Schore chap 2 part 2

12-12-06

treatment via psychotherapy

schore/ar/47 con’t from first part of his chapter 2

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“Recall Winnicott’s dictum that the therapist must understand, at an intuitive level, specifically the emotional history of the patient:  “In order to use the mutual experience one must have in one’s bones a theory of the emotional development of the child and the relationship of the child to the environmental factors” (1971b, p. 3, italics added).  [reminds me of Erik Erickson’s idea that we must look at life histories, not just case histories.] (Schore/ar/47)”

We each have a life history, a “case history,” and where they meet is our emotional history.

“With patients, especially those manifesting early-forming attachment pathologies and therefore developmental disorders of self-regulation, [here again, these need to be very carefully distinguished because I believe the damage is much greater than JUST to the self-regulatory aspects.] the psychotherapeutic interaction functions as an attachment relationship.  [And of course, I still have trouble with this idea.  Besides, if a person has an early attachment disorder so that they were prevented from forming a secure attachment by age 12 months, how are they going to do it now?  Perhaps with the 2 categories of less severe (in my mind) – dismissive avoidant and preoccupied ambivalent – but with the disorganized category it would be really difficult if not impossible.  And then there’s the group I call the “cannot attach” which might match their category of “cannot classify.”] (Schore/ar/47)”

Schore’s para con’t

“Recent models (Schore/ar/47) suggest that affect dysregulation is a fundamental mechanism of all psychiatric disorders (Taylor, Bagby, & Parker, 1997) [I looked this up and it seems that this reference is about 15 years of research on alexithymia…], that all psychotherapies show a similarity in promoting affect regulation (Bradley, 2000), and that the goal of attachment-focused psychotherapy is the mutual regulation of affective homeostasis and the restructuring of interactive representations encoded in implicit-procedural memory (Amini et al., 1996).  (Schore/ar/48)”

Interesting concept: restructuring of interactive representations encoded in implicit-procedural memory

“The direct relevance of developmental attachment studies to the psychotherapeutic process derives from the commonality of interactive right-brain-to-right-brain emotion-transacting mechanisms in the caregiver-infant attachment relationship and in the clinician-patient therapeutic relationship…..direct parallels between the clinical attributes of an effective therapist and the parental characteristics of the psychobiologically attuned interactive caregiver of a securely attached child….  (schore/ar/48)”

Well —  humm!!  Is that the best they can do with all this new information that they are gathering?  I am really disappointed!  I don’t want to be “an infant securely attached to my therapist!”  I want to be empowered to know and understand the exact damage that was done to my developing brain through my crazy mother’s interactions with me!  I want to know how that damage manifested itself in my thinking and feeling as a child, and how it affects me and my life today!  I want to be empowered through knowledge and information, not disempowered by coddling by a therapist [one that I couldn’t find or afford to pay, anyway!]

Perhaps it is just because my brain was not socialized “normally” that I don’t want to play the power games that therapists play.  And that I can see.  They NEED to feel better than, more competent than, weller than, as knowing more than their poor sick pathetic weak and needy clients, who need THEM to rescue the helpless, and they need the helpless to OWE them for this and to look up to them as gods and goddesses.

Yes, I know these words and ideas and feelings and awarenesses and observations of mine are HERESY!  I could be burned at the stake as a witch!  But I KNOW I am right (for me) because I can feel it, and I feel it in my body, so therefore it is information that is directly accessible to my right brain – and the right brain does not lie about a person’s reality.  Psychotherapists are busy projecting onto their clients their own weaknesses and defense mechanisms!  Like G said to me that first day, “I sense you are being resistant!”  Resistant?  I am not nor never was her client for her to use that twist of words against me!

She says she does healing work.  I suppose she does.  But she is not a healed or well healer.  I know I am not.  But I bet she wouldn’t admit that of and to herself.

So, I am like a one armed bandit, alone in all of this.  Nobody to talk to about it all.  I was told last night that mental health carries such a stigma still that nobody funds it.  There is funding for “positive parenting” but from what I saw even on the center for disease control’s website today, it is really all fluff.  It does nothing but give some pie in the sky fluffy things to aim for – but when parents are really in trouble, if they have insecure attachments and lots of their own unresolved trauma, they will not “make the grade” and expecting or even suggesting to them that they can, is a waste of time and a disservice.  They need to know what is truly and deeply and fundamentally WRONG in their brains so that they can start there to understand what was done to them, how it was done to them, and how specifically NOT to pass this on to their children.

I just see the whole “professional” approach as being so off-kilter!

[This is not a healthy place for me – I need my own printer and my own internet access – and yes, eventually a nonprofit umbrella.  My needing to find direction is my own.  Unfortunately for me, probably, I am not going to be either socioemotionally meshed or enmeshed with anyone else as I try to do this work.  But it is some sort of a paycheck right now until after 1/1 when minimum goes up and the holidays are over.]

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I would look these ideas up online if I had access!!  To be able to look things up as I go along, so I can stay “in the flow.”  Also, would be nice to just have this computer, as is, along side another one that could do the online!

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Therapists in general:

I am getting a lesson in therapists and their dysfunctions right here at BRI with a woman who is a “psychotherapist” doctoral level social psychologist, who by the system’s standards is “above” me – yet her subtle passive aggressivities are obvious and irritating!

I did not need the other office open yesterday at 5:30 am – even though I had mentioned the day before that some days I might come in early – but that logically and obviously would be so that I would be able to access the computer in the office I have the key to.  This other room that she opened yesterday at 5:30 – and did not hesitate to tell me that several times when she came in later – is the one I use when the online computer is busy.  It makes no other sense to me – other than to “guilt trip” me that she opened it up in the first place when there’s no way I needed it that early – or that she mentioned it once, let alone a few times…

And today when the 2 kids came for class and she knew this big room was locked, she left me standing without even a chair to sit on while she went about teaching the kids – and finally asks, “Oh, do you need the room open?”  It was irritating – both incidents – so maybe the guilt trip is also tied to being irritating and irritating someone else – using some accessing of anger as a power tool – though there are probably better ways for us to access power that we need other than in this way.

I really am frustrated in general, being this poor and now working for this $5.15 per hour.  Only until after the 1^st of Jan and today is the 13^th of Dec….but I could do what I am doing here at home – so it has to be about a trust issue, really, that they don’t just let me do that.  Oh well.  Maybe Cindy can make her new nonprofit something connected to brain growth and mental development throughout the lifespan, and I could write grants through them as an umbrella organization.

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[Maybe with the “fox incident” I was experiencing for myself what dissociation felt like!  Here a fox, there a no fox!  Just like that!  One state here, another totally different state there!  But while doing that I was the transition.  Me making the decision to close my eyes and turn my head the other way and open them again – from fox to no fox.  Until Mother exploded!]

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Schore goes on p 48 –

“For a working alliance to be created, the therapist must be experienced as [sic] being in a state of vitalizing attunement to the patient; that is, the crescendos and decrescendos of the therapist’s affective state must be in resonance with similar states of crescendos and decrescendos of the patient (Schore, 1994, 1997c).  Studies of empathic processes between the “intuitive” attuned mother and her infant demonstrate that this affective synchrony is entirely nonverbal and that resonance is not so much with his mental (cognitive) states as with his psychobiological (affective-bodily) states.  Similarly, the intuitive empathic therapist psychobiologically attunes to and resonates with the patient’s shifting affective state, thereby co-creating with the patient a context in which the clinician can act as a regulator of the patient’s physiology.  (Amini et al., 1996; Schore, 1994, 1997c) in (schore/ar/48)”

Sort of like dialysis, then!  I don’t think therapists can do this.  They are too human and too ill themselves, and too full of their own agendas and power trips and insecurities!

As long as we keep the stigma on “mental health” issues, how are we going to engage in an open and adult conversation about anything helpful?  How are we going to empower the public and disempower the “rulers of the mental health kingdom?”  Dictators, ruling through the misguided dependencies and ignorance of the masses.

If most mental illness is in malformations of the early right brain structures – then how are we going to learn the truth of this or be able to apply it in our lives?  To put this research with positive parenting is like finding the tiny imperfection in the sweater or the piece of cloth and pulling it until the whole thing unravels so that we can actually see the cause of the real flaw.  This is going against the status quo!

But mere fluff is not going to help anyone.  My guess is that the “fluffy” parenting can help the 50 – 55% if secure adults parent better, giving them specific parenting skills.  It might help the next 15% of dismissive/avoidant parents, but even these already have the brain malformation issues resulting in empathy disorders.  The rest of the insecure population needs much more information!

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“…right-posterior-cortical mechanism involved in the perception of nonverbal expression embedded in facial and prosodic stimuli…” makes the right hemisphere “dominant for the perception of the emotional states of others…”  (schore/ar/48)”

“It is also dominant for “subjective emotional experiences” (Whittling & Roschmann, 1993; italics added) and for the detection of subjective objects (Atchley & Atchley, 1998; italics added).  The interactive “transfer of affect” between the right brains of the members of the mother-infant and therapeutic dyads is thus best described as intersubjectivity.”  (Schore/ar/48)

p 49 –

“…the left brain communicates its states to other left brains via conscious linguistic behaviors….”  (schore/ar/49)

“The right brain is centrally involved in unconscious activities… so the right nonverbally communicates its unconscious states to other right brains that are tuned to receive these communications…. [Freud] called the state of receptive readiness [of the therapist toward the patient] “evenly suspended attention.”  Boin (1962b) referred to “reverie” or “dream state alpha,” clearly implying a right-brain state. (Schore/ar/49)”

Buck (1994) described “This same right brain-to-right-brain system…[is] “spontaneous emotional communication”…  (Schore/ar/49)”

I am calling in for Buck’s article – about species specific communication between limbic systems that makes the 2 communicating systems one organism.

“Indeed, this right brain process lies at the heart of the nonverbal relational communications between patient and therapist….[quoting Lyon-s Ruth (2000)] “communications are carried out at an implicit level of rapid cueing and response that occurs too rapidly for simultaneous verbal translation and conscious reflection” [pp 91-92] in (Schore/ar/49)”

Isn’t this equally true for ALL of us – at least in some situations when our right brains are tuned to one another?  The left brain cannot pick up these signals, only the right – that must be what true species-to-species communication is all about.  It has little or nothing to do with left-brain words.

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p 50 –

right hemisphere “…is specialized for “implicit learning” (Hugdahl, 1995), and performs rapid (80msec) valence-dependent, automatic, appraisals of emotional facial expressions )Pizzagalli et al., 199).  (Schore/ar/50)”

right hemisphere:

++  “uses expansive attention mechanism that focuses on global features”

++  “coarse semantic coding is useful for noting and integrating distantly related semantic information”

++ useful for free association – following tracks of nonverbal schemata, loosens hold of verbal system and associative process – gives nonverbal mode chance to drive the representational and expressive systems by “shifting dominance from a left to right hemispheric state.  (Schore/ar/50)”

++ unconscious system acts as a transmitter – “primitive process of communication between the unconscious of one person and the unconscious of another begins in early development, it continues throughout life” (quoting Klein) in (Schore/ar/50)”

++ is the “nonlinguistic dimension” of the “relational unconscious” he is speaking of client and therapist, but I would think this is true between people in general

left hemisphere:  “uses a restricted mode that focuses on local detail”

activation of “narrow semantic fields”

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“In my ongoing work I propose that nonverbal transference-countertransference interactions that take place at preconscious-unconscious levels represent right-hemisphere-to-right-hemisphere communications of fast-acting, automatic, regulated, and dysregulated emotional states between patient and therapist. (Schore/ar/50)”

“…recent neurobiological studies indicate that “attention is altered during emotional arousal such that there is a heightened sensitivity to cues related to the current emotional state” (Lane, Chua, & Dolan 1999, p. 986).  (Schore/ar/50)”

Talks about “…role of “fleeting facial expressions” that act as indicators of transference and countertransference processes (Andersen, Reznik, & Manzella, 1996…..) ..These cues are nonconsciously appraised from movements occurring primarily (Schore/ar/50)”  in the regions around the eyes and from prosodic expressions from the moutn (Fridlund, 1991).  (Schore/ar/50)”

Aren’t these same fleeting expressions always present?  I don’t suppose they study this in “plain old communications” between ordinary people??!

P 51 –

Schore says “Because the transference-countertransference is a reciprocal process, facially communicated “expressions of affect” that reflect changes in internal state are rapidly communicated and perceptually processed within the affectively synchronized therapeutic dialog…. In fact, these very same spontaneously communicated and nonconsciously perceived visual and auditory cues represent “the intrapsychic edge of the object world, the perceptual edge of the transference” (Smith, 1990, p. 225).  (schore/ar/51) ” [Meaning that most of our communications are not reciprocal processes??  I think this is where the problem lies – why we have to seek therapy, according to these guys…..]

“Only in a right hemispheric-dominant receptive state in which “a private self” is communicating with another “private self” can a self-object system of spontaneous affective transference-countertransference communications be created.  Fosshage (1994), a self-psychologist, noted that when the self object seeking dimension is in the foreground, the analyst must resonate at the deepest layers of his/her personality to be sufficiently available to the patient’s developmental and self-regulatory needs.  In other words, a state of resonance exits when the therapist’s subjectivity is empathically attuned to the patient’s inner state (one that may be unconscious to the patient), and this resonance then interactively amplifies, in both intensity and duration, the affective state in both members of the dyad.  Sanders (1992) stated that “moments of meeting” between patient and therapist occur when there are matched specificities between two systems in resonance, attuned to each other.  (Schore/ar/51)”

“Resonance phenomena are now thought to play one of the most important roles in brain organization and in central nervous system (CNS) regulatory processes  (Schore, 2000C, 2002b).  Although this principle is usually applied to the synchronization of processes within different parts of a whole brain, I have suggested that it also describes the resonance phenomena that occurs between the two right brains of the psychobiologically attuned mother-infant dyad. Thus, this also applies to the moments within the treatment process when two right brains, two emotion-processing unconscious “right minds” within the therapeutic dyad, are communicating and in resonance.  [Again, are these the only times this happens?  How sad that is!  What so prevents us as people from being able to listen to one another in this fashion?]  (Schore/ar/51)”

two right brains, two emotion-processing unconscious “right minds,” of the psychobiologically attuned dyad are communicating and in resonance

Why can’t we do this with each other?  Why don’t these guys address this?

“This leads to the following proposals:  Empathic resonance results from dyadic attunement, and its [sic] induces a synchronization of patterns of activation of both right hemispheres of the therapeutic dyad.  Misattunement is triggered by a mismatch, and describes a context of stressful desynchronization between and destabilization within their right brains.  Interactive reattunement induces a resynchronization of their right brain states.  These brain-state shifts occur rapidly (schore/ar/51) at levels beneath awareness.  In other words, the two right-brain systems that process unconscious attachment-related information within the coconstructed intersubjective field of the patient and therapist are temporally coactivated and coupled, deactivated and uncoupled, or reactivated and recoupled.  The unconscious minds and bodies of two self-systems are connected and coregulating, disconnected and autoregulating, or reconnected and again mutually regulating their activity.  Recall self-regulation occurs in two modes, autoregulation, via the processes of a ‘one-person psychology,’ or interactive regulation, via a “two-person psychology.”  (schore/ar/52)”

IMPLICATIONS OF A PYSCHONEUROBIOLOGICAL MODEL OF EMOTIONAL DEVELOPMENT FOR CLINICAL PRACTICE

P 52 –

Is it that we can’t be objective enough when engaged with another person?  We have to pay somebody to be that objective?

“Even more specifically, during the treatment, the empathic therapist is consciously attending to the patient’s verbalizations in order to objectively diagnose and rationalize the patient’s dysregulating symptomatology.  But he/she is also listening and interacting at another level, and experience-near subjective level, one that processes socioemotional information at levels beneath awareness.  (schore/ar/52)”

I guess “not in this world” can we do the following for one another:

“According to Kohut (1971), the empathically immersed clinician is attuned to the continuous flow and shifts in the patient’s feelings and experiences.  His/her “oscillating attentiveness” (Schwaber, 1995) is focused on “barely perceptible cues that signal a change in state” (Sander, 1992), in both patient and therapist, and on “nonverbal behaviors and shifts in affects” (McLaughlin, 1996).  The attuned, intuitive clinician, from the first point of contact, is learning the nonverbal moment-to-moment rhythmic structures of the patient’s internal states, and is relatively flexibly and fluidly modifying his/her own behavior to synchronize with that structure, thereby creating a context for the organization of the therapeutic alliance.  (schore/ar/52)”

Unfortunately, I can read this stuff, but I will never be able to understand it – and will never be able to apply it.  It is part of my personal damage, and will prevent me always from being able to be a therapist – it is part of my inability to attach – because I cannot have this kind of empathy – maybe ANY kind of empathy.  My brain cannot work this way.  But I would think others’ would!  At least in that top half of the population – that they could be taught the skills to listen and to attend this way.  But why would they want to?  I imagine that they can listen to one another this way.  It SHOULD be a natural process!!  It’s the rest of us damaged by insecure attachment that can’t do this – because nobody was there to do it for us!

And yet I think in some ways we are hyper-aware, hyper-sensitive, hyper-vigilant to other people’s signals and cues.  And the information does not get sent correctly to the left brain for verbal processing.  It all gets to be confusing information instead.

“…learning research on the importance of the implicit perception of affective information…in order for implicit affective learning to take place, the patient must have a vivid affective experience of the therapist (Amini et al., 1996). (schore/ar/52)”

“involvement of the right hemisphere in implicit learning” and “nonverbal processes” and the “orbitofrontal system in implicit (schore/ar/52) processing” and procedural or “emotion-related learning.”

Because I have such a narrow stress window, and everything gets sent over to distressed states, learning is difficult – at least “procedural or emotion-related learning,” but there’s too much emotion, anxiety and distress,  in ANY learning!

P 53 –

“alterations in what Stern, Brucshweiler-Stern, and colleagues (1998) called nonverbal “implicit relational knowledge” are at the core of therapeutic change.  In light of the central role of the limbic system in both attachment functions and in “the organization of new learning,” the corrective emotional experience of psychotherapy [at least it is supposed to be – and I guess not available elsewhere!], which can alter attachment patterns, must involve unconscious right-brain limbic learning.  (schore/ar/53)”

If this is what needs to be changed, and if this is how it happens, then maybe those of us who need it most are constantly CRAVING this – part of my being drawn to want to spend time with ER – because somehow our nonverbal moment-to-moment rhythmic structures of our internal states naturally resonate. But I’ll never never get enough of it.  He won’t allow it.

“But a dyadic-transactional perspective entails not only more closely examining the patient’s emotion dynamics, but also bringing the therapist’s emotions and personality structure more into the picture.  During a therapeutic affective encounter, the therapist is describing his/her psychobiological state of mind and the countertransference impressions made upon it by the patient’s unconscious transference communications.  These are expressed in clinical heightened affective moments when the patient’s internal working models are accessed, thereby revealing the patient’s fundamental transferential modes and coping strategies of affect regulation (schore, 1997c). (schore/ar/53)”

Yes, it would be helpful to know what a client’s coping strategies of affect regulation are, as well as what their internal working models are.  I am looking at DBT and it seems to be well thought out and seems to have a track record of success in helping BPDs – and others with emotional dysregulation problems.  But they do not start early enough in terms of the origination of the problems – not nearly early enough!

“Gans described the “ever-deepening grasp of the patient’s essence that can result from therapists’ ongoing efforts to distill meaning from reactions caused or evoked in them by their patients” (1994, p. 122)  in (schore/ar/53)

Is this any kind of a “short cut” from DBT where the client takes responsibility for their own recovery? Is it that helpful for the client to have somebody else “grasp their essence?”  Isn’t that patronizing?

Schore says the therapist will have visceral reactions to the client [in the gut stuff]

“Recall that attachment is fundamentally the right-brain regulation of biological synchronicity between organisms, and thus the empathic therapist’s resonant synchronization to the patient’s activated unconscious internal working model triggers, in the clinician, the procedural processing of his/her autonomic visceral responses to the patient’s nonverbal, nonconscious communications.  In rupture and repair transactions (Beebe…..)….the therapist alsoutilizes his/her autoregulatory capacities to modulate and contain the stressful negative state induced in him/her by the patient’s communications of dysregulated negative affect.  The psychobiologically attuned therapist then has an opportunity to act as an interactive affect regulator of the patient’s dysregulated state (see Schore, 2002b).  This model clearly suggests that the therapist’s role is much more than interpreting to the developmentally disordered patient either distortions of the transference, or unintegrated early attachment experiences that occur in incoherent moments of the patient’s narrative.  (schore/ar/53)”

“We need to go beyond objectively observing the disorganization of left-brain language capacities by dysregulating right-brain states and feeding this back to the patient in insight-oriented interpretations.  Rather, we can directly engage and therefore regulate the patient’s inefficient right-brain processes with our own right brains.  On the part of the therapist, the most effective interpretations are based on the clinician’s “awareness of his own physical, emotional, and ideational responses to the patient’s veiled messages “ (Boyer, 1990, p. 304.  On the part of the patient, the most “correct understandings” can be used by the (schore/qr/53) patient “only if the analyst is attuned to the patient’s state at the time the interpretation is offered” (Friedman & Moskowitz, 1997, p. XXI).  This interactive regulation allows the dyad to interactively hold online and amplify internal affective stimuli long enough for them to be

recognized, regulated, labeled, and given meaning.

This is an interactive context that supports a corrective emotional experience. (schore/ar/54)”

Again, is this a short cut from DBT’s skills training, or is this an unrealistic and laborious process doomed to failure simply by the massiveness of the problems being discussed/experienced?  Is this what happens in their version of personal psychotherapy?  How many therapists are this “clean” themselves to be able to work this way?  It frustrates me that I can never be “clean enough” myself to do this work, even if I managed an “earned attachment” so that I could provide “good enough” parenting to my own children.

“In light of the observation that “physical containment by the therapist of the patient’s disavowed experience needs to precede its verbal processing” (Dosamantes, 1992, p. 362), the interactive regulation of the patient’s state enables him/her to begin to verbally label the affective experience. In a “genuine dialogue” with the therapist, the patient raises to an inner word and then into a spoken word that he/she needs to say at a particular moment but does not yet possess as speech.  But the patient must experience this verbal description of an internal state is [sic] heard felt, and witnessed by an empathic other. In this manner the emotionally responsive aspects of the therapist’s interventions are transformative for the patient. [Is this the truth?]  (schore/ar/54)

“This affectively focused therapeutic experience may literally alter the orbito-frontal system…..what Holmes (1993b. p. 150) called turning “raw feelings into symbols.”  Recall that the same “neocortical network” that “modulates the limbic system” is identical to the right-lateralized orbitofrontal system that regulates attachment dynamics.  (schore/ar/54)”

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this comes from schore’s chapter 3 but fits here:

“…the rapid dyadic state matching allows the interactively regulated patient to begin to transition out of the negative into a more positively valenced state.  [As sands, 1997, p 700 noted, the patient will become “calmer and more organized, and her need to communicate through me decreases in intensity.”]  (schore/ar/99)

Interesting concept, communication through the therapist

“The dyad’s state-regulating, stress-reducing maneuvers, occurring at mostly preconscious levels, allows the therapist to remain connected to the patient’s state at the point of an “attuned” intervention, and for the patient to now switch out of a dissociated state into one in which he/she can internalize the therapist’s spontaneous expression of his/her empathic recognition of the patient’s pain.   (schore/ar/99)”

“In light of the observation that “physical containment by the therapist of the patient’s disavowed experience needs to precede its verbal processing: (Dosamantes, 1992, p. 362), the interactive regulation of the patient’s state enables him/her to now begin to verbally label the affective experience.  In a “genuine dialogue,” the therapist accesses a “focusing attitude” of waiting patiently in the presence of “the not yet speakable, being receptive to the not yet formed” (Leisjssen, 1990)….(schore/ar/99)”

“Stern (1989) suggested that the “narrative” model is the verbal rendition of the nonverbal internal working models of regulation as told to oneself or to another.  These models are encoded in implicit relational knowledge (Stern, Bruschweiler-Stern, et al., 1998).  The transfer of self-information from the nonverbal to the verbal level (and back) reflects a bi-directional transfer of informa- (schore/ar/99) tion between implicit and explicit processing, an adaptive advance. According to Bornstein, “When an implicit memory is made explicit, the origin of that memory is also made explicit, and the patient can better understand the causal chain of events that led from past experience to present function.  Simply put, the translation of implicit memories allows the patient to gain insight regarding the relationship between past and present experience:  (1993a, p. 341).

Go back to page 100 for Vanaerschot’s (1997) description of how implicit moves to explicit in schore/ar

“As Bucci (1993) described, the patient’s “referential structures” [see a fewparagraphs above about structure] can now link the nonverbal and verbal representational domains.  This structural alteration allows for the development of linguistic symbols to represent the meaning of an experience, while one is feeling and perceiving the emotion generated by the experience.  Ultimately, such therapeutic experiences allow for an “evolution of affects from their early form, in which they are experienced as bodily sensations [implicit memory], into subjective states that can gradually be verbally articulated:  (Stolorow & Atwood, 1992, p. 42).  This process is a central component of therapeutic narrative organization, of turning “raw feelings into symbols” (Holmes, 1993, p. 150).  (schore/ar/100)”

IMPORTANT

“As a result of such modulation, the patient’s affectively charged but now regulated right-brain experience can then be communicated to the left brain for further processing.  This effect, which must follow a right-brain-then-left-brain temporal sequence, allows for the development of linguistic symbols to represent the meaning of an experience, while one is feeling and perceiving the emotion generated by the experience.  The objective left hemisphere can now coprocess subjective right-brain communications, and this allows for a linkage of the nonverbal implicit and verbal explicit representational domains.  This in turn facilitates the “evolution of affects from their early form, in which they are experienced as bodily sensations, into subjective states that can gradually be verbally articulated” (Stolorow & Atwood, 1992, p. 42).  The patient can reflect upon not only what external information is affectively charged and therefore personally meaningful, but how it is somatically felt and cognitively processed by his/her self-regulatory system. (schore/ar/54)”

So there’s a problem when affectively charged right brain experience is NOT regulated, and then when, through interactions with the therapist, the experience becomes regulated, it still needs to move to left brain to become verbally processed – and conscious.

Early forms of affect are experienced as bodily sensations and need to be moved into subjective states – that then can gradually be verbally articulated (by the left brain).  I would also say that these primitive, primary emotional states begin to become differentiated in this process.

In the DBT skills book, Linehan says all emotions past the primary are “learned.”  I do not believe that we “learn” to have them.  We “learn” to clarify and differentiate them.  I think this is a big difference.

P 55 –

“The exploration for meaning is thus not in the content but in the very process of sensing and communicating emotional states.  In a growth-facilitating therapeutic context [here again, is there any way we can reproduce this type of context outside of therapy? This is what we missed in the beginning! So this really is reparenting.], meaning is not singularly discovered but dyadically created.  Focusing, at levels beneath and above awareness, not so much on cognitions as on the subtle or abrupt ebbs and flows [transitions between states] of affective states and on rhythms of attunement, misattunement, and reattunement within the therapeutic dyad [we also have trouble tolerating these misattunements in relationships – the scare and confuse us because we have no hope that the reattunement will follow – as we should have learned very early on] allows us to understand the dynamic events that occur within what Homes (1993b) called “the spontaneous encounter of two solitudes.”  The essential mechanisms that regulate, in real time, the connections, disconnections, and reconnections of the inner worlds of the patient and the therapist are mediated by the transactions of the nonverbal transference-countertransference. (schore/ar/55)”  [Well, how do we reproduce t & c in the real world?]

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“Brown asserted that the process of emotional development, as it continues in adulthood,  [do they mean, as this normally occurs irregardless of infant abuse?] brings the potential to observe and understand the processes of our own minds:  “Adult affective development is the potential for self-observation and reflection on the very processes of mental function”  (1993, p. 42).  This involves not only the affective content of experience but of the very processes by which affect comes into experience – how it is experienced by the self and what informs the self about its relationship to internal and external reality.  As brown noted, “Psychotherapy

is one medium of adult affective development

in the sense that it serves the purpose of disciplined conscious reflection on affective processes” (p. 56).  (schore/ar/55)”

If we could achieve this disciplined conscious reflection on affective processes without psychotherapy, we could make progress on our own!  But it’s both a matter of who would take the time for this, and who COULD accomplish the task.  PAY ATTENTION!

++++

“I suggest that Brown was describing a developmental progression in the patient’s internal psychic structures, namely the orbitofrontal system that performs functions central to affect regulation (puts a bunch of refs here)….This – “the thinking part of the emotional brain” (Goleman, 1995) – acts to “integrate and assign emotional-motivational significance to cognitive impressions; the association of emotion with ideas and thoughts” (Joseph, 1996) and in “the processing of affect-related meanings” (Teasdale et al., 1999).  Because its activity is associated with a lower threshold for awareness of sensations of both external and internal origin, it functions as an “internal reflecting and organizing agency” (Kaplan-Solms & Solms, 1996).  This orbitofrontal role in “self-reflective awareness” (Stuss et al., 1992) allows the individual to reflect on one [sic] his or her own internal emotional states, as well as others (Povinelli & Preuss, 1995).  Furthermore, in light of recent interest of neuroscience in the “mind’s eye” (Kawashima et al., 1995), I propose that the psychobiological operations of the right orbitofrontal system represent the “subjective lens of the mind’s eye.” (schore/ar/55)”

++ developmental progression in internal psychic structures

++ orbitofrontal system that performs functions central to affect regulation

++the thinking part of the emotional brain”

++ acts to “integrate and assign emotional-motivational significance to cognitive impressions; the association of emotion with ideas and thoughts”

++ and in “the processing of affect-related meanings”

++ Because its activity is associated with a lower threshold for awareness of sensations of both external and internal origin, it functions as an “internal reflecting and organizing agency”

++ This orbitofrontal role in “self-reflective awareness”

++ allows the individual to reflect on one [sic] his or her own internal emotional states, as well as others

++ the psychobiological operations of the right orbitofrontal system represent the “subjective lens of the mind’s eye.”

++++

“…the right-hemisphere cycles back into growth phases throughout the lifespan (Schor, 199a, 2002b, 2002e; Thatcher, 1994) and …

the orbitofrontal cortex retains a capacity for plasticity in later life (Barbas, 1995),

thereby allowing for the continuing experience-dependent maturation of a more efficient and flexible right frontal regulatory system within the growth-facilitating environment of an affect regulating therapeutic relationship.

Although short-term treatment may allow the patient to return to a regulated [assuming that there was ever regulation in the first place] (schore/ar/55) and premorbid attachment pattern, over long-term treatment this neurobiological development may mediate an expansion of the patient’s unconscious right mind and the transformation of an insecure into an “earned secure” attachment (Phelps, Belsky, & Crnic, 1998).  (schore/ar/56)”

He is not saying that the “right mind” becomes more conscious.  He is suggesting that it is an expansion of the unconscious right mind.  He is saying nothing about other ways that an earned secure attachment can be acquired.

Premorbid and a “return to a regulated” mean that these conditions were there in the first place – which of course we know was not the case in most insecure attachments – so this information is just about worthless, it seems to me!

++++

PREVENTION

P 56 –

FUNDAMENTAL PRINCIPLE:  “The infant literature clearly demonstrates that the nature of the mother’s right brain-driven affective experiences powerfully influences the affects she acknowledges and attunes to in her child.  (schore/ar/56)”

“This fundamental principle also applies to the therapeutic relationship.  The therapist’s use of his or her self in the treatment process of mutual reciprocal influences is expressed in his or her critical role as an affect monitor and regulator of the patient’s shifting internal psychobiological states.

“Cycles of organization, disorganization, and reorganization of the intersubjective field occur repeatedly in the treatment process.  Our own ability to “enter into the other’s feeling state” depends upon our capacity to tolerate varying intensities and durations of countertransferential states marked by discrete positive affects, such as joy and excitement, and negative affects, such as shame, disgust, and terror.  This range of our affective tolerance is very much a product of our own unique history of early indelibly imprinted emotionally-charged attachment dialogues [do we have these before the age of 12 months?], since it is these primordial interactive experiences that profoundly influence the origin of the self.  For this reason, I believe personal psychotherapy is a prerequisite for anyone entering the field.  (schore/ar/56)”

Oh, but would it be an ideal world if this option were also given to adults who were identified through the AAI as having insecure attachments so that they could prepare themselves to interact in the needed vital way with their offspring!

ONE OF THE MOST IMPORTANT PARENTAL ROLES:  affect monitor and regulator of the infant’s shifting internal psychobiological “feeling” states.  These are right brain-driven affective experiences that occur between infants and caregivers, and are cycles of organization, disorganization, and reorganization of the intersubjective field between the two.  Parents need to be aware of their own “range of affective tolerance” that is the product of their own unique history of early indelibly imprinted emotionally-charged attachment dialogues – those nonverbal dialogues that shape the structure of their infant’s growing brain.   These are the “primordial interactive experiences that profoundly influence the origin of the self.

“In a creative contribution, Homes pointed out that our security mechanisms are biologically programmed and do not need to reach consciousness to be activated, and that these mechanisms, shaped by early attachments, provide for a “sychological immune system.”  Holmes (2002) contended,

“Just as a tropical diseases expert needs to be immunized against the organisms she is likely to encounter, so personal therapy for therapists can be seen as an immunization process, not just to protect them and their patients from themselves, but also to extend the range of experience that therapists can then draw on in working with clients.  (p. 4)”

in schore/ar/56

THESE WORDS BELOW ARE JUST ABOUT THE SAME FOR PARENTS AS THEY ARE FOR THERAPISTS

“A psychoneurobiological model of the attachment communications between patient and therapist [and between parent and infant] indicates that in order to create an optimal working alliance, the therapist must access, in a timely fashion, both his/her own subjective, unconscious, intuitive, implicit responses, as well as his/her objective conscious, rational, theory-based explicit knowledge in the work (Renik, 1998).  (schore/ar/56)”

++++

“From a cognitive 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).  Recall that right– (schore/ar/56) hemispheric processes are central to implicit learning, and that psychotherapy essentially alters and expands implicit relational knowledge.  But in light of the intrinsic dyadic nature of attachment, this expansion occurs in the brain/mind/bodies of both the patient and therapist…..An attachment model grounded in both biology and psychoanalysis thus accounts for how a successful therapeutic relationship can act as an interactive affect-regulating context that optimizes the growth of two “minds in the making”; that is, increases in complexity in both the patient’s and the therapist’s continually developing unconscious right minds.  (schore/ar/57)”

So that would also mean that as parents interact with their infants in this affect-regulating context – indeed, with their children of any age (and people with people as a whole when this quality of interaction is active – that the brain/mind/body of the parent is also growing and expanding through these interactions –the continually developing unconscious right minds are increasing in complexity.

We do not think of parenting as a two-way growth opportunity.