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The World In A Grain Of Sand, Moments of Meeting In Psychotherapy

Daniel Stern Conference
November 6, 2004
Trinity College, University of Toronto
Lecture Notes by Leah Lucas

On Saturday November 6, at least thirty of the CTP contingent was present in an audience of possibly three hundred or at least a fully packed auditorium. Faculty, graduates and students spent an inspiring day listening to Daniel Stern speak of his latest thinking around psychotherapy as focusing primarily on the intersubjective, the Now moments that reveal so much in sometimes dramatic but often mundane ways. What follows are my twelve pages of notes from his lecture. Those of you, who may end up listening to the audiotape, please excuse my inconsistencies and possible distortions. What I hope to convey is the essence of his thinking in an understandable and accessible manner. He was certainly extremely clear and lucid in his lecture.

As a small child Daniel Stern spent time in hospital with only a Czech nurse for companionship. In those days parents were not allowed to spend much time visiting their sick children. Because Daniel did not speak Czech he became adapt at discerning her meanings through the sound and tones of voice along with feeling, expression and gesture. This developed ability heightened his interest and sensitivity to observing babies and young children. The way he sees the field of clinical psychology and metapsychology is moving into observation of the Now. What do we mean by Now? Here and now is where all the action is. Intersubjectivity takes a very large place in all of this, the clinical aspect of looking at the world in this way. Emphasis is placed upon the non-verbal and the implicit. In the last decade there has been an enormous pendulum shift around nature and nurture in many other fields besides psychology. Identity is being reconsidered as social issues. The self and consciousness being thought of as a social attribute learned by how you are seen in other people's eyes. The movement is towards a social construction of human experience, from individual to social, interpersonal. In psychodynamic psychotherapy what you really want to know is what was in the client's head before coming to see you. The current view is the interplay between two intersubjectivities that come into play as never seen before until they come together. The products of that play are what should be talked about. What is in their minds is not objectively there and you can never see it objectively. There can never be an objective stance. You can't act as if it truly exists in their mind. It is not an unveiling; it is a co-creation of now. It is a different world conceptually. How many in this audience are relational types and how many are traditional? Stern's idea is to lay out the landscape as it is changing. Phylogenesis has given way to ontogenesis. The main tenets of the traditional psychoanalytic position is the idea that in all of us exists primal unconscious fantasies that determine everything that happens to us. The end point is in man's prehistory. Freud's first theory was that the patient got traumatized as a child. The trauma got fixated; regression and replaying resulted in the early origins of pathology. We use unconscious fantasy without thinking of them.

The baby is less interested in eating when satiated and more interested in playing, he wants to solicit socializing from the mother. Who is the conductor, mother or baby? A feeding is an extraordinary period of choreography between two people. Oral gratification is minor to the baby learning different ways of being with the mother. Psychosexual stages look different when seen in a finer light. The lessons have to do with ways of being with one another and how people regulate each other. One may observe how lovers regulate each other and this keeps both engaged. At ten months, the only thing the baby is good at is face-to-face contact; voice is the most interesting auditory sound. It is the sound and light show! Adults cannot look another person in the eye for more than seven seconds without talking; only people falling in love can hold a longer mutual gaze. A baby cannot really get high with joy alone, he learns it with the mother. Pleasurable excitement is with other people. This has an impact on sexual pleasure, what one can tolerate without turning away. Some babies will get tired or fall asleep to get away from intolerable levels of excitement. The ability to tolerate joy can show up in creative blocks. One can start to get a rush, an avalanche of ideas that is frightening. Tolerating such a high level of overexcitement can be unbearable so it gets turned off.

Between mother and baby there is mutual dance, who is falling ahead or behind the beat? Mother throws in enough strength and stimulation to make it a joyous, pleasurable experience. The baby has to acclimate when it might fall. Laughter is a success, not a failed interaction. The child learns ways of being with someone in the first few years of life. There is not much to see that one can count on objectively. Infantile sexuality is not a true theory where psychic energy is fixed in a certain regression. There are not psychosexual stages where psychic energy gets accumulated. What can you replace it with? Something more simple; patterns of being with people. Culture is then added to this. Fantasy comes second. Being with people comes first. For practicing psychodynamic theories metaphors can be therapeutically active. The contents of fantasy are a later acquisition. The mind works in a much more mysterious way.

Where are we going to find the origins of neurosis and character disorders? In the social constructions of the mind, emphasis is no longer on the intrapsychic but on the interpersonal. The human mind is created thanks to the traffic it has with other minds. We need that circulation and flow to develop the mind. We need interaction with other people to maintain the mind, desires, affects, thoughts and intensities. The mind is seen as embodied. You can't think unless you have a body. Movement comes first. Consciousness doesn't exist without a body. The basis of language is movement; the primary metaphor. Bodily known experience is in the vertical dimension. Speech uses basic ways we see the world. Love is spoken of as a journey, "we took different paths, we went as far as we could go." With movement the visual parts of the cerebral cortex are stimulated. Baby needs the breast and the presence of the mother. His first experience of the breast is not visual. You don't have a mind unless there is a body. Relationships are felt as some kind of space. "I had to break away, it was too suffocating. I had to put some distance between us." These are active metaphors of an embodied mind. In observing babies the bias is for short, small things that happen. These small moments are the most basic of human interaction. The foundational level are small events between people, fantasies are the abstract layer.

What do we mean by the Now part? Intersubjectivity is the sharing lived experience between two minds; "I know that you know, that I know what you mean...etc." If you can't have intersubjectivity, you can't have empathy. There needs to be a mental overlap between two people. Mind to mind exchange is necessary to maintain and develop the mind. Philosophers are way ahead of psychotherapy in recognizing this as part of the human condition. Mind must be open to other minds and cannot start from zero in constructing a mind. Part of the pendulum shift is towards the social. The baby's existence is living in an intersubjective matrix, surrounded by other's desires, affects; tensions, which help construct his mind, yet in a totally unique way. We now have a psychobiological basis for intersubjectivity, motor neurons fire in the brain as if you are doing what the other person you are observing does. This means you unconsciously participate in the other's experience. This is the whole basis for identification; resonance makes neuronal sense. When we operate with voice which is made by voluntary muscles the other person hearing the voice has a virtual idea of what it is like to be the other. This permits empathy. Humans have adaptive oscillators. Most parts of the infant have little clocks that time themselves synchronisticaly with the outside and can be set back to zero. Adults are more complicated and adapt to each other. If a man and a woman meet and fall in love they will sync into each other; know the direction and timing of the other, the vibrations of being together, synchronise movement with the other. Lovers are always in tune with one another. Newborn babies will imitate the mother. It sees a proprioceptive motor pattern so can transfer from one modality to another. Babies at seven months will triangulate objects with another, pointing, interintionality, sharing the same focus. The two have the same thing in mind. Affective attunement is not what you see but what it felt like to be who you are and do what you did. The mother knows how to match baby's affect, feeling, overlap of internal state. Do we do this as therapist? It is a fascinating business of intentions. We read other people's intentions, know what the other person has in mind to do. Who, what, when, where, why and how is in the first sentence to hold the interest of the other. Babies are pre-wired to look for other people's intentions; they give primacy to the intention behind the action. Nothing is interesting unless there is intentionality, the more cognitive view of a wish. Survival depends upon knowing the intention. Motives are the primary units of the universe. The work is to co-construct the narrative as to how you became who you are and what you do. Effort is one of the most evident aspects we can resonate with. This gives a neurological basis for what we already intuitively know, making it neuronly real. The acquisition of language requires pattern recognition and intersubjectivity. It is a motivator, we have something to talk about.

What really happens when you watch children ages three to six play? They play at making secrets, tricking each other, lying, teasing, mucking up. You can't lie unless you have an idea of what is in the other person's head. Learning how to lie, cheat and trick is a high form of intersubjective accomplishment. What we see clinically in autistic children is an intersubjective failure. What is good imitation? Normal children act from the other person's sense of action. Autistic children act from their own sense of action. Personality disorders can't act from other persons centers, only their own which is a failure to connect. Connection is always there, you can't inhibit it from happening.

What is the Now in the Here and Now? That is where all these things are going on. You have to see the Now as the only time you are directly alive. Memory is occurring now, anticipation of future occurs now. You can't escape it since it is the only place we are. How long is it and how do we conceptualize it? Chronos - time, is always moving, it eats up the future and leaves the past in its wake. Kairos is different, it is a small piece of time, we come together right now, a window of opportunity opens to change your destiny. Heidegger thought the present moment has to be longer so that something can happen. He wants to give it a bigger duration. There is a past and future of the present moment all happening now. A phrase of music must be heard, a gestalt in an enduring present moment, in the middle of the phrase notes like the trail of a comet are still there. The way it is supposed to end are the implications of the first five notes, going from the horizon of the past to the horizon of the future. This is an entity. How long is now? It lasts between one and ten seconds, with an average duration of four seconds. The average musical score is two to four seconds, group steps into four; four times seven equals four seconds. In that time some gestalt unfolds and gets finished. One can break down human behaviour in the short periods of now. It depends upon some kind of intention fulfilling its fate; going somewhere in a melodic sense, there is a rest point before the next phase starts. A profile of emotionality and excitement is changing rapidly and in small ways. It is a profile of feeling form with shifts and tensions, affective shifts and excitations. Now has an architecture moving to an end point with shifting internal states of feeling. There are millions of stimuli coming to us all the time. We have to cut them up into assimilatable units, this cuts up the world. Memory is not just a library in your head. There are no real faithful volumes of what happens. The present moment puts conditions on what happens. The smallest unit of time is the crucial one between people. In meditative states one can lose oneself. These little moments are replaying larger themes that the mind grapples with all the time. Moral dilemmas are expressed in the present moment, a microworld of some kind.

How does psychotherapy change people? What emerges is a co-creation between analyst and patient; there is something unknown about the process. It is a variation of complex theory, so many variables change so rapidly. One can never predict what will happen next, never know what the patient will say. You don't even know what you will say until you say it. All is unpredictable in terms of timing. We see an emergent property where something gets co-created out of this mess. Unexpected new things change the state of the whole system. Babies don't talk yet they know so much about what to do interpersonally. It is a different form of the implicitly known, in contrast to explicit, verbal knowledge, it is no longer seen as impoverished. This is tough to put into words, how galaxies of little intuitions in a rare state create a marvelous, beautiful mess. Clear ideas do not exist.

We could talk about what really happened in the course of a therapy. But the main goal is to establish and negotiate the intersubjective state between therapist and client. Hours can be spent talking about a ten second moment of time. Everything that is psychic is the basis of our communicative stuff; the relational move, intention to influence the intersubjective state, where is it at right now between you and me. On either side, are you really listening to me? I'm not ready, don't do anything now, have you lost hope in me? Most of these things are transmitted intuitively without having to be asked. Anxiety arises out of a disordered intersubjectivity, one then had to do things to know where things are. Things have to unfurl in a treatment situation, moving along with no precise step or end point. Because of such imprecision and unpredictability it has to emerge out of moving together, the advantage is in the way the therapist handles this. Moving along is accumulating its own force to allow it to emerge in its own way. The examples can be shockingly banal, average stupid stuff that we do all the time. There needs to be a mutual acceptance of where they are at, not pushing it, the established territory where both know implicit rules of the game. The patient takes one step forward reconfirming, not closing down further. He can be in an unstable state, but can't stay that way too long, it is too anxious. Emphasis is not on content but on intersubjective negotiation. There is a lot of unpredictability.

Therapy is a sloppy process. It is a mess, it is fuzzy. A lot of the time is spent correcting and reconnecting, putting the rupture back together and coping. Errors are invaluable, a fruitful part of the co-creating process. We are making errors all the time. One of the practical applications of sloppiness is one becomes more tolerant of one's errors. A now moment can get highly lit up, emotionally charged and suddenly everything hangs in the balance. Nothing else is happening except the present moment, these are extreme now moments. The therapist is completely thrown off his horse and doesn't know what to do, anxiety rises. Most run and hide in technique, say something inadequate to cut the tension. You can't pretend there isn't a specific situation at hand. Such a now moment perturbs the intersubjective state. There needs to be a resolution, it will determine the outcome. The most successful will be a moment of meeting. The need is to bypass technique and go into something truly authentic. There needs to be a free moving along, it is not about power. Moments of meeting can change people. Making the unconscious conscious doesn't help people. The only thing that helps is working through the nature of their relationship with the therapist. A moment of meeting kicks the intersubjective to another level. There are many mini moments in the now. The relationship is progressively changing in small jumps. Movement is primary, words are secondary. It is a very special micro voyage where two people take the same emotional trip together. It can be shown in a physical act, it can be through voice, a vocal tone. These moments can change our lives.

Real cure occurs in working through the transference. Interpretive work is the excuse and the vehicle for changing the relationship between therapist and patient. The vocal chords are voluntary muscles. Children don't learn to speak until eighteen months so that the child can first learn how to relate non-verbally. The micromoment of intersubjectivity is invaluable. We have grossly underestimated the non-verbal, the implicit, different vocal tonality, rhythm, it is now or never. The clinical utility of all this doesn't tell you how to do things differently. But you do become much more tolerant of the sloppiness in the process. Mistakes don't have to be corrected. You get better at trying to reach into your own authenticity. It is what we need in order to get things to happen between people. We learn to tolerate that we don't know every step of the dance.

Compiled by Leah Lucas November 6, 2004