1. Voices Beyond the Threshold
Isabel Clarke
Consultant Clinical Psychologist

2. The Talk
What threshold – A psychological framework for understanding non ordinary experience
Managing the threshold - Therapeutic approaches
Understanding the transpersonal aspect
The transformative dimension.

3. Different types of experience: psychosis and spirituality revisited.
What is the connection between the journey of life: the journey of therapy, and the spiritual journey?
Why can some people manage to adust to difficult transitions
Whereas other people find themselves in a different dimension?
How is it that for some people this experience is creative and transformative?
Whereas for others it is the opposite?
What can we learn about this other dimension – and how can this help us to stand beside the journier?
Ask: what is spirituality. Discuss ideas of the sacred etc.

5. O the mind, mind has mountains; cliffs of fall
Frightful, sheer, no-man-fathomed. Hold them cheap
May who ne’er hung there.
Gerald Manley Hopkins (from ‘No worst, there is none, pitched past pitch of grief’)

6. Travel into the strange places of the mind
Not mind safely locked inside the skull;
No!: mind that envelopes us;
Mind that is sea we swim in
Travel across the threshold – the Transliminal – but never to let go of Ariadne’s thread!

7. Characteristics of the other way of experiencing
Metaphor come to life
Dissolution of boundaries

9. Cosmic significance – terrible or wonderful
Confusion about the self

11. Coincidence rules OK
Threat (cosmic)
Link with trauma

13. Two Views of the person Static Dynamic and in flux.
people are rational beings, with, needs, plans and aspirations, who function more or less well, unless they turn out to have an 'illness'
Static
people are perpetually seeking definition through dreams and symbols, and deeply dependent on important relationships; easily knocked off course by loss of any of these props, and perpetually trying to balance the inner state.
Dynamic and in flux.
Basic CBT’s model of mind is simple. Mind is about thought,physical arousal,feeling,&behaviour in interaction. The therapy seeks to effect change by altering thought and behaviour. This worked so well for straightforward anxiety and depression type conditions, that it has been progressively extended to more and more challenging diagnoses, such as pd and psychosis.
It has done this first by elaborating the basic model; adding in schemas, the second wave,
Picking up ideas from humanistic and psychodynamic approaches
and then by the development of the 3rd Wave therapies (term coined by Hayes, whose ACT is one of them)

14. Getting a scientific grip on the transliminal
The split between realities comes from the split in us!
Interacting Cognitive Subsystems provides a way of making sense of this ‘crack’.(Teasdale & Barnard 1993).
An information processing model of cognition
Developed through extensive research into memory and limitations on processing.
A way into understanding the “Head/Heart split in people.
Having reviewed these trends within the cultural map of therapy, I will return to the central challenge faced in attempting to facilitate change where the patterns to be changed are rooted in early or major trauma, and are deep seated, or where psychopathology is severe, as with serious psychosis.
The split between thought and feeling underlies the logic of CBT. Behaviour, and so the course of life and relationship tends to be governed by feelings and habitual patterns (schemas). If these can be thought about, with the facilitation of therapy, they can be changed. It was then noted that the relationship between thought and feeling operated differently in different situations. Under high threat/high arousal/ high emotion, the reaction was automatic and not reflected upon at all (hot cognition). For revision to happen – it had to be appraised coolly.
Different CBT therapist-researchers have come up with a bewildering variety of ways into the levels of processing split - which I will not bore you with. Instead, I will bewilder you with Interacting Cognitive Subsystems, which provides a neat explanatory framework across these areas (I suggest).

15. Interacting Cognitive Subsystems.
Body
State
subsystem
Relational
subsystem
Auditory
ss.
Implicational
Memory
Visual
ss.
This is a diagram of some of the processing subsystems in the brain, according to Teasdale and Barnard - based on research on cognitive processing. .
I am going to concentrate on the two large ones here - p and i.
p = verbal based logical reasoning - with a verbally coded memory store.
i = holistic, overall meaning processing. Direct connections with sense modalities (in contrast to p) and a memory store coded in every sensory modality - vivid and immediate. The connection with emotional response made possible by the direct connection with state of bodily arousal.
For complete processing, for “construing” in a Kellyan sense, you need both working in close communication. Because the systems are distinct, it is possible for this communication to become overloaded or skewed in some way.
This helps to explain a lot of what goes wrong for human beings.
Verbal
ss.
Propositional subsystem
Propositional
Memory

16. MIND REASONABLE (Implicational subsystem) MIND (Propositional
Linehan’s STATES OF MIND (from Dialectical Behaviour Therapy) – Maps onto Interacting Cognitive Subsystems
EMOTION
MIND
(Implicational
subsystem)
REASONABLE
MIND
(Propositional
Subsystem)
WISE
MIND
Though L does not refer to it specifically, the ICS split maps onto the basic DBT model of the mind, as follows: The idea of a shifting balance is central to DBT, so that the self is seen as moving between the minds. Wise mind is the same as the two central ss. in ICS working smoothly together; reasonable mind dominance suggests an avoidance of the emotional (because the physical state of arousal produced by memories is anticipated as too unpleasant). Emotional Mind is where the implicational is dominant, and a loop can be set up that excludes current reflection, and so revision of past patterns – whether of depressive rumination or impulsive action.
IN THE PRESENT
IN CONTROL

17. Using ICS to understand the Transliminal
Non-ordinary experience: when Emotion Mind/Implicational does not mesh properly with Reasonable Mind/Propositional
This leads to a different quality of experience – fine in the short term – a problem when stuck
Normalising the difference as well as the continuity – shared and unshared reality
Sensitivity and openness to anomalous experience – continuum with normality
Understanding the role of emotion – the feeling is real; the ‘story’ is improbable

18. Important Features of this model
Our subjective experience is the result of two higher order processing systems interacting – neither is in overall control.
Each has a different character, corresponding to “hot” and “cool” cognition.
The Relational Subsystem manages emotion – and therefore relationship.
The verbal, logical, propositional ss. gives us our sense of individual self.
This gives us the two ways of knowing:
The Everyday or Shared Reality (when Relational and Propositional are in synchrony)
The Transliminal or Unshared Reality (when they are in desynchrony).
Both of these are available to all human beings.
Both are incomplete
The transliminal has always both fascinated and spelt potential danger!

19. Evidence for a new normalisation
Schizotypy – a dimension of experience: Gordon Claridge.
Mike Jackson’s research on the overlap between psychotic and spiritual experience.
Emmanuelle Peter’s research on New Religious Movements.
Caroline Brett’s research: having a context for anomalous experiences makes the difference between
whether they result in diagnosable mental health difficulties
whether the anomalies/symptoms are short lived or persist.
Wider sources of evidence – e.g.Cross cultural perspectives; anthropology. Richard Warner: Recovery from Schizophrenia.

20. Being Porous: therapeutic approach
Some people are more open to this type of experience than others – cf. Schizotypy
Sensitivity and openness to anomolous experience – continuum with normality
Positive side as well as vulnerability
Validating the experience
Normalising the difference in quality of experience as well as the continuity – understanding the transliminal so that it can be recognized – give choice
Motivation to engage with shared reality
Manage the threshold – mindfulness is key

21. MIND REASONABLE (Implicational subsystem) MIND (Propositional
Linehan’s STATES OF MIND (from Dialectical Behaviour Therapy) – Maps onto Interacting Cognitive Subsystems
EMOTION
MIND
(Implicational
subsystem)
REASONABLE
MIND
(Propositional
Subsystem)
WISE
MIND
Though L does not refer to it specifically, the ICS split maps onto the basic DBT model of the mind, as follows: The idea of a shifting balance is central to DBT, so that the self is seen as moving between the minds. Wise mind is the same as the two central ss. in ICS working smoothly together; reasonable mind dominance suggests an avoidance of the emotional (because the physical state of arousal produced by memories is anticipated as too unpleasant). Emotional Mind is where the implicational is dominant, and a loop can be set up that excludes current reflection, and so revision of past patterns – whether of depressive rumination or impulsive action.
IN THE PRESENT
IN CONTROL

22. Managing the threshold
Awareness of vulnerability – of openness to transliminal experience
Grounding when the experience is overwhelming. Grounding activity. Grounding food.
Mindfulness to manage the threshold
Challenge of facing unshared reality mindfully – both pleasant and unpleasant
Transliminal state of mind = most accessible at high and low arousal
Managing arousal – breathing control to reduce arousal; mindful activity in the present to prevent it slipping.

23. Psychosis and the Transpersonal Dimension
ICS offers a challenging model of the mind
The human being is a balancing act as the two organising systems pass control back and forth: there is no boss.
The mind is simultaneously individual, and reaches beyond the individual, when the implicational ss. is dominant.
This constant switch between logic and emotion gives us human fallibility
The self sufficient, billiard ball, mind is an illusion
In our implicational/relational mode we are a part of the whole.

24. ‘That’s How the Light gets in’ (and the dark)
The Relational part of our mind is embedded in relationship; in the whole (the older part)
The newer, self conscious, part holds our individuality
Temporary control passing backwards and forwards between the two organising ss is experienced as normality
When the ‘relational’ takes over for any length of time, the character of experience changes
The person is no longer grounded in their individuality – boundaries dissolve – they are open to any influences – positive and negative.

25. Web of Relationships Sense of value comes from rel. with the spiritual
In Rel. with
earth:
non humans
etc.
In Rel. with
wider
group etc.
primary
care-giver
Self as
experienced
in relationship
with primary
caregiver
16 I would go further and suggest a theory of mind that says we create and our created by our relationships, and by the quality of our relationships; I see the individual as held in a web of relationship.
ICS, by suggesting that the verbal and emotional parts of our cognitive organisation work in partnership, opens the possibility of a theory of mind that holds two potentialities; one for the purely individual experience, and the other where human beings are organised in the context of relationship. In this way, the individual mind is not self sufficient, but makes sense within a web of relationship which both creates and is created by experience and action in relationship. The quality of those relationships shapes us in the core of our being.
Clearly, the person's early caregiver relationships, which influence all later intimate partnerships, are important, but the web extends wider; to the social group; the tribe or nation; the ancestors and those who will come after us; the non human creatures with which we share the planet, and to the planet itself. This model provides a way of understanding that "ground of being" that has been cited, or the mystery of the ultimate; of God (however designated) as the widest and deepest relationship of the web. This suggests a way into a universal human experience, but not one that can be precisely designated – it remains a mystery.
Sense of
value comes
from rel. with
the spiritual

26. What does this say about the possible transpersonal dimension of psychosis?
Taking experience seriously – experience of possession
Experience of cross generational healing
On the other hand – the transliminal is governed by a logic of both – and……

27. Psychosis – Potential for Transformation
Traditions such as Psychosynthesis and Spiritual Emergence/Emergency recognize the transformational potential of the transliminal.
They tend to distinguish between ‘psychosis’ and transformational crises
More and more this is seen as a false dichotomy – Spiritual Crisis Network (.org.uk)
Mike Jackson’s Problem Solving – Paradigm Shifting model.
Click into another dimension for a wider perspective – with the danger of a vicious circle getting set up – getting stuck
Role of stigma in trapping people.

28. The What is Real and What is Not Programme – designed to combat stigma
First : Form an Alliance.
Validate their reality
Introduce the idea that their reality is only one way of looking at it:
shared and unshared reality (negotiate the language).
The individual’s experience is taken seriously and valued – at the same time as working on a better relationship to shared experience
It is possible to get away from illness language – and arguments about diagnosis
Normalising openness to unshared reality – idea of the schizotypy spectrum
Advantages and disadvantages of openness to unshared reality
– e.g. of people who have used unshared reality positively.

29. Characteristics of unshared reality.
Idea of the line/ the threshold.
Importance of being able to manage the line
Motivational aspect – pros and cons.
Coping skills to manage the line
When is unshared reality most powerful; in charge?
Arousal as a means of being in control;
Stress management
Being alert and concentrated – watch out for drifting states
Grounding in the present
Wise mind and mindfulness
Focusing/mindfulness v. distraction

30. Session 2. The role of Arousal shaded area = anomalous experience/symptoms are more accessible.
Level of Arousal
Ordinary, alert, concentrated, state of arousal.
Low arousal: hypnagogic; attention drifting etc.
High Arousal - stress

31. Linehan’s STATES OF MIND applied to PSYCHOSIS
Ways of coping suggested by this approach –
management of arousal and constructive activity.

32. Final Session:Making sense of the experience
Why do people click into/get lost in unshared reality/the transliminal?
Discussion of Different meanings for the experience
Meaning for the individual
Place in their life – what was happening in their life when it all started?
Address and validate the emotion – that is reliable.
'Problem Solving' idea – Mike Jackson’s research.

33. Contact details, References and Web addresses
AMH Woodhaven, Calmore, Totton SO40 2TA.
Clarke, I. (Ed.) (2010 Forthcoming) Psychosis and Spirituality: consolidating the new paradigm. Chichester: Wiley
Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester:'O'Books.
Clarke, I. & Wilson, H.Eds. (2008) Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; working with clients, staff and the milieu. London: Routledge.