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 Clinical Enactments

The quintessential clinical context for a right brain transferential-countertransferential implicit communication of a dysregulated emotional state is the heightened affective moment of a clinical enactment.  There is now agreement that enactments, "events occurring within the dyad that both parties experience as being the consequence of behavior in the other" (McLaughlin, 1991), are fundamentally mediated by nonverbal unconscious relational behaviors within the therapeutic alliance (Schore, 2003a).  These are transacted in visual-facial, auditory-prosodic, and tactile-proprioceptive emotionally-charged attachment communications, as well as in gestures and body language, rapidly expressed behaviors that play a critical role in the unconscious interpersonal communications embedded within the enactment.  Aron observes,

Gradually, patient and analyst mutually regulate each other’s behaviors, enactments, and states of consciousness such that each gets under the other’s skin, each reaches into the other’s guts, each is breathed in and absorbed by the other...Where the patient is not capable of using symbolic or metaphoric thought, the analyst may receive communications only nonverbally often in the form of bodily communications, a change in the climate, the air (mediated by the breath), a change in the feel of things (mediated by the skin).  [T]he analyst must be attuned to the nonverbal, the his or her bodily responses. (1998, p. 26)

This dyadic psychobiological mechanism allows for the detection of unconscious affects, and underlies the premise that “an enactment, by patient or analyst, could be evidence of something which has not yet been ‘felt’ by them” (Zanocco et al., 2006, p. 153).

In my book on the Repair of the Self I offered a chapter, “Clinical implications of a psychoneurobiological model of projective identification” (Schore, 2003a).  This entire chapter on moment-to-moment implicit communications within an enactment focuses on phenomena which take place in “a moment,” literally a split second.  In it I offer a slow motion analysis of the rapid dyadic psychobiological events that occur in a heightened affective moment of the therapeutic alliance.  This analysis discusses how a spontaneous enactment can either blindly repeat a pathological object relation through the therapist’s deflection of projected negative states and intensification of interactive dysregulation, or provide a novel relational experience via the therapist’s autoregulation of projected negative states and coparticipation in interactive repair. Although these are the most stressful moments of the treatment, in an optimal context the therapist can potentially act as an implicit regulator of the patient’s conscious and dissociated unconscious affective states.  This dyadic psychobiological corrective emotional experience can lead to the emergence of more complex psychic structure by increasing the connectivity of right brain limbic-autonomic circuits. 

Consonant with this conception of implicit communication (and citing my right brain neurobiological model) Ginot (2007) concludes, “Increasingly, enactments are understood as powerful manifestations of the intersubjective process and as inevitable expressions of complex, though largely unconscious self-states and relational patterns” (p. 317).  These unconscious affective interactions “bring to life and consequently alter implicit memories and attachment styles.” She further states that such intense manifestations of transference-countertransference entanglements “generate interpersonal as well as internal processes eventually capable of promoting integration and growth.”

In parallel work Zanocco (2006) characterizes the critical function of empathic physical sensations in the enactment and their central role in “the foundation of developing psychic structure of a human being.”  Enactments reflect “processes and dynamics originating in the primitive functioning of the mind, ” and they involve the analyst accomplishing a way of interacting with those patients who are not able to give representation to their instinctual impulses.  These early “primary” activities are expressed in “an unconscious mental activity which does not follow the rules of conscious activity. There is no verbal language involved. Instead, there is a production of images that do not seem to follow any order, and, even less, any system of logic” (p. 145).  Note the implications to implicit primary process cognition and right brain representations. 

According to Friedmann and Natterson (1999),

Enactments are interactions of analysand and analyst with communicative and resistive meanings that lead to valuable insight and can constitute corrective emotional experiences. Enactments that are recognized and defined become valuable dramatizing moments that have condensing, clarifying, and intensifying effects upon consciousness. (p. 220)

That said, it is important to repeat the fact that this relational mechanism is especially prominent during stressful ruptures of the therapeutic alliance.  Enactments occur at the edges of the regulatory boundaries of affect tolerance (Schore, in press), or what Lyons-Ruth describes as the “fault lines” of self-experience where “interactive negotiations have failed, goals remain aborted, negative affects are unresolved, and conflict is experienced” (2005, p. 21).  In light of the principle that an enactment can be a turning point in an analysis in which the relationship is characterized by a mode of resistance/counterresistance (Zanocco et al., 2006), these moments call for the most complex clinical skills of the therapist. 

This is due to the fact that such heightened affective moments induce the most stressful countertransference responses, including the clinician’s implicit coping strategies that are formed in his/her own attachment history.  These right brain systems regulate intense states of object relational-induced negative affect. Recall the “right hemispheric dominance in processing of unconscious negative emotion” (Sato & Aoki, 2006).   Davies (2004) documents, “It seems to me intrinsic to relational thinking that these ‘bad object relationships’ not only will but must be reenacted in the transference-countertransference experience, that indeed such reenacted aggression, rage, and envy are endemic to psychoanalytic change within the relational perspective” (p. 714).  Looking at the defensive aspect Bromberg (2005) reports, “Clinically, the phenomenon of dissociation as a defense against self-destabilization…has its greatest relevance during enactments, a mode of clinical engagement that requires an analyst’s closest attunement to the unacknowledged affective shifts in his own and the patient’s self-states” (p. 5)

On the other hand, Plakun (1999) observes that the therapist’s “refusal of the transference,” particularly the negative transference, is an early manifestation of an enactment.  The therapist’s “refusal” is expressed implicitly and spontaneously in nonverbal communications, not explicitly in the verbal narrative.  A relational perspective from dynamic system theory clearly applies to the synergistic effects of the therapist’s transient or enduring countertransferential “mindblindness” and the patient’s negatively biased transferential expectation in the co-creation of an enactment.

Making this work even more emotionally challenging, Renik (1993) offers the important observation that countertransference enactments cannot be recognized until one is already in them. Rather spontaneous activity is expressed by the clinician’s right brain, described by Lichtenberg, Lachmann, and Fosshage (1996) as a “disciplined spontaneous engagement.”  These authors observe that such events occur “at a critical juncture in analysis” and they are usually prompted by some breach or miscommunication that requires “a human response”.  Although there is a danger of “exchanges degenerating into mutually traumatizing disruptions” that “recreate pathogenic expectations”, the clinician’s communications signal a readiness to participate authentically in the immediacy of an enactment.  This is spontaneously expressed in the clinician’s facial expressions, gestures, and unexpected comments that result from an “unsuppressed emotional upsurge.” These communications seem more to pop out than to have been planned or edited, and they provide “intense moments that opened the way for examination of the role enactments into which the analyst had fallen unconsciously.”

These “communications” are therefore right brain primary process emotional and not left brain rational logical secondary process communications. Thus explicit, conscious, verbal voluntary responses are inadequate to prevent, facilitate, or metabolize implicit emotional enactments.  Bromberg (2005) refers to this in his assertion, “An interpretative stance…not only is thereby useless during an enactment, but also escalates the enactment and rigidifies the dissociation” (p. 8).  Andrade (2005) concludes,

As a primary factor in psychic change, interpretation is limited in effectiveness in pathologies arising from the verbal phase, related to explicit memories, with no effect in the pre-verbal phase where implicit memories are to be found.  Interpretation – the method used to the exclusion of all others for a century – is only partial; when used in isolation it does not meet the demands of modern broad-based-spectrum psychoanalysis. (p. 677)

But if not an explicit analytic insight–directed response, then what type of implicit cognition would the therapist use in order to guide him through stressful negative affective states, such as terror, rage, shame, disgust, etc?  What implicit right brain coping strategy could not only autoregulate the intense affect, but at the same time allow him to maintain “an attunement to the unacknowledged affective shifts in his own and the patient’s self-states”?