Restructuring the Sense of Self by Building Self
Restructuring the Sense of Self by Building Self Compassion Leigh Mc. Cullough Ph. D. Associate Clinical Professor, Harvard Medical School Slides from the IEDTA Conference (International Experiential Dynamic Therapy Association UCLA, Los Angeles, CA. , September 2005 The point of this lecture was to demonstrate that compassion can be dealt with similarly to grief and anger in Short Term Dynamic Psychotherapy; i. e. , patients who are self attacking or self destructive need to be desensitized to positive feeling for self by exposure to feelings of care, concern, compassion for self and by the prevention of defensive and inhibitory responses. This approach is presented in detail in the following books (on the next two slides) and the website, www. affectphobia. com STDP Workshop - Leigh Mc. Cullough Ph. D. 1
Short Term Dynamic Psychotherapy STDP Short Term Anxiety. Regulating Psychotherapy for Restructuring Defenses, Affects and Attachments Basic Books, 1997 To Order: 1 -800 -386 -5656
Treating Affect Phobias: A Manual for Short Term Dynamic Psychotherapy Each chapter presents: 1) Basic concepts of STDP, and 2) Exercises for reader practice www. affectphobia. com To order: 800 – 365 -7006 STDP Workshop - Leigh Mc. Cullough Ph. D. 3
Go to our Website: www. affectphobia. com For information on our Training Programs in 2006 -7 in the Boston Area (Details to be posted in the Fall of 2005) STDP Workshop - Leigh Mc. Cullough Ph. D. 4
COMPASSION Synonyms: Sympathy, empathy, pity, concern, kindness, consideration, care softhearted, tenderhearted Antonyms: Hardhearted, stoneyhearted, callous, insensitive, pitiless STDP Workshop - Leigh Mc. Cullough Ph. D. 5
Thoughts on Compassion is the antitoxin of the sou where there is compassion even the most poisonous impulses remain relatively harmless. Eric Hoffer U. S. Philosopher STDP Workshop - Leigh Mc. Cullough Ph. D. 6
The Triangle of Conflict David Malan DEFENSES INHIBITION Behaviors, Thoughts, Anxiety, Guilt, Shame, Emotional Pain and Feelings ACTIVATING FEELINGS Adaptive forms of grief, anger, closeness, And. . . POSITIVE FEELINGS FOR SELF ( Interest/excitement, Enjoyment-joy) The emotional bases of. STDP self-care, compassion, pride, and Workshop concern, - Leigh Mc. Cullough 7 Ph. D. esteem
Compassion and its’ Blocks on the Triangle of Conflict DEFENSES ANXIETY/ CONFLICT Self Attack, I am afraid to be too big. Self-Hate I am ashamed to feel proud. It is too painful to feel good about myself. Low Self Esteem ADAPTIVE FEELING JOY OR INTEREST IN SELF Self Compassion, Self Care, Self Esteem, Pride, STDP Workshop Self Confidence, Self Worth, - Leigh Self. Mc. Cullough Respect, Trust in Self Ph. D. 8
Desensitization of Affect Phobias in STDP DEFENSIVE AFFECTS INHIBITORY AFFECTS Self Hate SHAME, Guilt, Pain RESPONSE PREVENTION ACTIVATING AFFECTS EXPOSURE Positive Self Feeling, Self Interest, Self Care, Self Compassion STDP Workshop - Leigh Mc. Cullough Ph. D. 9
A Bit of Exposure from Grapes of Wrath Steinbeck, Chapter 6 Muley Graves: (After talking about wanting to kill the peopl threw his family off their land; ) “Fella should maybe keep stuff like that in his head. ” Casey (Former Preacher): “Yes, you should talk, ” he said. “Sometimes a sad man can talk the sadness right out through his mouth. Sometimes a killin’ man can talk the murder right out of his an’ not do no murder. You done right. Don’t you kill nobody if you can help it. ” STDP Workshop - Leigh Mc. Cullough Ph. D. 10
Triangle of Person David Malan • Identify the Adaptive and Maladaptive Relationships at each pole • Exposure to care & concern (or lack thereof) from each person; CURRENT PERSONS THERAPIST CHANGING PERSPECTIVES ON THE SELF (Spouse, boss, friends, etc. ) ORIGIN VERSUS MAINTENANCE PAST PERSONS OF DESTRUCTIVE (Family of Origin, Lost Loves, DEFENSES STDP Workshop - Leigh Mc. Cullough Teachers, Friends ) Ph. D. 11
Interventions to Restructure the Sense of Self • Insight: Identify the self attacking defenses • Motivation to change the self attack Origin versus Maintenance of Defenses (You didn’t cause the problem, but you have to resolve it. ) • Exposure & DESENSITIZATION to compassion/care by: Changing Perspectives - THERAPIST (How do I feel about you? /Shared feeling. ) - others (What do they feel for you? ) - self (How do you feel about yourself? ) • Expression of Compassion: The ability to treat self with compassion and care outside the session STDP Workshop - Leigh Mc. Cullough Ph. D. 12
Theory in Restructuring the Self • Retranscribing the Memory Trace Changing patients’ world view about the self …or ”Self View” • Building new neuronal networks STDP Workshop - Leigh Mc. Cullough Ph. D. 13
Caveats There are inevitable problems that arise when you work with positive feelings. What might those be? STDP Workshop - Leigh Mc. Cullough Ph. D. 14
Problems (More frequently occurring as GAF becomes lower, especially. under 50) • Sexual feelings that arise with closeness – • Fear of boundaries being violated – • (Need exposure and desensitization when conflicted, but take care not to let sexual feelings act as defenses to closeness with therapist. (There are clear boundaries here, remember that we imagine murderous feelings, but no one actually is murdered. ) Over-idealizing therapist – (Sometimes a necessary phase with more regressed patients, but eventually therapist must been seen as fully human. ) • Never wanting to leave therapy (We need to set you free…Can you take me with you? …Can you take these feelings with you? Generalize to caring feelings of others. ) …. . OTHER EXAMPLES? STDP Workshop - Leigh Mc. Cullough Ph. D. 15
GAF SELECTING TREATMENT FOR PATIENTS BASED ON LEVEL OF FUNCTIONING More Expressive treatment 100 75 Short Term Restructuring of Defenses 50 25 0 Build supports, Inpatient Care Build defenses Cognitive Rx Supportive Rx Restructuring self/others STDP Workshop - Leigh Mc. Cullough Ph. D. Short term Restructuring of Feelings More Supportive treatment 16
Some Old Things & Some New Things COMPASSION follows the same principles as other affects, (e. g. , desensitization) but has some different mechanisms. • There seem to be no “breakthroughs” to compassion as with grief or anger. One builds, or develops this capacity incrementally. • There can be no full sense of compassion without comparable acceptance of grief and rage. STDP Workshop - Leigh Mc. Cullough Ph. D. 17
Global Functioning, Affective Competence, and underlying Ego Strength Patient Adm Lesser Twin Caged Man GAF 60 55 Spiritual Chemist 52 1 st Grief 1 st Anger SESSION 1 ~ 3 2 2 ~ (FU) GAF TBA 89 Grandmother Tortured Student 50 48 10 20 30~ 2 75 75 Lady Cloaked in Fog 42 50 54 85+ STDP Workshop - Leigh Mc. Cullough Ph. D. 18
Are There Stages in Achieving Compassion? • Denial and Anger • Bargaining • Acceptance STDP Workshop - Leigh Mc. Cullough Ph. D. 19
The Spiritual Chemist 37 year old divorced female; fired from job as a lab technician, estranged from son • Came to Rx for help during divorce • Initial GAF: 65 Current GAF: 89 (7 year follow-up) • Sense of Self: “An amino acid with legs” • Session 3: Exposure to closeness with and STDP Workshop - Leigh Mc. Cullough 20 Ph. D. acceptance from me.
The Superior Unchanging Grandmother 68 year old married female; 45 years of therapy, and almost as long on antidepressants. • Admission GAF: 55 Current GAF: 75 (2 yr F-U) • Sense of Self: “There’s something horrible about me. ” • Sessions 1, 5, 10 and 12 STDP Workshop - Leigh Mc. Cullough 21 • Off anti-depressants by Session 11 Ph. D.
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IT TAKES COURAGE TO BE KIND IT TAKES COURAGE TO BE … COMPASSIONATE … SOFTHEARTED STDP Workshop - Leigh Mc. Cullough Ph. D. 23
When time is limited: • Point out self-attacking defenses • Build compassion for self • Find loves that have been lost (people who found them special): ’Whose eyes lit up when they saw you? ’’ • Explore positive feelings in therapistpatient relationship • Use Socratic dialogue; What do you think I. . . – Feel for you? STDP Workshop - Leigh Mc. Cullough – Want for you? Ph. D. 24
Three Treatment Objectives Defense Affect Self/Other Restructurin g Restructuri ng Defense Recognition (Can the patient see the self attack? ) Giving Up Defenses (Is the patient motivated to give up self attack? ) FOCUS: DEFENSES & ANXIETY Affect Experiencing (Degree of felt care or compassion for self) Affect Expression (Can the patient FOCUS: treat self compassionately? ) FEELINGS & STDP Workshop. ANXIETY - Leigh Mc. Cullough Ph. D. Sense of Self (Positive and compassionate? ) Sense of Others (Realistic, adaptive? ) FOCUS: RELATIONSHIP & ANXIETY 25
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