Jane Hall (2022) introduced The Power of Connection as a book of essays and riffs. As a jazz pianist, I use this commentary as an opportunity to riff on my current consternation with the field of psychotherapy. To my dismay, I write at an ironically apposite time: the immediate aftermath of the 2024 presidential election in the United States. Entering the ninth decade of my life, I have never witnessed a period of more pervasive divisiveness in this country. We must place our hope in the power of connection. We have much to learn from the field of psychotherapy, also a potential domain of connection while historically riven with polarization that continues to escalate (Allen, 2023).
Mainstream psychotherapy in the U.S. is dominated by countless variations of cognitive-behavior therapies, which have largely cornered the market of short-term, evidence-based, and manualized therapies. These therapies have been designed to treat codified psychiatric symptoms and disorders to qualify for reimbursement in the healthcare system. Patients who want time to talk with therapists about their personal problems—largely in a developmental context of problematic relationships—will generally pay out of pocket, greatly limiting access to what many of us construe as psychotherapy as it has long been practiced (McWilliams, 2023). The field has now been inundated with hundreds of therapies and decades of research consisting of horserace-like competitions that generally show little differences among therapies in effectiveness; meanwhile, decades of research has shown that the quality of the therapeutic relationship strongly influences treatment outcomes (Wampold & Imel, 2015). Moreover, individual differences among therapists contribute substantially to outcomes, especially in the treatment of more severely impaired patients (Castonguay & Hill, 2017). Accordingly, I have argued that we should shift our focus from developing more therapies to enhancing the development of therapists (Allen, 2022). Psychoanalysis excels here.
In recent years, the beginning therapists I have taught and supervised have been overwhelmed by their sense that they must scramble to learn myriad methods and techniques to treat a host of psychiatric conditions. They must document the “evidence-based” interventions they employed in the session. I aspire to completely reorient their thinking, with therapeutic relationships foremost in mind. I acknowledge their insistence that they must “play the game” in their documentation. But I tell them that they began developing the skills that will play the most important role in their effectiveness in infancy and that, by the time in early adulthood that they begin conducting psychotherapy, much of their crucial development has taken place. They will superimpose essential professional knowledge and skills on this development, and their personal development of relational skill will continue throughout their lifetime. Moreover, to be effective, their professional knowledge must be assimilated into their personal knowledge such that the methods they employ will feel natural and intuitive as they forge therapeutic relationships with their patients. Furthermore, they and their patients must come to feel connected, building on relational skills originating in infant-care-giver interactions.
Thanks also to decades of research, we are fully aware of infants' preverbal relational skills, albeit contingent on and intermingled with care-givers' skills. Incipiently feeling connected, infants engage in emotion sharing (Tomasello, 2019), and they learn strategies for optimizing their attachment needs (i.e., managing distress) depending on the individual caregiver's emotional responsiveness to these needs (Ainsworth, Blehar, Waters, & Wall, 1978). Thanks to Ed Tronick's (2007) groundbreaking research, we have learned that a predominance of disconnection is normative in infant-caregiver interactions (i.e., a 70:30 proportion); this disconnection is relatively transient, however, and is essential for both infant and caregiver to learn mutually adaptive strategies for restoring connection. From attachment research (Main & Morgan, 1996) we also have learned how pervasive disconnection can profoundly derail the capacity for connection and form the basis of developmental psychopathology that we treat more or less belatedly—albeit ideally in infancy and early childhood (Slade, Sadler, Eaves, & Webb, 2023). Although language is profoundly transformative in the development of social learning and emotional connections, these basic preverbal relational skills also
continue to be refined over the later course of development and remain crucial in emotion sharing and feeling connected. We should bear in mind the obvious fact that all this developmental research is as pertinent to therapists' relational skills as it is to their patients. And all of us must appreciate that nothing is carved in stone to the extent that life can afford continuing opportunities for relational development, including our merely century-old cultural invention of psychotherapy (Sroufe, 2021). Accordingly, psychotherapy can be as crucial for therapists' development as it is for their patients (Orlinsky, 2022).
To my knowledge, the richest theoretical and clinical literature bearing on therapeutic relationships has evolved under the rubric of relational psychoanalysis (Mitchell & Aron, 1999; Seligman, 2018), which has long historical roots in psychoanalysis more broadly. Yet the influence of psychoanalysis on the field of psychotherapy has been constrained by enduring stereotypes of classical psychoanalyses as characterized by a relatively opaque analyst interpreting unconscious conflicts. The bane of this stereotype is the image of the therapist as emotionally detached—feeling disconnected. This recent relational literature has been transformative in offering concepts that illuminate the ever-developing feelings of connection that form the linchpin of therapeutic action. In what follows, I merely highlight the set of concepts that I find most helpful—and, in principle, applicable to all but the most rigidly manualized practices of psychotherapy. All these concepts entail a paradoxical synergy of togetherness and separateness, shared experience that preserves and enhances individual subjectivity. As Louis Sander (2008) articulated, “one of the central paradoxes in the developmental process,” contrasts “the singularity, the uniqueness of each individual, each newborn, each family system, and each developmental pathway” with “intersubjectivity; that is, how we are each a part of the other.” His central question: “How can we both be a part of each other and singularly unique at the same time?” (p. 178). And, from my phenomenological point of view, the feeling of connection is ineffable, although we can point our attention to it with language (Merleau-Ponty, 2012; Vygotsky, 1934/2012). Four concepts seem particularly helpful to me: recognition, the analytic Third, the interpersonal field, and implicit relational knowing. In each case, the authors cited provide extensive clinical examples that point to the relevant experience.
Recognition. We ordinarily use the word, recognition, to refer to a unidirectional process; one person identifies another as familiar, or a group accords admiration to an individual for an achievement. In the relational psychoanalytic literature, by contrast, recognition is an interpersonal, reciprocal process. It is intersubjective, as Sander (2008) articulated, emphasizing the specificity of the experience of recognition in unique moments of connection, that is, the “specificity in another's awareness of what we experience being aware of within ourselves.” (p. 184, emphasis added). Jessica Benjamin (2018) masterfully integrated the experience of connection with the sense of separateness:
Acts of recognition confirm that I am seen, known, my intentions have been understood, I have had an impact on you, and this must also mean that I matter to you; and reciprocally, that I see and know you, I understand your intentions, your actions affect me, and you matter to me. Further, we share feelings, reflect each other's knowing, so we also have shared awareness. This is recognition. (p. 4, emphasis added)
We have connection and togetherness that preserves and enhances individuality. I am especially interested in the connector and the feeling of connection, as described in complementary ways: most straightforwardly, the “We” between the “I” and “You.” I start there and then proceed to the more abstract concepts of the interpersonal field and the Third.
We. Envision a triangle with I and You at the base connecting to We at the apex. Michael Tomasello (2019) traces the development of a “sense of We” (p. 196) over the course of toddlerhood and early childhood (one-to-two and three-to-six years of age, respectively). In a similar vein, Peter Fonagy and colleagues (Fonagy et al., 2021) refer to the “feeling of ‘We-ness’” (p. 6) and interacting in the “we-mode” as “the shared thinking and feeling within a social system, a dyad, a family, or other social group” (p. 6). Fonagy (2022) asserts that “there is no mysterious leap into a mystical interpersonal space of ‘we-ness;’” rather, “the we mode is an individual state characterized by voluntary subsuming of the I mode into one where the dominant goal is joint action and collaboration” (p. xiv, emphasis added). I am in the we-mode and you are in the we-mode. No connector.
Interpersonal Field. Donnel Stern (D. B. Stern, 1983) views the interpersonal connection as an enveloping field of influence, jointly created by the analyst and patient and either enabling or constraining what each can experience in their being together. The interpersonal field is the “sum total of all influences, conscious and unconscious, that each of the analytic participants exerts on the other” as well as “the outcome of all those influences, relatedness and experience created between the two” (pp. 187–188). Stern appreciates the ineffable quality of the field; it is “emergent,” “unbidden,” and imbued with “mystery” (p. 252). Ideally and therapeutically, the field promotes spontaneity, creativity, and openness to previously unexpressed or defensively prohibited experience. Such a field creates a paradoxical negative capability: “being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason” (p. 255). Recognition entails inter-subjectivity, and the field is inter-personal. At the risk of reification (concretizing an abstraction), I puzzle: What is in the space between the individuals?
The Third. Substitute “the Third” for “We” of the apex of the I-You-We triangle. We have two individuals (separateness) and a connector, the Third (togetherness). Thomas Ogden envisioned a “third subjectivity, the intersubjective third,” that “coexists in dynamic tension with the analyst and the analysand as separate individuals with their own thoughts, feelings, sensations, corporal reality, psychological identity and so on” (p. 463). Further, “The analytic third is a creation of the analyst and the analysand, and at the same time, the analyst and analysand…are created by the analytic third” (p. 483, emphasis added). Here Ogden makes a crucial point: In the meeting of minds occurrent in the Third, the creation creates the creators.
Implicit Relational Knowing. Infant research provides solid scientific backing for my contention that we begin developing the interpersonal skills essential to conducting psychotherapy early in life (Amadei & Bianchi, 2008; D. N. Stern, 1985). I would hope that none of us talk therapists harbor any illusions about the limited impact of insight on behavior change. But I imagine that few of us focus merely on behavior change (or cognitive change, for that matter). Along with our patients, many of us aspire to understanding and being understood; such understanding is valuable in itself and, as recognition and related concepts attest, mutuality in understanding contributes to feeling connected. With
the basis of therapeutic change in mind, Daniel Stern and his colleagues (Boston Change Process Study Group, 2010) brought the experience of connection to the foreground in prioritizing shifts in implicit relational knowing, put simply: “the sense, based on one's history, of how to be with another” (p. 145, emphasis added). This preverbal and nonverbal way of knowing continues to develop in parallel to explicit (verbal-reflective) knowledge over the lifetime: “the implicit domain continues to grow in breadth and elaboration with age. Implicit knowledge is a far larger domain of knowing about human behavior than explicit knowledge at all ages, not just in infancy” (p. 147, emphasis added). Getting to the heart of feeling connected as pivotal in psychotherapy, Stern (D. N. Stern, 2004) focuses on present moments: “The moment of meeting need not be verbalized to effectuate change. A now moment followed by a moment of meeting is the nodal event that can dramatically change a relationship or the course of a therapy” (p. 220).
In prioritizing the feeling of connection, I do not aim to diminish the role of language in human relational life but rather wish to elevate the value of experience. In his critique of empiricism in science, Gabriel Marcel (2018) expressed my sentiment beautifully: we “take experience for granted and ignore its mystery; whereas what is amazing and miraculous is that there should be experience at all” (p. 140, emphasis added). Preoccupied with thinking, problem solving, and planning, we lose sight of experience. Marcel argued instead that experience should be “not so much a springboard as a promised land” (p. 115). At best, we are able to translate only a tiny fraction of our experience into words (Merleau-Ponty, 2012), and any efforts to do so will fall short to varying degrees (Vygotsky, 1934/2012). Moreover, as psychoanalysis attests, efforts to translate experience into words often will run into defenses. As Donnel Stern (D. B. Stern, 1983) elucidates compellingly, a cornerstone of psychoanalytic practice entails formulating unformulated experience, and doing so will require establishing a conducive interpersonal field. Ideally, such formulation (e.g., verbal reflection) will expand and enhance the range of experience rather than detracting from it (e.g., as intellectualization will do).
In closing, I address the impetus for this commentary, explicating controversies that have been implicit, including prioritizing treating psychiatric disorders versus the experience of life and the role of interpretation
and insight versus the experience of relating. Here I lodge a protest against scientism, characterized by Barbara Herrnstein Smith (2009) as the conviction that “the natural sciences should be taken as models for all knowledge practices,” coupled with the presumption that “the humanities disciplines are at best pre-scientific and should be shepherded as quickly as possible, along with some still vagrant social sciences, into the fold of the natural sciences” (p. 20). As applied to psychotherapy, scientism is anathema in its aspiration to “cancel out the personal, subjective, social and political; to arrive at an accurate, undistorted representation of nature” (Smith, 2006, p. 58), while employing “depersonalized ideas stated in special technical terms, ‘a language estranged from life’” (p. 68, emphasis added). My contrary stance: Science's majesty does not entitle it to a monarchy (Allen, 2023).
I believe that a scientistic ideology hampers our appreciation of the feeling of connection. To reiterate, I am intrigued by the connector that constitutes recognition, the interpersonal field, and the Third. Consider that many of us therapists are in the psych fields: psychiatry, psychology, psychotherapy, and psychoanalysis. The psyche refers to soul and spirit. Setting religion aside, we can refer to the mind. Enamored with more scientific terminology, we turned from mind to cognition. Embracing science and avoiding reification, we can construe connection (the “We”) as lodged in individual minds. But we can go full bore into scientism by concentrating on the brain. We have ample philosophical precedent for this counterintuitive perspective by construing human experience as an illusion, in effect, a theater created by the brain (Humphrey, 2011). We now have on offer Right Brain Psychotherapy, a way “to understand the relational mechanisms by which communicating brains align and synchronize their neural activities with other brains” (Schore, 2019, emphasis in original). Who or what is connecting with whom or what? Ignoring the brain's embeddedness in the body and the world leaves us imprisoned in our skulls—disconnected and alienated from human life (Fuchs, 2018, 2021). In our scientistic zeitgeist, allusion to the brain has become de rigeur. I find neuroscience to be fascinating and unquestionably valuable in its own right. But what I know about the brain has not helped me understand the person in front of me. Perhaps I don't know enough. Do You?
I criticize reductionistic thinking as I bristle at the constraints of scientism. My interest in feeling connected has brought this contrarian way of thinking to the fore. As a jazz pianist, I welcome the limits of verbal reflection along with the power of art as a medium of expression and understanding (Dewey, 1934; Taylor, 2016). I revel in the sense of mystery and propose the best word to capture my experience of connection: spiritual. Back to the psyche.