"Transformative and/or Destructive: Exceptional Experiences from the Clinical Perspective".

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

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

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

5. Evidence for a new normalisation • Schizotypy – a dimension of experience: Gordon Claridge. • Mike Jackson’s research on the overlap between psychotic and spiritual experience. • Emmanuelle Peter’s research on New Religious Movements. • Caroline Brett’s research: having a context for anomalous experiences makes the difference between whether they become diagnosable mental health difficulties • and whether the anomalies/symptoms are short lived or persist. • Wider sources of evidence – e.g.Cross cultural perspectives; anthropology. Richard Warner: Recovery from Schizophrenia.

6. “Third Wave” Cognitive Therapies • Developments in CBT as it tackles personality disorder, psychosis etc. • Therapeutic relationship important • Past history is significant • Change lies not so much in altering thought to alter feeling, but in altering the person’s relationship to both thought and feeling • Mindfulness is a key component. • Recognition of a split or incompleteness in human cognition – which mindfulness can bridge.

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

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

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

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

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

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

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

14. Ordinary Clear limits Access to full memory and learning Precise meanings available Separation between people Clear sense of self Emotions moderated and grounded Logic of Either/Or Supernatural Unbounded Access to propositional knowledge/memory is patchy Suffused with meaning or meaningless Self: lost in the whole or supremely important Emotions: swing between extremes or absent Logic of Both/And Shared Reality Unshared Reality

15. What is real & what is not?: about the programme. • A 4 session group programme for an Acute inpatient setting. • Run by a clinical psychologist and one or two others – trainees, nurses, OT etc. • Builds on the Romme and Escher ‘Voices Group’ tradition • Is different from other CBT approaches in normalizing the difference in quality of experience in psychosis, as well as thinking style. • This normalization attacks stigma by associating psychosis with valued areas such as creativity and spirituality. • Attempts to mitigate the damage to self concept of the traditional, diagnosis, based approach.

16. Session 2. The role of Arousalshaded area = anomalous experience/symptoms are more accessible. HighArousal - stress

17. Session 2 cont. DIALECTICAL BEHAVIOUR THERAPY: Linehan’s STATES OF MIND applied to PSYCHOSIS Discussion of Ways of coping suggested by this approach – management of arousal and distraction.

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

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