Allan N. Schore, PhD

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The Right Brain Implicit Self Lies at the Core of Psychoanalysis

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

Implicit Processes in Psychotherapy

A major tenet of my work dictates that the relevance of developmental attachment studies to the psychotherapeutic process lies in the commonality of implicit right brain-to right brain affect communicating and regulating mechanisms in the caregiver-infant and the therapist-patient relationship (the therapeutic alliance).  Not only psychoanalytic-based treatment models, but all forms of psychotherapy are now articulating the centrality of the therapeutic alliance, and are turning to attachment theory as the prime theoretical model (Schore, 2000).  In an overview of the extant literature on the therapeutic alliance Elvins suggests, “Attachment dynamics within caregiver child interactions have been robustly operationalized; and in addition to this measurement of interactional dyadic behavior, it also contains a well worked theory of the participants mental representations of the relationship.”  The attachment bond is specifically expressed in “aspects of patient, and therapist discourse in therapeutic sessions conceptually reflecting the attachment dynamic (significant affect laden disclosures from the patient, and the therapist’s response to these)” (Elvins, 2008, p. 14). 

I suggest that not left brain verbal explicit patient-therapist discourse but right brain implicit nonverbal affect-laden communication directly represents the attachment dynamic.  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.  On this matter Stern (2005) suggests,

Without the nonverbal it would be hard to achieve the empathic, participatory, and resonating aspects of intersubjectivity. One would only be left with a kind of pared down, neutral ‘understanding’ of the other’s subjective experience. One reason that this distinction is drawn is that in many cases the analyst is consciously aware of the content or speech while processing the nonverbal aspects out of awareness. With an intersubjectivist perspective, a more conscious processing by the analyst of the nonverbal is necessary. (p. 80)

Studies show that 60% of human communication is nonverbal (Burgoon, 1985).  

Writing on therapeutic “nonverbal implicit communications” Chused (2007) asserts, “It is not that the information they contain cannot be verbalized, only that sometimes only a nonverbal approach can deliver the information in a way it can be used, particularly when there is no conscious awareness of the underlying concerns involved” (p. 879).  These ideas are echoed by Hutterer and Liss (2006), who state that nonverbal variables such as tone, tempo, rhythm, timbre, prosody and amplitude of speech, as well as body language signals may need to be re-examined as essential aspects of therapeutic technique. It is now well established that the right hemisphere is dominant for nonverbal (Benowitz et al., 1983) and emotional (Blonder, Bowers, & Heilman, 1991) communication.

Recent neuroscientific information about the emotion processing right brain is also directly applicable to models of the psychotherapy change process.  Uddin et al. (2006) conclude, “The emerging picture from the current literature seems to suggest a special role of the right hemisphere in self-related cognition, own body perception, self-awareness and autobiographical memories” (p. 65).  Decety and Chaminade (2003) describe right brain operations essential for adaptive interpersonal functioning, ones specifically activated in the therapeutic alliance:

Mental states that are in essence private to the self may be shared between individuals...self-awareness, empathy, identification with others, and more generally intersubjective processes, are largely dependent upon...right hemisphere resources, which are the first to develop. (p. 591)

This hemisphere is centrally involved in ‘implicit learning’ (Hugdahl, 1995), and “implicit relational knowledge” stored in the nonverbal domain is now proposed to be at the core of therapeutic change (Stern et al., 1998).

Knox (2003) states, “In essence, it is the concepts of implicit memory and the internal working model which provide the basis for a paradigm shift in relation to our understanding of the human psyche.”  Describing the right hemisphere as “the seat of implicit memory,” Mancia (2006) observes, “The discovery of the implicit memory has extended the concept of the unconscious and supports the hypothesis that this is where the emotional and affective - sometimes traumatic - presymbolic and preverbal experiences of the primary mother-infant relations are stored” (p. 83). Right brain autobiographical memory (Markowitsch et al., 2000) which stores insecure attachment histories is activated in the therapeutic alliance, especially under relational stress. Cortina and Liotti (2007) point out that “experience encoded and stored in the implicit system is still alive and carried forward as negative expectations in regard to the availability and responsiveness of others, although this knowledge is unavailable for conscious recall” (p. 207). These affective communications “occur at an implicit level of rapid cueing and response that occurs too rapidly for simultaneous verbal transaction and conscious reflection” (Lyons-Ruth, 2000, pp. 91-92).

More specifically, spontaneous nonverbal transference-countertransference interactions at preconscious-unconscious levels represent implicit right brain-to-right brain face-to-face nonverbal communications of fast acting, automatic, regulated and especially dysregulated bodily-based stressful emotional states between patient and therapist (Schore, 1994).  Transference is thus an activation of right brain autobiographical memory, as autobiographical negatively valenced, high intensity emotions are retrieved from specifically the right (and not left) medial temporal lobe (Buchanan, Tranel, & Adolphs, 2006).  Neuropsychoanalytic models of transference (Pincus, Freeman, & Modell, 2007) now contend that “no appreciation of transference can do without emotion” (p. 634), and that “transference is distinctive in that it depends on early patterns of emotional attachment with caregivers” (p. 636).  Current clinical models define transference as a selective bias in dealing with others that is based on previous early experiences and which shapes current expectancies, and as an expression of the patient’s implicit perceptions and implicit memories (Schore, 2003a).