title: The role of facial expressions in the holding environment.
abstract: The significance of a visual dialogue between patient and therapist in assisting tension regulation for patients with severe narcissistic injury is proposed. Non-verbal interactions may unfold spontaneously and contribute to development of a "holding environment" in its broadest sense. There will be inevitably both countertransference and real elements in this bipersonal field. The development of a visual holding environment at a symbiotic level may be based on a counter-transference response by the therapist of an earlier need to "hold or be held." It has been suggested that it is difficult for the therapist to feel a "gleam in the eye" for patients who have missed early mirroring. Developmental stages of treatment involving active mutuality of eye contact, considered a "language of silence" beyond verbal interpretation, are suggested. These observations agree with Searles' paper that facial expressions form a bridge to personal relatedness.
mesh_terms: D003379:Countertransference; D004645:Empathy; D004777:Environment; D005149:Facial Expression; D005260:Female; D005403:Fixation, Ocular; D006117:Grief; D006801:Humans; D008297:Male; D008875:Middle Aged; D009034:Mother-Child Relations; D009289:Narcissism; D009633:Nonverbal Communication; D009769:Object Attachment; D011247:Pregnancy; D011613:Psychotherapy; D012380:Role; D012649:Self Concept