Psychoanalytic Dialogues, 11(2):187–194, 2001
Emotional Connections and Dyadic Consciousness in Infant–Mother and Patient–Therapist Interactions Commentary on Paper by Frank M. Lachmann
Edward Z. Tronick, Ph.D.
The emotional connection between patients and therapists and between developmental infants and researchers is argued to be a uniting basis for discussion of differences between therapists and researchers. Infant– mother research is seen as providing an understanding of the specificity of relationships and of the dyadic expansion of consciousness (DEC). DEC is hypothesized to be a mechanism of developmental change as well as a change process of therapy.
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EFORE GETTING TO THE IDEAS PROVOKED BY DR . LACHMANN’S PAPER ,
I begin with something of a digression. At a fundamental level, I have thought that work with infants and work with patients are connected by core feelings. We who do infancy research always have thought of ourselves as blessed to work with these little beings who elicit exuberant emotions, deep forms of connectedness, a sense of awe at their astonishing growth and change, and the promise of their, and our own, future. Of course, when they fail, our sense of desperation is great. The future seems lost. I believe that these also are the feelings provoked in the therapist working with a patient. It too is work filled with possibility, change, the future. And it too provokes feelings of caring and desperation. Nonetheless, these core feelings, in contrast to the obvious and important theoretical and empirical connections between developmental and therapeutic work, Edward Z. Tronick, Ph.D. is Chief of the Child Development Unit and Associate Professor of Pediatrics, Children’s Hospital, Harvard Medical School, and a member of the Process of Change Group, Boston Psychoanalytic Society and Institute.
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are seldom appreciated. Yet I believe that these feelings connect us— researchers and therapists—just as they connect us to our “subjects” and our patients. I make this digression (an association) because it was what I felt and experienced in reading Lachmann’s paper. The paper is infused with a sense of connectedness—his connectedness to (and respect for) his patients, his colleagues, his field, the research on infants, and theory. Of course, much of my sense of this is inferred, but inference, whether based on language or behavior, is always part of the recognition process. And though this digression may be just that (or, worse, a distraction), I believe that these feelings are critical to our— researchers’, clinicians’, theorists’—effort to coconstruct new procedures for our work with infants, patients, theory, and practice. Indeed, Lachmann is demonstrating how important these feelings of connectedness can be to our understanding, especially when they scaffold thoughtfulness such as Lachmann’s. Let me give an example of the importance of these feelings. In meetings with clinical colleagues, I have been struck by the gap between the language and ways of thinking of researchers and therapists. In a recent encounter with a clinical colleague, I described in microanalytic terms an infant’s reaction to a depressed mother. She immediately incorporated my description into a theoretical language. She saw her language as descriptive, and I saw it as abstruse and overdone. Upon my remarking on these differences in our language, she responded that I was interested in description (did she mean mere description?), whereas she was interested in meaning (real understanding!). This interchange was distressing, not only because I lost my baby (after all, this was my description of one of my subjects) but because the gap in the way we saw things was so great. But there was a mutuality of feeling between us that allowed us to move along and to struggle to establish a common direction. I came to see that researchers often do “merely” want to see what is going on with development. How does the infant change? What is the process that produces change? By contrast, clinicians want to help their patients to change. Their interpretative language provides them with guideposts for action. Clinicians want to know how what I am saying will help them work with their patients, and, for my part, I want to know how what they see will help me see things about my infants. We are both impatient in different ways. Development is complicated. I want to understand it now. But I have lots of time. Therapeutic change is complicated.
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Clinicians want to know how to do it now. They don’t have time. At the end of our discussion, we both had gained some insight about each other. What made our mutual insight possible was our sense of connectedness because of a shared set of core feelings and our implicit knowledge about procedures for being together. I connected to Lachmann through his paper. It produced many thoughts for me, which I want to discuss. One of Lachmann’s points that I like in particular, is that we must not blame the baby for the pathology we see in the adult. Babies were never like pathological adults. They never went through a normal stage that resembles pathological states. Lachmann, like Beebe (Beebe and Lachmann, 1994) and Stern (1985) and others, again saves the baby from all sorts of slurs accumulated over years of misthinking about virtual infants. To invert this idea, as an adult, I also want to thank Lachmann, because, if pathology is not infantile, then patients cannot be thought of as babies. Pathology develops in an individual who has been experiencing the world longer than the infant has. But the difference is not just time and the accumulation of the past brought into the present. The adult was a “being” who once had infant capacities but who no longer has (or no longer only has) infant, toddler, or child capacities. The adult has developed (an endless list of) capacities that were never present in the infant (e.g., perspective taking, conscious and unconscious abstract reasoning, time perspectives, representational processes) or capacities that were present in less complex forms (dynamic processes, a repertoire of implicit procedures for being with others that regulate intersubjective distance, direction, and emergent states of consciousness). It is with these fundamentally and qualitatively different capacities that adults experience, even reexperience (interpret), their experiences. Thus, pathology can occur at any point in development, and it will be different given the capacities at the time it developed, and it will be transformed as later developing processes come into place. Thinking that pathology is a linear outcome of an infantile/child experience is, as Kagan (1998) put it, a seductive idea but one that is incorrect. Adults are not infants, and pathology is not infantile—it is “adultile.” To extend these points a bit further, it also means that we must not apply models of mother–infant/child interaction to the therapeutic situation in a simple-minded, noncritical fashion. Infants are not patients. Mothers are not therapists. Although Wolff (1996) suggested that the two (infant research and psychoanalysis) are unrelated, it seems to me that we can learn a great deal about both by comparing
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and contrasting them to each other (Tronick, 1998). Contrasting them may be especially useful for understanding processes that lead to change when language is not at the center of the process. Nonetheless, we should not confuse and confabulate mothers and infants, patients and therapists. For example, though it is a dearly loved analogy, “holding” is not what goes on in mother–child interaction. We know that the infant, no less the mother, is far too active for “holding” to capture more than some part of what is going on. As Lachmann says, mother and infant are coconstructing meanings. Similarly, the patient and the therapist are far too active, even if only through implicit procedures, to be captured by the concept of holding. Lachmann provides us with an extremely interesting case to illustrate other critical ideas. In his discussion of his patient, a 39year-old woman, he speaks to her early childhood experiences with her father and her mother that affected her subsequent relationships. The events are clear, powerful, and nuanced. As a girl, she also was not only raised to high excitement with her father, but she was flattened when she returned home to her mother. Lachmann refers to this as the model scene. Model scenes, like Stern’s (1985) RIGs (representations of interactions that are generalized), are abstracted, depersonified ways of having expectations about being with others. The model scene for this patient was experienced initially with the father and was reexperienced in her relationships with others for 30 or so years. Lachmann does not see its effects as linear (“As a girl, I did this with my father; now I do it with my partner”). Rather, Lachmann recognizes that it was also changed by those relationships. It is no longer the model scene of her childhood. It also seems to me that this model scene is now changed again by the relationship between patient and therapist. I think Lachmann would agree. He does not see her as simply coming to a therapeutic insight. From his knowledge of infancy research and therapy, he recognizes that the model scene is now their coconstruction. It has been coconstructed by what they bring from their own past and from their ongoing and past active engagement with each other during therapy. He recognizes that he and his patient came to their version of her model scene together. Obstacles were in both of them, and their success came from their mutual engagement (Tronick, 1989; Beebe and Lachmann, 1994). Thus, Lachmann can say that what they have done is coconstruct the model scene. It is different than the childhood scene, and all the scenes in between, because of their mutual engagement.
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Lachmann goes on to suggest that what also has been coconstructed is their transference. Certainly this may be what has happened, but, as an infancy researcher, I see something additional. I believe that Lachmann and his patient, like a mother and a child, have coconstructed an implicit interactional procedure between them (Stern et al., 1998; Tronick, 1998). The procedure gives them a new way of being together. The procedure did not exist before. It uniquely arose out of their present and past interactions with each other in the therapeutic setting. It is a form of relational knowing (Lyons-Ruth et al., 1998). It is still implicit between them. It is not a conscious knowing (nor is it an insight), and it may or may not become conscious over the course of the therapy. In Lachmann’s terms, they may or may not develop a model scene about it. Thus, I don’t think they have only recoconstructed the transference, as wonderful as that may be. To me, they have done something far more wonderful—they have cocreated a truly new and unique implicit procedure for being together. Of course, it is based on their individual pasts, but, critically, it is also based on their own ongoing and past interactions with each other. At the time that Lachmann is writing, it seems that this procedure is not likely to occur outside their ongoing interactions. Nonetheless, the therapeutic effect is that it may eventually “give” her a new way of being with others (and give Lachmann a new way as well). I think that the ideas of uniqueness and cocreation demand that distinctions be made about the conceptualization of the model scene or Stern’s RIGs as abstracted and depersonified generalizations of how to be with others. Model scenes arise out of reiterated interactions with another person, often the mother. The child learns what the “procedural rules” are for interactions and uses them as an initial format or guide for interactions with others. In a way, it is like the child learning a game of peekaboo (“I do this, the other person does this”). The child also learns that the procedure can be used with lots of people. However, the polar opposite also occurs during development. Infants interact with mothers, fathers, and others in unique ways that are mutually created as the infant and the individual engage with each other (Tronick, 1989). These interactions and relational knowing are not generalized but remain specific to specific relationships. To me, the actions of the infant and a particular other are specifically fitted to each other and become increasingly differentiated and specific with ongoing engagement (“I do this with my mother,” “I do this with my father,” “I don’t do what I do with my mother with my father”). The fittedness and singularity of interactions and the experience of them
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are a fabulous cocreation that remains unique. They are not only reduced to a generalized model scene. Thus, on one side, the reiteration of interactions with others leads to learning general ways of being with others (e.g., “baby small talk”); on the other side, it leads to increasingly specific and particular ways to be with different individuals (e.g., “Only we do this together”). Indeed, I think what distinguishes relationships from “mere” interactions is the degree of specificity, the singularity, and the richness and coherence of their implicit knowings. One comment on another related point. Model scenes, RIGs, interactional schemes, and such are extremely useful in therapy. In therapy, discussions about interactions become narrations. They take on what Bruner (1990) called a canonical form, perhaps what Lachmann means by model scenes. Such canonization seems to be extremely effective in helping the patient and the therapist elaborate an understanding of how the patient was and is with others. They help to provide insight into the patient’s relational successes and failures. However, these canonical forms must not be confused with actual interactions or the interactional procedures and implicit relational knowings that the patient cocreates with specific others. Model scenes and such must not be instantiated. They are not the equivalent of the lived experience with others. Lachmann’s patient was uniquely related to her father and experienced their relationship in unique ways. This was also the case for each of her subsequent relationships with others. However, if we as researchers and therapists can gain an understanding of the polarities of the generalized model (e.g., model scene) and the singular (e.g., specific relationship), I think our understanding of the development of interactions and relationships outside (in the patient’s world) and inside (in the therapeutic setting) will be enhanced, as will our understanding of each other. Lachmann also suggests a set of basic motivations. I find these to be powerful concepts. These motives help us to understand the therapeutic process as well as what is changing during therapy. However, they are for the most part motivations “within the individual.” But I believe that there is also a “motivation” that is related to the conceptualization of the mother–infant or the therapist–patient as a dyadic system. The dyadic motivation arises out of the interaction and interactional processes (e.g., reparation, ongoing regulation, moving along; see Gianino and Tronick, 1988). I have referred to this dyadic motivation as the dyadic expansion of consciousness (DEC) hypothesis (Tronick and Weinberg, 1997; Tronick et al., 1998).
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Briefly, the DEC hypothesis is that each individual is a selforganizing system that creates its own states of consciousness—states of brain organization, if you will—which can be expanded into more coherent and complex states in collaboration with another selforganizing system, another person. When the collaboration of two individuals (two brains) is successful, each fulfills the fundamental system principle of increasing their coherence and complexity. For example, during the mutual exuberant smiling and cooing of an infant and mother, their states of consciousness are expanded because they have incorporated elements of the state of consciousness of the other into their own state. There is some form of recognition that “we know each other’s mind.” I believe similar expansions of consciousness occur between patient and therapist, perhaps at the moment when they have cocreated an insight or at the moment when they mutually recognize that they are having the same experience. I believe that DEC is fundamental to developmental change in the infant and to change in the therapeutic setting. The infant, mother, patient, and therapist all change when such dyadic states are formed. Critically, at the moment of its forming, and for the duration of its existence, there must be something akin to a powerful experience of fulfillment as one paradoxically becomes larger than oneself. I believe that this experience is the proximal reason for our seeking connection with others. Dyadic consciousness is a motivation in Lachmann’s sense, but it is a motivation that is available to individuals only as they engage each other and form dyadic systems. Lachmann has addressed issues based on systems theory and coconstruction, infant research and the therapeutic process. He provides us with ideas that demand our attention—our joint attention and mutual elaboration. Most important, he creates ways for therapists and researchers to coconstruct new understanding, to expand their consciousness, and to develop ways of being together.
REFERENCES
Beebe, B. & Lachmann, F. (1994), Representation and internalization in infancy: Three principles of salience. Psychoanal. Psychol., 11:127–165. Bruner, J. (1990), Acts of Meaning. Cambridge, MA: Harvard University Press. Gianino, A. & Tronick, E. (1988), The mutual regulation model: The infant’s self and interactive regulation. Coping and defense capacities. In: Stress and Coping,
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ed. T. Field, P. McCabe & N. Schneiderman. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc., pp. 47–68. Kagan, J. (1998), Three Seductive Ideas. Cambridge, MA: Harvard University Press. Lyons-Ruth, K., Brushweller-Stern, N., Harrison, A. M., Morgan, A. C., Nahum, J. P., Sander, L., Stern, D. N. & Tronick, E. Z. (1998), Implicit relational knowing: Its role in development and psychoanalytic treatment. Infant Ment. Health J., 19:282–289. Stern, D. N. (1985), The Interpersonal World of the Infant. A View from Psychoanalysis and Developmental Psychology. New York: Basic Books. Sander, L. W., Nahum, J. P., Harrison, A. M., Lyons-Ruth, K., Morgan, A. C., Bruschweiler, N. & Tronick, E. Z. (1998), Non-interpretive mechanisms in psychoanalytic therapy: The something more than interpretation. Internat. J. PsychoAnal., 79:903–921. Tronick, E. (1989), Emotions and emotional communication in infants. Amer. Psychol., 44:112–119. ed. (1998), Interactions that effect change in psychotherapy: A model used on infant research [Special issue]. Infant Ment. Health J., 19. Brushweller-Stern, N., Harrison, A. M., Lyons-Ruth, K., Morgan, A. C., Nahum, J. P., Sander, L. & Stern, D. N. (1998), Dyadically expanded states of consciousness and the process of therapeutic change. Infant Ment. Health J., 19:290– 299. & Weinberg, M. K. (1997), Depressed mothers and infants: Failure to form dyadic states of consciousness. In: Postpartum Depression and Child Development, Vol. 1, ed. L. Murray & P. Cooper. New York: Guilford Press, pp. 54–81. Wolff, H. (1996), The irrelevance of infant observations for psychoanalysis. J. Amer. Psychoanal. Assn., 44:369–392. Child Development Unit Children’s Hospital Harvard Medical School 300 Longwood Avenue Boston, MA 02115
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