The possibility of regression in a structured environment, 1963

These notes were written during a difficult time, when it seemed that the Mulberry Bush would have to be turned from an organism into an organisation. I was attempting to adjust to changes which I found intolerable. This paper was an attempt to come to terms with a deeply altered emotional climate. These were problems for everyone concerned with the Mulberry Bush during this phase of development, many of which have now been resolved.

The provision of primary experience must depend on the insight and skill of the individual therapist, and on his or her capacity to be able to be sufficiently involved with the child to produce an emotional climate comparable to maternal preoccupation (I shall be discussing the nature of this ‘climate’ later). Furthermore, the therapist will need to be able to make appropriate adaptations to the child’s special needs in this setting; these adaptations being provided with concern, consistence, and continuity over perhaps quite a long period of time.  Such adaptations are symbolic, but essentially something done by the therapist for the child, or something given to the child by the therapist.  What is done or given must be real (Sechehaye, 1951, talks of ‘Symbolic Realisation’).  One says of justice: ‘It is not enough for justice to be done – it must be seen to be been done.’ Of this primary provision through symbolic adaptation one could say: ‘It is not enough for it to be done – it must be felt to have been done.’  That the adaptation should feel right is as essential for the therapist as it is for the child (in this context ‘the therapist’ may be anyone in the place who is caring for the child).

Let me make it clear that I can imagine nothing worse than a conceptualised system of adaptation dosage, however well planned.  One sees such a system employed by obsessional mothers with their babies.  Many childhood psychoses have such a history: the mother claims with absolute truth, ‘But I did everything I was taught to do for my baby.’

Clearly, therefore, provision of primary experience has to be made as the result of a slow and natural process between grown-up and child.  It must be highly personal and individual: dependent – just as with a mother and her baby – on the particular personalities and the emotional climate in which the process takes place.

I have written elsewhere about assigned function and created role: the assigned function is the particular ‘job’ done by a person in a place, eg, a teacher or a matron.  The created role cannot be defined in terms of objective reality; indeed, such a role may never be recognised or stated: nevertheless, whatever the assigned function may be, every grown-up in the place will  be created subjectively in many roles by both children and fellow workers.

When one comes to consider role and function in connection with primary experience, one sees at once that a grown-up therapeutically involved with a child can only hope to provide primary experience if he or she accepts a provider’s role, within the assigned function.  The narrower and more specific the function, the more difficult will it prove to provide the continuity of experience and meet the expectation of adaptation to needs, which is required by the child.

A mother who hands over her baby to various people in the course of twenty-four hours, or who goes out to work for long periods, will never establish such continuity: this is in fact just the kind of mother who is likely to have an emotionally deprived child, a child who has gaps in his emotional experience – unless someone else in the environment has taken over the provider’s role in the original situation.

In the same way, a person working in a place for a few hours every day, or all the time in a very specific context, may become involved with a child who is in need of ‘gap filling’; but he or she may be unable to find any way of making continuous emotional provision which will ‘keep the child going’ and be sufficiently reliable to prevent further gaps in the child’s life.  A teacher, for example, in a boarding school for deeply disturbed children, who never gives a child a meal, or puts him to bed, or takes him out alone, has a much narrower field of provision and continuity open to him than would be available to him if he were to be in touch with the child outside as well as inside the classroom.

In our particular school there had been in the past extreme flexibility of function by grown-ups accepting provider roles.  However, in our own case, flexibility was by no means successfully equated with efficiency, and the school was in no ordinary sense an efficient organisation.  (I must note here that now in 1967 I think we can claim to have achieved a flexible organisation within which regression can take place without too many problems.)  The same grown-up might teach a child, take him to the dentist, give him a bath, or paint a picture with him; the same therapist might ask the matron to treat a minor injury, take a child to the staff house and cook a meal for him.    The therapist might spend money on a child (buying a symbolic gift of special sweets or some other special food) without making any formal arrangement in advance.  He might ask another member of the team – on the spur of the moment – to take over his group for an hour or more so that he can free himself to see a child the whole way through a rage.  Anybody, working in this way is continually ‘committed beyond his capacity’, as has been so well stated.  I do not believe that adequate provision of primary experience can be made without such commitment.  ‘Localisation’ would seem to be the only possible solution, if the environment is to be as structured as most places really seem to need to be, and this is the theme which I wish now to discuss.

I would like to consider the particular problem of giving one small boy, Tommy, what he needed at one point in his treatment.  Here is an extract from a letter from Tommy’s mother.

Tommy has had no tempers, he has been quite good really.  For the first four weeks at home Tommy only had about four nights’ sleep, he used to lay awake all night long, and he never slept in the day.  And he used to wet the bed and wet himself, or dirty himself.  But he has not done that for the past three weeks.  When he first came home I could not send him out to play, as he used to try and strangle the children he was playing with, and he started to talk like a baby.  But he has stopped that now.  But he won’t wash or bath himself, and he won’t comb his hair.  He used to bath and wash, and comb his hair, but not since he has been home.  He takes two hours to wash, and then someone has to wash him after because he has not really washed, just been playing about.  He won’t undress himself, or get dressed – but I make him do it….

My reply to this letter was:

Thank you very much for your letter which told me so much about Tommy during these holidays.

I can see how difficult it must have been for you to manage him at this stage, and in some ways I would have thought it better for him to have reached this stage at the Bush.  However, in other ways it seems to be extremely important that he has been able to go through this with you in his own home – because this is where it all belongs.

What I feel you have described is Tommy as a baby again, because it seems clear that this is how he has behaved, and that his needs have been those of a baby.  An experience such as this with you at home will make it possible for him to make more progress with us this term, because he has really gone back to the very beginning and filled in some of the gaps in the first year of his life – which you and I have talked about.  I think he may do this again from time to time, both here and at home, and he was probably trying to do it towards the end of the last term but was not able to because Mildred was going away.

You will remember we agreed when we met at the clinic that this was going to present real problems for him.  What I think is going to be very important is that when we meet the behaviour you describe here – and when you meet it at home – we should all remember that this is a very little Tommy and not a big Tommy at all, and let him have the bit of babyhood experience he is asking for.  Sometimes, of course this may be too difficult, but whenever we can I think we should let him enjoy this.  From experience with children who need this sort of thing I feel sure that this well help him towards recovery, in a way which nothing else can do.

I am hoping so much that you will come again to the Bush as soon as possible, so that we can talk about this together.  I shall also be going to the clinic at some point this term, and perhaps we could meet again there.

I shall be seeing Tommy myself quite a bit this term, when he will obviously be missing Mildred, and will also, I know be very unhappy leaving you…..

You will now want to know something about Tommy.  Perhaps he can speak for himself.  Tommy had a song:

The little boat sails
On the water.
And the little boat sails
On the waves.
And the little boat did
And the waves was dead
Then the waves had nothing
To do with the little boat
There was nothing for the little boat.

Tommy’s song referred to his babyhood.  He talked to me about the storm which had caused the waves which tossed the little boat about until they were dead and there was nothing left.  What we reached later together was that there was once a time when the little boat was rocking gently on the calm and sunlit sea, before the storm.  As Tommy said, ‘I did not know there was a beginning to the song; it is like there being a nought before there is a one.’

I think all of us have unsung songs, unpainted pictures, and unwritten pieces of music inside us.  The poets, the artists, and the musicians can communicate these in such a way that they sing, paint, or play their earliest experiences and find a response in us because we have also had a golden age at the beginning of our lives.  But the disturbed children whom we try to help in our school have, all too often, no unsung songs within them.  They have had nothing about which to sing.

It will be clear from her letter that Tommy’s mother could not give him the regression he so much needed.  It would really be more accurate to say that she was not able to allow herself and Tommy to experience involvement and a commitment.  She had not, however, shut her eyes to Tommy’s needs: her letter was in a way an appeal for us to make the provision which she could not make in this context: any more than she had been able to do when (with Tommy three weeks old) she had handed Tommy over to a foster mother for nearly a year.  How far, in the current structured environment (which must have resembled quite closely any good boarding school or children’s home) could we undertake this provision for regression, which we were being asked to do by both Tommy and his mother?

There are several regression zones referred to in this letter.

1. Tommy lay awake all night.  His mother – a reliable informant, on the whole – must have been awake herself, to know this.  A child in regression will often stay awake at night in order to experience continuity of care from the therapist, which is impossible during the busy day.  For the grown-up involved this may mean a sleepless night spent by the bed of the regressed child, perhaps holding his hand, or in any case meeting his needs in a special way, for hours at a time.
2. Tommy’s mother described him as being constantly wet and dirty.  This, in a residential place, means an endless supply of clean laundry, with clothes changed every time the child becomes wet and dirty (just like changing babies’ nappies) perhaps twice in a morning.
3. Tommy’s mother referred also to Tommy’s talking in a babyish voice.  This would mean that if there was to be a regression the grown-up would have to respond in kind – at least to respond to unintelligible little noises, in the way that a mother communicates with her baby.
4. His mother described how Tommy would not dress or wash himself (remember this was a lively, active child), and if left to do so, took a long time.  In treatment, if this zone was to be used, Tommy would have to be dressed and undressed unfailingly, perhaps for weeks on end.

There would probably have to be all sorts of secondary adaptations, but these were the regression zones indicated as appropriate by Tommy to his mother.  She, unable to meet his needs, did all she could do by writing to me and passing on the necessary information (she had not often written to us, and never before in this way).

The problem now confronting us was just how to provide Tommy with his regression, in a structured environment, without dislocating a well-run organisation which had only recently been established.

Let us consider the various points:

1. If a person in the place sat up all night (perhaps for many nights, and probably at least one each week), how could he or she work next day?  Would all the other children in the place require this adaptation?
2. If Tommy was to be changed whenever he got wet or dirty, and was not scolded but comforted, how could the laundry be managed? And here again, surely all the other children would get wet and dirty too?
3. If Tommy’s therapist responded to Tommy’s baby talk it would often take some time to understand his communication.  In the meantime, it might be getting-up time, lunch time, time for assembly, or time for lessons.  The child and the grown-up would constantly tend to be out of step with the organisation.
4. If Tommy was to be dressed and undressed every day by the therapist, this would cause disturbance to the established routine.  Other children would say ‘Why?’ The grown-up concerned might be a teacher, for example.  Perhaps he would not even be in the school at the particular time when Tommy gets up or goes to bed.

There is an Irish saying which goes roughly like this: ‘If that is where you want to get to, you should have started from somewhere else’, but this a defeatist attitude.  Tommy had to have his regression – and so did all the others like him – and the organisation had to be preserved.

Sometimes a child at the Mulberry Bush uses sessions with me as a regression zone.  Tommy did not do this, but he did bring a very small bear, which I gave him, to his sessions.  He kept this little bear tucked in his pocket.  This little bear was also Tommy – the little Tommy who needed the regression, who needed to be warm and contained and cared for.  Tommy allowed me to help to take care of this little bear; one could call this localisation of a kind, though displaced.

Tommy joined a spontaneous group which met in the evening with a member of the team.  This group was making soft white toy rabbits, which became important in their creators’ lives.  Tommy made such a rabbit, to which he was devoted.  A newcomer to the team, concerned for Tommy and knowing how easily possessions can be lost or destroyed, collected the rabbit from Tommy’s bed one morning, and locked it up in the clothing store for safety.  This was done out of kindness and concern, but Tommy was not able to understand this: regardless of all dangers, he wanted to look after his own rabbit.  Finally, however, he settled for a compromise, by which he could see the rabbit from time to time.  From a therapeutic standpoint such a compromise is unfortunately not satisfactory.  Tommy had created the rabbit, which was therefore in the deepest sense his rabbit.  Should he wish for his rabbit to be guarded, he could have asked the guardian of his choice.  Children have in fact the right to lose what belongs to them.  It can even be important for an emotionally deprived child to lose something he values; it may only be through loss that he can experience the realisation that he now has something to lose.  It is true that the rabbit could easily have been destroyed – perhaps even by Tommy himself – but there could be various important reasons for this to be a necessary experience.  For example, he could be destroying something personal, and through this act he might have reached a feeling of personal guilt in respect of his destructive act, and an acceptance of personal responsibility for his actions.

One could say, of a more mature child, that the creation of the rabbit was more important than the actual rabbit.

It would, however, be inappropriate to think of Tommy and other children who are so deprived, in these terms.  For somebody like Tommy there is only the rabbit he imagines, and its magical projection into reality.  The process of making the rabbit he would have found frustrating in the extreme, and this would be ‘ forgotten’ thus he preserved his infantile and magical omnipotence (the prototype of which was, he invented his mother and there she was!).

The rabbit might well – if it survived long enough – become a transitional object, such as Winnicott has written about.  For this to happen, the rabbit would need to belong completely to Tommy, rather than be looked after for him.  We all know mothers who take such care of their children’s toys that they can be proud of the toy’s long survival.  These, however, are not the toys which a child values: such toys are usually shabby, broken, and torn.

The little bear in Tommy’s pocket was more localised than the rabbit.  It was easier in a structured environment for the bear to become little Tommy than for the rabbit; grown-ups would not worry about a small bear in a pocket in the way they would worry about a rabbit on a bed.

Thinking on these lines, I find myself considering the letter from Tommy’s mother.  Tommy had attempted to have a regression at home, and this had proved impossible.  The regression zones found by Tommy do not seem to be any more possible in a structured environment than at home.  Symbolic objects like the bear and the rabbit remain once removed. We have considered the problems for the organisation which would turn up if Tommy had a regression on his own personal lines (awake at night, wet and dirty, talking baby language, and refusing to dress and undress).

Nevertheless, without the regression Tommy could not make an emotional recovery.  There is a real danger, however, that this kind of child may achieve a superficial social adjustment within the organisation.  This is what often happens in institutions of all kinds.  Such children are emotionally impoverished when they grow up.  Yet, for there to be a successful and smooth-running organisation, there must be exact timing; rules and regulations must be kept.  It is easy in such a situation for the child to prove that no special adaptations are available to him, and to withdraw from the possibility of regression.

I have spoken earlier of a very special emotional climate, which must exist if therapists are to provide primary experience.  In the normal mother-baby unity there is no super-ego factor present; there is no feeling of guilt in respect of deep involvement with another living being. The mother who is preoccupied with her baby has projected all super-ego elements by whatever means at her disposal.  The father then protects the mother-baby set-up from super-ego impingement.  The therapist going into a regression with an emotionally deprived child must also project super-ego; furthermore, she must be supported in doing so (I would stipulate, however, that the grown-up must be fully conscious of the involvement, the projection, and the support given).  This means that, just as the father protects the mother-baby unity from super-ego impingement (for example, dealing with the criticisms of envious relatives – ‘You are spoiling your baby’ or ‘You mustn’t give in to him’); so, in the therapeutic involvement, there must be a supporting team or individual to say when necessary ‘You are giving the child what he needs – go on.’

There are many factors in a structured environment which make involvement difficult.  Rules and regulations, unless fairly flexible, can operate as stern super-ego demands, instead of being ego supportive.  There is a time factor; a grown-up may be doing something very special for a child when a bell rings or a whistle is blown, and the grown-up realises that he or she may actually ‘get the child into trouble’ by making him late for a meal.  So the primary experience – whatever form it may have taken – may be interrupted; this interruption is in a subjective sense for ever, and is a faithful reproduction of just the kind of traumatic break expected by the child.

It is easy too for involvement to be seen as perverse.  A man accepting a maternal role created by a small boy may look after the child in a maternal way.  The fact that he is quite aware of what he is doing, discusses his work in detail, and so on, may not save him from suggestions that he is a homosexual.  There is nothing more vulnerable than a therapeutic involvement: once guilt has been let in at the door, primary preoccupation flies out of the window.

I have described some of the difficulties likely to turn up in a structured environment when a child needs a regression, and some of the reasons for these difficulties.  We are left with the question: given these circumstances and accepting the need (provisionally, at all events) for a highly structured environment, how could Tommy’s needs be met?

I have suggested localisation (in other papers I have referred to the successful use of localising symbolic adaptation).  Such an approach is of course open to all sorts of abuse.  Arbitrary, adult-determined adaptations, even though based on Tommy’s reported expectations, would not ‘feel right’ to either grown-up or child; they would only, at best, appear to be therapeutically correct techniques.  Here again, we all know the mothers who do this sort of thing because it is all they can do: we also know the devastating effect this has on the babies.

Localised adaptations, therefore, needed to be selected and indicated by Tommy himself.  Let us look again at the total requirements.

1. Someone with him at night.
2. To be constantly wet and dirty and to be constantly made warm and clean.
3. To have baby talk accepted as a means of communication.
4. To be dressed and undressed.

Ideally, all this provision would need to be made by one person (I have done this myself quite frequently, so I speak from personal experience).  In the absence of a provider, however, the child will accept a provider substitute (usually the person who specially acts as supporter to the involvement), but there must be a principal provider.  The result would be a climate and environment capable of containing Tommy’s regression.  Let me be quite clear about this; it could not be provided within our organisation, for perfectly good reasons.  The organisation could only be slightly disrupted, if at all.  The regression had to be drastically localised.

Now it would be easy to say:

1. Someone – even Tommy’s provider – could sit with him for ten minutes each evening.
2. Someone (it probably could not be the same person) could give him clean handkerchief tissues whenever he asked for them.
3. Someone could put on his tie every morning, or brush his hair, or do up his buttons, etc.
4. His own provider could accept baby talk from him in some special context.

Any of these adaptations might succeed, but only if, having failed to obtain the total regression, Tommy himself were to indicated the form of localisation which would feel right to him; as long as this also ‘felt right’ to his provider, one could be quite optimistic.  It was much more likely that the grown-up would say ‘I’m sorry, Tommy, I can’t dress you, but I will do up your button’ or whatever.  There would be a different state of affairs if the grown-up were to say ‘I wish I could dress you, Tommy, but I have to do something else at that time’ (or whatever the facts may be) ‘perhaps you and I can find something I can do for you that’ll feel right, and be what you need me to do.  It’s no use my saying I’ll do something unless I really can’. Of course the grown-up concerned would say this in the kind of words which would be meaningful to the child; but his would be the content of such communication.

Sooner or later the child would then indicate the adaptation zone and the localised area within this, but the grown-up – the provider – would need to be sensitive and aware enough of the implications to understand and recognise such an indication.

For example: Peter came to me for sessions over a long period.  He needed a localised regression for various reasons and had indicated several zones for regression which would have been impossible for me to use continually and reliably in the way he would need.  He always seemed to have a running nose and to be miserable about it yet unable to find any comfort, so I took care of his nose over quite a long period.  I brought handkerchief tissues, and when I was not there I let him know with whom I had left a supply for him.  I provided a little pot of cold cream to soothe the roughened skin: in this was I able to take care of his nose and to show him how much I was concerned about him, even when not present.  The hopelessly running nose was a signal which I picked up, and I really did mind about his poor nose; whatever we do for the child must matter to us.

This is why one cannot give instructions to people in a place; one cannot hand over therapeutic techniques in penny packets.  This is as true for mothers and babies as it is for therapists and their patients.  Mothers need to do what feels right to them and their babies.  It is no use telling an obsessional mother to put her baby on a demand feeding regime:  this will be alien to her, and if she carries out orders, she will do so in such a way that she and her baby will suffer.

Insight can only be gained slowly, and one must not confuse insight with intuition.  People can only do therapeutic work in terms of themselves as they really are.  We cannot teach this kind of work; we can only give people permission to learn, and support them in meeting the child’s needs, when they realise what they really are.

The greatest obstacle to regression and to the provision of primary experience is the resistance in involvement.  People can feel (or be made to feel) guilty in the way I have described; they are also usually unconsciously aware that involvement is a vulnerable, undefended, and dangerous state.  For therapeutic involvement to be present there must be a supporting emotional climate, however structured the environment may be.  Even in the case of the most localised adaptation, support will still be needed if the provider is to feel able to be sure that the provision is valuable and necessary.

I have discussed the possibilities of Tommy’s regression, and it may interest you to hear the sequel to the correspondence I have quoted.  I started writing this paper at the beginning of a term, and was surprised and impressed by just how well Tommy was tackling various difficult problems in the school, especially the departure of a much loved teacher.  I have not mentioned before the fact that we had done a good deal of work with Tommy’s mother, and that a lot of work had also been done for her before Tommy came to us.

Towards the end of the summer, there had been indications here that Tommy was ‘asking for’ a regression, and I had talked about this to his mother before he went home for the holidays.  When I received the letter from her which I have quoted, it never occurred to me that she was asking my approval for what she had already done, rather than asking for my understanding that this was something she could not really allow herself to do.  I did mention that she must have been awake herself at night in order to know that Tommy was not sleeping; imagine my surprise and delight when I had an interview with her at the referring clinic and found that in fact she herself had been able to provide Tommy with the total regression which had not been available to him here, the previous term.  What is more, she was able to tolerate the thought that this had been a pleasurable experience to her.

She had moved Tommy into her own room, and had been awake with him all night, while he gazed out of the window and talked to her; she had taken off his wet and soiled clothes and had bathed and dressed him with clean clothes on every occasion when this was necessary; she had accepted his baby talk as communication; she had dressed and undressed him in the morning and at night, as though this was the most normal state of affairs: and she had done all this with feeling and insight.  The psychiatrist supervising Tommy’s treatment (who was with us), Tommy’s mother and myself, were all equally happy as we talked about this.  Tommy’s mother knew that there were going to be more regressions, and was prepared to go through them with Tommy.   There was still a need for localised regression in the school, but the fact that Tommy was able to have a total regression with his mother, made these both less essential and easier to provide.

In this case, however, we had a mother who had gained insight through treatment and who had been given enough support by all of us to become involved with her own child.  There are only a few mothers who can be helped in this way so that they can give the therapy themselves: there are the countless deprived children in need of a regression who are entirely dependent on the people who care for them in residential placement.