Right Hemisphere Brain Activity & The Dao of Psychotherapy
The following article follows my recent reading of Psychologist Allan Schore’s Right Brain Psychotherapy, the thesis of which could be summed up in Schore’s succinct and forthright statement: “The right brain is dominant in psychotherapy”. This article reviews some of the main implications of recent neuroscientific findings on the function of the right brain as they relate to the creative interchange between client and therapist and its effect on neuroplasticity and attachment-related trauma. I have also included commentary on Schore’s extrapolations of his philosophy to the sociopolitical sphere and my observations about the bihemispheric approach to psychotherapy.
Allan Schore is a lover. He not only reminds us of the softer side of the psychological healing arts but also elevates his discussion with evidence from the hard neuroscience of the brain. Schore’s Right Brain Psychotherapy and associated Regulation Theory contribute to psychotherapy’s efforts to prove and improve itself and go beyond the mechanical cognitive-based therapeutic modalities to include creative intuition, maternal warmth, and interpersonal healing.
If you have had the experience of truly connecting with a therapist (or as a therapist, with your client) you will resonate (pun intended, stay tuned), with Schore’s materialist explanation of this very connectivity — the uncanny experience of one-mindedness that occurs between client and therapist. And if you have ever experienced long-term healing resulting from the honesty and vulnerability of a supportive human in any context, you will no doubt appreciate Schore’s explanation of the neurobiology that supports this interpersonal phenomenon.
Must Psychotherapy Be Evidence-based?
Over the past few decades, psychotherapy has fought to be included in evidence-based clinical practices backed by the medical and scientific community. As a result, psychotherapy has been elevated beyond just the spiritual care of an individual in psychological distress, to a legitimate part of the health and wellness routine of the modern secularist. Paradoxically, modern intellectual trends away from the whiggishness of the scientific method could reduce the necessity for legitimizing the healing arts. But at the moment, many still feel comforted by the paternalistic protection of the medico-scientific institution and its efforts to delineate evidence-based approaches to psychological healing from the pseudoscientific.
The statement that a psychotherapeutic modality is evidence-based often speaks to the clinical effectiveness of a practice as evidenced by subjective self-report measures of improved psychological well-being or interpersonal and social functioning. That is to say, the research suggests that an evidence-based therapeutic approach actually makes people feel better. This contributes to the secular-minded client’s willingness to be vulnerable with a clinical practitioner and open up their inner world to them. Formalizing therapeutic modalities also provides a framework for educating them in licensed practitioners. Of course, before the era of Western science and the medical establishment’s requirement of providing proof of efficacy, interpersonal healing practices found their place in society in the form of religious rites, meditative practices, supernatural and mystical ceremonies, and the application of mind-altering natural substances.
However, for the materialist who seeks to understand not only that a psychotherapeutic modality works but also how it is effective at the organismic level, the kind of evidence base mentioned above only goes so far. It may suffice for the medical community and the layperson who needs to be reassured that a mode of psychological treatment actually works. But from the biological and neuroscientific perspective, asserting that a modality is clinically effective does little to explain the biological basis for the efficacy of the treatment.
Enter the neuroscience of psychotherapy. Much of my writing in this space attempts to explore how we can harden up psychotherapy to understand more thoroughly what happens to the brain and body as healing occurs. This starts with understanding what happens to the brain in psychopathology (depression, anxiety, bipolar disorders, delusions, troublesome ideation, etc.), then what occurs when these disorders are resolved, and finally how these neurological mechanisms can be operationalized by psychotherapists. A clearer understanding of how a clinician’s interactions with a client impact their brain, not only holistically but with dialectical and neurological specificity, will allow us to create therapeutic modalities that target both the global neurobiological markers of a diagnosed disorder and their constituent components at the electrical and chemical level.
In sum, as the evidence base for psychotherapy moves beyond the clinical to the neuroscientific, it could take a metaphysical jump from the treatment of the mind to the treatment of the brain and mature into the targetted treatment of specific neurobiological regions, processes, and wounds.
Allan Schore’s unique brand of neuroscience-based psychoanalysis provides a piece of the puzzle in understanding the connection between talk therapy and brain changes.
Right Brain Psychotherapy & Regulation Theory
Allan Schore is a psychoanalyst. As I mentioned in my previous article about Canadian neuroscientist Georg Northoff, psychoanalysis is more than an outdated therapeutic modality crumbling under the scrutiny of modern social politics as it is often made out to be. Psychoanalysis is a sophisticated conceptual approach to understanding the dynamic human mind, elements of which can be used as a commensurate language to connect psychology and the material of the brain. Schore’s work connects interpersonal mechanisms from psychoanalysis with neuroscientific findings about neurobiological processes within the right hemisphere of the brain.
Is there a difference between the right and left brain?
Let’s face it: popular neuroscience confuses us about the bilaterality of the brain. On the one hand, we are told not to peg folks as right or left-brainers and that the situation is far more nuanced. At the same time, research indicates that bilateral shifts of hemispheric dominance in the brain can occur and that certain affective and specific cognitive components of consciousness can be located within the right or left hemisphere.
Schore is not alone in asserting that imbalances in hemispheric activity can result in psychological disorders. For example, what is often referred to as negative affect (sadness, guilt, fear, and depression) is seated in the right brain. Additionally, linguistic processes, intellectual cognition, and perception of social propriety occur more dominantly in the left brain. As a result, conclusions can be drawn about the necessity to increase interhemispheric neuroplasticity in the brains of individuals with intense bipolar experiences (extremes of positively valenced intellectual thought and depressive emotion) such that moderation can occur between the two modes of cognition.
So, I request that my dear reader suspend their criticism of hemispheric differences in brain functioning to follow the theoretical line of thought that supports Schore’s Right Brain Psychotherapy.
Significantly, Schore suggests that neural restructuring in the right brain can bring improvements in mental wellness not only in the short term but also that such restructuring can have a compounding effect over time as if the kernel of psychotherapeutic repair can spiral outward into future iterations of neurobiological and psychological development across the lifespan. This claim could shift the mental health field’s perspective considerably. Treating human suffering would no longer be a matter of altering brain chemistry with psychoactive compounds (psychopharmacology) nor of teaching people better ways of thinking (cognitive therapy such as CBT) but of using the therapist’s brain to effect a restructuring in the client’s such that a cascade of events occur that perpetuate healthful neurological development even after therapy has concluded.
Let’s dig in.
Key Themes
The following provides some key concepts from Right Brain Psychotherapy and Regulation Theory and how they help us understand the brain and the healing process. (By the way, Regulation Theory is the conceptual framework upon which Schore bases his psychotherapeutic modality. It encompasses the idea that when right brain synchrony occurs between client and therapist, the therapist’s brain becomes an extension of the regulatory apparatus of the client’s brain when the latter is overcome by intense affect. The clinician’s ability to regulate affect in the therapeutic chamber creates an environment wherein the client’s brain can strengthen its ability to regulate emotional overwhelm unilaterally).
Mutual Regressions in the Service of the Self
Regression is a psychoanalytic term that refers to an individual’s reverting to an earlier form of psychological functioning. Regression can be pathological, like when an individual under extreme stress begins acting in a way that is not developmentally appropriate for the interpersonal situation. Or it can be healthy like when you cast off your social inhibitions when appropriate such as in play (think dancing like a child at a party, acting like a hooligan in a sporting arena, laughing at crude humor in a comedy club) or sex, and then return unscathed to your normal form of developmentally appropriate social functioning.
Regression can also be operationalized, as in psychoanalysis. In the confidentiality of the therapy room, an individual can regress to an immature state, be brought back delicately to the present by the clinician, and go about their day as normal with new insights about themself. This process allows a reintegration of the earlier states of functioning that were repressed from consciousness.
So what makes it a mutual regression?
Essentially, the trained therapist (through the processes of transference and countertransference) regresses with the client — they can “go there” and come back with the client. The therapist’s brain has (to varying degrees of course) mastered the neurobiological art of regressing into right brain affective intensity and returning to a regulated state. This requires that the therapist’s brain is organismically developed and can maintain intense affective states without becoming overwhelmed or resorting to defense mechanisms — not even those provided by their professional clinical persona or the technicalities of their modality.
The mature therapist knows their traumatic trigger points. They can tolerate intense emotional states within themselves. They can surrender control of the room to the emotional intensity of the client. And then they can bring it back.
Right Brain Synchronicity & The Interpersonal Subjective Field
If the client and therapist regress successfully, they enter a state of right-brain synchronicity. From the perspective of the therapist, this is a flow-like state outside of phenomenological consciousness. Research from fMRI scans shows that, in these therapeutically aligned moments, the hemispheric domination of the brain changes in both client and therapist. The left brain, with its propensity for categorizing and differentiating, essentially goes offline and a dyadic subjective field is created. It should be noted that while simultaneous right brain dominance can be seen clearly in an fMRI during this phenomenon, no hard science is provided as evidence of a shared subjectivity that occurs between the client and therapist. (It appears that we may not yet possess the technology or perhaps have not asked the right questions of our brain scanners yet to demonstrate this). Experienced therapists relate to the felt experience of this phenomenon and may even use psychological mechanisms of their own to enter this state when performing their work. In Right Brain Psychotherapy, Schore does not explain how a clinician can affect this neurological state.
Here’s what Schore says about right brain synchronicity in the therapy room:
“The psychobiologically attuned intuitive clinician tracks the non-verbal moment-to-moment rhythmic structures of the patient’s internal states and is flexibly and fluidly modifying his or her own behavior to synchronize with that structure, thereby co-creating with the client a growth-facilitating context for the organization of the therapeutic alliance” .
There could be a disruption in the right brain synchronicity if therapeutic trust is broken. If this occurs the cyclical rupture and repair of synchronicity between client and therapist correspond to pivotal moments of neurological reorganization and synaptic restructuring.
Increased Affect Tolerance & Regulation
There is something about the term “Regulation Theory” that is off-putting. I get the same tummy twitch when I read about William Glasser’s “Control Theory”. Perhaps it is the all-too-common fear that the therapist is an extension of the regulatory mechanisms of our social infrastructure (a position that I fear some counselors actually absorb into their professional self-concept at times, particularly when treating minors). Clients must feel safe in the therapy room, not under threat of forced behavioral modification.
Additionally, emotional regulation is often required in interpersonal dynamics of oppression (as in employment situations) even to the extent that authentic experience becomes repressed from consciousness. But this is not that. Regulation Theory is not a behaviorist mechanism to teach self-control and conformity.
In fact, Schore differentiates between two forms of self-control. The first (more traditional sense) involves higher cognitive left-brain process. As in situations of enforced compliance, mechanics of authority and power are used to encourage behaviors that in time may alter the attitudes that underpin them. A benign example of this would be an individual’s begrudgingly following the directive to exercise three times a week only to find out 2 months later that they enjoy the practice.
Again, this is not that.
Regulation Theory is about training the brain to “regulate” intense emotional experiences. Previously denied emotional content finds space in the intersubjective field facilitated by the therapist such that the client develops the ability to tolerate ever-increasing intensity of emotion. The client develops their own adaptive psychological processes to regulate their emotional experience both in isolation and interpersonally, by leveraging a trusted relationship to assist regulating emotional overwhelm.
The therapist mimics a mother’s work. As an infant develops, it gradually experiences heightened levels of excitement, sadness, anger, and fear, and returns each time to the safety of the mother. Each time the child returns to the mother, right brains resynchronize and the child develops the neurological mechanisms to tolerate ever-increasing levels of emotional intensity. In healthy development, this results in a well-developed sense of self and resiliency, in contrast to a highly restricted self that relies heavily on socially maladaptive defense mechanisms that disallow emotional experience. At its mildest, maladaptive regulation manifests as an individual lacking emotional awareness — at its worst, diagnosable personality disorder. In a sense, the therapist facilitates the maternal titration of negative affect in the client and the healthy development of the regulation process.
The goal of right brain psychotherapy is to create a “growth-facilitating relational environment” that stimulates plasticity in the cortical and subcortical regions of the right brain. At the neurochemical level, this relational state is marked by increased levels of oxytocin as would be the case in the mother-child dyad. By recreating the optimal environment for neurogenesis in the therapy room, the therapist can assist the client in changing their brain (in a very material sense), repairing traumatic disruptions in interpersonal attachment and their neural correlates in the physical structure of the brain.
What is Love?
Allan Schore takes the psychoanalysts (and by extension the attachment theorist’s) approach to defining love. A mother’s love has long been praised by the poets. Conversely, there is no greater act of violence than a mother’s neglect. The absence of maternal bonding has been linked to psychological distress in adulthood, a reminder of the importance of maternal bonding and attachment in the crucial years of infant brain development for long-term emotional regulation and well-being across the lifespan.
Schore describes maternal love of the infant as the expansion and tolerance of two positively valenced emotions — quiet love and excitatory love. The mother enables the child’s brain to gradually increase its ability to regulate itself in the face excitation. Excitation, although usually considered pleasant, can lead to overwhelm if not regulated. This is the case in the positively valenced excitatory nature of mania. When the infant’s brain is overwhelmed by excitement, it is brought back to the safety of quiet love by the mother. The mother intuitively performs this regulatory dance of positive affect in her dealings with the child — with corresponding development in the child’s brain.
Love in the therapy room can be framed along these lines, absent the erotic power dynamics of the left brain. This aligns with the Rogerian approach to counseling that prescribes universal positive regard for the client. Like the good enough mother’s unequivocal love and unquestionable loyalty to her child, the therapist remains warm and accepting of the client regardless of any emotional outbursts or emotion-laden language from the client. The rupture and maintenance of the therapeutic bond mimic the exploration and return of the child to the mother’s universal acceptance and allow the client to enhance their psychological maturity and neurobiological health over time.
Bi-hemispheric Psychotherapy
Schore feels that too much emphasis has been placed on left-hemisphere cognitively dominated modalities. I agree. I would add to Schore’s thesis the emphasis that has been placed in recent years on post-modern, post-structural, and feminist modalities that emphasize power dynamics in relationships and how they interact with psychological functioning at the individual level. These theories leverage linguistics and cognition over the real-time interactive emotional dynamics of Right Brain Psychotherapy. Although the overanalysis of attachment styles in the therapy room is common today, these are discussed conceptually with very little acknowledgment by the therapist of their role in healing relational trauma at the organismic level.
Schore argues that right-brain-focused therapy is superior because of its focus on the neurological healing of attachment wounds. As a result, change occurs even after therapy concludes in future-forward cycles of neurological growth. Schore contrasts this to cognitive therapies, the downward causality of which must be reinforced regularly so that relapse into old behaviors does not occur. This is a compelling argument for the superiority of right-brain neuropsychoanalysis, although I have not yet seen the neuroscientific research supporting such a claim.
Schore loses me a bit in the final chapters of Right Brain Psychotherapy. In his passion for presenting a new modality that holds promise for healing at the neurological and relational levels, Schore goes so far as to extrapolate his ideology of right-brain superiority to the sociopolitical arena. (It appears to be a tendency of science writers who become excited about new potentials for healing to leap from the individual to the collective level. In my readings of The Myth of Normal by Gabor Mate and On Becoming a Person by the great Carl Rogers, I noticed both authors fall into the trap of attempting to extend their clinical theories to the social sphere).
Schore bemoans a dirth of right hemispheric dominance in our current sociopolitical environment. But, “What the world needs now is right brain dominance, sweet right brain dominance”, feels altogether too reductive.
Therapists tend to forget that their role is inherently one of conflict with higher strata of the socioecology. Society at large — its oppressive infrastructures, hegemonic ideologies, and restrictive norms — are the very elements of the collective social ecology that rub up against an individual’s unique sense of self such that psychological distress occurs. It is short-sighted for therapeutic practitioners to believe that their art could contribute to any permanent social change. If such a change were to occur, the therapist would soon find their approach ineffective as it would thereafter (post-revolution) reinforce the very community values that would have by that time become oppressive at the individual level. In the case of hemispheric therapies, if the world became more right-brain dominated, therapists might need to switch to the cognitive left-brain modes of healing to “bring balance to the force”.
Perhaps it would be more modest to focus on neuroplasticity across both hemispheres of the brain. The therapist may need to use a bi-hemispheric approach to therapy, leveraging not only the intersubjective field of Shorre’s right brain therapy but also cognitively-focused therapies that harness the strengths of left hemispheric processes. As right-brain psychotherapy increases the client’s tolerance for affective intensity, could a left hemispheric intersubjective field could increase intellectual, cognitive, and linguistic capabilities with application to interpersonal gameplay and power dynamics? If this were the case, a psychologically mature individual would experience developmentally appropriate extremes of right and left brain cognition, complemented with regulatory abilities in the contrasting hemisphere.
Psychobiological health would correlate to neuroplasticity across the corpus callosum in an alternating right-to-left shift in hemispheric dominance balanced by a simultaneous suspension of the contrasting mode of processing in the opposite hemisphere. Neuronal activity would move fluidly across brain hemispheres like the waves of the yin-yang, never losing the dot of contrast at their center that regulates each wave, moderating it and turning it back upon itself.
References:
Corballis MC. Left brain, right brain: facts and fantasies. PLoS Biol. 2014 Jan;12(1):e1001767. doi: 10.1371/journal.pbio.1001767. Epub 2014 Jan 21. PMID: 24465175; PMCID: PMC3897366.
Deng, K., Qi, T., Xu, J., Jiang, L., Zhang, F., Dai, N., … & Xu, X. (2019). Reduced interhemispheric functional connectivity in obsessive–compulsive disorder patients. Frontiers in Psychiatry, 10, 418.
Schore, Allan N. Right brain psychotherapy (Norton series on interpersonal neurobiology). WW Norton & Company, 2019.
