In this talk, Dr. Tobin applies the fundamental constructs of D.W. Winnicott's theorizing including "going on being" and the distinction between "object relatedness" and "object usage" to a clinical patient. The therapy hour selected features the therapist's and patient's complex negotiation of and resistance to aspects transitional junctures of the interpersonal space.

1. ATherapy Hour:
RevisitingWinnicott’s Notion
of “Object Usage”
JamesTobin, Ph.D.
Licensed Psychologist, PSY 22074
Private Practice, Newport Beach, CA
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2. Introduction
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3. Introduction
DonaldWinnicott (1896-1971) was an English
pediatrician and psychoanalyst.
His most important works include “Clinical Notes
on Disorders of Childhood” (1931), “The Ordinary
Devoted Mother and Her Baby” (1949), “Through
Pediatrics to Psychoanalysis” (1958), “The
Maturational Processes and the Facilitating
Environment” (1960), “Playing and Reality”
(1971), “Therapeutic Consultation in Child
Psychiatry” (1971), and, posthumously, “Holding
and Interpretation: Fragment of an Analysis”
(1986).
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4. Major Paper
“The Use of an Object and Relating through
Identifications” (InternationalJournal of Psycho-
Analysis, 1969, 711-716).
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5. The “Good Enough” Mother
Underlying all of Winnicott’s thinking: the
foundations of psychological and emotional
health are laid down through the ordinary efforts
of a caring, concerned mother (i.e., picking up
the baby, gathering the baby, bathing, and
feeding).
Winnicott emphasized the warm, sensitive, and
accurate “handling” of the infant.
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6. Holding
The child’s feeling the mother’s warmth, presence,
attentiveness and consistent technique of
handling are the basis for Winnicott’s central
metaphor of “holding” in psychotherapy: the
therapist’s creation of a facilitating environment
that is attuned and responsive to the specific
maturational needs of the patient.
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7. Winnicott’s View of Healthy
Psychological Development
ForWinnicott, with the provision of a holding
environment by a “good enough” mother, the
child simply “goes on being.”
The free, spontaneous expression of the child’s self
(or subjectivity) is affirmed and supported in the
atmosphere established by a consistently
present, good enough mother.
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8. Maladaptive Development: Impingement
“Going on being” is interrupted prematurely when
a stimulus from the environment (e.g., the
caregiver) causes the child to have to adjust to
the intrusion of the other (“impingement”).
When repeated impingements occur, the child’s
self-expression and natural maturational
processes are compromised by premature
accommodation to intrusions of reality.
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9. The “False Self”
The need to comply/accommodate at the expense
of self-expression may become characterological
(Winnicott’s “primary maternal preoccupation”);
in this situation, the omnipotence of others is
assumed and a False Self emerges (“the
absence of being”).
Winnicott conceived of numerous False Self
presentations; his formulations of mania and
greed revolve around defensive processes
geared toward concealing the absence of being
by the defense of compliance.
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10. Winnicott’s Relational Modes:
Object Relatedness and Object Usage
Object relatedness: a more primitive form of
human connection in which the other (the
object) is not separate or differentiated, but
intended only for the child’s (the subject’s) needs
and demands.
The object is the creation of the subject (what
Winnicott called the subjectively-perceived
object/“the subjective object”) and exists
merely to affirm the subject’s omnipotence.
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11. Winnicott’s Relational Modes:
Object Relatedness and Object Usage
Object usage: a more advanced form of human
relatedness in which the object is encountered as
a separate person who can be engaged, taken in,
and used for growth, exchange, challenge, and
other relational experiences that support the
subject’s creativity and self-expression.
The other becomes an objective object, not a
subjective object.
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12. Object Usage
In object relatedness, the self is singular (“an isolate”).
Object usage allows for full engagement with others
and transformations from contact with reality
(which promotes the feeling of being alive and real
in one’s mind and body).
Winnicott was the first theorist to suggest that
advanced object relations is the means by which
self-knowledge is expanded (his emphasis on
“creative self-expression” as the primary
competence for life).
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13. But What Promotes Movement from Object
Relatedness to Object Usage?
The answer may surprise you!
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14. But What Promotes Movement from Object
Relatedness to Object Usage?
ForWinnicott, the other must be “destroyed.”
If the other (the subjective object) survives the
destruction, it becomes REAL (for the first time)
and is transformed into an objective object that
can actually be seen, used, and loved: “You have
value for me because of your survival of my
destruction of you” (Winnicott, 1969, pp. 712-
713).
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15. Confusion about What Winnicott Means By
“Destruction”
Winnicott’s “destruction” is often compared to the
terrible-two’s in which the child begins to
rebel/says “No!” to the parent.
The capacity to say “No!” shifts the child out of a
position of compliance and accommodation,
thus confirming his/her own wishes and denying
the omnipotence of the parent.
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16. Confusion about What Winnicott Means By
“Destruction”
But the emphasis forWinnicott was less on the
destruction per se (aggression, rebellion, etc.)
than on the survival of the object in the face of
the subject’s self-preoccupied concerns.
.... essentially, the capacity to attend to and
“hold” the patient before the patient can
actually transact with the therapist
(Winnicott’s genius was cautioning us not to
assume patients are ready for actual
transactions**)
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17. Winnicott’s Notion of “Destruction”
Winnicott emphasized the "object's liability not to
survive” the subject’s self-preoccupied
concerns: non-survival can take many forms
including withdrawal, retaliation, boredom,
defensiveness, diminished receptivity, and “a
kind of crumbling .... in the sense of losing one’s
capacity to function adequately as mother”[or
as therapist] (Ghent, 1992, p. 148).
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18. Ramifications for Psychotherapy
(1)The therapist seeks to promote in the patient a
transition from object relating to object usage.
(2)This implies that the patient must first relate to
the therapist, then attempt to destroy the
therapist, then acknowledge the survival of the
therapist (the object’s otherness).
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19. Ramifications for Psychotherapy
(3)The patient’s central dilemmas are (a) the anxiety of
being held and found as a separate and distinct
being (“being a being”) and (b) the fear of actually
destroying the object.
(4)A remarkable implication of this model is that the
patient is rarely (or at least not for a long time) ready
or able to “use” anything the therapist says or does;
rather, for much of the time, the patient doesn’t
want to acknowledge the real-ness of the
therapist (which simultaneously conceals the real-
ness of the patient).
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20. Being Acted Upon and Waiting
For many of us, we as therapists prefer being used (in
Winnicott’s terminology) as an objet (acting on the
patient) rather than tolerating object relating and
efforts directed toward our own destruction
(allowing the patient to act on us).
But most of therapy has to do with tolerating and
working with these more primitive forms of
relatedness, and, to a large extent, waiting to be
used; Winnicott’s famous advisement was to
“allow the patient to use the analyst as someone
who is there to be found .... [not] to be shoved
down patients’ throats.”
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21. The “Transitional Space” of the Therapy
Hour
Object relating, attempts to destroy the object,
and object usage are not manifested in “phases,”
but can be seen in any particular therapy hour as
the patient struggles with different relational
positions.
There are ongoing shifts in patients’ attempts to
avoid and find the therapist, and to avoid and
find themselves (wanting to actually “being a
being” but then reverting to an absence of
being!).
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22. What the Patient is Actually Doing
Moment by Moment
Winnicott’s notion of the transitional space, i.e., the patient is moving back and
forth along a continuum:
(RELATING --------------------- DESTROYING --------------------------- USING)
self-preoccupation resisting affirming
self-punitive countering building upon
comparative/self-pity denying gratitude
attacking confronting
shaming self-expression
complying
asserting
intruding
Ongoing loops between “being a being” and the absence of being; these warrant different “holding” responses and
intervention approaches from the therapist
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23. Transcript of a Session
 Patient: [Arrives on time]. It is difficult to see
you today.
 Therapist: Difficult?
 Patient: Last session was very charged. You
made me see something that I had to admit to
myself, and I felt ashamed. It was that when I
am intimate with a man, I see it as a loss, like I
lose myself somehow, and this is what
prevents me from staying in a relationship, I
think. This gets to the heart of it somehow.
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24. Transcript of a Session
 Therapist: So the realization of intimacy as loss,
the admission of that, was—
 Patient: Shaming. I felt vulnerable. I felt like it
was a moment of intimacy between us, I was
exposed to you and you were connected to me and
I gave you something of myself.
 Therapist: Yes, I see how you are thinking about it.
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25. Transcript of a Session
 Patient: It was very charged, and for days I was
thinking about it and not really coming to any
conclusion, or epiphany, I just was sort of
marinating in it.
 Therapist: Marinating in it … soaking it up … that
sounds flavorful, like gaining some flavor or
becoming more complex, not negative.
 [Long silence]
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26. Transcript of a Session
 Therapist: And you had the sense that I made you
see something?
 Patient: Not that you made me, that’s not what I
really mean. Just being in here with you, the
atmosphere. You don’t actually make me do
anything, you don’t really even say that much, I
just sort of find myself stumbling into a corridor in
my mind and as we unravel something, unpack it,
things emerge and I guess that’s what therapy is.
 Therapist: So it sounds like therapy is interesting
for you in this way, but also very charged.
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27. Transcript of a Session
 Patient: Yeah, I almost want you to do something
more. Take a stand or make some kind of bold
statement like my other therapist did. That would
almost be easier: I would have something more
extreme to react to, and I would probably see less
of myself. In talking with you, I seem to realize
that things in my life never ultimately end up being
the way I have always seen them, there’s a kind of
twist or turn, a subversion, and the facts and
events, my motivations, my desires, suddenly get
overturned and what I thought was the truth isn’t
the truth. The truth I held onto was a truth I
wanted to see. You seem to know that.
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28. Transcript of a Session
 Patient: I had a dream over the weekend. I was
younger, maybe an adolescent, and I was in a pale
white sort of blank room, an apartment in Europe I
think, maybe London. It was very foggy, I couldn’t tell
if it was day or night. The apartment was a second-
floor walk-up and I was in there laying on a bed, I
don’t think I was sleeping, I was waiting for someone.
I later thought about the dream and wanted to think I
was waiting for you, that I wanted you to just lay
down next to me and I wanted to run my hands
through your hair. But in the dream you never came,
no one came. There were very few pieces of furniture
in the dream, there were no windows, only two or
three doors ...
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29. Transcript of a Session
 ...The whole thing was vague, blank, and I couldn’t
tell how I had gotten there or where I was going. From
the point of view of the bedroom, I could see that one
of the doors led to a corridor but I couldn’t get up from
the bed to walk to it. I wanted to, but I was stuck
there, or maybe I chose to just lay there, I think I had
the sense that going down the corridor would be more
or less the same, that it would bring me to another
room with another bed and another set of blank walls.
It was like this infinite array of rooms and doors but
would I ever get to something, would I ever really? I
don’t know … I don’t know what I wanted.
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30. Transcript of a Session
 Therapist: What were you feeling in the dream?
 Patient: Anxious, maybe, a little anxious. But
nothing really substantial. As I talk about it
though now I think probably you are going to say it
has something to do with desire, my desire for my
father, my desire for you, my desire for someone to
be with.
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31. Transcript of a Session
 Therapist: I hate being that predictable.
 Patient: You’re funny.
 [Long silence]
 Therapist: One thing that comes to mind for me
about your description of the dream: corridors
were a significant part of the dream and you used
that word earlier in talking about your work with
me.
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32. Transcript of a Session
 Patient: I think corridors often suggest pathways
to something, like a way out, or a freedom, or
realization, insight, like the bandThe Doors, the
doors of perception – that was some philosopher
or writer, right? But for me the sense of the
corridor was that it was less rewarding, it didn’t
lead anywhere …. like a Fallopian tube, like a
uterus, like veins and arteries, like a point in the
body that is just some segment of an endless
circuit.
 Therapist: How is a uterus like that?
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33. Transcript of a Session
 Patient: It is winding, empty. It doesn’t end in
something definitive; it’s just a cavity, a wall,
really.
 Therapist: With no zygote, no person, no identity.
 Patient: Yeah (becomes tearful). I am in that room
and I guess I want to find something in a corridor,
to find a man, a child, maybe myself, I don’t know.
I don’t know, but if I don’t become pregnant which
it looks like I won’t it will be a kind of tragedy, it
will be another empty corridor.
 Therapist: Another empty corridor where you find
no one, not even yourself.
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34. Transcript of a Session
 Patient: (tearful). I have not found anyone, really
ever.
 Therapist: But in the dream something is holding you
back it seems; you’re on the bed, waiting, and you feel
compelled to go through a door down a corridor, but
you are not able to move, you can’t move, or you don’t
want to move?
 Patient: I don’t know … there’s something about that I
just can’t get to.
 Therapist: Yeah, you want to get to it but you can’t;
like right now as we talk about it, there is something
eluding us about this pivotal part of the dream and
about you.
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35. Transcript of a Session
 Patient: Like I said, the whole dream is hazy,
foggy, so it seems to be about the stripping away
of detail where I am not supposed to see
something. It’s a kind of frustration, an
elusiveness that what is so easy for others is not
for me. Like just saying what I want, how we have
been talking about that. Saying what I want at
work, with my mother, with my friends … instead,
I hold onto my true thoughts, I am political as you
would say, I want to make peace and keep things
easy, not be too demanding.
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36. Transcript of a Session
 Therapist: So others can say what they want, and
that helps them get what they want, but you can’t
or won’t and you’re left feeling frustrated.
 Patient: Yeah, and I am trying to be political and it
doesn’t work. Despite all of my gifts I am just not
all that assertive, I am so concerned about how
the other feels, not wanting to make them feel
uncomfortable. I know that that’s wrong.
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37. Transcript of a Session
 Therapist: Wrong?
 Patient: It’s a weakness; it’s something I know I
need to change.
 Therapist: But you’re saying that the conflict is
really between saying what you want or need vs.
making the other person feel uncomfortable or put
off somehow. You are a person very focused on
how the other person feels in relation to you.
 Patient: I am.
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38. Transcript of a Session
 Therapist: And you’re saying that’s who you are. I
know you want to change it, but that’s a major
characteristic of who you are.
 Patient: It is.
 Therapist: If the other person is put off by you, they
will not feel good and will …. what, leave you? Go
away?
 Patient: Yes, of course, we’ve talked about the many
times this has happened. That’s how it’s worked with
my father, with others, in my professional life with
bosses – nothing is really for me, I exist for them and
their own needs.
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39. Transcript of a Session
 Therapist: Does this connect to the dream? What I
mean is, you said something about wanting to run
your hands through my hair if I was the one you
were waiting for in the room. But I never
appeared, right?, so you couldn’t really ask me.
 Patient: Yeah, it was something like that.
 Therapist: So if I never appear, you never have to
ask, or try to do something you want that might
offend me or put me off.
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40. Transcript of a Session
 Patient: I think that’s right. Just talking about the
dream and you in the dream is probably somewhat
off-putting for you, though I know you won’t ever tell
me. You’re not like that. It’s hard for me to know how
you really feel, because the focus is so much on me.
 Therapist: So you want more from me in that regard,
you want to know more about how I feel.
 Patient: I do and I don’t. It’s strange to me because
you’re so young but you’re more like an old-school
therapist, you’re conservative yet contemporary at the
same time ….
 Therapist: In the way I work with you? How?
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41. Transcript of a Session
 Patient: You don’t try to get somewhere with me,
you don’t ask me about my symptoms, we just talk.
The simplicity of that is, well, I don’t know, startling,
uncomfortable, but relieving somehow, it’s nice. It’s
like you’re just laying in bed with me and we’re
talking. My mother was never like that, though I
can remember wanting that from her in many ways
throughout my life, especially right before she died.
I was laying next to her in those last few days and I
just wanted to look at her and have her look at me
and maybe not saying anything to each other, just
seeing each other ...
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42. Transcript of a Session
.... But there was so much chaos, people in and out,
her doing her thing with complaining and getting
angry at my father, and I just felt lost in it, and I
couldn’t get what I wanted. I couldn’t get that
connection, a gazing into each other’s eyes, that’s
all. A recognition. The last guy I slept with turned
me over after we did it. He wanted to spoon and
what I wanted was to look into his eyes, with
nothing else, no words, no commentary, just the
two of us. [Short silence]. Isn’t there an old song,
some jazz/blues song called “Just theTwo of Us?
 [Long silence]
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43. Transcript of a Session
 Therapist: It occurs to me that you’ve wanted that
gaze, that recognition, just you and the other
person being with each other … you’ve wanted
that for a long time.
 Patient: A long time! And I’ve had it at times, I do
get it, but I guess, I don’t know … it doesn’t last, it
gets obstructed, it just gets lost somehow.
 Therapist: Does it get lost with me?
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44. Transcript of a Session
 Patient: Don’t take offense at this but yes, it does.
You’re really good in general, but there are times
you do something I don’t want and you miss me.
Maybe it’s my fault; maybe I should tell you when
it’s happening, I know you asked me to do that
before a long time ago, but it’s hard for me and in
the moment it’s hard to just stop the action …. it
might not be something you even say, it’s just the
vibe, your mood, your face, your posture, and the
tone gets off-beat ....
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45. Transcript of a Session
…. you go one way and I want you to come another way
… and of course I don’t tell you. It’s mostly after the
fact that I realize you might have been able to be there
with me, to please me I guess, but you weren’t quite
lined up with me …. it’s the sense that you were trying
to get somewhere with something and I guess that’s
your job but I really didn’t want to go anywhere …. I
know this is weird because for a long time I
complained that therapy wasn’t solving my problems
and you kept assuring me. But I guess that’s shifted.
 Therapist: I think it’s important we talk more about
this shift next time.
 Patient: OK. I will see you next week.
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46. JamesTobin, Ph.D.
 Licensed Psychologist, PSY 22074
220 Newport Center Drive, Suite 1
Newport Beach, CA 92660
 Assistant Professor of Clinical Psychology
The American School of Professional Psychology
Orange, CA
Email: jt@jamestobinphd.com
Website: www.jamestobinphd.com
949-338-4388
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