Case illustration: Moving along…and,is change gradual or sudden?

A sequence of analytic sessions of a professional woman in her forties is used to illustrate the moving along process. The material shows a gradual change, where the patient's experience of her sense of agency is altered through a particular kind of interactive sequence. The example is intended to make it clear that the group's view of how change occurs is not strictly or primarily in terms of sudden changes, and that the problem of assessing moments of meeting as well as quantitative and qualitative shifts is one with which the group continues to struggle. © 1998 Michigan Association for Infant Mental Health     

Why Is Being Nothing? An Apophatic Reading of Hegel’s Opening to the Science of Logic

The aim of this article is to analyze Hegel’s famous transition from being to nothing in the opening of the Science of Logic, to outline a variety of interpretations from commentators, and to defend what I call the “indirect apophatic interpretation” as support for the conclusion that Hegel is an ambiguously apophatic thinker. One benefit of the “indirect apophatic interpretation” is that it leads to a reassessment of Hegel’s conception of totality. The prevailing understanding of “totality” as exclusionary exhaustion, completion, and finitude has often been attributed to Hegel’s thought. But the “indirect apophatic interpretation” of the transition from being to nothing that I defend prepares the way for an alternative reading of totality in his work: not as the exhaustion of all positive content, but as the coincidence of being and nothing, as the contradiction A is -A, and as the exhaustion of form and content by way of a dialectic with the apophatic.     

Reflections on the process of psychotherapeutic change as applied to medical situations

This article takes the basic ideas on the process of changing implicit knowledge put forward in this special issue, and extends them beyond psychotherapy to include other therapeutic relationships that occur in medicine. One vignette, from an encounter between a medical student and a dying patient, illustrates how a “moment of meeting” changes the student as well as the patient. The second shows how therapeutic interventions for new mothers with their newborn infants involve “moments of meeting” that alter the mother's implicit knowledge of her baby and of herself as a mother. © 1998 Michigan Association for Infant Mental Health     

What Is Enactment What Is Dissociation

The current discussion offers an alternative to the dissociative self-state model of enactment and dissociation, emphasizing implicit memory processes in bodily comportment and style of relating with others. By embedding the occurrence of enactments within the ongoing flow of nonlinear dyadic process, the focus shifts to the subtle back-and-forth between patient and analyst that leads to the emergence of new relational (i.e., procedural) skills within a therapeutic relationship that is self-organizing at more inclusive levels. Enactment is thus seen as an emergent property of the dyad.     

Forms of Relational Meaning: Issues in the Relations Between the Implicit and Reflective-Verbal Domains

During these last decades, the notion of primary intersubjectivity has gained acceptance among developmentalists and clinicians. But a new challenge is put out to our models by recent findings on the triangular competence of the very young infant, or her capacity to simultaneously communicate with two partners at a time. This discovery raises the question of a collective form of intersubjectivity. Findings on the triangular competence of the 3- to 4-month-old interactions with father and mother in different contexts of the Lausanne trilogue play situation are reviewed and illustrated, with a view to examine whether it is based on a dyadic or triangular program and whether conditions for a threesome form of primary intersubjectivity are fulfilled. The discussion focuses on the revisions of the theory of intersubjectivity, of developmental theory, and of clinical practice these findings call for, pointing toward a three -person psychology too.     

Children’s sense of reality: The development of orbitofrontal reality filtering

Orbitofrontal reality filtering denotes a memory control mechanism necessary to keep thought and behavior in phase with reality. In adults, it is mediated by the orbitofrontal cortex and subcortical connections and its failure induces reality confusion, confabulations, and disorientation. Here we investigated for the first time the development of this mechanism in 83 children from ages 7 to 11 years and 20 adults. We used an adapted version of a continuous recognition task composed of two runs with the same picture set but arranged in different order. The first run measures storage and recognition capacity (item memory), the second run measures reality filtering. We found that accuracy and reaction times in response to all stimulus types of the task improved in parallel across ages. Importantly, at no age was there a notable performance drop in the second run. This means that reality filtering was already efficacious at age 7 and then steadily improved as item memory became stronger. At the age of 11 years, reality filtering dissociated from item memory, similar to the pattern observed in adults. However, performance in 11-year-olds was still inferior as compared to adults. The study shows that reality filtering develops early in childhood and becomes more efficacious as memory capacity increases. For the time being, it remains unresolved, however, whether this function already depends on the orbitofrontal cortex, as it does in adults, or on different brain structures in the developing brains of children.     

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     

Behavioral alterations in mice lacking the translation repressor 4E-BP2

The requirement for de novo protein synthesis during multiple forms of learning, memory and behavior is well-established; however, we are only beginning to uncover the regulatory mechanisms that govern this process. In order to determine how translation initiation is regulated during neuroplasticity we engineered mutant C57Bl/6J mice that lack the translation repressor eukaryotic initiation factor 4E-binding protein 2 (4E-BP2) and have previously demonstrated that 4E-BP2 plays a critical role in hippocampus-dependent synaptic plasticity and memory. Herein, we examined the 4E-BP2 knockout mice in a battery of paradigms to address motor activity and motor skill learning, anxiety and social dominance behaviors, working memory and conditioned taste aversion. We found that the 4E-BP2 knockout mice demonstrated altered activity in the rotating rod test, light/dark exploration test, spontaneous alternation T-maze and conditioned taste aversion test. The information gained from these studies builds a solid foundation for future studies on the specific role of 4E-BP2 in various types of behavior, and for a broader, more detailed examination of the mechanisms of translational control in the brain.