Advances in Neuropsychoanalysis, Attachment Theory, and Trauma: Implications for Self Psychology by Allan Schore 1 Advances in Neuropsychoanalysis, Attachment Theory, and Trauma: Implications for Self Psychology by Allan Schore

In 1971, Heinz Kohut, trained in neurology and then psychoanalysis, published ‘The Analysis of the Self’, a detailed exposition of the central role of the self in human existence. This classic volume of both twentieth century psychoanalysis and psychology was more than a collection of various clinical observations, rather it represented an overarching integrated theory of the development, structuralization, psychopathogenesis, and psychotherapy of disorders of the self. Although some of these ideas were elaborations of previous psychoanalytic principles, a large number of his concepts, including an emphasis on self rather than ego, signified an innovative departure from mainstream psychoanalysis and yet a truly creative addition to Freud’s theory. Kohut expanded the theoretical and clinical conceptions of self psychology in his second volume, ‘The Restoration of the Self’ (1977) and finally in ‘How Does Analysis Cure? ’ (1984). Over the course of his career he continually attempted to deepen his understanding of the four basic problems he initially addressed in his seminal volume: how do early relational affective transactions with the social environment facilitate the emergence of self? (development of the self), how are these experiences internalized into maturing self regulating structures? (structuralization of the self), how do early forming deficits of self structure lead to later self pathologies? (psychopathogenesis), and how can the therapeutic relationship lead to a restoration of self? (the mechanism of psychotherapeutic change). In this paper I want to suggest that although Kohut’s idea represent perhaps the most significant revision of classical psychoanalysis in the last 50 years, despite the fact that he was originally trained as a neurologist, he, like his contemporaries, was highly ambivalent about the incorporation of scientific data into the core of psychoanalysis and into the core of self psychology. Although there have been certain notable exceptions, this ambivalence still exists within current self psychology, even now when an interdisciplinary perspective is rapidly emerging in a number of other clinical and scientific disciplines that border psychoanalysis. In an earlier work I suggested that the time is right for a rapprochement between psychoanalysis, the study of the unconscious mind, and the biological sciences (Schore, 1997c). Developmental psychoanalysis is currently generating a complex model of the early ontogeny of the biological substrate of the human unconscious (Schore, 2003a), one that can potentially bridge the relational and intrapsychic realms of the unconscious mind. And neuropsychoanalysis is also contributing to this effort, by identifying the brain systems involved in the development of the dynamic unconscious (Schore, 2002a). Writing in the neuropsychoanalytic literature, Watt (2000) describes the critical importance of recent work on ‘(neuro) development’: “In many ways, this is the great frontier in neuroscience where all of our theories will be subject to the most acid of acid tests. And many of them I suspect will be found wanting. Clearly, affective processes, and specifically the vicissitudes of attachment, are primary drivers in neural development (the very milieu in which development takes place, within which the system cannot develop)” (p. 191). In the following I will first present a brief overview of Kohut’s concepts that represent the core of self psychology. In subsequent sections I integrate interdisciplinary data in order to construct a psychoneurobiological conception of the development and structuralization of the self, focusing on the experience-dependent maturation of the early developing right brain. Then, in a major focus of this work, I apply this developmental neuropsychoanalytic perspective to the psychopathogenesis of severe deficits in the self system. In particular, I articulate a model of the self psychology and neurobiology of infant trauma and the etiology of posttraumatic stress disorder and borderline states. And finally I will offer thoughts on the neurobiology of regulatory structures that result from psychotherapeutic change.