Chapter 3
Protecting the “Place of Being”
— On Western Psychiatric Wisdom and the Violence of Good Intentions
1. A Pediatrician Who Lived in London
London in the 1930s. During the nights when bombers flew overhead, many children were evacuated from the city.
However, a certain pediatrician made a striking observation: children who remained in London with their mothers, despite being exposed to the terrors of the bombings, were often more psychologically stable than those who had been evacuated to safe facilities in the countryside.
Why was this?
The doctor reasoned that what protects a child’s heart is not the “absence of danger,” but rather “having a person one can trust by one’s side.”
The physician who made this observation was Donald Winnicott (1896–1971).
◆ Who was Donald Winnicott?
Winnicott was a British pediatrician and psychoanalyst. He left behind profoundly original insights regarding child development and the environment that supports it. He is well-known for his psychoanalytic understanding of the “transitional object”—the phenomenon where a child becomes deeply attached to a specific stuffed animal or blanket. His ideas have exerted a profound influence on the practice of psychotherapy.
Among the concepts Winnicott proposed, the one that resonates most deeply with Preservational Psychotherapy is the “Holding Environment.”
For an infant to grow healthily, “correct stimulation” alone is insufficient. An infant needs an environment where they can safely “exist”—a space where they are permitted simply to be. When a mother gently cradles her baby, the sense of security within those arms supports the baby’s psychological development. This is the archetype of what Winnicott calls the “holding environment.”
Winnicott believed that the same process occurs in psychotherapy for adults.
The role of the therapist is less about interpreting the “correct” facts to the patient and more about creating an environment where the patient can safely “exist.”
This was a shocking shift. In the tradition of psychoanalysis since Freud, the therapist was “the interpreter.” Analyzing the patient’s unconscious, providing meaning, and prompting insight—this was considered the essence of psychotherapy. Winnicott called this into question. He argued that before interpretation can occur, there must first be a “place where one can exist.”
2. “Holding” and being “Abandoned”
Within Winnicott’s thought, there is another vital concept: the idea of the “good enough mother.”
His choice of the phrase “good enough” is intriguing. It is not the “perfect mother.” “Good enough” is sufficient.
According to Winnicott, a perfect mother is actually not necessary for a child’s development. Rather, a mother who “fails” in moderation is what prompts healthy growth. When a baby cries, they might be fed immediately, or they might be made to wait a little. Within this “optimal imperfection,” the baby gradually develops the “capacity to wait” and the “capacity to regulate their own emotions.”
The problem arises when this imperfection exceeds the bounds of “good enough”—that is, when a baby is “abandoned” for longer than they can bear.
Winnicott called this “primitive agony.” It is a terror that touches the very roots of existence before words are formed. This terror is etched into the depths of the heart as trauma and may manifest as psychiatric symptoms in adulthood.
If we translate this into the context of psychotherapy, what does it look like?
When a therapist “interprets too much”—entering too deeply into the patient’s heart—it is viewed within Winnicott’s framework as an “intrusion.” Rather than “holding” the patient, the therapist steps too far into the patient’s private space.
Conversely, if a therapist is “too indifferent,” it constitutes “abandonment.” The patient loses the sense that they are “allowed to be there.”
“Optimal holding”—this is the role of the therapist as shown by Winnicott. And this idea overlaps remarkably with the “active non-intervention” of Preservational Psychotherapy.
3. The Art of “Receiving”—The Thought of Bion
Alongside Winnicott, another psychoanalyst provided deep inspiration for Preservational Psychotherapy: Wilfred Bion (1897–1979).
◆ Who was Wilfred Bion?
Bion was an Indian-born British psychoanalyst who served in the First World War. He established unique theories, particularly regarding the psychotherapy of schizophrenia and group psychology. Though known as a difficult and complex thinker, his core ideas contain highly practical insights.
At the center of Bion’s concepts is the pairing of the “Container” and the “Contained.”
Simply put, it works like this: an infant “projects” emotions they cannot hold within themselves—such as terror, anger, or confusion—onto the mother through crying. The mother receives those emotions, considers what is happening within herself, and returns them in a form such as, “Oh, I see, you are hungry,” or “You were scared, weren’t you?” This process of “receiving, thinking, and returning” is the mother’s role as a “container.”
Through the repetition of this process, the infant accumulates the experience that “my emotions can be received” and “emotions can be given form.” This becomes the foundation for the “capacity to think for oneself.”
Bion applied this to psychotherapy. He argued that the therapist’s role is not to interpret, but to “function as a container.”
The essence of psychotherapy lies in the therapist receiving the chaos, terror, and meaningless fragments brought by the patient, “digesting” them internally, and returning them in a form that is more manageable.
What is crucial here is that the therapist does not simply return an “answer.” Rather than handing over a “correct solution” like “the cause of your anxiety is X,” the priority is to create the sensation that the patient’s experience has been “received.”
Bion also emphasized the importance of the therapist facing the patient “without memory and desire.” By not being dragged down by memories of past sessions and not harboring the desire to “cure them by this much today,” the therapist can face the patient purely in this moment. This attitude is what enables the therapist to function as a true container.
This resembles the practice of meditation. Or perhaps it is close to the sensation of a haiku poet facing a “seasonal word” (kigo) while letting go of all preconceptions.
4. What Schizophrenia Taught Us
The thoughts of Winnicott and Bion take on their most poignant meaning in the clinical treatment of schizophrenia.
Schizophrenia remains a mysterious disorder even today. It is characterized by symptoms such as hallucinations, delusions, and thought disorder. While pharmacotherapy (antipsychotics) began to show some effectiveness after the 1950s, a complex world remains within the patient’s heart even after symptoms settle. Early therapists who attempted psychoanalytic psychotherapy hit a heavy wall. Interpretations did not work. Attempts to form a relationship only confused the patient. Words failed to reach them.
Why was this?
In my current understanding, it is as follows: psychoanalytic interpretation presupposes a person who maintains a degree of “self-continuity.” An interpretation such as “this emotion of yours is connected to that past experience” only reaches someone who feels their “past,” “present,” and “self” as a continuous existence.
In the acute phase of schizophrenia or for those with profound trauma, this “continuity” itself is wounded. In a place where there is no continuity, the act of interpretation cannot hold meaning—on the contrary, it intrudes as a foreign object.
Therefore, what is required first is not interpretation, but “simply being there.”
◆ “The Capacity to be Alone”
Winnicott proposed the concept of the “capacity to be alone.” This is a paradoxical concept. The “capacity to be alone” is nurtured initially “in the presence of a reliable other.” Only within the sense of security that someone is nearby can a person eventually become safely “alone.”
This paradox deeply aligns with the practice of Preservational Psychotherapy. The therapist, by simply “being”—as a presence that does not interpret, does not rush, and does not judge—gradually nurtures the patient’s “capacity to be alone.”
What is the most profound lesson the clinical treatment of schizophrenia taught me?
It is that “treatment is not the therapist doing something, but rather protecting the space where the patient can become able to do something.”
This is easy to say but difficult to practice. Suppressing the therapist’s impulse to “do something”—which stems from good intentions—is a technique that requires training and experience.
5. Why Good Intentions Become Violence
Here, I must speak of something a bit painful to hear.
“I want to help the patient,” “I want them to get better”—these are a therapist’s natural feelings and the fundamental motivations of medicine. However, these good intentions can, at times, become “violence.”
What does this mean?
Imagine, for example, a scene like this: There is a person in their thirties who has been unable to go out for many years. Their family, out of concern, tells them repeatedly: “Go to rehabilitation,” “Start looking for a job,” “You can’t stay like this.” These are words born of love. Yet, for that person, being told every day to “change” may feel exactly the same as having their very existence slowly denied.
The same thing happens in psychotherapy. “Let us change your way of thinking,” “Let us let go of that defense,” “Let us express more emotion”—these come from the therapist’s good intentions, but from the patient’s side, they may be received as the message: “You are not acceptable as you are now.”
Good intentions, when directed unilaterally, often turn into a command: “You must change.”
The French philosopher Emmanuel Levinas (1906–1995) re-examined this through a philosophical lens.
◆ Who was Emmanuel Levinas?
Levinas was a Lithuanian-born French Jewish philosopher. Having experienced the Holocaust (and losing much of his family), he fundamentally re-questioned what “the Other” is. At the heart of his ethics is the concept of the “Face of the Other” (le visage)—the idea that the Other is an existence with an absolute alterity that exceeds my understanding or expectations.
If we translate what Levinas said into the context of psychotherapy, it becomes this:
The patient is not an existence that fits within my (the therapist’s) framework of understanding. No matter how sophisticated a theory I possess, it cannot reach the depths of the patient’s inner world. The moment I think “I understand,” I have “enclosed the patient within my own understanding.”
True respect lies not in trying to understand, but in accepting the fact that “one cannot fully understand.”
In particular, the experiences of those with deep trauma are often “un-verbalizable.” Extremely painful events are etched into the heart in a state before they become words. Prompting someone to “try to put it into words” or “find a meaning” can be a form of violence that attempts to forcibly convert the un-verbalizable into language.
Respect for that which cannot be testified—silence—is not an escape, but may be the only sincere response to show the existence of the unspeakable.
A therapist can also respond with silence. Not interpreting, not providing meaning, not claiming to understand—this “silence as a response” can become an expression of deep respect.
6. Ethics of Care—”Protecting” Vulnerability
There is one more thinker who is indispensable when considering the ethical foundation of Preservational Psychotherapy: the American psychologist and ethicist Carol Gilligan (1936–).
◆ Carol Gilligan and the “Ethics of Care”
In her 1982 book In a Different Voice, Gilligan criticized previous ethics for being constructed around “masculine” values such as “justice, rights, and autonomy.” She proposed a different ethical perspective centered on “care, relationships, responsibility, and vulnerability.” This is the school of thought known as the “Ethics of Care.”
What is the core of the Ethics of Care?
Every human being is vulnerable. We get hurt. We fall ill. We grow old. There are times in our lives when we cannot survive without relying on someone else. This “vulnerability” is not a weakness to be overcome, but a fundamental condition of human existence.
Modern society, however, tends to treat vulnerability as something “shameful” or “to be hidden.” Many people feel ashamed to become a “patient” in psychiatry. There is a phrase “mentally weak,” and an atmosphere that suggests “those who cannot overcome are at fault.”
Gilligan raises a question here: Why is vulnerability seen as something to be “overcome”? Why is “needing care” considered a weakness?
In psychiatric care, what Gilligan’s ethics of care signifies is seeing a patient’s vulnerability not as an “object to be cured and overcome,” but as an “object to be cared for and protected.”
When the heart is wounded, words like “be strong” or “get over it” are messages that deny the vulnerability itself. From the perspective of the ethics of care, supporting a person while they remain in a vulnerable state—without shaming them for it, but rather treating it as something precious—is the ethical response.
Preservational Psychotherapy does not seek to make the patient overcome their vulnerability; it seeks to protect that vulnerability to the end.
7. Affirming the “Freedom Not to Change”
Existentialist philosophy also provides an important perspective for Preservational Psychotherapy.
Existentialism is a philosophical movement that flourished in 20th-century France and Germany. Figures like Sartre, Camus, and Heidegger centered their thought on the proposition that “Man is free.” Human beings have no fixed “essence”; they create their own lives through their choices and actions. This is the basic stance of existentialism.
Reading this in the context of psychotherapy, it means this: People have the freedom to change. But at the same time, they also possess the “freedom not to change.”
The “freedom not to change”—this phrase may sound strange at first. But please consider it.
Suppose someone has been in a state of social withdrawal for many years and continues to say, “I don’t want to go out.” The family is worried, and the doctor says, “Social participation is important.” But for that person, is the choice “not to go out” truly a “mistake”?
For someone with long-standing wounds, not changing their current state can be the “best strategy for survival.” Being asked to change can be experienced as a “denial of one’s current self.”
To affirm the “freedom not to change” is to refrain from judging the patient’s current state as “right or wrong” based on the therapist’s values. No matter what state the patient is in, one maintains a gaze of respect, recognizing that the state has meaning and has emerged from the person’s choices and history.
The principle of “not rushing” in Preservational Psychotherapy is deeply connected to this “acknowledgment of the freedom not to change.”
8. Convergence of Three Ethics—”Self-Restraint of Power”
Winnicott and Bion’s psychiatric insights, Levinas’s philosophy of the Other, Gilligan’s ethics of care, and the existentialist “freedom not to change”—these may seem like disparate lineages of thought. However, for me, they converge at a single point.
That point is the concept of the “Self-Restraint of Power.”
Psychotherapy is, essentially, an exercise of power. A therapist enters the patient’s inner world through words, provides meaning, and in some cases, attempts to change it. No matter how much it is filled with good intentions, this is an exercise of power.
“Self-restraint of power” means consciously letting go of this power. It is “not changing” even though one could change them. It is “not interpreting” even though one could interpret. It is “not handing over the answer” even though one has the answer.
This is not weakness; it is a professional judgment of the highest order.
The “activeness” indicated by the word “Preservation” lies here. To protect the patient’s inner world from the very intervention that calls itself “goodwill”—this is the ethical core of Preservational Psychotherapy.
From the outside, a therapist may appear to be “doing nothing.” However, within that time of “doing nothing” is a distillation of the most delicate judgments made to protect the patient’s freedom.
Realizing the “violence of good intentions” and exercising self-restraint over that goodwill—practicing this daily in the consultation room is what is required of a practitioner of Preservational Psychotherapy.
9. Summary of This Chapter—and Toward the Next
In this chapter, we have explored the ideological foundations of Preservational Psychotherapy within Western psychiatry and philosophy.
Winnicott’s “Holding Environment”—protecting the place where one can safely exist. Bion’s “Container”—the act of receiving as a therapeutic act in itself. The paradox taught by clinical schizophrenia: “existence over interpretation.” Levinas’s respect for the Other—respect for that which cannot be fully understood. Gilligan’s ethics of care—protecting vulnerability. The existentialist “freedom not to change.” And the core of “self-restraint of power” that runs through them all.
However, this is not just a story of an individual consultation room.
The pressures of modern society—”recover quickly,” “be productive,” “overcome your symptoms”—drive patients into a corner from outside the medical field as well. For psychiatric care to hold an attitude of “not rushing recovery” also carries significance as a social critique.
In the next chapter, we will broaden this inquiry to the level of society. We will consider what meaning Preservational Psychotherapy holds within the pressures of the city, institutions, and time.
Column ③: What is “Transference”?
“Transference” (tenshi) is a central concept in psychoanalysis, referring to a phenomenon where a patient directs feelings they held toward a significant figure from their past (such as a parent or sibling) onto the therapist. For example, a patient might feel that “this therapist is like my father” and direct anger intended for their father toward the therapist.
In psychoanalysis since Freud, analyzing and interpreting this transference has been considered the heart of treatment. However, from the perspective of Preservational Psychotherapy, there are cases where maintaining the safety of the relationship in which the transference is occurring is prioritized over “resolving the transference through interpretation.”
This is because the attempt to resolve transference through interpretation can sometimes be experienced by the patient as “having the relationship destroyed.” In such cases, the choice to “leave the transference as it is” can be more therapeutic.
(End of Chapter 3)
