Allan N. Schore, PhD

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Right Brain Affect Regulation: An Essential Mechanism Of Development, Trauma, Dissociation, And Psychotherapy

Allan N. Schore, PhD
UCLA David Geffen School of Medicine

Right Brain Processes in Psychotherapy: Co-Construction of Intersubjective Fields

In the last figure, visualize 2 planes of one window of affect tolerance in parallel to another: one represents the patient’s window of affect tolerance, the other the therapist’s. At the edges of the windows, the regulatory boundaries, the psychobiologically attuned empathic therapist, on a moment-to-moment basis, implicitly tracks and matches the patterns of rhythmic crescendos / decrescendos of the patient’s regulated and dysregulated ANS with her own ANS crescendos / decrescendos.  When the patterns of synchronized rhythms (represented as dynamic changes within the green segments) are in interpersonal resonance this right brain-to-right brain “specifically fitted interaction” generates amplified energetic processes of arousal, and this interactive affect regulation in turn co-creates an intersubjective field.

The dynamic intersubjective field is described by Stern (2005) as “the domain of feelings, thoughts, and knowledge that two (or more) people share about the nature of their current relationship…This field can be reshaped. It can be entered or exited, enlarged or diminished, made clearer or less clear” (my italics).  In my work on the interpersonal neurobiology of intersubjectivity I have asserted that the right hemisphere is dominant for “subjective emotional experiences,” and that the interactive “transfer of affect” between the right brains of the members of therapeutic dyad is therefore best described as “intersubjectivity” (Schore, 1999).  An intersubjective field is more than just an interaction of two minds, but also two bodies, which, when in affective resonance elicit an amplification of both CNS and ANS arousal (see chapter 3 of Schore 2003b on the communication of affects in an intersubjective field via projective identification). 

At present there is an intense interest in incorporating the body into psychotherapeutic treatment.  The solution to this problem is to integrate into clinical models information about the autonomic nervous system, “the physiological bottom of the mind” (Jackson, 1931).  This system generates vitality affects and controls the cardiovascular system, effectors on the skin, and visceral organs.  Stress-induced alterations in these dynamic psychobiological parameters mediate the therapist’s somatic countertransference to the patient’s nonverbal communications within a co-constructed intersubjective field.  In previous writings on the psychophysiology of countertransference I stated:

Countertransferential processes are currently understood to be manifest in the capacity to recognize and utilize the sensory (visual, auditory, tactile, kinesthetic, and olfactory) and affective qualities of imagery which the patient generates in the psychotherapist (Suler, 1989).  Similarly, Loewald (1986) points out that countertransference dynamics are appraised by the therapist's observations of his own visceral reactions to the patient's material. (Schore, 1994, p. 451)

Recall the ANS contains dissociable sympathetic energy expending and parasympathetic components.  Extending this intraorganismic concept to the interpersonal domain, two dissociable intersubjective fields may be co-created:  (1). A sympathetic dominant high energy intersubjective field processes state-dependent implicit memories of object relational-attachment transactions in high arousal states. (Table 1), and (2). A parasympathetic dominant low energy intersubjective field processes state-dependent implicit memories of object relational-attachment transactions in low arousal states. (Table 2)

Table 1. High energy charge intersubjective field

Hyperarousal = hypermetabolic CNS-ANS limbic-autonomic circuits = stressful sympathetic dominant, energy-expending psychobiological states.

Hi energy explosive dyadic enactments; fragmenting implicit self.

Sympathetic dominant intersubjectivity; over-engagement with social environment.

Somatic countertransference to communicated high arousal affects expressed in heart rate acceleration. Focus on exteroceptive sensory information.

Regulation / dysregulation of hyperaroused affective states (aggression-rage, panic-terror, sexual arousal, excitement-joy).

 

Table 2. Low energy charge intersubjective field

Low arousal = hypometabolic CNS-ANS circuits = stressful parasympathetic dominant energy-conserving psychobiological states.

Low energy implosive dyadic enactments; collapsing implicit self. Parasympathetic-dominant intersubjectivity; dissociation/disengagement from social environment.

Somatic countertransference to communicated low arousal affects expressed in heart rate deceleration. Focus on interoceptive information.

Regulation / dysregulation of hyporaroused affective states (shame, disgust, hopeless despair).

Note the contrast of somatic transference-countertransferences in the dual intersubjective fields. Also, the form of primary process expressions in affect, cognition, and behavior differ in ultra-high and low arousal altered states of consciousness. Thus high and low arousal states associated with respectively terror and shame will show qualitatively distinct patterns of primary process nonverbal communication of “body movements (kinesics), posture, gesture, facial expression, voice inflection, and the sequence, rhythm, and pitch of the spoken words” (Dorpat, 2001, p. 451).  Recall that sympathetic nervous system activity is manifest in tight engagement with the external environment and high level of energy mobilization and utilization, while the parasympathetic component drives disengagement from the external environment and utilizes low levels of internal energy (Recordati, 2003).  This principle applies to not only overt interpersonal behavior but also to covert intersubjective engagement-disengagement with the social environment, the coupling and de-coupling of mind-bodies and internal worlds.

Recent models of the ANS indicate that although reciprocal activation usually occurs between the sympathetic and parasympathetic systems, they are also able to uncouple and act unilaterally (Schore, 1994).  Thus the sympathetic hyperarousal and parasympathetic hypoarousal zones represent two discrete intersubjective fields of psychobiological attunement, rupture, and interactive repair of what Bromberg (2006) terms “collisions of subjectivities.” (Figure 9).

Figure 9. High and low energy intersubjective fields

Figure 9. High and low energy intersubjective fields

It should be noted that just as emotion researchers have over-emphasized sympathetic dominant affects and motivations  (fear, flight-fight), so have psychotherapists overly focused on the reduction of anxiety-fear or aggression-rage states.  One outstanding example of this continuing bias is the devaluation of the critical role of dysregulated parasympathetic shame and disgust states in all clinical models. Similarly, psychodynamic models have highlighted the roles of rage and fear-terror in high arousal enactments, and subsequent explosive fragmentation of the high energy intersubjective field and the implicit self.  As a result there has been an under emphasis on the low energy parasympathetic dominant intersubjective field.  This is problematic, because clinical work with parasympathetic dissociation, “detachment from an unbearable situation,” is always associated with parasympathetic shame dynamics.

In my very first work I proposed that the parasympathetic low arousal state of shame, subjectively experienced as a "spiraling downward" represents a sudden shift from sympathetic hyperarousal into parasympathetic dorsal vagal hypoarousal (Schore, 1991).  Recall, the collapse of the implicit self is subtle, signaled by amplification of the parasympathetic affects of shame and disgust, and by the cognitions of hopelessness and helplessness, common accompaniments of traumatic experiences.  Working deep in the low arousal intersubjective field Bromberg (2006) observes that shame is present in those patients who ‘disappear’ when what is being discussed touches upon unprocessed early trauma, and that shame is the most powerful affect a person is unable to modulate.  He concludes,

The task that is most important, and simultaneously most difficult for the analyst, is to watch for signs of dissociated shame both in himself and in his patient - shame that is being evoked by the therapeutic process itself in ways that the analyst would just a soon not have to face…The reason that seemingly repeated enactments are struggled with over and over again in the therapy is that the analyst is over and over pulled into the same enactment to the degree he is not attending to the arousal of shame. (2006, p. 80)

Perhaps the most pointed observation is made by Nathanson: 

The entire system of psychotherapy, as we had been taught it, worked only if we overlooked the shame that we produced day in and day out in our therapeutic work…It became clear that post-Freudian society had been treated for almost everything but shame, and that the degree and severity of undiagnosed and untreated shame problems far exceeded anything we had ever imagined. (1996, p. 3)

Clinicians and researchers need top pay more attention to the energy-conserving parasympathetic-dominant intersubjective field of psychobiological attunement, rupture, and repair.