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Problems with the Self Dr. Louise McHugh University College Dublin.

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2 Problems with the Self Dr. Louise McHugh University College Dublin

3 Know thyself!

4 Where is your ‘self’?

5 Ferrari et al 2008 YOU ARE HERE!

6 I was so stressed yesterday, I wasn’t myself! Then who were you?

7 Social animals…

8 Charles Cooley ‘Looking Glass Self’ We notice how people act towards us and derive what others opinion must be

9 George Herbert Mead Symbolic interactionism Humans act toward things on the basis of the meanings they ascribe to those things Meaning is derived from social interaction with others and society

10 My ‘self’ changes with context Imagine you had 30 seconds to describe your ‘self’  An interview for a marketing position To serve jury duty On a first date

11 What does contextual behavioural science say?

12 A sense of self? Only humans have a sense of self Why?

13 Symbolic relationships between things… Is what allows us to make sounds that other people understand rather than simply pointing and grunting at things ‘HAT’ ‘Kelly’

14 Relationships based on cues Physical Relationships = CONTEXTUAL CUE

15 = IS SAME AS CONTEXTUAL CUE Nic BAD OK GOOD BADNic

16 THE JUMJAW EXERCISE Readily answer questionsLittle or no reaction CONTEXTUAL CUE BEFORE AFTER Is a jumjaw the same as a cat? Is a jumjaw bigger than a tractor? Does a jumjaw have ears? ETC. Is a jumjaw the same as a cat? Is a jumjaw bigger than a tractor? Does a jumjaw have ears?

17 When children are taught to name objects, they are provided with masses of explicit bi-directional training CUE Clue for ‘Name-Object / Object-Name’ responding

18 After thousands of such interactions, the child no longer requires explicit bi-directional training

19 Same as (‘Jumjaw is the same as dog’) Opposite (‘Day is opposite to Night’) Different (‘Boys are different from Girls’) Comparison (‘£1 is more than 10p’) Causal (‘If anxious then I will mess up’) Temporal (‘Bad now worse later’) Perspective (‘I am here and you are there’) We can relate in many ways

20 Relating is great it can help me solve problems!

21 Especially important problems!

22 Think of three single digit numbers (you can repeat numbers) and write them down in random order Now answer the following question, using the first number to pick the word in the first column, the second number to pick the word in the second column, etc. And we can relate everything!

23 How is a... (e.g., banana)(e.g., the cause of)(e.g., candle) 1. Banana1. like1. prostitute? 2. Race car2. unlike2. war? 3. Kangaroo3. better than3. chair? 4. Foreman4. different from4. candle? 5. Priest5. worse than5. house plant? 6. Football6. the father of6. book? 7. Hat7. the cause of7. mud hole? 8. Computer8. the partner of8. baby? 9. TV9. the opposite of9. toilet?

24 … the cause of… Causal Relations can be tricky! Emotions Problems That problem with the government, your neighbors, your boss, etc. That problem with you

25 Technical Term Alert! Function  basically means the ‘effects something has’

26 Psychological Function Transformation of Functions

27 ‘DOG’ is a

28 ‘Dog’ Psychological Function

29 ‘DOG’ ‘Jumjaw’ is a

30 ‘Jumjaw’ Psychological Function

31 produces

32 “Small Dog” “Average Sized Dog” “Enormous Dog” produces

33 “Tall Jumjaw” “Grande Sized Jumjaw” “Venti Jumjaw” produces

34 Relating and the Transformation of Functions Dougher, Hamilton, Fink, & Harrington (2007) 15 normal subjects Establish this relational network in half of them using arbitrary stimuli: A < B < C Give B a CS shock function and then present a single ½ strength shock in the presence of A Test the C stimulus...

35 Derived Relations of Comparison MORE THAN university classcorner store living room Panic attack in one’s own living room results in increased arousal and avoidance of corner store and university class

36 And deriving explodes… Try this exercise: Learn four relations and see what happens... LISA OLDER THAN HOMER RELATION 1:

37 RELATION 2: LISA MAGGIE OLDER THAN

38 RELATION 3: HOMER YOUNGER THAN ABE

39 RELATION 4: YOUNGER THAN ABE MONTY BURNS

40 From 4 Trained Relations... OLDER YOUNGER OLDER YOUNGER

41 With age comes… Wisdom Beauty Regret Freedom Responsibility Strength Weakness

42 Language We also learn to manipulate it through sound and symbols Milk Please! Just as we learn to manipulate the environment with our body and hands

43 So language is responding to abstract relations So what does that have to do with the ‘self’? ‘I think therefore I am’ No Rene – you learn to verbally discriminate your own behaviour from others behaviour - therefore you are

44 I had a banana for breakfast No silly I had a banana for breakfast What did YOU have for breakfast?

45 I feel happy I am happier than you! I am a happy person! As a child begins to relate more and more of their own behavior… …and to compare it with that of others… …they begin to have a concept of self I feel sad I am not as happy as you I am a depressed person!

46 I eat breadI eat ice cream I eat a steak I eat chocolate I hear musicI hear a driving carI hear birds singingI hear my mother calling I see a deskI see you comingI see a bright futureI see and hear a dog I touch the screenI touch my faceI touch into the waterI touch the hot pan I go to my officeI go homeI go into the darkI go back to school I think of my workI think of your painI think of lunchtimeI think of my father I am goodI am badI am a husbandI am a doctor

47 I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother calling I see a deskI see you comingI see a bright futureI see and hear a dog I touch the screenI touch my faceI touch into the waterI touch the hot pan I go to my officeI go homeI go into the darkI go back to school I think of my workI think of your painI think of lunchtimeI think of my father I am goodI am badI am a husbandI am a doctor

48 I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother callingI see a deskI see you comingI see a bright futureI see and hear a dog I touch the screenI touch my faceI touch into the waterI touch the hot pan I go to my officeI go homeI go into the darkI go back to school I think of my workI think of your painI think of lunchtimeI think of my father I am goodI am badI am a husbandI am a doctor

49 I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother callingI see a deskI see you comingI see a bright futureI see and hear a dogI touch the screenI touch my faceI touch into the waterI touch the hot pan I go to my officeI go homeI go into the darkI go back to school I think of my workI think of your painI think of lunchtimeI think of my father I am goodI am badI am a husbandI am a doctor

50 I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother callingI see a deskI see you comingI see a bright futureI see and hear a dogI touch the screenI touch my faceI touch into the waterI touch the hot pan I go to my officeI go homeI go into the darkI go back to school I think of my workI think of your painI think of lunchtimeI think of my father I am goodI am badI am a husbandI am a doctor

51 I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother callingI see a deskI see you comingI see a bright futureI see and hear a dogI touch the screenI touch my faceI touch into the waterI touch the hot pan I go to my officeI go homeI go into the darkI go back to school I think of my workI think of your painI think of lunchtimeI think of my father I am goodI am badI am a husband I am a doctor

52 I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother callingI see a deskI see you comingI see a bright futureI see and hear a dogI touch the screenI touch my faceI touch into the waterI touch the hot panI go to my officeI go homeI go into the darkI go back to schoolI think of my workI think of your painI think of lunchtimeI think of my fatherI am goodI am badI am a husbandI am a doctor

53 Noticing Perspective

54 ‘The key to a happier world is the growth of compassion’ Dalai Lama Understanding others?

55 Theory of Mind Module I Know what you are thinking! I have a ‘module’ in my brain that tells me!

56 I versus YOU HERE versus THERE NOW versus THEN Perspective relations specify a relation in terms of the perspective of the speaker Consider the three relations of: CBS Approach to Perspective- Taking

57 Each time a child is asked or answers questions such as: “ What are you doing here? ” “ What was I doing then? ” “ What am I doing now? ” “ What were you doing there? ” the physical environment will likely be different… The only constant across such questions are the relational properties of: I versus You Here versus There Now versus Then CBS Approach to Perspective- Taking

58 Relation Type I / YOU HERE / THERE NOW / THEN Complexity Simple Relations Reversed Relations Double Reversed Relations Two important variables: McHugh, et al., (2004) CBS Approach to Perspective- Taking

59 A Simple Relation Task I have a white brick and you have a red brick Which brick do you have? Which brick do I have?

60 I am sitting here on the blue chair and you are sitting there on the black chair and YOU were ME Where would I be sitting? Here:There: A Reversed Relation Task If I was YOU Where would you be sitting?

61 Yesterday I was sitting there on the black chair, today I am sitting here on the blue chair and NOW was THEN and THEN was NOW Where would I be sitting now? Now: Then: A Double Reversed Relation Task Where would I be sitting then? If HERE was THERE and THERE was HERE Here: There:

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63 McHugh, et al., (2004) - Developmental Profile – appears at same age as ToM Rehfeldt, et al, 2006 – those diagnosed with ASD less proficient Villatte, et al. (2010) – patients with schizophrenia less proficient Villatte et al (2008) – link between deictics and social anhedonia Weil et al (2011) – training in deictics with children with ASD produces gains on Theory of Mind tests Vilardaga et al (2009) - Link between deictic relational responding and empathy Empirical Support

64 Laura Skye & Dave Barmy

65 So how does this link to ACT?

66 Psychological Flexibility Contacting the present moment fully and without defense, as a conscious human being, and based on what the situation affords, changing or persisting in behaviour in the service of chosen values Be present Open up Do what matters

67 Psychological Inflexibility Not fully contacting experience Limited experience of the self Avoiding experience Even when it’s getting in the way of what we want and the person we want to be

68 Double Edged Sword Verbal self-knowledge is a two-edged sword

69 Were as smart as Steve Comparison is a bitch ‘I wish I…’ Were as young as I am in this photo! Had great hair like Russ Were as good at presenting as Robyn

70 Even if you are a mega star… 1969 I am not good enough as I am. In order to be good enough I need to look a certain way I am not good enough as I am. In order to be good enough I need to look a certain way

71 1979

72 1989

73 2009

74 3 Selves in ACT Self as content  Story Self as process  Contacting the present Self as context  Flexible Perspective Taking

75 ME BAD NOTHING BUT TROUBLE STUPID WORTHLESS EVERYONE LAUGHS AT ME NO-ONE LOVES ME UNWORTHY OF THE AFFECTION OR TRUST OF OTHERS MUST AVOID INTIMACY FEELINGS OF LONELINESS LONELY SAD INDIVIDUAL Lack of contact with social contingencies

76 Exercise What kind of self-descriptive ________ does the client fuse with? – judgements e.g., about body, personality, weaknesses, roles – beliefs – self-limiting attitudes – e.g., I can’t do X because of Y – predictions about the future

77 The conceptualized self trap I slept all day. I am a lazy person. Result: The only way to change your future is to change your past. You’re Stuck!

78 Exercise Why is attachment to both NEGATIVE and POSITIVE conceptions of self detrimental?

79 What ACT technique helps us let go of our attachment to our self concept?

80 Now select a judgment about yourself…

81 Put a self judgment into one word Now say: X is good X is bad X is ruthless X is beautiful X is a banana X is positive X is true X is false X is awful X is uplifting X is scary X is evil X is pretty X is a fish X is a girl X is hopeless X is disgusting X is boring X is safe X is menacing

82 Defusion is salience of many functions with no one function dominating Focus on process not content Highlight the non-literal quality of the client’s thoughts Defusion I’m not good enough I’m having the thought that I am not good enough

83 Perspective relations in defusion Respond to our thoughts as I HERE NOW - caught up in them Respond to our thoughts and feelings as I THERE THEN - they are seen as thoughts and feelings that we had

84 Self as Content I am a worthless person Self as Process I feel so worthless right now AND I HERE NOW notice that I am having the thought that I am worthless I HERE NOW am noticing that I am having the feeling that I am worthless Fusion and Defusion

85 SELF AS CONTENT I’m not good enough. I am too anxious SELF AS CONTENT I’m not good enough. I am too anxious SELF AS PROCESS I HERE NOW notice my thoughts and feelings and what I can see, hear, touch taste and smell SELF AS PROCESS I HERE NOW notice my thoughts and feelings and what I can see, hear, touch taste and smell EMPATHY I HERE NOW notice that you are feeling sad EMPATHY I HERE NOW notice that you are feeling sad SELF COMPASSION I HERE NOW notice my pain and respond with kindness SELF COMPASSION I HERE NOW notice my pain and respond with kindness TRANSCENDENT SELF I HERE NOW am the observer of my thoughts and feelings TRANSCENDENT SELF I HERE NOW am the observer of my thoughts and feelings

86 What about the other? Other as content Other as process Other as context

87 ACT Self Goals 1. Undermine attachment to conceptualised self 2. Help client notice continual flow of experience 3. Help client increase the availability of flexible perspective taking

88 Clinical example - Jessie Jessie says she’s “finally” seeking therapy because she’s “sick of feeling so awful all the time.” She says it’s been five years since she felt something other than “depression and shame.” She describes her life in terms of “the real me, before I got depressed,” and “this person I’ve become.” She says she doesn’t go places or do things because “I’m just too ashamed,” and “that shame takes away anything that used to be good about it.” She gives the example of hating for her family to see her “this way.” In session, Jessie is persistently tearful and has trouble following directions and giving contingent responses.

89 Broadening Her Experience of Self Expand her contact with stimuli in the world and her range of responding to stimuli Self as more than depressed World as more than source of shame Shame as more than thing to be avoided

90 John John struggles with chronic pain and spends much of his time trying to come up with a fool-proof strategy that will ideally get the pain to go away, or at least to let him get some control over it. He firmly believes that he has tried everything, but that nothing has worked. The pain and the struggle with it have gained such dominance over his life that much of who John is psychologically is about pain. In other words, John knows himself first and foremost to be a sufferer of chronic pain and many other aspects of his life have become secondary to this sense of self (not just in terms of his overt behaviour). As such, the identification with the problem has become almost the whole person that he resides in, and other aspects (e.g., husband, father, worker) have fallen away (e.g., “I can no longer play with the kids because my back will get sore”).

91 Hopelessness Acceptance Struggling and avoidance Obstruction Self and fusion Values John The solution has become part of the problem and isn’t this what has actually been the case for the last few years? Pain is perhaps inevitable, struggle is not Avoiding the struggle controls his behaviour more than actual pain He knows himself first and foremost to be a sufferer of chronic pain and many other aspects of his life have become secondary to this sense of self The pain has been allowed to take John’s life off in a direction that he did not see himself choosing

92 TIP - No need to win the conceptual war! The problem solving mind: sense making, prediction, and story telling Reduce its dominance by distinguishing  thoughts vs thinker  emotions vs feeler

93 TIP - Give examples of perspective Therapist can self disclose to give an example of perspective ‘When I get hurt, like you, I find it difficult to just step back and let the hurt be there, and instead see it as part of me’

94 Inner Child Exercise

95 Training Flexible Perspective Taking Step 1. Basic Perspective Training‘If I were you, where would I be?’ ‘If I were you and here was there, where would I be?’ Step 2. Empathy Training‘I feel sad. If you were me, how would you feel?’ ‘I’ve won a prize. If you were me, how would you feel?’ Step 3. Self-as-Context‘I watch thoughts and feelings come and go. Who is it that is watching them?’ Vilardaga& Hayes, 2009

96 Exercise For Step 2  design an intervention in session could that could target the transfer of emotions across perspective relations (empathy)

97 Transfer of emotions across perspective relations Think of a time when you were in distress that someone invalidated your pain? Contact how you felt at that time Think of a time when you invalidated someone else’s pain when they were distressed Now contact how they felt then

98 Self and the failure of empathy Narcissistic personality disorder – such strong fusion with a particular conceptualised self that events tend to be universally framed in terms of their relevance to this self and thus taking the perspective of another is made less likely High levels of anxiety - empathy is sometimes possible but it often results in such distress that it produces not sympathy for the other but self-concern and thus the result is the absence of overt empathic responding Burn out - Low levels of empathy can be produced by avoidance of the level of distress experienced during previous episodes of empathic responding

99 Context matters! There are a number of contextual variables that may make empathic responding more or less likely for any individual: – similarity between observer and observed – familiarity – social dispositions – cooperative versus competitive context – how much the observer likes the observed

100 Disconnected self Underdeveloped self Labeled self Classifying Self Problems

101 Disconnected self Perspective taking repertoires lacking Example: Autistic spectrum conditions Intervention – perspective training

102 Underdeveloped self Doesn’t have a clear idea of who they are and what they stand for Example: Trying to please others, social anhedonic Intervention: self as process work

103 Labeled self Fused with negative self narrative – Example - depression Fused with positive self narrative – Example - Narcissistic Intervention – self as context work

104 What looks like depression can be three different problems with self…

105 Underdeveloped Self – Depression Passive No sense of ‘what I want’ People pleaser Directionless  Self as process

106 Isolated self - Depression Aspergers / ASD / Social anhedonia / poor social skills – rejection isolation  Deictic (perspective training)

107 Labeled Self Fusion with I am bad / worthless  Self as context

108 Think of a client you have that fits one of these categories Disconnected self Underdeveloped self Labeled self

109 Informing intervention?

110

111 Signs self work are needed handout

112 Signs of Progress 1.Client reports sense of observing private experiences 2. Laughing at oneself in earnest 3. When they begin using these centering processes spontaneously in their own lives

113 Flexible self exercise Future you

114 For more on this…

115 Thank you!


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