Schore, A. (2003) | References | Narcissus and the Child

What This Research Found

Allan Schore's Affect Regulation and the Repair of the Self represents a landmark synthesis of neuroscience, attachment theory, and developmental psychology. Drawing on over 2,500 references across disciplines, Schore demonstrates that the capacity to regulate emotions is not innate but constructed through early relationships—and that failures in this process create lasting vulnerabilities that manifest across the lifespan.

The right hemisphere develops first and through relationship. During the first three years of life, the right hemisphere of the brain—which processes emotions, reads facial expressions, governs stress responses, and manages nonverbal communication—develops with marked priority over the left hemisphere. Crucially, this development depends on attuned interactions with caregivers. The right hemisphere is literally built through relationship, not through genetic programming alone. This means that the neural substrate for affect regulation is constructed in the context of the caregiver-infant dyad.

"Psychobiological attunement" builds regulatory capacity. Schore introduced the concept of psychobiological attunement to describe how caregivers help regulate infant emotional states. When a caregiver reliably responds to infant distress with soothing presence—matching the infant's arousal, then gradually modulating it downward—the infant's developing orbitofrontal cortex and anterior cingulate cortex build connections that will eventually enable self-regulation. The caregiver's regulated nervous system literally helps organise the infant's dysregulated nervous system. The infant internalises this external regulation, developing the capacity to do it themselves.

Early relational trauma becomes encoded in neural architecture. When caregivers are abusive, neglectful, or chronically unavailable, this regulatory scaffolding never forms. The child's nervous system remains in chronic dysregulation—hypervigilant to threat, unable to self-soothe, prone to emotional flooding or shutdown. The amygdala becomes hyperresponsive; the hippocampus, bathed in cortisol, may fail to develop normal volume; prefrontal-limbic connections remain weak. This isn't psychological damage in the sense of bad memories or learned fears—it's structural and functional changes in brain architecture that persist into adulthood.

The damage occurs below the level of language and conscious memory. Because the right hemisphere dominates during the first three years—before language develops, before autobiographical memory forms—early relational trauma is encoded in implicit, procedural memory rather than explicit, narrative memory. The patterns laid down in these years become the system upon which all later neural operations rely. This explains why survivors often cannot articulate what happened to them, why they struggle to "think their way out" of their difficulties, and why traditional insight-oriented therapy often feels insufficient.

Repair follows the same mechanisms as development. If affect regulation capacity is built through attuned relationships, then repair must also occur through relationship. Schore's work implies that the therapeutic relationship—when it provides the consistent, attuned responsiveness that was missing in early life—can help build the regulatory circuitry that was never properly constructed. This is not metaphor; it is neuroplasticity operating through the same mechanisms that should have operated in infancy.

How This Research Is Used in the Book

Schore's research appears throughout Narcissus and the Child as foundational framework for understanding how narcissistic abuse damages children's developing brains. In Chapter 4: What Causes Narcissism, Schore's work explains the neurobiological mechanisms underlying the abuse-to-narcissism pathway:

"The neurobiological mechanisms underlying this pathway connect to Schore's work on affect regulation and early brain development. Schore showed that right hemisphere development, which matures earlier than the left and governs emotional processing and stress response, critically depends on attuned caregiver-infant interactions during the first three years of life. When parents reliably respond to infant distress with soothing and validation, the infant's developing orbitofrontal cortex and anterior cingulate cortex build the capacity to modulate and handle overwhelming emotions. They internalise the comfort, and learn to do it themselves."

The book then describes what happens when this attunement is absent:

"But when caregivers are abusive or neglectful, chronically unavailable, this regulatory scaffolding never forms. The child's nervous system remains in chronic dysregulation, hypervigilant to threat, unable to self-soothe. This early relational trauma becomes encoded in neural architecture, creating the structural and functional brain differences observed in adult narcissists."

In Chapter 6: Diamorphic Agency, Schore's research explains why human infants are born so neurologically incomplete:

"Unlike most mammals whose brains arrive substantially pre-wired, we as human babies possess a brain that is largely a construction site—the scaffolding in place but most of the actual building is yet to happen. This is not a design flaw: it's a stroke of brilliance. It is nature's solution to a problem: how to create a brain complex enough to navigate an infinitely variable universe while being small enough to fit through a birth canal. Our brain completes its construction outside the womb once it can directly experience the world. Thereby using experience as part of its blueprint."

In Chapter 12: The Unseen Child, Schore's framework reveals the lasting impact of not being seen:

"Schore has shown that such chronic non-seeing literally shapes the developing brain. Neural circuits for emotional regulation and self-soothing require thousands of attuned interactions to form properly. The narcissistic parent's emotional absence does not just hurt feelings—it alters the architecture of the child's mind."

In Chapter 16: The Gaslit Self, Schore's research explains why gaslighting survivors struggle with emotional regulation:

"The emotional dysregulation reflects disrupted affect regulation capacity. Healthy emotional regulation develops through caregiver attunement and validation. Through 'affective synchrony,' attuned caregivers intuitively match infants' shifting autonomic arousal states, forming the basis for self-regulation capacity. Gaslighting provides the opposite: systematic emotional invalidation, destroying this foundational capacity."

Throughout the book, Schore's work demonstrates that narcissistic abuse during childhood doesn't just cause psychological distress—it prevents the brain from developing the basic architecture needed for emotional health.

Why This Matters for Survivors

If you were raised by a narcissistic parent, Schore's research validates something you may have always sensed: that the damage goes deeper than memories or beliefs, that something fundamental was affected, that your struggles aren't simply a matter of "getting over" the past.

Your regulatory struggles are neurological, not moral failures. The difficulty you have calming yourself when upset, the way emotions seem to flood you or disappear entirely, the chronic sense of being on edge—these aren't character flaws or signs that you're not trying hard enough. They reflect the absence of neural infrastructure that should have been built through attuned caregiving in your first years of life. You're not bad at emotional regulation; you're working without the circuitry that makes it possible.

The "implicit" nature of the damage explains why insight alone doesn't heal. You may understand intellectually what happened to you. You may have read books, done journaling, developed sophisticated frameworks for understanding your family dynamics. And yet the patterns persist. Schore's research explains why: the damage occurred in right-hemisphere implicit memory systems, below the level of language, before you could form autobiographical narratives. Insight—which relies on left-hemisphere, verbal processing—cannot directly access what was damaged. This is why you can "know" something without it changing how you feel or react.

The therapeutic relationship is the intervention, not just the context for intervention. If you've felt that therapy helped most when you felt genuinely seen and understood by your therapist—regardless of what techniques they used—Schore's research validates that experience. Affect regulation capacity is built through attuned relationship. The therapist who provides consistent, warm, attuned responsiveness is doing more than creating a "supportive environment"—they are providing the relational experience that builds regulatory capacity. The relationship itself is the mechanism of change.

Your body's responses make biological sense. The hypervigilance, the startle responses, the chronic tension, the difficulty feeling safe even in safe situations—these aren't overreactions or irrationality. Your nervous system was calibrated during development for an environment where threat was constant and soothing was unreliable. It is doing exactly what it was shaped to do. Understanding this can help you stop fighting your nervous system and start working with it—learning to provide for yourself the regulation that was never provided by others.

Healing is possible, but it takes time and relationship. The same neuroplasticity that allowed harmful patterns to be encoded allows healing patterns to be built. But this doesn't happen through willpower or insight alone. It happens through corrective relational experiences—with therapists, with safe friends, with partners who can provide the consistent attunement that was missing. This is slower and harder than changing a belief, because you're literally building neural infrastructure. But the research supports that meaningful change is possible at any age.

Clinical Implications

For psychiatrists, psychologists, and trauma-informed healthcare providers, Schore's research has profound implications for assessment and treatment.

Right-brain to right-brain communication is primary. Schore emphasises that therapeutic change in developmental trauma occurs through right-hemisphere to right-hemisphere communication—prosody, facial expression, timing, emotional attunement—more than through verbal interpretation. Clinicians should attend to the implicit, nonverbal dimension of the therapeutic interaction. The tone in which something is said may matter more than the words. The therapist's regulated presence communicates safety to the patient's right hemisphere in ways that verbal reassurance cannot.

The therapeutic relationship is the intervention, not merely the vehicle for intervention. For patients with early relational trauma, the therapist must become what Schore calls a "psychobiological regulator"—providing the attuned responsiveness that allows the patient's regulatory capacity to develop. This isn't just about creating rapport so that techniques can be applied; the relationship itself, over time, builds the missing neural infrastructure. Techniques matter, but they work through and because of the relational context.

Assessment should include developmental timing. When did the patient's adverse experiences occur? Trauma during the first three years—when right hemisphere development depends on attuned caregiving—has different implications than trauma in later childhood or adulthood. Patients whose trauma occurred during Schore's critical period for affect regulation development may present with more pervasive regulatory difficulties, may respond less quickly to treatment, and may require more intensive relational intervention.

Treatment intensity should match developmental depth. Standard outpatient therapy (weekly 50-minute sessions) may be insufficient for patients whose affect regulation circuitry was never properly built. Schore's work suggests that interventions approximating the conditions of early development—frequent, consistent, emotionally attuned—may be necessary for meaningful change. This has implications for treatment planning: more frequent sessions, longer sessions, adjunctive body-based approaches, and realistic expectations about treatment duration.

Consider body-based and right-hemisphere-engaging interventions. Since the damage occurred in implicit, right-hemisphere systems, interventions that engage these systems directly—EMDR, Somatic Experiencing, sensorimotor psychotherapy, attachment-focused EMDR—may access the injury more directly than purely verbal approaches. Schore's work supports the movement toward integrating body-based trauma treatment with relational approaches.

Pharmacological augmentation may support neuroplastic change. While Schore's work is primarily about relational mechanisms, the neurobiological framework suggests that pharmacological interventions supporting neuroplasticity may enhance therapeutic gains. SSRIs, which have been shown to increase brain-derived neurotrophic factor and enhance plasticity, may create neurobiological conditions more conducive to the relational learning that builds regulatory capacity.

Broader Implications

Schore's research extends far beyond individual therapy rooms. Understanding that affect regulation is built through early relationship illuminates patterns across society.

The Intergenerational Transmission of Dysfunction

If affect regulation capacity is built through the caregiver's regulated presence, what happens when the caregiver themselves lacks regulatory capacity? The parent who cannot regulate their own emotions cannot provide the regulatory scaffolding their child needs. The child grows up with compromised affect regulation, becomes a parent, and transmits the same deficit to the next generation. This is the mechanism of intergenerational trauma—not mystical transmission but neurobiological reality. Breaking these cycles requires interventions that address parental regulatory capacity, not just parenting behaviours.

Relationship Patterns in Adulthood

Adults whose affect regulation circuitry was inadequately built in childhood often struggle in intimate relationships. They may become flooded by emotions and react destructively, or shut down entirely and become unavailable. They may unconsciously seek partners who replicate familiar dysregulation, or sabotage relationships with partners who offer the unfamiliar experience of consistent attunement. Schore's framework helps explain why "attachment work" in couples therapy often requires individual work on each partner's regulatory capacity.

Workplace and Organisational Dynamics

The workplace is full of attachment-activating situations: evaluation, hierarchy, competition, collaboration. Adults whose early development left them with compromised affect regulation may struggle to manage the emotional demands of professional life—becoming reactive under criticism, anxious about performance, unable to collaborate effectively, or defensively hostile in team settings. Organisations that understand this can design management practices that support regulation rather than triggering dysregulation.

Institutional Care and Policy

Schore's work has direct implications for child welfare policy. Foster care systems that move children between placements disrupt exactly the relationships needed for regulatory development. Institutional care settings that provide physical needs but not attuned relational engagement fail to provide what children's developing brains require. Policies supporting parental mental health, family preservation where safe, consistent foster placements, and quality early childhood education are not merely humane—they are neurobiologically necessary.

Legal and Policy Considerations

Family courts making custody decisions should understand that frequent transitions between caregivers during the first three years may have neurobiological costs beyond the obvious psychological stress. Criminal justice systems might consider how early affect regulation failures contribute to difficulties with impulse control and emotional reactivity—not as excuse, but as context for rehabilitation approaches that address regulatory capacity rather than simply punishing regulatory failures.

Public Health Framework

Viewing early relational health through a public health lens reframes parental support from an individual family matter to a population-level priority. The adverse childhood experiences that prevent healthy affect regulation development—including narcissistic parenting—have downstream costs in healthcare utilisation, criminal justice involvement, workforce productivity, and welfare dependency. Investment in early intervention, parental mental health, and quality caregiving environments may represent one of the highest-return public health investments available.

Limitations and Considerations

Schore's work, while foundational, has important limitations that inform responsible interpretation.

Complexity of translating to clinical protocols. Schore's synthesis is masterful at the theoretical level, but translating "provide attuned relational experience that builds regulatory capacity" into specific therapeutic protocols remains challenging. Clinicians must interpret principles into practice, and the optimal methods for doing so are still being developed.

The challenge of measuring change. How do we know when therapeutic intervention has successfully built affect regulation capacity? Subjective report and behavioural observation are imperfect measures. Neuroimaging could theoretically demonstrate neural changes, but is not practical for routine clinical use. Better measures of regulatory capacity change are needed.

Individual variation in neuroplasticity. Not all patients respond equally to relational intervention. Genetic factors, age, severity of early deprivation, and other variables influence how much neural change is possible. Schore's framework may create expectations that not all patients can fulfil, leading to discouragement when progress is slow.

Cultural considerations. Schore's work draws primarily on Western attachment research. What constitutes "attuned caregiving" varies across cultures, and the specific expressions of healthy regulatory development may differ. Clinicians should be cautious about applying a universal template to diverse populations.

Historical Context

Affect Regulation and the Repair of the Self was published in 2003 as the culmination of Schore's decade-long project to integrate neuroscience with attachment theory. His earlier work—particularly Affect Regulation and the Origin of the Self (1994)—had established the theoretical foundation, drawing on Bowlby's attachment framework while adding the neurobiological mechanisms that Bowlby could only intuit.

The book appeared at a pivotal moment. Neuroimaging technology had matured enough to reveal brain changes associated with early experience. Attachment research had generated robust findings about the long-term consequences of different attachment styles. And trauma treatment was evolving beyond purely cognitive approaches toward recognition that the body and implicit memory systems mattered.

Schore's synthesis brought these streams together, demonstrating that attachment theory wasn't just psychology—it was neurobiology. The regulated caregiver wasn't just providing comfort; they were literally building their child's brain. The right hemisphere wasn't just "emotional" in some vague sense; it was the substrate of affect regulation, relational processing, and stress response, and it developed through specific mechanisms during specific windows.

The book has been cited over 4,000 times and has influenced fields from infant mental health to adult psychotherapy to social policy. Schore's "regulation theory" has become a foundational framework for understanding developmental trauma and its treatment.

Affect Dysregulation and Disorders of the Self

APA Citation