Infant Research and Adult Treatment: Co-Constructing Interaction (Book Review)
Author: Beebe, Beatrice & Frank M. Lachmann
Publisher: Hillsdale, NJ: Analytic Press, 2002
Reviewed By: Sophie Lovinger, Summer 2002, pp.55-57
Psychoanalysis has done itself a serious disservice. At a time when other therapeutic modalities were doing research on the efficacy of their approaches to support their claims of therapeutic efficacy, psychoanalysis circled the wagons against the onslaught of managed care. As a result, cognitive-behavioral treatment has taken over where psychoanalysis once reigned. Truthfully, cognitive-behavioral treatment can be a good beginning for some very intractable symptomatology. Unfortunately, the results often are not long lasting and that is where psychoanalysis comes in, to pick up the pieces and provide alteration in the underpinnings of those intractable conditions. While cognitive-behavioral treatment modalities are beating the drum, pointing to their positive short-term research findings, psychoanalysis has hidden the body of research on psychoanalytic theory. Even the two compilations by Fischer and Greenberg (1996, 1979) and one by Kline (1972) are not well known.
We, in psychoanalysis, have the most comprehensive system to date pinpointing what we need to look at and explore in our attempts to understand others and help them deal with problems in living. In Infant Research and Adult Treatment by Beatrice Beebe and Frank Lachmann we see an attempt to use current infant research to extend and expand our ability to aid those people we once were unable to help.
Beginning with the first chapter, where they revisit Beebe’s nine-year treatment of a young man with severe pathology, the writers slowly coax the reader along the path they carefully develop, intertwining psychoanalytic treatment and the wealth of available infant research. As supervisor and supervisee, Lachmann and Beebe describe the changes in their theoretical conceptualizations, from a separation-individuation model to one of attachment-individuation. They state that, “… the child’s developmental process should be assessed by the degree to which patterns of affect regulation remain warm and mutual…This model of development emphasizes assertive relatedness rather than separation to achieve autonomy” (p16). According to the authors their use of self-regulation refers to, “the management of arousal, the maintenance of alertness, the ability to dampen arousal in the face of over stimulation, and the capacity to inhibit behavioral expression”(p.27-28). This capacity arises out of early interactive experiences between caretaker and infant, and with growth, may be organized into non-verbal representational systems. Thus, this self-other regulation interaction, since it begins so early in life, functions out of the awareness of the individual and has no attached words. Beebe and Lachman see psychoanalysis as the process by which these early, non-verbal, interaction structures have the potential to become symbolic and analyzable. However, before this mutual regulatory system (between caretaker and infant) becomes symbolic it is conceptualized as being part of a presymbolic rather than dynamic unconscious. It is in this presymbolic regulatory system that the authors work. As they become attuned to their patients, mismatch their attunement and repair the mismatch that their patients begin to feel heard and understood, preparing the way for change and growth.
One must question how these hypothesized early, non-verbal representational systems relate to self and other representations. Beebe and Lachman suggest that the infant, towards the end of the first year of life begin to establish representations that is the result of generalizations of interaction with significant others, rather than, as has been previously conceptualized, an image of the other. At a plenary session of Division 39’s meeting in New York some years ago, Stern, presenting some of his infant research indicated that the data he was collecting suggested that rather than splitting experiences into good and bad, the infants average their experiences. This infant capacity for averaging can lead to the generalization of interactions underlying and giving support to the authors’ ideas of an unconscious, non-dynamic representational system.
These two analysts moving from a one-person treatment conceptualization to a dyadic systems view studied infant research for a year. They came to the conclusion that, “infant research is fruitful because the basic processes of interaction at the nonverbal level remain so similar across the life span” (pp.22-23). That is, these interactions occur at a non-verbal level. In this two-person/two way system of interpersonal interaction/regulation they assert that the analyst and analysand are influencing one another by word and deed, especially at the nonverbal level. The influences each partner of the dyad have on one another leads to attunement and awareness of the selves involved in the interaction. This, in turn, results in each becoming known by oneself and is matched by the way one is known by the other. According to the authors, this knowledge can lead to an increase in the patient’s ability to “act as an agent in his own self-regulation” (p.32).
Supporting their understanding of the interactive process in psychoanalysis they use a plethora of research that indicates, “From the very beginning of life, inner experience is organized in the interactive context…The potential pathology of the system is seen in an increasing inability on the part of the infant to be aware of his state, to be guided by that awareness, and to use his initiative to change his state” (p39). The research material they present is compelling. In a short period of time we have come from an infant experiencing the world either from a “tabula rasa” or a “blooming buzzing confusion” (p.81, Meyers, 1998) position to one of the infant as a very competent organism who has a role in and impacts parental child-rearing styles. As many child analysts will tell you, it is important to understand how a child really functions throughout early development to understand the experiences of our adult patient without the distortions of memory. Here are two adult analysts suggesting that the early attunement of patient and parent colors the analytic interaction to such a degree that it is imperative for the adult analyst to match the interactive need of the patient. Lachmann presents his patient, Karen, a young woman with serious difficulties in self-regulation. He describes his interaction with her:
“I responded to her constriction by partially constricting myself. I allowed myself to be influenced by her rhythm. I narrowed my own expansiveness to match more closely the limits imposed be her own narrow affective range. I did look at her continually, but I kept my voice even and soft. In my initial comments I remained within the limits of the concrete details that she offered. I thus altered the regulation of my own arousal, keeping it low and limiting my customary expansiveness. She was effective in communicating her distress, and I was able to respond by providing her with a range of stimulation that more closely matched the limited level of arousal she could tolerate. However, as I restricted my own expressiveness, at times I became fidgety and squirmy. She seemed oblivious to my moments of discomfort (pp. 50-51).”
He asserts that this approach is used without any assumptions as to the unconscious, dynamic meaning of the adult experience. In a sense he is trying to reproduce an infant-caretaker-like interactive milieu in an attempt to repair severe damage. The description of a therapeutic interaction is reminiscent of a split-screen tape of a mother in interaction with her four-month infant. The more mother attempted to play with her little girl the more upset the infant became and the more she attempted to get away from the source of the stimulation. She apparently found this type of interaction unbearable. When mother presented an affectless face this little one began cooing and smiling in what seemed like an attempt to engage the mother. This baby’s attempts to integrate charmed the mother so that she had a hard time keeping her face flat. Thus the mother learned about interacting with this baby in their mutual struggle with self and other regulation, just as Lachmann tried with his patient, Karen.
This book brings a number of streams of infant research together and attempts to translate these new understandings into therapeutic intervention with our most serious disturbed adult patients. However, they have not addressed the use of this approach with less seriously disturbed patients. While the research findings are very interesting, and clearly presented, the authors become turgid, at times, as they try to explain how to use the material in their interactions with patients. It is almost as if they understand the material they present so well they forget to help the reader gain the insights they have developed through years of working with this new approach. Beebe and Lachmann use short examples from adult treatment but they are not always well enough explained for the more naïve reader to follow. More explanation from them as to how to implement their proposed system would give the reader a better idea of the kinds of interactions they are discussing. Their longer case studies do a better job of describing the interactions.
It seems apparent, from their patient descriptions, that the approach described, matching their response to the needs of the patient, at the non-verbal level, was an important way to make contact with people who do not seem to have developed adequate, internal representations of people and relational interactions. Do they propose that only patients with serious levels of pathology be treated in this manner? Can typical patients be helped in this manner? Does the therapeutic paradigm change over time as patients begin to resolve their serious pathology? These are issues not addressed in this book and maybe I am asking for a book they did not intend to write. All in all, this is a book that needs reading and serious attention paid to the implications of infant research and findings on how we do treatment.
Fischer, S. & Greenberg, R.P. (1996) Freud scientifically reappraised: Test the theories and therapy. New York: John Wiley & Sons
Fisher, S. & Greenberg, R.P. (1977) The scientific credibility of Freud’s theories and therapy. New York: Basic Books
Kline, P. (1972) Fact and fantasy in Freudian theory. London: Methuen
Meyers, D. (1998) Psychology, 5th Edition. New York: Worth Publishers
Sophie Lovinger is retired from University teaching, but continues to work in a small private practice devoted to children. She is also in the process of writing a book on the issues of learning disabilities in development and treatment.
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