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 and Clinical Intuition

In my introduction I proposed that the therapist’s moment-to-moment navigation through these heightened affective moments occurs by not explicit verbal secondary process cognition, but by implicit nonverbal primary process clinical intuition. From a social neuroscience perspective, intuition is now being defined as “the subjective experience associated with the use of knowledge gained through implicit learning” (Lieberman, 2000, p. 109).  The description of intuition as “direct knowing that seeps into conscious awareness without the conscious mediation of logic or rational process” (Boucouvalas, 1997, p. 7), clearly implies a right and not left brain function.  Bugental (1987) refers to the therapist‘s “intuitive sensing of what is happening in the patient back of his words and, often, back of his conscious awareness.” (p. 11).   In his last work Bowlby (1991) speculated, “Clearly the best therapy is done the by therapist who is naturally intuitive and also guided by the appropriate theory” (p. 16).

In a groundbreaking article Welling  (2005) notes that intuition is associated with preverbal character, affect, sense of relationship, spontaneity, immediacy, gestalt nature, and global view (all functions of the holistic right brain).  He further discusses that “There is no cognitive theory about intuition” (p. 20), and therefore “What is needed is a model that can describe the underlying formal process that produces intuition phenomena” (p. 23-24).  Developmental psychoanalysis and neuropsychoanalysis can make important contributions to our understanding of the sources and mechanism of not only maternal but clinical intuition.  With allusions to the right brain, Orlinsky and Howard (1986) contend 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" (p. 343).  There are thus direct commonalities between the spontaneous responses of the maternal intuition of a psychobiologically attuned primary caregiver and the intuitive therapist’s sensitive countertransferential responsiveness to the patient’s unconscious nonverbal affective bodily-based  implicit communications.

In the neuroscience literature Volz and von Cramon (2006) conclude that intuition is related to the unconscious, and is “often reliably accurate.” It is derived from stored nonverbal representations, such as “images, feelings, physical sensations, metaphors” (note the similarity to primary process cognition).  Intuition is expressed in not language but “embodied” in a “gut feeling” or an in initial guess that subsequently biases our thought and inquiry. “The gist information is realized on the basis of the observer’s implicit knowledge rather than being consciously extracted on the basis of the observer’s explicit knowledge”  (p. 2084). 

With direct relevance to the concept of somatic countertransference, cognitive neuroscience models of intuition are now highlighting the adaptive capacity of “embodied cognition.”  Allman et al. (2005) assert, “We experience the intuitive process at a visceral level. Intuitive decision-making enables us to react quickly in situations that involve a high degree of uncertainty which commonly involve social interactions” (p. 370).  These researchers demonstrate that right prefrontal-insula and anterior cingulate relay a fast intuitive assessment of complex social situations in order to allow the rapid adjustment of behavior in quickly changing social situations.  This lateralization is also found in a neuroimaging study by Bolte and Goschke (2005), who suggest that association areas of the right hemisphere may play a special role in intuitive judgments. 

In parallel psychoanalytic work Marcus (1997) observes, “The analyst, by means of reverie and intuition, listens with the right brain to the analysand’s right brain” (p. 238).  Other clinicians hypothesize that the intuition of an experienced expert therapist lies fundamentally in a process of unconscious pattern matching (Rosenblatt and Thickstun, 1994), and that this pattern recognition follows a nonverbal path, as verbal activity interferes with achieving insight (Schooler & Melcher, 1995). Even more specifically Bohart (1999) contends that intuition involves the detection of “patterns and rhythms in interaction.”  But if not verbal stimuli, then which patterns are being intuitively tracked?

Recall, “transference is distinctive in that it depends on early patterns of emotional attachment with caregivers” (Pincus et al., 2007), and enactments are powerful expressions of “unconscious self-states and relational patterns” (Ginot, 2007).  Indeed, updated model of psychotherapy describe the primacy of “making conscious the organizing patterns of affect” (Mohaupt et al., 2006).  van Lancker and Cummings (1999) assert, “Simply stated, the left hemisphere specializes in analyzing sequences, while the right hemisphere gives evidence of superiority in processing patterns” (p. 95).  Thus I have suggested that the intuitive psychobiologically attuned therapist, on a moment-to-moment basis, implicitly tracks and resonates with the patterns of rhythmic crescendos / decrescendos of the patient’s regulated and dysregulated states of affective arousal.  Thus, intuition represents a complex right brain primary process, affectively charged embodied cognition that is adaptive for implicitly processing novelty, including object relational novelty, especially in moments of relational uncertainty.

Welling (2005) offers a phase model, in which the amount of information contained in the intuition increases from one phase to another, resulting in increased levels of complexity.  An early “detection phase” related to “functions of arousal and attention” culminates in a “metaphorical solution phase,” in which the intuition presents itself in the form of kinesthetic sensations, feelings, images, metaphors, and words. Here the solution, which has an emotional quality, is revealed, but in a veiled nonverbal form.  These descriptions reflect the activity of the right hemisphere, which is dominant for attention (Raz, 2004), kinesthesia (Naito et al., 2004), and the processing of novel metaphors (Mashal et al., 2007).

Phases of intuitive processing are thus generated in the therapists’s subcortical-cortical vertical axis of the right brain, from the right amygdala to the right orbitofrontal system (see Figure A-2 in Schore, 2003a).  The latter, the highest level of the right brain would act as an “inner compass that accompanies the decoding process of intuition” (Welling, 2005, p. 43).  The orbitofrontal system, the “senior executive of the emotional brain,” is specialized to act in contexts of “uncertainty or unpredictability” (Elliott, Dolan, & Frith, 2000).  It functions as a dynamic filter of emotional stimuli  (Rule, Shimamura, & Knight, 2002) and provides “a panoramic view of the entire external environment, as well as the internal environment associated with motivational factors” (Barbas, 2007, p. 239).  It also formulates a theory of mind, “a kind of affective-decision making” (Happeney et al., 2004, p. 4), and thereby is centrally involved in “intuitive decision-making” (Allman et al., 2005). 

I have suggested that the right orbitofrontal cortex and its subcortical and cortical connections represent what Freud described as the preconscious (Schore, 2003a).  Alluding to preconscious functions, Welling (2005) describes intuition as:

…a factory of pieces of thoughts, images, and vague feelings, where the raw materials seem to float around half formless, a world so often present, though we hardly ever visit it. However, some of these floating elements come to stand out, gain strength, or show up repeatedly. When exemplified, they may be easier to recognize and cross the border of consciousness. (p. 33)

Over the course of the treatment the clinician accesses this preconscious domain, as does the free associating patient. Rather than the therapist’s technical explicit skills the clinician’s intuitive implicit capacities may be responsible for the outcome of an affectively-charged enactment, and may dictate the depth of the therapeutic contact, exploration, and change processes.