Mind Space - Resources for psychotherapists (articles, research, documentaries)
A research team from UCLA under the leadership of doctor Faustner performed brain scans of 14 adults diagnosed with BDD and 16 healthy controls in order to map the brain's connections to examine how the white-matter networks are organised.
People with BDD had a pattern of abnormally high network "clustering" across the entire brain. This suggests that these individuals may have imbalances in how they process "local" or detailed information. The researchers also discovered specific abnormal connections between areas involved in processing visual input and those involved in recognizing emotions.
V. S. Rachmanadran argues that studying patients with anosognosia (Anton-Babynski syndrome) - that is patients who, following a stroke in the right hemisphere develop paralysis in the right side of the body, but deny that this is the case - will offer an experimental bridge to understanding Freudian defensive systems such as denial, repression and reaction formation. His suggestion is that the left hemisphere is invested in maintaining a coherent belief system and will typically deny small anomalies that do not fit within the belief system. The right parietal lobe has a role in noticing inconsistencies when they become significant enough and raising this into awareness. If this part of the brain is offline there is nothing to inhibit the left hemisphere's propensity to construct reality in a way that strictly fits with its previous beliefs.
was delivered at the The 5th Neuro-Psychoanalysis Congress, Rome 2004 on "Splitting, Denial and Narcissism: Neuropsychoanalytic Perspectives on the Right Hemisphere."
Jay Garfield: Why should we care about concepts of perception and self?
We tend to take for granted our perceptions and do not distinguish between our perceptions and reality. We also confuse a designated self from the real self. We assume that our concepts reflect reality as it is.
Here is a fascinating article
by Norman Holland published in Psychology Today, proposing the idea of personality as aa unique configuration of attractors (from chaos theory an attractor is a state towards which the system tends).
"We can think of our character, including our defenses, as a configuration of such attractors. That is, we will tend to respond to the ever-changing and random demands of reality (chaos) in ways that involve the least expenditure of energy. Our mental state will roll down, as it were, into the valleys. We will, therefore, tend to repeat the valley patterns of behavior."
Presentation given by Dr. Eoin Galavan at the Psychological Protection Society, at Aislin Hotel Dublin, 17/10/2014
Here are my notes from this workshop.
Between 20%and 50% of mental health practitioners will lose a client to suicide during our professional life, depending on the context in which we work.
the suicidal mind is: they always want to live and they always want to
die. We can get caught up in the thinking that because a client called out the
ambulance after ingesting medication she didn’t really want to die. It’s
important to keep this in mind: both wanting to live and wanting to die.
The way we approach suicidality has to be thought out. We
can’t throw everything we have at someone. It can be confusing and
overwhelming. We do it because we want to be covered.
Thomas Joiner model from "Why
people die by suicide"
Perceived burdensomness+thwarted belongingness
combined with developed fearlessness and ability leads to serious attempt or
death by suicide
Development of fearlessness – the suicide person has gone
through a journey that has allowed them to override the natural instinct for
self-preservation and to overcome fear.
Fearlessness of physical injury is developed by habituation
– getting used to threat of bodily harm to the point that it no longer provokes
fear but may induce states that are pleasurable. One has to suppress or depress
the fear response.
Reduction of the fear response through repeated exposure to
violence/injury/physical pain/provocation/abuse. Emergence of an opponent
process which is the exact opposite reaction to the same stimulus.
Eventually overtime the idea of self-harm does no longer evoke the fear
response, it evokes feelings of pleasure or calm.
Anorexia nervosa is a good example of how habituation works
There is a high rate of suicide in AN (a study looked at 240
women. 9 died of suicide. This is very high). This is because they have already
been through a process of habituation and are likely to use incredibly lethal
means because they are habituated thr
Different channels for habituation: Numbing of the body
sensations in young children who are neglected. Physical abuse early in life
leaves people with a high level of tolerance for physical pain but little
tolerance for psychological pain.
It is important to decouple biological death and lethal self
injury from the suicidal risk. A ‘slow graceful swan dive into nothingness’ is
NOT the same as jumping off a cliff. Suicidal people are not thinking about the
actuality of what they are doing. A realistic description awakens the fear
Societal and cultural expectations and in some countries
(US) legal statues which almost state that a counsellor must stop a suicidal person from killing
themselves as if we have that innate capacity.
It works its way up into the legislative and complaint process. In fact,
we don’t have that capacity to stop people from killing themselves. We should
stop being anxious about that and stop buying into this fantasy. 7% of all
suicides occur in psychiatric hospitals under increased surveillance.
“Perhaps what makes all of this so complicated is the fact
that unlike medicine, surgery or dentistry the mental health clinician is the
instrument of care – there is no equipment failure, no pathogen, no virus to
otherwise blame. We are the instrument of care; it does not get any more
personal than that” (Jobes, 2011)
This impacts on how we feel towards the patient and the therapeutic
relationship, which is the most precious thing we have.
Israel Orbach – “Therapeutic empathy with the suicidal
Two elements are always required when we work with the
suicidal person. It is important both to empathise with the suicidal wish and
at the same time to confront the self-destructiveness and state that biological
death is not a solution to life’s problem.
Outdated model of working with suicidal people was
reductionistic. Suicide was seen as symptom of depression involved but this is
an insufficient explanation.. The clinician was seen as the ‘expert’ and in a
one-up position. Inpatient hospitalization, treating the psychiatric disorder
and using of ‘no-suicide’ contracts.
There is no evidence that inpatient stays are in and of
themselves effective treatment for suicidality. In fact they become risk
factors. In fact people are more suicidal when they come out of hospital. The
group in society most likely to die by suicide are those who have just left
psychiatric hospital. 3 out of 100 will kill themselves. The general population
is 15 out of 100.000
There is a belief going around that we can stop people from
Using the CAMS (Collaborative Assessment and Management of
Suicidality) model authored by prof. David Jobes
This is an overall process of clinical assessment, treatment
planning and management of suicidal risk with suicidal outpatients.
clinical assessment of risk
treatment planning around what is most relevant
to a person with suicidality.
management of suicidal risk
advocates a collaborative stance: sitting side
by side and putting suicide on the table
suicide status form: pain, stress, agitation,
hopelessness, self hate
identifying reasons for living vs reasons for
intensive outpatient care that is suicide
developing other means of coping and problem
systematically eliminating the need for suicidal
Individual rating their own risk of suicide. We
are really bad at guessing where the individual think they are
Crisis response plan
Separate risk assessment from predition. Risk
assessment is NOT prediction. We are
terrible at predicting suicide. It’s such a rare behaviour that it’s very hard
to predict even with people who are in a high risk category
How invested are they in the plan? What is the
intent? Have they got access to means?
A risk assessment is simply a best guess –
current and static risk factors
Clinician’s ‘gut’ intuition needs to be
Risk assessment will dictate the type of
treatment and the frequency of contact
Most designated high risk are unlikely to kill
themselves! (3 out of 100 of those who just come out of psychiatric hosp will
kill themselves, but WHICH 3? That is impossible to predict) Many who kill
themselves are designated low risk. It’s extremely difficult behaviour to
We can’t make people divulge what is going on
We shouldn’t be too hard on ourselves if we get
When should hospitalisation be considered
extremely high risk of suicide
is the person at clear and imminent danger of
person is unwilling to work collaboratively and
work at resolving problems and putting suicide behaviour ‘off the table’
When are we negligent?
If there is clear and imminent danger by death
and we do nothing to try and avert this, that is negligent
****This article was published in Psychotherapy in Private Practice, 13 (1), 69-95****The Psychotherapy in Private Practice Journal is available online at:
Read the full article here
Psychologists have paid very little attention to the effect
their profession has on themselves and have consistently avoided examining its
effects on their families. This paper explores the question: Are
psychotherapists' families disadvantaged, or are they fortunate to have a
therapist-parent who is an authority in the emotional, cognitive, and
behavioral domains? Related areas that are explored are the uniqueness of
psychotherapists' personalities and the effect of their practice on their
personal lives. The paper focuses on the ramifications of the psychotherapists'
practice on their own lives and their families', and proposes possibilities for
enhancing the positive and preventing the negative effects of their careers on
themselves and their intimate connections.
Psychologists have studied the effects of a variety of
professions on the professions' practitioners. Physicians, career military
personnel, corporate executives, political leaders, and artists are among the
many who have been analyzed by psychologists. However, psychologists have
failed to systematically study the effect practicing psychotherapy has on their
own lives. Similarly, psychologists study the effects of every conceivable kind
of family dynamic on children. They have studied the children of alcoholics and
schizophrenics, disabled infants, and the children of divorce. They have
compiled volumes on baby rats, infant gorillas, puppies, and bunnies. Yet they
have consistently neglected to inquire into the dynamics of their own families.
They have consistently avoided hypothesizing on the impact of being or living
with a person who is an expert in the emotional, cognitive, and behavioral
While limited attention has been given to the effect of
psychotherapy on the practitioner, even less has been given to its effect on
the practitioner's family. Short of a half a dozen anecdotal articles on
families of psychotherapists, even fewer clinical reports on family or group
therapy, a single empirical study (Goldney, Czechowicz, Bibden, Govan, Miller,
& Tottman, 1979), a page or two on analysts' children in books by leading
psychologists, such as Kohut (1977), Miller (1981), and Bettelheim (1976), and
a thorough and thoughtful, but extremely anti-therapist biased book by Thomas
Maeder (1989) titled Children of Psychiatrists and Other
Psychotherapists, the field is suspiciously empty.
The resistance to attending to the complexity of
psychotherapists' lives is not only reflected in the lack of comprehensive
analysis, but also by the American Psychological Association's governing board
and membership's reticence to set up a nationally coordinated program to
identify and treat distressed psychologists and prevent burnout. Psychologists,
psychiatrists, and counselors have been instrumental in the development of
employee assistance programs tailored to serve the needs of other distressed or
impaired professional employees. In contrast to psychotherapists, the American
Medical Association (AMA) and the American Bar Association (ABA) as well as
national organizations of dentists, attorneys, nurses, and pharmacists long ago
established avenues for distressed professionals who are seeking help (Kilburg,
Nathan, & Thoreson, 1986; Laliotis & Grayson, 1985).
The reasons for this lack of attention to the hazards of the
profession are open to speculation. Many therapists claim that their
professional lives have no bearing on their personal lives. Therapists may
possess a prejudicial sense of grandiosity and invulnerability; they may assume
they are capable of helping other professionals, but be incapable of
recognizing that they themselves need help. Kottler (1987) attributes their
resistance to the illusion that psychotherapy is the pure application of "scientifically
tested principles and reliable therapeutic interventions" (p. 26). Other
psychologists admit their reasons for not studying themselves stem from
defensiveness and the professional practice of focusing all investigations on
the patients (Farber, 1983).
This paper maps the complexity of the interaction between
the practice of psychotherapy and the personal and familial life of the
practitioner. It is based on the author's work in individual, couple, and
family psychotherapy with psychotherapists and their families, and on a series
of workshops conducted with such families regarding the impact of their
clinical practice on their own and their families' lives. Participants were
representative of all therapeutic disciplines: psychiatrists, clinical psychologists,
clinical social workers, and master level trained counselors.
The clinical data gleaned from these subjects is combined
with an extensive review of the literature. Together these provide a map to
guide in the exploration of this rarely visited wilderland of therapists'
family dynamics. This paper identifies the areas of inquiry, separates myths
from realities, and critically examines the existing theories and research. In
addition, to specify the strengths and weaknesses the profession brings to
psychotherapists' families, the paper suggests ways of enhancing the positive
and minimizing the negative effects.
The basic question posed by the paper is: Are
psychotherapists' families disadvantaged, or are they fortunate to have a
therapist-parent who is an authority in the emotional, cognitive, and
In order to answer this, three further questions must be
are the distinguishing characteristics of psychotherapists' personalities,
and is there any truth behind the myth of the "wounded healer"?
aspects of psychotherapists' training and practice are relevant and likely
to affect their personality, quality of life, and interpersonal skills?
families parented by psychotherapists develop special dynamics due to the
parents' profession? And, if yes, what is the impact of the parents'
profession on their children?
Presentation delivered at the Psychologists Protection Society 40th anniversary Symposium on the 27th of June 2014 by Ian Gilman-Smith
The speaker is a psychotherapist
and social worker with experience as an expert witness. He is involved in the
process of making a decision in the case of someone who lacks legal capacity
Do’s and don’t’s of confidentiality
There is no neat script that can be handed out
to assist us in dealing with professional issues around confidentiality
There are different issues to a degree depending
of context: private practice, organisational work
- There is a lot of conflicting information about
The therapeutic relationship is not only with
our clients. We don’t work in a vacuum, isolated from the rest of the world.
Clients come to therapy because they want to,
are referred by GP, family members, have been sent by court order,
Working with multi- or inter-disciplinary teams.
Liaising with other members of the client’s professional team
The backdrop of social-media. The information is
shared potentially with the rest of the world.
Care program approach was developed to support
professionals in communicating with each-other (Baby P. was seen by 51
professionals, sex abuse scandals involving celebrities
How do we deal with confidentiality
- A mantra that professionals refer to is “sessions
- Do we know what we mean when we use the word
‘confidential’? Sometimes we don’t.
Clients agree to proceed as if statements about
confidentiality are the small print on a mortgage contract
Our intentions are to form a trusting
relationship in which they can disclose and find relief from the issues that
bring them to therapy
Are we merely using the term to reassure
ourselves and our clients
From a legal perspective
confidentiality is highly complex. Legal documents include
- Freedom of Information Act
- Human Rights Act
- Mental Capacity Act
- Access to Medical Reports Act
- Terrorism Act
In our adversarial legal system barristers are not necessarily on the therapist's side. They are highly skilled at understanding the nuances of these different documents.
There is a common law duty to
patient information should only be disclosed
with the patient’s consent.
What is it to be reasonable in
how we practice
they judge professionals by the standards of
are your actions accepted as common practice?
Would your peers do the same? On what grounds do
you make that judgement?
What is negligence
the omission to do something which a prudent and
reasonable man would do
clear reporting of risk and risk management
What is a confidential document
in the eyes of the law
English law does not recognise privilege just
because a document is considered confidential by a party of another
Information that could incriminate a third
party, diplomatic papers – nothing else is
Documents cannot be made privileged by simply
attaching a label
One of the roles of the therapist is to hold and
make sense of complex information
Taking the pre-emptive view that we need to be
informed about confidentiality and not to do so would be negligent.
Looking at worse-case scenarios because they
help us bring into sharp focus the issues around confidentiality.
Are we exempt from meddling
if we work in private practice
court order to give written evidence as to the
course of therapy in county courts, criminal courts, coroner’s courts
such requests are legally enforceable and they
can be enforced by being fined or sent to prison in contempt of court
Thresholds to confidentiality
1. What do I think
risk-assessment: risk is so easily overlooked.
Consider a number of domains of risk: not just
risk to self or others in broader terms: intentional self harm, unintentional
self-harm, risk from others, risk of exploitation from others or society, risk
to others, ability to survive (resources and living skills), psychological risk
(thinking feeling and behaviour), social risk (problems with activities or in
relationship with other people).
Can public good be achieved by disclosing the
risks identified. If there a risk to life of limb – that decision is easier to
Client disclosing something of concern such as
‘I can’t go on anymore’
2. What do I do
- if you identify risk but decide
not to contact next of kin, GP,
emergency services then reason: What did
I think of that information? What allowed you to make an informed decision?
What was your thinking? Was this the action that would have been taken on the
3. What do I write
struck by the sweeping generalisations that therapists make about their
clients i.e.: he drinks “far too much”
- clear documented process helps
account for our actions in a courtroom setting
- written records do not need to
be voluminous but need to be thorough
- fact finding: the judge wants
to know the facts of the case: client presentation, level of risk, historical
account, your professional views
- professionals becoming
incompetent or highly hostile in court, contradicting themselves
- the private practitioner is far
- responsibility for: managing
the issues of confidentiality pre, during and post therapy
- responsibility for being
professional CPD, supervision DBS check, indemnity, CPD, registration with the
Any risk identified needs to be made explicit in the therapy
supporting the client in managing risk themselves
contacting another agency
using the resource of the therapy encounter
what if the client does not support you in
contacting the GP
implications of breaking confidentiality: risk
not to uphold the right human rights, risk damaging the therapeutic therapy,
right to privacy
implications of not breaking confidentiality may
have severe consequences: fail to protect the rights and freedom of others,
minimising harm to vulnerable adults and children
it is clinician’s responsibility to report abuse
of vulnerable adults or children. What is “vulnerable person” (is or may be in
need of community services, unable to take care or protect himself against
significant harm or exploitation, mental disorder, age)
How do we protect
Clinicians with widely different views: ‘destroy
notes’, or ‘keep no notes’, ‘record everything’, ‘write report as if I was
going to be cross-examined’
Whatever confidentiality goes beyond one’s mind
can be requested
It’s your judgement call how you record and
Notes should be accurate, secure, processed in
line with client’s rights, kept no longer than necessary
Complaints can be made within 5 years since the
alleged incident. Claims of negligence can be made within 6 years since the
Registering with ICO. Information governance if
we keep reports on our computers.
The Institue of
TAG with 6 domains of
People want a professional
service that is easy to access and packaged for them.
Mistakes I’ve made and learned from.
- Profit equals income minus expenditure.
- I was a naïve amateur with dysfunctional beliefs about
- money is dirty: no, money is
- there is difficulty in charging
for help but solicitors and doctors charge for help
- it’s OK to charge for help
- some people believe aspects of
private practice is beneath them (advertising, charging, doing the accounts)
advertorial in the police service, local fire-station,
hospital magazine (don’t pay as policemen can get therapy for free)
Make it easy for people to work with you
We need to advertise : directories, web-page
Multiple contact methods: webform in googledocs.
Handling calls professionally – virtual
assistant: diverting the phone
Payment: buying a £50 card reader
Paypal link if working online
Avoiding the numbers: not logging all
expenditure (e.g. mileage)
balancing what we’re worth, what it cost us to
train, what local people charge, what is moral
If we are keeping people out of the welfare
system, out of secondary care we are saving people a lot of money so charge.
Don’t subsidise people by paying for their
Don’t put all your
eggs in one basket
too many counsellors/psychologists delivering
the same thing
why are you different/unique
what are you going to offer and are you the
person to deliver it
what do clients want?
only 30% of his clients come from self-referral,
agency referrals or EAP’s (55%)
Other sources of income: internet/phone,
supervision, couple counselling, CBT, training, consultancy
How can you specialise: either in the content or
the method of delivery. Be different in some way!
It is a mistake to not see the landscape.
There is a whole industry training people to see
clients for a long time which is costly and people have limited resources
Seeing the landscape: reaching
people through technology
What seems unusual now fifty years from now will
be the norm
Accepting that online/telephone counselling is
Delivery method: technology is happening whether
we like it or not. Be weary of conservatism and judgements against new methods
of delivery. Having to learn about new methods although. We can reach clients
who we couldn’t reach otherwise (disabled, living abroad, suffering from
- house insurance companies will see more risk if you're working from home
personal safety (buddy system, not leaving key,
emergency services on speed-dial, panic button)
people cross boundaries: higher proportions of
complaints come from private practice and most of them are about boundary
Business boundaries: life/work balance is
difficult to keep if working from home. Most people want to come in the
evening, after 5pm. The danger is to take anyone at any time of day or night.
"Psychology is evolving faster than ever. For decades now, many areas in psychology have relied on what academics call “questionable research practices
” – a comfortable euphemism for types of malpractice that distort science but which fall short of the blackest of frauds, fabricating data.
But now a new generation of psychologists is fed up with this game. Questionable research practices aren’t just being seen as questionable – they are being increasingly recognised for what they are: soft fraud."
(Extract from Chris Chambers' blog post "Physics envy: Do hard sciences hold the solution to replication crisis in Psychology?"
Steve Cole, Phd one of the pioneer researchers in the new field of psycho-immunology, delivers the Meng Wu Lecture at CCARE Stamford University. Watch it here.
My transcript of Steve Cole's lecture:
How we interact, how we
connect has a tremendous influence on how our genes are expressed. Traditionally we saw ethics, morality and the world of tangible, molecular biology
of cells as very different worlds/domains. We are starting to see the shadow of each domain playing out in the
Gene expression and social factors
The genome isn’t expressing
all its 20.000 genes at the same time. There is a lot of decision about which genes
get expressed. The change of the activity of
genes within our white blood cell is linked to
- Low SES (social-economic status)
- Social Loss/ Anticipated
- Post-traumatic stress
- Cancer diagnosis
- Social threat
- Social instability
- Chronic stress
- Low social rank
- Caregiving for seriously ill
- Early life low SES
The stress-response and the genome
From a study by Irwin and Comle, Nature
Reviews, Immunology, 2011
One of the major ways in which these
experiences play on the genome is through the fight-flight stress response
activated by the sympathetic nervous system, with the release of adrenaline
(epinephrine) and noradrenaline (norepinephrine). Noradrenaline is released in the
vicinity of a cell. Through its nteraction with receptors (ADRB2) on the surface of
the cell the result is a pumped-up activity of genes involved in the expression of pro-inflamatory
immune response genes and a stomping down of the activity of other genes (antiviral
immune response genes).
Through exposure to really
overwhelming stress a second response kicks in – a defeat/withdrawal response,
where your system shuts down, you are overwhelmed and your body hunkers down
and just tries to survive. That response is mediated by a second hormonal
pathway - the HPA (Hypothalamus - Pituitary - Adrenal). The hypothalamus tells your adrenal glands to produce
more cortisol, which has a different impact on gene expression – it lowers the
expression of antiviral immune response genes and lowers the expression of
pro-inflammatory immune response genes.
Different experiences of the
same event – either as a challenge that can be overcome or as something
profoundly overwhelming is going to have different effects on my genome, it
will evoke different kinds of biological response.
Studies by Cole et al. Proc Nat Acad of
Sci USA, 2011 and Powell et al. Proc Nat Acad of Sci, USA, 2013
Our bodies are extremely
dynamic at a cellular or molecular level. The average protein in the human body
has a half-life of eighty days so that every single day we have to replace 1 –
2% of the proteins in our body and that process is open to ‘advice’ from the
world outside the body, including the world that psychology creates in my mind.
Gene expression can also catalyse the production of new cells (monocytes and
dendritic cells which don’t live very long). This process is also orchestrated
by changes in gene expression that are susceptible to regulation by the nervous
system. In people who are confronting uncertain environments, the brain
interprets those environments as threatening and activates these
Norepinephrine signalling is delivered into the bone
marrow in a form of a ‘piece of advice’ to the stem cell which says 'produce
more myeloid cells: monocytes, granulocytes, dendritic cells'. As a
consequence of that we have more of these cells going out into the body and
circulating. For most of our development that made good sense but if there is
nothing for those cells to respond to - because there is no physical injury and hence no bacterial infections. These cells are programmed to find
trouble and do something about it. Some of the trouble they find might be the
early stages of proliferation of cancer or damage to the wall of our blood
vessels or minor damage in brain cells, all of which attracts these charged,
primed immune cells. As these cells attempt to repair tissue damage but can
inadvertently contribute to the sort of disease that nowadays are the true architects of our longevity . We no longer die of infectious disease, we now die of heart disease,
cancer and neuro-degenerative diseases.
(Sloan et al. 2010 Cancer
Research – done on a mouse injected with cancer cells and then confined to a
small space – a stress inducing situation)
When animals have too many of
these charged up monocytes in their body during the early stages of tumour-development they get many more cancer cells escaping from the initial tumour site
and spreading out (metastasising). This is mediated by those immune cells,
which having gone into the tumour to kill the microbes and repair damaged tissue. They liquify tissue so that the cancer
cells can grow out, they help grow blood vessels into the tumour thus feeding it and suppress the rest of the immune system’s response to the growing cancer.
Psycho-social events alter our biology
We used to think of the brain
and the immune system as separate it turns out that what is going on in the
world has some association with what goes on in our body at a microbial level.
Over millions of years our immune system has learned to listen to the chatter
from the brain and if it hears indications that you are feeling substantially
threatened it gets ready to deal wit tissue damage, whether tissue damage is
happening or not and inadvertently it fertilisers diseases and becomes the
architect of a host of problems.
- Central nervous system: inflammation and
- Vasculature: artherosclerosis
- Lungs: URI, asthma
- Lymphoid tissue: neoinnervation, HIV/SIV
- Solid tumor in the breast, ovaries: metastasis
That is why so many different
types of adversity (isolation, low SES, social threat, bereavement) seem to
draw out disease. There are many different ways that humans have learned to
feel threatened and stressed.
Attachment and isolation and how the body responds to stress
There are two different ways
to run our bodies which correspond to two social genomic programs in immune
cells. One operates in a world in which we are attached and safe, connected. In
this the big threats that we confront are the diseases that travel from one to
another (viruses). A separate modus operandi takes place in the context in
which we are separated from our community or feel threatened within our
community, which up-regulates these inflammatory genes which produce monocytes,
geared to fight bacteria (in anticipation of tissue damage). It doesn’t help us
as well because it fertilises chronic diseases.
Hedonic versus eudaimonic happiness
is the secret to making people feel genuinely safe? (Frederickson et al., PNAS,
2013) How should we live? What is the best way to thrive in human life? What is
the nature of true happiness. Hedonic happiness: consuming happy experiences
(Epicur). Eudaimonic happiness: satisfaction that derives from a deeper sense of
making a contribution to a purpose or a group outside ourselves, a community, a
cause, creation, discovery. It turns out that either eudaimonic or hedonic
pursuits are correlated to low levels of depression, but when researchers asked
the genome, eudaimonic happiness is correlated with healthy immune profiles
whereas hedonic happiness is not.
Prof Bloom suggests that the pleasure we derive from art, food, wine, objects is enhanced by our knowledge of its history - the context in which it was created and the level of effort that was invested in it. Prof. Bloom gives many examples including that of a painting attributed to Vermeer which used to draw masses of viewers when it was first exhibited, only to be completely dismissed when it was found out it was in fact a forgery. Another example is of a famous violinist who placed in an underground subway failed to attract any attention or make more money than an ordinary busker.
Bloom is a professor of psychology at Yale University and a developmental researcher. His research addresses how children and adults understand the physical and social world, with special focus on morality, religion, fiction, and art.
This lecture was presented by Prof. Paul Bloom at the Chicago Humanities Festival. View it here.
Lecture 3: Freud
Youtube description: "This lecture introduces students to the theories of Sigmund Freud, including a brief biographical description and his contributions to the field of psychology. The limitations of his theories of psychoanalysis are covered in detail, as well as the ways in which his conception of the unconscious mind still operate in mainstream psychology today."00:00
- Chapter 1. Sigmund Freud in a Historical Context06:51
- Chapter 2. Unconscious Motivation: The Id, Ego and Superego13:45
- Chapter 3. Personality Development and Psychosexual Development20:32
- Chapter 4. Defense Mechanisms, the Aims of Psychoanalysis, Dreams29:11
- Chapter 5. Question and Answer on Freud's Theories32:55
- Chapter 6. Controversies and Criticisms on Freud's Theories42:10
- Chapter 7. Examples of the Unconscious in Modern Psychology51:55
- Chapter 8. Further Question and Answer on Freud
Complete course materials are available at the Open Yale Courses website: http://open.yale.edu/courses
This course was recorded in Spring 2007.
The conscious Id - lecture delivered at the New York Psychoanalytic Institute
1. How the body is represented in the brain.
The 'external' body
There are two aspects of the body that are present in the brain and they are represented differently. The first is the 'external body' - the somato-topic body image, a map of the body represented on the surface of the brain in a point-to-point fashion. It is derived from the classical sensory receptors distributed over the surface of the body and projected on the surface of the brain. The body image is constructed out of a convergence, a hetero-modal conjoining of different exteroceptive sensory projections zones. The part of the brain which represents our external body also represents in the same manner all external objects. The external body is in other words an object, perceived in the same way that we perceive the external world. The motor projection zone, the motor-homunculus is also part of the map of body, in this case the muscular and skeletal body which gives effect to our voluntary movements. All voluntary movements give rise to sensations - there is kinesthetic and proproceptive change as we make a movement.
The 'internal' body
The internal milieu is represented deeper in the brain. These brain structures monitor the vegetative or autonomic states of the body. The brain representations of this part of the body function largely automatically but they also arouse the representation of the external body to serve the vital needs of the internal body in the outside world. There is a hierarchical interdependence between the two different aspects of the body as they are represented in the brain. These two different aspects of the body each generate very different types of consciousness. The interoceptive aspect of the brain gives rise to states of consciousness, the sort of background awareness, the 'page' on which the words of consciousness are written.
States of the body as 'subject' involve not only levels of consciousness like 'sleep' versus 'wakefulness' but also qualities of consciousness. Interoceptive consciousness is intrinsically affective - emotional. Affect is the modality of interoceptive perception, by which we qualify our interoceptive states of awareness. The key note is registered in the pleasure/unpleasure series (associated with the periaqueductal gray). These affective states tell us what is 'good' and what is 'bad', biologically speaking. Consciousness evolved to enable us to attribute 'good' and 'bad' valences to our experience. External experience does not need to be conscious - this is evident in 'blind sight', where visual awareness is transmitted to lower brain structures, and the patients are able to navigate spacially on the basis of this unconscious sense of vision. Consciousness 'colours' external perception and attributes value to it.
The motor aspect of the pleasure/unpleasure series is approach/avoidance behaviour. Arising from the periaqueductal gray (PAG) and ascending to the lymbic system there are different motivational circuits. These are also known as the circuits for the basic emotions. Each one of these has a motor stereotype attached to it, which is necessary for survival and reproductive success. Examples: foraging behaviour, copulating behaviour, aggressive attack, nurture and grooming, attaching to a maternal object, freezing and fleeing. Each of these basic aspects or instincts, has a particular feeling state attached to it, this is a higher elaboration of affect than what happens at the basic level of the PAG. Feelings like fear, anger, separation distress (panic), are basic instinctive emotions which are hard-wired (unconditioned responses) into particular circuits of the brain. They are not things that we learn, they are things that we inherit - ways of feeling and ways of acting that are our phylogenetic inheritance. There is a great chemical specificity to these basic instinctual/emotional circuits. They give rise to associative learning in the process of early experience.
3. Exteroceptive Ego, Interoceptive Id
It is easy to recognise these two aspects of the body in the Freudian metapsychology. The external body is represented in the Ego, the internal body in the Id. "The ego is first and foremost a bodily ego; it is not merely a surface entity, but is itself the projection of a surface. If we wish to find an anatomical analogy for it we can best identify it with the 'cortical homunculus' of the anatomists (...) (Freud, The Ego and the Id).
"the ego is ultimately derived from bodily sensations, chiefly those springing from the surface of the body. It may be this be regarded as a mental projection of the surface of the body (...)" (Freud, Footnote to the Ego and the Id)
About the bodily origin of the Id, Freud wrote this: "The id, cut off from the external world, has a world of perception of its own. It detects with extraordinary acuteness certain changes in its interior, especially oscillations in the tensions of its instinctual needs, and these changes become conscious as feelings in the pleasure-unpleasure series. It is hard to say, to be sure, by what means and with the help of what sensory terminal organs these perceptions come about. But it is an established fact that self-perceptions-coenaesthetic feelings and feelings of pleasure-unpleasure- govern the passage of events in the id with despotic force. The id obeys the inexorable pleasure principle". (Freud, 1939)
"An instinct (in the original "Trieb", meaning drive) appears to us as a concept on the frontier between mental and the somatic, as the psychical representative of the stimuli originating from within the organism and reaching the mind, as a measure of the demand made upon the mind for work in consequence of its connection with the body" (Freud, 1915)
"And what is an affect in the dynamic sense? It is in any case something highly composite. An affect includes in the first place particular motor innervations or discharges and secondly certain feelings; the latter are of two kinds - perceptions of the motor actions that have occurred and the direct feelings of pleasure and unpleasure, which, as we say, give the affect its keynote. But I do not think that with this enumeration we have arrived at the essence of an affect. We seem to see deeper in the case of some affects and to recognize that the core which holds the combination we have described together in the repetition of some particular significant experience. This experience could only be a very early impression of a very general nature, placed in the prehistory not of the individual but the species. (Freud, 1916-1917)
3. The exteroceptive fallacy
This parallelism between exteroceptive and interoceptive brain mechanisms on the one hand and Ego and Id on the other, gives rise to a radical revision of Freud's metapsychology. Freud never questioned the classical neuro-behavioural assumption that consciousness was a cortical function. "It will be seen that there is nothing daringly new in these assumptions; we have merely adopted the views on localization held by cerebral anatomy, which locates the 'seat' of consciousness in the cerebral cortex- the outermost, enveloping layer of the central organ." (Freud, 1923)
Freud understood that consciousness also entailed an interoceptive affective dimension. "I believe we can say that Freud's insights on the nature of affect are consonant with the most advanced contemporary neuroscience views." (Damasio, 1999)
In making the assumption that consciousness is cortical, Freud was following a long tradition, which continues today. "When electrical stimuli applied to the amygdala of humans elicit feelings of fear, it is not because the amygdala 'feels' fear, but instead because the various networks that the amygdala activates ultimately provide working memory with inputs that are labeled as fear. This is all compatible with the Freudian notion that conscious emotion is the awareness of something that is basically unconscious." (LeDeux, 1999) (This is the read-out theory of emotions)
The latest incarnation of this tradition is the theory of Bud Craig. He believes that there is a primary cortical projection zone for the internal body, and this projection zone is in the cortex, in the posterior aspect of the insula. This posterior insula Bud Craig describes as the basis for self-consciousness (awareness of the self).
4. Consciousness without cortex
Recent research demonstrates unequivocally that the cortical-centric view of consciousness and the self are wrong. According to the theory above, a patient with a completely obliterated insula should, lack subjective selfhood, he should lack the page upon which consciousness is 'written', but this is not the case. Damasio (2011) interviewed such a patient, who retained a sense of self.
High-brain encephaly, condition in which the child is born with no cortex whatsoever, usually due to a cerebro-vascular event in utero. As result of this stroke in the womb the higher part of the brain fails to develop at all. Bjorn Merker (2007) has a lot of experience working with many such patients. "These children are not only awake and alert, but show responsiveness to their surroundings in the form of emotional or oriental reactions to environmental events, most readily to sounds, but also to salient visual stimuli. They express pleasure by smiling and laughter and aversion by fussing, arching of the back and crying in many gradations their faces being animated by these emotional states. The familiar adult can employ this responsiveness to build play sequences (...)."
5. Consciousness is endogenous
There is in the cases of high-brain encephaly severe degradation in the type of consciousness that are associated or derived from the external body. By contrast, the background 'page' of consciousness, the raw phenomenal self onto which object experience is written is fully present. The body as subject is fundamentally intact, as is instinctual affect and motivation. The only intact ego function in these cases seems to be a rudimentary form of associative, implicit learning derived from unconscious perception impacting on their instincts. It seems that all cortico-centric views of consciousness are wrong, Freud's included.
If consciousness is not cortical, where is it generated? Basic states of consciousness like wakefulness versus sleep are regulated in sub-cortical structures (brain-stem), as are states of vigilance and arousal. Cases of lesions to these structures have demonstrated the veracity of this view. When damage occurs in the periaqueductal gray (PAG) consciousness is obliterated entirely. PAG is the smallest area of brain that needs to be lesioned in order to totally obliterate consciousness. We also know from epilepsy studies that consciousness is generated in the upper brain-stem regions. Penfield (1954) observed that seisures occurring cortically only impair one aspect of consciousness. It is only when they reach central-cephalic structures in the upper brain-stem that consciousness is lost.
All that is new is the realisation by people like Panksepp and Damasio that conscious states generated by these upper brain-stem functions are intrinsically affective or emotional. Consciousness is generated in the part of the mind that is driven by our internal bodily needs that activates instinctual motivational behaviours that are innate, hard wired (Id). Ego consciousness is derived from the Id, not the other way around. This is important, because it turns the talking cure on its head. For Freud, the value of words is their exteroceptive origin, their capacity to extend consciousness downwards. All the evidence points in the opposite direction.
6. Mental solids (object representations).
Representations of the actual world, that are stored in the cortex. They can be activated both externally and internally. They serve both perception and cognition (recognition). Such processes are unconscious in themselves. It's only when they are engaged by upper brain-stem consciousness that they come to mind. What renders objects conscious is their incentive salience to us - their biological relevance in the pleasure-unpleasure series.
Inhibitory constraints are required. Inhibition of actions entails toleration of frustration - that is an overriding the pleasure principle but more efficient and secure satisfaction of biological imperatives is achieved this way. Thinking is interposed between drives and action (working memory - trial action).
7. The reflexive ego
The external body representation represents 'me' as an object, experienced like other objects. It is a re-presentation of the subject, not the subject itself. We experience the illusion that the body is the locus of our consciousness. The body 'owns' the self the same way the child projects itself in the animated avatars in a computer games. These self-representations rapidly come to be treated by the child as if they really were the child itself. Kover and Ersen (2008) - performed body-swap experiments, in which a camera on the forehead of a mannequin (a false body) being projected into the goggles worn by an experimental body rapidly creates the illusion in the subject that the mannequin is their body. They come to feel it as being 'my body'. They are projected into being this mannequin robotic body. The objectivity of the illusion is demonstrated by the fact that fear responses can be elicited in the subject by threatening the false body with a knife.
This illusion is the same as the 'rubber hand illusion' in which the real hand is screened from view and the rubber hand is placed at the elbow. Both the real hand and the rubber hand are stroked simultaneously but only the rubber hand is seen. The subject rapidly comes to feel that the rubber hand is the real hand. (Also see 'phantom-limb phenomena). These phenomena demonstrate that the bodily self of everyday experience is an acquired representation - a memory image. fMRI studies show that 'bits' can be added or extracted from the cortical homunculi easily (the locus of Freud's bodily ego).The ephemary nature of the sensory motor homunculi is also demonstrated by the motor neuron phenomena. They are neurons which fire in the pre-motor cortex when we perform a certain movement. They also fire when we watch someone else perform the same movement. From the point of view of these neurons exactly the same thing is happening, it makes no difference which one is making the movement. How do we come to know which movement is ours (belongs to this object called 'my body') as opposed to that object called 'her body'. How do we tell the difference?
Vittorio Galesi suggests that in the prefrontal cortex additional inhibitory activity occurs which makes the distinction, when it is not 'me' performing the movement. Interestingly this does not happen in schizophrenic subjects. So in this respect the differentiation between 'self' and 'other' is controlled by the prefrontal lobe. In the primary process mode there is no distinction between self and object representations. Second order re-representation enables the subject to differentiate between 'self' and 'other objects'. It can re-represent itself as "me seeing something separate from myself". This "me doing things" is felt to be the agent of everyday experience. The gap between the primary phenomenal consciousness emanating from the Id and the secondary re-representation is illustrated in the experiments of Benjamin Libet, which show that there is a lag half a second between the subjects making a movement and thinking I am going to make the move now. (Subjects start making the movement before they are consciously 'deciding' to execute it). He interpreted this to mean "we unconsciously decide to make the movement before we consciously decide to make the movement".
This declarative self generated by higher-order re-representations is also felt to be the agent of episodic memory. The whole trend of the secondary process is to reduce surprise, to increase predictability and automaticity and thereby to decrease consciousness, to transform declarative, explicit cognitions into non-declarative, implicit cognitions, to minimise the need for the affective presence of the Id.
8. If the Id is conscious...
All this has massive implications for freudian metapsychology, including the metapsychology of the talking cure. "Where id was, there ego shall be" (Freud, 1933, New Introductory Lectures).
Mark Solms is the director of the Arnold Pfeffer Center for Neuro-Psychoanalysis at the New York Psychoanalytic Institute; a lecturer at the University College Londons Department of Psychology; a consultant in neuropsychology at the Anna Freud Center in London; and an honorary lecturer in the Academic Department of Neurosurgery at St. Bartholomews and the Royal London School of Medicine. Over the last 15 years, Dr. Solms has been the driving force in establishing the new field of neuro-psychoanalysis, which brings together the fields of neuroscience and psychoanalysis.
What is the nature of communication between the analyst and the patient
Defining psychoanalysis as "the talking cure" is somewhat misleading, a misnomer. We have the mystical-sounding phrase from Freud about the communication from the unconscious of the patient to the unconscious of the analyst. We speak of empathic attunement and projective identification as a form of communication between patient and analyst, which is reflected in the countertransference. The nature of communication in the analytic room somehow fails to be conveyed in the words that are transcribed down from a recording of the analytic session. Something goes on inside of the patient and the analyst in parallel with the talking which cannot be readily captured.
The building blocks of the meaning-making process.
The most rudimentary form of a conscious thing that stands for something occurs within ourselves about ourselves, to ourselves. Communication is communication of meaning. The best theory that we are working with revolves around the notion that consciousness originates in structures within the very deep core of our brain stems. These structures which project very widely to the forebrain, are representing aspects of the state of ones self, the subjective state, the visceral bodily state. This state of self is meaningfully being represented as a feeling of consciousness which either feels good or bad. Action tendencies are intrinsically interwoven to these feeling states. Pleasurable feelings are associated with approach behaviours, they motivate approach behaviours.
Negative/painful feelings are associated with avoidance behaviours. These raw feeling states originate in the periaqueductal gray (PAG). Even in such elementary forms of consciousness, something is conveyed but not necessarily intentionally. We see that in herd-contagion behaviour.
The approach mechanism is essentially a seeking mechanism. It has to do with detecting needs that can only be met in the outside world. It is almost an implicit predictive mechanism: "Unless I go looking for food, I am not going to survive". The feeling that comes with it is mildly optimistic, mildly curious - "something good is going to happen and I want to be there kind of feeling". Freud defined emotions as "mnemic residues of biological situations of universal significance". The universality of significance makes us all know what it means when we see it. Basic emotion systems link our core consciousness to the outside world and those around us. Emotions are a perceptual modality, they are a medium of consciousness just as vision, smell, hearing are a medium of consciousness.
When another animal (human) feels something and another sees it, hears it, smell it (there are all sorts of ways in which the state of an animal is conveyed) then one knows what the other animal is feeling. These are things which we can't afford to learn, they are "mnemic residues" - we just know what it means, although we may not be able to demonstrate. Empathic knowing When I see that experience it activates the same system in me. I know what it is because it is activated in me. Mirror-neurons allow a higher level elaboration of this basic system. Mirror-neurons were accidentally discovered in a research lab in Italy. When a monkey with a brain activity recording device on its brain observes another monkey eating a banana, the same areas in the brain of the observing monkey are activated. There is a mirroring of the motor-neuron activity in the acting monkey, which is activated in the brain of the perceiving monkey.
The prefrontal cortex allows for a suppression of the basic emotional systems, inhibiting the action tendencies associated with them. They enable us to not have to act on the feeling, to create virtual scenarios, to represent the relation between things. A 'non-doing' kind of thinking evolves - a highly abstracted, symbolic thinking removed from the emotional core. It is our 'pride and joy' but the price is that it alienates us from our feelings. We develop this curious inability to know what is driving our own actions.
In therapy the analyst is taught to listen with his "third ear", with an evenly suspended attention. The analyst does not listen to the words, because they only convey part of the story - she picks something up, she feel something, which is akin to a biological situation with universal significance. This way we recognise the patient's emotional configuration, and we use the words to convey our understanding. The talking cure is not about the talking - the talking is about feelings.
This is a workshop delivered by Prof Paul Gilbert at Palo Alto University in 2013 about the scientific premise and technique of Compassion Focused Therapy.
Overview of Compassion Focused Therapy and the process of change with compassion.
CFT is a psychological model, although it uses elements of CBT, humanistic and psychodynamic therapies. CFT started with Prof Gilbert's interest in patients who were struggling with standard therapies (diagnosis of Borderline Personality Disorder). These patients were focused on shame and self-criticism, which is linked to poor outcomes. He wanted to understand evolutionary mechanisms which maintained emotional problems.
Cognitive Behaviour Therapy traditionally focuses on replacing on unhelpful thoughts and behaviour with helpful thoughts and behaviour. However some clients say they see the logic of the alternative thoughts but do not feel reassured or helped at the emotional level. They also say: "I know I am not to blame but I still feel to blame"
We need to feel congruent emotion in order for our thoughts to be meaningful to us. Emotions "tag" meaning onto experiences. In order to be reassured by the thought "I am loveable", this needs to be linked with the experience of 'being loveable'. Many patients who come from traumatic backgrounds have few memories of being loveable or soothed and thus may struggle to feel reassured and safe by alternative thoughts.
Compassion focused therapy targets the activation of the soothing system so that it can be more readily accessed and used to help regulate threat-based emotions of anger, fear, disgust and shame.
Evolutionary model of psychopathology
We are an emergent species in the 'flow of life' so our brains, with their mechanisms for motives, emotions and competencies are products of evolution, designed to function in certain ways.
Anxiety disorders are related to how cognitions trigger innate defences - fight, flight, demobilisation (Marks, 1987) or danger modes (Beck, 1996)
Depressions are related to evolved mechanisms for coping with defeats and loss (Beck, 1987; Gilbert, 1992)
Personality disorders are related to the under or over development of innate strategies (e.g. cooperation vs. competition) (Beck, Freeman et al. 1990; Gilbert, 1987)
The social circumstances of our lives, over which we have no control, have major implications for the kinds of minds we have, the way our genes become expressed, the kids of brains we end up with, the kind of person we become, the values we endorsed and the lives we live.
How new psychologies emerged in the world
500 mil years ago - Reptilian psychology (territory, fear, aggression, sex, hunting)
120 mil years ago - Mammalian psychology (capacity for caring, group, alliance building, play, status)
2 mil years ago - Human psychology emerged (capacity for symbolic thought and self-identity, theory of mind, meta-cognition)
1 mil years ago - Human capacity for extended caring (looking after the old or the sick)
Why we have complex brains and minds that are difficult to understand and regulate
The Old Brain: Emotions (anger, anxiety, sadness, joy, lust); Behaviours (fight, flight, withdraw, engage) Relationships (sex, status, attachment, tribalism)
New Brain: Imagination, fantasise, look back and forward, collating and integrating vast amounts of information from different modalities- sensory emotional, plan, ruminate.
Social Brain: Need for affection and care
The brain has a number of built-in biases. Biased learning (fear of snakes, heights). Biases can be implicit or explicit. We tend to be self-focused, kin-focused and exhibit in-group preferences.
We have a capacity to become aware of being awareness. Mindfulness is the capacity to observe one's mind and it naturally calms us down. Compassion comes is a motivating system rooted in the caring system. Compassion has to be understood as an interaction - it depends also on the other being responsive to being cared for.
The mind is primarily a social signalling system (See Tronick's 'still face' experiment, Joseph Campos experiment on the role of non-verbal communication guiding behaviour in babies)
Humans have fundamentally have a desire to be helpful( Warneken and Tomasello experiments in compassion in babies).
Evolutionary functional analysis
There are three types of emotions, which act as motivators:
-those that focus on threat and self-preservation
-those that focus on doing and achieving
-those that focus on contentment and feeling safe.
The threat system is the dominant system in your brain. It is designed to over-rule and switch off everything else. Attention becomes narrow-focused, scans for threats, moves towards thinking about what could go wrong. In anger and anxiety the body feelings overlap. Borderline patients are not able to distinguish between tension and anxiety.
Professor Paul Gilbert gives the Meng Wu lecture at CCARE (Stamford University). He is currently developing the Compassionate Mind Training Mind programme in the UK. In this lecture Prof Gilbert describes the interaction of three different types of affective regulator system: the drive/seeking system, the threat system and the affiliative (care) system. Prof Gilbert has developed a training programme to support clients from shifting from the threat system into the care system, by expanding their ability for compassion.
Prof Gilbert comes from a tradition (clinical psychology), which understands compassion as primarily a cognitive and motivational process. The attributes of compassion are: sensitivity, care, non-judgement, empathy (understood here as perspective taking), distress tolerance and sympathy (understood here as the ability to feel the pain of another).
Compassion can be seen as a brain-organising process. His research suggests that compassion can be increased through the training of particular skills:
Attention - Choosing to pay attention to what is helpful to us, to the positive things that happen to us and turn attention away from the negatives (we are more inclined to focus on the negative)
Imagery - Being able to activate an internal nurturing Parent. Soothing self-talk.
Reasoning - "Compassion isn't stupid". It's important that we are able to reason and reflect, standing back and understanding things, thinking about the wider picture, not just about our immediate circle of concern.
Behaviour - The behaviours of compassion are often courageous. Doing the things one needs to do in order to flourish. Paying attention to one's breathing, one's tone of voice, one's posture (all of which stimulate the vagal system). Feeling the anger but not reaching for the hammer.
Feeling - Enhancing positive, warm feelings, kindness. Expanding our window of affective tolerance. Descent into suffering, pain, anger but not being overwhelmed by it. The point of mind-training is not to get rid of feelings.
A 2010 study by Johnathan Shedler of University of Colorado about the efficacy of psychodynamic psychotherpy, published in the American Psychologyst. Available in PDF format here: www.apa.org/pubs/journals/releases/amp-65-2-98.pdf
Reading the work of psychiatrist and transactional analyst James R. Allen gives me great pleasure as I discover a knowledgeable and nuanced and autonomous thinker who seamlessly incorporates science and hermeneutics. In the article "Yeastlings" Allen uses the metaphor of rising dough to signify "the quiet pockets of transformation" in transactional analysis paradigm. He is talking about a shift from Berne's modernist project to a postmodern transactional analysis. The article is available from the USATAA website.
A moving article by psychiatrist and psychotherapist Robert Lewis asking: "How does one both be the responsible healer who maintains the frame and the wounded healer inside the frame with the wounded patient? In some ways, one hopes to embody a presence, not unlike that of the parent who both takes responsibility for his child and yet remembers that the child (patient) knows at least as much about where your journey together must go."
There has been a lot of anecdotal evidence linking creativity and mental illness. This fascinating article "Neuropsychological evidence for dimensional schyzotypy: Implications for creativity and psychopathology" published by a team of researchers in the Journal for Research in Personality in 2oo4, establishes a link from a neurobiological perspective between creativity and psychopathology - schizotypal personality disorder in particular. The 'link' seems to be hemispheric asymmetry with a more pronounced right-hemispheric activity. Read the article here
Nature, nurture and development: From evangelism through science toward policy and practice by Michael Rutter. Article available here.
This article is a review of the scientific exploration of the nurture-nature debate in relation to psychopathology. Michael Rutter explores both the misconceptions and false claims on genetic, psychosocial and developmental research.
The highest environmental risks related to the development of psychopathology are:
- scapegoating of a child and exposure to consistent conflict
- a lack of individualised personal caregiving [institutional upbringing]
- the absence of play and conversation with a carer
- a negative social group that fosters maladaptive behaviour
The risk and protective factors emerge in the context of family, peer group, school and the wider social community. [Rutter, 2oo2, p. 8]
|A Practical Approach to Boundaries in Psychotherapy:Making Decisions, Bypassing Blunders, and Mending Fences
and Patricia Keith-Spiegel, Ph.D.
Abstract: Nonsexual boundary crossings can enrich psychotherapy, serve the treatment plan, and strengthen the therapist-client working relationship. They can also undermine the therapy, disrupt the therapist-patient alliance, and cause harm to clients. Building on Gutheil and Gabbard's (1993) conceptualization of boundary crossings and boundary violations, this article discusses and illustrates grounding boundary decisions in a sound approach to ethics. We provide 9 useful steps in deciding whether to cross a boundary, describe common cognitive errors in boundary decision-making, and offer 9 helpful steps to take when a boundary crossing has negative effects.
The Concept of Boundaries in Clinical Practice:
Theoretical and Risk-Management Dimensions
Abstract: The authors systematically examine the concept of boundaries and boundary violations in clinical practice, particularly as they relate to recent sexual misconduct litigation. They selectively review the literature on the subject and identify critical areas that require explication in terms of harmful versus nonharmful boundary issues short of sexual misconduct. These areas include role; time; place and space; money; gifts, services, and related matters; clothing; language; self-disclosure and related matters; and physical contact. While broad guidelines are helpful, the specific impact of a particular boundary crossing can only be assessed by careful attention to the clinical context. Heightened awareness of the concepts of boundaries, boundary crossings, and boundary violations will both improve patient care and contribute to effective risk management.
My reading: This article, originally published in 1993 represented a landmark in the field of professional ethics. The authors place the context of boundaries in its historical context, making reference to the clinical work of Freud, Winnicott, Ferenczi and Melanie Klein. The confusion around boundaries stemms partly from the inconsistency between Freud's theoretical prescriptions on analytic technique and his practice.
Therapists as Patients:A National Survey of Psychologists' Experiences, Problems, and Beliefs
Abstract: A survey of 800 psychologists (return rate = 59.5%) found that of 84% who had been in therapy, only 2 described therapy as unhelpful, 22% found it harmful, 61% reported clinical depression, 29% reported suicidal feelings, 4% reported attempting suicide, 26% reported being cradled by a therapist, 20% reported withholding important (mostly sexual) information, and 10% reported violations of confidentiality. Women were more likely than men to report sexual material in therapy; psychodynamically oriented respondents were more likely to report sexual material. Of those who had terminated, 63% reported recent consideration of resuming therapy. Most believed that therapy should be a requirement of graduate programs and licensure, but only about a third believed therapy mandated by licensing boards for resuming practice after violations of professional standards to be clearly or even likely effective.
Sexual Attraction to Clients: The Human Therapist and the (Sometimes) Inhuman Training System
ABSTRACT: Although we currently possess considerable information about the incidence and consequences of sexually intimate relationships between psychotherapists and clients, there is virtually no documentation of the extent to which psychotherapists are sexually attracted to clients, how they react to and handle such feelings, and the degree to which their training is adequate in this regard. Feelings toward clients are generally relegated to vague and conflicting discussions of countertransference, without benefit of systematic research. Survey data from 575 psychotherapists reveal that 87% (95% of men, 76% of women) have been sexually attracted to their clients, at least on occasion, and that, although only a minority (9.4% of men and 2.5% of women) have acted out such feelings, many (63%) feel guilty, anxious, or confused about the attraction. About half of the respondents did not receive any guidance or training concerning this issue, and only 9% reported that their training or supervision was adequate. Implications for the development of educational resources to address this subject are discussed.
Full article available here.
This is an interview available online
, through Online Events [you will need to set up an account].
Eric Berne – The Man and His Times
is a conference Paper delivered at the ITAA Conference, Montreal, 2010 by Ann Heathcote & Marco Mazzetti. Ann Heathcote is writing her doctoral dissertation on the life of Eric Berne. Marco Mazzetti is fascinated with Berne's travels. He says: "According to his biographers (Cheney, 1971; Cranmer, 1971; Jorgensen & Jorgensen, 1984; Stewart, 1992) he travelled a lot, visiting psychiatric institutions in India, Singapore, Fiji, Tahiti, Papua – New Guinea, Thailand, Sri Lanka, Hong Kong, Filipinas, Syria, Lebanon, Guatemala, Turkey, Bulgaria and several other countries. His first article published in a medical journal was entitled “Psychiatry in Syria” and appeared in the American Journal of Psychiatry in 1939 (Berne, 1939).
"So many people the world over are suffering from a form of existential whiplash from the economic tumult and personal loss of an identifiable being-in-the-world that makes ego syntonic sense to them. Lost jobs, economic hardship, familial collapse, loss of home, hearth and hope—such existential crises cannot be fixed by pills alone. The current controversy over proposed new diagnoses in the upcoming DSM-5 has psychologists and mental health professionals deeply concerned, as they see so many of these struggling people identified as mentally ill, given a diagnostic number, and treated with a cocktail of prescribed medicines that don’t come close to addressing what is really wrong. Speaking out against what they see as the dehumanizing of psychological care through over medicalization and over diagnosis of vulnerable populations of children and the elderly in particular (but touching the lives of the general public, as well), through revolt against the proposed DSM-5, the mental health community is shouting a resounding, “No!” Last fall, within months, more than 10,000 mental health professionals, organizations, international psychological groups, and others, had signed an online Open Letter petition asking the DSM-5 Task Force and the American Psychiatric Association to show greater transparency in their process of vetting some of the more controversial new diagnostic criteria (http://www.ipetitions.com/petition/dsm5/
). News media outlets and bloggers were quick to tell this David and Goliath story of the foot soldiers who see the impact of mis-diagnosis and the harm of over medication, and are standing up to the giant psychiatric publishing monolith as it moves the DSM-5 each day closer to press (it is due to close its review process in February 2012, and be published in May 2013)."
Science Daily article about Dr. Philip Shaw's longitudinal study of the ADHD brain which suggests that this disorder is cause by a delay in brain development. Read here
. The original press release
by the US National Institute of Mental Health. And here is a video of ADHD maturation delay.
Russel A. Barkley is an expert in ADHD [Attention Deficit Hyperactivity Disorder]. In His 2o12 Burnett Lecture Prof Barkley describes ADHD as Executive Function Deficit Disorder. He says that this new reconceptualisation has profound implications over how ADHD should be tested in the USA.
His theory is extremely interesting; I question his conclusions as he seems to over-emphasise medication [he is a consultant for pharmaceutical companies who produce the drugs that are used to treat ADHD in children]. The over-use of drugs is a problem as many children out-grow this developmental gap.
Summary of the theory of ADHD as EFDD
There are five brain structures involved in executive functioning: the medial prefrontal cortex, the dorso-lateral prefrontal cortex, the basal ganglia [striatum], the amygdala and the cerebellum. Together they create three distinct neural circuits, which are dopamine based [Javier Castellanos]
The frontal-striatal circuit: associated with deficits in response suppression, freedom from distraction, working memory, organisation and planning, known as the "cool" EF network
The frontal-limbic circuit: associated with symptoms of emotional discontrol, motivation deficits, hyperactivity-impulsivity and proneness to aggression, known as the "hot" EF network
The frontal-cerebellar circuit: associated with motor coordination deficits, and problems with timing and timeliness of behaviour, known as the "when" EF network.
[For a longitudinal study of the development of the ADHD brain see the research of Philip Shaw.]
These three circuits are associated with the following functions: timing of actions and behaviour [as well awareness of self in time], goal orientated behaviour, coordination and gracefulness of our movements [and thoughts], working memory [a memory of what I am here to do], emotional inhibition and meta-cognition [self-awareness, planning, problem solving, self-regulation.
What is executive functioning?
Dimen [198o] describes EF as the seat of social intelligence without which cooperation, reciprocity and group living would not be possible.
EF is self-regulation [self-control]. Self-control is anything we do to ourselves to change our behaviour. Through EF in the present we are trying to change a distant outcome. [exercising now to get fit and toned in the future], or changing behaviour to change the future that comes towards us.
There are seven different executive abilities. These abilities develop in a sequence and they are observable [externalised] in young children. In adults they become symbolic/private, unless we are alone and we are less inhibited and give ourselves commands out loud.
o-3 years - no self talk
3-5 years - audible self-speech [no voice in the head]
5-7 years- the child gives himself commands out-loud but starts suppressing the vocal cords and later the face movements
after 7 years - the voice in the head/the voice governs our behaviour privately
Emotional and motivational self-regulation
Self-talk helps us create and manage emotions and if we can manage our emotions we can manage our motivations. Anticipating pleasure in the future can motivate us to tolerate the time delay in getting the reward.
Starts at around three months of age and takes ten years to mature. Involves turning attention and sensing to self; self-monitoring; self-watching
Self-restraint or executive inhibition [stopping self from performing an action, resisting distraction]
Non-verbal working memory:
is the visual imagery system [theatre in the mind] that guides us to our goals. We resurrect images of our past to guide us towards the future.
Planning and problem solving
Children's play solves as a template for problem solving because it involves analysis/synthesis, the source of all human imagination and invention [Daniel Coleman- Thinking fast and slow]
Acting at a distance: interacting towards the future and preferring delayed rewards to immediate ones.
The pre-frontal cortex only fully matures in our early thirties. The older we get the more we expand our window to the future [anticipation of future events, thinking months and years ahead]. EF helps us create a scaffolding with the group and culture requires: being methodical, self-reliant, self-determined, resisting being manipulated by others to their advantage, being able to put a 'wall or filter' between yourself and others so you cannot be manipulated, self-defensive, reaching out and interacting with others, building friendships, reciprocity, sharing, turn-taking, initiating cooperative enterprise which is the basis of communities and government.
Understanding ADHD in adults
Time blindness - are nearsighted to time, adrift in time, are "getting pulled along by the 'now'".
Performance disorder: doing what you know and not knowing what to do; having a lot of knowledge but not being able to use it. It's a problem with knowing when to do and where to do rather than what to do and how.
Using the past at your point of performance - the place and time where you should have used your skill but didn't
It is an intention deficit disorder.
Treatment recommendations: Working at the point of performance. Neuro-genetic therapy [using drugs to work at the level of molecular mechanisms, a form of genetic treatment]. Make rewards positive and concrete; visualising and imagining rewards; time-management training - make time concrete through the use of clocks and timers; breaking down long tasks into small chunks; breaking tasks and taking breaks every ten minutes to allow for refuelling [EF depletes our resources]; keep the sugar levels in the bloodstream up; routine aerobic exercise to oxygenate the brain; make problem-solving physical [manipulating objects]; positive self-statements; biofeedback.
North West Wales NHS Trust, Bangor, UK.
"This paper reviews functionalneuroimaging studies on psychotherapy effects and their methodological background,including the development of symptom provocation techniques. Studies of cognitivebehavioural therapy (CBT) effects in obsessive-compulsive disorder (OCD) were consistentin showing decreased metabolism in the right caudate nucleus. Cognitive behavioural therapy in phobia resulted in decreased activity in limbic and paralimbic areas. Interestingly, similareffects were observed after successful intervention with selective serotonin reuptakeinhibitors (SSRI) in both diseases, indicating commonalities in the biological mechanisms ofpsycho- and pharmacotherapy. These findings are discussed in the context of currentneurobiological models of anxiety disorders. Findings in depression, where both decreasesand increases in prefrontal metabolism after treatment and considerable differences betweenpharmacological and psychological interventions were reported, seem still too heterogeneousto allow for an integrative account, but point to important differences between the mechanismsthrough which these interventions attain their clinical effects."
"Horizon uncovers the secret world of our dreams. In a series of cutting-edge experiments and personal stories, we go in search of the science behind this most enduring mystery and ask: where do dreams come from? Do they have meaning? And ultimately, why do we dream?What the film reveals is that much of what we thought we knew no longer stands true. Dreams are not simply wild imaginings but play a significant part in all our lives as they have an impact on our memories, the ability to learn, and our mental health. Most surprisingly, we find nightmares, too, are beneficial and may even explain the survival of our species."
"It is a feeling we all know - the moment when a light goes on in your head. In a sudden flash of inspiration, a new idea is born.
Today, scientists are using some unusual techniques to try to work out how these moments of creativity - whether big, small or life-changing - come about. They have devised a series of puzzles and brainteasers to draw out our creative behaviour, while the very latest neuroimaging technology means researchers can actually peer inside our brains and witness the creative spark as it happens. What they are discovering could have the power to make every one of us more creative."
From Louis Cozolino “The Neuroscience of Psychotherapy” [2o1o]
Dissociation is a result of high levels of stress associated with traumatic experiences. It occurs when the fight or flight response would be maladaptive, or when there is no response to one’s distress. It is a switch from hyper-arousal to hipo-arousal. In infants it is manifested as a gradual lack of protest [this is the reason why until recently it was believed that infants were insensitive to pain and so surgery was performed on infants without anaesthesia It is characterized by “a disconnection among thoughts, behaviours, sensation and emotions; dissociation demonstrates that the coordination and integration of these functions is an active neurobiological process.” [p. 2o-21]
“Dissociation allows the traumatised individual to escape the trauma via a number of biological and psychological processes”. [p.269] The brain releases endogenous opioids which create a sense of wellbeing. The explicit processing of overwhelming traumatic situations is decreased [hippocampus]. “Derealization and depersonalization reactions allow the victim to avoid the reality of his or her situation, or watch it as a detached observer. These processes can create an experience of leaving the body, travelling to other worlds, or immersing oneself in other objects in the environment…” [p.27o]
“General dissociative defences resulting in an aberrant organization of networks of memory, fear, and the social brain contribute to deficits of affect regulation, attachment and executive functioning. The malformation of these interdependent systems result in many disorders that spring from extreme early stress. Compulsive disorders related to eating or gambling, somatization disorders in which emotions are converted into physical symptoms, and borderline personality disorder all reflect complex adaptations to early trauma” [van der Kolk, 1996 in Cozolino, 2o1o, p. 27o]
The neuroscience of borderline personality disorder [p.282-283] [Also see Zero degrees of empathy by Simon Baron-Cohen]
- An overactive amygdala, primed to react to any indication of abandonment.
- Easily triggered fight or flight reaction [hypothalamus- pituitary –adrenal axis resulting in the release of adrenaline and cortisol]
- Orbitofrontal cortex inadequately developed so it cannot successfully inhibit the amygdala. Self-soothing is not possible.
- Orbitofrontal dissociation may result in disconnection between right and left hemisphere and top-down processing leading to dramatic shifts between positive and negative appraisals of relationships.
- The absence of internalized models of affect regulation so the patient cannot draw on these to self-soothe
- Rapid fluctuations between sympathetic and parasympathetic states
- Chronic high levels of stress hormones [cortisol] which compromise the functioning of the hippocampus, decreasing declarative, explicit memory and the capacity to control the amygdala.
- Lower levels of serotonin resulting in greater risk of depression and irritability.- Self-harming results in endorphin release and sense of calm
“Dissociation in reaction to trauma represents a breakdown of neural integration and plasticity. In therapy, we use moderate levels of arousal to access cortical mechanisms of plasticity in controlled ways with specific goals. The safe emergency of therapy provides both the psychological support and the biological stimulation necessary for rebuilding the brain. Much of neural integration and reorganization takes place in the association areas of the frontal, temporal and parietal lobes, serving to coordinate, regulate and direct multiple circuits of memory and emotion… narratives embedded within an emotionally meaningful relationship are capable of resculpting neural networks throughout life. Through the use of autobiographical memory, we can create narratives that bridge processing from various neural networks into a cohesive story of the self” [Cozolino, 2o1o, p. 343]
From Daniel Siegel’s “The Mindful Threapist: A clinician’s Guide to Mindsight and Neural Integration”“Dissociation involves various elements along a spectrum including a sense of being unreal, feeling numb or disconnected from one’s body, feeling depersonalization or a kind of distance from being grounded in oneself, and outright amnesia for events in one’s ongoing life.” [Siegel, 2o11, loc. 1377]
These experiences recur mainly under stress and are associated with unresolved trauma and loss and a disorganized attachment style. Dissociation is a protective state in a situation in which there is no escape from terror or “fear without solution” [Main, Hesse, Yost-Abrams and Rifkin, 2oo3 in Siegel 2o11]
The opposite of a dissociated or disorganized state is an integrated state. There are different levels of integration, just as there are different levels of dissociation.
Vertical integration – mind/body is facilitated by interoceptive awareness [posterior insula] Being aware of what is happening inside one’s body and using this information to make sense of our reality
Bilateral integration – left hemisphere/right hemisphere [logic, verbal/metaphoric, implicit, non-verbal]
Being able to use logic but also metaphor. [See Iain McGilchrist- the Master and his Emissary]
Memory integration – implicit memory/explicit memory [amygdala/hippocampus]
Narrative integration- the existence of a coherent autobiographical story
Additional resources: “The History of Dissociation and Trauma in the UK and its impact on treatment by Remy Aquarone and William Hughes” available online at: http://www.dissociation.co.uk/research.asp
Stephen Porges - "The polyvagal theory". Porges talks about incapacitation [fainting, passing out] as a distinctive coping mechanism, neurologically very different from sympathetic arousal [fight or flight response]
Michel Bitpol asks "Does consciousness have a material basis"?
Michel Bitpol is research director at the Centre National de la Recherche Scientifique.
There are many western thinkers that are opposed to the idea that consciousness has a material basis. This idea is asymmetrical. Matter is a basic given and consciousness is a derivative. How is it that material processes give rise to consciousness. This asymmetrical view may not be supported by the facts we have.
Is the view that conscious experience derives from a material basis imposed by science?
The very method of science tends to this idea because scientists are focused on objects and their objects are material objects that can be seen from the third person point of view.
There seems to be an apparent consensus:
The entire brain is sufficient for consciousness" [Christoph Koch, 2oo4]
"Consciousness is a physical, biological phenomenon, like reproduction [Dan Dennett, 25]
Arguments for this position
There are strong correlations between conscious events, mental events and the workings of the brain. Using these correlations we could even perform "thought reading". Placing detectors on the brain we could identify what the person is thinking based on which areas in the brain become active. We can stimulate certain parts of the brain and very specific experiences and contents of consciousness occur. [Penfield]
Yet in spite of these arguments there is widespread doubt:
"Describing a neural process is not living it." [G.Edelman, 21oo1] There is always a gap between the description and the experience.
"Subjectivity is too radically different from anything physical for it to be an emergent phenomenon" [Christoph Koch, 2o12]
Corelation does NOT automatically mean causation!
The fact that there is correlation between brain and mental events does not necessarily mean that brain events cause mental events.
There are other possibilities besides causation [A ->B].
Thesee are: reverse causation [B->A]
Bidirectional causation [A <--> B]
Common cause: Both A and B are caused by C
No cause: A and B are like the two sides of a spoon
Does trans-cranial stimulation prove that the brain causes consciousness? We now know that reverse causation is possible as well. Conscious events cause brain events [eg. Mental training changes the brain]
Consciousness is the starting point of any inquiry
According to the materialistic view what is 'given' is the matter. Yet what is more glaring and more obvious than material objects is the experience that we have of them.
Francisco Varela  "Lived experience is where we start from and where all must link back to, like a guiding thread."
Christoph Koch [2o12] "Without consciousness there is nothing"
Edmund Husserl  Consciousness is what is certain; any object of consciousness can be a delusion.
The blindspot of science
"Nothing in the visual field allows you to infer that it is seen by an eye" [Wittgenstein] The seer doesn't see itself. [The Upanishad] The eye of science does not see itself.
"As soon as one has adopted the standpoint of objective knowledge, the knower does not enter into the visual field." Nishida Kitaro
"The world of science is not the world of the true reality" Nishida Kitaro There most fundamental aspect of reality, which is experience, is lost to science in favour of objects.
The strange loop
There is a mutual relationship between the brain and consciousness and this mutual relationship is itself understood in experience.
"Men will urge that the mind is dependent upon the brain, or, with equal plausability that the brain is dependent upon the mind." Bertrand Russell
We see an image of a brain which is seen by an eye of somebody who has a brain. The picture of the brain is projected on the visual cortex and the person sees the brain. We, on the outside of the picture are seeing a brain which is seeing a brain? Who is seeing us seeing this image? We are not thinker, we are experiencers.
If I don't have a brain I don't have consciousness but also if I don't have consciousness I don't have a brain. We need consciousness to see that we have a brain.
A neuroscientific approach to consciousness does not need to be reductionistic and materialist.
Francisco Varela [1946-2oo1] did not want to have an objective science of subjectivity. Instead he wanted a science that would cultivate both the objective and the subjective points and connect them. He said that in any theoretical approach of consciousness "what is missing is not the coherent nature of the explanation but its alienation from human life" 
The DSM V Paraphilias Subworkgroup has reached a position of compromise regarding paraphilias. The DSM system of
classification has been criticised for the continued inclusion of sex-related
diagnoses (Kleinplatz, 2005). Psychiatrist Glen Gabbard pointed out out that the
term paraphilia remained pejorative in most circumstances
(Gabbard, 2007). In the DSM-V paraphilias are not ipso facto psychiatric disorders
and would only justify or require psychiatric intervention if it causes
significant personal distress. However Julian Keenan from the Medical Examiner says that this solution is absurd.
Richard Davidson lecture on the impact of mental training on the neural circuits of emotion and attention. Watch here.
Circuits of emotion
Sensory information travels from the sensory organs, through relay centres (sensory thalamus) to the cortex. Once the relevance of this information is processed (is it safe or dangerous), this is transmitted to the the visceral organs (heart and the lungs) and to the muscles in our face and body. If we perceive a threatening stimulus (i.e) a predator, our heart beats faster and hour lungs work harder, etc. The information about the state of the viscera and the body then travels back to the brain. It is only when the brain detects the changes in our body that the experience of emotion arises. This is an influential view espoused by William James in the "Principles of psychology". The fact that our perception of emotion is reliant of information from the body was proven through an experiment in which people who had botox injected in their forehead (in muscles associated with the expression of sadness) were tested before and after. The test showed that the lack of signal feedback from these muscles to the brain changed the emotional response of the person (they experienced less sadness).
James Papez was the first to describe a model of the circuit in the brain associated with emotion. His model included the hippocampus, the hypothalamus, the anterior thalamus and the cingulate gyrus.This was the first time that it was suggested that emotion is processed in parts of the brain that lie below the cortex. Later on, studies on patients with lesions to the prefrontal cortex showed that the cortex (the medial prefrontal part) is actually involved in emotional processing.
In the modern understanding, the capacity to regulate our emotions is associated with the prefrontal cortex. No other species can voluntarily regulate their emotions in the way humans do.
Emotion as a process is distributed throughout a circuit and different areas of the brain interact to create emotion (i.e. the limbic system and the prefrontal cortex. However there is no single site in the brain about which we can say: that is where emotion resides. There are circuits in the brain for positive emotions and circuits that process negative emotion.
Stress changes the structure of the brain, particularly the hippocampus, amygdala and orbito-frontal cortex. When an animal is chronically stressed the nervous cells in the hippocampus shrink shrink (fewer dendrites), whereas cells in the amygdala apear to have more ramifications. (Davidson & McEwan, Nature neuroscience, 2012)
Networks in the brain important for attention
Attention has different atributes and some can be distinguished in terms of circuits in the brain. There are three types of attention: alerting, orienting and executive control. Alerting occurs for instance when there is a big loud noise. Something happens in the environment and our attention is pulled towards it. Orienting is the capacity to direct your attention mentally to different senses. Executive control is about resisting distractions and directing our mind to focus on one thing and inhibit the distractive influences that come from somewhere else. There are parts of the brain involved with these attention functions that overlap with emotion. This is not surprising because it is emotionally relevant information in our environment that captures our attention. We do not become alerted to neutral stimuli.
The impact of contemplative training on networks important in attention
Children who have attention deficit hyperactivity disorder are very variable in how they pay attention. In a study in which participants practiced Vipassana meditation for three months, it was shown that this practice greatly helped reduce this variability of attention (Lutz et al. 2009, Neuroscience).
The view of the world that fits quantum mechanics has paradoxes which are hard to accept.
In the classical view science was considered to be a mirror of nature. This conception comes in two varieties. Western science has sought a faithful representation of reality as it is in itself (realism). Empiricists would say that a good theory is a faithful summary of observed phenomena. The idealistic view (Kant) was that our sensibility and understanding shapes phenomena into objects.
The third possibility is that a scientific theory is neither a mirror of nature nor a projection of our minds, but the expression of a fruitful interplay between nature and us. Francisco Varela developed this view under the name of "enaction" (Embodied mind). According to him our view of the world is dependent arising on the knower and the known. Science gives us methods to relate to the world in an efficient and powerful way. It is an instrument that helps us orientate in the world and nothing more.
What is a scientific theory?
In the history of western thought there are four major conceptions:
Aritotle (330 BC) - A statement of "first causes" and meant to find the "essential properties" of things.
Descartes (1637) - A mechanical explanation of the motion of bodies in terms of contact and collision
Newton (1687) - A mathematical description of phenomena in space and time: motion of celestial or terrestrial bodies
Bohr (1929) - A mathematical predictive tool able to predict in terms of probabilities the outcome of experiments.
We see a progressive decrease in the scope of theories coupled with a progressive increase in precision. The more efficient they become, the less they pretend to make us understand the world as it is.
What is the difference between a theory and its interpretation?
A physical theory is a mathematical framework (Bohr and Newton) to describe or predict phenomena. It is made of laws that connect variables (e.g. position and velocity). Classical mechanics is of this type.
Interpretations are views of what the world is made of. A physical theory can be consistent with different views of the world. The seventeenth century view was that the world is made of material bodies, which have position and velocity and attract each other (Newton). The nineteenth century view was that the world is made of pure energy and that the appearance of bodies is given by local concentrations of energy (Oswald, Duhem)
What is quantum theory?
Quantum theory is a mathematical scheme to predict the probability of a particle being found 'here' or 'there'. What view of the world fits with quantum theory? There are three different possible answers. 1. All reality is a wavelike (Schrodinger) 2. Only particles exist 3. Dual reality: part wave - part particle. Particles use waves to guide themselves through the world (Bohm)
There is a fourth possibility, which is very challenging. Quantum reveals nothing of the intrinsic nature of reality, it is just a tool that helps us orientate by probabilities through the phenomena that we meet in the world. Quantum theory may be powerful on a statistical level but weak on a descriptive level. An insurance company uses statistics to predict how many accidents there will be in a year and deduce what to charge its customers, and yet would not be able to describe us the nature of accidents. This position is supported by Werner Heisenberg and Anton Zeilinger. According to Heisenberg one cannot say what 'happens' in the world independently of one's intervention, experimentation or observation. According to Anton Zeilinger quantum mechanics is a theory of the limits of available experimental information.
Maybe quantum theory has revealed that nature has no intrinsic nature. This is a great challenge for western thought. Most physicists believe that quantum physics has "betrayed the ideal of science" (Isabel Stengers). Rene Thom a French mathematician referred to quantum theory as "the scandal of our century".
Should we persist with the ideal of science which brings with it many paradoxes or should we drop the ideal of science and regain some clarity? The ideal was so dear to so many scientists, it cannot be easily be suspended. It may be that quantum physics is so efficient and universal precisely because it does not aim to disclose the intrinsic nature of anything. It covers many events in many domains. It can even be applied to human sciences (i.e. linguistics and semantics). The common point between microphysics and semantics is that in both we have relational phenomena.
From a buddhist stance it is enough to appreciate what is given and just describe what is given but not try to imagine what is behind the veil of appearance. Maybe there is no veil at all, nothing hidden behind phenomena (Dogen)
Fanita English is well known for her revision of script theory and the concept of "racketeering" and "episcript". In this Keynote address at the 1997 ITAA conference, she talks about how she came to understand the episcript as the "transmission of a lifelong obligation to fulfil a destructive task".
The clock is an archetype of the old classical physics. What we have in the quantum mechanics is something that is not at all like that. A new way of thinking is required.
Einstein was at the crosswords between the old world and the new one. He said: "Behind the tireless efforts of the investigator there lurks a stronger, more mysterious drive: it is existence and reality that one wishes to comprehend." (Einstein, 1934) We all wish to comprehend reality, but what is our expectation about how that reality will show up?
Intrinsic properties have been defined as unique enduring properties that identify an object. Galileo made a distinction between primary and secondary qualities. He wrote" I think that tastes, odours, colours and so on are no more than mere names and they reside only in consciousness. Hence if the living creature were removed, all these qualities would be wiped away and annihilated." Secondary qualities are colour, smell, taste, sound, warmth. Primary qualities are size, shape, location, movement, contact, mass.
The failure of classical realism
The mystery is from the point of view of quantum physics: are these primary qualities truly primary? Is there a world of intrinsic objects or is the world intrinsically subjective - is it the world of experience?
Two great theories of modern physics
Relativity, which is a revolution in our understanding of space and time and simultaneity becomes significant only at high velocity. Quantum mechanics, which has revolutionised our understanding of light and matter becomes relevant only at small scales such as atoms.
Thought experiment. A relativistic challenge. To fit a 25cm pole in a 20cm long barn. Classically it is impossible because the pole is too long to fit in the barn. However at 75% the speed of light, the pole shrinks when seen from the barn to 18cm. If the barn is observed moving at 75% the speed of light towards the pole, the barn will shrink to 14 cm. Any object that moves becomes shorter in the direction of moving. Viewed from the barn the pole fits inside. Viewed from the pole, the pole is too long. These two views are classically inconsistent, but consistent from a relativistic point of view both are true, but with respect to two different observers, two different frames of reference.
What you are looking for is always in a context, a relationship. When you are asking what is the single true state of affairs you are presuming there can be a view from nowhere - no person just a situation with its own truth. When we forget the context we come into great difficulties. Difference reference frames create different contexts and lead to different understandings. The vantage point is absolutely important to even something like size. Every primary property is affected by relativity. From a standpoint of physics we have to keep into account the frame of reference of the observer. There is no privileged reference frame. Each observer has the same claim to truth.
Length shortening, time slowing and the relativity of simultaneity make analysis in terms of objects inappropriate and this becomes the new framework for understanding the new physics. David Bohm: "The analysis of the world into constituent objects has been replaced by its analysis in terms of events and processes" (Special theory of relativity) We so much want the world to be made up of objects - cells, neurons, atoms but this is a wrong view. We have phenomena and processes arise in time and they give the appearance of objects of enduring nature, but what is primary is the process.
It is a wrong view to look for a single objective state of affairs that everyone will see in a consistent way.There is a fundamental observer dependence (real or imagine). There is always a vantage point. To forget the observer is a fallacy. We find that primary atributes are relative. Properties are relational - they depend on the relationships that we experience. We are always looking for the objective reality beyond experience, we are looking for something other than experience to support experience, but this, on the basis of Einstein's theory is not a good choice. When you look ever more deeply you find context dependent relationships that give rise to phenomena that may be more and more subtle. What one has context dependent experience and there is no need for any foundation other than that. We need to not be stuck in a vantage point. If you get stuck on a vantage point you see everything from your own side and you fight from that truth.
A reality which you circle - you actually learn to take the point of view and position of others. Engaging with something different gives a fresh view on reality.
A brief history of changing attitude towards the act suicide from "There's no shame in suicide. There's no glory either" (published on the 30th of January, 2013)
"The Bible contains no obvious condemnation of suicide and reports the suicides of Saul and Samson without any apparent sense of condemnation. It was Augustine
who first argued that it contravened the sixth commandment, popularly translated as "thou shalt not kill" (though "thou shalt not murder" is a much better translation). Later, Aquinas intensified this prohibition with the insistence that suicide was unpardonable. And it wasn't until the mid-16th century that those who took their own lives were denied a Christian burial.
As it happens it was the dean of St Paul's, the priest and poet John Donne, who first signalled a change in the church's attitude towards suicide with his essay Biothanatos in 1608, encouraging "a charitable interpretation of theyr Action, who dye so". It took a while for attitudes to shift, but slowly the belief that suicide was a sin began to break down. And a good thing too.
However, from the mid-18th century onwards, and particularly with the advent of Romanticism
, a different problem presented itself: the glorification of the suicidal person as a romantic hero. In 1774, Goethe published the literary sensation, The Sorrows of Young Werther
, the story of a painfully earnest young man, tortured by unrequited love, who ends up shooting himself. All over Europe, other young men started to dress up in yellow trousers and blue jackets, following Werther. They also began to imitate the manner of his death, and Goethe's book was banned in several countries."
The Care Quality Commission finds mental health patients denied information, and staff inadequately trained
More people are being sectioned under the Mental Health
Act and too many of those detained are subjected to unnecessary restrictions and get too little help to recover, the NHS
watchdog reports today.The Care Quality Commission's (CQC) annual report into the working of the Mental Health Act 1983
(MHA) paints a picture of some pockets of excellent practice, where patients are treated with dignity and respect. But it also highlights concerns that "some hospitals have allowed cultures to develop where control and containment are prioritised over treatment and care".
David Behan, the CQC's chief executive, says: "Our report has found too many instances where people have been restricted inappropriately. It is unacceptable for the current situation to continue."In total, 48,631 people were detained in hospital to receive mental health treatment in England in 2011–12 – 5% more than the year before. Another 4,220 people became subject to a community treatment order – up 10%. A further 16,000 people voluntarily admitted themselves for treatment.
The CQC based its findings on visiting 1,546 wards, talking to 4,569 detained patients and checking more than 4,500 detention documents. Its findings include that on one in five visits – "an unacceptably high number" – MHA commissioners (inspectors) found that people who were in hospital voluntarily "might be detained in all but name". Although such patients are supposedly able to leave any time, "in 88 out of 481 visits there were no signs on locked doors that explained to voluntary patients how they could leave the ward".
The CQC is worried about staff being inadequately trained in how to correctly restrain those exhibiting disturbed or violent behaviour and wants safeguards improved. Some staff at a learning disability unit had not had refresher training for two or three years, despite the high number of such incidents in their unit.
On one ward, two patients who had become very disturbed were restrained by police using a Taser gun, according to the report. The CQC also found "two further examples of patients who were Tasered while being transferred in detention". Taser use within hospital premises "is of great concern" and raises questions about staff numbers, it said.
Of the 4,576 patient records checked by the CQC, 4% "showed irregularities that called the legality of the detention into question [which] means that more than 180 patients may have been unlawfully detained".
Paul Farmer, the chief executive of the mental health charity Mind, voiced concern that "people's basic human rights are being infringed at a time when they are likely to be at their most vulnerable". He says the overall rise in detentions and community treatment orders is "very worrying" and "is symptomatic of problems elsewhere in mental health services". According to Farmer, better access to talking therapies, or well-resourced crisis-care services that can respond to a person's individual needs, can help prevent a situation escalating until compulsion appears to be the only option. "Yet we know from extensive research that mental health services are failing in all these areas," he says.
For Paul Jenkins, chief executive of Rethink Mental Illness, the report shows that "the system has become too focused on managing risk, at the expense of quality care and treatment". The NHS is wasting money because some patients are being "needlessly detained in very expensive settings", which is "unfair and potentially damaging to the individual", he says. Mental health needs to undertake "a fundamental shift" and put less into secure care and more into early intervention services, to stop people becoming acutely unwell, he adds.
The CQC is also concerned that mental health services are under growing pressure, with wards overcrowded, staff overworked and too few community services. In some places, patients are being discharged too early, or without enough support. The watchdog is also worried that despite many initiatives, such as improvements outlined in the coalition's mental health strategy
and a mandate to the NHS Commissioning Board
, which legally requires the board to pursue the objectives of putting mental health on a par with physical health, there is still "a significant gap between the realities CQC is observing in practice and the ambitions of the national mental health policy
". Its report concludes: "Practice in some areas ... is a far cry from the policy vision."
published 30 January 2013
Under-resourced mental health services are in greater demand than ever as austerity cuts are causing an increase in the number of people experiencing depression. Guardian newspaper article by Mary O'Hara There are multiple ways in which austerity affects different groups – be it young people who can't find work, disabled people undergoing humiliating "assessments" for work-readiness, or families awaiting the financial reverberations of benefits cuts or the "bedroom tax". But there is one constant that appears to be woven into all: concerns about mental health. In recent months, I have interviewed scores of individuals all over the UK affected by austerity policies. I've also spoken to the frontline workers trying to help them. The subject of mental health and the unprecedented stress that the economic crisis and austerity have wrought comes up time and again, along with widespread concerns about what services will be available in the future to provide much-needed support if, as expected, things get worse.If there is one organisation that illustrates this particular pressure right now, it is arguably the charity Bipolar UK (bipolaruk.org). For three decades it has pioneered peer support for people living with bipolar disorder, a serious and common mental illness.
By establishing and nurturing a network of localised, accessible support groups as well as other advice services, it has become the only dedicated service of its kind for people with the disorder and their families.Indeed, Bipolar UK has over the years acted as an indispensable mechanism preventing people from reaching the crisis point that leads them to end up at the door of already stretched – and costly – statutory mental health services. Now, due to soaring demand in the past year for its services (driven largely by people pushed to the edge financially) and a battle to raise funds (the charity relies on independent donations for 90% of its income), it is facing closure within a matter of months unless it can find £100,000. This is a small charity that, with minimal resources, helps about 65,000 people in a typical year (more in the past 12 months).
These people would otherwise not have access to peer-support services. It is a beacon of user-led projects. And, as its chief executive, Suzanne Hudson, rightly points out, it is a great irony that at a time when public understanding of bipolar disorder – those with it experience depression and episodes of "manic" behaviour – is increasing, and when government has been lauding peer support, the people who most need help may no longer be able to access it.Make no mistake, statutory mental health services remain under-resourced. They face increased demand coupled with cuts to provision. As Wednesday's Care Quality Commission report notes, mental health accounts for a huge 23% of the overall health burden in the country.
If this wasn't reason enough for greater resources, consider that the report reveals more people being detained under the Mental Health Act, that bed occupancy rates in acute settings are rising, and that there is mounting pressure on services more generally. The closure of a charity such as Bipolar UK can only exacerbate an escalating demand that isn't being met.
Suicide statistics published last week by the Office for National Statistics showed a sharp spike in the number of people taking their own lives in 2011 compared with 2010. Suicide and the reasons behind it are complex, but it is not unreasonable to conclude that, unless appropriate services are available to people in mental distress when they most need them (and bipolar disorder increases the risk of suicide by 20 times), more people will face tremendous struggles. Marjorie Wallace, chief executive of the mental health charity Sane, summed up the seriousness of the situation: "Relentless cuts to mental health services are accelerating in an effort to save money, leaving all too many people at even greater risk, with no one to turn to and nowhere to go where they feel safe at times of crisis."
"Zoe from South Wales spent twelve years with undiagnosed Bipolar Disorder. The personal cost to this mother of three was devastating, as, over the years, she was told she had Post Natal Depression and treated with anti-depressants. It's long been recognised that Bipolar Disorder could be both misdiagnosed and under-diagnosed and Dr Nick Stafford describes a new pilot project in Leicester to screen for the condition."
Presentation by Richard Davidson on the first day of the Mind and Life conference (Day 1, starting min 1.46)
The human brain is the most complicated piece of matter in the Universe. There are more 20.000 genes that are expressed in the brain. There are approximately 85,000,000,000 neurons with 1,000,000,000,000,000 connections between them.The truth is that scientists have very little idea of how the brain actually works. We don't know how many episodes of mental states there are - there could be an unlimited number.
There are 20,000 - 30,000 in a mm3 (the approx size of a head of a pin). In that same amount of space there are approx. 4 km of axons (the connections between the brain cells). There are 10,000,000,000 synapses (physical connections) that exist among cells in a mm2. The different brain regions are extraordinarily interconnected.
The brain constructs our experience of reality. It does not faithfully represent the outside or the inside world. It transforms information and represents it in this transformed way.What we experience is not a faithful representation of what is outside. For examples some animals can hear frequencies we cannot hear. "Attentional blink" is an experience that people have very often in which something that appears in the environment is not noticed because the mind is fixated on something else. We may be able to enhance our attention to enable us to see things that others miss. Another example is "Change blindness". Another area is in detecting facial expressions.
The brain is both a source of delusion and insight. Constructivist design suggests that the brain never faithfully represents our internal and external world. Delusion (distorted perception) results from distortions caused by: emotions, our beliefs and expectations and mental time travel.
Humans engage in mental time travel. The prefrontal cortex, which is larger in humans than in any other species, allows us to anticipate the future. This is a skill that is beneficial but can cause trouble. We have the capacity to worry about the future and ruminate about the past in a way that no other species can. We have the capacity to remember the past and think about the future. A study found that 47% of our awaking time we are either ruminating about the past or anticipating the future and not focused on what we are doing in the present. This might be a significant contributor to the problems in education.
The contemplative traditions may have some useful exercises that can help us to maintain our focus, and this question is currently being investigated by contemplative neuroscience.
Twenty of the world's foremost scientists and philosophers with His Holiness the Dalai Lama and other senior Tibetan scholars address topics that include the historical sweep of science and the revolutions in our understanding of our physical universe and the nature of the mind.
Scientific and the classical Buddhist philosophical methods of inquiry were studied, as well as selected topics in quantum physics, neuroscience, and Buddhist and contemporary Western views of consciousness.
In addition, the applications of contemplative practices in clinical and educational settings will be explored.
Day 1 - Introduction
Morning: Exploring the Nature of Reality: Buddhist and Scientific Perspectives
Afternoon: Session: The Sweep of Science: Knowledge and the Nature of Reality
Day 2 - Physics
Morning: Quantum Physics, Relativity, and Cosmology
Afternoon: The Nature of Reality
Day 3 - Neuroscience
Morning: Changing the Brain
Afternoon: Exploring Neuroplasticity
Day 4 - Consciousness
Morning: Consciousness in Western Science and Philosophy
Afternoon: Approaches to Consciousness
Day 5 - Applications of Contemplative Practice
Morning: Clinical and Educational Applications of Contemplative Practice
Afternoon: Promoting Human Development
Day 6- Future Directions
Morning: The Future of Monastic Science Education & Buddhism, Science and Modernity
His Holiness the 14th Dalai Lama
Michel Bitbol, PhD
Directeur de Recherche
Centre National de la Recherche Scientifique
Khen Rinpoche Jangchup Choeden
Gaden Shartse Monastery
Richard Davidson, PhD
Founder and Chair
Center for Investigating Healthy Minds University of Wisconsin-Madison
Sona Dimidjian, PhD
Department of Psychology and Neuroscience University of Colorado at Boulder
James R. Doty, MD
Center for the Study of Compassion and Altruism Research and Education
John Durant, PhD
Adjunct Professor Science,Technology & Society Program Massachusetts Institute of Technology
Anne Harrington, PhD
Department of the History of Science Harvard University
Wendy Hasenkamp, PhD
Program and Research Director Mind & Life Institute
Thupten Jinpa, PhD
Adjunct Professor McGill University Chairman Mind & Life Institute
Bryce Johnson, PhD
Director Science for Monks Staff Scientist Exploratorium
Library of Tibetan Works and Archives
Rajesh Kasturirangan, PhD
National Institute of Advanced Studies, Bangalore
Christof Koch, PhD
Chief Scientific Officer Allen Institute for Brain Science
Geshe Dadul Namgyal
Member and Translator/Interpreter Emory-Tibet Science Initiative Emory University
Lobsang Tenzin Negi, PhD
Senior Lecturer Emory University
Vijayalakshmi Ravindranath, PhD
Professor and Chair Centre for Neuroscience
at the Indian Institute of Science
Matthieu Ricard, PhD
Buddhist Monk Shechen Monastery
Geshe Ngawang Samten
Central University of Tibetan Studies
Tania Singer, PhD
Department of Social Neuroscience Max Planck Institute for Human Cognitive and Brain Sciences
Founder and President
The Academy for the Love of Learning
Diana Chapman Walsh, PhD
Wellesley College Governing Board Member
The Broad Institute of MIT & Harvard
Carol Worthman, PhD
Professor Department of Anthropology Emory-Tibet Science Initiative Emory University
Arthur Zajonc, PhD
President Mind & Life Institute
"New research shows that reading a baby's mind aids its development. Claudia Hammond reports on a new technique which helps mothers connect with their infants. Known as mind mindedness this method cuts across social groups and is being used successfully to help women with serious mental illness bond with their babies.And should people with mental illness be told the long term effects of their drugs? One listener thinks this is a message that should be handled with care. Plus, how a poem written twenty years ago by a twelve year old dyslexic boy has inspired a new art science collaboration"
"In this episode Brian Cox visits South East Asia's 'Ring of Fire'. In the world's most volcanic region he explores the thin line that separates the living from the dead and poses that most enduring of questions: what is life? The traditional answer is one that invokes the supernatural, as seen at the annual Day of the Dead celebrations in the Philippine highlands. Brian sets out to offer an alternative answer: one bound up in the flow of energy through the universe.
On the edge of Taal Volcano lake, Brian demonstrates how the first spark of life may have arisen. Here, heat energy from the inner Earth forces its way to the surface and changes its chemistry, just as it did in our planet's infancy. It is now believed that these chemical changes set up a source of energy from which life first emerged.Today, virtually all derives its energy from the Sun. But there's a paradox to this as according to the laws of physics energy can neither be created nor destroyed. So life doesn't 'use' energy up. It can't remove it from the universe. So how does energy enable living things to live?Brian reveals life to be a conduit through which energy in the universe passes, just one part in a process that governs the lifecycle of the entire Universe. By diverting energy in the cosmos living things are able to grow and thrive.
But whilst the flow of energy can explain living things, it can't explain how life has endured for more than three billion years. So Brian meets an animal in the Borneo rainforest that holds the key to how life persists - the orangutan. Ninety seven per cent of our DNA is shared with orangutans. That shared heritage reveals a profound conclusion: that DNA is a record of the evolution of life on Earth, one that connects us to everything alive today and that has ever lived.So life isn't really a thing. It's a chemical process, a way of tapping into the energy flowing through the Universe and transmitting it from generation to generation through the elegant chemistry of DNA. Far from demanding a mystical explanation, the emergence of life might be an inevitable consequence of the laws of physics."
The myth of mental illness is a classic anti-psychiatry article authored by Thomas Szatz and published in the 1960. Read it here
New experiments with weak measurement techniques challenge the predictions of Heisenberg's Indeterminacy or uncertainty principle (1927).
This principle states that in our attempts to measure small particles like photons we cannot but disturb the reality we are observing.
Heisenberg famously said "The "path" [of a particle] only comes into existence when we observe it." My understanding is that this is because all observation at the smallest level of reality (quantum level) normally require a direct interaction with the quantum particles, they require a small scale "collision", which changes the path and the momentum of the particle. At quantum level, where any presence is extremely influential, to measure something is to change the course of what you are observing. The observing "device" becomes part of the reality being observed.
Why does quantum physics matter to psychotherapists?
Quantum physics and the uncertainty principle have been hugely influential in the way we think about our attempts to understand reality through observation.
The question of validity of observation was raised for me during the one year I spent as an assessor for the Metanoia Counselling and Psychotherapy Clinic. During that time I assessed one hundred individuals who had been referred or self-referred to the clinic for counselling and psychotherapy.
My role as far as I could tell was that of a gate-keeper and match-maker. I had to make sure that the clients who were offered therapy were also likely to benefit from treatment. As an assessor I needed to learn enough about the nature of the client's symptoms, their relational patterns and history, their availability for dialogue and motivation for change. Based on this information which I would gather in fifty minutes, I would make a decision about whether a short to medium term humanistic therapy with a trainee therapist may be helpful. I had to enlist the client's cooperation in this process - their willingness to answer a somewhat structured interview, covering presenting issues, current situation, history, previous therapy and diagnosis (if available), medication, was essential.
But my assessment was never made based on the information volunteered by the client. I also payed attention to my observations of their behaviour in the room, as well as my internal responses (countertransference). I began to wonder how much of what I was observing was linked to the context in which we were meeting and to my presence in the role of the assessor.
An assessment is a stress inducing situation for both therapist and client. The client finds themselves in an unfamiliar environment, with a person they haven't met before. The schedule is pretty tight, and the time we can spend on warm-up niceties is reduced to a minimum. There are unfamiliar forms to fill-out asking very personal questions such as: "Do you sometimes think of harming yourself or others?"
Although the therapist is familiar with the environment, they do not know who is going to walk through the door. There is no filter. To me every assessment felt like going on a blind date. The client may be distressed, psychotic, extremely unwilling to participate in the task or violent. This only happened with five out of one hundred clients (so an incidence of 5%) but it is impossible to predict whether the next encounter will be a difficult one or not.
So the client who is stressed is interacting with a possibly stressed therapist. The client will unconsciously pick up on this and this will affect their behaviour. By and large I have found this to be diagnostic in that the client's ability to deal with the stress-inducing situation and the vulnerability of the therapist is a great predictor of their ability to tolerate the stress of engaging with another in therapy.
There are times however when the clients seek to over-adapt in order to fulfil the criteria for being accepted for therapy and because of their need and my power to deny them access to what they think they need, they may decide to withhold information, give false information, exaggerate, downplay and act. I have to take the client's words at face value, and may not know if I am being lied to.
What I rely on, is the felt sense I get from being with the client. Whether I feel calm, friendly, scared or angry - these are all clues about the client's internal experience and the roles they take or make others take in relationships.
Although the existence of the DSM is an attempt to inject certainty and precision in assessment and diagnosis, fundamentally we cannot always be certain. People don't always fit neatly into diagnostic categories, their realities and personalities cannot be neatly put in a box.
Intuition and categorisation
I think that assessment is a very delicate process, that starts with the therapist's curiosity and their intuition. Intuition is a very different process from categorising. These are two functions which are lateralised in our brain. Intuition involves the right hemisphere which is adept at reading between the lines as well as welcoming information from the body about feeling states present in the presence of the client. Intuition about danger is neuroceptive, not perceptive. "Neuroception" is a term invented by Stephen Porges to describe a cognitive process that is bodily based and may not involve conscious thought. Berne speaks about "primal image" and "primal judgement". It may be a gut feeling or an image that says something about the client - we may not fully understand what.
Diagnosis is a process of synthesising intuitive knowledge with data from the client's narrative and other measures to create a 3D model and to place the client's presentation into a category of functioning. Categorising is a function of the left hemisphere.
Ultimately the written assessment is the therapist's narrative, not the client's. We can see how at every step we encounter uncertainty and the possibility of error. This is not exact science and it may not always be a faithful description of the client's reality. The diagnosis and decision to take the client on for therapy is hardly foolproof.
Because he takes on the role of a gatekeeper the assessor may nevertheless be seen to "know" and "be right", particularly by trainee practitioners who may be less experienced. I felt I had to challenge this perception. By doing this I wanted to invite the clinicians to be their own authority, to always take the assessment report as a provisional story about the client, but no more than that. They need to conduct their own assessment of whether they can work with a client. They need to trust their own judgement.
Ian McGilchrist gives a lecture at Schumacher. Watch here.