Book Review: The Present Moment in Psychotherapy and Everyday Life

Reading Stern's book is like trekking through the Swiss Alps on a clear warm sunny day. Turning the pages we climb and approach the summit where the heightened landscape changes dramatically – it is suddenly, without warning, panoramic, far-seeing, spectacular in depth and clarity, lifting and thrusting our myopic worldview and senses into wide perspective. We shiver with a thrill of excitement, the wondrous beauty of the moment. The experience, if not scary and unfamiliar, is deeply sensual. Our hard won concepts on life are jolted and markedly shift; our very understanding of existence mutates in an instant. We see the world through Blake's words as 'a grain of sand and heaven in a wild flower, we hold infinity [of the moment] in the palm of our hands'.

Daniel Stern prefaces his new book The Present Moment with Blake's words before commencing his pioneering journey through the book to explain what for him being-in-the-world may entail. The writing of this book, Stern advises, has doggedly chased him for decades in that it encompasses a considerable period of preoccupation stemming back to the 1960s when he used film and video to study mother-infant interaction. Stern in his previous internationally acclaimed work The Interpersonal World of the Infant (2000) parsed human contact into small fleeting moments between mother and child which he suggested gave rise to the infant's sense of self and the experience of engaging and being-in-the-world. In this his latest work, Stern turns his attention to the nature of time and the 'nowness' of what constitutes a present moment. Much of the work presented in the book is a development and expansion of his previous works (1977, 1995 & 2000) together with ideas and concepts stemming from the work of colleagues in the Boston Change Process Study Group. For Stern, a psychoanalyst, the vital fleeting experience of the present is an entrancing subject area heavily loaded with psychological significance that strongly informs our subjective sense of self. Although Stern's work is based extensively on current research in neurobiology, it may however be considered to be radical in that it places emphasis on the therapeutic activity or dynamic that takes place in the realm of what he terms 'implicit knowing'.

Stern begins by pointing out that we are subjectively alive and conscious only now. The only phenomenal experience, 'raw subjective reality', is now the present moment. To grasp the nature of the present moment Stern points out it is necessary to understand that present moments have a temporal structure - a concept influenced by the work of Husserl (1859-1938). The pervasive theme throughout the text focuses on the hypothesis that small momentary events make up our world experience. Stern extends this thought-line to suggest that these lived experiences make up the key moments of change in psychotherapy and nodal points in our everyday relationships. Patient and analyst (Stern's words) affect each other in complex ways, coming together for brief periods which he terms 'now moments', and more intense interactions (which permanently change the relationship between client and therapist) which he refers to as 'shared feeling voyages', and 'moments of meeting'. The crux of Stern's argument is that change occurs in the moment of meeting with the other, the interaction of two parties in the nonconscious realm of shared implicit knowing. The client-therapist dyad provides opportunities to forge new ways of being-with-another, over-writing old scripts and past influences with new co-created experiences. Stern's implicit knowledge is out of awareness primarily because it is nonconscious, as opposed to Freud's unconscious, and more often non-verbal – a new slant on the importance of silence shared between two parties in communication.

The book comprises ten chapters divided and presented in three parts. Part 1 is an exploration of the present moment, and part 2 focuses on notions needed to situate and contextualize the present moment in the therapeutic setting. In part 3, Stern offers some insights into how the present moment may manifest in the clinical setting between two people. In the Appendix Stern describes a micro-analytic interviewing approach to demonstrate what he means by 'now', or to be more exact the aspect of consciousness that is the intention of study. The focus of the book is on experience as it is lived, however, Stern postulates that this is rarely fully realized or fully consciously cognized. Stern points out that although a normal narrative account is constructed from original experience it is 'mindsized' and reduced by thought and narration. The micro-analytic interview example presented by Stern in the Appendix is a 1.5 hour duration interview based upon a 5 second lived experience of a volunteer pouring his orange juice whilst preparing breakfast. He refers to the findings as a 'composite narrative' which he suggests probably lies somewhere between the actual lived experience and the narrative of the experience. It is simply an attempt to examine and move closer to an objectification of the actual lived experience and thereby helps to provide new insights and ideas into phenomenal reality of the moment. Stern concludes; 'the results attest to the richness of the micro-momentary world of present moments' and suggests that the notion of a present moment as 'a world in a grain of sand' provides a tenable hypothesis.

The book begins using these micro-analytic interviews as the focus to explore the nature of the present moment – in particular its duration, temporal architecture and characteristics. He presents the hypothesis that the present moment lasts no more than ten seconds, probably more like 5 or 7 seconds. He notes most spoken phrases occupy no more than 3 to 5 seconds, which he relates to the normalized breath cycle of 3 seconds or musical phrases after which the subjective sense of forward movement ceases. He concludes we live experience in 'chunks' of a few seconds at a time, which is in itself governed by the neurobiological way our brains function. Each 'chunk' is a moment of experience which is individually organized according to our individual brain patterns which he refers to as 'vitality affects'. There are echoes here of Stern's earlier work on affect attunement – expressive gestures which are exchanged between mother and child. Stern concludes the first part, essentially as he began, stating that the present moment is a phenomena subjectively experienced as a lived story. A story because it can be objectively described but nevertheless is nonverbal, a temporal contour of vitality affects that serve as the canvas or plot of the lived experience.

In part 2 Stern attempts to contextualize the present moment in the therapeutic process exploring the notions of intersubjectivity, implicit knowing and consciousness. He argues for example in Chapter 6 that intersubjectivity is itself an innate primary motivational system – a condition of 'humanness' – similar to sex or attachment. He suggests the two major forces underlying intersubjectivity engagement are the desire for orientation, the need to read the intentions and feelings of others, and the second as the need to make contact with ourselves, to establish self-cohesion, definition, and identity. Stern's underlying point is that intersubjective need and motive is instrumental in directing the second-by-second process of the therapeutic relationship whereupon shared mental landscapes are negotiated. The present moment establishes the nature of the intersubjective space where this interplay (dynamic) takes place. He suggests it is intersubjectivity that drives and energizes the process of therapy to move forward enabling patients (clients) to share and feel what it is like to be oneself.

Stern then moves on to discuss the concept of 'implicit knowing'. This he describes as the second of two basic agendas in any clinical situation; the first being explicit verbal content, the second – implicit knowing – is the domain of knowing, the basic unit of subjective experience which is neither reflectively conscious, or unconscious, but nonconscious. Both agendas, (the explicit i.e. verbal and implicit knowing) from a clinical standpoint influence the therapeutic relationship as well as each other. It is important to note that Stern differentiates between nonconscious and unconscious. The term nonconscious is not to be confused with Freud's das Unbewusste 'the unconscious' which is an implied repressed cognitive conscious activity not easily accessed by the individual. The term nonconscious is used in the neurobiological sense of non-conscious cognition and such is not held by Stern to be the subject of psychological resistance.

Stern ends part 2 tackling the difficult subject of consciousness as it applies to the present moment. Having argued that the formation of a present moment, as it unfolds, is an implicit process (i.e. it happens out of awareness), he moves on to question how an experience, if it is to be recognised as a present moment, must be brought into awareness and made conscious. This leads Stern to define three types of consciousness at play in the clinical situation. Phenomenal consciousness, an experience one is aware of as it happens, introspective consciousness, which is verbally based, and intersubjective consciousness which is an intense co-created phenomenal experience that happens in therapy or at other special moments in life. With intersubjective consciousness, in the moment-to-moment process of therapy, Stern suggests there is a matching, or an overlap of the phenomenal experience of each partner. Although the experience is co-created it clearly originates from different centres of orientation. Stern argues that providing certain conditions of reflectivity are met, e.g. the therapeutic setting, the intersubjective experience will surface on the shared conscious horizon.

Having scaled the mountain pass of parts 1 and 2, and negotiated a number of difficult concepts, the peak is finally in sight. With a foothold on what constitutes a 'present moment', and notions of 'intersubjective consciousness', 'non-awareness', and 'implicit knowing' Stern guides the reader on to the plateau of part 3. He rewards the effort of the climb with a heightened view across the psychotherapeutic landscape focusing on a clinical perspective of the present moment and its centrality to the process of mutation and change. Having argued that the intersubjective moment is the basic metric of psychological experience Stern moves on to explore the influence of the past (which he describes as a multitude of fragmentary memory traces of prior present moments) on the present and therapeutic change. He adopts a phenomenological stance to explore different kinds of pasts that are linked to the present and inform the clinical position. Drawing upon the concept of fractals in general dynamic systems theory (Freemen, 1999; Prigogine, 1997; Thelen & Smith 1994), to explain how patterns of large scale forms or processes, regardless of scale, can be inferred from fractals/momentary processes, he presents a close examination of what is happening in the present by giving examples of session transcripts. In so doing he provides the reader with the basis of how the patient's intersubjective psychological world may be glimpsed in a grain of sand of the present moment. The multitude of associations from the past permits a variety of responses in what Stern terms the 'sloppiness' of the therapeutic process. Attending to the implicit flow of the session, and accepting that although therapy is by its nature not only spontaneous and unpredictable but importantly potentially creative, maladaptive experiences carried in memory can be changed at the level of implicit knowing and intersubjectivity.

The major contribution of this book to the field of psychotherapy is in my opinion its focus on the phenomenological notion of consciousness. Stern makes a pioneering break from the traditional psychoanalytic notion of the Freudian unconscious, and although he is politic in not denying either its existence or significance in psychoanalysis, he makes the point, assertively, that a patient's mutation in psychoanalysis is not beholden to psychoanalytic interventions, and/or interpretations of the here and now. Nor is therapeutic insight and patient change solely dependent upon the here and now of the analyst-patient relationship. Stern's presentness is a different here and now concept to that commonly held in psychoanalysis and derivative therapeutic modalities. Stern's here and now is the present moment that occurs in the heat and intensity of the presentness of the moment. Present moments that bring about insight and change in therapy are nonconscious.

This is a courageous piece of work for which the reader might be forgiven for believing that large chunks of the book were dictated by a phenomenological-existentialist. Although some may find it intellectually demanding in places the book is written in simple clear language which itself tends to obscure the radical terrain of ideas presented. A must read for psychotherapists.

References

• Freeman, W.J. (1999). How Brains Make Up Their Minds. London: Weidenfeld & Nicholson.
• Prigogine, I. (1997). The End of Certainty. New York: Plenum.
• Stern, D.N. (1977). The First Relationship: Infant and Mother. Cambridge, MA: Harvard University Press.
• Stern, D.N. (1995). The Motherhood Constellation. New York: Basic Books.
• Stern, D.N (2000). The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology. New York: Basic Books.
• Thelen, E., & Smith, L. (1994). A Dynamic Systems Approach to the Development of Cognition and Action. Cambridge, MA: MIT Press.

Maurice Jenkinson