The good enough mother

Donald Winnicott was a paediatrician and psychoanalyst whose work had a profound influence on our understanding of psychological development. In today’s episode, Lynsey and Chrissy discuss Winnicott’s concept of the good enough mother and the importance of parent-infant relationships for healthy psychological development.

If you would like to learn more about Winnicott’s work, we wholeheartedly recommend reading some of his original work: The Child, the Family, and the Outside World  is a great place to start. 

If you or someone you know is struggling with mental health difficulties, there is lots of help available. You can contact your primary care provider in the first instance, or if you are based in the UK the NHS perinatal mental health website will help you to find support in your local area.

Transcript

[00:00:10] Lynsey: Hello and welcome to the podcast. This is beyond baby blues. Our podcast about maternal mental health. 

I'm Dr. Lynsey McAlpine. I'm a trainee psychiatrist based in east London.

[00:00:19] Chrissy: And I'm Dr Chrissy Jayarajah. I'm a consultant perinatal psychiatrist and clinical lead working in London.

[00:00:27] Lynsey: This is a podcast for anyone with an interest in maternal mental health. So if you're a parent yourself, if you're a healthcare professional that you work in social care, or even if you just have an interest in the field of women's mental health, then there's something in this podcast for you. 

Today, we're going to be talking about some concepts from the world of psychoanalytic thinking. And specifically, we're going to be talking about a 20th century, British psychoanalyst called Donald Winnicott and his theories about something that he described as the good enough mother. 

[00:00:56] Chrissy: So Lynsey, this might be a good opportunity for us to just explain a little bit about the difference between psychotherapy and psychiatry.

[00:01:04] Lynsey: Sure. So you and I are both psychiatrists, which means that we have gone through medical training as doctors, and then going on to specialize in mental health. So we use something called the bio-psycho-social model of medicine, which means that we understand the illnesses can have biological, psychological, and social components. 

So we can prescribe medication alongside using other psychological and social interventions. Psychotherapy is slightly different. It's a form of talking therapy, which is based on various theories about the development of the mind and the sense of self. Some clinicians do both. So some psychiatrists will also train as psychotherapists and Chrissy. I know that you're trained in systemic psychotherapy, which is a type of family therapy. And even for those of us who are not psychotherapists, we still learn a lot about the psychoanalytic and psychodynamic theories in our psychiatry training. And these theories and ways of thinking. are so important for our day-to-day clinical practice. 

[00:01:58] Chrissy: Oh yeah, In perinatal mental health, it's absolutely essential to have an understanding of the core concepts and principles in family dynamics and in therapy.

[00:02:08] Lynsey: Yeah. And that brings us to Donald Winnicott. So who is he? Chrissy tells a bit about him.

[00:02:14] Chrissy: Oh gosh, yes, let me, let me tell you all about Donald Winnicott. He was a paediatrician and a psychoanalyst who trained and worked in London, during the 1920s all the way through to the 1970s. He was really an important figure around the Second World War. He was a consultant paediatrician for evacuated children and he did a lot of work treating children who had been displaced from their homes in London. 

[00:02:42] Lynsey: That's right. And then in the post-war period, he continued to see patients in his private psychoanalytic clinic alongside doing his work as a pediatrician. And although he didn't have any children of his own. Winnicott's work was really profoundly shaped by his work with children and families during the war. And after. And in particular, it was shaped by his work with babies and their mothers. So a lot of his theories focused on the parent infant relationship and on a more relational and social model of development, which emphasize the importance of early environment and early experiences. And I think that was very different to a lot of the psychoanalysts that had come before him. 

It was a shift away from the very Freudian theories about psycho sexuality and the Oedipus complex. Winnicott focused much more on the infants and their relationship with the family and the outside world.

[00:03:29] Chrissy: I think also, you know, in the context of World War II, we, we think a lot, obviously, about maternal bonding and attachment. Whereas Winnicott was really thinking about the flip side of that, which is what happens when a mother and child are separated. 

So his research was so pivotal in the way that we understand not only about bonding and attachment, but actually the importance of that relationship if it's removed. 

[00:03:55] Lynsey: And although he primarily focused on mothers and infants in most of his work, he did also think a lot about the importance of fathers and co-parents and wider society in an entrance development. And I think that's part of the reason why his work still feels so relevant today. 

I think it's important too, to just highlight the contributions of his second wife Clare Winnicott, she was a social worker and a psychoanalyst in her own. Right. And she collaborated with him really closely on a lot of his later work. They co-authored a number of books and papers together, and she had a huge impact on his thinking and the development of his theories. So some of the credit here should really go to her 

[00:04:31] Chrissy: absolutely. 

[00:04:33] Lynsey: So when I was preparing for this episode, Chrissy, I went back and find some of my old Winnicott books from back when I was preparing for my postgraduate psychiatry exams. And I've just had a lovely weekend rereading them all. And I think that it's reminded me about how. Easy and enjoyable. It is to read some of Winnicott's work. 

 cause, you know, a lot of psychoanalytic theories are very dense and intellectual and hard to read. But one of the things that's really striking about Winnicott is that he wrote for the general public. He had his own radio show and he was very interested in informing the public about parent infant relationships and infant development. He was also really interested in the role of play in a child's development. And I think that really comes across in the playful and joyful sort of way that he writes. 

[00:05:17] Chrissy: That's fantastic. Yeah. I mean, yeah, I love his approach too. It's so practical. You can carry it with you wherever you are. I remember a psychoanalyst actually teaching me that your face is a baby's best toy. They don't need all the fancy gadgets and gizmos. They just need a parent's eye contact and interaction. And that will keep them happy and occupied for days. So really, again, the importance of play and the infant parent relationship.

So Winnicott famously said that there's no such thing as a baby. And, and what did he mean by that?

[00:05:54] Lynsey: It's a pretty bold statement for a pediatrician to make. He went on to explain that statement by saying that if you set out to describe a baby, you will find that you're describing a baby and someone, a baby cannot exist alone, but as essentially part of a relationship. So I think what he meant there is that there's no infant without its parents. 

[00:06:13] Chrissy: He felt that you can't conceptualize the baby in isolation because it's so closely linked to its parents. He went so far as to view the mother and newborn baby as being merged. He said that at the start of its life, the infant only exists within an environment of maternal care.

[00:06:32] Lynsey: And he didn't mean this literally clearly babies and mothers are separate beings. But he really gets the point across about how closely linked a parent's mental state and an infant's mental state are. in those early days. 

He really highlights that a child is very vulnerable and psychologically fragile in its early life. I mean, a child doesn't understand itself. It doesn't have any idea if for when it's next, feed will arrive, but it can't understand and communicate it's own needs needs. So it's the responsibility of everyone around the baby to interpret and meet its needs. And at the heart of Winnicott's work is this idea that a child's sense of itself, which is so important for healthy, psychological development. Could only really develop in the right environment and the parent infant relationship is the environment. 

So from Winnicott's point of view, the quality of the parent infant relationship is absolutely essential for a child's healthy, psychological development. 

So how does a mother create such a safe environment for a newborn?

[00:07:27] Chrissy: Winnicott describes something called Primary Maternal Preoccupation. 

[00:07:32] Lynsey: Yes. So this is a postpartum state of mind. That allows the mother to become very closely attuned to the needs of her infant. He describes it as this heightened sensitivity where everything else becomes totally secondary. And the mother becomes intensely focused on providing the right environment for her baby to thrive. 

[00:07:49] Chrissy: I suppose in modern day times, you might have heard of the phrase, fourth trimester. So it's that first three months after having a baby where, your whole world revolves around this newborn and everything comes secondary to that. 

[00:08:04] Lynsey: Absolutely. And this creates something that Winnicott described as a holding environment for the child. So, you know, you can imagine that a mother is literally holding her baby and keeping it safe, but she's also figuratively holding it at mind. In that very highly focused attention and that state of primary and maternal preoccupation. So this holding environment, it's, it's a physical and an emotional environment in which the child is held and feels physically and psychologically safe. 

[00:08:31] Chrissy: And why is that significant? I mean, Winnicott thought that if children were deprived a holding environment in early life, this might contribute to later emotional problems. 

And clinically speaking, clinicians need to provide a similar sort of holding environment if they're doing psychotherapy, or in any other therapeutic interactions, in, in adulthood. The therapist is trying to provide a similar, psychological holding environment to help their patients work through their emotions.

[00:09:04] Lynsey: That's right. So I suppose part of what Winnicott was doing was looking at these early infant relationships but also applying it to later adulthood and to his psychoanalytic work in adults as well. 

[00:09:14] Lynsey: Okay, so let's move on and think a little bit about this, this concept of the good enough mother. So we've described this state of primary maternal preoccupation. And in that state, the mother or the primary caregiver starts out by being perfectly attuned to her baby's needs so perfectly available to the exclusion of all else.

[00:09:33] Chrissy: But in reality, we, we know that nobody is perfect. No situation is perfect and no one is able to be perfectly available at all times because you know, we're flawed human beings, with our own needs too. 

[00:09:49] Lynsey: Of course, and it's perfectly normal for people to become tired and hungry and sleep deprived and frustrated. Um, some parents have another child to attend to, or other responsibilities that claim their attention that's all part of the parenting experience.

[00:10:04] Chrissy: So this is when we come to the idea of, um, one of my favorite concepts of Winnicott's work, which is the good enough mother. And that's been extended to the concept of the good enough parent. Essentially, Winnicott recognized that no parent is perfect. And what is important is to be just good enough.

So why is that important? 

[00:10:27] Lynsey: Well, like we mentioned earlier, a newborn infant doesn't have a very clear sense of itself and its relation to the world. It's so reliant and so closely linked with his primary caregiver. That the child doesn't actually know that it's a separate person, which comes back to what, Winnicott was saying about how the mother and baby's mental states are merged.

And as part of it, psychological development, the child has to realize that it's a separate and autonomous being, and it goes through a very gradual process of coming to realize that, and good enough parenting allows that process to happen in a way that feels safe for the child. 

So when a parent fails a child and I'm using the word fails in, in inverted commas here, So, for example, when a child feels hungry, but has to wait for a few minutes before being fed. The child learns that there are limits to what the environment can provide. And as the experience, these limitations and frustrations, they start to become more aware of their mother and their environment as separate entities to itself. And remember that must be absolutely terrifying for the child because they don't understand what's going on. 

Winnicott wrote this great line where he said that if you fail a baby, it must feel as if the wild beasts will gobble him up. And I think that really brings to life how. I frightened in this experience must be for a child.

So good enough parenting allows the child to experience these small failures in a safe way that doesn't overwhelm the child with feelings of hopelessness and despair. So a mother starts off with almost complete adaption to her infant's needs. And then as time progresses, she adapts less and less completely, according to the child's psychological growth and its growing ability to deal with these failures. 

Winnicott also wrote about how important to is for parents to let their child experience these difficult emotions in a safe way. So when a child comes distressed or angry, for example, he encourages parents to allow their child to experience these feelings.

He says that parents should try to put aside their own feelings and needs in that moment. Because if the people around the child are calm and unhurt. This helps the child to learn that it's feelings, that fear that the wild beasts will gobble him up. Those feelings are not necessarily real and true. Um, that's a really important part of good enough parenting.

[00:12:36] Chrissy: Lynsey, I use this concept of the good enough parent in my clinical practice all the time. As a counteract to the perfect parent, I think we live in a world and a society where we're almost obsessed with perfection. You know, having the perfect house, having the perfect body, having the perfect family, etc. So this idea of being good enough is really difficult for women, but also for many parents when they expect perfection.

What Winnicott was trying to say so many years ago is that you don't need to be perfect as a mother or as a parent so I think, mothers and parents breathed a sigh of relief because they could actually allow themselves to not be perfect and to just essentially be human with, with human needs as well.

[00:13:27] Lynsey: Definitely. Okay. So we have an infant that starts out as essentially being in this merged state of oneness with their mother or their primary caregiver. The child doesn't actually know that they're separate. And then they go through this gradual process where the child starts to conceptualize themselves as being separate, but still related to the mother. And this transition is really important because it's the beginning of the child developing their own sense of self, but it can also be quite an anxiety provoking transition.

And that brings us to another Winnicott concept, something called the transitional object. 

[00:14:00] Chrissy: So I'm sure many parents listening to the podcast will know about this, may have never heard of transitional objects, but I'm sure you might have a bunny rabbit, a teddy bear, or a really dodgy blanket that's full of rags and dirty, but you're not allowed to wash Essentially it's an item of clothing or, or a object usually something soft and cuddly that a child becomes extremely attached to, and they usually become attached to this at particular stages in their life. 

[00:14:30] Lynsey: That's right. And to us, it might just be a regular old blanket, but to the child, it takes on this really significant and meaningful place in their heart. And in their mind, The transitional object is one of the first items that our child would recognize as not me, as opposed to me. And it demonstrates this very early capacity to symbolize and think symbolically. So for the child, the transitional object can feel like an extension of the caregivers. Love and warmth. Which the child then internalizes and uses to self-sooth. So this object is important in facilitating that early separation from their mother. When the child starts to realize that there were separate person. But it's also important for other situations where there's a transition from one kind of experience to another, and children will often use their transitional object to reestablish feelings of safety. Whenever they're in an unfamiliar, uncertain, or unknown situation.

[00:15:23] Chrissy: So it could be if they're moving into the big cot, for example, or if you're going on holiday, your environment is changing, or starting school, they become quite attached to this item as a reminder of their their childhood and their youth.

[00:15:41] Lynsey: Yeah, and it doesn't end in childhood either. The concept of transitional objects has carried through to adult psychotherapy too. And that can become particularly relevant and important in therapy. When someone is processing grief or major life changes and transitions.

[00:15:56] Lynsey: So just as we're finishing up. I wanted to think a bit about what Winnicott's work means for us as perinatal psychiatrists. 

The most important thing that I've taken from today's episode is the appearance. Mental state is an absolutely integral part of the infant's environment. So in order for infants to grew up into happy and emotionally healthy adults, we need to support parental mental health in a way that allows parents to create the right psychological environment for their child to thrive. 

Winnicott really emphasizes the importance of just letting your child be by which he means that we should allow children to experience and process all of their feelings, even the negative ones. He was very clear that we shouldn't be trying to force a child to be cheerful and playful all of the time when they're not feeling it. And he often wrote that he worried about children who were made to feel responsible for their parents' mood and emotional wellbeing because of the impact that this had on their longer term emotional development. He also words does to remember that infants are incredibly psychologically fragile. And one of the most important tasks of parenting is to create that safe, psychological holding environment for the child. He said that one of the hardest things a parent has to do is to put aside their own feelings in the moment in order to be present with their child. And he was really clear that this isn't always easy. 

I knew one's going to get it right all the time. 

[00:17:14] Chrissy: So what it comes down to, and what I like to remind my patients is that a good enough parent is better than a perfect parent,

[00:17:22] Lynsey: Yeah, for sure. And I think that's the take home message from today's episode.

[00:17:26] Chrissy: Absolutely. ,

we really hope that you've enjoyed today's podcast thinking all about Donald Winnicott and the great work he did. If you are interested in learning a little bit more, uh, the Squiggle Foundation is, a great resource online which has a lot of information and resources about his life and also the works that he's done. 

[00:17:46] Lynsey: With this podcast, we normally try to recommend resources that are free and open access. But I think in this case, I'd really urge you to try and get your hands on a copy of Winnicott's published work. That's available to you. I think it's much more enjoyable and far better to read these theories in Winnicott's own words, rather than to read all the theories and academic writing about his work. So definitely, definitely take a look. If you get a chance. We'll put some more info in the episode description. 

[00:18:12] Chrissy: Absolutely. ,

we just wanted to thank the Royal College of Psychiatrists and the Perinatal Faculty for their support with the podcast. 

[00:18:20] Lynsey: If you want to follow us on social media for updates by the podcast, you can find us on Twitter at beyond baby blues or on Instagram at beyond baby blues podcast.

[00:18:29] Chrissy: And if you would like to hear more about maternal mental health, you can subscribe and find all of our podcasts on Spotify, Apple Podcasts, or wherever you get your podcasts.