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Restructuring the Sense of Self by Building Self Compassion Leigh McCullough Ph.D. Associate Clinica

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be dealt with similarly to grief and anger in Short Term Dynamic ... There can be no full sense of compassion without comparable acceptance of grief and rage. ... – PowerPoint PPT presentation

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Title: Restructuring the Sense of Self by Building Self Compassion Leigh McCullough Ph.D. Associate Clinica


1
Restructuring the Sense of Self by Building Self
Compassion Leigh McCullough Ph.D. Associate
Clinical Professor, Harvard Medical
School Slides from the IEDTA Conference
(International Experiential Dynamic Therapy
Association UCLA, Los Angeles, CA., September
2005

The point of this lecture was to demonstrate
that compassion can be dealt with similarly to
grief and anger in Short Term Dynamic
Psychotherapy i.e., patients who are self
attacking or self destructive need to be
desensitized to positive feeling for self by
exposure to feelings of care, concern, compassion
for self and by the prevention of defensive and
inhibitory responses. This approach is presented
in detail in the following books (on the next two
slides) and the website, www.affectphobia.com
2
Short Term Dynamic Psychotherapy STDP
  • Short Term Anxiety-Regulating Psychotherapy
  • for Restructuring Defenses, Affects and
    Attachments
  • Basic Books, 1997
  • To Order 1-800-386-5656

3
Treating Affect Phobias A Manual for Short Term
Dynamic Psychotherapy
Each chapter presents 1) Basic concepts of
STDP, and 2) Exercises for reader
practice www.affectphobia.com To order 800
365 -7006
4
Go to our Website
www.affectphobia.com For information on our
Training Programs in 2006-7 in the Boston
Area (Details to be posted in the Fall
of 2005)
5
COMPASSION
Synonyms Sympathy, empathy, pity, concern,
kindness, consideration, care softhearted,
tenderhearted Antonyms Hardhearted,
stoneyhearted, callous, insensitive, pitiless

6
Thoughts on Compassion
Compassion is the antitoxin of the soul where
there is compassion even the most poisonous
impulses remain relatively harmless. Eric
Hoffer U.S. Philosopher

7
The Triangle of Conflict David Malan
DEFENSES Behaviors, Thoughts, and Feelings
INHIBITION Anxiety,
Guilt, Shame, Emotional Pain
ACTIVATING FEELINGS Adaptive forms of grief,
anger, closeness, And...POSITIVE FEELINGS FOR
SELF ( Interest/excitement, Enjoyment-joy) The
emotional bases of self-care, concern,
compassion, pride, and esteem
8
Compassion and its Blocks on the Triangle of
Conflict
DEFENSES Self Attack, Self-Hate Low Self Esteem
ANXIETY/ CONFLICT I am afraid to be too big. I
am ashamed to feel proud. It is too painful to
feel good about myself.
ADAPTIVE FEELING JOY OR INTEREST IN
SELF Self Compassion, Self Care, Self Esteem,
Pride, Self Confidence, Self Worth, Self
Respect, Trust in Self
9
Desensitization of Affect Phobias in STDP
INHIBITORY AFFECTS SHAME, Guilt, Pain
DEFENSIVE AFFECTS Self Hate
ACTIVATING AFFECTS
Positive Self Feeling, Self Interest, Self Care,
Self Compassion
10
A Bit of Exposure from Grapes of Wrath
Steinbeck, Chapter 6

Muley Graves (After talking about wanting to
kill the people who threw his family off their
land) Fella should maybe keep stuff
like that in his head. Casey (Former
Preacher) Yes, you should talk, he said.
Sometimes a sad man can talk the sadness right
out through his mouth. Sometimes a killin
man can talk the murder right out of his
mouth an not do no murder. You done right.
Dont you kill nobody if you can help it.
11
Triangle of Person David Malan
  • Identify the Adaptive and Maladaptive
    Relationships at each pole
  • Exposure to care concern (or lack thereof)
    from each person
  • CHANGING PERSPECTIVES ON THE SELF

CURRENT PERSONS (Spouse, boss, friends,
etc.)
THERAPIST
ORIGIN VERSUS MAINTENANCE OF DESTRUCTIVE
DEFENSES
PAST PERSONS (Family of Origin, Lost
Loves, Teachers, Friends )
12
Interventions to Restructure the Sense of Self
  • Insight Identify the self attacking defenses
  • Motivation to change the self attack
  • Origin versus Maintenance of Defenses
  • (You didnt cause the problem, but you have to
    resolve it.)
  • Exposure DESENSITIZATION to compassion/care by
  • Changing Perspectives
  • - THERAPIST (How do I feel about you?/Shared
    feeling.)
  • - others (What do they feel for you?)
  • - self (How do you feel about yourself?)
  • Expression of Compassion The ability to treat
    self with compassion and care outside the session

13
Theory in Restructuring the Self
  • Retranscribing the Memory Trace
  • Changing patients world view about the self
    …or Self View
  • Building new neuronal networks

14
Caveats
  • There are inevitable problems that arise when
    you work with positive feelings.
  • What might those be?

15
Problems
  • (More frequently occurring as GAF becomes lower,
    especially. under 50)
  • Sexual feelings that arise with closeness
  • (Need exposure and desensitization when
    conflicted, but take care not to let sexual
    feelings act as defenses to closeness with the
    therapist.
  • Fear of boundaries being violated
  • (There are clear boundaries here, remember that
    we imagine murderous feelings, but no one
    actually is murdered.)
  • Over-idealizing the therapist
  • (Sometimes a necessary phase with more regressed
    patients, but eventually the therapist must been
    seen as fully human.)
  • Never wanting to leave therapy
  • (We need to set you free…Can you take me with
    you?…Can you take these feelings with you?
    Generalize to caring feelings of others.)
  • …..OTHER EXAMPLES?

16
SELECTING TREATMENT FOR PATIENTS BASED ON LEVEL
OF FUNCTIONING
More Expressive treatment
GAF
100
Short term Restructuring of Feelings
Short Term Restructuring of Defenses
75
Build defenses Cognitive Rx Supportive
Rx Restructuring self/others
50
Build supports, Inpatient Care
25
More Supportive treatment
0
17
Some Old Things Some New Things
  • COMPASSION follows the same principles as other
    affects, (e.g.,desensitization)
  • but has some different mechanisms.
  • There seem to be no breakthroughs to compassion
    as with grief or anger.
  • One builds, or develops this capacity
    incrementally.
  • There can be no full sense of compassion without
    comparable acceptance of grief and rage.

18
Global Functioning, Affective Competence, and
underlying Ego Strength
  • Patient Adm GAF 1st Grief 1st Anger GAF
  • SESSION SESSION
  • Lesser Twin 60 1 2 TBA
  • Caged Man 55 2 TBA
  • Spiritual Chemist 52 3 (FU) 89
  • Grandmother 50 10 30 75
  • Tortured Student 48 20 2 75
  • Lady Cloaked in Fog 42 50 54 85

19
Are There Stages in Achieving Compassion?
  • Denial and Anger
  • Bargaining
  • Acceptance

20
The Spiritual Chemist
  • 37 year old divorced female fired from job as a
    lab technician, estranged from son
  • Came to Rx for help during divorce
  • Initial GAF 65 Current GAF 89 (7 year
    follow-up)
  • Sense of Self An amino acid with legs
  • Session 3 Exposure to closeness with and
    acceptance from me.

21
The Superior Unchanging Grandmother
  • 68 year old married female 45 years of therapy,
    and almost as long on anti-depressants.
  • Admission GAF 55 Current GAF 75 (2yr F-U)
  • Sense of Self Theres something horrible about
    me.
  • Sessions 1, 5, 10 and 12
  • Off anti-depressants by Session 11

22
(No Transcript)
23
IT TAKES COURAGE TO BE KIND IT TAKES COURAGE
TO BE … COMPASSIONATE … SOFTHEARTED

24
When time is limited
  • Point out self-attacking defenses
  • Build compassion for self
  • Find loves that have been lost (people who found
    them special) Whose eyes lit up when they saw
    you?
  • Explore positive feelings in the
    therapist-patient relationship
  • Use Socratic dialogue What do you think I...
  • Feel for you?
  • Want for you?
  • Hope for you?

25
Three Treatment Objectives
Defense Restructuring
Affect Restructuring
Self/Other Restructuring
Defense Recognition (Can the patient see the self
attack?) Giving Up Defenses (Is the patient
motivated to give up self attack?)
Affect Experiencing (Degree of felt care or
compassion for self) Affect Expression (Can
the patient treat self compassionately?)
Sense of Self (Positive and compassionate?) Sense
of Others (Realistic, adaptive?)
FOCUS RELATIONSHIP ANXIETY
FOCUS DEFENSES ANXIETY
FOCUS FEELINGS ANXIETY
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