[ECHOES]

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.

and the rest of the article if you wish: http://tinyurl.com/evenmorehere

just sharing my reading with you

[BlueMoon6]

Thanks Echoes. I had to read this a number of times.

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

This passage almost sounds to me like the pre-development of a bpd- beginning as early as babyhood.
Desk-t said to me that my I did not attach to my mother. There was a void, although she was there in the house on and off. I attached somewhat to my grandmother and was scared of my father. This passage seems to fit what my babyhood was probably like. It describes a time in my life before I could talk, before I could remember, but somehow I believe its true for me. I dont understand how it is possible to heal from damage done so young. I dont think it is. How does that empty, painful void inside of me ever feel filled, ever feel whole? When its been there forever.

[Melbadaze]

Oh Echoes, LOL, will you stop posting these long posts, I hate lots of words but am always compelled to come back and read interesting articles LOL!, dam! I Must go bath and cook my Apple Pies first though LOL!

[ECHOES]

LOL M
But you are one who I particularly think will share my interest!
I could be persuaded to not post wordy posts....like..erm..an apple pie...

[ECHOES]

BlueMoon, I agree this is where BPD originates. It's where the "Unthoght Known" develops, where we unconciously decided: others kind, unkind, attentive, neglectful, distracted, loving, absent... And from that our expectations are formed about ourselves and others.

Your childhood relationship sounds so much like mine, it's uncanny. [What is uncanny, anyway... the opposite of 'canny'?!? oh too early for that one..]

I asked T once if, since we internalize our early caregivers, could we also internalize their feelings that resulted in neglect? If we internalize "I don't like/love you" from them, then it becomes part of our psychological makeup, it becomes our own feelings toward ourselves. From outside of us we perceive it as it is used toward us, we internalize it and then use it toward ourselves. "You are no good, unworthy, unlovable..." becomes "I am no good, unworthy, unlovable".

I think with time we can learn how to fill much of that empty void.
I suspect it will not completely go away, but I'm willing to lose that bet.

[MissCharlotte]

Echoes,
Wow, this is so fascinating. Kohut is the "father" of the self-psychology movement. I think T must have studied a lot of his writings because I feel like my "false, shame based self" is reflected in that passage. I too think back to my infancy, trying to figure out where it all went "wrong." I must have gotten something because I have been able to be attuned to my own children. However, there was only 19 months between my elder brother and me and he was the only boy (adored). My grandmother helped out and she did not like me for whatever reason. I know she was abusive when I was in childhood and we were left in her care. I can only imagine that she was abusive to me as an infant as well. This explains the shame based M.O. My mother was a victim herself -- of my grandmother and my father's alcoholic rages. So in truth I don't think she had all that much of a sense of self to offer and what she did, my brother got.

Now I have to go read the rest of the article.

Blue--I think the healing comes in the context of therapeutic relationship. So on a very real level -- although you liked and respected her -- you did need more than desk T could offer. Your baby self needs much more nurturing and positive reflection.

Melba--how about sharing some apple pie?

Echoes, thanks for posting this article. I haven't quite finished reading it, but it resonates very strongly. I seem to still need a lot of external validation of the fact that my childhood was not OK and that my ensuing struggles to relate to people in a satisfying way are not an indication that I am a failed human being. Even though they seem to set off a kind of grief reaction, articles like this are helpful in showing me the truth.

ECHOES, thanks for posting that - very interesting!

After I read the first part about integrity, I though oh, I have integrity! And then I read the second part about shame and all the feelings that go along with that, and I thought - hey, wait a minute - I have all those feelings, too!

Obviously, I only know what went on in my infancy from photos and from what my mother has told me. I do know that when I was 18 months old, my parents separated for awhile after my father had an affair, and I also had eye surgery. Based on my history with my mother, T and I have surmised that my mother must have leaned on me even at that young age, when my father wasn't living with us. But I definitely got love from my father and my grandparents. Those feelings of being unworthy of being loved are very real in me, though - it's hard to pinpoint where they originated.

The therapist in that article writes about mirroring and idealizing as part of transference and developing a positive attunement with the patient - it almost sounds like the therapist is saying that the patient needs to idealize the therapist in order to build the relationship. Did anyone else read it like that?

[ECHOES]

patient needs to idealize the therapist in order to build the relationship. Did anyone else read it like that?

Dreamseeker, I have also been exploring my idealizing of my T and last session we talked about kids idealizing their parents. She said yes we do idealize when we are young, and we come to know the reality of the parent slowly over time, and at the appropriate time.
I think this is true with idealizing the therapist too. It seems like a natural progression and when the process works as it should, done appropriately, it may be this that 're-wires' us, gives us the 'corrective' experience to internalize and become the new and healthy Unthought Known.

[BlueMoon6]

Originally Posted by ECHOES

BlueMoon, I agree this is where BPD originates. It's where the "Unthoght Known" develops, where we unconciously decided: others kind, unkind, attentive, neglectful, distracted, loving, absent... And from that our expectations are formed about ourselves and others.

Im glad you agree, when I was reading it, it sounded so much like the specific feelings I have that are related to my bpd behviors/feelings. But in a baby. It made me wonder. I feel very much like my feelings are baby-ish, I dont mean that in a judgemental way toward myself. I mean that I need "babying" and in some way that I can only be in touch with in a an intuitive way, the baby I once was (and still have inside of me) is crying and yearning for love.

Your childhood relationship sounds so much like mine, it's uncanny. [What is uncanny, anyway... the opposite of 'canny'?!? oh too early for that one..]

I also think that. When you post about your childhood, I say YES YES YES! We are sharing a brain .
The thread about insecure attachment was a little too much for me to read. Because that is me and it seemed a little too painful. I did go back and read it some, and I will do it again...even if it ends pushed to another page....

[quuoteI asked T once if, since we internalize our early caregivers, could we also internalize their feelings that resulted in neglect? If we internalize "I don't like/love you" from them, then it becomes part of our psychological makeup, it becomes our own feelings toward ourselves. From outside of us we perceive it as it is used toward us, we internalize it and then use it toward ourselves. "You are no good, unworthy, unlovable..." becomes "I am no good, unworthy, unlovable".[/quote]

What a good question for t. It does look like that what happened. And it seems like the beginning of bpd patterns. How I feel about myself and the people around me. Did you shut down really young from your mother? Or did you keep trying? I dont know when I shut down, as far as I remember I must have shut down. But there just may have been times I kept tyring and dont specifically remember yet.

I think with time we can learn how to fill much of that empty void.
I suspect it will not completely go away, but I'm willing to lose that bet.

I could have written that word for word. I hope it isnt true- but this is me, this is my life. I cannot imagine losing that empty, sad, alone place. The place not even the love of children can touch. Id have to wake up in the morning as a different person. (I have wondered what it is like to wake up as someone else...a happy person).

[BlueMoon6]

Originally Posted by MissCharlotte

Echoes,
Wow, this is so fascinating. Kohut is the "father" of the self-psychology movement. I think T must have studied a lot of his writings because I feel like my "false, shame based self" is reflected in that passage. I too think back to my infancy, trying to figure out where it all went "wrong." I must have gotten something because I have been able to be attuned to my own children.

(((((Miss C)))) I also feel that this false, shame-based self is at the core of who I am. I think in some way I must have gotten something from them, too, because I am attuned to my children. What I imagine is that the mothering I got was extremely inconsistent. And then I craved what glimmer of hope and love I might have briefly seen. When I didnt get that, I just knew it was me and my fault. But I am able to give to my children, especially as babies, the love I wanted on a consistent basis.

However, there was only 19 months between my elder brother and me and he was the only boy (adored). My grandmother helped out and she did not like me for whatever reason. I know she was abusive when I was in childhood and we were left in her care. I can only imagine that she was abusive to me as an infant as well. This explains the shame based M.O. My mother was a victim herself -- of my grandmother and my father's alcoholic rages. So in truth I don't think she had all that much of a sense of self to offer and what she did, my brother got.

((((((MIss C))))) It is very sad, tragic, how it is passed on from generation to generation. And how much work and pain it takes to break the cycle.

Blue--I think the healing comes in the context of therapeutic relationship. So on a very real level -- although you liked and respected her -- you did need more than desk T could offer. Your baby self needs much more nurturing and positive reflection.

I hope so, I really hope so. I have been sort of stuck on ftt being CBT and that isnt what I need. She has said she is "eclectic" which is good, too. And she knows I have had my share of behavioral therapy. She has been great so far, but I wanted a psychodynamic t. She has said specifically said she wasnt trained that way and doesnt do that. It made my heart sink. But she is good anyway. Very good. It is my instinct that I will only be able to heal at this point through experiencing the loving and care with a therapist. A realtionship so different than that of RL, like my h or kids. I need a therpautic relationship to heal the deeper wounds. Someplace where my baby self can go and "speak." Desk-t had some strengths, but allowing my baby self to show herself wasnt one of them

[velcro003]

Wow-i haven't read this thread yet (I'm in a car on my phone), but I was JUST thinking how I wanted to find/read more on attachment and psychotherapy! Thanks Echoes I can't wait to read it.

[BlueMoon6]

Echoes- what is the orientation of your t? Im sure you posted it before and the info is hanging on a brain cell in my head somewhere....

[ECHOES]

LOL BlueMoon. My T is psychodynamic/psychoanalytic. She is a MSW (Masters in Early Childhood Development) and is trained in psychoanalysis..which is how I found her~by contacting a psychoanalytic institute and asking if they had a candidate (student) who had a practice in my area. She's been a therapist over 20 years.

Wow that sounds more like a resume than an answer to your question. I guess I tend to say all that when someone asks because prior to this therapy, I always insisted on my therapist being a psychologist and now I see that it isn't the degree designation that matters. Big lesson for me.

...now that brain cell of yours can rest.

[BlueMoon6]

She sound so good. I like her resume I was looking for someone psychodynamic but couldnt find one I liked. ftt is CBT, I hope its ok. There is a male t in her office that is psychodynamic, but I cant imagine going to a male t again. But if it doesnt work with ftt.....I am happy so far with her.

I have a no-brainer question I will ask anyway, why doesnt the degree designation matter? What kind of lesson did you learn?
I ask b/c I always wanted a psychologist, dt was a psychologist. My previous t had only a CAC. And ftt has a social work degree.

...now that brain cell of yours can rest.

Oh, Thank God! Cant stress out the brain cells...they give out on me......

[ECHOES]

BlueMoon, I must have been tired when I posted that.

The *rest* of the story... lol.. is that my T is a LMHC, Licensed Mental Health Counselor. That, I think, is what makes her so supportive and why she offers between session contact, something I've never had with psychologists. (just my experience).
The combination of this orientation plus the psychoanalytic training just make it a good fit for me. (except whe she insists on being real and having photos in her room and taking vacations. lol)

The lesson was that before this T, I would have argued that only a psychologist can provide *good* therapy. I would have looked down on this T as having insufficient qualifications.

lol It's just a darn good thing I didn't know her degree designations until I met her. Even then I think it was one of the things that made me angry at the first visit.
I'd tried one therapist who, after 5 minutes declared me depressed, was writing me a referral to get a Wellbutrin Rx, and was going to find some social groups to get me involved in. Slam-bam-thank-you-ma'am therapy. lol Then I saw a psychologist who was nice enough, but who suggested relaxation via guided imagery, then when that's all we were doing and I said I wanted to talk..she advised me that this would eventually become hypnotherapy. Actually I am interested in hypnotherapy, but I was very weirded out that she was not upfront about that. So that was the end of that.

This one is the real deal.

[sittingatwatersedge]

ECHOES >> What is uncanny, anyway... the opposite of 'canny'?!?<<
yes exactly, the opposite of canny, which is a cool word although not used these days.

ECHOES >> I asked T once if, since we internalize our early caregivers, could we also internalize their feelings that resulted in neglect? If we internalize "I don't like/love you" from them, then it becomes part of our psychological makeup, it becomes our own feelings toward ourselves. From outside of us we perceive it as it is used toward us, we internalize it and then use it toward ourselves. "You are no good, unworthy, unlovable..." becomes "I am no good, unworthy, unlovable". <<

Echoes what was yr T's response to yr question?

[ECHOES]

sawe, I apologize for not responding to your question way back here.
My T's response to my question was "What do you think?" (rolls eyes--I asked YOU! lol) and I said that I thought it was possible that this happens. She said quietly "Yes, it absolutely can.".

[(JD)]

I enjoy reading you ECHOES...but too many words doth make a person maD!

[ECHOES]

I must not be a person then.

Love the pie!!

[rainbow8]

This thread is VERY interesting to me, and I'm glad it was revived. I'm interested in attachment, and since I also have BPD, how I got it. I was loved by my parents, so I always guess that's it's from being a preemie, or else maybe my mother was too anxious and I needed more.

Blue, I also have that feeling about the preverbal baby stuff fitting me. I wanted to be a baby with my T, but she didn't want me to. The "baby stuff" is always screaming inside of me, wanting to be heard.

I don't want a CBT T, but it seems like ftt is using other methods with you even though she has that orientation.

ECHOES, thanks for this thread.

CBT works really well in conjunction with other methods. Sounds like you have an eclectic t. That's a good thing.

[ECHOES]

rainbow, yw

Along with attachment, or aside maybe, exploring 'separateness' is really helpful. On the surface it seems obvious, but in the intricate matrix of feelings and interactions and expectations, there is so much more.