Magazine article Clinical Psychiatry News

Patient Alliance Key in Attachment Therapy: Positive Transference Important

Magazine article Clinical Psychiatry News

Patient Alliance Key in Attachment Therapy: Positive Transference Important

Article excerpt

LOS ANGELES -- The challenge in attachment therapy is to form a therapeutic alliance with a patient who finds it difficult to establish trusting relationships, Allan Schore, Ph.D., said at a conference on attachment theory sponsored by the University of California, San Francisco.

Effective therapy relies heavily on the spontaneous, nonverbal transference and countertransference of feelings between patient and therapist, Dr. Schore said.

Attachment therapy focuses on the right hemisphere because that's where attachment functions--including the nonconscious processing of social and emotional information--are coordinated. In preverbal children, interpersonal experiences affect right-brain maturation, which is essentially complete by 3 years of age, so abuse or neglect can have lingering mal-adaptive effects on right-brain function.

Because right-brain interaction relies on nonverbal communication, the therapist must receive and interpret those signals from the patient and send out signals suggesting that the patient can feel safe in expressing his or her trauma. That means "the deeper layers of the therapist's psyche must be open to stimuli that emanate from the patient's communications," said Dr. Schore of the University of California, San Francisco.

A strong therapeutic alliance helps restore normal right hemispheric activity and so is essential for a successful outcome, he said. "In this way, the emotional relationships forged during the process of psychotherapy are covering the deficiency caused by the lack of emotional relations in early childhood."

Body language and facial expressions are powerful, nonverbal ways of communicating various messages to patients. Patients with attachment disorders are extremely sensitive to cues conveyed through facial expression, although much of this information is processed by the right brain on a subconscious level. …

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