Daniel Hill - Affect Regulation Theory: A Clinical Model

Affect Regulation Theory

Copyright 2015 by Daniel Hill

All rights reserved

FIRST EDITION

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The Library of Congress has cataloged the printed edition as follows:

Hill, Daniel (Psychologist)

Affect regulation theory : a clinical model / Daniel Hill ; foreword by Allan N.

Schore. First edition.

pages cm. (The Norton series on interpersonal neurobiology)

Includes bibliographical references and index.

ISBN 978-0-393-70726-7 (hardcover : alk. paper)

1. Affect (Psychology) 2. Affective disorders. 3. Affective neuroscience.

I. Title.

BF175.5.A35.H55 2015

152.4dc23

2015017865

ISBN: 978-0-393-70726-7

ISBN: 978-0-393-71132-5 (e-book)

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Affect
Regulation
Theory

A CLINICAL MODEL

Daniel Hill

Foreword by
Allan N. Schore

W. W. NORTON & COMPANY

New York London

A Norton Professional Book

AFFECT REGULATION
THEORY

AFFECT REGULATION THEORY is a dream fulfilled for me professionally and personally. During my entire career I have been distressed by the fragmentation of the field. I have searched for a model that integrates psychoanalysis and its schools of thought with other approaches.

Affect regulation theory, as Im using the term, derives from Allan Schores work and my integration of it with mentalization theory developed by Peter Fonagy and his collaborators. It is an integration of attachment theory, developmental affective neurobiology, developmental social-cognitive neurobiology, emotional studies, mother-infant studies, and developmental psychoanalysis. It is thus a developmentally based approach to psychobiology in the tradition of Piaget and Freud (my early professional enthusiasms) whose work is based in an understanding of how the mind emerges from the body into a bodymind. John M. Bowlby and Allan N. Schore are of this traditionintegrating psychology and biology.

Affect regulation theory is also a dream fulfilled for my work with patients. Psychotherapy has suffered from being either comprehensive and inefficient (too inefficient for our times), or efficient but failing to appreciate and treat problems as they extend throughout the bodymind and into the whole person. It has also suffered from being overly focused on either the mind or the body, with resulting application of top-down or bottom-up approaches. Affect regulation theory and the therapeutic techniques that are being developed from it bring efficiency and the body to psychodynamic psychotherapies. More than ever, I feel that I am working with the core of my patients and from the core of myself.

I now understand patients with developmental disorders to be suffering from the sequelae of relational trauma. Along with the focus on affect, nothing has changed the way I work more than the understanding of the effects of early attachment trauma on self experience, relational life, and vulnerability to psychiatric disorders. It puts a malformed nervous system, shame and dissociation at the center of clinical work.

This book is my attempt to make affect regulation theory more accessible to practitioners. Learning enough of the disciplines that provide the theoretical underpinning for affect regulation theory is a daunting task. Learning the language and concepts of a new, paradigm-shifting theory is only slightly less daunting. I have provided the necessary understanding of affective neurobiology and classical and modern attachment theories. The book is organized around Allan Schores regulation theory, and my contributions are additions to it.

There are many friends, colleagues, and students to whom I am indebted. Allan Schore has been a generous mentor, guiding my reading and discussing his theory. Along the way he has become a valued colleague, friend, and occasional partner in crime. I am extremely grateful to the staff at Norton. Deborah Malmud, Andrea Costella Dawson, Kevin Olsen, Kathryn Moyer, Trish Watson, and Ben Yarling were attentive, helpful, and, above all, patient throughout the process.

The book was written with my study groups in mind. I spoke to them as my study of affect regulation therapy deepened, and they provided a secure exploratory haven for my developing understandings and ideas. I shared early drafts of the book with them, and their reactions have been invaluable. They are Beverly Brisk, Amy Gladstone, Ann Rasmussen, Debby Russ, Kitty Cullina-Bessey, Janice Rosenman, Susan Markowitz, and Susan Parente; Clair Goldberg, Deborah Kaplan, Harriet Power, Hea-Kyung Kwon, Naomi Fox, Rosemarie Ciccarello, Sarah Karl, and Susan Levine; and Alice Rosenman, Carol Antler, Claire Haimon, Emily Nash, Kenneth Greenwald, Maria Rosen, and Satya Lauren. Friends and colleagues Barbara Gerson, Laura Kogel, Marty Rock, Peter Deri, Sharon Kozberg, and Terry Marks-Tarlow offered important feedback on early chapters, and Bob Karen offered invaluable help with my writing style.

Beyond everything, I am grateful to my partner, Nina, my other half, without whom this book would not be what it is. Imagine the ideal editor, attuned emotionally and intellectually, reading closely and rereading every chapter, whom you feel loved by and whom you love. Imagine that.

IN THE FOLLOWING chapters, Daniel Hill clearly articulates the specific, dual purposes of this book: to formulate a coherent clinical model of affect regulation theory and to offer numerous concrete clinical examples of affect regulation therapy. In light of the fact that the theory has substantially developed over the last three decades, this is no easy task. It involves synthesizing the essential principles of the theory and translating these principles into not only an overarching clinical model but also one that describes the subtleties and uniqueness of any individual psychotherapy. This ambitious goal calls for the efforts of an author who is simultaneously a writer, able to bridge and integrate a number of scientific literatures, and a master clinician familiar with the complexities of the clinical encounter. Let me say up front that this remarkable book succeeds on both counts, and then goes even further. Much more than presenting a concise, coherent formulation of regulation theory, it expands the affect regulation model with a significant number of creative clinical contributions. But before I speak directly about Hills exposition and expansion of regulation theory, let me give some background to what he is building upon.

The central tenets of affect regulation theory were set out in 1994, in my first book, Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. The volume offered for the first time an overarching psychoneurobiological model of early emotional development. In parallel, various clinical literatures including clinical psychology, psychiatry, and psychoanalysis were presented, interwoven with extant research data from neuroscience and infant studies. The early chapters integrated psychology and biology in order to model normal development. The latter chapters offered clinically relevant heuristic models of the interpersonal neurobiological origins of a spectrum of psychopathologies, as well as a model of psychotherapeutic change that focused on emotion, especially affective processes that operate beneath levels of conscious awareness. The 37 chapters described developmental changes in not only emerging psychological function but also biological structure, addressing both critical early periods and later psychotherapeutic contexts.