Use and Abuse in Psychotherapy

In this paper I propose to look at the concepts of ‘use’ and ‘abuse’ with reference to the work of Alice Miller and also of Winnicott, and link these ideas with some of my own recent clinical work.

In the above ditty the word ‘use’ has, in essence, the meaning abuse. Don't deceive me (by abusing my trust) or leave me (abandon me) - two significant facets in a situation of abuse, be it child or adult, sexual or non-sexual. I should like to add another feature to the situation of abuse, which perhaps is implied - that of actual, or feared, humiliation.

In her recent work Alice Miller vehemently takes up ideas of abuse of children by their parents. Abuse can come in many forms. It can cover the whole gamut from a lack of respect and non-mirroring, to shaming and humiliating, and to sexual abuse. She has radically revised her thoughts on Freud's drive theory as an explanation of human behaviour and returned to his original trauma theory. She is distressed by what she has called ‘poisonous pedagogy’ in much of today's analytic theory with its adherence to the drive theory and the Oedipus complex. Dr Miller is constantly looking for the patient's story - for what actually happened to that particular patient as an infant and young child. She states ‘in terms of the drive theory parents do not actually abuse their children in order to fulfill their own needs but children supposedly fantasize this abuse, repressing their own aggressive and sexual desires (‘instinctual drives’) and experiencing these desires - through the mechanism of projection - as being directed against them from the outside’ (Miller 1985, p. 4). She is convinced that, if she can understand a person's suffering as a child, she then has the key to understanding a person's entire later life. ‘. … I gained emotional insight into the predicament of the totally dependent child who must repress his trauma if there is