ORBITOFRONTAL notes

From schore/ar – chap 2 part 2

++ the same “neocortical network” that “modulates the limbic system” is the right-lateralized orbitofrontal system that regulates attachment dynamics.

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

++ right brain is centrally involved in unconscious activities

++ right brain-to-right-brain system — right-hemisphere-to-right-hemisphere — is spontaneous emotional communication

++ the right nonverbally communicates its unconscious states to other right brains that are tuned to receive these communications….

++ right brain process lies at the heart of the nonverbal relational communications/interactions between the infancy-traumatized individual and the recipient listener

++ take place at preconscious-unconscious levels

++ fast-acting, automatic, regulated, and dysregulated emotional states between the recipient listener and the infancy-traumatized individual

++ are carried out at an implicit level of rapid cueing and response

++ occur too rapidly for simultaneous verbal translation and conscious reflection

++ right hemisphere is dominant for the perception of the emotional states of others…”

++ because right-posterior-cortical mechanism are involved in the perception of nonverbal expression embedded in facial and prosodic stimuli

++ fleeting facial expressions  act as indicators of intersubjective processes

++ These cues are nonconsciously appraised from movements occurring primarily in the regions around the eyes and from prosodic expressions from the mouth

++ also dominant for “subjective emotional experiences”

++ and for the detection of subjective objects

++   when the recipient listening participant has “evenly suspended attention.”

++  when the recipient is in the equivalent of a “reverie” or “dream state alpha,” clearly implying a right-brain state.

++ “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.

++ transference:  “the redirection of feelings and desires and esp. of those unconsciously retained from childhood toward a new object (as a psychoanalyst conducting therapy)”

++ countertransference:  “the psychotherapist’s reactions to the patient’s transference – the complex of feelings of a psychotherapist toward the patient”

++  when the self object seeking dimension is in the foreground, the recipient listener must resonate at the deepest layers of his/her personality to be sufficiently available to the infancy-traumatized individual’s developmental and self-regulatory needs.

++ a state of resonance exits when the recipient listener’s subjectivity is empathically attuned to the infancy-traumatized individual’s inner state (one that may be unconscious to the infancy-traumatized individual), and this resonance then interactively amplifies, in both intensity and duration, the affective state in both members of the dyad.

++  “moments of meeting” between the infancy-traumatized individual and the recipient listener occur when there are matched specificities between two systems in resonance, attuned to each other

++ Resonance phenomena are now thought to play one of the most important roles in brain organization and in central nervous system (CNS) regulatory processes

++ Although this principle is usually applied to the synchronization of processes within different parts of a whole brain

++ it also describes the resonance phenomena that occurs between the two right brains of the psychobiologically attuned mother-infant dyad.

++ 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. (Schore/ar/51)”

++ Empathic resonance results from dyadic attunement, and its [sic] induces a synchronization of patterns of activation of both right hemispheres of 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 at levels beneath awareness.

++  the two right-brain systems that process unconscious attachment-related information within the coconstructed intersubjective field of the infancy-traumatized individual and the recipient listener 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.

++  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)”

++  In therapy, during the “treatment” process, the empathic recipient listener is consciously attending to the infancy-traumatized individual’s verbalizations in order to objectively diagnose and rationalize the infancy-traumatized individual’s dysregulating symptomatology.

++ But he/she is also listening and interacting at another level, an experience-near subjective level, one that processes socioemotional information at levels beneath awareness.  (schore/ar/52)”

++  the empathically immersed recipient listener is attuned to the continuous flow and shifts in the infancy-traumatized individual’s feelings and experiences.

++ His/her “oscillating attentiveness” is focused on “barely perceptible cues that signal a change in state” (Sander, 1992), in both the infancy-traumatized individual and the recipient listener, and on “nonverbal behaviors and shifts in affects” (McLaughlin, 1996).

++ The attuned, intuitive recipient listener, from the first point of contact, is learning the nonverbal moment-to-moment rhythmic structures of the infancy-traumatized individual’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 therapeutic alliance.  (schore/ar/52)”

++++

++ learning research on the importance of the implicit perception of affective information…

++ in order for implicit affective learning to take place, the infancy-traumatized individual must have a vivid affective experience of the recipient listener

++ involvement of the right hemisphere in implicit learning” and “nonverbal processes” and the “orbitofrontal system in implicit processing” and procedural or “emotion-related learning.”

++++

++ alterations in 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, which can alter attachment patterns, must involve unconscious right-brain limbic learning.  (schore/ar/53)”

++ But a dyadic-transactional perspective entails not only more closely examining the infancy-traumatized individual’s emotion dynamics, but also bringing the recipient listener’s emotions and personality structure more into the picture.

++ During a therapeutic affective encounter, the recipient listener is describing his/her psychobiological state of mind and the countertransference impressions made upon it by the infancy-traumatized individual’s unconscious transference communications.

++ These are expressed in clinical heightened affective moments when the infancy-traumatized individual’s internal working models are accessed, thereby revealing their fundamental transferential modes and coping strategies of affect regulation (schore, 1997c). (schore/ar/53)”

++++

++ attachment is fundamentally the right-brain regulation of biological synchronicity between organisms

++ the empathic recipient listener’s resonant synchronization to the infancy-traumatized individual’s activated unconscious internal working model triggers, in the recipient listener, the procedural processing of his/her autonomic visceral responses to the infancy-traumatized individual’s nonverbal, nonconscious communications.

++ In rupture and repair transactions, the recipient listener also utilizes his/her autoregulatory capacities to modulate and contain the stressful negative state induced in him/her by the infancy-traumatized individual’s communications of dysregulated negative affect.

++++

++ dysregulating right-brain states cause disorganization of left-brain language capacities

++  The psychobiologically attuned the recipient listener can act as an interactive affect regulator of the infancy-traumatized individual’s dysregulated state

++ the recipient listener can engage and therefore regulate the infancy-traumatized individual’s inefficient right-brain processes with their own right brains.

++ the most effective interpretations are therefore based on the recipient listener’s “awareness of his/her own physical, emotional, and ideational responses to B’s veiled messages “

++ the infancy-traumatized individual can use the most “correct understandings” given by the recipient listener only if the recipient listener is attuned to the infancy-traumatized individual’s state at the time the interpretation is offered

++ physical containment by the recipient listener of the infancy-traumatized individual’s disavowed experience needs to precede its verbal processing

++ 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.

++ the infancy-traumatized individual is enabled to begin to verbally label the affective experience only after their state has been interactively regulated

++ In a “genuine dialogue” with the recipient listener, the infancy-traumatized individual 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 infancy-traumatized individual must experience this verbal description of an internal state as heard, felt, and witnessed by an empathic other.

++ In this manner the emotionally responsive aspects of the recipient listener’s interventions are transformative for the infancy-traumatized individual.

++ This is an interactive context that supports a corrective emotional experience

++ This affectively focused “therapeutic” experience may literally alter the orbito-frontal system, turning “raw feelings into symbols.”

++ 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

++ 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”

++ the infancy-traumatized individual 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.

++ “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, 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 of affective states and on rhythms of attunement, misattunement, and reattunement within therapeutic dyad 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 recipient listener and the infancy-traumatized individual are mediated by the transactions of the nonverbal transference-countertransference. (schore/ar/55)”

++ Brown asserted that the process of emotional development, as it continues in adulthood, 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)”

++ 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 and premorbid attachment pattern,

++ over long-term treatment this neurobiological development may mediate an expansion of the infancy-traumatized individual’s unconscious right mind and the transformation of an insecure into an “earned secure” attachment (Phelps, Belsky, & Crnic, 1998).  (schore/ar/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 therapeutic relationship.  The recipient listener’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 infancy-traumatized individual’s shifting internal psychobiological states.

++ Cycles of organization, disorganization, and reorganization of the intersubjective field occur repeatedly in the treatment process.

++ Intersubjectivity is the interactive “transfer of affect” between the right brains of the members of the mother-infant and therapeutic dyads

++ 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)”

“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 “psychological 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

“A psychoneurobiological model of the attachment communications between the infancy-traumatized individual and the recipient listener indicates that in order to create an optimal working alliance, the recipient listener 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

++ 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”

++  Recall that right-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 infancy-traumatized individual and the recipient listener

++ 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 infancy-traumatized individual’s and the recipient listener’s continually developing unconscious right minds.  (schore/ar/57)”