Problems with the Self Dr. Louise McHugh University College Dublin

Know thyself!

Where is your ‘self’?

YOU ARE HERE! Ferrari et al 2008

I was so stressed yesterday, I wasn’t myself! Then who were you? I was so stressed yesterday, I wasn’t myself!

Social animals…

Charles Cooley ‘Looking Glass Self’ We notice how people act towards us and derive what others opinion must be

George Herbert Mead Symbolic interactionism Humans act toward things on the basis of the meanings they ascribe to those things Meaning is derived from social interaction with others and society

My ‘self’ changes with context Imagine you had 30 seconds to describe your ‘self’  An interview for a marketing position To serve jury duty On a first date

What does contextual behavioural science say?

A sense of self? Only humans have a sense of self Why? Although studies have suggested that animals have some awareness of self such as work with chimpanzees being able to notice that a dot on this

Symbolic relationships between things… Is what allows us to make sounds that other people understand rather than simply pointing and grunting at things ‘HAT’ ‘Kelly’

??? Physical Relationships Relationships based on cues = CONTEXTUAL CUE 13

??? = CONTEXTUAL CUE CONTEXTUAL CUE IS SAME AS Nic Nic BAD BAD OK GOOD 14

GENERATIVITY in human language THE JUMJAW EXERCISE BEFORE AFTER A jumjaw is a dog Is a jumjaw the same as a cat? Is a jumjaw the same as a cat? Is a jumjaw bigger than a tractor? Is a jumjaw bigger than a tractor? Does a jumjaw have ears? Does a jumjaw have ears? ETC. CONTEXTUAL CUE Little or no reaction Readily answer questions

When children are taught to name objects, they are provided with masses of explicit bi-directional training CUE Audience participation moment (writing materials) Mimic adult child name game – teach audience Irish for ‘ball’ ‘Lumlap’ – novel object; Gaelic ’hurley’ stick / camann Clue for ‘Name-Object / Object-Name’ responding

After thousands of such interactions, the child no longer requires explicit bi-directional training

We can relate in many ways Same as (‘Jumjaw is the same as dog’) Opposite (‘Day is opposite to Night’) Different (‘Boys are different from Girls’) Comparison (‘£1 is more than 10p’) Causal (‘If anxious then I will mess up’) Temporal (‘Bad now worse later’) Perspective (‘I am here and you are there’) 18

Relating is great it can help me solve problems!

Especially important problems!

And we can relate everything! Think of three single digit numbers (you can repeat numbers) and write them down in random order Now answer the following question, using the first number to pick the word in the first column, the second number to pick the word in the second column, etc.

How is a. . . (e.g., banana) (e.g., the cause of) (e.g., candle) 1. Banana 1. like 1. prostitute? 2. Race car 2. unlike 2. war? 3. Kangaroo 3. better than 3. chair? 4. Foreman 4. different from 4. candle? 5. Priest 5. worse than 5. house plant? 6. Football 6. the father of 6. book? 7. Hat 7. the cause of 7. mud hole? 8. Computer 8. the partner of 8. baby? 9. TV 9. the opposite of 9. toilet?

Causal Relations can be tricky! Emotions That problem with the government, your neighbors, your boss, etc. … the cause of… Problems That problem with you

Technical Term Alert! Function  basically means the ‘effects something has’

Transformation of Functions Psychological Function

‘DOG’ is a

Psychological Function ‘Dog’

‘DOG’ is a ‘Jumjaw’

Psychological Function ‘Jumjaw’

produces produces produces

“Small Dog” “Average Sized Dog” “Enormous Dog” produces produces

“Tall Jumjaw” “Grande Sized Jumjaw” “Venti Jumjaw” produces produces

Relating and the Transformation of Functions 15 normal subjects Establish this relational network in half of them using arbitrary stimuli: A < B < C Give B a CS shock function and then present a single ½ strength shock in the presence of A Test the C stimulus . . . Dougher, Hamilton, Fink, & Harrington (2007)

Derived Relations of Comparison Panic attack in one’s own living room results in increased arousal and avoidance of corner store and university class MORE THAN MORE THAN university class corner store living room

And deriving explodes… Try this exercise: Learn four relations and see what happens. . . RELATION 1: OLDER THAN HOMER LISA

RELATION 2: OLDER THAN MAGGIE LISA

RELATION 3: YOUNGER THAN HOMER ABE

RELATION 4: YOUNGER THAN ABE MONTY BURNS

From 4 Trained Relations. . . YOUNGER OLDER YOUNGER OLDER OLDER YOUNGER OLDER OLDER OLDER YOUNGER YOUNGER OLDER OLDER YOUNGER YOUNGER OLDER OLDER YOUNGER

With age comes… Wisdom Beauty Regret Freedom Responsibility Strength Weakness

Language Just as we learn to manipulate the environment with our body and hands We also learn to manipulate it through sound and symbols Milk Please!

So language is responding to abstract relations So what does that have to do with the ‘self’? ‘I think therefore I am’ No Rene – you learn to verbally discriminate your own behaviour from others behaviour - therefore you are Well, according to the CBS view, the self is the product of learning to put one’s own behavior into relation to others learning to verbally discriminate ones own behavior from others' behavior

What did YOU have for breakfast? I had a banana for breakfast No silly I had a banana for breakfast

I feel happy I feel sad I am happier than you! As a child begins to relate more and more of their own behavior… I am happier than you! …and to compare it with that of others… I am not as happy as you I am a happy person! I am a depressed person! …they begin to have a concept of self

The emergence of self I am good I am bad I am a husband I am a doctor I think of my work I think of your pain I think of my father I think of lunchtime I go to my office I go home I go back to school I go into the dark I touch the hot pan I touch into the water I touch the screen I touch my face I see you coming I see a bright future I see a desk I see and hear a dog I hear music I hear birds singing I hear a driving car I hear my mother calling I eat ice cream I eat a steak I eat chocolate I eat bread

The emergence of self I am good I am bad I am a husband I am a doctor I think of my work I think of your pain I think of my father I think of lunchtime I go to my office I go home I go back to school I go into the dark I touch the hot pan I touch into the water I touch the screen I touch my face I see you coming I see a bright future I see a desk I see and hear a dog I eat chocolate I eat a steak I eat ice cream I hear music I hear a driving car I eat bread I hear my mother calling I hear birds singing

The emergence of self I am good I am bad I am a husband I am a doctor I think of my work I think of your pain I think of my father I think of lunchtime I go to my office I go home I go back to school I go into the dark I touch the hot pan I touch into the water I touch my face I touch the screen I hear music I hear a driving car I eat chocolate I eat ice cream I hear birds singing I eat a steak I see a desk I see and hear a dog I see a bright future I see you coming I eat bread I hear my mother calling

The emergence of self I am good I am bad I am a husband I am a doctor I think of my work I think of your pain I think of my father I think of lunchtime I go to my office I go home I go back to school I go into the dark I touch the hot pan I touch into the water I hear a driving car I hear birds singing I hear music I eat chocolate I eat ice cream I eat a steak I hear my mother calling I see a desk I touch the screen I touch my face I see and hear a dog I see a bright future I see you coming I eat bread

The emergence of self I think of your pain I think of my work I think of lunchtime I think of my father I go into the dark I go home I go to my office I go back to school I am a doctor I touch the hot pan I am bad I am a husband I am good I touch into the water I hear a driving car I hear birds singing I hear music I eat chocolate I eat ice cream I eat a steak I hear my mother calling I see a desk I touch the screen I touch my face I see and hear a dog I see a bright future I see you coming I eat bread

The training of perspective I go back to school I go into the dark I go home I go to my office I think of my work I think of your pain I think of my father I am a husband I am a doctor I am bad I am good I touch the hot pan I think of lunchtime I touch into the water I hear a driving car I hear birds singing I hear music I eat chocolate I eat ice cream I eat a steak I hear my mother calling I see a desk I touch the screen I touch my face I see and hear a dog I see a bright future I see you coming I eat bread

The emergence of self I go back to school I think of my work I go into the dark I go home I go to my office I think of your pain I think of my father I am a husband I am a doctor I am bad I am good I touch the hot pan I think of lunchtime I touch into the water I hear a driving car I hear birds singing I hear music I eat chocolate I eat ice cream I eat a steak I hear my mother calling I see a desk I touch the screen I touch my face I see and hear a dog I see a bright future I see you coming I eat bread

Noticing Perspective

Understanding others? ‘The key to a happier world is the growth of compassion’ Dalai Lama

Theory of Mind Module I Know what you are thinking! I have a ‘module’ in my brain that tells me!

CBS Approach to Perspective-Taking Perspective relations specify a relation in terms of the perspective of the speaker Consider the three relations of: I versus YOU HERE versus THERE NOW versus THEN

CBS Approach to Perspective-Taking Each time a child is asked or answers questions such as: “What are you doing here?” “What was I doing then?” “What am I doing now?” “What were you doing there?” the physical environment will likely be different… The only constant across such questions are the relational properties of: I versus You Here versus There Now versus Then

CBS Approach to Perspective-Taking Two important variables: Relation Type I / YOU HERE / THERE NOW / THEN Complexity Simple Relations Reversed Relations Double Reversed Relations McHugh, et al., (2004)

I have a white brick and you have a red brick A Simple Relation Task I have a white brick and you have a red brick Which brick do you have? Which brick do I have?

A Reversed Relation Task I am sitting here on the blue chair and you are sitting there on the black chair Here: There: If I was YOU and YOU were ME Where would I be sitting? Where would you be sitting?

A Double Reversed Relation Task Yesterday I was sitting there on the black chair, today I am sitting here on the blue chair There: Here: Now: Then: If HERE was THERE and THERE was HERE and NOW was THEN and THEN was NOW Where would I be sitting now? Where would I be sitting then?

Empirical Support McHugh, et al., (2004) - Developmental Profile – appears at same age as ToM Rehfeldt, et al, 2006 – those diagnosed with ASD less proficient Villatte, et al. (2010) – patients with schizophrenia less proficient Villatte et al (2008) – link between deictics and social anhedonia Weil et al (2011) – training in deictics with children with ASD produces gains on Theory of Mind tests Vilardaga et al (2009) - Link between deictic relational responding and empathy

Laura Skye & Dave Barmy

So how does this link to ACT?

Psychological Flexibility Contacting the present moment fully and without defense, as a conscious human being, and based on what the situation affords, changing or persisting in behaviour in the service of chosen values Be present Open up Do what matters

Psychological Inflexibility Not fully contacting experience Limited experience of the self Avoiding experience Even when it’s getting in the way of what we want and the person we want to be

Double Edged Sword Verbal self-knowledge is a two-edged sword

‘I wish I…’ Comparison is a bitch Were as good at presenting as Robyn Were as young as I am in this photo! Were as smart as Steve Had great hair like Russ Comparison is a bitch

Even if you are a mega star… 1969 I am not good enough as I am. In order to be good enough I need to look a certain way

1979

1989

2009

3 Selves in ACT Self as content  Story Self as process  Contacting the present Self as context  Flexible Perspective Taking

FEELINGS OF LONELINESS MUST AVOID INTIMACY UNWORTHY OF THE AFFECTION OR TRUST OF OTHERS Lack of contact with social contingencies FEELINGS OF LONELINESS LONELY SAD INDIVIDUAL WORTHLESS BAD NO-ONE LOVES ME NOTHING BUT TROUBLE ME EVERYONE LAUGHS AT ME STUPID

Exercise What kind of self-descriptive ________ does the client fuse with? judgements e.g., about body, personality, weaknesses, roles beliefs self-limiting attitudes – e.g., I can’t do X because of Y predictions about the future

The conceptualized self trap I slept all day. I am a lazy person. Result: The only way to change your future is to change your past. You’re Stuck!

Exercise Why is attachment to both NEGATIVE and POSITIVE conceptions of self detrimental?

What ACT technique helps us let go of our attachment to our self concept?

Now select a judgment about yourself…

Put a self judgment into one word Now say: X is good X is bad X is ruthless X is beautiful X is a banana X is positive X is true X is false X is awful X is uplifting X is scary X is evil X is pretty X is a fish X is a girl X is hopeless X is disgusting X is boring X is safe X is menacing

I’m having the thought that I am not good enough Defusion Defusion is salience of many functions with no one function dominating Focus on process not content Highlight the non-literal quality of the client’s thoughts I’m having the thought that I am not good enough I’m not good enough

Perspective relations in defusion Respond to our thoughts as I HERE NOW - caught up in them Respond to our thoughts and feelings as I THERE THEN - they are seen as thoughts and feelings that we had

I feel so worthless right now Fusion and Defusion Defusion Self as Context I HERE NOW notice that I am having the thought that I am worthless Fusion Self as Content I am a worthless person Self as Process I feel so worthless right now AND I HERE NOW am noticing that I am having the feeling that I am worthless Self as Context

SELF AS CONTEXT SELF AS CONTENT I’m not good enough. SELF AS PROCESS I am too anxious SELF AS PROCESS I HERE NOW notice my thoughts and feelings and what I can see, hear, touch taste and smell SELF AS CONTEXT SELF COMPASSION I HERE NOW notice my pain and respond with kindness EMPATHY I HERE NOW notice that you are feeling sad TRANSCENDENT SELF I HERE NOW am the observer of my thoughts and feelings

What about the other? Other as content Other as process Other as context

ACT Self Goals 1. Undermine attachment to conceptualised self 2. Help client notice continual flow of experience 3. Help client increase the availability of flexible perspective taking

Clinical example - Jessie Jessie says she’s “finally” seeking therapy because she’s “sick of feeling so awful all the time.” She says it’s been five years since she felt something other than “depression and shame.” She describes her life in terms of “the real me, before I got depressed,” and “this person I’ve become.” She says she doesn’t go places or do things because “I’m just too ashamed,” and “that shame takes away anything that used to be good about it.” She gives the example of hating for her family to see her “this way.” In session, Jessie is persistently tearful and has trouble following directions and giving contingent responses.

Broadening Her Experience of Self Expand her contact with stimuli in the world and her range of responding to stimuli Self as more than depressed World as more than source of shame Shame as more than thing to be avoided

John John struggles with chronic pain and spends much of his time trying to come up with a fool-proof strategy that will ideally get the pain to go away, or at least to let him get some control over it. He firmly believes that he has tried everything, but that nothing has worked. The pain and the struggle with it have gained such dominance over his life that much of who John is psychologically is about pain. In other words, John knows himself first and foremost to be a sufferer of chronic pain and many other aspects of his life have become secondary to this sense of self (not just in terms of his overt behaviour). As such, the identification with the problem has become almost the whole person that he resides in, and other aspects (e.g., husband, father, worker) have fallen away (e.g., “I can no longer play with the kids because my back will get sore”).

John Hopelessness The solution has become part of the problem Acceptance and isn’t this what has actually been the case for the last few years? Struggling and avoidance Pain is perhaps inevitable, struggle is not Obstruction Avoiding the struggle controls his behaviour more than actual pain Self and fusion He knows himself first and foremost to be a sufferer of chronic pain and many other aspects of his life have become secondary to this sense of self Values The pain has been allowed to take John’s life off in a direction that he did not see himself choosing

TIP - No need to win the conceptual war! The problem solving mind: sense making, prediction, and story telling Reduce its dominance by distinguishing  thoughts vs thinker emotions vs feeler

TIP - Give examples of perspective Therapist can self disclose to give an example of perspective ‘When I get hurt, like you, I find it difficult to just step back and let the hurt be there, and instead see it as part of me’

Inner Child Exercise

Training Flexible Perspective Taking Step 1. Basic Perspective Training ‘If I were you, where would I be?’ ‘If I were you and here was there, where would I be?’ Step 2. Empathy Training ‘I feel sad. If you were me, how would you feel?’ ‘I’ve won a prize. If you were me, how would you feel?’ Step 3. Self-as-Context ‘I watch thoughts and feelings come and go. Who is it that is watching them?’ Vilardaga& Hayes, 2009

Exercise For Step 2  design an intervention in session could that could target the transfer of emotions across perspective relations (empathy)

Transfer of emotions across perspective relations Think of a time when you were in distress that someone invalidated your pain? Contact how you felt at that time Think of a time when you invalidated someone else’s pain when they were distressed Now contact how they felt then

Self and the failure of empathy Narcissistic personality disorder – such strong fusion with a particular conceptualised self that events tend to be universally framed in terms of their relevance to this self and thus taking the perspective of another is made less likely High levels of anxiety - empathy is sometimes possible but it often results in such distress that it produces not sympathy for the other but self-concern and thus the result is the absence of overt empathic responding Burn out - Low levels of empathy can be produced by avoidance of the level of distress experienced during previous episodes of empathic responding

Context matters! There are a number of contextual variables that may make empathic responding more or less likely for any individual: similarity between observer and observed familiarity social dispositions cooperative versus competitive context how much the observer likes the observed

Classifying Self Problems Disconnected self Underdeveloped self Labeled self

Disconnected self Perspective taking repertoires lacking Example: Autistic spectrum conditions Intervention – perspective training

Underdeveloped self Doesn’t have a clear idea of who they are and what they stand for Example: Trying to please others, social anhedonic Intervention: self as process work

Labeled self Fused with negative self narrative Example - depression Fused with positive self narrative Example - Narcissistic Intervention – self as context work

What looks like depression can be three different problems with self…

Underdeveloped Self – Depression Passive No sense of ‘what I want’ People pleaser Directionless  Self as process

Isolated self - Depression Aspergers / ASD / Social anhedonia / poor social skills – rejection isolation  Deictic (perspective training)

Labeled Self Fusion with I am bad / worthless  Self as context

Think of a client you have that fits one of these categories Disconnected self Underdeveloped self Labeled self

Informing intervention?

Signs self work are needed handout

Signs of Progress Client reports sense of observing private experiences 2. Laughing at oneself in earnest 3. When they begin using these centering processes spontaneously in their own lives

Flexible self exercise Future you

For more on this…

Thank you!