A Jungian whole person approach to dynamic psychotherapy Margaret Wilkinson Edinburgh 2014

Psychological Therapies enable the well-being of the whole person of a client while engaging primarily with mind ‘to cope with the privileged access to the mind of the client a split has been made that excludes the body’ (Sinason 2006) Therapies that focus only on the mind will continue to promote the now out-dated Cartesian split.

We cannot ignore the body ‘traumatic events of the earliest years of infancy are not lost but, like a child’s foot prints in the wet cement, are often preserved lifelong’ ‘time does not heal the wounds that occur in those earliest years; time conceals them. They are not lost; they are embodied’ if we do not explore how to work with this we ignore ‘ that which is actually the somatic inscription of life experience on to the human body and brain’ Felitti in Lanius et al, 2010 xiii-xiv

Schore’s seminal work Enables a creative approach to dynamic psychotherapy Teaches us how to explore research from the fields of neurobiology, attachment and trauma Offers a basis for the development of a therapeutic approach to the whole person

Plasticity enables change we make new neurons and new connections when we are stimulated by change, newness and difference. ‘Enriched environment living….enhances the survival of newly generated cells in the hippocampus’ (Gould and Gross 2002) the emotional and intellectual engagement that occurs between subject and another subject in psychotherapy is just the kind of enriched environment that can bring about change

Right hemisphere and attachment The right hemisphere is ‘preferentially involved in sympathetic activation’ whereas the left’ is preferentially involved in parasympathetic activity associated with reduced tension or calming responses (Allman et al 2010) The VEN- containing areas of the right hemisphere have extended their homeostatic regulatory functions to ‘the regulation of social relationships and the homeostasis of interpersonal relationships’ (Allman et al 2010)

Learned Secure Attachment A sustained experience, such as that provided by longer term counselling or psychotherapy, that is experience over time of a different kind of relating enables a different kind of attachment to be learned. Outcomes: ‘a state of neural integration and more complex cortical development and capacity for self-regulated affect’ (Wilkinson 2010)

Systems neuroscience Studies of ‘intrinsic connectivity networks’ (ICNs) in individuals (Seeley et al 2007, p.2349) have led to our understanding the brain as being composed of multiple, distinct and interacting networks that support complex cognitive and emotional processing and the complex interactions that occur between our mind, brain and body.

The salience network The salience network consists of ‘the dorsal anterior cingulate (dACC), and orbital frontoinsular cortices with robust connectivity to subcortical and limbic structures’ (Seeley et al 2007) the network for meaning-making concerning cognitive, emotional and bodily aspects of experience.

The insula An integral hub mediates ‘dynamic interactions between other large-scale brain networks involved in externally oriented attention and internally- oriented or self-related cognition’ (Menon & Uddin 2010) facilitates the processing of ‘the physiological condition of the body’ and the development of ‘subjective feelings from the body’ (Craig 2010)

Gaze as a window to the mind a strong association between the right anterior insula in and ‘the perception of one’s own bodily states and the experience of emotion’ Menon & Uddin 2010, p.658 In health direct gaze activates a cortical route that enhances evaluative ‘top-down’ processes underlying social interactions. In PTSD direct gaze leads to sustained activation of a sub-cortical route of eye-contact processing that is an innate alarm system Steuwe et al 2012

The dissociative defence ‘the emotional significance of the experience remains hidden all along from the patient so that not reaching consciousness, the emotion never wears itself out, it is never used up’ Jung 1912: para. 224

Three interacting systems control the gut one in the gut itself with hormonal and neuronal mechanisms and memory for coordinating ingestion and digestion One in the hypothalamus for automatic homeostatic control integrating gut functioning with the rest of the body One in the insular and related cortices and linked to self-awareness and decision-making

The insula as a switching agent Activates chief executive function when thinking is required, CEN is vital for cognitive decision-making, for working memory and for initiating and sustaining goal-directed behaviour. Switches to default mode network which enables self-referential processing when the functions of the CEN are no longer necessary

A secure attachment style affected by major early loss A retreat from mind into body Whole being and life patterns are affected Behaviour and symptoms expresses the patient’s dilemma

Conclusion The interaction between overwhelming and unmanageable emotional experience and bodily response, may be modulated by careful processing of traumatic experience within a secure and empathic relationship 25