) in order to allow analysis of the transference neurosis. By contrast, Winnicott put forward the view that the positive aspects of the analytical setting provide a facilitating and holding environment which allows for regression. The emphasis is on an active, responsive environment in which the setting represents aspects of the analyst’s attitude. Winnicott emphasised the vital importance of the setting as a therapeutic agent in itself for those patients whose developmental disturbance has led to the formation of a false self (1955). Such patients require a deep regression within the analytic treatment, in which the physical setting and the analyst’s alive presence provide the facilitating environment necessary for healthy development of the (true) self to emerge; the withholding of premature interpretations is part of the adaptation the analyst needs to make. Melanie Klein (1952, p. 55) defined the therapeutic space as one that is dominated by the transference, seen as the “total situation” of the interaction between the analysand and the analyst, where interpretation is viewed as the analyst’s primary tool for interacting with the patient. Klein sought to create, in alliance with Freud, an objective space where projections of both good and bad internal objects–as well as parts of the ego–are free to emerge in the analytic space. Winnicott described a different kind of setting from the one established by Klein. Where Klein seeks objectivity in the therapeutic space, Winnicott pursues an entirely different space, one that through “reliability” creates an atmosphere which facilitates the analysand’s subjectivity-- subjectivity in that the space conforms to the patient’s individual sense of being and seeks not to impinge on it. “The setting of analysis reproduces the early and earliest mothering techniques. It invites regression by reason of its reliability” (Winnicott 1955, p, 286). Winnicott’s thesis is that in some patients there exists a primitive state of “un- integration” that requires regression to the earliest stages of development. Through this regression, the analysand can confront his or her developmental distortions and fixations in order to find other solutions, with the analyst creating a safe and sensitive environment. Thus, there is “the provision of a setting that gives confidence” (Winnicott, 1954, p. 287) to the analysand allowing “regression of the patient to dependence” (ibid), a healthy dependence that can then reinitiate early developmental processes. An interesting parallel could be made with Laplanche’s concept of the “hollowed-out” transference, which also regresses to origins, that of the enigmatic desires of early caretakers (Laplanche, 1997, 2010). Other analysts, such as Etchegoyen (1986), think that the setting was not designed to create the regression, but to discover it and contain it. Within Kleinian metapsychology regression is seen rather as a form of “psychic retreat” (Steiner, 1993); regression is not the product of the setting, but the patient’s pathology evidenced in the specific working conditions offered by the analytic setting.
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