Boston Change Process Study Group Research Articles

A new language for traumatic experience: From dissociation–enactment to the fracturing of embodied wholeness

When viewed from the vantage point of embodiment, the psychoanalytic understanding of traumatic experience is transformed. In this article, a new language is proposed that describes traumatic experience as disturbances in the flow of an individual’s effortless, unconscious focusing on oneself (“I”), the other or others (“you”), on oneself as connected to others (“we”), and on all that involves the nonhuman surround (“world”). From this perspective, developmental and late-onset trauma models are seen as overlapping rather than competing. The authors support their proposal by drawing on self psychology, relational theory, and the Boston Change Process Study Group and offer illustrative clinical material.

Nonverbal moments of meeting – an analysis of three psychodynamic therapy sessions

ABSTRACT The objective of this study was to empirically enrich the so far theoretically elaborated concept of Moments of Meeting (MoM), that enable processes of change in psychotherapies as described by the Boston Change Process Study Group (2018). In order to describe dyadic verbal and nonverbal patterns in those Moments of Meeting on a microanalytic level, a verbal scenic narrative microanalysis (SNMA) and a nonverbal neuropsychological gesture coding system (NEUROGES) were applied in three single psychodynamic therapeutic sessions. The verbal psychoanalytic-hermeneutic selection of moments of meeting via SNMA showed notable connections to significant nonverbal markers especially in terms of synchronic turn-taking of gestures indicating MoM. Results indicate the importance of including the communicative function of resonant nonverbal behaviour as a facilitator for mutual understanding in the psychotherapeutic setting. Furthermore, the potential of ruptures, and their repair in the dialogue, are discussed as precedents for MoM.

Moving Together Along the Spectrum: Toward an Empathic Dialogue with Autistic Children and Their Families

ABSTRACT The role of sensory-motor impairment as a factor in autistic development is increasingly recognized but there remains a dearth of synthetic models that bridge autism’s psychobiological origins in perinatal development with its later manifestation as a disruption to agency, intersubjective engagement, and social interaction. This article expands on the work of Daniel Stern and the Boston Change Process Study Group on the primacy of embodied intersubjectivity in development, applying recent findings on Autism-specific impairments in intentional movement and dynamic vitality form perception to posit an embodied developmental-relational framework for Autism Spectrum Disorders. In this view, deficits in the regulation and timing of movement subsystems dampen inter-personal kinesthetic and affective bodily resonance during early dyadic interactions, reducing the frequency of “moments of meeting” in the first year of life, with “knock on” effects on implicit relational knowing and later cognitive development. In relational terms, autistic infants and adults face challenges with the “intention unfolding process,” in “mutual sensing,” and with “moving through and being moved by” the other in sustained engagement.

Traditions of Understanding in Psychoanalysis

Abstract Psychoanalysts try to facilitate their patients’ grasp and understanding of themselves. Since the mid-19th century, we have two conceptions of understanding. In one tradition, we need to suspect presented pictures and try to get “behind” facades in order to grasp the “true” self. In this tradition we get a hold of ourselves if we look for the origins: we need to see where we come from. In the other tradition we should not try to “tear off the masks”, but start a dialogue with the text or person we try to understand. If we succeed in this, the truth “steps forward”. In this conception we need to move on to goals and positions not yet attained. According to the general view Freud belongs to the first tradition. The author asks how we view understanding in modern psychoanalysis. Through a reading of (1) the Boston Change Process Study Group, (2) Peter Fonagy and Mary Target and (3) Veikko and Riitta Tähkä he concludes that we in psychoanalysis have moved from the first to the second tradition. He discusses what inferences we should draw regarding technique and theory, concentrating on the phenomena and concepts of interpretation and the unconscious.

Now Moments in Psychotherapy and Psychoanalysis and Baby Watching

ABSTRACTNow moments and moments of meeting are concepts derived from careful observation of mother-infant interaction using a theoretical frame that employs implicit knowing and nondeterminate sloppy processing. This dyadically derived construct has been transported and applied to the therapeutic dyad by Daniel Stern and his colleagues at the Boston Change Process Study Group (BCPSG) as a means to understand the something more that complements classically modeled psychoanalytic interpretation in promoting change. Tracking the origin, development and application of this idea opens the concept to scrutiny and will permit testing of its explanatory power, its flaws, and offer direction for future study.

Intersubjektivität in Gruppen – „Wenn ich spüre, dass Du spürst, dass ich spüre …“

Intersubjectivity in groups – “When I feel that you feel that I feel …” Group processes facilitate access to intersubjective perception in individual treatment. In my work with groups, I find the triangular space of the group helpful to better understand the effective and beneficial phenomena of being-in-contact in the psychotherapeutic situation as well as in individual treatment. Through their multiple perspectives, groups also facilitate access to the intersubjective view. Here I would like to show what we can learn from groups with regard to an intersubjective attitude. To this end, the theory of the group matrix (Foulkes, 1964) is sketched on the basis of considerations on intersubjectivity of the Boston Change Process Study Group (Stern et al., 2012) and the intersubjectively colored attitude (Schwaber, 2013). Using the example of an outpatient group treatment, the phenomena of intersubjectivity and intersubjective access to the therapeutic process are then illustrated.

A Conversation With the Boston Change Group on Enactments

Psychoanalysts are increasingly preoccupied by enactments, a phenomenon as difficult to capture in the moment as it is to define theoretically. Analytic authors, particularly from the relational school, see enactments as arising out of dissociation (Stern, 2004). The Boston Change Process Study Group (2013) believes that enactments happen entirely between the two participants in the here-and-now. Incremental shifts in how therapist and patient interact pass a threshold that brings the two seemingly of a sudden to a different level of relational organization. I propose that these two views derive from different angles and distances in relation to their subject. The dissociation model provides a view from within a historically situated, holistic individual. The systems model provides a view from above of interacting system influences.

Broadening the Contours of Attachment Experience and Implicit Relational Knowledge: Reply to Commentaries by Dr. Kaplan and Dr. Nahum

Replies to Dr. Kaplan and Dr. Nahum (this issue) focus on the complexly layered aspects of both attachment dimensions and clinical engagement. Attachment is looked at in the context of multiple self states. Thus, despite the predominant annihilation anxiety that accompanies disorganized attachment, there may also be self experiences of shame and humiliation generated by dependency needs. In response to the Boston Change Process Study Group, the paper proposes the idea that there is “something more” than implicit relational knowledge— something that is not subsumed under that theoretical paradigm. In keeping with the theme of multiple self states, “dissociation” and “enactment” are believed to be useful concepts in providing a path for transformative relational experience.

Moments of Meeting: A Self Psychological Approach

In their attempt to understand what promotes growth in the clinical setting, the Boston Change Process Study Group retrospectively examined the microprocess of analytic hours and determined that moments of meeting (the events that rearrange the intersubjective experience for the dyad) are a powerful agent of therapeutic change. In this article, following a thorough definition of moments of meeting, I look at what clinicians can do prospectively in order to facilitate moments of meeting. In contrast to the Boston Change Process Study Group’s delineation of specific phases that comprise a moment of meeting and their belief that moments of meeting exist outside of standard technique, I suggest that when the therapist is empathically immersed in the patient’s subjective world, moments of meeting are an organic outgrowth of the process and within the bounds of conventional technique. Clinical examples illustrate how a self psychological approach including understanding selfobject longings, active engagement in the rupture repair sequence, as well as imagining one’s way into the patient’s inner experience lead to the unfolding of moments of meeting. I then contrast the moments of meeting that emerge from empathic immersion with the relational shifts that derive from other listening modes.

The Intrapsychic and Interactional Realms: A Hermeneutic approach to Mental Space.

This paper addresses the tension between Freud's emphasis on the intrapsychic world and the emphasis placed by the Boston Change Process Study Group (BCPSG) on real interaction. Freud claimed that the intrapsychic world is primary; the BCPSG claim that interaction is primary. Both assume that these "levels" are discrete domains that can be isolated empirically, and that interact according to regulative rules in the natural world. This assumption reifies the metaphorical concept of mental space and freezes it at the metapsychological level of discourse. From a hermeneutic perspective, we must put these metaphorical concepts in dialogue with the context-specific processes of interpreting the patient's communication and intervening therapeutically. It then becomes clear that (1) the meaning of the terms "intrapsychic" and "interactive" is context-sensitive; (2) the question of primacy is a pragmatic one that cannot be decided through metapsychological debate; (3) when we say that a behavior or mental process operates on the "intrapsychic" or "interactive" level, we are making a judgment call that is not based on reason (even if our judgment enlists reason in its support). These metapsychological constructs help us think about our experience with patients. However, their meaning exists largely as a potential and is never definitively determined.

EPA-0536 - Observation on the therapeutic use of sloppiness and co-creativity in the institutional care pathway

Sloppiness refers to the indeterminate, untidy or approximate qualities of the exchange of meaning between patient and psychotherapeutics (Boston Change Process Study Group, 2005). In an institutional’good-enough’ Day-Hospital, patients move around psychiatry, physicians, phychotherapists, rehabilitation groups giving arise a relational field where something happens. Beyond known therapeutic factors,’something else’ arises from intrinsic indeterminancy of the relationship among minds. Our work is an attempt to elaborate and explore the idea of sloppiness and co-creativity as a model of therapeutic teamwork organization in an institutional Day-Hospital. The sloppiness as a model of teamwork organization may permit to individuate features relevant in a co-creation process among teamwork members and patient in severe psychiatric disorder. We present four case reports belonging to different diagnostic classes: psychosis, affective disorder, personality disorder and anxiety disorder. Long time clinical observation suggests that different features significantly affect clinical outcome in different patients. So, sloppiness has a pivotal role in the therapeutic process leading to a change because,’playing’ among teamwork in a unstructured relational space, patients drawn on what they authentically need. Sloppiness and co-creativity might represent’something else’ which allow patient to create his personal therapeutic pathway, and teamwork to fine-tune dynamically therapeutic act on patient. So sloppiness , as a tool of encounter between patient and teamwork in an institutional Day- Hospital, might advance co-creativity process leading to an individual care pathway good-fitted on patient.

The companion to the unknown. With the question as a starting-point and the mystery as a destination?

Many authors have shown that Freud, irrespective of his own claims, was influenced by his Jewish background, and that this background forms part of his scientific contribution. Today, many psychoanalysts say that we have parted from many of Freud´s basic assumptions, and that contemporary psychoanalytic theory is based on empirical evidence. One may thus ask if the Jewish origins have vanished from the scene of psychoanalysis. The claim of this paper is that this is not the case. As an influential example of contemporary psychoanalytic theory, the authors present the basic ideas of the Boston Change Process Study Group (BCPSG). Following that, they describe the defining moment of Jewish belief and identity, i.e., the covenant at Sinai. The authors argue that there are many parallels between the myth of Sinai and the “moments of meeting” of the BCPSG: in both descriptions (1) we have a meeting; (2) the counterpart of the meeting includes an Other; (3) in the meeting one leaves one´s idiosyncrasies behind; (4) and becomes oneself through (5) an alliance. As a conclusion, the authors briefly discuss how this parallel influences the scientific credibility of psychoanalysis, how specific the outlined characteristics are for precisely Jewish thought, and to what degree contemporary psychoanalysis has really changed from Freud´s time.

The Boston Change Process Study Group: Reflections on a Clinical Theory

Change in Psychotherapy: A Unifying Paradigm. By the Boston Change Process Study Group. New York: W. W. Norton, 2010. 256 pp.

Moments of complexity and enigmatic action: a Jungian view of the therapeutic field

In presenting clinical case material for a panel on archetypes and/or primal phantasies an initial discussion of archetypes as emergent phenomena organizing 'moments of complexity' is given(1) . The relationship of such moments to 'moments of meeting' as developed by the Boston Change Process Study Group is commented on and explored within the context of the case. A condensed report of a multi-year analytic treatment of a bipolar patient having a severe trauma history is offered for discussion. Several unusual, enigmatic events are detailed to illustrate the occurrence of moments of complexity. Dreams highlighting psychological transformation stemming from a changing relationship to emerging archetypal material related to a psychotic process in the patient are offered to further detailed moments of complexity.

Change in Psychotherapy: A Unifying Paradigm by Boston Change Process Study Group

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The Impact of Nightmares on the Treatment of a 10-Year-Old Girl

This paper describes the transformational moments created by the telling of three horrifying nightmares of a 10-year-old girl during her treatment. The process of sharing these nightmares allowed this child to share her struggles and needs in a new way, which helped advance the treatment, intensify the patient/therapist relationship and provide her with a new way of accessing and being with another, expanding her repertoire of “implicit relational knowing.” These special moments co-created by the patient and therapist were initiated by the reporting of these nightmares and were like the “moments of meeting” described by the Boston Change Process Study Group. The work of the Boston Change Process Study group helped illuminate the special moments discussed in the paper.

Something More, Something Too Much: The Relentless Search for “Just Right”

Articulating the ‘magic’ of the child treatment process has confounded clinicians for years. The work of the Boston Change Process Study Group has contributed to the beginnings of our understandings and articulation of the nonverbally articulated processes in reatment: the ‘something more’. The child papers under discussion are considered in light of the contributions of the BSG. This discussion focuses on emergent transformative moments in the dyadic, bidirectional and interactively regulated treatment process between child patient and adult analyst.

The transcendent function, moments of meeting and dyadic consciousness: constructive and destructive co‐creation in the analytic dyad

In reading the work of Beebe (2002), Sander (Amadei & Bianchi 2008), Tronick (2007) and Stern and the Boston Change Process Study Group (1998), resonances to the transcendent function can be registered but these researchers seem to be more focused on the interpersonal domain. In particular Tronick's concept of 'dyadic expansion of consciousness' and 'moments of meeting' from the Boston Change Process Study Group describe external dyadic interactions between mothers and babies and therapists and patients while, in contrast, Jung's early focus was on the intrapsychic process of internal interaction between conscious and unconscious within an individual. From an overall perspective, the interpersonal process of change described by infant researchers, when held in conjunction with Jung's internal process of change, together form a transcendent whole that could also be called a complex adaptive system. Such new theoretical perspectives from other fields confirm and elaborate long held Jungian notions such as the transcendent function which is, in many ways, harmonious with a systems perspective. Throughout this paper, clinical vignettes of interactive moments along with sand play and dreams will be used to illustrate theoretical points regarding the healthy process of the transcendent function along with descriptions of failures of such conjunctive experiences.

Embodied Language in Neuroscience and Psychoanalysis

There have been relatively few discussions of systematic studies of language, including neuroscience studies, in the psychoanalytic literature. To address this dearth, a detailed review of research on embodied language in neuroscience and related disciplines is presented, after which their findings are considered in light of diverse views of language in psychoanalysis, specifically the models of the Boston Change Process Study Group, Wilma Bucci, Fonagy and Target, David Olds, and Hans Loewald. The juxtaposition of psychoanalytic models with the findings of research on embodied language shows that scientific studies can focus psychoanalytic understanding of verbal processes, and that integrations with neuroscience neither inherently threaten the traditional psychoanalytic focus on verbal meanings nor reduce the richness and complexity of psychoanalytic theory.

Engaging the Implicit

The Boston Change Process Group has presented a new model of therapeutic action based on implicit relational knowing. Derived from empirical studies of dyadic interaction between infants and their caretakers, the model is geared to the realities of clinical interaction and is consonant with theories of therapeutic action advanced within interpersonal and relational psychoanalysis. This article investigates the overlap between these traditions and the Boston Change Process Study Group, while highlighting differences in their respective approaches to actual clinical work, in particular regarding enactment, dissociation, and attunement. The author begins with a brief synopsis of the Boston Group's model. A short clinical vignette is offered, at first viewed through the Boston Group's language and, later, using the language of relational and interpersonal psychoanalysis. The author concludes that, while the BCPSG offers an important new way of understanding the implicit dimension in human interaction, the relational and interpersonal traditions advance important clinical and theoretical conceptions for engaging the implicit in treatment.