Moving along to things left undone

This paper expands on three areas of clinical theory that are introduced and discussed in the lead paper and the others in this symposium. The first issue addressed is the concept of the real relationship as used in the moment of meeting model of psychotherapeutic change. Particular focus has been placed on the past, the present, and the hierarchy of goals in the treatment relationship. Second, the paper explores the concept of implicit relational knowledge with attention to the concepts of transference, countertransference, interpretation, and insight in the change process. Finally, the paper attends to the nature of the “now moment” in the moment of meeting model. Specifically explicated are ways this concept relates to changes in brain organization and also ways the moment of meeting model relates to other psychotherapy models, such as the relational schools and self-psychology. © 1998 Michigan Association for Infant Mental Health     

Dyadically expanded states of consciousness and the process of therapeutic change

This paper addresses an intersubjective issue that arises out of our model of therapeutic change: Why do humans so strongly seek states of emotional connectedness and intersubjectivity and why does the failure to achieve connectedness have such a damaging effect on the mental health of the infant? A hypothesis is offered—the Dyadic Expansion of Consciousness Hypothesis—as an attempt to explain these phenomena. This hypothesis is based on the Mutual Regulation Model (MRM) of infant–adult interaction. The MRM describes the microregulatory social-emotional process of communication that generates (or fails to generate) dyadic intersubjective states of shared consciousness. In particular, the Dyadic Consciousness hypothesis argues that each individual, in one case the infant and mother or in another the patient and the therapist, is a self-organizing system that creates his or her own states of consciousness (states of brain organization), which can be expanded into more coherent and complex states in collaboration with another self-organizing system. Critically understanding how the mutual regulation of affect functions to create dyadic states of consciousness also can help us understand what produces change in the therapeutic process. © 1998 Michigan Association for Infant Mental Health     

Implicit relational knowing: Its role in development and psychoanalytic treatment

It is increasingly apparent that “something more” than interpretation is needed to bring about change in psychoanalytic treatment. Drawing on clinical and developmental observations, we propose that interactional processes from birth onward give rise to a form of procedural knowledge regarding how to do things with intimate others, knowledge we call implicit relational knowing. This knowing is distinct from conscious verbalizable knowledge and from the dynamic unconscious. The implicit relational knowing of patient and therapist intersect to create an intersubjective field that includes reasonably accurate sensings of each person's ways of being with others, sensings we call the “real relationship.” This intersubjective field becomes more complex and articulated with repeated patient–therapist encounters, giving rise to emergent new possibilities for more coherent and adaptive forms of interaction. During a transactional event that we term a “moment of meeting,” a new dyadic possibility crystallizes when the two persons achieve the dual goals of complementary fitted actions and joint intersubjective recognition in a new form. We argue that such moments of meeting shift the relational anticipations of each partner and allow for new forms of agency and shared experience to be expressed and elaborated. © 1998 Michigan Association for Infant Mental Health     

Juveniles' understanding of trial-related information: are they competent defendants?

There exists a national trend lowering the age to transfer children facing serious charges to adult court for trial. This study examined juvenile offenders' understanding of factual information about trials. Juveniles ages 11 through 16 experiencing their first institutional placement were administered a competence to stand trial screening measure, shown an educational videotape, and readmin- istered the measure. Findings suggest that a majority do not have sufficient understanding for meaningful participation in their trials. Special care appears warranted with juveniles ages 13 and under, and juveniles with low average or below average IQ scores. Further, substantial training may be necessary for some juvenile offenders. ©1997 John Wiley & Sons, Ltd.     

Facilitating Interorganizational Collaboration: The Contributions of Interorganizational Alliances

In an attempt to promote service delivery integration and improve interorganizational collaboration, many recent human service delivery initiatives have included the development of interorganizational alliances such as coalitions and coordinating councils. Despite their popularity, little is known about how these alliances influence interorganizational collaboration, specifically the extent to which they alter the interactions among human service delivery organizations. The present study examined the interorganizational interactions, specifically the exchange relationships, within one county that was implementing two interorganizational alliances—a countywide coordinating council and interagency service delivery teams. Membership on both alliances was associated with broader interorganizational exchange networks. Organizations involved in a coordinating council were more likely to be included in client, information, and resource exchanges, and participate in joint ventures with a broader range of organizations. Providers involved in interagency teams also exchanged clients and information with a broader sector of service delivery organizations than nonparticipating providers. Observational data suggested that both alliances created structures and processes intended to facilitate interorganizational exchanges. Together, these results suggest that the development of opportunities for and encouragement of staff and leader involvement in these types of alliances may be an important part of our attempt to create a more integrated social service delivery system. The implications of these findings for researchers and practitioners are discussed.