Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.

Lloyd, J., 2009. Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.. Reformulation, Summer, pp.34-35.


Physiological Evidence for the early origin of Reciprocal Roles

Understanding infant development has always been important to both psychology and psychotherapy, not only from curiosity, but also because it offers a way of getting at the fundamentals of whom we are. As part of the nature-nurture debate, if psychologists could understand infant experience, in-built skills and potential, then it would be possible to calculate in what way upbringing and later experiences contribute to maturation. Achieving such a description then permits the leverage points in psychotherapy to be better appreciated.

Most early psychoanalytic and cognitive psychologists including Freud, and later Mahler, based their understanding of infants on the ‘theorised’ infant. For example, Vygotksy wrote “[The infant’s] world is, of course, full of noises and shapes, but his sensory organs are still of no use to him; he is still unable to distinguish individual impressions, he cannot recognise objects and can single out nothing among this general chaos. For him, the world of known, perceived things does not exist, and he lives in the midst of all this like a hermit.” (page 91).

Infant observation, assisted by modern technology, shows just how wrong this idea from Vygotsky was, although his idea was consistent with how infants were thought of in the 1930s. As a theory, CAT takes a great deal from Vygotsky, particularly his understanding of how development is not the isolated product of the growing child, but grows through the relationship with more competent others.

In the early days of the development of CAT, the sophisticated technology used nowadays to assist infant observation was unavailable and the CAT notion that RRs have their origin in early childhood was mostly intuitive. Ryle (1995) described Reciprocal Roles (RR) as a heuristic device, a construction, intuitive reflection or abstraction used to link a person’s history with current patterns of self-management and relationships with others. How does this concept stand up in the light of some of the current infant research?

In this book, Beebe and Lachmann explore ‘interactive regulation’ (which might be described as RR in CAT), i.e., the interaction patterns that are characteristic modes of interaction and self-regulation that the infant comes to recognise, remember and expect. In arriving at this concept of interactive regulations, they consider diametrically opposed views by earlier psychologists on whether the direction through which this occurs either starts from the inner world of the baby who then learns social regulations or whether such regulations are learnt socially, at first, and then become internalised. Their radical viewpoint is that neither is the case, because the passage is two way simultaneously, and always occurs through being constructed jointly by both partners. In this vein, self-autonomy emerges from good enough ‘interactive regulation’.

To support this view, the authors describe current research that uses 24 frames per second recordings and physiological measures of the mother-infant dyad, showing the split second world of extremely rapid infant-parent responsiveness to look at the degree and type of mirroring and the consequences for the young infant of these typical patterns of interactions. They show how infants are not in their own individual affect track and how attention, affect and arousal are continuously linked to what mothers do and vice versa in how the mother is affected by the infant’s agency. They give the example of a four-week old infant’s two-minute interactions with three other people (his mother, a researcher and one of the authors) in order to describe the different reciprocal roles that each pair shows. The authors make the point that because of reciprocations, the baby shows very different behaviours. Beebe & Lachmann do not use the term RR; but describe a similar concept about sharing the experience of an action with another doing that action. These experiences then build up the infant’s procedural knowledge of both the social environment and their own level of self-autonomy.

In addition to normal examples they give a potentially problematic example of a four-month-old infant-mother dyad described (and illustrated with photos). They showed how the mother met the infant’s gaze, loomed forward, and how the infant moved his head back and away, breaking visual contact. During the next 6½ seconds, the infant never visually engaged; nevertheless he remains acutely sensitive, through peripheral vision, to every maternal head and body movement. The two-minute sequence continued with the baby trying to avoid the mother who stepped up her attempts to get him to respond, whilst the baby’s heart rate remained high. This is contrasted with more normal interactions, in which, as infants disengage and their heart rate goes down, so the mother disengages too; allowing the pair time to process and re-integrate. The authors talk about the normal continuous control model of co-regulated communication in which each person’s actions is susceptible to modification by the continually changing action of the partner. They describe what was going wrong from the baby’s perspective in this sequence: “As you move in, I move away; as I move away, you move in”. They speculate that later this might, at a symbolic level become, “When I stay close to you, I feel you are moving in on me: I feel over-aroused and inundated. No matter where I move in relation to you I cannot get comfortable. I can neither engage nor disengage.” Reciprocally, for the mother, her vocalised experience might be “When I want to connect with you, I become aware of how much I need to be responded to. I feel you move away from me as I show my wish to engage. I cannot find a comfortable place in relation to you. I feel anxious and rejected.”

Research findings using depressed mothers and controls include the finding that babies of depressed mothers have different neurological and bodily reactions to these interactions from controls, and that their interaction pattern continues to occur even when the depressed mother’s behaviour is similar to controls. Also, the dyad’s ‘chase and dodge’ style as described in the previous example, extends to the infant’s interactions with strangers, and that the infant’s relational style differentiates them from control babies. In CAT terms the infant’s expectation is that other people are bound to behave in the same way as their depressed mothers and so they must deal with it in the way they have learnt with their mothers. This produces a narrowing of their range of relational possibilities. The authors then use the attachment framework to explore how different degrees of mirroring by the mother lead to different attachment tendencies. Both tracking which is either too highly contingent, or an absence of mirroring, can lead to insecurely attached infants.

The authors link the components of pitch, rhythm, volume and body movement used in infant research to consider process issues in adult psychotherapy, describing how the core features of psychotherapy cannot be about what is discussed, but much more about non-verbal elements that describe the therapeutic dyad. As the authors describe, the value of infant research goes beyond its application to adult treatment and an interactive model of mind. “It provides a systemic view of the origins of the processes of relatedness itself”. Such non-verbal components of therapy are often thought about by writers, which Beebe & Lachmann acknowledge. However, how they linked the patterns of early interaction and regulation that they named and described into examples of non-verbal processes in adult therapy is particularly striking. They give clinical examples involving pre-verbal vocal rhythms and pitch and the degree of co-ordination of the emotional qualities of the interaction in the development of therapeutic attunement and attachment. 

Beebe & Lachmann’s book came out prior to the extensive mirror neuron research now available, using functional magnetic resonance imaging which shows the operation of mirror neurons (e.g., Rizzolatti & Craighero 2004) which discharge for both the observation and execution of similar actions (i.e., both doing an action and watching someone do that same action). It also came out prior to Gerhardt’s book (2004) on how early relationships shape a baby’s brain and future emotional well-being via the development of specific neurological pathways affecting how we respond to stress. This means Beebe & Lachmann’s research was unable to break down further the basic neurological component of RR. I believe that another book by Beebe is currently in press, which may address some of the more recent research findings. However this book has not been superseded because the level it stands at is explored thoroughly and methodically. Their findings move the conceptual status of RR from a notion theorised to originate in early infancy to one that is supported by careful split-second observations and measurements of physiological status within infant-other dyads.

As an American text, apart from the internationally famous infant research by Stern and Tronick, many of the names of researchers and clinicians will be unfamiliar to a non-American readership. However, this need not put off many non-American readers who will be able to think of parallel European research examples that are going along a similar track e.g., Trevarthen and Reddy.

I would like to thank Tony Ryle for his helpful comments on this review.

Gerhardt, S. (2004) Why Love Matters: How affection shapes a baby’s brain. London: Routledge
Rizzolatti, G. & Craighero, L. (2004). ‘The mirror-neuron system’. Annual Review of Neuroscience. 27: 169 - 192
Ryle, A. (1975). ‘Self-to-self and self-to-other: The World’s Shortest Account of Object Relations Theory’. New Psychiatry: 12 - 13.
Trevarthen, C. (2004) ‘Intimate contact from birth: How we know one another by touch, voice, and expression in movement’. In, Kate White (ed.). Touch, Attachment and the Body, pp. 1-15. London: Karnak.
Vygotsky, L. (1978). Mind in Society: The development of Higher Psychological Processes. London, Harvard University Press.

Full Reference

Lloyd, J., 2009. Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.. Reformulation, Summer, pp.34-35.

Search the Library

Related Articles

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.

The Development of Self in Early Experience: Borderline Mothers and Their Infants
Danon, G., Rosenblum, O. and LeNestour, A., 2001. The Development of Self in Early Experience: Borderline Mothers and Their Infants. Reformulation, ACAT News Autumn, p.x.

Book Review of: How Infants Know Minds. Reddy, V. (2008). Harvard University Press.
Ryle, T., 2009. Book Review of: How Infants Know Minds. Reddy, V. (2008). Harvard University Press.. Reformulation, Summer, pp.33-34.

Attachment, The Body and Trauma
Diamond, N., 2005. Attachment, The Body and Trauma. Reformulation, Autumn, pp.25-26.

Some Subjective Ideas on the Nature of Object
Dunn, M., 1993. Some Subjective Ideas on the Nature of Object. Reformulation, ACAT News Autumn, p.2.

Other Articles in the Same Issue

A Little Italian Story – Service Development
Fiorani, C., Poggioli, M., 2009. A Little Italian Story – Service Development. Reformulation, Summer, pp.13-14.

Aims and Exits from Self-Defeating Procedures
Toye, J., 2009. Aims and Exits from Self-Defeating Procedures. Reformulation, Summer, pp.26-29.

Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.
Lloyd, J., 2009. Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.. Reformulation, Summer, pp.34-35.

Book Review of: How Infants Know Minds. Reddy, V. (2008). Harvard University Press.
Ryle, T., 2009. Book Review of: How Infants Know Minds. Reddy, V. (2008). Harvard University Press.. Reformulation, Summer, pp.33-34.

CAT and People with Learning Disability: Using CAT with a 17 Year Old Girl with Learning Disability
David, C., 2009. CAT and People with Learning Disability: Using CAT with a 17 Year Old Girl with Learning Disability. Reformulation, Summer, pp.21-25.

CAT Effectiveness: A Summary
Quraishi, M., 2009. CAT Effectiveness: A Summary. Reformulation, Summer, pp.36-38.

Letter from the Editors
Elia, I., Jenaway, A., 2009. Letter from the Editors. Reformulation, Summer, p.3.

Meeting with Older People as CAT Practitioners: Attending to Neglect
Sutton, L., Gaskell, A., 2009. Meeting with Older People as CAT Practitioners: Attending to Neglect. Reformulation, Summer, pp.6-13.

Obtaining Consent to Publish – Further Thoughts
Toye, J., Lloyd, J., Jenaway, A., 2009. Obtaining Consent to Publish – Further Thoughts. Reformulation, Summer, p.3.

Reflections on Our Experience of Running a Brief 10-Week Cognitive Analytic Therapy Group
John, Dr C., Darongkamas, J., 2009. Reflections on Our Experience of Running a Brief 10-Week Cognitive Analytic Therapy Group. Reformulation, Summer, pp.15-19.

State Regulation of Psychotherapy: Protecting the Public or ‘Professionalising’ Psychotherapy at the Expense of Therapeutic Integrity, Creativity and Diversity?
Pollard, R., 2009. State Regulation of Psychotherapy: Protecting the Public or ‘Professionalising’ Psychotherapy at the Expense of Therapeutic Integrity, Creativity and Diversity?. Reformulation, Summer, pp.29-31.

The CAT Articles Review
Knight, A., 2009. The CAT Articles Review. Reformulation, Summer, p.32.

Thoughts on the Rebel Role: Its Application to Challenging Behaviour in Learning Disability Services
Fisher, C., Harding, C., 2009. Thoughts on the Rebel Role: Its Application to Challenging Behaviour in Learning Disability Services. Reformulation, Summer, pp.4-5.

Update on Statutory Regulation
Westacott, M., 2009. Update on Statutory Regulation. Reformulation, Summer, p.20.

Help

This site has recently been updated to be Mobile Friendly. We are working through the pages to check everything is working properly. If you spot a problem please email support@acat.me.uk and we'll look into it. Thank you.