The Musical Edge of The Therapeutic Dialogue (Book Review)

Author:  Knoblauch, Steven H.
Publisher: Hillsdale, NJ: Analytic Press, 1999
Reviewed By: William J. Coburn, Summer 2001, pp. 62-63

Psychoanalysis traditionally has been transfixed on the words of our songs instead of the musical orchestration and improvisation--the implicit patterns of subjective experience--that prereflectively shape and inform their meaning. Even now, you may be aware of reading the words on this page (I’m assuming), attempting to derive explicit meanings from them, while you may remain unaware of how the rhythm, tone, and tempo of these printed symbols structure, inform, and particularize your emotional sense of, and response to, what I am saying.

Steven Knoblauch’s The Musical Edge of the Therapeutic Dialogue vigorously flips the lid right off the unconscious communication box, organizing its contents in exceedingly cool fashion. He deserves an extended round of finger-snaps for his illuminating in concise, contemporary dialogue what underlies the unique, context-sensitive experiences of emotional resonance (and dissonance) germane to human interaction. He does write about the highly-nuanced, fluid, and seamless emotionality of human relating, the intersubjective coalescence of subjective experience, and he offers a clearer take on therapeutic action; but, what makes his melody especially inviting to the clinician’s ear is that he transforms the often staunch, objectivist voice of the researcher and developmentalist into useable notes, themes, and variations.

Knoblauch sounds well-versed in contemporary theory and research: a resounding blend of intersubjectivity theory, affect resonance (infant) research, relational theory, language theory, and neo-Kleinian theory, this book sports plenty of complex harmonies for theorists and clinicians alike. Thankfully, it does not slide into prescription or technique, but maintains the dignity of an authentic contextualist perspective.

Knoblauch cautions us that “...the [clinical] examples have been offered to simplify an otherwise complex phenomenon [the vicissitudes of the rapid sequencing of dyadically-shaped emotional process contours]... While they facilitate sorting out the subtle nonverbal dimensions of a continuous process, they also could be misconstrued as representing a generalized model that can be universally applied for ‘how to do it.’ This is not what I intend to communicate”(p. 32). And indeed he does not. His detailed vignettes are poignant and self-disclosing, shaping his theory of the musical edge into intelligible tones, and reveal in real-time, how and when he was successful, and how and when he was off-key. I think this is a “warts and all” book. The clinician with the familiar refrain, “But just tell what to do with my patient,” remains, once again, frustrated. In that sense, this book is decidedly descriptive, and (again, thankfully) not prescriptive. Indeed, Knoblauch’s music seems intended to flow through and around the clinician, like all good theory and poignant experience, to be heard, felt, and responded to emotionally, not to be reified and carted back to the office on Monday morning for measured implementation.

Striking a refreshing balance between theory, research, and clinical life, Knoblauch underscores that human knowledge (epistemology) and experiencing (phenomenology) are inextricably intertwined and contextually- and intersubjectively-derived (as is therapeutic action); they coalesce not solely via readily identifiable “discrete-state” phenomena (such as biology, culture, nosological categories, appearance of specific affect, observable relational enactments, etc.) but largely through the interplay of moment-by-moment affective resonances and dissonances, or continuous, rapidly-transforming process contours (the “simultaneous construction” of emotional experience). Whereas a wide range of verbal and nonverbal modes of communication (auditory, visual, olfactory, etc.) facilitate the simultaneous and dyadic constitution of human experiencing, he privileges rhythm (Chapter 1), tone (Chapter 2), and turn-taking (Chapter 3) as the substance and medium of the resonance/dissonance process. And whereas he acknowledges the primacy of affect attunement (resonance) as researched and elaborated by Daniel Stern, Beatrice Beebe, and other important contributors, Knoblauch highlights equally the essential role of dissonance in human interactions and positive transformation. He writes: “We cannot experience harmonious attunement (matching) without a background of dissonance (mismatching) against which the attunement can be configured, and we cannot experience dissonance (mismatching) without a background of attunement (matching) against which the dissonance can be configured” (p. 142).

Taking a step further, he presents a clinical vignette (Chapter 8) in which it seems to be exactly his affectively dissonant, perturbing response to his patient that ultimately helped coalesce a more novel, vitalizing, and transformative trajectory for her and her relational development. He usefully references the rhetoric theory of Bahktin here vis-à-vis the contextualization of words and language, and this calls to my mind Derrida’s notion of traces, in that what seems absent (or in the “background”) is as much present and determinative of the observed phenomenon as the phenomenon itself. Overall, this offers another example of Knoblauch’s consistent adherence to a contextualist sensibility and what he terms the “resonant minding metaphor” (in contrast to the “hydraulic metaphor” à la Freud and the “plastic metaphor” à la object relations). As he clearly accentuates in his last chapter (Chapter 8, Coda), “[a]ffects are not in the person. An affective field is continuously constructed and shifting between persons who affect each other” (p. 158).

This book helps reconcile the endless point and counterpoint debates about therapeutic action as Knoblauch eases us into the dynamic, often unpredictable world of the musical edge in which what is useful one moment is otherwise the next. He states, “...meaning emerges not just from a particular and isolated interpretive insight, empathic act or authentic gesture, but rather from the interactive sequencing that constitutes the context influencing the potentially mutative impact of any interpretive gesture, however insightful, empathic, or authentic” (p. 136). Interpretations or interventions give rise to meaning and are mutative only when the mutual and reciprocal (often nonverbal) resonance (or dissonance) process, seamlessly unfolding on a moment-by-moment basis, allows for novelty, vitality, a transformed sense of oneself in the world. This is concordant with the sensibilities of the intersubjective/relational models that refuse the single element theory of therapeutic action-models, for example, that consider an interpretation a relational event, just as relational events are considered interpretations, or models, for another instance, that find the experience and process of communicating understanding to be inextricable from that which is being understood (Stolorow & Atwood, 1992; Mitchell, 1993; Aron, 1996).

For Knoblauch, a substantial component of therapeutic action involves, first, the clinician’s increased sensitivity to the harmonic and dissonant micro-patterning of experiencing and relating and to how this nonlinear patterning reflects and shapes the broader organizing themes in the lives of each participant. Second, it points to the clinician’s likelihood of violating the patient’s expectations of familiar micro and more explicit patterns via a novel accompaniment to the patient/soloist. This punctuates Knoblauch’s reference to the value of seeking “listening time” experiences (where action can be slowed down for reflection and where potential space can open for expanded possibilities for experiencing and meaning-making), as opposed to remaining always in the realm of “action time” (where emotions are “continuously evaporating, condensing, or absorbing into each” [p. 2] and are often not accessible for reflection and articulation). He encapsulates what the musical edge can do for clinicians in the following passage: “[It] focuses the clinician on the patterns and shifts in patterns of continuous process contours (volume, tone, tempo, rhythm, and turn-taking) that emerge in dyadic interaction and the particular subjective meanings that are both created and subjectively organized by analyst and analysand within these subtle, complex patterns” (p. 60). For Knoblauch, as for many intersubjectivity theorists, this is germane to the transformation of subjective experience.

One of the more profound implications of Knoblauch’s work doubtless lies in his attempts to capture, in musical language, the nuances and patterning of human experience and its extraordinarily contextualized nature. Another resides in reconceptualizing the subject matter of investigation: that is, whereas it may be that we are examining the patient’s subjective experience (along with our own), the data of investigation, more broadly, is now recast as dyad- or system-generated phenomena, the ownership and authorship of which is ultimately indeterminate. The postmodern, nonlinear systems (or complexity) sensibility (Thelen and Smith, 1994; Cilliers, 1998) continues to insinuate itself into our languages, our theories, our clinical perspectives. And this is excellent music. Elsewhere I commented (Coburn, in press), “We do not necessarily experience the world in the way it seems to work. To develop a broader understanding of psychological phenomena, we rely upon various conceptual distinctions-the most salient of which is recognizing the great conceptual divide between living, interpenetrating systems and an individual’s actual lived experience to which they give rise. Perhaps the ultimate irony of attempting to remain as experience-near as possible in our investigating and theorizing about psychological phenomena lies in the fact that we must understand our subject matter as fundamentally embedded in experience-distant, hypothetical constructs, such as complex systems, that, in and of themselves, cannot be said to have any experience at all” (p. 28). Knoblauch’s work on the musical edge, however, shortens this divide between lived subjective experience and the concepts we use to explain it, giving us a clearer, more experience-near glimpse into the music that determines and that sometimes transforms human life. And for that, a resounding “Bravo!”

Aron, L. (1996). A meeting of minds: mutuality in psychoanalysis. Hillsdale, NJ: The Analytic Press.
Cilliers, P. (1998). Complexity and postmodernism: understanding complex systems. New York: Routledge.
Coburn, W. (in press), A world of systems: the role of systemic patterns of experience in the therapeutic process. Psychoanalytic Inquiry.
Mitchell, S. (1993). Hope and dread in psychoanalysis, New York: Basic Books.
Stolorow, R. & Atwood, G. (1992). Contexts of being, Hillsdale, NJ: Analytic Press.
Thelen, E. & Smith, L. (1994). A dynamic systems approach to the development of cognition and action. Cambridge, MA: MIT Press.

William Coburn is a clinical psychologist at the Institute for Contemporary Psychoanalysis in Los Angeles.

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