2024-25 Grand Rounds Series 

Dr. Theodore Fallon will present ongoing work illuminating a developmental perspective on working with adult patients in talk therapy. This perspective focuses on three different stages in child development:

1. Developing a core sense of self which in “normative” chronology takes place during the first 18 months of life;
2. The psychic equivalent mode of thinking predominates and the child lives in dyadic relationships in the present moment which has been identified “normatively” between the ages of 3 and 7 years of life, and;
3. After a watershed developmental moment, reflective thinking, object constancy, theory of mind, empathy, triadic and community relationships predominate in the child’s mind. The child “normatively” has the capacity to reach these psychological capacities by seven years of age.

At each of these three stages of development, growth promoting interactions, that is, good parenting, occur in one of three frames depending on the development of the child. In each of these three frames, the parent and the child predominantly follow one of three general sets of rules of engagement that fit the stage of development.

In ongoing clinical work, as well as extensive observations of residents’ interactions with patients, and recent public events over the last ten years, Dr. Fallon has observed that each adult thinks, behaves and interacts with others using predominantly one of these three sets of rules of engagement. In the context of a talk therapy, growth promoting interactions seem to occur when the therapist follows the rules of engagement that match the patient’s. Teaching residents to identify and engage in the rules of engagement that are growth promoting for each particular adult patient has enhanced the residents’ capacity for effective talk therapy.