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Review Essays of Academic, Professional & Technical Books in the Humanities & Sciences


American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2004 (American Psychiatric Association) Annual reference presents eleven practice guidelines developed by the American Psychiatric Association. Each guideline offers a set of patient care strategies to help practicing physicians in their decision making. Covers:  Psychiatric Evaluation of Adults, Delirium, Alzheimer's Disease and Other Later Life Dementias, HIV/AIDS, Schizophrenia, Major Depressive Disorder, Bipolar Disorder, Panic Disorders, Eating Disorders. Borderline Personality Disorders, and  Suicidal Behavior.

American Psychiatric Association Practice Guidelines for the Treatment of Psy­chiatric Disorders: Compendium 2004 collects in one place eleven of the Amer­ican Psychiatric Association's published Practice Guidelines. This compendium, which will be periodically updated as existing guidelines are revised and new guidelines are approved, includes helpful introductory material and a cumula­tive index.

The aim of the American Psychiatric Association Practice Guidelines is to improve patient care. The Practice Guidelines provide a comprehensive synthesis of available information relevant to the clinical topic. The guidelines are vehicles for educating psychiatrists, other medical and mental health profes­sionals, and the general public about appropriate treatments. The series also identifies areas in which critical information is lacking and in which research could be expected to improve clinical decisions. The Practice Guidelines are also designed to help those charged with overseeing the utilization and reimbursement of psychiatric services to develop more scientifically based and clinically sensitive criteria. 

The American Psychiatric Publishing Textbook of Forensic Psychiatry: The Clinician's Guide edited by Robert I. Simon, Liza H. Gold (American Psychiatric Association) In this work for general clinicians working in psychiatry, Simon (psychiatry, Georgetown University School of Medicine) and Gold (Program in Psychiatry and Law, Georgetown University School of Medicine) provide basic information for discharging forensic obligations, whether required or voluntary, and for recognizing when the skills of a professional forensic specialist are necessary. Early chapters cover the legal system, starting a forensic practice, and the forensic examination. Later chapters cover civil litigation and issues in criminal justice. Chapter introductions, key points, and practice guidelines are included. Material will also be useful for experienced forensic practitioners.

Excerpt: Forensic psychiatry has become a recognized subspecialty in the prac­tice of psychiatry. The practice of forensic psychiatry dates back many years. In the nineteenth century, individuals with mental disorders were considered to be "alienated" from themselves and from society. "Alien­ists," individuals who examined and treated the mentally ill, also pro­vided testimony in legal cases involving defense or prosecution claims of mental disorders. More recently, forensic psychiatry has again begun to assume a more prominent role in the practice of medicine and psy­chiatry.

The trend in forensic psychiatry is for increasing expertise through education and fellowship training. Psychiatric residency programs today offer more courses in psychiatry and law than ever before. Some forensic training programs existed prior to the 1960s. However, such programs were not formally organized until after the founding of the American Academy of Psychiatry and the Law (AAPL), the first profes­sional organization of forensic psychiatrists, in 1969. Since that time, more than 30 accredited forensic psychiatric fellowships have been de­veloped. Board certification first became available in the 1970s through the American Board of Forensic Psychiatry. In 1992, subspecialty board certification became available through the American Board of Psychiatry and Neurology. To take the forensic subspecialty board examination, psy­chiatrists must already be board-certified in general psychiatry and com­plete a 1-year accredited fellowship.

Forensic psychiatry has become increasingly subspecialized to the point that many general forensic psychiatrists prefer to refer cases to colleagues who have expertise in the various forensic subspecialties. Board certification has increased the number of highly qualified experts in the field. Almost 2,500 psychiatrists are members of AAPL, and many of them work exclusively in the field of law and psychiatry. Increasingly, lawyers seek experienced forensic psychiatrists to conduct clinical as­sessments and then testify when necessary.

Nevertheless, general psychiatrists without subspecialty board cer­tification or formal training in forensic psychiatry conduct most forensic psychiatric examinations. General psychiatrists also give the majority of forensic psychiatric testimony. The general clinician has been drawn into the courtroom as an expert for various reasons. The rise of HMOs and insurance controlled treatment has created economic pressures that have made other areas of psychiatric practice, such as forensic psychia­try, more appealing. Although the general psychiatrist may become more involved in civil or administrative cases than in criminal ones, the publicity that often accompanies high-profile forensic cases has also on occasion drawn practitioners to this subspecialty field. Finally, many at­torneys prefer to retain academicians or general clinicians who have not specialized in forensic psychiatry. These attorneys are concerned about the "hired gun" label when utilizing the services of psychiatrists who have testified in hundreds of cases. They prefer someone with extensive clinical experience who has not been labeled as a forensic specialist.

This textbook is therefore both important and timely. It is geared to the general clinician working in psychiatry who may become involved in any of the fascinating aspects of forensic psychiatry. Once psychia­trists become known to attorneys as effective expert witnesses, they may be called on to participate in a number of future cases. Clinicians interested in developing an effective and successful forensic practice should have a basic understanding of the legal system and the role of the clinician in forensic cases.

General psychiatrists who increase the amount of time they devote to forensic psychiatry should not believe that by doing so they are giv­ing up the clinical practice of psychiatry. The term clinician has at times created some confusion in respect to forensic subspecialists in that "clinical practice" is often used erroneously as a synonym for the prac­tice of providing treatment to patients. This distinction is important and at times may be critical. When the term is used by attorneys, questions about "clinical practice" are often a means of discrediting experts by implying that they are not "real" doctors. Attorneys may also hope to bar the admission of the experts' testimony because in some states experts are prohibited from testifying if a certain percentage of their practice is not "clinical."

All forensic psychiatrists are clinical psychiatrists. All assessments, examinations, and review of medical and clinical records are included  in the practice of clinical psychiatry. Not all forensic specialists have treatment practices (although most do). The approach taken by the ed­itors of this textbook and the contributing authors is especially gratify­ing in that they have recognized that a good forensic psychiatrist first needs to be a good clinician. The authors of these chapters are acknowl­edged clinical as well as forensic experts.

The general practicing psychiatric clinician who enters the legal arena will find this textbook a "must read." However, experienced fo­rensic psychiatrists will also find that this volume contains a great deal of useful information. The ethics associated with forensic psychiatry differ in significant ways from those associated with general psychiatry. These differences require changes in general practice when one is con-ducting forensic rather than clinical evaluations. Psychiatrists may find that the laws governing the insanity defense vary from state to state and from federal law. Duty to warn and other statutory laws may also vary from one state to another. Even experienced forensic psychiatrists often find it challenging to navigate these complex ethical and legal waters.

This textbook covers substantive issues in forensic psychiatry that are required knowledge for the general practitioner and experienced fo­rensic psychiatrist. It contains information that is valuable both aca­demically and practically. Each chapter provides practical guidelines to help clinicians structure their approach to each subject as well as sug­gested readings for those who want to further explore a given subject. Psychiatrists who wish to expand their knowledge and their practices to include the exciting and still developing field of forensic psychiatry are well advised to thoroughly acquaint themselves with this book's pages.

Affect Dysregulation and Disorders of the Self by Allan N. Schore (Norton); Affect Regulation and the Repair of the Self (TWO-VOLUME SET) by Allan N. Schore (Norton) The latest work from a pioneer in the study of the development of the self. In 1994 Allan Schore published his groundbreaking book, Affect Regulation and the Origin of the Self, in which he integrated a large number of experimental and clinical studies from both the psychological and the biological disciplines in order to construct an overarching model of social and emotional development. Since then he has expanded his regulation theory in more than two dozen articles and essays covering multiple disciplines, including neuroscience, psychiatry, psychoanalysis, developmental psychology, attachment, and trauma.

These two volumes are the first presentation of his comprehensive theory in book form as it has developed since 1994. Affect Dysregulation and Disorders of the Self contains writings on developmental affective neuroscience and developmental neuropsychiatry. Affect Regulation and the Repair of the Self contains chapters on neuropsychoanalysis and developmentally oriented psychotherapy. Absolutely essential reading for all clinicians, researchers, and general readers interested in normal and abnormal human development.

I n 1994  Schore published Affect Regulation and the Origin of the Self, and in the very first paragraph he asserted, "The beginnings of living systems set the stage for every aspect of an organism's internal and external functioning throughout the lifespan." In that book Schore outlined the principles of regulation theory. Using then-current information, he applied the theory to a model of how regulated and dysregulated affective transactions within the infant's attachment relationship with the primary caregiver facilitate or inhibit the experience-dependent matu­ration of the infant's brain, especially the early developing right brain. He then used the theory to generate a model of normal social-emotional development, of abnormal development and psychopathogeneis, and of the mechanism of developmental change, as expressed in the psychotherapeutic context.

Since 1994, and over the course of "the decade of the brain," a vast amount of new information on these matters has appeared. Along the way Schore incorporated this data from a wide range of the biological, psychological, and social sciences into his research and publications. Due to the interdisciplinary nature of his work, these articles and chapters appear in journals and edited collections in a variety of fields -developmental psychopathology, psychiatry, neuroscience, psy­choanalysis, as well as in the emotion, attachment, and trauma literatures.

These two volumes, Affect Dysregulation and Disorders of the Self and Affect Regulation and the Repair of the Self, are sequels to the 1994 book, and represent expansions of his earlier presentation of regulation theory. Each con­tains a combination of already-published contributions as well as new material. Due to the fact that his writings are distributed over a wide array of disciplines, it has been difficult for a reader in one field to find publications in another. Schore’s intention here is to provide readers with not only newer findings in a multitude of basic and clinical sciences, but also to offer an overarching perspec­tive on regulation theory as it has expanded in the nine years since his first book. These two volumes thus represent the first comprehensive articulation of regulation theory as it has developed since Affect Regulation and the Origin of the Self.

In Affect Dysregulation and Disorders of the Self, Schore presents chapters in developmental affective neurosci­ence and then, in Part 2, developmental neuropsychiatry. Each chapter includes studies of attachment functions, and the development of coordinated interactions between the maturing central and autonomic nervous systems should be investigated in research on attachment structures.

The next chapters stress the importance of the prenatal and postnatal periods of human life. It is true that some degree of brain plasticity remains at latter points in the lifespan, and, because of this, in Affect Regulation and the Repair of the Self, Schore details the relevance of regulation theory to the process of change as it occurs in the psychotherapeutic context (see below). But, in Affect Dysregulation and Disorders of the Self, Schore emphasizes the implications of this work for early prevention. These interventions should represent applications of what developmental science knows about the remarkable plasticity and responsiveness of the developing brain to enriched interpersonal environments.

In Schore’s introduction to a special edition of the Infant Mental Health Journal (2001) he described the current debate in American society, channeled through the broadcast and written media, about the importance of the first three years of human life. Neuroscience has been placed at the center of this debate and neuroscientists have become the arbiters. A number of authors are now painting what they see as brain-mind portraits of infants, each highlighting certain very, prescribed areas of developmental neurobiology and developmental psychology. The different portraits, in turn, reflect the different images of infancy that; are prevalent in current society.

How we, as adults, "see" our infants, how we attempt to understand the baby's structural development and expanding functional capacities and potentialities, is biased by our own individual perceptual lenses as well as by thus cultural filters mediating our experience. These unique and shared biases strongly influence the subjective perception of our infants as relatively indepen­dent or fundamentally dependent on adult caregivers, as passive or active agents, as open and plastic or closed and fixed systems, as durable or fragile:' biological organisms, and as cognitive machines or feeling, sensate beings. Perhaps the greatest point of difference in the debate is the question of mind - since infants have no verbal abilities, are they mindless or do they possess a communicating, developing consciousness?

These different images of the earliest stages of humanhood are critical because they contain within them the representations of our possible futures they model the potential developmental extension of our individual and collec­tive social identities. The ongoing debate among the different theories of brain-mind development is, in turn, tightly coupled to pragmatic questions: When and where shall we place our current resources in order to optimize the future of human societies? And so we turn to science, and particularly to our most recent and powerful brain technologies, to offer us more "objective data" on the matter. The interpretation of this data will have extremely important social, political, and economic implications. How much should we value the very beginnings of human life, in tangible social program dollars?

The vast amounts our society spends on defense budgets and medical research is directed towards allowing each of us to feel secure (in mind and body) in our everyday life. This matter of inner security is clearly a psychological state. Even though an internal sense of security is a desirable, indeed longed­for state, it cannot be imposed upon a passive individual. External and internal conditions must be appraised in order for the self-system to actively create and maintain the internal sense of safety that comes from the implicit knowledge that one can cope with the various stressors that accompany human existence.

It is now clear that the development of the critical capacity to create and maintain an internal sense of emotional security comes from the inner (but not necessarily conscious) knowledge that during times of stress, one can cope. Coping can occur either by autoregulation or by means of going to others for interactive regulation. The findings of developmental psychology and neurosci­ence are converging on this issue as different strands of research show that this adaptive ability is essentially established in the first three years of human life, and that it is the product of our early attachments. The intense interest in early development in every discipline of mental health strongly suggests that further interdisciplinary research will lead to increasing amounts of information that will be directly translatable into the creation of more effective programs of early prevention and which will have an impact on development over the course of the entire lifespan.

Current developmental conceptions that integrate the psychological and bio­logical realms are bringing us closer to a complex biopsychosocial model that can serve as a source of not only the next level of questions for science, but also for pragmatic applications. These deeper investigations of infant mental health of the primary forces that impact the development of human nature can do more than alter the inetergenerational transmission of psychopathology. They can also significantly increase the numbers of individuals who possess an intiuitive sense of emotional security, thereby improve the quality of life of the infant, child, and adult members of our societies.

These conclusions are the product of Schore’s own appraisals of the recent inter­disciplinary developmental literatures- from developmental psychology, through developmental biology, neurobiology and neurochemistry, to develop­mental psychoanalysis.  The integration of psychological and biological data is seen in contemporary models of the self, and there is a growing consensus that its origin must be explained in terms of the complexities of developmental psychology and devel­opmental neuroscience. The ontogenesis of the human mind is now thought to involve more than the emergence of increasingly complex cognitions. Affective processes appear to lie at the core of the self, and due to the intrinsic psychophysiological nature of these bodily-based phenomena recent models of human development, from infancy throughout the lifespan, are moving towards brain­nind-body conceptualizations. These models are redefining the essential charteristics of what makes us uniquely human.

Indeed, within the last ten years a shift has occurred in science's focus re­tarding what it considers to be the essential attributes of the human condition. n an issue of the journal Science, Richard Davidson concluded, "The self and personality, rather than consciousness, is the outstanding issue in neuroscience. So much of our behavior emerges from processes to which we have little conscious access" (2002, p. 268). There is an intense interest in nonconscious processes, fundamental operations of the brain-mind-body that occur rapidly and automatically, beneath levels of conscious awareness. This specifically applies to the behavioral, cognitive, and particularly emotional processes that mediate the fundamental capacity for self-regulation.

The self-regulation of emotion is usually defined in terms of the conscious ,elf-regulation of emotion, the set of control processes by which we influence, -consciously and voluntarily, the emotions we have, when we have them, and how we experience and express these emotions. This conception -that we can change the way we feel by consciously changing the way we think-is a pri­mary corollary of the current dominant field in psychology, that is cognitive psychology. A secondary postulate is that rational thinking and the "cooling" attentional strategy of distraction are the major coping mechanisms for damp­ening down the "hot" negative emotional consequences of a distressing experi­ence. The adaptive function of the amplification of positive emotion and the Fundamental bodily-based operations that lie at the foundation of emotional processes are usually not addressed.

However, in contrast to this model of the down-regulation of emotion pro­cessing by conscious operations, a large body of studies indicates that most moment-to-moment psychological processing occurs nonconsciously. The es­sential self-regulatory functions that allow us to appraise and adapt to personally meaningful changes in the environment occur largely at levels beneath con­scious awareness. Indeed, both researchers and clinicians are converging on the findings that rapidly communicated nonconscious social emotional infor­mation is primarily processed and acted upon at the implicit rather than the explicit level. In their clinical practice, psychotherapists of all persuasions are focusing upon both negative and positive "hot" rather than "cool" cognitions, and asserting that modifications in implicit relational knowledge and uncon­scious internal representations are the major changes in the psychotherapy context.

Researchers in social psychology are also exploring the important differences between implicit and explicit learning, as well as the direct relevance of the former to specifically social cognition. Cognition means knowing the world, but it is usually misinterpreted to signify only conscious verbal knowing. Much of the exchange of essential subjective information in human relationships is nonverbal, and includes dynamic changes in facial expression, prosodic tone of the voice, touch, gesture, and bodily state. These operations are essential to the functioning of the implicit (as opposed to the explicit) self.

This dichotomy between the verbal-conscious and nonverbal-unconscious realms also applies to neuroscience's research into self-regulation. Current stud­ies in cognitive neuroscience are for the most part investigating the brain sub­strates involved in the conscious, voluntary control of emotional states. For example, this line of research is delving into verbal reappraisal strategies, whereby we mentally talk to ourselves in order to regulate anxiety states. These operations are lateralized to the verbal left hemisphere, especially in prefrontal areas. But neurobiological research also demonstrates another form of emotion regulation strategy, one that does not involve an interpretative verbal compo­nent. This mechanism is lateralized to the right prefrontal areas, and is specifi­cally accessed in states of very high or very low arousal associated with intense emotions. The data presented in the chapters of this volume indicate that this right lateralized affect regulating function is dominant for coping with the stress and uncertainty that is a fundamental accompaniment of the human condition.

Indeed, one of the major advances of the Decade of the Brain has been the rediscovery that "the brain" is in actuality two brains, two different processors of external and internal information. Studies are moving away from the familiar territory of the verbal left hemisphere and are charting the unique functions of the right hemisphere. Despite earlier controversies on affective laterality, a growing body of research cited in this volume demonstrates the general superi­ority of the right hemisphere for the expression and reception of both positive and negative emotions. Furthermore, this hemisphere is dominant for the im­plicit cognitive processing of facial, prosodic, and bodily information embedded in emotional communications, for attention, for empathy, and for the human stress response. These essential processes -central to both the regulation of homeostasis and the capacity to flexibly alter the internal environment to opti­mally cope with external perturbations-take place extremely rapidly, at levels beneath conscious awareness. Converging neuropsychologic and neurobiologi­cal data strongly suggest that the right hemisphere is critically involved in the maintenance of a coherent, continuous, and unified implicit sense of self.

A number of authors are pointing out that the concept of implicit and ex­plicit dimensions of the self is a direct analogue of Freud's separation of the mind into unconscious and conscious levels. Indeed, contemporary neuropsychoanalysis is correlating the unique functions of the left and the right brains with the conscious and unconscious left and right minds. But due to the nature of psychoanalysis (the science of unconscious processes) it has always been most interested in the operations of the nonconscious realm, the province of primary process cognitions, the bodily-based drives, and the earliest primordial events that impact the developing mind-body. Freud's essential discovery was that this unconscious realm contained the major systems of human motivation that operate in everyday life, and that knowledge of the functional capacities of this unconscious system allows for a more comprehensive understanding and prediction of overt behavior than does a consideration of the conscious system. This principle is echoed in the Affect Regulation triad in the assertion that the implicit self is the key to a deeper understanding of personality and the prob­lems of normal and abnormal behavior.

Just as the other sciences have been transformed in the last decade, so has psychoanalysis. Although many scientists have a conception of psychoanalysis frozen in time, as it existed in the early twentieth century, Freud's original theoretical and clinical models have been substantially updated and in some cases radically altered. Attachment theory, an outgrowth of psychoanalysis, is only one example -the concept of the centrality of the unconscious in every­day life was incorporated into Bowlby's nonconscious internal working models. But even Freud's characterizations of the unconscious inner world have been transformed. Instead of a repository of archaic untamed passions and destructive wishes, the unconscious is now seen as a cohesive, active mental structure that continuously appraises life's experiences and responds according to its scheme of interpretation. And in contrast to a static, deeply buried storehouse of ancient memories buried and silenced in "infantile amnesia," contemporary intersubjective psychoanalysts now refer to a "relational unconscious," whereby one unconscious mind communicates with another unconscious mind. In a num­ber of upcoming chapters, I describe how this communication begins in early attachment experiences, which imprint the developing right brain, the biologi­cal substrate of the human unconscious.

Schore points out that throughout Affect Regulation and the Repair of the Self the generic term "psychodynamic" can be exchanged for the term "psychoanalytic." Also "psychoanalyst" can be translated to "clinician." The reader will note that the term Schore usees to describe the clinical approach to severe self pathologies is "developmentally­oriented psychotherapy." Not only psychoanalytic theory but psychoanalytically-oriented technique has changed in order to optimally meet the challenges and treat the deficits of individuals who at one time were seen to be refractory to psychotherapy. This treatment, guided by understandings from develop­mental psychoanalysis and its derivative attachment theory, is best achieved in other than a traditional clinical psychoanalytic context, that is, face-to-face. The focus is as much on process as content, and on the psychobiological rather than the mental state.

Schore’s identification with psychoanalysis specifically reflects his interests in the nonconscious realm, in modifying the patient's representational processes and internal object world, and in strengthening psychic structure in order to en­hance the capacity to organize affects and self-regulate the implicit as well as explicit self systems. These goals are no longer just within the domain of psychodynamic clinical models - indeed, they have been adopted by the larger group of eclectic clinicians. Also, Schore has no personal identification with any particular school of psychoanalysis. The essays in Affect Regulation and the Repair of the Self reappraises the works of a number of psychoanalytic pioneers and the chapters range across almost all of the subdisciplines of psychoanalysis, demonstrating that each emphasized the concept of regulation. Yet, despite their differences, all share "a fascination with the mysterious and marvelous transmutative power of conversation within a human dyad".

But even beyond psychoanalysis, as a clinician-scientist my interest is in the commonalties of all psychotherapies -that is, the generic change process itself. The phenomena of transference and countertransference, once considered a hallmark of psychoanalysis, are now seen to be fundamental to all forms of psychotherapy. Furthermore, the criticial importance of the therapeutic rela­tionship, first discussed by Freud, is being validated in a large body of basic clinical research. Indeed, among the common elements of psychother­apy, the therapeutic allience (i.e., the collaborative relationship between patient and the therapist) is most important to positive therapeutic outcome. It is now accepted that a primary component of the alliance is the emotional bond within the dyad of patient and therapist and so all schools of psychotherapy are now placing emphasis upon the affective aspects of the therapeutic relationship. All forms of clinical interpretative and noninterpretive technical interventions are mediated through this relational mechanism.

Thus, throughout Affect Regulation and the Repair of the Self, Schore focuses on the underlying mechanisms by which the therapeutic relationship can alter the patient's internal structural brain sys­tems that nonconsciously and consciously process and regulate external and internal information, and thereby not only reduce the patient's negative emo­tional symptoms but expand his or her adaptive capacities. Contemporary clini­cal models suggest that the therapeutic alliance is a common element of all of the different therapy modalities, that it accounts for more of the variance of treatment outcome than treatment method, that affect dysregulation is a funda­mental mechanism of all psychiatric disorders, and that all psychotherapies show a similarity in promoting affect regulation. The principles outlined in the following chapters apply equally well to short-term as well as long-term treat­ment models.

If development fundamentally represents the process of change, then psy­chotherapy is, in essence, applied developmental psychology. The data in de­velopmental affective neuroscience and developmental psychoanalysis clearly demonstrate that in the critical early periods of life the maturing human brain/

mind/body evolves to greater degrees of complexity within the context of an affect regulating relationship with another human being. This essential inter­personal component of a growth-facilitating developmental matrix clearly sug­gests that psychotherapeutic changes are mediated by aspects of the relationship of the patient and therapist. When effective, this cocreated dyadic system can facilitate the further development and organization of the patient's internal brain/mind/body systems. The brain sciences demonstrate that the adult brain retains plasticity, and this plasticity, especially of the right brain that is domi­nant for self-regulation, allows for the emotional learning that accompanies a successful psychotherapeutic experience.

Although there was initially anxiety among some clinicians that neurosci­ence would lead to reductionistic and over-simplified models of the complexi­ties of human normal and abnormal behavior, as the following chapters demonstrate, a growing number of researchers are also becoming interested in the central role of affect regulation in psychotherapy. Neuroscientists are concluding that "the ability to modulate emotions is at the heart of the human experience [and] the use of emotional self-regulatory processes constitutes the core of several modern psychotherapeutic approaches", that the development of self-regulation "may be open to change in adult life, providing a basis for what is attempted in therapy", and that "experts in neuro­psychology and clinical psychology should play a leading role in developing the next generation of illness-specific and neural pathway-targeted psychothera­peutic techniques". The idea that pharmacology changes the brain and psychotherapy changes the mind is clearly outdated. Recent research cited in this volume shows alterations in brain function that accompany successful psychotherapeutic treatment. Indeed neuroimaging stud­ies support the principle that you "change the mind and you change the brain"

This work on regulation theory and on creating models that synthesize the interactions of biological and psychological data also attempts to integrate bio­logical psychiatry with dynamic psychiatry. Schore suggests the field is now in a posi­tion to actualize the enormous potential of the biopsychosocial model. Just before the Decade of the Brain, George Engel, a major contributor to this integrative formulation, presciently wrote,


“It is not just that science is a human activity, it is also that the interper­sonal engagement required in the clinical realm rests on complementary needs, especially the need to know and understand and the need to feel

known and understood.... The need to know and understand originates in the regulatory and self-organizing capabilities of all living organisms to process information from an everchanging environment in order to assure growth ... self-regulation, and survival. In turn, the need to feel known and understand originates ... in the life-long need to feel socially con­nected with other humans.”


The interpersonal engagement that occurs in psychotherapy represents a potent medium in which an individual self can subjectively experience the need to know and the need to feel known in a safe, emotionally-responsive

context. Although psychotherapy has recently been devalued or at best under­valued, the art and the science of psychotherapy, of the careful study of the inner worlds of a multiplicity of psychopathologies, as well as the necessary self study involved in this profession, are as complex and rigorous as any other discipline in the experimental or applied human sciences. These skills are deepened by repeated careful observations of the external and internal patterns of resistances against, yet, possibilities for, change in a wide range of human psychopathologies, and take many years to craft. In addition to the subjective learning that comes from clinical experience, professional growth also involves a continual need to incorporate the new objective findings from not only the psychological, psychiatric, and social, but also the biological sciences.

Regulation theory is an effort in that direction. The theory focuses upon how the clinician can gain this new knowledge in order to more effectively use the explicit and particularly implicit self in order to treat, at close intersubjective range, a spectrum of early-forming disorders of the self. Over the last ten years these clinical populations have dramatically increased, and they now rep­resent a significant proportion of the case load of most clinicians. In the follow­ing chapters Schore refers back to the neurobiological models of psychopathogenesis outlined in the companion volume to this book, Affect Dysregulation and Disorders of the Self, and elaborate the applications of regulation theory to the affectively-focused, developmentally-oriented treatment of infant, child, and adult attachment pathologies and severe personality disorders.

Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development by Allan N. Schore (Lawrence Erlbaum) (PAPERBACK) "This impressive work takes as its central theme the view that the adult's socioaffective life is critically determined by events in infancy between the child and the primary caregiver, usually the mother. Hardly news to a psychotherapist or anyone versed in modern versions of psychoanalytic theory,notably attachment and object relations theory, but here we have a vast amount of neurobiological data supporting this contention and offering the possibility of a rapprochement between neurobiology and psychoanalysis, as Freud always hoped. Allan Schore reveals himself as a polymath, the depth and breadth of whose reading, bringing together neurobiology, developmental neurochemistry, behavioural neurology, evolutionary biology, developmental psychology, developmental psychoanalysis and infant psychiatry, is staggering. This is a superb integrative work, an excellent source book for psychiatrists wishing to locate their work within the much broader study of mind...It might also form the basis of what could be an enormously creative dialogue between neurobiology and psychoanalysis". -- British Journal of Psychiatry

"In recent decades it has become almost impossible to keep abreast of the burgeoning literature in a range of allied disciplines. Almost daily, it seems, new findings are reported regarding matters of such fundamental interest to psychoanalysis as the function of affect regulation. As a result, the majority of psychoanalysts are falling increasingly out of touch with current knowledge in the broader scientific field of which their discipline is a part. This book, in which Allan Schore summarizes and integrates the recent literature of developmental neurobiology, infant and attachment research, and related disciplines relevant to the function of affect regulation, therefore serves a very useful purpose for psychoanalysts who want to catch up with recent developments in these neighboring fields...the centrality of the topic it addresses provides the reader a broad overview of the current state of the art in these fields. Schore's central thesis is that "the early social environment, mediated by the primary caregiver, directly influences the evolution of structures in the brain responsible for the future socioemotional development of the child". In successive chapters, his book surveys the literature in different fields, presenting levels of evidence relevant to this thesis in an impressive sweep that incorporates data drawn from such disparate areas as mother-infant observation and molecular biology. The resultant model explicates in exemplary detail the precise mechanisms by means of which the infant brain might internalize and structuralize the affect-regulating functions of the mother, in circumscribed neural tissues, at specifiable points in its epigenetic history....I unreservedly recommend this uniquely informative book to psychoanalytic readers". -- Journal of the American Psychoanalytic Association

"In this extensively researched (over 2,300 references!) and cogently argued text, Allan N. Schore provides a major contribution to the study of the relationship between the neurological processes and structures of the brain and the socioaffective and object representational phenomena that we generally associate with the mind...Schore's approach is an outstanding example of the genre of studies seeking to demonstrate neurological isomorphisms for the kind of mental or psychic states that have been postulated by psychoanalytic theory." -- Psychoanalytic Quarterly

"Allan Schore's Affect regulation and the Origin of the Self is a brilliant, if not awesome, synthesis with supporting data from a spectrum of many disparate sources, including anatomic, developmental, neurochemical and psychodynamic. He has developed a coherent and integrated neuropsychological model of the location, development, and mechanism of the self" -- International Society for the Study of Subtle Energies and Energy Medicine

"For those who read this book, the study of human development will be entirely transformed. Not only is this book destined to be an authoritative reference for those who work with infants and children, but it also promises to radically restructure many of our current paradigms of infant/child development and care". -- Contemporary Education

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