The patient had a dream of being stuck in a foggy room waiting on a bed, unable to move down corridors that may or may not lead anywhere. In session, the patient and therapist discuss how the dream relates to the patient's difficulty asserting desires and finding fulfillment. While the patient wants to change this pattern, there is also something holding them back from fully exploring the root of this issue in therapy or in life. The hazy dream reflects the elusiveness of truly understanding one's inner experiences and motivations.

1. A Therapy Hour: Revisiting Winnicott’s
Notion of “Object Usage”
James Tobin, Ph.D.
Assistant Professor of Clinical Psychology
Argosy University, Orange County, CA
Private Practice, Newport Beach, CA
phone: 949-338-4388
web: www.jamestobinphd.com
email: jt@jamestobinphd.com
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2. Introduction
2

3. Introduction
Donald Winnicott (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” (International Journal of Psycho-
Analysis, 1969, 711-716).
4

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
For Winnicott, 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).
12

13. But What Promotes Movement from Object
Relatedness to Object Usage?
The answer may surprise you!
13

14. But What Promotes Movement from Object
Relatedness to Object Usage?
For Winnicott, 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 for Winnicott 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, dim
inished 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. 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.
23

24. 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. 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. 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. 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. 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 ...
28

29. 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.
29

30. 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.
30

31. 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.
31

32. Session
• Patient: I think corridors often suggest pathways to
something, like a way out, or a freedom, or
realization, insight, like the band The 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?
32

33. 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.
33

34. 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.
34

35. 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. 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.
36

37. 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. 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.
38

39. 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.
39

40. 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?
40

41. 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 ... 41

42. 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
the Two of Us?
• [Long silence]
42

43. 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?
43

44. 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 ....
44

45. 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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