Tuesday, August 28, 2018

Fiftieth High School Reunion: Lodi Union High School Class of 1968


Entry for 28 August 2018:

In order to attend my fiftieth High School Reunion, we delayed our return to Scotland for this year’s annual late August running of Strathclyde’s Emotion-Focusing Therapy Level 1 training.  Now, on our way back, I’m still thinking about What It All Means.  

To prepare, I spent part of a day reviewing the 1968 Tokay, the Lodi Union High School (LUHS) Yearbook.  I looked through pages and pages of coverage of sports, social events, and arts performances, finding my 17-year old self missing in action. I remember feeling that these activities had nothing to do with me, nor me with them. I remember feeling pretty socially anxious a lot of the time, and not very good about myself.  Oh, there I was, popping up in a couple of places: chess club, literary magazine, minor academic honours. So I studied (but not super hard), read a lot of books, and had a few extracurricular activities to show for myself.  Oh, yes, and I did a few things that took me completely out of my comfort zone: I took a public speaking course, went to some speech tournaments, and ran for Senior Class President, which involved giving a speech (fortunately, I lost).  I remembered how terrifying these latter activities were. 

Then, I went through everybody in my senior class, pages full of rows and rows of names and photos of scrubbed and coiffed 17-year olds, with their ties or single-pearl necklaces, some 700 in all.  I spent 13 years in the Lodi public school system, kindergarten to 12th grade, and so crossed paths with hundreds of fellow students during that time.  Who did I still remember? Who would I recognise at the Reunion?  It was a big school, made of many overlapping subcommunities.  A surprising number, at least a hundred, were met with a sense of recognition of name or face, something in my body answering, “Yes, I knew this person”.  Some were friends or folks I hung out with, associated with specific memories, others were simply people that I knew I had known, faces seen, names heard again and again in attendance roll call, echoing in my memory.  Human facial memory is a wonderful thing, but name recognition is pretty good as well.

After that I read through the hand-written notes from friends and acquaintances, which filled the opening and closing pages of the yearbook.  My best friend Philip Frey (who died two years ago) was there, reflecting on our moderating influence on each other.  He’s a person I would certainly like to sit down and talk to now.  Several people commented on the speech I’d given when I ran for Senior Class President.  I had remembered this as an excruciating experience, probably better off forgotten, but the comments were positive, which surprised me.

We arrived a bit after 6pm at the Woodbridge Golf & Country Club.  I’d spent a lot of time there as a kid, caddying for my dad and at the swimming pool.  Parts looked somewhat familiar, but most of it was completely unfamiliar, since it has been completely rebuilt.  There were a lot of 68-year-old people whom I didn’t recognise, plus a mixture of spouses from elsewhere to confuse things further.  We were issued with name tags with our senior yearbook photos on them.  That helped.  We ran into my old friend Sam Hatch, whom we’d had a visit from 18 months ago when we first arrived in Pleasanton; he introduced us to his wife Susan and we had a great time visiting with them.  I also ran into several people I’d known from Saint John the Baptist Episcopal Church: Carol Gerard, Cindy Chappell, and others from various phases.

The reunion was very well-organised, with many nice features such as a free photo booth, prizes and so on, but two things really caught my attention: First, there was a set of class photographs from the LUHS’s elementary and junior high school feeder schools, so that many of us could see ourselves at even earlier stages. There I was, from kindergarten to third grade, in my plaid shirts and buck teeth.  Diane had trouble seeing the resemblance but I recognised me.

Second, there was a board of about 20 people known to the organisers to have died, a sombre reminder of how much had passed and what we had lost.  This was obviously a difficult thing to put together, and a thankless task.  The loss was only underscored by the fact that no one, myself included, had let anyone on the committee know that Philip Frey (one of the valedictorians) and Margaret (Linstrom) Weitzel had passed.  These were my two best friends from high school, and I still feel their loss keenly.  A 50th high school reunion is obviously a time for celebrating accomplishments, remembering good times, and renewing friendships, but it is also a time to acknowledge losses: youth and naïve enthusiasm, of hang-ups and pretensions, of opportunities and hopes, and of people loved and lost.  It is a kind of Memorial Day, of smiling through tears, of marking lives spent in the best way we knew how, of celebrating what has been and resolving to do our best with what remains of our lives: For us, the living, the best thing is to take each day as a gift, and each person met and then met again also as a special kind of gift.

Vale, LUHS Class of 1968!

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Tuesday, August 14, 2018

On Psychiatric Diagnostic Categories from the Point of View of Humanistic-Experiential Psychotherapy


Entry for 12 June 2018 [revised 14 August 2018]:

This started out as a long email to Ueli Kramer & Antonio Pascual-Leone, posted, with their permission, only now two months later (a piece of unfinished business after my return from China).

I was stuck waiting in the Chinese Consulate in San Francisco for hours today, so you now have to suffer through the following screed:

Thanks for your responses and questions.  I taught in a clinical psychology doctoral course for almost 30 years, and also taught Abnormal Psychology on many occasions, as well as using different structured psychiatric diagnostic instruments.  Like you, I am intimately familiar with the very messy, complicated process of applying psychiatric labels to people in both clinical and research settings.  I studied with Ted Sarbin, and have what I consider to be a healthy ambivalence about the larger DSM/ICD enterprise.  On the one hand, I’m very aware of and have witnessed the various difficulties with stigmatisation, reification, questionable reliability and validity, conceptual muddiness/overlap, lack of etiological basis, and philosophical disharmony with humanistic-experiential approaches.  I also strongly believe that the language we use and the implicit assumptions and metaphors that it contains are important and powerful, for better or worse.  I regard language use as an ethical issue.

On the other hand, these categories have their merits and uses: (1) I’m aware that there are regularities that the diagnostic categories seek to capture; it’s not only or simply a social construction. I’m a dialectical constructivist here: the labels both point to something in the world and are at the same time a social construction of what’s there.  (2) Some clients find acquiring a diagnostic label to be clarifying and validating. I don’t want to deprive them of that, although I don’t mind reminding them that the categories are social constructions cooked up by groups of people as part of a political process.  (3) To progress and disseminate our work we have to be able to communicate with researchers with different philosophical perspectives and lived experiences, including those who exist in an unreflected way within a diagnostic system and psychiatric language that they are attached to and that feels like home to them. They will feel threated and will fight us if we try to take their cherished language from them.  (4) Some labels are more useful, reliable, valid etc than others, or at least less broken or over-simplifying than others; others, I think, pretty much suck and best consigned to the dustbin of history.  

Given these complexities, here is the course of action I have long tried to follow:

First, I try lead by example: I try to keep my language as clean as possible.  I personally find the word “disorder” to be stigmatising, so I try to always say “difficulties” instead; this has the advantage of allowing me an alternative gloss for favourite abbreviations like PTSD (“post-traumatic stress difficulties”).  I personally find “borderline personality disorder” to be especially problematic and therefore moved first to “borderline processes” and then, following Margaret Warner, to “fragile process”, which I find to be a far more accurate term anyway.  I replace “schizophrenia” with “psychosis”.

Second, although I do have my strong views, I try to avoid being polemical or confrontational. Snark such as inveighing against the evils of the “medical model” can be fun but it just puts some people off, and of course also ignores the fact that this too is a kind of stigmatising diagnosis, which for starters ignores the fact that there are many quite different “medical models”.  The main point here, however, is I understand that people are typically very attached to forms of language that are familiar and comfortable to them.  This can be difficult at times and I’m not sure that I always succeed.  In general, I try to assume good intentions in others, even when I experience their language as unreflected and potentially offensive or even harmful to some.  When this happens I go back to my first strategy of leading by example; and I expect others to extend the same respect for my use of language that I offer them: we may not agree with the language the other person uses, but I expect us to respect each other’s need or habit of using that language, at least for the moment.  This means that sometimes I will need to provide translations of my favoured ways of talking, even though I find these translations not to my liking.  At times, gatekeepers may even try to suppress my favoured ways of talking, in which case I will try to find a mutually-acceptable compromise. Only as a last resort and for carefully-considered pragmatic reasons will I capitulate to using language that I do not agree with.

Third, I think it’s very important for us to dialog about these differences in language, to try to develop both our understanding and our language more fully so that it increases in accuracy, transparency, respect and usefulness for our clients and research participants. That’s why I raised the issue when I saw your article.

See: Kramer, U., & Pascual-Leone, A. (2018). Self-Knowledge in Personality Disorders: An Emotion-Focused Perspective. Journal of personality disorders, 32:329-350. DOI: 10.1521/pedi.2018.32.3.329

China Impressions: EFT in Shanghai


Entry for 12 August 2018:

Six days’ EFT training in Shanghai.  I’ve flown from Glasgow to San Francisco, spending 3 days in Pleasanton and getting in a brief visit with Kenneth before flying on to China.  California is hot and dry, and on fire in many places.

First time in mainland China (previous trip to Hong Kong, but somehow feels like that doesn’t count).  Airport is full of construction; we land out in far reaches of airport; it takes bus what seems like ages to get to terminal & pick up suitcase.  Foreigners have to do self-service finger-printing before they can go through immigration.  Joyce has sent her helper Celia to wait for me and escort me to hotel.  When I finally emerge from international arrivals; she is surprised at how long it’s taken me.

Uber car to city:  Huge city: 25 million & counting. Radio is playing American pop music.  It takes us over an hour to go from airport to hotel, which is apparently toward the western end of the city.  It’s 30C but feels closer to 40, and very humid. It gets dark early, around 7.  My room on the 12th floor has a great view of the nearby Shangfeng Park and the cityscape beyond, although it turns out that we are many miles from downtown.  Joyce & Morley meet me for dinner in the hotel a bit later.  There is no one else in the restaurant, although it’s Saturday night.  I’m so jet-lagged I can’t later remember what we talked about, except to make plans for Sunday. I take a melatonin and go to bed about 9pm.

I get up early the next day and go for a run on one of the treadmills in the empty gym facility in the hotel.  After showering and breakfast, Joyce & Morley pick me up in an Uber car (they don’t own a car in Shanghai).  They take me to the International Church in Shanghai, a nondenominational evangelical church in the ballroom of a large hotel. We have to show our passports to get in, proving that we are foreign nationals.  The first 45 min is prayers followed by contemporary praise music, nice enough, but after a while a bit repetitive for someone used to complicated Anglican hymns.

After church we grab sandwiches at the Starbucks and get picked up to be driven west of Shanghai to a “water town”: an old town built along a set of canals, with markets of little shops on the lanes that parallel the canals. We spend the afternoon there wandering around in the heat amidst throngs of Chinese people (almost no Westerners), looking in shops, while Morley talks to the shopkeepers, and we shop. We visit a Taoist temple, a rustic hotel, and an old tea-house where we eat fruit prepared by the owner, who is also a painter.  We take a canal ride, on a boat whose boatman propels it forward with a kind of rear mounted rudder/oar.  It’s very peaceful, and a great way to people-watch on a hot August Sunday afternoon.  Then it’s back into town for dinner, but on the way we have a fascinating and far-ranging theological discussion/sharing.  Dinner is at one of their favourite Shanghainese restaurants, whose ceilings are strikingly decorated with 20th century figurist paintings of colonial Shanghai.  At every Chinese restaurant we go to, Morley orders for everyone, curating our dining experience with an expert touch.  He is particularly good at selecting a wide range of vegetarian dishes, which I greatly appreciate.  At this dinner, I meet Jennifer, who is going to translate for me for most of the week.

The Great Firewall of China stymies me repeatedly, even though I’ve prepared by investing in a highly-rated VPN service: they’ve blocked all Google services, including Gmail, as well as BBC news (but for some reason not NPR); Dropbox is blocked as is YouTube and Facebook.  It also turns out that they’ve recently blocked my VPN service, even though there are still web ads everywhere claiming that it works. Fortunately, Skype & Zoom still work, so I can talk to Diane & Kenneth most days, working around the 15 hr time difference.  Also, my Strathclyde email still works so I locate and install a recent version of Outlook, and have Diane scan my Gmail account and forward critical email to me.

Monday morning: Celia picks me up in taxi and takes me to Shanghai Care Corner Counselling Center, the clinic and training center that Joyce and Morley run with the help of Mary and Celia.  They have 6 counselling rooms, which they also use for skill practice break-out rooms, plus a relatively large training room that can squeeze in up to 45.  Morley embarrasses me with a totally over-the-top introduction in which he dramatically describes me in almost magical terms, with laser-like empathy coming out of my eyes. 

This presages 6 days of the most intense EFT training I’ve ever had the opportunity to deliver: 1 day EFT for Social Anxiety; 2-days Advanced Empathic Attunement; 3 days Module 2 (Focusing, Reprocessing Work, Two Chair work).  First, there are lots of participants in these trainings, ranging in number from 38 to 42. Second, they are eager to learn, to do skill practice, to volunteer for live demonstrations, and to ask questions on a wide variety of topics.  It’s invigorating, challenging, and ultimately exhausting.  It pushes my thinking forward in numerous places.  They interact in an uninhibited manner with each other, sometimes arguing and challenging one another.  Not all, but most fearlessly dive into their pain: rejecting mothers; overly strict, even abusive fathers; huge expectations placed on only children (an effect of China’s one-child policy).  Underlying much of the personal pain, is the legacy of the Chinese Cultural Revolution of the 1960’s and 70’s, directly experienced or transmitted cross-generationally.  This comes out sometimes as roughness or abrasiveness, sometimes as a kind of frozenness, which can break with a large release of emotion. There are many heart-wrenching stories that emerge during the week.

They refer to me as a “master” and “teacher”.  There are endless photographs during breaks and at the end of each day. Towards the end, Morley starts running interference for me so that I can have recovery time during my breaks. They soak up what I’ve got to say, even with the sequential translation.  At the best moments, the translators and I get into a kind of rhythm, as I condense what I have to say into a series of short sentences that build dramatically to climaxes. A couple of times during the week, to illustrate a key point, I find myself sharing a highly dramatic personal story, and am startled (and pleased) when they spontaneously applaud at the end. I share my mantra: Love, courage & wisdom.  Love and courage they have in abundance; for them as for me, the wisdom part is a work in progress.

To cope with the intensity, I have a power nap each day, and take melatonin most of the week, to avoid the episodes of severe insomnia I had last time I dealt with double jet lag. As we finish on the 6th day, I write in my Pukka Pad, “tired, drained, relieved”. I have the feeling of being filled with ideas for how to move EFT theory, practice & training forward, too many to write down so that I am left hoping that they will come back when I need them. Here are a few that I was left with at the end of this running of Module 2: (1) The Focusing input needs a major update (reduce coverage of Clearing a Space, re-do task model to reflect flexible emotion-scheme based questioning strategy, which can also be used for skill practice, emphasize use within Chairwork).  (2) Due to popular demand, I’ve written part of a new input on emotion regulation (needs to be finished, lead with emotion regulation principles; figure out good place for it in later modules, probably with first chairwork).  (3) Better integration of Reprocessing Work with Chairwork is needed, to highlight its role both as stand-alone and within Chair Work. (4) Better integration of Empty Chair Work and Two Chair work is needed, underlining the role of self-interruption conflict splits in Empty Chair Work and more importantly the integrated task of Conflict Splits about an Important Other, in which it’s useful to alternate between Two Chair Work and Empty Chair Work, as each task supports work on the other.

Last day: Up early, I think maybe I’ll attempt a run in Shangfeng Park near the hotel, but it’s disgusting outside,  like a steam bath: 30C already, near 100% humidity, and the rain has already started; it’s been clear and dry all week but now a typhoon is coming in.  Run on the treadmill again; shower, pack, breakfast.  Mary meets me at 10am, checks me out of hotel.  Uber car to airport, heavy rain part of way; reminds me of Ohio summer.  Long conversation with Mary about her experiences growing up. She waits with me in the queue at check-in in case of problems (they’ve taken such good care of me here!); after taking selfie with me, she leaves me at immigration & security.  The flight is two hours late leaving, but I’m pleased with the first EFT training I’ve run in China.

When I visit a new country, I make a practice of learning about and collecting some of its folk and popular music.  Hearing of my interest, Mary has kindly assembled a diverse collection of Chinese music of various kinds and ethnicities. (I think she said there were 17 different ethnic groups represented.)  Also, the other night, Joyce & Morley took me to a record/DVD store after dinner and bought me a couple of collections of interesting Chinese music.  It is going to take me quite a whole work my way through all of this richness. 

One more thing: I’ve also picked up a bit of Chinese, simple words for “thank you” (“Xièxiè”, pronounced “she-she” with a falling tone on each syllable), “OK”   (“Hǎo”), and “Right” (“Duì”). Chinese characters fascinate me, and as I return home I’m taken with the idea that the standard written Chinese for “San Francisco” is not a transliteration but is instead the native Chinese name for San Francisco from the 19th century:
旧金山 , in Mandarin transliterated back into the roman alphabet as “Jiù Jīn Shān”
This is not a transliteration but instead means Old (“”) + Gold (“”) + Mountain (“”), a reference to the California gold rush, which started in 1849. (I think of the archeological remains of the old Chinese dam below my brother Conal's place in Murray Creek up in the foothills of the Sierra Nevada, imagine Chinese workers trying to extract the last of the gold from the valley.  I hope they found some...)

As the plane crosses the wide Pacific Ocean, I review all this richness in my mind.  A word from last Sunday’s sermon surfaces: It is the Greek perissos, meaning “abundance or plenty” (from 2 Corinthians 9:8).  Earlier in the week I asked Kenneth about the etymology of the word, puzzling to me because of its similarity to per- cognate with English fear.  He laughed, reminding me that that is Latin, not Greek.  Instead, per- is a prefix that means “around or at the edge of” (cf. “peripheral”).  Issos, he said is the Greek verb “to be”; hence, “overflowing being”: perissos, abundance.  That pretty much describes my week in Shanghai.

Sunday, May 13, 2018

Jeremy Safran: April 23, 1952 – May 7, 2018


We are all more deeply connected to each other than we can ever know, and sometimes it takes a tragedy to remind that this is so.  All of my networks have been buzzing this week with the news of Jeremy Safran’s brutal and senseless murder last Monday.  Even if you’ve never heard of Jeremy or haven’t read anything of his, if you are a psychotherapist or counsellor today, the chances are very good that he has influenced your practice.

His was a maverick spirit, wandering restlessly between most of the major approaches to psychotherapy, always open to new things. He started in the humanistic-experiential therapy tradition, where he first studied with Les Greenberg and help lay the theoretical ground work for emotion-focused therapy.  After that, with Zindel Segal, he was responsible for broadening and softening CBT, by adding an interpersonal emphasis.

Although I’d known him since the early 1980’s, mu closest interactions with Jeremy were in the 1990’s, when we both were running American clinical psychology doctoral programs.  We were both part of a rump faction of DCTs (Directors of Clinical Training) who tried to resist the rising tide of CBT in American clinical psychology in what felt like a dark time, as CBT advocates attempted to impose this approach as the dominant approach in our courses.  It was good to have an ally and we had lots of interesting talks.

In my opinion, his most important work was with Chris Muran, with whom he initiated a major continuing line of research and practice on therapeutic rupture and repair.  If the phrase “alliance rupture” is in your working vocabulary, there you will find Jeremy in your work as a counsellor or psychotherapist.  Finally, I think, he found a home, or rather several homes, in psychoanalysis and Buddhism, and the dialogue between them.

If you want to learn more about Jeremy Safran and his many contributions, you can go to his website:
http://www.jeremysafran.com/ 

Rest in peace, Jeremy, you are part of us, and live on in us.  We won’t forget you.

Tuesday, January 30, 2018

In Memorium: Gladys Stands at the Crossroads

Note: Gladys Pearson, my mother-in-law, died unexpectedly a month ago, on 29 December 2017.  She had lived a long and exemplary life, and was 87 when she passed.  A year ago, Diane and I moved to Pleasanton, California, to help take care of her during even-numbered months.  In spite of her gradually increasing frailty, we had settled in for the long haul with the hope of supporting her for several years or longer.  Her death leaves us with an existential vacuum that I think will take us quite some time to work our way through.  For now, we have decided to make no decisions for the next 6 to 8 months while we work with Diane’s siblings to settle Gladys’ affairs. 

I’ve known Gladys for roughly 45 years, and for the past five years since my own mother’s death, she has been like a second mother to me, and more so since we’ve been living near her in Pleasanton.  She was completely different from my mom in many ways, but over the many years I’ve known her, I’ve become quite fond of her and to really appreciate her..

I wrote the poem below in her memory to try to capture some of what I’d come to know and love about her.  I started from verses 8:1-3 from the biblical book of Proverbs, one of the readings for her memorial service:
Does not wisdom call, and does not understanding raise her voice?
On the heights, beside the way, at the crossroads she takes her stand;
Beside the gates in front of the town, at the entrance of the portals she cries out.
(New Revised Standard Version)
Last Sunday, at church in St Mary’s in Glasgow, the first two hymns we sang were both contemporary John Bell pieces. (John Bell is a member of our congregation and often sits about six rows back from us in church.)  I asked myself what it was that I find so distinctive and appealing about his hymns. I noticed first his use of language: There were almost no long, latinate words in either hymn; instead, he used short, Germanic words, which gives his writing a more direct, earthy quality.  In addition, as is common for him, he used lots of alliteration.

Well, I thought, Gladys was a down-to-earth, plain-spoken person; let me try to write a poem for her in the style of John Bell, and see comes of it. The result is the following poem.  She wasn’t too fond of my recent rewriting of the Lord’s Prayer, which I posted here late last year.  I hope that she would have been pleased by this attempt to honor her, and not too embarrassed. I wish that I’d been able to read it to her when she was still alive. 


Gladys Stands at the Crossroads
(Gladys Pearson, 19 August 1930 – 29 December 2017)

Gladys stands at the crossroads,
Where four roads meet.
She does not cry out, that is not her way;
Instead she waits and watches with us.
Far behind her is the farm, the smell of ash,
The long line of all that is past in her long life,
Those she’s known, loved, protected,
Present and departed.

The road to her left leads to love:
Family and friends, work and church,
Taking in the children of many lands,
Making them family.
She knows this way well,
She’s walked it all her life...
This is the way of the heart.

The road to her right leads to courage:
To do and say what is right,
To face loss, to tend the sick,
To defend the weak and those who’ve gone astray,
To seek truth and grasp understanding...
This is the way of the mind.

The road before her is dark, obscure,
Full of unknowing, a tangled bramble:
Through this there is no clear path,
She must weigh the different ways,
With prayerful thought and care.
Love and courage are helpful there,
But wisdom is what she needs and has...
This is the way of the soul.

We watch her go along that forward way
Into the mist. She has left
A small candle flickering in our hearts,
But it does not go out.
We too stand at the crossroads,
Or at the city gates, or even in a high place,
And perhaps we do cry out, for her.
But she is still there, the candle still burns:
We carry her courage, we live her love,
we walk her wisdom.

                                                            -Robert Elliott, 27 January 2018 

Thursday, December 07, 2017

The Adaptive Functions of Nonadaptive Emotion Responses


Entry for 7 Dec 2017: FEAR Conference on Brain, Behaviour and Society in Aarhus

Sandwiched between my November Scottish work period and my December California work-and-holiday-period, I’ve just been to a fascinating and challenging two-day conference hosted by the University of Aarhus Institute for Advanced Studies (AIAS).  I found this conference fascinating because it was by the far the most multidisciplinary scientific meeting I’ve ever been to.  I also found it challenging, for exactly the same reason:  The scientific disciplines featured ranged from cellular biology and neurophysiology on one end of the spectrum, to political science and even history and theology at the other extreme, with many gradations in between.  Along this spectrum, I would have to put myself somewhere in the middle.  What all these folks had in common was an interest in understanding fear and anxiety at multiple levels and from different angles.

I’m pretty sure that the work that I’m going to find most useful going forward is that of the largest group of folks in the middle of that continuum: A collection of experimental field biologists/ethologists/neuroscientists, who are essentially doing animal psychology on animals ranging from racoons to South African birds to snails.  These folks, most notably Liana Zanette, Mike Clinchy, Dan Blumstein, and Tom Flower, do naturalistic field research on predator-prey interactions in wild animals, which is a natural place to study fear.  They use a range of relatively new methods such as camera traps (think motion-sensitive or sound-activated CCTV for spying on animals), battery-powered portable speakers (for scaring animals with the vocalisations of predators), and robotic pseudo-predators.  Related to them are more lab-based neuroscientists like Ken Lukowiak and Cornelius Gross, who use new, elegant technologies such as optogenetics to turn particular sets of brain neurons on and off at will, in order to study their behavioural effects and to trace neural pathways.

I found this work, in itself, to be fascinating, and because I read Science News regularly, I felt I was able to follow it pretty well. It also helped in conversations over meals to be able occasionally to ask for translation of the more obscure jargon terms.  So on first approach I loved being drawn into the world of field biology/ethology, which deeply resonated with the young boy I had once been, fascinated by strange animals and the adventure of field work.

However, this work is actually important for Emotion Focused Therapy and our understanding of how human emotion processes function and can go awry, even when they are doing exactly what they are evolved to do. Over the two days, I was able to see many useful connections. This group has identified persuasive analogues for several important clinical/EFT phenomena: 

First, Liana Zanette & Mike Clinchy, from the University of Western Ontario (now rebranded as Western University), have developed an analog for PTSD by subjecting prey animals (eg, chickadees, racoons) to predator stress, created by intermittently playing predator sounds in the immediate vicinity of birds or smaller mammal further down the food chain.  Played repeatedly and predictably over time, this creates chronic stress in the animals, including behaviours that resemble many specific symptoms of PTSD, such as hypervigilance, exaggerated startle response and loss of appetite. Most strikingly, they have shown that these stressed animals have higher mortality rates and fewer offspring; even more strikingly, this increased mortality and lowered reproductive success is passed on their offspring, and also affects species below them in the food chain. 

Yesterday before I left to catch my bus back to Billund Airport, I had one more relatively brief visit with Liana and Mike at breakfast.  They wanted to make sure I got their main message: Trauma-induced chronic fear/anxiety -- which EFT refers to as Primary Maladaptive Fear/Anxiety – is from an evolutionary point of view, not maladaptive but fundamentally adaptive:  By motivating constant vigilance, this reaction to stressful or even traumatic predator exposure increases the probability of not being killed by those predators.  They argued that falling victim to a predator instantly reduces the individual’s chances of survival to zero.  Our emotion system evolved the ability to overgeneralise from single traumatic events because this has survival value, especially in predator-rich environments, which until recently were quite common. As Mike said this morning, this tendency purchases maintenance of life at the cost of quality of life.  Mike and Liana wanted to know if I had heard anything in these two days that was going to affect how I work with clients.  Of course, it’s hard to know exactly with new ideas, but I told them I thought it might.

One thing for sure, however, is that it’s going change how I talk and write about emotion response types: From an EFT point of view, we assume that by and large Primary Adaptive ERs are more adaptive than the others, and that the broad goal of therapy, both within and across sessions, is to help clients reduce Primary Maladaptive, Secondary Reactive, and Instrumental ERs while at the same time increasing Primary Adaptive ERS.  However, it’s now clear to me that all four types of emotion response distinguished in EFT theory evolved because they had useful functions and survival value, especially in social units or groups:
Primary Adaptive Emotion Response (ER): This is what the emotion evolved for in the first place, eg, danger => fear => flee/freeze.  This is our first, natural and specific emotional response to a particular situation.  Note that in a given situation, our first, most natural response to a situation does not always provide the best way to get our needs met; eg, violation in the form of abuse by a powerful/unsympathetic other => anger => increased danger of further/worse harm.
Primary Maladaptive ER: Predisposes us to develop quite general, long-lasting learning from single traumatic episodes, “because I can’t afford to wait for a second chance”; increases sensitivity/strength of response to danger, but also anticipation of possible danger => anxiety => pause/orient/prepare.  In fact, “generalised primary emotion response” might be a more accurate term for this kind of emotion response.
Secondary Reactive ER: Gives us the ability to respond in complex ways (such as inhibition/interruption) to our emotion responses; eg, violation => anger => fear of possible damage to relationships => partial inhibition of anger allowing time to develop more nuanced useful responses
Instrumental Emotion Display: Gives us the ability to influence others, behave appropriately, or preserve relationships even when we are not feeling the relevant emotion; eg, danger from manageable adversary (eg, mountain lion or bully) => instrumental anger display to intimidate.  Drongo bird (South Africa) example (from Tom Flower): Opportunity to steal food => give danger alarm cry to scare or distract the other.  This works bests where the instrumental emotion display is the expected response or, failing that, where the other lacks the ability to detect the true emotion, or can’t afford to get it wrong.

The implication of this analysis is that the judgement of adaptiveness requires more than just identifying the type of emotion response; some further consideration of two kinds of context is required:  First, the emotional context of our key needs in the situation; second, the interpersonal context of others’ likely responses to our emotion responses.  Taking these further factors into consideration requires a fairly high level of emotional intelligence, both awareness of the range of our important emotions in the situation and reasonably accurate simulation of others’ likely reactions to our emotion responses.

This is why in EFT we don’t talk about maladaptive emotions (except when we are speaking carelessly), but only about maladaptive emotion responses:  This emotion response was useful originally, in the presence of danger, but isn’t here and now, in this particular situation.  Liana and Mike’s research suggests that the tendency to form overgeneralised, automatic fear responses is deeply embedded in us in an evolutionary sense, and research by others (such as Cornelius Gross) indicates that it is very likely to be mediated by the limbic system (especially the amygdala and the hippocampus).

To conclude, when a client with PTSD presents with a stuck feeling of constant fear of being revictimised that is causing them a lot of emotional pain and ruining their ability to get on with important life projects (as in the video I showed at the conference), it is clearly not true that their fear has always been maladaptive. It’s also the case that their continuing hypervigilance and strong response might very well be adaptive in some situations in their current life, more adaptive than a more relaxed view. Thus, it is only in particular situations, in which the person finds themselves unreasonably afraid when they and others’ carefully assess that this is not the case, that we would be justified in concluding that the person’s emotion response of fear is maladaptive, because it doesn’t fit the current situation. However, the fact that they have this response is completely natural, understandable and in the broad evolutionary sense adaptive. 

Friday, November 03, 2017

Ten Petitions: A Prayer

1. Dear Lady of the Universe,
You hold all things in your hands,
All peoples, times and places;
Help me recognise you 
In all your many names and many faces.

2. Help me to know that this is what you want for us:
To meet you in each other,
Here and now, and in the future,
With wisdom, courage and love.

3. And help me find each day
Just what it is that will sustain me;
And enlarge my spirit
And the spirits of those around me.

4. Please understand and contain my limitations,
Just as you help me to understand 
And contain the limitations of others.

5. Help me to listen to and accept all the parts of myself,
However wounded, lost or scared,
Seeking to heal my own and others’ injuries,
Transcending my limitations and theirs.

6. In the end, help me to know 
And truly love myself and those I meet,
Knowing us all to be little bits of consciousness 
Floating on the sea of time.

7. Because I am such a little bit of consciousness,
It’s all too easy for me to feel 
That I’ve come from from nothing 
And will soon disappear;
Therefore help me to accept 
That I can’t really know 
Where I came from or where I go.

8. Also, therefore, help me always know
Each moment, day and year as a gift to me,
And to appreciate how everything I have and am
Comes from you and those who came before me.

9. And help me also see how everything I have and am
I am already passing on to those around me
And those who will come after me.

10. Finally, help me know all this as so,
Each day, and ever here thereafter.
 
 
Notes: This poem is a very loose and highly personal paraphrase of the Lord's Prayer, drawing on previous pieces I've written.  I wrote it in the middle of two sleepless nights in Singapore while I was suffering from the cumulative effects of 15 hours of jet lag over 10 days. The views expressed here are not necessarily those of any particular religious denomination or system of theology. The stanza numbers enumerating the petitions are not to be read aloud but are meant to echo verse numbers in spiritual texts.