Being in rhythm: dissociative attunement in therapeutic process.

Dissociative attunement is a profound rhythmic encounter in therapeutic treatment. Attunement is a synchronized awareness of implicit knowing that is nonlinear and bidirectional. Empathically attuned clinicians are like microtonal tuning forks. They resonate with a variety of emotional pitches and will resonate with nuanced shifting of emotional tone. This resonance is the basis of dissociative attunement. Concepts such as empathic attunement, affect attunement, "the unthought known," "implicit relational knowing," and "a two-person unconscious" help us to understand unique aspects of projective identification, transference, and countertransference within the dissociative frame. However, "dissociative" attunements are systemically self-emergent moments in which multiple self-states are shared by means other than projection. Using clinical vignettes, I demonstrate how dissociative attunement can paradoxically appear to be misattunement. By synthesizing scientific and theoretical concepts applied to these clinical moments, we can understand dissociative attunement as a therapeutic tool as well as a pathway to vicarious traumatization.