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Observing and working with infants and young children with a range of clinical challenges, as well as adaptive patterns, has provided an opportunity to further understand early developmental pathways. From observations of early infant/caregiver affective interactions, we constructed the Developmental, Individual-Difference, Relationship-Based (DIR) model, a framework which delineates functional emotional developmental capacities, individual biologically based motor and sensory processing differences, and formative relationship patterns. We have employed this model to describe early developmental pathways associated with anxiety disorders and depression, bipolar, obsessive/compulsive, and narcissistic patterns, as well as autistic spectrum disorders, borderline conditions, and personality disorders. The DIR model also provides insights into the therapeutic process. It describes different levels of prerepresentational experience and enables the psychotherapeutic process to address these levels as well as individual constitutional and maturational differences. Understanding early developmental
pathways broadens the scope of the psychotherapeutic process to include patients with a large range of personality organizations.