Counselling Psychology Quarterly,

September 2005; 18(3): 227235

BOOK REVIEW

A psychodramatists view of Daniel Sterns latest book

The Present Moment in Psychotherapy and Everyday Life
DANIEL STERN
W.W. Norton & Company Inc. NY, 2003
300 pages, 23.99 (hardcover)
Introduction
This article is mainly an account and a review of Daniel Sterns latest book: The Present
Moment in Psychotherapy and Everyday Life. In his work he investigates and reflects on the
importance of this concept and describes its characteristics both within the individual
and in the encounter as a shared experience, named inter-subjectivity. He regards this
experience as essential for change in therapy and elsewhere. He refers to newly identified
neurological structures, mirror neurons, as the possible site for brain functions responsible
for inter-subjective phenomena. He draws attention to two unfairly treated concepts, the
implicit functions and the consciousness, the later of which is widened to be regarded as
an intersubjective function fundamental for development.
In the beginning of the twentieth century the founder of psychodrama, J.L. Moreno
speculated about the concepts of The Genuine Encounter and of Tele. He (and Martin
Buber) regarded the former as necessary for change and the latter as a spontaneous
non-projective communication determining the emotional characteristics of the encounter.
He was among the first to formulate an interpersonal psychological theory and suggest a
therapy of the moment, psychodrama.
As a practising psychodramatist, I welcome Daniel Sterns book, which in my opinion
expresses observations and ideas supported by modern scientific resources which seem to
confirm and highlight many parts of Morenos early theories.
In this account Sterns book is reviewed with special reference to its importance for a
psychodramatist.

? ? ?
The title of Daniel Sterns latest book, The Present Moment in Psychotherapy and Everyday
Life immediately attracted me. Since Moreno and Buber in the twenties presented
the idea of the Genuine Encounter, the present moment has been the main subject of
Psychodrama. I regard this book as a substantial support for Morenos ideas and of great
value for anyone practising Psychodrama.
Stern has performed pioneering work on the interplay between babies and their mothers,
described in his earlier book The Motherhood Constellation. The use of modern recording
equipment allows detailed studies of short moments and reveals an earlier unknown
richness of interaction. The present book offers a more general view of human interaction

ISSN 0951-5070 print/ISSN 1469-3674 online 2005 Taylor & Francis

DOI: 10.1080/09515070500322484

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Book review

and with special emphasis on the psychotherapeutic situation. Beside recording techniques
he utilises neurophysiological advances as well as traditional observations and interviews.
Daniel Stern is apsychoanalytically trainedresearcher on early childhood development who has given an account of his and his colleagues research in a number of earlier
publications. One has found that even the new-born child is a surprisingly competent
being, with a developed capacity for perception and discrimination and also genetically
equipped to actively establish contact with its protector. It seems to be a fundamental
prerequisite for survival and development. Stern designates the term Schema for the
interactional gestalts in the interplay between mother and infant and expresses their
developmental importance.
Psychodrama is a form of group psychotherapy originally developed from experimental
spontaneous theatre. The clientsupported by the leader and the groupstages in
dramatic present time, relevant aspects of his life. His inner pictures are presented on the
stage, where he has the freedom to move freely in time dimensions and between reality
and fantasy. Everything is experienced here and now with all his senses and in interaction
with the other participants of the drama. The techniques of psychodrama are designed to
facilitate genuine encounters, which are regarded as necessary tools for any change between
persons or between different parts inside a person. The high involvement of spontaneous
action is favourable for a high degree of use of implicit functions.
Role theory is important for understanding what happens on the psychodramatic stage.
A role is defined as the manifest expression of the self in a given moment in relation to
another person (who has the counter-role). Every role has a cognitive, an emotional and
an action component. Roles are formed through earlier experiences and cultural patterns
and contain a varying amount of genetic core. Roles can be classified from comprehensive
(clusters) to very specific. The interaction between the mother and the infant may
be described in terms of roles where both parts learn to develop roles and counter-roles
governed by genetic and cultural (the mother) influences and with varying conditions for
freedom of spontaneity. The roles of mother and infant become the comprehensive roles
which comprise a number of more specific roles connected with physiological functions
and social interaction.
Telewhich means distanceis Morenos term for the emotional flow between two
individuals in an immediate relationship. It was originally defined as the connecting force
that constitutes a sociogram.1 Spontaneity and creativity are two major concepts in psychodrama. Spontaneity is defined as the capacity to make an adequate response in a new
situation or a new adequate response in a familiar situation. Creativity presupposes
spontaneity. Both tele and spontaneity can in modern terminology be regarded as mainly
implicit functions. In my opinion it is profitable to connect these concepts to present
research about intersubjectivity.
Stern refers Present Moment to small momentary events that make up our world of
experience. What interests me most is when these moments enter ones awareness and
are shared between two people. These lived experiences make up the key moments of
change in psychotherapy and the nodal points in our everyday intimate relationships
(p. xi). He continues: An event must be lived, with feelings and actions taking place in
real time, in the real world, with real people, in a moment of presentness (p. xiii).
. . . verbally understanding, explaining or narrating something is not sufficient to bring
about change (p. xiii). Sterns ideas are in perfect agreement with Morenos request
to his clients: Dont tell us, show us!
Sterns book comprises three parts. Part I is an exploration of the present moment, part II
deals with concepts relating to the therapeutic situation, mainly intersubjectivity, implicit

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knowledge and consciousness, part III comprises a view of the present moment in the
clinical situation. This review is mainly focused on the two first parts.
Chapter 1 contains a review of different aspects of time. Chronos is the objective view of
time, the eternal movement of the second-hand eats the future and leaves the past behind.
The present hardly exists. In narrative time the teller creates the temporal ordering. Like
Freuds complex psychic time it disregards linear time. Both can be regarded as attempts
to tame chronos through creating coherence and purpose. However, the now has already
happened and the moment is never caught. Stern suggests the use of the Greek concept for
subjective time, Kairos, a moment of opportunity, when events demand action or are propitious for action. Events have come together in this moment and the meeting enters awareness such that action must be taken, now to alter ones destinybe it for the next minute or
a lifetime. In no action is taken, ones destiny will be changed anyway, but differently,
because one did not act (p. 7). Stern suggests micro-kairos as a name for the minor
life-course decisions of the everyday life present moments. Againthis description of
kairos reminds of Morenos definition of spontaneity cited above, an adequate reaction in
a new situation or a new and adequate reaction in a familiar situation. Moreno also adds
that spontaneity is essential for survival and that lack of spontaneity thus prevents us
from making good choices and taking adequate action. In this chapter Stern also presents
one of his starting points in his studies of the moment, the micro-analytic interview,
where he scrutinizes the complexity of single 35 second moments and reveals their
enormous complexity.
Chapter 2 investigates the nature of the Present Moment. The sense of presentness
poses a challenge to the neurosciences. How do we know that something took place
in the past and when? How do we recognise the present now? How is the future marked?
How is the time marker inserted into the memory trace and where in the brain does that
take place? (p. 23). One has suggested that temporal consciousness and knowing
consciousness may be different modes. Stern calls presentness something like an existential affect (p. 24). Many difficult questions remain to be answered? What happens
in dissociative states? A sense of self seems necessary for the feeling of presentness. What
is the neurophysiological representation of self? What happens when absent-mindedness
moves attention far away.
The paradox of the Present Moment is that it is conceived as a now and has a duration.
A musical phrase is a good example. For me it feels natural to refer to Gestalt psychology
and say that the moment is a gestalt on its own that arises and disappears to be replaced by a
new gestalt according to the figure/background principle. Stern refers to Husserl, father of
Phenomenology, who already a hundred years ago, wrestled with the concept of
the moment and suggested that it consisted of three parts, the last of which indicated the
direction forward.
Different psychotherapeutic schools tend to ignore the importance of the Present
Moment, psychoanalysis through over-emphasis on the past and narrative-reconstructive
therapies through denying what in not rendered verbally.
Stern ends this chapter giving a mini-list of the features of a clinically relevant present
moment: It is conscious. It is a lived experience, not a verbal account. It is whatever is in
awareness in the moment. It is actively created and we accept as something natural that
it appears in our awareness. Usually we jump from moment to moment. Moments are
short, a few seconds. They have a psychological function, they emerge and may necessitate
action (see kairos). Moments are holistic happenings (gestalts). Time dynamics can be
very different (compare the moment when you watch a rocket rise and explode with a
moment when someone says to you: I dont think youre telling the truth). The unfurling

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Book review

of moments are partially unpredictable. There is an experience of self relative to

the moment including a degree of closeness or distance. Different moments have different
importance.
In Chapter 3 the temporal architecture of the present moment is discussed. The moment
has a duration of 110 seconds, in average 34 seconds. Good examples are phrases, lines of
poetry, pauses in conversation. On average they are as long as a breath cycle. Moments in
action are often experienced as grouped, for instance marching, breathing, flexing and
extending.
Stern relates the duration of the moment to our scanty knowledge about the neurophysiological mechanisms of consciousness. It seems likely that a re-entry loop involving a
number of neurons is crucial for a stimulus to reach consciousness. When a group of
neurons is activated by an incoming stimulus they may send a signal to another group
of neurons. The second group then reactivates (reports back to) the first group and a
re-entry or recursive loop that is created. This could then spread to a third group that
would report back to the first and second groups (p. 52) etc.
The first loop is rapid with a duration of around a quarter of a second. It corresponds
to the time to have unconscious intuitive likes and dislikes. I imagine that the emotional
reactions triggered by fast tachistoscopic pictures belong to that category as well as tele
and certain spontaneous actions.
It takes severalfour moreloops for a stimulus to reach consciousness. This mechanism is supposed to protect us against overstimulation to make possible a stable flow of
consciousness. It takes about 34 seconds to notice a stimulus, act and be conscious
of what happens in the moment. Stern suggests that human beings organise courses of
events in basic units, moments, which may have a length from one to ten seconds.
Chapter 4 deals with the moment as a lived story. Stern starts from his experiences
with observations of children. His view is that childrenalso in the preverbal phase of
lifeperceive the human world in intentions, as do adults, that is all that happens is
supposed to have a meaning and an intent. The story puts form to the intentional.
Children cant tell autobiographical narratives until they are 34 years old but according
to Stern observations show that they understand and live through stories much earlier.
How, then, is the story developed? Firstly, something must become conscious, something
new, unexpected, a problem or a conflict. The story depends on an implicit assumption
about how the world works and what can be normally expected. The story is an attempt
to integrate the new experience. This is in correspondence with Piagets concepts assimilation and accommodation. Secondly an intrigue is part of itwho, what, why, when, and
how the different elements hang together. Finally, the dramatic tension necessary to
bring the story forward through the crisis to its denouement is needed.
The idea of having a self anchored in ones body is crucial to make the experience our
own. Stern supports the notion that an experiencing self exists from birth or maybe earlier.
Stern regards the moment as a kind of movement, the intentional-feeling-flow. Genuine
intentions are goal-directed and are fully developed in children, 18 months old, also in more
implicit and incomplete form earlier and constitute the most common form also in adults.
The concept of vitality affects was originally introduced to explain the mothers affective
attunement to her infant. In this book Stern widens the concept to comprise the subjectively
experienced shifts in internal feeling states, being stimulated from outside and inside,
but first of all in the interplay between individuals. Smiles, sounds of words, watched movements etc are changed in every second and influence the inner feelings of the receiver. Stern
names many examples of these qualities captured in kinetic termssurging, fading away,
fleeting, explosive, tentative, full of effort, accelerating, decelerating, climaxing, bursting,

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drawn out, reaching, hesitating, and so on. It is described as a diversified emotional

communication, possibly neurophysiologically understandable as a function of mirror
cells and adaptive oscillators (see below). Stern suggests that vitality affects are crucial
for distinguishing an artistic performance from a technical one. This reminds me of
Morenos emphasis on the coupling of spontaneity and creativity and the necessity
of action. Man is an actor!
Chapter 5 presents the intersubjective matrix. Stern suggests that we can perceive the
intentions and feelings of other people because of the way our neural systems are
constructed. The traditional idea of a one-person psychology and entirely intrapsychic
phenomena is not tenable. Two souls co-create intersubjectivity, intersubjectivity creates
two souls. These formulations agree with Morenos and Bubers views about the necessity
of a genuine encounter to make a change.
There is neurophysiological support for the idea of intersubjectivity. One has recently
discovered a new type of neurons, mirror cells, situated adjacent to motor neurons. They
mirror in the observer the movements of the observed. So far there is evidence what regards
hand, mouth, face, vocal and foot actions. Another feature of this system is its particular
sensitivity to goal-directed actions. Stern suggests that two individuals may have to be
unconsciously in accord with each others to be able to resonate.
The adaptive oscillators constitute another neurophysiological discovery. They are cells
synchronising the rate of neural firing with incoming stimulation, which allows individuals
to co-ordinate their movements with precision. Maybe that is the explanation of the
exceptional skill of an acrobatic troupe? The point is, Stern maintains, that we participate
in some aspect of the experience of someone else. I know what you are feeling. So far
it is one-way intersubjectivity. What is then two-way or total intersubjectivity. I know
that you know that I know what you are feeling, and vice versa. At least two readings
of the other are required for two-way intersubjectivity. The first is to know what the other
is experiencing. The second is to know how the other is experiencing your experience of
him or her (p. 81). First you get a picture of the experience of the other, second you find
out the reaction of the other on how he or she reacts on your experience of him or her.
The context has a decisive role. In my eyes Stern reformulates and cultivates Morenos
original tele-concept with the help of modern neurophysiological tools and underlines
its importance.
The discussion above pays attention to another question. How come that we are not constantly permeated by the experiences of others? The system needs breaks. Stern describes
three mechanisms. The first implies a selection of our attention. The second stops the
motor neuron from being activated to automatic imitationwhich can be observed in
psychotic and demented persons. The third doses the degree of resonance. Overfunction
of that mechanism is a possible explanation of lack of empathy, which is part of some
psychiatric disorders. Stern emphasises that there are great normal variations and that
continued research is needed for instance to explore the role of developmental experiences.
Observations show that the capacity of intersubjectivity is developed early in infants,
which supports the idea of a genetic basis. It should be mentioned that Moreno also
wrote about a possible genetic basis of tele. Stern writes that the infants capacity to imitate
as well as the affect attunement between mother and infant must be regarded as intersubjective functions. He recounts for observations that show the development of the childs
intersubjectivity in cognitive direction inside a human world of intentions.
To summarise: Children are enclosed in an intersubjective matrix which functions as a
support and basis for development, a necessary prerequisite for normal growth. In contrast
autistic children seem to lack this basis and therefore have to resort to an instrumental

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and mechanical type of learning. Maybe autism as a phenomenon is a proof that intersubjectivity is necessary for normal development.
In Western tradition we havefollowing Descartesseen the mind as separate from the
body, from nature and other minds, a distinct development from our animistic and
polytheistic past. The German philosopher Edmund Husserl, contemporary with Freud,
has been important for the formulation of a holistic view of man and his phenomenological
approach has been revitalised by contemporary philosophers and scientists. This new
view assumes that the mind is always embodied in and made possible by the sensorimotor
activity of the person, that it is interwoven with and co-created by the physical environment
that immediately surrounds it, and that it is constituted by way of interactions with other
minds . . . Without these constant interactions there would be no recognisable mind
(p. 95). Thus one can regard the mind as, by nature, intersubjectively open. It means
that the human being has an inborn disposition to regard the other as an embodied being
like oneself.
Chapter 6 has the title Intersubjectivity as a basic primary motivational system.
Intersubjectivity should be seen as a basic human need, universal and inborn, dependent
on important influence from the environment. Psychotherapy can most easily be understood as a regulation of the intersubjective field between therapist and patient.
Intersubjectivity contributes in three ways to survival. It favours formation of groups,
strengthens the function of the group and consolidates the coherence of the group through
development of norms (moral). Man as a species has few defences and survives because of
its brain and its capacity to co-ordinated group activity. We are the most social and mutually
dependent of all mammals. Intersubjectivity works in groups as well as dyads. Stern refers
to observations describing three-way-intersubjectivity between parents and infants,
36 months old. The family history extends and is provided by the repeated intersubjective
experiences.
Stern suggests that the intersubjective motives regulate the degree of feelings of psychological belonging, a group quality unique for human beings. The extreme positions are
cosmic loneliness and total fusion with a loss of self. Stern distinguishes intersubjectivity
from attachment. Both are important, attachment however is more a feature of physical
closeness and group bonding, rather than for psychological intimacy. The functions support
each other, closeness allows intersubjectivity to develop, intersubjectivity favours attachment. One of Sterns arguments for the distinction is the experience that autistic children
can have a very strong attachment to their parents despite a badly developed intersubjective
capacity. The language and the rich repertoire of facial expressions and sounds are the most
important tools in the service of intersubjectivity. Also the art of playing is most developed
in human children. It should be mentioned that psychotherapy in its best sense is a form of
play (Winnicott) and that the techniques of psychodrama were developed from Morenos
observations of childrens play.
Stern distinguishes two motives for intersubjectivity. First the need to be safely oriented
among other human beings, understand what is going on and apprehend the feelings and
intentions of the others. Unable to read the situation intersubjective anxiety may occur.
Second is the need to confirm ones own identity through the other. Stern also discusses
other examples, like childrens relations to imaginary companions, falling in love and
the participation in rituals and communal activities like dancing and singing.
Chapter 7 deals with implicit knowledge which is nonsymbolic, nonverbal, procedural
and unconscious in the sense of not being reflectively conscious. Explicit knowledge
is symbolic, verbalisable, declarative, capable of being narrated and reflectively conscious
(p. 113). The importance of implicit knowledge has long been overlooked but constitutes

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the quantitatively overwhelming part of our total knowledge. Stern writes that most of
our social skills belongs to the implicit and should remain there. Milton Ericksson, the
famous hypnotherapist, expressed similar ideas when he advised his clients to trust their
unconscious. It also questions the classic aim of psychoanalysis to make the unconscious
conscious. Generally it has been a tendency since the birth of psychotherapy to regard
the unconscious as mainly primitive, dangerous and uncontrollable, as something
that should be brought under conscious control. Stern suggests one should reserve the
original psychoanalytic concept to be intended for psychic material, that has been repressed
through the classic defence mechanisms and where there is an active resistance to make
it conscious.
In the situation of psychotherapy there are two agendas. One is the explicit verbal
content, what the client says and the therapist answers, as if the client and the therapist
were standing side by side, looking at a third thingthe content external to their
immediate relationship. The search is for meaning, co-constructed by therapist and patient
in a narrative format (p. 119). In active therapies like gestalt and psychodrama, the explicit
is present, for instance as an answer to questions like Where in your body do you feel
that. Implicit material becomes explicit through the process of narrating.
The second agenda deals with the regulation of the implicit content in the relation
between therapist and client. This includes extensive and important parts, the working relation, transference- and counter-transference-relationships the holding environment, the
real relation which all are created and unconsciously regulated by therapist and client
together. The implicit regulates the intersubjective field. Stern assumes that it takes place
through sequences of moments, a mainly unconscious dyadic process, where both parts
read what happens in the room. In dealing with this relational-process agenda, the patient
and therapist are no longer standing side by side looking at a third thing. They are either
face-to-face looking at each other, or they are standing side by side looking at themselves,
looking at each other, or alternating between these two positions (p. 121). This reminds
me again about Morenos formulation of the authentic encounter. It also effectively dispatches the old myth about the objective, neutral therapist who can work unaffected and
just apply his techniques. Of course the role of the implicit will depend on technical aspects
of the therapy. I imagine that the emphasis on action, spontaneity and encounters in
psychodrama will mobilise implicit resources in a fruitful manner.
Chapter 8 deals with the role of consciousness and the notion of intersubjective
consciousness. Freuds emphasis on the unconscious has led to a psychoanalytic lack of
interest in the moment and the phenomenological experiences. There are also different
ways to think of consciousness. Awareness concerns mental focusing, consciousness
refers to the process of being aware. Phenomenal consciousness concerns direct experience.
Introspective consciousness is the awareness of having the phenomenal experience, which is
expressed verbally in talking therapies. In psychodrama and other action methods,
phenomenal consciousness is usually synonymous with action.
Stern formulates a central question: How can a present moment that is implicitly
grasped become conscious? Stern suggests the term intersubjective experience to answer
the question. When two people co-create an intersubjective experience in a shared
present moment, the phenomenal consciousness of one overlaps and partially includes
the phenomenal consciousness of the other. You have your own experience plus the
others experience of your experience as reflected in their eyes, body, tone of voice and
so on. Your experience and the experience of the other need not be exactly the same.
They originate from different loci and orientations. They may have slightly different coloration, form and feel. But they are similar enough that when two experiences are mutually

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validated, a consciousness of sharing the same landscape arises. This is intersubjective

consciousness (p. 125).
Stern reminds us how a stimulus becomes conscious only through a number of loops
in the brain and suggests the possibility that a re-entry loop is created between two
minds that can give rise to a common integrated experience in both. Stern suggests a
more social view of consciousness, a social mirror theory meaning that reflective consciousness is social in origin and depends on a shared experiential world and social reflectivity.
It would mean that we become aware of our own mental states as we discover that
others have them. The point is that the other must be different from the self-who-isundergoing-the experience.
Let us compare with Morenos poetic description of the genuine encounter: A meeting
of two: eye to eye, face to face. And when your are near I will tear your eyes out and place
them instead of mine. And you will tear my eyes out and will place them instead of yours,
then I will look at you with your eyes and you will look at me with mine.
Stern also expresses the possibility that context-specific multiple selves can interact
with each other and converse together out of consciousness and that it is normal, not limited
to pathological dissociative states, and serves the same mirror function. The presence of a
psychotherapist makes the situation much more social. What happens in the intersubjective
present moment can create a shared experience which enters the long-term memory and
becomes a part of the work for change.
Sterns work is in my view a strong support for all forms of group psychotherapy. Moreno
noticed 1913after having initiated group meetings between prostituted women
in Viennathat they soon abandoned their initial scepticism, found a deeper meaning in
the meetings and realised that they could help each other. Moreno expresses that every
group member could be the therapeutic agent of the other. Moreno at an early stage
used the terms co-conscious and co-unconscious for what is developed between the
members of a group. The co-conscious seems to be developed from social mirroring.
The co-unconscious remains as implicit knowledge, that is lived through and expressed
but hardly can be formulated in words. These experiences of group therapy fit nicely
to the ideas presented in this book around the present moment, implicit knowledge and
intersubjective consciousness.
In the chapter of social mirror theory Stern describes a rather decentralised and
non-hierarchical self, far from the traditional psychoanalytic view. The multiple selves he
mentions could in Morenos terms be described as inner roles, who may be disturbing
but mainly are resources and an antidote to ego-constriction. On the psychodrama stage
these inner roles can be concretised and enacted by other group members, a challenging
intersubjective experience.
I have given an account of rather than reviewed Sterns very rich and creative work
because I have found it extremely important and it has helped me to develop my own
perspectives of psychodramaa psychotherapy of the momentalthough drama is hardly
mentioned in the book. I hope I have been able to do enough justice to his work and can
stimulate other professionalsnot least group psychotherapiststo read it. I am aware
that I have hardly mentioned the last third of the book.
There might also be a reason to address things that Stern doesnt write about. Like
Moreno he seems to be an optimist regarding the possibilities of man. It is understandable
that the one who performs pioneering research around the fascinating interaction between
mother and infant and is one of discoverers the enormous potential of the human infant
writes a bright and optimistic book. Stern gives no answer as to why the history of man

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is so full of violence, persecution and suffering. Still I am thankful for a book that conveys
new experiences and ideas about the human being in such a positive way.
Lars Tauvon
Notes
1

A Sociogram is Morenos graphic description of the interconnections in a group, based

on a sociometric choice, that is every group member chooses another member according
to a specific criterion.