The Science of the Art of Psychotherapy

The Science of the Art of Psychotherapy

by Allan N. Schore, PhD. W.W. Norton & Company, New York, New York, 2012, 458 pages, $45.00 (hardcover).

The Science of the Art of Psychotherapy is an updated collection of the work of Allan N. Schore, expanding the work he began in his 3 earlier books that involves affect regulation and attachment and its origin in developmental neurobiology. The book is divided into 2 sections: (1) Affect Regulation Therapy and Clinical Neuropsychoanalysis and (2) Developmental Affective Neuroscience and Developmental Neuropsychiatry.

Dr Schore has been a pioneer in writing about integrative neurobiological models of development, and this book presents a chronological rerelease of prior writings, with new editing and material. His work makes a persuasive case for including emotion processing as a critical element of psychotherapy. I would certainly second this viewpoint, and I must add that Dr Schore does not quite accurately reflect contemporary approaches to emotion in cognitive-behavioral treatments. Despite this, the text is of great value to anyone interested in the theoretical basis underlying attachment and affect regulation. Of particular interest to psychotherapists is that the book explores how psychotherapists’ neurobiology may be altered as a function of the practice of psychotherapy. Dr Schore additionally makes a persuasive case for social and political changes that could address childhood maltreatment and advocates for prevention of emotional disorders by intervening in earlier stages of development; it is difficult to read parts of the book without feeling frustrated by the lack of influence scientific understanding has in forming public policy. The text will be of value to teachers who want to integrate important findings about current neuroscience into psychotherapy training. Any clinician who believes in the centrality of developmental processes regarding the understanding of adult patients will be riveted by the descriptions of the interdisciplinary data that support our theories of attachment and emotion regulation.

The first section includes 5 chapters that introduce the reader to concepts regarding the neurobiological and neurophysical correlates of attachment and the mechanisms linking attachment to affect regulation. The significance of right brain development and subsequent interpersonal functioning and, therefore, its importance in psychotherapeutic relationships is a unifying theme in these chapters. A subsequent chapter integrates findings of neuroscience with theories of self-psychology. The book then elaborates on ideas about how emotional attachments and attunement produce change in psychotherapy from a neuropsychoanalytic point of view. Many of the ideas advanced would, I believe, apply to common elements of all effective psychotherapies, although a significant amount of this work is devoted to explanations of psychoanalytic concepts via the lens of affect regulation theory. One caveat is that because this is a compilation of previously written chapters rather than a stand-alone volume, some repetition exists.

The second part comprises 7 chapters with an underlying theme of development and affect. Again, many of the central concepts in the first part are reviewed here and applied to related areas, including linking affect regulation and attachment to pediatrics and the prerequisites needed in development for optimal mental health. There is a review of attachment behaviors and stressors in elephants(!), a discussion of dissociative phenomena and attachment, and a small study of evoked potentials in borderline personality disorder. The book closes with several chapters about emotion regulation and attachment applied to wider social and cultural domains. Dr Schore makes arguments for maternal and paternal leave to decrease infant exposure to day care and bolster secure infant attachments, discusses recommendations for the assessment of mother-infant dyads, and discusses his views on family law based on attachment theory. These chapters are written with the author’s sincere conviction and may be thought-provoking or provocative depending on your theoretical orientation or political views. Nevertheless, I recommend that all psychiatrists become conversant with Dr Schore’s work. This book certainly provides a wide array of well-written chapters to sample.

Donna M. Sudak, MD

[email protected]

Author affiliation: Drexel University College of Medicine, Philadelphia, Pennsylvania.

Potential conflicts of interest: None reported.

J Clin Psychiatry 2013;74(9):e867 (doi:10.4088/JCP.13bk08680).

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