Written by Allan N. Score

The hottest topics in psychotherapy

Review by Gunnel Minett

The research presented in this book has the potential to cause a paradigm shift in psychotherapy. Allan Schore, a leader in the field of neuropsychology based psychotherapy, presents a number of ground-breaking ideas; Affect Regulation Therapy (ART), attachment, developmental neuroscience, trauma and the developing brain. It represents a wide and representative overview of regulation therapy and its

clinical models of development and psychopathogenesis. In particular he points to the wide-ranging applications for the theory of an interpersonal neurobiological model of emotional and social development.

This new approach, which draws on a combination of (evolutionary) psychology and neurobiology, offers clear evidence that for psychotherapy to have a lasting impact it needs to include ‘right brain to right brain’ contact between therapist and client. As Schore points out, with new technology and unobtrusive brain scanning methods it has been possible to probe much further into how problems occur and consequently the effects of various forms of psychotherapy. In particular it has been possible to explore and understand the role of the right brain phase in a child’s early development. Schore explains the role of the developing right brain in attachment and trauma, infant attachment and psychotherapeutic change.

The right brain is so important in psychotherapy because it plays a dominant role during the first two years of life, in forming the brain’s development. It is particularly sensitive to difficulties arising from interaction with carers and environment. Problems during this period are often the cause of deeply rooted physical and psychological difficulties later in life. To assist the client in a healing process, the therapist will need to find ways to access and work with these non-verbal right brain issues. Trust and honesty are essential concepts in this process. Contrary to previous belief, this form of deep involvement means that the therapist too will be experiencing brain, mind and body changes.

This requires a change in the approach of many forms of therapy, not least cognitive therapies. According to Schore, the verbal approach is no longer sufficient in itself. From being the core of many techniques, it is now seen as merely a ‘way into’ the core of the therapeutic process. This opens up new exiting possibilities for body oriented therapies such as, for instance, Breathwork. This already has abundant anecdotal evidence that simply altering the breathing pattern may create deep changes in the client’s mind. At the same time it confirms the need for a more structured professional approach to such powerful techniques to avoid replacing one problem with another.

Another and even more important aspect of this book is its emphasis on giving children the best possible start in life. Schore quotes himself from his previous book “Relational trauma in infancy” (Routledge, 2001) to summarize his views on this topic: “[T]he earliest stages of humanhood are critical because they contain within them the representation of our possible futures – they model the potential developmental extension of our individual and collective social identities… When and where shall we place our current resources so as to optimize the future of human societies… How much should we value the very beginnings of human life, in tangible social program dollars?” (p 4)

Given that many problems children are experiencing in today’s Western societies are reaching epidemic proportions, the issue of where to focus resources is a really hot topic. It is not just that psychological problems, including eating disorders, addiction, and aggression (often leading to criminal behaviour), are spiralling out of control in children and teenagers. A poor start in life often makes people more prone to having medical problems later in life. Jus how deeply our lives are affected by early childhood experience is still not known. But the more that this area is researched, the more connections are made between childhood and adult problems. Exactly how much this is costing societies is also unknown but judging by the huge amounts of tax payers’ money spent on healthcare, this should be top priority for politicians everywhere.

But more important than the money, is the fact that many adults problems could have been avoided if their parents had had help and assistance to give them a better start in life. It is all well and positive that psychotherapists learn how to help their clients towards a better life. But that will always be a second best to prevention, and we now know a lot about how to apply this prevention.

A frightening aspect is that parenting is a learnt behaviour. Children growing up without proper parenting will struggle to offer their own children a good start in life. If we add to this the fact that children with ADHD and other learning difficulties (often treated with mind altering drugs rather than appropriate parenting) may struggle to get a basic education, we can see a downward spiral which is intensifying rapidly.

There is only one negative aspect of this very important book. It is clearly addressed to academics when it really needs to be made available to all – from politicians to parents and all other adults who can help children to a better life. We really owe it to our future generations to at least try our best and with men like Allan Schore we can no longer blame ignorance for not doing more.


W.W, Norton, London, 2012, http://www.wwnorton.com