Continuity and Discontinuity: cognitive science and psychotherapeutic perspectives'

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Continuity and Discontinuity cognitive science
and psychotherapeutic perspectives.

• Isabel Clarke
• Consultant Clinical Psychologist.

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What I hope to cover

• Outline the discontinuity hypothesis
• Ground this in cognitive theory
• Implications for therapy
• Third Wave Cognitive therapy
• my additions to CBT for psychosis
• Wider Vision of the person

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Instead of psychosis and spirituality, I propose
two ways of operating in the world

• The everyday
• The transliminal
• Both of these are available to all human beings.
• THE DISCONTINUITY exists between these two
  states.

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The Everyday TheTransliminal

• Ordinary
• Clear limits
• Access to full memory and learning
• Precise meanings available
• Separation between people
• Clear sense of self
• Emotions moderated and grounded

• Numinous
• Unbounded
• Access to ordinary knowledge/memory is patchy
• Connections abound - or all is meaningless
• Self lost in the whole or supremely important
• Emotions swing between extremes or absent

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Looking at this cognitively

• Two complementary approaches
• Kellys Personal Construct Theory
• Interacting Cognitive Subsystems (Teasdale and
  Barnard).

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Constructs

• Are based on past experience/memory
• New experience is filtered through our constructs
• They colour and help to define our world
• Each persons construct system is unique to them.

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Transliminal Experience operating Beyond the
Construct System

• No means of anticipating or discriminating
• A state without boundaries
• Both/and - two contradictory things can be
  simultaneously valid

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Beyond Constructs and Boundaries

• Liberating ecstatic one with the universe
• BUT
• Mind is no longer private
• Open to any influence or insertion
• Loss of the construct safe/dangerous - danger
  can come from anywhere.
• The boundary between inner and outer is lost.

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Interacting Cognitive Subsystems Teasdale
Barnard 1993.

• An information processing model of cognition,
  developed through extensive research into memory
  and limitations on processing.
• 9 subsystems, each with its own type of coding.
• Some deal with sensory perception - auditory and
  visual
• Some deal with language processing
• There are two higher order systems the
  propositional and the implicational.

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Interacting Cognitive Subsystems Teasdale
Barnard 1993.

• An information processing model of cognition,
  developed through extensive research into memory
  and limitations on processing.
• 9 subsystems, each with its own type of coding.
• Some deal with sensory perception - auditory and
  visual
• Some deal with language processing
• There are two higher order systems the
  propositional and the implicational.

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Interacting Cognitive Subsystems.
Body State subsystem

Implicational subsystem
Auditory ss.
Implicational Memory
Visual ss.
Verbal ss.
Propositional subsystem
Propositional Memory
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Important Features of this model

• Our subjective experience is the result of two
  higher order processing systems interacting
  neither is in overall control.
• Each has a different character, corresponding to
  hot and cool cognition.
• The IMPLICATIONAL Subsystem manages emotion and
  therefore relationship.
• Presumabley, the verbal, logical, PROPOSITIONAL
  ss. gives us our sense of individual self.

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Two Ways of Knowing

• Good everyday functioning good communication
  between implicational/relational and
  propositional
• At high and at low arousal, the relational ss
  becomes dominant
• This gives us a different quality of experience
  one that is both sought and shunned.
• Managing that good communication is key
  Teasdale was a pioneer in introducing Mindfulness
  to CBT.

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I suggest

• Both ways of encountering reality are equally
  valid
• Both are intrinsically incomplete
• Human beings have always honoured the
  transliminal
• Made space for the sacred.

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Advantages of this model

• It clarifies the characteristics of the
  transliminal
• both/and, not either/or
• paradox
• numinosity
• It brings psychosis into the realm of universal
  human experience
• It helps to explain common psychotic experiences,
  such as
• thought insertion
• distortions in the sense of self
• It raises interesting questions around scientific
  enquiry into the transpersonal.

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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 persons
  relationship to both thought and feeling
• Mindfulness is a key component.
• Role of mindfulness in managing the threshold
  between the two ways of knowing.

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Third Wave term coined by Hayes (Acceptance
Commitment Therapy)

• Kabat-Zinn. Applied mindfulness to stress and
  pain.
• Segal, Teasdale Williams. Mindfulness Based
  Cognitive Therapy (relapse in depression.)
• Linehan. Dialectical Behaviour Therapy (BPD)
• Chadwick. Mindfulness groups for voices.
• Hayes

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Parallel Developments in other modalities

• Bateman and Fonagy Mentalisation. Promotes
  theory of mind,collaboratively and through skills
  training.
• Developments in Cognitive Analytic Therapy for
  severe personality disorders.

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DIALECTICAL BEHAVIOUR THERAPY Linehans STATES
OF MIND

• EMOTION
• MIND

REASONABLE MIND
WISE MIND
IN THE PRESENT IN CONTROL
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Working with Psychosis using the Discontinuity
Model

• Managing arousal the transliminal is accessible
  at both high and low arousal
• Validate the experience
• Validate the feeling
• Persuasion to join shared reality
• Sensitivity normalisation based on Claridges
  work on schizotypy.

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The Relational Mind

• Developmentally, we make sense of ourselves only
  in relation to others.
• We grow, and are moulded, through relationship
  all relationship.
• The self sufficient, atomistic, mind is an
  illusion
• Our verbal, propositional ss. sets a limit on
  what we can know precisely
• We can reach out in relationship beyond that
  limit.

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Web of Relationships
In Rel. with earth non humans etc.
In Rel. with wider group etc.
primary care-giver
Self as experienced in relationship with
primary caregiver
Sense of value comes from rel. with the spiritual
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• Spiritual Crisis Network.
• www.spiritualcrisisnetwork.org.uk
• My website (publications)
• www.scispirit.com/Psychosis_Spirituality/
• Chris Clarke Ed.2005. Ways of Knowing science
  and mysticism today.  Exeter Imprint Academic.
  
• Clarke, I. Ed. (2001) Psychosis and Spirituality
  exploring the new frontier.  London Whurr.