Mutual attention and joint gaze as developmental forerunners of the therapeutic alliance.

ABSTRACT

This paper attempts to integrate child developmental research and early childhood neural-cognitive development within the complexities of the early infant-mother relationship as described by psychoanalytic theory. Accumulating research evidence for the importance of the complex transition from mutual gaze to joint gaze calls into question the origin and analytic significance of the alliance relationship that emerges from the primary relationship between the mother and child. This paper explores the apparently neglected relationship between the respective theories of the therapeutic alliance of Zetzel, Greenson, and Brenner, and the developmental progression from mutual gaze and joint gaze, upon which important aspects of mental and cognitive development rest. Nonblind infants and children rely heavily on the ability to see in order to learn and form representations, while trauma affects these dynamics and perception. This issue is particularly relevant given the high incidence of unresolved childhood trauma in the form of neglect, loss, and abuse in those who seek out therapy. Freud's original conception of developmental phase progression has been unsubstantiated by recent researchers in terms of chronological progression and the receptors through which the infants experience the world. In this paper the author applies specific developmental lenses to this basic conception of the dyadic relationship in psychoanalytic treatment, and will reexamine and redefine both working and therapeutic alliance in the frame of an essential developmental stage of joint visual attention. A clinical example will reveal compromised normal preverbal interactive development, exposing faults in the complex transition from mutual gaze to joint gaze.