- There has been a paradigm shift in neurobiology from looking at cognition and behaviour to studying emotion: the questions before us today are not what makes people behave in a certain way, but how we explain and understand the feelings which generate both behaviour and cognition. Schore is quite clear that behaviour and cognition cannot be changed independently of the feelings which drive them. And feelings are to be located in the body: they are not somehow squashed inside our skulls! 'Use your head' will not work as advice to an overwrought individual - the head not where it's at. This is the position that has been taken by depth psychotherapy for a long time.
- Schore: "Right brain affective processes operating at levels beneath conscious awareness are dominant in development, psychopathogenesis [how psychological disturbance gets started], and psychotherapy.' Throughout the entire workshop, the author of so many excellent articles and books which have illuminated the processes we wrestle with in psychotherapy consulting rooms up and down the land, made clear again and again his firm conviction that it is the right brain that is exercised in all our key experiences of emotional disturbance, our capacity for good relationships, and our most important work as human beings in creativity.
- He acknowledged the importance of the work of Iain McGilchrist (The Master and His Emissary, 2009) in differentiating the two hemispheres of the brain. Each has a distinct mode of functioning, and creates coherent, utterly different and often incompatible versions of the world, with competing priorities and values. In McGilchrist's view, the right brain is master, while the left brain is emissary. That is, right brain surveys the territory to be explored, asks the questions, and sends left brain to go out and find the data - the more detailed knowledge that will enable the questions to be answered. But left brain cannot answer these questions on its own! It returns with the data to the right brain, which then absorbs and integrates it along with all the other knowledge, experience and wisdom gained over many such surveys of the lie of our lands. And right brain makes the decisions about what is to be done about these things. Good psychotherapy is a right-brain-to-right-brain activity. Results cannot be achieved by cognition alone. We cannot simply 'think ourselves well.'
Look at these ways of thinking about the functions of the two brains:
rational brain versus emotional brain
linguistic brain versus social brain
implicit versus explicit self systems
conscious versus unconscious minds
5. There has been a paradigm shift from attachment theory to right brain regulation theory. Attachment theory told us much that was illuminating about how mother and infant relate to each other, and what can go wrong. But now, says Schore: 'mother-infant attachment implants the developing right hemisphere for better of for worse, and can either facilitate resilience to stress or create a predisposition to affect dysregulation and thereby psychopathology." That is, the problem is essentially a matter of dealing with our feelings. When our feelings are hyperaroused (or hypoaroused, i.e. there is too much or too little response) we are then in danger of reactions and behaviours and thoughts which will cause us and sometimes other people pain. These patterns, once seeded (beautiful word!) in the psyche remain with us throughout life unless there is some exposure to means of changing them. 'Coping skills' are not that type of exposure. They are cognitive and left brain matters. Real change comes about only when the original pattern of dysfunctional emotional response is changed. Sighs of relief all around the large group of psychotherapists in the Great Hall at King's, who have been saying and practising this very approach for many years! It's not that we didn't know it - it's that it's wonderful to have this view of human being so thoroughly validated, and by a man of such eminence and experience.
6. And of course the 64,000 dollar question of how change is achieved is now effectively answered for a generation - until perhaps we learn what lies behind feelings themselves. The answer is really that in the human relationship encounter (such as takes place in the consulting room), there is a possibility of a meeting of feelings - that the feelings which mother originally arounsed by her face, touch, the sound of her voice with the baby will now recur, maybe with increasing calmness and harmony and lack of the dysregulation that characterised the early mothering experience. Psychodynamically, we have long called this meeting transference and countertransference - probably unhelpfully - and clearly this is not confined to consulting rooms but takes place wherever human beings meet together. And this experience constitutes a gradual repair of what has been previously ruptured by too much or too little of what was needed at the time. The brain is highly plastic, we now know, and can repair itself - but it must have the kinds of experiences that enable it to recover from the early difficulties. Repetition of more of the same will not do it. So we therapists have to find out what it was like in those early weeks and months for the neonate, and find ways to make it different this time.
7. Perhaps you're wondering how we find out? Naturally this is not a straightforward business - much that went wrong early on is pre-verbal, and the patient or client simply cannot tell you what it was like. In addition, Schore posed the hypothesis that what goes wrong in hyper- and hypo-arousal states is that the set point of normality in feeling, as it were, is changed, so that what seems 'normal' to the infant is now a higher (or lower) state of arousal than before. And that there is a point where dissociation kicks in - because so much 'too much' has been loaded on to the infant brain that it cannot tolerate the state of dysregulation any longer, and erases the whole experience - dissociates from it. But this dissociation is an unconscious process, and hence the infant does not know that this has happened, and therefore cannot report it later on to the therapist. NB: dissociation is not the same as repression, which is about pushing away stuff that is already known and experienced, however briefly. Dissociation involves 'not knowing' from the first instant by not experiencing it. Thus, the only way to retrieve these memories is to experience them, either in a clinical setting, or via some equivalent human contact. There are times, for instance, when a patient experiences anger for the first time, and it can be revelatory.
It is re-experience - sometimes (in dissociation) a different experience with a different outcome - in the presence of the other that constitutes the repair process. Reading the book, researching it on the internet, will not do it. It is not possible to do it alone - think in terms of like emotion arousing like responses, and they must be feeling and not purely cognitive responses - not advice on how to cope with 'your' stuff, such as partners frequently give each other in an argument! When you cry at the cinema, you are being aroused by something that has already taken place in your psyche, and now you are remembering feelings and reprocessing those 'feeling memories,' even though it is hard to recall precisely what memories. Indeed, have you not been utterly surprised at how much emotion a simple play or a film or a TV programme can arouse? Or a book or a poem? Better yet, the showing and telling of it to another human being is key - when your friend cries, you often cry in sympathy. This is the repair process at work - and the repair is for both parties involved - it is not merely for the one who has been designated 'client.' Both must be involved, and thus, psychotherapy is a relational process, pure and simple, depending utterly on empathic attunement by the therapist, and cannot be any other way. More sighs of relief round the room!
6. Schore calls this process the rupture and repair cycle, and of course where there has been significant unconscious dissociation there are powerful defences against the arousal of feeling which was, after all, unmanageable before. They will not loosen up in a second, or a session. We need to think in terms of a graded, step by step process of repair which takes place over a period of time. How long? As long as it takes, is the only possible answer. Time limits are meaningless to the unconscious psyche. The psyche takes its own time, like it or not - indeed, it could be more accurately expressed as a case of the psyche being unaware of the existence of time! Which of course always raises questions about cost but rarely about cost-benefit. I would have thought that governments and caring bodies of all kinds would have been only too glad to know that we can now repair a great deal of psychological disturbance - even if it takes some years to complete. Yes, it costs money, but have you any idea of the cost to the national economy and culture of mental ill health? Bearing in mind that one person's ill health affects many others around them and is not an individual matter alone.
7. It's important to say here that the therapist's own capacity for feeling in the session is critical to making the rupture/repair process work. Schore goes further and assures us that the single biggest blockage to successful treatment is the therapist's own defences - his or her personal taboos against feeling with the patient. These are of course rooted in the therapist's own psychopathology. Hence the emphasis we have placed in the psychoanalytic field on personal therapy as a key part of the training of a therapist is entirely validated. You can't go in 'cold' to a patient in distress, without having experienced your own distress, harbouring perhaps a defensive conviction that 'you're ok' and need no work on yourself. You need a great deal of therapy as preparation, in fact, regardless of how well you feel you may cope with your life. Remember that 'coping' is a cognitive process which has little deep root in the right side of the brain. I have always been good at coping - until I discovered how much of this 'coping' was only skin deep.
As an energy therapist as well as a psychodynamic one, I found much to think about in the above work. We have I think restored an important dimension to therapy by emphasising the importance of the body in psychological disturbance. Working with the body allows a trickle-down effect on the psyche of the patient, because of the association between unconscious processing and the body systems. The subtle energy system ('the feeling unconscious') impacts significantly on the patient's emotional state, and if we learn how to communicate with it skilfully we certainly produce results, often far-reaching and surprising ones in fields like early trauma and obsessive-compulsive disorders which were formerly hard to reach.
The questions I was left with were: how far does this communication go? Is it deep enough to influence the early neurobiological disruptions which have caused the problem in the first place? How is the touch factor in energy therapy experienced by the deeper right brain psyche, and how does it impact on the dissociated unconscious? Are those energy modalities that use relatively little touch likely to have a deeper impact? In particular, how do we ensure that the key relational aspects of the work are not sabotaged in the exciting business of working with the subtle energy system?
7. Perhaps you're wondering how we find out? Naturally this is not a straightforward business - much that went wrong early on is pre-verbal, and the patient or client simply cannot tell you what it was like. In addition, Schore posed the hypothesis that what goes wrong in hyper- and hypo-arousal states is that the set point of normality in feeling, as it were, is changed, so that what seems 'normal' to the infant is now a higher (or lower) state of arousal than before. And that there is a point where dissociation kicks in - because so much 'too much' has been loaded on to the infant brain that it cannot tolerate the state of dysregulation any longer, and erases the whole experience - dissociates from it. But this dissociation is an unconscious process, and hence the infant does not know that this has happened, and therefore cannot report it later on to the therapist. NB: dissociation is not the same as repression, which is about pushing away stuff that is already known and experienced, however briefly. Dissociation involves 'not knowing' from the first instant by not experiencing it. Thus, the only way to retrieve these memories is to experience them, either in a clinical setting, or via some equivalent human contact. There are times, for instance, when a patient experiences anger for the first time, and it can be revelatory.
It is re-experience - sometimes (in dissociation) a different experience with a different outcome - in the presence of the other that constitutes the repair process. Reading the book, researching it on the internet, will not do it. It is not possible to do it alone - think in terms of like emotion arousing like responses, and they must be feeling and not purely cognitive responses - not advice on how to cope with 'your' stuff, such as partners frequently give each other in an argument! When you cry at the cinema, you are being aroused by something that has already taken place in your psyche, and now you are remembering feelings and reprocessing those 'feeling memories,' even though it is hard to recall precisely what memories. Indeed, have you not been utterly surprised at how much emotion a simple play or a film or a TV programme can arouse? Or a book or a poem? Better yet, the showing and telling of it to another human being is key - when your friend cries, you often cry in sympathy. This is the repair process at work - and the repair is for both parties involved - it is not merely for the one who has been designated 'client.' Both must be involved, and thus, psychotherapy is a relational process, pure and simple, depending utterly on empathic attunement by the therapist, and cannot be any other way. More sighs of relief round the room!
6. Schore calls this process the rupture and repair cycle, and of course where there has been significant unconscious dissociation there are powerful defences against the arousal of feeling which was, after all, unmanageable before. They will not loosen up in a second, or a session. We need to think in terms of a graded, step by step process of repair which takes place over a period of time. How long? As long as it takes, is the only possible answer. Time limits are meaningless to the unconscious psyche. The psyche takes its own time, like it or not - indeed, it could be more accurately expressed as a case of the psyche being unaware of the existence of time! Which of course always raises questions about cost but rarely about cost-benefit. I would have thought that governments and caring bodies of all kinds would have been only too glad to know that we can now repair a great deal of psychological disturbance - even if it takes some years to complete. Yes, it costs money, but have you any idea of the cost to the national economy and culture of mental ill health? Bearing in mind that one person's ill health affects many others around them and is not an individual matter alone.
7. It's important to say here that the therapist's own capacity for feeling in the session is critical to making the rupture/repair process work. Schore goes further and assures us that the single biggest blockage to successful treatment is the therapist's own defences - his or her personal taboos against feeling with the patient. These are of course rooted in the therapist's own psychopathology. Hence the emphasis we have placed in the psychoanalytic field on personal therapy as a key part of the training of a therapist is entirely validated. You can't go in 'cold' to a patient in distress, without having experienced your own distress, harbouring perhaps a defensive conviction that 'you're ok' and need no work on yourself. You need a great deal of therapy as preparation, in fact, regardless of how well you feel you may cope with your life. Remember that 'coping' is a cognitive process which has little deep root in the right side of the brain. I have always been good at coping - until I discovered how much of this 'coping' was only skin deep.
As an energy therapist as well as a psychodynamic one, I found much to think about in the above work. We have I think restored an important dimension to therapy by emphasising the importance of the body in psychological disturbance. Working with the body allows a trickle-down effect on the psyche of the patient, because of the association between unconscious processing and the body systems. The subtle energy system ('the feeling unconscious') impacts significantly on the patient's emotional state, and if we learn how to communicate with it skilfully we certainly produce results, often far-reaching and surprising ones in fields like early trauma and obsessive-compulsive disorders which were formerly hard to reach.
The questions I was left with were: how far does this communication go? Is it deep enough to influence the early neurobiological disruptions which have caused the problem in the first place? How is the touch factor in energy therapy experienced by the deeper right brain psyche, and how does it impact on the dissociated unconscious? Are those energy modalities that use relatively little touch likely to have a deeper impact? In particular, how do we ensure that the key relational aspects of the work are not sabotaged in the exciting business of working with the subtle energy system?
