Chapter 7 The Contribution of Self- and Mutual Regulation to Therapeutic Action: A Case Illustration

Empirical infant research can expand our understanding of therapeutic action in adult treatment (Beebe and Lachmann, 1994; Lachmann and Beebe, 1992a, 1996a). The concepts of self- and mutual regulation, derived from a systems approach to the study of infant—caregiver interaction, permit a more detailed view of patient–analyst interaction and the processes of analytic change. A case is used to illustrate the origins and transformations of a patient's psychopathology. In this case, chronically mismatched interactive regulations led to premature, drastic self-regulations. We trace the interactive processes of therapeutic action.

We have previously offered three organizing principles derived from infant research to describe how interactions are regulated, represented, and begin to be internalized in the first year of life (Beebe and Lachmann, 1994; Lachmann and Beebe, 1996a). These principles are “ongoing regulations,” “disruption and repair” of ongoing regulations, and “heightened affective moments.” They constitute hypotheses about how social interactions become patterned and salient. Although infant research has been construed as relevant to adult treatment in many ways (Emde, 1988; Horner, 1985; Osofsky, 1992; Sander, 1985; Seligman, 1994; Soref, 1992; Stern, 1985, 1995), in this chapter we focus on the principle we consider to be overarching, ongoing self- and mutual regulations. Through metaphor and analogy, we apply this perspective to analyst–patient interaction, verbal and nonverbal, in one case.