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

Right Brain Nonverbal Attachment Communication: Implicit Communications Within the Therapeutic Alliance

It is now accepted that the ‘‘non-verbal, prerational stream of expression that binds the infant to its parent continues throughout life to be a primary medium of intuitively felt affective-relational communication between persons’’ (Orlinksy and Howard 1986 ). Right brain transactions also mediate the relational unconscious as it is expressed in the psychoanalytic encounter, and Lyons-Ruth’s ( 2000 ) description of affective exchanges of implicit relational knowledge within the therapeutic alliance:

Most relational transactions rely heavily on a substrate of affective cues that give an evaluative valence or direction to each relational communication. These occur at an implicit level of rapid cueing and response that occurs too rapidly for simultaneous verbal transaction and conscious reflection. (pp. 91–92).

Scaer ( 2005 ) describes essential implicit communications embedded within the therapist–client relationship:

Many features of social interaction are nonverbal, consisting of subtle variations of facial expression that set the tone for the content of the interaction. Body postures and movement patterns of the therapist…also may reflect emotions such as disapproval, support, humor, and fear. Tone and volume of voice, patterns and speed of verbal communication, and eye contact also contain elements of subliminal communication and contribute to the unconscious establishment of a safe, healing environment (pp. 167–168).

These right brain communications convey expressions of ‘‘the personality of the therapist’’ more so than conscious verbalizations.

These developmental studies have direct relevance to the psychotherapeutic process based on the commonality of implicit intersubjective right brain-to-right brain emotion transacting and regulating mechanisms in the caregiver– infant relationship and the therapist–patient relationship. Schore describes the nature of implicit and explicit processes in the psychotherapeutic context:

During the treatment, the empathic therapist is consciously, explicitly attending to the patient’s verbalizations in order to objectively diagnose and rationalize the patient’s dysregulating symptomatology. But she is also listening and interacting at another level, an experience-near subjective level, one that implicitly processes moment-to-moment socioemotional information at levels beneath awareness (Schore 2003b , p. 52).

A fundamental question of treatment is how we work with what is being communicated but not symbolized with words. In discussing subsymbolic processing, Bucci ( 2002 ) observes ‘‘We recognize changes in emotional states of others based on perception of subtle shifts in their facial expression or posture, and recognize changes in our own states based on somatic or kinesthetic experience (p. 194).’’ These implicit communications between the client and therapist’s right brain systems are expressed within the therapeutic alliance between the client and therapist’s right brain systems.

Human beings rely extensively on nonverbal channels of communication in their day-to-day emotional as well as interpersonal exchanges. The verbal channel, language, is a relatively poor medium for expressing the quality, intensity and nuancing of emotion and affect in different social situations…the face is thought to have primacy in signaling affective information. (Mandal and Ambady 2004 , p. 23)

As in the developmental attachment context, right brainto-right brain prosodic communications also act as an essential vehicle of implicit communications within the therapeutic relationship. The right hemisphere is important in the processing of the ‘‘music’’ behind our words. When listening to speech, we rely upon a range of cues upon which to base our inference as to the communicative intent of others. To interpret the meaning of speech, how something is said is as important as what is actually said. Prosody conveys different shades of meaning by means of variations in stress and pitch—irrespective of the words and grammatical construction (Mitchell et al. 2003 ). These data support suggestions that the preverbal elements of language—intonation, tone, force, and rhythm—stir up reactions derived from the early mother–child relationships (Greenson 1978 ). In the recent literature on the psychotherapeutic context, Andrade concludes, ‘‘It is the affective content of the analyst’s voice—and not the semantic con-tent—that has an impact on the patient’s store of implicit memories’’ ( 2005 , p. 683).

During heightened affective moments these right brain dialogues between the relational unconscious of both the patient and therapist (like the attachment communications of the infant and mother) are examples of ‘‘primary process communication’’ (Dorpat 2001 ). According to this author, ‘‘The primary process system analyzes, regulates, and communicates an individual’s relations with the environment’’:

[A]ffective and object-relational information is transmitted predominantly by primary process communication. Nonverbal communication includes body movements (kinesics), posture, gesture, facial expression, voice inflection, and the sequence, rhythm, and pitch of the spoken words (Dorpat 2001 , p. 451). 

Interestingly, in addition to psychoanalytic authors who have implicated the right brain in primary process functions (see Schore 1994 ), neuroscience researchers now contend that ‘‘the right hemisphere operates in a more free-associative, primary process manner, typically observed in states such as dreaming or reverie.’’ (Grabner et al., p. 228).

It is important to stress that all of these implicit nonconscious right brain/mind/body nonverbal communications are bidirectional and thereby intersubjective (see Schore 2003b for a right hemisphere-to-right hemisphere model of projective identification, a fundamental process of implicit communication within the therapeutic alliance). Meares (2005 ) describes,

Not only is the therapist being unconsciously influenced by a series of slight and, in some cases, subliminal signals, so also is the patient. Details of the therapist’s posture, gaze, tone of voice, even respiration, are recorded and processed. A sophisticated therapist may use this processing in a beneficial way, potentiating a change in the patient’s state without, or in addition to, the use of words (p. 124).Implicit right brain-to-right brain intersubjective transactions lie at the core of the therapeutic relationship. They mediate what Sander ( 1992 ) calls ‘‘moments of meeting’’ between patient and therapist. In light of current neurobiological data that suggests ‘‘While the left hemisphere mediates most linguistic behaviors, the right hemisphere is important for broader aspects of communication’’ (van Lancker and Cummings 1999 ), Schore ( 2003b ) has proposed that just as the left brain communicates its states to other left brains via conscious linguistic behaviors so the right nonverbally communicates its unconscious states to other right brains that are tuned to receive these communications. Regulation theory thus describes how implicit systems of the therapist interact with implicit systems of the patient; psychotherapy is not the ‘‘talking’’ but the ‘‘communicating’’ cure.