Next Level Practitioner

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1 Next Level Practitioner - Best Advice Week 88, Day 3 - Ed Tronick, PhD - Transcript - pg. 1 Next Level Practitioner Week 88: Treatment Specific Advice Day 3: How Advice Can Change Our Outlook on Our Therapeutic Model with Ruth Buczynski, PhD and Ed Tronick, PhD

2 Next Level Practitioner - Best Advice Week 88, Day 3 - Ed Tronick, PhD - Transcript - pg. 2 Week 88, Day 3: Ed Tronick, PhD How Advice Can Change Our Outlook on Our Therapeutic Model Dr. Buczynski: What is the first task of the practitioner? The answer for Dr. Edward Tronick came from a series of influential supervisors. But where to start wasn't the only advice Ed took to heart. Here, he shares how he found a new way of looking at things...even after many years in the field. Dr. Tronick: I got a lot of advice from a lot of supervisors. Probably most of it was more than well deserved. I had some really wonderful supervisors, including Urie Bronfenbrenner, Jerry Bruner, Berry Brazelton, and a number of supervisors during my clinical training at Children's Hospital. It's actually pretty difficult to pick out the single, best piece of advice. What they all brought for me was an appreciation of the individual. The people that I worked with wanted to hear the story that the individual was telling you. I think there was always an emphasis on letting the story be theirs. My first task was to hear the story, not to interrupt it, and to try and understand what it was that the individual was experiencing. If I think about Urie Bronfenbrenner with his ecological model, here I am doing micro-analytic work on mother-infant dyads or seeing infant mental health patients where I'm working with the dyad. Sometimes maybe the other parent is there but mostly working with the dyad. Hear the story, see what their experience is, and try to understand the larger set of factors. And Urie Bronfenbrenner has an ecological model is saying, "Yes, this is very important, but you need to think about the larger factors that are influencing them." What I find now in terms of my own work and training around infantparent mental health is I'm still emphasizing the idea of hearing the story, seeing what their experience is, and trying to understand the larger set of factors that are influencing them. I'm somewhat psychodynamically oriented. I've now become, oddly enough, much more concerned about

3 Next Level Practitioner - Best Advice Week 88, Day 3 - Ed Tronick, PhD - Transcript - pg. 3 internal regulatory processes of what I call making meaning. You need to understand the meaning that an individual is making. Jerry Bruner was not a clinician, but was the first person who said you need to understand the meaning that an individual is making. That's something, certainly, that Berry Brazelton was talking about. Jerry Bruner was clear that individuals make meaning. It was a very active process; it wasn't just a passive reception of information. It wasn't simply the reality that might be going on but that it was the individual s own experience and own interpretation of what was going on that led them to have meaning and that led them to act in the world in a particular way. Jerry Bruner saw that as largely a cognitive process. But as I worked with infants, what I came to realize was that infants have all sorts of in general cognitive processes, but the processes by which they make meaning have to do with much more bodily processes. Sometimes I call them biopsychological processes or neurosomatic processes. Infants do that with their autonomic nervous system. They do that with their HPA access. They do it with their immune system. All these systems influence how the individual operates, acts, in the world. Parallel to that came the work by Bessel van der Kolk, starting to talk about trauma and somatic processes the idea that the individual who was traumatized held the effect, held the memory of that trauma in their body. For me, that was a powerful connection between infant work and adult work, and not just around trauma, because I think when you consider other process be it depression or anxiety or other disorders those too have bodily processes going on that are affecting the adult and how they're operating in the world. Of course, the adult has symbolic processes, language, abstract thought. But part of what might be their issue is the connection between these processes; one has awareness about and these bodily processes that are operating to affect one's meaning that gets made that eventually ends up in consciousness but that are happening outside of awareness. So, you asked what was the single piece of advice from these clinicians. I don't think there's any single piece of advice. For me, it was my clinical supervisors. Obviously, this was a long time ago. I think they were all psychoanalysts, and certainly they were

4 Next Level Practitioner - Best Advice Week 88, Day 3 - Ed Tronick, PhD - Transcript - pg. 4 psychodynamically oriented. That was at Children's Hospital. We don't have people like that supervising clinicians anymore. I have a strong, strong view that there's always ambivalence in feelings. There's always the potential for an unconscious dynamic kind of conflict. There's always ambivalence in feelings. And certainly, most of my work has been focused on trying to understand the meaning that infants make and how they make meaning. But I think all of us as adults still have that infant inside of us. And that's said by a lot of people Selma Fraiberg, talking about ghosts in the nursery. Researchers who do epigenetic research, or people who are looking at the HPA access, show that, given certain early experiences, the HPA access changes in its function. You come into a situation possibly being hypervigilant or possibly being shut down. And all of those affect how it is that you'll make meaning out of the situation. I suppose I mentioned the other change for myself, this focus on internal processes. This is old and new for me. I've spent my career looking at relationships and looking at interactions and looking at the microanalysis of those, trying to figure out how the infant is able to make meaning out of these situations. So, for example, the still face experiment is an experiment where what I see is that the infant is confronted with a situation that doesn't make sense for them. They're trying to figure out a way to make sense about it. In looking at the interaction, we all are emphasizing that meaning and experience gets shaped by earlyinteractive experiences. And I think while that's true, what we've Most of the meaning has to do with internal processes by the individual. tended to forget is that most of the meaning or the processing of that kind of meaning has to do with internal processes by the individual, so that if your experience with someone or with you, then it makes no difference what that experience was. anything doesn't get inside you and isn't changed and processed by When you make meaning out of it the way Bruner talked about it, or the way Berry Brazelton talks about it when you make meaning out of that, you change the meaning. You make it into something unique, idiosyncratic. I've come to believe that most of the real work of the experience of relationships actually gets done

5 Next Level Practitioner - Best Advice Week 88, Day 3 - Ed Tronick, PhD - Transcript - pg. 5 internally over time by the individual. They re structuring their world, and the relationship is a place where they're getting information, and critical information, to work on. But they need to work on it. So clinically, when I see infants and parents together, it's really important for me to see what's going on in the relationship and really looking at very small pieces of what might going on a particular touch, a particular way they share gaze, a particular way they shift their mutual attention to different objects. Most of the real work of the experience of relationships actually gets done internally over time by the individual. But then the question that I have to grapple with for the infant is, what does this mean to the infant? What sense is the infant making out of this experience which I've just watched? How did it affect the infant's meaning-making systems? If the parent is intrusive, is that lighting up one of the infant's systems like the autonomic nervous system, the way Steve Porges would talk about it and leading the infant to disengage? If that's an on-going pattern, does the infant begin to make meaning about how to cope with either the intrusiveness or what it means to the infant? They start to bring that meaning back into the situation. I don't think that's all so different than the ways many therapists think about adults and how adults are functioning. But I think the emphasis has to do with the infants are building these meanings. They come into the world with some, but they're developing states of consciousness, states of awareness whereas people like myself or ourselves, we already have anything pretty fixed. It's much easier to work with infants and change them than it is to change adults. But coming back to it, the body is important, and this internal work is really important. I'm not sure that 20 years ago I would have said anything like what I just said; it's been a real change for me. Dr. Buczynski: After seeing the theories his colleagues were using, Ed was able to weave them into his own work with infants. Tomorrow, we'll hear how two experts uncover motivation and find balance. But now I want to hear what you think. How will you use these ideas in your work with clients? Please, share your thoughts, and feel free to leave comments on other comments as well.