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

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

DIALECTICAL BEHAVIOUR THERAPY: Linehan’s STATES OF MIND

EMOTION

MIND

REASONABLE

MIND

WISE

MIND

IN THE PRESENTIN CONTROL

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.

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.

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

Self and Relationship.Emotion Mind Reasonable Mind

other Self (as object

Self (as subject

Info. Aboutself.

Experience stored in Emotion Mind.memory

activated

Traumaor

Transitions

Early selfre-

experienced

Early provisional

self develops

Sense of self as object disrupted;early info. Needs

re-integration

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

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

FEARRAGE

SADNESSCut selfAttempt suicide

Friends and family alarmed. Could lose custody of children.

Feel worse

Nightmares: can’t sleep

More difficult to cope

Avoid going out and seeing people

More time to brood

PAST ABUSELOSSES

PARTNER LEAVING

Typical formulation

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

feelingsIt is natural to avoid when things feel too

horrible• We are asking people to face the horrible

feelings

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

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.

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.

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.

BodyState

subsystem

Auditoryss.

Visualss.

Interacting Cognitive Subsystems.

Implicational subsystem

ImplicationalMemory

Propositional subsystem

PropositionalMemory

Verbalss.

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

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”

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!

Web of Relationships

Self asexperienced

in relationshipwith primary

caregiver

Sense ofvalue comes

from rel. withthe spiritual

primarycare-giver

In Rel. with wider

group etc.

In Rel. withearth:

non humansetc.

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.

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 ………

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.

Email, books and Web address

• isabel@scispirit.com

• Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester:'O'Books.

• Clarke, I. (Ed.) (2010) 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