Key Pioneers of Two-Person Relational Psychology

, Jeffrey R. Strawn2 and Ernest V. Pedapati3



(1)
Division of Psychiatry and Child Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

(2)
Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA

(3)
Division of Psychiatry and Child Psychiatry Division of Child Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

 



There can be no knowledge without emotion. We may be aware of a truth, yet until we have felt its force, it is not ours. To the cognition of the brain must be added the experience of the soul.

—Arnold Bennett


This chapter reviews some of the leading experts who have contributed to the field of child and adolescent two-person relational psychotherapy through their research. The list is by no means complete as it would be beyond the scope of this book to include all of those who contributed to further expand the understanding of the complexities of infant development . We limit this review to the authors who pursued infant–caregiver research—the “baby watchers,”—and spawned the concepts most applicable to the two-person relational psychodynamic psychotherapy of children and adolescents.

We have organized this chapter into three sections. We begin by focusing on those researchers who were directly involved in developmental research studies, followed by those who have synthesized vast amounts of empirical research from neuroscience and summarized the relevance to the clinical work of the psychotherapist. We end by reviewing the developmental researchers who were instrumental in formulating what are now known as the attachment and temperament theories.


4.1 Developmental Psychology Researchers


Developmental psychology refers to the scientific discipline that studies the biological, social, and cultural factors that affect development and advance the knowledge and theory of development of children and adults across their life span. Developmental theorists have been keenly aware that a key aspect in social interactions is the ability of one person to understand the mental states of others.


René Spitz (1887–1974)


René Spitz , a psychiatrist and psychoanalyst best known for his systematic observations and video recordings of the interactions between infants and their mothers, preceded many of the attachment theorists (Palombo et al. 2012). Spitz studied the infant’s relationship to their caregivers. He found that infants who were hospitalized and did not have direct exposure to their mothers or caregivers developed what he coined hospitalism , characterized by anaclitic depression and a failure to thrive syndrome, based on the infant’s reaction to maternal deprivation. Moreover, he was among the first psychoanalysts to use the research laboratory to affirm the importance of a child’s need for social interactions with other humans as essential for the child’s survival and biopsychosocial development. It is important to note that his work occurred nearly 10 years before Bowlby’s writings on attachment theory. Further, another important contribution is the findings from observations of planned separations between the mother and the infant in prison nurseries. His findings proved that early loving caregiving were internalized at an early age by the infant and that later separation had devastating consequences for the infants, i.e., grief and depression. Thus, what had become standard practice, that adoption was best when it occurred after the first year of life, changed to promote early adoption when possible, to facilitate the bonding needed for affective reciprocity and ego development (Emde and Hewitt 2001).


Robert Emde (1935–)


Robert Emde, a psychiatrist and psychoanalyst, was a student and mentee of René Spitz during Emde’s residency at the University of Colorado. He wrote that he “got hooked in beginning a career in infant research and psychoanalytic thinking about the importance of the mothering for early social-emotional development” (Emde 2009). He continued Spitz’s work with regard to mother–infant dyads and later developed a distinguished research program for the systematic analysis of video recordings of the interactions between infant and mother or caregiver. Their research highlighted the infant’s need for social referencing and affective attunement by the caregiver. Emde’s team believed that there was a need for “mutuality ” between caregiver and child for survival and emotional growth, indicating “the development of the self and the development of the other did not develop separately but were two sides of the same coin.”

Emde’s team posited that social referencing was a form of active emotional communication thought to mediate behavior when the infant is confronted by a situation of uncertainty. For Emde (1980, 1983, 2000), emotional availability referred to the “receptive presence” of the parent to the child’s emotional signals. It connoted a type of presence and availability that had a great deal in common with the way a psychotherapist “is there” for a patient (Biringen and Easterbrooks 2012).

Emde is recognized in the field of psychoanalysis for his role in integrating the information gathered from research about childhood development with psychoanalytic theory. He suggested that the adherence to conflict-based drive theory limited the understanding of the child, in that it failed to recognize the value of the new findings from developmental research. In his paper “From Ego to ‘We-Go’: Neurobiology and Questions for Psychoanalysis,” he used the term “we-go,” which—as a concept—led contemporary psychoanalysts to begin to view Freud’s ego as a concept that did not take into account the intersubjectivities and mutuality between the infant and the “other.” The term “we-go ” had been credited posthumously to George Klein (1967). Emde writes that, in 1987, when presenting his “From Ego to ‘We-Go’” paper at a plenary address at the International Psychoanalytic Association annual meeting, he mentioned that psychoanalysis was in need of the theory of we-go to supplement the theory of the ego , and “it resulted in somewhat of sensation.” His contributions led to a surge in the interest of two-person relational psychology influenced by infant developmental research by many of his psychoanalytic colleagues. Emde traced the origins of the shared we-go to the beginnings of social referencing during the second half of the first year of life.

Emde is also known for a classic study in which healthy 3- and 4-year-old middle-class children were initially asked to play with toys in the presence of a researcher. Each child’s mother then entered the room and brought her child two new toys and would let her child know her wish that the new toys should not be played with after she left the research room. The mother then left the room, and the researcher challenged the prohibition given by the mother by tempting the children to play with the new toys. Surprisingly, a number of children resisted the temptation, to which Emde states, “We came to the realization that these children had developed an executive sense of ‘we’ of the significant other being with them, giving them an increased sense of power and control.” He goes on to say: “The self is a social self. Moreover, research indicates that from infancy, innately given brain processes support social reciprocity and the development of “we-ness ”” (Emde 2009).

Further, Emde and his team believed that the infant’s autonomous self existed within the context of a social connectedness to the other and had the capacity to develop a rudimentary moral compass for empathy with others. For example, in an experiment they noted that as early as 3 years old, children had parental prohibitions internalized. When facing a challenge in their play, these children accessed and abided by these internalized rules. The team added that when 3- to 4-year-olds in their control group were read stories that conveyed moral dilemmas, the children “understood and struggled with the dilemmas, with many achieving pro-social outcomes” (Oppenheim et al. 1997).


Daniel Stern (1934–2012)


Daniel Stern , a psychoanalytically trained psychiatrist, was also a prominent infant researcher best known for his book The Interpersonal World of the Infant (1985). His detailed observations of the mother–infant interactions in the research laboratory led him to bridge infant developmental research to the practice of psychodynamic psychotherapy and psychoanalysis (Emde 2013). Early in his research, he departed from Mahler’s separation–individuation theories (Mahler 1974), and with the information gathered from his infant observations, he proposed that for the infant to organize a coherent and core sense of self, it would need to successfully develop four interrelated senses of self-experience. He observed that the infant’s self-experience senses began within the first 2 years of life and progressed as such: The process starts with the emergent self, continues through the core self and the subjective self, and then finalizes with the verbal self. Primary attachment figures played a critical role in helping the infant with this process, and the developmental achievements in each phase persist over the child’s life span. During the period of the subjective self (in the 7- to 15-month-old range), the child becomes aware that his thoughts and experiences are distinct from those of others, and with proper attunement by the primary caregivers, the child can cocreate dialogue with others that requires the use of mirror neurons. This allows the child to participate in another person’s actions without having to imitate those actions. He termed this as “affective attunement ” and described it as “the performance of behaviors that express the quality of feeling of a shared affect state without imitating the exact behavioral expression of the inner state.”

Stern noted that in the case of a caregiver who suffers from depression and is unable to provide the affective attunement needed by the child, the child would be deprived of positive intersubjective experiences. This would interfere with the child’s development, which could lead to the child being unable to connect emotionally with others or make sense of another person’s action in any meaningful way.

Stern’s important contribution, which influenced the writing of this book, is the concept of intersubjectivity, defined as “the capacity to share, know, understand, empathize with, feel, participate in, resonate with, enter into the lived subjective experience from another” (Stern 2004, see Chap.​ 5). For Stern, intersubjectivity occurred in the implicit and preverbal domain. He felt that intersubjectivity was used in a continuous manner, and it expanded as the infant grew.

Moreover, Stern believed that what was implicit occurred in the “nonconscious ” realm, a term Stern preferred over unconscious, because nonconscious resides in a dynamic system that is nonsymbolic and nonverbal and does not need to be repressed.


The Boston Change Process Study Group (BCPSG)


The Boston Change Process Study Group was created in 1995 by a small group of psychoanalysts, developmental researchers, and psychoanalytic theorists who proposed that here-and-now intersubjective experiences observed in infant studies shed light on how change could be facilitated by psychotherapy and psychoanalysis. The original members of the BCPSG were Nadia Bruschweiler-Stern, Karlen Lyons-Ruth, Alexander Morgan, Jeremy Nahum, Bruce Reis, Louis Sander (deceased), Daniel Stern (deceased), and Edward Tronick (no longer part of the group). The group was strongly influenced by Stern’s work in infant research. They made great strides in developing theoretical models that relied on the understanding of deeper psychodynamic levels of meaning based in implicit forms of representation, co-constructed by a person’s intentions during their interactions. Since its inception, the group has published several seminal papers and books. In addition, they asserted that the therapeutic relationship itself, even in the absence of interpretation, was sufficient to promote a therapeutic change. They were also proponents of the co-constructed exchanges that occurred at the implicit domain and came to constitute implicit relational knowing with significant psychotherapeutic effects.

The BCPSG explains that when making reference to implicit relational knowing, the group is not referring to the infant’s cognitive function, but rather to the physiological and later to the social/behavioral regulation carried out between the infant and its caregiver, an act that is remembered by the infant. They see the earliest forms of biological regulation in the infant emerge for the basic capacity of adaptation: “The fact that these earliest forms of biological regulation are stored in memory systems, have mental concomitants and are psychologically meaningful has been intuitively grasped by some, but is not widely understood. Through representing these dyadic regulatory exchanges, the human infant moves from being a physiological to being a psychological being” (Nahum 2000).

Further, they describe what they believe are the reasons why the implicit domain has significant relevance to psychotherapeutic encounters: “Implicit processing consists of the representing of the relational transactions that begin at birth and continue throughout life. Such implicit processing guides the moment to moment exchanges that occur in any interaction, including the psychoanalytic situation. All the things that are the stuff of the interactive flow, such as gestures, vocalizations, silences, rhythms, constitute this moment to moment exchange, which we refer to as the local level”.


L. Alan Sroufe (1941–)


L. Alan Sroufe is best known for his work on the Minnesota Longitudinal Study of Parents and Children, which began in 1975 and is currently in its 38th year. The project’s researchers follow a sample of 267 first-time mothers who enrolled in the study during the third trimester of their pregnancy. They have followed these mothers and their children to monitor the course of the child’s individual development and to discern the factors that lead to good and poor outcomes. They have studied the subjects at different points in their lives and across diverse settings, including at their home, in social relationships, and at school.

Sroufe’s team conceptualized attachment as a dyadic emotion-regulation process, in which infants are not capable of regulating on their own and therefore require their caregiver in this process. How the infant ultimately learns how to regulate their emotions will depend heavily on how the caregiver regulates his or her own emotions. The research from the project demonstrated a high correlation between the caregiver’s attachment status and the attachment status of the infant with that particular caregiver. Sroufe and colleagues’ research viewed a child’s behavior as a product of their past history within the context of the current environment. Further, his team proposed that parallel assessments of a child’s early experiences and the influences of their environment predicted psychopathology better than either alone. Sroufe’s research articulated a general model of development and psychopathology: “Within attachment theory, psychopathology is viewed as a developmental construction, resulting from an ongoing transactive process as the evolving person successively interacts with the environment. Individual transforms environment but also is transformed by it…. Patterns of infant-caregiver attachment and other aspects of early experience may have a special role in the developmental process via their impact on basic neurophysiological and affective regulation” (Sroufe et al. 1999). Sroufe believed that when children are able to safely express their emotional and physical needs, they developed better self-regulatory skills. Not surprising, children who grow up in chaotic environments have better outcomes when their attachment to caregivers is positive than those in which the caregivers are an extension of a chaotic environment, and the children are more prone to relational trauma. Children with histories of anxious attachment are more likely to have problems in adolescence or adulthood than are securely attached children.


Edward Tronick (1942–)


Edward Tronick is a developmental researcher and clinical psychologist at the University of Massachusetts and former member of the Boston Change Process Study Group. He collaborated with pediatrician T. Berry Brazelton in creating the Neonatal Behavioral Assessment Scale and Touchpoints tool, which is designed to interpret what newborns are communicating through their behavior. He is best known for the “still-face experiment” and the “mutual regulation model.” In his still-face disruptions, Tronick ’s work has led to significant contributions of how mental health clinicians think about biopsychosocial states of infant consciousness, the process of meaning making, and how and why we engage with others in the world. His work contributed to the understanding of the infant self-regulation processes when maternal scaffolding is temporarily and abruptly unavailable. During the experiment, infants initially signal to the mother hoping to get her to resume her normal behavior. When this fails, the infants express negative emotion and use self-regulatory behaviors. When the experiment is over, for the next few minutes there is a continuation of the infants’ negative mood and a reduction in visual regard of the mother (Tronick 1989). In the model of mutual regulation, Tronick states, “In our view, the infant–adult meaning-making system is a dyadic, mutually regulated communicative system in which there is an exchange of each individual’s meanings, intentions, and relational goals—what we call the mutual regulation model.” He adds that it does not necessarily lead to pathology: “The infant of a depressed mother might become exceedingly sensitive to her emotional state in order to read her better and to better regulate the interaction. Such sensitivity may be useful when the infant interacts with others” (Tronick 1989).

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Dec 3, 2016 | Posted by in PSYCHOLOGY | Comments Off on Key Pioneers of Two-Person Relational Psychology

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