Affect Regulation and the Repair of the Self and Affect Dysregulation and Disorders of the Self (Book Review)

Author:  Schore, Allan N.
Publisher:  New York: W.W. Norton & Company, 2003
Reviewed By:  Mary E. Pharis, Spring 2004, pp. 33-34

In 1994, the Austin Society for Psychoanalytic Psychology selected “Affect “ as the subject for our yearlong study, and I was to present the first paper of the year, on the topic “The Development of Affect.” After I had done what I thought was a careful literature review, I found myself uneasy to say the least. The theory and the research did not seem to hang together, and the various writers all seemed to be coming at the topic from dozens of different directions. Each time I sat down to write, I found myself quite unsure that I could offer our members a coherent, comprehensive and useful overview of the topic.

Then, two weeks before I was to give my talk, I discovered Allan Schore’s newly published book, Affect Regulation and the Development of the Self: The Neurobiology of Emotional Development (1994). I cannot tell you how utterly thrilled I was as I began to read it! I not only devoured the book, I put together a chapter-by-chapter synopsis and extracted quotes which ran to 14 pages of single spaced small font type, to assist the other speakers on the topic of “Affect” who were to follow me in that 1994-1995 year of presentations. Not only that, I called and left Allan Schore a long phone message expressing my delight with his book and my gratitude for the monumental service he had done the profession by pulling together such an incredibly complex body of information and creating the first meaningful comprehensive framework to integrate and interpret all the previous literature on the topic. When I met him later in person for the first time at the Denver Division 39 Annual Meeting in 1997, he told me my call had been the very first feedback of any sort that he had received after the publications of his book, and it had pleased and encouraged him very much.

Since that time, if you were determined to keep up with the development of Schore’s thinking over the last ten years, you would have had to read his more than 50 publications in numerous books and such disparate journals as the Infant Mental Health Journal, Journal of the American Psychoanalytic Association, Development and Psychopathology, Neuro-Psychoanalysis, Australian & New Zealand Journal of Psychiatry, and his excellent contributions to our own Psychologist-Psychoanalyst. And if you were a real Allan Schore groupie, you could also have trailed him around the world as he gave keynote speeches and invited presentations at the Tavistock Clinic and the Anna Freud Clinic in London; the World Health Organization in Luxembourg; at national conferences in Australia; and at many other distinguished settings throughout the U.S. and Canada.

We should be grateful that Dr. Schore has now made it much easier for us to keep up with him by means of the publication of these two volumes. Much of his work over the last decade is reproduced in this newly edited pair of books. Together they contain 17 chapters, five of which are versions of chapters previously published in edited books, and ten of which previously appeared in some form in various journals; only two chapters and one extraordinary Appendix appear to have been produced specifically for this set. Given that Schore has written or presented an average of almost 6 major speeches, chapters and/or articles each year over the last decade, yielding a corpus of over 60 citations in that period of time, his selection of these 17 chapters surely must identify those he sees as his most important contributions.

If you are not familiar with these important contributions, these are the books to buy: they are all here. Inevitably, when an author assembles a compilation of his or her work in a particular area of science, especially if that work is detailed and extensive, there is likely to be a fair amount of overlap and repetition, and that is true of many of the chapters in these two books. But because the research that Schore surveys is extensive and sophisticated, and because at times his writing can be complex and convoluted, the repetition of points and his variations on the central themes might prove more helpful and clarifying than frustrating to many readers, especially those new to his thinking. If you are already thoroughly familiar with Schore’s main concepts, however, such as those pertaining to the neurobiology of emotional development; the effects of trauma on right brain development, affect regulation, and infant mental health; or the early organization of the nonlinear right brain and the development of predispositions to psychiatric disorders, then you may find yourself flipping through quite a number of pages as he reiterates his central themes.

But even if you are thoroughly familiar with Shore’s ideas, I suspect you will want to slow down and carefully study both a new chapter and an impressive Appendix in the second volume, Affect Regulation and the Repair of the Self. I believe they show that Schore is moving closer than ever before to specifying how his ideas translate into principles for the clinical practice of psychoanalysis or psychotherapy. The chapter is titled “Clinical Implications of a Psychoneurobiological Model of Projective Identification,” and the 3-page Appendix lists 20 succinct “Principles of the Psychotherapeutic Treatment of Early-Forming Right Hemispheric Self Pathologies Based Upon the Developmental Models of Schore’s Regulation Theory.”

In his chapter on projective identification, Shore writes, “Current developmental models thus emphasize the fact that projective identification, both in the developmental and the therapeutic situation, is not a unidirectional but instead is a bidirectional process in which both members of an emotionally communicating dyad act in a context of mutual reciprocal influence” (2003b, p. 65). He also specifies his agreement with Klein’s belief that projective identification is not confined to the transmission of negative spectrum psychic states or emotions from one person to another, but commonly is a process that “also involves the projection of a much-valued part of the self into another” (p. 64). Clearly, Schore sees projective identification as one form of the right-brain-to-right-brain communication he has outlined so carefully in his prior work. He states explicitly,

“Thus, in the clinical context, although it appears to be an invisible, instantaneous, endogenous unidirectional phenomenon, the bidirectional process of projective identification is actually a very rapid sequence of reciprocal affective transactions within the intersubjective field that is co-constructed by the patient and therapist” (p. 73). The logical implication for clinicians, of course, is that we must learn to focus just as intensely (Schore might say more intensely) on what our patients’ and our own bodies are telling us, via right brain channels, as we have always tried to do with the intellectual and verbal transmissions that flow between us via left brain channels.

I confess that when I first saw the inclusion of the phrase “…And the Repair of the Self” in the title of the second of these books, I hoped to find that Schore had devoted the entire book to the application of his ideas to various everyday clinical issues and dilemmas. But it is primarily in the final three pages of the second book that he moves in the direction of making explicit the implications of his studies to the day-to-day practice of psychoanalysis or psychotherapy. He says, for example, that good therapy must focus heavily on “dysregulated right brain ’primitive affects’—such as shame, disgust, elation, excitement, terror, rage, and hopeless despair …rather than the analysis of unconscious resistance and disavowal of repressed affect” (p. 280), and he suggests that we revise our understanding of defense mechanisms to see them as “nonconscious strategies of emotional regulation for avoiding, minimizing, or converting affects that are too difficult to handle” (p. 280). It seems to me that if we are to take his Principles seriously, the thrust of our training of analysts and therapist, even our selection of candidates for training, would necessarily shift dramatically. My guess is that Schore would have our graduate programs focus much more heavily on selecting candidates who give indications that they are aware of and comfortable with emotional transactions of all sorts, particularly those in the negative spectrum. And while most graduate training programs in all professional fields of therapy place heavy emphasis on mastery of a huge body of academic material, and the national qualifying exams test for mastery of that material, Schore would undoubtedly want to find ways of teaching and testing the fledgling therapist’s abilities to connect with patients empathically and ”read” their own and the patient’s unconscious, body-based communications with as much skill as they process the patient’s verbal flow. I find myself hoping that Schore’s next book will directly address the monumental graduate training and internship transformations that would be required.

Reviewer Note

Mary Pharis is a Div. 39 member, a past president of the Austin Society for Psychoanalytic Psychology and retired from the University of Texas at Austin where she was the Willoughby Centennial Fellow in Child Welfare.

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