Shirah Vollmer MD

The Musings of Dr. Vollmer

Relationships Heal: Fairbairn Comes Alive

Posted by Dr. Vollmer on August 6, 2012

“My dependence on my mother is so great, and she is so privileged in my eyes that it makes my rage more acute and more forbidden. Mommy is someone I cannot attack….My position with her is so precarious that I don’t risk upsetting the balance.” Karl, the name given to W. Ronald Fairbairn’s patient that he writes about in 1958 in his article entitled ‘Nature and Aims of Treatment’.  Karl continues with a dream. As Fairbairn describes the dream, “he was starving in the dream and there was no food available apart from the pudding. He knew, therefore, that if he did not partake of the pudding, he would die of starvation; but he also knew that the pudding was poisoned and that, if he ate it, he would likewise die. It goes without saying, of course, that the poisoned pudding symbolized his relationship with his mother.” Fairbairn used Karl as an example that not only does he need to understand his sense of deprivation from his mother, but he also needs to develop a therapeutic relationship with his therapist so that he can see that not all deep relationships consist of poisoned pudding. This notion was then re-branded by Kohut as Self-Psychology, where the theory purports the same therapeutic action.

W. Ronald Fairbairn (1889-1964) studied divinity and then served in the British Army in Palestine before returning to his native Scotland and becoming a physician. He spent most of his professional career in Edinburgh, which was quite peripheral culturally and politically to London, with the result that much of his work was not appreciated by the larger psychiatric and psychoanalytic community until late in his career.

Re-reading Fairbairn for my upcoming Journal Club with the Psychiatric Residents, I am once again struck by how his ideas, although poorly written, were not brought to the light of day until, thanks to Kohut, we could now begin to tolerate the notion that relationships are therapeutic, even without the attainment of insight. Sure, my issue with Kohut is that he writes as though Fairbairn did not state this years before, but at the same time, I credit Kohut for having the charisma to take these ideas to a broader audience. In essence, the packaging is almost as important as the product. Kohut was a better salesman. Fairbairn’s ideas kick started our movement towards understanding the importance of the two people in the consultation room: their relationship matters.

2 Responses to “Relationships Heal: Fairbairn Comes Alive”

  1. Shelly said

    Interesting. When is pudding just pudding and not representative of a relationship with one’s mother? Does psychiatry frown upon therapists coming up with their own interpretations instead of relying upon historical theories like Freud’s, Jung, Fairbairn, or Kohut’s?

    • The pudding example demonstrates how a child is completely dependent on emotional nourishment from his/her caretaker and so when that nourishment is poison, as is the case with some mothers, then the child has very few options for survival. This terrible bind then gets re-enacted throughout one’s life, especially if one is never conscious of this dynamic. It is not that the pudding in the dream could have also meant other things, but this one way of understanding the dream helps to illustrate a very important point, which may be a theme in Karl’s life. Interpretations are supposed to be a form of play, where creativity and imagination dominate the experience, so the answer to your question is actually the opposite. Psychiatry, and psychoanalysis in particular, frowns upon “off the shelf” interpretations in favor of more original ideas about the individual’s dynamics. Having said that, the default, or lazy approach to interpretations is to pull an idea from Freud, Jung, Fairbairn or Kohut, and hence these interpretations tend to have less meaning because they are far less personal. Thanks.

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