Prologue to Dissociation and the Parent-Infant Dialogue: A Longitudinal Perspective from Attachment Research

This 2003 paper on contributions of the early parent-child dialogue to later dissociation summarised much of the literature on disorganised attachment at that time and underscored the dialogic origins of defence mechanisms previously thought to be generated intrapsychically. The paper also rooted those defensive adaptations in the infant's attempts to manage fearful arousal in interaction with the caregiver, rather than in dynamics related to aggression or sexuality. Most importantly, the paper discussed the empirical findings that tied young adult dissociation, or in Laub's (1993) wording “knowing but not knowing”, to the caregiver's “seeing but not knowing” in infancy. Specifically, it was the caregiver's lack of involvement in an affective and interactive dialogue with the infant, a “trauma of absence” rather than a trauma of abuse, that very strongly predicted dissociation in young adulthood. Note that this 2003 paper was based on early partial data analyses. The final longitudinal results are presented in the following articles, Dutra and colleagues (2009b), and clinically elaborated in Lyons-Ruth and colleagues (2006), and in Dutra and colleagues (2009a).

These insights into the relevance of early interaction for later adaptation also led to a series of clinical papers emphasising the need to incorporate the concept of “implicit relational knowing”, a form of representation that encodes the “deep structure” of relational exchanges, into a psychoanalytic theory that too heavily privileged explicit verbal reflection as the primary curative mechanism in psychodynamic psychotherapy (Lyons-Ruth, 1998). Still awaiting fuller consideration is the proposal here that one way to define the broad goal of psychodynamic relational psychotherapy is the fostering of a more collaborative and inclusive relational dialogue that includes the most vulnerable aspects of the patient's experience. This proposal stems from the repeated finding in attachment research that such a collab