1. Trauma and the Elusive Self Isabel Clarke Trauma violates It violates the person, their sense of safety and integrity, their assumptions about themselves and the world. It violates time The role of emotion – understand what is happening Understanding self as process – not as a given

2. The Role of Emotion Both strong emotion, and avoidance of emotion interfere with the process that is SELF. The function of emotion is to govern relationship – both with self and others To meet emotion it is necessary to be able to reflect on it – (different therapy modalities approach this slightly differently, but it is always there somewhere) Where problems are rooted in early trauma etc. patterns are set up that are resistant to revision The cool reflection needed is hard to achieve

3. DIALECTICAL BEHAVIOUR THERAPY: Linehan’s STATES OF MIND EMOTION MIND REASONABLE MIND WISE MIND IN THE PRESENT IN CONTROL

4. Levels of Processing problem Being human is difficult because our brains have 2 main circuits – they work together most of the time, but not always. There is one direct, sensory driven type of processing and a more elaborate and conceptual one. The same distinction can be found in the memory. Direct processing is emotional and characterised by high arousal. This is the one that causes problems – e.g. flashbacks in PTSD.

5. Features of Emotion Driven Processing Emotion regulates relationship – both with yourself and others It mobilises the body for action That physical mobilisation gives the emotion its punch Where physical arousal is prolonged it is unpleasant – motivates people to avoid emotion Time is collapsed in Emotion driven processing – past threat is added to current threat Role of past trauma in psychosis and PD is now being properly recognised.

6. Relationship, trauma and the construction of the self – a way into understanding Complex Cases. A sense of self is gained through relationship. The reaction of others gives us information about threat, safety and value. Identity formation is dynamic & comprises –sense of self as subject – emotional system; –sense of self as object – rational system. Major threat disrupts the sense of self – hence personality disorder – competing ‘selves’. If things get too unbearable – escape from the grounded sense of self – psychosis

7. Self and Relationship. Emotion Mind Reasonable Mind other Self (as object Self (as subject Info. About self. Experience stored in Emotion Mind.memory activated Trauma or Transitions Early self re- experienced Early provisional self develops Sense of self as object disrupted; early info. Needs re-integration

8. The ‘horrible feeling’ Human beings need to feel physically safe and OK about themselves Emotion Mind produces a sense of threat when those conditions are not met Emotion Mind/ Emotion Mind memory presents past events as present (trauma) People develop ingenious ways of avoiding facing the sense of threat

9. WAYS OF COPING WITH THE HORRIBLE FEELING Giving in - signalling submission (depression) Constant anxiety, worry and hypervigilance Anger - attribute elsewhere. Displacing anxiety – OCD, eating disorder Drink, drugs, etc. Dissociation – flipping between different experiences of the self Cutting out reasonable mind appraisal – psychosis

10. FEAR RAGE SADNESS Cut self Attempt suicide Friends and family alarmed. Could lose custody of children. Feel worse Nightmares: can’t sleep More difficult to cope Avoid going out and seeing people More time to brood PAST ABUSE LOSSES PARTNER LEAVING Typical formulation

11. Selling the new approach ‘It is Simple but Difficult’ We are asking people to go against what feels natural It is natural for people to follow their feelings We are asking them to go against their feelings It is natural to avoid when things feel too horrible We are asking people to face the horrible feelings

12. How we break the vicious circles Management of arousal, up and down: Breathing techniques. Anxiety and stress management. Activity – concentration and exercise. Managing attention - Mindfulness Managing emotion: DBT techniques –to extend tolerance of unpleasant emotion –start to notice and increase pleasant emotion –express emotion in helpful ways (eg. anger management) Managing psychotic symptoms Permission to look after yourself: self compassion: Making Friends Group approach Identifying and supporting pursuit of valued goals in life

13. Directly addressing the trauma – when? This model suggests that it is important for the individual to be able to manage overwhelming emotion first, before unpacking the trauma. Mindfulness of your strong self. Finding a safe place Being able to contain urges to self harm etc in response to emotion All important before the work of reliving is attempted.

14. Two Views of the person 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.

15. Introducing Interacting Cognitive Subsystems (Teasdale & Barnard 1993). Interacting Cognitive Subsystems provides –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.

16. Body State subsystem Auditory ss. Visual ss. Interacting Cognitive Subsystems. Implicational subsystem Implicational Memory Propositional subsystem Propositional Memory Verbal ss.

17. Important Features of this model Our subjective experience is the result of two overall meaning making systems interacting – neither is in control. Each has a different character, corresponding to “head” and “heart”. The IMPLICATIONAL Subsystem (which I will call RELATIONAL) manages emotion – and therefore relationship. The verbal, logical, PROPOSITIONAL ss. gives us our sense of individual self. Role of bringing oneself into present awareness – mindfulness to manage the split. This means facing ourselves – and the uncertainty of reality

18. Relational Subsystem concerns Relationship Meaning and meaningfulness The self; threat and value Intense, extreme feelings (all or nothing) Loss of fine discrimination and boundaries (domain of the propositional subsystem) This gives us the quality of experience I will call the “transliminal”

19. A Challenging Model of the mind The mind is simultaneously individual, and reaches beyond the individual, when the relational ss. is dominant. There is a constant balancing act between logic and emotion – human fallibility The self sufficient, atomistic, mind is an illusion In our relational mode we are a part of the whole. In this way the crack is healed - not by the perfectability of the individual, but by our embededness in a great web of relationship. WE ARE NOT WHO WE THINK WE ARE!

20. Web of Relationships Self as experienced in relationship with primary caregiver Sense of value comes from rel. with the spiritual primary care-giver In Rel. with wider group etc. In Rel. with earth: non humans etc.

21. The Relational Mind We are partly individual and partly only make sense in the context of relationship We grow, and are moulded, through all these relationships The quality of them affects us in our deepest being – where they are sound and loving, we flourish Where they are abusive, even if it is not our personal intention – we are diminished.

22. Openness/Vulnerability - 2 sides of the coin! Making ourselves open in relationship, in empathy is the way to live fully, in the moment But – it opens the way to pain as well as joy Love means taking responsibility for the beloved - for the earth and other non human creatures ………

23. There is another side to this.. There is the sense of the sacred that survives in a scientific age There is the response of wonder to beauty – whether natural or person made There is the individual sense of specialness, even in the most abused individual Perhaps the source of all this is the sense of relationship with that widest and deepest circle of the web. Often, those who are traumatised are more open to this dimension of experience.

24. Email, books and Web address isabel@scispirit.com Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester:'O'Books. Clarke, I. (Ed.) (2010) 2 nd Edition: Psychosis and Spirituality: consolidating the new paradigm. Chichester: Wiley Clarke, I. & Wilson, H.Eds. (2008) Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; working with clients, staff and the milieu. London: Routledge. C.Clarke, Ed.(2005) Ways of Knowing: science and mysticism today. Exeter: Imprint Academic. www.isabelclarke.org www.SpiritualCrisisNetwork.org.uk