Estelle: I'd like to begin with a question addressing my own abiding curiosity about what makes an individual develop in particular ways with particular interests. Your first chapter provides a delightful introduction to the ongoing collaboration between the two of you, beginning in 1972, telling something about how each of you got there, and where you went. But I'd like to know from both of you what, in your lives, led you first into adult treatment, and then also into infant research?

Frank: Understanding people was a family tradition. My mother was warm, outgoing, and a busybody in whom people did not mind confiding. Being a private practitioner is in my father's tradition. His early advice to me was, "Don't work for anyone. Work for yourself." He was reserved, modest, ambitious, and articulate about his values and ethics. He worked for himself, at home, as a CPA.

I have been interested in research since my high school days. In later years, as a psychologist, I was interested in the REM sleep-dream research and in Lloyd Silverman's work on subliminal perception. When I met Beatrice, she was already doing infant research and that fit well into my analytic interests.

Beatrice: My mother was a school psychologist, and my father was a researcher, a biostatistician, investigating the long-term medical consequences of the radiation traumas of Hiroshima, Nagasaki, and Chernobyl. I grew up thinking that research was one of the most important things that one could do in life.

From my mother's influence, I grew up immersed in the idea that each person has a different and complex psychology, which led to my interest in adult treatment. I was interested in becoming a psychologist, but I did not want to do exactly what my mother did. Psychoanalysis became my own separate interest. To deal with this family, it seems that I had to have two different careers. My specific interest in infant research stemmed from my fascination with development. It led to my seeking out Dan Stern, who then had a pivotal role in solidifying my investment in infant research.

Estelle: Before we get into the body of this work, could you each say something about how it has been to work together? What makes it possible for you two to maintain a collaboration for thirty years, and a productive collaboration at that?

Frank: It's been great to work together, and it was easy.

Estelle: In a chapter in his book, Relationality, Mitchell, after detailing his new ideas about four different modes or categories of relationality, and then applying these modes to a discussion and comparison of two clinical cases, asks himself the question, "What general interpersonal and technical conclusions might be drawn from this comparison?" and answers himself, "None at ALL!" Now in this book in which you discuss and compare infant research and adult development, I wonder how you would respond to a similar question about what general interpersonal and technical conclusions might be drawn from this comparison? I know that you would answer differently, and that the entire book, in one sense, constitutes an answer, but could you comment briefly in general about this connection?

Beatrice: Steve Mitchell's concept of varying organizational structures, how minds organize experiences according to different principles, is very similar to our concept of "organizing principles." The main point of his chapter is the elucidation of four modes of organization. However, the organizing principles he suggests, based on theories of adults, are quite different from the ones we suggest, based on observations of mothers and infants. In common with him, we are interested in how these principles can be used by the clinician.

Estelle: In Chapter 1, aptly entitled "Burton, Then and Now," you review the conceptualizations you had used in the early 70's (and wrote about it in a paper published in 1983), to treat this patient, critiquing them against your more current ways of thinking, based on a systems view. Thus, the case becomes a kind of "Two Analyses of Mr. Z." This is a fascinating chapter, and provides a wonderful preview and glimpse into what follows, but it is interesting to me that what you largely focus on here is differences in understanding of the treatment of Burton; I wonder in what ways the treatment itself might have been different in terms of therapeutic interventions, or how you might predict the patient himself might have been different had you followed a systems-based understanding of treatment?

Frank: First, we view "Burton, Then and Now" as very different from "The Two Analyses of Mr. Z." In the case of Mr. Z the first analysis was deemed inadequate. In the case of Burton, the clinical work was clearly successful. However, we would not work identically today. There were some aspects of our clinical work that were not adequately conceptualized by the theory available at the time. For example, in the chapter we noted that although we did not conceptualize the attachment process, it was very present in the treatment. Similarly we did not conceptualize a two-way influence process. We focused on the therapist's impact on the patient, but not the patient's impact on the therapist. Nevertheless, Burton's impact on Beatrice was powerful and palpable in the treatment, and we discussed this in the chapter. Burton clearly knew that he was very important to Beatrice. We also conceptualized the nature of Beatrice's influence solely in terms of interpretation. In the chapter, we do note that in retrospect there was a powerful nonverbal process occurring as well. The use of nonverbal processes constitutes a continuity in the way we work clinically; although, we now conceptualize these processes more explicitly. Another important continuity in our work, then and now, is the emphases on self-regulation, although we did not use that term as a central organizing construct in the treatment of Burton. In retrospect, we focused intensely on his self-regulation difficulties: drug use, eruptive aggression, and an addictive quality to his relationship with his girlfriend.

Estelle: As I read your work, you argue for the view that the value of infant research is that it serves, not so much to enhance our understanding of the infantile origins of adult psychopathology, nor that it provides apt metaphors for understanding the relationship between patient and analyst, as that it enhances our understanding of interactive processes between patient and analyst, processes that remain similar across the life span. First, are you merely drawing analogies here between infants and mothers and the two adults in the treatment situation, or are you actually defining how self-and-interactive regulation evolves between individuals of any age? Second, if the latter is true, which I think it is, does not your innovative, indeed almost revolutionary, perspective on what constitutes the real value of infant research, that it neither describes earlier stages that are recapitulated in adult treatment nor suggests similes for caring relationships, separate your work from most of the thinking that has already been done on the usefulness of infant observation and research for understanding adult treatment?

Beatrice: Yes.

Estelle: Along this line, when we think of how to understand "normal" development using a nonlinear dynamic systems perspective, it seems to me that the older stage or phase models taking the individual into maturity are cast into severe question. How do you now think of development past infancy? Do you think the fruitful ideas brought forward here by you would offer new ways to approach this question? What about "critical periods?" How do they fit in?

Frank: We have not worked on this problem; although, it is clearly very important.

Estelle: Contemporary psychoanalytic contributions divide between those that conceptualize room for both the intrapsychic and the interpersonal or intersubjective in their theorizing, and those that focus exclusively on the intersubjective. With your systems model focusing on self-and-interactive regulation, it would seem that both the intrapsychic and the intersubjective, or interpersonal would pertain. Is that accurate?

Beatrice: Yes.

Estelle: Or how do you think of this issue? And how do you think of intersubjectivity? In a developmental, sense, ala Stern, Benjamin, Ogden, or in Stolorow, et al's conceptualization?

Beatrice: This is too big of a question to address here. You might look at my article in the forthcoming Psychoanalytic Dialogues (2003), Beebe, Knoblauch, Rustin, and Sorter, "Forms of Intersubjectivity in Infant Research and Implication for Adult Treatment."

Estelle: At the end of the Chapter on "A Dyadic Systems View," you offer an excellent summary (pages 43-44) of the general principles for a theory of interaction at the nonverbal level, one of the many gifts that you provide for the reader of your book. These principles, as you indicate, help us to understand how inner state and interactive process are integrated. Would you say that this set of principles applies to the adult treatment situation? Or would they have to be modified or selectively applied?

Frank: In Chapter 9, we believe the dimensions of our dyadic systems model in relation to its implications for adult treatment. Most of the points in the summary of Chapter 2 "A Dyadic Systems View" reappear in Chapter 9 where we spell out more directly how these concepts can be used in adult treatment.

Estelle: I think that Chapter 7, "Representation and Internalization in Infancy: Three Principles of Salience" is among the best of the chapters in this book, expanding as it does on that most original paper that the two of you wrote, I think in 1994, where I first came to really love your contributions. But now you have included much more, particularly material that enhances our understanding of psychoanalytic treatment. The three principles are so salient, that perhaps you wouldn't mind recalling them in your own words for the readers of this review?

Beatrice: We quote from Chapter 7, "Representation and Internalization in Infancy: Three Principles of Salience," pages 143-144:

"In this chapter we return to one of the basic themes of the book, how the mind is organized in interaction. We revisit the subject of presymbolic representation in order to illuminate the origins of internalization. We suggest three organizing principles, three "principles of salience," that determine the salience of events for the infant, organizing what the infant expects from interactive encounters. These three principles are 'ongoing regulations,' 'disruption and repair' of ongoing regulations, and 'heightened affective moments.' They further define the nature of self-and-interactive regulation. They constitute hypotheses about how expectancies of social interactions become patterned and salient in the first year. In the next chapter we apply these principles of salience to an adult treatment case, showing how they can further specify modes of therapeutic action. These three principles give us additional ways of drawing analogies between adult treatment and infant research.

"Of the three principles, the overarching one is 'ongoing regulations,' based on the expected and characteristic ways in which an interaction unfolds. Disruption and repair captures a specific sequence broken out of the broad pattern. In heightened affective moments, one dramatic instance stands out in time. Thus the three principles provide a hierarchical definition of interaction patterns, temporally organized at three levels: the broad pattern, a sequence, and a moment. These three levels of organization should be seen as a nested series in which each level constitutes a context for the next.

"Each of our three principles of salience provides a different perspective on the organization of representations and on the origins of 'internalization' in the first year. Self and object representations can be seen as based on early perceptual capacities, interaction patterns, and emerging capacities for category formation, abstraction, and later, symbol formation. Interaction patterns are characteristic modes of interactive and self-regulation which the infant comes to recognize, remember, and expect. . .. This description of representations as organized by the three principles of salience can simultaneously illuminate the origins of internalization. Interactive regulation is a central concept both in the empirical infant literature and in discussions of internalization (Schafer, 1968). In our view, however, interactive regulations do not become inner regulations. Rather, interactive regulations have always been inner, in the sense that they always occur in tandem with self-regulations. We suggest a view of internalization in the first year in which both partners jointly construct modes of regulation which include interactive as well as self-regulations. The expectation and representation of the dyadic modes of regulation, as organized by the three principles of salience, constitute the inner organization."

Estelle: I think it is important to emphasize how psychoanalysis, in its focus on frustration, had been in error concerning the pervasive influence of that experience in development. Remember Freud believed that the infant would not change or grow at all, were it not for the fact that the infant's hallucinatory which fulfillment of the breast would be ultimately fail him, leaving him frustrated, still in a state of hunger, and forcing him into action - crying - if he wished to be fed. Even Kohut postulated optimal frustration as the path toward structure formation, mild frustration requiring the individual to take over functions heretofore provided by selfobject functions. In that light, don't you think that your concept of ongoing structural patterning, ongoing regulation, offers us considerable understanding of change and development in the therapeutic process of adult patients? If the majority of the infant's experience in development is of ongoing regulation, with heightened moments and disruption and repair less frequently occurring, what implication may be drawn for adult treatment of these distinctions?

Frank: There is no research comparing the prevalence, much less the organizing impact, of interactions patterned by (a) ongoing regulation, (b) disruption and repair, and (c) heightened affective moments. (Although it's a good bet that ongoing regulation is the most prevalent). So, we don't know the answer to this question in infancy. Even if we did, we would be very cautious about drawing any one-to-one correspondences with adult treatment. Nevertheless, we do think that the three principles are very important for analysts to use in conceptualizing therapeutic action in the adult analysis. Most likely, the relative organizing impact of the three principles varies from treatment to treatment.

Estelle: I notice that you use both representation and internalization as concepts to explain presymbolic representation during the first year of life. I'm not sure what distinctions you make between these concepts, and why you use "internalization" at all.

Beatrice: In the book, we discuss the concepts of representation and internalization. "Although it has been argued that internalization is different from processes that establish the original representations of the internal and external world, we hold that internalization in the first year is a process not distinct from the process of presentations" (p. 178). We go on to argue that whereas the term "internalization" has generally been applied to processes after the first year when symbolic levels of self and object are in place (secondary internalizations). We are interested in applying the three principles of salience to reconceptualizing "primary internalization" in the first year. In so doing we address the presymbolic origins of internalization.

Frank: Why do we use the term "internalization" at all? We want a dialogue with psychoanalytic theory. It is important to show analysts how the infant research can be used to inform and reconceptualize some of the most basic concept in psychoanalysis. We emphasize "reconceptualize" because in this book our definition of internalization has shifted from a dyadic two-person concept. We believe we have rescued Schafer's original interactive emphasis in his statement "the regulatory interaction has been interiorized" (p. 180). Our second reconceptualization is that regulatory interaction with the environment does not become inner regulation. Instead regulatory interactions and inner regulations proceed hand in hand and shape each other. We note that internalization is not the optimal metaphor for this process.

Estelle: I want to end with a statement, rather than a question: I was delighted with your book as a whole, the way in which the concepts and constructions were always and adequately illustrated with clinical material, the way the chapters built on one another, and the way you end with your final chapter, "An Interactive Model of the Mind for Adult Treatment." I think this book is a "must read" for any clinician interested in reaching all of his or her patients. I want to thank you both for a book that is a pleasure to read, a pleasure to quote, a pleasure to teach, and a pleasure to treat by. Thank you.