• Livio Provenzi

The Still-Face Paradigm in Clinical Practice

In 1978, Ed Tronick and colleagues published a paper on infants' sensitivity to "entrapment between contradictory (maternal) mesages in face-to-face interaction", namely the Still-Face Paradigm. This paper set the stage for four decades of research on infants' socio-emotional regulation, further contributing to our understanding of mother-infant dyadic interaction and providing researchers with a reliable observational procedure to assess infants stress regulation using behavioral and bio-physiological markers.

Three systematic reviews of literature have been published to date on the behavioral and physiological correlates of infants' socio-emotional regulation in the face of maternal still-face (Adamson & Frick, 2003; Mesman et al., 2009; Provenzi et al., 2016). The impressive amount of literature on the Still-Face Paradigm witness the robustness and age-appropriateness of this procedure to assess socio-emotional regulation in infants and to observe dyadic parent-infant interactions.

Thanks to its well-acknowledged scientific ground and the pretty universal characteristics of infants' reactions to the Still-Face Paradigm "entrapment" (but see Montiosso et al., 2015 for individual differences), Tronick's observational paradigm appears to be a suitable procedure to be implemented also with at-risk infants. At the 0-3 Center, we use the Still-Face Paradigm to obtain richer and deeper information on the socio-emotional regulation skills of infants diagnosed with neurodevelopmental disabilities (e.g., cerebral palsy, genetic syndromes, pervasive developmental disorders and other conditions). Additionally, combining the videotaping of the Still-Face Paradigm with techniques from the video-feedback tradition, we use Tronick's procedure also as a means to support parenting of infants' with this kind of disabilities.

The FFSF paradigm appears to be a useful tool for clinical assessment of socio-emotional regulation in infants with neurodevelopmental disabilties and promote the quality of parenting and early parent-infant interaction.

Recently, we have published a paper on Frontiers in Developmental Psychology (Giusti et al., 2018), in which we present the rationale, the purposes, the methodology, the strengths and the limitations as well as exemplificative clinical cases for the use of the Still-Face Paradigm in the clinical setting of neurorehabilitation with infants with neurodevelopmental disabilities and their parents. This contribution is meant to describe, share and witness how the inclusion of the Still-Face Paradigm contributes to the quality of our clinical observation and to support parenting in at-risk developmental conditions.

Fourty years after its first appearance in a published paper, the Still-Face Paradigm remains one of the more robust, scientifically sound, well-validated and acknowledged observational procedures for the assessment of infants' socio-emotional development and dyadic functioning early during the first months of life. Its use in clinical practice is warranted to provide clinical psychologists and pediatric healthcare professionals with a unique tool and point of view which might offer relevant insights on the peculiar needs and difficulties of infants with neurodevelopmental disabilities and their parents.

This paper is part of the project: The epigenetic trial of mother-infant intervention


  • Adamson LB, Frick JE (2003) The Still-Face: A history of a shared experimental paradigm. Infancy, 4(4), 451-473.

  • Giusti L, Provenzi L, Montirosso R (2018) The Face-to-Face Still-Face (FFSF) paradigm in clinical settings: Socio-emotional regulation assessment and parental support with infants with neurodevelopmental disabilities. Frontiers in Psychology, doi: 10.3389/fpsyg.2018.00789.

  • Mesman J, van IJzendoorn MH, Bakermans-Kranenburg MJ (2009) The many faces of the still-face paradigm: A review and meta-analysis. Developmental Review, 29(2), 120-162.

  • Montirosso R, Casini E, Provenzi L, Putnam SE, Morandi F, Fedeli C, Borgatti R (2015) A categorical approach to infants' individual differences during the Still-Face paradigm. Infant Behavior and Development, 38, 67-76.

  • Provenzi L, Giusti L, Montirosso R (2016) Do infants exhibit significant cortisol reactivity to the Face-to-Face Still-Face paradigm? A narrative review and meta-analysis. Developmental Review, 42, 34-55.

  • Tronick E, Als H, Adamson L, Wise S, Brazelton TB (1978) The infant's response to entrapment between contradictory messages in face-to-face interaction. Journal of the American Academy of Child Psychiatry, 17(1), 1-13.