Introduction

Jessica Benjamin’s intersubjective concepts of ‘mutual recognition’ and ‘the third’ (Benjamin, 1988, 1990, 2006, 2015, 2018) are central to the theorization of the felt experience of reciprocal interactions between subjects. This article uses a case illustration to demonstrate the application of these constructs to Child-Parent Psychotherapy (CPP). CPP is a relationship-based, infant-early childhood mental health (IECMH) intervention model for traumatized children and their caregivers (Zeanah & Zeanah, 2019). It focuses on enhancing the emotional quality of the relationship between parents and children from birth to age five through joint child–parent sessions (Leiberman & Van Horn, 2008).

Although Benjamin’s theory of intersubjectivity and CPP both perceive relationships as the bedrock of psychological development and well-being and the core component of the therapeutic process, Benjamin’s work is scarcely addressed in the CPP literature, and the relevance of her theory to CPP interventions remains unexplored. The current article uses a case illustration of the clinical work that the author, a social worker, conducted with a mother and her four-year-old son to demonstrate how the concepts of mutual recognition and thirdness fit the CPP model and enhance therapeutic work that addresses the relational impact of trauma on young children.

The article begins with an overview of CPP and the concepts of mutual recognition and the third. Next, the family’s background and the social positioning of the clinician and the family are described. The treatment is then presented, coupled with an analysis of the intervention in light of Benjamin’s concepts. Last, the discussion examines how Benjamin’s theory of recognition complements CPP and explores how it supported the clinician’s ability to advance the CPP treatment goals.

CPP

CPP originated in infant–parent psychotherapy, as developed by Selma Fraiberg (Fraiberg, 1980). It evolved from Fraiberg and colleagues’ (1975) underlying psychoanalytic conceptualization of “ghosts in the nursery,” which reflects the intergenerational transmission of trauma and the unconscious defense mechanisms employed to cope with the unresolved feelings associated with early relational conflicts, losses, and traumas. Building on the relationship-based foundation of Fraiberg’s work, Leiberman and colleagues (Lieberman & Van Horn, 2008; Lieberman et al., 2011; Ghosh Ippen & Lieberman, 2024) developed CPP as a multi-theoretical model that incorporates psychoanalytical theory, including attachment theory, stress and trauma work, and developmental psychology.

The model aims to enhance the mental health of traumatized young children and strengthen their caregivers’ capacity to nurture and protect them (Lieberman & Van Horn, 2008). Accordingly, the main goals of CPP are to facilitate emotional connections among family members and help them derive meaning from stressful or traumatic events that impact the child, the caregiver, or their relationship. Additionally, CPP aims to assist families in adaptively managing the consequences of these experiences and restore the child and family to a healthy developmental path (Lieberman, 2004).

Rooted in attachment theory, CPP echoes a long tradition of scholars and clinicians who highlight caregivers’ emotional availability and empathic responsiveness as essential to helping children regulate affect and organize internal experiences (Lieberman & Zeanah, 1999). Thus, a major feature of CPP is an aspiration to foster the caregiver’s “capacity to serve as a secure base, legitimate protective figure, and regulatory partner” (Ghosh Ippen & Lieberman, 2024, p. 295).

The nature of the relationship between a child who has experienced trauma and their caregiver can moderate or exacerbate the child’s traumatic response and aid or hinder their recovery from trauma (Lieberman, 2004). For this reason, proponents of CPP assert that it is best to address the range of harms caused by exposure to trauma in early childhood within the context of the child’s primary attachment relationship (Ghosh Ippen & Lieberman, 2024). CPP interventions, which involve joint sessions that include the caregiver and the child, aspire to help children see the primary caregiver as a secure and trustworthy figure when they are in distress through therapist-guided play and positive experiences that give words and meaning to their trauma (Hoffnung-Assouline & Knei-Paz, 2024).

In practice, CPP is a flexible model that is built from simplicity, responds to the family’s needs and emphasizes the importance of acknowledging the influence of social (e.g., poverty, racism) and cultural (e.g., values, developmental expectations) contexts on family members’ mental health (Lieberman & Van Horn, 2008). The treatment process consists of three phases. The first is the foundational phase, which includes sessions with the caregivers without the child and serves as the anchor for subsequent sessions by creating a therapeutic climate. This phase allows the therapist to get to know the caregiver and their perception of the child’s difficulties and prepare for the dyadic portion of treatment (Reyes et al., 2017). The second is the core intervention phase, which involves introducing the therapy to the child and includes an array of treatment modalities, e.g., offering developmental guidance, providing emotional support, interpreting emotions and actions, modeling protective behaviors, identifying traumatic triggers, and promoting developmental processes, which are implemented through various points of entry according to the therapist’s clinical judgment regarding the family’s needs (Van Horn & Lieberman, 2009). The last phase is the essential closing phase, which involves a summary of the treatment that focuses on the family’s strengths and helps the family anticipate and prepare for possible future difficulties and traumatic triggers (Ghosh Ippen & Lieberman, 2024).

CPP’s efficacy has been empirically documented in five randomized controlled trials with diverse groups of high-risk toddlers and preschoolers. The findings across these studies indicate that CPP improves the emotional, cognitive, and social behavior of traumatized children and reduces traumatic symptoms (Guild et al., 2021).

Mutual Recognition and the Third

Jessica Benjamin is a prominent relational psychoanalyst who drew from various disciplines, including object relations theory, feminist theory, and German idealist philosophy (Meehan, 2019). Profoundly influenced by the work of Winnicott (1971) and infant researchers such as Daniel Stern (1985), Beebe (1985), and Trevarthen (1979), she developed a theory of recognition that focuses on the intersubjective nature of psychic development. Intersubjectivity, according to Benjamin, is “a relationship in which each person experiences the other as a ‘like subject,’ another mind who can be ‘felt with,’ yet has a distinct, separate center of feeling and perception” (Benjamin, 2009, p. 5). Benjamin asserts that developing such intersubjective relatedness requires an experience of recognition that can be expressed in a person sensing: “I am seen, known, my intentions have been understood, I have had an impact on you and this must also mean that I matter to you” (Benjamin, 2018, p. 4).

The significant novelty of Benjamin’s theory lies in the assertion that recognition is necessarily mutual and involves not only the need to be recognized by the other but also the need to recognize the other as a separate person who is similar yet distinct. According to McKay (2019):

Beginning early in life, a child feels recognized by and capable of reaching her parent only if this parent can be experienced as someone whose feelings—delight, tenderness, even exasperation—are unique and specific to who she is and to her feelings for this particular child. (p. 80)

Therefore, mutual recognition is more than a sense of being understood by another. It is also a reciprocal relationship that involves a constant tension between the assertion of the self and the recognition of the other (Benjamin, 2006). Benjamin defines this relational space, which enables the dyad to sustain the tension of the difference between the needs of each subject, as the symbolic space of thirdness, a space that is “outside the two” but connected to both (Benjamin, 2018). Thirdness involves the dyadic pleasure of two subjects contacting each other’s minds and sharing affective states and the interplay of sameness and difference (Benjamin, 2014).

However, such mutual relatedness can easily devolve into one-sided interactions where both parent and child feel that recognizing the other forces them to negate their own subjectivity. This breakdown of thirdness creates a complementary structure in which dependency becomes coercive, and each person in the dyad feels “done to” by the other— the “doer” (Benjamin, 2018). When complementarity arises, the search for recognition can become a power struggle in which neither parent nor child can “recognize the other and confront difference without surrendering to or controlling the other” (Benjamin, 2009, p.139), leaving the dyad without recourse to self-reflection or mentalization (Curk, 2018). Importantly, thirdness always collapses, and we constantly lose and recover the intersubjective view. Benjamin (2018) describes how the breakdown and repair of thirdness are, in themselves, crucial for the development of ongoing mutual relatedness.

At the clinical level, working toward mutual recognition and thirdness requires a warm, accepting space where both therapist and patient can experience themselves as unique individuals. Together, they explore the patients’ relationships, including their interactions in therapy. The clinical atmosphere is one of openness, collaboration, and shared exploration, where both therapist and patient contribute to the therapeutic process (Muran et al., 2010).

Benjamin’s work corresponds with much of CPP’s theoretical basis and its premise that mutuality in the early parent–child relationship is essential for developing intersubjectivity and psychological well-being. Specifically, the conceptualization of the breakdown and repair of thirdness is in line with CPP’s endeavor “to repair emotionally damaging perceptions and interactions and to create or restore increased levels of affect regulation, mutuality, and developmentally appropriate interactions” (Lieberman & Van Horn, 2008, p. 64).

Despite these similarities, the CPP literature scarcely refers to Benjamin’s work, and the relevance of her theory to CPP practice has yet to be explored. In what follows, the author exemplifies how the concepts of mutual recognition and the third enhanced his ability to implement CPP intervention with a mother and her four-year-old child by describing how these concepts enabled him to better understand the relational dynamics between the mother, child, and therapist and how they guided his clinical actions and decisions.

Rita and Rony: Background

The Names used are Pseudonyms and Other Identifying Information has been Modified to Protect the Privacy of the Family, who Generously Consented to Share its Story.

Rita, 37, and her four-year-old son, Rony, were referred to the child–parent community center by their child welfare social worker three months after Rony was placed in Rita’s care following their separation at birth. Rony was born with neonatal withdrawal syndrome (NWS) due to Rita’s substance use during pregnancy. Both Rita and David, Rony’s father, acknowledged their inability to care for the child due to their addictions. They requested that social services place Rony in kinship foster care with his maternal grandmother. After spending two and a half months with his grandmother, Rony was transferred to a transitional foster home. When he was five months old, he was placed with his father’s brother’s family, where he spent three and a half years developing a close and loving relationship with his uncle, aunt, and three-year-old cousin.

When Rony was a year old, Rita completed rehabilitation and petitioned the court to initiate a reunification process with him. Rita demonstrated her motivation, capability, and ability to raise Rony for three years, during which she remained drug-free, meticulously attended all the contact visits with Rony, demonstrated her ability to receive guidance, and engaged positively with social services. The court ruled that Ront would leave his uncle’s home and Rita would be granted custody of him. Importantly, while Rony lived with his foster family, Rita met Max, a person who had previously used drugs. They became a couple and began living together six months before Rony transitioned to their home. At the time of the transition, Rony had met Max only twice, so he barely knew him. Two months after the transition, they were referred to the author for CPP.

The Clinician’s and the Family’s Social Positioning

Rita is an immigrant woman living in poverty, currently in recovery from a substance missus disorder, whose child was removed from her custody. The clinician is a middle-class, married white man and father of three. Their backgrounds reflect distinct cultural perceptions about parenthood and child development and an imbalance of social power. The fact that Rita was referred by her social worker as part of the statutory intervention plan designed to support Rony’s transition to her home added to this power imbalance.

In line with CPP’s attentiveness to the impacts of race, class, gender, and ethnicity on families’ experiences and relationships (Leiberman & Van Horn, 2008) and Benjamin’s emphasis on the therapist’s subjectivity (Benjamin, 2018), the clinician continuously reflected on and addressed the social aspects of his relationship with Rita and Rony and their experiences in society. For example, Rita and the clinician discussed the regulatory and supervisory aspects of the intervention. In addition, Rita’s material hardships were discussed throughout the treatment. Her difficulties were often framed as a struggle with structural barriers (e.g., having to cancel meetings due to her work as a contracted employee) and negative social attitudes toward her as a mother whose child had been taken into care (e.g., understanding the nursery school teacher’s malicious comments on her parenting as microaggressions and accompanying her to a meeting with her).

The Treatment

Rita and Max discussed their concerns during the initial session with the clinician and the child welfare worker. They spoke of significant difficulties with Rony and feeling overwhelmed by his behavior. They described him as restless, inattentive, lacking boundaries, and unable to play independently. The nursery school teacher echoed these concerns, noting instances of Rony’s aggression toward other children. After briefly introducing CPP, the clinician invited Rita and Max to a first meeting to begin the foundational phase of treatment (Ghosh-Ippen & Leiberman, 2024).

Despite the clinician’s intention to hold a parent-only session, Rita and Max arrived for the first meeting with Rony. In light of this unexpected change, the clinician positioned himself as an observer for the play observation. The session was tumultuous, with Rony constantly shifting between activities while Rita and Max attempted to impose discipline. Rony displayed aggression in his play and resistance to the couple’s attempts to guide his activities. Despite their efforts to introduce didactic games, such as puzzles and cards, Rony insisted on controlling the play dynamics.

Rony found a piece of cloth, approached Rita and Max, covered them, and demanded they sleep. At first, they were unwilling to play, so I asked if he wanted me to sleep, too, and he said yes, and we all pretended we were going to sleep. Rony did this many times, repeating the instruction to sleep. It was very important to him that we close our eyes, and he shouted for us to close them every time we opened them. It made them (and me) uneasy. It was difficult for them that he was domineering, and there was something quite unpleasant about it. With Rita, it felt violent; at one point, he pushed her head onto the table to make her sleep. She told him to stop and said that she wouldn’t play with him like that, so he immediately apologized and kissed and hugged her, also really hard. Rita said, “Good,” and we continued. He silenced us all the time. When we sat and slept quietly, he calmed down, but Rita had trouble pretending to stay asleep and told him, “We’re getting up now!” He yelled at her that he refused. Rita and Max said, “You see? He wants to decide everything. That’s how it is all the time.”

The interaction exemplified the complementary structure of the relationship between Rony and Rita at the time. It was evident that Rony felt unsafe and unheard and that to experience a sense of control and connection with his mother, he needed to symbolically assert dominance over the situation through vocal outbursts and physical actions. This dynamic left little room for playfulness or creativity. Rita responded by attempting to impose structure and discipline on their interactions, often coercing Rony into apologizing. However, Rony’s apologies seemed to stem more from anxiety about Rita’s threat to leave him than genuine empathy for her feelings. Consequently, Rita remained unsatisfied with his apologies and struggled to engage with his attempts at play, failing to acknowledge and address his underlying needs.

This negative cycle of recognition, devoid of space for thirdness, persisted throughout the treatment. A significant portion of the intervention focused on fostering thirdness in the relationship between Rita and Rony and addressing breakdowns in recognition, as explained below. The following sections outline and present examples of three strategies the author employed as a clinician to cultivate thirdness within the therapeutic dynamic: exploring and acknowledging the link between trauma and complementarity, distinguishing between play and reality, and working with the clinician’s subjectivity. These approaches aimed to disrupt the entrenched patterns of interaction between Rita and Rony, ultimately fostering a more balanced and nurturing relationship dynamic.

Exploring and Acknowledging the link between Trauma and Complementarity

Following the unplanned meeting with Rony, the clinician met Rita for several sessions alone as part of the foundational phase. In these sessions, he learned from Rita’s perspective about Rony and the series of traumatic events he had experienced in his short life. He also learned about Rita’s complex and traumatic past. She was born abroad and raised by her grandparents. Her mother was only partially involved in her life. She was sexually harassed by a neighbor at the age of five and suffered from bullying that included physical abuse at school at the age of six. Alongside these traumatic experiences, she described a meaningful relationship with her grandfather. At age 12, she immigrated with her family. She shared that when she immigrated, she promised herself never to be a victim again and explained that this stance made her very aggressive and led to her involvement in many violent confrontations. She left school at 16 and met an older man with whom she became addicted to drugs. She became pregnant at 18 and gave birth to her first daughter. In the next 12 years, Rita went through several cycles of drug use and gave birth to another daughter whom she did not raise. She spent long periods on the streets, suffering from poverty and violence. At age 30, Rita entered a rehabilitation community and managed not to abuse drugs for three years, during which she lived near her two children, worked, and felt well. She met Rony’s father and became pregnant. In the seventh month of the pregnancy, she began to use drugs again, and Rony was born while she was still using drugs.

During these sessions, Rita expressed profound dread at the prospect of being unable to fulfill her role as Rony’s mother and meet his needs. She constantly fretted that Rony did not perceive her as his mother and felt intimidated by the presence of Rony’s aunt, who had cared for him for most of his life. Rita described numerous challenges that had arisen since Rony’s transition to their home, including his apparent refusal to acknowledge her maternal role, disobedience, controlling behavior, and a desire to dictate all decisions within the household. She openly shared her struggles, describing moments when she felt powerless in the face of Rony’s defiance, revealing that she often resorted to asking him to keep his distance and expressing her reluctance to be around him.

Another insight that emerged from these conversations was the impact of Rita’s early traumatic experiences on her parenting, i.e., her “ghosts” (Fraiberg et al., 1975). As therapy progressed, Rita was able to reflect on how she reacted when she felt Rony was attempting to assert control over her. It became apparent that these moments acted as traumatic triggers for Rita; Rony symbolized the children who had mistreated her in her childhood and her mother’s failure to address her distress. Her aggressive withdrawal from Rony when he attempted to dominate her was rooted in these childhood experiences.

Another crucial aspect of the foundational phase consisted of exploring the impact of Rony’s adverse childhood experiences on his development, behavior, and relationship with Rita. Specifically, Rita and the clinician delved into how Rony’s ability to form trusting relationships was affected by being separated from Rita for most of his life and experiencing multiple transitions between attachment figures. They discussed the numerous ruptures in Rony’s attachment system and his struggle to rely on Rita as a secure base and regulatory partner. Instead of finding comfort in Rita’s attempts to regulate him, Rony perceived them as traumatic reminders of his past losses and the unpredictability of attachment figures.

Rita and the clinician explored the links between Rita’s and Rony’s traumatic pasts and the complementary structure of their relationship, building upon these understandings. In addition, they discussed how Rita’s unresolved traumas and anxieties about motherhood intersected with Rony’s relational trauma, manifesting as her feeling of being suffocated by him. Although Rita’s capacity for reflection was pivotal for progressing toward thirdness, the impact of these insights remained limited during the initial phases of the process. As explained below, only when these relational traumas were enacted in the room throughout the intervention could Rita use these insights to increase her capacity to deal with Rony’s difficult feelings toward her.

Differentiating play and Reality

The dyadic sessions with Rita and Rony reinforced the clinician’s initial observation regarding the complementary nature of their relationship. During the sessions, Rony frequently shifted between activities and disregarded any attempts to engage with him or establish some form of regulation. In his play, he gravitated toward the play kitchen and food toys, assuming control over food preparation and distribution, reflecting the disruption in nurturance he had experienced. His play was marked by aggression; he would shout, assign blame, and withhold food from Rita and the clinician.

Rita found this behavior intolerable and promptly refused to engage in such games, responding with concrete and aggressive actions. She was not attuned to Rony’s need to express aggressive and destructive impulses through play. This lack of attunement resulted in escalating reactivity in both parties and culminated in a breakdown of play and the emergence of a symbolic struggle for recognition in the room. Rita and Rony continued to reach an impasse each time they played. With the hope of supporting them in overcoming these impasses, the clinician focused his interventions on differentiating between play and reality:

Rita and I tried to take an active part in the game, but as it progressed, Rony started saying, “Shhh.” or “Be quiet.” and then just yelled, “Shut up!” every time I tried to talk. Rita told him it was unpleasant that he wouldn’t let us talk. I said that I saw that it was very important for him to decide, that this was a place where he could really be allowed to decide, but that didn’t mean he could speak unpleasantly to us. He continued to shout for us to be quiet. I told them that perhaps Rony was showing us that he was angry and that we could think about what was making him angry, and then he screamed, “Quiet!” directly into my ear. At that moment, I told him that what he had done was unpleasant and that he could ask us to be quiet but should understand that his mother and I were also there and wanted to play with him, that we were there to learn to play together, and that we needed to differentiate between playing and pretending and doing unpleasant things to us. He shouted at me and suddenly seemed very coercive. I felt that Rita was suffering every moment. I told her that even if it was difficult for us that Rony was angry, he needed to have a place to be angry. It’s really OK to be angry, but if he wants to actually harm someone, he can only do it in a game of make pretend. She said, “OK, but we have to tell him if it’s unpleasant to us.” I agreed.

Over time, the validation of destructive and aggressive feelings and urges within the symbolic space yielded two significant outcomes. First, it empowered Rita to withstand Rony’s symbolic attacks. Once she acknowledged that Rony was using the symbolic space to process his traumatic experiences and express his aggression, she could recognize his need for independence without feeling as though she was invalidating herself. Consequently, she gradually became attuned to Rony’s signals during play and successfully navigated his outbursts.

Second, these interventions created space for Rita’s (and the clinician’s) subjectivity. By distinguishing between play and reality, Rony became aware of the impact of his actions on Rita. Furthermore, because his feelings were acknowledged when expressed during play, he did not perceive attempts to regulate him in reality as hurtful or intimidating. This change, in turn, enabled Rita and the clinician to participate in the symbolic play. This reciprocal process gradually made room for thirdness to emerge.

The following excerpt from a session that took place six months into the treatment exemplifies the evolution of differentiation between play and reality into a symbolic space of thirdness, as well as Rita’s and Rony’s growing ability to repair breakdowns of recognition:

At some point, he returned to the basket, picked up a walkie-talkie, and said, “Hello?” I asked whom he was calling, and he said, “A friend.” I asked which friend, and he said, “Rita.” Rita got up and brought the second walkie-talkie and said, “Here, I’m your mother, and we can talk.” He went to the working tool play corner and sat with his back to us. Rita called and asked when he was coming home because she was making him food. He said, “In a little while.” She asked what he wanted her to make, and he said, “Orange juice.” As he played, he came to take care of her mouth as if he were a dentist, and she called him now and then and asked what he wanted. They managed to talk on the phone for about ten minutes, and there was something very pleasant and communicative about it. At some point, he put the medical equipment into her mouth in a slightly unregulated manner. She told him, “Rony, it’s not pleasant like this. If you want to play dentist, you must do it carefully and pretend.” He said, “OK, I’ll pretend,” and tried again and succeeded. The game continued to flow from there.

In this excerpt, a marked shift in the nature of the play in the room compared to the earlier phases of treatment is apparent. The symbolic space of thirdness enabled more mutual and reciprocal play. Rony could express aggressive impulses through imaginative play, such as pretending to be a dentist, while Rita played the role of both patient and mother. However, the thirdness was disrupted when Rony’s impulses manifested in reality, resulting in him inadvertently hurting Rita. Despite this breakdown, Rita demonstrated her ability to differentiate between Rony’s need to act out aggression in play and his actual behavior. By maintaining her regulation and validating Rony’s urge to play the aggressor while asserting her own subjectivity, Rita repaired the rupture in their relationship (Gianino & Tronick, 2013; Hughes, 2007) realigning thirdness in the therapeutic space.

Working with the Clinician’s Subjectivity

While Benjamin views thirdness as an intersubjective mental space co-created by individuals, other scholars highlight the third as a function that can lead to successful psychotherapeutic interventions in the parent–infant dyad (Jones, 2006; Pitillas, 2020). Remez (2010) suggests that the therapist can serve as a third entity used by the dyad to “hold, reflect, and recognize their experience of each other as well as their own internal experience” (p. 306).

Indeed, the clinician consistently endeavored to remain attuned and maintain a reflective stance toward Rony, Rita, and, most importantly, their dyadic intersubjectivity. Nevertheless, throughout the first two months of therapy, he experienced breakdowns in his ability to recognize each of them, which led to deterioration into a complementary structure between him and them. The interaction depicted in the following excerpt from the second month of treatment occurred after a discussion regarding Rony’s difficulty in trusting Rita, which the clinician linked to their separation at the time of his birth:

I said that I saw that Rony was very angry with his game today and that perhaps it was related to what we had discussed at the beginning. He went to the door and said, “That’s it. I’m going home.” I said we had time and could play some more. Rony opened a construction kit, took out a hammer, and hit my leg with it. I jumped up and, in my angriest tone, said, “Rony, I won’t allow this. You really hurt me just now.” Rita said, “It’s because you let him… he only behaves like this here. He allows himself because you let him decide.”

This brief interaction exemplifies how Rony and Rita utilized the clinician to support thirdness, contain their difficult emotions, and redirect their impulse to overpower each other following their emotionally charged conversation at the beginning of the session. By the session’s end, the clinician felt angered by Rony’s physical aggression toward him and overwhelmed with anxiety and guilt after Rita’s accusation that he was enabling Rony’s violent behavior. He became concerned that his attempts to create space for their challenging emotions and behaviors were becoming counterproductive.

Upon reflection, the clinician realized that Rony and Rita had used him as a buffer to avoid reverting to a complementary dynamic. Rather than directing his destructive impulses toward Rita—still an unsafe action for him at that stage—Rony projected them onto the clinician through physical aggression. Rita, in turn, interpreted Rony’s aggression as a reflection of her failure to regulate him and projected her guilt onto the clinician.

Although the members of the dyad struggled to maintain mutual recognition despite their intense emotions, the clinician’s presence allowed the mother and son to navigate the situation and prevent it from collapsing into complementarity. By acting as a buffer, he facilitated their ability to manage their emotions and behaviors while preserving a degree of mutual recognition between them.

One of the most prominent traps Rony and Rita repeatedly fell into revolved around Rony’s desire to play hide-and-seek. In the third month of the therapy, Rony asked to play hide-and-seek with his mother and the clinician at every session, sometimes for the entire session. After several rounds, Rita told Rony that the game was boring and hiding in such a small room made no sense. She told the clinician she had no patience to play such a game for so long.

The clinician attempted to frame the dynamic of the game of hide-and-seek in the context of Rony’s traumatic experiences of separation and fragmented relationships. He suggested that Rony was reliving his need for her to search for him and, more importantly, forcing her to prove that she would continue searching even when she was exhausted. The more Rony felt that Rita did not want to play hide-and-seek, the more he insisted on playing it.

As mentioned above, comprehending the connection between Rony’s trauma and his behaviors did not provide a sufficient foundation for establishing thirdness. While Rita could acknowledge why Rony acted as he did, she struggled to embrace his needs fully and often felt overwhelmed, perceiving herself as being acted upon rather than actively engaging. It appeared that playing hide-and-seek triggered Rita’s early traumas and the experience of losing Rony in his infancy. She was also exhausted by the need to prove herself as a mother and weary of hearing that his pain and anger were related to their separation, particularly when she carried so much pain and anger of her own.

In practice, Rita found it challenging to participate in games such as hide-and-seek for more than a few minutes at a time, and the clinician frequently found himself attempting to convince her of their importance for Rony’s development. This impasse persisted for several months, leaving the clinician uncertain how best to support them moving forward. It took time for the clinician to realize that supporting thirdness involved more than merely absorbing projections while Rony and Rita developed their capacities for thirdness. Instead, he came to understand that he could serve as a facilitator when the dyad became stuck:

Rony said he wanted to play hide-and-seek one more time. Rita said, “Tell me what can be done about the fact that he constantly wants to play hide-and-seek? It’s not fun when it’s over and over again.” I asked her and Rony if they remembered that we talked about him wanting us to show him that we always have the strength to keep looking for him. He said, “Now, play now!” I said, “I hear that it is really tiring for your mother. It’s really very hard to play a game so many times.” I asked her if she thought that even though it was tiring, she had the strength to play a little more. She looked at me, frustrated. I said, “I have an idea. Maybe your mom will rest for two rounds, and I’ll look for you in the meantime. She can help you hide.” He was enthusiastic, and we played two rounds. I asked them whether we could do one last round where his mom would look for him, and they agreed.

The game of hide-and-seek became a trigger for Rita and Rony, trapping them in a negative cycle of complementarity that resulted in frequent breakdowns and hindered the development of thirdness. To help them break free of this pattern, the clinician intervened by playing two rounds instead of Rita. This shift aimed to move Rita and Rony away from the complementary dynamic in which their relationship was confined to two options: submission or resistance. By recognizing that Rony’s desire to play was rooted in his needs and Rita’s resistance stemmed from genuine difficulty, the clinician created space for the third to emerge. However, his replacement of Rita also served as an enactment of Rita and Rony’s separation at Rony’s birth, and in order to make it possible to move forward, the break was temporary and followed by a suggestion that the session would end with Rita looking for Rony. As the option of involving the clinician became available, hide-and-seek gradually lost its ability to arouse tensions and disrupt regulation. In the final months of therapy, Rony’s requests to play hide-and-seek decreased, and when he did ask Rita to join him, she responded with increased attentiveness to the child’s needs. They no longer required the clinician’s presence to navigate their interactions and repair breakdowns.

Discussion

Drawing from clinical material obtained through the clinician’s work with Rony and Rita, three strategies aimed at fostering the development of thirdness within CPP interventions have been outlined: exploring and acknowledging the interplay between trauma and complementarity, delineating boundaries between play and reality, and working with the therapist’s subjectivity.

Incorporating Benjamin’s theory of recognition into the treatment supported the clinician’s ability to advance the CPP treatment goals of strengthening the emotional bond between Rony and Rita, helping them to align better as mother and son, and supporting them as they addressed the relational imbalances between them. Utilizing the concepts of mutual recognition and the third complemented the CPP model in three ways.

First, Benjamin’s conceptualization of the development of intersubjectivity provides therapists and caregivers another lens through which to explore the enactment of traumatic experiences within the caregiver–child relationship. In the case illustration, Rita found the link between her feeling that Rony was attempting to humiliate and subjugate her and her traumatic childhood experiences helpful and liberating. While the practice of understanding “ghosts” and linking the traumas of the past to the difficulties of the present is a basic CPP intervention skill (Ghosh Ippen & Leiberman, 2024), the use of intersubjectivity to explain Rita’s and Rony’s tendency to revert to complementary added another layer to the construction of the narrative about her difficulties with Rony. It helped Rita make sense of Rony’s behavior, her emotional reactions, and the dynamic that stemmed from these.

Second, one of the challenges of conducting CPP is the need to balance “the polarities of experience between child and parent [that are] enacted in the therapists’ inability to hold an even perspective on the separate subjectivity of each partner” (Liberman & Van Horn, 2008, 247). Embracing mutual recognition as a lens through which to examine what happened in the room brought the intersubjective aspect to the forefront of clinical attention and action. The intersubjective lens enabled the clinician to understand the splits and conflicting identifications throughout the treatment as reflections of Rita and Rony’s struggle over recognition. It required him to strive to recognize the interaction between their separate subjectivities and promote a space for thirdness. For example, when Rita counter-attacked Rony’s need to express hostile feelings toward her, instead of explaining to Rita why and how she should contain his aggression, the clinician focused the intervention on developing a symbolic space of thirdness in which aggression is not experienced as domination, enabling Rita and Rony to recognize each other’s subjective needs.

Third, Benjamin’s conceptualization of the breakdown and repair of thirdness as a necessary and integral component of meaningful therapeutic processes provides therapists with a theoretical rationale for understanding moments that can otherwise feel unbearable and offers a possible course of action when they occur. The influence of these insights on the clinician’s capacity to provide support during such breakdowns evolved throughout the treatment. In the early dyadic sessions, the interaction between Rony and Rita intimidated the clinician and led him to respond intuitively by attempting to regulate them on the one hand and assessing the interaction between them as destructive on the other. However, as the treatment evolved and the clinician adopted an intersubjective perspective on these moments, he could remain regulated and support Rony and Rita in recovering from the breakdowns.

Nevertheless, the theoretical rationale was not merely a reassuring insight. It also prompted the clinician to use moments of breakdown as important points of entry into the relational impact of the traumas experienced by Rita and Rony. Thus, instead of attempting to divert them from conflicts, he used these moments to restore thirdness by reflecting the negative cycle of complementarity, enabling them to express difficult feelings towards him separating play and reality, and actively responding to Rita’s and Rony’s needs (e.g., giving her a break in the hide-and-seek game; enabling him to continue playing hide-and-seek).

Conclusion

It is important to emphasize that, like every clinical case illustration, the one reported in this article inevitably provides only a partial description of the intervention, and many details regarding the background of the family and the treatment were omitted due to space limitations and the focus on the application of the theoretical concepts. Therefore, important issues such as Rony’s developmental history, the treatments he underwent before transitioning to Rita, a detailed account of the individual meetings with Rita, the advocacy work done with the family, and the role Max, her partner, played in the treatment, were beyond the scope of this article. Moreover, the theoretical presentation of Benjamin’s concepts focuses on their manifestation in early infancy and does not address their manifestation throughout the life span and across different developmental stages and trajectories. This shortcoming is a result of both the limited scope of the article and the dearth of literature that explicitly applies these concepts in diverse stages and contexts. Thus, it highlights the need for further inquiry via systematic literature reviews and developmental research.

These limitations aside, this article contributes to the theoretical base of CPP. In line with Leiberman’s and Van Horn’s (2008) assertion that the CPP model is constantly “open to new theoretical frameworks and clinical practices that inform and refine clinical effectiveness” (p. 8), it demonstrates how the concepts of mutual recognition and thirdness helped the clinician advance the treatment with Rita and Rony.

By presenting an in-depth exploration of the theoretical and practical implications of Benjamin’s version of intersubjective theory for CPP, the article suggests an additional theoretical perspective that complements the attachment-based and psychoanalytical approaches at the model’s foundation. Although it demonstrates the application of these approaches in the treatment of a family that experienced a specific set of adversities, i.e., separation in infancy, foster care, and multiple traumas, the compatibility of intersubjectivity with CPP, which was applied successfully in various contexts, suggests that the application of theories discussed here are relevant to a diverse range of populations.