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Research Article
Psychopathology 2020;53:60–73
Making Meaning Together: Embodied
Narratives in a Case of Severe Autism
Jonathan T. Delafield-Butt
a M. Suzanne Zeedyk
b Susanne Harder
c
Mette S. Vaever
c Phoebe Caldwell
d
a Laboratory for Innovation in Autism, University of Strathclyde, Glasgow, UK; b School of Psychology,
University of Dundee, Dundee, UK; c Department of Psychology, University of Copenhagen, Copenhagen, Denmark;
d Private Practitioner, Beechstones Barn, Lancaster, UK
Received: August 1, 2019
Accepted: February 17, 2020
Published online: May 18, 2020
Jonathan Delafield-Butt
Laboratory for Innovation in Autism
University of Strathclyde
50 George Street, Glasgow, G1 1QE (UK)
jonathan.delafield-butt @ strath.ac.uk
© 2020 The Author(s).
Published by S. Karger AG, Basel
karger@karger.com
www.karger.com/psp
DOI: 10.1159/000506648
Keywords
Narrative · Embodied intersubjectivity · Social connection ·
Intimacy · Autism
Abstract
Shared understanding is generated between individuals be-
fore speech through a language of body movement and
non-verbal vocalisation, expression of feeling and interest
made in gestures of movement and voice. Human under-
standing is co-created in these embodied projects, displayed
in serially organised expressions with shared timing of recip-
rocal actions between partners. These develop in narrative
events that build over cycles of reciprocal expressive action
in a four-part structure shared by all the time-based arts: “in-
troduction,” “development,” “climax,” and “conclusion.” Pre-
linguistic narrative establishes the foundation of later, lin-
guistic intelligence. Yet, participating in social interactions
that give rise to narrative development is a central problem
of autism spectrum disorder. In this paper, we examine the
rapid growth of narrative meaning-making between a non-
verbal young woman with severe autism and her new thera-
pist. Episodes of embodied, shared understanding were en-
abled through a basic therapeutic mode of reciprocal, cre-
ative mirroring of expressive gesture. These developed
through reciprocal cycles and as the relationship progressed,
complete co-created narratives were formed resulting in
shared joy and the mutual interest and trust of companion-
ship. These small, embodied stories enabled moments of co-
regulated arousal that the young woman had previous dif-
ficulty with. These data provide evidence for an intact capac-
ity for non-verbal narrative meaning-making in autism.
© 2020 The Author(s).
Published by S. Karger AG, Basel
Introduction
Narratives are at the heart of meaning-making be-
tween individuals [1, 2]. They are typically considered de-
pendent on language and an abstract, rational intelligence
[3]. However, infant research demonstrates a precocious
ability from birth to engage in pre-linguistic narrative
meaning-making through expressive gesture of the body
and voice [4–7]. The enactive, participatory co-creation
of units of meaning establishes a foundation for learning
the patterns and embodied practices of a culture, from the
proto-habitus of family life right through to the complex
rituals and requirements of classroom learning [8–12].
is is an Open Access article licensed under the Creative Commons
Attribution-NonCommercial-4.0 International License (CC BY-NC)
(http://www.karger.com/Services/OpenAccessLicense), applicable to
the online version of the article only. Usage and distribution for com-
mercial purposes requires written permission.
Making Meaning Together
61
Psychopathology 2020;53:60–73
DOI: 10.1159/000506648
Participating in social interactions is regarded as one
of the central problems of autism. This is emphasised
within the diagnostic criteria for autism and is reflected
in the psychological research literature [13–15]. This em-
phasis on social impairment has led to a view that people
with autism cannot engage easily with others, that they
dislike social interaction, and that it is exceptionally dif-
ficult for them to create the kind of shared meaning that
lies at the heart of communicative exchanges. These dif-
ficulties lead to a popular assumption that autistic indi-
viduals cannot communicate and develop within social
interaction.
In contrast, this paper presents evidence that social in-
teraction can be easy to create and enjoyable with a per-
son with severe autism, given that one approach them in
the right manner. It will explore the ability and motiva-
tion of a young autistic woman to engage with a new prac-
titioner using a technique of interaction that adapted to
her primary and basic sensorimotor level of expression
using her rhythms and means of embodied expression in
ways comparable to the rhythms of parent-directed
speech. By doing so, the young autistic woman generated
social engagement, play and companionship at the level
of primary intersubjectivity. Based on this study, we sug-
gest that autism does not prevent intersubjective engage-
ment and exchange, but rather occludes it. This conten-
tion holds implications for contemporary theories of au-
tism and about the empirical paradigms that the research
and therapeutic fields employ, for these ultimately draw
out, or obscure, behavioural capacities available.
Under typical circumstances people with autism can
have difficulty engaging in communicative exchanges.
These interpersonal difficulties have been explained as a
deficit in understanding the personal perspective of the
other, either from a cognitive disruption weakening one’s
capacity for “theory of mind” [13] or “central coherence”
[14] or from an affectual disruption preventing emotion-
al connectivity to others [15]. An alternative set of ac-
counts, which are receiving growing interest, hold that a
primary disruption exists in the sensorimotor systems of
people with autism, obstructing efficient intentional
movement and affective engagement [16] with evidence
for disruption to an embodied “interactional system” [17]
and possible disruption to the “mirror neuron system”
[18, 19]. Sensory hyper- and/or hypo-sensitivities may
exacerbate the condition [20–22]. These accounts argue
that difficulties in perceiving and responding to the com-
municative behaviours of another underlie the social im-
pairment, and are therefore possible primary deficits in
autism that later give rise to more advanced developmen-
tal delays, such as those characterised as “theory of mind
deficits” [16, 23].
Underlying all of these theoretical explanations, even
if not explicitly acknowledged, is a concern with primary
intersubjectivity. Primary intersubjectivity was first iden-
tified through detailed microanalysis of pre-verbal moth-
er-infant interaction [24, 25]. It stresses the point that ef-
fective social interactions for learning and development
require intersubjectivity. That is, communication re-
quires two individuals, that is, two subjects, to produce
interactions that are joint, entwined and mutually mean-
ingful. Such intersubjective meaning is brought about
through a process of mutual focus, turn-taking and re-
sponsiveness to the emotions and intentions of the other,
as discerned in their facial expressions, eye gaze and body
movements [26, 27]. It is in responding to and building
upon the feelings and intentions of one’s partner that
joint meaning is created [28]. If a person were unable to
perceive the actions of their partner as organised and
meaningful, this would naturally render it impossible for
them to communicate with that partner in any contingent
and reciprocally meaningful manner, and social-depen-
dent development can become thwarted [29].
Humans are capable of primary intersubjectivity from
birth, reflected, for example, in the patterns of expres-
sions between infant and parent [6–8] that create narra-
tive structures resembling story-making [2, 4, 30]. These
very early pre-verbal narrative patterns of meaning-mak-
ing evident between infant and mother form the basis of
verbal narratives that employ the same patterning of
arousal and interest as in later linguistic childhood [9].
Their narrative forms remain a universal invariant, giving
structure to the interactions and the ability to contextual-
ise specific gestures and their affects within a unit of
meaning with a discreet beginning, development, climax
and resolution [31]. These narrative forms of intersubjec-
tive engagement are based on the capacity to perceive and
respond with sensitivity to changes in the other’s emo-
tional attentiveness, thereby yielding periods of engage-
ment with turn-taking and temporal synchronicity [24–
27, 30–32].
These exchanges are organised into rhythms and phas-
es, with characteristic contours of energy. Periods of en-
gagement are punctuated with periods of disengagement.
The predictability of this structure has led theorists to
classify infant-adult interactions as “proto-narratives”
[33], but their invariance of form and structure across de-
velopment, from pre-verbal to verbal narrative, suggest
these are not simply precursors to narrative, but are in
fact fully fledged acts of meaning-making; the term “nar-
Delafield-Butt et al.
Psychopathology 2020;53:60–73
62
DOI: 10.1159/000506648
rative” holds true [4, 8]. Such evidence underlies Bruner’s
[1] view that “narrative structure is even inherent in the
praxis of social interaction before it achieves linguistic ex-
pression” (pp. 77).
Autistic people can struggle with this intersubjective,
co-creation of meaning. Evidence indicates that they do
not share the same temporal, co-created patterns of
arousal and excitement that non-autistic children and
adults do and that the mismatch between autistic and
non-autistic patterns of action may disrupt communica-
tion and development [34, 35]. However, we reasoned
that if it could be shown that autistic individuals are ca-
pable of building mutual narratives organised in standard
structures, with an engaged partner, then that would ad-
dress queries central to contemporary theoretical debates
about autism. Are autistic people able to engage in spon-
taneous exchanges and, if so, under what circumstances?
Why has the literature so repeatedly demonstrated defi-
cits in this regard?
What do interpersonal narrative structures look like?
Bruner [1] has typified them as composed of a 4-part
structure, unfolding over time and moving through its
sequence of phases as (i) initiation, (ii) build, (iii), climax
and (iv) conclusion. Over the course of an extended com-
municative exchange between two people, this narrative
structure may arise a number of times. Narratives occur-
ring later in the interaction are likely to pick up themes
from earlier narratives, thus weaving an overarching nar-
rative that enriches the relationship between the two part-
ners.
This narrative structure requires two key features,
which carry implications for theories of autism [16]. First,
the two individuals must attend to and be cognisant of
each other’s expressive acts. These expressions always oc-
cur through intentional actions of the body, that is,
through facial gestures, bodily movements and vocalisa-
tions. They constitute a primary level of expressive action
[36]. Thus, it is imperative that the sensorimotor systems
of the two partners be sufficiently attuned to one another,
for it is only through attuning one’s sensorimotor system
to the partner that it is possible to perceive their expres-
sive acts and to respond to them in a reciprocal exchange.
Second, the exchange needs to have a rhythmic temporal
pattern. Successful interactions depend upon a shared
tempo, with particular expressive acts usually occurring
on the “beat” [7]. It is the sharing of rhythm that is im-
portant for the co-creation of meaning [1, 8].
The basic form of narrative is a skewed curve (Fig.1) [2],
where (i) the initiation of the narrative opens the intensity
of energy between the two partners; (ii) reciprocated ex-
pressive acts, enacted in rhythmic exchange, build the emo-
tional, psychological and often physical intensity of the in-
teraction over the beats of bars and with the quality and
timing of each expressive act crafting its feel, character and
tone until; (iii) the two participants climax to a point of
maximal tension before and (iv) their energy dissipates and
the narrative recedes to its conclusion, falling back to a
more relaxed level. As the plot in the narrative thickens over
its course, so too does its intensity, achieved through a rich-
er set of invested actions and reciprocated re-actions, an
increase in the modalities utilised and often greater force
and dimensionality of movement. By the end of the conclu-
sion, the narrative has died, but the experience of its cre-
ation will remain with each of the partners and between
them they will hold its special memory – a memory of a
unique, shared experience, the co-creation of which imbues
the memory with “meaning.” The conclusion is typically
followed by a pause, or period of disengagement, which al-
lows the two partners to renew their mutual focus, ready to
begin building a new narrative cycle.
In this paper, we adopt the theoretical framework of
narrative to explore the interaction of a young woman
with autism during her first meeting with a new practitio-
ner. This is unusual in studies of autism, despite the view
of seminal developmental theorist that narrative is central
to understanding human communication. Similarly,
Read and Miller [38], social psychologists, consider nar-
rative to be “universally basic to conversation and mean-
ing making” (pp. 143). We chose a case study approach
because it allowed us to examine communicative interac-
tion in microanalytic detail. During the exchange anal-
ysed here, the practitioner employed a technique known
Time
Introduction Development Climax Resolution
Intensity
Fig. 1. Intensity contour of a narrative over 4 phases: (i) “interest”
in the narrative begins at a low-intensity in the introduction, which
“invites” participation in purposefulness; (ii) the coordination of
the actions and interests intensifies over the development, as the
“plan” or “project” develops; (iii) a peak of excitation with achieve-
ment of mutual intention and interest is reached at the climax,
after which (iv) the intensity reduces as the participants share a
resolution, and the close engagement separates. Reproduced with
permission from Trevarthen and Delafield-Butt (2013).
Making Meaning Together
63
Psychopathology 2020;53:60–73
DOI: 10.1159/000506648
as Intensive Interaction, the core principle of which is
that the practitioner attune their bodily movements and
rhythms to those of their autistic partner [39]. Previous
practice-oriented evaluations have shown that Intensive
Interaction nurtures social interest and emotional en-
gagement, while also reducing distress and challenging
behaviour [40, 41]. We were curious to know whether or
not this technique was effective enough to yield the kind
of interpersonal, meaningful narratives thought to be dif-
ficult for people with autism. We were especially inter-
ested in whether narratives built by the pair would take
the same form traced for other non-verbal cohorts, espe-
cially mother – infant dyads, or a different form.
We hypothesised that there remains within autism a
basic human capacity for intersubjective meaning mak-
ing, expressed through the co-creation of narratives, and
that this basic capacity is elicited when a partner behaves
in an emotionally and behaviourally attuned manner. We
thus reasoned that if a standard narrative pattern was
present within the interactions between a severely autistic
person and a new partner, this would attest strongly to a
capacity for intersubjectivity present and active in both.
The aim of this study was to determine whether or not this
capacity for intersubjectivity through narrative co-cre-
ation could be identified in the interactions of the dyad of
an autistic person and her partner, and if so, we were curi-
ous what we might see within those episodes that could
improve our understanding of the aetiology and function
of autism. If a severely autistic person can be shown to co-
create joyous, joint narratives with a stranger, in a period
well under one hour, then a new basis can develop for un-
derstanding autism and, indeed, human connection more
widely. We will suggest that that new basis is likely to lie
within a sensorimotor, rather than cognitive account.
Materials and Methods
Design
The study adopted a case study design, in which a therapeutic
session between a young female adult with autism and a practitio-
ner specialising in the technique of Intensive Interaction was ex-
amined microanalytically. This session constituted the first occa-
sion on which the two had met and also the first occasion on which
this form of intervention had been attempted with this young
woman. Ethical permission for the use of the video footage was
granted by the institution in which she resided and by the School
of Psychology Ethics Committee, University of Dundee.
Participating Dyad
The young client, Kirsten (not her real name), was 18 years old
and had attended a daily educational resource centre for a number
of years. Filming took place at the resource centre. Kirsten’s diag-
nostic classification indicated severe autism. She was entirely non-
verbal and consistently psychologically and emotionally distant.
She frequently exhibited stereotypies (e.g., head shaking, slapping
and rocking) and extremely aggressive behaviour, including bit-
ing, scratching and kicking staff, on a daily basis. Previous inter-
vention approaches had failed to reduce the extremity of her chal-
lenging behaviour – termed ‘distressed behaviour’ within an Inten-
sive Interaction framework. The practitioner was very established
in the use of Intensive Interaction, experienced particularly in its
use with individuals with severe autism. She had been invited to
work with Kirsten because staff had become fearful of her increas-
ing aggression (i.e., distress) and had found no means of reducing
it.
Intervention Technique
Intensive Interaction involves interacting with a person by us-
ing their own sounds and movements [39, 42]. The practitioner
partner intently observes what his/her client partner is doing and
then “joins in,” using the same movements, vocalisations and
rhythms in a creative, non-rigid manner. The aim is to respond to
the client’s interests, concerns and behaviours, such that the client
comes to recognise the practitioner’s actions as a response [43].
The technique offers a means of building a direct, contingent and
embodied relationship between the two partners within the do-
main of primary intersubjectivity.
Microanalysis and Coding
The video footage was digitally transferred to a computer mov-
ie file (H.264 Codec, QuickTime, Apple Inc.,) to allow analysis in
normal, fast, slow and frame-by-frame playback modes. This flex-
ibility allowed for precise (±1 s) temporal mapping of vocalisations
and expressive acts.
Engagement Periods
First, periods of engagement between the therapist and her cli-
ent were identified and their beginning and ending times recorded.
Engagement periods were operationally defined as periods of en-
gagement between the therapist and patient during which time
expressive action was either (a) attempted by one or the other per-
son (e.g., knocking on the door or rubbing hands on the wall), or
(b) expressed by one person and responded to by the partner, in-
dicating it had been treated as if it were communicative even if it
was unlikely that the partner had intended it in this fashion (e.g.,
moving legs across the bed surface), or (c) an act was delivered and
received as communicative (e.g., a sharp foot-slap on the mattress).
The start time of an engagement period was coded by the video
frame time (rounded down to the second) in which the occurrence
of the act began, and the end time was coded as the video frame
time (rounded down to the second) when attention to the partner
had been withdrawn (e.g., by turning the head away). The periods
of time between engagement periods were classed as “interim pe-
riods.” A narrative description of the events occurring during all
engagement and interim periods was compiled (Table 1). Coding
for engagement periods was performed by the first author and ver-
ified by the authorship team.
All of the engagements were then coded by four variables: nar-
ratives phases, complexity, proximity and emotional valence.
Next, ten randomly chosen engagements from the nineteen identi-
fied were coded by another researcher. This researcher was naïve
to these data and this project, but familiar with infants and chil-
Delafield-Butt et al.
Psychopathology 2020;53:60–73
64
DOI: 10.1159/000506648
Table 1. Description of the interaction in each engagement and interim period
Engagement Time codes:
onset and end
Total
duration
Description of activity
1 1.00–1.03 3 s The practitioner (P) is standing outside the room where the client (K) is lying on waterbed face-down with her feet to the door and her head partially under
a pillow; 3 carers are sitting quietly in corners of room; P tentatively invites interaction from K by rapping 3 times lightly on the door; P remains outside its
threshold, as one would do when knocking to come into a house
Interim 1.03–1.12 9 s P waits in silence for a response from K; some words are exchanged between P and the carers
2 1.12–1.15 3 s P repeats the rapping with 6 knocks on the door
Interim 1.15–1.20 5 s P waits in silence for a response from K
3 1.20–1.35 15 s K makes sweeping movements with her legs on the waterbed, extending them laterally and then retracting back again, in a roughly rhythmic manner; P mirrors
this action by rubbing her hand against the wall, using the same rhythm and shape as K’s actions; this produces the same acoustic effect as K’s movements; P steps
over the threshold (at 1;33), to stand by the wall at the foot of the waterbed
Interim 1.35–1.43 8 s Stillness and silence by both P and K
4 1.43–2.04 21 s K moves first with a leg sweep; P imitates with her hand rub on the wall; there appears to be some dialogue between their actions, with elements of turn-taking
and imitation; further, K raises her head slightly from the mattress, as if attending more alertly to P; the engagement ends with P giving 6 strong rubs as if to con-
tinue the engagement more strongly
Interim 2.04–2.08 7 s Stillness and silence from both P and K
5 2.08–2.17 9 s K’s head remains lifted from the bed, which takes a determined use of physical energy; unexpectedly, K raises her right foot and slaps it down on the bed, yielding
a very audible “slapping” sound; responds by slapping the wall, coordinating her slaps with K’s, producing some very minor rhythmic turn-taking; P intensifies
the interaction by using 2 slaps as a reply to each of K’s single slaps; K produces a single slap, then a double, then a triple foot slap; P came in on top of this final
triple with yet more slaps, this time in the rhythm of a sextuplet; that proved to be an end to the engagement, because K did not respond further
Interim 2.17–2.22 5 s Stillness and silence from both P and K
6 2.22–2.23 1 s P slaps on the wall, inviting engagement
Interim 2.23–2.50 27 s Stillness and silence from both P and K
7 2.50–3.33 43 s A new engagement emerges slowly, beginning with K’s sweeping movement of her legs across the bed, in a rough rhythm; P once again mirrors this, with her
hand against the wall, overlapping and sometimes initiating in synchrony with K’s leg movements; then, K produces 3 foot-slaps; P imitates and then doubles the
number of slaps; K produces a single slap; P concludes with a single slap; all of these acts are taken in turns, before each returns to sweeping motions, on the bed
and wall respectively; these movements (and especially their acoustic effect) occur in an overlapping manner; they never become rhythmically coordinated,
though, and after some seconds, seem to die away
Interim 3.33–3.38 5 s Stillness and silence from both P and K; P glances around the room
8 3.38–3.51 13 s P now moves closer to K, leaning over the end of the mattress and delivering slaps onto the surface of the mattress; momentously, K actively lifts her head from
the bed, listening more closely to the sounds emanating from the foot of her bed; however, she does not turn her head to look in the direction of the sounds (or,
thus, to look at P); P gives several slaps on the mattress; K lifts her head yet higher to hear the sounds; K replies with 3 foot slaps, delivered by alternating her feet;
P replies in turn with a fast series of hand slaps; K listens for further slaps, but does not actively reply
Interim 3.51–3.59 8 s Stillness and silence from both P and K
9 3.59–5.46 107 s K abruptly returns her head to the bed, which is still lodged under the pillow. She resumes her leg sweeps; P once again mirrors these sweeps, echoing their
rhythm and quality; the sweeping motions offered by P garner a foot-slap from K; P responds with a comparable hand-slap, K responds with a foot-slap, and P
responds accordingly; crucially, P heightens the intensity by using a double hand-slap, rather than an imitative single slap
K then does something novel; she replies with short, sharp contractions of her legs, which push her feet down into the waterbed mattress; this has the force and
sharpness of a foot-slap, but is achieved without raising the leg, so requires a different, more forceful kind of physical energy from her body; P picks up on this
novel expression, bringing it playfully into the exchange, by pushing her hand downward into the mattress, P continues pushing at the mattress, producing the
same kind of thrusts and ripples that K had previously created; K repeats her leg contractions, producing a corresponding reply from P, who once again increases
the intensity of the interaction by pushing down fast and hard, with both hands, into the mattress, putting the weight of her whole body behind the movement to
give it added force; this generates strong ripples that flow down the entire length of the mattress and the length of K’s body.
Immediately, K returns to sweeping movements of her feet, although this time carried out with more force, thus maintaining the ripples of the mattress; P mirrors
this movement, and the ripples, with her hands, overlapping with K’s movements; K then delivers a sharp foot-slap (at 4.48), to which P responds with a triple
hand-slap; a rhythmic, turn-taking exchange of single and double slaps then ensues; there is an oscillating rise and fall in intensity as the movements shift from
periods of rubbing to periods of slapping; K is initiating all of the intense slapping episodes; P is amplifying them by increasing the number of slaps into a rapid
sequence of expression; P&K build up the intensity of the interaction, until K does something new again: she slides her body down toward the end of the bed,
toward the place and person from which the acoustic and vestibular stimulation emanates; indeed, while K is sliding her body, and simultaneously making a foot
slap, K reaches out and slaps P’s hand as it comes down to make a hand slap; Bodily contact has been made.
This contact results in 2 consequences; first, K quickly scoots up the bed, returning herself to her original position; second, P appears to feel invited to come to sit,
in a settled posture, at the foot of the bed for more intimate, direct play; More slapping play ensues; as it does so, K chooses to turn around fully, to orient visually
to P; P smiles broadly at this interest; the 2 look at each other directly, in a sustained fashion, and continue to play, with P smiling broadly; to the viewer, the psy-
chological contact has intensified significantly; K brings her foot actively and purposefully onto P’s hand; for the first time, they both vocalise, in unison, in joyful
laughter; heir play continues on this elevated level, now with regular touching and regular vocal exclamations, supplied particularly by P, to emphasise the mo-
ment of contact; moments of teasing enter the game, with P moving her hand sideways and K succeeding in coming into tactile contact with it nonetheless; their
modes of communication have expanded
10 5.46–5.59 13 s The playful slapping exchange between the pair continues, but it is now calmer and less intense; the pace of the slaps is slower, the force lazier; the relation be-
tween them feels companionable; K is smiling very broadly, as is P
11 5.59–6.27 28 s K is lying on her stomach, facing away from P; she delivers a more emphatic foot-slap than has been the case for some seconds, her right foot slapping P’s right
hand; P’s left hand then comes over to slap K’s right foot; K’s left foot then slaps, stacking on top of P’s right hand; P’s left hand comes over to slap and stack on
top of K’s left foot; this cycle is repeated until they come to a climax, both exclaiming their contentment with highly vocal laughter (at 6.17); the intensity of the
game declines slightly for a few moments; then P and K renew the slapping-stacking game, picking up the pace briefly and continuing to take turns; P places her
slaps on the soles of K’s feet; K places her foot-slaps on the bed; they pass through 3 cycles of exchange until K breaks off and withdraws
Interim 6.27–6.34 7 s K disengages from the exchange moves the whole of her body rolling onto her side, she reorient to P as she does so, with the pillow still held over her head
12 6.34–6.54 20 s K stretches our her left leg toward P and makes a foot slap; P responds with some slaps to the bed; the pair return to games of slapping and touching, in a rough
rhythmic fashion; the rhythm has changed and intensified, in that the turns are more languorously spaced, and moments of touching between K’s foot and P’s
hand extended, between slaps; vocal exclamations of excitement accompany the slaps; K uses both feet, very intentionally, to place slaps on P’s hands; the excite-
ment that has been mounting is stopped, suddenly, when K disengages by failing to take another turn, instead lying back and looking up at the ceiling
Making Meaning Together
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Psychopathology 2020;53:60–73
DOI: 10.1159/000506648
dren. She was instructed to code the variables as per the definitions
below, then left alone to code them. Inter-rater reliability was cal-
culated for each of the variables. Cohen’s κ value was > 0.89 for each
variable (mean 0.94). The variables were coded as follows.
Narrative Phases
For each engagement period, we identified the occurrence or
absence of the four phases of narrative units, operationally defined
as follows. Initiation: initial act that could have been or was treated
as communicative. Build: receiving a response from a partner’s
initiation, often in a reciprocal form, but not necessarily. Climax:
an energetic apex, following a period of building intensity. Conclu-
sion: decrease of energy and intensity, following a climax, in which
the ensuing calm is shared by the two partners. It is inherent with-
in the structure of narrative units that classifying a later phase as
‘present’, within any particular engagement period, means that
earlier phases must already have been identified. Without this con-
tinuity, a coherent narrative story would not exist.
Complexity
We monitored the complexity of interactions by noting the ex-
pressive acts and modalities through which communicative ex-
changes were delivered. For each engagement period, we recorded
when any of the following behaviours featured in the exchange:
slap, rub, push (on bed), turn of head or body (to orient to partner),
vocalisation, touch partner and full embrace. The total number of
different expressive acts was calculated for each engagement pe-
riod.
Engagement Time codes:
onset and end
Total
duration
Description of activity
Interim 6.54–7.00 6 s K momentarily lies in this new position, rocking slightly from side to side
13 7.00–7.01 1 s P slaps and holds both of K’s feet, but K does not engage
Interim 7.01–7.08 7 s K brings the pillow over her head and retracts her feet toward her trunk and away from P
14 7.08–7.48 40 s P makes a wailing sound; K brings her foot forward and slaps it down; P slaps her hand on it; P and K then renew the turn-taking slapping game; K is now lying
on her back, monitoring P’s movements through the mirror, and with one arm hanging on to the pillow, positioned behind her head; the intensity and intimacy
of the slapping game increases, with slaps that linger in the touch they provide; vocal exclamations remain; the game gives way to a combination of slapping and
pushing, picking up earlier themes in the play; each teases the other, with P running a series of slapping movements towards K’s feet; K retracts her feet, keeping
them out of P’s reach; all of these qualities intensify the emotional energy and intimacy of the interaction; this intensity then dissipates, resulting in a sense of
shared, calm quiescence
Interim 7.48–8.02 14 s K lies still for a few seconds; then, unexpectedly, K makes an effortful body movement, pushing herself up and rolling to the side with the pillow covering her head; it
looks as though she is going to withdraw and P makes an “Oach” sound of disapproval; K then determinedly pushes her torso upward, until she is sitting on her knees
and is reoriented directly facing P; K is situated at the far end of the mattress
15 8.02–8.37 35 s K moves her body rhythmically, leaning backwards and forwards, pushing herself with both hands, on and off her haunches; she does this with laughter and high,
bouncy energy; her hands push down on the mattress, while P’s slap down on the mattress; they are taking turns and both are laughing; this movement has led
their hands to reach a place where they each touch; there is a brief moment of release and then a renewed touch; then, with both hands stretched out, K slaps P’s
hands and extends fully forward, into the centre of P’s chest; P opens her arms in what feels a totally natural and spontaneous response, embracing K with a long,
contented “Ahhh”; K exhales vocally and relaxes; both rest their heads nuzzled into each other’s shoulders, in an extended, intimate, calm embrace; here follows a
period of gentle laughter and intimate sighs
K disengages slightly, putting a small space between herself and P, as if to renew the hand-slapping game; but she then breaks off abruptly and returns to a psy-
chologically disengaged state, looking away from P and shaking her head from side to side; P marks these had movements with rhythmically matched vocalisa-
tions
Interim 8.37–9.10 33 s K then stands up abruptly and walks purposefully away from the mattress, sighing and grunting repeatedly, vocally; she walks to the far side of the room, away from
P, making it clear she wishes to put distance between P and herself
P follows K at a distance, making herself available should K wish to begin interaction on this new side of the room; K does not do this, however; instead, she returns to
the waterbed and lies down again, facing the place where P was last sitting and where they had just shared an intensely intimate moment
16 9.10–10.52 102 s K calls P over to the mattress by slapping it twice, sharply; as P nears, K slaps again, and P is now able to join in, slapping the mattress, in turn, as she sits down on
the floor, facing K; without skipping a beat, they are back into a hand-stacking game; they come to the conclusion of the exchange very quickly; lets out a long sigh
of relief as the game concludes; they pause, sitting closely together again once more; a shift occurs in the pace (at 9.41); it is less intensive and focused; the 2 re-
main physically close together, oscillating between close face-to-face contact with intimate whispers, touching with fingers and hands, and grunting vocalisations
interspersed with episodes of more defined engagements, with hand slaps and hand stacks
Interim 10.52–10.58 6 s K disengages, arches back gently, and glances around the room slowly; P waits still and silent
17 10.58–11.50 52 s K returns to lying facing P as before, P sits at the end of the bed on the floor with her legs outstretched; K extends her hand across the end of the bed and makes a
slapping motion towards P in the air; P playfully slaps her hand (as with the stacking game); K makes some scratching movement and P tells her off; K laughs and
turns away slightly, P laughs and the observers laugh; play continues; P adds slaps and vocalisations that match the timing of K’s hand movements; there a few
shrugs of shoulders alternated between them and grunting vocalisations from K and echoed by P, which maintain the feeling that had been achieved during deliv-
ery of the slaps; laughter and teasing is frequent
Interim 11.50–11.54 5 s K backs up and sits on her feet, pausing briefly; P watches with her arms crossed
18 11.54–13.58 124 s P and K simultaneously make movements; P slaps her hands on the mattress and K lunges forward, slapping both hands on the mattress so she is now on all
fours; P echoes with slaps as does K; this could be a moment repeating the embrace (in Engagement 15), but P remains seated and K flops to the bed, resuming
their previous intimate position facing each other with more gentle slaps and vocalisations
The engagement recedes in intensity; K looks around the room, but maintains gentle, rhythmic slaps in tune with P’s; there is some gentle stroking of the hands
and K rocks her body gently on the waterbed; the play becomes lazy, but continuous; they look at each other through the mirror; P imitates some basic nose
scratching by K; the engagement continues to reduce in energy
Interim 13.58–14.03 5 s K moves to the end of the bed and lies on her back, looking up at the ceiling; P remains still and begins talking to the observers
19 14.03–14.40 37 s K returns to P and makes a lunging movement; P calms her down and rubs her head; K returns to lying facing P and the 2 resume quiet, relaxed games of gentles
slaps; K becomes distracted by the zipper of the bed and P begins to talk to the observers about what has occurred in the session; their interaction concludes
Table 1 (continued)
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Proximity
We tracked changes in the proximity of the pair, using a scale
of closeness. A position of face-to-face gaze was treated as baseline
(0). Steps representing less proximity were as follows: outside the
room (–5), just inside the room (–4), standing near the bed (–3),
sitting at the foot of the bed (–2), reaching to touch Kirsten’s foot
on the bed (–1). The only step that represented proximity greater
than baseline was embracing (+1). For each engagement period,
we recorded the highest level of proximity exhibited.
Emotional Valence
We tracked changes in the emotion displayed by each member
of the dyad. Neutral was treated as baseline, represented by a
“score” of 0. Positive categories were represented as smile (+1) and
laughter (+2). Negative categories included frown (–1) and distress
(–2). For each engagement period, we recorded the highest level of
emotional valence exhibited by each member.
Results
Engagement Periods
A total of nineteen engagement periods were identi-
fied during the 15 min of the intervention session, rang-
ing in length from 1 to 124 s. Table 1 provides a detailed
description of the exchanges that took place during each
engagement period and their associated interim peri-
ods. Figure 2 provides an illustration of these exchang-
es, using a storyboard of still images extracted from the
video.
Narrative Structures
It was predicted that if the interactions reflected actual
intersubjectivity, they should also demonstrate the four-
part narrative structure that has been shown in other hu-
man communicative interaction, including adult-infant
interaction. We were especially interested in whether all
the components of the narrative emerged (i.e., initiation,
build, climax and conclusion), and if not, how these epi-
sodes of engagement differed from standard structures.
We found that narrative units became more complete
as the intervention session progressed (Fig.3). In the ear-
ly engagements, only initiations were observed. It was not
until Engagement 4 that any reciprocity in expressive acts
emerged. Once established, it became possible to turn-
take, nurture intensity, and develop a “plot line” around
which expressions could build. However, there was an ab-
sence of any climax until Engagement 9, which meant
that the intensity of these “plot lines” had nowhere to go
and that the client withdrew from these early interactions.
In observation, this termination left us with a sense of un-
settled, emotional distance.
In Engagement 9, the pair experienced a climax where
the intensity that they had been building reached an apex.
Interestingly, this was also the most complex of all the
engagement periods, involving an extensive amount of
negotiation. It is during this engagement within its cycles
of reciprocity that more creative expressive acts, such as
pushing down on the waterbed, emerged and the modal-
ities involved in the communication expanded (see de-
tails below). It is significant that this engagement offered
the first occasion on which joy was expressed, through
smiles and laughter (as described in Table 1). This would
be expected for the climax of an intersubjective exchange.
Notably, however, no conclusion was permitted. The cli-
ent withdrew before a period of quiescence was allowed.
It is only two engagements later, during Engagement
11, that a conclusion to the narrative units finally emerged,
thus constituting the first time that the pair had been able
to share an entire narrative cycle. Once they did this, their
emotional valence was maintained in positive affect for
the rest of the session. We reason that completion of the
narrative unit with its intimate climax and conclusion en-
abled each participant “appropriate” the shared, co-cre-
ated episode of meaning.
Overall, the pattern of narrative components shows
the predicted four-part narrative structure did emerge.
Crucially, it took time for those to develop; they were not
present from the outset. Once the pair had established
turn-taking communication through an initiation and
build, they did not lose this intersubjective capacity. The
engagements that were being constructed became more
coherent and more structured along narrative lines. We
argue they become more psychologically meaningful in
this way. The client’s apparent increasing joy in the en-
gagement is evidence to this effect and appears a conse-
quence of a developing coherence in her social engage-
ment and is indicative of an internal experience of a sense
of “meaning”.
Complexity
The presence of modalities and means of expression
increased over the course of the session (Fig.4). The ses-
sion begins simply with engagements consisting only of
slapping or rubbing expressions. As the session pro-
gressed, a wider range of expressive acts was used in each
engagement, moving from only the slap or rub (Engage-
ments 1–6) to pushing the bed and combining these in
different ways (Engagements 7, 9). Then, the composition
changed markedly, first in Engagement 9, with energetic
bed pushes, and then in Engagement 11 where vocalisa-
tion and touching became prominent, interestingly at the
Making Meaning Together
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Psychopathology 2020;53:60–73
DOI: 10.1159/000506648
ab
cd
ef
gh
Fig. 2. Storyboard of still photographs extracted from video re-
cording of the intervention session. a Engagements 1–7. The client
has chosen to lie on the waterbed face down, with her feet to the
practitioner. She makes rubbing motions with her legs at first, then
rubs and slaps in response to the practitioner (standing), who ap-
proaches from a distance and invites interaction through slapping
or rubbing the wall. b Engagement 7. Rapport develops between
the pair. The client partially orients to the practitioner, who has
taken up a position at the foot of the bed. c Engagements 9–14. The
interactions of the dyad develop, becoming more intimate, with
increased modalities and breadth of expression and with full ori-
entations by the client to the practitioner, including (d) developing
hand-on-foot play. e Engagement 15. Their interaction climaxes
as the client orients her entire body to the practitioner, oscillates it
back and forth and lunges (f) into a final embrace. After this cli-
mactic unification, (g) the client takes a break from togetherness.
h Engagements 16–19. After a moment, she returns to the bed for
more intimate and quiet face-to-face interaction. Note: the facial
features of the client have been masked to maintain her anonym-
ity.
Delafield-Butt et al.
Psychopathology 2020;53:60–73
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DOI: 10.1159/000506648
point where the full narrative unit also became apparent
(Fig.3). Vocalisation and touching remained prominent
and regular in every engagement thereon out. When the
total length of relevant engagement periods is calculated
(from Table 1) and compared, it becomes clear that 66%
of the session was spent in complex exchanges with slap-
ping, vocalisation and touch.
Proximity
The proximity of the partners increased over the
course of the session (Fig.5). They began from a distance
and came into physical contact in Engagement 10, when
the practitioner touched Kirsten’s foot from the end of
the mattress. The subsequent engagement is the period
during which the narrative phase of “climax” emerged
for the first time. The session itself came to a climax at
Engagement 15 when the 2 partners embraced and
laughed together, after which proximity settled to an in-
timate face-to-face position for the remainder of the ses-
sion.
Emotional Valence
The session progressed from a neutral valence to posi-
tive affect (Fig. 6). The pair begin emotionally neutral,
neither displaying hostility nor happiness. They remain
this way over the course of the first 8 engagements. In En-
gagement 9, this changed markedly and both client and
practitioner break into laughter and smiles after a long
and complex negotiation of play with expanding modali-
ties (Table 1). The laughter marked the climax of a narra-
tive (see above). Once this positive affect was established,
it was maintained throughout the course of the session,
moving between low and high levels. (Only Engagement
13 was devoid of positive affect, because it was merely an
unanswered initiation lasting one second.)
Discussion
These data show the intervention was successful in
promoting emotional engagement, rapport and intersub-
jective communication. Within a single session, trust and
companionship had been established between the practi-
tioner and young woman, whereas previously anxiety had
been the dominant affect and violence the dominant so-
cial behaviour. Primary intersubjectivity was evident
through the changes in the measured variables and espe-
cially though the co-production of standard narrative
structures. These data speak to a need to reconsider con-
temporary accounts of autism.
5
4
3
2
1
0
Narrative components
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Engagement
■ Conclusion
■ Climax
■ Build
■ Initiation
Fig. 3. The narrative components featured in each engagement.
8
7
6
5
4
3
2
1
0
Expressive components
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Engagement
■ Embrace
■ Touch, C
■ Touch, P
■ Vocal, C
■ Vocal, P
■ Bed push
■ Rub
■ Slap
Fig. 4. Type of expressive components featured in each engage-
ment measured as dyadic (slap, rub, and bed push) or individual
(vocal, and touch) contributions. “vocal, P” and “vocal, C” denote
practitioner and client vocalisations, respectively. “touch, P” and
“touch, C” denote the practitioner touching the client and the cli-
ent touching the practitioner, respectively.
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Narrative and Primary Intersubjectivity
The development of multiple modalities of expression,
proximal intimacy, positive emotional valence and the in-
creasing narrative structuring of the pair’s engagements al-
together make clear that primary intersubjectivity was op-
erative. The therapist and patient engaged with one anoth-
er, formed rapport, and established positive relations that
climaxed into a full embrace and concluded with intimate,
gentle face-to-face play. They engaged with each other with
teasing and provocation initiated at different times by one
or the other. Their expressions of voice and body were made
in rhythmic turn-taking in multiple modalities that alto-
gether formed predicted narrative patterns [1, 2, 4–9, 44].
The success of the intervention to bring out intersubjec-
tive relations may be due to the practitioner’s means of at-
tuning to the client through imitation, as well as her respect-
ful approach. Imitation has been shown to be an effective
means of engaging both autistic and non-autistic children
and infants [45–48] and is thought to assist what has been
termed “mind-reading” [49]. By attuning to the level of sen-
sorimotor function available to a partner, imitation creates
a channel through which communication may take place.
Thus, an intersubjective connection is afforded. The fact
that communicative engagement, such as we have shown
here, is so seldom reported in the experimental or interven-
tion literature can be explained by the fact that it is rare for
experimenters or practitioners to purposefully attune their
movements with those of their autistic partners. Indeed, it
can feel awkward as it requires breaking social norms.
The opening engagements (1–3) made by the practitio-
ner were simple invitations to engage based on the sponta-
neous body movements of the autistic woman. She quickly
engaged with these and began to turn-take with her practi-
tioner’s expressions (Engagements 4–5, 7–8), building in
other means and modes of expression as she did. The ease
and rapidity of her engagement is notable, given her history
of aggressive, distressed behaviour. From the beginning,
these bouts of playful turn-taking began to take on narrative
form, building in plot until, in Engagement 9, the pair came
to a climactic peak and vocalised in laughter together. Si-
multaneous multimodal expression is characteristic of nar-
rative climaxes, giving a peak moment of excitation and en-
ergy. As the engagements progressed, so too did their inti-
macy and trust, reflected in the proximity of one to the
other and in the client’s visual orienting to the practitioner,
as well as their obvious expressed joy through smiles and
laughter. The peak moment for the pair culminated in a full
embrace, initiated wholly by the client (Engagement 15).
The intensity of this intersubjective coming together re-
turned her to her stereotypies and afterward she broke off
2
1
0
–1
–2
–3
–4
–5
–6
Distance
0 5 10 15
20
Engagement
3
2
1
0
–1
–2
Emotional valence
0 5 10 15
20
Engagement
Fig. 5. The proximity of the practitioner to the client, scored as
(–5) outside the room, (–4) entering the room, (–3) standing near
the bed, (–2) sitting at the foot of the bed, (–1) reaching to touch,
(0) sitting face-to-face and (+1) embracing.
Fig. 6. The emotional valence of the dyad in each engagement from
high-negative (–2) through neutral (0) to high-positive (+2) affect.
Delafield-Butt et al.
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contact for a short time. Remarkably, she returned to the
bed and beckoned her partner to follow and to re-engage
(Engagement 16). Her practitioner did so, and they re-
sumed interactions, now sitting face-to-face. During these
interactions, full narratives with moments of peak climax
followed by quiet conclusions were readily apparent (En-
gagements 16–19). It is remarkable how quickly their inti-
macy developed.
However, if we compare the interactions made by this
practitioner-client pair with parent-infant interactions in
the first year of life, we see that the form of expression and
width of expressive possibility appear narrower than we
would expect an infant’s to be at about four months of
age. The degree of intermodal fluency appears restricted.
Still, even within this narrow channel, it was possible to
develop a characteristic temporal narrative course, effec-
tive enough for co-creating and sharing joy. This narrow
intersubjective course is dependent on the practitioner
tuning in and giving reciprocal, contingent feedback.
Nonetheless, performed well, the same experiences of joy,
intimacy and sharing that are available to an infant ap-
pear to be available to this autistic individual. Primary
intersubjectivity remained intact.
Sensorimotor Simplicity
The sensorimotor simplicity of the expressions – a
slap, rub, push – used in the dyad reduced complex an-
ticipatory requirements. There was no complex composi-
tion of individual movements within a particular expres-
sion of the kind required for language [2]. They were pri-
mary sensorimotor actions [36] with nuances of affect
conveyed by single actions with “forms of vitality” [33, 50,
51]. Their expressions were made with two simple move-
ments of the arm, a lift up and a slap down. Further, the
reciprocal turn-taking pattern of sharing meant that it
was enough merely to anticipate the next expressive ac-
tion of one’s partner and to have poised a reciprocal re-
action. Turn-taking in the dyad and practitioner’s re-
sponsive posture ensured a cyclical event. This points to
a deficit to do with an inability to understand and build
complex sensorimotor actions, and consequently to use
these for communication and social understanding [4, 36,
52].
These observations agree with experimental findings
that autistic children may not anticipate the secondary
consequences of preliminary actions [53, 54]. In these
studies, non-autistic individuals were found to immedi-
ately anticipate the final goal at the start of an action se-
quence, but autistic individuals were less able to predict
the final goal at the start and demonstrated anticipation
only during the final motor act in the sequence. Autistic
individuals did not appear to “action chain” into the pro-
spective future, but remained in a single action world
where intersubjective sympathies remained tied to antic-
ipations of the intent of immediate actions. Extrapola-
tion, or “action chaining,” to future possibilities beyond
the single action may be compromised for individuals
with autism. They may be “locked in” to single-action
events and not able to see beyond them, and thus unable
to socialize, or “mentalise,” beyond them. The efficacy of
the therapeutic intervention shown here is arguably a
matter of tuning-in to the familiar and understood sen-
sorimotor simplicity of the client and to use these expres-
sive acts for intersubjective sharing and companionship.
Intact Primary Intersubjectivity
Assumptions that primary intersubjectivity itself may be
disrupted in autism are not supported by this analysis. Re-
cently, Jaswal and Akhtar [55] presented a compelling argu-
ment that motivation to engage socially in meaningful ways
is preserved in autism, but its means of intersubjective con-
nection are thwarted. In many contexts, including experi-
mental settings within psychology, primary intersubjectiv-
ity and the wish to engage socially, may appear to be dis-
rupted artificially by the experimental context. We have
shown here that when a partner attunes her behaviour to fit
with the rhythms and perceptuomotor patterns of her au-
tistic partner, primary intersubjectivity is able to flourish.
Our data support the hypothesis that disrupted com-
munication in autism is related to a more fundamental
motor disruption [16, 56, 57]. Efficient embodied com-
munication appears disturbed, with a resulting capacity
to be misunderstood [58]. Motor disruption is evident in
disturbance to the subsecond kinematics of action [59]
that can affect their forms of vitality in expressive com-
munication [60, 61]. Communication difficulties may be
exacerbated by sensory sensitivity issues [20, 21]. Disrup-
tion to expressive motor timing may originate from
brainstem processes responsible for the subsecond tim-
ing of expressive action seen to be disrupted in children
with autism [62–64]. Altogether, efficient expressive “res-
onance,” or primary intersubjectivity, with a neurotypical
other in reciprocal shared sensorimotor interaction can
be thwarted. Everyday interaction can become difficult.
Neural dissonance, rather than resonance, between the
two mirror neuron systems may result [18, 52, 65]. This
basic social mis-attunement, due to such a temporal mis-
alignment of the forms of expressive motor action, may
thwart learning and the development of a sensorimotor
intelligence shared between individuals [10, 66].
Making Meaning Together
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DOI: 10.1159/000506648
In the therapeutic context analysed here, motor imita-
tion made with a reciprocal affective response to the other
appears to “fill the gap” between solitary motor actions and
shared codes that inform about what one is doing within a
sequence, or narrative parcel. Observable action can be held
in memory, time-bound, literal, concrete and within reach
of low-functioning individuals with autism and can deliver
expressions of pleasure [46, 67]. A growing body of work
demonstrates the success of imitation to make contact with
children and adolescents with autism and severe commu-
nicative impairments who are socially isolated [39, 41–43,
48, 68, 69]. Psychological contact mediated by imitation has
been shown to reduce stereotypies, anxiety and challenging
behaviours, thus affording new possibilities for action, in-
teraction and learning. Reciprocity in this rhythmic ex-
change of expressive body movement is the basis of dance
movement therapy known to improve social well-being in
autism [70], with the potential to become elaborated in the
musicality of shared meaning-making [71, 72].
This paper examined a single case of intervention by
an experienced practitioner in a technique of interaction
based on imitating of the affective quality made in move-
ment with similarly toned movements in an attempt to
engage and to elicit social connection. This technique and
the practitioner in question is in demand in the UK and
was awarded the Times-Sternberg prize for her work with
autistic patients. The recognition of success of her achieve-
ment has been noted in practice, but is not as well covered
the academic literature. Carers of these patients report a
decrease in anxiety, stereotypies and challenging behav-
iours after intervention. The technique operates at the
level of body movement and is entirely non-verbal, re-
turning communication to an ontogenetic primary – a
foundation of social meaning-making evident from the
first days of infancy onward [4, 66].
Conclusion
This case study has shown that autism does not entirely
rupture an individual’s capacity for primary intersubjectiv-
ity. This young woman, regarded by carers as aggressive
and psychologically distant, was able to co-create meaning-
ful communicative exchanges in partnership with another
human being whom she had just met. Such an outcome
raises important theoretical questions, for it conflicts with
the prediction made by the predominant cognitive ac-
counts, which hold that a theory of mind deficit prevents
autistic people from sharing mental and emotional states.
The data here show that a communicative partner who used
an attuned and responsive style of interaction developed
intense and vibrant primary intersubjective exchanges.
Further, we emphasise the fact that in our data narrative
structures, a cornerstone of human meaning-making, were
generated within the dyad’s interactions and followed a
normal, characteristic pattern. These data show primary in-
tersubjective capacities readily emerge in the right social
environment, with feeling expressed in reciprocal move-
ment of body and voice attuned to the individual.
Acknowledgements
The authors would like to thank our colleagues and students
for feedback on this paper and especially Colwyn Trevarthen for
discussions and insight into the narrative nature of non-verbal
communication.
Statement of Ethics
Ethical permission for the use of the video footage was granted
by the School of Psychology Ethics Committee, University of
Dundee, in accordance with the World Medical Association Dec-
laration of Helsinki.
Disclosure Statement
The authors have no conflicts of interest to disclose.
Funding Sources
The analysis presented here was part funded by a Danish Re-
search Council (FKK) grant no. 09-065858 to Delafield-Butt.
Author Contributions
J.T.D.-B., M.S.Z., S.H., and M.S.V.: conceived the study. P.C.:
produced the video data and carried out the interaction analysed
here. J.T.D.-B., S.H., and M.S.V.: developed the narrative analysis.
J.T.D.-B.: carried out the narrative analysis. S.H. and M.S.V.: car-
ried out the descriptive analysis. J.T.D.-B.: wrote the paper with all
co-authors.
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