Community-based management of psychotic clients: The contributions of D. W. and Clare Winnicott

Abstract

While the term “management” connotes images of impersonal care, D. W. Winnicott repeatedly used this term to describe the responsive environmental holding that is central to all human development. Influenced by observations of how normal mothers and families address the physical and psychic needs of children, he and his wife, Clare, a distinguished British social worker, operationalized this concept in finding and supporting “facilitating environments” with a wide range of disturbed children and adults. Using case material from a contemporary community program for the mentally ill, this paper will review the Winnicotts' important, but often neglected, perspectives on the environmental management of psychotic adults.