Core Affects. The Core Attachment Affects. Affect Experiencing. Three components to true affect experiencing:

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1 Core Affects The energy moves outward The experiences is relieving and drops anxiety and defenses Leads to transformation of character Desensitized client to what was feared (impulses and emotions) Increases client s sense of power and stability The Core Attachment Affects Anger/rage Guilt Grief/sadness Positive Feelings Sexual/closeness Excitement/interest Affect Experiencing Three components to true affect experiencing: 1. Name the feeling: I feel angry 2. Physiological pathway of feeling: I feel a heat rising inside me 3. Impulse/action tendency: I want to shake him

2 The somatic pathway of Core Attachment Affects Anger/rage: Guilt: Grief/sadness: Positive Feelings: Sexual/closeness: Excitement/interest: Inhibitory Affects Inward moving Shuts down the client We do not want to encourage a deeper experience of these Serve a defensive function Perpetuates suffering They Are: Shame/ humiliation Disgust/contempt Anxiety Embarrassment Unrealistic, punitive guilt Anxiety

3 Anxiety In therapy, anxiety is caused by feelings and impulses triggered by our attempts to have emotionally close relationship with the client No objective threat in the therapist office Fear vs Anxiety What is fear? Our threat detection system Promotes safety and survival Run! Based on objective threats Why Feelings Trigger Anxiety Feelings or experience Threaten bond Triggers (anxiety) Example: My anger makes mom avoid me My sadness makes dad scold me

4 Anxiety Assessment: Pathways of Anxiety Discharge 3 Pathways of Anxiety: Striated Muscle Smooth Muscle Cognitive Perceptual Field Why important? Informs us that emotions are being activated and lets us know we are in the right place Informs us where to focus our interventions (signals) Informs us of client s capacity to experience and tolerate their feelings Guides us in our pacing of interventions Gives us an idea how long treatment will take Helps us to know if client is Fragile or not

5 Striated Pathway Examples: Thumbs, hand clenching Tension in the arms, shoulders, legs, neck and face Clenching of the jaw, biting, chewing Tension in the chest sighing respirations Striated Examples Smooth Muscle Examples: Nausea, vomiting Cramps Heartburn Migraine headache Jelly legs Bladder Urgency Diarrhea

6 Smooth Example Cognitive Perceptual Disruption Examples: Dizziness, Fainting Foggy thinking Numbness, loss of feeling in body Freezing, limpness Drifting Ringing in the ears When anxiety is going here, then there is no tension in the muscles, the pa5ent looks calm and can be indifferent although is confused etc. CPD Example

7 Associated Medical Issues Striated Tension: Tension headache, panic attacks, chest pains, Fibromyalgia, chronic pain syndrome Smooth Muscle: Migraine headach, IBS, Hypertension, Urinary track issues, acid reflux, abdominal cramps CPD: Visual blurring, fainting, tunnel vision, memory loss, pseudoseizures, dizziness, blindness. Anxiety Exercise 1: Identify the Pathway Therapist Intervention Client Response Anxiety Pathway Could we look at an example of when this was a problem for you? (Sighs), A couple of days ago she said she wanted to dump me What is your feeling towards her for saying that she wanted to dump you? (Hear stomach gurgles)..mmm I feel kinda sick to my stomach What do you notice feeling here with me? What is your feeling towards him for hitting you? (Patient stares past you) I lost my train of thought. Could you repeat the question? (Clenches hands) I feel really tense and worried he is cheating on me You seem anxious right now, when did that begin? (sighs) as soon as I sat down. My shoulders feel really tight right now Signs Patient is Exceeding Threshold Dizziness, Fogginess Slowed thinking, blanking out (w/o Striated) Fainting, nausea Abnormally slow respiration Limpness Migraines Ringing in ears Blurred vision Dissociation Hallucination

8 Anxiety Threshold: Optimal Level -Cognitive perceptual disruption -Smooth Muscle Anxiety level Threshold Striated Muscle Anxiety When we reach threshold (How to Regulate) Stop Exploring Feelings Attention to anxiety Symptoms Review sequence Review until anxiety disappears Explore feeling in a different corner Example Anxiety Regulation how do you feel towards your daughter for lying to you? Observe & attend to anxiety Inventory anxiety in the body / name anxiety symptoms Describe Causality Have client review for you Explore feeling in different area Clt: I m getting a ringing in my ears You say you are having a ringing in your ears. Do you notice feeling anxious right now? Link symptom to anxiety: The ringing in your ears is sign of anxiety. OR Feeling like throwing up is a sign of anxiety Ect So you have a feeling towards your daughter for lying to you. That feeling makes you anxious, and the anxiety makes your ears ring. Does that make sense? Could you repeat back what you heard me say to make sure we are both on the same page Could we look at another example?

9 Anxiety Regulation Role Play Each student takes a turn I will be the client You will ask how do you feel towards your daughter for lying to you? Continue pressure to feeling until you see that I have reached an anxiety threshold Stop pressure and go through anxiety regulation steps Common Mistakes Assuming the client has no anxiety if they present as limp and calm Moving ahead to feeling to quickly Pressing to breakthrough to feeling in face of unregulated anxiety Mistaking a freeze response for striated discharge Quiz Describe the difference between fear and anxiety Name 3 pathways of anxiety discharge Which pathway is a green light to explore feeling? Identify three signs your patient has exceeded anxiety threshold Describe the process for regulating anxiety

10 Complex Transference Feelings (CTF) I Complex feelings mobilized in therapy which are linked to the past bond, trauma, pain, rage and guilt about rage. Includes deep appreciation for the therapist persisting with them for the best outcome. As well includes irritation toward the therapist (T) because of the challenge to resistance. Anxiety --muscle tension, sweat, heart race, mind blanks. Anger Defense: tantrum, self-attack obsessiveness, critical, devaluing, passive aggressive, defiant Impulse/Feeling --Heat/energy rising, volcano, urge to grab, hit, kick, inflict harm Spectrum of Psychoneurotic Disorders

11 1. Low Resistance 2. Moderate Resistance 3. High Resistance Patterns of Problems from Attachment Trauma Spectrum of Psychoneurotic Disorders Fragile Spectrum 4. High Resistance with Repression 5. Mild- Moderate or Severe Fragile Character Structure: repression, splitting, and projection dominant The Low Resistant Patient: Open access is already there Low Resistant patients come with an alliance in place -there is no Rage, thus no Major Resistance Only have tactical defenses They go to the issue then dance around it until you encourage them to feel the grief about the loss in the past. 5 percent of office referrals Davanloo, H Abbass 2002 Low Resistant Patient Eg. Kind of, a little Eg. Maybe, perhaps Tactical Defences Eg Smile Eg. vagueness Grief No Rage= No Major Resistance Only Tacticals

12 Moderate Resistant With more resistance, the patient brings more defenses that obstruct the process Pressure is needed to mobilize Complex Transference Feelings (CTF) Resistances mount and need to be clarified, blocked or challenged Presence of Murderous Rage, Guilt, Grief Davanloo, H Abbass 2002 Moderate Resistant Client Detaching Eye avoidance Eg Smile Major Resistances: Isolation of affect Rationalizing Murderous Rage, Guilt, Grief, Craving Highly Resistant Patient They have major resistances and go to resistance in the Transference Heavy focus in the Transference is needed Standard intervention is Pressure, clarification, challenge, Head-on-collisions Small breakthroughs first to weaken the resistance Later in process typical breakthroughs of MR or PMR in the T which transfer the image to the past figure Primitive Murderous Rage, Guilt, and Grief/pain, love Davanloo, H Abbass 2002

13 The Highly Resistant Patient: The Locked Unconscious Helpless Defiance Arguing Major Resistances Murderous Rage and Guilt Grief Slowing down Devaluing Externalizing High Resistance With Repression Instead of feeling rage, it is repressed into the body In face of feelings, client goes flat, loses tone and energy, instant repression takes place. Often weepy Will often have physical symptoms: IBS, Stomach upset, migraines Anger is turned inward to protect attachment figures from the anger Common among depressed clients Highly Resistant Patient with Repression Hopeless Repression Major Resistance: Repression Going flat Primitive Rage, Guilt, Grief, Craving

14 Fragile Character Structure Severe trauma plus weak attachment Cognitive disruption when anxious Primitive defences: projection, splitting, dissociation, regressive defences Lack clear sense of self Self-harm common (cutting, drugs/alcohol, acting out) 25% of office referrals sessions to treat Davanloo, H Abbass 2002 Inquiry Resistance Rises Pressure Resistance crystallizes in the transference Clarify, Challenge, Head on Collision GO FLAT: No striated muscle anxiety Dr Allan Abbass 2017 Breakthrough of grief about loss Striated muscle anxiety plus feel complex transference feelings Striated muscle anxiety plus feel complex transference feelings Depression, smooth muscle anxiety or motor conversion Cognitive-perceptual disruption or primitive defenses Low Resistan ce Moderate Resistance High Resistan ce High Resistance with Repression Fragile Character Structure Complete treatment in 1 or 2 sessions Repeated unlocking, working through, termination Capacity Building Formats

15 Technical Blockers of Rise in UTA and CTF Lack of pressure (reaching to the patient) Misplaced pressure (same as no pressure) Premature challenge Lack of challenge or misplaced challenge No delivery of the reality of the situation (lack of head on collision) Missing the passage of feelings Why No Signals?? Blockers of Primary Engagement in the Process Ambivalence re interview process: 1 foot in 1 foot out Forced to be there and don t want to cooperate: Conscious defiance Absence of unconscious Problem

16 Unc Anxiety going other places: Cognitive/ Perceptual Disruption Smooth Muscle anxiety Somatic Gum chewing, tensing and relaxing Hiding the tension consciously Characterological Unconscious Defenses blocking rise in Core Feelings Defiance Compliance Externalization Passivity Hopelessness Helplessness Major Intellectualization Syntonic defensive system: cant see problems Denial Devaluing Organic or Brain Factors Actual confusion about the process Below Average Intelligence Physical Illness and exhaustion Drugs or Sedating Medications

17 Why no Signals Projection or Projective Identification Suicidal or Homicidal plans Repression of Feelings Depression Conversion Why no Signals Therapist technical issues: Not enough pressure Pressure in wrong place, to defense or feelings which are not present Premature challenge Transference activation: In the parent s shoes