Abstract

The authors propose to clarify concepts of emotional attunement and failures of attunement in early development derived from theoretical and clinical work (Kohut) and infant psychiatry (Stern). Early attunement failures are experienced as shameful by the infant/child, and without repair they form a nidus for later destructive adult interpersonal relationships, "social blindness," and depression. The authors present a case illustrating these ideas. The role of empathic attunement experienced in the unique setting/structure of psychotherapy emerges as the single critical variable for a successful outcome.

CASE ILLUSTRATION

Concerns with sympathy and compassion are age-old factors in medicine and healing. They constitute the matrix from which our twentieth-century focus on empathy emerged.1 Interests in healing within relationship and in the role of empathy bridge two lines of development: the clinical material on development of self and the findings from maternal-infant research. With regard to the first, Melanie Klein2 viewed early infant development as a process moving from attachment to separation of the self. Heinz Kohut3 emphasized the role of empathy in the development and formation of the self, underscoring his belief that the goal of human maturation involves differentiation within empathic relationship. With regard to the second, infant research has extended these understandings of the inborn attachment functions of the infant and their interplay in optimal infant/caregiver relationships in the first year of life.4–7 In mutual gaze transactions, the caregivers' facial expressions stimulate and amplify the positive affect, the joy, of the infant. The experience of interpersonal oneness in joy is a source of vitality,5 aliveness,8,9 and vigor10 for the infant, which the infant seeks to reactivate. Around the end of the first year of life the child is able to remember these socioemotional experiences. These memories of past experiences, named internal mental representations, serve as model behaviors in new interpersonal encounters throughout life. Empathic selfobject experiences, then, are sources of vitality that result in the maturation of a person with a whole self, a person with integrity.

Whereas empathic attunement results in a state of joy and excitement, misattunement results in a drastic diminution of joy and excitement. Interest, enjoyment, exploration, activity, and eye contact stop. These misattunement events create an experience of the mother as a stranger and the infant as deficient. These experiences of misattunement may be understood as shame experiences. Shame experiences result from the sudden awareness that one is being viewed differently than one anticipated. In a shame experience, there is a split in awareness. The self is simultaneously experienced as deficient, helpless, confused, exposed, and passive, and at the same time is experiencing the shaming other as if inside the self. The other is experienced as powerful, overwhelming, judging, and right. Unrepaired shame experiences result in a self defined in shame. The shame self leads to a preoccupation with the feelings, behavior, and concerns of the other. This is a "false" self that experiences disorganization and an inability to regulate itself.11

The state of wholeness (i.e., of integrity), resulting from experiences of mutual empathic attunement, can be understood as the origin of desire. Desire is a longing to reactivate the vitality and aliveness that was experienced in early infancy oneness-in-joy interactions. The empathic reciprocal shared looking, smiling, touching, and cooing between infant and caregivers grow into the adult choice of sharing because of the sought-after affect of joy in bringing pleasure to and experiencing pleasure with other persons.12 The self developing within mutual empathic attunement and the experience of repaired misattunement will develop with integrity and a reliable capacity to accurately read the interpersonal environment. In addition to being able to judge social situations with clarity, this person with a whole self will also be capable of providing empathic attunement with others, which is the basis for a healthy conscience.

The state of shame (i.e., of ruptured integrity), resulting from experiences of misattunement that are overwhelming and unrepaired, can be understood as the origin of learned patterns of interpersonal connections based on fear—fear of losing the other, fear of losing the love or approval of the other, fear of being unlovable, fear of punishment by the other, and fear of not living up to one's ideal for one's self. These misattunement states may be lived out in a counterphobic manner wherein the importance of relatedness is denied.13 These patterns, when internalized, can result in a kind of social blindness that emerges from the person's desperate seeking for selfobject functions in adult relationships. Impetuousness, in fact, undermines the access of true self intelligence required to judge social situations reasonably clearly. The person living in a state of ruptured self is preoccupied with feelings defined in shame. The self is simultaneously concerned with its own emotional pain and lack of adequacy, and overwhelmed with concern about the other as one who controls the self experience and well-being.

We present a case illustration of an individual who demonstrates a self predominantly developed within misattunement. The case demonstrates the shame state, manifested as depression, which is punctuated by experiences of hypomania when others are discovered who can serve as effective selfobjects. This case illustrates the social blindness that results from the ruptured integrity in states of both depression and hypomania. Following the case presentation, we discuss our understandings of the case within the framework of attachment functions.

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