Dr. Allan Schore

That's already a toddler.

Yeah, what I'm saying is it's a secure attachment. And let me back up a step on that. The key to attachment is psychobiological attunement. You know the phrase. Notice psychobiological attunement. That the mother is regulating not only the psychological aspect, but literally is regulating the physiological aspect of that, which means that she's regulating the autonomic nervous system.

Think about Porges social engagement system. What we have here is the capacity by insecure attachment who have, and then the second part of the attachment is repair. Now, let me go back. Psychobiological attunement. Sometimes she misattunes. Sometimes she misreads the baby's states for one reason or another.

What happens in a good enough caregiving is that the mother who was misattuned now reattunes to that baby. now re-synchronizes with that baby, now reconnects right brains to right brains with that baby. And that repair is a key here. So you have misattunement and repair. So the key to a secure attachment is not only psychobiological attunement, but it's also the repair of the misattunement.

And that allows the baby now to expand that situation and being able to use that now to order a case. That's a secure. But if she misattunes, for example, and doesn't repair, let's say, or she's not that good at psychobiologically attuning, let's say, as an avoidant mother, because avoidant personalities are uncomfortable with real closeness.

Another term for an avoidant personality is a dismissive personality. And what they are dismissing is the need for interactive regulation. So they're always auto-regulating it.

Or you have another time in which you have another form of attachment, an insecure anxious attachment, where that person is always interactively regulating or is always going to others to help them regulate, but can't auto-regulate.

All of this is happening in the right brain. And incidentally, attachment relationship is retained as an autobiographical memory in the first two years of life, even before there's a left hemisphere. And that under later stress situation occurs. That will be the key there. Incidentally, the attachment, whether it's secure or insecure, is also the key to positive and negative transferences.

That's where it's communicated. Let me go back and say a little bit more about one other form of attachment, and that you mentioned the type D attachment.

Yeah, these are disorganized babies. So you have secure. You have two types of organized insecures. Okay, the avoidant and the anxious. And then you have a disorganized, disoriented one. Now, ultimately, that person under stress is not able to auto-regulate or to interact and regulate.

So what they will do at that point now, I'm now thinking about, let's say, PTSD or various borderline personality disorders. That person now literally can't go to the other for autoregulation or interactive regulation, that person now will use a defense, literally, to shut down the attachment system. And that's exactly what dissociation is. Dissociation just shuts down the attachment.

So in the anxious attachment, you have a continual activation of the attachment system, which means a continual activation of the right hemisphere all of the time. And in the insecure attachment, A dismissive attachment, you have a deactivation of the attachment system, which would be a deactivation of the right brain.

So in the end, a secure attachment is an efficient one, but it's an efficient one that can switch back and forth between them. Not only that, it also, at a later point in time when the left comes online, it can also communicate much better with the left hemisphere than without that.

Regulation theory is essentially a theory of the development of the self in an optimal situation, but it also talks about the psychopathogenesis of the self, the early origins of psychiatric disorders and personality disorders. I'm thinking about not only schizophrenia and depression, but I'm now thinking about narcissistic personality disorders, borderline personality disorders.

Maybe we'll come back to more on that. And then ultimately, the repair of the self. So regulation theory is about the development of the self, the psychopathogenesis of the self, and then the repair of the self. Because these attachment situations are now going to play out under all periods of stress. The right hemisphere is dominant for the stress response.

The right hemisphere is dominant for the sympathetic nervous system, the energy expending, and the right hemisphere is dominant for the parasympathetic nervous system. So again, all of that will play out at later points under stress, and when those systems break down, that's when the patient will form symptomatologies and come into therapy. And in therapy, the therapist now, the key,

I'm jumping here. No, this is great. Because there's a right brain to right brain interaction between the mother and the infant. There's also a right brain to right brain interaction between the therapist and the patient. And the key to both of them is regulation. A person is coming in in a dysregulated state. The key to that is regulation.

And the key to any form of therapy, whatever the form of it is, again, is interactive regulation, and it's a therapeutic relationship. The thing which is the best indicator of whether somebody will do well out of therapy and whether a clinician will do well out of therapy is how well they can deal with the therapeutic relationship.

And a really good therapist literally knows how to bring back those attachment things there because now the person is starting to feel safety and trusted and, incidentally, Attachment is about safety and trust, which is very much autonomic. But again here, the key to therapy is being able to form a therapeutic relationship with the patient.

So the key here is, can the therapist form, co-create a therapeutic relationship with an avoidant patient, with a secure patient? with anxious patient, with a borderline patient. As you can imagine, the toughest thing is going to be able to do with the borderline patient or the schizophrenic patient. So what you have here is that the attachment dynamics are being laid out.