Psychotherapy Changes Neurobiological Patterns of Relatedness: The “Still Face” Experiment and the Boston Change Process Study Group

A group of clinicians and researchers, utilizing fundamental principles of bonding between the infant and caregiver, have identified how the therapeutic relationship modifies implicit relational patterns in the patient.   

KEY POINTS:

• Drawing from research in developmental psychology (especially the “Still Face” experiment) and related fields, the Boston Change Process Study Group (BCPSG) argues that psychotherapy changes the patient’s brain by restructuring neural pathways.
• Through repeated relational experiences between the therapist and patient, psychotherapy integrates cognitive and emotional networks for the patient, promoting brain plasticity and allowing for new patterns of thinking, feeling, and behaving.
• The implicit relationship between therapist and patient serves as the main vehicle for change.
• Psychotherapy works primarily through the therapist’s deep emotional presence with their patients, not via the therapist’s words or actions as previously believed.
• The change process centers on “now moments” in treatment, which are sudden, emotionally-charged events that disrupt the established therapeutic relationship. They create a sense of heightened mutual awareness and often lead to transformative “moments of meeting” that can reshape the patient’s relational patterns.
• These special connecting moments establish fresh intersubjective contexts that alter the patient’s relational world. They do more than simply add new information to the patient’s intellectual understanding of him- or herself; they adjust the entire system of the patient’s implicit relational knowing (i.e., the unconscious, procedural knowledge of how to interact with others and regulate emotions).
• This re-organization creates what the BCPSG describes as “new potential.” Through repeated experiences in therapy, new patterns of relating for the patient that operate below conscious awareness are created. This potential extends beyond the therapy room and becomes represented as a future possibility for all the patient’s relationships.

The Still Face Experiment

The Still Face Experiment is a renowned study that has provided significant insights into human emotions and interactions. Conducted by Edward Tronick, Ph.D. in the late 1970s, this experiment sought to explore the connection between infants and their caregivers. It revealed how sensitive infants are to emotional and nonverbal cues.

In the experiment, a mother is instructed to interact with her infant as usual, creating a warm and engaging environment. After a short period, she is asked to adopt a neutral “still face,” refraining from responding to the infant’s attempts to engage her. When the caregiver adopts a still face, infants often respond with a range of behaviors such as smiling, vocalizing, or gesturing in an attempt to regain attention; these initial reactions to the still face are typically marked by distress, with successive behaviors indicating strategies to re-engage the caregiver.

The Still Face Experiment has yielded several key findings that have profound implications for understanding human emotions. First, it demonstrates the critical role of attuned and responsive caregiving in fostering secure attachment and emotional well-being. Infants rely heavily on their caregivers for emotional regulation and reassurance.  Infants who experience consistent, responsive caregiving are more likely to develop secure attachment styles, which are linked to positive outcomes in later life such as enhanced emotional regulation, social competence, and mental health. Disruptions in the dynamics of the relational bond between caregiver and infant can lead to distress.  Even brief disruptions in communication can significantly affect a child’s emotional state, emphasizing the importance of consistent and responsive interactions.

Neuroscientific research supports these findings by demonstrating that social interactions activate specific regions in the brain associated with emotions and bonding. The absence of expected responses triggers stress-related mechanisms in infants, highlighting the biological underpinnings of emotional distress caused by social neglect.

Moreover, the experiment illustrates the importance of the mirror neuron system, which allows individuals to understand and mimic the emotions of others. In infants, this system is pivotal in learning and forming emotional bonds.

The Boston Change Process Study Group (BCPSG)

With Tronick as one of its founding members, the BCPSG is a collective of psychoanalysts and mental health professionals who have generated significant theoretical knowledge and empirical findings in the realm of psychotherapy, particularly in understanding the dynamics of change within therapeutic relationships.  Tronick’s pioneering Still Face Experiment serves as a cornerstone of their work, demonstrating the profound impact of caregiver responsiveness on an infant’s emotional and psychological development and providing a lens through which psychotherapy can be viewed.

Traditional models of therapy often focus on cognitive or verbal exchanges between patient and therapist, neglecting the profound impact of non-verbal communication and mutually co-created experience that occur in psychotherapy. The BCPSG sought to bridge this gap by integrating insights from various disciplines, including developmental psychology, neuroscience, and psychoanalysis.

How Positive Change Occurs in Psychotherapy

The BCPSG has put forth a range of theoretical concepts and empirical findings to explain how positive change occurs in psychotherapy.  Their major ideas are summarized below.

• Declarative Knowledge Vs. Implicit Relational Knowing. The BCPSG views traditional forms of psychotherapy as being based on “declarative knowledge,” i.e., patients gain explicit, conscious understanding of their patterns and dynamics, and learn how to link past experiences and current problems. When therapists explain something, the patient understands it intellectually. For the BCPSG, this declarative knowledge (“knowing what”) alone is a necessary but insufficient condition for change.
  

Implicit relational knowing (called “implicit knowledge” or “procedural knowledge”) occurs below conscious awareness. It covers how we interact with others and control our emotions. Unlike declarative knowledge, implicit knowledge grows through procedural learning—gradually picking up skills and habits through practice and experience. This represents the “knowing how” part of therapeutic change. This knowledge system develops as repeated experiences alter and fine-tune neural systems, building new automatic patterns of emotional response and interpersonal behavior.

• Interactive Synchrony. Tronick’s research emphasizes the concept of “co-regulation,” where caregivers and infants (and, by extension, therapists and patients) mutually influence each other’s emotional states. “Interactive synchrony” refers to the harmonious flow of interactions where both parties are attuned to each other’s emotional states.

Tronick’s work suggests that disruptions in this synchrony, such as those observed in the Still Face Experiment, can lead to emotional distress and developmental challenges.  When applied to psychotherapy, sudden shifts or disruptions in the interactive synchrony between therapist and patient are naturally occurring events that should not be viewed as negative, but, instead, as opportunities to be capitalized on.

Using the concepts of “co-regulation” and “interactive synchrony” as a basis from which to evaluate how change occurs in therapy, the BCPSG identifies two critical events that are transformative— “now moments” and “moments of meeting.” These create lasting neurobiological change through implicit relational mechanisms.

• Now Moments. These are sudden, emotionally-charged events that disrupt the interactive synchrony of the therapeutic relationship. Now moments appear unexpectedly and need immediate attention. Stern and other psychoanalysts view these interpersonal events as interrupting and challenging the ongoing relational dynamics between client and therapist, threatening the intersubjective field and creating a crisis. Clinical markers that signal a now moment include a sudden disruption of the typical interactive pattern; heightened emotional intensity for both participants; and/or a sense that the therapeutic relationship itself is at stake.
• Moments of Meeting. These resolve the crisis introduced by now moments. Moments of meeting refer to those unique instances during therapy when the emotional and psychological barriers between the therapist and client dissolve, allowing for genuine connection and understanding. These interactions are characterized by a shared experience that transcends the typical therapist-client dynamic, creating a space where both individuals can explore their vulnerabilities and insights. These shared experiences create a new state of intersubjectivity that re-arranges the patient’s procedural knowledge of “being with others.”

Viewed as “connecting” experiences, moments of meeting produce what Tronick calls a “dyadic expansion of consciousness.” The patient and therapist, having experienced something strange and new together, without preconceived notions or assumptions (what BCPSG term a unified psychological system), re-arrange the patient’s implicit relational knowing system at a neurobiological level, resulting in “new intersubjective contexts.”

The Therapist’s Responsiveness and Authenticity

Therapists must balance technical skill and personal authenticity to facilitate moments of meeting. Research reveals that the therapist contributes to these moments of meeting by offering spontaneous and authentic responses that surpass neutral technical interventions and signal to the patient a deep personal involvement in what is occurring (while remaining professional).  Others see these moments of meeting as possible only when the clinician adopts a humble stance in the therapeutic moment, able to accept that he or she does not know what is happening and does not have to occupy an authoritative, know-it-all position.

The emergence of the therapist’s humble spontaneous personhood in the clinical encounter is often described as necessary for forging a “real relationship” between patient and therapist, one that rises above the traditional and conventional professional relationship. Empirical research supports the notion that moments of meeting in psychotherapy and the emergence of a real relationship are transformative experiences for the patient that surpass the impact of the therapist’s technical skill and knowledge.

Conclusion

The BCPSG has changed how we understand psychotherapy. Their work moves away from content-based interpretations offered by the knowledgeable therapist and places the therapeutic relationship at the heart of change.

Our relational patterns have deep roots in development, which is why therapeutic change takes time and repetition. Early attachment experiences shape internal working models that guide our relationships throughout life. Therapy works because it offers corrective emotional experiences within a relationship that gradually rewrites these implicit expectations. According to the BCPSG, “now moments” and “moments of meeting” facilitate how therapeutic breakthroughs occur. Patients experience the therapeutic relationships in completely new ways, ultimately reshaping their implicit knowing system at a neurobiological level.