Lullaby

    Clinicians just starting out often worry about saying the ‘right’ thing to a patient. I often tell supervisees that people come to us not for answers, and not necessarily for words, but for “something more,” such as a longing to be recognized, to have someone take an interest in their inner lives. As humans, we usually have an interest in others, and as therapists, a deep interest in others and in their inner lives. We have a desire to know more, and we make an effort not to impinge with our curiosity, to have a benevolent curiosity if you will. So far so good.

     People also come to us needing to be held in mind. Just as caregivers grow the brains of their infants by gazing at them, by enjoying them, by remembering and imagining what it was like to be such a baby with an inner life and with experiences, so the holding a patient in mind (even outside of the session) comes to us as we reflect on and imagine the past, present, and future experiences of our patients. The caregivers’ interest grows the baby’s inner life: the baby experiences itself as ‘I am interesting. I am important. I have a right to be here. I exist.’ 
Sometimes our patients need such things from us: to be held in mind, to be enjoyed, to hold our interest, to have their feelings “marked” (in the same direction of the affect, without being identical). These experiences are part of “implicit relational knowing” and do not require words to effect reconfigurations in brain anatomy and brain chemistry. 

Sometimes our most sorrowful of patients have missed out on some necessary pre-verbal experiences: of being gazed at, nursed, rocked, sung to, of being held in the caregiver’s arms, and being held in mind. Ogden called this very important fundamental stage of sensory experience the autistic-contiguous position. It is the foundation or sensory ‘floor’ upon which subsequent experience is integrated and organized.  

    I recall a 15 year old boy with a horrible history of abandonment, neglect and physical and sexual abuse, often in foster care, who was court ordered to see me after punching his father. (His father had called the police.)  The boy arrived for the first appointment very angry. He crossed his arms, declared emphatically that he was not going to talk to me, and promptly fell asleep on the couch for the entire session. 
Perhaps I had the autistic-contiguous position in mind. Perhaps I was thinking about this boy’s childhood (some of it previously revealed to me by his father when the father had made the appointment) and thus was imagining that this boy had probably never been held in the mind of a caregiver, never been held in a caregiver’s arms and been rocked and sung to, never had consistent opportunities for mutual regulation of distressing affects. But, whatever the 'reason,' I began to sing him a lullaby as he slept there immobile. When the session was over, he lept off the couch. He returned the following week and each week thereafter, and talked and told me his sorrows. (He even hoped to continue long past the six months ordered by the court.)

Ogden, TH. (1989) The Primitive Edge of Experience. Northvale, NJ: Jason Aronson.