VIDEO: Dr. Allan Schore on the Role of Non-Verbal Communication in Treating Suicidal Patients

Watch an excerpt from PsychAlive’s interview with Dr. Allan Schore.

Dr. Allan Schore discusses the non-verbal communications critical to affecting outcomes in therapy with suicidal patients. 

Dr. Allan Schore: Just for the record, we’re not talking here about anxiety and guilt.  Anxiety and guilt are kind of left (brain).  We’re talking about affects which are, have signatures in the autonomic nervous system, which trigger an HPA response, which trigger cortisol, etc., etc., heart rate, etc.  We’re talking about the following affects – and I said this earlier, before; hopeless despair, rage states, shame, disgust and positive emotions.

Let me go back.  Part of the problem with early relational trauma is not only that there’s abuse and neglect.  But there is a paucity of any play in relational trauma between the mother and the infant.  So this baby does not know how to play, and it’s out of play that comes joy and excitement, etc.  And therefore, positive emotions are very far to these individuals.  They don’t what to do with them, how to recognize them, what meaning to make of them, uncomfortable in the body with them, etc.  So positive emotions also would be critical pieces here to boot.

But ultimately, in my work, in my understanding, I think that the most difficult affects to hold on to in the counter transference are hopelessness and helplessness.  You know, there’s an easy, “Well, you can do this or that or the other thing.”   But that’s been this person’s life.  This person’s life has been into severe dis-regulation and then you get a freeze response and they’re blocked literally because essentially what you have here is no access to any active coping strategies.  It’s all passive coping, it’s moving deeper and deeper within.  Ultimately one moves too deeply within, so to speak.  Under stress, you can get a collapse of the inner world and then we’re looking at again a suicidal crisis.

One other piece on that:  it’s been said, and I agree with this, that, essentially, because the right (brain) is setting up so poorly, what you have here is this individual is attempting to live his life or her life in the left hemisphere.  And so everything is rational and logical, analytic, even the plan to kill is rational and analytic and logical, etc.  But the left hemisphere only has so much capacity for regulating affects and ultimately when that, you know, when the right breaks down, so to speak, then we’re looking at these crises.  But, yes, the affect tolerance is a key there.

This also means that the person is very sensitive to the communications that are coming from the therapist.  Now, the communications that were coming to the baby in these moments of neglect and abuse were processed by the baby.  Why?  Because the state change in the caregiver as she began to get into the dis-regulated state, as she was about to massively abandon the child and pull away interact regulation or intrude into the child hyper-arousal.

And so you have a system here whereby these individuals are exquisitely sensitive to non-verbal communications of either abandonment, which would be neglect and disengagement or hyper-engagement, etc.  That means in the transference kind of transference, where these communications are going back and forth between the therapist and the patient, through the right brain mechanisms, not words, but non-verbal communications:  facial expression, tone of voice, prosody —  these are processed exquisitely by the patient, so to speak, at a sub-cortical level.

And again, what this means, is that if there is a lack of awareness, so to speak, of how one’s own subjectivity is being communicated to the other side of the inter-subjective field, this can really be problematic here.  And what you have is very small mis-attunements which can be looking away at the wrong period of time can trigger a shame response, and now we’re going into a spiral, etc. etc.  So again I would suggest to you that this knowledge, this new information about non-verbal communications also is critical for this kind of work.

Tags: communication, Suicide, suicide prevention, video