Interventions that effect change in psychotherapy: A model based on infant research

At the present time we are experiencing wide interest in rethinking and reformulating the conceptual and the clinical bases for understanding the way in which change takes place in psychotherapy. Almost daily one encounters new books, journal articles, and conferences that are directed toward this goal. We are moving psychology from traditional psychoanalytic language and conceptual frameworks to new vocabularies of chaos theory and nonlinear dynamic systems as we seek to describe “process” in the therapeutic interaction. Discussion has moved from explanations of change in the psychotherapeutic process as based on insight, as the unconscious becomes conscious through effective interpretation, to explanations described in terms of shifts in the organization of consciousness. These shifts in consciousness are brought about through moments of shared awareness—Tronick’s hypothesized dyadic states of consciousness—between patient and therapist as they experience “moments of meeting” within their “intersubjective environment.” With these changes in explanation, we are aligning our thinking with new information about the way the brain works in its construction of perception and memory and the way brain morphology becomes shaped by early experience. We are beginning to speak of “themes of organization” in the construction of expectancy for the flow of sequence and consequence in the stream of the recurrent daily events that construct one’s