SIQR for New Users and Other Lay Readers

.
The following is an enhanced, online version of printed handouts for those who wish to use the new SIQR cognitive-behavioral therapy method.

A reader who has used SIQR further simplified the text immediately below. Thus if my version seems too complex, please go to the end of the article and see his version in dark red.

Self-talk Identification, Questioning and Revision (SIQR) is both a cognitive-behavioral and neuropsychological therapy. It aims to reduce anxiety, grief, depression, anger or other emotional discomfort by identifying, questioning and revising unconscious beliefs, values, ideas, assumptions, convictions and/or attitudes that cause the inaccurate appraisals, interpretations and/or evaluations of what happens in life that lead to emotional discomfort.

There are many other cognitive-behavioral therapies (CBTs) designed to do the same thing, but SIQR is based on recent research into brain function, as well as well-established and widely used non-CBT therapies like Eye Movement Desensitization and Reprocessing (EMDR) (see http://www.emdr.com/briefdes.htm). For most people, SIQR relieves anxiety, grief, depression, anger and other emotional problems much more quickly and permanently than traditional CBTs.

More importantly, SIQR also provides those who use it with easy-to-use tools that empower the SIQR user to deal with emotional stress they may encounter at any time in the future.

Additionally, SIQR is not a form of "belief indoctrination" or "neural-linguistic programming." The person using SIQR engages in his or her own revision of existing, and development of new, beliefs, ideas, values, notions, assumptions, convictions and attitudes. Revised and new beliefs, ideas, values, etc., are a product of the SIQR user’s own experience, as opposed to the adoption of stipulated beliefs, values, ideas, assumptions, etc., from any authoritarian source, such as a medical, religious or philosophical authority.

SIQR “works” by causing the locations in the brain where emotional memories are stored to link up to other locations where language and reason can make sense of those emotional memories. These locations are almost always in separate brain hemispheres. SIQR’s use of either non-dominant handwriting or two-hand typing on a computer keyboard “works” the two hemispheres in a “bi-lateral” manner similar to EMDR so that the two hemispheres communicate with each other to overcome the hemispheric separation of brain functions that prevents emotional memories from being “digested.” (See http://sighkoblahgrr.blogspot.com/2009/05/siqr-introduction-summary.html and the links near the end of this article written for mental health professionals.)

EMDR (and the other “bi-lateral trauma treatments”) do a fine job of helping people who suffer from unresolved emotional trauma from the past. What SIQR does that EMDR does not do is help the anxiety, grief, depression or anger sufferer understand and gain control over his or her emotions when they pop up in the future. Practiced diligently for a few weeks, then regularly though less often and “as needed” from then on, SIQR provides people with the ability to identify, question and revise the beliefs that cause them to react to challenges in their lives in ways that cause them grief.

SIQR’s CBT components are based on the work of giants in cognitive therapy. SIQR’s neuropsychological components are based on the work of equally giant people in the field of brain function mapping and manipulation. For those interested in understanding why SIQR works, please see the references at the end of this article.

SIQR is built on the notion that “as we believe, so shall we feel, and as we feel, so shall we behave” that underlies Beck’s, Meichenbaum’s and Seligman’s cognitive-behavioral therapy; Ellis’s rational-emotive behavioral therapy, Young’s schematherapy, and Wessler’s cognitive appraisal therapy. All of these approaches are combined in SIQR which is also built on the same college-freshman-level “critical thinking” (see http://en.wikipedia.org/wiki/Critical_thinking) used by debaters and lawyers to argue their “cases.”

SIQR is usually done in four phases: In the first phase, one learns about logical fallacies and psychological concepts. In the second, one practices SIQR for the first time with Ellis’s 12 Big Ideas (see them listed below). In the third, one practices SIQR with a longer set of belief sentences supplied by the SIQR therapist. In the fourth, one begins to develop and work with belief sentences they are now able to identify in their thinking by themselves. In fairly short order, one is able to “own” and use the SIQR technique so effectively that he or she no longer needs the therapist. (“Give a man a fish and he eats for a day. Teach a man to fish and he eats forever.”)

Stage One

SIQR users learn about “logical fallacies” like all-or-nothing, black-or-white, all-good-or-all-bad (vs. some-good-and-some-bad), always-or-never, all-right-or-all-wrong, all-win-or-all-lose and always-better-or-always-worse judgments; as well as catastrophizing, globalizing, unsupported if-then linkages, and supposed musts, oughts, shoulds, have-to's and necessities that aren’t really the case. (See http://www.onegoodmove.org/fallacy/toc.htm, http://en.wikipedia.org/wiki/List_of_fallacies, and http://www.unc.edu/depts/wcweb/handouts/fallacies.html.)

New SIQR users often benefit from reading Albert Ellis’s A Guide to Rational Living (see http://www.amazon.com/Guide-Rational-Living-Albert-Ellis/dp/0879800429/ref=sr_1_1?ie=UTF8&s=books&qid=1257370759&sr=1-1).

They also learn other simple, psychological concepts like “co-dependence,” “wishful thinking,” “authoritarianism vs. authoritativeness,” “parenting styles,” “attachment schemes,” “the Karpman Drama Triangle,” “external and internal locus of control,” “learned helplessness,” the “false self,” the “as-if personality,” the “inner children and inner parents,” etc.

SIQR users employ those concepts to identify, question and revise the mistaken – but widely accepted – beliefs, ideas, values, assumptions, convictions and attitudes that famed author-lecturer Wayne Dyer called “your erroneous zones” in the multi-million-selling book of the same name (see http://www.amazon.com/Your-Erroneous-Zones-Wayne-Dyer/dp/0061091480).

Stage Two

The new SIQR user works through Ellis’s 12 Big Ideas, which are…

1) I must have love or approval from all the people I find significant.
2) I must always be thoroughly adequate, capable, competent and achieving.
3) I must always perform important tasks completely and perfectly.
4) If I don't get what I want, it's terrible and I cannot tolerate it.
5) When people act rude or unfair, I should blame them and see them as bad, wicked or rotten.
6) I have to view things as awful, terrible, horrible and catastrophic when I become frustrated, am treated unfairly or rejected.
7) I have little or no ability to control or change my feelings.
8) If something seems dangerous, threatening or fearsome, I must preoccupy myself with it and make myself anxious about it.
9) It is easier to avoid facing life's difficulties and responsibilities than to utilize self-discipline to face the truth.
10) Anything that once strongly influenced my life has to keep determining my feelings and behavior forever.
11) I must view it as awful and horrible if I do not find good solutions to life's grim realities.
12) I can achieve happiness without any commitment or effort to change.)

The new SIQR user applies each one to the process shown below. (DST = dysfunctional self-talk, TQ = thought questioning, ARST = affirmating revised self-talk, NRST = negating revised self-talk). He or she writes the following with his or her non-dominant hand or types the four sentences with a computer, word processor or typewriter:

DST: I must have love or approval from all the people I find significant.
TQ: Is it true that I must have love or approval from all the people I find significant?
ARST: It is true that I must have love or approval from all the people I find significant.
NRST: It is not true that I must have love or approval from all the people I find significant.

The new SIQR user then composes a brief essay on what he or she experienced while writing or typing the four sentences, including the emotions experienced. Here’s an example:

“It’s true that I have believed that I really had to have love and approval from certain people like my mother, father, older brother, Coach Jones, Prof. Smith, my two wives and my first wife’s mother. But now that I think about it, I would actually have been ‘okay’ even if most of them were less ‘loving’ or ‘approving.’ I like it that mom and dad love and approve of what I say and do, but I can see that’s it’s not crucial anymore. And thinking that being approved of by some of the guys at work is really nuts when I don’t really respect how some of them think.

“I felt sort of foolish, childish and stupid when I started typing. By the end of the typing, however, I began to feel like a door was opening. I began to feel stronger, more competent, more energetic and capable. I began to sense that I really don’t need love or approval from others as much as I thought I did, and that I can stop punishing myself when I make a mistake.”

Stage Three

When all 12 of the “Ellis sentences” are worked through in this fashion, the therapist reviews the work and presents the new SIQR user with one or more sets of sentences developed by Aaron Beck and Arthur Freeman for the known beliefs of specific personality types. Examples might include…

DST: Relationships are messy and interfere with my freedom.
DST: I should never trust other people.
DST: I am not able to tolerate unpleasant feelings.
DST: I will be helpless if I am alone.
DST: It is not safe to follow the advice of others.
DST: Most people are too demanding and controlling.
DST: I cannot depend upon anyone else for help when I need it.
DST: It is crucial that others recognize, admire and praise me for what I do.

The new SIQR user does the same thing with these sets of sentences as he or she did with Beck’s first 12 and presents the work to the therapist. The therapist reviews the work, and development of the new SIQR user’s own identified beliefs gets underway.

Stage Four

The therapist will usually work with the new SIQR user for a few sessions to identify more beliefs, values, ideas, assumptions, convictions and attitudes for SIQR processing. Self-identification of various appraisals, evaluations, interpretations, judgments, analyses and/or attributions of meaning about current events, people and behavior leads to identification of all manner of previously unrecognized beliefs, ideas, values, assumptions, convictions and attitudes. The new SIQR user begins to develop his or her own DST sentences, perhaps like those found in the articles listed below.

The entire course of work with the SIQR therapist is typically six to ten sessions over the course of as many weeks with telephone or email availability six to ten additional weeks. By then, the vast majority of SIQR users have “graduated” to their own effective use of the technique.

Examples of SIQR Use

The follow articles were written for clinical managers and therapists, but the SIQR process examples used are easy to grasp:

Management of Perceived Threat III:Managing countertransference, anxiety and defensiveness with female intimidators, at
http://sighkoblahgrr.blogspot.com/2008/12/management-of-perceived-threat-iii.html;

SIQR and Inaccurate, Conflicting, Polarized Beliefs, at http://sighkoblahgrr.blogspot.com/2008/12/siqr-and-inaccurate-conflicting.html;

SIQR over a Base of TA for Addictive and/or Bipolar Impulsivity, at http://sighkoblahgrr.blogspot.com/2009/01/siqr-over-base-of-ta-for-addictive.html;

SIQR for Sex, Romance & Relationship Problems, at
http://sighkoblahgrr.blogspot.com/2009/01/siqr-for-sex-romance-relationship.html;

SIQR Treatment for Bipolar Hypomania, at
http://sighkoblahgrr.blogspot.com/2009/01/siqr-treatment-for-bipolar-hypomania.html;

SIQR for Intimacy Development or Remediation, athttp://sighkoblahgrr.blogspot.com/2009/01/siqr-for-intimacy-development-or.html;

SIQR for Addiction to a Nymphomanic Sexopath: An REBT/CBT Approach to Boundary-Setting with a Purposely Hyper-Stimulating Female, at http://sighkoblahgrr.blogspot.com/2009/04/siqr-for-addiction-to-nymphomanic.html;

The Five Components of PTSD & CDDCR Treatment Therefore, at http://sighkoblahgrr.blogspot.com/2009/05/green.html;

Priming SIQR with Transactional Analysis: Nudging Inner Parents & Inner Children in the Neuropsychological CBT, at
http://sighkoblahgrr.blogspot.com/2009/05/priming-siqr-with-transactional.html;

DBT Overview with SIQR & Drop Drill Applications, at http://sighkoblahgrr.blogspot.com/2009/05/dbt-overview-with-siqr-drop-drill.html;

SIQR and Ego Modification, at
http://sighkoblahgrr.blogspot.com/2009/07/siqr-and-ego-modification.html;

SIQR for Self-Attribution Errors, at
http://sighkoblahgrr.blogspot.com/2009/07/alanatherapy.html;

SIQR for Sex and Romance Addiction, at
http://sighkoblahgrr.blogspot.com/2009/08/siqr-for-sex-and-romance-addiction.html; and

SIQR for Excessive Guilt, at
http://sighkoblahgrr.blogspot.com/2009/09/siqr-for-excessive-guilt.html.

References

SIQR’s CBT components are based on the work of giants in cognitive therapy including...

Aaron Beck (see http://www.beckinstitute.org/Library/InfoManage/Guide.asp?FolderID=200&SessionID={EB5A3055-22D2-4F93-8746-2F26A8CE06D8}),

Albert Ellis (see http://www.rebtinstitute.org/public/),

Donald Meichenbaum (see http://www.apa.org/videos/4310803t.html),

Martin Seligman (see http://www.ppc.sas.upenn.edu/vitae.htm),

Jeffrey Young (see http://www.schematherapy.com/id30.htm), and

Richard Wessler (see http://books.google.com/books?id=ML8MqIO0JOgC&dq=richard+wessler+cognitive+therapy&printsec=frontcover&source=bl&ots=5cd_vJoVjl&sig=t-qW-yOY4pzwI7aqe_t-pFKD4QY&hl=en&ei=n9fxSvH7FYSosgPzt4n5AQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CBoQ6AEwAg#v=onepage&q=&f=false), as well as many others.

SIQR’s neuropsychological components are based on the work of equally “giant” people in the field of brain function mapping and manipulation including...

Louis Cozzolino (see http://www.amazon.com/Neuroscience-Psychotherapy-Building-Rebuilding-Human/dp/0393703673/ref=sr_1_3?ie=UTF8&s=books&qid=1244015743&sr=1-3),

Michael Gazzaniga (see http://cwx.prenhall.com/bookbind/pubbooks/morris4/medialib/readings/split.html),

Alfred Kaszniak et al (see http://www.amazon.com/Toward-Science-Consciousness-III-Discussions/dp/0262581817/ref=sr_1_1?ie=UTF8&s=books&qid=1257373247&sr=1-1),

Joseph LeDoux (see http://www.cns.nyu.edu/ledoux/overview.htm),

Jaak Panksepp (see http://www.amazon.com/Affective-Neuroscience-Foundations-Emotions-Science/dp/019517805X/ref=sr_1_1?ie=UTF8&s=books&qid=1257373374&sr=1-1),

Alan Schore (see http://www.amazon.com/Affect-Dysregulation-Disorders-Allan-Schore/dp/0393704068/ref=sr_1_2?ie=UTF8&s=books&qid=1257373464&sr=1-2),

Francine Shapiro (see http://www.emdr.com/shapiro.htm),

Otfried Spreen et all (see http://www.amazon.com/Developmental-Neuropsychology-Otfried-Spreen/dp/0195067371/ref=sr_1_2?ie=UTF8&s=books&qid=1244015403&sr=1-2),

Douglas Watt (see http://www.jurispro.com/files/documents/doc-706625874-resume.pdf),
and others.

The resources and references for this introduction are found throughout the articles at the links listed above.

© 2009 by Rodger Garrett; all rights reserved. Links are fine. Please contact not_moses@fastmail.fm with comments or questions. Thank you.

The further simplified explanation by an SIQR user begins here:

SIQR for New Users

The following is for those who wish to use the new SIQR cognitive-behavioral therapy method to reduce emotional stress now and in the future.

What is SIQR?

Self-talk Identification, Questioning and Revision (SIQR) is both a cognitive-behavioral and neuropsychological therapy. The purpose of (SIQR) is to reduce emotional stress and discomfort by identifying, questioning and revising our unconscious beliefs. There are many other cognitive-behavioral therapies (CBTs) designed to do the same thing. The fact that future belief systems are affected is what separates SIQR from other already established types of cognitive therapy.

SIQR is based on the most recent research into brain function, as well as well-established and widely used non-CBT therapies like Eye Movement Desensitization and Reprocessing (EMDR). SIQR has been proven to relieve the emotional stress caused by anxiety, grief, depression and anger much more quickly and permanently than traditional (CBTs).

SIQR is built on the notion that what we believe affects how we feel, and that what we feel, affects how we behave. If the easy to use system is practiced routinely for a few weeks, then regularly on an as needed basis, SIQR will provide one with the ability to identify, question and change or revise the beliefs they hold now and in the future that cause them to react to challenges in their lives in ways that cause them emotional stress.

Who developed SIQR?

SIQR was developed by Rodger Garrett, Psy.D., MS-CCP, through his studies in the fields of clinical psychology, cognitive-behavioral psychotherapy, neurobiology and brain-function mapping. By utilizing his studies he has developed a fast and easy system to reduce the negative aspects of anxiety, grief, depression and anger, which cause emotional stress.

Why it works

SIQR works by causing the locations in the brain where emotional memories are stored to link up to other locations where language and reason can make sense of those emotional memories. These locations are almost always in separate parts of the brain. By using either non-dominant handwriting or two-hand typing on a computer keyboard when performing SIQR, the two parts of the brain are enabled to communicate with each other in a way that helps to overcome the separation of brain functions that prevent emotional memories from being digested. Once these memories are more fully digested, relief from emotional stress is experienced.

SIQR and it’s neuropsychological components are based in large part on the theories and practices of Albert Ellis an American psychologist who in 1955 developed (REBT) rational emotive behavior therapy as well as other renown scholars working in the field of cognitive therapy such as Aaron Beck, Martin Seligman, Jeffrey Young and Richard Wessler, and brain function mapping including Louis Cozzolino, Michael Gazzaniga, Joseph LeDoux, Jaak Panksepp and Douglas Watt. For a complete list of these scholars and much of their work please see the references at the end of this article.

How it is done

SIQR is usually done in four stages with the help of a therapist trained to use the SIQR treatment.

Stage 1: One learns about logical fallacies (misconceptions which result in part from the undigested memories) as well as psychological concepts.

Examples of the judgmental thinking created by logical fallacies are: all-or-nothing, black-or-white, all good-or-all bad (versus) some good-and-some bad, always-or-never, all right-or-all wrong, all win-or-all lose and always better-or-always worse. One also learns to identify unrecognized beliefs, values, ideas, assumptions, convictions and attitudes.

Stage 2: One practices SIQR for the first time with Albert Ellis’s 12 Big Ideas:

1) I must have love or approval from all the people I find significant.
2) I must always be thoroughly adequate, capable, competent and achieving.
3) I must always perform important tasks completely and perfectly.
4) If I don't get what I want, it's terrible and I cannot tolerate it.
5) When people act rude or unfair, I should blame them and see them as bad, wicked or rotten.
6) I have to view things as awful, terrible, horrible and catastrophic when I become frustrated, am treated unfairly or rejected.
7) I have little or no ability to control or change my feelings.
8) If something seems dangerous, threatening or fearsome, I must preoccupy myself with it and make myself anxious about it.
9) It is easier to avoid facing life's difficulties and responsibilities than to utilize self-discipline to face the truth.
10) Anything that once strongly influenced my life has to keep determining my feelings and behavior forever.
11) I must view it as awful and horrible if I do not find good solutions to life's grim realities.
12) I can achieve happiness without any commitment or effort to change.)

The new SIQR user applies each one of Ellis’s 12 sentences to the process shown below:

(DST ) = dysfunctional self-talk
(TQ) = thought questioning
(ARST) = affirming revised self-talk
(NRST)= negating revised self-talk

He or she writes the following with his or her non-dominant hand or types the four sentences with a computer, word processor or typewriter:

DST: I must have love or approval from all the people I find significant.

TQ: Is it true that I must have love or approval from all the people I find significant?

ARST: It is true that I must have love or approval from all the people I find significant.

NRST: It is not true that I must have love or approval from all the people I find significant.

The new SIQR user then composes a brief essay on what he or she experienced while writing or typing the four sentences, including the emotions experienced.

Here is an example:

“It’s true that I have believed that I really had to have love and approval from certain people like my mother, father, older brother, Coach Jones, Prof. Smith, my two wives and my first wife’s mother. But now that I think about it, I would actually have been ‘okay’ even if most of them were less ‘loving’ or ‘approving.’ I like it that mom and dad love and approve of what I say and do, but I can see that’s it’s not crucial anymore. And thinking that being approved of by some of the guys at work is really nuts when I don’t really respect how some of them think.

“I felt sort of foolish, childish and stupid when I started typing. By the end of the typing, however, I began to feel like a door was opening. I began to feel stronger, more competent, more energetic and capable. I began to sense that I really don’t need love or approval from others as much as I thought I did, and that I can stop punishing myself when I make a mistake.”

Please Note: New SIQR users will benefit greatly by reading Albert Ellis’s A Guide to Rational Living. Go to: http://www.amazon.com/Guide-Rational-Living-Albert
Ellis/dp/0879800429/ref=sr_1_1?ie=UTF8&s=books&qid=1257370759&sr=1-1 to see the book and order if you wish.

Stage 3: When all 12 of the “Ellis sentences” are worked through in this fashion, the therapist reviews the work and presents the new SIQR user with one or more sets of sentences developed by Aaron Beck and Arthur Freeman for the known beliefs of specific personality types. Examples might include…

DST: Relationships are messy and interfere with my freedom.
DST: I should never trust other people.
DST: I am not able to tolerate unpleasant feelings.
DST: I will be helpless if I am alone.
DST: It is not safe to follow the advice of others.
DST: Most people are too demanding and controlling.
DST: I cannot depend upon anyone else for help when I need it.
DST: It is crucial that others recognize, admire and praise me for what I do.

The new SIQR user does the same thing with these sets of sentences as he or she did with Beck’s first 12 and presents the work to the therapist. The therapist reviews the work, and development of the new SIQR user’s own identified beliefs gets underway.

Stage 4: The therapist will usually work with the new SIQR user for a few sessions to identify more beliefs, values, ideas, assumptions, convictions and attitudes for SIQR processing. Self-identification of various appraisals, evaluations, interpretations, judgments, analyses and/or attributions of meaning about current events, people and behavior leads to identification of all manner of previously unrecognized beliefs, ideas, values, assumptions, convictions and attitudes.

Eventually, one begins to develop and work with his or her own DST or belief sentences they are now able to identify in their thinking by themselves. In a fairly short time, one is able to use the SIQR technique so effectively that he or she no longer needs the help of a therapist. “Give a man a fish and he eats for a day. Teach a man to fish and he eats forever.”

The entire course of work with the SIQR therapist is typically six to ten sessions over the course of as many weeks with telephone or email availability six to ten additional weeks. By then, the vast majority of SIQR users have “graduated” to their own effective use of the technique.

Examples of SIQR Use

The following articles were written for clinical managers and therapists, but the examples used are easy to grasp (same list that appears at the end of the original article above).

Treatment of Trauma- or Neglect-Induced Paranoid Personality

.
The following is the first draft of an article on evidence-based treatment for DSM-IVR Axis II paranoid personality disorder underlying repeated decompensations in the Axis I anxiety, bipolar, depression and post-traumatic stress disorders.

Abstract

When paranoid personality is the largely the result of repeated, early life, traumatic experience in which a pre-cognizant child experiences relentless environmental failure to recognize and care for his survival needs; trust development, affect management and cognitive distortion are the principle targets for therapeutic endeavor.

Hypothesis

The biogenetically sensitive, pre-natal traumatized, mother-abandoned, caregiver-swapping (and uncertain), under-supported, emotionally overwhelmed infant is likely to be conditioned by primitive cognitive experience to become overly frightened of stressors in the environment... and become "paranoid." Successful therapy will have to address these precise circumstances.

Background

Unlike Henry Hill (the non-fictional, central character in Martin Scorcese's feature film, "Goodfellas") who knew his mother cared about him even as his father battered him, and who also had the social support of his gang buddies, and like D (who knew his father cared about him even as mother battered him, and had the support of guys on his sports teams), the paranoid cannot “take his punishment like a man,” shrug it off and move on.

This is because the paranoid tends to have been abused and/or abandoned (under-supported) by both parents and/or had little or no support from extra-familial sources (see Clarkin and Lenzenweger, Ekleberry, Millon et al, and Stone).

Parenthetically, this is a dynamic I often saw in the cult members I dealt with many years ago. They seemed to be able to dissociate (see Van der Kolk) wholly that they willingly sacrificed their overly thick, paranoid boundaries to their cult gurus and higher-ups in order to gain a sense of protection from the "big, bad world" inside the cult.

The adult child who remains biologically sensitive, pre-natal traumatized, mother-abandoned, caregiver-swapping (and uncertain), under-supported and emotionally overwhelmed will continue to fear an environment he never learned to trust and continues to expect to be unworthy of trust. That adult child will seek to empower himself to deal with environment by any means other than trust of others.

He will, in Wilson's words, try to become his own "higher power" in a smugly self-righteous and pseudo-certain, narcissistic schema... or seek an external higher power rather than one within his own "weak, puny, defenseless" mind. Sometimes, of course, he will alternately do both. Many paranoids appear to alternate in borderline-organized fashion between narcissistic and dependent or avoidant. (See Clarkin and Lenzenweger, Millon et al, Stone, and Vaknin and Rangelovska on the narcissistic personality; Rotter on "external locus of control", Selgman and "learned helplessness;" and Kernberg, and Meissner on "borderline organization.")

In crisis circumstances, he will cry for help but expect abuse and angrily defend himself against those from whom he expects abuse. In an environment filled with half-trained, stress-burnt, ostensibly “professional” caregivers, he is likely to get exactly what he expects.

Discussion of Therapeutic Strategy

That adult child will have to be taught from scratch to trust his own accurate perceptions of a less threatening environment wherein at least some of the people are relatively trustworthy and competent. He will have to come to be able to tolerate environmental stress without succumbing to affective overload. He will have to “radically accept” (see Dimeff and Koerner, Linehan, and Marra) that the world is full of bad people, but that bad people are not "everywhere."

He will need to abandon his understandable, intolerable-fear-dissociating, histrionic reaction formation in favor of quiet (reasonable and pragmatic; not paranoid nor hyper-vigilant) environmental monitoring.

1) Observe the environment dispassionately, concurrently observing and rejecting filtration through his own "cognitive perception," leaving appraisal off the table for the moment (Cermak's detachment, Garrett's containment);

2) Monitor, tolerate and process affects resulting from environmental events with some form of meditation (Livesley's and Marra's exposure therapy, Kabat-Zin's and Linnehan's extended mindfulness, Garrett's drop drill);

3) Identify, question and revise appraisals (a.k.a. evaluations, interpretations, analyses, determinations, conclusions, assessments, attributions of meaning) and core beliefs (a.k.a. ideas, values, ideals, assumptions, convictions, attitudes) with some form of cognitive-behavioral therapy (e.g.: Young's CAT, Ellis's REBT, Garrett's SIQR, Beck's split-tee-form CBT).

The order of skills acquisition should be as follows:

1) The third activity should, in my experience, be developed first, because it figures heavily in activity number one, which depends upon development of the third and second activities. CAT / CBT / REBT / SIQR / etc. can be conducted in group instructional (not therapy) settings to minimize interpersonal threat, the single most fundamental orientation for the paranoid patient. Widespread use of this method in incacertaion settings has demonstrated success (see Dolan in Millon et al, 1998).

2) The second activity cannot be developed until the therapist has developed a camraderie with the patient sufficient to underpin a "therapeutic alliance" or collaboration built on trust (see Erikson) even under the often stressful circumstances of practicing affect monitoring and tolerance.

3) But the second activity should be developed before moving to the first, because detached, contained observation is only possible once the patient has practiced and acquired the essential skills of affect tolerance and regulation (see Marra especially, though most recent Dialectical Behavior Therapy literature addresses this matter regularly).

The process for developing this acquistion of skills is loosely described throughout Dimeff and Koerner, Linehan, Livesley, Marra, and Schiraldi, but is not presented anywhere that I know of in the brief and precise thematic manner shown above.

Summary

Developed as it appears to be from a pre-cognizant experience of relentless environmental failure to address and care for the infant's needs, the infant grows into an adult who fears the environment unduly, expecting it to be relentlessly threatening, unwilling to meet his survival needs and largely underserving of his trust. To effectively deal with such a schemata, the therapeutic approach should be one of trust development, cognitive restructuring and exposure for the development of affect tolerance and processing, in that precise, though not entirely discrete, order.

Resources and References

Anonymous: Adult Children of Alcoholics: Alcoholic / Dysfunctional Families, Torrance, CA: ACA World Service Office, 2006.

Arsenault, L.; et al: Being Bullied as an Environmentally Mediated Contributing Factor to Children’s Internalizing Problems…, in in Archives of Pediatrics & Adolescent Medicine, Vol. 162, February, 2008.

Bandura, A.: Self-Efficacy: The Exercise of Control, San Francisco: W. H. Freeman, 1997.

Beck, A.: Cognitive Therapy and the Emotional Disorders, New York: Penguin-Meridian, 1976.

Beck, A.; Freeman, A.: Cognitive Theory of the Personality Disorders, New York: Guilford Press, 1990.

Beck, A.; Wright, F.; Newman, C.; Liese, B.: Cognitive Therapy of Substance Abuse, New York: The Guilford Press, 1993.

Black, C.: It Will Never Happen to Me: Children of Alcoholics as Youngsters-Adolescents-Adults, New York: Ballentine, 1981, 1987.

Bowlby, J.: A Secure Base: Parent-Child Attachment and Healthy Human Development. London: Routledge; New York: Basic Books, 1988.

Brazelton, T.; Cramer, B.: The Earliest Relationship: Parents, Infants and the Drama of Early Attachment, Reading, MA: Addison-Wesley, 1990.

Cassidy, J.; Shaver, P.: Handbook of Attachment, New York: Guilford Press, 1999.

Centers for Disease Control and Prevention: The Effects of Childhood Stress Across the Lifespan, Atlanta, GA: CDC, 2008.

Cermak, T.: Diagnosing and Treating Co-Dependence, Minneapolis: Johnson Institute, 1986.

Clarkin, J.; Lenzenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996.

Copeland, W.; Keeler, G.; et al: Traumatic events and posttraumatic stress in childhood, in Archives of General Psychiatry, Vol. 64, 2007.

Courtois, C.: Guidelines for the Treatment of Adults Abused or Possibly Abused as Children (with Attention to Issues of Delayed or Recovered Memory), Washington, DC: The Psychiatric Institute of Washington, 1997.

DeBellis, M.: Developmental Traumatology: Neurobiological Development in Maltreated Children with PTSD, in Psychiatric Times, Vol. 16, No. 11, 1999.

Dimeff, L.; Koerner, K.: Dialectal Behavior Therapy in Clinical Practice: Applications Across Disorders and Settings, New York: The Guilford Press, 2007.

Dong, M.; Anda, R.; et al: The interrelatedness of multiple forms of child abuse, neglect and household dysfunction, in Child Abuse and Neglect, Vol. 87, 2004.

Duman, R.: Neural plasticity: consequences of stress and actions of antidepressant treatment, in Dialogues of Clinical Neuroscience, Volume 6, 2004.

Ekleberry, S.: Seminar on Substance Abuse and Axis II Personality Disorders, San Francisco: Arcturus, 2000.

Ellis, A.; Harper, R.: A Guide to Rational Living, North Hollywood, CA: Melvin Powers, 1961.

Ellis, A.; Dryden, W.: The Practice of Rational Emotive Therapy, New York: Springer Publishing Company, 1987.

Ellis, A.: Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy, New York: Promethius Books, 2001.

Erikson, E.: Childhood and Society, New York: W. W. Norton, 1950, 1967, 1993.

Erikson, E.: Identity and the Life Cycle, New York: W. W. Norton, 1959, 1980.

Forward, S.: Toxic Parents: Overcoming their Hurtful Legacy and Reclaiming Your Life, New York: Bantam Books, 1989.

Friedman, M.: Post-Traumatic and Acute Stress Disorders: The latest assessment and treatment strategies, 4th Ed., Kansas City, MO: Dean Psych Press dba Compact Clinicals, 2006.

Heim, C.; Nemeroff, C.: The role of childhood trauma in the neurobiology of mood and anxiety disorders: pre-clinical and clinical studies, in Biological Psychiatry, Vol. 49, 2001.

Heim, C.; Nemeroff, C.: Neurobiology of early life stress: clinical studies, in Seminar on Clinical Neuropsychiatry, Vol. 4, 2002.

Herman, J. L.: Trauma and Recovery, New York: Basic Books, 1992.

Huttenlocher, P.: Neural Plasticity: The Effects of Environment on the Development of the Cerebral Cortex, Cambridge, MA: Harvard University Press, 2002.

Johnson, S.; Ballister, C.; Joiner, T.: Hypomanic vulnerability, terror management, and materialism, in Personality and Individual Differences, Vol. 38, 2005.

Kabat-Zinn, J.: Mindfulness Meditation: Health benefits of an ancient Buddhist practice, in Goleman, D.; Gurin, J., editors: Mind/Body Medicine, New York: Consumer Reports Books, 1993.

Kaufman, J.; Plotsky, P.; Nemeroff, C., et al: Effects of early adverse experiences on brain structure and functions: clinical implications, in Biological Psychiatry, Vol. 48, 2000.

Kernberg, O.: Severe Personality Disorders: Psychotherapeutic Strategies, New Haven, CT: Yale University Press, 1977.

Kira, I.: Taxonomy of Trauma and Trauma Assessment, in Traumatology, Vol. 7, No. 2, 2001.

Kluft, R.; et al: Childhood Antecedents of Multiple Personality Disorder, Washington DC: American Psychiatric Press, 1985.

Lang, A.; Laffaye, C.; et al: Relationship among childhood maltreatment, PTSD, and health in female veterans in primary care, in Child Abuse and Neglect, Vol. 30, 2006.

Lazarus, R.: Emotion and Adaptation, New York: Oxford University Press, 1991.

Linehan, M.: Cognitive–Behavioral Treatment of Borderline Personality Disorder, New York: Guilford Press, 1993.

Livesley, W. J.: Practical Management of Personality Disorder, New York: Guildford Press, 2004.

Ludwig, D.; Kabat-Zinn, J.: Mindfulness in Medicine, in Journal of the American Medical Association, Vol. 300, No. 11, September 2008.

Maret, S.: Frank Lake's Maternal-Fetal Distress Syndrome: An Analysis, Dissertation - Clinical Theology Association, St Mary's House, Church Westcote, Oxon, England, OX77SF, 1996.

Marra, T.: Dialectical Behavior Therapy in Private Practice, Oakland, CA: New Harbinger, 2005.

Meissner, W.: The Borderline Spectrum: Differential Diagnosis and Developmental Issues, New or: Jason Aronson, 1984.

Munich, R.; Allen, J.: Psychiatric and Sociotherapeutic Perspectives on the Difficult-to-Treat Patient, in Psychiatry, Vol. 66, No. 4, Winter 2003.

Negrao, C.; Bonanno, G.; et al: Shame, Humiliation and Childhood Sexual Abuse: Distinct Contributions and Emotional Coherence, in Child Maltreatment, Vol. 10, No. 4, Nov. 2005.

Ogden, P.; Minton, K.: Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory, in Traumatology, Vol. 6, Issue 3, October, 2000.

Perry, B.: Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence, in Osovsky, J. (ed.): Children, Youth and Violence: The Search for Solutions, New York: Guilford Press, 1997.

Perry, B.: Childhood Experience and the Expression of Genetic Potential: What Childhood Neglect Tells Us About Nature and Nurture, in Brain and Mind, Vol. 3, 2002.

Putnam, F.: Dissociation in Children and Adolescents: A Developmental Perspective, New York: The Guilford Press, 1997.

Putnam, P.; Saevarsson, S.; van Honk, J.: Hypomanic trait is associated with a hypovigilant automatic attentional response to social cues of danger, in Bipolar Disorders, Vol. 9, No. 7, November 2007.

Rogers, C.: On Becoming a Person, Boston: Houghton Mifflin, 1961, 1995.

Rotter, J.: Generalized expectancies for Internal vs. External Locus of Control of reinforcement, in Spielberger, C.: The Development and Application of Social Learning Theory, New York: Praeger, 1982.

Ruggiero, V. R.: Beyond Feelings: A Guide to Critical Thinking, 4th Ed., Mountain View, CA: Mayfield Publishing, 1995.

Sanderson, W.; Rego, S.: Empirically Supported Psychological Treatment of Panic Disorder and Agoraphobia; Washington, DC: Medscape CMEs; 2000.

Schiraldi, G.: The Post-Traumatic Stress Disorder Source Book, 2nd Ed.; New York: McGraw-Hill, 2009.

Schore, A.: The Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health, in Infant Journal of Mental Health, Vol. 22, 2001.

Seigel, D.: Toward an interpersonal neurobiology of the developing mind: Attachment relationships, “mindsight,” and neural integration, in Infant Mental Health Journal, Vol. 22, 2001.

Seigel, D.: Reflections on the Mindful Brain, in Mind Your Brain, Los Angeles: Lifespan Learning Institute, 2007.

Shaver, P.; Mikulincer, M.: Psychodynamics of Adult Attachment: A Research Perspective, in Journal of Attachment and Human Development, Vol. 4, 2002.

Simard, V.; et al: The Predictive Role of Maladaptive Parental Behaviors, Early Sleep Problems and Child/Mother Psychological Factors, in Archives of Pediatrics and Adolescent Medicine, Vol. 162, April, 2008.

Stern, D.: The Interpersonal World of the Infant: The View from Psychoanalysis and Developmental Psychology, New York: Basic Book, 1985.

Stern, D.: The First Relationship: Infant and Mother, Cambridge, MA: Harvard U. Press, 2002.

Stone, M.: Abnormalities of Personality Within and Beyond the Realm of Treatment, New York: W. W. Norton, 1993.

Ursano, R.; Bell, C.; Eth, S.; et al: Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder, in The American Journal of Psychiatry, November, 2004.

US Dept. of Health and Human Services: In Focus: Understanding the Effects of Maltreatment on Early Brain Development, Washington, DC: US Government Printing Office, 2001.

US Dept. of Health and Human Services: Child Maltreatment 2006, Vol. 17, Washington, DC: US Government Printing Office, 2008.

Vaknin, S.; Rangelovska, L.: Malignant Self Love - Narcissism Revisited, Prague: Narcissus, 2003.

Van der Hart, O.; Horst, R.: The Dissociation Theory of Pierre Janet, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.

Van der Kolk, B.; Hopper, J.; Osterman, J.: Exploring the Nature of Traumatic Memory: Combining Clinical Knowledge with Laboratory Methods; in Journal of Aggression, Maltreatment & Trauma, Vol. 4, No. 2, 2001.

Wessler, R.; Hankin, S., Stern, J.: Succeeding with Difficult Clients: Applications of Cognitive Appraisal Therapy, San Diego: Academic Press, 2001.

Wilson, B.: Alcoholics Anonymous, New York, A. A. World Services, 1939, 1955, 1976, 2001.

Winnicott, D.: The Child, The Family and The Outside World, 2nd Ed., San Francisco: Da Capo, 1992.

Wood, M.; Balduf, J.; Howard, K.; Huang, H.; Marino, P.; McConky, K.: Reactive Attachment Disorder: A Disorder of Attachment or of Temperament? Unpublished but peer-reviewed manuscript at http://www.personalityresearch.org/papers/wood.html, Rochester, NY: Rochester Institute of Technology, 2003-2005.

Young, J.: Cognitive Therapy for the Personality Disorders: A Schema-Focused Approach, 3rd Ed., Sarasota, FL: Professional Resource Press, 1999.

© 2009 by Rodger Garrett; all rights reserved. Links are fine. Please contact not_moses@fastmail.fm with comments or questions. Thank you.

Film Review: "Coraline"

Through The Looking Glass" Revisited?

Lewis Carroll had read a lot of Charles Dickens when he wrote "Alice in Wonderland" and "Through..." a century and a half ago. He understood the formidable mind of the neglected child with an IQ of 130 or more. And that's pretty much what we have here.

If understood for what it is, "Coraline" is a very sophisticated look into the inventions of alternate realities many small children will turn to in the face of parental abandonment.

It's a road singer Tori Amos (herself a "recovering brilliant, but abandoned, child") has gone =waaaay= down in her work for the past 20 years, though not in this particular fashion. (It's also a theme Tim Burton is examining a bit with the redoubtable Johnny Depp as the "Mad Hatter" in next year's "Alice...")

The =big problem=, of course, is that some of these children go down that road and never really come back, forever using fantasy as a defense against the insecurities from which they were unprotected as toddlers, pre-schoolers and grammar school children. We call the unfortunate result "psychosis" if the unreality is near total, and "borderline" if it's just "here" and not "there."

This is a =terrific= film that parents should watch =with= their children and discuss afterwards.

(c) 2009 by Rodger Garrett. Inquire or comment to not_moses@fastmail.fm.

Book Review: The Post-Traumatic Stress Disorder Sourcebook, 2nd Edition

Second Edition: For the Clinician

September 23, 2009, by Rodger Garrett "SighKoBlahGrr" (Loma Linda, CA USA) - See all my reviews

Issued ten years ago, the first edition of Schiraldi's PTSD Sourcebook became (at least over time) the "industry standard" orientation text for new counselors and therapists in the VA Healthcare System. Then, as now, it was both comprehensive and easy to understand.

I wondered (in about 2000 or 2001) why it wasn't used as a complete "patient education" piece, but over time, I came to understand that the VA is =very= conservative about such matters. With good reason, at least in some respects: There was material in the first edition that was surely capable of triggering PTSD symptoms in readers who had not yet progressed far enough in therapy to defend against such triggering.

While not a substantial revision of the original, the second edition does add a number of simplified descriptions of therapeutic techniques as well as mentions here and there of newer efficacy research to support these and previously included methods. That said, the second edition continues to be the single best, mass-market text available for understanding PTSD's causes and conditions, as well as doing something meaningful about it.

With regard to the controversy over triggering, my suggestion is simply that while PTSD sufferers with denser, more primitive ego defenses (e.g.: dissociation, rage, nihilistic depressive orientation) require some work before tackling a book like this, most sufferers - and family members alike - will be hugely rewarded for diving in here. Schiraldi's book is "practical" and "hands-on," as opposed to "heavily neurobiological" or "interactionally theoretical."

This is not Bessel van der Kolk's (wonderful) =Traumatic Stress= or even Matthew Friedman's terrific little =Post-Traumatic and Acute Stress Disorders=. But, as a clinician, I found it (once again) to be a very effective re-orientation toward discussing PTSD and its component issues =with= those who are neither neuropsychologists or theory-soaked experts on interactional traumatization, let alone psychopharmacologists.

Schiraldi neatly distills the whole gamut of topics on nature and nurture, as well as stress and de-stress, into one- and two-syllable verbiage we can use to make sense of it all the same way the =patient= will have to make sense of it.

Do I have issues with the book? Of course. Shiraldi does tend towards the VAHS culture's view that one size fits all here and there. And some clinicians who have not themselves worked through their all-or-nothing orientations may get the idea that the author has covered all of the possible bases. He has not. But if he tried to do so, the book would be impossibly large, as well as needlessly difficult for lay readers.

That's a critique, however, that can be made of nearly any mass market book on such a complex subject. On the whole, this is a valuable and worthwhile read for clinicians and patients alike.

Borderline Organized =and= Passive-Aggressive

When I use the terms "borderline-organized" and "passive-aggressive" together, I'm talking about people like the suspected killer in this article.

http://news.yahoo.com/s/ap/20090922/ap_on_re_us/us_virginia_killings

The young man's "passive" and "aggressive" natures are in two, separate mental compartments, neither of which are known to the other, and he does not have sufficient ego strength to be able to see either of those two compartments from a more conscious "okay inner parent" or "competent adult" compartment, because he doesn't have one.

His core belief / value / ideal / assumption / conviction / attitude sets are either "kill" or "be killed," "complete dominance" or "complete submission," "persecutor" or "victim," and they are completely polarized without any gray area in between them.

That degree of polarization is called "level III or IV borderline organization" (Google Otto Kernberg and William Meissner.) The levels of borderline organization are described in (probably too) exhaustive detail at http://sighkoblahgrr.blogspot.com/2008/06/borderline-dichotomy.html.

People who are thus polarized can be treated, but will usually only engage in treatment because of extreme emotional discomfort.

In my direct experience, most people who display this combination of syndromes were severely neglected, severely invaded, intellectually invalidated, repeatedly battered or otherwise mistreated by ostensible caregivers when they were small children. The learned to "give up" over here, but remain extremely angry about it over there.

In response, a correspondant asked:

"I would like to hear more about this part if you can: ...They learned to "give up" over here, but remain extremely angry about it over there."

I answered:

The repeatedly neglected, abandoned, invaded, invalidated and/or abused actual (physical) child typically has two ongoing reactions to what is happening to him. One is rage; the other is depression.

He is angry because he isn't getting what he needs. He becomes depressed because his expressions of need (and rage) aren't "working" to get him what he needs. Discovering that his expressions of rage are unproductive (or worse, that they induce further neglect, abandonment, invasion, invalidation and/or other abuse) when focused on others, he begins to direct his rage onto himself. Subsequent to his "attacks" of rage, he experiences guilt and shame for having lost control and appearing incompetent, causing him to experience depression.

The value systems driving rage vs. depression are not conscious, however. They are not a part of a developing ego or "collection of experiences of and conclusions about things and events as they are." All he (dimly) knows is that the environment does not not "work" for him.

Not being able to see his own choicemaking (beginning at about age five or six), he continues to believe that live happens to him rather than as (at least in part) as the result of his choicemaking. He takes what Rotter called the "external locus of control" point of view.

Without intervention to teach him an "internal locus of control" point of view, he becomes, as Seligman called it, "learned helpless." His learned helplessness is the sum of his beliefs about the "impossibility of ever getting what I need" from the environment.

Unless or until an effective, ego-building intervention takes place, he continues to rage in his angry, not-okay inner child space (see Harris) and give up in his other, depressed, not-okay inner child space.

The correspondant then asked:

"Without intervention to teach him an 'internal locus of control' point of view." and "Unless or until an effective, ego-building intervention takes place..." Now how do you do that? My way has been the mindful thinking meditation and it was the only time I started to consciously see myself in the world.

I answered:

MM (see Kabat-Zin and http://search.yahoo.com/search;_ylt=A0oGkkZsdrpKmHMBI6FXNyoA?p=mindfulness+meditation+Kabat-Zin&fr2=sb-top&fr=chr-yie8&sao=1; see also Garrett on the "Drop Drill" form of MM at http://sighkoblahgrr.blogspot.com/2007/10/drop-drill.html) does a fine job of increasing ego capacity for observation and emotion-tolerance, but cannot, by itself, deal with the lack of development of critical thinking that is pretty typical for those raised in highly authoritarian, all-or-nothing, always-or-never, black-or-white, all-good-or-all-bad family and school environments.

For that, one needs collegiate courses (or at least the books they use) in critical thinking. I like Ruggiero's (see below), but there are =many= others. Albert Ellis's books (also see below) are =bedrock= to the psychotherapuetic remediations for this form of ego destruction or developmental limitation.

In very recent times, we have come up with methods to utilize critical thinking and rational-emotive behavioral (as well as cognitive-behavioral) therapy in =very= rapid fashion. One of the is the SIQR method described at http://sighkoblahgrr.blogspot.com/2009/05/siqr-introduction-summary.html, but there are others, as well.

Ruggiero, V. R.: Beyond Feelings: A Guide to Critical Thinking, 4th Ed., Mountain View, CA: Mayfield Publishing, 1995.

Ellis, A.; Harper, R.: A Guide to Rational Living, North Hollywood, CA: Melvin Powers, 1961.

Ellis, A.; Dryden, W.: The Practice of Rational Emotive Therapy, New York: Springer Publishing Company, 1987.

Ellis, A.: Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy, New York: Promethius Books, 2001.

One can buy any of these books online at amazon.com.

The correspondant answered (in part):

"Now, life has other moments as well and I was discussing an issue with a friend of mine a few years ago and he replies, well what could possibly happen? how could that hurt you? ...and I was stumped in a way because I had never approached a situation with those questions.

"Maybe I am reaching a good point in my recovery where I can start to apply critical thinking in my social life and interpersonal and intimate interactions, where the resistance of the five-year-old inside me is not as large as it used to be or my adult mind or self has grown enough to take some control from his hands and apply critical thinking in daily situations. I hope that is the case because I see the value of it. But it is still so foreign of a territory that I often sit amazed looking at it rather than applying it."

I responded:

The environment (our parents, our friends, our religious leaders, our bosses, the media, etc.) =bombards= us with polarized black-and-white, all-or-nothing, always-or-never, all-bad-vs.-all-good, win-or-lose, better-or-worse, all-one-way-or-all-the-other thinking. It is endemic to the authoritarian (demand-command-threat) -- as opposed to authoritative (research-factual) -- way of thinking that continues to dominate almost all major cultures in the world.

This kind of thinking is useful for keeping cultures together so that they are easily unified against external threats from other cultures. But it extracts a huge price from people who tend to see the environment in borderline-organized, polarized fashion.

And it is, in fact, the bedrock of "what ails us" when people take it too far into their intra- and inter-personal schemata. It is what we have to dismantle in those who are suffering emotionally because they see threat where it really doesn't exist (or doesn't exist to the extent they =believe= it exists).

In fact, what we find from help people think critically is that their inner 5-, 6- and 15-year-olds get a lot more comfortable with the environment as a result of seeing =for themselves= that it's not as threatening out there as they very understandably came to believe it is.

The small child who is constant subjected to "torture" of various sorts =will= come to see the environment as frightening. Who wouldn't? But they can be shown -- over time -- that their fears are accurate only with regard to what happened in specific circumstances in their lives, not with regard to everything else in the world.

Our inner children (mine, too, bud) got the idea that pretty much everything and everyone are potentially dangerous because in the smaller worlds of their youth, the environment really =was= dangerous. Those inner children will spend the rest of their lives believing that unless they begin to Identify those beliefs (that Self-talk), Question them, and Revise them sufficiently to let go of their essential distrust of others.

In time they come to be able see that while there =are= some people they'd do better to steer clear of, =most= people in the environment are relatively safe.

References

Rotter, J.: Generalized expectancies for Internal vs. External Locus of Control of reinforcement, in Spielberger, C.: The Development and Application of Social Learning Theory, New York: Praeger, 1982.

Seligman, M.: Learned Optimism: How to Change Your Mind and Your Life, New York: Knopf, 1990.

Harris, T.: I’m Okay—You’re Okay, New York: Harper and Row, 1968.

Kabat-Zinn, J.: Mindfulness Meditation: Health benefits of an ancient Buddhist practice, in Goleman, D.; Gurin, J., editors: Mind/Body Medicine, New York: Consumer Reports Books, 1993.

Other articles on borderline personality and organization:

Runaways Gone Multiple at
http://sighkoblahgrr.blogspot.com/2006/02/runaways-gone-borderline.html,
Borderlines in Bondage at
http://sighkoblahgrr.blogspot.com/2006/02/borderlines-in-bondage.html,
Borderline Boundary Setting at
http://sighkoblahgrr.blogspot.com/2006/02/borderline-boundary-setting.html,
The Painful Polarization of Object Relations at
http://sighkoblahgrr.blogspot.com/2006/03/polarization-of-painful-reality.html,
Spectral Reality at
http://sighkoblahgrr.blogspot.com/2006/03/spectral-reality.html,
AMaC Recovery: A Process, Not an Event at
http://sighkoblahgrr.blogspot.com/2006/06/child-abuse.html,
Under, Over, Alongside, Facing Away and Switching Positions at
http://sighkoblahgrr.blogspot.com/2006/07/child-abuse-iii.html,
Borderline Self-Mutilation at
http://sighkoblahgrr.blogspot.com/2007/04/borderline-self-mutilation.html,
A Spectral Taxonomy of Personality at
http://sighkoblahgrr.blogspot.com/2007/04/spectral-taxonomy-of-personality.html,
Borderline and Multiple Personality Disorder at
http://sighkoblahgrr.blogspot.com/2007/05/borderline-vs-multiple-personality.html,
Multi-Axial Spectrum of Behavior at
http://sighkoblahgrr.blogspot.com/2007/05/multi-axial-spectrum-of-behavior.html,
The Purpose of Personality… and Multiple Personality Disorder at
http://sighkoblahgrr.blogspot.com/2007/05/cognitive-view-of-purposes-of-specific.html,
PTSD + Bipolar Usually = Borderline at
http://sighkoblahgrr.blogspot.com/2008/02/ptsd-bipolar-usually-borderline.html,
Codependent Dramatization of Three Polarized Dilemmas at
http://sighkoblahgrr.blogspot.com/2008/02/codependents-perfectionistic-impulse-to.html,
The Borderline Manifesto(s) at
http://sighkoblahgrr.blogspot.com/2008/03/borderline-manifestos.html,
Four Levels of Borderline Dichotomy at
http://sighkoblahgrr.blogspot.com/2008/06/borderline-dichotomy.html,
The Self-Empowered AMaC Borderline at
http://sighkoblahgrr.blogspot.com/2008/08/self-empowered-amac-borderline.html, and
The Dissociative Borderline: A Busload of Developmentally Deficient Children at
http://sighkoblahgrr.blogspot.com/2008/09/dissociatve-borderline-busload-of.html.

(c) 2009 by Rodger Garrett; all rights reserved. Links are fine. Please inquire of comment to not_moses@fastmail.fm. Thank you.

30-Q CBT for Shame, Guilt & Conflict Resolution

.
There are times in our lives when we do and say things again and again we later wish we hadn’t. This usually occurs because we mis-appraise, mis-interpret, mis-evaluate, mis-attribute, mis-analyze and, well, mis-judge what’s going on because of grossly inaccurate core values, core beliefs, core ideals, core assumptions, core convictions and core attitudes we began to develop when we were very young.

Have alcoholic, drug-addicted, career-obsessed, hyper-religious, neglectful, abandoning, over-authoritarian or emotionally invasive – let alone physically abusive and reality-invalidating – parents? Then figure on some haywire core orientations toward the environment.

But that’s not what I’m talking about here.

What I’m talking about is autonomic nervous system shock (Google "Hans Selye" on the "fight-or-flight response") and the cognitive reactions we sometimes have to it because we have acquired the core values rigid perfectionism from media, business, academic, professional and other influences in our achievement-obsessed society.

I recently found myself in shock when a trusted and morally righteous, if aging and confused, friend turned irrational and vindictive because something he bought from me “blew up in his face” when he attempted to use his new toy in a fashion that struck me as wholly counter to his stated values.

Perhaps to defend himself against his own sense of shame about being caught, he suddenly and vituperously blamed me for what he had done. I reacted emotionally myself, and that’s not something I do anymore without substantial recrimination.

Because moral and ethical principles were involved, I rejected the advice of the majority who said, “Oh, just take it back and give him his money.” Instead, I examined, considered and questioned in the manner of Self-talk Identification, Questioning and Revision (see http://sighkoblahgrr.blogspot.com/2009/05/siqr-introduction-summary.html), but ultimately followed my own values. “Your skin may crawl, but rewarding him for what he did that flies in the face of his supposed spiritual healing isn’t something you’ll live easily with.”

My skin did crawl for a while. And the exercise shown below is what I had to do about it. I had to ask myself a series of questions to determine not only the extent of my involvement, but also the extent to which the conditionings of parents and society were effecting my logic. I picked the questions up from Glenn Schiraldi’s brand new and impressive The Post-Traumatic Stress Disorder Source Book, 2nd. Edition, 2009.

The question from Schiraldi's book are shown in dark red. My answers are in black.

1) Were you thinking coolly at the time? No; I was stunned and thrown off balance.

2) Were you aware of all your options? Certainly not in the heat of the moment; it took me two weeks to work through the list of possibilities.

3) What were your choices? a) Rectify his damage to the item at my expense and return it to him figuring he might do the same thing again. (“How many times will I have to fix it for him,” I wondered.) b) Refund his money, repair the item and either keep it for my own future use or re-sell it. c) Accept the consequences of telling him to sue me (having done so before I moved several hundred miles away) and putting up with an uncertain process of adjudication. d) Decide whether or not I was willing to drive back and forth from my new home a few times to do the do for that.

4) Were any of the choices good ones? Having rationalized that even if it cost me a thousand dollars to lose a summary judgment for non-appearance, I was better off emotionally and neurobiologically to let barking (they certainly weren’t sleeping) dogs bark and ignore the matter.

5) Had you ever been in the situation before? Yes; I had operated a business a decade ago during which two customers purchased items and misused them in somewhat similar fashion, threatening action if I did not fix repair the items. I finally stood my ground with one who insisted upon trying to do what she was trying to do that I told here again and again would not work. I told the other that I would repair the item once, but if he insisted upon using his purchase in the same way again, I would go to court with him. I never heard from him – or her – again.

6) Was there any way of knowing for sure what the best option would be? Of course not; I’m not a mind reader.

7) Were you clearly aware of all the outcomes of all the options? While I can project the likely outcomes, I am not a fortune teller, either. The purchaser has another year and half to consider his options in this state. I just have to accept that and move on.

8) What would have been the outcome of each choice? a) Off the hook for now, but what about later (if I don’t get it across to a very determined, stubborn, and obsessed customer that every time he tries to use his purchase that was, he can expect it to go verblungent). b) Off the hook, but knowing I have rewarded someone who has already wrecked his life once believing he can get away with such behavior. c) Play the lack-of-resolution / tolerance-for-unresolved-conflict waiting game, just as I am now doing. d) Blow another thousand bucks (at least) in lost income and expense to plead in front of another (notoriously suspect) small claims judge (the likes of which with whom I have had “good” and “bad” experiences over the years).

9) Were any of the choices clearly the right one? Not that I can tell. But “c” seemed “better” (meaning more practical and moral) than the others.

10) Were there any choices without a cost? No. “a” suggested lack of resolution and reward by me for immoral behavior. “b” was “easy” physically and financially, but would bother me morally and ethically. (“What if he tries and somehow succeeds in using what he bought from me for an immoral purpose?”) (Yes; I see that I was attempting to take more responsibility than was reasonable for control of his behavior.) “c” extracts a price in “continuing, mild irritation” and occasional checking to see if my bank account has been garnished. “d” would have extracted utterly unreasonable costs timewise, emotionally and neurobiologically even if I had countersued and won, and very likely have punished him with intolerable humiliation.

11) Were you aware of all this at the time? Of course not. Processing to this extent takes time and variation in emotional states.

12) Were any of your options taken away? Initially, yes; by my shock-driven reaction to his aggression of telling him to sue me. It’s an event I hope to learn from for the future. Afterwards, I did opt to communicate through a third party he had introduced into the matter that I would repair his item and return it to him very inexpensively, but that I was unwilling to bear the cost myself. He stonewalled.

13) Did you lack information that would have helped you make a wiser choice? Initially, yes. I was unsure of the cause of his complaint at first because, in part, I did not want to believe that he would use the item to do with it what I now have very little doubt he used it for. I also did not have previous personal experience with precisely this kind of misuse of such items; I had to contact others to ascertain with “95% certainty” that my supposition in the hours following the upsetting meeting was correct. I also did not know right away that I could repair the piece as quickly and inexpensively as I found out the next day.

14) Did you have time to fully weigh your choices, to see all angles? In the heat of the moment and in the state of shock I experienced in the discovery of highly immoral behavior on the part of a formerly highly trusted confidant… no. I reacted emotionally because I was more than momentarily overwhelmed.

15) Were there mitigating factors such as fatigue, hunger, substance abuse, chaos, confusion, lack of support, lack of vital information, etc.? Yes; confusion, uncertainty and lack of vital information.

16) Did you deliberately try to harm someone? No.

17) Was the outcome as you intended? No. And I have to continue to accept the consequences of that, but I have made a choice – over time – to stand my ground for moral and ethical reasons. The consequences, whatever they are, will result therefrom. But even if the price to me is $2000.00; I will deal with those consequences then rather than suborn my ethics now.

18) Was it an honest mistake? On my part, yes. On his, my sense is that he cannot come to terms with his very longstanding obsession to act out the damage done to him as a child in a very self-, and potentially other-, damaging way. I could perhaps live with the former; the latter greatly concerns me.

19) What was a reasonable expectation, given the situation? That I would be shocked by the suddenly sociopathic behavior of a trusted associate. At the time, however, I told myself that I “should have known better because I had briefly seen a sign of possible acting out, but I ignored it.” In fact, it was a very brief sign packaged in a fashion that made it seem “historical” and “processed,” as opposed to “present” and “operative.”

20) Did you accomplish you initial objectives? No. And I have no way of knowing if I ever will. I am forced to simply try to let go of it.

21) Will there be other opportunities to do better? Probably not with him, but perhaps with others in similar circumstances. I will certainly listen more closely to what people tell me that may have sociopathic implications. But I recognize that context is context, and I am never going to see or hear the significance of every single thing others say.

22) How could you have coped worse? I could have made a public issue of the matter in our group of common acquaintances with the object of ruining him. I did share my upset with a few trusted people who understand such matters, but asked them to keep it in confidence, which they evidently have. I could also have dragged him into court and made an issue of his behavior there. The man has suffered already for his immoral behavior; I do not care to add to that if I can prevent so doing because humiliating punishment is usually counterproductive.

23) Did your imperfect actions avert a worse disaster? Thus far, anyway; yes.

24) How might you have responded better to create more of a sense of mastery and control? My supposition at this time is that I would have done better to move immediately into the Drop Drill (see http://sighkoblahgrr.blogspot.com/2007/10/drop-drill.html), get up from the table, walk out without saying anything, and let him do whatever.

25) Did you know how to do what you have described then? Actually yes, but I was too overwhelmed with the sudden (but unverified) awareness of what he had probably done to be able to do that. I don’t know if I would act all that differently in similar circumstances in the future, but perhaps I would.

26) Was it reasonable to expect that you could have done so at that time? I don’t think so. It may have been possible, but I expect now that it was unlikely.

27) Can you imagine yourself responding more effectively now? Very much so, but only if I saw the torpedo wakes in the water for a bit before they hit the side of the ship. I had no time to cry “General Quarters!” over the 1MC.

28) If this were your daughter, son or best friend who reacted as you did, how would you feel? I would shrug and accept it as entirely expectable.

29) What would you tell them? It makes complete sense to me that you would react as you did.

30) Could you forgive them for their actions? Of course. But then, I would also not think that what they had done begged any forgiveness. I would see them as having been shocked and temporarily knocked off balance for having publicly acted in a fashion counter to their previous public pronouncements of values.

I recognize after having done the work here that this was a person I had, for reasons best left unstated here, projected as a “moral authority” and therefore “superhuman.” When he acted counter to my unrealistic projection, I was forced to revise my appraisal of him. That I could not do so before I had reacted emotionally myself now seems understandable. So, yes; I could now forgive anyone else for making such a mistake.

The point of this presentation is not to argue a case for my decision making with any of the very few people who may read this who know who the other party is. It is to offer another method for conflict resolution and show how it was used in a real-life situation.

That said,

1) Did it work for me? Yes.
2) Did I come to a perfect resolution of the conflict? No. But it did help me to come to a point where I can accept the remaining ambiguity without mulling this situation over again and again.

A post script:

Subsequent to writing this some time ago, I fell into a discussion with a sophisticated and enlightened, progressive Christian minister about the notion of making “gods” of religious leaders and then rejecting Christianity outright (i.e.: “throwing the baby out with the bathwater”) when one of them stumbles into his or her own human frailty.

That led to a brief description – and discussion – of Martin Scorcese’s controversial, 1988 film, “The Last Temptation of Christ,” in which Willem Dafoe, as the title character, wrestles for two and half hours with a conflict between his flesh and his divinity. By the end of the film, he is firmly convinced of his purpose as God’s messenger of divine forgiveness.

The film, and the Nicos Kazantzakis book upon which it was based, may have been speculations, but they illustrated (at least for me) that those who are not thoroughly divine (well, who is?) are likely to experience the imperatives of the flesh.

From that realization, I was able to grasp not only the behavior of my former trusted friend, but my own shock-driven reactions to it. It is no longer necessary for me to point my finger at him for what he did. Nor is it necessary for my punishing inner parent to point the finger at my confused inner child for what he did in response.

© 2009 by Rodger Garrett; all rights reserved. Links are fine. Please comment or inquire to not_moses@fastmail.fm. Thank you.

SIQR for Excessive Guilt

.
While guilt per se may be useful as a motivation for cognitive and behavioral change, excessive guilt is most often counter-productive and pathology-inducing. Excessive guilt is most typically the result of irrational and illogical core beliefs, values, ideals, assumption, convictions and attitudes driving inaccurate appraisal, evaluation, interpretation, analysis and/or attribution of meaning to one’s interaction with the environment and others in the environment (see Ellis, Beck et al, Seligman, Wessler et al, and Young).

The following sentences representing identified suspect beliefs in the core cognitive schema of the pervasive guilt sufferer are taken from Schiraldi, G.: The Post-Traumatic Stress Disorder Source Book, 2nd Ed.; New York: McGraw-Hill, 2009. My intention here is to illustrate how they can be questioned and rejected or revised with the Self-talk Identification, Questioning and Revision technique described at http://sighkoblahgrr.blogspot.com/2009/05/siqr-introduction-summary.html.

Clarifying the acronyms: NOIP=not-okay inner parent, NOIC=not-okay inner child, OIP=okay inner parent, OIC=okay inner child (all as per Thomas Harris's redefinition of Freudian ego states); SIQR=self-talk identification, questioning and revision; CBT=cognitive behavioral therapy; REBT=rational-emotive behavioral therapy.

DST: I am either all responsible or not responsible at all.
TQ: Is it true that I am either all responsible or not responsible at all.
ARST: It is true that I am either all responsible or not responsible at all.
NRST: It is not true that I am either all responsible or not responsible at all.

The logical fallacy (see http://www.google.com/search?sourceid=navclient&aq=0&oq=logical+fallacies&ie=UTF-8&rlz=1T4ADBF_enUS304US306&q=logical+fallacies+examples) is clearly “either-or” and flies in the face of what is often an ambiguous mix of partial responsibility vs. partial non-responsibility. Such either-or fallacies are usually driven by schema in the NOIP and introjected by the NOIC from experience with biological parents as well as other authority figures. It is my job to sort out the responsibility that is attributable to my thinking and behavior vs. the responsibility that is not attributable to my thinking and behavior. Other parties (including the “injured” second and relatively innocent or relatively culpable third) may be involved. Additionally, circumstance beyond my, the injured party’s or anyone else’s control may be minimally, partially, largely or wholly responsible. It’s a shades-of-gray deal demanding tolerance for ambiguity and conflict.

DST: I feel so badly that I must be completely responsible.
TQ: Is it true that I feel so badly that I must be completely responsible?
ARST: It is true that I feel so badly that I must be completely responsible.
NRST: It is not true that I feel so badly that I must be complete responsible.

The logical fallacies of unwarranted absolutism (a form of black-or-white, all-or-nothing thinking) and Albert Ellis’s “musturbation” (see Ellis, 1961, 1987 and 2001) applies here. I have assumed an if-then relationship where one is not necessarily the case, as well as accepting total responsibility because my emotions are so strong. The strength of my emotions has no required linkage whatsoever with my involvement or lack thereof. I may well be minimally, partially, largely or complete responsible, but not merely because my emotions are powerful.

DST: I don’t deserve to live or live happily because of my behavior.
TQ: Is it true that I don’t deserve to live or live happily because of my behavior?
ARST: It is true that I don’t deserve to live or live happily because of my behavior.
NRST: It is not true that I don’t deserve to love or live happily because of my behavior.

This is another flaw in the connection between an identified “if” and an irrationally stipulated “then” in an if-then hypothesis. Why is it necessarily “true” that I “don’t deserve” to live or live happily because of past unfortunate behavior especially if I no longer do that behavior and the results of my having done it in the past have been amended to the satisfaction of others involved? (Perfect “amends” – as per 12 Step practice – may not be possible, but if I did all that I reasonably could to rectify the situation and/or repair the damage, what is gained from believing that I am “still bad?”

DST: I should have done better.
TQ: Is it true that I should have done better?
ARST: It is true that I should have done better.
NRST: It is not true that I should have done better.

The operative word here, of course, is “should.” The word implies a demand similar to “ought,” “must,” and/or “have to.” “Better” is an evaluation, and evaluations are products of core beliefs, values, ideals, assumptions, convictions and attitudes. If any of them are unduly perfectionistic, globalizing, all-encompassing and/or rigid, the resulting evaluations may be inaccurate in any given circumstance. “It would have better for all involved if I had acted more appropriately” is a more reality-based – and ambiguity-tolerant – summation of the circumstances in most cases. Most of us simply cannot do everything perfectly all the time.

DST: The more I punish myself, the more I show I care.
TQ: Is it true that the more I punish myself, the more I show I care.
ARST: It is true that the more I punish myself, the more I show I care.
NRST: It is not true that the more I punish myself, the more I show I care.

Here’s another unfounded link between “if” and “then.” Why would it be necessarily the case that I care more (or show that I care more) as the direct result of self-punishment? Self-punishment has no inherent relationship either actual caring or the (questionable) display thereof unless one believes it does. So long as I am operating at Level 2.3 or higher in Kohlberg’s schema of morality orientation and have genuine remorse for what I have done, and act upon the remorse to rectify the situation (of possible), additional self-punishment seems dysfunctional without accomplishing anything useful either for the victim of my transgression or for my own further maturation. What does excessive self-punishment actually achieve if I experience grief but do not change my behavior? Reparation and changing my behavior are actually all that matter.

DST: The more I suffer and punish myself, the more I will ease another’s suffering.
TQ: Is it true that the more I suffer and punish myself, the more I will ease another’s suffering?
ARST: It is true that the more I suffer and punish myself, the more I will ease another’s suffering.
NRST: It is not true that the more I suffer and punish myself, the more I will ease another’s suffering.

There is no direct (or indirect) causal linkage between anything I do – other than rectify or repair the damage done – and the easing of my victim’s suffering. See the discussion immediately above and refer to Steps Eight and Nine in Kannon, Wilson, Anonymous, and Anonymous.

DST: The more I suffer, the less likely I will be to repeat the mistake.
TQ: Is it true that the more I suffer, the less likely I will be to repeat the mistake?
ARST: It is true that the more I suffer, the less likely I will be to repeat the mistake.
NRST: It is not true that the more I suffer, the less likely I will be to repeat the mistake.

To a degree, it may be true for some that greater “weight of consequence” over a longer period of time will make those who have done harm less likely to do so in the future. But the research into the results of incarceration in penal institutions have made it abundantly clear that neither length of term nor quality of penal environment have a direct correlation with resistance to recidivism in all prisoners. In fact, increased length of incarceration is positively associated with increased rates of recidivism up to the age of 45 or so (see Millon et al). Increased suffering may make one less likely to repeat and mistake, but there is no guarantee whatsoever that it will do so. Moreover, positive correlations between a combination of cognitive restructuring and mindfulness meditation, and reduction of impulsivity have been demonstrated in voluminous research (see Dimeff and Koerner, Kabat-Zin, Linehan, Livesley, and Marra).

DST: If I give up guilt, I will be disloyal to my values, God, or those who have suffered.
TQ: Is it true that if I give up my guilt, I will be disloyal to my values, God, or those who have suffered?
ARST: It is true that if I give up my guilt, I will be disloyal to my values, God, or those who have suffered.
NRST: It is not true that if I give up my guilt, I will be disloyal to my values, God, or those who have suffered.

We have another falsely asserted linkage between cause and effect here. How will giving up (excessive) guilt make me disloyal to my values, God, or those who have suffered? Unless my values are unduly perfectionistic, absolutistic and rigid; unless my concept of God is perfectionistic, absolutistic, rigid and punishing; and unless those others are sadists who derive pleasure from my suffering; how is giving up (excessive) guilt disloyal to those values? Thus, if I continue to believe that this assertion is true, I need to look at my values, my concept of God, and/or the motives of those I harmed.

DST: If I suffer enough, I will somehow restore fairness and justice.
TQ: Is it true that if I suffer enough, I will somehow restore fairness and justice?
ARST: It is true that if I suffer enough, I will somehow restore fairness and justice.
NRST: It is not true that if I suffer enough, I will somehow restore fairness and justice.

Here, it seems, is the most self-evident of the tortured “if-then” linkages between cause and effect. How can my suffering do anything to restore fairness and justice? My behavior caused the problem; not my emotions. My behavior - not my emotional state – is required to rectify the problem. The only thing I can do to restore fairness and justice is to repair the damage and/or rectify the situation. If I have done all that I realistically and appropriately can to do that, I may continue to feel badly about what I did, but I at least know that 1) I did what I could to fix the problems I caused, and 2) my continued suffering has no further bearing on the matter. (Again, see Steps Eight and Nine in Kannon, Wilson, Anonymous, and Anonymous.)

DST: I should be able to fix all problems, right all wrongs, save all who are in trouble and vanquish all evil.
TQ: Is it true that I should be able to fix all problems, right all wrongs, save all who are in trouble and vanquish all evil?
ARST: It is true that I should be able to fix all problems, right all wrongs, save all who are in trouble and vanquish all evil.
NRST: It is not true that I should be able to fix all problems, right all wrongs, save all who are in trouble and vanquish all evil.

I gave up trying to be John Wayne some time ago. I cannot Rescue (see Karpman, and Garrett at http://sighkoblahgrr.blogspot.com/2009/04/karpman-drama-triangle-summary.html) anyone but myself, at least not for long, and not without consequences. All-or-nothing / always-or-never thinking is the logical fallacy here: I may be able to fix some problems, right some wrongs, save a few people who are largely and consistently willing to be saved (at whatever cost to myself), and vanquish a limited amount of evil… that’s it. That I cannot fix all problems, right all wrongs, save all who are in trouble, or vanquish all evil is simply the Way It Is and Not the Way It Is Not.

DST: I shouldn’t have been afraid.
TQ: Is it true that I shouldn’t have been afraid?
ARST: It is true that I shouldn’t have been afraid.
NRST: It is not true that I shouldn’t have been afraid.

One is either afraid or not. To some extent, we are afraid of circumstances in the environment because we have been conditioned to form core beliefs, values, ideas, assumptions, convictions and/or attitudes that do cause us to appraise, interpret, evaluate, analyze, judge and/or attribute meaning to the environment as “frightening” when in fact, they are not inherently threatening or dangerous. Likewise, there are circumstances in the environment that really are threatening and dangerous. In the latter case, we do well by ourselves to be fearful; in the former, how do we know what is truly fearful from what isn’t if authority figures are telling us to fear this, that and the other? My job is to use my perception, intellect and capacity to examine the evidence… if I have time to do so. The cat who cowers when he sees a human coming with a dish of food did not “invent” his fear; he learned it from watching his mother do the same thing. Should we feel guilty because we learned the same way? Or do we do better to question, rather than merely accept, our appraisals?

DST: I am somehow responsible – even totally responsible – for a crime committed against me.
TQ: Is it true that I am somehow responsible – even totally responsible – for a crime committed against me?
ARST: It is true that I am somehow responsible – even totally responsible – for a crime committed against me.
NRST: It is not true that I am somehow responsible – even totally responsible – for a crime committed against me.

I understand (because I have experienced this phenomenon in a number of rape and battering victims) that people can be conditioned to believe that this is the case (see Herman, and Russell, as well as Van der Kolk). I do not experience this belief, but if I did, I would search for, identify, question and reject or revise the core beliefs I might have that could cause me to appraise as done in this sentence. Adults who were children of punishing, perfectionistic, authoritarian, rigid (often overly religious) parents sometimes think like this. Such children often acquire the belief that they cause their parents to punish them far more harshly than is appropriate. When that belief becomes crystallized into the adult child’s identity structure, an over-reaching sense of responsibility and belief in deserving harsh punishments – including criminal acts by others viewed as “karma” for “bad behavior” in the past – is sometimes the result.

DST: There is absolutely nothing I can do to improve upon the past.
TQ: Is it true that there is absolutely nothing I can do to improve upon the past.
ARST: It is true that there is absolutely nothing I can do to improve upon the past.
NRST: It is not true that there is absolutely nothing I can do to improve upon the past.

The word “absolutely” gives this one away. While there are absolutes in the world (e.g.: the progression of time, gravity, the laws of thermodynamics), they are rare compared to all the shades of gray. Gradient – rather than absolute – reality is the norm 95 or 98 percent of the time. Next, the past may be the past, and what has happened can not be changed per se, but the past does not indicate, demand or control the future. I can learn from what I did in the past and the consequences (or results) thereof. If I change my behavior the next time I encounter similar circumstances, will I get a different result? All one can do is experiment. For that, in fact, is precisely what life is.

DST: My character is flawed and unchangeable
TQ: Is it true that my character is flawed and unchangeable?
ARST: It is true that my character is flawed and unchangeable.
NRST: It is not true that my character is flawed and unchangeable.

I have yet to meet anyone whose character is not at least somewhat flawed. (I have a very successful friend whose character seems to me to be astonishingly evolved and functional most of the time. But under stress, she makes the same sort of mistakes I do.) But virtually every one of my character flaws has succumbed to varying extents (some more; some less) to therapeutic interventions of one sort or another. I am not remotely the same person that I was five years ago, let alone ten, in many respects. People can change if they do what is required to do so. “Progress, not perfection,” said Wilson.

DST: I should have acted in a way that only came to me later.
TQ: Is it true that I should have acted in a way that only came to me later?
ARST: It is true that I should have acted in a way that only came to me later.
NRST: It is not true that I should have acted in a way that only came to me later.

Hindsight is often 20/20. And hindsight is often the product of a mind that is less stressed, better fed, less lonely, less angry and less fatigued. (See “H.A.L.T.” in Wilson, 1939.) I tell myself today that things may have come out better if I had been able to act in a way that only came to me later, but I also see how improbable and/or unlikely it was that I could have done so in the heat of the moment. Reggie Bush will forever be remembered at the University of Southern California for deciding to lateral the football to an unprepared teammate in the 2006 Rose Bowl game against the University of Texas. To him at that split second, it seemed like the most appropriate thing to do… and it might well have worked in a different split second. Has he been bothered by a belief like this ever since then? Considering his professional career to date, very possibly so. Do I gain from “second-guessing” myself? No. Do I gain from considering the choices I have made and revising my choice-making the future? Not always, but more often than not.

Resources and References

Anonymous: Adult Children of Alcoholics: Alcoholic / Dysfunctional Families, Torrance, CA: ACA World Service Office, 2006.

Anonymous: Co-Dependents Anonymous, Phoenix, AZ: Co-Dependents Anonymous, 1995.

Beck, A.: Cognitive Therapy and the Emotional Disorders, New York: Penguin-Meridian, 1976.

Beck, A.; Freeman, A.: Cognitive Theory of the Personality Disorders, New York: Guilford Press, 1990.

Beck, A.; Wright, F.; Newman, C.; Liese, B.: Cognitive Therapy of Substance Abuse, New York: The Guilford Press, 1993.

Beck, A.: Prisoners Of Hate: The Cognitive Basis of Anger, Hostility, and Violence, New York: Harper-Collins, 1999.

Dimeff, L.; Koerner, K.: Dialectal Behavior Therapy in Clinical Practice: Applications Across Disorders and Settings, New York: The Guilford Press, 2007.

Ellis, A.; Harper, R.: A Guide to Rational Living, North Hollywood, CA: Melvin Powers, 1961.

Ellis, A.; Dryden, W.: The Practice of Rational Emotive Therapy, New York: Springer Publishing Company, 1987.

Ellis, A.: Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy, New York: Promethius Books, 2001.

Herman, J. L.: Trauma and Recovery, New York: Basic Books, 1992.

Kabat-Zinn, J.: Mindfulness Meditation: Health benefits of an ancient Buddhist practice, in Goleman, D.; Gurin, J., editors: Mind/Body Medicine, New York: Consumer Reports Books, 1993.

Kannon, J.; et al: Narcotics Anonymous, Van Nuys, CA: World Service Office, 1983.

Kohlberg, L.: The Psychology of Moral Development: The Nature and Validity of Moral Stages, San Francisco: Harper & Row, 1984.

Linehan, M.: Cognitive–Behavioral Treatment of Borderline Personality Disorder, New York: Guilford Press, 1993.

Livesley, W. J.: Practical Management of Personality Disorder, New York: Guildford Press, 2004.

Marra, T.: Dialectical Behavior Therapy in Private Practice, Oakland, CA: New Harbinger, 2005.

Millon, T.; Simonsen, E.; Birket-Smith, M.; Davis, R.: Psychopathy: Antisocial, Criminal, and Violent Behavior, Guilford Press, 1998.

Russell, D.: The Secret Trauma: Incest in the Lives of Girls and Women, New York: Basic Books, 1986.

Schiraldi, G.: The Post-Traumatic Stress Disorder Source Book, 2nd Ed.; New York: McGraw-Hill, 2009.

Seligman, M.: Learned Optimism: How to Change Your Mind and Your Life, New York: Knopf, 1990.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.

Wessler, R.; Hankin, S., Stern, J.: Succeeding with Difficult Clients: Applications of Cognitive Appraisal Therapy, San Diego: Academic Press, 2001.

Wilson, B.: Alcoholics Anonymous, New York, A. A. World Services, 1939, 1955, 1976, 2001.

Wilson, B.: The Best of Bill: Reflections on Faith, Fear, Honesty, Humility and Love, New York: A. A. Graprevine, 1986.

Wilson, B.: Twelve Steps and Twelve Traditions, New York: A. A. World Services, 1951.

Young, J.: Cognitive Therapy for the Personality Disorders: A Schema-Focused Approach, 3rd Ed., Sarasota, FL: Professional Resource Press, 1999.

See also:

Shame and Guilt as Useful Modifiers of Motivation at
http://www.blogger.com/posts.g?blogID=12164587,

© 2009 by Rodger Garrett; all rights reserved on original material only. Please comment or inquire to not_moses@fastmail.fm. Thank you.

Inner Parents & Inner Children Explained

Someone wrote asking for an explanation of these widely used terms. I wrote back:

Our inner parents are the beliefs, values, ideals, concepts, convictions, assumptions and attitudes we picked up from our parents and other authority figures, for better and for worse.

Our inner children are the emotional and behavioral reactions to all those inner parental beliefs, values, ideals, etc., as well as the innate desire for sensory stimulation through exploration and other interplay with the environment.

Okay inner parents are reality-based, accurately perceptive, rational-logical, authoritative (see Baumrind), empathic, positively regarding (see Rogers), and appropriately limiting of the child's stimulation seeking and exploration.

Not-okay inner parents are dictum-based, inaccurately perceptive, irrational-illogical, authoritarian (see Baumrind), neglectful-abandoning (see Baumrind) or over-involved and controlling, negatively regarding, and inappropriately limiting or unconcerned with the child's stimulation seeking and exploration (see Clarkin and Lenzenweger).

The inner child of an okay inner parent tends to be life-affirming, shades-of-gray thinking, accurately perceptive, rational-logical, appropriately sensation-seeking or -avoiding given the immediate circumstances, appropriately in control or self- and other-accepting, and capable of realistic and functional give and take with others. They are emotionally well balanced and relate well to most other people. They set effective boundaries in relationships and tend to have functional attachments (see Bowlby).

The inner child of a not-okay inner parent tends to be life-negating, black-and-white ("either-or") thinking, inacurately perceptive, irrational-illogical, unduly sensation-seeking or -avoiding, controlling or uncontrolled, and over-enmeshed or over-distanced from others. Most have personality disorder traits and suffer at least some degree of depression or mania, as well as difficulty relating to others. They set no boundaries, or boundaries that are too thick, with others and tend to have anxious, avoidant or dismissive attachment schemes (see Bowlby, and Clarkin and Lenzenweger).

The terms were first used by Berne and Harris (that I know of) in the late 1960s to illustrate a somewhat different organization of the ego structure than Freud had described with his somewhat -- but not precisely -- equivalent notions of "superego" and "id." The concepts are bedrock in the "transactional analysis" and "games theory" schools of psychodynamic psychology and continue to be influential in current-day treatment practice.

References

Baumrind, D,: Current Patterns of Parental Authority, Monograph in Developmental Psychology, Volume 4, Number 1, Part 2, New York: American Psychological Association, 1971.

Berne, E.: Games People Play: The Psychology of Human Relationships, San Francisco: Grove Press, 1964.

Clarkin, J.; Lenzenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996.

Harris, T.: I’m Okay—You’re Okay, New York: Harper and Row, 1968.

Rogers, C.: On Becoming a Person, Boston: Houghton Mifflin, 1961, 1995.

(c) 2009 by Rodger Garrett; all rights reserved. Please comment or inquire to not_moses@fastmail.fm. Thank you.

Book Review: Major Theories of Personality Disorder

Plenty of Late 20th Century Meat on the Bone

Clarkin, J.; Lezenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996, 2004.

While Strack's Handbook of Personology and Psychopathology is more current and extensive, it'll also set you back a good $80.00 or so to lay your hands on one at this time. The "flooring" here is '90s vintage, but it's pretty solid construction both theoretically and empirically. The nine contributors hereto were all among the top people in personality theory at the time, with Aaron Beck, Lorna Benjamin, Otto Kernberg and Teddy Millon ranking at the very top of the heap.

Of necessity in a book this size, Major Theories... is a tree-topper much of the way, but three of the five conceptualizations are plenty deep for beginning (or even intermediate-level) readers. Kernberg, Benjamin and Millon (with sometime co-author Roger Davis) go long, and though the sledding can get pretty soggy here and there (Millon can be a trial for anyone), full attention is well rewarded.

Kernberg (arguably The Man on borderline personality) gives one of the most coherent presentations of his career here. Moreover, he brings a very modern perspective to the psychoanalytic theory that (at least for me) used to make Kernberg's extremely important work pretty verbally opaque. One can see it all quite clearly here.

Benjamin summarizes her work in Interpersonal Reconstructive Therapy (1993) in detail, then clarifies how it relates to personality in crystal clarity. Her explanation of the "important person and their internalized representation" is one of the most literate descriptions of psychodynamic theory I've ever come across.

Millon and Davis make you work for it, but as has been the case every time I've gone down the road with Teddy, the meat is all there on the bone (and, perhaps unfortunately, then some; some of the material here seems irrelevant). For those who have read Millon's epic Personality Guided Therapy (1999), here, at least, is the "how" and "why" of his remarkable illuminations.

Beck (and co-author James Pretzer) make a convincing case for personality as the behavioral result of core beliefs, ideals, values, assumptions, convictions and attitudes driving current appraisals, evaluations, interpretations, judgments, analyses and/or attributions of meaning. The depth here is not what it is in Beck's and Freeman's Cognitive Theory of Personality Disorders (1990; strongly recommended), but it is adequate to establish a grasp of what is currently the most accessible and widely utilized theory in current psychotherapeutic practice.

Because I come from extensive study of personality theory, behaviorism, object relations theory (and psychodynamic psychology in general), and cognitivism, I was personally most impressed with the foregoing sections of Major Theories... But my schooling in millennial-era "neuropsychology" met with disappointment in Depue's solid but limited article on the biology of personality. While he certainly covered impulsivity in spades, I saw as much relevance in Millon's notions about the bipolar nature of personality-disordered behavior and how they might fit into both essentially manic and essentially depressive, as well as truly Axis I "bipolar" schemes.

I surely would have looked more deeply into the "condition" of the bits and pieces of the limbic system's "brake lining," into dendritic growth or decay in affective memory centers, into excitotoxicity (a major issue in the paranoid, schizotypal and borderline PDs), and into the autonomic nervous system in general and post-traumatic stress disorder in particular. (The data was available in the mid-'90s; see Louis Cozolino, Michael Gazzaniga, Joseph LeDoux, Alan Schore and Bessel van der Kolk, just to name a few.)

In whatever event; the rest of the book is so worthwhile, I am forced to give it a nice "high five."

(c) 2009 by Rodger Garrett; all rights reserved. Please comment or inquire to not_moses@fastmail.fm. Thank you.