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A Tribute to Daniel Stern - Mentor, Colleague and Friend

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Perspectives in Infant Mental Health
Vol. 21 No. 1
|
Winter 2013
A Tribute to Daniel Stern – Mentor, Colleague
and Friend
Contents
Nugent J. A Tribute to Daniel Stern - Mentor,
Colleague and Friend ............................................ 1
Weatherston D., Fitzgerald H. & Foley M. From
the Editors ................................................................. 3
Keren M. President’s page ................................... 3
Fivaz-Depeursinge E. Daniel Stern, the Baby
and the Triad ............................................................4
Berg, A. From South Africa -Personal
Reections on Prof Dan Stern ............................6
Puura K. Meeting Daniel Stern ........................... 6
Gocek E. & Erol N. Reections from Turkey .... 6
Schechter D. Memories of Dan Stern ..............7
Gauthier Y. Daniel Stern, In Memoriam ..........8
Stern D. The Clinical Relevance of Infancy: A
Progress Report (Reprint) ....................................9
Foley M. & St-André M. Aliates Corner:
WAIMH membership and Aliates
membership renewal campaigns: Building
synergy of action for 2013 ................................21
Barlow J. The UK AIMH .......................................22
Kaukonen P., Puura K. & Sorsa M. News from
the WAIMH Central Oce ..................................23
Reddy V. & Trevarthen C. Zero to Three Corner:
What we Learn About Babies from Engaging
With Their Emotions ............................................24
Flyer of Perspectives in Infant Mental Health
.....................................................................................29
WAIMH Central Oce
University of Tampere, Medical School, Laakarinkatu 1, Arvo-building Room C221, 33014 University of Tampere, Finland
Tel: + 358 50 4627379, E-mail: oce@waimh.org, Web: www.waimh.org
Professional Publication of the World Association for Infant Mental Health
By J. Kevin Nugent, Director, the Brazelton
Institute, Boston Children’s Hospital and
Harvard Medical School, USA
Dr. Daniel N. Stern died in Geneva,
Switzerland on November 12, 2012. He
leaves his wife, Nadia, who collaborated
with him on much of his research, his two
sons, Michael and Adrien; three daughters,
Maria, Kaia and Alice Stern; a sister, Ronnie
Chalif; and 12 grandchildren. To them we
extend our deepest sympathy.
Everyone who knew Dan will remember
his brilliance, his charm and his
commitment to the eld. We here at the
Brazelton Institute, remember him for
personal warmth and quick humor, as well
as for his originality as a theorist, and his
brilliance as researcher, clinician, mentor,
speaker and writer. We knew all along
that he was one of the great minds of our
time. On hearing the news, Berry Brazelton
paid tribute to Dan by saying that «he was
a thoughtful, lovely person. I learned so
much from him and we shared so much
together. I miss him very much».
Daniel N. Stern was born in Manhattan
in New York City. He came to Harvard as
an undergraduate and then attended
Albert Einstein Medical College, where
he completed his M.D. in 1960. He
conducted psycho-pharmacology research
at the National Institutes of Health in
Bethesda, Md., before he completed his
residency in psychiatry at the –Columbia
University College of Physicians and
Surgeons. He later trained at the Center
for Psychoanalytic Training and Research
at Columbia. During his illustrious career,
he was Professeur Honoraire in the Faculty
of Psychology at the University of Geneva,
Adjunct Professor of Psychiatry at Weill
Cornell Medical College, and Lecturer
at the Columbia University Center for
Psychoanalytic Training and Research.
Dan Stern transformed the eld of
developmental psychology, by creating
a bridge between psychoanalysis and
empirically based developmental
models. Because he believed that clinical
practice needed to be based on scientic
research, he dedicated his time to the
observation of infants and to clinical
reconstruction of early experiences. As a
result, his ideas have changed the way that
we think about babies and the parent-
child relationship, about the transition
to parenthood and the development of
mental life.
There is an easy coherence between his
ideas and our research eorts here at the
Brazelton Institute. He integrated Berry
Brazelton’s understanding of the infant’s
contribution to the emerging parent-
infant relationship, when he wrote that the
infant’s behavior could be a powerful «port
of entry» into the parent-child system.
Dr. Stern is the author of seven books,
most of which have been translated into
dierent languages:
- The Interpersonal World of the Infant:
A view from psychoanalysis and
developmental psychology, (Basic
Books, 1985)
- The Interpersonal World of the Infant:
A view from psychoanalysis and
developmental psychology, (Basic
Books, 1985)
- Diary of a Baby, (Basic Books, 1992)
- The Motherhood Constellation: a unifying
view of parent-infant psychotherapies.
(Basic Books, 1995)
- The Birth of a Mother, (written with Nadia
Bruschweiler-Stern, Basic Books, 1997)
2 PERSPECTIVES IN INFANT MENTAL HEALTH WINTER 2013
Editorial Sta
Editor
Deborah Weatherston, USA
Assistant Editors
Hiram E. Fitzgerald, USA
Maree Foley, New Zealand
Editorial Board
Astrid Berg, South Africa
France Frascarolo, Switzerland
Antoine Guedeney, France
Anna Huber, Australia
Mariko Iwayama, Japan
Catherine Maguire, Ireland
Mirjami Mäntymaa, Finland
Campbell Paul, Australia
Kaija Puura, Finland
Joshua Sparrow, USA
Mark Tomlinson, South Africa
Elizabeth Tuters, Canada
Jean Wittenberg, Canada
Charles Zeanah, USA
President’s page
Miri Keren, Israel
Editors’ perspectives
Deborah Weatherston, USA, Hiram E.
Fitzgerald, USA & Maree Foley, New
Zealand
Aliate’s Corner
Maree Foley, New Zealand & Martin
St.André, Canada
From the Kauppi Campus -News
from WAIMH Central Oce
Pälvi Kaukonen, Kaija Puura & Minna
Sorsa, Finland
Production Editor
Minna Sorsa, Finland
Perspectives in Infant Mental Health is a quarterly publication of the
World Association for Infant Mental Health. Address correspondence to
Deborah Weatherston (dweatherston@mi-aimh.org). ISSN 2323-4822.
All opinions expressed in Perspectives in Infant Mental Health are those
of the authors, not necessarily those of WAIMH’s. Permission to reprint
materials from Perspectives in Infant Mental Health is granted, provided
appropriate citation for source is noted. Suggested format: Perspectives
in Infant Mental Health 2013, Vol 21, No. 1 WAIMH.
- The Present Moment in Psychotherapy
and Everyday Life, (2003), W.W. Norton.
- In 2010, Forms of Vitality: Exploring
Dynamic Experience in Psychology,
the Arts, Psychotherapy, and
Development, which used new
understandings of neuroscience
to explain human empathy, was
published by Oxford University Press.
In this, his nal book, he draws on work
from neuroscience, psychotherapy,
and arts to explore creativity and the
creative arts.
He is also the author of several hundred
journal articles in journals such as
the Infant Mental Health Journal, the
International Journal of Psychoanalysis
and the Journal of American Academy
of Child Psychiatry. He also wrote many
book chapters, the latest of which was «A
new Look at Parent-Infant Interaction» in
Nurturing Children and Families: Building
on the Legacy of T. Berry Brazelton, edited
by Barry M. Lester and Joshua D. Sparrow
and published by Wiley in 2010.
While Dan Stern’s ideas were complex,
his writing was always accessible. His
writing style was energetic and buoyant,
the buoyancy generated by his sensitivity
to cadence and tone and his awareness
of the poetry of language. Even «The
Interpersonal World of the Infant,’’ and
«the Motherhood Constellation», arguably
his two most theoretical books, are both
characterized by a poetic lyrical prose
style, especially when he presents his
observations of mother-infant interactions.
«The Diary of a Baby» is a work of self-
delighted inventiveness, as he tries to
imagine the inner world of the young
child. «The Birth of a Mother: how the
Motherhood Experience Changes You
Forever», which was written along with
his wife, Nadia, is also a book that retains
its conceptual richness and at the same
time is a book that is accessible to any
expectant mother or father.
The words of the 16th century English
writer, Robert Whittinton, describing Sir
Thomas More, can be applied to Dan:
He is a man of an angel’s wit and
singular learning; I know not his
fellow. For where is the man of
that gentleness, lowliness, and
aability? And as time requireth
a man of marvellous mirth and
pastimes; and sometimes as of
sad gravity: a man for all seasons.
Daniel Stern was, indeed, a man for all
seasons. Now more than ever, we realize
how privileged we are to have known him
as a colleague and friend. We will miss him,
but his ideas will live on in our thoughts
and in our work.
3 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH WINTER 2013
By Deborah Weatherston, Hiram E.
Fitzgerald, Editors, Michigan, USA and
Maree Foley, New Zealand
Daniel Stern: He captured our attention; he
challenged our capacity to see more of what
was hidden fom plain sight; he pleaded with
us to slow down, listen, watch and learn before
constructing a story; he introduced us to babies
and their interactions in a dynamic fresh way;
he called us to be present with the language of
experience.
When WAIMH members received word that
Dan Stern had died, many around the world
expressed deeply felt sorrow for the loss of a
colleague, a mentor, and revered leader who
had an enormous inuence on the infant
mental health community. The WAIMH Board
sent a note of sympathy to Nadia Bruschweiler-
Stern (Dan’s wife), his children and family,
but struggled with how to say “good-bye
and honor a man who was so very important
to the development of our thinking about
babies in relationships and the rapidly growing
infant mental health eld. After considerable
thought and a urry of e-mail communications,
board members agreed that there could be
a special edition of Perspectives in which
we would publish remembrances, personal
and professional. In turn, several colleagues
responded quickly, conrming their willingness
to contribute their reections.
From the Editors
By Miri Keren, WAIMH President, Israel
Some two months ago, our daily work was
interrupted by the spreading news about Dan
Stern’s death….
While writing this very sentence, I reect on my
hesitation of which word to choose…»passed
away», or «was gone», or simply «died.»…Is it
because the notion of «death» is too dicult
to comprehend …not only for children but also
for grown-ups….that we tend to use metaphors
such as «gone forever», or, as we commonly
say in Hebrew «went into his/her world»? The
rst reaction is almost, «What? It can’t be. I just
talked to him a month ago…Well, yes, he was
very sick, but he got through each time…»
Losing our parents and our teachers is a
«natural» fact of life and still it presents us with
existential questions…especially for those of
us who already have half of our lives behind us.
When one of my residents in Child Psychiatry
was waiting for his rst baby to be born a few
weeks ago, I thought of a common denominator
between the two extremes, life and death. The
exact time of the rst breath, as well as of our
last breath, is unpredictable , even when birth as
well as death is more often than not expected.
In a way, birth as well as death is always sudden
and as such, surprises us. May be it has to be
so because these two «present moments» (as
Dan would say) are so overwhelming in their
intensity and their absolute, «all or none»
quality, that it is better, in psychological terms of
survival, not to know them in advance. We know
what happened to Adam and Eve when they ate
the apple form the Tree of Knowledge…they
started to experience fear, anxiety…what we
call negative emotions!
President’s page
In that sense, life is not less anxiety-provoking
than the prospect of death. The dierence is
that in life, the young children, the adolescents,
and the young adults can talk to their elders and
get a sense of what is lying ahead of them so
that they can prepare themselves, make plans,
use the experience of others. They also know
that if they feel alone or afraid, they can turn to
their attachment gures (hopefully!). Death, and
what comes after, if anything does, is the only
life event that nobody can give a good advice
about it. If only one could tell us about what
really is in the aftermath…
The closer the deceased person is to us is, the
more we are bothered by the question, “What is
the «present moment» now for Dan?” Whether
there is one, we will never know…but for us, the
living, the way to continue Dan Stern’s “present
moment” is to go on teaching our students and
young colleagues not only Dan’s major concepts
of aect attunement, selves, motherhood
constellation, but also his philosophical and
scientic stance: to observe directly and then
to reect on the signicance of the observed
phenomena.
I met Dan a year ago, at the IACAPAP meeting in
Paris. He was already very sick, but I was struck
and deeply moved by his tenacious way of
thinking about what he observed around him…
as if it had become a reex behavior…This is, in
my eyes, the most powerful legacy Dan Stern
has given us and the following generations of
infant mental health clinicians and researchers.
This issue of Perspectives in Infant Mental
Health is fully dedicated to the many ways he
has been perceived by many of us…
As a result, this Winter 2013 issue is dedicated to
Daniel Stern and contains a series of reections
from colleagues, concerning interactions and
experiences they had with him. These generous
oerings provide a rare window into the person
of, and the work of, Daniel Stern. They highlight
the fact that he didn’t talk the walk, he walked
and sometimes even danced the talk. 
In addition to the contributions from those
who knew him, we have made one article
available, with permission from the publisher,
the Michigan Association for Infant Mental
Health: Stern, D. (2008). “The Clinical Relevance
of Infancy: A Progress Report,” Infant Mental
Health Journal, Vol. 29(3), pp. 177-188. This
is representative of the many books and
journal articles that he published during his
wonderfully productive career.
Finally, we hope that this issue of Perspectives
will help keep Daniel Stern’s many contributions
alive and in mind as all of us continue our work
with and/or on behalf of infants; and as we
enter into meaningful working relationships
with one another, savoring every moment. 
dweatherston@mi-aimh.org
tzger9@msu.edu
maree.foley@vuw.ac.nz
4 PERSPECTIVES IN INFANT MENTAL HEALTH WINTER 2013
Daniel Stern,
the Baby and
the Triad
By Elisabeth Fivaz-Depeursinge,
Switzerland
Daniel Stern was my master and friend.
He supported me in my endeavors with
Antoinette Corboz-Warnery to describe
triadic interactions by designing the
Lausanne Trilogue Play (LTP) (Fivaz-
Depeursinge & Corboz-Warnery, 1999) as
we went about adapting the microanalytic
methods he and others had developed
for exploring dyadic interactions. This
long journey was paved by numerous
encouragements, constructive criticisms
and collaborations. Thanks to his curiosity
and openness to new questions, he raised
issues and objections that we didn’t (want
to) think of. While he had no objection
to considering the triad as a system from
the observer’s perspective (Stern, 2000;
2008a; Stern & Fivaz-Depeursinge, 1997),
his main interrogation was whether
and how the subjects, in particular the
infant, experienced the triad as a whole
(Stern, 2005): What were the processes by
which an infant might grasp triangular
interactions between herself and her two
parents?; How might she communicate
with both at the same time rather than
sequentially, in dyads? After all, she
could only look at one person at a time;
and nally, how would she construct
triangular representations, as a base for
her participation in the family’s collective
intersubjectivity?
In remembering his generous reviews
of our writings, his discussions of our
work at conferences and regarding our
collaborative papers, I see three main
moments where Daniel Stern met with us,
stepped alongside us, and challenged our
model.
Interfaces: In 1991, he and I convened the
rst interface group, in Lausanne, which
included colleagues who had contrasting
perspectives on infants and their families:
developmental, psychodynamic, systemic.
Our main goal was to draw relationships
between dierent levels to approach the
nuclear family: behavioral interactions,
their subjective and unconscious
meanings, and their intergenerational
bases. His microanalytic interview of a
parents’ couple LTP, a 30 seconds sequence
of interactions, set the stage for the
group’s co-construction of a common
language and shared concepts. The results
of this work were presented in the WAIMH
Chicago conference and published in the
IMHJ (Fivaz-Depeursinge, Stern, Bürgin,
Byng-Hall, Corboz-Warnery, Lamour &
Lebovici, 1994) along with a thoughtful
and challenging discussion by Robert
Emde (1994). The group’s relational history
was marked by friendship, playfulness,
and hot debate. This adventure was the
inspiration for the plenary interfaces
organized in the Paris, Yokohama and
CapeTown WAIMH conferences.
Collective Intersubjectivity: In his theory
on intersubjectivity as a motivational
system (2004, 2005), Daniel Stern
contended that intersubjectivity plays
an important role in the survival of the
species:
Human beings don’t survive
without groups, family, team,
tribe, etc. Thus is it necessary
to have systems which can
hold the group together.
Attachment is such as a system,
but intersubjectivity is also one.
In a group of hunters or in a
basketball team, cooperation
and cohesion require to know
what is in the mind of others
at any time. Morality is also
essential for survival. We know
that there is no morality, shame,
guilt, embarrassment, without
intersubjectivity between
persons. To experience moral
emotions, one has to be able
to see oneself in the eyes of
another; this comes under
intersubjectivity(Stern, 2005)
Basing this argument on our work, among
others, Daniel Stern opened our eyes
to new perspectives that we had not
envisaged.
The infant’s representation of the triad
as “dynamic forms”. We were privileged
to witness Daniel Stern’s struggle with
the question of the infant’s capacity
to represent a triad as a Gestalt. After
imagining many dierent mechanisms,
for instance combining a dyad in the
foreground with a third party in the
background, he squarely asked how the
infant could hold three characters in mind
simultaneously:
Given a triad is not made up
of three separate dyads seen
sequentially (additively), but
rather of one threesome, all three
characters must be held in mind
simultaneously. How could an
infant do that and then represent
it? (Stern, 2008, oral presentation)
Later, in a discussion of our work in Rome
he proposed to deal with this question in
terms of “dynamic forms”. Recalling that:
The baby is aware of his
own movements through
proprioception as he is aware of
his parents movements visually
and auditively, it is relatively easy
to see how the baby would be
aware of the dynamic patterns of
motion (speed, duration, force,
direction relative to another or
self, etc). The harder question is
how could all the simultaneous
dynamic forms of three separate
people be integrated by the baby
into a whole, into an overarching
dynamic form? (Stern, 2008b)
In answer to this question, Daniel Stern
told of a personal experience which he
considered to be directly relevant to the
dynamic interactions that babies engage
in with their parents. First, he spoke of
dancers: .
There is an exercise for
improvisional modern dancers
that asks a room full of a dozen
or so dancers to walk around
aimlessly. While they are doing
that, each is to hold one specic
- “target” other person in the left
visual eld and a second specic-
target person in the right visual
eld. To best do this while you
and everyone else is moving,
one should not in fact look at
either of the two target people
but anywhere else to hold them
both in separate peripheral vision
spaces. It is remarkably easy; the
only hard part is not bumping
into all the other moving people.
(Stern, 2010a, p. 123)
Next, he referred this dance exercise, back
to the baby in the LTP:
The parents play together with
their 9 month-old. Having tried
several games, they nally
settle to play “sneezing”. The
5 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH WINTER 2013
two parents call for the baby’s
attention: Attention! attention!!,
attention !!!”...The baby looks at
them with awe, they pause a bit
more and then they both sneeze
together. The baby laughs; then
he looks up at father, at mother,
anticipating the next round. The
parents go on... the excitation
rises with each turn, until they all
break into a joint laughter (Stern,
2008b).
Of this dynamic dance of interaction, he
commented:
The dynamic forms are numerous.
The parents’ signals are dierent,
to some extent – the father’s
rmer movements and low voice
contrasting with the mother’s
smoother movements and
higher voice, but both on the
same rhythm and tune...etc. The
diversity makes for the richness
of the stimulation; but they are
suciently synchronized and
coordinated to form together
with the baby’s responses an
overarching Gestalt... At the level
of the threesome, it begins with
a well marked staccato, in three
steps, then a pause, then the
sneezing explosion...etc.” (Stern,
2008b)
Finally, the parallels between
choreography and human interaction were
great inspiration for Daniel Stern; and for
me, his last book on “Forms of Vitality”
(2010b) is the most fundamental of his
works. At heart it examines how we know
that we are alive; and it captures his style
which was the very embodiment of human
vitality and will remain alive in our minds.
References
Emde, R. (1994). Commentary:
Triadication experiences and a bold
new direction for infant mental health.
Infant Mental Health Journal, 15(1),
90-95.
Fivaz-Depeursinge, E., Stern, D. N., Bürgin,
D., Byng-Hall, J., Corboz-Warnery, A.,
Lamour, M., & Lebovici, S. (1994). The
dynamics of interfaces: Seven authors
in search of encounters across levels
of description of an event involving a
mother, father, and baby. Infant Mental
Health Journal, 15(1), 69-89.
Fivaz-Depeursinge, E., & Corboz-Warnery,
A. (1999). The Primary Triangle. A
Developmental Systems view of
Fathers, Mothers and Infants. New York:
Basic Books.
Stern D. N. (2000). Introduction to the
Paperback Edition. The Interpersonal
world of the Infant. A view from
Psychoanalysis & Developmental
Psychology. New York: Basic Books.
Stern, D. N., Fivaz-Depeursinge, E. (1997).
Construction du réel et aect. Cahiers
Critiques de Thérapie familiale et de
réseaux, 18 (1), 77-85.
Stern D. N. (2004). The Present Moment in
Psychotherapy and Everyday Life. New
York:: W.W. Norton.
Stern, D. N. (2005). Le désir
d’intersubjectivité. Pourquoi ?
Comment ? Cahiers critiques de
thérapie familiale et de pratiques de
réseaux, 35 (29-42).
Stern, D. N. (2008). The clinical relevance
of Infancy. A progress report. Infant
Mental Health Journal, 29 ( 3), 177-188.
Stern, D. N. (2008b). The issue of internal
representations in dyads and triads.
Discussion of Fivaz-Depeursinge: “The
infancy of triangular communication
in the family.” Rome, Conference on
Gestalt Therapy, Jan. 25-27, 2008.
Stern, D. N. (2010a). Foreword to Fivaz-
Depeursinge, Lavanchy-Scaiola, and
Favez . Psychoanalytic Dialogues, 20
(121-124).
Stern, D. N. (2010b). Forms of Vitality:
Exploring Dynamic Experience in
Psychology, the Arts, Psychotherapy,
and Development (2010). Oxford
University Press.
6 PERSPECTIVES IN INFANT MENTAL HEALTH WINTER 2013
Photo of Dan Stern
From South
Africa –
Personal
Reections on
Prof Dan Stern
By Astrid Berg, Cape Town, Western Cape
Association for Infant Mental Health, South
Africa
Prof Dan Stern’s work became know to
me in 1995, after the rst Conference
on Infant Mental Health was held in
South Africa. With my interest in babies
awakened, I bought and studied his
book “The Interpersonal World of the
Infant”. It has remained my most referred-
to text since that time. Prof Stern’s
ability to bring together the internal,
subjective world of the baby with the
objectively researched infant has been
for me his greatest gift. He built a bridge
between what is intuitively known, what
psychoanalysts have grappled with
over many years, and the infant in the
laboratory - measured, videotaped and
coded. He did so in a deceptively simple
way with straightforward language – all
of this is only possible when there is
in-depth knowledge of both elds. For
these insights and for creating this bridge I
remain forever grateful to Dan Stern.
In the year 2008 I had the pleasure of
seeing and experiencing him twice – I will
start backwards, with the more personal
meeting in November of that year.
This was at a Conference in Milan, Italy
on «The Body from - 1 to 6 years - Drive,
Phantasy, Emergence” and was held
under the auspices of the International
Association for Analytical Psychology. Dan
Stern himself did not speak, but had come
to listen and also to confer with Alessandra
Piontelli with whom he was doing some
research at the time. I met with him per
chance one morning in the breakfast room
of the hotel – he had a freshly squeezed
orange juice and I remember him looking
not well, but his mind was full of vigour.
He spoke about the research, which, if I
recall correctly, he was conducting with
a team in Geneva on the intentionality of
foetuses. He was working with a group of
mathematicians who were calculating the
trajectory followed by foetuses moving
their arm towards the uterine wall, thereby
trying to ascertain the probability of
intent. I am not at all sure whether I had
understood this correctly and whether
my recollection now is accurate – but
this is what I remember and what I carry
with me. I was amazed and in awe: what a
productive, creative and innovative mind
he had, how his curiosity was alive and
intense – I was deeply moved but also
concerned about his physical inrmity.
The other time I saw him was a few
months before, at the WAIMH Congress
in Japan in August 2008. He delivered a
plenary address “Perspectives on Infant
Mental Health” and focussed on the state
of research generally speaking and in
particular as it relates to infant mental
health. It was an erudite, provocative ‘call
to action’ which I will never forget. Stern
challenged many sacredly held beliefs on
the reductionist approach of research that
breaks up the whole into tiny pieces – the
‘higher order’ which the infant is capable
of, is being dissected and ultimately
rendered meaningless; he challenged
evidence-based medicine, stating that
we understand enough, that in the eld
of infant mental health it is time to do
something else, to redress that which has
been lost. What has been lost is that what
babies need, namely mothering – we have
more than enough evidence for this. He
made an appeal to ‘go big’, to hold concerts
with rock stars, and mobilize the people,
so that the politicians may realize that the
vote, the power lies with women and men
who wish to reclaim the importance of
parenting.
This was a man, frail long before his time,
in obvious physical distress, but he was,
until the end, bold; he had the courage to
say what many of us may think, but dare
not utter. His mind was colossal and deep,
it had huge capacity for both analysis and
synthesis; his spirit had the conviction, the
daring to challenge and to swim against
the stream. The world lost him too early
and too soon. Our thoughts are with his
family and friends.
Meeting Daniel
Stern
By Kaija Puura, WAIMH Associate Executive
Director, Finland
I met professor Daniel Stern for the rst
time in a small Congress in Riga, Latvia
in 1994. We were both attending the City
reception and he happened to stand
beside me while we were waiting for the
ceremonies to begin. He politely asked
who I was and I naturally told him that I
had read his book The Interpersonal World
of the Infant, and that it had absolutely
loved it. With the cheek of a young
researcher I also told him that I disagreed
with him. «Oh, I´m interested to hear with
what», he said. I told him that I thought
that sense of being would come before
sense of becoming. He smiled at me
warmly with a glint of amusement in his
eyes and said «Well, that is a possibility, but
I think I´ll stand behind my own opinion.»
I met him several times after that in various
WAIMH Congresses but thinking of our rst
encounter always brings a smile to my face.
I remember him as a warm person, who
treated everybody with respect and was
curious about people and their ideas, while
at the same time standing rmly behind
his own.
Reections
from Turkey
By Elif Gocek and Nese Erol, Turkey
We, as the Turkish scientic community,
would like to express our profound
grief and deep sorrow for the loss of
Dr. Stern. Some people simply watch
history, some people truly make history.
Dr. Stern truly made history through his
research, observations and profound
expertise in infant development. He made
exceptional theoretical contributions
to our understanding of «infancy» and
«motherhood» that continue to inuence
every researcher in this eld to this
date. Dr. Stern was a great thinker who
dedicated his life to promoting «Infant
Mental Health». From the very beginning,
his comprehensive research, vision and
expertise enlightened and inspired many
professionals who are working with infants
and their families. Dr. Daniel N. Stern’s
contributions to science and his legacy
will continue to inspire many Turkish
professionals for many more generations
to come.
7 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH WINTER 2013
Memories of
Dan Stern
By Daniel S. Schechter, M.D., Switzerland
As for many of us at WAIMH, Dan Stern
represented an ideal-- someone who
was passionate about and successful
in working with infants and parents.
He observed, created, and challenged
existing paradigms. He enjoyed life in all
its aspects. I consider myself very lucky
and privileged to have crossed his path
professionally and personally in both of
his, in fact, now our hometowns: New York
and Geneva. Having rst been enthralled
with the Interpersonal World of the Infant
when it was hot o the press back in
1985, as shared by one of his/our early
mentors Eleanor Galenson at Mount Sinai’s
Therapeutic Nursery in New York, and then
having gone on to do my own training in
psychiatry and psychoanalysis where he
had been (Columbia), with my interest in
infancy, parenting, intersubjectivity, and
observational research using microanalytic
techniques. I remained a fan. It was
serendipitous and not at all directly related
to the Sterns that I was recruited to the
University of Geneva and aiated hospitals
to do parent-infant clinical work and
research, this being where Daniel Stern
worked in the late ‘80s before moving to
the Faculty of Psychology. Unfortunately,
by the time I arrived in 2008, Dan Stern was
already in poor health. But, I will always
treasure the moments that I was so lucky
to have shared with him together with his
wife Nadia. Here are two memories, one
from either side of the Atlantic:
New York
I was nishing my child and adolescent
psychiatry residency in New York in 1998-
99. I was feeling very inspired and proud
of my work with a very traumatized mother
and her toddler (A case as it would turn
out that set the stage for a program of
research on which I am still working to
this day). I was asked by Ted Shapiro at
Cornell to present my videos and write-up
to none other than Daniel Stern. I started
by presenting the history and the context
of the videotaped material that I was going
to show, proud of my frame-by-frame
microanalyses that I had gone over with
Beatrice Beebe, a supervisor of mine at
Columbia. Stern abruptly interrupted me
and said:
«Cut!» «Stop talking and just roll
the lm...otherwise you are asking
us to see what you see-- maybe
we will see something else. You
can talk later.»
I felt like someone had poured a bucket
of cold water on my head. But then, after
the shock, it was refreshing as I «let the
interaction tell the story...» as he would
write later, in the book, The Present
Moment in Psychotherapy and Everyday
Life, following from his work with Boston
Process of Change Group.
Letting the interaction tell the story
involved learning how to jump into
the moment(s) of interaction and stay
there with as little memory and desire as
possible. By practicing this, I could then
discern just by paying very close attention
to the sweep of action over time or «the
dance» as he called it, the «gestalt» of this
mother-daughter relationship without
knowing «the story.» As Theodor Adorno
once noted in his Quasi una Fantasia:
Essays on Modern Music (1963/1998),
narrative language or telling can obscure
meaning; whereas music and, by
extension, Sternsdanceorshowing can
reveal meaning in far greater complexity
and richness.
While nobody could quite get what the
story might have been exactly before I told
what I knew of it, it did not matter as much
as I had thought. Everyone in the room
knew already that it was a story of horror,
suering, and loss, but also of attempted
repair and great strength on the part of a
traumatized inner-city mother. And that is
what mattered most. We had all dived into
the moment with the coaching by Dan and
we were all refreshed.
Geneva
In 2008, when I was recruited to Geneva
to run the pediatric consult-liaison unit
and to continue my program of clinical
research on traumatized mothers and very
young children, my wife Christine-- also
as a speech-language pathologist having
read and been a fan of Dan, the kids and
I all took up Nadia and Dan Stern on their
gracious invitation for tea in their home
in Chêne Bougeries, a nearby suburb of
Geneva. It was a beautiful day in early
summer. I was sitting with Daniel Stern in
the Sterns’ magnicent garden. We were
sharing recipes (we both enjoyed cooking
and had similarly Eastern European
grandmothers who had made very rich
deserts) while jointly attending with him
to the largest sage bush that I had ever
seen. He was not so keen on walking. And
so we both just sat and chatted outside
while Christine, Nadia, and the kids stayed
in the house. Then, all of a sudden, he
said, «Shhh... listen... and look». We both
lost ourselves for what seemed like a long
while looking into the universe: the Sterns’
enormous sage bush lled with owers,
itting butteries, and bees. We had both
caught a glimpse of a brilliantly colored
but very tiny hummingbird that he had
spotted. We shared what for me will be an
ever-present moment that was inspiring
and beautiful. It reminded me that if you
don’t take time to stop and look and listen,
you will never see the hummingbird-
-it will have too quickly own away,
unrecognized. The motif of diving into
the present moment-- the sage bush, and
savoring it, was once again refreshing and
inspiring. I saw something I would not have
seen and there were no words to get in the
way.
Such was my schema of «being with Dan
Stern» that helped change the way I do
things, a variation on that of being with
him in the clinical conference at Cornell
in New York, that had transformed my
afternoon with him in his garden in
Geneva. Having taken in this wonderful
aftenoon’s interaction with him, I still
draw on these memories in my work and
elsewhere-- as a parent, when words
and explanations or theories seem too
important and not so helpful.
References
Adorno, T.W. (1963/1998). Quasi una
Fantasia: Essays on Modern Music. London:
Verso Books.
Stern, D.N. (1985). The Interpersonal World
of the Infant. New York: Basic Books, Inc.
Stern, D.N. (2004). The Present Moment
in Psychotherapy and Everyday Life. New
York: W. W. Norton & Company.
8 PERSPECTIVES IN INFANT MENTAL HEALTH WINTER 2013
Daniel Stern,
In Memoriam
By Yvon Gauthier MD, Emeritus Professor
(Psychiatry), Université, Canada
In the wide eld of infant and child
development and psychopathology, Dan
Stern played a major role all throughout
his fascinating career. I like to think that
among the results of his work was the
opening up of psychoanalytic theory to
early development and its practice.
We have to remember that as
psychoanalytically-trained child
psychiatrists we had to imagine how
early child development took place - until
child analysts developed sophisticated
instruments which gradually showed
that the rst years of the child happen
in the context of more and more
complex interactions with the parental
environment and that they are crucial for
the outcome of the adult. Daniel Stern was
a pioneer in such microanalysis of infant-
mother interactions. In his book, The First
Relationship: Mother and Infant (1977), he
wrote:
« Somehow, in this brief period
that I shall call the rst phase of
learning about things human,
the baby will have learned how
to invite his mother to play and
then initiate an interaction with
her; he will have become expert
at maintaining and modulating
the ow of a social exchange;
he will have acquired the
signals to terminate or avoid an
interpersonal encounter, or just
place it temporarily in a «holding
pattern». In general, he will have
mastered most of the basic
signals and conventions so that
he can perform the «moves and
run o» patterned sequences in
step with those of his mother,
resulting in the dances that we
recognize as social interactions.
This biologically designed
choreography will serve as
a prototype for all his later
interpersonal exchanges» (Stern,
1977, p. 1).
It is in the course of such work that Stern
developed his theory of development
of the self within the context of an
interpersonal world, around concepts
which are manifestations of development
within a social network: representations
of interactions that have been generalized
(RIGS), evoked companions, self with other.
It is also interesting to remember that
Stern’s ideas often came in conict with
analysts who seemed to think that this
emphasis on observed interactions and
environmental inuence was felt to be a
threat on the internal, imaginary life of
the child. This conict was dramatically
shown in a meeting held in London
where André Green and Dan came into
an intense struggle (Sandler et al, 2000).
Green accused Stern in particular (as
well as Robert Emde and Peter Fonagy
in the same volley) of tryingto destroy
psychoanalytic theory by replacing it with
a non-psychoanalytic, so-called scientic
psychology. In response to this accusation,
Stern suggested that infant observations
could lead to hypotheses most pertinent
for psychoanalysis.
Such work did not stay at that hypothetic
level and led to most important papers on
factors of change in psychotherapy: «...
even in a “talking therapy”, a vast amount
of therapeutic change occurs in the realm
of procedural knowledge that is not
conscious, especially implicit knowledge
of how to act, feel, and think when in
a particular relational context (implicit
relational knowing)». (Stern, 1998, 307).
That the relationship is a factor of change
came again in Dan’s work in his discussion
of several papers on early intervention
with disadvantaged parents where he
writes:
«... The largely unpredictable
products of their interaction
become the subject matter
that brings about change…the
process of interrelating, itself,
brings about change...it brings
about new experiences, feelings,
insights, and interactional skills».
(Stern, 2006, 3).
We will all miss Dan’s presence and his
unique way of elaborating his thinking.
We will also remember him through our
therapeutic work that now has to integrate
the fundamental idea that therapist
and patient are in the process of living
a new relationship which may lead to a
signicant transformation.
References
Stern, D. (1977). The rst relationship.
Mother and Infant. Cambridge:
Harvard University Press.
Stern, DN. (1998). The process of
therapeutic change involving implicit
knowledge: Some implications of
developmental observations for adult
psychotherapy. Infant Mental Health
Journal, 19(3), 300-308.
Stern, D. (2006). Introduction to the
special issue on early preventive
intervention and home visiting. Infant
Mental Health Journal, 27(1), 1-4.
THE SERGE LEBOVICI DISTINGUISHED LECTURE
THE CLINICAL RELEVANCE OF INFANCY:
A PROGRESS REPORT
DANIEL STERN
ABSTRACT:
In the past few decades, findings from infant observations have played a key role in the
following selected areas: (a) The emphasis now is on interpersonal and intersubjective processes rather than
on intrapsychic processes. This is a paradigm shift towards a two-person psychology. (b) The elaboration
of the attachment domain has reoriented our views of development and treatment. (c) The success of
extended home-visiting programs as a preventive measure for parents and infants at risk has brought an
agonizing reappraisal of what makes prevention (and therapy) work. (d) By default, the baby’s world is
nonverbal. This has led to a productive reexploration of unconsciousness, especially the domain of implicit
knowledge. For the future, the following are some of the areas of great promise: (a) Attachment, love and
“holding” must be disentangled. (b) We must study how and when the mirror neuron system gets micro- and
macroregulated. One is not always open to empathic reception. (c) The articulation between the nonverbal
(implicit) with the verbal (explicit) needs far more study. (d) The nonspecific factors of psychotherapy
seem to be the most important in bringing about change and prevention. We need a greater systematic study
of the nonspecific. (e) The triad and quartet, and so on need further exploration. (f) There are many more,
but the beauty of research is that you can’t know where it will go next.
RESUMEN:
En las ´
ultimas d´
ecadas, los resultados obtenidos de las observaciones a infantes han jugado
un papel importante en las siguientes ´
areas espec´
ıficas: (1) El ´
enfasis ahora se pone en los procesos
interpersonales e intersubjetivos, en vez de los procesos intras´
ıquicos. Esto representa un cambio de
paradigma hacia una sicolog´
ıa de dos personas. (2) La elaboraci´
on del campo de la afectividad ha vuelto
a orientar nuestras opiniones del desarrollo y el tratamiento. (3) El ´
exito de los programas de extendidas
visitas a casa como una medida preventiva para progenitores e infantes bajo riesgo, ha resultado en una
agonizante revaloraci´
on de qu´
e es lo que hace que la prevenci´
on (y la terapia) funcione. (4) De hecho,
el beb´
e vive en un mundo no verbal. Esto ha llevado a una productiva vuelta a explorar el concepto de
inconsciencia, especialmente el territorio del conocimiento impl´
ıcito.
Para el futuro, las siguientes son algunas de las ´
areas de gran promesa: (1) La afectividad, el amor
y el apoyo se deben tratar por separado. (2) Debemos estudiar c´
omoycu
´
ando el sistema del neuro
espejo es micro- y macrorregulado. Uno no est´
a siempre dispuesto a la recepci´
on enf´
atica. (3) Se necesita
estudiar mucho m´
as la articulaci´
on entre lo no verbal (impl´
ıcito) y lo verbal (expl´
ıcito). (4) Los factores
no espec´
ıficos de la sicoterapia parecen ser los m´
as importantes para lograr el cambio y la prevenci´
on.
Necesitamos un mayor studio sistem´
aticodelonoespec
´
ıfico. (5) La tr´
ıada y el cuarteto, etc., necesitan
Direct correspondence to: Daniel Stern, 14 Claire-Joie, Chˆ
ene-Bourg, CH-1225 Gen`
ave; e-mail: Daniel.stern@
tele2.ch.
INFANT MENTAL HEALTH JOURNAL, Vol. 29(3), 177–188 (2008)
C
2008 Michigan Association for Infant Mental Health
Published online in Wiley InterScience (www.interscience.wiley.com).
DOI: 10.1002/imhj.20179
177
178 D. Stern
mayor exploraci´
on. (6) Hay muchos m´
as, pero la belleza de la investigaci´
on radica en que no se puede
saber a d´
onde se le llevar´
adespu
´
es.
R´
ESUM ´
E:
Ces trente derni`
eres ann´
ees les r´
esultats d’observations de nourrissons ont jou´
eunr
ˆ
ole cl´
e
dans ces domaines: (1) L’accent est d´
esormais plac´
e sur les processus de communication et les processus
intersubjectifs plutot que sur les processus interpsychiques. C’est un glissement de paradigme vers un
psychologie `
a deux personnes. (2) L´
elaboration du domaine de l’attachement a r´
eorient´
e nos perceptions
du d´
eveloppement et du traitement. (3) Le succ`
es de programmes de visites `
a domicile de longue dur´
ee en
tant que mesure pr´
eventive pour les parents et les nourrissons `
a risques a amen´
eunr
´
eexamen d´
echirant de
ce qui fait marcher la pr´
evention (et la th´
erapie). (4) Par d´
efaut le monde du b´
eb´
e n’est pas verbal. Ceci a
men´
e`
a une r´
eexploration fructueuse de l’inconscient, surtout le domaine de la connaissance implicite.
Quelques domaines tr`
es promettants pour le futur sont les suivants: (1) L’attachement, l’amour et le fait
de tenir le b´
eb´
e doivent ˆ
etre d´
emˆ
el´
es. (2) Nous devons ´
etudier quand et la mani`
ere dont le syst`
eme de neuron
miroir se micro- et macro-r´
egule. On n’est pas toujours ouvert `
a une r´
eception empathique. (3) L’articulation
entre le non-verbal (implicite) et le verbal (explicite) a besoin d’ˆ
etre plus ´
etudi´
e. (4) Les facteurs non-
sp´
ecifiques de la psychoth´
erapie semblent ˆ
etre les plus important lorsqu’il s’agit de changement et de
pr´
evention. Nous avons besoin d’une ´
etude syst´
ematique plus pouss´
ee sur le non-sp´
ecifique. (5) La triade
et le quartet, etc, doivent ˆ
etre plus explor´
es. (6) Il existe bien d’autres domaines promettants, mais ce qui
est beau dans la recherche, c’est qu’on ne peut pas savoir la direction qu’elle prend.
ZUSAMMENFASSUNG:
In den vergangen Jahrzehnten haben die Ergebnisse der Beobachtung von
Kleinkindern eine bedeutende Rolle in diesen Gebieten gespielt: 1. Es wird nun mehr Wert auf die zwis-
chenmenschlichen und intersubjektiven Prozesse gelegt, als auf die innerpsychischen. 2. Die Ausarbeitung
der Bindungstheorie hat unsere Ansichten ¨
uber Entwicklung und Behandlung neu orientiert. 3. Der Erfolg
der ausgedehnten Hausbesuche als vorbeugende Maßnahme f¨
ur Eltern und Kinder mit erh¨
ohtem Risiko
haben best¨
urzende Erkenntnisse zu den Fragen was Vorbeugung (und Therapie) wirklich bringen kann,
gebracht. 4. Es ist einfach so, dass die Welt des Babys nicht sprachlich ist. Dies hat zu einer produktiven
Neuuntersuchung des Unbewussten, besonders im Bereich des impliziten Wissens gef¨
uhrt.
F¨
ur die Zukunft sind dies die vielversprechenden Gebiete: 1. Bindung, Liebe und ,,Halten“ m¨
ussen
unterschieden werden. 2. Wir m¨
ussen untersuchen, wie das Spiegelneuronensystem mikro- und makroges-
teuert wird. Man ist nicht immer zu einer empathischen Reaktion im Stande. 3. Die Verbindung zwischen
dem Non-verbalen (impliziten) und dem Verbalen ben¨
otigt noch mehr Studien. 4. Die nicht spezifischen
Faktoren der Psychotherapie scheinen bei Ver¨
anderung und Vorbeugung die bedeutendsten zu sein. Wir
brauchen gr¨
oßere, systematische Studien der nicht spezifischen. 5. Die Triade und das Quartett ben¨
otigen
weitere Untersuchungen. 6. Es gibt noch viele andere, aber die Sch¨
onheit der Forschung bringt es mit sich,
dass man nicht weiß was als n¨
achstes kommt.
Infant Mental Health Journal
DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.
Clinical Relevance of Infancy 179
***
It is a very special pleasure for me to be presenting the Serge Lebovici Distinguished Lecture.
Serge Lebovici was somebody very important to me; he introduced me to French thinking in
our field. I learned much from him. I respected him a great deal, and still do, and I grew very
fond of him. So I want to thank the scientific committee for giving me this opportunity to honor
him and to talk under his sign.
Today, we see babies and we see psychotherapy and prevention of parent–infant interactions
differently than we did at the last WAIMH meeting, and certainly very differently from the way
we did 10 years ago. What I would like to do is to bring up three key ideas that have played a
role in this shifting perspective. I would especially like to talk about the implications of these
ideas, in particular, for clinical domains.
These key ideas are not at all new; they have been around for a while. What is new is that
we are starting to see their implications. What happens is that we accept these new ideas, but
we do not explore them very far because in our daily lives we have many other things to do.
Nevertheless, they are powerful ideas deserving fuller exploration. This is what I hope to do in
this article.
KEY IDEA 1: A SHIFT FROM A ONE-PERSON PSYCHOLOGY
TO A TWO-OR-MORE-PERSON PSYCHOLOGY
The first key idea or perspective has to do with the progressive shift from a one-person psychology
to a two-person (or more) psychology. We all talk about it, and know about it. The question is
“Do we realize its full implications?”
The traditional model in clinical psychology is to describe the therapeutic process as a
largely linear, causal process. This seemed to be more compatible with a one-person psychology,
especially the traditional psychoanalytic model where the therapist is assumed to be “neutral.”
Yet, as we shall see, much of what happens is neither linear nor causal.
When we are in the middle of a psychotherapy session, we are often lost. We don’t know
what the other person is going to say next, and we don’t know what we are going to say next
until we open our mouth and say it. This is the reality of the therapeutic situation—perhaps more
so when we are in a triad or quartet. In supervision, what we usually do is tell what happened
in a session at the end of the session, after it happened. Then it looks linear, coherent, and all
nice. The reality is that when we are in the middle of the session, we are lost. And that’s true
regardless of how experienced we are. Or perhaps, if we are more experienced, we are even
more lost because we are not holding onto our theory with such tenacity, and we have come to
accept a degree of lostness from time to time.
Infant Mental Health Journal
DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.
180 D. Stern
A causal, linear model well describes what happens, but only for certain stretches of a
session, then a nonlinear, noncausal model describes better for other stretches. They alternate as
optimal descriptors. Even when considering a single individual, the variables from the past, the
present, and the immediate context operating at any given moment are too vast and interacting
to permit causal progression and linear coherence.
With triads and larger groups, the variables and their potential interactions are multiplied. It
would appear logical that the world would becomes less linear, and less predictable. And what
happens is more spontaneously co-created, very sloppy, full of errors and repairs, and sudden
direction changes; however, this need not be so. Both individuals and groups can behave in very
ritualized (even stereotyped) ways where the next sequence is highly predictable. And they can
both flip into a nonlinear, noncausal mode where co-created, on-the-spot, emergent properties
arise to confound prediction.
To deal with this reality, we need to be aware of the nonlinear, noncausal models that already
exist, such as dynamic systems models and complexity theory models. These models have been
described elsewhere (e.g., Edelman, 2000; R. Fivaz, 2000; Prigogine & Stengers, 1984; Varela,
1996). These models are now being widely used (e.g., Thelen, Smith, & Thompson, 1994).
But in parent–infant clinical work, we don’t use them much. This is what we have to begin
to do if we are to move beyond where we are now. The beauty of these models is that they
were designed specifically for situations that are complex, unpredictable, and nonlinear; more
specifically, where things change suddenly and the changes are not progressive, they occur in
jumps, bringing discontinuity, and where you can’t explain why something changed exactly as
it did or when it did. So, we need to understand and use a model for describing this kind of
process because this is what we are really dealing with.
Here is another problem for us. How do we deal with the fact that these spontaneously
co-created, emergent properties arise in moments of change, in turning-point moments that
occur in seconds? How do we understand this? What in the world is a turning-point moment?
In fact, what in the world is a moment? What is a present moment? And this poses a huge
problem. It is another implication of what we have to think about in a two-person psychology
or a three-person psychology. If changes are going to occur, in a moment, in a short period of
time, we best understand it.
Now, a moment is a very complex thing. It has to do with how we view time. I have spent
a lot of time considering this because it is so fascinating. There are probably two main ways to
look at time, both of which have been coined by the ancient Greeks. The first is chronos that
everyone knows about and that has been used by the natural sciences and most of psychology
and psychiatry. In this view, you have the present instant which moves evenly, all the time. As
it moves, it eats up the future as it passes and leaves the past in its wake. But it is just a point.
It is very, very thin. It is so thin that nothing could happen in it before it becomes the past.
There is no such thing as the present moment. But that’s contrary to how we experience our
lives. We experience our life as being directly lived in the here and now. The now, a present
moment, has a duration. It has its own temporal unfolding. The ancient Greeks had another word
for that: kairos.Kairos is the moment of opportunity. It is a moment of coming into being. It
is the moment when all of a sudden, things come together, unpredictably, and we have a small
window in which we can act. And if we act in that window, we can change our destiny. If we
don’t act in that window, our destiny changes anyway precisely because we didn’t act. What
I propose is that most moments of our lives when we are awake are essentially moments of
Kairos. The consequences of any given present moment can be very great and can change our
Infant Mental Health Journal
DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.
Clinical Relevance of Infancy 181
life course, or the consequences can be very small because they only determine what we are
going to say or do next, or what the mother is going to say next, or what the baby is going to do
next. But these present moments determine the future in a way that cannot be predicted until it
happens.
The other thing about the present moment is that if we are going to move towards any kind
of clinical situation which is oriented towards the subjective or the phenomenological, we have
to recognize that one is only alive subjectively, “now.” Now is the only time when we are having
direct, real experiences This is the only time when we feel what is going on. A memory happens
now, it doesn’t happen back then. An anticipation doesn’t happen in the future, it happens now.
There is no escaping from this reality. So when we talk about the here and now, we are talking
about present moments, and each of these is a moment of kairos (Stern, 2004).
There is another implication of a kairos. We, as baby watchers, are in the habit of seeing
things in very short time units; taking 1 to 10 s, 3 or 4 s on average. The mother does this,
the baby does that, the facial expressions form, the body goes tense or relaxes, and so on. The
interaction is a fast back-and-forth. Our basic unit to understand an interaction is seconds, or
even split seconds. This is not the case when we are discussing meaning. Meanings can develop
and become deeper over a longer period of time.
If our basic unit is a present moment, which also is a turning point that determines the
future, then we have entered into a new domain of what I will call “nanopsychology.” We are
familiar with this scale of events. It is interesting that when physicists moved into nanophysics,
they found that the rules of classical physics no longer held. And the basic units of the universe
also changed. So as we move into nanopsychology, we are going to have to reconsider some of
our basic thinking, both clinically and theoretically. This is an issue for our future.
Of course, longer periods and sequences of present moments are very important. That is
where representations get accumulated and built. But what are they built of? They are built of
these moments strung together, generalized, prototypicalized, and so on. So we don’t really get
away from present moments.
Another shift that goes with the movement towards a two-person psychology is that more
and more people look at triads and quartets and larger family groups that include infants. Here,
the work of Elisabeth Fivaz, Antoinette Corboz, and their colleagues in Lausanne stands out
(Fivaz-Depeursinge & Corboz-Warnery, 1999). I must say that until I met the Lausanne group, I
considered a triad to be nothing more than three dyads at play at the same time. It took me a long
time to realize that there is another entity called “the triad.” I think that my difficulty was not
particular to me. Many of us who work with the dyad do not appreciate the systemic reality of
triads, such as mother–father–baby or mother–baby–therapist. We say we know about systems
theory because we are dealing with mothers and babies, and a dyad is already a system, but we
don’t understand the depth of the system theory needed to fully understand the situation. We
must spend a lot more time doing that.
Another implication of moving to a two-person psychology is that once you do that, you
have opened up the space—in fact, the necessity—for intersubjectivity. Intersubjectivity is the
means, the royal road to having two minds make any kind of contact about their shared ongoing
experience. It underlines just about anything that we as clinicians hold dear, such as sympathy,
identification, empathy, sensitivity, caring, and loving.
So, let’s look a little more closely at intersubjectivity. I am going to just summarize here
the developmental aspects because I find them useful (Trevarthen, 1980). Probably, we are born
with a capacity for intersubjectivity in some primary fashion, and it has its own developmental
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course. I do not agree that all of a sudden there is “real” intersubjectivity at 5 years or 6 years
because a theory of mind is accessible then. I find that unhelpful.
I think that we are born with intersubjectivity, and it then develops further in various steps
over time. I think that neonatal imitation uses intersubjectivity in a primitive form (Meltzoff &
Moore, 1977). Pointing at 7 months or affect attunement around 9 months could not happen
unless there was some capacity for interattentionality or interaffectivity between two people, so
again, intersubjectivity is clearly present (Stern, 1985). The other finding that is very convincing
is the work of many people such as Meltzoff and his colleagues on the fact that what matters to
infants after the first birthday is not what you do but what your intention is (Meltzoff, 1995). In
other words, infants spend their lives noticing the intentions, unseen behind the acts, and not the
seen actions themselves.
In one of Meltzoff’s experiments that I love, the experimenter takes an object that is novel
and passes it over the mouth of a vase as if trying to drop the object into the vase. At first pass,
he drops the object short of the vase. It falls on the table. On the second pass, he drops it beyond
the mouth of the vase. He never gets the object to fall into the vase. The baby is sitting there,
watching. He then sends the baby home. The baby comes back the next day, and he picks up the
object and puts it right into the vase, without hesitation. This is what babies do in many other
experimental situations (Rochat, 1999).
Relevant to this, neuroscientific studies show that we have, and presumably babies have,
“intention detector centers” (Ruby & Decety, 2001). So whenever an intention is enacted, this
detection center discharges. This speaks to the profound importance of reading other peoples’
intentions, a quintessential act of intersubjectivity. Remember by intersubjectivity I mean being
able to participate in and, in some way, sense or know about the other person’s experience. If
the other person is experiencing an intention, you can capture it.
One of the interesting things that happens later on is when children get to be 3 to 5 years old,
and they are not in the classroom and are playing freely and unsupervised with their peers. What
is very clear is that they spend most of their time imitating one another, tricking one another,
teasing one another, and lying to one another (Dunn, 1999; Reddy, 1991). This is what that
world is all about. In the classroom, they learn about things in the world that are more orderly
and nice, largely explicit knowledge, but in the playground and on the street, they learn about
the reality of human social interchange. For that, you have to be able to lie and trick and cheat.
To some extent, lying is one of the landmarks of development because it is proof that you know
what is in another person’s mind to some extent, enough to be able to do something that the
other person did not realize was going to happen. Therefore, it isn’t simply a morally bad thing,
but it is a positive mark of development.
There is another interesting observation. From 6 to 12 years of age, recent studies have
shown that most children in all cultures studied have imaginary companions. We thought that
children let go of these earlier, but apparently, however, the growing mind seems to need this kind
of intersubjective contact. This is another example of a developmental step of the intersubjective
need.
The final implication of this move to a two- or three-person psychology instead of a one-
person psychology has to do with a move towards the social and the cultural spheres and
away from the individual. So many capacities of infants and children in development come
about through dialogue with other persons. Those capacities won’t emerge if the infant is not
in dialogue with other minds. Language doesn’t happen without the dialogue (That’s where
language really emerges and gets hammered out.); there has to be an equipment, but there has to
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Clinical Relevance of Infancy 183
be a dialogue (Tomasello, 1999). Morality is dialogic, even reflective consciousness within one
person is dialogic in origin (Stern, 2004). Everything of great affective and social importance,
like joy, is grown in this dialogue with other minds. Of course, this is where intersubjectivity
becomes so essential. We have to identify and describe the dialogic atmosphere in which the
child’s mind grows because the atmosphere is a matrix of the traffic with other minds. Babies
develop with the intentions, affects, beliefs, thoughts, and actions of other people impinging at
every moment of their lives, except those moments when they are alone. From these interactions,
their minds will form and be maintained.
KEY IDEA 2: IMPLICIT KNOWLEDGE
The second key idea has to do with the importance and the scope of implicit knowledge. This
is something that has been sneaking up on us. By implicit knowledge, I refer to knowing and
memory that is nonverbal, nonsymbolic, and nonconscious, as compared to explicit or declarative
knowledge. Largely through the study of infant development and therapeutic process work
(The Boston Change Process Study Group, 2002; Lyons-Ruth, 1998; Stern et al., 1998), what
we call “implicit relational knowing,” because it is about the ways of being with someone, has
emerged as an important construct.
Implicit knowledge used to be what we call sensorimotor intelligence,orprocedural knowl-
edge. These are no longer adequate terms. Implicit knowledge, we realize now, includes affects,
nonverbal concepts, expectations, and representations, but in a different code from the symbolic
code. The concept of what is implicit has expanded enormously. We also have learned that for the
most part, the baby’s implicit knowledge does not turn into explicit linguistic verbal knowledge
when she or he acquires language. We often describe infants as “preverbal,” or “prelinguis-
tic,” but these are so often, in my mind, misused terms. While “pre” means before, it also means
and carries the connotation of being an early form of, a precursor, turning into. For instance,
I can see that babbling may be considered prelanguage. But what about shaking the head no?
I don’t see that as prelinguistic. I think that you learn to shake your head before language, and
you also can shake your head when you learn to say “no.” You shake your head all your life,
and you shake your head when you say “no” and when you don’t say “no.” It is part of the
repertoire which is independent, although very tied to the verbal “no.” It looks like a precursor,
but it is not. In addition, we don’t think about walking as a prerunning event. Implicit knowledge
does not disappear when we learn language, its repertoire simply becomes larger. We keep it
throughout our lives, and it continually grows. My guess is that implicit knowledge of the social
and emotional world is probably 80 to 90% of all such knowledge.
There are some research implications of this that are quite interesting. The first implication
has to do with this extraordinary, fascinating movement from verbal to nonverbal and back
and forth because the two have an awful lot of traffic between them. We are beginning to
realize the existence and importance of nonverbal concepts in providing a base for linguistic
concepts and meanings. Here, I am thinking of the works of Lakoff and Johnson (1999) and
of McNeill (2005). They talk about “primary metaphors.” These primary metaphors are not
linguistic inventions or conventions. These are body concepts. They are implicit. And they are
nonverbal and nonconscious. An example of a primary metaphor would be as you move through
space, even if you are crawling like a baby, and you go from one place to another place and
then you stop, and then you start again and change the direction of where you go and the place
at which you arrive. All of that is known in experience, implicitly. So now, if I say “Well, in
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the relationship that I had with her, we only went so far, then we stopped,we stopped moving,
and . . . we got stuck there for a while, and then we both went in our different directions.”
Where do the italicized words or phrases come from? “We only went so far.” Where is far? “We
stopped.” Where is “there?” The point is that the verbally transmitted knowledge rests upon
body knowledge of movement and time and space—upon the implicit knowledge of the body
in the world. There are a multitude of these primary metaphors that are nonverbal concepts that
language can use and build upon. This is a very promising area for looking for the relationship
between the verbal and the nonverbal.
The most interesting thing about implicit knowledge with regard to clinical application is
that implicit knowledge contains representations, affects and memories, and nonverbal concepts.
This begins to have important clinical implications. How much of what we usually think of as
the dynamics of past experience will get subsumed by our notions of implicit knowledge? Are
we in the process of rewriting psychodynamic theory? Let me explain.
Will implicit knowing and its subcategories start to absorb concepts such as transference,
countertransference, primary fantasies, or relational past experiences that bear on what happens
now? Are these not all implicit relational knowings? Trauma might be a separate entity, but we
don’t know that yet. What I am saying it that there is a crisis now going on about what we are
going to do with the past, with fixations, trauma—all of the past that impinges on the present. As
we start thinking about the past differently by virtue of this expansion of the concept of implicit
knowing, the dynamic unconscious of classical psychoanalysis, that which is under repression,
gets relegated to a very small part of everything that is not consciously available. So we have to
think more about this constructive crisis, and we have to figure out to what extent this particular
key idea and its implications are going to alter our research strategies and our clinical practice
because it seems to me that the implications are very far reaching for the future.
KEY IDEA 3: NONSPECIFIC FACTORS IN THERAPY
The final idea that I want to mention has to do with the nonspecific factors in treatment that, once
again, we all know about. Most of us have been dragged kicking and screaming to the realization
that what really works in psychotherapy is the relationship between the therapist and the client.
That’s what does the work. We are all devastated by this reality because we spent years and a
lot of money learning a particular technique and theory, and it is very disheartening to realize
that what we have learned is only the vehicle or springboard to create a relationship—which
is where the real work happens. But that is where it is, from my point of view. We need to
have a technique, and we cannot have a technique without a theory. We have to do something
and act like we know what we are doing in a therapy session, otherwise we cannot create a
relationship. The relationship, of course, is not symmetrical, but we need not delude ourselves
that the technique is what achieves most of the results.
The reason I say this is the following: Outcome studies, which are always painful to
clinicians, show that it doesn’t matter too much which technique we apply. If we have been well
trained, we believe in the technique, and we have some experience, all of our techniques cure
roughly equally (Frank & Frank, 1991; Parloff, 1988; in parent–infant psychotherapy: Stern,
1995). And if we combine treatments, our effectiveness might improve a bit. If we add drugs,
that also may increase efficacy. But basically, there is something at work that is common to every
therapeutic approach: the nonspecific factors built into the relationship. This realization greatly
upsets therapists with strong beliefs in their approach.
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People who do brief psychotherapy with parents and infants find that one can achieve results
quickly, but are they lasting? In some cases they are, but in most cases they are not lasting. What
really happens is that the parents need to reapply some kind of therapeutic maneuver—1 month,
3 months, 6 months later, whatever—to bring therapeutic attention to the new situation that they
find themselves in with the baby, who is developing so rapidly. Now the baby no longer has a
feeding problem but does have a problem with aggression or anxiety. Brief psychotherapy, most
often, is a first step in a series of follow-ups of one kind or another.
The third observation is the success of home-visiting intervention programs. I think this is
very important, and it speaks very loudly to us. I am talking here about the work of many here
at the Congress (Ammaniti et al., 2006; Boris et al., 2006; Lyons-Ruth, Connell, Gruenebaum,
& Bostein, 1990; Olds et al., 1997; Zeanah, Boris, & Larrieu, 1997; Zeanah, Larrieu, & Naggle,
1998) who have all shown in one form or another that some kind of home visiting seems
to be extraordinarily useful prevention for people who are at risk for one reason or another.
What is interesting about these programs is that they are often conducted by non-mental-health
professionals. Most of the people who are doing home visiting have not been trained extensively
to do it. Instead, they are highly selected for being experienced mothers and generally kind
with people. They receive supervision and support, but basically they are improvising. They do
establish important relationships with the people at home with whom they visit. The results of
these studies are fascinating because they show in large part that this kind of intervention has
superior results to other methods that have tried to prevent adverse long-term outcomes.
There is a caveat to this general assertion: The home visitor must visit the home over a
long time and frequently. Most of the programs provide once-a-week visits for a minimum
of 12 months, optimally 18 months according to some studies. Each of the studies is slightly
different, but the basic story is: You get a non-mental-health professional who goes to the home,
and without specific training establishes a relationship, deepens the relationship—once a week
over 12 to 18 months—and the families fare far better than those with similar risk status who
do not receive the intervention. Given this situation, we must reexamine what we are doing and
what our therapy is really about, how we train people, and how we select them. This requires an
agonizing reappraisal of what we consider to be the work of child psychology and psychiatry
in the clinical sense. I am not sure how we are going to resolve this because it is not an easy
challenge.
What then are the nonspecific factors that make these relationships so successful therapeuti-
cally? We are beginning to pay more attention to these factors that we call by different names. One
of the heads of the World Health Organization, an extraordinary man named Benedetto Saracena
(personal communication), mentioned a study on parent–infant psychotherapies drawn from all
around the world. He said that all of the good programs have five things in common: (a) You’ve
got to listen, (b) you’ve got to take the time, (c) you’ve got to support them, (d) you’ve got to
be open and welcoming, and (e) you have to have an attitude in which suffering is as important
or more important than illness. He went on to say that if you look at any society, what they do
is that they all arrive at these same five principles, and they do these five things, but they all do
it differently. The exact form depends upon the culture, the time, the place, resources available,
the education system, but they all end up with the same five principles. They manage to put them
into a system that is compatible with their cultural reality, which determines the technique, the
theory, and the special conditions under which this goes on.
We have to look at our therapy from this perspective. How do we do this? We do have a num-
ber of names for the relationship which seems to be the largest therapeutic factor: the therapeutic
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alliance, the holding environment, attachment or an attachment transference, transference and
countertransference. These are our key terms and concepts when talking about the therapeutic
relationship. We have to be clearer about these notions and incorporate the five nonspecific
attributes in some way.
All of these terms and concepts are hugely overlapping, and to make any clarity here, we
have to disentangle them. We also must make it clear what we mean by this or that term. No one
from a particular school of thought can talk to someone from another school without a great deal
of clearing away. We have to sit down and draw where the boundaries are to have clarity in the
clinical situation and in the theoretical situation. For instance, I have a very hard time knowing
where attachment leaves off and love begins, and where love leaves off and dependency begins,
and how is that related to caring? The same applies to the boundaries of intersubjectivity. Now
there are certain problems. People who do attachment research have what sometimes looks like
an imperialistic view in which they incorporate “love,” “caring,” and “intersubjectivity” into the
construct of attachment. People who study intersubjectivity appear equally imperialistic, and
they tend to subsume everything into that construct.
For too long, we have avoided paying the necessary attention required to unpack the
nonspecific factors in therapies and act on them. For instance, the selection process for most
home visitors is to pick an older woman who has had a family and some experience. That is not
crazy. The good business schools around the world won’t take any student without experience,
preferring 5 or more years out in the marketplace. I wish they would do that for doctors and
lawyers, but that’s a long way off. But it is as important for therapists.
In conclusion, we are clearly in a new phase and a new place here at the 10th meeting of
WAIMH, and if we are going to lay the groundwork for different experiences between the 10th
and 11th and 12th meetings, I think that we are going to have to take such key concepts and
study much more their implications. We need to see, in fact, how and where they fit with what
we really do. This, I think, will assure us a much clearer path into the future that we are all going
to share.
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9 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH WINTER 2013
Aliates Corner
January 2013
By Maree Foley , New Zealand and Martin
St-André , Canada
As the new year begins, it is time for many
of us to renew our membership to various
professional organizations. For infant
mental health professionals, the oer
seems at times a bit daunting: regional,
national and international organizations;
discipline-specic organizations,
interdisciplinary organizations, clinically-
oriented groups, academically-oriented
groups. The diversity of our memberships
reects the richness of our aliations
and of our professional identity. But we
sometimes end up feeling a bit torn
between these various commitments, each
organization claiming the importance
of maintaining – and even increasing -
its membership base for pursuing and
developing its missions.
At the end of 2012, Aliates presidents
generously provided the Aliates
Council with their annual reports. Several
observations emerge. First, Aliates
across the WAIMH family are broadening
their repertoire of activities. They invest
considerable eort to consolidate their
organizational structure, and they create
together hundreds of infant mental health
educational and advocacy events in their
various communities. Second, Aliates
report working very hard at renewing
and even expanding their membership
base. They report also the challenge of
establishing new bridges among sub-
WAIMH membership and
Afliates membership renewal
campaigns: Building synergy of
action for 2013
groups of infant mental health workers
within their own community. For Aliates,
the challenge of maintaining membership
is especially important in the economic
context of most countries. For those of us
living in neoliberal economies, it is more
important than ever to emphasize the
value of social solidarity and to protect
society’s most vulnerable members -
including infants. A third observation
gleaned from the Presidents’ annual
reports is that the mailing list of all the
Aliates totals near 15000 persons and
organizations. Hence Aliates and their
mailing lists provide a powerful vehicle for
disseminating information and calling for
actions across the WAIMH community.
For WAIMH and for the WAIMH Board,
2012 has been a watershed year for the
enrichment of a bidirectional relationship
with the Aliates: supporting the
necessary infrastructure of the Aliates
Council, prioritizing the discussion of
Aliates issues during Board meetings,
catalyzing inter-Aliates relationships,
supporting the emergence of new
Aliates, and encouraging the creation of
Aliates-driven events for the next WAIMH
World Congress. By deciding to provide
free access to Perspectives in Infant Mental
Health and by planning to facilitate the
dissemination of conference material
from the next World Congress, WAIMH has
concretely demonstrated the extent of its
prioritizing of Aliates needs.
Why should you promote dual
membership to WAIMH and to your
Aliate in your Aliate community?
By deciding to become a member of
both WAIMH and of your Aliate, you
contribute directly to the expansion
and to the enrichment of a reciprocal
relationship between your Aliate and
WAIMH. You support the growth of your
Aliate by bringing in the scientic and
transdisciplinary culture of WAIMH. You
contribute directly to the nurturance of
other Aliates throughout the world and
to the action of WAIMH for its Aliates.
And nally, you contribute to align the
actions of WAIMH with the priorities that
you notice from the perspective of your
own community.
As 2013 gets under way, we wish you a
most productive year for your Aliate and
we assure you of our ongoing commitment
to support your input within the WAIMH
community.
Contact information:
Maree Foley
Aliates Council Representative
maree.foley@vuw.ac.nz
Martin St-André
Aliates Council Chair
martin.st-andre@umontreal.ca
Save the date
WAIMH 2014 Congress at the Edinburgh
International Conference Centre June 14 – 18
– Babies: Their Contribution, Our Responsibility
21
10 PERSPECTIVES IN INFANT MENTAL HEALTH WINTER 2013
By Jane Barlow, President, U.K.
AIMH UK was founded in 1997 by Dilys
Daws who on a long plane journey
back from meeting the Australian Sister
Organisation (AAIMH) took the rst steps in
establishing the UK aliate, which covers
England, Wales, Scotland and Northern
Ireland (see below). In 2012 we have a
membership of around 400 individuals
from diverse professional backgrounds
including parent-infant psychotherapy,
child psychiatry, health visiting, midwifery,
psychology. We have also given birth to a
six UK based sister organisations:
AIMH UK (NI)
Our regional oce in Northern Ireland was
launched on November 19th 2009, and is
extremely pro-active with a good growth
programme in place, and excellent PR
recently with representation on Northern
Irelands main Radio Station.
AIMH UK (NE)
Our regional oce in the North East of
England has developed from 9 members
before the AIMH (UK) 2010 Conference,
to 61, post conference. We have our most
diverse range of member professions
within AIMH (NE) including solicitors,
high-ranking members of the police force;
crisis intervention workers; domestic
abuse professionals, and counsellors,
amongst many other infant mental health
professionals.
AIMH UK (Scotland)
We are in the process of setting up a
regional oce in Scotland. At the last AIMH
(UK) AGM, Committee members were
identied to lead on the establishment of
AIMH UK (Scotland). Christine Puckering
who is leading this group is Honorary
Clinical Senior Lecturer at the University
of Glasgow and member of AIMH (UK’s)
Advisory Board is currently helping to run
Mellow Parenting’s annual conference
‘Every Baby Matters: Antenatal and
postnatal attachment, development and
wellbeing’. Christine has been inuential
with regard to the development ofScottish
policy in relation to infant mental health,
through authorship of ‘Infant Mental
The UK AIMH
Health: A Guide for Practitioners for Heads
Up Scotland’.
AIMH UK (East of England)
An AIMH regional oce in the East of
England has been developed from the
AiMH UK 2011 National conference,
which was held in Cambridge. AIMH UK
(EoE) branch will be working closely with
the active and thriving East of England
Perinatal and Infant Mental Health
Network.
AIMH UK (Wales)
We have active members in Wales whom
we are hoping to encourage to establish a
Welsh branch in the next few years.
AIMH UK (South West)
In the South West, Paul Barrows, AIMH
(UK) advisor and an ex-chair of AIMH
(UK) hosts an annual infancy conference,
which provides further opportunities for
recruiting members.
The UK Context
The UK is most fortunate in having some
seminal thinkers in the eld including
Peter Fonagy and Colwyn Trevarthan
and, indeed, some seminal organisations
including the Anna-Freud, Tavistock
Centre and the Scottish Institute of Human
Relations. Nationally, there is cross-party
recognition and consensus about the
importance of infant mental health, with
the Graham Allen MP Report (2010) Early
Intervention: The Next Steps, highlighting
the importance of the rst two years of life.
Andrea Leadsom MP has now established
PIP UK which aims to establish jointly
funded Parent-Infant Psychotherapy
Services across the country, and Frank Field
has set up the Foundation Years Action
Group. In England we are still in the early
stages of developing a National Infant
Mental Health Policy, and Scotland have
progressed faster.
Extending our work
AIMH (UK) is extending the breadth
and depth of our membership through
a programme of diverse workshops
and conferences and through the
redevelopment and redesign of our
website..
This year’s annual conference has
the theme Mentalisation and Mind-
Mindedness: Introducing new ways
of working into practice, and keynote
international speakers are Arietta Slade
and Dana Shai.
AIMH UK members are contributing to the
inception of an All Party Parliamentary
Groups for Babies (APPGB), whose
members will play a key role in shaping
future policy. They are also part of other
policy groups such as the Early Years
Champions.
AIMH members play a signicant
educational role in terms of the production
of books and documentaries for parents
including The Essential First Year by
Penny Leach, who with colleagues also
produced a series of guides to Joyful
and Condent Parenting of infants and
toddlers, and a wonderful Channel 4
Documentary called ‘Help me to Love my
Baby’ involving Amanda Jones. Amanda,
went on to develop with the NSPCC a
series of ve short documentaries entitled
‘Breakdown or Breakthrough’ focusing
on how to support parents to provide
parenting that will enable their infants to
develop a secure attachment relationship.
Books for professionals include Why
Love Matters: How Aection Shapes a
Baby’s Brain by Sue Gerhardt, Keeping
the Baby in Mind: Infant Mental Health
in Practice, which is edited by myself and
PO Svanberg, and Relational Trauma in
Infancy: Psychoanalytic, Attachment and
Neuropsychological Contributions to
Parent-Infant Psychotherapy edited by
Tessa Baradon, and Through the Night:
Helping Parents with Sleepless Infants and
Reecting on Reality: Psychotherapists at
work in Primary Care co-edited by Dilys
Dawes, and Nurturing Natures: Attachment
and Children’s Emotional, Sociocultural and
Brain Development by Graham Music.
Our clinical workshops have been
delivered by a range of national and
international specialist presenters with
themes directed at diverse audiences.
Themes include Complex Safeguarding
Cases; Video Interaction Guidance on an
International Perspective; working with
teenage mothers and their babies; work in
neo-natal units and making sense of the
Aliates Corner
January 2013
22
11 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH WINTER 2013
symptoms and behaviour of survivors of
child abuse who suer from Complex Post
Traumatic Stress Disorder and borderline
traits.
Added to this, our website, which
incorporates membership site software,
has been designed and developed
specically to create maximum interest to
IMH professionals who can join on-line and
gain immediate access to premium website
content. We are in the process of updating
the website because we recognise the
importance of this in attracting both
national and international interest and in
keeping the website fresh and current.
AIMH (UK) holds good strong relationships
with many relevant organisations
(including the Association of Child and
Adolescent Mental Health and Young
Mind) as we begin to see a stronger
presence and reach using our active Links
and Events pages, through the website.
In turn all these organisations readily
promote our events. We also enjoy close
links with the UK Marce society and over
the next 4 years will be looking to develop
some reciprocally benecial arrangements
including some joint conferences and
workshops to boost interest in AIMH (UK).
Articles/reports/papers and conference/
workshop presentations are represented
on the AIMH UK website Homepage with
an enticing ‘teaser’ that is viewable to all,
but actual content accessible to members
only, through using their own unique
password. Our Events Calendar on the
Homepage highlights all AIMH UK’s events,
month by month.
AIMH (UK)’s website also allows us to
continue to build on new initiatives
and incentives which currently include
Children’s Centre membership (allowing
those professionals who normally would
not be able to become a member of AIMH
(UK) to join, as a unit), student membership
(students can join at a lower rate, subject
to eligibility) and Corporate Membership
for relevant organisations. AIMH UK have
set up a ‘Recommended Books’ page, on
the website, where Committee Members
review relevant and key books for our
members.
Our on-line store facility allows us to sell
educational DVD’s to members allowing
prot to AIMH (UK), and the producers of
the DVD. The DVD currently on sale, ‘Early
Relationships and Child Development’
showing the lives of four young children
From the Kauppi Campus
-News from WAIMH Central Oce
in a baby home in Russia, has raised
over £2000 for HealthProm and the St
Petersburg Early Intervention Institute. 
Forthcoming
The next two years is a busy
period for AIMH UK as we
move toward hosting the
WAIMH 2014 Congress at
the Edinburgh International
Conference Centre June
14 – 18th. Our theme –
Babies: Their Contribution,
Our Responsibility – aims
to highlight research
emphasizing the reciprocal
and co-constructional nature
of parent-infant interaction,
and we hope to attract some
diverse presentations.
By Pälvi Kaukonen, Kaija Puura and Minna
Sorsa, Finland
Dear WAIMH members,
The WAIMH needs your contribution! It is
time to make nominations and elect two
new members to the Board of Directors of
WAIMH. The Board of Directors manages
the business of the association and
exercises all corporate powers. You can
see the composition of the current Board
of Directors on the WAIMH website (www.
waimh.org -> about us). There you will also
nd the Bylaws of the association. Article
7 of the Bylaws describes the purpose,
power, election process, meetings and
actions of the Board of Directors. Your role
in nominating candidates and electing
new directors is important to the decision
making process and strength of our
association.
Deborah Weatherston and Campbell Paul
will end their four-year term of oce in
May 2013. They have worked with great
dedication and warmth on behalf of
WAIMH during their term. All the active
WAIMH members are now kindly invited
to nominate candidates for two new
directors for the Board of Directors. The
Call for Nominations will be sent to WAIMH
members on March 7, 2013. Members
will have time to nominate candidates
until April 7, 2013. We hope to have many
candidates who will carry on the mission of
WAIMH through their work on the board.
The electronic vote will be open through
May 31, 2013 and we will inform you about
the newly elected directors by June 5,
2013. So, please, be active, participate and
inuence!
The next WAIMH World Congress will take
place June 14-18, 2014 in Edinburgh,
Scotland. The theme for the Congress
is «Babies: Their Contributions, Our
Responsibilities». Together with the Local
Organising Committee and its chair,
Jane Barlow, and congress organiser, In
Conference, we are currently preparing the
Call for Papers that will be available on the
ocial WAIMH Congress site in March of
this year. At this point we can already say
that the programme will oer plenaries
of the highest quality with topics ranging
from parental brain research and infant
brain development to attachment and
psychotherapy. In addition to attending
the extraordinary events planned for the
Congress, you will nd that Edinburgh is a
beautiful city with a rich history that will be
well worth spending a few days relaxing
and sightseeing in before or after the
Congress.
Last but not least, please renew your
WAIMH membership for the year 2013
online at the WAIMH website www.waimh.
org. There are two separate categories: the
student (45 USD) and professional (75 USD)
memberships. As a WAIMH member, you
have the privilege of ordering the Infant
Mental Health Journal at a special rate.
The rates in 2013 are: USA 50 USD, Canada
52.50 USD and International orders 62.50
USD. All journal subscriptions are now also
including access to the online IMHJ at the
Wiley website. Please, contact the WAIMH
Central Oce, if you need guidelines or
support for the membership renewal
(oce@waimh.org).
We hope you all would be active in
promoting WAIMH. From our website you
can print a WAIMH Flyer to share with
your colleagues. Ask them to join our
multidisciplinary and global association for
the benet of infants all over the world.
23
12 PERSPECTIVES IN INFANT MENTAL HEALTH WINTER 2013
ZERO TO THREE Corner
To know what a baby feels or thinks, we must engage with her, allowing ourselves to
feel the sympathetic response that the other’s actions and feelings invite. This article
(Zero to Three, Volume 24, Number 3) explores how engagement allows a richer, more
useful interpretation of infant behavior than does detached observation. Engaging
with babies is crucial not only for obtaining a fuller empirical picture of infant
development, but also for the infant’s development itself. Copyright ZERO TO THREE.
All rights reserved. For permission to reprint, go to www.zerotothree.org/reprints.
What we Learn About Babies from
Engaging With Their Emotions
of neonatal imitation, her only concern was
about what neonatal imitation meant.
Refusing to believe something until we
have experienced it ourselves is familiar
to all of us. We may not have believed,
for instance, that bringing up a child can
be quite so exhausting, or that losing a
parent can be disorienting even to adults,
or that kidney stones can be as painful as
others say they are—until we feel them
ourselves. But watching a baby do things
is not quite the same as these experiences
of exhaustion or despair or pain. The baby’s
actions are observable to anyone—to the
parent, the pediatrician, the scientist. Why
should we need to engage with the infant’s
behavior ourselves to be convinced of
what we are seeing?
There are several simple reasons
for accepting that in order to “see”
psychological phenomena, or understand
the processes that move psychological
“subjects,” we do in fact need to engage
with babies feeling that, similar to
ourselves, they are psychological beings.
1. The ndings from Gestalt psychology
a century ago clarify that organisms
perceive in meaningful wholes rather
than in parts; that which is perceived
varies between species in adaptive
ways. Only an organism with feelings
and thoughts can perceive feelings and
thoughts in another.
2. When we perceive things, we also
respond to them. Our response
legitimizes that which we perceive
and enables us to perceive it in one
way rather than another—that is, to
perceive it through the medium of
our response. If we observe a young
infant smile, we observe something
very dierent than if a dog or a Martian
were doing the observing, and we
respond in a dierent way.
3. When someone is saying or doing
something directly to us, we have
access to information that might
be unavailable to someone else
observing from the sidelines. This often
becomes a serious source of confusion
when psychologists present data on
communication from experiments,
which are inevitably selective. When
we greet a baby and receive a smile
in return, our experience of that smile
is dierent from that of someone else
doing the observing; the warmth and
the compliment that the infant gives
you in that smile must aect whether
and how you see that expression,
as must any historical knowledge
you have of the baby’s previous
interactions.
As Professor Bates may have discovered,
in trying to get a newborn grandchild to
imitate our protruding tongue, we are
enormously sensitive to detail in terms
of the baby’s gaze, mood, and previous
actions, which statistical analyses can only
attempt with diculty. It is not surprising
that Bates was more convinced by her
own single experience than by years of
data reporting statistical frequencies of
responses to “stimuli.
Emotions: The Key to
Engagement
We suggest that emotions are the key to
psychological engagement. Emotions
do not exist to be locked away inside
an individual. First, emotions are an
important agent in an infant’s active,
moving, and assertive relationship with the
By Vasudevi Reddy, Department of
Psychology, University of Portsmouth,
Portsmouth, U.K. and Colwyn Trevarthen,
Professor of Child Psychology and
Psychobiology, Edinburgh University, U.K.
In this article, we explore what we
can learn from engaging with babies.
Engagement is the way in which we gain
psychological knowledge about others,
including babies. Even psychologists use
the engagement approach to gather key
information about a person. If we want
to know what a baby, an adult, or any
animal feels or thinks, we must engage
with them, allowing ourselves to feel the
sympathetic response that the other’s
actions and feelings invite. This approach
diers from the position of doubt and
detachment concerning knowledge of
other people’s feelings and thoughts
adopted by 20th century psychology. But
for a scientist studying the behavior of
any system, engaging and participating
with it provides insight into the meaning
of natural events and processes—insight
that more detached observation cannot
give. Engagement is especially essential in
understanding social phenomena.
Why Is Engagement
Especially Informative?
In 1993, the late Elizabeth Bates,
a pioneering researcher on early
communication and language learning,
was an invited speaker at a conference
of the British Psychological Society in
Birmingham, England. She was sitting
in the audience when another invited
speaker, Giannis Kugiumutzakis (1998)
of the University of Crete, presented his
ndings on the imitation of vocal sounds
and facial gestures by babies less than
1 hour old. Neonatal imitation has been
one of the most controversial of all 20th
century ndings on infant development
because it violates the Piagetian
model, which assumes that all social
skills, including imitation, are complex
intellectual achievements involving much
trial and error in an infant’s early months.
In a question to Professor Kugiumutzakis,
Bates admitted that she had been one
of the skeptics, not believing in the
possibility of neonatal imitation—until she
successfully got a newborn child to imitate
her. Now that she believed in the existence
24
13 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH WINTER 2013
louder in volume than any other
vocalization I had heard, and
clearly lled with rage. Then she
made no other sound, although
the look on her face remained
angry. I was extremely taken
aback, and felt almost guilty.
Our history of engagements and my
emotional responses of shock and
guilt clearly helped me understand the
meaning behind Shamini’s acts. Without
such meaning, laborious mechanical
analyses could strive but still fail to
determine the signicance of the baby’s
reactions. When interacting with an infant,
anyone—including a researcher—must be
emotionally involved in sympathy with an
infant to fully understand why an emotion
has emerged, and what purpose or eect
it may have in the child’s experience of
life. We can learn a lot from intimate and
“respectful” engagement with babies’
actions and feelings. This way of observing
alters not only the empirical picture of
what a particular infant at a particular
time is capable of doing and feeling. It
also alters the whole theoretical story
about how infants develop, and what they
are motivated to experience and to be
changed by. Observation in the context
of emotional engagement completes the
partial picture that one obtains by distant,
objective observation and by assuming
that mental events cannot be observed
directly.
Openness to Emotional
Engagement in Studies of
Infants: Interpretation and
Misinterpretation
We take three examples of infant
behavior—protoconversation, coyness and
shyness, and teasing—to make two points:
First, that researchers never would have
studied these phenomena had it not been
for psychologists’ openness to engaging
with their infants’ emotions; and second,
that engagement allows a richer (and, we
would argue, more useful) interpretation
of infant behavior than does detached
observation.
Proto-Conversation
In 1971, the linguist and anthropologist
Mary Catherine Bateson rst highlighted
the phenomenon of “protoconversation
with 2-month-olds when she reported
on the lmed observations of a mother
with a 9-week-old (Bateson,1971). The
Why We Prefer SYmpathy to Empathy for Understanding
Engagement
Empathy is often used to mean comprehending how others feel, and, by extension,
kindness, helpfulness, or concern for others. But, the word is derived from the
Greek word empatheia, meaning “projecting feeling into something.” In modern
Greek, this word signies the “evil eye. Sympathy, in contrast, is derived from the
Greek sympathiea, meaning “feeling with, compassion, liking.” It is clearly more
intersubjective and two-way than empathy, which is more self-centered.
Adam Smith, the 18th century philosopher of the Scottish Enlightenment, in his
“Theory of Moral Sentiments” (1759/1976) designated sympathy as any kind of
“moving and feeling with,” whether motivated positively or negatively, and including
posturing and acting in the same expressive way as another’s body. He said “How
selsh soever man may be supposed, there are evidently some principles in his
nature, which interest him in the fortune of others, and render their happiness
necessary to him, though he derives nothing from it except the pleasure of seeing
it. (Part I, Of the Propriety of Action; Section I, Of the Sense of Propriety; Chapter I, Of
Sympathy, p. 9). “Pity and compassion are words appropriated to signify our fellow-
feeling with the sorrow of others. Sympathy, though its meaning was, perhaps,
originally the same, may now, however, without much impropriety, be made use of
to denote our fellow-feeling with any passion whatever.” (p. 10).
Of the words available to us, sympathy clearly conveys best the core sense of
intersubjective awareness of agency and emotion that works reciprocally between
persons.
Theologian and philosopher Martin Buber (1958) has urged us to acknowledge the
fundamental dierence between the sympathetic “I–thou” engagement between
persons, and one person’s relationship to an inanimate “it.”
world (Freeman, 2000; Panksepp, 2003).
Second, and most important, emotions
are intensely shared, because it the nature
and function of emotions are to stir
sympathetic responses in others (Schore,
1994; Stern, 2000). We do not know how
this response happens, but we cannot
deny this sympathy. Among those who
deal with infants, emotional engagements
with those infants provide the most
informative as well as the most helpful
route to understanding them. The two
anecdotes below, taken from the records
following the birth of the eldest child
of one of the authors (VR), illustrate the
power that emotional engagements have
on all involved, and the kinds of awareness
levels that they demand.
Shamini and the Still Face
Shamini was about 6 weeks old when her
father and I tried the Still Face Experiment,
which we had heard so much about (but
which I had neither quite believed nor
really understood; Murray & Trevarthen,
1985; Tronick, Als, Adamson, Wise, &
Brazleton, 1978). In the middle of a good
smiley “chat,” when she was lying on the
bed and I was leaning over her, I stopped,
with my face pleasant but immobile, and
continued looking at her. She tried to smile
a bit, then looked away, then looked back
at me and tried to chat, then looked away
again. After maybe 30 seconds, I couldn’t
stand it any longer and, smiling, I leaned
forward and hugged her, saying, “Oh, you
poor thing!” At this, she suddenly started
crying. Her reaction was a turning point
for me. I was shocked. And very moved.
I didn’t know she cared. Neither reading
about the research, nor even subsequently
watching Lynne Murray’s videos of still face
experiments, told me quite as much as this
experience.
Shamini’s Rage
Shamini (5 weeks old) was angry
with me today. I was delaying
feeding her because it was only
2 hours since her last feeding
and she had been awake during
that whole 2 hours. As a result,
she had become hungry quickly
and had wanted another feeding
for some time. At rst, Shamini
remained quiet, then became
restless, and then, after some
fussing, she frowned. Then she
yelled—a furious-sounding shout,
25
14 PERSPECTIVES IN INFANT MENTAL HEALTH WINTER 2013
observations were lmed in the linguistics
laboratory at Massachusetts Institute of
Technology.
The phenomenon of “talking” with a baby
who is only a few weeks’ old is a familiar
one to most parents: Babies look at us and
start smiling, then “chat in extended bouts
of sharing a mutual gaze, turn-taking,
cooing, moving lips and tongue, waving
arms, turning wrists, and extending ngers
(Stern, 2000; Trevarthen, 2001, in press;
Trevarthen & Aitken, 2001). They seem
to experience our conversational acts
as communication and feel the need to
respond expressively. If you allow yourself
to be similarly engaged with a 2-month-
old infant—especially an infant whom
you know well and who knows you—it is
impossible to resist becoming involved and
talkative. It is impossible, then, to doubt
the baby’s communicative intent, or to
argue that the baby’s acts merely appear to
be responses to yours. We cannot assume
that the babies’ actions are merely some
kind of biologically preprogrammed reex
behavior lacking appropriate feelings.
Similarly, we also cannot assume that the
baby is merely appreciating and testing
the “mechanical” contingency of your
behavior in time, with no appreciation for
its aective or companionable content.
Such assumptions are possible only if we
atly refuse to engage in the chat and insist
that the only accurate data source comes
from detachment and an unemotional
analysis that involves counting the
number of responses to a controlled
regime of stimuli. Emotional acts need
emotional perception. We cannot easily
perceive emotionally without similar
emotional engagement. In the 1970s,
the eld of experimental developmental
psychology—much more male dominated
at that time—refused to accept the claim
that infants not yet 3 months old can
have “conversations” in which they take
turns, show signs of pre-speech, and
respond to and invite others’ expressions
of emotion. Psychologists qualied these
infant–mother conversations with the
prex “pseudo” (false) instead of “proto
(earliest). Since the 1970s, psychologists
have questioned the belief that infants—
who are essentially unsophisticated
organisms—can comprehend and learn
psychological states and acts. However,
Stephen Malloch (1999; Trevarthen and
Malloch, 2002) has recently oered
rened descriptions of the motives and
emotions of proto-conversations. He
adapted precise computer-assisted musical
acoustic methods to reveal the “musicality”
of the vocal patterns that mother and
child generate, in mutual sensitivity, in an
undisturbed and enjoyable chat.
Coyness and Shyness in 2-Month-Olds
Self-conscious, aective reactions in
2 month-olds—that is, expressions
of coyness or shyness—are another
phenomenon that researchers have
recently identied (the existence and
interpretation of which is bound to be
challenged). It is not uncommon to hear
parents remarking, even about 2- and
3-month-old babies, that they are being
shy or coy (Reddy, 2000). The behavior itself
involves a particular pattern: The infant
smiles, and as she smiles, starts turning
her head and/or gaze away from the other
person; sometimes she curls her arms up
in front of her chest and lowers her face.
When you see this behavior in so young an
infant, you might interpret it in a variety
of ways. You could remark on the behavior
and see it as a kind of “xed action pattern
that may have been triggered by a specic
stimulus (e.g., a too-close approach by a
stranger). Or you could, as some parents
do, interpret it as an emotional response.
How do we decide which interpretation is
better?
Observational data on the occurrence of
the behavior helps. In one longitudinal
study of 5 infants (Reddy, 2000), we found
that all 5 exhibited coy behavior, although
frequency of occurrence diered from
infant to infant. The infants demonstrated
this coy behavior not only with strangers,
but also with parents and even with their
own reections in a mirror. The likelihood
of the behavior occurring with strangers
was greater at around 4 months of age,
when parents reported that through
such behavior, their infants seemed to be
inviting interaction and play. It can also
be seen, with other complex displays of
“sociability”, between infants when no
adults are present (Selby & Bradley, 2003).
We found that the behavior was more likely
to be seen early, in the rst seconds after
renewing an interaction, rather than later.
The baby’s actions are strikingly similar to
the behavior of older children and adults
whom we describe as shy. The infant’s
smiling gaze, the turning of the head
(often with quick return of head and gaze),
and the armraising are frequently observed
accompaniments to the embarrassed
(albeit more controlled) smiles that older
children exhibit. The pattern resembles
the stereotyped rituals of coquetry that
many cultures encourage females to use—
the fan in front of the face, the kimono
sleeve in front of the mouth (revealing
smiling eyes), the face tipped down to
show a sidelong glance, and so forth. The
context in which the babies displayed this
behavior mirrored that of toddlers and
adults—in which an unexpected onset
of attention spurs toddlers and adults
to blush and show embarrassment, as
Charles Darwin (1873) and Leary, Britt,
and Cutlip (1992) observed. (Of course,
other more sophisticated contexts elicit
embarrassment in older children and
adults.)
We chose to interpret early coy smiles
as a kind of aective self-consciousness,
even in the young infant. When an infant
looked at us, and we said hello, and
she turned away with an intense smile
then curved her arms and turned back
to look at us, it felt as if she was being
coy. We trusted our reactions. Because
we experienced these babies’ smiles as
aective self-consciousness, we went
on to conduct analyses comparing their
smiles, structurally and functionally, to
embarrassed smiles in older children and
adults. (If it weren’t for developmental
psychologists’ own emotional reactions to
Cognitions and Emotion in Life Experience
Jaak Panksepp (2003), a leading expert on emotional systems in the brain and aective
neuroscience, says this about the scientic problem of relating rational processes to
feelings:
At times I do fear that cognitive-imperialism, the prevailing view in mind
sciences, will continue to suocate the need for focused research on
aective issues, and thereby, continue to delay a scientic analysis of
such matters of foremost concern for understanding the existential inner
qualities of human lives. (p. 5).
That, I believe, is a hangover of Cartesian dualism along with the
prevailing assumption that subjective brain-mind issues, since they
cannot be directly measured, should not be deemed a topic of
disciplined scientic discourse or inquiry. (p. 6).
26
15 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH WINTER 2013
infant behavior within engagement, most
of the interesting things we know today
about infants would not have even been
recorded.)
Infant Teasing
Infant teasing is a third type of behavior
revealed through engagement (Reddy,
2003). In 1986, I (VR) videotaped
an interaction when Shamini was 9
months old. She is oering her father a
bikkipeg—a small babyteething toy—
while he is trying to get her to talk for
the camera. After he has accepted the
toy several times, each time saying Ta”
(meaning, “Thank you!”) dramatically and
giving it back, she oers it again with a
half smile. He trustingly reaches out to
accept it and she pulls it back, her smile
broadening. He feels tricked, comments on
his feeling, and reaches forward, laughing,
“You! Give it to me!” A few seconds later,
Shamini again oers the toy with a smaller
movement of the hand, again with a half
smile and with her eyes on her father’s
face. Just as he reaches, she withdraws
the toy and turns as if to run away. The
family, sitting around the table, laughs;
Shamini’s grandmother comments that
lately, Shamini has been doing this teasing
routine quite frequently.
This is not an uncommon behavior or
exchange within a family. But what do
we make of it? Shamini’s father felt as if
he had been tricked. I, across the room
and behind the camera, chuckled when
I saw Shamini make her oer with the
watchful half smile, even before she
withdrew the toy. The whole family
laughed, especially after Shamini repeated
the oer and withdrew the object for
the second time. The interpretation we
oered was that Shamini recognized the
shared understanding—that holding out
an object meant that the object would
then be released into the reaching hand
(Shamini had only recently started doing
this and was evidently enjoying the whole
routine). We also noted that Shamini was
playfully and intentionally violating that
shared understanding in order to elicit an
emotional reaction from her father.
This interpretation made some
assumptions that ran counter to
developmental theory at the time
(although many developments in babies
around 9 months old are now interpreted
as constituting a kind of “revolution” in
social understanding, especially of other
persons’ intentions; Trevarthen, 2001;
Trevarthen & Hubley, 1978). The most
central assumption we made was that
Shamini must know something about
her father’s expectation that she would
release the object; otherwise she would
not expect an emotional reaction to
the nonperformance of that act. This
assumption was not compatible with the
theoretical position that children do not
even recognize the existence of other
people’s expectations until about 4 years
of age. Mainstream theorists oered a
simpler explanation as an alternative
to ours: The infant may have previously
received positive feedback (such as
laughter and excited chasing) to an
unintended oer and withdrawal of an
object, and had subsequently learned that
this act was a good way to elicit that sort
of reaction—a plausible enough story.
The crucial point is, however, identifying
the assumptions that each story makes
about the infant’s understanding,
at 9 months of age, about other
people’s emotional attitudes. It is
about the emotions that an infant can
sympathetically feel. Our story assumed
that Shamini knew her father’s emotionally
charged intention (or expectation) to
receive the object from her—and that
the subject of her playful teasing was her
father’s perceived psychological state
and the pleasure associated with it. The
alternative explanation assumes that this
9-month-old could not have known her
father’s intentions or expectations and
feelings. This explanation suggests that by
simply remembering previous responses
that had occurred “accidentally, Shamini
was trying to elicit similar behavior.
From the psychologist’s perspective, the
dierence between these alternatives is
academic in the weakest sense of the term;
they don’t matter except as arguments
that pay people’s salaries. For anyone
dealing with infants, however, the choice
of explanation matters a great deal. If we
assume that the infant does not know
our expectations or intentions, we act
accordingly. We do not encourage the
baby to cooperate with or play with our
intentions and expectations. We do not
engage with infants’ actions that may be
attempts to engage our expectations and
intentions. For a playful parent who enjoys
shared emotions, this approach does not
seem to be the correct choice.
Engagement Creates,
Reveals, Learns, and Teaches
Meaning
Engaging with babies is crucial not only
for obtaining a fuller empirical picture
of infant development, but also for the
infant’s development itself—for well-
being, learning, and teaching (Bruner,
1996; Hobson, 2002; Rogo, Paradise,
Arauz, Correa-Chavez, & Angelillo, 2003;
Trevarthen, 2001, in press). Our responses
within engagement enable us to notice
and interpret infants’ specic behaviors
and to recognize and legitimize these
behaviors. When we engage and respond
to someone, we are entering a shared
reality in which each person can share
in the other’s behavior. Consider this
example:
A 12-month-old infant is sitting on his
mother’s lap, looking out of the window,
and he sees a ock of birds y up in a
rush. He points to them excitedly, vocally
exclaiming and with both arms extended,
but not turning around to look at his
mother. His mother looks too, and says, in
a lively, conrming way, “Oh yes! Isn’t that
exciting!” The infant leans back into his
mother’s body and continues to watch the
birds.
Her reaction—from the tone in her voice
and the movement of her body—arms
her son’s excitement and legitimizes his
act of communication about the birds. Her
response celebrates their companionship
as they gain knowledge about the world
and experience the emotions that such
learning can stir (Dissanayake, 2000;
Hobson, 2002). The simple example of a
mother and her son discovering a ock
of birds suggests that if an infant does
not receive an emotional reaction to his
emotions, he might stop expressing them
or he might not experience them in quite
the same way.
Looking at the incidents we have
described from the infant’s point of view,
we might ask what various adult behaviors
mean to the infant. What does someone
else’s gaze mean? What does someone’s
smiling mouth mean? What does a frown
mean? The most powerful meaning of
a smile, gaze, or frown emerges in the
infant’s engagement with the human
events surrounding these facial responses.
If we didn’t engage with infants, they
wouldn’t learn very much about us, and
we wouldn’t learn very much about them.
We uncover their knowledge and they
uncover ours. This method is how infants,
and adults too, “learn how to create
meaning” from each other (Hobson, 2002;
Trevarthen & Hubley, 1978).
We can look at learning from two
perspectives. The rst, denying the
agency of one of the partners (the learner)
and observing, as it were, from beyond
engagement, focuses on imparting
experience through instruction and
then assessing the student’s gains. The
second, observing and responding
27
16 PERSPECTIVES IN INFANT MENTAL HEALTH WINTER 2013
within engagement, acknowledges the
emotionally involved agency of both
partners— teacher and learner—who can
easily swap roles. This second perspective
is necessary, we argue, for anything
other than a sterile and mechanistic
understanding of human mental and
emotional development and, indeed, for
promoting development itself (Reddy,
2003). We must share and respond to
the powerful emotions of our infant
companions.
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Sympathy in the Brain
Functional imaging of activity in normal adult brains responding naturally to real
emotive events, and/or expressing communication with emotion, is bringing exciting
evidence for extensive systems that reect states of mind between people. Decety
and Chaminade (2003) say, of their ndings:
Motor expression of emotion, regardless of the narrative content of the stories,
resulted in a specic regional cerebral blood ow (rCBF) increase in the left inferior
frontal gyrus . . . . these results are consistent with a model of feeling sympathy that
relies on both the shared representation and the aective networks. (p. 127).
Most remarkable of all, the same “mirror” systems for matching expressive states
between people are already active in the brain of a 2-month-old baby who is looking
at a person’s face, responding sympathetically to it, and [suggesting that he is] ready
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Mazoyer, 2002).
28
www.waimh.org
PERSPECTIVES IN INFANT MENTAL HEALTH
Perspectives in Infant Mental Health (formerly, The Signal), the quarterly Professional Publication of
WAIMH, gives members an opportunity to share research of interest, provides a forum for the exchange
of news and views from around the world, serves as a nexus for the establishment of a communication
network and informs members of upcoming events and conferences.
A free Open Access Publication at www.waimh.org with no printing costs for authors.
To inquire about Perspectives
in Infant Mental Health or
to submit articles, contact
Deborah Weatherston, Editor,
dweatherston@mi-aimh.org.
CONTACT
Publication dates
Winter issue: March 1 (submit your
article by January 1)
Spring issue: June 1 (submit your
article by April 1)
Summer issue: September 1 (submit
your article by July 1)
Fall issue: December 1 (submit your
article by October 1)
Author and Submission
Guidelines
APA, sixth edition, for style
12 point font
Double spaced
250 words per page
Articles of varying length are
welcome, however, length should not
exceed 20 pages
Word-format
Send pictures and tables in separate
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pixels/inch
Manuscripts are accepted throughout
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the permission to publish it in
Perspectives and also online. The
form can be found on the WAIMH
website at www.waimh.org.
www.waimh.org
During the past 50 years infant mental health has emerged
as a signicant approach to the promotion of social and
emotional wellbeing in infancy, as well as a preventive-
intervention approach to treatment when signicant risks to
the infant or young child, the parent and the relationship are
identied. Within this same time frame, the infant mental health
movement has expanded to a global network of professionals
from many disciplines, research faculty, and policy advocates,
all of whom share the common goal of enhancing the quality
of relationships that infants and young children have with their
parents and other caregivers. The global reach of infant mental
health demands attention to the cultural context in which a
child and family lives, as well as critical attention to issues that
aect child development, child health, child mental health,
parental mental health and early relationship development.
We invite all members of the World Association for Infant
Mental Health and all members of its 50 international Aliates
to contribute to WAIMH’s international publication, newly
named by the WAIMH Board, «Perspectives in Infant Mental
Health,» where views about infant mental health can be shared,
discussed, and indeed, even debated. We welcome your articles,
brief commentaries, case studies, program descriptions, and
descriptions of evidence-based practices.
Articles will be reviewed by the editors and members of the
Editorial Board, all of whom are committed to identifying
authors from around the world and assisting them to best
prepare their papers for publication.
Because WAIMH is a member-based organization, we invite
each of you to think creatively and consider submitting an
article that provide a “window on the world” of babies and
their families - scientic articles, clinical case studies, articles
describing innovative thinking, intervention approaches,
research studies, book reviews, to name a few. In the spirit of
sharing new perspectives, we welcome your manuscripts.
Deborah Weatherston, USA, Editor
Hiram Fitzgerald, USA, Associate Editor
Maree Foley, New Zealand, Copy Editor
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Resumo This article examines how people learn by actively observing and “listening-in” on ongoing activities as they participate in shared endeavors. Keen observationand listening-in are especially valued and used in some cultural communities in which children are part of mature community activities. This intent participation also occurs in some settings (such as early language learning in the family) in communities that routinely segregate children from the full range of adult activities. However, in the past century some industrial societies have relied on a specialized form of instruction that seems to accompany segregation of children from adult settings, in which adults “transmit” information to children. We contrast these two traditions of organizing learning in terms of their participation structure, the roles of more-and less-experienced people, distinctions in motivation and purpose, sources of learning (observation in ongoing activity versus lessons), forms of communication, and the role of assessment.
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