Allan N. Schore, PhD

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Modern Attachment Theory: The Central Role of Affect Regulation in Development and Treatment

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

Introduction
This special edition of the Clinical Social Work Journal affords us a valuable opportunity to put forth our ideas on a modern update of attachment theory, what we call regulation theory, an interdisciplinary developmental model that has specific implications for therapeutic work. Attachment theory is deceptively simple on the surface: it posits that the real relationships of the earliest stages of life indelibly shape our survival functions in basic ways, and that for the rest of the life span attachment processes lie at the center of the human experience. We now can explain in depth why this is so: as a result of interdisciplinary developmental and neurobiological research over the last 15 years Bowlby’s core ideas have been expanded into a more complex and clinically relevant model. We will argue that at this point in time, any theory of development and its corresponding theory of therapy must include these psychobiological findings regarding precisely how early emotional transactions with the primary object impact the development of psychic structure, that is, how affective attachment communications facilitate the maturation of brain systems involved in affect and self regulation. The rich intricacy of an integrative interdisciplinary theory now encompasses all the essential elements that allow us to comprehend and treat disorders of self and affect regulation more effectively.

Bowlby’s  (1969) original descriptions occurred during a period of behaviorism and included an emphasis on the strange situation and secure base behaviors, which then gave way to the dominance of cognition and an emphasis on attachment narratives and reflective capacities. Despite these trends, we remind the reader of Ainsworth’s ( 1969 ) characterization of Bowlby’s seminal Attachment volume: ‘‘In effect what Bowlby has attempted is to update psychoanalytic theory in the light of recent advances in biology’’ (p. 998). We suggest that in line with Bowlby’s fundamental goal of integrating psychological and biological conceptions of human development, the current clinical and experimental focus on how affective bodily-based attachment processes are nonconsciously interactively regulated within the mother–infant dyad, and how psychobiological attunement and relational stress impact the experience-dependent maturation of early developing brain regulatory systems, has shifted attachment theory to a regulation theory.

The advances in neurobiology initiated in the last decade, the ‘‘decade of the brain’’, have stimulated the transformation of classic attachment theory over the last 10 years. In 1994 Schore offered a large amount of existing interdisciplinary data to propose that attachment communications are critical to the development of structural right brain neurobiological systems involved in processing of emotion, modulation of stress, self-regulation, and thereby the functional origins of the bodily-based implicit self. In 2000 , within an introduction to a reissue of Attachment, Schore proposed, ‘‘In essence, a central goal of Bowlby’s first book is to demonstrate that a mutually enriching dialogue can be organized between the biological and psychological realms’’ (p. 24), and argued that attachment theory stresses the primacy of affect and is fundamentally a regulation theory. This linkage of the theory with affective dynamics was mirrored in Fonagy et al.’s ( 2002 ) Affect Regulation, Mentalization, and the Development of the Self, and Mikulincer et al.’s ( 2003 ) work on ‘‘attachment theory and affect regulation.’’ Indeed, Fonagy and Target ( 2002 ) concluded that ‘‘the whole of child development to be the enhancement of self-regulation.’’

This shift of the theory into affect and affect regulation has had an important effect on translating the developmental theory into a pragmatic framework for models of both psychopathogenesis and the change process in psychotherapy. It is only in the last decade that the clinical applications of attachment theory have been extensively articulated. In parallel to the linkage of early attachment to the neurobiology of optimal and pathological emotional development and the genesis of personality disorders (Schore 2001a , 2002 ), the problem of linking the theory to psychotherapy models could be elucidated by focusing the treatment upon the affective dynamics of right brain insecure internal working models that are activated within the therapeutic alliance. In the Seventh Annual John Bowlby Lecture, Schore ( 2001b ) proposed that the empathic therapist’s capacity to regulate the patient’s arousal state within the affectively charged nonconscious transference-countertransference relationship is critical to clinical effectiveness.

The current energization of modern attachment theory is now being expressed in the updating and deepening of its underlying theoretical concepts, its increased clinical relevance, and its expanded connections with other disciplines (e.g., psychoanalysis, neuroscience, psychiatry, traumatology, pediatrics), including clinical social work. From its very beginnings, attachment theory has shared with clinical social work a common biopsychosocial perspective. Indeed, clinical social work itself is now undergoing a re-examination and re-definition as the quality of master’s level education is evaluated (see the March 2007 issue of this journal). We agree with the assertion of Simpson et al. ( 2007 ) that the clinical specialization fundamentally includes two core issues, person-in-situation and relationship. The ‘‘person-in-situation’’ orientation encompasses not only nonconscious psychological relational dynamics beginning in infancy, but also individual biological and somatic factors, and social/cultural influences that are both internalized and situational. This biopsychosocial perspective of clinical social work is absolutely consonant with modern attachment theory’s elaboration of the mechanisms that operate at the unconscious psychobiological core of the intersubjective context, the brain–mind– body–environment relational matrix out of which each individual emerges. And so we argue that individual development arises out of the relationship between the brain/mind/body of both infant and caregiver held within a culture and environment that supports or threatens it.

To say this in another way, attachment experiences shape the early organization of right brain, the neurobiological core of the human unconscious (Schore 2003b ). Clinical social work has long embraced the psychoanalytic concept of the importance of unconscious functions in everyday life. Indeed, therapeutic interventions are rooted in these same dynamic relational processes. The cocreation of an attachment relationship between the empathic social worker and client has also been seen as the sine-qua-non of clinical practice, and respect for the individual is, and always has been, paramount. The current expansion of neurobiologically supported attachment principles of interactive affect communication and regulation both explains and justifies this approach. The mechanisms of developmental change thus include changes in both psychic function and structure, not only in the earliest but also in all subsequent stages of development. Modern attachment theory is thus a regulation theory consonant with the current relational intersubjective trends in the psychodynamic literature, and can thus be readily incorporated into the core of social work theory, research, and practice.

Towards that end, in the following we will outline the general precepts of modern attachment theory, with reference to the practice of clinical social work. We will initially present an overview of the central role of unconscious interactive regulation in establishing attachment relationships and the lifelong impact this has on the development of the implicit self. We then discuss the interpersonal neurobiology of implicit nonverbal communications within the therapeutic alliance in the form of transference–countertransference transactions. And finally, we offer some thoughts on the implications of regulation theory for models of clinical expertise. In doing so we will assume a familiarity with basic concepts of classical attachment theory, object-relations, self and relational psychology and focus on integrating these models with their neurobiological underpinnings so that we end up with an interpenetrating and overarching theory.