Attachment Focused Family Therapy by Hughes Introduction (3)*** The therapist’s frequent goal

Attachment Focused Family Therapy by Hughes

Introduction (3)***

The therapist’s frequent goal is to identify and bring into expression the subjective and intersubjective experiences- which are often confusing, frightening, shameful, and nameless- in the day-to-day life of the members of the family.

The meaningful affective states are not generated from within the mind of the therapist, but rather are cocreated and coregulated by all present.

Therapists are wise to take advantage of the intersubjective process that truly is the foundation of our humanity.

When the nonverbal and verbal are not congruent, this disparity (difference) is addressed and understood.

Affect has a role in understanding and giving expression to the meaning of an experience and its current memory. The simple expression of an isolated affect- such as screaming or hitting a pillow as techniques to make one more comfortable with anger- is of little lasting value.

Affective-reflective dialogue is a technique where therapists help the patient integrate the affective (emotional) meaning of an event with the cognitive understanding of the event. Integration of the affective-reflective is important, because when dialogue is reflective only, it tends to be intellectualization (excessive reasoning to not feel emotions) and when dialogue is affective only, it is catharsis (releasing from emotions) which is not a therapeutic goal.

Attachment focused family therapy involves the process of facilitating the abilities of parents and child to engage in an affective/reflective (a/r) dialogue with the therapist and each other. Within such reciprocal state of affective communication, the focus of attention, whatever it may be, is more able to be assessed and assume a part in the narratives of the family members, becoming an aspect of their coherent autobiographies. As the child and parent increase their abilities to engage in this process, past events associated with anxiety and shame are now more able to fully enter the narrative as particular experiences among many varied affective/cognitive experiences.

The child needs to experience the parent as being affected by the event or it will have less meaning to the child. If such a failure in making the child’s experience intersubjective with the parent happens often enough, the meaning the child will give herself will be similarly restricted. She will become a child who does not carry much meaning for her parent. Therapy becomes much more likely transformative when the client knows affectively that he or she has meaning in the therapist’s life.

For parents to feel safe and then be able to ensure safety for their children, the therapist meets alone with the parents for several sessions before involving the children in the treatment. The therapist goal is to develop an alliance with the parents through experiencing empathy and understanding for them, understanding their parenting and attachment histories, discovering their strengths and vulnerabilities, and presenting to them this model of treatment and parenting.

The here-and-now nonverbal communications serves as the foundation of the coregulation of affect and co creation of meanings that are at the core of the treatment. The verbal aspect of the dialogue always rests upon and is congruent with nonverbal expression of the vitality (being strong, active and enera9 gized) affect.

Therapist does not place herself in a “professional chair” that lies outside of the family, but rather sits within the family’s intersubjective matrix.

The therapist frequently “speaks for” and “speaks about” the children and at times the parents- in guiding the dialogue into the underlying themes that are creating dysregulating affective states and hindering the development of coherent narratives.

Speaking for the child in the first person often deepens the meaning of the words with the child’s experience and enables him or her to both understand and express the experience more fully in the future.

When we provide both parent and child with the skills to engage in such a/r dialogues, attachment security is facilitated.

In most recent years this model has been successfully employed where one or both biological parents is parenting the child. With these families the interventions are directed both toward the past attachment behaviors and intersubjective patterns that existed within the family, as well as the contemporary patterns. Seeds of a secure attachment, embedded in the original relationship can be elicited and utilized in developing new patterns. Seeds of secure attachment, embedded in the original relationship can be elicited and utilized in developing new patterns. At the same time, activated maladaptive attachment patterns from the past need to be actively modified so that they do not impede the emergence of new patterns.

Initial stage of treatment involves the parents without their children. The purpose of this treatment component is to ensure that the parents can provide attachment security for their children by first experiencing safety themselves with the therapist.

Chapter 1: Attachment & Intersubjectivity (12) ***

In speaking of attachment security, I will be referring to the pattern of behaviors manifested by the child and parent. These are the behaviors by which the child attains physical and psychological safety through proximity with a parent who is available, sensitive, and responsive to the child’s various self-expressions. While also repairing any relationship breaks that might threaten the self-sense of safety. Within attachment security the parent serves as a secure base, which provides the child with the safety needed to begin to explore and interact with the world. Within attachment security the parent serves as a “safe haven” to whom the child can return when the novel and strange features of the world create fear.

In speaking of intersubjectivity I am referring to those moments when the parent and child are in synch: when they are affectively and cognitively present to each other, when the vitality of their affective states are matched, their cognitive focus is on the same event or object, and their intentions are congruent.

Without intersubjectivity, attachment security would be limited in their developmental range and power to influence what we know and who we become.

5 central developmental processes:

Safety and exploration

The sequence of breaks and repairs within attachment relationships

The coregulation of affect

The cocreation of meaning

Development of a coherent self

Safety and Exploration

Infant’s safety is enhanced as they improve their communication skills and have specific adults who got to know their unique expressions (be sensitive) so that the adult can respond more efficiently.

The better infants are at communicating with those who care for them, the safer they will feel.

Physical proximity with a sensitive and responsive parent becomes a building block for the attachment behaviors that become strong in the second half of the first year. Successful, repeated, intersubjective experiences between infant and parent are additional building blocks to further strengthen attachment security. Both, together, facilitate the young child’s optimal development.

Another view of describing this crucial development path is to focus on the interwoven (link) nature of safety and exploration behaviors. When infants feel safe (a secure base), they become very interested in exploring their world. When, during exploration, they do not feel safe for whatever reason, the exploration needs are set aside, and their attachment needs (a haven) are activated again. What is fascinating during the first several months of life, is that both infants’ safety seeking and many of their exploration behaviors are directed toward their caregivers. When they begin to explore the world, they are the most interested in exploring their parents. They want to become engaged with them intersubjectively and so learn about self and other (primary intersubjectively). They learn about the world (secondary intersubjectively) through reciprocal affect, attention, and intentions-the intersubjective triad-being directed toward an object or event in the world. When their attachment behaviors are active, infant want their parents to protect and comfort them (often through coregulating their affective states). When their exploration behaviors are active, they want their parents to engage in joint discovery and meaning making. The two pathways both alternate and are interwoven.

“Cross-modality’ matching (the ability to recognize objects presented in two different modalities) is very important for the development of the range and depth of the communication that is occurring between infant and parent and hence for the skill by which the parent can keep her infant safe. By using another modality, the parent is demonstrating that she is responding to the child’s communication about his inner affective state. In doing, she is helping her infant become aware of having an inner affective state. The infant’s inner state can be expressed through various nonverbal modalities. The specific nonverbal modality is not what is important in the interaction. The parent’s act of responding to the nonverbal communication is not as important as the act of communicating that the child’s nonverbal expression is connected to the child’s inner affective state. The parent is making clear the particular state that she has notices and is responding to. The parent is communicating empathy and understanding for her child’s inner state, not simply for his or her nonverbal behavioral expressions.

The infant’s inner state exists within the parent’s inner state.

Through intersubjective experience we become more able to identify, regulate, and express our affective life. Through such experiences, we can develop empathy for others and to successfully engage in shared, reciprocal, social experiences. Through intersubjectivity we can understand the thoughts, wishes, and intension of others just as we become able to identify and express our own. The inner lives of others become a central part of our own inner life. We can share our inner worlds, thus making our subjective worlds much more vital and interesting as well as making it possible for us to relate effectively within and about these worlds.

From 7 to 9 months of age, the infant’s “sharable mental states start to include goal-directed intentions, focus of attention, affects and hedonic evaluations, and, as before, the experience of action”. Three domains that are developing:

Participation in the other’s feelings

Ability to share the focus of attention

Ability to read the intentions of the other

Continuity in relationships: commitment, breaks, and repair

The continuity of relationship is crucial if it is to function as a source of safety and at the same time facilitate the emergence of intersubjective states that facilitate the development of a coherent (reasoned) self. Within attachment security, trust in such continuity becomes strong. Separations are temporary. Physical separations always lead to reunion. Psychological separations always lead to repair.

It is the characteristic of attachment security that parent’s commitment for their child is unconditional. Parents communicate eb words and deed that when their child needs them, they will be there. Nothing will take priority over the well-being of their child. The parents will remove any threat to their child, if they cannot remove the threat, they will face it with their child. Their child will not face it alone.

There are sometimes when the parent is preoccupied with other worries and responsibilities and is not ready as often for intersubjective engagement with her child. The young child’s affective state is mildly dysregulated, and the parent is not ready to coregulate that state- or the parent may also be in a dysregulated state. At these times the parent’s presence may make an anxious child more anxious rather than serve as the source of soothing.

Such breaks in the intersubjective dance represent a temporary crisis in the relationship that must be seen, accepted, and repaired. When they are repaired, they represent an opportunity-the other side of the crisis-to expand both the relationship as well as the subjective realities that can be explored within the dyed. The relationship is expanding in that it becomes one in which brief separations, mis attunements, differing intentions, or discipline can be present and not destroy the relationship. When such dimensions are added to the relationship, it may well become stronger, rather than more fragile. The child becomes aware that these breaks will always be repaired. Any distress inherent in these breaks will be regulated and transient. Breaks that are neither too long nor too frequent, and that are consistently repaired, enables the child’s sense of safety too deepen. he need not fear breaks because they are never a threat to attachment security.

Interactive repair is also valuable in facilitating attachment security and intersubjective skills when it focuses on the child negative affect that is associated with the breaks. Repairs communicate the child’s anger or anxiety associated with discipline or other breaks will be understood and accepted and the affect will be coregulated by the parent. The parent is communicating the child’s negative affect toward the parent herself need not be denied. The child’s anger at the parent is not a threat to the attachment security. The child’s anger at the parent can itself enter the intersubjective focus of the relationship. It does not have to be excluded and hence, it is much more able to become integrated into the child’s developing narrative.

Coregulation of Affect

As the infant notices the parent’s response, she notices the infant noticing her, and she affectively responds to his or her interest in her which guides the child’s affective state that is associated with noticing her. This same process occurs as the infant notices and they jointly respond to objects in their immediate environment, whether they are a colorful toy, a dog, music, or a button. Their affective experience is reciprocal.

Attunement involves the intersubjective sharing of affect. Attunement permeates the intersubjective experience so that infant’s attention as well as their intentional actions within the intersubjective experience will be greatly influenced by their associated affects. The matched affective states of the parent and child enable parents to hold infant’s attention, extending their attention span while they focus on the parent or while the two together focus on a separate object or event. As infant’s nonverbally expressed wishes are noticed, given meaning, and responded to by the parent, they develop an interest in their own inner life, as well as acquiring the communication skills needed to understand the other and be understood by her.

Coregulation of affect, occurring naturally in intersubjective experiences, refers both to helping children to increase minimal affective states and to decrease maximal affective states. This process occurs for both positive and negative affective experiences, making both more understandable, more able to be contained, and more validated and shared. Someone referred secure attachment as being the effective dyadic regulation of emotion in infancy.

When the parent maintains attunement during positive experiences children are enabled to experience reciprocal joy and delight, and their capacity for enjoyment and excitement becomes enhanced. Children can elicit delight in their parent’s eyes- they can cause their parents to experience happiness. The child’s parents are discovering and responding to a positive quality that involves who the child is, and over time the child discovers that he or she can have a similar, positive impact on others as well. Without the parent matching this positive affective state with her own more animated and playful state, the child’s state would be in danger of moving from excitement to agitation and anxiety.

When the parent maintains attunement during negative affective experiences, she prevents her child from entering a state of affective, behavioral, and cognitive dysregulation. When the distress is cause by a separation from the parent, it is resolves by the support and comfort provided by the parent when they reunite. When the distress is caused by the parent limiting or being nonresponsive to the infant’s behaviors, resolution again comes when the parent nonverbally reassures the infant or toddler that, even if a particular behavior is not permitted, he or she is accepted and special to her, and can elicit empathy in her eyes. Thus, the child can elicit empathy in her eyes. Thus, the child experiences the parent as resonating with his or her affect and finds that the affect is being contained. The child’s affect is becoming associated with new meaning that conveys a new sense of self and other- a common meaning is being established. It is fundamentally an intersubjective experience for both parent and child. Attunement enables the child to begin to access, identify, and make conceptual the ongoing affective states that comprise his or her developing sense of self, including expanding symbolic abilities.

Cocreation of Meaning

Within the safety created by attachment security and the development of intersubjective skills, within the continuity of the attachment relationship which incorporates separation and reunion, breaks and repair, and within the dyed that coregulates the emerging affective experiences, infant and parent are actively cocreating the meaning of their worlds. The infant is actively discovering who he or she is, who the parents are, and the nature of the events and objects he or she encounters by the child. The parents are actively discovering their infant as well as themselves as parents.

The term primary intersubjectively refers to interactional process in which children’s view of self emerges from their experience of what their parents are recognizing and responding to. When parents fully respond to an aspect of a child’s expressions with acceptance, joined attention, matched affect, and curiosity, it becomes part of the child’s subjective experience that then becomes integrated into his or her early sense of self. The meaning that the parents find and respond to within the child’s nonverbal expressions becomes the core meaning that he or she gives to those expressions.

Infants in states of primary intersubjectively with their parents are experiencing a sense of self-efficacy that is empowering. They can elicit joyful, enthusiastic, and captivating responses from their parents. They can make the parents deeply engaged with them in discovering who infants are, what they like, and what they can do.

During the breaks in the relationship the parent, it is hoped, will be able to experience the break with much less anxiety than does her child. The parent is likely to be more able to see the break as being temporary and having no relevance to the security of the relationship. However, these breaks will be more challenging for the parent if they represent for her features of her own attachment relationships with her parents that were unresolved. In that case the breaks may be experienced as a threat to the relationship and a threat to her experience of herself-as-parent. In this way attachment patterns are passed from generation to generation.

The meaning of these breaks is intense, frequent, and often unresolved. In those situations, both parent and child are likely to experience shame in association with the perceived threats to the relationship. It is in such situations that parents seek family treatment. Thus, the clinician need not be surprised at the quality of defensiveness and resentfulness that both parent and child manifest when they arrive for the first appointment.

During intersubjective states the infant is being experienced, not evaluated, as being worthwhile and loveable. The parents are not sitting back and forming a judgement about their infant’s worth. Within the intersubjective state they are discovering his or her worth, delightfulness, resilience, and unique, meaningful qualities.

Infants who have parents experience and discover their innately positive qualities are profoundly different from infants whose parents evaluate them as being loveable. In describing how infants discover themselves in their parent’s eyes, we often fail to focus on this act of discovery and instead focus on how important it is for infants that they see these positive qualities in their parent’s expressive eyes. The crucial question is how the infant’s characteristics found their way into the parent’s eyes. Most parents have no choice in the matter when they are intersubjectively present with their infant. They perceive their infant as they experience their infant as he is giving expression to his inner life. They are not evaluating the infant and giving him, or her qualities based on their judgment and their needs. The qualities emerge from the child, rather than being imposed on him or her. This is not to say that parents do not “step back” and reflect on their infant and “evaluate” him from a more distant perspective. Rather, it is to emphasize that even such reflections are necessary to the primary knowledge of their infant which is experimental. Also, their infant’s primary experience of self emerges intersubjectively, rather than from his parent’s more reflective, secondary knowledge of him, unless that knowledge affects their intersubjective experience.

Since infant’s emerging sense of self is being discovered by their parents, they are free to give expression to who “they” are, continuously discovering qualities of “themselves” being reflected by the significant people in their lives as well as by the effects of their initiatives on objects. Infant’s sense of self is not endangered by other’s evaluations- others do not define their worth. They are inherently worthwhile and when others are not able to “see” those positive qualities in them, there is a deficiency in other’s vision, rather than in the infants.

During the second half of the first-year infants are increasingly interested in learning about the world. This knowledge too comes primarily from their experience with their parents and has been referred to as secondary intersubjectivity

The cocreation of meaning does not stop when the child leaves infancy. Rather, the cocreation of meaning proceeds throughout the lifespan and becomes more complex and diverse. With words, child and parents can identify and express nuances of subjective experiences that were not accessible intersubjectively prior to the child’s ability to use words. The focus of their intersubjective present can now extend much more easily into the past and future. As the parents use words to describe their own subjective experiences, the child becomes able to understand their state of mind more fully and accurately. Sharing inner states is often a never-ending interest of preschool children and their parents. With the success of each stage of developmental mastery the child can more fully approach these new mastered events in a more intersubjective manner. Also, as children mature, they are exposed to an increasing number of people with whom they are very motivated to become engaged in meaning-making activities. As their sphere of safety extends outside the family, so too does their desire to be influenced by, and influence, others within intersubjective experiences extending into the community.

Family who seeks treatment frequently have difficulty accepting differences in meaning-making experiences. Differences in judgements, perceptions, feelings, and thoughts are often seen as inappropriate or wrong. Rather than accepting differences in each other experiences, these differences are seen as being a threat to the relationship. Rather than simply evaluating behaviors, the self of the other in the dyad is often evaluated. Differences are experiences as a threat to the worth of the self or a sign of disrespect. At other times the meaning given to the motives of the other in the dyad is predominately negative. Efforts to clarify and understand their inner life of the other become secondary to judgements that are made in response to the behaviors of the other. Intersubjective experiences become infrequent, and the individuals become more isolated, unsafe, and non-communicative.

The development of a coherent sense of self

The integrated self is defined here as the comprehensive, coherent, continuous, and comprehensive organization of subjective experiences. With this definition, self is not a rigid entity, but rather an open, flexible, actively integrating, and unique character of experiences through engagements with others as well as the objects and events of the world. Attachment security and intersubjective states are stem cells of subjective experiences that became organized into a coherent self of sense. The parent’s subjective experiences of their child’s nonverbal expressions of his or her inner states, cocreates the meanings of these expressions. This act of co creation is not a one-time process. The meaning of events and objects is continuously being cocreated, created alone, and recreated again intersubjectively or alone. As self and other are increasingly differentiated withing the parent-child dyad, on his own, the child is increasingly able to create circumstances of safety, repair breaks, regulate affect, and create meaning. However, it is important to stress that child-and adult- is not fully alone. The presence of “virtual others” remains a part of one’s experiences throughout the course of a lifetime.

In a fundamental way, attachment security and a coherent self are two sides of the same coin. Leading researchers describe the securely (or “autonomous”) attached adult as having a coherent autobiographical narrative. Within attachment security, the child or adult can remain open to whatever event or object that she or he encounters, regulate or coregulate the affect associated with it, create or cocreate meaning from it, and integrate it into her or his autobiographical narrative. Events and objects become subjective experiences that become organized within the differentiation and integration of the developing self. They do not have to be denied or distorted. They do not threaten the send of self with fragmentation or dissociation, as a result, the “self” is able to remain continuous, comprehensive, and organized in a coherent manner.

When parents can recognize the psychological truth and place value on the uniqueness of their child’s experience, they provide intersubjective experiences that demonstrate acceptance and curiosity about the meaning-making activities of their child. These parents do not discourage their toddler from having a subjective experience that differs from their experience. They make it clear in their intersubjective presence that there are a wide range of feelings, desires, attitudes, and intentions about many objects and events that are equally acceptable. By doing so, they are encouraging the development of a subjective self that is curious, open to new experiences, comfortable with differences, and ready to create and cocreate meaning from the vents and objects that pass before one. (There are certainly some necessarily behavioral limitations that parents must apply to specific objects and events. While limiting the behavior, the parents are still well advised to grant their child the freedom to develop his or her own unique meaning regarding that same object or event.)

Chapter 2: Family Treatments: An Overview (9)*

Communication involves affecting and being affected by someone else. The transaction involves the transmission of feelings, thoughts, or whatever between two minds. Therefore sharing-and, if my argument is correct, sharing implicates feelings-is at the root of all communication and all intentions to communicate.

The basic therapeutic stance involves acceptance and curiosity, empathy, and playfulness. This stance applies to the client’s initiatives and responses, to his resistance and to his deep engagement. The therapist’s intersubjective presence is always available as the therapist follows and leads and follows, exploring confidence and fear, doubt and certainty, pride, and shame. Again, and again the therapist is coregulating emerging affect, developing with those present more coherent representations for these poorly integrated affective states and establishing a common meaning now accessible to those present. Again, and again the therapist is repairing the relationship as needed so that intersubjective process can continue to flow and produce its therapeutic effects. The therapist’s active engagement in the intersubjective process guides the members of the family into the same process with her and with each other. She strives to remain intersubjectively present with all members of the family, together or separately, while focused in themes that have prevented the family members from being intersubjectively present with one another at home.

Attachment

The therapist’s first task is to facilitate a sense of safety among all members of the family. To be more specific, she first establishes safety with the parents, and then she and the parents jointly provide safety for the children.

The family therapist facilitates this sense of safety in the following way:

She maintains an attitude of relaxed engagement that includes the qualities of playfulness, acceptance, curiosity, and empathy (PACE). Safety is immediately enhanced when the family members experience this nonjudgmental foundation along with a very clear commitment to understand each person’s narrative and to coregulate any emerging stressful affective states while assisting in recognizing the experiences associated with these states so that they become less stressful.

She reduces ambiguity (inexactness) about her intersubjective experience of all members of the family by openly communicating her empathy and interest nonverbally with her facial expression, voice tone, gestures, posture, touch, and timing of response. She is making clear the impact that the family members are having on her. This impact is overwhelmingly positive. If a family member is having a negative impact on her, then her intention will be to get to know that person at a deeper level that will elicit a positive response from her. By communicating clearly where each person stands” with her, the therapist is reducing the ambiguity that often generates anxiety.

She matches the vitality of the affective expressions of the members of the family, creating for each a sense of being deeply understood.

Her intention is to understand the respective experiences of every member of the family. A related intention is to communicate that there is no “right” or “wrong” experience. All experiences are valid, all will be heard. A third intention is to assist the family in creating a safer place for the expression of all experiences so that differences between experiences may be understood, resolves, or integrated into their joint narratives.

She demonstrates clearly that she respects the basic values and traditions of the family that reflect its cultural, national, religious, racial, and generational heritage. If he perceives difficulties within or between family members, she will openly ask how these difficulties might be addressed within the framework of their heritage.

She provides basic information about attachment and intersubjectivity theory, child development, and family process so that this information will help members of the family to understand the reasons for her interventions and recommendations, as well as help them to anticipate “what is coming next.”

She develops a sense of safety for the parents first, so that together they can provide safety for the children. She addresses openly the shame and doubt that they are likely to feel upon seeking family treatment and opens a space where she- and they- can experience their strength as parents, including their motivation to provide the needs of their children.

Throughout the family sessions the parents need to remain the attachment figures for their children. In the area of attachment, the relationship between parent and child remains one directional. The child turns to the parent for safety, not vice versa. While the intersubjective process is reciprocal, the parent’s intention must include a commitment to ensure the safety of their child, whereas a similar commitment is not expected from the child. (When a child is frequently worried about the wellbeing of the parents, the therapist is likely to address this worry.)

This reality-that attachment behaviors associated with safety are one directional- is addressed with the parents alone at the onset of the treatment. It is presented as being a central feature of the parental role that includes providing both physical and psychological safety for their children.

Once individuals feel safe, the reciprocal nature of intersubjectively becomes more active and evident.

The following factors represent how safety issues can be addressed throughput the course of treatment:

Children’s functioning often reflects a lack of a felt sense of safety. Examples of this will be presented to parents prior to the onset of treatment. The attitude of PACE will. Be actively facilitate the child’s and parent’s sense of safety during the sessions. The family will learn through the intersubjective experiences of the treatment session how to maintain this sense of safety while addressing conflicts and various states of shame.

Parents do not feel safe when interactions with their child active unresolves issues from their own attachment history, the nature of this process will be presented to the parents and their attachment history will be explored. When aspects from their history become activated in their present family relationship, they will be addressed.

Certain child-rearing principles, influenced by attachment theory, facilitate a child’s sense of safety. These principles will be shared with the parents first and then with the entire family.

The affective state of shame greatly undermines one’s sense of safety. Information regarding shame and guilt will be presented to family members, and when shame is evident in the session it identified and responded to within the framework of PACE.

Breaks and repairs are a crucial sequence that will occur frequently throughout successful treatment sessions. Family who seeks treatment will often experience considerable difficulty integrating conflicts, misattunements, discipline, and differences into the continuity of their relationships. Family therapy itself will at least in part, be focusing on this relationship breaks and in so doing is likely to activate a here-and-now break within some of the relationships. The therapist needs to identify these breaks and initiate interactive repair whenever they occur. She will be facilitating the family’s ability to repair similar breaks when they occur at home.

If the therapist is not able to consistently feel safe herself during the session, due to either treatment failures that elicit shame or else to be activated, unresolved, issues in her own attachment history, she will address this through reflection, supervision, psychotherapy for herself.

Intersubjectivity

The intention of psychotherapy-whether individual or family- is to create experiences in the present that will influence experiences from the past and generate hope for more healing and integrative experiences for the future. Within intersubjectivity, the therapist-from a position of safety-strives to join her experience of each person with the person’s experience of self. In so doing she is influencing the self-experience and being influenced by the other, and cocreating a new experience of self (primary intersubjectivity). The client’s new experience of self includes features such as courage, honestly, resilience, openness, delight, compassion, persistence, competence, and a motive toward health that were discovered by the therapist through the impact that the person was having on her. Discovered by the therapist, these features can now be seen and experienced by the client. Within family treatment, when the therapist discovers these features in one member of the family, the other members are also likely to experience those same features within their child, parent, or sibling.

As this state of primary intersubjectivity deepens, and with it the experiences of safety and openness to discovery, the therapist invites the attention of the client to go toward the events of the past. (Secondary intersubjectivity). She experiences these past events- in the present- with the client conveying his experience of those same events. She is now with him, in the past, experiencing those events with him. She is ow able to coregulate any affect associated with those events. Being together reexperiencing the past events, the events are certain to contain less fear and less shame. The events now hold another perspective, new meanings can be cocreated, and the client is now able to acquire an emerging sense of mastery of the event.

Three qualities of intersubjective experience- matched affect- joint attention, and congruent intentions-which exist within each treatment session, with the therapist. Being an active participant in the dyad or triad.

Attunement

First, matched vitality affect-or-attunement-among those present is necessary to facilitate an intersubjective matrix within the family session. It becomes possible to develop new meaning of the event because the intersubjective experience that is being attended to involves two or more matched states of affective vitality. This provides the child or parent within the ability to coregulate the emerging present vitality affect associated with the categorical affect of the past event.

Ambiguity does not facilitate the joint process of coregulation of affect and cocreation of meaning.

Attending to the same event/object

It is important to stress that in therapy the primary focus of attention is not on the event itself, but rather, the client’s experience of the event. In this way their respective experiences are being reorganized, new meanings of the event can be cocreated by all, and the event as experienced by each is now able to be welcomes into each member’s narrative.

Congruent intentions

The third quality of intersubjectivity

At some level of awareness, the therapist and family need to jointly communicate that their intentions are congruent. (Read page 49)

The intention of the therapist is crucial in determining whether the family will enter the intersubjective experience with her.

Personal and family development (a more accurate term than change) occurs because the intersubjective experiences of reciprocal enjoyment, acceptance, curiosity, and empathy inherently facilitate such developments within the human being.

The immediate intention is simply to coregulate the present affective states and to cocreate meaning of the events being explored.

Intersubjective a/r dialogue is not “just talking”. This is not “the talking cure” but rather the “communicating cure”.

Coregulation of affect

By tracking the nonverbal, the therapist is insuring that the dialogue will not drift outside the intersubjective matrix. She is also insuring that the client’s affective state will remain regulated while they jointly explore any stressful themes. Indeed, the essential role of intersubjectivity in regulating affect cannot be overstated.

The essential biological purpose of intersubjective communications in all human interactions, including those embedded in the psychobiological core of the therapeutic alliance, is the regulation of right-brain/mind/body states.

The therapists’ first intention in tracking the nonverbal experiences of all present is to be able to coregulate whatever affective states are emerging within the dialogues. If anyone in the session becomes affectively dysregulated, none of those present is likely to feel safe enough to proceed with the intersubjective exploration that represents the broader therapeutic goal.

All affective states have a nonverbal, bodily expression which, when matched by a similar nonverbal expression by the therapist, will make them more likely to be regulated by those involved in the dialogue. When the family member gives expression to a categorical affect such as anger, fear, sadness, or shame, the intensity of these affects may rapidly lead the person toward rage, terror, despair, or pervasive shame if she is left to manage the affective state alone. She is much less likely to feel alone in that state if the therapist can match the nonverbal, vitality of the expression of the affect.

Read page 52 & 53

The therapist resonates with the overall bodily expressions of the family members as frightening or shameful stories emerge. She may then address these bodily expressions within the safety of their relationship, so that the parent or child may begin to achieve some integration of the theme which had lay hidden within this aspect of the body. I believe that when such bodily, affective, expressions emerge within attachment security and intersubjectivity, these core expressions of nonverbal (and possibly verbal) communication allow for true resolution and integration to occur.

If the therapist restricts her expression to a ‘professional” and detached tone, the person will feel less safe, more alone within the affect, and more likely to become dysregulated.

The cocreation of new meanings through primary and secondary intersubjectively

The child discovers who she is and how she exists in the mind and heart of her parents through the ways that she is having an impact on them. In turn, her parents discover themselves as parents through the impact that they are having on their child. Many qualities that emerge and are experienced together, intersubjectively, would often not be experienced alone. These include pride, vitality, hope, gratitude, joy, empathy, contentment, confidence, and affection. When their child experiences her parents expressing these affective states in her presence, she becomes aware that they are responding to qualities within her. They are not pretending, nor are they engaged in the ‘job” of being a parent. They experience deep positive states when with her, because of who she is, just as she experiences similar states with them because of who they are.

Read page 54

More often, the child’s experience of his parents and self reflects his efforts to understand the meaning of their ongoing conflicts and joint unhappiness. It may also reflect his efforts to reduce the shame experienced within the self by blaming his parents.

In family treatment, the therapist’s task is to continually search under the presenting symptoms of the child, the parent, or their way of relating, and find new meaning for these symptoms. The therapist needs to create a sufficient degree of safety among all present so that they can enter an intersubjective presence that coregulates the affect and cocreates meaning. While still being focused on the nature of the breaks and the lack of repairs. The meaning that the family has given to the symptoms most likely is permeated with shame and associated anger, fear, and discouragement. The therapists need to provide a context that will generate nee meanings. The therapist will work to uncover deeper affective states, motives, and qualities in their relationship which lie under the shame. These qualities have long since been forgotten but reflect their reciprocal desire for love, support, safety, affirmation, mutual joy, sharing, and their fear of loss, rejection, and abandonment. When the therapist is unable to uncover and facilitate communication about these meanings, transforming family development can occur. There is now hope that the dreams that were present when the parents and infant first gazed into each other’s eyes may be realized.

The affective process of cocreating meaning that I am recommending would require that the therapist constantly fine tune her contribution to this process, just as the parent repeatedly repairs the intersubjective stance with her baby. The therapist continually observes the verbal and nonverbal of the family to her meaning-making expressions, and then either modify her expressions when they are not congruent with the family’s response or else addresses the incongruent response. The therapist frequently asks a family member for his or her response to the therapists’ expression, to assess to what extent the family member was perceiving qualities in the therapist that were not intended. The therapist clarifies the implications about her and about the relationship, and then offers empathy for the client if these implications elicit fear or shame or other stressful emotions.

The therapist’s empathy is coregulating the emerging affect. It enables the child and parent to stay in the experience much longer than if he or she were experiencing the associated affect alone or within a critical atmosphere.

Please read page 57

Chapter 3: Developing playfulness, acceptance, curiosity, and empathy (PACE): The central therapeutic stance (12)

Empathy requires that we vicariously experience the trauma that our patients have survived.

PLAYFULNESS

If the therapist can integrate playful attitude into the treatment session it will often provide a way to realize that the stressful experiences are only one aspect of the ongoing relationship.

The following represent various dimensions of the value of playfulness in the treatment session:

A playful stance shifts the a/r experience of the event to one that is lighter, bringing some helpful relief to the intensity of the primary stance.

Combining a playful stance with the primary a/r stance, both the therapist and client can sense that they are focused on experience- not any “objective fact”-and as a result become aware that there is more than one way to experience an event. Experiences are more open to being cocreated.

Within a playful stance, the therapist can convey an awareness that while a certain activity may be difficult for a client, the active presence of the therapist or parent will manage it. One would not be playful if there was a likelihood of failure.

An openness to playfulness enables the therapist and client to focus on other events as well as the difficult ones. While experiencing other events that are more likely to be experienced as humorous, casual, and light, the therapist and client can take a break from the harder work. The therapist is also conveying the belief that all experiences of the family members- not just the problems- are of interest to the therapist. Those present are unique, complex, individuals within a unique, complex family, they are not cases.

Playfulness represents a move into positive affect which is then able to be coregulated. It is often forgotten that the child (and possibly parent as well) needs to develop her regulation abilities for positive affective states just as much as she does for negative affective states. The ability to autoregulate all affective states is a skill that emerges first within coregulation experiences.

For many clients, playfulness is safer than are expressions of affection and caring. It also often has a place in early stages of the development of a relationship before affection feels appropriate.

Within a playful stance, there is often less room for the affective states of shame or fear. It is a valuable means of coregulating these negative affective states.

Playfulness should not be confused with anxious laughter or with humor that distracts from or minimizes the primary affective states because they are too difficult to bear. Such defensive humor may be used by the client or therapist when the intensity of the negative affect is too great for the therapeutic relationship to contain. Laughter then enables both to avoid negative affective states. But playfulness, as defined here, does not avoid that state. Rather, it represents mindfully stepping back from it to take a rest from the difficult work or to experience an event in a different way.

From a playful affective state, one often moves more easily into an affect of sadness and vulnerability.

By utilizing playfulness, the therapist is not avoiding discussions about difficult themes. Rather, she is helping the client to regulate his anxiety, she is taking a break from the stressful work, and she is adding a bit of shared positive affect to their intersubjective experience. From her playful stance, she is perceiving core aspects of the selves of the parent and child and she is responding to her experiences of them. Her responses elicit self-states from the parent and child that are characterized by a sense of being valued, along with shared joy and hope. All three sense that their intersubjective experience will prove to be sufficient to resolve whatever problems are addressed.

Acceptance

With acceptance, the therapist can join the affective rhythms and bring some regulation to them. With curiosity, the therapist then, while maintaining the rhythm, begins to explore and develop the theme or themes that are running through the narratives of the family members at that time.

Acceptance communicates a commitment to the person and confidence in who that person is. Without a sense of acceptance, fears of rejection and abandonment are not too far from awareness, acceptance sees under the behavior and communicates that the relationship will remain regardless of the conflicts and separations. When they are breaks in the relationship, there is always a commitment to repair the break.

Certain behaviors may not be accepted, but the thoughts, feelings, wishes, fantasies, and intentions that ked to these behaviors are always accepted.

By communicating acceptance of the other’s subjective experience, we are welcoming that experience into intersubjective matrix. We are inviting clients to become aware of their experience and to share it with us. Client’s subjective experience is an aspect of their subjectivity, and thus this is an aspect of their self. Each experience, by being accepted, is not being evaluated or judged, but is simply an aspect of the continuity of the client’s self. The more the individual’s experience is accepted, the more easily it can be integrated into his or her narrative. It will become one aspect of the uniqueness of the client’s self. Because it is accepted by the therapist, it is in a position where it can lose its qualities of shame and terror. It can be understood for the experience that it was, without compromising the integrity of the self. It no longer needs to be defended against in the client’s consciousness and affect. If it contained terror, it now may contain realistic fear, or no fear at all. If it contained shame, it now may contain realistic guilt, or no guilt at all.

Acceptance within the intersubjective experience greatly facilitates the individual’s acceptance of her subjective experience.

Parents may need assistance in remembering that their child’s subjective experience may also not be objective fact. Ex: I will not get better.

The focus is always on the experience being conveyed, not whether the therapist has the same experience.

Example of phrases for possible responses from a therapist to a client:

If you think that I don’t care, that must be hard for you! I feel sad that you experience me as not caring.

What do you do when you think someone doesn’t care for you? Do you have that experience with someone in your family/friend?

Are there other times when you have the same thoughts about yourself?

I do care for you but am not communicating it well or you would sense it.

Discipline with acceptance tends to be much more effective in reducing conflicts associated with the act of discipline. When a parent disciplines her child the degree to which she accepts his or her experience while limiting the behavior is often communicated by her tone of voice and facial expressions. If her voice and face convey strong annoyance and disappointment, the child will frequently experience the discipline as being directed at the self, rather than the behavior. If, instead, the parent conveys a more relaxed and matter-of-fact tone, separating the relationship from the act of discipline, the child often can regulate the affect associated with the discipline much more easily. He or she is often confident that the parent is responding to the behavior, not to the child and their relationship.

Often parental acceptance of their child breaks down when the parents want the child to behave in a certain way and the child fails to meet the expectation. When the attitude of acceptance leaves, the intersubjective dialogue quickly follows.

Curiosity

Proponents of narrative therapy stress the importance of curiosity in coming to know the other individual’s story.

Proponents of mindfulness are often describing a stance that combines qualities of both acceptance and curiosity.

The therapist is attuned with and responsive to the emerging subjectivity of the child or parent. As the client gives expression to his or her subjective experience, the therapist is receptive to this experience in both cognitive and affective terms. She is curious about the experience, and she experiences empathy for the client in the experience. As she explores the experience further with the client, she understands it more and more deeply. The deeper understanding makes way for a deeper capacity to experience empathy for the client. The deepening empathy, in turn, opens a window to understanding the experience even more fully. Curiosity is the cutting edge of empathy. While empathy leads curiosity into new depths.

Curiosity-radical (progressive)curiosity-opens the way for the therapist to understand client’s subjectivity much more fully. Taking this understanding-in the context of radical empathy-the therapist may now enable the client to reexperience the event by the therapist coregulating the associated affect, and cocreating the new meanings that are developing. The child is no longer alone in trying to make the event-whether it has been stressful or shameful-a part of his autobiographical narrative. And now with both radical curiosity and empathy the therapeutic process comes to also include radical acceptance.

It will also only be helpful if the parents, especially the father, are able too hear their child’s description of his subjective experience with acceptance and curiosity as well, in spite of any distress that is being caused.

For our curiosity, to be a transformative experience for our client, the client must experience our experience of his or her experience of the event. The client must experience our curiosity-and its related understanding and empathy-intersubjectively, or the understanding that is generated will have less value. It may enter the client’s ego state but will not touch the client’s soul.

To reach the soul, the therapist openly expresses the experience of wonder at the person she is discovering, at the narrative she is experiencing. If her curiosity has come from a mind that was “not-knowing” the wonder is easily shown nonverbally in expressions of surprise, awe, delight, and radical empathy. The process truly involves moment-to-moment acts of discovery, with related expressions of deep satisfaction from the process of experiencing the uniqueness of the other.

If, at times, it is necessary for the child to follow our directives, it would be so helpful to remember that if we can coregulate the affect associated with integrating this function of compliance within his or her narrative (cocreating its meaning), we are functioning as a parent in facilitating the coherence of the child’s narrative. There need not be a choice between my coherence as a parent and our child’s coherence as a child. Withing my chapter as parent lies the function of being the steward of my child’s narrative. Following my directives need not compromise the child’s narrative coherence if I engage him with acceptance, curiosity, and empathy.

Through accepting and understanding the client’s experience of her behavior, the therapist can respond without becoming defensive and can then modify her behavior and repair the relationship.

Empathy

Empathy here is described as an active mental (a/r) process that exists between two or more minds and hearts. It involves the experience of each member of the dyad (or triad) as well as the experience of each other’s experience.it is intersubjective. \

Empathy with stresses two key components of empathy: first, the therapist’s empathy is barren unless experienced by the client. Second, when the therapist’s empathy for the client’s experience is experienced by the client, he now is likely to experience empathy toward himself.

Curiosity is the cutting edge of empathy. Within curiosity, the reflective quality of the mind is the foreground while the affective quality is in the background. Within empathy, affect is in the foreground, reflection is in the background. Together, there is a meeting of the minds and hearts. With curiosity therapist is actively leading both mind into the narrative of the other. With empathy the therapist is actively experiencing with the client emerging aspects of his or her narrative. The therapist’s intention is to participate in each meeting of mind and heart with each member of the family as a whole, as well as to facilitate such meetings among the members of the family.

The term wrong or right do not apply, if they want their child to understand his or her experience and to develop meaning likely to be more similar to their own meaning, they must first show acceptance, curiosity, and empathy for the child’s experience.

Empathy is never a thing that must be given to or done to our client. It is an intersubjective experience, with the minds and hearts of both therapist and family members focused on a troubling aspect of each family member’s narrative or their joint family narratives. Empathy is then experienced by both the therapist and family for this aspect of the individual’s developing self or the family’s developing identity.

If you can’t think of anything to say, experience and express empathy. At the very least it will buy you some time, and most likely it will also be helpful.

Empathy is not a technique where one gives empathy words to make the other feel understood. Empathy is an intersubjective experience when one is in the world of the other, experiencing their experience of an event and the event itself with them. Empathy involves being touched by the other and giving expression to that experience so that the other is touched by one’s being touched.

Taken together, playfulness, acceptance, curiosity, and empathy provide an attitude that facilitates intersubjective experiences that in turn offer safety, affect regulation, and the creation of meaning.

Chapter 4: Fostering affective/reflective dialogue (6) *

What I am describing is intersubjective mindfulness. The therapist is fully in the present moment, accepting whatever presents itself, being curious about what she is being aware of, having compassion for self and other. In contrast to the more traditional centers of awareness in mindfulness (breathing, sounds, a tree), in this situation the subjectivity of the present other is the center of awareness, along with ones’ own subjective respond to his or her subjectivity, and the other’s subjective response to one’s own subjective response.

Certainly, it might be wise for the child not to participate in the exploration of certain themes or experiences of their parents. But often it is appropriate, and the deeper understanding of her parent’s narratives may make it easier for the child to understand the parent’s motives and feelings and to feel more secure in the relationships.

When many clients do not have the skills needed to understand the meaning of their behaviors, and when they have longed stopped trying to develop these skills, the therapist needs to actively lead them into becoming engaged in the process of understanding themselves. They need to understand the thoughts, feelings, and intentions that are associated with their behaviors, and then begin to comprehend the past and present experiences that generate them. Understanding a specific example is generally not important itself. Developing interest in the process of self-exploration, followed by skills to make sense of what the client thinks, feels, and plans across a wide range of experiences, are basic to the therapeutic process.

Characteristics of A/R dialogue

Attitude of playfulness, acceptance, curiosity, and empathy (PACE).

Connection-break-repair: maintaining the intersubjective connection with the family is the overriding therapeutic goal. Since the themes are likely to elicit frequent relationship breaks, the therapist notes them, accepts them, is curious about them, and then initiates repair. Breaks are not avoided but rather are utilized for their meaning and as an opportunity for new change opportunities in the relationship and the self.

Follow-lead-follow: the therapist follows the lead of a family member, joins the focus, is curious, and responds. The therapist leads into related areas, elaborating, wondering about implications, and following the response that the other gives. When necessary, the therapist leads into areas that are being avoided, while again following the person’s response to that lead. This patterned after the parent-infant dance of affect and meaning making.

Nonverbal communication: for toddlers verbal communication flows naturally from nonverbal communication. For all of us, nonverbal communication is the primary means we have for giving expression to our inner lives as well as for becoming aware of the inner life of the other. The therapist needs to be sensitively aware of the nonverbal expressions of the family members, helps to make these expressions verbal when indicated, and addresses any verbal/nonverbal incongruities. The therapist is clear, not ambiguous, in her nonverbal and verbal expressions. The therapist is receptively open to facial expressions, eye gaze, voice tone and variations, the range and intensity of gestures, as well as postural changes.

Affective/reflective balance and integration: meaningful dialogue contains a blend of affect and cognition, conversation, and reflection, holding the interest of the participants, and cocreating the meanings of the discussions and their place in the narratives. All memories, experiences, and affective states are included. Themes that do not spontaneously enter the dialogue are invited into it by the therapist, who then has an attitude of PACE for whatever responses are given by the members of the family. The therapist strives to maintain a broad, moment-to-moment, awareness of the following:

Ease and quality of expression of experience of events.

Self/other balance in dialogue

Blend of specific and general

Degree of turn taking

Degree of organization and focus

Affective/reflective balance

Degree in which it is coherent, comprehensive, and succinct

Degree to which each is open to perspective of others

Cocreation of meanings: throughput the dialogue experiences of primary 9 person-person) and secondary (person-person-event) intersubjectively are frequent. Matched affect, joint attention, and congruent intentions are present. Intersubjective communication within attachment relationships regulates affect, deepens understandings, and cocreates new meanings regarding the experience of each other as well as the events that are being explored.

Frequent sequence of a/r dialogue

An event is described.in most sessions, events that were experienced as being positive as well as those experienced as being negative are both explored. Generally, over the course of the sessions exploration of positive events are first, then negative ones, and again positive ones. This is like attachment sequence (connection-break-repair) described earlier and tends to make a/r dialogue more effective. If the client(s) enter the office in a depressed or agitated state, certainly this will be focused on first rather than trying to manufacture a positive event.

The event itself is separated from the experience of it. Different individuals are likely to have different experiences of a given event. Thus, the experience of an event can vary greatly between individuals and within the same individual at different times. The therapist, therefore, cannot assume that she knows the experience of the family member when she knows the nature of the event. She needs to discover what the experience was. She needs to be curious about the experience and ask her client to describe it for her. She asks her client to clarify the experience by describing the inner life components of the event. She asks about the client’s thoughts, feelings, perceptions, and judgements about the event. She asks about his or her wishes and intentions that may have influenced the event to happen as well as the experience of it. The therapist never assumes that she knows what her client’s experience of the event was.

The motives that the client attributes to self or other related to the vent are now explored. The therapist wants to understand why the child thinks that she acted that way. She also wants to understand why the child thinks that her parent (or other) acted that way. When the therapist understands what the child thought were the motives of self/other that were related to the event, the therapist can understand a great deal of the meaning that the child created about the event. Often the client does not know why he or she responded in a certain way to an event. At this point the therapist takes an active, curious stance, assisting the person in the organization of the experience.

The client’s experience of the event is now having an impact on the therapist. Following the understanding that is emerging from the explorations of the client’s thoughts/feelings/perceived motives related to the event, there is often a deepening affective response to the dialogue that elicits empathy within the therapist. The therapist is fully present with the client within his experience of the event. It is this impact on the therapist-the therapists’ experience of the client’s experience of the event- that opens the way toward the cocreation of a new meaning of the event. The therapist’s affective (empathy) and reflective (curiosity response, resting on a foundation of unconditional acceptance of the client’s experience, enables the client to safely make herself available to reexperience and reorganize the event both affectively and reflectively.

Through experiencing the therapist’s experience of the event and their new joint creation of the meaning, the shame or fear associated with the event is now much less. The behavior, in the context of the new meaning that was just cocreated, has become more normalized. Given the client’s experience of the event (thoughts, feelings motives of self/other), her response is now open toward more coherent self-awareness and self-empathy.

The child is now encouraged to communicate this deeper meaning that she has discovered about the event. To her parents.

The parents are now encouraged to express understanding and empathy for the meaning that their child now attributes to the event. It is the parent who is asked to take the lead in communicating acceptance and empathy of the experience of her child.

Read page 105 and 106

Finding the words for the experience of the event.

If, at any time, the client says that she is not thinking or feeling what the therapist had guessed, the therapist immediately accepts her statement and expresses curiosity about what other meaning to give to the behavior.

Example: I know how important that was for you…no wonder you are upset! You probably don’t know why I said no … That probably makes it harder for you, especially if you think that I don’t care that it bothered you. I wonder if you got mad at him because he is allowed to go, and you are not. Maybe you broke it because right then you just didn’t care. After what I said, maybe you don’t like me very much right now. Looks like you are not going to talk right now. maybe you don’t know what to say…maybe you do but won’t say it. Maybe you don’t want me to know what you are thinking…maybe you want me to just leave you alone.

All a/r dialogue contains a on verbal core with congruent verbal communications resting upon it. The dialogue occurs within the context of the therapist’s very expressive facial expressions, rich voice tonality and inflections, gestures, eye contact, posture, and touch, all congruent with the narrative.

Narrative therapy is based on creating stories congruent with a child’s own history. The act of telling the story may be at least as important as the story itself. Emotional communication occurs primarily through the nonverbal expressions of face, voice, gestures, timing, and movements. The words themselves being to resonate when they emerge within such expressions. Because ethe story being created is from the child’s own life, the dyadic telling and witnessing serve to create a common meaning that is integrative and transforming.

When the therapist is taking the lead in the a/r dialogue, the client’s nonverbal cues are crucial signals as to whether or not, he is affectively present with the therapist during the dialogue. Any communication by the therapist is irrelevant if the client is not engaged in it. The therapist actively attends to the nonverbal cues, accepts them, and tried to integrate them into ongoing interaction. By doing so, the client is much more likely to feel that his inner life- as manifested by his nonverbal expressions- is noticed and valued. He senses that what he thinks, and feels is both important and understood. In such a setting he will begin to feel safe at a sensory affective level of experience, which is much more crucial than thinking that he is safe rationally.

Speaking for

If the child does not speak, the therapist should accept her inability or unwillingness to put the experience into words and offer to tell the child’s caregiver for her. with his consent, the therapist should then tell the caregiver the child’s experience of an event. The therapist tells the child that she will guess what the child might have thought or felt or wished at the time. She will add that if she guesses wrong, the child can correct the therapist at any time or even tell the therapist to stop guessing if she does not like the flow of the conversation. The dialogue is like to have more emotional meaning for the child if the therapist speaks for the child in the first person.

Numerous times children have taken what the therapist initiated in the dialogue and continued their own, totally claiming the therapist’s words as their own. Often the child intently looks to his parent for a response to “his” words. At times the child will correct a few words, wanting the therapist to speak again for him, incorporating the changes given. Frequently child will express wonder and gratitude over the therapist knowing what he thought and felt, even though he often did not know himself what he thought and felt, until the therapist spoke the words.

The therapist also may speak for the parent-with permission-when the parent is struggling to find the words to say to her child.

Speaking for the person often enables him to feel safe, remaining in the background. If he wishes, he can deny that those are his thoughts and feelings. If his parent does not respond in an empathic and understanding manner, he can more easily pretend that it does not matter because those were not his words.

Speaking About

While speaking for a person tends to increase his affect and reflection, speaking about him tends to decrease his affect and increase his reflection.

Often the therapist might speak about a child when she thinks that he needs a break from the dialogue, the affect is becoming too intense for him to regulate, or she wants to reflect upon the dialogue before continuing.

When the therapist speaks about a child to his parents, she is certain to say positive things, bringing out his strengths, and speaking with hope. By doing so she is conveying her intersubjective experience of the child to both the child and his parents. The impact that the child is having on her will begin to have a congruent impact on both the child and his parents.

Talking about a child to his parents is a wonderful opportunity to convey acceptance and empathy, to bring out the positive, to reduce the affect, and increase the reflective function, and to share the impact that he or she is having on the therapist with the parents.

Chapter 5: Treatment Onset: Meetings with Parents (12)

The purposes of this initial stage of treatment involves:

Developing an alliance with the parents. This will include providing them with a setting for their thoughts and feelings regarding their child to be expressed and be heard, without concern that they will be hurt by the therapist’s expressions or that their children will be hurt by their parent’s expressions. The therapist needs to establish that she will serve as an attachment figure for the parents and that the parents and therapist will, together, serve as attachment figures for the children. This exploration will also include the awareness that neither they nor their children will be blamed for the child/family difficulties.

Exploring the parent’s own attachment histories to assess the transmission of their own history into the attachment patterns that exist with their child.

Presenting the attachment-focused parenting and treatment models.

Inviting the parents to actively participate in this model of treatment.

Developing an Alliance with the Parents

If they are to openly acknowledge the difficulties that brought them into therapy, they need to experience the therapist’s acceptance of their subjective experiences as parents. If they feel judged and criticized as parents, they are likely to react with shame, defensiveness, and resentment.

If the parents are to feel safe, they need to experience the same degree of PACE from the therapist that is being provided for their child when he or she is present later in the treatment. They need o experienced the mind and the heart of the therapist in intersubjective terms. The therapist needs to be communicating that she experiences their commitment to their child, that she knows that they want what is best for him or her, and that they are doing their best. If they have made mistakes, it is not from a lack of trying or from poor motives. The therapist is communicating hat she sees and responds to their motives and goals for their child. She experiences hem as being good people who love their kids and who work hard to give them the best life that they can. If the therapist is successful in creating a sense of safety for the parents, she will have assisted them. In experiencing realistic guilt over any mistakes that they may have made in their parenting behaviors, rather than experiencing shame.

Hopes and Dreams

First, the therapist might well inquire about the parent’s hopes and dreams before they had their child. As the parents express these original thoughts and feelings, they are brought into contact with the early positive wishes and feelings that they had. They may well have forgotten those times, and by remembering them, they are able to move closer to an increase in hope and commitment.

By having the therapist hear and respond to those early experiences and wishes, the parents are gaining confidence that she does truly experience how much they love and want what is best for their child. As, as they recall those positive experiences from the past, they are more likely to reexperience those qualities that they have experienced in the past.

Doubts

Second, the therapist might explore when the parent first developed doubts about how well their child was functioning, as well as their ability to help their child and to maintain a positive relationship with him or her.

Grief

Third, the therapist then needs to explore if the parents have experienced grief over the loss of their hopes and dreams for their child, as well as for the end if the intensely positive affective experiences that they may have has with their child in the past years. Were the doubts and failings so pervasive that the parents became convince that their family life would never improve? Did they begin to see the behaviors- either their child’s or their own- as representing some basic character or relationship flaws that could not be changed? Were the parents demonstrating ongoing anger and despair that represented unresolved grief?

Shame

Forth, the therapist needs to explore if the parents, following an ongoing pattern of failures n relationship with their child, reacted with shame to their inability to improve their relationship or the child’s functioning. Such shame is the parents, if not recognized and resolved, will lead to denial, defensiveness, blame, and excuses, followed by resentment and rage. If the therapist can assist the parents in reducing the shame, then she is likely to be able to assist the parents in feeling guilt over whatever errors they may have made as parents. With guilt, the parents are then able to address and repair these features of their relationship with their child.

Resentment

Fifth, the therapist will now have the context in which the patterns of any resentment toward their child developed.

Acceptance

Sixth, the parents may well now be more accepting of their parental narratives. They are then likely to be more open and less defensive in exploring their strengths and weaknesses as parents.

Commitment

Seventh, through experiencing empathy and a reduction in any shame that resulted from the family difficulties, the parents are more likely to develop a new sense of commitment to try again to be a more successful parent.

Realistic hopes and dreams

Eighth, the parents are now able to create more realistic hopes and dreams-with the active participation of their childr5en and the therapist.

Attachment security

Ninth, having successfully journeyed through their parenting history, and looked back at their original attachment histories, the parents can provide attachment security for their children while they all explore the various chapters of their family narrative in the present.

Pride and joy

Tenth, as progress becomes evident, the entire family becomes aware of an increase in pride and joy over the increase in successes and decrease in failures. Guilt begins to occur without shame. A parenting history that may be different from the original attachment history begins to develop. Any continuing difficulties are met with PACE rather than shame and resentment among the members of the family.

The therapist’s motive is to experience the family from the perspective of the parent, not to evaluate whether or not that perspective is problematic. However, in this process, the therapist is also working to deepen the parent’s perspectives. This is done through an attitude of persistent curiosity about the situation. The therapist is continuously seeking to understand more about the inner lives of the child and parent. In doing so, she is encouraging the same open, curious, and nonjudgmental stance by the parent.

At the onset parents are encouraged to describe their child’s behaviors for which they are seeking treatment. It is important that the therapist not dismiss these concerns as unimportant. It is equally important that the therapist not suggest that these behaviors will be addressed eventually, possible in a few months, after the more important issues are first resolved. To develop an effective alliance with the parents, the therapist needs to communicate a desire to understand the parent’s concerns about their child and an agreement that their concerns warrant their joint attention. At the same time, the therapist will take advantage of this initial focus on symptoms to begin to demonstrate the core of the treatment model.

At the beginning stage of treatment, the therapist is not suggesting that she knows the right motives for the child’s behaviors. Rather, she is communicating the need for an open and curious attitude to understanding better what the child’s motives might be for his or her behaviors. The therapist is deeply interested in what lies under the behavior, communicating to parents that such understanding is likely to hold the key to change.

In arriving at an understanding about possible reasons for the child’s behavior, the therapist is facilitating the parent’s ability to experience empathy for their child. The therapist may need to stress that reasons are not excuses, for the parents to be willing to try to understand their child, with acceptance, not judgement. The therapist may suggest that a reason becomes an excuse only when the reason removes accountability for the behavior. Reasons guide interventions; they are part of the assessment that is needed before the treatment, at any appropriate parental discipline, can begin.

While this dialogue is occurring between the therapist and parents the therapist is also likely to be noticing parental behavior that the therapist may believe is possibly contributing to the child behavior. Just as it is important to understand the reasons for the child’s behavior n order to facilitate parental empathy toward the child, it is equally important for the therapist to understand the reasons for the parent’s behavior to facilitate the therapist’s empathy toward the parents.

In noticing the parent’s behaviors, it is best to do so in a direct and natural manner, without a serious, judgmental, tone. The therapist might simply ask the parents about what areas of themselves-with regard to their parenting- they tend to be the most critical. Which of their behavior would they like to change? Which behavioral changes would be likely to help their child with his or her problems? While being just as direct, the therapist then could become curious about why the parents think they engage in those behaviors. Understanding the roots of the behaviors, the therapist-and parents-are more likely to have empathy for the parent for the behaviors and parents will be more willing to work to modify them if necessary.

After successfully initiating a working alliance with the parent the therapist may or may not ask to have a similar meeting alone with the child. This would be necessary id the therapist believes that by not seeing the child, the parent will not be confident that the therapist understands the situation enough to make a treatment plan. It would also be necessary if the therapist believes that the child will not be willing to engage in joint treatment if he or she knows that the therapist has heard the parent’s perspective but has not heard the child’s perspective. It would also be necessary if the therapist has Significant questions or concerns that she wanted to address before presenting her model of treatment and parenting to the parent.

However, often such a separate meeting with the child is not necessary. Th therapist believes that the attachment perspective is appropriate for addressing the full range of child/family problems. If the therapist’s goal is to have the parents provide attachment security for their children, then their presence us crucial. The child’s participation will be insured only after she experiences, intersubjectively, the therapist’s attitude (PACE) toward her and discovers thar the sessions are helpful. The child will respond more quickly when she experiences safety while being with the parents in their joint sessions.

Exploring the parent’s own attachment histories

The therapist summarizes our increasing knowledge that the attachment patterns that are transformable in adulthood are central to the parent-child relationship and to the related qualities of safety, affect regulation, and meaning-making, tend to be patterns that are like what existed in prior generations. Comparisons will then be made between the parent’s patterns in their families of origin and those manifested by their child. Parents will also be asked to note whether or not certain behaviors of the child serve to activate certain patterns from their own histories.

The therapist addressed this pattern directly. She describes the intergenerational nature of attachment behaviors. She asks to understand the parent’s own attachment history to have a better understanding of the current family attachment patterns. Her attitude is based on PACE. It is clear that she is not searching for reasons to blame the parents for the current difficulties. She is not judgmental. She simply wants to understand their experiences as children, to better understand their experiences as parents, parenting their child.

As parents begin to share their own histories, they often become aware of various similarities between their past experiences and those in present that involve themselves or their child. This awareness is facilitated by the therapist’s acceptance, curiosity, and empathy about whatever they are recalling. His awareness often will immediately increase the parent’s abilities to reflect upon and responds to their child’s behavior rather than simply react to it.

At times parents who seek family therapy manifest aspects of their attachment history that are not fully integrated and organized, leaving their own narrative somewhat lacking in coherence. When this is the case, the therapist asks the parent to explore these themes in greater detail to seek a resolution that will prove to be very beneficial for the family treatment. Often this simply necessitates brief individua/couple treatment prior to the inset of family sessions. Periodic sessions are necessary with the parents alone. Sometimes continuing throughout the course oof the family sessions, to address factors related to their attachment histories. Sometimes the parent(s) need to be referred to another therapist (or two) because the interventions are likely need sufficient time and intensity to require the involvement of more than the family therapist.

Presenting the attachment-focused treatment/parenting model

Some books that are helpful: Time in parenting, unconditional parenting, and the science of parenting

Closeness, affect, and its coregulation

Certain child-rearing principles that stress isolation when a child experiences intense affect, especially anger, may be consistent with some models of development but are not congruent with attachment theory. Anger should be treated no differently from fear, sadness, or any other intense affective state in providing the child with one’s affect-regulating presence. Through such presence, the parent is showing the child that such a state does not bring rejection, does not have to be faced alone, and is not something that the child needs to hide in shame. The state of anger is no different from any other affective state. It is accepted, understood, and coregulated by the parent.

Isolation from the parent is likely to be indicated only if the parent is not able to regulate her own negative affect and so may frighten the child. It might also be chosen if the parent tends to ignore he child when she is doing well, and attend to her only when the child is engaged in inappropriate behavior associated with certain affective states such as anger. Or it might be chosen is the child’s shame is so intense that the parent’s presence makes it more extreme.

In emphasizing the benefit to the child of having parents coregulate the developing affective states, it becomes clear that parents need to accept responsibility for being able to regulate their own affective states. If parents, when present with their child, hold dysregulating feelings of rage, anxiety, or disgust toward him, their child will develop with an impaired view of self (primary intersubjectivity) and be at risk of being unable to learn to regulate his own affective states.

Parental closeness and affect regulation abilities are also necessary if a child is to learn to regulate positive affective states. Excitement and joy can quickly turn to uncertainty and anxiety if the parent is not present to share the excitement and reassure the child ( often nonverbally) that this intense affect state can be regulated and given meaning that is positive.

Touch is central to the coregulation of affect and facilitating a sense of felt safety between parent and child. Touch is important both in coregulating affect and in cocreating meaning between parent and the child. The comforting touch helps the child to attain resolution about the most painful loss. The deep touch assist the agitated child in becoming calm. The gentle touch enables the annoyed child to accept a parent’s limit on her behavior. The caressing touch enables the child to feel love when she thinks that she may be unlovable. Touch needs to be varied, finding a place in family relationships in many contexts and for many reasons. It needs to be long and short, deep and light, playful and affectionate. Within touch the parent-child relationship is felt more deeply. Good times are experienced as being even better and bad times are easier to get through.

A child needs to view his or her home as both a secure base from which the child will leave to explore the world, and a haven to which the child will return when he or she needs a break from the world.

Connection-break-repair

No matter how long the separation and how severe the conflict, unconditional love, and readiness to care for the others in the family when they are in need will remain.

During brief period of mild distress, a parent is not responsive, and the child gradually learn that she can manage the distress alone, and the parent will often allow or even encourage the child to do so. When the distress is too difficult for the child to manage alone, the parent will be there to assist her, and they will manage it together. Over time, the amount of stress that the child can manage alone increases, but she still knows, even in adulthood, that the parent will be available and responsive if needed.

With young children, states of shame associated with parental discipline are not likely to be autoregulated well. They require active repair through coregulation with the parent. In secure attachments, as the child develops with the certainty of interactive repair, parental discipline elicits guilt rather than shame. The discipline is experienced as being associated with the behavior, not with the child’s self not with the relationship. This child is often able to autoregulate the guilt and it take little on the part of either child or parent to repair the relationship and for both to be available for intersubjective experiences.

Not only do breaks often take a negative and dysregulating characteristic, so too do the acts of repair often become ver difficult for both the parent and child to initiate and successfully complete. Number of factors:

Initiating repair is seen as giving in to the other

Initiating repair is often experienced as an apology that neither wants to give

Initiating repair places one at risk for being rejected by the other

Initiating repair raises the possibility that by focusing on the break, the conflict will intensify again.

When parents initiate repair, it is often seen by them as diminishing their authority.

Parents often see repair as processing in which the primary intension is to prevent the recurrence of the break. The need to repair the security of the attachment is overlooked.

Once the reasons for the difficulties in successfully repairing breaks in the parent-child relationship are understood, the therapist is in a good position to assist the parents in taking the lead in being able to initiate repair during the treatment sessions and at home.

The following guidelines are likely to serve as an outline for facilitating the attachment-break-repair sequence:

The habitual, interpersonal/affective atmosphere of the home I open, inclusive, and is generally comfortable to all members of the family.

Differences are addressed openly, with focus on how specific behaviors affect the self/family along with a proposed way to resolve the differences.

All members of the family who are involved in the conflict have a role in its resolution.

The goal of discipline is to teach, not to punish; to help the child to learn, not to feel shame. If one person hurts another, the goal is for the person to feel appropriate guilt, not shame-over his or her act and repair the relationship.

To facilitate effective discipline, the parent is encouraged to speak with empathy rather than anger. Empathy keeps the focus on the behavior, rather than the child, whereas anger moves to focus to the relationship and away from the behavior. Being sad for a child over the difficulty that he has learning a behavior and for any related consequences tends to be much more effective than being mad at him.

The parent is committed to repairing the relationship and returning it to the original relaxed and mutually enjoyable intersubjective state as quickly as possible. The parent does not use psychological distancing over an extended period to teach the child to make better choices. The attachment relationship is kept out of the discipline.

When the parent’s discipline does involve anger directed toward the child, the anger is short and associated with the effects of the child’s behavior. When the anger reflects the parent’s own affective state and is not seen as being necessary part of discipline, the parent acknowledges that and will apologize for the anger when appropriate.

The parent may initiate a discussion in which both reflect on particularly difficult conflict in a manner that communicates that they both felt strongly about something and were not feeling close to each other for a while. The parent is communicating acceptance of the break as being natural to all relationships and not being something that warrants shame or fear. She adds that she is happy that they are feeling close again.

Intersubjective perception and influence

By their parents experiencing them as actual, their infant is more able to make them actual. This is the zone of proximal development. The parent influences her child’s development by accepting what he or she expresses. Perceiving the potential as emerging into the actual and expecting-without pressure-that those qualities will be manifested too.

Through their acts of perception of their child’s subjective expressions-not objective behavior-parents are having a significant influence on their child’s development. The perceptions are both affective and reflective.

Too often when parents initiate family therapy their perceptions are negative and they assume negative motives under their child’s behavior. What influence they have tended to be based on their positions of power within the family, rather than reciprocal influence. They tend to forget that if they do provide their child with a sense of safety and if they have confidence in their child’s abilities, their child is likely to have more confidence in herself as well.

Within the act of reinforcement, parents are evaluating their child’s behavior, judging it to be correct, and providing a consequence intended to maintain the behavior. The child is expected to rely on the judgment of the parent, rather than to develop his own judgment about what is best for himself. He may come to overly depend upon his parent’s judgement. Or he may begin to directly-or indirectly-oppose his parent’s judgement because it is experienced as being controlling or indifferent to the child’s own experience (thoughts, feelings, motives, perceptions, etc.). within the intersubjective experience the parent is not engaged in the evaluation of her child but rather is discovering qualities within the child’s experience which facilitates her child’s ability to experience the same qualities within himself. Dependency or opposition are much less likely to occur because the parents are more focused on cocreating the meaning and coregulating the affect of the child’s experience rather than on evaluating his behavior.

Attitude of PACE

If the parents can maintain this attitude for most of the time during most days, the overall family atmosphere will be one that generates safety, comfort, sharing, and reciprocal enjoyment. When conflicts occur, they are seen as routine stress that is easily managed by the overall security of the attachments. This attitude makes it likely that conflicts will not lead to dysregulated affective states but rather are able to be integrated into intersubjective matrix.

The parents are presented with the description of these qualities along with an explanation as to their power in facilitating attachment security. They are asked to recall how these qualities were present during their early experiences with their child’s infancy. They are also asked to explore how they think they may have drifted from that attitude.

Other parenting characteristics to facilitate attachment security

Parents can facilitate the forming of a secure attachment by their children through a variety of ways of interacting with them. It is valuable for the therapist at the onset of treatment to explore these interactions with the parents.

Eliciting the parent’s commitment to the treatment model.

The therapist is guide and consultant; parents make the final decisions.

When there are differences that are not resolves, these need to be explored with acceptance, curiosity, and empathy for all. If the focus can remain on the long-term goals for the family, and if the therapist and parents perceive similar goals, then differences regarding present interventions can simply be seen as different pathways to achieve the same goal. However, if the goals differ significantly, or if the therapist or parents believe that differences regarding interventions are likely to interfere with maintaining a basic trust and confidence in each other’s expert status, then the therapist needs to initiate dissuasion about possible termination and referral to another therapist.

It is often helpful for the therapist to develop a waving relationship with the parent (s) before beginning the family sessions. During the initial sessions with the parent, at some point the therapist says:

Do I have your permission to wave you during the session with your son when I think that you are saying or doing something that might be hurting your relationship with him? After I wave, I’ll give you a suggestion about what you could say or do that might help your relationship with him.

The therapist might also suggest that the parents wave to her if they think that she is saying or doing something that is hurting the family relationships.

When, due to time constrains or the wish to mange an immediate crisis, the initial phase of meeting with the parents is not done adequately, there is a risk that the subsequent treatment process will be compromised.

The therapist is responsible for insuring that the parents feel safe during the sessions. The therapist is also responsible for insuring that the children feel safe during the sessions. In planning for the children’s safety, the therapist builds confidence in the parent’s ability to facilitate their child’s sense of safety while the stressful themes are being addressed in the treatment. The initial meetings with the parents alone are often crucial in efforts to build his confidence.

When the children are brough into the sessions, they too are given a brief description of the nature of the sessions and the goals that have been developed with their parents. Their perception of these goals, as well as the function of family treatment, are then explored to elicit their engagement in the treatment process at the onset. During these explorations, the nonjudgmental tone of the therapist as well as the explicit statement that all the family member’s contributions to the family strengths and difficulties will be addressed, will make it easier for the children to become engaged in the treatment.

Difficulties getting started

The most important time to address relationship breaks, misattunements, defenses, and conflicts is at the beginning of treatment, with the parents. If they are not addressed then, the therapeutic alliance will not be stable, the parents feel not feel safe, the therapist too will struggle with trying to feel safe, and certainly the children who join the sessions later will not feel safe.

Chapter 6: Being with children (6)

The child like her parents is in the therapist’s mind and heart, and the child like the parents, experiences this. The intersubjective presence of the therapist is the overriding context in which the treatment occurs. The child experiences herself in the therapist’s mind (through acceptance and curiosity) in the therapist’s heart (through playfulness and empathy). Experiences of primary and secondary intersubjectivity are the central change agents in the therapist’s manner of being with children. Similar intersubjective experiences occur between parent and child, parent, and therapist, as well as within the parent, child, and therapist triad.

Children discover many positive traits within themselves because their parents respond in positive ways to the children’s expressions of their inner life. There are qualities within children that evoke these positive responses from within their parents. At the same time, parents are discovering qualities within themselves as parents because they are having an impact on their children. They are experiencing themselves as the parents that their children are experiencing them to be.

Inconsistencies in the story that worry or puzzle the therapist will be addressed from a stance that only tries to understand he inconsistencies, not to change the story. If the child is actively participating in his exploration of her story, she will work out the inconsistencies in a way that is true to her need for a coherent narrative.

Characteristics of being with a child

The therapist sits close to the child, often on the edge of the child’s comfort cone. The right degree of closeness can be sensed nonverbally. If the therapist is too close, as is evident in the resulting posture, level of tension, or facial expression of the child, the therapist simply moves away a bit until the child appears to be more relaxed. When the therapist is too fa away, she senses this by nothing that the affective tone is not as rich, it is more difficult to hold the child’s interest, and more difficult to become engaged in a/r dialogue. She then moves a bit closer.

Reasons for sitting as close as possible:

It establishes a greater psychological safety, once the child is accustomed to the degree of closeness.

It makes it easier to be attuned with the child’s affective state

It makes it easier to hold the child’s attention

It makes it easier to notice the child’s nonverbal expressions which might elicit the therapist’s curiosity and subsequent a/r dialogue.

It makes it easier to clearly communicate, nonverbally, one’s own a/r experiences.

Makes it easier to touch the child when appropriate for purposes of coregulating affect with comfort, enjoyment, or affection. It also makes it easier to place extra emphasis on a particular understanding through touch. Touch also assists a child to maintain his attention to a theme.

The following are examples of 3 crucial modalities of nonverbal communication:

Facial expressions-clear expression of surprise, delight, confusion, awe, enjoyment, sadness, empathy, acceptance, curiosity.

Voice tone/inflections. Often melodic, rhythmic. Punctuated with pauses, variations in speed, emphasis. Frequent repetitions of words and phrases.

Gestures/posture. Animated/quiet, quick/slow, expansive/controlled, based on the attentional focus and emerging affect. Often leaning forward. Much variability often present.

Verbal expressions are congruent with nonverbal expressions. The therapist’s intention is his choice of words is to remain w/o judgement-focused on the inner life experiences of the child, not the truth of the object or events. The focus is continuously being brought under the symptoms, to the affect and meaning associated with the events and objects that are being presented in the story. The expressed words often have these characteristics: (fostering a/r dialogue):

Frequent, nonjudgmental questions, followed by surprise, delight, ah-hah expressions.

Exclamations, or quiet repetitions of what was just said.

Thinking outload to communicate intentions, curiosity, empathy.

Empathic or playful communication of affect.

Talking about the child to the parent (to decrease affect and increase reflection).

Talking for the child to the parent or the therapist (to increase affect, reflections, and a felt sense of connection while maintaining safety.)

Facilitating the child and parents’ ability to engage in a/r dialogue with each other.

The nonverbal content carries much of the affective aspect of the dialogue, whereas the verbal component carries much of the reflective aspect. The nonverbal expressions along with curiosity often carry the momentum of the dialogue, and dialogue that is transforming is always affective/reflective. At times the nonverbal component will carry both the affective and reflective, without any needs for words. The child or parent can indirectly read the mind of the therapist in the smile, movement, or vocal expression, while directly experiencing the therapist’s heart. Sometimes making this explicit with words is helpful, while other times allowing it to be communicated nonverbally conveys a deeper meaning.

Some may be skeptical that words could have such transformative power for children. Words tends to do so when they are rational interpretations of the child’s behavior and history. They often fail to do so when they are given within a lecture with an intention to problem solve. It is when they emerge from the intersubjective matrix, representing the therapist’s discovery of the affective and meaningful aspects of the child’s experience of an event/object, that the therapist’s words with the child become so powerful. The therapist’s discovery of the affective and meaningful aspect s of the child’s experience of an event/object, that the therapist’s words with the child become so powerful. The therapist’s discovery is made from within her own experience of the child’s experience.

The following represent ways that the therapist sometimes relates differently with children from the way she relates with adults:

With children there is usually a greater need for taking breaks in the dialogue because of the child’s greater difficulty with maintaining attention, regulating affect, or maintaining motivation.

When matching the child’s vitality affect, the therapist is likely to show greater variation, range, and intensity.

There will be a greater need for the therapist to speak for and speak about.

The therapist will more often be likely to touch the child to provide comfort and to assist in regulating affect and attention.

The therapist is likely to have to assume greater responsibility for maintaining the momentum of the dialogue.

The therapist is likely to have to lead more and allow less.

The therapist is likely to assume greater responsibility for deepening new understandings and cocreating new meanings.

Chapter 7: Managing shame (9)

Shame is an affective experience that violates both interpersonal trust and internal security. Intense shame is a sickness within the self, a disease of the spirit.

Pervasive shame functions to hide the self from the anticipated negative evaluations of others. Within this state, the person experiences herself as being wrong, stupid, bad, unlovable, or worthless. Within this state the person assumes that her behavior reflects intentions, self-states, or abilities that are flawed, selfish, lacking, or evil. Shame greatly restricts the nature of the self as it emerges during development. It colors certain experiences so that they reflect one’s hopelessness and worthlessness. These experiences are defended against through anger, denial, excuses, or blaming others. If the shame intensifies, more extensive defenses against it involve rage or dissociation. Events associated with shame and its defenses are not experienced intersubjectively and are not successfully integrated into one’s narrative. The narrative becomes fragmented, filled with gaps, distortions, and inconsistencies. Shame is likely to represent the greatest barrier to developing a coherent autobiographical narrative. Events that are full of shame do not become subjective experiences fit for inclusion into one’s story of oneself.

When an event causes a reaction of intense shame, the event becomes frozen in our mind, being unintegrated with the more interactive, meaning-making structures of our mind, and rigidly, seeks to avoid similar events in the future, that might elicit similar reactions of shame. The new events may have many dissimilarities with the original shameful event. The person does not notice these differences as the amygdala has already made a judgment that precludes new learning: establishing a feeling of safety is paramount. The event is avoided, and the person is left with the assumption that it was of the same nature as the original event.

While fear, anger, or sadness may become dysregulating, they more often are routinely regulated within the safety of attachment security, present within the family.

It is when fear, anger, and sadness are infused with shame that. The normal interactive repair behaviors are likely to be poorly functioning. When fear, anger, and sadness are associated with shame, they are at risk of becoming chronic states or intensifying and becoming terror, rage, and despair.

In fear, the child seeks her parent, in shame the child hides from her parent. When the therapist can assist the family in reducing the shame that is felt by the one or all of the family members, then any affective states of fear, anger, or sadness that emerge regularly are much more likely to be resolved and integrated.

When the attachment figures elicit shame in a frequent and unpredictable manner, the child is likely to avoid contact with the attachment figure whenever possible. If physical avoidance is not possible, the child is likely to freeze and avoid psychological contact with this figure. When the attachment figure elicits shame in a frequent, but more predictable manner, such as when she is angry, the child is likely to avoid physical or psychological contact with this figure when she is in such states. When the parent elicits shame primarily because of the child’s behavior, the child is likely to avoid physical psychological contact whenever he thinks that he did something that his parent will not like. Thus, the child’s avoidance of his parent may be restricted to situations involving his own behavior, or the parent’s affective state, or the parent herself, regardless of her state. Clearly, the more limited are the areas of avoidance, the less damage is being done to the relationship. The less pervasive are shameful events, the less restricted are moments of intersubjectively and the more available are such moments for regulating the affective states of fear, anger, or sadness.

When the child avoids a parent due to shame, even in the most limited situations, the child is unlikely to enter into intersubjective experiences with the parent at thse times. In such situations, the child’s ability to learn about self/other or to develop meaning about that affective state or that type of event, is going to be impaired. The impairment is a natural result of the illimitations placed on primary and secondary intersubjectivity at those times. Meaning making and affect regulation, so crucial for the development of a child’s coherent narrative and integrated self, occurs and develops the best in these intersubjective experiences. Shame restricts these experiences. Pervasive shame creates the risk that intersubjective experiences will be habitually avoided and the organization of experiences into a coherent narrative will be impaired.

Shame is a painful negative affective state that is difficult for the toddler to autoregulate, though he attempts to do so often by gaze avoidance, becoming motionless and speechless, and hiding psychologically, and possibly physically.

At these moments, the attuned attachment figure is sensitive to the painful negative affect that her toddler is experiencing as well as the child’s difficulty regulating it. She assists the toddler by coregulating the affect through empathy and comfort. Then, through reassurance, a brief explanation about the behavioral event, or redirection, she becomes reattuned with the child as he enters a more positive affective state. Shame is contained. It remains small and can be regulated, initially with the affective and behavioral interventions of the parent and eventually through the child’s own increasing autoregulation abilities. When the parent after eliciting a shame response through mis attunement or limit-setting-quickly repairs the relationship, the shame is contained, and the important role of socialization is successful.

Central differences between shame and guilt:

Shame focuses on self; guilt focuses on behavior.

Shame is a much more painful affect that is guilt.

With shame one experiences feeling small, worthless, and powerless. With guilt, one experiences feeling tense, remorseful, and regretful.

With shame one is concerned with the other’s evaluations of oneself. With guilt one is concerned with the effect of ones’ behavior on others.

With shame, the self is split between the observed (devalued) and observing self. With guilt, the sense of self remains unified and is not devalued.

With guilt, one does something wrong, and the self is left intact. With shame, one’s behavior is a sign of an aspect of self that is damaged. One’s behavior reveals to others that one is inherently bad or flawed. As a result, the self-attempts to achieve a distance from the behavior and hide from the eyes of others. With shame one shrinks from being exposed, whereas in guilt, one addressed one’s own behavior with the other to repair the damage that the behavior caused to the person or the relationship with him or her.

When, under conditions of shame, one is not able to hide, but remains exposed to the other, one is likely to lash out in a state of rage.

There is no relationship between guilt and anger. Studies say that whereas here is a positive correlation between measures of guilt and empathy, the correlation between shame and empathy is negative. Shame is correlated with many measures of psychopathology, whereas guilt is not. In family treatment app participants-parents, child, and therapist- are likely to be vulnerable to the effects of shame.

Shame becomes extreme is cases of child abuse or neglect or moderate in cases of habitual harsh discipline, especially when it involves emotional abuse and withdrawal from the child.

Individuals who suffer from shame are likely to find psychological treatment very difficult because shame activates the tendency to deny one’s behavioral problems and hide from the eyes of others when these problems are exposed. In such states the person is often convinced that the attachment figure will see the flawed self under the behavior when the behavior is explored. The person is very likely to withdraw into defensive states that attempt to avoid and prevent the exposure of the shameful self. The secure base that the therapist is trying to create proves to be very fragile and transient because the client often believes that such security is based on the fact the therapist or attachment figure has not yet seen the shameful self. Once this self is exposed, all security is thought to e likely to vanish and the client expects to be rejected and abandoned.

Not only do such clients anticipate that others will see them as being bad, but they see themselves that way. This certainly is likely to be a central factor in the fact that many individuals with histories of abuse and neglect who now manifest various psychological problems are low in measures of reflective functioning and lack insight. These individuals are not likely to reflect on their motives and intensions for their behaviors because they are convinced that such explorations will only lead to evidence of being worthless.

This suggest two core reasons why shame is such a central factor in both the development of psychopathology and in the resistance to treatment. First, shame places one in a fog, hidden from potentially significant others, actively avoiding the exposure to another who could provide through intersubjective experiences of acceptance, understanding, and empathy-a pathway toward both affective regulation as well as self-awareness. Second, shame prevents the development of the ability to reflect on, understand, and make sense of one’s behaviors and subjective experiences. This reduces the ability to develop a coherent and continuous narrative that includes attachments as well as affective meaning and purpose to one’s life.

To protect the members of the family against shame the therapist needs to remind all of them in word and deed that the dialogue being sought is the expression of subjective experience, not any effort to prove that something is objectively present. The child may say that she feels that her mother is being unfair to her. This does not mean that the mother is being objectively unfair. Rather than entering a debate as to whether or not mom is unfair, the therapist makes it clear that what is most important is helping the girl to understand and experience empathy for her experience that her mother is unfair. Questions regarding what that feels like, how she manages those feelings, why, if she is correct, her mother would treat her unfairly, will be at the forefront of their attention, not efforts to resolve a behavioral conflict. Once these underlying thoughts and feelings are coregulated and clarifies, the therapist is able to facilitate a dialogue about the deeper meaning of the conflict or the symptom. Within such an intersubjective exploration, new meaning is being cocreated. Often then therapist will ask the child to say to the parent a statement such as “mom, sometimes when you say no to me it seems that you are being unfair to me. Then I don’t feel close to you, and I don’t like it when that happens.” Such comments are made within an expression of vulnerability. Conveying an experience without blaming anyone and are likely to be responded to with understanding and empathy rather than defensive justifications.

Often both parents and children attempt to avoid the experience of shame through defensiveness or feigned indifference to a dialogue. When expressions of shame finally emerge, this represents an opportunity for a therapeutic transformation of the person who is now vulnerable to the experience of shame and receptive to empathy and comfort. Often the opportunity is lost when the attachment figure or the therapist quickly responds to a person who says that he is worthless by reassuring him: “youre not worthless, you just made a mistake!” such reassurance covers over the emerging sense of shame so that it is unlikely to become integrated into the narrative. The message to the person who is finally finding the courage to acknowledge to self and others that he experiences himself as being worthless is not being met with an accepting, intersubjective matrix. Rather he is left thinking that other does not understand how he experiences himself, does not want to be exposed to that disgusting trait, is lying about her experience of him, or is not strong enough to experience the shame with him.

Expressing empathy for a child’s state of shame is more likely to reduce his experience of shame than will reassurance. The therapist, or parent, might say: oh john! When you do something wrong you often think it is because you are bad! Now I understand better what makes it so hard for you when you do something that you should not do. Wow! No wonder why you tend to get angry when we talk about your behavior that gets you into trouble. To you it is a sign that you are bad!

Are there times when you do something wrong when you don’t feel that you are bad?

Have you felt that about yourself for a long time? Do you recall the first time that you thought that you were bad when you did something wrong?

How do you manage that feeling of being bad?

Do you think that others see you as bad? Is there anyone who does not see you as bad? Why do you think that person does not do so?

It is intersubjectively-not a lecture or reason that will facilitate a new exploration of the child’s narrative.

It is crucial to remember that there will be room for realistic guilt and motivation for corrective behavioral change only when the states of shame are diminished.

The affective state of shame needs to be accepted before the individual is receptive to exploring its origins, affective/cognitive associations, and alternative ways of experiencing an event. Later, her father refused to participate in the treatment, and did not remain active in Melinda’s life. Rather than moving into heightened shame over this, Melinda was able to express her anger and then sadness about her father’s decisions. Denise again conveyed empathy for her daughter without expressing range at her ex-husband, which would have impaired Melinda’s ability to organize her own experience of her relationship with her father.

When shame becomes exposed and expressed and is responded to with empathy, the resulting intersubjective experience is often transforming. The sense of self deepens and becomes more coherent as an aspect of the past begins to be welcomes into the narrative. A new meaning of an event is now being cocreated. Without the barrier of shame, the event can be integrated into the self. If guilt is present, it further motivates that person to repair the relationship with the other. The attachment security is enhanced, and the self is transformed. Conflicts that have existed within the family for months, if not years, are now amenable to repair.

Chapter 8: Breaks and repair (12)

Interactive Repair

I’m suggesting that discipline does not have to exclude empathy. Indeed, empathy can make discipline more effective. The homework rule does not mean that you are indifferent to her feelings. You do feel sad with her when she is sad! So, you are showing that the homework rule must be important since you are sensitive to her distress and feel sad with her when she is in it-regardless of the reason.”

In this example, the therapist might also have focused longer on her relationship with the mother, if the mother continued to express a defensive response. That would suggest that the mother was feeling shame over the possibility that the therapist was suggesting that she might respond differently with her daughter. This might then lead to an exploration of the mother’s difficulty whenever anyone including her children-questions her decisions. Such a pattern would suggest that the therapist needed to gently explore connections between her response-not expressing empathy for her daughter’s distress-and her own attachment history.

The break-repair sequence is often an excellent means of exploring and understanding underlying thoughts, feelings, and intentions that are eliciting reactive or defensive behaviors on the part of either parent or child. Breaks may represent states of underlying fear or shame. Difficulties with repair may represent patterns that greatly impede the family’s ability to explore and resolve conflicts while maintaining a sense of safety necessary for intersubjective discoveries and mastery.

Turning to father, I can see it is hard for you now, listening to what your son is telling me. would it be OK for me to continue to better understand your son’s experience now and then try to understand what is hard about this for you? Thanks.

General guides for the therapist in initiating repair within the session:

The therapist notes the nonverbal (or verbal) expression that suggests a break and then accepts it and acknowledges it nonverbally. The break may then dissipate if the person becomes aware that his or her nonverbal communication was recognized and accepted by the therapist.

The therapist notes the nonverbal expression and then verbally explores it with PACE.

If PACE is not sufficient, the therapist might then clearly communicate her thoughts and intentions behind her actions and elicit a response to this information, again with PACE.

The therapist acknowledges that the break is continuing, and she invites explorations about ways that the break might lead to a resolutions or she explores the possible implications if a resolution is not possible. She accepts the break; no one need be right or wrong.

At any step the therapist may express sorrow that the client is in distress over something that she said or did. If she thinks that her actions did represent a mistake on her part, she will apologize for her actions.

Breaks as a natural part of the attachment/intersubjectivity sequence

These moments of lapses in intersubjectivity may be called “breaks” rather than “resistance”. The interactions following each break may be referred to as repair rather than working with resistance.

When playfulness is appropriate, the stress that caused the break is often winked and smiled at and a return to the dialogue frequently follows naturally. Through acceptance, the therapist is conveying the stance that no one is to blame for the break. The break is not wrong. Through curiosity, the therapist is conveying a desire to understand the reasons for the break. Without any evaluation of the reasons. When the break is caused by the distress that was inherent in that part of the dialogue, empathy naturally follows.

Some common reasons for these breaks during the treatment:

Breaks are natural phases of intersubjective processes.

Breaks are likely to be more common when the attuned affect is more intense.

Breaks are likely to be more common when the attuned affect involves affective states that are more difficult to integrate.

Breaks are likely to be more common when the demands on attention span related to a given topic increase.

Breaks are likely to be more common when the topic is difficult to integrate into the narrative of one or more of those engaged intersubjectively.

Breaks are likely to be more common when the intentions of the participants are ambiguous or ambivalent.

Breaks are likely to be more common when the intersubjective history of one of those engaged is restricted in terms of affective states, memories, and readiness to enter intersubjective states.

Children require more breaks

It is crucial in family work to t=remember that children generally need more breaks from intersubjectively than do adults.

Throughout the family sessions, becomes somewhat distant or distracted, it is wise to simply accept that response, possibly explore something else that is lighter, and then casually go back to the original theme. The child’s behavior as meaning that he or she is not working hard enough or changing the topic to avoid (the theme) or distracting whenever it gets hard is likely to be counterproductive. What the parents or therapist is likely to accomplish through such a statement is an increase in the child’s shame, fear, or resentment.

The child quickly learns that he or she will not be trapped in discussions of conflict or shame. There is no need to guard against such discussions because when they become stressful, the child knows that if she or she disengages from the discussion, this will be accepted and understood.

The therapist conveys acceptance for. Break is a variety of ways:

She might choose to change the topic to a less stressful theme. In changing g the subject of their attention, she will also be changing the vitality affect so. That it is more congruent with the child’s change in vitality. Often the child will quickly join in this new intersubjective dialogue or a related one. As this topic winds down and there is a natural pause, the therapist then can casually return to the original dialogue, possibly with an unfinished question. Frequently the child will then rejoin that discussion without resistance.

The therapist may also continue discussing the original theme, but directing the discussion to the parent alone, communicating implicitly that the child is not being asked to reply or even listen if he or she chooses not to do so. Again, the therapist changes her vitality affect to match the change in the child’s vitality affect. Frequently, when the child is given the opportunity to be an observer of the dialogue rather than a participant, he or she is likely to rejoin when ready to do so.

When the theme continues to be discussed, with the child being an observer, the therapist may choose to speak about the child to the parents, implicitly communicating that the child need not respond. The gives the therapist an opportunity to communicate understanding and empathy for the child to the parents. The child hears the dialogue and is free to agree or disagree as he or she chooses. The therapist is also able to communicate empathy for how hard the exploration of the theme is and how strong the child is to be able to participate in the dialogue when it is so stressful. Such comments will help the child to feel accepted when he takes a break, and it will help the parent to accept her child when he takes a break.

While the therapist is speaking about the child to the parents, she may also choose to facilitate mor engagement by the child is the dialogue, without asking for the full engagement that would be created by asking the child to directly participate. She may do this by speaking for the child to the parents. At other times, the therapist speaks for the child because the child is nt able to name the unclear, possibly disruptive, experiences of his or her inner life. In this instance the therapist’s intention is to gradually bring the child back into the dialogue. The child may have the words already but is not ready to join the dialogue. When speaking for the child, the therapist uses the first person, often with the child’s own words and intonations.

Finally, silence is another way to convey acceptance while the child takes a break from the discussion. In a family session, more so than individual treatment, silence is likely to have to be brief. It serves to acknowledge the value in catching my breath as well as reflecting on what was just discovered or experienced. The therapist needs to insure that all present are accepting the need for and value of silence or it may be experienced as conveying a pressure to speak and irritation with the family member’s withdrawal from the intersubjective experience. In many nonverbal ways of communication, acceptance might exist in name only because there are nonverbal expressions of dissatisfaction with what is occurring. This then changes the entire meaning of the silence, of the break in dialogue, and of the intentions of those present. When this occurs at least one of those present will be likely to feel judged by the others, and be at risk to enter inti shame, defensiveness, and anger.

If the client senses that the therapist accepts and understands his or her withdrawal from exploring a traumatic or shameful theme, he or she is more likely to remain engaged with the therapist if she goes deeper into the withdrawal to understand its presence and strength: I can really see how much you’d rather not talk about this. You really, really don’t want me to bring this up…what do you think, makes this hard for you to discuss?

One effective way to lead the child into dialogue rather than react to his or her demands is to match the vitality of the child’s affective expression, with the same rhythm and general contour of the expression. Such matching conveys empathy for how much the child wants something to happen and how worried or angry he or she is likely to feel if a request is turned down. In matching the vitality of the expression, the therapist may be able to catch the child’s attention and direct it toward the reason why he or she would be very upset if a request is denied.

Other family members are likely to be ready to interpret the break as being due to an unwillingness to try, pervasive anger, rejection, their own failure, or the failure of the treatment. Words such as
“that’s just how he is at home too! This is a waste of our time!” are about to descend over those present and color the session, the course of treatment, and the meaning of the family relationships.

The therapist, in contrast, begins to color the break with the same attitude of PACE that she brought to the fully engaged “moments of meeting” in the intersubjective matrix. She has a variety of options, often expressed in the following order:

She might begin by inviting the child back into the dialogue. She could stay: Robert, I’ve been wondering if what we have just been saying makes my sense to you. “

If the child refuses the invitation, she could acknowledge the refusal and address it with the same attitude:

Thanks for letting me know that you don’t want to say now what you think about what you were saying. Would you be willing to help me understand what makes you not want to talk about it now? I worry that your parents or I may have said something that bothered you, but I’m not sure what. Would you tell me why you don’t want to talk now?

If the child refuses to discuss his motives for not talking she might guess that motives with the same attitude, to determine if the child will speak if he is given some help getting started or finding the right words:

Susan, I think that your son, Robert, might be telling us that this discussion has gotten hard, and he might want to set it aside today. Or he might not trust that will really understand what was going on with him and we might just criticize him, as if we are trying to make him feel awful. If that’s what he is thinking, I can sure understand why he doesn’t want to talk anymore about it. Is that about right, Robert?

The therapist might skip that final question, and even some of the guesses about Robert’s motives. She might go directly to accepting the decision, giving empathy for whatever motives are behind it:

Susan, I think we need to listen to Robert now. He is saying that he doesn’t want to walk about the conflict yesterday anymore in this session. I’m not sure why, but I know that he is clear in his mind and let’s accept this decision.

The therapist and parent may continue to explore the theme without any efforts to reengage Robert. The therapist insures that any future discussion does not contain negative guesses about the child’s motives. The therapist also insures that the discussion does not then lead into other examples of the problem. Which would only prove to the child that his withdrawal from the dialogue was the right decision.

The therapist might change the focus to another area of discussion, generally one that is characterized by little or no apparent shame or fear for the person who withdrew from the dialogue. The child will then be more likely to reengage. If he does not, and there was no expectation that he do so, the session is more likely to end without failure being given to the meaning of the session.

Adults need breaks, too

The parent may initiate a break from the intersubjective process for reasons like those of her child. Family treatment asks parents to expose themselves to areas of potential shame and fear that are often likely to be very difficult to explore. They are being asked to become vulnerable and to express their own experience while at the same time maintaining attachment security for their children.

The following reasons represent the therapist’s own break patterns that require her awareness.

Personal events outside of the treatment sessions are compromising the therapist’s affective states, attention, and strength of intention throughout the session.

A given topic, affective state, or motivation manifested by a family member is difficult for the therapist to respond to with acceptance, curiosity, and empathy.

The therapist is not able to identify with the narrative of the parent or child, due to an overidentification with the narrative of the other.

The therapist is reluctant to address breaks of members of the family out of anxiety over the conflict, disapproval, or the distress to self or other that might follow.

The therapist is not able to accept that she will make mistakes or be mis attuned. Rather than respond with simple awareness or realistic guilt to these situations, she reacts with shame.

The above break patterns especially 2-5 are alikely to relate to features of the therspist’s own attachment history that have not been resolved and integrated into her narrative. When the therapist is not able to address and resolve them through self-refletion, it is likely that resolution will require that the therapist participate in similar intersubjective experiences to those that are described in this work. These experiences may involve the therapist exploring these patterns of breaks with her own attachment figures, her supervisor, or her therapist. Her goal is to be able to respond with a acceptance, curiosity, and empathy to whatever emerges intersubjectively within the treatment session. she may require similar intersubjective experiences with her own attachment figures to attain such a goal.

By accepting these breaks, the therapist is not avoiding them. In fact, she may often address the reasons for the breaks. She makes the reasons explicit so that their meaning may be understood and the affective states associated with them may be regulated. By addressing the breaks with acceptance, curiosity, and empathy, she is making it clear thar the breaks themselves need not be avoided. The client is never going to be trapped withing intersubjectivity.

In family treatment breaks are presented not as failures but as natural and important parts of all attachment relationships. If they are avoided, the attachment becomes limited and increasingly formal and rigid. If they are not avoided but also not repaired, they are likely to create dysregulating anger, fear, hopelessness, or shame. Members then relate with each other in either an inhibited and cautious \way or a volatile and impulsive way. Either way, many unrepaired experiences become excluded from intersubjective engagement.

Chapter 9: Exploring and resolving childhood trauma ()

The principles of basic safety and then safe exploration through intersubjectivity prove to be an excellent context from which to approach and resolve trauma.

When the child has experienced trauma, this can be addressed in the family sessions so long as he is able to experience safety through the presence of his parents. If his parents were the source of the trauma, then it is crucial for the parents to have resolved the factors that led to them traumatizing their child to accept full responsibility for their acts and to be committed and able to not traumatize their child again.

Within intrafamilial trauma (various acts of abuse and neglect):

Safety is destroyed and developmental patterns become disorganized.

Intersubjective explorations are reduced and avoided.

The self is an object to the other, not an intersubjective partner.

Traumatic events are not explored and experienced in an integrative, coherent, intersubjective manner. They are not assimilated into the autobiographical narrative.

Traumatic events create dissociation, as do subsequent memories of such events, causing rigid avoidance or the risk of traumatization.

There is danger that processing of the trauma might be retraumatizing itself. There is also the danger thar waiting for the child to initiate the exploration of the trauma will result in the trauma never being explored. The therapeutic window within which the awareness of the trauma is very small for some clients. Treatment guidelines have therefore been developed to enable the treatment of such complex traumas to facilitate integration and resolution while not retraumatizing the client. These guidelines have 6 components: safety, self-regulation, self-reflection, traumatic experience integration, relational engagement, and positive affect enhancement.

Stages of trauma resolution:

The therapist and other adults present need to serve as the source of attachment security. The key factors in attachment security, being available, sensitive, responsive, and committed to relationship repair, must be consistently present during the treatment sessions. The therapist must not assume that if she demonstrates these traits that her client will experience them as well. Her expressions to facilitate safety may either go unnoticed, be misinterpreted, or in themselves generate anxiety. Signs of caring and interest will not necessarily create a sense of safety.

The therapist initially focuses on light, neutral, and positive themes and notices whether the exploration of these themes generate an intersubjective experience with its matched affect, joint awareness, and complimentary intentions. If it does, she makes her experience very clear to reduce the anxiety that comes from ambiguity. She develops a reciprocal, positive affective experience. If it does not develop, she accepts the response, repairs any relationship break, and invites a new intersubjective experience. She is persistent; her message bring that she will not be impatient, she will not give up.

As pockets of safety begin to emerge, she attempts to deepen and broaden them by moving into mildly stressful themes and then facilitating an intersubjective exploration of them as well. Increasingly she finds success in the discovery of qualities of self in the child or adult that have been hidden and are probably unknown. These qualities include courage, honestly, resilience, strength, being a person of worth, and a person committed to a life better than what he or she has known. Within these experiences of primary intersubjectivity, the child begins to experience herself tentatively in positive ways. These experiences also generate an additional sense of safety. She also begins to experience the therapist as a person who truly is interested in her well beings, who has confidence in her abilities to improve her life, who values and is committed to her. More and more in the session, the rhythm and momentum of a/r dialogue is occurring and generating a reciprocal, experiential, positive, and hopeful state.

Once primary intersubjectivity is established, the child is more likely now to become engaged with the therapist in experiences of secondary intersubjectivity. The child is now becoming open to allowing the impact on the therapist of the past events now being explored to have a similar impact on her. She is receptive to beginning to recognize her experiences of past events, based on the therapist’s experience of them in the present. Once the therapist notices that this is occurring, she turns her attention to the past traumatic events as well.

Through secondary intersubjectivity the child is beginning to again experience the traumatic events of the past through the experience of them that the therapist has. She is much safer in doing so, being able to coregulate the affect associated with the event based on the therapist’s affective response to it. The therapist did not experience the terror and shame that the child originally did when exposed to the event. The child is now approaching the event from the safety of the therapist’s affective response to it.

With the associated affect no longer consisting in dysregulating shame and terror, the child can reexperience the event, combining her experience and the therapist’s experience-two perspectives- and so cocreating new meaning of the event. It is not enough that she experiences the therapist’s experience of the event. She must herself, reexperience that past event now in the present, being influenced by the therapist’s experience of it.

As the child is now fully creating the meaning of the event, affectively and reflectively, she can begin to assimilate the event into her autobiographical narrative. The child had dissociated from the original traumatic event so that it had not entered the flow of her subjective experience. She is now sufficiently able to organize the experience of the event so that it is able to enter the narrative.

As the event is being assimilated, it can be impacted by and impact in turn, other events in the narrative. She is now in position to develop a coherent narrative in which certain events no longer remain rigidly isolated from other aspects of the narrative.

The coregulation of basic neurological and physiological states also involves the coregulation of affect. When the infant and parent are engaged in an affective/bodily rhythm, the internal state of the infant is becoming able to inhibit responses and regulate its level of affect. Within these states of affect attunement, the infant’s neurological development becomes organized and develops the ability to begin to autoregulate these states.

As the infant develops so too us her brain developing. Safety and regulation are primary concerns of first the amygdala, and shortly thereafter the anterior cingulate, and by 8 to 10 months of age, the prefrontal context. As the brain is developing during the first year of life and beyond, it is increasingly able to insure safety and regulation through increasingly subtle discriminations and resonance between the organism and the environment, enabling more flexible responses to specific environmental variations.

These reciprocal and attuned interactions-the original intersubjective experiences- facilitate the development of the prefrontal cortex, which, in turn, is necessary for the development of these skills.

Dyadic communications that generate intense positive affect represent a growth-promoting environment for the prefrontal cortex…orbital prefrontal areas are critically and directly in attachment functions. This cortical area plays an essential role in the processing of social signals and in the pleasurable qualities of social interaction. Attachment experiences (face to face transactions between caregiver and infant) directly influence the imprinting or circuit wiring of this system.

The prefrontal cortex provides a depth and breadth of integrative and meaning-making abilities that the amygdala and anterior cingulate lack. It is both the most dyadic and the most integrative structure of the brain. The prefrontal cortex blends cognitive, affective, and bodily awareness. It incorporates past knowledge from both implicit and explicit memories and utilizes this knowledge in working to understand the meaning of the present. It brings the reflective skills of the cortex to identify, regulate, and express the affective states that the infant is experiencing. It brings the overall integrative skills-affect, cognition, and body sensation- and enables the infant and young child to begin to make sense of the mother’s congruent, contingent communications.

It is important to note that much of the social and affective developments that compromise the sense of self are centered in the right hemisphere of the brain, including that part of the prefrontal cortex lying within the right hemisphere.

The essential biological purpose of intersubjective communications in all human interactions, including those embedded in the psychobiological core of the therapeutic alliance, is the regulation of right-brain/mind/body states.