Enhancing Intersubjectivity.

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Enhancing Intersubjectivity.

• Relation is reciprocity.
• Martin Buber.

Parent Infant Psychotherapy Talking to Babies. .
Bristol Annual Infancy Conference. 5th June 2009.
robin.balbernie_at_glos.nhs.uk
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• Infancy is a time of essential
  intersubjectivity. a condition of any
  psychological field formed by interacting worlds
  of experience, at whatever developmental level
  these worlds may be organised. (p. 3. Stolorow,
  R. D. Atwood, G. E. (1992) Contexts of Being
  The Intersubjective Foundations of Psychological
  Life. Hillsdale, N.J. The Analytic Press.)
  
  This is the experiential overlap
  where mother and baby
  produce a felt event to be
  shared.

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• Attachment, in all mammals, is there to
  keep the young in close proximity to the adult.
  It prevents them being munched up or mislaid.

But

• Intersubjectivity is the constantly renewable
  overlap where mother and baby each contribute to
  a time and place of harmonious interpenetrating
  mix up (Balint, The Basic Fault, p.66) when they
  actively participate in and influence each
  others immediate experiences.

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• Attachment behaviour is merely an indicator of
  an intersubjective emergency. It has to be
  triggered by an observed event and takes up a
  tiny proportion of any childs life.
• In contrast, intersubjective processes are
  active within all interpersonal contacts,
  whatever the level of affect or motivation.

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Mirror neurons.

• Mirror neurons are found in the premotor
  cortex and the inferior parietal areas
  associated with movement and perception as well
  as in the posterior parietal lobe, the superior
  temporal sulcus and the insula, regions that
  correspond to our abilities to comprehend someone
  elses feelings, understand intention and use
  language. This is how we are designed to have
  visceral reactions to each others actions,
  mishaps and feelings making intersubjectivity an
  innate aptitude.

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• Through mirror neurons we automatically imitate
  or rehearse every action we witness.
• Mirror neurons also fire at the sound of
  something previously experienced.
• When we listen to sentences describing actions
  the same mirror neurons fires as would have if
  the subject had done or witnessed the actions.
• Mirror neurons play a key role in perceiving
  intentions. Different ones fire depending on
  expected action.

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• Daniel Stern describes intersubjective contact
  as occurring when Two people see and feel
  roughly the same mental landscape for a moment at
  least. (Stern, 2004 The Present Moment. p.75)
• He points out that this is a primary
  motivational force quite separate from
  attachment, but together they form a mutually
  contributing system. Attachment keeps people
  close so that
  intersubjectivity can develop or
  deepen, and intersubjectivity creates
  conditions that are conducive to
  forming attachments. (p.102)

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• The brain does not begin its day as a tabula
  rasa. The brain is imbued at the start of life
  with knowledge regarding how the organism should
  be managed, namely how the life process should be
  run and how a variety of events in the external
  environment should be handled. (p. 205)
  (Antonio Damasio, (2004) Looking For Spinoza.
• London Vintage.)

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Inescapable intersubjectivity.

• Attachment is not just a matter of infant
  safety, it sets up the conditions for
  intersubjective contact between mother and
  infant. What occurs within this has become a
  crucial aspect of human development. This place
  of closeness socialises the child, sculpting his
  psyche and neurobiology.
• The human brain is the only brain in the
  biosphere whose potential cannot be realised on
  its own. It needs to become part of a network
  before its design features can be expressed.
  (p.324)
  Donald, M. (2001) A Mind So Rare.

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• Trevarthen summarizes how It is becoming
  increasingly clear that the human central nervous
  system, with the human body, is designed for an
  exceptionally elaborate brain-to-brain linking so
  the motive regulations of one brain can
  powerfully interact with those of the brain in
  another person.
• Trevarthen, C. (2001) Intrinsic motives for
  companionship in understanding Their origin,
  development, and significance for infant mental
  health. IMHJ, Vol. 22 (1-2), 95-131.

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• Human infants have profoundly undeveloped
  brain. Maintaining proximity to their caregivers
  is essential both for survival and for allowing
  their brains to use the mature states of the
  attachment figure to help them organize their own
  mental functioning. (p.149) Daniel Siegal, The
  Developing Mind.

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• In humans intersubjective awareness motivates
  cultural learning the intergenerational
  transmission of knowledge and skills with all the
  conceptual and material consequences.
• Trevarthen, C. Aitken, K.J. (2001) Infant
  intersubjectivity research, theory, and clinical
  application. Journal of Child Psychology
  Psychiatry. Vol. 42 (1)

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• And as a part of this, Stern suggests that
  intersubjectivity contributed to species survival
  as it promotes group formation, it enhances
  group functioning, and it assures group cohesion
  by giving rise to morality. (The Present Moment,
  p.98)

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• The target of therapy is the intersubjective
  field between infant and parent emphasising how
  early intervention is set within the shared space
  of the attachment and caregiving systems, and
  does not favour one at the expense of the other.

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The intersubjective field.
Reflective function. Containment. Holding.
Representation of infants mental
state. Reflected back to infant.
Inference.
Core of psychological self.
Internalisation.
Inaccurate mirroring (or non-contingent
responses) leaves the baby with unlabelled
feelings, which will be harder to regulate.
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If all goes well

• The securely attached child perceives in the
  caregivers reflective stance an image of himself
  as desiring and believing. He sees that the
  caregiver represents him as an intentional being,
  and this representation is internalised to form
  the self. If the caregivers reflective capacity
  has enabled her accurately to picture the childs
  intentional stance, then the child will have the
  opportunity to find himself in the other as a
  mentalizing individual. At the core of our selves
  is the representation of how we were seen.
  (p.348) Fonagy, Gergely, Jurist Target. (2002)
  Affect Regulation, Mentalization, and the
  Development of the Self.

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• A caretaker with a predisposition to see
  relationships in terms of mental content permits
  the normal growth of the infants mental
  function. His or her mental state anticipated
  and acted on, the infant will be secure in
  attachment. Fonagy, Steele, Steele,
  Moran, Higgitt, (1991) The capacity for
  understanding mental states The reflective self
  in parent and child and its significance for
  security of attachment. Infant Mental Health
  Journal, 12, (3)

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Reflective function and quality of attachment.

• Secure attachment and reflective function are
  overlapping constructs, and the vulnerability
  associated with insecure attachment lies
  primarily in the childs diffidence
  in conceiving of the world in
  terms of psychic rather than
  physical reality.
• (p.351) Fonagy, Gergely, Jurist Target.
  (2002) Affect
  Regulation, Mentalization, and the
  Development of the
  Self.

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• Attunement requires an awareness of the infant
  as a psychological entity with mental experience.
  It presumes a capacity on the part of the
  caregiver to reflect on the infants mental
  experience and re-present it to the infant
  translated into the language of actions the
  infant can understand.
  (p.207)
• Fonagy, P., Steele, H., Steele, M., Moran,
  G. S.
  Higgitt, A. C. (1991) The capacity
  for
  understanding mental states The reflective
  self in
  parent and child and its significance for
  security of
  attachment.
• Infant Mental Health Journal.
  
  Vol. 12. (3) pp 201-218.

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• Thomas Ogden writes Holding is concerned
  with being and its relation to time the
  container-contained is centrally concerned with
  the processing (dreaming) of thoughts derived
  from lived emotional experiences.
  (2004) On holding and containment, being and
  dreaming. Int. J. of Psychoanalysis. 85.

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• Bion described containment as a function of
  maternal reverie, seen as that state of mind
  which is open to the reception of any objects
  from the loved object and is therefore capable of
  reception of the infants projective
  identifications whether they are felt by the
  infant to be good or bad. (p.36) Learning From
  Experience.

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• Britton gives a later, more hands-on,
  description of containment.
  The mother, if she is
  receptive to the infants state of mind and
  capable of allowing it to be evoked in herself,
  can process it in such a way that in an
  identifiable form she can attend to it in the
  infant. In this way something which in the
  infant is near-sensory and somatic is transformed
  by the mother into something more mental which
  can be used for thought or stored as memory.
  (p.22)
• Britton, R. (1998) Belief and Imagination.

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• Emde (198938) remind us that the infant
  comes to the world with a biological preparedness
  for participating in social interactionsThe
  infant has built-in capacities for initiating,
  maintaining, and terminating social interactions
  with others. (p. 38) The Infants Relationship
  Experience Developmental and Affective Aspects.
  In Relationship Disturbances in Early Childhood.
  Ed. Sameroff Emde.

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• Fonagy puts this in attachment terms.
  Secure attachment may thus have a great deal in
  common with successful containment. What is
  critical is the mothers capacity mentally to
  contain the baby and respond, in terms of
  physical care, in a manner that shows awareness
  of the childs mental state yet reflect coping
  (mirroring distress while communicating an
  incompatible affect).
• (p.166)
• Fonagy, P. (2001) Attachment Theory
  
  and Psychoanalysis.

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• Donald Winnicott described the mothers
  capacity to put herself in the babys place and
  know what the baby needs in the general
  management of the body, and therefore of the
  person. He called this early maternal provision
  the holding phase, - when with the dawn of
  intelligence and the beginning of a mind as
  something distinct from the psyche the infant
  changes from a relationship with a subjectively
  conceived object to a relationship with an object
  objectively perceived.
  He defined holding as the total
  environmental provision prior to
  the concept of living with.

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• Secondary intersubjectivity arises when the
  infant can systematically combine interests in
  immediate physical reality with communication
  about their knowledge and intentions. A
  deliberate sought sharing of experiences about
  events and things is achieved for the first
  time.
• Trevarthen, Hubley, (1978) Secondary
  intersubjectivity confidence, confiding and acts
  of meaning in the first year. In Lock, A. (Ed.)
  Action, Gesture and Symbol The Emergence of
  Language.

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Secondary intersubjectivity.

• The sign of secondary intersubjectivity is
  when something can become a shared focus between
  infant and another. This new development is
  heralded by the systematically combining of
  interests of the infant in the physical,
  privately-known reality near him, and his acts of
  communication addressed to persons. (p.184)
• Trevarthen, C. Hubley, P. (1978) Secondary
  intersubjectivity confidence, confiding and acts
  of meaning in the first year. pp 183-229 in
  Lock, A. (Ed.) Action, Gesture and Symbol The
  Emergence of Language.

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