time, space and phantasy – by rosine jozef perelberg

Book Reviews

Nurturing Natures: Attachment and Children’s Emotional, Socioculturaland Brain Development by Graham Music. Published by PsychologyPress, Hove, East Sussex, 2011; 314 pp; £24.95 paperback.

It is not often that that the ‘puffs’ about a book contain as many superlatives asthose for Graham Music’s book do – nor, in my experience, is it often that thereviewer finds herself in such total agreement with them. This is an excellentbook, deeply scholarly, yet one which makes the complicated child developmentresearch it describes lively and accessible.

Music takes a clear and coherent approach to his very complex topic. Hepresents the latest research findings from developmental science, genetics andneuroscience, using often complicated ideas presented in a digestible way, tointroduce the reader to concepts which aid our understanding of emotional andcognitive processes and illuminate the question of how anyone of us becomes aswe are.The book is divided into parts, into chapters and into subdivisions withinthose chapters which are printed on the front page of each – allowing the readerto be signposted exactly as to where they are going, and enabling someone tofind a particular topic with ease. Indeed my only reservation about the bookrelates to this layout: I did not like the way each chapter began with the contentson a page on the right-hand side, making the first page of text on the left –somehow at odds with what we expect in a way I found strangely disconcerting.Yet, despite this way of presenting information within distinct sections, Musichas also kept a thread going throughout the book so that there is a feeling thatideas are built upon. He logically starts with Beginnings of Emotional and SocialDevelopment (Part I), which takes us from conception and birth into earlyrelating, the importance of attunement, mismatches, the effects of maternaldepression and an introduction to theory of mind, among other topics. We arethen given a fairly thorough opportunity to think about what he calls theOverarching Bodies of Ideas (Part II), which includes attachment theory, theimportance of culture, and a description of biology and the brain which wasexplained with a clarity for which I was very grateful. Part III looks at Devel-opmental Capacities and Stages, looking at the development of language, memo-ries, play and learning and thoughts about gender. Part IV, entitled Not JustMothers, simultaneously looks at influences beyond the mother–child dyad(non-maternal care, fathers, siblings and peer groups) and takes a developmen-tal approach, looking at how the child’s world widens from infancy, throughchildhood and adolescence into adulthood. The book closes with chapters onthe ‘Consequences of Early Experiences’, looking at trauma and neglect,the importance of resilience and the interrelationship between genes andenvironment.

Music introduces his readers to the latest research on all these topics. Hedescribes experiments that have shown, for example, young children’s innatewish to be helpful, or the increased activity in certain parts of the brain shownby subjects in experiments designed to show how differently we may respond todistressing pictures being inserted into a list of words to remember. From my

© The authorsBritish Journal of Psychotherapy © 2011 BAP and Blackwell Publishing Ltd, 9600Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. 407DOI: 10.1111/j.1752-0118.2011.01252.x

limited experience of attempting to read and understand such research myself,I am bowled over by Music’s capacity to take these papers and translate theminto something exciting and manageable for the interested but non-specialistreader.The book contains just under 40 pages of references.While some authorsleave me thinking that other writers have been cited to show off their scholar-ship, I never have this sense with Music. Rather he gives the impression that,having read about something he found fascinating, he wants to share what hehas discovered with us.

Music, who is an adult therapist and a child and adolescent psychotherapist,uses a perspective beyond the purely psychoanalytic.When looking at the role offathers, for example, or the influence of the culture within which an individuallives, he also references sociologists such as Bourdieu, while social anthropolo-gists provide him with information about other forms of child-rearing: he drawson studies of rats in the laboratory and monkeys in the wild to throw light onhuman behaviour.There is repeated acknowledgement of the adverse influenceof poor social environment, with a compassionate understanding of how hard itmight be for a parent to provide the qualities of ‘mind-mindedness’ and atten-tiveness, which are shown to be helpful for all aspects of a child’s development,including academic achievement, when living in poverty or a stressful environ-ment.This determination to avoid blame (‘Parents affect their children but oftenfor reasons well beyond their control’ [p. 241]) seems to come both from anunderstanding of the struggles parents make and from an awareness of the needto hold in mind the complexity of the issues involved, with some factors such asmaternal depression seeming more immediate,but with more‘distal’ factors suchas poverty also being influential. Music also carefully outlines the way in which achild’s individual genetic inheritance affects how that child is treated,noting howsome children seem to elicit harsher responses from their caregivers.He explainshow genes may predispose an individual to the risk or likelihood of certainbehaviour, but that aspects in the environment can protect against, say, thedevelopment ofADHD.How one is treated will affect what one expects from theworld (for example, children who have been maltreated are seen at nursery ageas unempathic to the distress of others), and it is important to disentangle whatare the separate and intertwined influences of every factor. He warns againstfindings which may seem to suggest causality but which on further examinationmay simply show coexistence: ‘Explanatory factors themselves often needexplaining’ (p. 214). Similarly, he avoids simplistic ‘either/or’ conclusions. Muchof the book highlights how disadvantageous adverse early life experiences canbe, but in the chapter on resilience he also cites research that shows that havinghad to struggle with some adverse experiences also fits us better to manage laterchallenges.Yet,at the same time,he points to the cost that such‘overcoming’ mayexact in terms of psychosomatic illness or Balint’s ideas of a fault-line.

Music also writes of how the individual’s trajectory is not determined,changes can take place as a result of helpful interventions or adverse life events:

The individual enters any new moment constrained by their current externalsituation and also by their history and prior expectations, their own set of

408 BRITISH JOURNAL OF PSYCHOTHERAPY (2011) 27(4)

emotional and biological capacities. Yet the next moment is always open to possi-bility and although people have patterns in place, such patterns can be eitherconfirmed or challenged by new experiences and new opportunities. (p. 242)

As a child and adolescent psychotherapist, as well as an adult one, I foundmuch of this research compelling. In trying to think what the mainly adultpsychotherapist readers of the BJP might find relevant I thought that Chapter10 on memories, Chapter 17 on trauma, neglect and their affects and Chapter 18on resilience and good feelings might be of particular interest. Music (2009) haspublished a paper in the BJP using some of these research ideas and showinghow they have influenced some of his clinical practice. Ideas about how memo-ries are formed, specifically with ideas about the reliability of rememberedabuse, could be of great use to clinicians, while the description (p. 212) ofdefensive and appetitive approaches seemed to me one that could help orien-tate me in work with certain patients. Music gives the example of participants,wired to display brain activity, being shown images of both happy and negativescenes. Subjects described as ‘high in neuroticism’ showed little brain activitywhen shown the positive images but had very active brains when shown nega-tive ones. The converse was true for extroverts. While Music’s statement, ‘Weperceive and react to a version of the world that we expect and understand’(p. 218), makes sense to me, I also find myself curious and possibly scepticalabout how the ‘neuroticism’ was measured. Of course, since the study thatproduced these results is referenced, I can be stimulated to look into it furthermyself! While we as therapists might not be surprised at studies which show theimportance of a subject being able to reflect on experience and hold ambiva-lence, it is useful to find research that backs our beliefs, and Music points out tohis non-therapeutic readers how these ideas are at the heart of much psycho-therapeutic theory. He also makes a brief mention of the usefulness of mentalhealth interventions as one of the forms of intervention that can alter ormitigate how someone approaches the problems which they have to deal with.Of course, I am aware of psychoanalysts and psychotherapists who feel that it isonly the internal world that we should concern ourselves with.While it may wellbe that we need to be mindful of those things we can alter and those we cannotand that we should concentrate our efforts within the areas in which we haveexpertise, I think it is always useful to keep in mind the patient’s context and beaware of their external reality. Knowledge of individuals’ capacities, someunderstanding of how their brains work and have been affected by past expe-rience, surely only add to our ability to work psychotherapeutically with them ina helpful way.

I believe that all psychotherapists would benefit from having the understand-ing that is conveyed by the research and the use that Music makes of it. I echothe praise given by Fonagy (‘beautifully written, highly accessible and inspir-ing’) and others and strongly recommend this book.

Janine SternbergThe Portman Clinic, London[[email protected]]

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ReferencesMusic, G. (2009) What has psychoanalysis got to do with happiness? Reclaiming the

positive in psychoanalytic psychotherapy. British Journal of Psychotherapy 25(4):435–55.

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Time, Space and Phantasy by Rosine Jozef Perelberg. New Library ofPsychoanalysis (Editor: D. Birksted-Breen). Published by Routledge inassociation with the Institute of Psychoanalysis, London, 2008; 221 pp;£24.99 paperback.

Take the large words of the title of this book out of context for a moment andthe scope of the enterprise feels dizzying – which might not be the frivolousresponse it appears, but a pointer to how ambitious a project this book is andthat it will make demands. The book’s epigraph should be noted as a warning:‘Einstein said:“The only reason for time is so that everything doesn’t happen atonce” ’. This deceptively simple statement leaves you puzzling over the ques-tions it raises, and the complexities and mysteries implicit in the title. Fortu-nately, Rosine Jozef Perelberg is generous with her explanations, as well as ameticulous guide through Freudian metapsychology and, specifically here, hisconception of psychic space and time.

At the outset the author makes clear her belief that psychoanalysis has madea revolutionary contribution to ‘the modern understanding of time and space inthe constitution of the individual’ (p. 3). Mystics and poets have alwaysexpressed the difficulties which time and space present and how intense thelonging for an escape from them can be. Is it not an attempt to resolve theintractable when Blake writes: ‘To see a World in a Grain of Sand/And aHeaven in a Wild Flower,/ Hold Infinity in the palm of your hand/And Eternityin an hour’ (Blake, 1988)? Or Crashaw’s ‘Welcome, all wonders in one sight!Eternity shut in a span’? (Crashaw, 1973). Such ideas seem to speak to the wishfor time and space to cease because they cause human beings to suffer, theydeny them satisfaction.

In taking on time, space and phantasy, Perelberg is bringing into focus thenexus of concepts underpinning Freudian thinking as she grapples withcomplex and elusive processes of mind. For all the abstractions of the title, thebook is of course rooted in clinical practice so, once the intricacies of theoryhave been unpacked, there are several chapters presenting this psychoanalyticunderstanding in action in the consulting room. Perelberg comes wellequipped for the undertaking. Her academic training began in social anthro-pology. She possesses a deep knowledge of Freudian texts and, as she issteeped in both the French and the British analytic traditions, she brings a richmixture of thinking, deeply absorbed and digested through both study andclinical work.

The first chapters give a succinct outline of Freud’s understanding of earlypsychic evolution. She brings the theory to life in its original context of theinfant’s early experiences of physical needs and the maternal body. (This linksto the primacy of sexuality which we later understand as central to the action


of her thesis on après-coup.) And from the picture of the child with thecotton-reel, she draws in the laying down of memory traces, the strugglebetween the pleasure principle and reality, absence and loss. She writes: ‘InFreud’s formulations, phantasies constantly reshape memories retrospectively’(p. 31). This in combination with other processes involving temporality, suchas repetition, is a key concept for an analytic undertaking – for the attempt tocreate new possibilities for an individual whose capacity for living has becomerestricted by the nature of their unconscious phantasies. This takes us to theaction of après-coup.

Perelberg is unequivocal that the concept of après-coup is pivotal to Freud-ian thought because, applying a Marxist term, she says that it works as a‘general illumination’ in his conceptual framework, that it is ‘the notion oftime that gives meaning to all the others’ (p. 24). She intriguingly envisagesthe whole concept of multiple temporalities as operating ‘like a heptagon inmovement’ (p. 31). The picture is of a rolling figure consisting of dimensionssuch as development, regression, fixation, repetition, and so on, with après-coup as the point, or dimension, which can be hooked into service by theanalyst.

Familiar, of course, but not as far as I know much discussed in Britishpsychoanalytic writing, après-coup has been treated as key in French thinking– the main reason for her choice of the French phrase over the Englishtranslation of Nachträglichkeit, ‘deferred action’. Following several chapters atthis point in the book which detail a number of very interesting and relevantcase studies, Perelberg takes up the discrepancy between French and Englishthinking in a paper about the Controversial Discussions. She notices theabsence of après-coup in the dialogue at this determining point in Britishpsychoanalysis, although it was implicit in debates around unconscious phan-tasy and its malleability. And, she asks, could the differences between theBritish schools – specifically on the question of whether earlier or later eventshad more impact psychically – not have been resolved by using the concept ofaprès-coup?

One of the challenges of this book is the discussion of relatively unfamiliarideas to British readers. Concepts like desire and absence, as well as après-coup,have a more central place in French psychoanalytic thinking, or have beentheorized about differently, so Perelberg takes pains to reconcile the diver-gences by returning systematically to the shared roots of Freudian meta-psychology. She cites Winnicott and Bion and Britton, but equally Green andLaplanche and Pontalis, and Lévi-Strauss appears often enough to show theformative effect of anthropology on the development of her ideas. How con-scious she is of the divide seems to peep out in an unexpected, small detail, anaside almost, when she describes telling a Paris-based psychoanalyst about adebate between André Green and Daniel Stern. The analyst had not heard ofStern. But, as though to emphasize her surprise at an insularity that is probablyquite normal, and not only among psychoanalytic Societies, she adds a culturalparallel – the visitor from some unspecified distant land who had not heard ofMozart, nor, she cannot resist adding, of olives. It suggested to me how much

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the issues of cultural, intellectual and academic divides, and how they canbe thought about, underlie her sensitivities – and how fortunate for us thatPerelberg has the motivation to be interested in re-investigating what otherwisecould petrify as given history, in this instance in the story of British psycho-analysis.

In the section on Applications the author takes a step back from theory anddirect clinical considerations to allow a wider perspective on the same themes,including an illuminating discussion of One Hundred Years of Solitude, theclassic Gabriel García Márquez novel in the Latin-American tradition. In thefinal chapter, entitled ‘The Infant and the Infantile’, another difference betweenthe British/American schools and the French is explored – that (between Greenand Stern) on the value of infant observation versus the search for the ‘psycho-analytic infant’. Perelberg cites a clinical example which suggests a complemen-tarity, but makes clear how a simplistic reading of observation and its predictivevalue is unacceptable, because the ‘future reinterprets the past’. This particular‘clash between different psychoanalytic cultures’ (p. 182) is another arenawhere the author’s loyalties seem divided but, while holding the distinctions, sheachieves rapprochement in a creative way.

Her argument here also involves both temporality and research, and Perel-berg follows on to the debate about the scientific validity of psychoanalysis.On this, the further Einstein quote heading the chapter is reassuring: thatit is all right to work from theory, however unprovable, because the keyscientific credential of observation is itself subject to the theory you startfrom.

It is difficult not to see the structure of the book – the order of the papers– as significant in light of this scrutiny of the concept of après-coup. As I havealready commented, the papers are not placed chronologically, but carefullyarranged to inform understanding both in a linear progression and retro-spectively. The effect of this is to demand that the reader revisits earlierpapers in order to better understand later ones. It makes it complex,but in that complexity it comes to life as a tour de force of understandingand effectiveness.

This is a book to read and re-read, to return to for specifics as well as toimmerse oneself in for further revelation. The author offers her erudition andintellectual vigour to be shared, not just admired; she invites you into herthinking process, making one feel better equipped to return afresh to Freud’stexts. At one point Perelberg quotes Bollas on the psychoanalytical processand its evocation of a complex network of ‘affective, ideational, memorial,somatic and cognitive workings in the analysand’ (p. 142). Reading this bookis rather like that. And writing about it has become something of a process ofcontinual re-organizing of my responses and thoughts in the light of succes-sive responses and thoughts. Perhaps what Perelberg has done is delineate aspace, by a play of intellect and curiosity, so that we can grasp the apparentlyformless – space and time – in the context of the psyche as shaped anddirected by the powerful workings of phantasy. I strongly recommend findingthe time to read it.


Elizabeth FordLondon Centre for Psychotherapy, London

[[email protected]]

ReferencesBlake, W. (1988) Auguries of innocence. In: William Blake: Selected Poetry, p. 147.

Harmondsworth: Penguin.Crashaw, R. (1973) In the Holy Nativity of Our Lord (1648 version). In: Lewalski, B.K.

and Sabol, A.J. (eds), Major Poets of the Seventeenth Century, p. 653. New York, NY:Odyssey Press.

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Reading Winnicott edited by Lesley Caldwell and Angela Joyce. NewLibrary of Psychoanalysis Teaching Series (Editor: A. Lemma). Pub-lished by Routledge in association with the Institute of Psychoanalysis,London, 2011; 336 pp; £21.99.

This book is in the New Library of Psychoanalysis Teaching Series and con-sists of 14 of Winnicott’s key papers chosen to give an overall view of thedevelopment of his ideas and practice. However, the book should not just bejudged on Winnicott, but more on the extensive and detailed editing by LesleyCaldwell and Angela Joyce, acknowledged academic and clinical experts onWinnicott.

The excellent introduction consists of a clear summary of the four main areasof Winnicott’s work: the relational environment and the place of infant sexual-ity, aggression and destructiveness, illusion and transitional phenomena, and thetheory and practice of psychoanalysis with adults and children. There are alsobiographical notes and sections on how Winnicott’s work was influenced byFreud, Klein and others including short sections on Jung and Lacan. The linksand differences between Winnicott and Klein are well dealt with here. At thebeginning of the book there is also a chart with dates of papers and importantevents in his life. This chart makes clear the vast amount of writing Winnicottdid, both to a psychoanalytic and a wider audience; no one has since come nearhim in his ability to put psychoanalysis before the public in such a convincingand appealing way.

At the beginning of each paper there is a box with details of other paperswritten by Winnicott around the same time and contemporary papers on similarsubjects, which incidentally provides an interesting short history of psychoana-lytic writing in Britain from the 1940s–1960s, and then an extensive introductionby the editors. At the end of most papers, including those written near the endof his life, is another small box that lists ideas that Winnicott was developing inthe paper, helping the reader to bear in mind these developments in laterpapers. All this information provides a short but comprehensive description ofWinnicott’s life and work, contextualizing the papers chosen here. It must havebeen a hard choice limiting the prolific Winnicott to 14 essential papers but, readwith the introductions which refer frequently to other papers, a comprehensivepicture of his model emerges.

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To my regret it is years since I have more than dipped into Winnicott, just anoccasional rereading mostly of the well-known papers. So I approached thisbook with great interest, looking forward to an in-depth rereading to see indetail, rather than by memory, what his model of the mind is and the conse-quences of this for treatment. Winnicott’s ideas can be both over-familiar andnot familiar enough, too easily referred to without knowing the full implica-tions. I rediscovered these papers as the most rewarding and fascinating read;Winnicott is a wonderful writer, with something intriguing and thought-provoking on every page. Even when reading over and over again, say, thecrucial importance of the mother–infant relationship, his voice still comes overwith passion and freshness, especially considering that the early papers in thisbook were written nearly 70 years ago. Right until the end of his life Winnicottcontinued to think and write with an inspiring creativity, and it is fitting thatsome of his late papers are about creativity and the importance of being able tolive life creatively rather than compliantly.

Ogden, who believes that Winnicott is the one great writer on psychoanalysiswriting in English, describes his writing thus:

The most distinctive signature of Winnicott’s writing is the voice. It is casual andconversational, yet always profoundly respectful of both the reader and the subjectmatter under discussion. The speaking voice gives itself permission to wander, andyet has the compactness of poetry; there is an extraordinary intelligence to thevoice that is at the same time genuinely humble and well aware of its limitations;there is a disarming intimacy that at times takes cover in wit and charm; the voiceis playful and imaginative, but never folksy or sentimental. (Ogden, 2001, p. 300)1

It is that voice that I had found too elliptical and difficult to pin down in thepast and not helpful enough in the day-to-day intricacies in trying to understandwhat a patient is saying. Reading Winnicott provides a very different experienceto reading, say, contemporary Kleinian literature in which there is often minuteanalysis of a particular session.2 This time round I found this refusal to bedetailed much more inspiring in its means of showing you about being with andunderstanding a patient on a very early and nonverbal level. There is remark-ably little detailed adult clinical material in this collection apart from in Cre-ativity and Its Origins (1971, Chapter 14) which gives such a good illustration ofhow intuitively Winnicott worked.

I found it more useful to read the introductions to the papers after reading theactual paper. Winnicott’s language is so particular and in reading him you gethold intuitively of what he is trying to say and go through the process with him ofwhat he is working out;and so it makes sense to come to the papers fresh and readthe expansion and commentary afterwards.There is a very well-known quote byWinnicott in Primitive Emotional Development (1945, this volume, Chapter 2):

I shall not first give an historical survey and show the development of my ideasfrom the theories of others, my mind does not work that way. What happens is thatI gather this and that, here and there, settle down to clinical experience, form myown theories and then, last of all, interest myself in looking to see where I stolewhat. Perhaps this is as good a method as any. (p. 57)


It is possible to read these papers in a similar sort of a way: settling down tothe paper, puzzling about what he was saying and how he was saying it, gath-ering thoughts and forming ideas about what he had written, in a way ‘playing’with the text. Reading in this way mirrors how Winnicott came to believe thattreatment should be conducted, play is what is aimed for, so it is partly in anexperiential rather than a learning way, that reading him is inspiring.Winnicott’swriting – in a way matched, in my view, only by Bion – enables readers to thinkfor themselves in a very creative way.

Winnicott, for the most part, does not use language to arrive at conclusions; rather,he uses language to create experiences in reading that are inseparable from theideas he is presenting, or more accurately, the ideas he is playing with. (Ogden,2001, p. 299)

Having read the paper, the introductions provide expansion, understandingand interpretation. They are a dense three or four pages and, in comparison tothe Winnicott texts, interestingly different – and at times difficult – to read. Inthe main these introductions stick to a detailed explication of the paper at handand its links with some of his other papers; their aim is to explain and illuminateWinnicott’s position rather than offer a detailed critical account or justificationfor his views, but they include comparison with the ideas of Klein, Bion andothers and a description of their differing beliefs when relevant. Winnicott’sparticular use of language with all the complexities this brings to his meaning iswell explained. Occasionally it is frustrating that the editorial voice gets lost inan impressive familiarity with the literature, when the point being made is leftto multiple references to other writing, complicating rather than simplifying theissue.

In their conclusion to the Introduction the editors describe in rather negativeterms their view of the position of Winnicott today and make a plea for theimportance of more open debate and discussion in psychoanalysis, the absenceof which they believe has impeded the ongoing evaluation of Winnicott’s workand its links with other theorists. They believe that his reputation has sufferedby lack of understanding. This collection of papers, together with their intro-ductions, certainly gives the reader a thorough understanding of Winnicott’smodel of the mind, and by doing this provides a vigorous defence of the ongoingimportance of studying his views on the essential issues for psychoanalysis, bothcontemporary and historical. Hopefully this will not just be seen as a usefulcollection of papers for teaching; it is far more than that. It is a book ofwide-ranging, careful scholarship that should be the essential starting point foranyone interested in Winnicott.

Linda PethickLondon Centre for Psychotherapy, London

[[email protected]]

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Notes1. This article by Ogden is an excellent analysis of a psychoanalytic text as a piece ofwriting. Ogden believes that psychoanalytic papers should be studied by reading themline by line as texts, thereby gaining the maximum access to the unconscious meaning;Winnicott’s papers are ideal for this treatment.

2. See, for example, Michael Feldman (2009) for a paper which provides an excellentanalysis of the meaning of one incident in a patient’s life.

ReferencesFeldman, M. (2009) The dynamics of reassurance. In: Doubt, Conviction and the Analytic

Process, pp. 54–71, London: Routledge. (New Library of Psychoanalysis.)Ogden, T. (2001) Reading Winnicott. Psychoanalytic Quarterly 70: 299–323.


time, space and phantasy – by rosine jozef perelberg

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