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 Process Central to Change: Affect Regulation

According to Ginot (2007), “This focus on enactments as communicators of affective building blocks also reflects a growing realization that explicit content, verbal interpretations, and the mere act of uncovering memories are insufficient venues for curative shifts” (p. 317).  This clearly implies that the resolution of enactments involves more than the standard Freudian idea of making the unconscious conscious. But if not these explicit factors, then what implicit therapeutic experience is essential to the change process, especially in developmentally impaired personalities who are not psychologically minded? At the base the implicit change mechanism must certainly include a dysregulating affective experience that is communicated to an empathic other. 

But in addition, the relational context must also afford an opportunity for interactive affect regulation, the core of the attachment process. Ogden and her colleagues conclude,

Interactive psychobiological regulation (Schore, 1994) provides the relational context under which the client can safely contact, describe and eventually regulate inner experience…Rather than insight alone, it is the patient’s experience of empowering action in the context of safety provided by a background of the empathic clinician’s psychobiologically attuned interactive affect regulation that helps effect…change. (2005, p. 22)

It is the regulation of stressful and disorganizing high or low levels of affective-autonomic arousal that allows for the repair and re-organization of the right lateralized implicit self, the biological substrate of the human unconscious.

It is now clear that a deeper understanding of affective processes is closely tied to the problem of the regulation of these processes. Affect regulation, a central mechanism of both development and the change process of psychotherapy, is usually defined as set of conscious control processes by which we influence, consciously and voluntarily, the conscious emotions we have, and how we experience and express them.  In a groundbreaking article in the clinical psychology literature Greenberg (2007) describes a “self-control” form of emotion regulation involving higher levels of cognitive executive function that allows individuals “to change the way they feel by consciously changing the way they think.”  This explicit form of affect regulation is performed by the verbal left hemisphere, and unconscious bodily-based emotion is usually not addressed in this model. Notice this mechanism is at the core of insight, heavily emphasized in therapeutic models of not only classical psychoanalysis but also cognitive behavioral therapy.

In contrast to this conscious emotion regulation system, Greenberg describes a second, more fundamental implicit affect regulatory process performed by the right hemisphere. This system rapidly and automatically processes facial expression, vocal quality, and eye contact in a relational context.  Therapy attempts not control but the “acceptance or facilitation of particular emotions,” including “previously avoided emotion,” in order to allow the patient to tolerate and transform them into “adaptive emotions.’’  Citing my work he asserts, “it is the building of implicit or automatic emotion regulation capacities that is important for enduring change, especially for highly fragile personality-disordered clients” (2007, p. 416).

Even more than the patient’s late acting rational, analytical and verbal left mind, the growth-facilitating psychotherapeutic relationship needs to directly access the deeper psychobiological strata of the implicit regulatory structures of both the patient’s and the clinician’s right minds.  Effective psychotherapy of attachment pathologies and severe personality disorders must focus on unconscious affect and the survival defense of pathological dissociation, “a structured separation of mental processes (e.g., thoughts, emotions, conation, memory, and identity) that are ordinarily integrated” (Spiegel & Cardeña, 1991, p. 367). The clinical precept that unregulated overwhelming traumatic feelings can not be adaptively integrated into the patient’s emotional life is the expression of a dysfunction of “the right hemispheric specialization in regulating stress - and emotion-related processes” (Sullivan & Dufresne, 2006).  As described earlier this dissociative deficit specifically results from a lack of integration of the right lateralized limbic-autonomic circuits of the emotional brain (see Figure 1).

But recall Ginot’s assertion that enactments “generate interpersonal as well as internal processes eventually capable of promoting integration and growth.”  Indeed, long-term psychotherapy can positively alter the developmental trajectory of the right brain and facilitate the top-down and bottom-up integration of its cortical and subcortical systems (Schore, 2003a).  These enhanced right amygdala - ventral prefrontolimbic connections allow implicit therapeutic “now moments” of lived interactive experience to be integrated into autobiographical memory.  Autobiographical memory, an output of the right brain, is the highest memory system that consists of personal events with a clear relation to time, space, and context.  In this right brain state of autonoetic consciousness the experiencing self represents emotionally-toned memories, thereby allowing for “subjective time travel” (Kalbe et al., 2008).  The growth-facilitating expansion of interconnectivity within the unconscious system also promotes an increased complexity of defenses, right brain coping strategies for regulating stressful affects that are more flexible and adaptive than pathological dissociation.  This therapeutic mechanism supports the possible integration of what Bromberg (2006) calls “not-me” states into the implicit self.

Indeed, these developmental advances of the right lateralized vertical axis facilitate the further maturation of the right brain core of the self and its central involvement in “patterns of affect regulation that integrate a sense of self across state transitions, thereby allowing for a continuity of inner experience” (Schore, 1994, p. 33).  These neurobiological re-organizations of the right brain human unconscious underlie Alvarez’s (2005) assertion, “Schore points out that at the more severe levels of psychopathology, it is not a question of making the unconscious conscious: rather it is a question of restructuring the unconscious itself” (p. 171).

Earlier I suggested that the right hemisphere is dominant in the change process of psychotherapy.  Neuroscience authors now conclude that although the left hemisphere is specialized for coping with predictable representations and strategies, the right predominates for coping with and assimilating novel situations (Podell et al., 2001) and ensures the formation of a new program of interaction with a new environment (Ezhov & Krivoschchekov, 2004).  Indeed,

The right brain possesses special capabilities for processing novel stimuli…Right-brain problem solving generates a matrix of alternative solutions, as contrasted with the left brain’s single solution of best fit. This answer matrix remains active while alternative solutions are explored, a method suitable for the open-ended possibilities inherent in a novel situation. (Schutz, 2005, p. 13)

The functions of the emotional right brain are essential to the self-exploration process of psychotherapy, especially of unconscious affects that can be potentially integrated into a more complex implicit sense of self. At the most essential level, the work of psychotherapy is not defined by what the therapist explicitly, objectively does for the patient, or says to the patient.  Rather the key mechanism is how to implicitly and subjectively be with the patient, especially during affectively stressful moments when the “going-on-being” of the patient’s implicit self is dis-integrating in real time.