With the growing emphasis in our field on a contextualist, nonlinear dynamic systems' sensibility, I find myself curious about the complex interplay between patient and analyst, curious, especially, about the simultaneously interacting micro-processes of moment-by-moment procedural communication and the macro-processes of linguistic, narrative engagement, as patient and therapist attempt to make sense together of the patient's experience in a way that may lead to the patient's feeling recognized and understood.
I think attachment research and infant research together can usefully offer a macro and micro perspective on these co-constituted processes, for several reasons. First, patterns of interaction associated with attachment strategies may be seen as emergent, self-organizing properties of the intersubjective field. Second, the procedural micro-analytic processes that infant researchers study translate into sensory-motor, affective psychological processes within the intersubjective field. Finally, evidence from micro-analytic infant-caregiver research, for example, studies by Beebe and her colleagues on vocal rhythm matching and facial mirroring index attachment status.
Enlivened by Atwood and Stolorow's Faces in a Cloud (1993), I am curious about the role of the analyst's subjectivity, including the theoretical preferences with which she or he resonates in attempting to understand and respond to a given patient's subjective organization.
Inspired by many colleagues who have developed and contributed to these ideas, I now ask different sorts of questions about the analytic process.
How do our subjective biases and notions of therapeutic action and change impact the clinical choices we make in our joint inquiry into the patient's experience? What forms of participation can we comfortably allow with a certain patient and what forms do we tend to exclude in the subtle interplay between us? How do we address patients' accommodations to our subjective biases of which we are unaware in our continuous process of self and interactive regulation?
How does one's subjective state, evoked by a patient's initiatives and self-regulatory style, impact the next moment of that patient's experience, thus influencing the trajectory of treatment? How in a given moment do a patient and therapist's history, attachment strategies, procedural history, self and interactive regulatory patterns, beliefs, attitudes, self-object needs, and continuously organized emotional meanings interact and coalesce into communicative meanings that constitute the organization of each partner's experience at that moment? How do we decide (reflectively and intuitively) in a given moment what we think will be an efficacious response on behalf of our patient? What processes may shift or punctuate a continuous process of experience into a discrete state of awareness for either patient or therapist? When does our listening stance shift from one of listening from within the patient's perspective to a stance from within our own perspective, as the other? What limits the reflective awareness of either partner at a given moment, and what processes enable the pair to expand reflective awareness of the meanings of each other's pre-reflective, sensory-affective, communicative actions? And is reflective awareness always necessary for transformation of repetitive regulatory patterns or ways of thinking, feeling, and acting?
A complex dynamic systems perspective allows access to addressing these questions pertaining to interacting "multiply contextualized experiential worlds" (Stolorow et al, 2001). Daniel Stern (2002) puts it this way: "We grow up in the soup of others' intentions, feelings, and actions." Minds are permeable and co-created, not separate, isolated, or boundaried.
I draw on many specific clinical concepts in thinking about these questions. A few include: 1) Stolorow and his colleagues' idea of conjunctions and disjunctions between experiential worlds, 2) Bacal's Specificity Theory that points to the optimal fitting together of who the patient and therapist are at any given moment in a way that is therapeutically useable by the patient, along with his ideas about the self-object needs of both therapist and patient, 3) Beebe and Lachmann's ideas about processes of self and interactive regulation, 4) Shane, Shane, and Gales articulation of different forms of transformational engagement such as self with self-transforming other and self with interpersonal sharing other within their broad theory, and 5) Orange's concept of co-transference.
I find useful the infant researchers' notions about how change occurs. The Boston Change Process Study Group emphasizes modification of emotional procedures, those continuous, unspoken, intersubjective processes of knowing how to be with another that Lyons-Ruth (1998) calls patterns of implicit relational knowing. Other useful concepts from this group are moments of meeting, the something more than interpretation, and dyadically expanded states of consciousness. Beebe, Lachmann and their colleagues emphasize, among other dimensions, change in the implicit, nonverbal patterns of self and interactive regulatory processes that complexly interact with narrative understanding of dynamic themes. Their concepts, ongoing regulations, disruption and repair, and heightened affective moments serve to bridge, by analogy, processes of the infant/caregiver system and therapist/patient system. These inspiring metaphors that capture the continuous nonverbal mutual engagement of transformational moments are increasingly gaining specificity as therapists describe case examples that articulate the nuances of communication processes and emergent meanings, including the history of prior contexts and the meanings of current motivational states at play.
I'll illustrate a few of these ideas with a clinical vignette. Alice, a graduate student made anxious by an elective course on attachment theory sought treatment with me. On our first meeting, Alice smiled warmly and spoke in an appealing way. Yet, I had a barely noticeable feeling of contradiction. My feeling I think was in response to her soft-spoken vocal tone, the tension of her facial muscles, a slight questioning look in her eyes, and her subtle sideways orientation to me, expressing a hesitance or uncertainty about coming into the office. I found myself softening my vocal tone and introducing myself more gently than usual, thereby, implicitly matching her demeanor. I was also aware of feeling slightly puzzled by my response, uncertain as to whether my matching her in this way was useful or not. Was I being overly cautious or compliant with her, perhaps worried like her? Perhaps a more robust, confident, less worried stance on my part would have been more helpful to her. Yet, I usually trust my initial intuitions as I negotiate "fitting together" with a person on our first meeting.
At the beginning of the next session I experienced this same pull, but this time resisted matching her. Rather, I was more assertively welcoming, engaged, and inquiring. She then revealed that she had always felt hesitant about entering her mother's room, which had served as her mother's retreat. Mother rarely welcomed her into her room. She also told me that she and her violin teacher were each so afraid to initiate anything, afraid of offending the other, as Alice thought that the conversation was difficult to get going. I then realized how a conjunction in our personal meanings had shaped and were shaped by the procedural aspects of our interaction. My reticence in response to her cautiousness, instead of disconfirming her expectation of rejection, led her to be more cautious, setting a trajectory that could have ended in stalemate. I remarked how I thought that we, too, were walking on eggshells around each other last time, that perhaps we both were being careful with each other. She acknowledged that she, too, thought that was the case and we both enjoyed a chuckle together. As we continued to explore the meanings to her of this kind of interaction with me and with others, she was more vitally engaged. In the process of commenting on our repetitive pattern, acknowledging our shared contribution, a transformation of the more familiar pattern was enacted with our experience of enhanced relational knowing remaining tacit.
Thus, I think one can appreciate the application and usefulness of incorporating infant research, attachment theory, intersubjective systems theory, and nonlinear dynamic systems theory into our clinical work.
