Reconstructing the Infant : Review of 'The Interpersonal World of The Infant' by Daniel Stern

Scott Stewart, M., 2001. Reconstructing the Infant : Review of 'The Interpersonal World of The Infant' by Daniel Stern. Reformulation, ACAT News Autumn, p.x.


In psychotherapeutic clinical work the picture of the patients life and difficulties are anchored in some complex view of development. CAT has a theory of development which is much like the scaffolding of CAT therapy itself which is a construct and much of the detail of how development progresses is held in references to other theorists. This in itself is no bad thing as it leaves the therapist free to draw on many different sources. One of the sources that have been increasingly drawn on is the work of Daniel Stern.

Daniel Stern's book is concerned with the reconstruction of the infant who is a human being who can be observed and has subjective experience, which can be inferred. His main sources are theoretical reconstructions from analytical studies connected to psychotherapeutic work with adults and the observations of research and developmental psychologists working with infants and (m) other child dyads, including Stern's own research observations, and the research of attachment theorists.

As an adult psychoanalyst and a psychologist observing babies and children he is uniquely placed to allow one set of understanding to work on the other. The infant studies help to correct the adult psychoanalytic view of development, which had, according to Stern, adultomorphised the actual development of the infant, attributing many types of experience far to early. The part of him, which is the psychoanalyst, can use the research observations as a starting point then go on to infer what the subjective experience might be like. There can be no clinical work in psychotherapy without this kind of inference. This kind of merging of developmental work with inference about dynamic structures is part of CAT's development. Michael Leiman had wanted to use Vygotsky’s work but could not integrate this into practise until he discovered Ryle's PSORM. The rest is CAT history.

The evidence is that the infant is born with emerging capacities for physical and mental organisation and cohesion, for example, to be able to link experiences across the different modalities of touch/taste, hearing and seeing. Stern describes the heady days when new-born infants were, for the first time, asked questions. Infants could answer in response, by head turning, looking and sucking. Experiments showed that infants would pick out invariants in variant experiences. They could use generalisations to organise experience right from the start. These organising principles Stern calls RIGs, Representations of Interactions that have been Generalised.

Looking at studies of infants from birth to 15 months old he contrasts the psychoanalytical programme and radically challenges its assumptions. The notion that babies are asocial and undifferentiated from (m) other is seen to be untenable when faced with the emergent abilities of the baby. From the beginning (0-2 months) the baby can, in a social context, can use its innate abilities to begin to make sense of its' experience. From 2-6 months the baby consolidates its sense of bodily agency and coherence, for a period hugely interested in others, then in things. From 7-15 months a deepening understanding of others subjectivity develops. All this happens in a non-verbal exchange in an indivisible social environment. In this picture of the social and developing world of the baby there is no suggestion of fusion, or of the baby not being able to engage from the beginning. In is at the verbal level, after 15 months, that defences of merger, fusion and splitting can occur. Paranoid fantasy can only appear as languge and symbolism is emerging, as infancy ends. Stern outlines these emergent, cores, subjective and verbal selves, which, he says, can be valuably linked to narratives and metaphors arising in therapy.

He questions the analytical notion that developmental phases are fixed. While the senses of self may be more significant and vulnerable when first developing they are nevertheless parts of self that continue to develop through the whole of life. This means that any insult or trauma that occurs can disrupt some sense of us at any point in our lives. This releases us from any temptation to try to think back to when a trauma occurred. The patient will tell us through some narrative part or metaphor when it occurred for them.

Stern is not saying that the outlines of development in analysis are obsolete, far from it. He may feel that concepts like ego and id are not very useful, but he thinks that difficulties with what he would call orality, autonomy, trust, can happen at anytime. In the reconstruct inquiry of therapy the important task, for effective therapy, is to find the narrative point of origin. His reconstruction of the different selves that the infant portrays at different stages of early development is driven by the need, in therapy, to find the metaphor, which offers the most explanatory power.

Stern has created an understanding of the infant, which can be integrated into other systems. It is a masterly work of integration. Hence the Kleinians or any standpoint starting form the self/other dialectic can use Sterns concepts. He gives a number of examples, which illustrate how his thinking could be used in a CAT reformulation. One is of a female patient who had a high-powered job but who came complaining of difficulties with motivation and feeling intimidated by those she worked with. She had been in hospital for a period aged seven or eight and much of the work in therapy had focused on this and the feeling of being controlled that she has at this time. Much of how she felt about others was well expressed, so in Stern's terms she seemed able to work with the intersubjective and verbal realms relating to this experience. But it did not seem to help her. Change came when he shifted his focus into an understanding of control relating to an earlier core sense of agency. Once this had been introduced herfeeling at the present time, of not having any power to move things physically began to make sense and she could get better. Thinking about the reciprocal role Controlling/Controlled/Rage in Stern's terms may help locate a more effective metaphor.

Where he writes about BPD he again gives us some indication as to how his thinking may be again helpful in reformulation. He thinks that the very varied description in psychoanalytical writing of the central state in BPD is due to the descriptions being located in the different senses of selves. Buie described the central state as a need to be held of merged which Stern would place in core relatedness: core senses of agency, coherence, history and affectiveness. Kohut described it as an absence of empathetic experience, which Stern would place in the intersubjective realm. Other descriptions have been defence against abandonment, failure of gratification, fear of the annihilating object, distancing causing secondary loneliness: all of which Stern would place in the realm of verbal relatedness. These give ways helpful ways in which to explore and find the metaphor, which will help to sustain the therapy and the patient.

Mog Scott Stewart

Full Reference

Scott Stewart, M., 2001. Reconstructing the Infant : Review of 'The Interpersonal World of The Infant' by Daniel Stern. Reformulation, ACAT News Autumn, p.x.

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