The Divided Therapist: Hemispheric Difference and Contemporary Psychotherapy

In The God of the Left Hemisphere I explored the remarkable connections between the activities and functions of the human brain that writer William Blake termed ‘Urizen’ and the powerful complex of rationalising and ordering processes which modern neuroscience identifies as ‘left hemisphere’ brain activity. In The Divided Therapist I extend this analysis, exploring its implications for our mental health and the practice of therapy itself – the regeneration and reintegration of the psyche. If the first book was about the “fall into Division”, this book is about the “Resurrection to Unity”: the restoration of psychic wholeness.

 

Introduction: The Divided Brain and the Basis of Psychotherapy

“It was Freud’s hope”, neurologist David A. Scola observed, “that a neural basis for his clinical observations and psychological explanations of the human mind would eventually be established”. A hundred years after Freud’s pioneering work into the nature and structure of the human mind, and perhaps appropriately following in the tradition of his own early interest in neurology and neuropathology, we are finally beginning to glimpse the outlines of this exciting new topography.

“Throughout Freud’s writings,” Solms notes, “again and again he said that he was eagerly looking forward to the day when it would be possible to reunite his observations from the psychological perspective with neuroscientific ones”. Thanks to recent advances in interpersonal neurobiology, affective neuroscience, developmental neuropsychiatry, and psychoanalytic theory – much of which is presented in The Divided Therapist – we are now near to establishing the ‘neural basis’ – the biological substrate – for the processes and mechanisms of the mind that Freud once dreamed of.

One of the most exciting discoveries has been the uncovering of the nature of the divided human brain, and a new understanding of the precise nature of hemispheric difference. Of particular relevance to therapy has been the discovery of the correlation between the “right hemisphere” of the brain with “unconscious” processes and networks, and the left hemisphere of the brain with the more explicit, verbal “conscious” activities. As Professor of Psychology Louis Cozolino notes: 

The similarity between hemispheric specialization and Freud’s notion of the conscious and unconscious mind has not been lost on psychotherapists. Right hemisphere functions are similar to Freud’s model of the unconscious in that they develop first and are emotional, nonverbal, and sensorimotor … This nonlinear mode of processing allows the right hemisphere to contain multiple overlapping realities, similar to Freud’s primary process thinking most clearly demonstrated in dreams. The linear processing of conscious thought in the left hemisphere parallels Freud’s concept of secondary process, which is bound by time, reality, and social constraints.

Indeed, this idea of the right hemisphere being associated or identified with the more implicit or “unconscious” self, and the left hemisphere with the conscious self (the “conscious left brain self system”, as Schore puts it), is one of the most consistent and striking findings. There is widespread consensus that the right hemisphere of the brain constitutes the “biological substrate of the human unconscious” (Schore, The Divided Therapist). There could hardly be a more succinct or striking endorsement of Freud’s initial suppositions regarding the existence of the unconscious, or confirmation of his hope for the discovery of neural correlates for the processes he did so much to unearth and bring to our attention. 

 

The Divided Therapist:  Mental Health and the Restoration of Integrity

The Divided Therapist examines the precise nature and origin of the divided brain and explores its relevance for contemporary psychotherapy. It shows how the relationship between the two hemispheres of the brain is absolutely central to our well-being and mental health, and outlines both the practical and theoretical implications for therapy that the latest neuroscientific and psychoanalytic research has opened up. 

Hemispheric imbalances and disconnections underlie many of our most prevalent forms of mental distress and disturbance, as a number of authors in the volume compellingly suggest. These include issues of addiction, autism, schizophrenia, depression, anorexia, relational trauma, borderline and personality disorders, psychopathy, anxiety, derealisation and devitalisation, and alexithymia. A contemporary understanding of the nature of the divided brain is therefore of importance in engaging with and treating these disturbances.  Indeed, as Schore compellingly suggests, “deficits in right brain relational processes and resulting affect dysregulation underlie all psychological and psychiatric disorders”. And as Cozolino notes, “psychotherapy can serve as a means to reintegrate the patient’s disconnected hemispheres”, observing that “the integration of dissociated processing systems is often a central focus of treatment”:

A primary focus of neural integration in traditional talk psychotherapy is between networks of affect and cognition. Dissociation between the two occurs when high levels of stress inhibit or disrupt the brain’s integrative abilities among the left and right cerebral hemispheres as well as among the cortex and limbic regions … Examples from psychiatry and neurology strongly suggest that psychological health is related to the proper balance of activation, inhibition, and integration of systems biased toward the left and right hemispheres.

Psychotherapy facilitates neural integration between the cortex and limbic regions, as well as between conscious and unconscious processes, and the networks of affect and cognition, thereby restoring coordination among a number of vital systems where these have been disrupted or damaged. The Divided Therapist reveals how the hemispheric relationship lies at the heart of the therapeutic process itself, explaining how a better understanding of the underlying mechanisms that enable integration between the left and right brain will help to transform the practice of psychotherapy and psychoanalysis in the twenty-first century.  

Far from being at odds with Freud’s original psychological speculations regarding mental processes and functions, many of his theories are finding surprising corroboration in contemporary neuroscience. These are especially evident with regard to his prescient observations concerning the nature of the unconscious, and how unconscious processes map onto what we now know about the structure and function of the right hemisphere. As Schore strikingly notes, there is now widespread agreement that “the right brain is the biological substrate of the unconscious” – a remarkable finding that will have profound implications for our conceptualisation of psychotherapy, and is already transforming both the theoretical and practical aspects of therapeutic practice. Pointing to the increasing recognition of the role of the right hemisphere in particular in our modern understanding of the relational foundation of therapy and the underlying change mechanism of therapy, Schore acutely observes that “right brain processes that are reciprocally activated on both sides of the therapeutic alliance lie at the core of the psychotherapeutic change process” (Schore, The Divided Therapist).

Knowledge of the exact role and nature of hemispheric dysfunction and imbalance is therefore seen as being of increasing importance for contemporary therapists, who themselves of course are equally ‘divided’ in terms of hemispheric bilateralisation. Indeed, it is precisely the nature of the relationship between the two hemispheres of the patient, and between the hemispheres of the patient and the therapist, that is central to successful therapeutic outcomes, as a number of the authors in the volume suggest. As Cozolino notes, the attuned therapist acts as a sort of bridge, or integrator, of these divided worlds, and he compellingly explores the pivotal role of the therapist in being able to access and repair these often rather dissociated and dis-integrated systems:

Hopefully, the therapist will be better integrated than the client in a therapeutic relationship. This will allow the therapist to react to what is said with emotion, resonate with the client’s emotions, and then share thoughts about these emotions with the client. Thus, the therapist’s ability to traverse the colossal bridge between his or her own right and left hemispheres serves as a model and guide for the client.

Indeed, this new understanding of the therapist as both a mediator and integrator of hemispheric worlds – and of the therapeutic importance of the role of the integrated, attuned, and compassionate therapist (the ‘undivided therapist’) – may I believe provide an important model for all of us in suggesting a radically new approach to attending to and caring for each other in our increasingly divided and divisive world.

 

From Machinery to Prosody: The New Model of the Human Brain

Our models of the brain have always reflected the society out of which they emerged. During the last couple of centuries, the brain was routinely compared to a machine or a computer, a mechanical and functionalist device – where for example memories were said to be ‘stored’ or ‘filed’, like you would on a computer or filing cabinet.

We can now see how limited and rather quaint this model is, with its unilinear modelling and rather static, mechanical, lifeless, representational feel. In the neuroscientific modelling world of the twenty-first century, the brain is now revealed to be much more sophisticated and dynamic, and above all alive, entity – an extraordinarily fluid, engaged, nonlinear, responsive, relational form of organisation, one that is constantly coming into being – like a score – through the sum of its interactions.

It is an interweaving, interconnecting world of mutual resonance and constant reverberation, acting and reacting in response both to experiences within and without, where the metaphors of resonance, attunement, and reverberation come alive in a dazzling display of mutual action and interaction – of constant call and response.

In an earlier age, Plato used a very different metaphor for the brain than the machine model that has dominated Western scientific thinking since the Enlightenment. In his dialogue ‘Theaetetus’, which explores the nature of knowledge, Socrates compares our thoughts and memories to birds in an aviary, perhaps drawing on the ‘call-and-reply’ aspect of consciousness that modern researchers have again begun to recognise and appreciate. The aviary model also suggests the intimate association that is felt between ‘music’ and ‘memory’ – how the ‘past’ also calls to us, reverberates – which is why its resonant patterns and structures are so evocative.

With the rise of more left hemispheric ways of thinking about the world in the Enlightenment, this organic and dynamic model was replaced by a more rigid, and much more passive, model of the mind (as simply a ‘tabula rasa’ upon which things were unilinearly inscribed). This mechanical and materialistic view of the brain generally prevailed in scientific literature until the late twentieth century.

One brief exception was during in the eighteenth century, when a more dynamic understanding of the brain and body re-emerged with David Hartley’s ‘Associationist’ school of psychology, which focussed on neural connectivity and explored how various neural ‘vibrations’ and ‘modulations’ in the brain had an impact on both our bodily and mental activity.

This ‘vibrational’ model of the mind was picked up by a number of the leading Romantic writers and thinkers, including Coleridge, Wordsworth, and Shelley, in their striking ‘Aeolian Harp’ metaphors for consciousness. Shelley’s magnificent – and extraordinarily prescient – incorporation of this way of thinking about consciousness is evident in his A Defence of Poetry (1821): “Man is an instrument over which a series of external and internal impressions are driven,” he notes, “like the alternations of an ever-changing wind over an Æolian lyre, which move it by their motion to ever-changing melody”.

Interestingly, as we have seen, a rather similar model has emerged in recent neuroscience, with the concept of ‘reverberation’, ‘modulation’ and ‘resonance’, in which our brains similarly render and receive fast influences in rapid multilinear and multivalent ways, and in which the forebrain itself is now seen as being “overwhelmingly an area of reverberating reciprocal influence” (Kinsbourne).

At the very level at which the brain itself operates, matter itself seems to behave in a ‘reciprocal’, not a ‘linear’, way, in a constant and mutual process of call and response, rather as Socrates had suggested. As McGilchrist remarks, “it seems that this reciprocity, this betweenness, goes to the core of our being”. Plato was right. Our heads, it seems, are full of birdsong.”

 

The Resurrection to Unity: The Integration of Mind

“The main task of psychotherapy”, Vadim Rotenberg notes in the concluding chapter of The Divided Therapist, “is the restoration of the patients’ right frontal lobe skills, the polysemantic way of thinking”. By this he means the patient’s “holistic grasping of numerous interrelationships”, echoing psychotherapist Barbara Dowds’s earlier observations regarding the “kind of broad, diffuse and holistic attention that is characteristic of the right hemisphere” and which “is destroyed by the intense focus and analytic atomisation of the left” (‘Connection and Emergent Meaning in Life and in Therapy’, The Divided Therapist).

Rotenberg emphasises that this right brain sense of interrelationship and integrative ability is also manifested in the way it responds to words and communication – in a “polysemantic” way, he notes, rather than the more linear, simplified, unambiguous and “logical” manner of the left hemisphere’s “monosemantic” mode. “Polysemantic” simply means “on many semantic planes simultaneously”, and as examples of this mode he gives the richly condensed formations of dreaming, poetry, and art.   

“The common function of all of the structures of the right hemisphere”, he notes, “is to apprehend and deliver the holistic approach to the world”. Each hemisphere has a distinct semantic style, therefore, and this is related to their distinct sense of self: the left hemisphere is discrete, conscious, differentiated (Rotenberg calls this “self-concept”); the right hemisphere is more relational, more implicit and less conscious; more embodied (“self-image”), and these dual aspects manifest themselves in various psycho-physiologies.

Rotenberg beautifully links the early maturational movement from the right hemisphere (which is the dominant hemisphere for the crucial first eighteen months of life) to the left, with the development of much wider historical and cultural shifts. His startling reinterpretation of the story of Adam and Eve as symbolising exactly such a transition (from right-hemisphere oceanic “oneness”, to a necessary fall into separation and discreetness – and then a final return to reintegration or “paradise regained”) is a striking example of the deeper aspects of this discussion.

We continually fall in and out of paradise, in that sense, he suggests: there is a constant dynamic of merging and separation, giving and receiving, holistic awareness and analytic self-consciousness. Too often, he notes, the patient remains stuck in a monosemantic world, and he suggests that in such instances the task of the therapist is “the reintegration of the subject in the polydimensional world”, to help the patient to a more fully integrated and alive state, on a deeper level.

Therapy is in that sense a way of restoring on a new level that “pre-reflective state”, a deeper and more interconnected world of neurological maturation and integration – a restored and regained “Eden”, in Rotenberg’s powerful and evocative metaphor of this process of necessary separation and synthesis. Thus, the aim “is not to make the unconscious conscious,” notes Rotenberg, so much as “the reintegration of the subject in the polydimensional world” – the restoration of an “I/Thou” sense of relationship with reality, rather than an objectifying and instrumental “I/It” one, in Buber’s terms (Buber, I and Thou).

Therapy helps to heal that sense of rupture, or series of ruptures (of subject-object, inner-outer, cognitive-affective, mind-body), through the difficult process of tikkun olam that so many practices and traditions have sought to recapture, a deep longing for reconnection and re-union. The world’s literature has always been about recovery, about reintegration – an enduring recognition of the need to recover these forgotten or mis-remembered worlds, these dis-membered gods, these broken shards of meaning: integration regained.

 

Reviews and Endorsements for The Divided Therapist 

“A magnificent achievement” – Professor Jeremy Holmes, psychiatrist and author of Exploring in Security: Towards an Attachment-Informed Psychoanalytic Psychotherapy and The Search for the Secure Base: Attachment Theory and Psychotherapy

“Fascinating – both lucid and intriguing” – Adam Phillips, psychoanalyst and author of Becoming Freud: The Making of a Psychoanalyst and Attention Seeking

“Wonderful – a really important book revealing the missing key to understanding psychopathology and psychotherapy” – Dr Phil Mollon, psychoanalyst and author of Shame and Jealousy: The Hidden Turmoils; Psychoanalytic Energy Psychotherapy; and The Fragile Self: The Structure of Narcissistic Disturbance

“This book explores and explicates insights that are fundamentally important to the practice of therapy today. Really fascinating” – Robert Snell, analytic psychotherapist and author of Uncertainties, Mysteries, Doubts: Romanticism and the Analytic Attitude

 

Rod Tweedy, PhD, is the author of The God of the Left Hemisphere: Blake, Bolte Taylor and the Myth of Creation (Routledge, 2013), a study of William Blake’s works in the light of contemporary neuroscience, and the editor of The Political Self: Understanding the Social Context for Mental Illness (Routledge, 2017) and The Divided Therapist: Hemispheric Difference and Contemporary Psychotherapy (Routledge, 2020). He is also an active supporter of Veterans for Peace UK and the user-led mental health organisation, Mental Fight Club.

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