Trauma and the Elusive Self Isabel Clarke

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Trauma and the Elusive SelfIsabel Clarke

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

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The Role of Emotion

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

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DIALECTICAL BEHAVIOUR THERAPY Linehans STATES
OF MIND

• EMOTION
• MIND

REASONABLE MIND
WISE MIND
IN THE PRESENT IN CONTROL
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Levels of Processing problem

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

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Features of Emotion Driven Processing

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

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Relationship, trauma and the construction of the
self a way into understanding Complex Cases.

• A sense of self is gained through relationship.
• The reaction of others gives us information about
  threat, safety and value.
• Identity formation is dynamic comprises
• sense of self as subject emotional system
• sense of self as object rational system.
• Major threat disrupts the sense of self hence
  personality disorder competing selves.
• If things get too unbearable escape from the
  grounded sense of self psychosis

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Self and Relationship.Emotion Mind
Reasonable Mind
Info. About self.
Self (as subject
Self (as object

other
Trauma or Transitions
Early provisional self develops
Experience stored in Emotion Mind.memory activat
ed
Early self re- experienced
Sense of self as object disrupted early info.
Needs re-integration
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The horrible feeling

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

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WAYS OF COPING WITH THE HORRIBLE FEELING

• Giving in - signalling submission (depression)
• Constant anxiety, worry and hypervigilance
• Anger - attribute elsewhere.
• Displacing anxiety OCD, eating disorder
• Drink, drugs, etc.
• Dissociation flipping between different
  experiences of the self
• Cutting out reasonable mind appraisal psychosis

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Typical formulation
PAST ABUSE LOSSES PARTNER LEAVING
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Selling the new approach It is Simple but
Difficult

• We are asking people to go against what feels
  natural
• It is natural for people to follow their feelings
• We are asking them to go against their feelings
• It is natural to avoid when things feel too
  horrible
• We are asking people to face the horrible feelings

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How we break the vicious circles

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

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Directly addressing the trauma when?

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

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Two Views of the person

• people are rational beings, with, needs, plans
  and aspirations, who function more or less well,
  unless they turn out to have an 'illness'
• Static
• people are perpetually seeking definition through
  dreams and symbols, and deeply dependent on
  important relationships easily knocked off
  course by loss of any of these props, and
  perpetually trying to balance the inner state.
• Dynamic and in flux.

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Introducing Interacting Cognitive Subsystems
(Teasdale Barnard 1993).

• Interacting Cognitive Subsystems provides
• An information processing model of cognition
• Developed through extensive research into memory
  and limitations on processing.
• A way into understanding the Head/Heart split in
  people.

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Interacting Cognitive Subsystems.
Body State subsystem

Implicational subsystem
Auditory ss.
Implicational Memory
Visual ss.
Verbal ss.
Propositional subsystem
Propositional Memory
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Important Features of this model

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

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Relational Subsystem concerns

• Relationship
• Meaning and meaningfulness
• The self threat and value
• Intense, extreme feelings (all or nothing)
• Loss of fine discrimination and boundaries
  (domain of the propositional subsystem)
• This gives us the quality of experience I will
  call the transliminal

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A Challenging Model of the mind

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

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

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

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Openness/Vulnerability - 2 sides of the coin!

• Making ourselves open in relationship, in empathy
  is the way to live fully, in the moment
• But it opens the way to pain as well as joy
• Love means taking responsibility for the beloved
• - for the earth and other non human creatures
  

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There is another side to this..

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

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Email, books and Web address

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