Alexandra M. Harrison

Explicating the implicit: the local level and the microprocess of change in the analytic situation.

This paper proposes a method of examining the micro‐events of the analytic process that borrows heavily from developmental research. The increasing importance of illuminating the microprocess of interaction to understanding the process of change in analytic treatment is emphasised. A set of constructs and terminology is proposed for the study of the moment‐to‐moment interactive process in psychoanalytic therapy referred to as the local level. A theory of therapeutic action based on ‘local‐level’ process is then explicated. Its central element involves a step‐by‐step process of ‘fitting together’, which leads to changes in implicit knowing through alteration of emotional procedures.

“The Noise Monitor” A Developmental Perspective on Verbal and Nonverbal Meaning-Making in Psychoanalysis

This paper discusses a contribution of developmental theory to the psychoanalytic concept of “the talking cure.” The developmental theory presented is the dyadic expansion of consciousness model (Tronick 2007), a model consistent with the principles of nonlinear systems theory. The concept of “polysemic bundles” as a way of understanding the multiple simultaneous meaning-making processes occurring in dyadic communication is introduced. The theoretical discussion—focused primarily on the analysis of children—is illustrated with descriptions of videotaped sequences from the first session in the analysis of a five–year-old boy. The relevance of these insights to the analytic treatment of adults is then considered.

Herding the animals into the barn: a parent consultation model.

Initial assessments of children with psychological problems are important both to develop appropriate diagnoses and to provide the basis for productive discussions with parents on treatment alternatives. This paper develops an assessment method referred to as the Parent Consultation Model (PCM) that emphasizes the use of videotape micro-analysis and developmental theory to provide critical information to parents as well as to the clinician in this important initial stage. The paper provides a description of the PCM and an expanded example of the use of the PCM, including illustrations of how these methods can be used to organize information and engage parents in the initial consultation. The paper concludes with some observations on the role of new techniques and ideas in psychotherapy and psychoanalysis.

Change in psychoanalysis: Getting from A to B

The change that occurred during an analytic hour with a seven-year-old girl is explored by means of videotape observation and aspects of developmental theory drawn from the field of infant research. Detailed review of the videotape and transcript of twelve minutes of the analytic hour revealed significant change in the girls attitude toward the loss represented by a cancelled session. The moment-to-moment process between two points, A and B—identified as representing the beginning and end of the change in the girls ability to deal with loss in the analytic relationship—is studied and described in two forms: written transcript for the verbal material, and narrative description for the nonverbal material. The methodology is based on observed behaviors but also relies on the clinical experience of the analyst in the interpretation of affects and the recognition of intentions in both participants. The results suggest that, taken as a whole, many such small transitional episodes during the course of a treatment play an important role in the process of therapeutic change.

The sandwich model: The ‘music and dance’ of therapeutic action

My premise is that a ‘layered’ approach is necessary to understand the process of exchanges that result in therapeutic change. I imagine these processes occurring in three layers – although the number of domains in which change is taking place is actually infinite – such as in a sandwich. The top layer, or top slice of bread of the sandwich, represents a broad view of the change process; it is non‐linear and includes the feature of uncertainty, a general principle of dynamic systems theory. The middle layer, or the meat of the sandwich, is explained by theories that are immediately and clinically useful to a therapist, such as psychoanalytic theories. These are primarily linear theories and use language and symbols to ‘tell a story of what happened’. The bottom layer, or bottom slice of bread of the sandwich, is the micro‐process; this layer includes the moment‐to‐moment patterns of coordinated rhythms that both communicate meaning and provide the essential scaffold for all higher‐level change processes. The micro‐process also requires a non‐linear theory to make sense of its variability and emergent properties. Taking a bite out of the sandwich will include a ‘polysemic bundle of communicative behaviors’ (Harrison and Tronick, 2011). I will illustrate the ‘sandwich model’ with the clinical case of the analytic treatment of a 5 year‐old boy.

Infancy research, infant mental health, and adult psychotherapy: Mutual influences

This article considers the influence of infant research on psychodynamic theory and practice. Infant research highlights the dramatic effects of the early caregiving relationship on development throughout the life span. It also provides important perspectives on psychotherapeutic processes. This article highlights such elements as empathy, mutual recognition and attachment, along with elaborating the intersubjective and transactional systems perspectives. In addition, it stresses the powerful role of nonverbal, implicit communication and meaning-making, which play a greater role in human relational experience-and therefore in the therapeutic process-than previously understood. In addition to clarifying these general orientations, the article describes specific therapeutic strategies based on the expanded developmental knowledge.

THE CASE OF SOPHIE

ABSTRACT: The analysis of a girl from ages 3 to 5 years old offers a clinical illustration of an alternativetheory of change. In this theory the process of change is organized around nodal points of exchangebetween patient and analyst, designated as “now moments” and “moments of meeting.” In the casepresented, these moments were preceded by an intensification of affect and were accompanied by a senseof openness and ambiguity. As often as not they were nonverbal and sometimes did not even involvesymbolic representation. The process resulted in a progressively expanded repertoire of ways of beingtogether and ways of doing things together. In a parallel and mutually influencing track, the child wastelling me a story that gave meaning to her world, and increased the coherence of her sense of self. RESUMEN: El ana´lisis de una nin˜ade3a5an˜os de edad ofrece una ilustracio´n cli´nica de otra teori´a sobreel cambio. En esta teori´a el proceso de cambio se organiza alrededor de puntos nodales de intercambioentre la paciente y el analista que se designan como “momentos de ahora” y “encuentros momenta´neos.”En el caso presentado, estos “momentos” fueron seguidos de una intensificacio´n del afecto y fueronacompan˜ados por un sentido de apertura y ambigu¨edad. Tan frecuente como nunca antes, fueron “mo-mentos” sin hablar y algunas veces no involucraron representacio´n simbo´lica. El proceso resulto´enunrepertorio progresivamente expandido de maneras de estar juntos y maneras de hacer cosas juntos. Enforma paralela y de influencia mutua, la nin˜a me estaba contando una historia que le dio significado a sumundo e incremento´ la coherencia de su sentido del yo.

Psychodynamic psychotherapy: adults and children.

Psychodynamic psychotherapy is a major therapeutic modality for adults and children. It covers a number of related therapies based on psychoanalytic concepts and models. In this paper, we address new developments in thinking and practice, recent changes relating to teaching, and new findings from research and developmental science. A child case is presented to illustrate the complexity of arriving at a diagnosis and treatment.

“EFFECTIVE VOLUNTEERISM:” HELPING CHILD CAREGIVERS IN DEVELOPING COUNTRIES

This article proposes a method of volunteering mental health consultation to child caregivers in developing countries in the context of episodic visits and a long-term relationship. It is derived from the authors experience doing this work for approximately 12 years. The two foundational features of the method—the role of a consultant and a long-term relationship—are described. The method is then elaborated in two settings: consultation to caregivers in an orphanage in Central America and at a hospital in India. While these examples are distinct in multiple domains, they have in common the core features of the consultative model and a long-term relationship. Finally, the article briefly addresses challenges that the consultant experiences when working with neglected and traumatized children and the usefulness of reflective practice. It is hoped that an articulation of this method may make it possible for many who might wish to volunteer to do so, in a way that neither interferes significantly with their work and family life at home nor creates the problems of “helicopter volunteering.”

“EFFECTIVE VOLUNTEERISM:” HELPING CHILD CAREGIVERS IN DEVELOPING COUNTRIES: Consultation to Child Caregivers

This article proposes a method of volunteering mental health consultation to child caregivers in developing countries in the context of episodic visits and a long-term relationship. It is derived from the authors experience doing this work for approximately 12 years. The two foundational features of the method—the role of a consultant and a long-term relationship—are described. The method is then elaborated in two settings: consultation to caregivers in an orphanage in Central America and at a hospital in India. While these examples are distinct in multiple domains, they have in common the core features of the consultative model and a long-term relationship. Finally, the article briefly addresses challenges that the consultant experiences when working with neglected and traumatized children and the usefulness of reflective practice. It is hoped that an articulation of this method may make it possible for many who might wish to volunteer to do so, in a way that neither interferes significantly with their work and family life at home nor creates the problems of “helicopter volunteering.”