Schore puts the neurobiology of the transference-countertransference relationship in a two- person context with his focus on interactive regulation. He takes as his starting point the research on parent-infant relating which has identified the rapid mutual cuing with which parent and infant signal each other about their internal states. This signaling includes a wide variety of nonverbal cues: body movements, posture/muscle tone, gesture, facial expression, voice inflection, prosodics (sequence, rhythm and pitch of vocalizations). At the same time as parent and infant are signaling each other, they are also effectively impacting on the other’s internal state. Signaling excitement raises the other’s arousal level, signaling calm or mild sadness lowers it in the partner. Head turning or gaze averting on the part of the infant breaks the interactive sequence and halts the arousal of the other more or less abruptly depending; the adult has a greater range of expressiveness to do the same thing. In this way, interactive partners are mutually regulating – and dysregulating – each other. The co-constructed pattern of these affect and arousal interactions, repeated again and again, become wired in as the neural and physiological basis of our earliest Internal Working Models. They have the power to influence the ongoing experience-dependent maturation of the social brain centers, particularly in the early-developing right hemisphere.

Transference-countertransference relating, then, is the re-evoking of these psychobiological patterns. Therapist and patient are responding to one another through the same kind of rapid mutual cuing observed with infants and parents (and indeed, any interacting dyad), activating each other’s hardwired patterns of response and arousal. As the stuff of emotional experience, this visceral activation is integrated with the social brain’s analysis of the ambient situation and a moment of transference or countertransference is produced. Therapist and patient are interactively regulating – and dysregulating – each other. This time, however, one of the parties is clued in to the process and trained to use her awareness of arousal patterns and bodily experiential cues. This countertransference-based tool helps us to understand the unconscious story of what is happening between intimate dyads, and influence the mutual regulation process in a better direction – one that will ultimately begin to influence the hardwiring of the patient, with the help of the verbal left brain, toward more flexible, conscious, integrated and successfully regulated responding.


Our understanding of unconscious processes helps in shaping a therapeutic approach that allows patients to gain more self-awareness and better emotional adjustment. Traditionally dreams, transference and counter-transference experiences have informed psychoanalyst therapists about hidden motivations within patients. Bringing unconscious processes to light is one of the challenges of psychoanalytic work. The advancement of neruopsychoanalysis supports our ability to articulate unconscious experiences in terms of body-based sensations with emotionally motivated experiences. Self awareness and affective regulation is achieved through the exploration of unconscious wishes, fears and the deeply entwined experiences of therapist and patient.