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The Therapeutic Holding Environment

So much development occurs before an infant has language. We have learned that significant developmental arrests can occur during this time if the mother is unable to provide a safe holding environment. The therapist can address these deficits if she or he can provide a space in which the client is able to re-examine those early experiences.

A Time Before Language

Theoretical development and clinical experience over the past 20 years have come increasingly to recognize a group of pathologies whose onset occurs in the early developmental period of the child, before language and before significant structural differentiation has taken place. These pathologies, involving developmental arrests and deficits in the core structure of the self, have necessitated a revision or certainly an extension of classical theory and technique. We have come to recognize that crucial reparative work must frequently be done and that this work must take place within the context of a relationship that provides the kind of empathic attunement that was missing in the original mother/infant experience. The psychoanalytic therapist, like the good mother, must furnish a safe space, a holding environment, in which the patient’s maturational needs can unfold. For those patients who evidence these early developmental deficits, the traditional tools of psychoanalysis, i.e., free association and verbal or representational exploration of the transference relationship, are not readily available. These patients must first experience the “being,” the holding, the confirmation of their continuous existence, much of which must be communicated nonverbally before the symbolic conflict-based work can proceed.

The Interactive Infant

Our work in this area, once thought to be outside the domain of psychoanalysis, has been greatly facilitated by the convergence of several lines of discourse which I wish to touch upon briefly. Our understanding of the early mother/child relationship, for example, has been greatly expanded by the explosion of research which has revolutionized our view of the infant. Observational research from many quarters has taught us that from the moment of birth the intelligent infant is an engaging, hard-working being, striving within the limits of its physical capabilities to interact with the caregiver and thereby influence its human environment. The notion of a passive, encapsulated, nearly autistic phase has given way to the realization that from birth on the infant has the capacity to synthesize experience and arrange an ever-widening and complex assortment of stimuli. What has emerged from our greatly increased understanding of this early phase of life is a realization of the extraordinary complexity of the mother/infant relationship. Though the communication is largely non-verbal, certainly on the part of the infant, mother and child are found to be engaging in a complex continuing social dialogue, one which is absolutely crucial in the formation of a human being. Insofar as we attempt to replicate aspects of this early relationship in the clinical setting, we must acknowledge that a significant part of the communication between therapist and patient will be, at least initially, in nonverbal form.

References:

Toronto, E.L. (1999). The Application of Therapists’ Maternal Capacity in Prerepresentational Body-Based Transference and Countertransference. Psychoanal. Soc. W., 6(2):37-59

The Therapeutic Holding Environment


Ellen Toronto, Ph.D.

Dr. Ellen Toronto is a licensed clinical psychologist/psychoanalyst in the state of Michigan.


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APA Reference
Toronto, E. (2020). The Therapeutic Holding Environment. Psych Central. Retrieved on June 1, 2020, from https://blogs.psychcentral.com/see-saw-parenting/2020/05/the-therapeutic-holding-environment/

 

Last updated: 30 May 2020
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