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Can Psychiatr Assoc J . 1977;22 (1) :3-9
With the work of Mahler, Bowlby and others it has been increasingly recognized in recent years that there is a sequential progression in the nature of the first dyadic relationship which forms the basis for the type and quality of subsequent interpersonal transactions. Four levels of development of dyadic relationship may be recognized. To begin with the infant is in a state of not recognizing the existence of the other individual - the autistic phase. At the toddler stage there is awareness of a separateness of physical attributes between the child and the significant other, but the persistence of the symbiotic belief that there is substantial co-extension of mental processes between the two. With further separation and individuation in the pre-school and early school-aged child, a period of magical thinking prevails for varying durations in the child, in which there is an attempt made to retain an omnipotent control of the thinking of the significant other by the mechanism of projection of thought. In the mid-elementary school-aged child the decentering process emphasized by Piaget, together with the emerging capacity for making allowance for the context within which events occur, leads to the dyadic relationship being seen by the child as being mediated through the transactions of two autonomous mental apparatuses. Dependent upon the quality of the first dyadic relationships, the nature of the communication which occurs in them, of traumatic psychological events and of the integrity of the integrated forces of personality formation, residues of earlier modes of perceiving the dyadic relationship may be encountered. Examples of these in adolescent and adult patients are given. The recognition of the possibility of shifts in the perception of the levels of the dyadic relationship is of importance in the conduct of individual pschotherapy, as the therapist can then deal more realistically with such topics as the establishment of goals, the management of the modes and quality of communication, as well as of transference and counter-transference relationships. This is particularly true of the treatment of patients with poorly integrated personalities. The fluctuations referred to are seen most dramatically with some schizophrenic patients.