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

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

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

5. Evidence for a new normalisation Schizotypy – a dimension of experience: Gordon Claridge. Schizotypy – a dimension of experience: Gordon Claridge. Mike Jackson’s research on the overlap between psychotic and spiritual experience. Mike Jackson’s research on the overlap between psychotic and spiritual experience. Emmanuelle Peter’s research on New Religious Movements. 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 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. 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. Wider sources of evidence – e.g.Cross cultural perspectives; anthropology. Richard Warner: Recovery from Schizophrenia.

6. “Third Wave” Cognitive Therapies Developments in CBT as it tackles personality disorder, psychosis etc. Developments in CBT as it tackles personality disorder, psychosis etc. Therapeutic relationship important Therapeutic relationship important Past history is significant 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 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. Mindfulness is a key component. Recognition of a split or incompleteness in human cognition – which mindfulness can bridge. Recognition of a split or incompleteness in human cognition – which mindfulness can bridge.

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

8. Body State subsystem Auditory ss. Visual ss. Interacting Cognitive Subsystems. Implicational subsystem Implicational Memory Propositional subsystem Propositional Memory Verbal ss.

9. 2 Ways of experiencing ICS gives us a normalizing way of understanding exceptional experiences/ the transliminal. 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 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 When they become desynchronized, the imp. temporarily takes over This feels different; in extreme forms leads to openness to anomalous experience. This feels different; in extreme forms leads to openness to anomalous experience. This quality of experience is also sought and valued! This quality of experience is also sought and valued!

10. Linehan’s STATES OF MIND (from Dialectical Behaviour Therapy) – Maps onto Interacting Cognitive Subsystems EMOTION EMOTION MIND MIND(Implicationalsubsystem) REASONABLE MIND (Propositional Subsystem) WISE MIND IN THE PRESENT IN CONTROL

11. A challenging model of the mind. There is no boss – our unitary sense of self is an illusion! 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. The mind is simultaneously individual, and reaches beyond the individual, when the implicational ss. is dominant. This happens at high and at low arousal. This happens at high and at low arousal. There is a constant balancing act between logic and emotion – human fallibility There is a constant balancing act between logic and emotion – human fallibility Dysynchrony between the systems explains anomalous experiences – psychosis! Dysynchrony between the systems explains anomalous experiences – psychosis! Mindfulness is a useful technique to manage the balance. Mindfulness is a useful technique to manage the balance.

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

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

14. Shared Reality Unshared Reality Ordinary Ordinary Clear limits Clear limits Access to full memory and learning Access to full memory and learning Precise meanings available Precise meanings available Separation between people Separation between people Clear sense of self Clear sense of self Emotions moderated and grounded Emotions moderated and grounded Logic of Either/Or 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

15. What is real & what is not?: about the programme. A 4 session group programme for an Acute inpatient setting. A 4 session group programme for an Acute inpatient setting. Run by a clinical psychologist and one or two others – trainees, nurses, OT etc. Run by a clinical psychologist and one or two others – trainees, nurses, OT etc. Builds on the Romme and Escher ‘Voices Group’ tradition 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. 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. 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. Attempts to mitigate the damage to self concept of the traditional, diagnosis, based approach.

16. 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

17. 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.

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

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