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(Received 30 April 2013)
My premise is that a ‘layered’ approach is necessary to understand the process of exchanges that result in therapeutic change. I imagine these processes occurring in three layers - although the number of domains in which change is taking place is actually infinite - such as in a sandwich. The top layer, or top slice of bread of the sandwich, represents a broad view of the change process; it is non-linear and includes the feature of uncertainty, a general principle of dynamic systems theory. The middle layer, or the meat of the sandwich, is explained by theories that are immediately and clinically useful to a therapist, such as psychoanalytic theories. These are primarily linear theories and use language and symbols to ‘tell a story of what happened’. The bottom layer, or bottom slice of bread of the sandwich, is the micro-process; this layer includes the moment-to-moment patterns of coordinated rhythms that both communicate meaning and provide the essential scaffold for all higher-level change processes. The micro-process also requires a non-linear theory to make sense of its variability and emergent properties. Taking a bite out of the sandwich will include a ‘polysemic bundle of communicative behaviors’ (Harrison and Tronick, 2011). I will illustrate the ‘sandwich model’ with the clinical case of the analytic treatment of a 5 year-old boy.