Allan N. Schore, PhD

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Relational Trauma and the Developing Right Brain: An Interface of Psychoanalytic Self Psychology and Neuroscience

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

CONCLUSION: RAPPROCHEMENT BETWEEN PSYCHOANALYSIS AND NEUROSCIENCE

Researchers now conclude that due to dissociation elements of a trauma are not integrated into a unitary whole or an integrated sense of self.77 The symptomatology of pathological dissociation, or what Kohut described as “walling oneself off” from intense, traumatizing experience thus represents a structural impairment and deficiency of the right brain, the locus of a “corporeal image of self,”44 affective empathy,6,33 and a “sense of humanness.”78 Recall Kohut’s speculation that early trauma acts as a growth inhibiting environment for the developing self, one which generates “an impoverished psychic organization,” a deficit in being empathic, and an inability “to be fully human.” The self-depleting, structure-altering cost of characterological dissociation is thus a central psychopathogenetic concept of both self psychology and neuroscience.

A central tenet of Kohut’s model of psychopathogenesis is that the long term effects of chronic maternal failure to provide growth-facilitating selfobject regulatory functions is the genesis of a “developmental arrest.” Recall the self psychological proposal that due to early trauma the developing selfobject regulatory function is deficient or “damaged.” This development impairment can now be identified as a maturational failure of the right brain affect regulatory system. A large body of clinical observations and psychiatric research strongly suggests that the most significant consequence of early relational trauma is the child’s failure to develop the capacity to self-regulate the intensity and duration of emotional states. The principle that maltreatment in childhood is associated with adverse influences on brain development specifically refers to an impairment of a higher circuit of emotion regulation on the right side of the brain.

At the beginning of this chapter I stated that a central area of inquiry of Kohut’s psychoanalytic theory was the problem of how the therapeutic relationship scaffolds the “restoration of self.” Early relational trauma and the characterological use of the right brain strategy of pathological dissociation are common elements of the histories of severe self pathologies of personality disorders, a clinical population of increasing interest to self psychology and psychotherapists in general. A large multicenter study of adult patients with a history of early childhood trauma reports that psychotherapy is an essential element of the treatment of such cases, and indeed is superior to pharmacotherapy as an effective intervention.79

Any psychotherapeutic intervention with these patients must treat not only traumatic symptoms but also the dissociative defense.66 Spitzer’s80 research shows that higher levels of dissociation predict poorer outcome in patients in psychodynamic psychotherapy. These authors conclude dissociative patients have an insecure attachment pattern negatively affecting the therapeutic relationship, and that they dissociate as a response to negative emotions arising in psychotherapy. Clinical authors now suggest that the treatment of traumatic dissociation is essential to effective psychotherapy with these patients.11,81

The self psychological focus on selfobject regulation clearly suggests that deficits and defenses of affect and affect regulation are a primary focus of the treatment of these early forming psychopathologies. With respect to the mechanism of change Kohut postulated “psychoanalysis cures by the laying down of psychological structure.”5 This structure is essentially in the right brain and its limbic emotion regulating circuits. Studies indicate that emotional self-regulatory processes constitute the core of psychotherapeutic approaches,82 that the development of self-regulation is open to change in adult life, providing a basis for what is attempted in therapy,83 and that psychotherapy affects clinical recovery by modulating limbic and cortical regions.84

In addition to a more complex understanding of the psychotherapy change process an integration of neuroscience and self psychology has another important potential benefit. Psychoanalysis, neuroscience, and child psychiatry all share the well-established psychopathogenetic principle that maltreatment in childhood is associated with adverse influences on the infant’s brain/mind/body and thereby alters the developmental trajectory of the self over the ensuing life span. Interdisciplinary research that incorporates psychoanalytic self psychology with the developmental and biological sciences can deepen our understanding of the underlying psychoneurobiological mechanisms by which early relational trauma mediates the unconscious intergenerational transmission of the deficits in affect regulation of early forming self psychopatholgies. This information may in turn generate more effective models of early intervention during the brain growth spurt and thereby to the prevention of a broad range of psychiatric disorders.