1. From ‘The Body Remembers’, Babette Rothschild
‘If it is true that at the core of our traumatised and neglected patients’ disorganisation is the problem that they cannot analyze (and process) what is going on when they re-experience the physical sensations of past trauma, but that these sensations just produce intense emotions without being able to modulate them, then our therapy needs to consist of helping people to stay in their bodies and to understand these bodily sensations. And that is certainly not something that any of the traditional psychotherapies, which we have all been taught, help people to do very well.’ Van der Kolk ‘98)

2. Consider the Self Not born with sense of self
It develops in a good-enough relationship with the carer
Sense of self is a vital factor in mental health
Can be quite vulnerable
Constantly being constructed and re- constructed in pulses every few seconds
Constructed in present.
Damasio, Metzinger, Nijenhuis, many others.
Devt of sense of self
effects of ongoing good-enough nurturing relationship or the lack of it.
effect of Trauma and trauma –traumas to do with the absence of enough of what should be there, and traumas of impingement.
development of self-beliefs from the interactions with carers
Effects of trauma on a previously established good-enough sense of self.

3. Some aspects of the good-enough sense of self
Experiencing the present moment of time and the present context appropriately
Coherent, flexible, adaptable
Good sense of boundaries, purpose and direction
Sense of one’s narrative history and personal continuity through time
A sense of being at home in one’s body and emotions
The interpersonal self – the self in relationships
Recognition of the self in different roles
The conceptual self or the idea of ‘me’
Adapted from Neisser 1994 – in Cozolino 2002
What is a sense of self? Philosophers could continue to debate this for ever, but: Here are some aspects of the sense of self that will suit our purpose.
Integrating the various inputs from the different senses, internally as well as externally, awareness of the context and matching it to previous experience. Thus providing cohesion in the present moment.
5. home, work, as parent, as son or daughter, friend, etc.
cozolino refers to the importance of the conscious and unconscious organisation into narratives and the enormous amount of hidden processing to bring this about. ‘ the nature of the hidden processing results in a number of illusions, distortions and self-deceptions that inluence our narratives and are a focus of many forms of psychotherapy. The centrality of narratives to memory, development and psychotherapy derives fro the influence of language and story-telling in the building and organisation of our brains during evolution.

4. “Integration is not a function of the self. It is what the self is”
Bit cryptic
Ogawa et al paraphrasing Loevinger from Siegel ‘The Developing Mind’(1999), P 314

5. Integration
The processing of experiences towards integration can be thought of as a digesting of experience, and then that experience becoming assimilated as part of a harmonious whole.
The ‘whole’ then becomes expanded and enriched.
Adaptive learning will have taken place preparing for any similar experiences.
‘”Integration” refers to the way the mind establishes a functional flow in the states of mind across time.’ Siegel 1999 p 8.
People vary in their integrative capacity
Cf digestive capacity.
Imagine if digestive juices were too weak. Blobs of undigested matter which couldn’t be got rid of or integrated into the system.
How healthy are the digestive juices
How healthy is the integrative capacity?
Depends on previous experience. Cf jigsaw puzzle. When half made, the capacity to fit in / integrate any individual piece is much greater.
If a good structure already, then easier to integrate experience.
Need to know more about it in order to understand how to help people’s selves to rebuild after unresolved traumatic experiences.

6. Emotional arousal and integration
Level of
emotional
arousal
Too high
Optimal level of emotional arousal for integration of experience to take place
What is trauma
Definition from PTSD
Big T and little t traumas (EMDR)
What is felt as life-threatening depends on a lot of factors. What is life- threatening to a baby or someone who has been previously traumatised is very different
Where I hope you are now.
Sudden loud noise
Others, maybe disturb previous experience which although unresolved was notcausing any trouble, and may develop PTSD.
Too low

8. Normal, successful, completed stress / trauma response - 1
Thalamus –
Gateway from senses
Amygdala –
Smoke alarm
Switches on fight/flight
Active defences
Amygala has other functions too.
Constant state of readiness. 24/7 Monitoring external and internal environments.
It connects emotional value to the thing seen based on instincts and learning history and can learn to pair any stimulus with anxiety and fear
Hippocampus aids cortex by providing a context in time and place
Left prefrontal cortex –
Narrative (explicit) memory.
Adaptive learning takes place
Hippocampus –
Raw materials processed
and given context
File sent to ….

9. The normal, successful, completed stress/ trauma response - 2
Amygdala –
Smoke alarm
Switches off
Switches off fight/flight
Updating of settings
Amygala connects emotional value to the thing seen based on instincts and learning history.
Hippocampus aids cortex by providing a context in time and place
Updating of files
Left prefrontal cortex –
Narrative (explicit) memory.
Adaptive learning takes place
Hippocampus –
Raw materials processed
and given context

10. When overwhelm prevents processing and integration of experience
Fight/flight
blocked –
Submit/freeze
activated
Thalamus –
Gateway from
senses
Amygdala –
Smoke alarm
Frontal cortex
No context or time given to the event, so remains undigested and ‘eternally present’. The experience thus remains ‘stuck’ in the past and may intrude into the present at any time, if triggered, as if still happening.
Limbic system
Brain stem
Hippocampus –
off-line, so no context
or meaning given.
Amygdala
Supersensitised to
similar triggers
Experience stored as isolated implicit ‘memory’ in limbic and sensorimotor areas mainly

11. Person’s capacity to process and integrate
Symptoms
Extremely
Stressful
life event
No symptoms

12. MOTHER BABY Speedy repair to ruptures of attunement Attunement Safety
Healthy brain/mind organisation depends on the quality of the interactions between baby and mother
MOTHER
Speedy repair to ruptures
of attunement
Attunement
Safety
Emotion modulation
BABY
Co-constructed
narratives
Love and nurture
Baby - Genetic endowment
Innate self-states
Pre-birth experiences
Drive for social and exploratory experiences
Organising tendency
Baby
There’s no such thing as a baby.
Bb’s sense of self
Has Innate action systems and drives, but not likely to be joined up into a coherent sense of self.
The sense of being is wrapped up with the mother and whether he feels secure, loved, and all is kept within a window of what is tolerable. As long as experience is within that window then there is a sense of continuity of being, and the sense of self begins to get woven together from all the fragments of experience.
E.g.’s of good enough and breaks to ruptured continuity.
Baby begins as different action systems. Not yet integrated.
Steele ‘ Infants have not coalesced a ‘firm’ personality, rather their states exist as ‘islands’ of experience that will gradually come together and link as the child has a stable and consistent environment that supports and modulates many different states and senses of self. An ‘integrated’ personality is, in this sense, a developmental achievement.
How well one’s personality develops is dependent on: 1.maturation of integrative structures of the brain (e.g. hippocampus and cortices)
2. Inborn temperament and regulatory capacities
3. The skills and traits of caregivers that are modelled
4. A ‘good enough’ relational environment
The loss of maternal presence, engagement and vitality may all be experienced (at a biological level) as threatening to an infant. Coz 261
Providing templates
for neural organisation

13. Influence of stress in building a strong sense of self
The developing self
Influence of stress in building a strong sense of self T I M E
9 months
Trauma
Birth

14. Influence of stress in building a strong sense of self
The developing self
Influence of stress in building a strong sense of self T I M E
Repair soothing and
integration. New learning.
Strengthening and enlarging
the sense of self.
Resilience
Rupture to ongoing
continuity of being

15. Present time
Continuity of time
Birth

16. A division occurs. A part that shares the same growing up body feels
But where no repair or external modulation is available,
or where the capacity to integrate a trauma is completely overwhelmed
Present time
A division occurs. A part
that shares the same
growing up body feels
stuck forever at the point
of the trauma, and may
constantly relive it. T I M E
The ongoing self is
diminished.
Shifts and blending
between
different parts
the ongoing experience of the self in the present is diminished
Trauma age 3

17. Lifespan Integration – Peggy Pace 2003

18. Lifespan Integration – Peggy Pace
Borderline Personality Disorder is similar to DID
Lifespan Integration – Peggy Pace

19. ‘Two–dimensional time’
The Present
For some, the present could be represented in this way.
The darker circle representing the part of the self that is the most grounded in the present in the body.
But the present being invaded by blobs of unintegrated unprocessed experiences from a different time period.
maybe as fragments of experience such as pain, or whole vivid raw memory experiences
The present is overloaded and distracting.
Wd have very little sense of being anchored in a personal time narrative and very little sense of future.
Read Archaeological map and time confusion.

20. Phobic barrier
ANP EP
Two opposing forces: Apparently Normal Personality and Emotional Personality (trauma-linked in time)
phobic barrier for untintegrated disturbing mental contents
the minds drive to make meaning and to integrate the unintegrated.
Integrative capacity
Variable
depends on number of factors, but especially early experience in the nurturing relationship.

21. Must submit. Only safe when tuned in to Moral defence your needs
‘Im bad.
Shameful
Idealised parent
Need you
Don’t need you
Flight
Self identified
with abusive
Parent.
Anger or self-
harm
Abusive
parent
Where there has been lack of approp nurturing and abuse from very early in development, then not just fragments of experience that are unintegrated, but much deeper divisions especially of the defence action systems.
Where the parent is confusing or abusive, different representations of themselves in relation to the caregiver develop.
This results in a lack of self-continuity in relation to the other, and therefore leads to more difficulty in becoming integrated in the sense of self.
BPD or DD’s like DID
Helpless
Victim
Terror
Freeze

22. Therapist Client EPs Fight Flight Freeze Submit Hyperalert
Attachment cry
Recuperation
+ others
Each EP with 100% commitment to their role and still fixated at time of the tr.
You may not know which one is sitting in the chair!
Heaven help if the therapist doesn’t know their own EPs.
Could get v. messy!
Kate: Fight Rage towards others and self
Flight Run like crazy, or hide or avoid
Freeze Hyperaroused but a part freezes every movement Provides very tense body armour blocking use of any active defences
Submit I give up, no use, despair, suicidality
Hyperalert Watch out! Cannot go off duty, threat everywhere
Attmt cry Don’t leave me, I’ll be all alone
Perp introjects Part holding beliefs about the self transmitted by aggressors. ‘I’m just a worthless scumbag’
Spcific tr mems or fragments, partial or complete amnesia. Observer part

23. Relationship between course of time and degrees of reality
Present
The present moment is anchored in a sense of the past and the anticipated future, otherwise it floats of as a meaningless speck not attached to anything.
E.g. think of a musical phrase (3rd and 4th notes of national anthem). Flg of past and future of a phrase. Lots of other associations too. A network. So the experience is anchored (joined up)
Linear time
How did we get to learn that time is continuous and linear?
Circular time ……..
Past
Future
Source: Adapted from Janet 1928a and Van der Hart et al 2007, P 163

24. Time compacted by trauma into dysfunctional present
Almost no sense of past or future
% reality
High % past active in present
Present
The deficit in this vital aspect of the structure of the sense of self tends to stay hidden. There may be no real concept of it, and no conceptual framework on which to build an understanding, even in terms of what it means to grow up and become an adult.
Linda has described it like this: 'I and other adult parts of me have continued to be unable to have any meaningful understanding of what it feels like to grow up, and how it feels to change into an adult. It's as if the system within has maintained a kind of Peter Pan illusion .... that time has no effect nor demands a progression. We (me and mine) have set up our life such that it poses no threat to the Peter Pan illusion. It is as if we have skirted along the surface of time without having to, or without being able to face/accept the consequences of it. The integration of the passage of time had remained perpetually elusive.'
It is probably impossible to achieve the full integration of a memory (especially presentification) when there is no embodied structure or template of the autobiographical self.
Can this deeply embodied experiencing of one's personal continuity through time be developed in psychotherapy? Can the experience of time be stretched out to provide its vital dimension to the survivor's chaotic flat-pack of their present experience? Can there be a re-building of the metaphorical 'structure of the self' that will bring the sufferer relief and also settle disturbances from the past without having to work directly with the actual experiences?
Past
Future
Low % reality in present

25. The Self and Continuity of Time (2)
‘The integrating mind attempts to create a sense of coherence among multiple selves across time and across contexts’ (Siegel 1999)
‘The co-construction of narratives drives the integration of cognition, affect, sensation, and behaviours’ (Cozolino, 2002)
‘The core of the self lies in patterns of affect regulation that integrate a sense of self across state transitions, thereby allowing for a continuity of inner experience. (Schore, 1994)

26. “Therefore the failure to integrate salient
experience represents profound distortion
of the self system. When salient experience
must be unnoticed, disallowed, unacknowledged
or forgotten, the result is incoherence in the self structure.
Interconnections among experiences cannot be made, and the resulting gaps in personal history compromise both the complexity and the integrity of the self.”
Ogawa et al, quoted by Siegel in The Developing Mind, (1999) P 314

27. Therapy tasks
Relationship – experienced and modelled between therapist and client
A firm anchoring in the present
Developing a sense of continuity through time
Facilitating but keeping out of the way of the client’s reorganisation of self in the present
Working through the phobias
Transforming trauma memories into narrative memories

28. Memories Narrative (fluid, flexible) Traumatic (fixed, static)
Stories
Can be intentionally retrieved
Flexible
Reconstructive
Have social and relational functions
Sense of personal ownership
Verbal and time-condensed
Adds cohesion to personality across time and contexts
Known to be from past
Experiences
Automatically reactivated or triggered
Intrusions into consciousness
Rigid, timeless
Experienced as re-living
Sensorimotor and affective experiences
Intense arousal
May be non-verbal
Disrupts functioning and sense of self
Obviously applies to traumatic memories, but at some level applies to all that is not processed and integrated.
See Ogden P 236
Experience in the present is informed by unprocessed memories that are stored at an implicit and unconscious level.
This would be the experience of other mammals (apart from possibly some primates to some degree or people who only experience present consciousness
Either through brain damage or because they have very little sense of self as a continuity through time.

29. Healthy brain/mind re-organisation depends on the
quality of the interactions between client and therapist
THERAPIST
CLIENT
Speedy repair to ruptures
of attunement
Attunement
Genetic endowment
Innate self-states
Organising tendency
Life experiences
Ambivalence and Phobias
Expectations based on early experience
Safety
Emotion modulation
Co-constructed
narratives
Appropriate provision of ‘love and nurture’
in the form of a good therapy relationship with well-considered boundaries.

30. Lifespan Integration Can be used for:
Building and/or strengthening the core self- structure
Attachment repair work
Treatment of disturbing memories including PTSD, anxiety and panic disorders
Working with birth trauma and pre-verbal memories
Treatment of depression, eating disorders,etc
Many presenting issues can be treated using the standard protocol
Lifespan Integration Therapy
Lifespan Integration therapy offers a theoretically well-founded way of using memory cues as described above that leads generally to highly positive outcomes, and is effective across a wide range of mental health problems. Pace asserts that: 'Based on the results I have observed with clients, I propose that Lifespan Integration therapy promotes neural integration in the brain between hemispheres, and between sub-cortical and cortical regions.'
It is a way of re-constructing the sense of self, which naturally implies some de-construction to begin with so therapists are urged to proceed with great care and then only after training in the method.
The key features of Lifespan Integration therapy are:
Repeatedly taking the client through the memory cue list, with the adult self showing the images of the journey through life to the imagined newborn baby self. Each image, as it is remembered, opens up a present moment in time from the past, which includes the whole self-state experience (somatic, visceral, emotional, cognitive, etc)
Each self-state memory experience is just touched on enough to open that memory network, and then the therapist draws the client on to the next, and so on. Emotion regulation is contained by the therapist by her own groundedness and internal coherence and also by moving faster through cues which arouse more emotions, so as not to allow the activation to develop and risk the client being pulled in to an abreaction.
Neural connections are forged from one self-state to another through time, building a rough scaffolding for a felt sense of the continuity through time. This creates more coherence among self-states across time and across contexts.
A space-time map of the self is created, and the adult self of the client and the child ego state in effect co-construct an autobiographical narrative of self.
More memories arise spontaneously through subsequent repetitions of the time line and become woven in to the lived continuity of time experience.
The therapist needs to help the client to stay present during the time line work, and she contains potential hyperarousal by encouraging the client to 'just notice it' as she pulls her on through to the next images. One does not stop at any of the memory scenes, any longer than to slightly open the memory network, and for the shifts of sensation to be noticed.
Great care and skill is needed in using this way of working especially with those with dissociative disorders. It is a powerful and intensive tool and can be quite destabilising, if not used correctly. Training in this way of working is vital so that one does not have to re-invent or re-make mistakes that have already been ironed out in its development. There are various subtleties that both safeguard the client and also enhance the effectiveness of this way of working.
The effect on some of my clients has been quite remarkable. Linda now feels much more fully present and is less easily triggered. She is able to settle parts of her who do still get triggered more easily, as she is able to place the danger in the past reassuring the disturbed part that she (her adult present self) is taking care of her now. She is developing a sense of time which she describes as unfolding in front of her and behind her. She realises she can make plans for the future, can take actions and actually change things and not just be surviving in the moment. One example of this is her recent acquisition of a casserole dish, as she now has the capacity to plan ahead. She can plan meals, instead of just responding to hunger on the spot, when she used to eat whatever happened to be available at that moment. Another client, Abi, has reported that her mind feels less chaotic now, and it feels as if there's more space.
Pace (2007, p 25) proposes that 'once an individual has developed a neurological map of self that allows him to see himself as existing continuously throughout his entire lifespan, it is no longer possible for that individual to become frozen in time or even to be triggered by an implicit memory.' That is a claim of huge significance, but one which many other therapists are affirming.

31. Four functions of LI Improves client’s ability to regulate affect
Allows client to re-organise neural networks
Integrates self-states, feeling states and somatic states that were not integrated in early development and/or integrates material that has been split off for survival
Builds a solid sense of core self
Pace 2008

32. Lifespan Integration Factors involved: Good therapeutic relationship
Many state shifts within the time framework
State shifts include feeling states and somatic states that were not integrated at the time of happening
All from the perspective of the present
A way of working with the client which is (as in other ways of working) dependent on the relationship.
Empathic yet detached
Loving
Present
Containing
Non-reactive
Not attached to any particular outcome for the client

33. Time disorders From van der Hart & Steele (1997)
Automatic shifts in experiences of past and present events
2. Distortions in experiencing the future Confusion of flashback experience with present reality
Dominance of developmentally fixated time perspective
Identities experience of the non- traumatic past as present reality
Areas of difficulty
When a 5 y-o e.g. experiences of danger would have been encoded in the instinctive defensive systems, and remain highly sensitised to any triggers, internal (implicit) or external, eliciting the same early fear reaction at whatever age or situation., and without there being any real threat. What is dangerous to the 5 y-o most probably is not an actual threat to the 40 y-o. There may not even be explicit memories of the original situations of danger which primed and ‘hard-wired’ the defence systems. The neural networks stuck in time need updating.
Young parts of the self, with child’s experience of time – endless, no way of marking the hours or days, as if stuck in it forever
Don’t know the present. Sometimes express confusion not knowing therapist or where they are. Or being a home and it is not familiar, not how they expect it to be.
‘One of the major tasks of psychotherapeutic treatment is the development of an integrated, subjective sense of past and present so as to distinguish between then and now.’ (Hopenwasser 98)

34. Time disorders (2) Re-experience of traumatic memories
Complete loss of a sense of time
Amnesia for traumatic events
Amnesia for recent events
Amnesia for the distant past.
5. Flashbacks with obliteration of any sense of the reality in the present
6. An experience of limbo with a loss of sense of self

35. References:
Damasio, A. (1999) . The Feeling of What Happens: Body, emotion and the making of consciousness. New York: Harcourt.
Pace, P. ( th Edition 2007) Lifespan Integration: Connecting ego states through time. Available from or Amazon
Siegel, D. (1999) The Developing Mind: How relationships and the brain interact to shape who we are. Guilford: New York.
Simeon, D and Abugel, J. (2006) Feeling Unreal: depersonalisation disorder and the loss of the self. Oxford: New York.
Stern, D .(2004) The Present Moment in Psychotherapy and Everyday Life. Norton: New York.
Van der Hart, O., Nijenhuis, E., and Steele, K. (2006) The Haunted Self: Structural dissociation and the treatment of chronic traumatisation. Norton: New York.

36. from Jim Kepner