At first, there won't be any mental disorder, just issues with behaviors such as eating and sleeping. Then during the phase of intersubjective relatedness, the focus switches to controlling, sharing, or influencing the subjective experience of self and others. At this stage, if caregivers are not emotionally attuned enough to the infant, problems may arise such as depression. If they are only attuned when the infant behaves a certain way, this may lead the child to start forming a false self in order to please others. There can also be misattunements between caretaker and child, in which one or the other misreads emotional cues and responds inappropriately. And it's very important for a caregiver's attunement to be authentic.
There are also four types of self-experience: social, private, disavowed, and "not me." Disavowed refers to the parts of self the child learns not to share, and the "not me" experience is the part of self that is repressed. If the child learns to repress a lot of their emotions, they might develop a related pathology.
Some Implications for the Theories Behind Therapeutic Reconstructions
This chapter relates theories of development to the "observed" infant. Infants undergo a "stimulation barrier" period in which they can only tolerate certain levels of stimulation without becoming upset, and try to block out the excess. But across a person's life span, the basic quality of capacity for tolerating stimulation remains the same. Stern's main point about orality is that it's closely tied to the concepts of hunger and satiety, but is no more important at any stage than seeing or hearing. He also notes that many psychoanalytical theories about drive and ego don't fit very well with the observed infant. For example, they show signs of an active ego, as opposed to just an id, from very early on.
In addition, Stern agrees that infants experience a stage of connectedness with their mother that is very powerful, but he believes it is the result of actively constructing RIGs (representations of interactions with self-regulating others), as opposed to a passive developmental phase. Also, infants must be capable of holding onto memories of interactions with others long enough that they can both build relationships with others, and separate themselves from those relationships.
Other developmental issues that may lead to pathology include the "splitting" of good and bad experiences, and the awareness of fantasy vs. reality. Stern believes the infant lives in a state of reality from day one, especially because initially they don't have the mental capacities necessary to create fantasy.
Implications for the Therapeutic Process of Reconstructing a Developmental Past
In this chapter, Stern begins by stressing the importance of putting developmental stages behind what therapist and patient actually encounter when trying to construct a narrative about the patient's past.
He then gives examples of clinical cases in which viewing the pathology in terms of development of the different senses of self is helpful. For example, a woman who is passive and insecure, yet is always focused on controlling her physical environment, may have a problem related to the sense of agency. He also talks about the importance of identifying a "key metaphor" or theme to describe the person's pathology. This metaphor is also easily adapted to his theories about different senses of self.
In cases where a diagnosis is already known, such as borderline personality disorder, therapists need to isolate the primary underlying cause in terms of the broader scope of senses of self. In addition, when the age of a traumatic experience is already known, such as the death of a parent, Stern's theory of the senses of self can help determine what went wrong with what sense of self during that time. Then treatment can be based on focusing on that impaired sense of self. Or there may be more than one involved, such as the core self, the intersubjective self, and the verbal self.
Finally, the book ends with a discussion of what happens when a therapist views the different senses of self as "age-specific" sensitive time periods. The earlier a pathology begins to develop during one of these critical periods, the more serious it will likely become later in life. He questions what features of self-experience are being molded during the different time periods, and how these features would affect later pathology.…