The Present Moment in Psychotherapy and Everyday Life (Book Review)

Author:  Stern, Daniel N.
Publisher:  W.W. Norton
Reviewed By:  Karen Zelan, Vol. XXVII, No. 3, p. 70

, by . New York: , 2004; 300 pp., $29.95.
, PhD

Daniel Stern defines the “present moment” as a lived story and, like most stories, it has not just a beginning and an end, but also a plot containing intentional characters, together with a “temporal contour along which the experience forms during its unfolding” (p. 219). The present moment is lived through as it is happening and thus is not distanced by language or abstract explanation from those experiencing it. Stern’s theory of the present moment is both an intriguing addition and a challenge to psychoanalytic theory and practice.

Stern draws upon his earlier work, The Interpersonal World of the Infant (1985), as he relates how the mother and child dyad, or the therapist and the patient, move along a trajectory linking new ways of being-with-the-other as the relationship develops. Stern’s descriptions of infant-parent studies illustrate the many aspects of the present moment in life-as-lived, which he generalizes to psychotherapy.

To round out his theory, Stern elaborates two dynamic concepts, the “now moment” and the “moment of meeting.” The now moment consists of an emerging interpersonal process that is unpredictable—hence “sloppy.” Created conjointly, these momentary interactions, sloppy as they are, illuminate two important dyads—the parent and child, the therapist and patient. They set up an interpersonal crisis that begs for resolution.

Happily, the now moment is often followed by the moment of meeting. When this occurs, the dynamic between self and other dramatically alters a family relationship or an emerging relationship in the therapeutic hour. The partners to these relationships are experiencing the unfolding of a piece of reality. Since they share the now moment to an important extent, they “read in the behavior of the other a reflection of their own experience” (p. 220-221). The experiential sharing, in turn, assures that the co-created ambience becomes intersubjectively conscious.

Not incidentally, Stern’s theory unites two aspects of psychological theory into a parsimonious integration of theory-of-mind events with attachment behavior. The shared narration of the child’s or patient’s life sensitizes the parent-child and the therapist-patient dyad to the other’s mind, and provides the glue to the intersubjectivity so important to the therapeutic exchange and to healthy recovery. When events become intersubjectively conscious, writes Stern, “…this opens the door for the experience to be verbalized and narrated and to become a landmark reference point in the narrative history of the treatment.” Stern thus echoes Donald Spence’s earlier work, Narrative Truth and Historical Truth (1982).

A thirteen-year-old boy with whom I once worked seized upon a “now moment” in psychotherapy to advance his adolescent agenda. He came to his last session with a huge bouquet of flowers and shyly held them out to me upon his arrival. He must have known I would appreciate flowers since he had, for some two years, walked by my flower garden as he approached the office. This one act—the giving of flowers during his last appointment—was at once playful and linguistic. He had written a brief, appreciative note of our work together to accompany his gift. He was still distrustful of verbal communication, so he depended more on actions than on talk to determine what others were all about, and what he, himself, was all about.

I didn’t offer even an “experience-near” (Pine, 1985) interpretation of his gift, such as, “You know I like flowers because of my garden which you must have noticed for many months.” This would have minimized an appropriate social act in the present moment. The gift of flowers is an accepted social gesture indicating affection for the other person and gratitude for the relationship.

Unpacking the meaning inherent in the boy’s gift would have added an unnecessary layer to a spontaneous interaction between the boy and me as he left psychotherapy. Nonetheless, the present moment took center stage as a sub rosa segment of the therapeutic moment. Such present moments, according to Stern, have not been given their proper due, compared to that given to elaborate interpretations uniting past and present. Stern’s attention to the present moment is a theoretically important contribution, with far-ranging implications for therapeutic technique.

Pine, F. Drive, ego, object, and self: A synthesis for clinical work. New York: Basic, 1990.
Spence, D. Narrative truth and historical truth: Meaning and interpretation in psychoanalysis. New York: Norton, 1982.
Stern, D. The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. New York: Basic, 1985.
Stern, D. The present moment in psychotherapy and everyday life. Norton, 2004.

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