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Home arrow Articles arrow A Schore Thing - At The Cutting Edge of Psychotherapy

A Schore Thing - At The Cutting Edge of Psychotherapy Print E-mail

by Ellen Stuebe

At his recent series of Australian seminars (March 2009), Dr Allan Schore was billed as “one of the world’s leading authorities on early childhood trauma, neurobiology and attachment theory” (Australian Childhood Foundation
www.childhood.org.au). He has also at times been dubbed “The American Bowlby”.


On the clinical faculty of the Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, and at the UCLA Center for Culture, Brain, and Development, Dr Schore has earned a solid reputation internationally for the unique manner in which he has brought together the most recent insights of neuroscience and developmental psychology, into a non-linear dynamic systems theory of infant development. This synthesis of disciplines has allowed him to paint a new kind of picture of the early years of human life. This picture, whilst far from complete, affords us a vision of the child’s experience that is simultaneously ‘within and without’. A model he said, that is groundbreaking precisely for the way in which it can “shift back and forth between the psychological and biological levels”.


Dr Schore is a small man with a huge presence. His presentation was, like his books, a deluge of theory delivered dry. Despite the endless stream of powerpoint pages however, the material was compelling and kept the audience riveted in attentive silence.


In this seminar, Schore used his multidisciplinary approach to shed light on how early experience mediated through the relationship with the primary caregiver, directly influences the evolution of structures in the infant’s brain. He specifically focused on the importance of the right brain – which is now understood to be directly responsible for the kind of coping systems a child develops – for example how they are able to regulate their emotions, how they manage stress, or whether they are able to empathise with others.


Schore explained that maturing earlier than the left hemisphere of the brain and deeply connected with the limbic system, the right brain receives information and lays down neural circuitry in ways that will be carried forward as a series of unconscious procedural expectations, models of interrelating with the world, laying the foundation stones of the ‘self’. Among other things, he said the right hemisphere regulates the central and autonomic nervous systems; processes high arousal positive affects; detects threats; processes negative affects and pain; regulates the human stress response and cortisol secretion; and controls vital functions, enabling survival, in the event of emotional stress.


On a relational level, Schore said it is the right brain that is engaged in “the infant’s recognition of the mother’s face, and the perception of arousal-inducing maternal facial expressions, is psychobiologically attuned to the output of the mother’s right hemisphere, which is involved in the expression and processing of emotional information and in nonverbal communication”.


He gave evidence of an increasing number of studies confirming the activation of infants’ right brains in early exchanges with their primary caregivers. Even in sleep, research is showing infants’ right brains continue to take in the sounds around them, ‘wiring and firing’ in accordance with this implicit information.


Through a multitude of scientific examples of right brain engagement in various dyad experiments, Schore’s presentation irrefutably confirmed the vital nature of attuned parenting – parenting that emanates from the right, emotional brain. Indeed, Schore said research shows that some mothers would seem to use their left brain in parenting – using only conscious, logical brain processes. Such mothers, he said, would seem to generate children with avoidant attachment and thus must literally learn how to listen to their emotional mind, how to engage their right brains.


Where there is early relational trauma – where the caregiver has failed to adequately provide attuned and regulating parenting – a series of maladaptive physiological and behavioural responses will directly shape the child’s ability to cope in future life. Ultimately, Schore said, the child exposed to ongoing trauma – whether abuse or neglect - is at risk of developing a response to stressors of either hyperarousal or hypoarousal.


Schore suggested that the therapeutic community has put far too much emphasis on how to manage states of hyperarousal – in which clients may display states of extreme rage and aggression. But that in his view, the state of hypoarousal – in which a person disengages and dissociates under stress – is far less frequently identified, despite it being the more difficult state to work with. Dissociation, Schore said, in which the body enters a parasympathetic state including reduced heart rate and blood pressure, is simply a “primitive strategy of right brain autoregulation for coping with intense emotional arousal and pain”. In the state of dissociation, the right brain’s ‘red phone’ compelling the mind to take action, is dead. Instead, it would seem that the right brain cortical sub-cortical system is unable to recognise or process either external or internal stimuli in this state.


Key to Schore’s presentation was the notion that attachment theory turns out in fact to be a theory of regulation. What began with Bowlby, he said, now provides a reliable relational context for the neurobiological realities made evident through fMRIs and other scientific methods. Schore stressed that the key therefore, to working with people who have experienced developmental trauma, is not in unblocking their experience or attempting to have them put it into words, but rather, in employing the approach of regulation – in reinstating a state of regulation.


The final section of Schore’s presentation was dedicated to how a practitioner in fact does this. For along with synthesising neuroscience and attachment theory, Schore has also traditionally drawn psychoanalytic theory into the mix, in the form of object relations and self psychology. A significant surprise of this seminar however, was the revelation that Schore now espouses intersubjectivity as the key theoretical stance to effective therapy and in particular, working with trauma. Schore spent considerable time explaining the importance of working in a two person psychological model, going as far as saying that one person psychology is “dead”. “So much for the neutral therapist!” Schore laughed. “That was a fantasy! How much should we reveal? We are leaking all the time!”


He read aloud a quote of psychiatrist Daniel Stern who once said, “Most of us have been dragged kicking and screaming to the realization that what really works in psychotherapy is the relationship between the therapist and the client… We are all devastated by this reality because we spent years and a lot of money learning a particular technique or theory, and it is very disheartening to realize that what we learned is only the vehicle or springboard to create a relationship – which is where the real work happens”. Among the audience primarily oriented around a one person psychological model, this generated a round of somewhat uncomfortable laughter.

Schore underscored the direct and powerful nature of the intersubjective relationship in affecting neurobiology and the building of ‘self’. He articulated the presence in intersubjective work of a non verbal realm, an implicit right brain to right brain communication, that is central to good therapy. As more and more of the client is revealed, Schore said, they begin to fear “that you as a therapist will dysregulate them: either by intruding too close and hyperarousing them, or by withdrawing in such a way that hypoarousal will occur”. Herein, said Schore, lies the opportunity to work intersubjectively in a way that can allow for the new experience - impacting relationally, developmentally and neurobiologically.


To say that Schore’s paradigm shift to intersubjectivity is significant, is an understatement. Indeed, by placing intersubjectivity at the heart of his dynamic systems theory approach, is an act that could be seen to relegate one person psychology to the dustbin forever.


As a student of the ACCSP whose training also brings together the latest insights of neuroscience, with developmental theory and intersubjectivity, I found Dr Schore’s seminar not only deeply engaging but also profoundly validating of the training’s place at the cutting edge of psychotherapy worldwide. Further, it would seem that the body – integrally present in the neurobiological – is finally finding its rightful place in mainstream psychotherapy. Not as an add-on, nor as or a fringe approach concerned with touching or not touching, but rather as an intrinsic aspect of human experience unable to be separated out. In the near future perhaps, the term ‘somatic psychotherapy’ may be deemed a tautology – and ‘contemporary psychotherapy’ might instead intrinsically encompass all aspects of human experience - experience that Schore’s work sheds light on in exciting and revolutionary ways.


Ellen Stuebe is a 2007 graduate of ACCSP. She runs a Sydney-based psychotherapy practice and has a special interest in infant development and attachment theory.