"Transformative and/or Destructive: Exceptional Experiences from the Clinical Perspective". Isabel Clarke Consultant Clinical Psychologist Hampshire Partnership NHS Foundation Trust

Normalizing Unusual Experience Extraordinary experience has always been part of being human - part that has always been both feared and valued Simply pathologizing is not the answer Research: new and not so new: can offer a more balanced perspective – a perspective that is less crushing than dismissing the experience as ‘illness’

A Word about Words ‘Exceptional’ – neutral in that it can describe both positive and negative experiences – but veers to the positive Psychosis and spirituality – obviously loaded! Transpersonal – better, but often used to exclude the shadow experiences Spiritual emergence/emergency – still a suggestion of dichotomy I adopt Thalbourne’s ‘transliminal’

Evidence for a new normalisation Schizotypy – a dimension of experience: Gordon Claridge. Mike Jackson’s research on the overlap between psychotic and spiritual experience. Emmanuelle Peter’s research on New Religious Movements. Caroline Brett’s research: having a context for anomalous experiences makes the difference between whether they become diagnosable mental health difficulties and whether the anomalies/symptoms are short lived or persist. Wider sources of evidence – e.g.Cross cultural perspectives; anthropology. Richard Warner: Recovery from Schizophrenia.

“Third Wave” Cognitive Therapies Developments in CBT as it tackles personality disorder, psychosis etc. Therapeutic relationship important Past history is significant Change lies not so much in altering thought to alter feeling, but in altering the person’s relationship to both thought and feeling Mindfulness is a key component. Recognition of a split or incompleteness in human cognition – which mindfulness can bridge. Basic CBT’s model of mind is simple. Mind is about thought,physical arousal,feeling,&behaviour in interaction. The therapy seeks to effect change by altering thought and behaviour. This worked so well for straightforward anxiety and depression type conditions, that it has been progressively extended to more and more challenging diagnoses, such as pd and psychosis. It has done this first by elaborating the basic model; adding in schemas, the second wave, Picking up ideas from humanistic and psychodynamic approaches and then by the development of the 3rd Wave therapies (term coined by Hayes, whose ACT is one of them)

Separate pathways in the brain Developments in CBT come up with 2 or more separate types of processing – the split in human cognition! There is one direct, sensory driven, type of processing and a more elaborate and conceptual one. The same distinction can be found in the memory. Direct processing is emotional and characteristed by high arousal. This is the one that causes problems – e.g. flashbacks in PTSD. The two central meaning making systems of ICS provides a neat way of making sense of this.

Interacting Cognitive Subsystems. Body State subsystem Implicational subsystem Auditory ss. Implicational Memory Visual ss. This is a diagram of some of the processing subsystems in the brain, according to Teasdale and Barnard - based on research on cognitive processing. . I am going to concentrate on the two large ones here - p and i. p = verbal based logical reasoning - with a verbally coded memory store. i = holistic, overall meaning processing. Direct connections with sense modalities (in contrast to p) and a memory store coded in every sensory modality - vivid and immediate. The connection with emotional response made possible by the direct connection with state of bodily arousal. For complete processing, for “construing” in a Kellyan sense, you need both working in close communication. Because the systems are distinct, it is possible for this communication to become overloaded or skewed in some way. This helps to explain a lot of what goes wrong for human beings. Verbal ss. Propositional subsystem Propositional Memory

2 Ways of experiencing ICS gives us a normalizing way of understanding exceptional experiences/ the transliminal. When the imp.ss and the prop.ss are working together, that gives us an ordinary, grounded quality of experience. When they become desynchronized, the imp. temporarily takes over This feels different; in extreme forms leads to openness to anomalous experience. This quality of experience is also sought and valued!

Linehan’s STATES OF MIND (from Dialectical Behaviour Therapy) – Maps onto Interacting Cognitive Subsystems EMOTION MIND (Implicational subsystem) REASONABLE MIND (Propositional Subsystem) WISE MIND Though L does not refer to it specifically, the ICS split maps onto the basic DBT model of the mind, as follows: The idea of a shifting balance is central to DBT, so that the self is seen as moving between the minds. Wise mind is the same as the two central ss. in ICS working smoothly together; reasonable mind dominance suggests an avoidance of the emotional (because the physical state of arousal produced by memories is anticipated as too unpleasant). Emotional Mind is where the implicational is dominant, and a loop can be set up that excludes current reflection, and so revision of past patterns – whether of depressive rumination or impulsive action. IN THE PRESENT IN CONTROL

A challenging model of the mind. There is no boss – our unitary sense of self is an illusion! The mind is simultaneously individual, and reaches beyond the individual, when the implicational ss. is dominant. This happens at high and at low arousal. There is a constant balancing act between logic and emotion – human fallibility Dysynchrony between the systems explains anomalous experiences – psychosis! Mindfulness is a useful technique to manage the balance. Human fallibility; our proneness to emotional overload and breakdown, leading to the sorts of depression, anxiety disorder and psychosis that are the stuff of my working life. This model give me a clear way of understanding psychopathology and an alternative perspective to the dominant “illness” model; one that I find useful in therapy as it makes sense to people; it gives them a way of taking responsibility for their process without blaming them.

Being Porous: therapeutic approach Some people are more open to this type of experience than others – cf. Schizotypy People high on the schizotypy spectrum are more sensitive and “open”. Leading to the need to regulate stimulation. This can lead into an avoidance cycle; social isolation and withdrawal = the other ‘reality’ takes over. Sensitivity and openness to anomolous experience – continuum with normality Positive side as well as vulnerability

Normalising the difference in quality of experience as well as the continuity Validating the person’s experience Helping people to manage the threshold – mindfulness is key Understanding the role of emotion and arousal – the feeling is real, though the story might be suspect. All this helps with building a therapeutic alliance. Persuasion to join “shared reality” – motivational work. Realistic about the risks of “unshared reality”. Recognizing the attraction of “unshared reality” for many – offering specialness, buzz and a handy escape Mobilising and nurturing strengths Creative expression

Shared Reality Unshared Reality Ordinary Clear limits Access to full memory and learning Precise meanings available Separation between people Clear sense of self Emotions moderated and grounded Logic of Either/Or Supernatural Unbounded Access to propositional knowledge/memory is patchy Suffused with meaning or meaningless Self: lost in the whole or supremely important Emotions: swing between extremes or absent Logic of Both/And

What is real & what is not?: about the programme. A 4 session group programme for an Acute inpatient setting. Run by a clinical psychologist and one or two others – trainees, nurses, OT etc. Builds on the Romme and Escher ‘Voices Group’ tradition Is different from other CBT approaches in normalizing the difference in quality of experience in psychosis, as well as thinking style. This normalization attacks stigma by associating psychosis with valued areas such as creativity and spirituality. Attempts to mitigate the damage to self concept of the traditional, diagnosis, based approach.

Session 2. The role of Arousal shaded area = anomalous experience/symptoms are more accessible. Level of Arousal Ordinary, alert, concentrated, state of arousal. Low arousal: hypnagogic; attention drifting etc. High Arousal - stress

Session 2 cont. DIALECTICAL BEHAVIOUR THERAPY: Linehan’s STATES OF MIND applied to PSYCHOSIS Discussion of Ways of coping suggested by this approach – management of arousal and distraction.

Transformative Potential Mike Jackson’s problem solving theory Loosening constructs - both/and thinking Link with re-experiencing trauma Encounter with whole can seduce - effect on self Importance of context and holding Clinically encouraging people to join shared world; work in shared world Failure of society to provide adequate containment to allow transformative process - Spiritual Crisis Network

Contact details, References and Web addresses isabel@scispirit.com Clarke, I. (Ed.) (2001) Psychosis and Spirituality: exploring the new frontier. Chichester: Wiley Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester:'O'Books. www.SpiritualCrisisNetwork.org.uk www.isabelclarke.org