The neurobiological basis of human relationships: a summary of concepts and underlying studies

Authored by Henry Strick van Linschoten

Attunement

When we speak of attunement in psychotherapy, it is possible to recognise and describe significant physical, bodily elements in what is going on in line with the non-dualist ideas about mind and body. Apart from what is perceived to happen psychologically, body systems, organ systems, parts of the body are in tune, are running synchronously and this is directly connected or perhaps even partly identified with the psychological sense of the attunement. Attunement has to a limited extent been studied in biology and medicine, but it has a large component that is seen to belong to psychology. Amongst many other aspects, this is a prime example of the unity of body and mind, going beyond the mutual influencing of somehow independent systems to a fully integrated single bodymind reality.

The prime example and source of information about attunement can be found in babies and infants with their primary caregivers. Stern (1977, 1985, 1995), Tronick (2008, passim but especially Parts III and V and chapters 15, 16, 17, 20,29 and 32) and Beebe & Lachmann (2002, especially chapters 2, 5 and 6) are key sources. The attachment behavioural system can only function on the basis of attunement: basic attachment security is formed in the first year to year and a half of life, and that period is largely pre-verbal.

As with many underlying concepts, there are a number of synonyms or overlapping ideas such as intersubjectivity, resonance, shared states, dyadic states, mutual regulation, co-constructed interaction, rapport, or even dialogue, conversation and I-Thou relationship.

The following are a number of important milestones in the development of the wider attunement concept since the 1970s:

• Intersubjectivity can be defined as the processes involved in a mind obtaining knowledge of the mental activity of another mind. This includes the ability to distinguish between minds and things. Colwyn Trevarthen did a great deal of pioneering work to establish that this ability is already present in infants so young that it must be called innate, and was able to describe its observable features in detail. One of his own summaries of his work from the early 1960s onwards is Trevarthen (1980). He himself describes the history of his work in this field in Trevarthen (1998)
• The psychologist Dr Daniel Stern did a great deal of pioneering work painstakingly observing infants and their interactions with caregivers. The first published book in a series of publications was Stern (1977), in which he reported on the infant’s recognising other human beings, on structure and timing of the behaviour repertoires, and how interaction developed into relationship. He lay the groundwork for his work of the next few decades, in particular by taking the idea of mutual regulation as basic to human intersubjectivity and relationship.
• Harris (1998) is based in the rather different psychoanalytic tradition, but from a modern relational perspective, and sites the body firmly at the centre of psychotherapeutic theory and clinical practice. She bases herself firmly on a complete mind-body integration, emphasises the body and the person as only understandable in its relationality, and in addition draws attention to the importance of the overall social context. In addition she refers to the importance of general systems theory and to the metaphoric meaning and power of the terminology and processes she describes.
• Fonagy et al. (2008) come from a slightly different trajectory of research projects started in the early 1990s. In this chapter they summarise the latest state of their thinking, and pull together and connect relational psychoanalytic theory and practice with attachment theory, systems theory and (neuro-)biological ideas to show that it is not too early for a rich synthesis of relational and attachment thinking that can be one very helpful basis for clinical practice for the substantial group of practitioners who are part of all these traditions. They also demonstrate here the good fit between this synthesis and the new ideas developed by their group around the concept of mentalisation.
• Surrey &smp; Kramer (2013) show how relational psychotherapy and intersubjectivity can be anchored and linked with the ancient traditions of Buddhism and mindfulness in a way that strengthens and deepens the understanding of what is really happening in relationality and how this powerful understanding further develops the acquisitions of other traditions. They use practical examples of methods and therapeutic moments to illustrate their statements.
• Schore (2012) is perhaps currently the most complete, detailed and systematic example of how attunement as the basis for intersubjectivity can be used clinically to develop the therapeutic relationship in safe and effective ways towards a firmly-held, relational and attachment-based holistic conceptualisation that is enriched by an understanding of and integration with the latest ideas of neurobiology.
• Siegel (2012, Ch. 23) is a chapter from one of Siegel’s several summaries and integrations of most of the above strands into one seamless whole called Interpersonal Neurobiology. In this chapter he emphasises how many strands come together in the concept of attunement. Short as it is, he stresses that attunement is an essential element in the movement towards integration, one of the fundamental organising principles of Siegel’s formulation of Interpersonal Neurobiology.

Attachment theory

At its origin, attachment theory was very much rooted in biology, including ethology and evolution theory, as is evident from the foundational book, Bowlby (1982), that was originally written in the late 1960s. Attachment theory has continued to be open to and influenced by interpersonal neurobiology.

A summary of attachment-related work that has been done in areas of neurobiology can be found in the chapters in Part II of Cassidy & Shaver (2008), and especially in Coan (2008). However, the focus of ongoing research in attachment theory has been primarily on the diagnostic / categorical model of different qualities of attachment security, measurement and diagnosis of these in infants, adults and at other ages, and correlations between these categories over time, between closely related people, and with other categories of interest such as the classifications of mental disorder.

Attachment theory has been a significant influence on the development of psychotherapy, and has been understandably integrated in many of its new conceptualisations (Schore, 2012; Fonagy et al., 2008; Siegel, 2010, 2012; Cozolino, 2010), that are based on an interdisciplinary synthesis of research findings.

Mirror neurons

Mirror neuron theory is listed by Siegel (2012, Ch. 19) as an aspect of interpersonal neurobiology and there is great interest in this phenomenon among those studying the unconscious and involuntary impact of the other upon the self at an embodied and affective level, a core concern in relational approaches to psychotherapy.

Mirror neurons are a special group of motor neurons in the cerebral cortex. They were first identified in the ventrolateral part of the premotor cortex of monkeys. They are activated not just as part of preparation for some kind of (muscle) action, but also when behaviours of other animals are being observed. A minimal response to this discovery would be to assume that they play a role in procedural imitation learning. In general the premotor cortex appears to play a major role in the initiation of motor action, of which the voluntary execution would be driven from the primary motor cortex. The premotor cortex also contains Broca’s area, the location that since the 19th century is known to play a role in producing speech. A key question is the meaning and implications of the special role being played by the mirror motor neurons compared with other neurons in the premotor area.

They were first observed in experiments conducted in Italy with macaque monkeys, as described in Gallese et al. (1996). This article reports the observation of two monkeys; it reported that there was a strong correspondence between observation and prepared action in about 30% of the neurons. In interpreting the results it compared the neurons with the neurons in Broca’s area. The paper was combined with an article with more interpretation of the same results, Rizzolatti et al. (1996). Some of the conclusions reached have been:

• Primate experimenters have been able to study action potentials of individual neurons. In humans this is almost never possible for ethical reasons; as a result the research is almost exclusively based on non-human animals, mainly animals, and to some extent birds. The few studies that suggest that mirror neurons exist in humans only show activity in particular areas, and show that in a number of different areas. Dinstein et al. (2008) review and critique the human protocols that have been used.
• It appears that neurons with similar properties to the ones whose properties were described by Gallese et al. (1996) and Rizzolatti et al. (1996) may be more common than initially thought. Similar responses have been found in the supplementary motor area, in the primary somatosensory cortex and in the inferior parietal lobe.

A number of readable books have been written expanding the mirror neuron narrative, such as Rizzolatti & Sinigaglia (2008), Stamenov & Gallese (2002) and Ramachandran (2010). Mirror neurons have now been described as explaining empathy (either the Rogerian version or the simulation theory of Goldman and Gordon), supplying the neurological basis for human self-awareness, explaining the origins of human language skills and have been implicated in the causes of autism.

Some reviews and perspectives are given by Hickok (2009), Dinstein et al. (2008), Catmur et al. (2007)and Gallese et al. (2011). Gallese et al. (2011) was a discussion forum during which supporters and skeptics of mirror neuron theory jointly looked at research evidence and tried to evaluate the support for conclusions in a number of areas. Hamilton (2013) reviews the evidence for a mirror neuron influence on autism, and concludes that the research evidence is very limited.

References

Beebe, B. & Lachmann, F.M. (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Hillsdale, NJ: The Analytic Press.

Bowlby, J. (1982). Attachment (2nd edition). London: The Hogarth Press.

Cassidy, J. & Shaver, P.R. (Eds.) (2008). Handbook of Attachment: Theory, Research, and Clinical Applications (2nd edition). New York: The Guilford Press.

Catmur, C., Walsh, V. & Heyes, C. (2007). Sensorimotor learning configures the human mirror system. Current Biology 17: 1527-1531.

Coan, J.A. (2008). Toward a neuroscience of attachment. In J. Cassidy & P.R. Shaver (Eds.), Handbook of Attachment: Theory, Research, and Clinical Applications (2nd edition). New York: The Guilford Press.

Cozolino, L. (2010). The Neuroscience of Psychotherapy: Healing the Social Brain (2nd edition). New York: W W Norton.

Dinstein, I., Thomas, C., Behrmann, M. & Heeger, D.J. (2008). A mirror up to nature. Current Biology 18:233; R13-R18.

Fonagy, P., Gergely, G. & Target, M. (2008). Psychoanalytic Constructs and Attachment Theory and Research. In J. Cassidy & P.R. Shaver (Eds.), Handbook of Attachment: Theory, Research, and Clinical Applications (2nd edition). New York: The Guilford Press.

Gallese, V., Fadiga, L., Fogassi, L. & Rizzolatti, G. (1996). Action recognition in the premotor cortex. Brain 119: 593-609.

Gallese, V., Gernsbacher, M.A., Heyes, C., Hickok, G. & Iacoboni, M. (2011). Mirror neuron forum. Perspectives on Psychological Science 6: 369-407.

Hamilton, A. F. de C. (2013). Reflecting on the mirror neuron system in autism: a systematic review of current theories. Developmental Cognitive Neuroscience 3: 91-105.

Harris, A. (1998). Psychic envelopes and sonorous baths: siting the body in relational theory and clinical practice. In L. Aron & F.S. Anderson (Eds.), Relational Perspectives on the Body. Hillsdale, NJ: Analytic Press.

Hickok, G. (2009). Eight problems for the mirror neuron theory of action understanding in monkeys and humans. Journal of Cognitive Neuroscience 21: 1229-1243.

Ramachandran, V.S. (2010). The Tell-Tale Brain: Unlocking the Mystery of Human Nature. London: William Heinemann.

Rizzolatti, G., Fadiga, L., Gallese, V. & Fogassi, L. (1996). Premotor cortex and the recognition of motor actions. Cognitive Brain Research 3: 131-141.

Rizzolatti, G. & Sinigaglia, C. (2008). Mirrors in the Brain: How Our Minds Share Actions and Emotions.Oxford: Oxford University Press.

Schore, A.N. (2012). The Science of the Art of Psychotherapy. New York: W W Norton.

Siegel, D.J. (2010). The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration. New York: W W Norton.

Siegel, D.J. (2012). Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind.New York: W W Norton.

Stamenov, M.I. & Gallese, V. (Eds.) (2002). Mirror Neurons and the Evolution of Brain and Language.Amsterdam: John Benjamins Publishing.

Stern, D.N. (1977). The First Relationship: Infant and Mother. Cambridge, MA: Harvard University Press.

Stern, D.N. (1985). The Interpersonal World of the Infant: A View From Psychoanalysis and Developmental Psychology. London: Karnac.

Stern, D.N. (1995). The Motherhood Constellation: A Unified View of Parent-Infant Psychotherapy.

Surrey, J.L. & Kramer, G. (2013). Relational mindfulness. In C.K. Germer, R.D. Siegel & P.R. Fulton (Eds.), Mindfulness and Psychotherapy (2nd edition). New York: Guilford Press.

Trevarthen, C. (1980). The foundations of intersubjectivity: development of interpersonal and cooperative understanding in infants. In D.R. Olson (Ed.) The Social Foundations of Language and Thought. New York: W W Norton.

Trevarthen, C. (1998). The concept and foundations of infant intersubjectivity. In S. Bråten (Ed.), Intersubjective Communication and Emotion in Early Ontogeny. Cambridge: Cambridge University Press.

Tronick, E. (2007). The Neurobehavioral and Social-Emotional Development of Infants and Children. New York: W. W. Norton.