Dan Hughes on Intersubjectivity

Intersubjectivity is when I know that you know that I know that we’re feeling the same thing at the same time. I know you feel me in your gut and I feel you in my mine. Crying together, laughing together, or good sex creates intersubjective experiences. So does good therapy.

According to Hughes, in intersubjectivity there is a coregulation of affect and a cocreation of meaning. It happens in contingent (responsive) interactions and is an affective (feeling) state between two brains. For good therapy we must "slide out of a neutral stance and be emotionally involved." We have to "impact our clients and be impacted by our clients." Let the client know he has an impact by showing it in your posture, your voice, and your face. "Emotional communication within therapy restructures the clients working models. (Fosha says much the same thing, differently.)

Intersubjectivity creates a discovery of the self as: lovable, worthwhile, competent, honest, resilient, smart, enjoyable, courageous, delightful, hopeful, persistent, and builds new skills.

With babies and clients, first there’s safety and then exploration. In secondary intersubjectivity, kids and clients explore the world through the experience of their attachment figure/parent/therapist. They get another perspective, create mastery, reduce shame, and reduce terror. (Think of when you said, "Of course you couldn’t know that, you were only a little child," and the client saw himself through your eyes.)If a parent traumatizes you, it’s a "fact" that you’re bad. "A new reality from a different experience of you lets you see yourself differently."

With intersubjectivity there is a match of shared

    • affect—attunement
    • awareness—interests
    • intentions—purposes

To reorganize and deepen intersubjective experience:

  • Take the lead in the affect
  • Be playful, bring in lightness and spontaneous presence
  • Embody acceptance: open awareness, loving kindness
  • Curiousity: a not-knowing stance. Have acts of discovery.
  • Empathy: resonating affects, targeted compassion

It’s the therapist’s responsibility to

  • Insure the flow of attuned vitality affect
  • Insure the ongoing presence of joined awareness (utilization, ala Milton Erickson)
  • Insure the ongoing presence of shared intentions
  • Insure an affective/reflective balance in the dialog (NOT the content)
  • Keep the momentum going back and forth
  • Address the gaps that present in experience ("It seems we’re not talking about X.")
  • Provide clear/explicit nonverbal and verbal communications about experience.
  • Experience and elucidate the motives, vulnerabilities and strengths that lie under the behavior.

Then Hughes showed a gorgeous video about working with an adopted, attachment-disordered kid. I wish I could convey the sensitivity and humor with which he helped this little guy open his heart to his adopted parents, his playfulness, his competence, and his grief. If I’d most like to have lunch with Sue Johnson, I’d most want Dan Hughes to be my therapist. Too bad he only works with kids and lives in Maine.

The 3rd Day

Yaak Panksepp: The Emotional MindBrain

Panksepp is a researcher at Washington State University. He knows things that I’ll never know. I’ll tell you some of his main points, but can’t begin to do justice to him. The thing that most sticks in my mind is that he found out that rats laugh. If you tickle a rat (that knows you’re friendly) it will chirp at a higher tone than we can hear. It will then follow you anywhere for more tickles. I saw it on the video; Rats laugh.

Some tidbits:

  • Affect is the most important, scientific question of psychiatry.
  • Affects developed early in evolution to provide comfort zones by which mammals lead lives.
  • Affects anticipate survival needs/future events (hunger is not starvation, but if you don’t eat, you’ll starve).
  • Eliminate the cortex (higher brain) and all the affects still live in the animal.

There was a lot more that I don’t know how to boil down then

  • Endogenous opioids mediate social attachments. We can be addicted to drugs or people. Panksepp thinks that if we provided drug addicts with good social community, they wouldn’t need the drugs.
  • Opioids and oxytocin both alleviate distress calls/panic. Contact activates internal opiods.
  • Autistic kids have an excess of endogenous opiods and have less separation distress, less gregariousness, less pain sensitivity, increased stereotypes (not seeing individuals for who they are) and more rough play (possibly to feel the contact) Opioid blockage with naltrexone helps ½ of autistic kids to become more relational. !!!
  • Opioids are underutilized by psychiatry. They help depression and pleasure deficit. There’s a new one: Buprenophine (@ .2 mgs, under the tongue) that is not addicting. It’s replacing methadone in many drug treatment centers.
  • Play is necessary for prosocial learning.
  • If ADHD kids had lots more unstructured play, they could focus better and be much better socialized. Play sensitizes the pro-social part of the brain. There isn’t enough of it for our societies too regulated kids.

Then there was Diana Fosha, who I’ll write about next month. And Porges again. Before the final panel discussion I left for a week-long drive with Doug, up the California coast. Let the vacation begin!