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Harris, M. Bick, E. (2011). The Tavistock Model: Papers on Child Development and Psychoanalytic Training. The Tavistock Model: Papers on Child Development and Psychoanalytic Training, 1-405. Karnac Books Ltd..
Psychoanalytic Electronic Publishing: The Tavistock Model: Papers on Child Development and Psychoanalytic Training
Harris, M. and Bick, E. (2011). The Tavistock Model: Papers on Child Development and Psychoanalytic Training, 1-405. Karnac Books Ltd..
The Tavistock Model: Papers on Child Development and Psychoanalytic Training
Martha Harris (1919-1987) was born Martha Gemmell Dunlop in Beith, Ayrshire. She read English at University College London, and then Psychology at Oxford. She worked for some years as a schoolteacher, specialising in history, and taught in a Froebel Teacher Training College. She trained as a psychologist at Guy's Hospital, then as a psychoanalyst at the British Institute of Psychoanalysis, where she was a training analyst; her own supervisors were Melanie Klein and Wilfred Bion and her analyst Herbert Rosenfeld. She worked very closely with Esther Bick and in 1960 became responsible for the Child Psychotherapy training which Bick had established at the Tavistock. She developed this in many innovative ways, making use of both her Kleinian and her teacher-training experience. This course came to attract a very international range of candidates and to become a model for psychoanalytically-oriented clinic work with children and families in many countries (the “Tavi Model”).
Together with her husband, Roland Harris (poet and teacher), Martha Harris started a pioneering schools' counselling service. With Donald Meltzer (psychoanalyst), whom she married after
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Harris's death in 1969, she taught widely throughout Europe, and in North and South America and India. They established the Roland Harris Educational Trust, which published for thirty years as the Clunie Press.
Martha Harris wrote newspaper articles on child development and the family, and organized a series of books for parents, written by Tavistock therapists. Her most popular book, Thinking about Infants and Young Children (1975) has been published in many languages (new edition 2011). Her books on older children include Your Eleven Year Old, Your Twelve to Fourteen Year Old and Your Teenager, which have since been reprinted in one volume as Your Teenager (Harris Meltzer Trust, 2007). In 1976, at the request of the UN Organization for Economic and Cultural Development, she collaborated with Donald Meltzer on A Psychoanalytical Model of the Child-in-the-Family-in-the-Community, written for multidisciplinary use in schools and therapeutic units. Her many papers on psychoanalytic training, clinical work, and child development, were first collected (though not completely) in Collected Papers of Martha Harris and Esther Bick (Clunie Press, 1987). Most are republished in the present volume, but those specifically on adolescence are published instead in a joint collection by Harris and Meltzer entitled Adolescence (Harris Meltzer Trust, 2011).
A tribute to Martha Harris by some of her ex-students is in preparation, to be entitled Enabling and Inspiring (Harris Meltzer Trust).
Esther Bick (1901-1983) was a physician and psychoanalyst. She was born in Poland to orthodox Jewish parents and studied under Charlotte Bühler in Vienna, where she began to develop a method for the observation of infants and young children which took into account the need for both scientific objectivity and for making use of the emotional experience of the observer. She married, but separated from her husband before herself emigrating to England in 1938 to escape the Nazi occupation. Here she initially worked in a children's nursery, whilst having analysis with Michael Balint. She then qualified as a psychoanalyst in London and had further analysis with Melanie Klein. In 1949 John Bowlby asked her to establish
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an analytic training course at the Tavistock. Here she developed further her Infant Observation method and made it foundational to her view of a psychoanalytic training. In 1960 Bowlby asked her to step down as course leader and Martha Harris succeeded her in this role. Bick continued to teach infant observation and Kleinian child psychiatry at the Clinic until 1967. She also taught privately trainees from both the Tavistock and the Psychoanalytic Institute. She ceased clinical practice in 1980. Although she wrote very little, and reluctantly, her papers proved highly influential, and she was invited to conduct seminars in France, Italy and South America, and her teaching and methodology have since had a profound and growing influence in the UK and abroad.
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Acknowledgements are due to the following journals in which some of these papers first appeared: “Child analysis today”, International Journal of Psychoanalysis (1962), vol. 43, pp. 328-32; “Notes on infant observation in psychoanalytic training”, International Journal of Psychoanalysis (1964), vol. 45, pp. 558-566; “Therapeutic consultations”, Journal of Child Psychotherapy (1966), vol. 1(4), pp. 13-19; “The family circle: brothers and sisters”, in New Society (15, 22, 29 June and 6 July 1967); “The child psychotherapist and the patient's family”, in Journal of Child Psychotherapy (1968), vol. 2 (2), pp. 50-63; “The experience of the skin in early object relations”, International Journal of Psychoanalysis (1968), vol. 49, pp. 484-86; “The place of once-weekly treatment in the work of an analytically trained child psychotherapist”, in Journal of Child Psychotherapy (1971), vol. 3 (1), pp. 31-39; “The complexity of mental pain seen in a six-year-old child following sudden bereavement”, in Journal of Child Psychotherapy (1973), vol. 3 (3), pp. 35-45; “Some notes on maternal containment in ‘good enough’ mothering”, in Journal of Child Psychotherapy
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(1975) vol. 4 (1), pp. 35-51; “Growing points in psychoanalysis inspired by the work of Melanie Klein”, in Journal of Child Psychotherapy (1982), 8:2, 165-184; “Esther Bick”, in Journal of Child Psychotherapy (1983), vol. 9 (2), pp. 101-102.
Acknowledgements are also due to Wildwood House which first published “The Tavistock training and philosophy” in The Child Psychotherapist, edited by Dilys Daws and Mary Boston (London, 1977); and to Caesura Press, which first published “The individual in the group: on learning to work with the psychoanalytical method”, in Do I Dare Disturb the Universe? A Memorial to W. R. Bion, edited by James Grotstein (Beverly Hills, 1981). Other papers were first published in Collected Papers of Martha Harris and Esther Bick (Clunie Press, 1987).
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The Collected Papers of Martha Harris and Esther Bick were published in 1987, the year of Martha Harris' untimely death.1 More than twenty years later, it seems appropriate to reintroduce them to a new generation of readers and workers. Since that time, Bick's work has become widely influential—to a significant extent through its promulgation by Harris, who from the beginning saw her as a “growing point” in psychoanalytic thinking that she determined to help bring into flower.2
Martha Harris was a training analyst for the British Society, working with both adults and children, and in 1960 had taken over from Esther Bick as head of the Child Psychotherapy training at the Tavistock Clinic, then in its cramped Beaumont Street premises. She devoted herself to developing and expanding the course, and to establishing child psychotherapy as a viable profession for the future. As Donald Meltzer has written: “If ever anyone had ‘greatness thrust upon them’, it was the reluctant Mattie at
1 That volume included nineteen papers by Harris (eight previously published) and three papers by Bick (1962, 1964, 1968). Martha Harris was disabled after a car accident in 1984.
2 As in her paper “Growing points”; see this volume, Chapter 5.
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the time when Mrs Bick left the Clinic and it was up to Mattie to either take over or to let the infant Child Psychotherapy course fade away.”1 As Bick wrote in 1962, child analysis was in danger of becoming non-existent; and Harris, like Bick, believed that work with children was crucial for both the community and the vitality of psychoanalysis itself. She ensured that Bick—together with Meltzer, who also specialized in child analysis—continued to provide the backbone of external teaching for the child psychotherapy trainees. When Bick ceased her sessions at the Clinic itself, in 1966, she continued supervising outside it.2 Harris also made full use of the potential offered by the Tavistock's move to the new building in Hampstead in 1967, in terms of the course's structure and outreach.
Harris's colleague Shirley Hoxter, who took over leadership of the course from 1981 to 1986, reflected on its history as follows:
Martha Harris, herself trained by Esther Bick, succeeded her at the Tavistock and later on developed a longer and more substantial course taking a far larger number of child psychotherapy students. She also widened the scope of the pre-clinical studies to deepen the insights applicable by those of other professions in their work relating to a wide range of child and family care issues… Their teaching events spread far beyond the original base of the child psychotherapy training at the Tavistock and were attended by analysts and psychotherapists from every part of the world.3
Hoxter emphasized that both Bick and Harris excelled in “the live to and fro of spontaneous response in the setting of the seminar or supervision” (1988, p. 102). Of Bick she wrote:
Although a poor writer, she was a brilliant educator in her face-to-face contacts with her students, revealing to us an
1 See Meltzer, Appendix I to this volume, p. 345 below. Further page numbers also refer to the present volume unless stated otherwise.
2 See below, Chapter 6, and Appendix II. For an account of the collaboration between Bick and Meltzer at the Tavistock see S. Hoxter, “Experiences of learning with Donald Meltzer” (Hoxter 2000, pp. 12-26).
3 S. Hoxter, review of the original edition of Collected Papers of Martha Harris and Esther Bick (Hoxter 1988, p. 102).
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awareness of the child's inner world and the recognition of unconscious phantasies and their power to influence personalitydevelopment. Her methods of infant observation were first developed for our training and influenced all our later work. (Hoxter 2000, p. 15)
Certainly the personalities and presence of both Bick and Harris were a significant factor in their teaching. Owing to her personal charisma and her belief in the efficacy of establishing a work-group atmosphere in which an ethos of fairness and hard work prevailed, and infant rivalries were contained and even used constructively in a scientific spirit, it has not always been recognized objectively to what extent Harris' structural innovations and modifications were both pioneering and revolutionary. Her introduction of the “work discussion” group, her deepening of the psychoanalytic rationale behind infant observation and seminars, her expansion of psychoanalytic knowledge and techniques into the wider community, were highly personal moves that derived from her own experience in life and in teaching. Close collaboration with her husband Roland Harris (deputy head of an inner London comprehensive school) was also an important factor. “In retrospect”, writes Margaret Rustin, “this shift of gear still takes one's breath away”1—the change from reliance on authority and bureaucracy, to inspiration by admired figures capable of instilling passionate devotion to the work.
In terms of core values, as Meltzer puts it:
The central conviction, later hallowed in Bion's concept of “learning from experience”, was that the kind of learning which transformed a person into a professional worker had to be rooted in the intimate relations with inspired teachers, living and dead, present and in books. (below, pp. 345-46)
In line with this, Harris tried to establish a process of “self-selection” through the stages of the course—which, though it may sound utopian, was actually highly practical in conception: aimed at both fostering hidden talents and at facilitating realistic career choices
1 Margaret Rustin, introduction to the original edition of Harris & Bick's Collected Papers (Rustin 1987, p. xii).
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through greater self-knowledge. The application of psychoanalytic knowledge in other fields she believed to be essential both to society and to the survival of psychoanalysis itself, and she sought various means of disseminating it, but always in accordance with “the possible” rather than the ideal—she was above all, a realist.
Klein and Bion, her supervisors, were—Meltzer has said—a “great inspiration” to her, equivalent to Bick; yet he adds, she read them only “half-heartedly”; their inspiration for her was derived from clinical work and personal discussion, and can be seen applied in her own writings from the very beginning. She recognized the truth of their ideas partly as a result of her extensive reading in history and literature, and partly through her own reading of human nature, both inside and outside the consulting room, and—in earlier days—in the school classroom. She also saw how to make use of these ideas in a variety of situations. She had a “particular gift” (said Hoxter) for interrelating and integrating “in an apparently effortless way, bringing together areas and levels of experience which most of us find disparate and can only deal with one at a time” (p. 103). It was her “inclusiveness of attention”, Hoxter continues, that
enabled her to be such an outstanding therapist, permeated her teaching and [that] comes across clearly in her writings. The comprehensive nature of her awareness heightened both her ability to integrate and also her ability to make fine distinctions. (Hoxter 1988, p. 104).
This comprehensive perspective contributed to her deliberately restrained use of theoretical formulations, and she frequently warns of the limitations of theory, whilst never being an anti-theorist (a state of dogmatism in itself). “Theory is convenient but not sacred”, as she put it: what is needed is a “three-dimensional growing through introjective identification” (p. 21). The value of theories is organizational, not diagnostic: “they enable us to mobilize our attention and our ability to see more” (p. 62). Like Bion and all the great psychoanalysts she put her faith in observation and sought constantly for means of enhancing it.
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Harris applied the same principles to her students as to her analysands—and indeed to herself: the goal being to learn in a three-dimensional rather than a two-dimensional way, whether alone or in a group. The search for knowledge (Bion's K-link) was always at the core of any activity that she undertook, for herself or with students. Like Keats who said that “real difficulties nerve the spirit of a man—the imaginary nail him down for a sufferer”,1 her philosophy when faced with conditions that were not ideal was to try to use the deficiency constructively. Thus she describes how having insufficient time can throw into relief the ever-present oedipal and sibling emotions that underlie rationalizations of “it's not possible”; becoming aware of these “unrealistic idealizations” of oneself and one's practice can then clear the path for an imaginative solution, and be rewarded by “the exhilaration that thrives upon difficulties” (p. 54).
Where Bick wrote reluctantly and to a degree awkwardly, Harris with her literary background had the true writer's ability to refine understanding through the process of writing; hence, perhaps, her recommendation to all her students to reflect and organize their thinking through written work. Hoxter points out that while none of Bick's papers “convey the unforgettable brilliance and intensity of her living presence in the seminar or supervision”, Harris
writes beautifully and almost each one of her nineteen papers is a delight to read. She makes frequent references to Bick's paper on “second skin”, contributes two papers specifically relating to infant observations and, additionally, makes frequent further referenes to infant observation. Indeed the whole body of her work evidences the enhancement of sensitivity and the deepening of insight gained from such studies. Harris's writings therefore provide valuable examples and amplifications of Bick's papers, bringing these to life and rendering them more accessible to most readers. (Hoxter 1988, pp. 102-103).
Readers will notice that all her papers apart from the very shortest have a similar structure: a survey of the relevant ideas, and a longer section of clinical or observational examples which are
1 Keats, letter to C. Brown, 23 September 1819 (Letters, ed. Gittings (1970), p. 303).
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brought in to frame one or two highly specific points of detail. Having listed the possible permutations and combinations, she then likes to undermine them, in order to demonstrate that learning from experience (as distinct from learning about) takes place only in a context of emotional involvement in a human reality. Her love of precision took the form of an intense focus on the particular—the particular situation, and the individual or individuals within it. “Never sacrifice a child to an ideology”, she once said; and every human situation has within it a child and an ideology. The child is the infant idea that is struggling to take root (in its “creative-destructive” potential in Bion's terms, p. 27); and the ideology is the exoskeleton of memory and desire. The challenge for both the individual and the group is to “keep the mystical idea of psychoanalysis alive within a formal structure” (p. 27). Frequently Harris documents her own surprise at unexpected developments that fall outside the box and that can only be understood with hindsight, when some almost-overlooked detail emerges from the background and, as in the philosophers' “selected fact”, organizes the pattern.
The fine distinctions that make up the uniqueness of any human situation emerge in the process of trying to accurately describe its minutest features; and as many others have also said (including Bick and Meltzer), seeing and describing happen simultaneously and reinforce one another. When relating a baby observation, for example, she finds that in the process of precise description, a new concept emerges that transcends the expected scenario of baby, thumb and transitional object:
Then there is the quality of filling the emptiness, the reminder of the nipple in the thumb which interestingly is perceived as “coming” to her aid at a moment of acute distress, as if it were the agent of an internalized object in advance of the baby's own conscious control (p. 156).
The meaning of the thumb's movement is not that of a transitional object controlled by the baby; it is an agent of inspiration—not substituting for but linking with the internal object, after the manner of the “herald” in Emily Bronte's poem “He
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comes with western winds”. Hence the need for detailed examples and finding the right words to convey their impact; and hence her encouragement to students to write their observations down—not necessarily for publication (indeed she generally threw her own notes away), but for the purposes of enhanced attention and more penetrating observation.
In her later papers she makes more use of Bion's formulations than in her earlier ones, not because his theories have suddenly percolated into her consciousness, but because she sensed that they were becoming more known and it was therefore possible—without discouraging her audience—to speak in terms of K, O, the “commensal”, and “becoming”, whilst “transpos[ing these ideas] into a lower key” as she put it (p. 28). She was very alert to the dangers of the type of verbalizing that “blurs” observation, and of students being led to misread Bion. Meltzer has described how a certain apparent stutter in her speech was in fact “a complicated process of accommodation between the complexity of her thought and the minute responses of her audience”;1 and the elegance of her writing disguises a similar strenuous accommodation, in which simple expression frequently houses complicated nuance. Read slowly and carefully, these papers constitute a painless way of absorbing difficult ideas—which was indeed the way she taught in person, according to the testimony of her students.
It is not only the theorist whom she consistently warns against (the person—or aspect of the self—too much in love with their own verbalization-faeces) but the comforter or reassurer, too much in love with their own mummyishness. Together these seductive faces constitute the false combined object. She often reminds her listeners that the useful qualities of an inspiring object are “strength and sensitivity”, not authority and reassurance. These are the qualities needed in a therapist (p. 221), in order to offer a model to the child (or child-within-the-adult) of learning to cope with unexpected situations, with the reality which is never fully known. For “the attempt to persevere in understanding the dynamics of the situation is in itself therapeutic, even when the understanding
1 Meltzer, foreword to Harris & Bick's Collected Papers (Meltzer 1987, p. vii).
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is imperfect—as it must always be” (p. 222). Even when fate seems inexplicably cruel, as in the case of the six-year-old whose father had suddenly died, the answer is not to offer comfort but to make known—in the child's own language—the complexity of the pain and thus clarify the “muddle” (Chapter 16). The same applies, on a less intense level, to teachers in schools; more than once she gives an example of two types of teacher—the overpraiser, and the accurate assessor who helps the pupil “know where they are” (p. 224). It is reality, not daydream, that enables life to continue and to develop.
The essential vitality of a learning attitude is the reason why the presence of a non-judgemental observer in a situation such as infant observation can have a therapeutic effect. It models a position of humility, of educability, which can help the mother to make contact with her internal resources (Chapters 8, 10). This she terms the “respectful” experience (p. 91). It is the reason why infant observation was made central to the work-group containment of the students, as well as to the therapeutic work with children and families. Martha Harris stresses the need for “fellow-feeling” and a “non-directive” approach with children who have or cause difficulties (pp. 17, 307), not because it is nicer, but because it is more effective. This fellow-feeling can be acquired by the observer who is using their privileged position not only to gainknowledge about mother-baby interaction but also to gain self-knowledge. Not only are the nuances of non-verbal communication best learnt through mother-infant observation, but also, the process of knowing one's own objects—the meaning of introjection.1
For the analytic stance which is genuinely useful in situations in the wider community is primarily self-analytic, rather than the application of psychoanalytic theories. It enables people to “distinguish appropriate goals from the impossible ones of deluded omnipotence” (p. 339)—to assess a situation realistically. The key premise of Martha Harris's vision for a better society is that any
1 As one of Martha Harris' students, Margot Waddell, has recounted: on beginning the training she asked what exactly was introjection? to which the “gnomic” answer was “wait and you will find out” (personal communication). In other words, there is no point defining what can only be learned from experience, on the pulses.
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worker's usefulness increases exponentially with their self-knowledge, because this enables them to deal with situations which have not been stamped with a name; and any condition which has been named is liable also to have been partially obscured. Before autism was commonly diagnosed, for example, she had in her clinical vocabulary two different types of developmental interference: the “omnipotent distortions” that are traditionally the subject of the psychoanalytic treatment of neurotic patients, and another type that she calls “turning away” (p. 224). Later, in the context of subsequent work on autism, which she includes loosely alongside second-skin and two-dimensional personality structure, she advocates a closer inspection of the “lacunae” in ourselves (p. 175). Her view is that these autistic or “turning away” features exist in everyone, just as do narcissistic and paranoid-schizoid tendencies, and it is only the ability to recognize them in oneself that equips the analyst to cope with such cases. Consequently the psychoanalytic method is no different in new autistic cases from that in old narcissistic cases: the requirement is as always to engage with the infantile transference, and it is the analyst's responsibility to find a way of establishing this contact—which can be done only through introspection.
The same applies to other situations which may not fulfil standard criteria for analytic work: such as non-intensive or short-term therapy. “I have used the word ‘analytic’ advisedly”, she writes in the context of a seven-session analysis, “because the technique used in these sessions was that of following the child's communications, trying to clarify them in the transference” (p. 236). On other occasions the most practicable or even preferable type of intervention may be a non-analytic one: it may simply be interest, or the sharing of anxieties, which constitutes the “therapeutic or mutative factor” and restores to life a stalled developmental process (p. 313). Here again, it is the therapist's “personal analysis” that allows for flexibility in determining how to “use the observations he has been trained to make, without consistently employing the psychoanalytic technique of interpreting in the transference” (p. 60). It is what validates the otherwise non-economic exclusivity of psychoanalysis in a needy world where, she says, a balance must be
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maintained between intensive practice and social obligation, and indeed is ultimately more developmental for the therapist.
To quote once more from Shirley Hoxter:
Psychoanalytic practitioners will find particularly valuable her discriminations between infantile elements and adult strivings, between external and internal influences, between transference and countertransference, between pseudo-cooperation or superficiality of development, and a genuine striving towards truth and a greater capacity for bearing mental pain. Harris is aware of the simultaneous existence of such matters and of the strugglings of the student (or experienced therapist or her readers) to encompass such a range and to maintain a state of learning which includes the pains of not knowing and of not idealizing or overestimating (or underrating) the developments to be achieved by psychoanalytic therapy. (Hoxter 1988, p. 104)
Self-scrutiny, therefore, provides the basis for coping with any situation in life, inside or outside the consulting-room. This is her credo, rather than adherence to any authority old or new. Indeed, she warns specifically against treating Melanie Klein as a “latter day saint”, or (anticipating a Bion bandwagon) regarding oneself as “spokesman for some advanced psychoanalytic group”. Instead, she says,
One can hope to promote a relationship between fellow workers, students and teachers which might be described by Bion as symbiotic for some, and for the rest at least commensal: coexistent if not mutually profitable. Thus the therapist's relationships with his patients, objects of study, may take place within a framework of teachers or colleagues who are all dedicated to the task of enlarging their field of observation and of self-scrutiny. In such an atmosphere, hopefully, senior colleagues instead of being content to rest upon positions earned by past achievements, or longevity, may be able to continue or to allow others to continue that process of mental and emotional growth whose infinite possibilities are released, according to Bion, by putting aside memory and desire in order to have a better apprehension of the present moment (p. 32).
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This volume contains eighteen papers by Martha Harris, of which three were not included in the 1987 Collected Papers; and some from that volume are omitted here as they are being republished in a companion collection on adolescents. The three papers by Esther Bick are reprinted, though they are easily found elsewhere, since they illuminate the historical picture. The order of the papers has been altered from that in the original edition, in order to lead the reader from the Tavistock analytic training and its philosophy, through the role of infant observation, to child analysis and the wider applications in family and society, ending with a paper from the 1960s describing the pilot project in a comprehensive school that she initiated with her husband Roland Harris and that later became the Tavistock Schools' Counsellors course. Examples of clinical work appear throughout. In three appendices will be found a brief statement about Martha Harris and the Tavistock course by Donald Meltzer; an account of supervision that she had arranged with Esther Bick for one of her students, Ann Cebon; and a review of the legacy of Bick's method of Infant Observation by Margaret Rustin, a student of Harris and Bick who was head of the Tavistock Child Psychotherapy training from 1986 to 2008.
Martha Harris wrote that “Hopefulness informed by experience is the most precious ingredient this work requires; but also, I would think, the realization that it is not possible to hand over one's experience en bloc in the form of theories or advice” (p. 315). It is however, as Donald Meltzer said, possible for new readers to have “intimate relations with inspired teachers, if not present in life, then in books” (p. 346).
Meg Harris Williams
The three papers newly included in this volume are: “The place of once-weekly treatment in the work of an analytically trained child psychotherapist”, “Growing points in psychoanalysis inspired by the work of Melanie Klein”, and “Esther Bick”; also additional sections of “The family circle”. Omitted papers by Harris are:
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“Depressive, paranoid and narcissistic features in the analysis of a woman following the birth of her first child and the death of her own mother” (1960), whose material is also used in Chapter 10; while “Depression and the depressive position in an adolescent boy” (1965), “Infantile elements and adult strivings in adolescent sexuality” (1976), and “Discussion of an adolescent girl” (1975), are all included in the new collection Adolescence: Talks and Papers by Donald Meltzer and Martha Harris (2011). A further unique tract in collaboration with Donald Meltzer, A Psychoanalytical Model of the Child-in-the-Family-in-the-Community (1976), is also being published separately and was included in Sincerity: Collected Papers of Donald Meltzer, edited by Alberto Hahn (Karnac, 1994).
Harris, M. and Bick, E. (2011). The Tavistock Model. 1-405. Karnac Books Ltd..