What does it mean: to gather the fragments of the enactment? What are the underlying principles of 'gathering the fragments'?

• it’s understood that the therapeutic relationship is a two-person system, so we gather fragments across all the multiple levels and bodymind processes - all the multi-dimensional processes within each and between the two - of both the two people involved, client AND therapist
• one of the most basic understandings from the body-oriented tradition is the importance of spontaneous and emergent processes in the 'here and now' - many of these we can consider pre-verbal, non-verbal and subliminal manifestations of the amorphous notion of unconscious processes. The unconscious manifests in tangible, subtle but observable 'here & now' relational processes, which are involuntary and happen - and keep happening - in spite of conscious control, voluntarily intentions and habitual defence mechanisms
• neuroscience has given us some validation for this pre-reflexive level of intersubjective understanding between humans, in the theory of mirror neurons or - in its recent form - the notion of ‘embodied simulation’ (which basically says that we use our bodies to simulate what we perceive - via our mirror neurons - to be the internal state of the other, without having to think about them, speculate mentally or any need to have a 'theory of mind' - search Vittorio Gallese); this automatic, body-to-body mutual understanding - sometimes equated with implicit relational knowing - goes much further than most psychotherapy of the last hundred years has imagined (except for Wilhelm Reich's idea of vegetative identification)
• the practical upshot of this is that when we 'gather the fragments', we intuit each fragment as belonging either into the category of spontaneous or reflective fragments; we do not need to categorise them consciously, we intuitively know: spontaneous bodymind fragments emerge without bidding, in spite of voluntary control - they are ‘happenings’ rather than ‘doings’, ‘intendings’ or ‘thinkings’
• in the olden days, we used to think that these spontaneous bodymind fragments are all coming from the body, but this is a very misleading oversimplification: there are spontaneous body processes like shaking, trembling, sudden breaths or gestures, twitches, jerks and other movements, involuntary flushes or gasps; but there are also other spontaneous processes not in the body, but in the mind, like spontaneous images and metaphors, melodies or thoughts which come unbidden, Freudian slips of the tongue, and all the non-verbal messages of the voice apart from the words
• reflective fragments are all those bodymind processes which counter or inhibit or override spontaneous processes (whether these manifest in the body or in the mind or both), whether they manifest spontaneously or habitually (the fact that reflective processes can manifest spontaneously already indicates their fundamentally paradoxical nature – so these binary distinctions will break down the more we get into the nitty-gritty of experienence); reflective then refers to the reflective capacities of the mind, but reflection also includes the Gestalt idea of retroflection as a bodily process of inhibition, or Reich’s idea of the ‘turning against the self’ as a habitually repeating and re-enacted process of character formation
• from developmental psychology we understand that the client’s experience carries habitual embodied conflict (developmental wounding and deficiency due to character formation and the ‘turning against the self’) – this manifests in chronic implicit conflict across all aspects of the client’s bodymind system (i.e. embodied character style = developmental injury frozen into the bodymind; biographical psychology fixated in biology); in simple terms: chronic conflict between ‘habitual mode’ and ‘emergency’ (see hand-out: The Client’s Conflict between ‘Habitual Mode’ and ‘Emergency’ (2015))
• the defensive ego system is trapped in a habit of constantly fighting and counteracting the wounding inherent in the ‘emergency’; this is rooted in the origin of the ego’s defensive script: “I will do whatever I can to prevent that kind of wounding ever happening again – I will control things so I will never ever have to experience that again!”
• the wounding inherent in the ‘emergency’ has a tendency towards spontaneous ‘coherence’: like any unfinished cycle, it wants to come to the foreground so it can be re-experienced and be healed by finding a different, more satisfying outcome: the wounding can be experienced and held and healed, if all the fragments of the conflict can be momentarily held in ‘coherence’, the person then feels – at least temporarily – more ‘whole’. Wholeness is the full bodymind experience of coherence, and constitutes the transcendence of chronic defensiveness and conflict - even if it only lasts a second, it means the categorical either-or all-or-nothing rigidity of the defensive system is broken (and if it can happen for a second, it can happen again and for longer - uncertainty has broken through and broken the rigid implicit 'rules' of the habitual mode’s defensive logic)
• the way the defensive ego system keeps the wounding at bay is by constantly counter-acting and fragmenting the tendency towards ‘coherence’; by constantly re-interrupting the emerging cycles towards coherence and re-enacting the wounding all over again, by denying, suppressing and keeping the fragments of the wounding experience fragmented, so they don’t emerge and cohere into awareness - paradoxically, by keeping the ‘emergency’ at bay, the wounding isconstantly being re-enacted
• traditional body-oriented theories oversimplified the chronic conflict between ‘habitual mode’ and ‘emergency’: the inhibiting defensive ego was conceptualised as repressing the spontaneous, expressive feeling of the body (life force), by equating 'the mind' with repression and equating 'the body' with aliveness = this is the traditional notion of the Body Psychotherapy's 'body-mind split' (as a manifestation of Cartesian dualism, or what Wilber calls ‘European Split’)
• this over-simplification of the 'body-mind split' – although is has a lot of truth to it – becomes unhelpful in practice; the fallacy is easy to see: there is spontaneity in the mind and there is reflection/inhibition in the body. The conflict does manifest between mind and body, but it also manifests within the mind (between different aspects of the mind), and it also manifests within the body (between different aspects of the body).
• in order to avoid the trap of that over-simplification, we need a more complex formulation: the conflicted ego in conflict with a spontaneous conflict;
• this notion does retain the mind-over-body conflict: the reflective ego is in conflict with spontaneous forces, battling against them and keeping them at bay
• but the new formulation means we do not imagine the ego as one entity (like a defensive castle); we do not imagine the body as one simple impulse or feeling; both sides of the wounding relationship inherent in the ‘emergency’ are embodied as a conflict; we imagine the ego itself as split and conflicted (building on Fairbairn’s theory: 'libidinal' versus 'anti-libidinal' parts of the ego)
• Fairbairn was in a philosophical battle against Freud’s drive theory, and wanted to establish the essential human nature as relational (object-seeking versus drive theory): by minimising the influence of biological drives, he wanted to emphasise the wounding of the human connection at the root of character formation; however, in the process he lost the ‘Id’ and the body, and located the conflict only in the ego
• the idea of the conflicted ego in conflict with a spontaneous conflict combines Fairbairn’s object relations with Reich’s holistic character formation
• it’s a simplistic summary, but usually one part of the ego champions the wounded child and the other part of the ego champions the wounding object; or we could say: the ego is a parallel process to the wounding inherent in the ‘emergency’ – the ego replicates the wounding relationship, with both people in the wounding relationship represented by the opposing parts of the ego (which is what Fairbairn was trying to get at by calling them 'libidinal' versus 'anti-libidinal')
• the fragmented ego is a fragmenting mechanism that maintains fragmentation and aborts potential emergent wholeness, in the process of habitually aborting the wounding inherent in the ‘emergency’ (the ego is fragmented and the ego operates to keep fragmenting the rest of experience which is already fragmented spontaneously)
• so in recognition of the fragmentation of the ego itself and its fragmentation strategies against bodymind coherence, gathering the fragments is basically an invitation: “I am here with you, to bear with you the experience of the wounding in whatever way it shows up here and now (and/or to participate in the always possible transcendence/transformation of the wounding).”
• the key principle of transformation: transformation of the wounding enactment becomes more likely the more fragments can be gathered in awareness across the multi-dimensional system of the therapeutic relationship - 'gathering the fragments' can engender a critical mass of coherence and transformation can then occur spontaneously (a slow steady accumulation of small incremental changes leading to a tipping point of large-scale changes, as in chaos and complexity theory = 'butterfly effect')
• there are many, many fragments, manifesting across many dimensions and many levels of parallel process, in two broad categories: bodymind fragments and relational fragments (i.e. figures/characters in the field)
• a simple summary would be: gathering the fragments involves sensations-emotions-breath-images-thoughts-intuitions in the 'here & now' of the therapeutic relationship (where 'relationship' implies the 3 parallel relationships (past, internal, present), each manifesting the 5 steps of character formation, comprising the whole configuration of multiple characters)
• an important idea here is the holographic principle: every part contains the whole image = every fragment contains the whole story – by attending to the detail of one fragment, the whole story of the enactment scenario can unfold (e.g. the process and structure of a hand movement contains the whole story of trauma, including the wounded child and the internalised abuser and the wounded child’s attempts to protect against it = every time we attend to a charged fragment, the whole wounding experience is embedded within it; gathering the fragments would need to include, for example, the shaking of the girl as part of biological-organismic recovery from trauma)
• in contrast to this multi-dimensional, embodied, parallel process, holographic/fractal understanding, traditional Eurocentric talking therapy is so diminished and partial in its philosophy, perception, understanding/theory and intervention/technique – it can only gather some of the levels and some of the fragments some of the time haphazardly, and therefore makes a full bodymind transformative experience unlikely; therefore, the traditional approaches can only approximate transformation – it needs an embodied, integrative, integral-relational approach to enactment in order to maximise our gathering of the fragments across all levels (philosophy/meta-psychology, perception, understanding/theory and intervention/technique as well as relational stance)
• gathering of the fragments is a co-created, intersubjective two-person bodymind process (as opposed to a one-person psychology stance where the therapist has all the perceptions and interpretive understandings and just passes these on to the client via interpretation or education; the client’s capacity to receive explanations and interpretations within the enactment is limited, as usually they feed the enactment – this kind of psycho-education is usually unavailable within the enactment due to regression and defences; it may be possible in degrees depending on whether the client’s mind is able to think dissociatively)
• from our side as therapists, in order to maximise gathering of the fragments we need full embodied awareness (so we do not by default exclude all the most important spontaneous fragments) AND relational flexibility (so we don’t get stuck and identified with fixed roles within the enactment) - flexibility around relational stance and modality always already implies equivalent flexibilities across all other levels (philosophy/meta-psychology, perception, theory and technique)
• from the therapist's side, different interventions could come from each and all of the modalities, i.e. the same or similar intervention could be made from multiple stances, as the dialogical cousin, the doctor, the evacuated child, the fairy god parent, the bad object step parent, the working partner collaborator, etc; and from the client's side, every therapeutic intervention can be perceived (or mis-perceived) as coming from each and all of the modalities
• psychotherapy integration on the level of relational modalities means we need to be flexible between them and – whatever our therapeutic intention or intervention – we want to be aware of how every therapeutic intention or intervention, from whatever modality, can become a vehicle for further enactment (even when our intervention is meant to simply invite a ‘gathering of the fragments’, it is still likely to fall into and exacerbate enactment)
• in order to help us with this flexibility between relational modalities, we can expand and extend Petruska Clarkson's original idea of the relational modalities into what I have called the 'Diamond Model of relational modalities' (which goes further and makes several significant adjustments and enhancements to Clarkson's model)
• the key principle is that any therapeutic intervention from each and any of the modalities can appear well-intentioned, effective, therapeutically justified and ‘helpful’, but can constitute another enactment (from within each and every modality), so we want to keep tracking the actual effect on the system (increase or decrease in charge), rather than make assumptions

A complementary blog post, addressing similar topics more generally, can be found here:

How is Countertransferential Enactment Worked Through? - Steps towards an embodied-relational answer

WEAVE AND MEND

Old Woman is watching, watching over you.
In the darkness of the storm she is watching.
She is weaving, mending, gathering the fragments.
She is watching over you.

Old Woman is weaving, gathering the threads.
Her bones become the loom she is weaving.
She is watching, weaving, gathering the colors.
She is watching over you.

For years I’ve been watching, waiting for Old Woman,
Feeling lost and so alone, I’ve been watching.
Now I find her, weaving, gathering the colors.
Now I find her in myself

Chorus: So weave and mend, weave and mend.
Gather the fragments safe within the sacred circle.
Sisters, weave and mend, weave and mend.
Old woman, weave and mend.

Clarification Questions

•  to begin with, the enactment is largely unconscious;  definitely for the client,  but usually in large degrees also for the therapist -  so how do we become conscious of the unconscious? How do we bring awareness to what is outside awareness?

•  I use the term ‘fragments’,  because (as it says in the blog post):

• the fragmented ego is a fragmenting mechanism that maintains fragmentation and aborts potential emergent wholeness, in the process of habitually aborting the wounding inherent in the ‘emergency’ (the ego is fragmented and the ego operates to keep fragmenting the rest of experience which is already fragmented spontaneously)

•   the way character defences work in bodymind terms is by fragmenting what might otherwise be a more whole, coherent and comprehensive experience -  subjectively, rather than experiencing myself as a whole in a particular body-mind-psyche-feeling state,  my experience is split into fragments,  with some of these fragments repressed and dissociated, i.e.  inaccessible to my awareness and therefore unconscious. That’s the whole point of defences,  in simple terms: that I don’t get to fully feel what I’m actually feeling

•  rather than having a ‘whole’ bodymind experience, in which my body sensations, my emotions, my imaginative mind and my reflective mind all cohere together,  I am landed with a collection of fragments,  some of which I am aware of, some of which I can become aware of and some of which I’m habitually unaware (roughly equivalent to Freud’s distinction between conscious - pre-conscious and unconscious)

•  so that fragmentation of experience applies to both the two people’s psychology involved in therapy: client and therapist;  each of them is only partially aware of themselves and of the other, i.e.  they only have awareness in the stream of consciousness of fragments of themselves and of the other

•  enactments occur outside awareness between these two wounded and defended fragmented people,  and have the power to draw awareness to the fragmentation  with its inherent wandering which can thus  potentially become transformed through enactment -  i.e. fragmented states can transform into a sense of wholeness through becoming aware of enactments ( so rather than Freud’s “where Id was there Ego shall be” = making the unconscious conscious,  we are formulating it as a two-person psychology process where it’s not just the client who is unconscious and not just the therapist who makes things conscious

•  as I said above: if both people are  in degrees unconscious, and are both unconsciously perpetuating enactment and  caught in it,  gathering the fragments is - simply - about bringing awareness to the enactment

•  in this process, one of the most difficult and complex questions is the role of the body and the mind (or better: the  relationship between spontaneous processes and reflective processes) and what the mind can contribute to gathering the fragments (taking into account that historically the assumption was that it is purely the conscious/rational mind that does make things conscious and makes meaning,  by reflecting on bodymind experience -  but that dualistic assumption doesn’t work very well)

•  so then we need to pay attention to how the ego-mind  is involved in the therapeutic relationship (both the client’s and therapist’s),  taking into account that the original function of the defensive ego is to avoid and defend against pain, by keeping experience fragmented -  so how does a defended ego ever become conscious and gather the fragments of enactment?  It goes against the grain of the defended ego to experience wholeness, because wholeness would include the wounding,  and the purpose of the defended ego is to avoid the wounding (both the client’s and therapist’s)

The post Gathering the fragments (2018) appeared first on INTEGRA CPD.

The most recent advances in interpersonal neurobiology

For those of you not familiar with his work, Schore has been working as an interdisciplinary giant, bringing together psychoanalysis, neuroscience and the affective cognitive sciences, as well as developmental psychology and attachment theory. In his famous trilogy of books:

• Affect Regulation and the Origin of the Self (Lawrence Erlbaum Associates; 1 edition 1994)
• Affect Dysregulation and Disorders of the Self (WW Norton & Company, 2003).
• Affect Regulation and Repair of the Self (WW Norton & Company, 2003)

as well as numerous articles and chapters, he has documented the significant advances that have been made in our understanding of early human development and in the application of this developmental information to models of psychopathogenesis and psychotherapy.

His Regulation Theory, grounded in developmental neuroscience and developmental psychoanalysis, focuses on the origin, psychopathogenesis, and psychotherapeutic treatment of the early forming subjective implicit self. His contributions appear in multiple disciplines, including developmental neuroscience, psychiatry, psychoanalysis, developmental psychology, attachment theory, trauma studies, behavioral biology, clinical psychology, and clinical social work. His groundbreaking integration of neuroscience with attachment theory has lead to his description as "the American Bowlby" and with psychoanalysis as "the world's leading expert in neuropsychoanalysis.[1]

You can access many of his papers on his website: http://allanschore.com/bio.php

Others before me have pointed out the irony of how he tends to deliver his teaching on these kinds of events: it boggles the mind how the greatest champion of right-brain-to-right-brain attunement can spend 6 straight hours talking from his left brain (abbreviated as LH for left hemisphere) at yours, reading out his PowerPoint notes (of which you are given a hard-copy to help you keep up), extolling the virtues of right-brain (abbreviated as RH for right hemisphere) spontaneity and reverie, imagining that this constitutes optimum engagement and learning for the audience.

But that doesn't take anything away from the intellectual and interdisciplinary substance he was trying to get across. Except for some detailed neuro-biochemistry after lunch which went over my head, he did get most of it across to me (although from talking to other participants, it looks like I was a bit of an exception – others people’s left brains had apparently checked out much earlier in the day).

The main purpose of this report is to share this substance with you, whilst offering you also some kind of critique as we go along.

Schore’s influences

It's not so easy to find biographical detail regarding Schore's training or his own experience of analysis or analytic training, so I am not sure how they shaped his way of being as a therapist. The strongest influences - always in the background of Schore's thinking - seem to be attachment theory and the self psychology tradition within psychoanalysis (the titles of his first books followed Kohut's on the origin, disturbances and repair of the self). In terms of neurobiology he is, of course, an interdisciplinary giant, drawing on a wide range of neuroscientists, but high-profile in the lecture were references to Ian McGilchrist's book 'The Master and his Emissary'.

Bringing together infant studies, attachment and the intersubjectivity of early development with affective neuroscience is what Schore is famous for, leading to the crucial recognition that the development of the child's brain (right down into the detail of anatomy and brain chemistry) and mind are dependent on the early emotional environment and attachment relationships. Being involved in the painstaking nitty-gritty of the actual scientific research, he has been instrumental in milking the neuroscience towards that insight and putting it on the map, which has then been popularised by many others (e.g. Sue Gerhardt "Why Love Matters").

He has also made crucial contributions to drawing the parallels between attachment in early development and the equivalent attachment dynamics in therapy, manifesting in his statement that therapy is mainly about ‘right-brain-to-right-brain’ attunement between client and therapist. These days, throughout the psychotherapeutic field, we take these parallels for granted (sometimes, arguably, too much, to the point of oversimplification), and it's easy to forget just how significant an influence these neuroscientific validations of traditional therapeutic intuitions have been.

Whereas in his earlier writing Schore seemed to be quite wedded to psychoanalytic technique (with interpretation, however, always embedded in the primacy of the empathic attunement and dependent upon it), in this lecture I was surprised by the breadth of authors that he quoted from, drawing strongly also from Jungian analysts (e.g. Kalsched, Ullanov), especially in his clinical vignettes. I guess the Jungians have always been ahead of the rest of the field when it comes to recognition of the therapist’s own wounds, based on explixit inspiring statements about the wounded healer and the therapist’s own complexes by Jung himself. The vignette most relevant to the topic of mutual regression was a direct reading from a case study by Kalsched which involved the transformation of a pretty full-blown enactment. But most of the rest of the lecture, especially theory, was drawing on quotes from different phases of the history of psychoanalysis. There was a mention of Carl Rogers as the greatest psychologist, so, overall, there was a refreshing integrative atmosphere to Schore’s wide-ranging influences.

When you study Schore’s writings in sequence, it is apparent that his shift towards two-person psychology and the notion of enactment is much more recent. I gather he was influenced by being part of an interdisciplinary study group that included Philip Bromberg (who is, of course, one of the elders in relational psychoanalysis). As we will see, a good chunk of my critique hinges around Schore’s notion of enactment, and what appears to me an unacknowledged, un-integrated and confusing co-existence of clashing paradigms, mainly between ‘one-and-a-half-person psychology’ assumptions to do with neuroscientifically inspired ideas of regulation, and ‘two-person psychology’ notions around enactment[2].

What role for the body-oriented tradition?

The person who would have been most delighted with Schore's lecture is probably Wilhelm Reich, except - as has happened throughout Reich's life and since his death - he was not mentioned and was not even on the radar. But just about all the themes that occupied Reich and to which he made significant contributions were being (re-)discovered by Schore: intense affect (i.e. the distinction between social feelings and raw emotion – in Schore’s terms: between the RH and the primitive brain stem), repression, character, defences, regression - Schore formulated them as crucial to the process of deep psychotherapy (i.e. transforming deeply embedded attachment and character styles). It's unfortunate that Schore is not familiar with the Reichian and post-Reichian tradition – I specifically went up to him and asked him about that; he has, of course, heard about Reich, but doesn't seem to recognise just how significant the body-oriented tradition could be to just about everything he touched upon in this lecture, especially in terms of translating Schore's propositions and model into actual therapeutic practice.

There are three major ways in which the body-oriented community of practitioners has developed skills and understandings that can contribute to that fairly urgent task of application in practice:

• the therapist's embodied presence and self awareness as bodymind process (i.e. a detailed and differentiated body awareness underpinning 'implicit relational knowing')
• a whole host of techniques and interventions that facilitate what Schore is proposing as priorities: a de-emphasising of LH, a deliberate invitation of RH, and most importantly active techniques for bringing the raw affect of the brainstem into awareness and into the interpersonal contact
• a developing understanding of enactment as bodymind process (most of you reading this will appreciate that I've been preoccupied with this point for 20 years now, and as I have only published one very condensed indication of this, it's not entirely surprising that it hasn't acquired the status of common knowledge).

The problem with bringing back Reich is the same as bringing back the transformative potential of regression generally: Reich - like many of the psychoanalysts that Schore draws from historically in his re-valuing of regression - was firmly embedded in a ‘one-person psychology’ perspective. So whilst there is some sense that we are re-inventing the wheel of regression, any new wheel based upon traditional principles is indeed in need of being revised and re-visioned through a two-person psychology lens.

Coming from the US, Schore equates body psychotherapy with Somatic Psychology as it’s known there, first and foremost represented by Pat Ogden (who I think was part of the same study group with Philip Bromberg, which - as far as I know - is where she acquired an interest in enactment, too; for the last few years she has made comments about enactment being the cutting-edge of innovation). It appears that the embodied-relational tradition, as we have developed it here in the UK, has not made an impact and is not being widely recognised in the US yet.

So one of my underlying contentions in writing this review is that there is a small section of the embodied-relational community which has developed a way of working which is in line with Schore's abstract principles and propositions already. One of the main questions from the audience was: whilst we see the rationale for the kind of therapy that involves mutual regression in enactment, we don't see any training that prepares us for it - how do you help students and therapists learn this way of practising therapy?

I will stick my neck out and venture to say that it isn't via listening to PowerPoint presentations. Because of the fleeting subliminal nature of ‘right-brain-to-right-brain’ communication, it certainly requires experiential training. It obviously also requires here-and-now attention to the therapist's own internal bodymind process, and their own woundedness as well as their characterological defences.

As soon as you neatly compartmentalise training into theoretical seminars and experiential process, every student's characterological defence has already adjusted to the training format, and found ways of manouvering the training in a way which avoids their own wounds manifesting. We need to find ways of learning that allow attention to the student’s habitual position as a therapist and how they unconsciously construct the therapeutic space (this also is a bodymind process). So if we want to include attention to spontaneous bodymind process, there is no way around live sessions in the training context. In order to maximise the action and reflection cycles for the therapist in the learning process, and to catch enactment dynamics whilst they are building up, live sessions probably need to be interrupted by judicious breaks for shared reflection, where the therapist can receive on-the-hoof supervision and then go back into the session.

a)  A two-person psychology at the spontaneous mind-brain-body interface

In a nutshell, Schore is systematically combining two paradigm shifts, to lay the theoretical foundations for a 'deep' psychotherapy of the future:

1. the neuroscience-inspired reversal from left-hemisphere (LH) cognitive dominance to the valuation of right-hemisphere affective supremacy (RH) and - as he calls it: the mind-brain-body interface
2. the consequent re-vision of all one-person psychology ideas and their re-conceptualisation into two-person psychology formulations

Once a towering interdisciplinary and scientifically-oriented mind like Schore’s has got hold of a new paradigm, it is well capable of consequently applying and transferring its principles across the whole domain. There are any number of therapeutic ideas and concepts which go back to the days of classical psychoanalysis (including Reich), and which therefore originated within a taken-for-granted ‘one-person psychology’ paradigm. All of these ideas, with all the kernels of wisdom and validity they contain, are candidates for wholesale re-visioning and reformulation. What intersubjectivists call the Cartesian 'myth of the isolated mind' has spawned countless foundational ideas in psychology, all of which need revisiting through a two-person perspective – a project which on an abstract level is well underway, and Schore’s new thinking represents another leap in that direction. As we will see, it’s the application to practice that requires a lot more attention still.

b)  The double-edged sword of regression and its possible therapeutic action

The key idea being revisited for this particular day with Schore was regression. In the olden days, this was clearly a one-person psychology notion, and indeed a pejorative one because regression was classified as a defence. But even then, from the beginning it was understood as containing both dangers and therapeutic potential. Freud already used the phrase "reculer pour mieux sauter" (to draw back in order to make a better jump), recognising that regression could serve therapeutic progression (or in Kris's later, but better-known phrase "regression in the service of the ego" which is a questionable formulation in my opinion). Schore spent quite a good chunk of his presentation initially on the history of regression, spelling out its ambiguous nature, but overall re-validating it as an essential ingredient in 'deep' psychotherapy. This fits in with his overall policy of reversing the culturally dominant left-brain over right-brain supremacy, and in his presentation (using Freud's original abbreviations CS for conscious system and UCS for unconscious) he says:

"Regression as the act of going back; a return to the place of origin, including early right-brain emotional development and the origin of the self; regression from LH conscious analytical mind to RH unconscious mind and bodily-based emotions, from verbal LH secondary process to non-verbal RH primary process cognition; from later-forming CS left-brain-to-left-brain verbal communication versus early forming UCS right-brain-to-right-brain non-verbal communication."

Part of my critique would be the oversimplifying idealisation which occasionally comes across in lumping everything therapeutically good with the right brain, and everything emotionally questionable with the left brain[3]. But an important point (which we also need to get back to in more detail), is a relatively new addition to his model: the idea of neurobiological regressions not only between (left and right) but also within cerebral hemispheres. This is finally beginning to do justice to what body-oriented therapists have been saying for decades (although not in as sophisticated and scientifically validated ways) - he quotes Lehtonen (2006): "The classical approach in psychoanalysis, while centering on metaphoric and symbolic work within fully developed psychoanalytic object relations, has not traditionally included in this work the meaning of the body and the earliest layers of the personality, due to their preverbal and unconscious nature."

In the course of discussing the history of regression within psychoanalysis, he, of course, draws on Michael Balint's (1968) seminal work and his distinction between malign and benign regression (a distinction that we would need to question in its categorical and apparently neat binary division). But we need to give Schore credit for sticking his neck out and comprehensively validating regression as a possible new beginning and an essential ingredient (i.e. a potential turning point) in the therapeutic process.

c)  Mutual regression and the wounded healer as the home ground of therapy

But what is revolutionary beyond Schore’s attempt to bring regression in from the cold, is his unashamed and unambiguous declaration of it as a mutual process. In my language, I would usually refer to that principle as the therapist's embracing of the wounded healer archetype, but because Schore formulates mutual regression as part and parcel of therapeutic enactment, his affirmation of regression goes way beyond abstract philosophical principle into the nitty-gritty of therapeutic interaction. The idea that the therapist's regressed state, the therapist's wounded subjectivity, is not only a valid ingredient in the therapeutic position, but actually necessary for therapy to work, is groundbreaking.

In my opinion, this was Schore blazing a trail in the therapeutic jungle, especially vis-à-vis the perennial notion of ‘treatment’, and why I had been attracted immediately to the title of the day. Any therapist who can surrender to their own regressive states in service of the therapeutic process has effectively deconstructed the dualistic doctor-patient split and transcended an exclusively treatment-oriented paradigm.

As far as I'm concerned, Schore’s formulation finally puts the therapeutic horse before the cart, turns the uprooted tree of therapy into its natural position by putting its roots firmly into the ground, and finally gives therapy a place to stand in its home territory of subjectivity. In my opinion, therefore, this formulation of Schore's deserves spreading far and wide throughout the field - whatever we mean by 'relational' therapy, this is a central and foundational idea and it gains substance, validation and credibility from Schore's authority.

d)  Iatrogenic effects of traditional, left-brain dominated, theory-led psychotherapy

Schore did not present the idea of mutual regression as a desirable optional add-on to ‘deep’ therapy. It is an essential feature without which therapists cannot do justice to what they are supposedly offering. Without it they cannot deliver what clients - and what they themselves - expect them to deliver if change of characterological patterns is on the agenda.

If mutual regression is not understood, appreciated, embraced and actively worked with, what are we left with?

We are left with either superficial therapy of the reassuring, symptom-reducing kind. Or we are left with the actively harmful, counter-therapeutic effects of the therapist’s own repressive and dissociative defences, enshrined in their habitual therapeutic position.

Schore talked vehemently about the iatrogenic effect of traditional one-person psychology interventions, which he formulated quite clearly as the therapist's counter-resistance (although he didn't use that term). He is exhorting therapists to drop their LH investment in traditional stances and techniques, and regress and surrender into the receptivity of the RH which then becomes a communication channel for picking up the client's dissociated unbearable affects.

He made repeated, passionate statements unambiguously criticising - in his terms: the left-hemisphere (LH) dominated - assumptions of traditional psychotherapy. He doesn't quite say so in simple, straightforward language, but if I translate it, I would summarise the gist as: in their therapeutic and human presence, the therapist needs be able to inhabit as well as model non-defensive authenticity. Any investment or clinging to any therapeutic persona or identity mainly rooted in cognitive or intellectuallising left-brain bias - or role-bound habitual defensiveness - is counter-therapeutic.

He implied that he sees just about most of CBT as hopelessly lost in LH domination, and therefore, as far as deep psychotherapy is concerned, somewhere between useless, misleading and dangerous (these are my words, translating his implicit message).

But he explicitly applied his critique also to much of traditional psychoanalysis (of the interpreting ‘one-person psychology’ kind)[4]. So the upshot is: in order to reach the client's unconscious experience beyond their repressive and dissociative defences, and make any impact on early attachment styles and character patterns, the therapist needs to let go of - in Schore's terms - their own LH bias and defensiveness, and needs to be capable of surrendering into RH 'presence' - 'being' as well as 'doing'.[5]

e)  Two forms of therapy: a short-term symptom-reducing, long-term deep growth-promoting

Schore made clear that he does not postulate his model of mutual regression for all kinds of therapy, but only for ‘deep’ therapy that addresses early attachment and character patterns, that correlate to relational ‘working models’ stored in RH pre-reflexive implicit memory. The distinction itself, of course, rehearses a long-standing way of thinking about different depths and time-frames of therapy, and at first sight should not cause much controversy.

However, as we will see later in other respects, it does raise questions in my mind: the idea that therapeutic enactments are relevant only for early, pre-verbal woundings, leading to severe disturbances (like ‘personality disorders’), where dissociation is the main defence and where LH ‘talking therapy’ interventions can’t reach is based on several assumed equivalences that I find too limiting. Certainly the equivalence of symptom-reducing and short-term with more LH cognitive approaches does not match my experience (I guess it depends on what kind of symptoms we are talking about – anything involving psychosomatic symptoms rather than plain mental ones does not respond well to purely cognitive interventions, I think).

Also, rather than a binary distinction, I would prefer a spectrum of client configuration that calls for a range of therapeutic responses, from CBT to counselling to psychotherapy to depth psychotherapy or analysis.

f)   A comprehensive model of dissociative and repressive defences

I have hinted at it above, but another substantial point worth sharing is Schore’s new more comprehensive model of defences distinguishes early developmental dissociative defences (more primitive) from later developmental repressive defences (more ego functions are required to make repression work), which in turn correspond to two types of regression (counter those respective defences) – a distinction which at the same time elegantly brings together Freud's topographical and structural models. All these ideas are anchored, as usual, in brain hemispheres and functions, giving it that neuroscientific grounding which Schore is famous for.

Schore relates Freud’s topographical model (system CS = conscious on top of – or repressing - system UCS = unconscious) to an inter-hemispheric repression defence of LH against RH, and correspondingly a therapeutic regressive shift (from LH to RH).

He relates Freud’s structural model (Superego on top of Ego on top of Id) to an intra-hemispheric dissociation defence of RH cortex against the deeper RH brainstem, and correspondingly a therapeutic regressive shift (from RH cortex to RH).

Report & Review: “The growth-promoting role of mutual regressions in deep psychotherapy” - Part 2

Rather than writing out the second part of the summary and critique, I am here including an audio recording of an evening seminar that was held in Oxford in February 2018.

Unfortunately, for most of the recording, there is a background hum because the recorder was lying next to the fan of the projector, so it's difficult to make out some of the questions by participants. But whatever isn't clear in the recording, it should be easier to follow if you listen to it in conjunction with the presentation. In the latter part of the evening, I was following the slides of the presentation (roughly the last third), especially when I was discussing points of critique - as you can see, some slides are missing text, but they should be addressed in the audio recording.

Audio Recording of an evening seminar (27/2/2018) in Oxford

Audio Recording of an evening seminar (27/2/2018) in Oxford

PDF of accompanying presentation

Download the PDF: Presentation PDF

Footnotes

[1]     If you do not want to invest in buying the three books, there are various papers of his available on the internet, which give good summaries and overviews:

The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health

Attachment and the regulation of the right brain

For the body psychotherapists, there is also a very comprehensive commentary on Schore’s work by David Boadella, comparing and contrasting it with Biosynthesis: “Affect, attachment and attunement - thoughts inspired in dialogue with the 3-volume work of Schore”

“Schore studies regulation in relation to the following five major areas of relevance for the understanding of human health, neurosis and disease, and treatment or therapy: the body, the brain, the mind and personality including the formation of the self, the bio-psycho-social fields in which development takes place, and the therapeutic processes which seek to repair disturbances to the self. I will try to give an overview of some central concepts Schore presents, in each of these five areas.”

Biosynthesis, according to Boadella, draws on the following fields which overlap and correspond with Schore’s theory of regulation:

“a) Cellular bio-energetic: autonomic nervous system; psycho-neuro-immunology and molecules of emotion (Candace Pert)

1. b) Functional neurology: tripartite brain studies based on embryological development
2. c) Attachment theory: developed by John Bowlby
3. d) Attunement theory: […] The emphasis is on the dance-like interaction between mother and baby, in the early non-verbal periods of the developing self, which form a somatic foundation of the verbal self which develops in the third year of life. In Biosynthesis we work with a model of dialogue, invasion and deprivation. Dialogue corresponds to a flow of contact through touch, eye contact, tone of voice and empathic resonance: these contact forms are aspects of good attunement. Invasion and deprivation, which correspond in Stern's model to over-stimulation and under-stimulation, can be seen as opposite forms of disturbed relationship.
4. e) Dynamic Systems theory: including study of non-deterministic change (chaos theory & catastrophe theory)”

“The energies of the autonomic nervous system, which is central to the regulation of all the organ systems of the body, is divided into two major functional systems. The sympathetic nervous system is an energy-arousing system, which is characterised as ergo-tropic: tending to activate, arouse, and energise. The parasympathetic nervous system, on the other hand, is an energy-conserving system which ischaracterised as tropho-tropic: supporting reductionof arousal, withdrawal, rest, and lower levels of energisation.”

“There are three principal forms of imbalance:

1. a) Extreme hyper-arousal
2. b) Extreme hypo-arousal
3. c) Double autonomic activation: extreme hyper-arousal and extreme hypo-arousal co-exist in a paradoxical condition […], and is a basis of bio-systemic insights into trauma. Schore describes it poetically as equivalent to driving the car with full acceleration with the brakes on.”

“Schore's fundamental message, throughout all his writings, is that the body, brain and person, the self, develops out of the interaction of organismic processes (genetic, somatic, neurological) and the quality of care which the infant receives.”

“We can define four major groups of disciplines which have been strongly interacting during the last decades of the previous century, and which continue to build integration between disciplines concerning the body, the mind, the human environment and the soul.

1. biological sciences (physiology, embryology, neurology, classical medicine, energy medicine)
2. psychological sciences (psychodynamics, behav- ioural psychology, cognitive science)
3. socio-educationalsciences(developmentalpsychol- ogy, psycho-therapy,family systemics)
4. phenomenological sciences (consciousness studies,transpersonaI psychology)

From a systemic perspective these four domains: bio- psycho-social-spiritual are all overlapping, interacting, mutually connecting. When these four domains are taken account of in therapeutic work with the human being, then we have the possibility of a bio-psycho-socio-spiritual therapy.”

[2]     Just to clarify it upfront: I am not criticising the coexistence of different paradigms. I'm not advocating that all traditional ‘one-person psychology’ be superseded by 'proper' ‘two-person psychology’ - on the contrary: I have long argued for an integration of these modes, popularised through the seminal book by Stark. To me, relationality requires an appreciation of how the different modes not only come and go and interweave, but how they are simultaneously present and conflicted, pulling the therapist in contradictory directions which reflect the client's internal conflicts. This is not to deny that usually the therapist's own conflicts, woundedness and subjectivity are also involved. But I am arguing that these conflicts and dilemmas appear in the countertransference, even when the therapist's own conflicts are not actively constellated.

[3]     and indeed, the first question from the audience, in those short spells when questions were allowed and possible, was regarding the integration of the hemispheres for optimal healthy functioning, rather than a reversal of the current dominance from LH to RH. I did not think this question was ever fully addressed, so for me the anti-left and pro-right bias lingered throughout the day - a point we need to come back to later

[4]     However, there seemed to be an inherent contradiction in his presentation: whilst criticising the LH-dominant implications of classical psychoanalysis, most of his quotations substantiating the positive potential of regression (Reik, Kris, Loewald, etc, but with repeated mentions of Carl Rogers as one of the greatest psychologists of the 20th century) came from the same period of psychoanalysis which he was criticising. This is not as grave a contradiction as it might at first seem: we can find throughout the canon of psychoanalytic writing early intuitions of modern convictions and corroboration of just about every point we care to make. But as we shall see later, the contradiction is not without some substance.

[5]     What he didn't say is that those iatrogenic reactions by the therapist are one manifestation of the enactment, which - if caught and attended to - can be traced back to the therapist's defence against their own regression (as part of the mutual regression). It is not defensive reactions on the therapist’s part per se that are iatrogenic, but whether these reactions are attended to and processed by the therapist as enactments. So a more sophisticated appreciation of enactment would lead to a more differentiated analysis of iatrogenic reactions in the therapist, a point we will have to come back to later. It is only when such defensive reactions are habitually structured into the therapist's position, and taken for granted as normal and therefore unavailable for reflection as enactments, that we can call them definitively iatrogenic (my assumption is that Schore was using the term in that sense and context).

The post Report & Review – Allan Schore: “The growth-promoting role of mutual regressions in deep psychotherapy” appeared first on INTEGRA CPD.

How safe does the therapeutic space need to be?

In our attempts to create a safe, empathic and accepting environment for the client in which they can afford to feel open, undefended and vulnerable, we provide a therapeutic presence which can appear entirely benign and ‘on their side’.

Therefore, on the most basic level, we aim to provide Carl Rogers' core conditions in the humanistic tradition, and in the psychodynamic at least benign attentive neutrality. In Lavinia Gomez's (2003) terms, we try to position ourselves ‘alongside’ the client, their suffering and their struggles (as an ally and a champion, ultimately of their self-actualisation).

Why do we want to make it a ‘safe’ environment?

Why not just approach the encounter with the client as we would any social meeting, within the ambiguity of them being friend or foe, trustworthy or suspicious, with whatever degree of pain and problems they are willing or unwilling to share and disclose? Why make it ‘nice’?

Because beyond any philosophical bias or presupposition, our experience tells us that unless we are giving at least a minimum of such assurances, clients just don't turn up or don't come back to the second session.

Why do we think it's quite reasonable for the client to expect us to provide a minimum of benign conditions? When we look more deeply into this, we could say simply it’s because we realise the client is already vulnerable - that's why they risk turning up in the first place.

But if we look more deeply, we would need to say: we realise that without some kind of positive indication on the therapist’s part, the client is already liable to assume a self-fulfilling prophecy of a negative outcome. We realise they do not come with neutral expectations: consciously they come with positive expectations, unconsciously they are already half out the door, because in their vulnerable state they are already feeling the likelihood of the worst. Within one-person psychology language Freud might call this the repetition compulsion. In two-person psychology terms we could say: the client’s unconscious already expects a re-enactment. The enactment has already happened. We are not dreading some eventual future disappointment, it's already occurred.

In simple terms: in making the therapeutic environment safe we implicitly realise that the client is not only an adult seeking therapy. They are already a hurt child, for whom we quite naturally have empathy and are prepared to make allowances, adjustments, and reassuring gestures. Some therapists have quite valid and categorical misgivings about this, and therefore deliberately refuse to bend or incline the space towards the child or to make it easier for them. As we will see, there are many good reasons for this. But this is one of the areas of therapy where what the left brain thinks and intends is easily undermined by what the right brain (inspired by the heart) actually does - most of us find it incredibly hard to resist nodding and smiling in empathic recognition, and usually that is already to some extent a communication to the client’s inner child.

So, in summary so far: we think it's reasonable to make the therapeutic space safe because we have already empathically adjusted ourselves to the wounded child and the reparative response it evokes and needs.

The necessity of the reparative relationship

Many therapeutic approaches make explicit assumptions and pursue strategies that construct therapy as re-parenting the client's hurt inner child, or make it at least one of its central tasks. Petruska Clarkson (1994) validates this modality of therapy as the 'reparative' or 'developmentally needed' relationship - the therapist as the ‘better’ parent who heals the wounds and makes up for the neglect and injuries of childhood: the parent who actively cares and gets empathically involved where there was neglect and coldness; who accurately mirrors the child's reality where there was mis-attunement and parental projection, insensitivity and outright dumping; who spaciously regulates and holds the child’s overwhelming feelings where there was unresponsiveness or reactiveness; whose delighted gaze gives the child the permission, encouragement and faith in their separating and differentiating impulse to move away from the parent and grow into their own subjectivity; and who reliably provides firm boundaries where there was invasion and abuse. These kinds of parental responses are genuinely needed, then and now, and because of their absence then there has been lasting damage (i.e. developmental deficits and arrests) right up until the present moment because the developmentally needed parental responses were not forthcoming. The appropriate maturational responses were systematically lacking, at the crucial time, in the crucial developmental window.

These responses were needed and they are still needed, and it is pychosomatically impossible to give up on longing for them. Whatever tricks the mind tries to play - I am not a child anymore, I am now grown up, I have achieved the depressive position and won't torture myself any further by hankering after an impossible fantasy that is not going to happen - the bodymind does not actually give up (especially the body part of the bodymind).

Sitting in the therapeutic position, our own bodymind as therapists is capable of informing us quite reliably about the presence of the client’s developmentally needed experience, and we naturally want to provide that reparative response, ideally unfailingly.

The insufficiency of the reparative relationship

It would be wonderful for all of us if therapy could be made to work just exclusively within these assumptions and this reparative framework. However valid and essential the core conditions, the therapist's benign presence and empathic-reparative efforts are to building a working alliance, a safe space and relational container, in the longer term we find that the effects of providing such therapeutic conditions are limited. They can provide the necessary foundation, by contradicting the client's negative patterns,  expectations and negative self-fulfilling prophecies, but we find they are often not enough for transformation of negative patterns to occur, and not sufficient for healing of deep wounds to become possible.

Why is that?

Reason 1: Good-enough is not good-enough

Whatever the particular detail of our developmental injury, because the presence of a good-enough parent could not be sufficiently relied upon frequently enough, as adults we are left doubting that the appropriate response will arrive when needed. We therefore cannot afford uncertainty. We cannot bear to vulnerably wait for a response that might or might not be forthcoming.

So we (or more precisely: our defensive egos) want certainty or a guarantee: a good-enough therapist won't do. It needs to be a perfect one. In simple terms, the minimum requirement becomes an idealising fantasy of the therapist as some kind of fairy godmother or godfather, who can magically heal the wounding without the client ever having to actually experience it. The medical version would be of some omniscient, omnipotent psychological doctor who can perform characterological surgery under perfect anaesthesia – and we wake up afterwards, healed.

However natural and valid our empathic response to the client's pain and wounding, we easily end up in a rescuer position - certainly in the client's longing and perception, if not in our own actual intentions and behaviour.

Reason 2: Defences keep out the bad and the good

In our wish to establish a safe and positive working alliance, we then easily miss or underestimate the fact that - before clients come to us - they have spent years building up effective, functional and ideally watertight defences and protective survival strategies (what - at the extreme and traumatised end - Donald Kalsched (1996) calls the 'self-care system’). Our well-meaning reparative therapeutic responses can glance of these defences like water off a duck's back, which means our therapeutic care and empathy and support do not really land or get received in the deeper parts of the client's psyche, where it matters. However desperate the client is on the surface, the presence of the defences ensures that the system of the client's bodymind-psyche is not really (or not fully) receptive to therapy and its healing influence - in fact: on a deeper level the client's defences shut out the therapy and therapist - they work towards maintaining the status quo and thus are designed to make therapy fail or impossible.

Wilhelm Reich (1942) knew this decades ago when he said: "Every [therapeutic] interpretation of the unconscious material glanced off from this secret hostility [defensive shield]. … Every patient is deeply sceptical about the treatment. Each merely conceals it differently."

Donald Kalsched defines the essence of the self-care system as the impulse to destroy the therapy and the therapist, thus consistently proving the impossibility of healing and reconfirming its own (supposedly superior) survival logic and reason for continued existence.

Reich's and Kalsched's formulations come across as quite categorical and extreme, but their statements are not meant to characterise the totality of therapy - both are insistent on pointing out one crucial aspect of the therapeutic process which often gets neglected.

Whilst the history of psychotherapy provides a sophisticated range of concepts and techniques for understanding and engaging with the client's defences (going all the way back to Reich and Freud and especially his daughter Anna’s exposition of defence mechanisms), it is less understood and established that the therapist needs to allow themselves to be affected by the defences, disarmed, unseated, obstructed, foiled and made helpless and powerless, to the point of losing their therapeutic position and feeling like a failure.

The clash between the therapist and the self-care system

The defences are a worthy enemy, long-established, well-rehearsed and fine-tuned, and their raison d'être is to avoid the re-experiencing of the wounding which they are defending against and protecting. That is the point where the medical metaphor of a poisonous boil comes to mind – a boil that the therapist knows they need to lance, but is blocked from doing so by the defences. The self-care system knows very well that the lancing of the boil will release the poison in it, and that will be unpleasant, messy and painful, maybe unbearably so.

The therapist is working on the basis of the intuition that that poisoned state will be temporary, and then the healing can begin (once lanced, we can wash and empty out the poisonous swamp spoon by spoon).

The self-care system is working on the basis of the conviction that the poisonous (re-)experience of the wounding must be avoided at all costs.

The therapist relies on the paradoxical theory of change: change happens (spontaneously) when we accept what is (what is, in the metaphor, is that the poison is there; in fact it's silently accumulating while being kept at bay and buried).

The self-care system is convinced that the poisonous feelings arising are the truth and the whole truth, now and forever (because they are so strong and ‘real’). The therapist assumes that the poisonous feelings will be temporary - they are a mixture of the past and the present, with the past feelings probably constituting the bulk of the unbearableness.

So there is an inescapable paradigm clash between the therapist's rationale of paradoxical healing (requiring that the wounding will be re-experienced as part of the process) and the self-care system's binary rationale which is not going to be dragged back there, come hell or high water (locked into a linear, either-or logic, which refuses to be titrated and regulated, as there cannot be shades and degrees of experiencing the wounding - there can only be all-or-nothing: EITHER the defences are all victorious and succeed in conquering the wound OR the wounding will take over and we will be at the mercy of it all over again).

The elusive transformative object: beyond the 'idealised' versus the 'bad'

The transformation of the wounding cannot be strategically achieved – to some extent it can be consciously and deliberately prepared, but it cannot be made to happen. The shift from the pain of the ‘bad’ towards the experience of the good-enough cannot be manufactured. It needs to occur spontaneously. We may be able to invite and give space to that transformation – it may require both therapeutic 'doing' and 'being'.

How do we generate that therapeutic space, permeable and malleable and susceptible to the unconscious?

We do that by allowing the extremes of the 'idealised' and the 'bad' to manifest and be constructed within the space, by allowing ourselves to be constructed as those objects. It's only in the ‘here & now’ of the enactment that the wounding is sufficiently present, in its full bodymind and relational intensity and reality, that it can ever become available for change and transformation. It's only in the charged ‘here & now’ emotionality of the enactment that neuroplasticity exists. It's only when the therapeutic position is lost in enactment, and the therapist expands beyond their professional role, and fails the idealised promise required by the client’s self-care system, that healing can occur (in any fashion that is deep enough to be satisfying and lasting).

Every wounding in the psyche constellates - as a minimum - these four figures: the hurt child, the bad parent, the idealised parent and the elusive transformative object (as summarised in this hand-out - Soth 2014). Once we get into an enactment of the wounding, in the actual detail it can get more complicated with a whole crowd of objects, but these four figures are the minimum we need to pay attention to and understand, in order to stand any chance of surviving the enactment.

That means we need to be able to allow ourselves as therapists to be constructed in these four positions, as these four figures.

The essential conflict in the therapeutic position

The co-construction and re-enactment of the wounding involving these four figures is in constant tension with the possibility of an authentic meeting between client and therapist. So the fundamental polarity in the therapeutic position is between intersubjective relating (or as relational psychoanalysis, following Jessica Benjamin, calls it: mutual recognition) on the one hand and allowing the construction and enactment of the wounding on the other (see this hand-out - Soth 2014: The Essential Relational Conflict Inherent in the Therapeutic Position: Object- versus Subject-Relating). Winnicott profoundly advanced our understanding of allowing ourselves to be constructed when he spoke about the 'uses of an object'. Rather than the therapist insisting on being ‘themselves’ and recognised as ‘themselves’, an important aspect of allowing the client's unconscious to manifest and even dominate the space is that the therapist can allow themselves to be used as an object.

Something is being put upon me and into me so strongly that I am becoming it (i.e. projective identification; process-oriented psychology has a nicer phrase: I'm being 'dreamed up'). Once I gain a bit of awareness of this initially unconscious process, my subjective experience is that I'm being objectified - I am being made into a particular object.

For most of us, being on the receiving end of this as a therapist is not the first time in our lives that we experience being objectified. For most of us, it has profound - and painful - resonances with our childhood, and we are entitled to be scared of it, to resent it and avoid it like the plague.

Allowing - and importantly: sustaining - the experience of being objectified, of being constructed, is counterintuitive. The only reason for sticking with it as a therapist is because initially I can see the point of it (so I am inclined to experiment with hanging out there), and over time - surviving enactments over and over again with unexpected and occasionally magical results - I gain confidence in its profoundly transformative power.

Our therapeutic capacity to allow ourselves to be de-constructed

But before that becomes possible, I need to risk my habitual position. For most of us as humanistic integrative practitioners, succumbing to being constructed feels like a disturbingly alien idea, counter to all our principles of authenticity and the importance of genuinely being ourselves.

What about my congruence? Isn't that essential?

Yes it is, but from the perspective of the unconscious, that's too neat, straightforward and convenient. Congruence is only as helpful and robust as the degree of incongruence it can allow and embrace.

That's why we have a profound paradigm clash between the humanistic and psychoanalytic traditions – and that's why it is a valid and precious and creative clash we would not want to be without. That's why the integration of these traditions is difficult: it requires bringing together equally valid, but mutually exclusive, diametrically opposed, philosophical truths.

Most of us in the humanistic tradition are deeply invested in the idea of a self-actualising authentic self (or in Winnicott’s - worryingly binary - terms: ‘real’ self as opposed to the ‘false’ self).

But we become less sure of who that supposedly coherent self that I supposedly am, actually is, once we experiment with allowing projective identifications, allowing ourselves to be constructed, allowing ourselves to be ‘dreamed up’.

It's one thing for post-modern philosophy to postulate that my 'self' is contextual, socially constructed, multiple - dependent upon the web of relationships I am currently experiencing; or for spiritual wisdom to encourage me to open up to our fundamental interdependence as humans or for existentialists to declare our a priori relatedness.

It's quite another thing to actually feel deconstructed, mangled, confused and disturbed by experiencing myself as actually becoming the object. It can be pretty maddening, actually. And it is especially disturbing to become a wounding object when my habitual position as a therapist is to be an empathic, benign healer (wounded maybe, but definitely not wounding).

Supporting our capacity to be constructed and de-constructed

So in order for us to be 'big' enough to allow ourselves to be constructed, especially as the 'bad' or the 'idealised' object (two sides of the same coin, really), which we may be willing to do for the deeper purpose and the greater benefit of our clients' therapeutic process, we need to be supported by others who see the wisdom rather than just the folly of that adventure. We need a community of the like-minded, so we are able to stretch ourselves beyond our habitual position as therapists.

If we want to include in our client’s therapeutic process the unconscious, on its own terms (rather than on the preferred terms of our therapeutic egos), we realise we need to drop any number of cherished beliefs, sophisticated assumptions, barriers and protections, which we have been trained to embed into the structure and framework of the therapeutic space we offer.

We need permission to be ‘bad’ and nasty as well as to be idealised and grandiose. We need reassurance that this can indeed become transformative, so we are capable of sticking with it when it gets unpleasant and the going gets tough.

We need support to process, reflect and think within the enactment (which is usually the precise moment when our clarity of mind departs as we are going down the plughole of the unconscious), and gather the systemic bodymind fragments of the enactment.

I have used the metaphor of a vortex in the sea to describe the enactment: rather than frantically struggling sideways to get out of it and getting exhausted and drowning, the way to survive the vortex of enactment is by surrendering to being sucked down and down to the bottom where it will then spit us out. From there we are then free to float back to the top. Once we have been through it and down it a few times, and we are less panicked by being sucked down, we might even have spare attention to enjoy the scenery on the way down, and be curious about what we encounter.

So ideally we want to establish a community of practitioners that support each other in these disturbing and deconstructing realms of the therapeutic relationship.

We want to help each other holding the tension between being able to be truly ourselves in an authentic way (as wounded healers, with personal-professional integrity) on the one hand versus allowing ourselves to be constructed and used as an object on the other hand. As mentioned above, we can formulate this as the essential conflict inherent in the therapeutic position (as illustrated in this hand-out - Soth 2014)

The workshop will be an opportunity to explore how we each can thrive within these realms of uncertainty and contradiction, access a genuine sense of therapeutic authority (regardless of the fact that it is built on quicksand), and develop our own resources and style for inhabiting the paradoxes of the therapeutic space.

References

Clarkson, P. & Wilson, S. (1994, 2003) The Therapeutic Relationship. Oxford: Wiley-Blackwell

Gomez, L. (2004). Humanistic or psychodynamic - what is the difference and do we have to make a choice? Self & Society, 31, 6, 5-19

Kalsched, D. (1996) The Inner World of Trauma: Archetypal Defences of the Personal Spirit. Routledge.

Reich, W. (1942, 1948, 1973, 1983) The Function of the Orgasm. Souvenir Press.

Soth, M. (2014) The 4 Main Countertransference Objects in the Enactment (2014). Retrieved: 1/12/2017 https://integra-cpd.co.uk/cpd-resource/soth2014_therapist-4objects_in_enactment/

Soth, M. (2014) The Essential Relational Conflict Inherent in the Therapeutic Position: Object- versus Subject-Relating. Retrieved: 1/12/2017 https://integra-cpd.co.uk/cpd-resource/soth2014_therapys_essential_conflict_object_vs_subject/

The post Allowing ourselves to be constructed and the enactment of the bad object appeared first on INTEGRA CPD.

Dengan hal tersebut punya arti, jikalau ada 9 orang pada permainan itu jadi banyaknya kartu yang dapat terpakai ialah 18 kartu buat pemainnya dan 5 ticket buat meja. Hal tersebut dijalankan biar kita siap memandang sebagaimana besar sisi kemenangan kita serta berelasi pada bagian taruhan dalam permainan pokerqq online itu.

Langkah sebelumnya buat mengawali Langkah sebelumnya buat start ialah memandang kesibukan yang dijalankan oleh pemain judi bola poker online tidak cuman anggota. Secara umum, pemain dalam Indonesia akan mengerjakan fold jikalau itu menggenggam kartu di bawah tujuh atau miliki backing card atau slip ke dua yang kecil juga.

Anda bisa memandang berapakah beberapa orang yang fold dalam room itu. Jikalau sedang penuh, peluang kesempatan keluarnya ticket besar tentunya semakin besar sebab nilai slip yang kecil semua umumnya ada di tangan pemain taruhan poker online.

Lalu hal yang Anda kerjakan sebagai memandang langkah apa yang dapat diambil musuh seusai kartu taruhan poker online terbuka. Apa sang musuh dapat mengerjakan Cek, Raise, All-in, atau justru, Fold? Seterusnya anda dapat menafsir sendiri apa pencegah anda punyai kartu yang kuat atau mungkin tidak.

Terkecuali memakai sistim memandang proses musuh, sistim yang lain yang cukup berefek tapi efisien dengan memandang pantulan musuh taruhan poker online jikalau kita mengerjakan Raise. Ingat, sistim ini mengagumkan berefek, jadi jangan sembrono memakai sistim ini. Anda semestinya memakai sistim ini jikalau urutan anda biasa menggenggam one pair dengan urutan 2 paling besar dibanding kartu yang terbuka dan Raise yang anda kerjakan tak sangsi serta nampak begitu sedikit.

Apa yang Mesti Anda Kerjakan dalam Main Pokerqq Online?
Seusai Anda mengerjakan raise yang memberlakukan dalam permainan jadi musuh taruhan pokerqq online anda tentunya dapat curiga serta cuma punyai 3 pilihan, turut Anda. Serta mendongakkan kepala taruhan atau Fold. Kalau ia ikuti Anda, harapan dia cuma pingin memonitor kartu setelah itu. Jikalau juga kartunya tidak pas yang dikehendaki ia tentunya akan mengerjakan Fold. Baca info terlengkapnya di https://maniaqq.asia/id/.

Jangan khlaf buat memandang kartu taruhan dalam permainan bola poker online Anda yang di meja. Apa punyai prosentase kemenangan yang sedang? apabila iya, Anda bisa mengerjakan langkah Raise dengan nilai yang semakin besar dari yang awalnya. Kemungkinan sang musuh dapat mengerjakan Fold & dikau dapat meraih kemenangan sisi permainan taruhan poker online itu.

Pertama kalinya mulai main, hanya dengan mengingat metode main serta memerhatikan tangan Anda sendiri. Akan tetapi demikian Anda sukses, sangat utama buat memandang apa yang berlangsung di meja. Di Texas Holdem , cari kabar apa tangan paling baik buat penuhi ketidakberhasilannya. Yakinkan Anda memerhatikan peluang flush serta straight. Dalam stud 7 kartu , cermati apa yang diunjukkan serta apa yang dilipat orang sewaktu Anda pertimbangkan buat menyebut musuh. Yakinkan Anda bisa menentukan tangan mana yang menang di Texas Hold'em.

Mudah-mudahan penjelasan dari artikel yang kami beri ini tentang pokerqq sangat percaya Anda mengenai situs. Kita dapat bersua pada artikel setelah itu. Selamat main serta mudah-mudahan memberikan keuntungan!

The post Metode Membaca Kartu Dalam Judi Pokerqq Online Paling baik appeared first on INTEGRA CPD.

OTS Couple Workshop Series 1

When the honeymoon is over …

An evening/1-day workshop for couples – with Michael Soth

“You are not the same person that I fell in love with!”

This statement could be an appreciation rather than an accusation – it could be an appreciation of how your partner has grown and has continued to change alongside you. After all, just imagine the nightmare if your partner were to remain fixed and static whilst life moves on around us!

Usually, however, that statement is the beginning of a painful conversation, and for some couples the beginning of the end. Feeling disappointed and betrayed usually goes both ways, with both partners feeling let down by the other in different, but equally hurtful ways.

During the honeymoon, it seems promises were made which our partner is now no longer delivering – frequently they have turned into the very opposite, from an angel into a demon. Falling in love seemed to promise lasting happiness and fulfilment. But often our partner now protests: “But I never made that promise!”

When the honeymoon is over, the daily nitty-gritty of loving begins – the mundane ‘work’ of forging loving out of falling in love. Falling in love is easy – it can happen to anybody, without much effort or awareness. Loving – and ensuring that our partner feels loved by us – is a whole other process. It requires commitment and tenacity, and it usually involves pain and struggle – let’s bring some of these qualities to the workshop.

Michael will draw from a wide range therapeutic approaches to help you work creatively and experientially with your live relationship issues. No prior experience of therapy is necessary. It goes without saying that you will not be required to expose anything unless you are comfortable and willing to do so.

Michael has been practising as therapist, supervisor and teacher of counsellors and psychotherapists for more than 30 years. He has had a private practice in Oxford since 1991, and has been teaching on a wide variety of training courses, conferences and professional development events. He has been working with couples for many years.

OTS Couple Workshop Series 2

Making commitments and recovering trust after infidelity

An evening/1-day workshop for couples – with Michael Soth

Having fallen in love, commitment is easy. But beyond that, with any and every step in commitment, the stakes get higher. The agreement to be monogamous, moving in together, shared finances, buying a house together, marriage, having children - each step towards deeper commitment deepens our vulnerability to the other: the more we are intertwined, the more painful the wrench will be if for any reason we have to separate.

It is therefore emotionally quite understandable that each step towards deeper commitment raises the spectre of insecurities, fears and previous betrayals, and with it reluctance, ambivalence, defensiveness and rejection. Both internal and external thresholds have to be re-negotiated at every step.

At each such threshold all kinds of irrationalities come up, and couples check and test each other. Like a stress test in a factory, if we keep putting on more and more pressure with each test, it’s going to become a self-fulfilling prophecy: at some point the thing will break.

Having made commitments or exchanged marriage vows, it usually seems clear and straightforward that the one who breaks them is the guilty party. But whilst the injured party may take some satisfaction from taking the moral high ground, really, that way we are on a hiding to nothing. If all you want is revenge, then this is an effective avenue.

If, however, as well as as wanting your own back, you want to stand any chance of recovering love, it is more helpful to remember that each and every step in the relationship was co-created. The more productive question, therefore, is: as you cannot go back to how things were, what is the learning that will help you move on to a new relationship? Whatever kind of love was destroyed by infidelity, what is the new kind of loving that wants to emerge?

This workshop is for couples who are either struggling with a threshold in commitment, or for those where commitments have been broken - we will use these two sides of the coin of commitment to learn from each other.

Michael will draw from a wide range therapeutic approaches to help you work creatively and experientially with your live relationship issues. No prior experience of therapy is necessary. It goes without saying that you will not be required to expose anything unless you are comfortable and willing to do so.

Recommended reading: “Mating in Captivity” by Esther Perel

Michael has been practising as therapist, supervisor and teacher of counsellors and psychotherapists for more than 30 years. He has had a private practice in Oxford since 1991, and has been teaching on a wide variety of training courses, conferences and professional development events. He has been working with couples for many years.

OTS Couple Workshop Series 3

Why should I love you more than you love yourself?

A workshop for couples – with Michael Soth

“You do not love me enough!” “Why can’t you love me in the way I want to be loved?”

These are common accusations between couples, and they generate cycles of frustration and guilt. When the partner then re-doubles their efforts and makes deliberate attempts to show more love in the ‘right’ way, it usually still isn’t right: their efforts do not seem to reach the parts that need it. That is distressing for both partners - the unmet demands intensify and the partner feels criticised, helpless or resentful, because there seems to be no realistic way of satisfying the apparent need for more love.

Sometimes this happens because for all our demands to be loved, we are not actually receptive to it or we do not actually feel we deserve it. There is not enough self-love in the first place, for love to be given or received. Often the partner protests, somewhat defensively: “I can’t possibly deliver this ideal love you seem to be demanding!”

But for many couples, where self-love and self-compassion are insufficient to begin with, a deeper question is more helpful: “Why should I love you more than you love yourself?”

This can become a profound challenge to the endless cycles of co-dependent demands and frustrations.

If we want love, what kind of work is required for us to get ready to receive it? How can we prepare ourselves to be loved?

Michael will draw from a wide range therapeutic approaches to help you work creatively and experientially with your live relationship issues. No prior experience of therapy is necessary. It goes without saying that you will not be required to expose anything unless you are comfortable and willing to do so.

Michael has been practising as therapist, supervisor and teacher of counsellors and psychotherapists for more than 30 years. He has had a private practice in Oxford since 1991, and has been teaching on a wide variety of training courses, conferences and professional development events. He has been working with couples for many years.

OTS Couple Workshop Series 4

What is the deeper purpose of couples fighting?

“Though this be madness, yet there is method in it.” Hamlet Act 2, scene 2

An evening/1-day workshop for couples who think there might be method in the madness – with Michael Soth

Many couples fight, mostly about apparently trivial things. Over time, deeper conflicts become apparent and repeat themselves in predictable arguments going round in predictable cycles. Over further time, as these never seem to get resolved, the fights get more bitter and entrenched. Increasingly, they outweigh whatever love was there - slowly, they erode affection until there is a morose stand-off or there are affairs or separation. What is the purpose of all this bickering and fighting?

Most therapeutic approaches to couple work, as well as self-help books on the topic, exhort you and instruct you how to become more loving: how to listen, how to assert your needs without imposing, how to curb your irrationalities, how to appreciate your partner, how to focus on the bright side - in short: how to behave like reasonable adults and well-adjusted cooperative partners. Many of these approaches work well up to a point, and if you are entirely satisfied with these methods, this workshop is not for you.

However, if you consistently fail to be reasonable, if irrational passions continue to leak out, if you have set your sights beyond well-behaved normality, if you suspect that more love and more loving is possible, or if you just plain cannot stop fighting, this workshop may be of interest.

Through learning to fight well – that is: both passionately and productively - we may discover the uniquely purposeful gifts which resentment, negativity, anger and hostility can bestow on your relationship.

Michael will draw from a wide range therapeutic approaches to help you work creatively and experientially with your live relationship issues. No prior experience of therapy is necessary, but considering the topic, some direct expression of anger is likely to occur during the workshop (if you have any doubts or concerns at all how this can be handled safely and without victimisation, please feel free to ask questions and discuss this beforehand). It goes without saying that you will not be required to expose anything unless you are comfortable and willing to do so.

Michael has been practising as therapist, supervisor and teacher of counsellors and psychotherapists for more than 30 years. He has had a private practice in Oxford since 1991, and has been teaching on a wide variety of training courses, conferences and professional development events. He has been working with couples for many years, helping them survive relationship crises and deepen their commitment as well as occasionally helping them separate amicably and productively.

The post OTS-Oxford: Couple Workshop Series 2018 appeared first on INTEGRA CPD.

The psychological therapies are a minefield, and very confusing for the layperson. What are the differences between psychology, CBT, counselling, psychotherapy and psychoanalysis (and many, many others)? Even the therapists themselves are not always clear about it, so how can an ordinary person?

This series of free events gives you an opportunity to join the conversation and ask all the questions you did not know whom to ask. No previous experience is necessary.

As an experienced integrative therapist and trainer and an OTS Director, Michael Soth has a reputation for presenting an appreciation of all the various disciplines and approaches that comprise the field of the psychological therapies. In this profession nobody can be entirely impartial, but we will give it a good go - we will at least approximate a sympathetic understanding and validation of the diverse approaches, which the field has to offer.

These workshops are being offered by OTS, which was set up by Justin Smith as an initiative to de-mystify psychotherapy and counselling and make it more accessible and affordable to the wider community. OTS is unique in bringing together therapists from a broad spectrum of therapeutic approaches, working together to tailor the therapy to our client’s needs and ‘match’ clients to therapists. Our idea is to create the best fit for what is going to work best for each client and maximise the ‘quality of relationship’ (which is widely recognised as a crucial factor in making therapy work). OTS also aims to make therapy more affordable, through offering effective group therapy.

Michael & Justin will offer these events with the help of OTS therapists who will assist them in creating a safe and conducive atmosphere. It is likely that we will spend some of the time in smaller groups, to give everybody a chance to speak and get involved, if they want to.

About the timing & scheduling of these events:

Please email us to let us know which of the events listed below you are interested in, and which of the times and venues indicated would be possible for you. As we are offering a number of events and want to make sure they will all be well attended, we will schedule them in collaboration with everybody who expresses an interest in attending them.

We hope to be able to have the first free events taking place in February 2018.

1. Everything you always wanted to ask about therapy …

With Michael Soth

The fields of counselling, psychotherapy and psychoanalysis do not have a good track record in terms of communicating clearly and openly with the general public, despite the fact that all of these professions aim to assist with our common human experience. However, therapeutic theory has traditionally been shrouded in mystifying language and psychiatric labels with little meaning.

Amongst the competing and conflicting theories, each claiming to be better than anything else (at the last count, there now exist more than 400 distinct therapeutic approaches), it’s next to impossible for the ordinary layperson to see the wood for the trees.

How do you find the ‘right’ therapy or therapist for yourself or for a loved one?

In this open evening, Michael will attempt to answer all your questions in a way that is informative, accessible, impartial, and engaging.

Michael has been running an assessment and referral service in Oxfordshire for 25 years, and has a reputation for helping people find a good match between client and therapist. This ‘fit’ is crucial in establishing a good working alliance, which is one of the key factors for a productive outcome of therapy. In order to do this well, he relies on a fairly unbiased appreciation of the many differing therapeutic approaches available. Michael is known for his uniquely wide integration of all the therapeutic approaches, recognising the strengths and weaknesses of each of the traditions.

2. How does therapy help (or does it)?

With Michael Soth

In the world of therapy, there are very few ‘truths’ that all therapists agree on. The fundamental principles claimed by any one approach are questioned and contradicted by another. In that way, the different therapeutic approaches appear worse off than the religions (many of which at least do agree about some fundamental human values, like kindness and peace). What is supposed to be helpful in therapy, and what is supposed to be useless, counterproductive or outright dangerous is very unclear and controversial. The traditional approaches are making not just different, but often opposite claims.

One of the main questions that divides the field of counselling & psychotherapy is: How does therapy work? Does it? What do we mean by ‘work’? What goes ‘right’ and what goes ‘wrong’, and how do we know? The different approaches have contradictory answers and views on this question, so as a layperson, how can you find your way through the maze?

In this open workshop session, Michael will attempt to answer all your questions in a way that is informative, accessible, impartial, and engaging.

Michael is known for his integrative teaching, which is based upon an appreciation of the many diverse therapeutic approaches available, and their respective strengths and weaknesses. In this workshop he will explain why he sees the contradictions between the approaches as potentially productive avenues into a deeper and more embracing understanding of the therapeutic process.

3. The helping relationship - beyond therapeutic approach and professional discipline

With Michael Soth

The disciplines dealing with emotional and mental distress are profoundly fragmented and divided not only from each other, but often against each other. The layperson does not understand the differences between psychiatrists, psychologists, counsellors, psychotherapists, and psychoanalysts. They have even less of an idea about the different theories and approaches which sub-divide those disciplines further.

If all of these practitioners are available to provide psychological help, how come they contradict each other? If they can’t agree between each other, how can you trust them as a profession?

The layperson finds it hard to understand why there should be such contradictory theories and assumptions.

The client’s experience of being ‘helped’ has little to do with how therapists split hairs between each other. As a client, I am not interested in how the professionals disagree – ‘I want them to pull together and prioritise me and my needs and how I can be helped. I couldn’t care less about the finer differences between the disciplines and approaches.’

How can we get down to the human level, and the different kinds of help that may be needed by different people in different crises and at different stages in their lives?

In this open workshop session, Michael will attempt to answer all your questions in a way that is informative, accessible, impartial, and engaging. Michael is known for his integrative teaching, which is based upon an appreciation of the many diverse therapeutic approaches available, and their respective strengths and weaknesses. He sees the contradictions between the approaches as potentially productive avenues into a deeper and more embracing understanding of the therapeutic process.

4. Beyond the talking therapies – the bodymind dimensions of the psyche

With Michael Soth

For about 100 years, the bulk of the psychological therapies have agreed on one thing: the conscious, talking mind as the avenue for dealing with emotional and mental distress. Much of this is based on the assumptions of the 19^th century when Freud originated the ‘talking cure’: it’s mind over matter (or what is sometimes called the Cartesian split, after the philosopher Rene Descartes).

It’s only been since the 1990’s and the decade of the brain, that modern neuroscience has comprehensively thrown out and transcended these assumptions. It’s common sense experience for most of us that body, feelings and mind hang inextricably together, and that the psyche is interwoven with all these aspects of the bodymind.

Traditional talking therapy has found it difficult to do justice to the holistic, multi-dimensional complexity of the psyche. It’s no wonder that it has limited effectiveness and haphazard results.

This becomes most pressing in conditions like eating disorders, trauma, anxiety (which usually has a strong physical component), hyper-tension and many others where the ‘felt sense’ of the body is obvious. But the traditional talking therapies have frustrating limitations for most clients in most other situations, too. Most of us realise that insight is not enough – we are dealing with entrenched patterns, which involve all levels of the bodymind in creating conflict, blockages and stuckness.

In this open workshop session, Michael will attempt to answer all your questions in a way that is informative, accessible, impartial, and engaging. Michael is known for his embodied-relational approach to therapy, having worked at the bodymind interface and with the psychosomatic connection for the last 30 years.

5. Individual or Group Therapy – what works when?

With Justin Smith

It is a curious thing that over the last 40 years, since the beginnings of the humanistic revolution in therapy, the option of group therapy has declined in popularity, both in terms of what’s actually on offer and also in terms of its perception and credibility in with the public.

We believe this is a shame – it’s an unnecessary, misguided and unhelpful development, and our vision for OTS is to give group therapy back its rightful place. For many people and in many situations, group therapy should be the favoured option, being more affordable and more directly effective in terms of the presenting issues.

Therefore, group therapy should be recognised as a valid and productive format of therapy, and one of the options we recommend when assessing people seeking psychological help.

There are, of course, many other situations where group therapy is not a good idea, and where individual, couple or family therapy is preferable, required or advised, and also likely to be more effective.

In this open workshop session, Justin will offer an exploration of the considerations and criteria we take into account when making recommendations. We will attempt to answer all your questions in a way that is informative, accessible, impartial, and engaging. It is an evening that will also help you decide whether group therapy is for you or not.

6. Who Am I – Who Are You?

With Justin Smith

‘The unexamined life is not worth living’ is a famous dictum apparently uttered by Socrates at his trial for impiety and corrupting youth, for which he was subsequently sentenced to death. No one will be sentenced in this workshop, but we will consider what it means examine our lives, and wonder how we might do that to useful effect.

We all develop as people with a set of beliefs about our selves and other people. The beliefs are mainly generated through interactions with the significant and influential people in our lives from the first moments of our being onwards. But are these beliefs the truth and right? What is subjective truth and what is reality.

In this open workshop we will take a whistle-stop journey through child development, the unconscious mind, beliefs, truth, human relationship and curiosity.

7. How does the mind, our personality and character develop?

With Justin Smith

The mind is often defined as ‘the element of a person that enables them to be aware of the world and their experiences, to think, and to feel; the faculty of consciousness and thought.’ But where is mind? We tend to think of it as being between our ears, as that is where we experience ourselves thinking – in the head. So, does our body have anything to do with thinking? ‘What does your heart or your gut tell you’? People say. How come? How does this relate to the mind between the ears?

And, where is our personality and our character structure located? What is the relationship with mind here, and how do they all develop? Are they fixed or can they be altered?

In exploring these questions, you will begin to think about yourself in new ways, with new possibilities!

8. Knowing Yourself & Being Effective

With Justin Smith

This conversational workshop will explore questions such as: How did we become who we are; what makes relationships difficult; why are emotions so problematic; why did my therapy not work; how do you live a more joyous life; what is love; and many others. The style of the workshop will be conversational around these questions, and people can come to more than one workshop, as each one will be different.

These workshops will help develop your understanding of the unconscious processes which impact how we think and feel, and how we interact with others and life in general; they can be used to think about what actually supports us in life, and what gets in the way of us having the life we want.

The post OTS-Oxford: Public Workshop Series 2018 – All About Therapy … appeared first on INTEGRA CPD.

The upshot is: not very 'durable' at all = 53% relapse, of those 79% within first 6 months - this is very much born out by anecdotal evidence we get from interviewing prospective clients in assessment sessions. When they talk about previous therapy experiences and CBT treatment, I would estimate 20% tend to report some marginal, temporary benefit, about 50% are dismissive and described as useless, and about 30% are outright derogatory. Now I'm not suggesting that this is the plain truth, and we need to take these kinds of reports with a pinch of salt, especially when they come to another new person for another assessment. There are experienced CBT therapists who combine CBT with other approaches, and there the anecdotal evidence gives a very different picture.

The post How durable is the effect of low intensity CBT for depression and anxiety? appeared first on INTEGRA CPD.

The paper is free to access, and the link is at the end of the summary below. Please do disseminate this paper as widely as you can."

The post New paper indicates counselling is comparable to CBT in treating depression appeared first on INTEGRA CPD.

• Quicker access to mental health services
• Better choice of treatments
• More prevention
• Increased funding
• Tackle stigma and discrimination
• Least restrictive setting
• Improved workforce – skill mix and staffing
• Improved care planning
• Better parity of esteem (physical and mental health)
• More talking therapies

One of the key findings is that a greater choice of therapies, readily accessible, beyond limited CBT options, is what users want to see. This was how it was summarised in a Guardian article: "Leaked report reveals scale of crisis in England's mental health services"

You can find the full original report online here

From the Foreword

In March 2015 NHS England launched a Taskforce to develop a five-year strategy to improve mental health outcomes across the NHS, for people of all ages. Essentially, this will be a 'Mental Health Five Year Forward View' which clearly sets out how national bodies will work together between now and 2021 to help people have good mental health and make sure they can access evidence-based treatment rapidly when they need it. Collectively, we have a chance in a generation to deliver change that is achievable, urgent and necessary. This is an important opportunity to improve experiences and outcomes for people of all ages.
Our approach is one of co-production – involving people with lived experience of mental health problems, carers, professionals, providers, voluntary organisations and the component parts of the NHS – who are all part of the Taskforce. Our first step has been to find out what people want to see change, and this interim report reflects what they have shared and sets out what will happen next.

I have summarised the most important points from the report for those of us working in the private sector:

13. It was thought that much could be gained from a ‘community asset’ approach, particularly in working with community and voluntary sector organisations, including faith-based organisations, to equip people with knowledge and skills to understand and manage their own mental health and that of those close to them.
17. Timely access to effective, good quality evidence-based mental health treatment and therapies in response to need, always in the least restrictive setting, was a primary concern for the majority of survey respondents. Over half (52 per cent) of people said access is one of their top three priorities, and 33 per cent cite needing choice of treatment. 10 per cent specifically mentioned greater access to a range of psychological therapies in their top three priorities and wanted access and choice from a full range of evidence- based psychological therapies
19. Aspects of access raised through the survey included substantially reduced waiting times and an expansion of the choice of services to include a broader range of therapies for different types of mental health conditions. Some people stated a preference for being able to self-refer for treatment.
26. There was a clear call for support and interventions to always be provided in the least restrictive setting appropriate to meet a person’s needs, at any age. This was specifically cited by 15 per cent of survey respondents as a top priority. In engagement events, participants called for: provision of good quality home treatment; access to short stay crisis or recovery houses (where a person experiencing the onset of crisis can elect to stay in a respite setting providing intensive treatment and practical support); longer-term specialist residential services for those who need them (instead of long stays within secure inpatient services); and voluntary admission to inpatient care for those who need it, which is not always possible when thresholds for inpatient care are extremely high.
29. Survey respondents ranked different types of interventions in order of priority for improved access and quality. The top five areas people prioritised are:

• Early intervention;
• Psychological therapies;
• Home treatment;
• Information and skills to manage one’s own mental health; and
• Mental health awareness among the public;

30.People raised several aspects of the experience of being supported to respond to mental health problems. Of people citing choice as a top priority, 13 per cent described the importance of having the right information to make meaningful decisions about their treatment. Similarly, 13 per cent of people stated the need for wider diversity and skill mix in NHS staff, including the need for peer support and more staff with psychological support skills.
32. People expressed the need to have more control over their own care and to access the support that would work best for them as an individual, in line with the principle of ‘no decision about me, without me’. People reflected the view that, too often, care was ‘done to’ them rather than shaped with them and that health professionals did not systematically listen to them or take their concerns seriously.
35. People raised particular issues around medication, where many reported that they were not always given full information about potential side-effects, or were put on medication before other support options had been explored. Where people wanted to reduce or come off medication, they described a need for more support to be available to help them do so. There were calls for more research into the long-term effects of psychiatric medication.
39. People described wanting frontline staff across the NHS, including support staff, to have the confidence and skills to support people’s mental health needs. This included wanting staff to have the skills to work collaboratively to identify goals and plan care and treatment, and to involve carers appropriately and meaningfully. Developing a paid peer support workforce (people with lived experience) had considerable support.
42. There was support for greater regulation of non-NHS providers, particularly counsellors and psychotherapists, to protect people who use their services and ensure a high standard of care.
43. People described wanting a greater say in what services are available in their local area and how they are delivered, calling for services to promote wide- ranging and much more meaningful involvement with people who used services. People wanted to be paid for their time and expertise when helping to develop services, in recognition of the expertise they bring.

The post Mental Health in the UK: The 5-Year Forward View Mental Health Taskforce appeared first on INTEGRA CPD.

How can we make a broad-spectrum therapeutic response accessible and available to the community?

A year ago, after much preparation, my colleague Justin Smith initiated the Oxfordshire Therapy & Self-Development Centre (OTS). Now, in 2016, we have a vibrant and growing community of 20-odd therapists who are aiming at developing a one-stop access point for the general public, to provide a wide range of psychological therapies in terms of professional disciplines, therapeutic approaches and formats.

We might have hoped that some service like that could have been developed from within the NHS, but in Oxfordshire it hasn't (although in other regions there may be the odd NHS-led inter-disciplinary multi-modality project - please tell us if you know about or are connected with any such initiative).

You can find out more details about what we are trying to do in the presentation we gave to the Oxford Psychotherapy Society last November. Amongst other things, one of our aims is to put group therapy back on the map, and especially an integrative version of group therapy that draws from both humanistic and psychoanalytic traditions of group work.

The post How to Improve Access to ALL the Psychological Therapies? appeared first on INTEGRA CPD.