Therapeutic Presence Part 4: Attunement

Attunement in a therapeutic relationship means to be able to attune to one’s self and the client but also to the space immediately around the practitioner and client’s bodies, to the office space and to nature and then back cyclically. It involves the spontaneous and deliberate movement of attention between these boundaries of awareness very slowly and the simultaneous capacity to be still or rest one’s attention on one’s heart and breathing. I call it a cycle of attunement and feel that it is the most basic unit of work that we do in any type of client-therapist relationship. Attunement practiced in this way builds resonance, empathy and compassion. Consequently, the principle therapeutic affect that a therapist seeks to attune with is love, a deep sense of kindness rooted in our biology. This is done by starting with a conscious orientation to stillness in self and other and the subsequent perception of the interchange between stillness and slowness called Primary Respiration in biodynamic craniosacral therapy. I have included quotes below previously published in my Biodynamic Craniosacral Therapy Volume 4. I hope the reader can begin to understand that the therapeutic relationship is a two person biology.

Infant Research on Attunement

  1. From: Stern, D. 2004. The Present Moment in Psychotherapy and Everyday Life. New York: W.W. Norton & Company. (Reprinted with permission.) (Stern 2004).
  2. 241- [Definition of attunement from the Glossary]

Affect attunement (also attunement) is a special form of behavior in response to the communicative affective behavior of another. Just as imitation is a faithful rendering of the other’s overt actions, affect attunement is a faithful rendering of what the other must have felt like when he or she expressed him- or herself with those actions. This requires that the attunement imitates only the temporal dynamics of the intensity, form, or rhythm of the other’s behavior but in a different modality or at a different scale. In this way, the actual actions of the other do not become the referent of the attunement (as they would for imitation); rather, the feeling behind the actions becomes the referent. It is a way of imitating, from the inside, what an experience feels like, not how it was expressed in action.

From: Siegel, D. 1999. The Developing Mind: Toward a Neurobiology of Interpersonal Experience (1Ed). New York: The Guilford Press. (Reprinted with permission.)(Siegel 1999), pp. 69-70

As this therapist and patient illustrate, engaging in direct communication is more than just understanding or even perceiving the signals – both verbal and nonverbal – sent between two people. For “full” emotional communication, one person needs to allow his state of mind to be influenced by that of the other (Trevarthen 1993). In this example, the therapist’s sensitivity to the patient’s array of signals allows his own state to become aligned with that of the patient. The sense that his head is “about to burst,” followed by the release of pressure, shows how the patient’s shifts from bewilderment to rage to sadness is experienced by the therapist. This shift in his own state may be a part of the internal process that makes him aware of the often subtle and rapid nonverbal signals sent in this direct form of emotional communication. The alignment of the therapist’s state allows him to have an experience as close as possible to what the patient’s subjective world is like at that moment. Sensitivity to signals allows for the therapist’s internal response in his own state, which permits an awareness of his perceptions of the patient’s experience. In addition to yielding important experiential information for the therapist, such an alignment permits a nonverbal form of communication to the patient that she is being “understood” in the deepest sense. Her state directly influences his; she is “feeling felt” by another person. This attunement of states forms the nonverbal basis of collaborative, contingent communication (Trevarthen 1993). The capacity to achieve this attuned form of communication, sometimes called “affect attunement,” (Stern 1985; Haft and Slade 1989) is dependent on an individual’s sensitivity to signals. Parental sensitivity to signals is the essence of secure attachments (Ainsworth et al. 1978; de Wolff and van IJzendoorn 1997; Ward and Carlson 1995) and can inform us about how two people’s “being” with each other permits emotional communication and a sense of connection to be established at any age. In these transactions, the brain of one person and that of another are influencing each other in a form of “co-regulation” (Hofer 1984).

If you are interested, I am teaching a two day class on interpersonal neurobiology at the body therapy Institute in Siler city North Carolina. This will take place on June 11 and 12th 2015. For more information please visit my website at This information and process is the foundation of a three day course I am also teaching on Biodynamic Craniosacral Therapy: Working Heart to Heart in North Carolina on August 20-22. Click here for more information:

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