Academic journal article International Journal of Psychoanalysis

The Sandwich Model: The 'Music and Dance' of Therapeutic Action

Academic journal article International Journal of Psychoanalysis

The Sandwich Model: The 'Music and Dance' of Therapeutic Action

Article excerpt

Introduction

This paper represents my attempt to integrate what I have learned from infant research and the study of videotapes of child analytic sessions with the psychoanalytic theory I use in my daily work. In effect, that means inte- grating the verbal and symbolic with the micro-process, while at the same time keeping in mind the frame of reference provided by the general princi- ples of dynamic systems theory. I will demonstrate the micro- process, or what I call 'the music and the dance' of what goes on in a therapeutic ses- sion, with descriptions of videotapes and the microanalysis of these video- tapes. This is a level of therapeutic activity that psychoanalytic theory can only help us understand to a limited degree (Stern et al., 1998). I will then put this level of therapeutic action together with what psychoanalytic theory is good at explaining, 'the story of what happened, or what is happening' in a psychoanalysis. To do this, I will introduce a clinical tool I developed to integrate the multiple domains of therapeutic action, the 'sandwich model'. In addition to the psychoanalytic narrative, this model includes two addi- tional domains of therapeutic activity - although the actual number of domains of therapeutic activity is infinite - that are not easily explained by psychoanalytic theory. I will illustrate my points with the clinical case of a 5 year-old boy.

Whereas psychoanalysts primarily focus on the symbolic content of the analytic session - the language and the play - current thinking recognizes the importance of the non-symbolized and the moment-to-moment process (Beebe, Jaffe and Lachmann, 1992; Beebe et al., 2000; Bucci, 1997; Harri- son, 2009; Harrison and Tronick, 2007; Stern et al., 1998; Tronick, 2002a). Psychotherapists come to be attuned to communications made by their patients in the micro-process, even while it remains out of their awareness (Heller et al., 2001). In addition, the therapist's capacity to communicate expressively in her facial expression, gestures, and non-verbal speech ele- ments, is an important asset (Zacki et al., 2008). These movements, or what I call the 'dance of psychoanalysis', are easier to visualize in the play of child analysis than in adult analysis, but the dance occurs in both, in con- tinual fluctuations in the coordinated patterns of therapist's and patient's bodies and voices (Kelso, 2002). For example, as two partners may settle their bodies into their chairs or to the floor in one synchronous movement, or as they reach across a play space to take turns in a reciprocal movement, such as that which I refer to as a 'do-si-do'.

In fact, the level of the micro-process does not just involve making mean- ing through bodily movements and gestures, or patterns of vocalizations. In the non-conscious realm of human experience, the nervous system, muscles, and gut communicate with one another to create neurophysiological mean- ings related to threat, distress, or wellbeing, for example (Tronick, 2007). These 'somatic' communications form an essential context within which the symbolic meanings are interpreted, in an ongoing, constantly evolving pro- cess. I use the term 'somatic' to signify all those ways of making sense of our experience that are not directly related to language (Harrison and Tro- nick, 2011). I prefer this to 'non-verbal' since my essential focus is on how the system functions as a whole to make meaning, and from that perspec- tive it is impossible to segregate a non-verbal domain.

According to the general principles of dynamic systems theory, growth in open systems - such as the change that occurs in psychotherapy or in nor- mal development - is manifested in an increase in the complexity and coher- ence of the system (Van Bertalanffy, 1968). Here, the 'open system' is the individual, and the growth occurs in the increasing complexity and coher- ence of the meanings he makes about himself and his relationship to the world (Sander, 2008; Tronick, 1998). …

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