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Applying Findings from Infant Research

There is no such thing as an infant.

Winnicott, 1965, p. 39

Introduction

There is an active, vibrant interpersonal field between the child and mother from the start. This forms the cornerstone of all relationships throughout life. Contemporary research paints a picture of an infant actively engaged in lively person-to-person contact. The newborn has an impressive array of cognitive, emotional and relational abilities that help them deepen their attachment to their caregiver. We now know, too, that ‘An infant can develop an early sense of self’ as they discover the world around them (Nugent et al., 2009; Rochat, 2001, p. 32).

One of the most important developments for psychotherapy over the last 40 years is the compelling evidence from developmental psychology, neurobiology and attachment research that cognitive and emotional development depend on interpersonal relationships from infancy (Schore, 1994; Stern, 1985; Piontelli, 1992). Findings from infant research are becoming increasingly incorporated in psychotherapy and in psychoanalysis and analytic thinking. They provide an extensive understanding of the essentially relational nature of people and how this plays out in psychotherapy. Infant development research also helps us understand the consequences of developmental disruption from trauma. Because arrested development limits an individual's ability to reflect, sense, express, respond, defend and repair, we need in psychotherapy to address the developmental capacities of our clients.

Psychoanalyst Esther Bick is famous for her introduction in 1948 of infant observation as part of training in psychoanalysis, a part still required today. She saw observation of babies and mothers in their own homes as an objective way to ‘understand the earliest experience patients bring with them into therapy’ (Sayers, 2000, p. 139). Direct observation of caregiver–infant interactions can counter or support traditional theories about the development of the infant that are based on hypotheses drawn from the clinician's understanding of the adult. The result of such theories is what Stern (1985) calls a ‘clinically constructed child’. Clearly there are limits to such a construction and its attempt to show early processes of experience, function and expression and the way they develop. Fonagy (2001) questions the assumption that experience drawn from the consulting room corresponds to an actual infant's early life. He states that ‘to accept clinical data as validating developmental hypotheses flies in the face not only of ferocious opposition from philosophers of science … but also of common sense’ (Fonagy, 2001, p. 8). In contrast, infant research from the latter half of the twentieth century uses advances in technology to observe both the capacities of the infant and the finely tuned interaction between the infant and the caregiver as they are happening and even from the inside.

We know now from close observation that babies sense and engage with the other in much less disorientated ways than previously thought. This has led to key concepts in developmental theory such as Stern's Representations of Interactions that have been Generalized (RIGs)1 and reports by scientists like Rochat and ‘schema-of-being-with’2 on research showing that an infant probably has the ability to differentiate between self and non-self stimulation from birth. Rochat concludes that ‘rather than being absolutely separate from their environment or confused about it, infants are attuned to it from the outset’ (Rochat, 2001, p. 32). As the trend towards inclusion in psychotherapy of new findings and concepts continues, I think it is interesting to note that many concepts like projection, introjection and internalization still appear to stand up well, and even find support from new work.

Studies from neuroscience, meanwhile, reveal the remarkable extent of the body–mind connection. Schore describes how the structure of the brain is influenced by ‘early socio-emotional experiences’. He summarizes this as ‘experience-dependent maturation’ and quotes Cicchetti and Tucker (1994, p. 538). ‘Nature's potential can be realized only as it is enabled by nurture’ (Schore, cited in Green, 2004, p. 24). Science has begun in particular to show how non-verbal, affective processes are mediated by the right brain. As a result, we need to recognize the significance of the transmission and regulation of affects as threads that stitch and potentially repair the cloth of development.

I have found these key scientific findings helpful in my own work with clients and in guiding my supervisees. In Chapter 5, I explore the body–mind connections that they uncover in more depth, and below introduce some from infant research that can also be readily applied in our practice.

Intersubjectivity

In intersubjectivity, we find one of the vital elements of the therapeutic relationship, one that I take up in more depth as the topic of Chapter 4. Infant studies suggest that ‘Learning how to communicate represents perhaps the most important developmental process to take place in infancy’ (Papousek and Papousek, 1997, cited in Green, 2004, p. 34). Infants have an ability to engage in interpersonal communication from birth (Stern, 2004, p. 85). They develop within a matrix of ‘primary intersubjectivity’ defined as ‘an active and immediately responsive conscious appreciation of the adult's communicative intentions’ and as ‘a deliberately sought sharing of experiences about events and things’ (Trevarthen and Hubley, 1978; Trevarthen, 1979). The infant has an awareness specifically receptive to subjective states in other people (Trevarthen, 1998, pp. 124–136). Winnicott's famous remark that ‘there is no such thing as an infant’ makes us realize this receptivity is crucial when he explains that ‘if you set out to describe a baby, you will find you are describing a baby and someone else. A baby cannot exist alone, but is essentially part of a relationship [italics in original]. (Winnicott, 1965b, p. 39).

Intersubjectivity – ‘minds attuned to other minds’ (Stern, 1985, p. 85; see also Chapter 4 on the Intersubjective Experience) – naturally forms the basis of our work as psychotherapists. Knowledge about its elemental role and form can help to shape a therapist's way of working with the individual needs of each client. Babies engage in empathic and reciprocal communication. Even at just a few days old, an infant can imitate the caregiver's expressions, including opening their mouth, smiling, sticking their tongue out, pursing their lips, expressing surprise and moving their head, hand or fingers (Beebe et al., 2005, p. 37; Meltzoff, 1985; Rochat, 2001, p. 143). From neuroscience, we learn that the capacities which facilitate intersubjectivity, including face recognition (Wilkinson, 2006, p. 5), the ability to tune into the rhythm of the human voice and to self-soothe (p. 19), are linked to the right hemisphere of the brain. ‘Self awareness, empathy, identification with others, and more general intersubjective processes, are also largely dependent upon right hemisphere resources’ (Decety and Chaminade, 2003, p. 557, cited in Wilkinson, 2006, p. 20). Schore examines the right brain connection and points out that ‘preverbal maternal–infant communication’ that occurs before the ability to speak3 represents ‘transactions between the right hemispheres’ of the mother and child (Schore, 2003, p. 26).4 He suggests that the essence of development is contained in the concept of ‘reciprocal mutual influence’ where these same forms of non-verbal, pre-rational mother–child communications ‘continue throughout life to be a primary medium of intuitively felt affective communication between persons’ (Orlinsky and Howard, 1986, cited in Schore, 2003, p. 26). This non-verbal, emotional coregulation forms our earliest experience of intersubjectivity and the rudiments of social understanding. Mutual engagement, unavoidable and filled with possibility, plays a central role in our work with clients as it infuses the working alliance and serves as the ground for what occurs within it.

Two-way exchange: Including the other

Therapy involves the kind of interpersonal exchange that Buber (2008) called ‘dialogic’: ‘a relation between persons that is characterized in more or less degree by the element of inclusion’ (p. 97). The ideas around two-way exchange include concepts like empathy, containment, correspondence, mirroring, holding, metabolizing, reflecting, resonance and being in tune with the client. Communication that recognizes and responds to the other without any need to change the other is inherent in infants. It becomes a lifelong resource and one to fall back on if later aspects of development fail (Rochat, 2001).

The infant's readiness to perceive the qualities and features of the other orients them, and helps them establish an intentional relationship with their caregiver. Mutual imitation, empathic social mirroring and proto-conversations5 improve the early bonding process and make the infant and caregiver eager to engage. I believe that this form of interacting is similar to the positive rapport that can develop between the therapist and the client.

Reciprocity

Recognizing and communicating with their caregiver...