Interpersonal Neuroscience - NT[1] · • Learning is self-directed and pacing is determined according to the individual time parameters/schedule of each participant. • With the

InterpersonalNeuroscience

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WelcometoLightUniversityandthe“InterpersonalNeuroscience”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onDVDandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,

RonHawkinsDean,LightUniversity


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TheAmericanAssociationofChristianCounselors

• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits30thanniversaryin2016.

• Known for its top-tier publications (Christian Counseling Today, the Christian CounselingConnectionandChristianCoachingToday),professionalcredentialingopportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounselingeducation, an arrayof broad-based conferences and live training events, radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode, and collaborative partnerships such as Compassion International, the AACC hasbecomethefaceofChristiancounselingtoday.

• The AACC also helped launch the International Christian Coaching Association (ICCA) in

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The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,and laychurchmemberswith littleorno formal training. It isourintentiontoequipclinical,pastoral,andlaycaregiverswithbiblicaltruthandpsychosocialinsights that minister to hurting persons and helps them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.


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TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).

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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly300,000

students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).

• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.

• Educational and training materials cover over 40 relevant core areas in Christian—

counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.

OurMissionStatement

TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.

AcademicallySound•ClinicallyExcellent•DistinctivelyChristian


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Video-basedCurriculum

• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.

• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.

• Learning is self-directed and pacing is determined according to the individual time

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Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.

Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.

Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.

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• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).

• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.

Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.

Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.


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Afterallquizzesaresuccessfullycompleted,a“PrintYourCertificate”buttonwillappearnearthetopofthecoursepage.YouwillnowbeabletoprintoutaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.


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Presenterfor



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PresenterBiographyGarySibcy,Ph.D.,isProfessorofCounselingintheSchoolofBehavioralSciencesandCenterforCounselorEducationandSupervisionatLibertyUniversity,whereheteachesdoctoralcoursesinadvancedpsychopathologyanditstreatment,empiricallysupportedtreatmentsforchildrenand adults, and attachment theory. He is a Licensed Clinical Psychologist (LCP), has been inprivate clinical practice formore than 20 years, and currentlyworks at Piedmont PsychiatricCenter.Dr.Sibcyspecializesinanxietydisorders,includingOCDandpanicdisorder,andchronicdepression in adults, as well as the diagnosis and treatment of children with severe mooddysregulation. He is currently developing an empirically supported treatment within theframework of interpersonal neurobiology and attachment theory. Dr. Sibcy has co-authoredseveralbookswithDr.TimClinton,includingAttachmentsandWhyYouDotheThingsYouDo.


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IntroductiontoInterpersonalNeuroscience

TableofContents: INS101:IntroductiontoInterpersonalNeuroscience..............................................................1GarySibcy,Ph.D.INS102:CorePrinciplesofInterpersonalNeuroscience..........................................................7GarySibcy,Ph.D.

INS103:PracticeModels:UnderstandingMemory,Depression,andAnxiety........................14GarySibcy,Ph.D.INS104:TheNeuroscienceofEverydayLife...........................................................................27GarySibcy,Ph.D.INS105:Greenspan’sIntegratedDevelopmentalModel........................................................33GarySibcy,Ph.D.INS106:TheSECUREModelofChange..................................................................................40GarySibcy,Ph.D.INS107:EffectiveEmpirically-supportedTreatmentsforDepressionPartI............................48GarySibcy,Ph.D.INS108:EffectiveEmpirically-supportedTreatmentsforDepressionPartII...........................56GarySibcy,Ph.D.INS109:TheNeuroscienceofTraumaandRecovery:Trauma-relatedDisordersandanOverviewofEffectiveTreatments..........................................................................................63GarySibcy,Ph.D.INS110:AntidotetoTraumaI:DistressToleranceandAffectRegulation...............................72GarySibcy,Ph.D.INS111:AntidotetoTraumaII:CognitiveandEmotionalProcessingInterventions................79GarySibcy,Ph.D.INS112:AntidotetoTraumaIII:EnhancingIdentityandStrengtheningRelationships...........86GarySibcy,Ph.D.NOTE:SomeofthevideosinthiscoursewereoriginallyrecordedaspartoftheAACCChristianCounselingBestPractices2.0Series.Therefore,youmayhearDr.Sibcyattimesrefertothelecturesasathree-partseries.Thiscourseisa12-hourexpansionofthepreviouslyrecordedthree-hourcourse.


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INS101:

IntroductiontoInterpersonalNeuroscience

GarySibcy,Ph.D.


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Summary

Neuroscienceisacomplexandsometimeschallengingtopicofdiscussion.Therearenumerous

facets and functions related to the neurobiological systems in the human body and many

individuals have developed theories and ideas to help explain these complexities in better

detail. In this presentation, Dr. Sibcy discusses the development of neurobiology from the

understanding of interpersonal communications and functions in the body. Interpersonal

neuroscienceinvolvesthemind,brain,andself,orrelationshipswithothers.JoinDr.Sibcyashe

explains two important theories that intertwine neurobiological systems and allow them to

worktogetherasone.

LearningObjectives

1. Participantswill discuss how attachment and relationships affect the development of

interpersonalneuroscience.

2. ParticipantswillidentifySiegel’sTriangleofWell-Beingandhowitbringsunderstanding

tointerpersonalneuroscience.

3. ParticipantswillexploretheRiverofConsciousnesstheoryandhowitcreatesauseful

workingmodelforinterpersonalneuroscience.


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I. Introduction

A. TwoMainQuestions:

1. Whydowedothethingswedo?

2. Whatistheroleofthebodyinrelationshipsandspirituality?

B. AttachmentisTiedtoNeurobiology

C. GrowthPathways

D. HelpingOthersChange

E. ScripturalContext

II. IntroductiontoNeurobiologyandNeuroscience

A. Siegel’sTriangleofWell-being

1. Threebasicconstructs–brain,mind,andrelationships

2. Bylearningtothinkdifferently,wecanchangethebrain.

3. Howrelationshipsaffectthebrainandmind


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B. TheRiverofConsciousness

1. Distinctionbetweentheselfandthebrainandthemind

2. Thebrainisanorgan–itisnotwhoyouare.

3. Differencebetweenhavingathoughtandthinking

• Thinkingissomethingyouvolitionallydo.

III. InterpersonalNeurobiology

A. Theory

1. Applyingtheory

2. Biblicalworldview

B. DanSiegel’sTriangleofWell-being

1. Mind–Brain

• BrainchangescanleadtoMindchanges

o Diet

o Exercise

o Medication

o ChangeYourBrain,ChangeYourMind–DanielAmen,Ph.D.

• TheMindcanaffecttheBrain

o TrainYourMind,ChangeYourBrain–SharonBegley

o Neuroplasticity

• StudyatUCLA

o ChangesinthecircuitsasafunctionofCognitiveBehavioralTherapy


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• StudyatSouthClevelandHospital

o TreatingdepressionwithInterpersonalTherapyandantidepressants

• StudyatUniversityofToronto

o CognitiveTherapy(topdown)versusantidepressantuse(bottomup)

o Notcompetingtherapies;theyinfluenceoneanother.

• RelationshipsaffectboththeBrainandtheMind

2. Mind

• Anembodiedprocessthatregulatestheflowofenergyandinformation

o Energy=thephysicalpropertiesthatpropelustotakeaction

o Emotion=anactionpotential;energy

o Information = is the representation of something other than itself (e.g.

wordsandideas)

3. Brain

§ Theneurocircuitry throughwhich energy and information flow– concentrated

primarilyinthehead,butextendsthroughtheentirebody.

• Thegutcontainsalltheneurochemistrythatresidesinthebrain.

4. Relationships

• Howenergyandinformationissharedasweconnectandcommunicatewithone

another

• Relationshipsareco-regulatorsofenergyandinformation.

o Examplesofhowtherapistscanusethetherapeuticrelationshiptohelp

transformother’smindandbrain

o 1Corinthians12:12


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C. TheRiverofConsciousness

1. Mind-Brain-Self

• Mindisintheflowoftheriver.

• Selfhastheabilitytoobserve,describe,evaluate,reflect,andusethecontentof

themind.

o Selfusesthebraintocarryoutcertainfunctions.

• Brainisconstantlyprocessinginformationautomatically

o Processinginformationfromtheenvironment

o Processinginformationthroughpastexperience(schema)

o Processinginformationfromthebody

o As a result of processing information, the brain produces thoughts,

feelings,images,andsensations;memories.

o Theselfcanobserveanddescribethis.

o Psychopathology iswhen the Self confuseswhat is flowing through the

streamofconsciousness.

2. Youarenotyourthoughts.

3. Youarenotyourbrain.

4. Thoughtsdonotcontrolordefineyou.

• Redirectingthoughtsintotherealworld

IV. Conclusion

A. TherapeuticRelationships

B. TheRiverofConsciousness


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INS102:

CorePrinciplesofInterpersonalNeuroscience

GarySibcy,Ph.D.


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SummaryDespite the complexities of neuroscience, there are certain core principles that can be

discussedinordertograsptheinnerworkingsofthemind,brain,andself.Dr.Sibcyusesthis

lecture to introduce newpieces of theories and build on those already discussed, aswell as

provide some basic principles that help shape one’s understanding of neuroscience. This

presentationwillfurtherdiscusshowtheneurobiologicalsystemdevelops,grows,andchanges

throughoutlifeandlifeexperiences.Learnerswillalsodiscoverwhatahealthyneurobiological

systemconsistsofandhowtousetheseprinciplesintherapy.

LearningObjectives

1. ParticipantswilldiscussaGeneralSystemsTheoryandothersupportingideasinvolving

thedevelopmentoftheneurobiologicalsystem.

2. Participants will explore the important role of neuroplasticity in neurobiological

development.

3. ParticipantswillidentifyahealthyneurobiologicalsystemthroughtheFACESmodel.


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I. Introduction

A. ZoneofProximalDevelopment

1. Changerequireschallenge.

2. Therapist’sjobtochallengeclients

B. FACES

1. Adaptability

C. Coherence

1. Attachment

D. Energy

1. Findingmeaningandpurpose

2. Spiritualimplications

II. CorePrinciplesofNeurobiologyandNeuroscience

A. GeneralSystemsTheory

1. Undifferentiated

• Millionsofundifferentiatedcellsthatarenotdividedintogroups

2. Differentiated

• Separate/individuatedwithspecializedfunctionsandsovereignty


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3. Integration

• Linkedtogether,butretainsseparatenessinspecializedfunctions

4. SoccerAnalogy

5. TherapeuticExamples

• Situation

• Feelings

• Thinking

• Behavior

B. PrinciplesofGrowth

1. Vygotsky’sZoneofProximalDevelopment(ZPD)

• Supportthesystem.

• Challengethesystemtogrow.

2. Perturbation,Disturbance,Disorder

• Perturbationisnotchallengingenough.

• Disorderistoomuchchallenge.

• Disturbanceisgoodmiddle-ground.

o Resttime

3. Specificity

4. Findingbalanceofacceptanceandchange


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C. TheConceptofNeuroplasticity

1. Thebrainisanopen,notclosed-offsystem.

2. Referstohowenvironmentbecomesincorporatedintothebrainstructure.

3. Mirrorneurons

4. Environmentinfluencesgenetictranscriptionandmyelinationprocess.

5. How the brain can change its structure in order to adapt to the environment is

crucial.

D. CoreConceptsofBrainDevelopment

1. EnrichedEnvironments

• Safe,secure,andstimulating

2. LearningandaLevelofStress

• SurmountableEmotionalObstacles

3. Effectivetherapycreatesintegrativelinks.

E. TheHebbianPrinciples

1. Neuronsthatfiretogetherwiretogether.

2. Gettingneurons involved inemotion to connectwithneurons involved in thinking

andfeeling


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F. DanSiegel

1. SnaggingtheBrain

2. StimulatingNeuronalActivationandGrowth

G. CharacteristicsofWell-FunctioningSystems:FACESFlow

1. FlexibleSystem

2. AdaptiveSystem

3. CoherentSystem

4. Energized

5. Stability

H. Siegel’sRiverofIntegration(FACES)

1. ChaosandRigidity

2. ExampleofPTSD

3. ExampleofDepression


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III. Conclusion

A. SystemGrowth

1. Changerequireschallenge

B. FACES

C. Application


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INS103:

PracticeModels:UnderstandingMemory,Depression,andAnxiety

GarySibcy,Ph.D.


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SummaryThis presentation is unique in length and topics covered, as considerable information is

included inthisone lecture.Althoughthe lecture itself isdivided intothreecomponents, this

presentation flowsasone. Learnerswillhave theopportunity to learnagreatdeal regarding

theneurobiologicalsystemthroughthislesson,particularlyintheareaofapplication.Dr.Sibcy

beginsbydiscussingingreatdetailthedevelopmentofthebrainbytakingacloselookatthe

differentpartsresponsibleformuchoftheneurobiologicaldevelopment.Understandingwhere

the brain regulates both emotional and physical signals is imperative to this topic. Dr. Sibcy

thendiscussesthetwotypesofmemoryandtwotypesofattentionandhowthesebrain/mind

functionsaffecttheneurobiologicalsystem.Thelectureendswithathoroughapplicationofthe

principlesdiscussedtoparticulartherapeuticsituations,suchasanxietydisordersandchronic

depression.

LearningObjectives:

1. Participantswill identifypartsof thebrain responsible forneurobiologicalgrowthand

development.

2. Participantswillexplorethetypesofmemoryandattentionusedbytheneurobiological

system.

3. Participantswilldiscusshowtheinformationlearnedregardingneurosciencecanaidin

treatingclientssufferingfromanxietydisordersandchronicdepression.


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I. Introduction

A. BrainFormation

1. Autonomicnervoussystem

2. LimbicSystem

3. PrefrontalAreasoftheBrain

B. KindsofMemoryandAttention

C. ApplicationsforAnxietyandDepression

II. BrainDevelopment

A. AreasoftheBrain

1. BrainStem

• HousesSympatheticandParasympatheticSystems

• BalanceActivationandRegulationofthePhysicalstructures

2. LimbicSystem

• RegulatesEmotionalstructures

• Encodesimplicitmemoriesandcoreschema/workingmodels

o Amygdalalabelsincomingstimulifromtheexternalworldandthebody.

o Hippocampuscovertsmemoryintolong-termmemory

3. PrefrontalCortex

• Focusesattentionontheexternalworldandtheinnerworkingsofthebrain

• VerticalOverride


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B. HowtheBrainGrows

1. Fromthebottomtothetop

2. Fromtherighttotheleft

3. Experiencesformtheexternalworldandattachment

C. Integrated,RegulatedBrain

1. Finding thezone–What in theenvironmentandrelationshipscreates thecontext

forneuro-circuitstowiretogether?

• Support–safeandregulated

• Challenge–emotionalactivation

o HebbianPrinciple

• Think–label,communicate,problemsolve

• Relate–attend,backandforth,collaborative

D. TheRoleofExperience

1. Brainwiresitselfbasedonexperience.

2. Asksthesequestions:

• Istheworldasafeplace?

• CanIcountonmycaregiver’stohelpmeintimeofneed?

• CanIgetthecareIneedwhenIneedit?

3. Highlystressfulearlyenvironmentssettheautonomicnervoussystemonhighalert

(sympatheticallydominant).


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4. Safe environments set the autonomic nervous system to a parasympathetically

dominantmode(calm,relaxed,focused,curious).

E. VerticalIntegration

1. Nervous system ascends from the bottom (our bodies and gut) to the top (brain

stem,limbicsystem,prefrontalcortex).

2. Vertical integration is about linking these different areas together, bringing bodily

sensationupintoawareness.

F. LimbicSystem

1. EmotionalControlCenterintheBrain

2. Encodesemotionallychargedexperiences

3. Formingofkeymentalmodels/schemasabout

• Self

• Others

• World

4. ConditionedemotionalResponses

5. Associativelearning

6. Transference


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G. PrefrontalCortex

1. Themiddleprefrontalcortex

• Anteriorcingulate

• Orbitalprefrontalcortex

• Themediateprefrontal

• Ventrallateral

2. NinefunctionsoftheMiddlePrefrontalCortex(linkedtoAttachment)

• Bodyregulation

• Attunedcommunication

• Emotionalbalance

• Responseflexibility

• Insight

• Empathy

o Theoryofmind

o Mindsight–mentalization

• Fearmodulation

• Accessingintuition

• Morality

III. MemoryandAttention

A. TwoKindsofMemory

1. ImplicitMemory

• Mostbasicformofmemory

• Presentatbirth

• Includesbehavioral,emotional,perceptual,body

• Associativelearning

• Mentalmodels–whenstatesbecometraits


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• Consciousattentionnotrequiredforencoding

• Nosenseofrecollectionwhenmemoriesrecalled

• Doesnotinvolvehippocampus–mostlyamygdala

• TheroleofPriming

2. ExplicitMemory

• Encodingrequiresconsciousattention

• Emergesinthesecondyearoflife

• Senseofrecollectionwhenrecalled

• IncludesSematic(factual)andEpisodic(autobiographical)

o Ifautobiographical,senseofselfintime

o Narrativememory

o Involveshippocampus–convertstocontext

• Ifautobiographical,itinvolvestheprefrontalcortex

B. TwoKindsofAttention

1. Nonfocal

• Amygdaladriven

• Warnsofdanger

• Leadstoimplicitmemory

2. Focal

• PrefrontalCortexDriven

• Focusesonthepresent

• Leadstoexplicitmemory


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3. ApplicationtoHappinessResearch

• Happinessisrelatedtoaperson’sabilitytoanchortheirattentioninthepresent

moment

• Particularlyimportantwhendealingwithclientswhostrugglewithanxiety

IV. ApplicationofInterpersonalNeurobiologytoAnxietyDisorders

A. RespondWelltoExposure-BasedCognitiveTherapy

B. TriangleofAnxiety

1. Physical

• AutonomicNervousSystem

• PhysicalSymptoms

2. Thinking

• CatastrophicThinking

• AmygdalaDriven

3. Behavior

• SafetyBehaviors

• AvoidanceBehaviors

C. TheUseofTherapytoTreatAnxiety

1. Step1:Teachmildrelaxationandbreathingtraining

2. Step2:CognitiveRestructuring

3. Step3:TargetSafetyandAvoidanceBehaviors


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D. CoreofTreatment

1. Helpingclientsbehaveoppositeofhowtheyfeel/thinkofthesituation

2. FearLadder

• SUDS=SubjectiveUnitofDistress

o 0-3=milddegreeofanxiety(10%)

o 4-7=moderatedegreeofanxiety(50%)

o 8-10=severedegreeofanxiety(0%)

3. WorryHill

• On-screenillustration

• Habituation

V. Application of Interpersonal Neuroscience to Early Onset Chronic

Depression

A. PsychosocialProfile

1. Historyofearly–sometimescomplex–relationshiptrauma;attachmenttrauma

2. RelationshipTrauma–continuousseriesof“lowgrade”trauma

• Psychologicalinsults,putdowns,interpersonalrejection/punishment

3. Combinedwithoneormore“highgrade”traumas

• Physical/sexualabuse,actualparentalabandonment,emotional/physicalneglect

4. Neurocognitivedeficits,pre-operationalthinking,apre-causalviewoftheworld

5. Learnedhelplessness(lowinternallocusofcontrol)


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6. Chronicmooddysregulation

• Doesnotrespondtoinformation/disputation/insight/cognitiverestructuring

7. Behavioralshut-down

8. Ineffective,self-defeatingpatternsofsocialbehavior

9. SubmissiveIPstyle

• Pulls therapist into dominant role, recapitulates previous relationships,

helplessness

B. Therapy

1. LearnClientHistoryofRelationships

• TheSelfisassociatedandlinkedtoexperiencewithrejection,criticism,betrayal,

abuseofothers

• Implicitmemory

• Leadstoanxiety,shame,andguiltfortheneeds,wants,feelings,andopinionsof

theself

• Leadstoavoidingfeelings,worthlessnessandhelplessness

C. LearnedHelplessness

1. Leadstoshutdownofenergy,motivation,andpleasure

• Thesecognitionsleadtobehaviorchanges

2. ActivatesAutonomicNervousSystem

• Survivalmode,fight-flight,on-edge


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D. EmotionDysregulation

1. AvoidanceBehavior

2. Dissociation

3. TensionReductionBehaviors

E. AvoidanceBehaviors

1. Stopengaginginmasterybehaviorsandpleasurebehaviors.

2. Brainstopsproducingneurochemistry

3. Leadstomorelossofenergyandmotivation

4. Reinforceshelplessness/worthlessness

5. Leadstomoreavoidancebehavior

F. EmotionDysregulation

1. Tensionreductionbehaviors:

• Self-mutilation

• Sexualactingout

• AddictiveBehavior

• SuicideFantasy


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G. NeurocognitiveConsequences

1. The neurobiological consequence of chronic emotion dysregulation is the

disintegrationofdendriticconnectionsbetweenPFCandvarioussubcorticalsystems

inthelimbicsystem,includinghippocampus.

2. Degeneration of middle frontal areas of the brain and hippocampus leads to

impairedabilitytoattendtoandcontextualizingrelationshipevents.

• Consequently,personrelatesinmindlessfashion,repeatingsameoldpatternsof

relationshipexperiences–“InterpersonalSameness”

• Confirmsfeelingsofhopelessnessandhelplessness

3. This interferes with the brains ability to form autobiographical memory and the

neurocognitivedeficits.

4. These neurocognitive deficits are similar to deficits described in other research,

includingTheoryofMind,Mindsight,andMentalization.

5. AlsosimilartoPiagetianconceptofpreoperationalfunctioning:childlikeego-centric

patternofthinkingwheretheindividualisnotinfluencedbyexternalenvironment

6. Failure of Perceptual Engagement – visually disengaged from social environment,

using past experience to interpret presentmoment, thus creating the past in the

present–continuousinterpersonalsameness

H. Securevs.InsecurePatterns


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I. Self-DefeatingPatternsofInterpersonalBehavior

1. Fail tounderstandhowtheyaffectothersandactually “pull”others intobehaving

exactlythewaytheyexpectotherstobehave

2. Theyusethepasttointerpretthepresent

3. Youkeepgettingthepastinthepresent

4. Recapitulationofpastincurrentrelationshipexperiences

VI. ConclusionA. BrainDevelopment

B. MemoryandAttention

1. AdultAttachmentInterview

C. ApplicationinTherapy


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INS104:

TheNeuroscienceofEverydayLife

GarySibcy,Ph.D.


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SummaryWe are not our thoughts, yet sometimes it is hard to separate ourselves from what runs

throughourminds.Inthispresentation,Dr.GarySibcypaintsaneasy-to-understandpictureof

howyourthoughtsareprocessedinyourbrain.Therelationshipbetweenthebrainandvarious

mentaldisorderscanbedifficulttounderstand,butDr.Sibcybringsclarityandunderstanding

totheissuesofpanicdisorder,post-traumaticstressdisorder,anger,anddepression.

LearningObjectives

1. Participantswillgainathoroughunderstandingoftherivermetaphor.

2. Participants will explore the relationship between the brain and various mental

disorders.

3. Participantswillbeabletoapplytherivermetaphortotheirdailylives.


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I. TheRiverMetaphor

A. Thoughts

B. Images

C. Feelings

D. Sensations

E. YouareNotYourThoughts!

II. TheBrain

A. BrainHemispheres

1. Left:Logical,verbal,analytical

2. Right:Emotional

B. TheBrainStem

1. Autonomicnervoussystem

2. Thegaspedal


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C. TheLimbicSystem

1. Amygdala

2. Labelsexperiences

D. ThePrefrontalCortex

1. Servesasago-between

2. Orientsyoutoreality

E. TheWholeBrain

1. Worksbestasateam

2. TimeTravel

III. TheBrainandDisorders

A. PanicDisorder

1. Thebrainevaluatesthepresentinlightofthepast.

2. Thelimbicsystemreliesonreal-worldexperienceratherthanlogic.

3. Oncedesensitizationoccurs,thealarmsystemturnsoff.


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B. Post-TraumaticStressDisorder

1. Fearofmemoriesratherthanfearofactualevents

2. Thebrainisameaning-makingorganthatattemptstomakesenseofexperiences.

3. Whenwords are put to emotions, it creates an autobiographical narrative out of

shatteredmemoriesandallowsthebraintomakesensetheexperience.

4. Talking through the memories in a safe, therapeutic environment can bring

resolution

5. PTSDisn’tnecessarilyabrokenbrain,itisabrainthatistryingtoheal.

C. Anger

1. People who struggle with anger get stuck inside their heads thinking about the

wrongsthathavebeendonetotheminthepastandthewrongsthat theyexpect

willbedonetotheminthefuture.

2. Itisimportanttodistinguishbetween“shouldville”and“realville.”

D. Depression

1. Whenpeoplearepronetodepression,andtheyexperiencestressful lifeevents, it

triggersthebraintogointoashutdownmodethatturnsoffenergy,motivation,and

pleasure.


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2. Helppeoplegetbackintodailyactivitiesandoutintolife–oncethebrainrecognizes

that they need energy and motivation, it will begin to recreate that kind of

chemistry.

3. Changecancomefromtheinsideout


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INS105:

Greenspan’sIntegratedDevelopmentalModel

GarySibcy,Ph.D.


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Summary

In this two-part lecture, Dr. Sibcy will focus first on the concept of developmental

psychopathology as a metatheory, with a special emphasis on developmental pathways,

multifinality,andequifinality.Inthesecondhalfofthepresentation,hediscussesGreenspan’s

structural development model, known as the Developmental, Individual Differences,

Relationship-based Approach (DIR). Development refers to the six core social-emotional

processes thatunfold in the first four to fiveyearsof lifeandhow theseprocesses form the

foundationofone’sselfexperiences.

LearningObjectives

1. Participantswill exploredevelopmentalpathwaysandhowthesepathwaysadaptand

shiftovertime.

2. ParticipantswillexploretheworkofStanleyGreenspanandhowhistheoriesimpactan

understandingofinterpersonalneuroscienceandattachment.

3. Participantswilldiscoverthesixcoresocioemotionalprocessesofdevelopment.


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I. Introduction

A. DevelopmentalPsychopathology

1. Ametatheory:Notatheorythatcompeteswithothertheories,itstandsaboveother

theoriesandhelpsusmakesenseofthem.

2. People develop morally, cognitively, emotionally, with gender and sexual

orientation,withhowtheirattachmentandhowtheyformrelationships,withtheir

senseofself;theyallinfluenceoneanother.

3. Spirituality,not justanother singularpartofdevelopment,but ratherhowwell all

thesepartsworktogether.

• Forexample, thinkofabasketball team.Spirituality in thissensewouldnotbe

oneplayerandwellheplays,buthowwellthewholeteamplaystogether.

4. Beingmoredevelopedinoneareadoesnotnecessarilymeanonewillbedeveloped

inanotherorallareas.Forexample,justbecausesomeonemightcognitivelyhavea

great amount of theological knowledge, he or shemight not necessarily have the

mostdevelopedsenseofmoralityorattachment.

5. The environment also plays a part in development. Different areas are arranged

hierarchically;family,society,culture.

B. Pathways

1. Equifinality

• Multiple possible causes, or pathways, for a disorder. For example, childhood

sexual abuse, ADHD, and emotion dysregulation can all be possible causes for

borderlinepersonalitydisorderlaterinlife.


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2. Multifinality

• Acausecanhavemultipleoutcomes,orpathways.Forexamplechildhoodsexual

abusecanhavemultipledifferentoutcomes.

C. Continuity

1. Homotypic(fairlyuncommon)

• Theideathatthingsthatthatareorganizedatonelevelwilllookexactlythe

sameovertime.

• Asmallchildcryingatthedoorwhenaparentleaves.Itwouldbevery

uncommonforthatbehaviortolookthatsameinadulthood.

2. Heterotypic

• Theideathatthingsthatareorganizedatonelevelwilllookdifferentlyover

time,buthavesimilarunderlyingfactors.

• Insteadofcryingatthedoorwhenaspouseleaves,likeachildwouldataparent

leaving,anindividualwithaninsecureattachmentstylemightbecomebitterata

spousewhohastogooutoftown.

D. Time

1. Chronologicalstagesvs.developmentalstages

2. Transitionpoints

3. Lookingatstressintermsofwhatstageinwhichitoccurs

4. Criticalperiodsandsensitiveperiods

• Criticalperiodsaretheonlytimesinwhichtolearnsomething

• Sensitiveperiodsarethebesttimesinwhichtolearnsomething


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E. PrinciplesofGeneralSystemsTheory

1. Reductionismvs.Holism

2. Feedbackloops

3. Interactionandemergence

4. Hierarchicalregulation

5. Co-regulation,dyadic

6. Undifferentiated,differentiated,integrated

• Psychotherapyasintegrativelinks

7. Perturbation,disturbance,disorder

8. Vygotsky’sZoneofProximalDevelopment

• Scaffolding

II. TheWorkofStanleyGreenspan

A. ThreeInteractiveDomains(DIRmodel)

1. Developmental

2. IndividualDifference

3. Relationship


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B. NewInsights

1. Language,cognition,emotionregulation,andsocialskillsarealllearnedthrough

interactiverelationships—affectiveinterchanges.

2. Relationshipqualitiesneededinorderforthebraintodevelop.

• Warmthandsecurity

• Regulated

• Relatednessandengagement

• Back-and-forthemotionalsignalingandgesturing

• Problem-solving

• Usingideasinameaningfulandfunctionalway

• Thinkingandreasoning

3. Individualdifferenceorvariationsexistinunderlyingmotorandsensoryprocessing

(orregulatorycapacities).

• Auditory/linguisticprocessing

• Visual/specialprocessing

• SensoryModulation

• Motorcoordination

4. ANewRoadmapofFunctionalEmotionalDevelopmentalCapacities

• Alllinesofdevelopment:emotional,cognitive,social,linguistic,motor,etc.are

linkedandworktogetherasanintegratedteam.

• Assessmentofdevelopmentneedstonotonlyassessindividuallinesbuthow

wellthe“team”workstogether.


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C. Development:SixCoreSocial-EmotionalProcesses

1. Regulationandsharedattention

2. Engagementwithwarmth,trust,intimacy

3. Two-waypurposefulcommunication

4. Interactiveproblem-solving/useofgesturesincontinuousflow

5. Functionaluseofideas

6. Buildingbridgesbetweenideas


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INS106:

TheSECUREModelofChange

GarySibcy,Ph.D.


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Summary

Abasicunderstandingof interpersonalneurosciencecanbepersonallytransforming,andalso

have a significant impact on the lives of clients and one’s counseling practice. In this

presentation,Dr.Sibcydefinesthefoundationforinterpersonalneuroscienceanddiscussesthe

SECUREModelofChange.Eachelementofthismodelplaysakeyroleinthehealingprocess,

yet counselors need to recognize the sequence and duration of each step. In today’sworld,

there is an ever-increasingneed for anunderstandingof interpersonal neuroscience and the

changethatapplyingtheseconceptscanbringtothelivesofthosewhoarestruggling.

LearningObjectives

1. Participantswill delve into the topic of interpersonal neuroscience and explore some

foundationalinformationandbackgroundelements.

2. Participantswillbeexposedtothepyramidofinterpersonalrelationshipsandbeableto

usethismethodtohelptheirclientsevaluatetheirrelationships.

3. Participants will analyze each of the six steps of the SECURE Model of Change and

understandhowtoimplementthemintheirlivesandinthelivesoftheirclients.


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I. TheSECUREModelofChange

A. TheTriangleofWell-being

1. Themindisanembodiedprocessthatregulatestheflowofenergyandinformation.

2. Thebrainisthecircuitrythroughwhichenergyandinformationflow.Changesatthe

brainlevelcanimprovethemind,butchangesatthemindlevelcanalsochangethe

brain.

3. Relationshipsmatter.Thetherapeuticrelationshiphasspecificqualitiesandpowers

thatcanchangethemindandthebrain.

B. BackgroundElementstoConsider

1. Inordertocookwell,youneedtoknowwhatingredientstouse,theorderinwhich

tousethem,andhowmuchheattouse.Similarly,goodcliniciansneedtoknowhow

andwhentouseeachelementoftheSECUREModelofChange.

2. Christiancounselorsneedtotakeintoaccounttheworkof theHolySpirit intheir

ownlivesandinthelivesoftheirclients.

3. Counselors need to understand the role ofattachment. There is almost a 75-80%

overlapbetweenamother’sattachmentstyleandherchild’sattachmentstyle.

4. Understandingyourownbackground is fundamental.Goduses thewoundsofour

livestoaccomplishHisends.

5. Takecareofyourself–don’toverdo itandovercommityourselfbeyondwhatyou

canrealisticallyhandle.


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II. TheIngredientsintheSECUREModelofChange

A. Safety

1. Asafe,therapeuticrelationshipisakeytochange.

2. Differenttheoristshavereferredtothisconceptbydifferentnamesacrosstheyears.

• TheSafetyZone

• SecureBase

• TheHoldingEnvironment

• Container

3. Safetyalsoreferstothetherapeuticalliancebetweenthecounselorandthepatient.

4. Thekindofinformationyougather,theassessmentsyouuse,andthegoalsyouset

canalsohelppromotesafety.

B. Education

1. In order for individuals to change, theyneed to understandwhy they feel poorly.

Educationcanbethetoolthatenlightensthem.

2. This isalsoreferredtoasneuroempathy,which ishelpingclientsunderstandtheir

problemsandhowtheproblemsaffecttheirneurobiology.

3. Education also includes teaching clients new skills to counteract these problem

areas.

4. Counselors can help clients work through things one step at a time, using new

educationaltoolsandstrategies.


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III. ThePyramidofInterpersonalRelationships

A. “A”LevelRelationships

1. “A”levelrelationshipsaretheclosestrelationships.

• Family

• Romanticrelationships

• Friends

2. Theseareattachmentrelationshipsandarethereforeatthetopofthehierarchy.

• Exclusive

• Trustworthy

• Reliable/Reliablyaccessible

• Willingness

3. Aspouseorfamilymemberisnotautomaticallyincludedinthe“A”level.

4. Findoutwhofitsinthe“A”category.

B. “B”LevelRelationships

1. Theserelationshipsoccurwhenyoudothingswithpeople.

• Activities

• CommonInterest

• Recreational

• Hobbies

2. Whenyoufindpeopletodothingswith,theybecome“B”friends.


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C. “C”LevelRelationships

1. “B”scomeoutofthe“C”pool.

2. Thesearepeoplewhoareacquaintancesbutnotonapersonallevel.

D. ConfusingtheRelationships

1. Problemsarisewhenpeopleapply“A”levelcriteriato“B”levelfriends.

2. Thisisparticularlythecasewhenapersonisdepressed.

3. Thischarthelpspeopleevaluatethequalityoftheirrelationships.

4. Thefirststepistoget“C”sinto“B”sfromthere,workon“A”levelrelationships.

5. “A”levelrelationshipsaredifficulttoacquireandmaintain.

IV. TheSECUREModelofChange

A. Education(Continued)

1. Yourmindandyourbrainaredifferent.

• Youarenotyourbrain.

• Youarenotyourthoughts.

2. Thebrainstoresthoughtsandtheycanberetriggered,butthekeyistorealizethat

thoughtsarejustthoughtsandyoucanletthemgo.


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B. Containment

1. Therapy creates safety, but it also turns up the heat to create challenge.

Containment is about creating a balance between emotional activation and

emotionalregulation.

2. Thegoalistogetpeopleintoacertaintherapeuticwindow.

3. Patterns of thinking, acting, and relating lie dormant until they are activated by

stress.Oncetheyareactivated,theycanberestructuredandreformatted.

4. Thetherapeuticwindowiswherethereistherightamountofemotionalactivation

to teach people new skills and modify implicit relational beliefs they hold about

themselvesandothers.

5. Containment also deals with how we deal with ruptures in the therapeutic

relationship.

C. Understanding

1. Clients need to understand how to resolve conflict and issues that will inevitably

arise.

2. The patterns of thinking, feeling, and relating that have been learned in previous

relationshipsmayneedtoberestructured.Thiscanbedonethroughthetherapeutic

relationship.


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D. Restructuring

1. Thislooksatschemareconstructionandisaveryintentionalprocess.

2. The goal is to help people restructure their self-defeating patterns of thinking,

relating,andfeeling.

3. Restructuring also includes fostering forgiveness and giving up the right to blame

othersand“geteven.”

4. Anger shutsdown thebodyand turnsoff energy andmotivation. Forgiveness can

releasethebodyfromthoseforces.

E. Engagement

1. Engagement involves helping people get into their interpersonal world and get

connectedmoredeeplytothosearoundthem.

2. Sometimes, for people to make changes in their lives, they must face other

outcomesthattheyaretryingtoavoid.

3. Paradoxicalcost-benefitanalysiscanbeahelpfultooltouse.

4. Client-therapistempathycanbeveryimportant.

5. The client needs to learn how to anticipate and deal with relapses and how to

overcomelapsesinthetherapeuticprocess.


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INS107:

EffectiveEmpirically-supportedTreatmentsforDepressionPartI

GarySibcy,Ph.D.


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Summary

Major Depressive Disorder is a relatively commonmental health condition that affects both

menandwomen.Althoughforsomepeopledepressionmayimprovewithmedicaltreatment

alone, there are those who suffer from chronic depression and are resistant to treatment.

Despitethefactthatantidepressantsmaybeineffectiveforsome,onlyasmallpercentagewith

the diagnosis receives a combination of medication and psychotherapy. In Part I of this

presentation,Dr.Sibcyfocusesonassessmentandtreatmentofchronicdepression,detailsthe

characteristics of the disorder, and offers a comprehensive psychosocial profile of the

chronically-depressedclient.

LearningObjectives

1. Participants will discover key facts and statistics regarding the treatability of Major

DepressiveDisorder

2. Participantswillidentifythecoreneurobiologicaldeficitsunderlyingchronicdepression

3. Participants will identify self-defeating patterns of interpersonal behavior and how

thesepatternshindertherecoveryprocess


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I. TreatingDepression

A. FactsAboutDepression

1. MajorDepressiveDisorder(MDD)isarelativelycommonpsychiatricdisorder,witha

lifetimeprevalencerateof7%to12%formenand20%to35%forwomen(Kessler

etal.,2003).

2. TheannualcostofMDDintheU.S.wasestimatedat$81.3billion(Greenbergetal.,

2003) and the World Health Organization predicted it to be the second-leading

causeof functional impairmentanddisabilityworldwideby2020 (Murry& Lopez,

1996).

3. Althoughanumberofeffectivepsychiatricandpsychologicaltreatmentshavebeen

developed,asizeableportionofpatientshaveachronic,treatment-resistantcourse

ofillness,characterizedbyafailuretoreachfullremissionandcontinuingtoexhibit

asubstantialsymptomology.

4. Inclinicaleffectivenessstudieswithrepresentativetreatmentsamples,70%-89%of

patientsfailtoreachremissionafterrelativelyextendedtreatmentcoursesof8-12

months(Linetal.,1997;Rostetal.,2002;Rushetal.,2004).

B. STAR*DStudy

1. Inthelargestreal-worldeffectivenessstudyofMDDeverconducted,theSequenced

Treatment Alternatives to Relieve Depression (STAR*D), a four-step treatment

protocolwasdesignedtotreatpatientstoremission.

2. Each level of treatment lastedup to12weeks.All patients entered Level 1 and if

theyachievedremission,theyremainedatthesamelevelandwerefollowedupto

oneyear.


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3. Iftheyfailedtoreachremission,theywereupgradedtothenext levelandoffered

differentaugmentationstrategies.

4. Ofthe60%ofpatientswhocompletedthestudy,33%achievedremissionatLevel1,

57%atLevel2,and63%and67%achievedremissionatLevels3and4,respectively.

5. Theupshotof this studywas thatwitheachsubsequent levelof treatment, fewer

patientsachievedremission,withonly about 10%of treatment resistantpatients

(i.e., thosewhofailed toreachremissionafterLevels1and2)achievingremission

afterlevel4.

6. Moreover,relapseratesincreasedwitheachtreatmentstep:40% instep1,53% in

step2,65%instep3,and71%instep4,andtheoveralldropoutratewas40%.

7. Thus, a substantial proportionof patients fail to achieve remission (33%of those

who remain in treatment over the course of one year) and the majority of

treatment-resistant patients (65%-71%) within one year, even when continuing

maintenancemedication.

8. Consequently, these results represent a need to develop alternative treatments

that not only increases the proportion of patients achieving remission, but also

reducesbothrelapseratesanddropoutrates.

C. CharacteristicsofChronicDepression

1. Long-standing history of Dysthymic Disorder, now referred to as Persistent

DepressiveDisorderwithmultiple,superimposedMajorDepressiveEpisodes.


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2. MultipleMajorDepressiveepisodes,eachlastingseveralyears.

• Someneverfullyrecoverandremaininpartialremission

3. Manyhavecomorbiddisorders,includinganxietyandpersonalitydisorders.

D. TypicalTreatmentHistory

1. Longperiodsofuntreateddepressionbeforeseekingfirsttreatment

2. Previouslymisdiagnosed

3. Antidepressantonlyatinadequatedosesand/orlengthoftreatment

4. Thosereceivingtherapyderivedlittletonobenefit

5. Fewwillhavereceivedcombinedmedicationandpsychotherapy.

E. CharacteristicsofChronic,TreatmentResistantDepression

1. Highlyresistanttonearlyalltreatmentmodes

2. Resistanttomedication

3. Resistanttopsychotherapy

• CBT

• IPT

• STDP


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II. TheChronicallyDepressedClient

A. PsychosocialProfile

1. Historyofearly–sometimescomplex–relationshiptraumaorattachmenttrauma

2. Relationship trauma leads to a continuous series of “low grade” traumas:

psychologicalinsults,putdowns,interpersonalrejection/punishment

3. Combinedwith one ormore “high grade” traumas: physical/sexual abuse, actual

parentalabandonment,emotional/physicalneglect

4. Neurocognitivedeficitsresultinpreoperationalthinking,indicatingapre-causalview

oftheworld

5. Learnedhelplessness(Lowinternallocusofcontrol)

6. Chronicmooddysregulationresultsinamindthatdoesnotrespondtoinformation/

disputation/Insight/cognitiverestructuring

7. Behavioralshut-down

8. Ineffective,self-defeatingpatternsofsocialbehavior

9. Submissive interpersonal style – pulls therapist into dominant role, which

recapitulatespreviousrelationshipsandresultsinhelplessness

B. LearnedHelplessness

1. Helplessnesssignalsthebraintoshutdown.

2. Itcanalsosignalthebraintogointosurvivalmode.


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3. Emotiondysregulation:Avoidancebehavior

• Stopmasterybehavior

• Stoppleasure

• Signalsthebraintostopproducingneurochemistry

• Leadstoalossofenergy,motivation,andpleasure

• Reinforceshelplessness/worthlessness

4. EmotionDysregulation:Tensionreductionbehaviors

• Self-mutilation

• Sexualactingout

• Addictivebehavior

• Suicidefantasy

• Resultsinmoreemotiondysregulation

C. NeurocognitiveConsequences

1. The neurobiological consequence of chronic emotion dysregulation is the

disintegration of dendritic connections between PFC and various subcortical

systemsinthelimbicsystem,includingthehippocampus.

2. Degeneration of middle frontal areas of the brain and hippocampus results in

impairedabilitytoattendtoandcontextualizerelationshipevents.

• Consequently,personrelatesinmindlessfashion,repeatingsameoldpatternsof

relationshipexperiences–“interpersonalsameness”

• Confirmsfeelingsofhopelessnessandhelplessness.

3. This interfereswith thebrain’sability to formautobiographicalmemoryandother

neurocognitivedeficits.


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D. NeurocognitiveDeficits

1. These neurocognitive deficits are similar to deficits described in other research,

includingTheoryofMind,Mindsight,andMentalization.

2. AlsosimilartoPiagetianconceptofpreoperationalfunctioning:childlikeego-centric

patternofthinkingwheretheindividualisnotinfluencedbyexternalenvironment.

3. Failure of Perceptual Engagement – visually disengaged from social environment,

usingpast experience to interpretpresentmoment, thuscreating the past in the

present…continuous,interpersonalsameness.

E. Securevs.InsecurePatterns

1. Securityrecognizesthetransactionalnatureofrelationships

2. Insecuremodelsarenotopentonewinformationfromothers

F. Self-DefeatingPatternsofInterpersonalBehavior

1. Fail tounderstandhowtheyaffectothersandactually “pull”others intobehaving

exactlythewaytheyexpectotherstobehave.

2. Theyusethepasttointerpretthepresentandasaresult,keepgettingthepast in

thepresent.

3. Recapitulationofpastincurrentrelationshipexperiences.


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INS108:

EffectiveEmpirically-supportedTreatmentsfor

DepressionPartII

GarySibcy,Ph.D.


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Summary

Whenmedicationalone fails to treatchronicdepression,counselorsandothermentalhealth

practitioners may explore alternatives that can help relieve the suffering client. Chronic

depression does not have to be a lifelong struggle, and research demonstrates that

psychotherapeutictechniquesandinterventionscanprovidemuchneededanswers.InPartII,

Dr. Sibcydescribes a step-by-stepprotocolwithpractical exercises thathelppeoplewhoare

strugglingwithchronicdepression.Thechallengeistogetclientstoseethingsdifferentlyand

consistentlyengagewith the therapeuticprocess.Utilizingacase studyapproach, counselors

areshownhowtoincorporateCognitiveBehavioralAnalysisSystemofPsychotherapy(CBASP)

withtreatment-resistantpatients.

LearningObjectives

1. Participantswillexploredifferentpracticaltechniquesandinterventionsthatbeusedto

helpclientswithtreatment-resistantdepression

2. ParticipantswilldiscovertheprinciplesofCBASPanddescribethestepsofconductinga

situationalanalysis

3. ParticipantswillwalkthroughtheuseoftheCBASPSituationalAnalysistechnique


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I. TreatingChronicDepression:InterventionsandTechniques

A. StepsinSignificantOtherHistory

1. Identifykeyplayers

2. Foreach,ask:

• “Whatwas/isitlikebeingaroundthisperson?”

• Getexamplesofkeywords

• “Whathasbeenthestampthispersonhasleftonyourlife?”

• “Howhasitaffectedthewayyoufeelaboutyourself?”

• “Howhasitaffectedthewayyoufeelaboutothers?”

• “Howhasitaffectedthewayyouhandleyourfeelings?”

3. Attheend,ask:

• “Lookingbackonall theserelationships,what istheeffectyouthinktheyhave

hadonwhoyouaretoday?”

B. TransferenceHypothesis

1. Fourcontentdomains

• Relationalintimacy

• Disclosureofprivatematerial

• Mistakes

• Feelingorexpressingnegativeemotions

2. Formulate transference hypothesis as highly probable interpersonal event (hot

spots)whichwilltriggerpatient’sinternalworkingmodel

3. Basicmodel:IfIdo…theywill…


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C. DisciplinedPersonalInvolvement/ConditionedPersonalResponsivity

1. Designed to penetrate a patient’s interpersonal sameness through perceptual

engagement

2. Confrontinginterpersonalbehavior

3. Increasingmentalization,understandinghowaperson’sbehavioraffectsothers

4. Notusingthepasttointerpretthepresent

5. Usuallywillactivate“TransferenceHotSpot”

D. InterpersonalDiscriminationExercises

1. Hotspotisactivated

2. Drawattentiontoit.

3. Askhowotherswouldreacttoit.

4. Askhow“you”reactedtoitwiththeminsession.

5. Compareandcontrastittopast/others.

6. Askaboutimplicationfortherapy.

7. Askaboutgeneralizationtofuture.


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II. CognitiveBehavioralAnalysisSystemofPsychotherapy

A. CBASPSituationalAnalysis

1. Usescopingsurveyquestionnaire

2. Twophases:

• Elicitation – Situational analysis used as an interpersonal, cognitive behavioral

diagnostictool.

• Remediation–Problematicbehaviorsaretargetedforchangeandreviseduntil

newbehaviorsbringadesirableconclusion.

3. Confronts avoidance and directs the patient’s attention to the interpersonal

environment.

B. TheSevenStepsofCBASPSituationalAnalysis

1. Step1:Describewhathappened. (Abrief“sliceoftime”withabeginning,anend,

andashortstoryinbetween.

2. Step 2: Describe your interpretationofwhat happened– howdid you “read” the

situation?(Adescriptionoftheprocessofthesituation.)

3. Step3:Describewhatyoudidduringthesituation–whatyousaid/howyousaidit.

(Whatsomeoneelsewouldhaveobservediftheyhadbeenabletoseeyouduring

thissituation.)

4. Step4:Describehowtheeventcameoutforyou–theactualoutcome.(Goesback

totheendofthesituationinStep1.)


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5. Step 5:Describe how youwanted the event to come out for you – your desired

outcome.(Lookingattheendpointofthissituation,whatisthebestyoucoulddoat

thatpoint?Remember,goalsmustberealisticandattainable.

6. Step6:Wasthedesiredoutcomeachieved?Yes______No______

7. Step7:Why?

8. SituationAnalysisWorksheet

• Situation-

• Interpretations-

• Behaviors-

• ActualOutcome-

• DesiredOutcome-

• DidYouGetDesiredOutcome-

• Why-

C. EarlySampleNarrative

1. Narrative:“Myhusbanddoesn’tappreciateme.NothingIdointerestshim.Hecares

more about his video games than me. He’s always had sort of an addictive

personality…he gets totally absorbed in things…he doesn’t care about anyone but

himself…Iguessit’sjustme.IfItrytosaysomethingtohimabouthowIfeelhejust

goesoffandstartsputtingmedown.It’suselessformetosayanythingtohimabout

myfeelings.Theydon’tmattertohim.”

2. Situation:Athomeeatingdinner.AssoonashusbandandIfinisheddinner,hegotup

fromthetableandtookhisplatetothesink.Thenhestartedtoheaddownstairs.I

askedhimwherehewasgoing.Hesaid,“IthinkI’llgoplaysomewarofaircraft.”I

didn’tsayanythingbutjustnoddedmyhead.Heturnedandwalkedoffdownstairs.


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3. Interpretations:

• Hedoesn’tloveme.

• Imustbesuchabore.

• What’sthepoint…noonecaresaboutwhatIneed.

4. Behavior:

• Ijustnoddedmyheadupanddownandstaredpasthim.ThenIdroppedit.

5. RevisedDesiredOutcome:

• Totellhim:Ireallywanttospendsometimewithyouthisevening…canwedo

thatlater?

6. Didyougetthedesiredoutcome?

• No

7. Why?

• Ididn’tsayanythingtohim.

8. ReviseInterpretations:

• Hedoesn’tloveme.

• I’msuchabore.

• What’sthepoint…noonecaresaboutwhatIneed.

9. RevisedActionRead:

• Askhimtospendtime;speakup.

• Benice.


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INS109:

TheNeuroscienceofTraumaandRecovery:

Trauma-relatedDisordersandanOverviewof

EffectiveTreatments

GarySibcy,Ph.D.


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Summary

Thislecturefocusesonoutliningthecoresymptomsoftraumaandhowtheydevelop.Special

attention is given to the neurodevelopmental and relationship factors that can affect the

development of trauma-related disorders. The lecture will address how trauma reactions

develop and how post-traumatic stress disorder (PTSD) symptoms may emerge out of the

brain’s natural algorithm for healing and recovery. Finally, Dr. Sibcy will discuss the core

processesinvolvedintraumarecoveryandhowtheseproceduresarereflectedacrossavariety

ofeffectivetreatmentmethods.

LearningObjectives

1. Participantswilldefineanddescribethecoresymptomsoftrauma.

2. Participants will analyze trauma and its effects from a relational and attachment

perspective.

3. Participantswillevaluatetheroleofclassicalconditioninginthedevelopmentoftrauma

reactions.


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I. UnderstandingTrauma

A. TheCoreSymptomsofTrauma

1. Trauma reactions emerge from the brain’s natural algorithm for healing and

recovery.

2. Thecoreprocessesinvolvedintraumarecovery

3. Allthetreatmentsthatworkhavecommonelements.

B. TheSecureBaseSystem

1. Theparentrepresentsthesecurebase,whichhelpscreateasenseoffeltsecurity.

2. Thechildthenexplorestheworld,butifthereisaperceivedthreattheexploration

systemturnsoffandtheattachmentsystemturnson.

3. Theattachmentsystemisdrivenprimarilybythesympatheticnervoussystem.

4. Thekeyisthattheparentreadstheproximity-seekingbehaviorandworkstogether

withthechildinagoal-directedpartnershiptoachievethesafehavenexperience.

C. TraumafromanAttachmentPerspective:RelationalTrauma

1. Traumaisbestunderstoodfromanattachmentperspective.

2. Thecaregiveroperatesasboththesourceofandthesolutiontothechild’sdistress.

3. Thiscreatesabiologicalparadox.


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4. EarlyrelationaltraumascansetthestageforthedevelopmentofPTSDinthefuture.

5. Emotionregulationcapacitiespresentpriortoexposuretoatraumaticeventcanbe

whatsetsthestageforPTSD.

II. TheNatureofTrauma:FourCoreSymptoms

A. IntrusiveExperiences

1. Memoriesandrecollections

2. Dreams

3. Flashbacks/dissociativereactions

4. Physiologicalreactiontointernalorexternalcuesthatsymbolizetrauma

B. Avoidance

1. Internal:

• Feelings,thoughts,memories,sensations

• Emotionalnumbing,feelinghollowandemptyontheinside

2. External:

• People,places,contexts,activities

C. AlterationsinCognitionsandMood

1. Dissociationofmemoryofevents


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2. Negativethinking

3. Persistentnegativeemotionalstate

• Inabilitytoexperiencepositiveemotions

• Happiphobia/safetyphobia

• Emotionalperfectionism

4. Distortionsaboutcausesoftrauma–blameselforothers

5. Lossofinterest

6. Feelingdetachedfromothers

D. Hyper-reactivity

1. On-edge,hypervigilance,startleresponse

2. Decreasedconcentrationandsleepproblems

3. Irritable>Angry>Explosive>Aggressive

4. Self-destructivebehavior

• Tensionreductionbehaviors

• Sexualactingout

• Drugsandalcohol

• Cutting,piercings,excessivetattoos,otherformsofself-mutilation

• Binging,purging


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III. KindsofMemory

A. ExplicitMemory

1. Verbally-based–VerbalAccessMemory(VAM)

2. Emergesinsecondyearoflife

3. Senseofrecollectionwhenrecalled

4. Includessemantic(factual)andepisodic(autobiographical)

5. Requiresconsciousattentionforencoding

6. Involveshippocampus–convertstocontext

7. Ifautobiographical–involvesprefrontalcortex

B. ImplicitMemory

1. Sensory/situationallybased–SensoryAccessMemory(SAMs)

2. Presentatbirth

3. Includesthoughts,feelings,behaviors, images,sensations,andelementsofcontext

–allfragmented

4. Triggeredbyprimes

5. Mentalmodels–statesbecometraits

• Thebrainisameaning-makingorgan


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• Whatinterfereswithaperson’sabilitytomakesenseofwhathappened?

• Theinabilitytotoleratethenegativeemotions.

6. Sourceattributionerror:Thebrainassumes that thecurrentevent is thecauseof

thesethoughtsandfeelings.

• “SharkMusic”

7. Consciousattentionnotrequiredforencoding

8. Nosenseofrecollectionwhenmemoriesrecalled

9. Feelseternallypresent–pastexperiencedinthepresent

10. Doesnotinvolvehippocampus–mostlyamygdalaandbrainstem.

IV. ConditioningandTrauma

A. ClassicalConditioning

1. UnconditionedStimulus(US)leadstoanUnconditionedResponse(UR).

2. Pairing a Neutral Stimulus (NS) with an US results in the NS becoming a

Learned/ConditionedStimulus(CS)leadingtoaConditionedResponse(CR).

B. ApplicationtoTrauma

1. Aneutraleventpaidwithatraumaticeventcanresultintheneutraleventbecoming

aconditionedresponseresultinginfear,anxiety,orhelplessness.


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2. Context, tastes, smells, sounds, sights, or tactiles can all be triggers for negative

emotions.

3. Peoplewillavoidthingsthattriggernegativeresponses

4. Avoidancebehaviormaintainsthedysfunctionalsysteminyourbrain.

5. Therapy seeks to reestablish an experience of trust and block the avoidance

behavior.

V. TheEssenceofEffectiveTrauma-focusedTherapies

A. TheFiveComponents

1. ExposuretoTriggers

• Invivoexposure

• Imaginalexposure

• Activateemotion

• Don’toverwhelmbutdon’tunderwhelm

2. TitratedAffectActivation(ConditionedEmotionalResponse,CER)

3. Disparity–ActualoutcomedoesnotequalFearedOutcome

4. Desensitization–brainrecalibratesbasedonreal-lifeexperience

5. Counter-conditioning–experiencesafetyinthecontextofemotionalactivation


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B. TheTherapeuticWindow

1. Toomuchsupport,notenoughchallenge

2. Toomuchchallenge,notenoughsupport

3. Balanceofchallengeandsupport


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INS110:

AntidotetoTraumaI:DistressToleranceand

AffectRegulation

GarySibcy,Ph.D.


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Summary

Thislecturefocusesonkeyskillsandstrategiesforimprovingaclient’saffectregulation.Some

of the strategies that will be discussed include: understanding primary versus secondary

emotions, mindfulness-based breathing, distress tolerance skills, the mindfulness river

metaphorapplied,andidentifyingandrestructuringemotionalschemas.

LearningObjectives

1. Participantswilldifferentiatebetweenprimaryandsecondaryemotions.

2. Participantswillunderstandhowprimaryandsecondaryemotionsariseandwhattodo

withthemoncetheyarepresent.

3. Participantswillbeabletodrawouttherivermetaphorforusewithclients.


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I. Introduction

A. God’sBiggerPicture

1. EachpersonhashisorherownnarrativeofhowGoduseshimorhertoaccomplish

Hispurposes.

2. Painful,distressing,andtraumatizingsituationscanbedealtwithwhenpeople

understandtheeventsinthecontextofalargerpicture.

B. ScienceandFaith

1. Scienceandfaithdonotcontradicteachother.

2. Peopleendorsedifferenttheoriesbutknownscientificfactsalignwithscripture.

II. TheKeySkillsandStrategiesforImprovingAffectRegulation

A. PrimaryEmotions

1. Adaptive

2. Actionpotential

3. Increases/decreasesenergy

4. Combinationofthoughts,feelings,andbehaviors


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B. SecondaryEmotions

1. Resultofavoidingprimaryemotions

2. Unwillingnesstoexperienceangermayresultinasecondarymaladaptiveemotion

suchaspanic

3. Maladaptive

C. Anxiety

1. Alwaystheperception(realorsymbolic)ofdanger

2. Motivatesanescaperesponse(the“flight”partofthefightorflightresponse)

3. Makesyoufeelweakandincompetent

D. Anger

1. Canbeeitheraprimaryemotionorasecondaryemotion

2. Canarisefromtheperceptionofinjustice

3. Motivatesadaptivebehaviortochangeasituation

4. Resultsintheadaptivebehaviorofassertiveness

5. Canarisefrombeingblockedfromagoal


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E. Sadness

1. Alwaystiedtotheperceptionofloss

2. Unlikeangerandanxietythatactivatethesympatheticnervoussystem(resultingin

action),sadnessturnsoffmotivation,energy,andpleasure

3. Helpsusunderstandgrief

4. Thebody’swayofregisteringthevalueofthatwhichhasbeenlost

5. Whenyoudon’tallowyourselfgrieve,yourbodyandyourbrainwon’tcometo

termswiththefactthatthepersonisactuallygone.Asaresult,youcontinuetoturn

offmotivationandenergy.Tomoveon,youhavetofeelthesadnesssothatyour

brainregistersthatthepersonisgone.

6. Peoplewhoarefrozeningriefhavenotallowedthemselvestoprocess.

F. DealingwithEmotions

1. Primaryemotionsarewaysthatourbrainstrytomakesenseoftheworld.

2. Itisquitepossibleforpeopletohaveperceptionsthatarenotaccurate.

• IswhatIthinkishappeningactuallyhappening?

3. Procrastinationincreasesasenseofstress.Tochangethefeeling,youhavetoact

theoppositeofhowyoufeel.

4. Ifyoufeelanxiousaboutsomething,youhavetoactuallygointothesituationto

provetoyourbrainthatisnotdangerous.


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III. UnderstandingtheRiverMetaphor

A. TheMind

1. Likeariver–thereisaconstantflowofconsciousness

• Thoughts

• Feelings

• Images

• Sensations

2. Youarenotyourthoughts!

3. Justbecauseyouthinksomethingdoesnotmeanyoubelieveit.

4. Ourgoalistohelppeoplestepoutoftheirheadsandbeobservers.

B. TheBrain

1. Thebrainisprocessinginformationthatcomesinfromthebodyandmakessenseof

itinlightofpastexperiences.

2. 80%ofwhatthebraindoesisautomatic.

3. Youcandrawupanawarenessfromyourbrain.

4. Exercise:

• Takeamomentandturnyourattentioninward.

• Canyoufindyourleftpinkytoeinyourawareness?

• Youarenotyourbrain–itisanorganinyourbody.


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5. Whatyourbrainpartis,inlargepart,notunderyourcontrol–butyoucanuseitand

controlimportantpartsofit.

6. Whatyoucandowithyourbraindoesdependongeneticsandneurobiology

7. Wewanttohelppeoplebeabletoengagetheirenvironment(buildingabridge

acrosstheriver).

C. TheSelf

1. Bepresent

2. Exercise

• Mindfulnessbreathing

• Practicefocusingyourmindonsomethingoutsideofyourhead.

• Bepresent-focusedandsuspendthetendencytoanalyzeandjudgeexperience.

• Aimandsustain

• Youhavetopracticemindfulnessinordertogetbetteratit.

• Disciplineyourmindtostaypresent.

3. Ifyou’regoingtouseyourbrain,youhavetotrainyourbrain.


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INS111:

AntidotetoTraumaII:Cognitiveand

EmotionalProcessingInterventions

GarySibcy,Ph.D.


LightUniversity80

Summary

ThislecturebuildsoffofAntidotetoTraumaIinthatDr.Sibcywillbegintodiscussstrategiesfor

cognitive restructuring and attachment-focused emotional processing interventions. He will

coverseveralkeyelementsinthislectureincluding:helpingtraumatizedindividualslearnhow

toidentifytraumatriggersandemotionalhotspots,howtousetherivermetaphorasawayof

identifyingkeycognitivedistortions,andoutliningattachment-informedemotionalprocessing

skills.

LearningObjectives

1. Participantswillevaluatewaystoincorporatemindfulnessintotraumarecovery.

2. ParticipantswilldiscoverandbeabletousetheCOALprinciple.

3. Participantswillexploredifferenttypesofexposure-basedtreatmentsfortrauma.


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I. ProcessingTraumaticMaterial

A. Mindfulness

1. JohnBriere–PrinciplesofTraumaTherapy

2. Breatheinanaturalway.

3. Payattentiontothebreathingprocess.

4. Breathedeeply.

5. Focusedattentionwillonlystayonsomethingfor4-7secondsbeforeitstartsto

drift.

6. Mindfulnessisaboutattentionaltraining.

B. Embeddedness

1. Psychicequivalence

• Thedifferencebetweenrememberingsomeeventfromthepastandrelivingthe

memoryasifitwerehappeninginthepresent.

2. Thoughtactionfusion

• Thebeliefthathavingathoughtmakesittrue

• ThebeliefthathavingathoughtmeansIbelieveit

• Thebeliefthathavinganimageself-engaginginsomeactionisequivalentto

doingit

3. Thegoalisforpeopletobeabletotalkaboutit–makesenseofit–putwordstoit.

• PeoplewithOCDorotherdisorderswithintrusiveideas


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C. TheCOALPrinciple

1. Developinganewstancetowardsself–andone’sinnerexperience

2. Curious

3. Open

4. Accepting

5. Loving

• Goesagainstthetideofmasochism

• Asopposedtoharmingorneglecting

II. ExplainingtheRationaleforExposure

A. ExposureandExperientialBasedTherapies

1. Twosidesofthesamecoin

2. Intrusionsarenaturalalgorithmsthebrainusesforhealing.

• Makingmeaning

• Translatingfragmentedimplicitexperienceintoautobiographic,narrative

experience

3. Theproblemofavoidance

• Internal–experientialavoidance

• External–people/places/context/sensoryavoidance

• Preventsconversiontomeaningandfailstodisconfirmfear-basedcognitions


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4. Exposureisexperientiallybased.

• Givesthebraintheopportunitytoovercomefear-basedcognitions

• Convertintrusionsintorememberedstoriesofexperienceswithnewmeanings

B. TypesofExposure

1. Invivoexposure

• People

• Places

• Contexts

2. Imaginalexposure

• Memories

• Internalexperiences

C. InVivoExposure

1. Teach

• Subjectiveunitsofdistress

• Fearedoutcomeprobability

• Createhierarchy

• Startwithinwindowoftolerance

• Makeplan

• Makecommitment

2. Thekeyisthatyougointoandyoustayinthatexposuresituationforatleast20-30

minutesoryouranxietycomesdownto50%ofitspeak.

3. Monitor


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D. ImaginalExposure

1. Fearedoutcome

2. Identifymemoriestofocuson

• Peoplewithtraumaareafraidofanxietyitself

3. Narrateinpresenttense

• Nameemotions,thoughts,images,sensations(linktobody)

• Thetriangleofneurobiology

• Thetherapististheregulatoroftheexperience

4. Record

5. Replay

6. Repair-resiliency,strength,reframe,reconsider

E. AdditionalInformationonExposureTreatments

1. Youneedmorethana30-45minutesession.

• Debriefingtakesatleast15minutes

2. Therearetwocriteriafordiscontinuinganexposure:

• Itdropsby50%fromitshighestpoint

• Youstaywithitforapredefinedperiodoftime

3. Don’tstartwithmemoriesthataresotraumaticthattheydissociate.


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4. Thepurposeoftalkingabouthowtodothisisnottomakeyouanexpert.

• Getmoretrainingbeforeyoutrythistypeoftreatment.

• Getadditionalsupervision.


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INS112:

AntidotetoTraumaIII:EnhancingIdentityand

StrengtheningRelationships

GarySibcy,Ph.D.


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Summary

This final lecture focuses on key intervention strategies designed to help the traumatized

individual strengthen his or her sense of identity and capacities for managing close

relationships. Dr. Sibcy will discuss strategies for dealing with the inevitable resistance that

emerges in both attachment and trauma-focused therapies. This includes strategies such as

significant other history, transference hypothesis construction, interpersonal discrimination

exercises,and interpersonal situationanalysis. Specialattentionwillbegiven toDavidBurns’

EARCommunicationSkillsModel.

LearningObjectives

1. Participants will define and describe how internal working models are formed and

maintained.

2. Participantswill discover the relationship pyramid and analyze the different levels of

relationships.

3. Participantswillidentifywaystohelpclientsdealwithconflictandcriticismutilizingthe

EARModel.


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I. IdentityandEngagement

A. InsecureVs.Secure

1. Insecuremodelsarenotopentonewinformationfromothers.

2. Securityrecognizesthetruenatureofrelationships.

B. HowInternalWorkingModelsareFormedandMaintained

1. Theideaofexpressingone’sneeds,wants,andfeelingstriggersanxiety,shame,and

guilt.

2. Rejectionandcriticismisthefearedoutcome.

• I’mflawed.

• It’sallmyfault.

• Idon’tmatter.

3. Peoplethenengageinavoidancebehavior,stuffingtheirfeelings,leadingtofeelings

ofworthlessnessandhelplessness.

4. This is common for those who have experienced ongoing neglect and traumatic

experiences.

5. Thesenseofselfdisappearsandtheynolongerknowwhattheywantorfeel.

6. In therapy, to ask people “What do you want in that situation?” creates anxiety

becausetheydon’tknow.


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C. Kiesler’sModel

1. Passivityleadstofeelingsofhostility.

2. Oneofthegoalsintreatmentishelpingpeoplelearnhowtomoveoutofthisstate

andintoassertiveandfriendly.

3. Peoplecanlearnhowtoassertwhattheywant/don’twant,like/don’tlike,butthis

cancreateanxiety.

D. EngagingNewRelationships

1. Traumatizedpeopletendtobelonely.

2. Peoplecan’tworkonrelationshipsiftheydon’thaveanyrelationshipstoengagein.

II. TheRelationshipPyramid

A. ALevelRelationships

1. These are your closest relationships. They tend to be attachment relationships.

Theserelationshipshaveacertainamountofexclusivityandspecificity.

• Spouse

• Bestfriends

2. Thesepeoplearetrustworthy,accessible,andreliable.

3. AlevelRelationshipsaredifficulttocomeby.


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B. BLevelRelationships

1. Thesearethepeoplethatyoudothingswith.

• B-someoneyouplaygolfwith

• B+someoneyoudomultiplethingswith

2. TheideaaboutBsisthatthey’repeopleyouengageincompanionshipwithbutnot

peopleyouwouldposeAcriteriaonto.Ifyoudo,itwillcreateproblems.

3. People who struggle with histories of attachment trauma tend to want to move

everyoneintotheAcategory.

4. IfyouuseAcriteriaonBrelationships,yourunpeopleoff.

C. CLevelRelationships

1. Thesearepeoplewhoareacquaintances.

2. CsarepossibleBs,butitwillrequiresomeengagementandsomeconversation.

3. IfyouwanttogetpeopleintoA,youhavetogoupchronologically

• CtoBtoA

4. WithyourBs,youmustbecarefulintermsofhowyoudisclosethings.


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III. HelpingPeopleDealwithConflictandCriticism

A. EARCommunicationSkills–DavidBurns

1. Empathy:Acknowledgingandacceptinghowanotherpersonfeelsandwhytheyfeel

thatway.Sayingwhattheyfeel,acknowledgingit,andacceptingit.Notnecessarily

endorsingit,butlookingtoacknowledgewhattheyfeelandacceptingthattheyfeel

thatway.

2. Assertiveness:Expressingyourfeelings,wants,andneeds.

3. Respect:Beingkindandvaluingyourrelationshipwiththeotherperson.Lettingthe

otherpersonknowthattherelationshipisimportanttoyou.

B. TwoLaws

1. Thelawofreciprocity–thegoldenrule

• If youwantpeople to take you seriously, youhave to listen to themand take

themseriously.

2. Thelawofopposites

• Whensomeoneisangrywithyouandyouinvalidatetheirfeelings,theangerwill

getworse.

• Whensomeonecriticizesyouandyouresist,theircriticismwillgetworse.

C. Empathy

1. Inquiry–youcan’tempathizewithsomethingifyoudon’tknowwhatitis.

2. Feelingempathy–whattheotherpersonisfeeling


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3. Thoughtempathy–whytheotherisfeelingthatway

4. Disarming–findingthetruthinthecriticism

D. Assertiveness

1. Expressingyourfeelings

2. Whenyou_______Ifeel_______

3. Expressingwhatyouneed/want

4. Expressingyourownnegativefeelingsaboutyourownbehavior–humility

• I’mreallyangrywithmyselffordoing__________.

• Thisisreallypainfultohear,butthereisalotoftruthinwhatyouaresaying.

E. Respect

1. DO

• Bekind

• Overtlyvaluetherelationship

• Givepeoplethebenefitofthedoubt

2. DON’T

• Blame

• Judge

• Usesarcasm


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F. LookingataSliceofTime

1. Movingbeyondglobal,transitionaldescription

2. Anchoringrelationshipeventsintoanactualplaceandanactualtimeframe

3. Identifyingasliceoftime:withabeginning,amiddle,andanend

4. Identifyhotspotintheconversation

5. MovetoRelationshipEventWorksheet

G. SampleNarrative

H. Worksheet

1. StepOne:

• “Youbloweverythingoutofproportion”

2. StepTwo:

• “I’mjusttryingtotellyouhowIfeel”

3. StepThree:

• “Youjustneedtogetalife”

4. StepFour:

• ReviseusingEARskills

I. AnalyzeStep2

1. Didsheuseempathy?

• Didsheacknowledgehisfeelings?


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2. Didsheuseassertiveness?

• Didsheacknowledgeherfeelings?

3. Didsheuserespect?

• Didsheacknowledgehowmuchshevaluedtherelationshipwithhim?

J. UsingtheEARSkills

1. You’reright.Idoblowthingsoutofproportion(thoughtempathy,disarming).

2. IknowitticksyouoffwhenIdothat(feelingempathy).

3. IreallyhateitwhenIloseitlikethat(assertiveness).

4. ButIjustreallymissourspendingtimetogether(assertive,respectful).

5. I really value that time and Iwant us to find away to spendmore time together

(respect,assertive).

K. TeachingtheRepairProcess

1. Intimacyispainful

2. Insteadofavoidingemotionallychargedsituations,approachthemskillfully

3. Useempathyproactively,especiallydisarmingskills


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L. OtherImportantDetails

1. Therapeuticframe

2. Practiceinsafetyoffourwalls.

3. Use reverse role plays, where you are the patient’s role and they play the other

person.

4. Addresstransferencereactions.

5. Dealwithresistance.

M. TypesofResistance

1. ProcessResistance

• Peopledon’twanttoparticipateintheactivitythatittakestogetwell.

2. OutcomeResistance

• Themagicbuttonandparadoxicalcost-benefitanalysis

• Iftheydidgetwell,whatwouldtheirlifelooklike?


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Documents

Interpersonal Neuroscience - NT[1] · • Learning is self-directed and pacing is determined according to the individual time parameters/schedule of each participant. • With the