Creating the Umbilical Cord: Relational Knowing and the Somatic Third

This paper examines and clinically highlights the co-creation of an attachment bond between patient and analyst through the activation and regulation of somatic body experiences in both members of the dyad. Through clinical case material I highlight working from within the implicit, relational field in the treatment of Kathleen, a patient who presents with extreme dissociation and a history of profound attachment disruption. The attachment or “umbilical cord” is developed by linking felt states of the analyst and patient, and by enabling the patient (and at times the analyst) to reclaim dissociated body sensations. Integrating attachment research, neurobiology and affect regulation, the place of implicit relational knowing, becomes accessed through somatic experience before it can be verbalized and articulated. Dissociation from self and others requires the therapist to access the self states of the patient through somatic tracking and sensations, lending the therapist's nervous system to the patient as a resource for interactive, mutual regulation. It is in the space of implicit procedural knowing that interactive regulation can take place, generating mutual intersubjective recognition, that is, “the analytic third.” Finally, it is through mutual recognition that individual subjectivities can coexist surviving bidirectional rupture, thereby, creating and sustaining attachment between two embodied subjectivities.