MOMENTS OF MEETING: THE RELEVANCE OF LOU SANDER'S AND DAN STERN'S CONCEPTUAL FRAMEWORK FOR UNDERSTANDING THE DEVELOPMENT OF PATHOLOGICAL SOCIAL RELATEDNESS.

Lou Sander and Dan Stern made seminal contributions to our understanding of early child development, particularly in regard to the moment-to-moment intersubjective exchanges and mutual sensitivity that are at the core of the caregiver-infant relationship. Although their own studies focused primarily on the ways in which children's intersubjective experiences of mutual attunement lead to adaptive social relatedness and validate a healthy sense of self, this article focuses on the applicability of their theoretical conceptions to the development of pathological social relations. It explores the premise that the emotional validation derived from recurrent intersubjective experiences of mutual attunement involving negative affects can be as emotionally compelling from the child's standpoint as that derived from positive exchanges. Children's needs to recreate unhealthy, but affectively meaningful, moments with their caregivers can lead to ingrained, automatically operating pathological patterns of social behavior and affective expression that can take on a life of their own and strongly shape the child's subsequent socioemotional functioning. Following an overview of Sander's and Stern's conceptual thinking, developmental research and clinical case material will be utilized to illustrate how their work can enrich our understanding of developmental processes that can contribute to a number of emotion-specific, early relational disturbances.

Psychoanalytic perspectives on early trauma: interviews with thirty analysts who treated an adult victim of a circumscribed trauma in early childhood.

Information on the long-term effects of early trauma and how such effects are manifested in treatment was obtained through interviews with thirty analysts who had treated an adult patient with a circumscribed trauma in the first four years of life. Childhood traumas fell into four categories: medical/accidental; separation/loss; witnessing a traumatic event; and physical/sexual abuse. Traumatic carryover was recorded in terms of explicit memories, implicit memories (somatic reliving, traumatic dreams, affective memories, behavioral reenactments, and transference phenomena), and global carryover effects (generalized traumatic affective states, defensive styles, patterns of object relating, and developmental disruptions). Linkages between the early trauma and adult symptomatology could be posited in almost every case, yet the clinical data supporting such linkages was often fragmented and ambiguous. Elements of patients' traumas appeared to be dispersed along variable avenues of expression and did not appear amenable to holistic, regressive reworking in treatment. The data did not support linear models of traumatic carryover or the idea that early traumatic experiences will be directly accessible in the course of an analysis. Factors that we believe help explain why traumatic aftereffects in our sample were so heterogeneous and difficult to track over the long term are discussed.

Event trauma in early childhood: symptoms, assessment, intervention.

Expanding research over the last two decades has documented that very young children's responses to an event trauma will involve the same three basic categories of posttraumatic symptomatology observed in older children and adults that is, reexperiencing, numbing/avoidance, and hyperarousal. The ways in which these three symptom clusters will be manifested in very young children and recent progress in the establishment of developmentally sensitive and reliable criteria for the diagnosis of posttraumatic stress disorder (PTSD) in this age group are described. In addition to PTSD symptomatology, three additional factors that differentiate young children's responses to a trauma from those of older children and adults-their cognitive immaturity, their developmental vulnerability, and the relational context of early trauma given young children's dependence on caregivers-also are discussed. Principles of assessment and treatment are then described. These discussions emphasize the importance of normalizing traumatic responses, supporting the parent-child relationship and restoring trust, desensitizing the child's distress to traumatic reminders, helping the child and parents to process and develop a meaningful narrative of the traumatic event through expressive therapeutic techniques, and promoting effective strategies of restoration and repair.