Non-interpretive mechanisms in psychoanalytic therapy. The 'something more' than interpretation. The Process of Change Study Group.

It is by now generally accepted that something more than interpretation is necessary to bring about therapeutic change. Using an approach based on recent studies of mother-infant interaction and non-linear dynamic systems and their relation to theories of mind, the authors propose that the something more resides in interactional intersubjective process that give rise to what they will call 'implicit relational knowing'. This relational procedural domain is intrapsychically distinct from the symbolic domain. In the analytic relationship it comprises intersubjective moments occurring between patient and analyst that can create new organisations in, or reorganise not only the relationship between the interactants, but more importantly the patient's implicit procedural knowledge, his ways of being with others. The distinct qualities and consequences of these moments (now moments, 'moments of meeting') are modelled and discussed in terms of a sequencing process that they call moving along. Conceptions of the shared implicit relationship, transference and countertransference are discussed within the parameters of this perspective, which is distinguished from other relational theories and self-psychology. In sum, powerful therapeutic action occurs within implicit relational knowledge. They propose that much of what is observed to be lasting therapeutic effect results from such changes in this intersubjective relational domain.

Early emotional care for mothers and infants.

The experiences of most child health professionals give them only partial insight into the complex emotional and behavioral changes brought on by maternity. This article describes an approach to clinical management and emotional care based on the principles of birth as an opportunity for reorganization and changes; the meeting of the mother's "real" and "imagined" infants; appreciation of the infant's strengths; and development of a therapeutic alliance with the mother. Central to this process is the creation of a safe holding environment for the mother, especially mothers of preterm infants.

[The role of implicit knowledge in therapeutic change. Some implications of developmental observations for adult psychotherapy]. / Die Rolle des impliziten Wissens bei der therapeutischen Veränderung. Einige Auswirkungen entwicklungspsychologischer Beobachtungen für die psychotherapeutische Behandlung Erwachsener.

Several aspects of development change that are dependent on interactions between parent and infant are examined for their value in casting light on the process of change in adult psychotherapies. First, the domain of implicit knowledge (where changes necessarily occur in nonverbal infants) is identified. The vast majority of therapeutic change is found to occur in this domain. We then examine the improvised, largely unpredictable, nonlinear environments toward mutual goals that characterize the process of parent-infant and therapist-patient interactions. Finally, we provide a microdescription of these processes and provide a terminology for the "moments" that make up their flow. Of particular importance is the "moment of meeting", in which the participants interact in a way that created a new implicit, intersubjective understanding of their relationship and permits a new "way-of-being-with-the-other". We view "moments of meeting" as the key element in bringing about change in implicit knowledge, just as interpretations are thought to be the key element in bringing about change in explicit knowledge.