1. Complexity Informed and Ecologically and Somatically Aware PsychotherapyASPA Conference 2013 Dr Werner Sattmann-Frese Jansen Newman Institute - Sydney

2. Questions Is the world still getting worse in spite of a hundred years of psychotherapy (Hillman & Ventura)? How helpful are the new developments in neuroscience for a deeper understanding of the human condition? What are the elements of a complexity informed and somatically and ecologically aware approach to counselling and psychotherapy? 3. Questions What are the current epistemologies informing psychotherapy and counselling What are the factors contributing to adverse childhood experiences and attachment problems including abuse and neglect? 4. Psychologies One-person psychology Thoughts, feelings, and behaviours are generated from within Relational psychology Emotions and feelings are socially constructed rather than natural, spontaneous, and private Ecological psychology Feelings, thoughts, and behaviours are the results of complex interactions of natural, relational, and environmental factors (as well as rather than either - or) 5. Waves 1. 2. 3. 4. 5.Psychoanalysis Behaviourism General Systems Theory Constructivism Chaos and complexity (ecology) 6. Selves The notion of the self is currently under siege: True selves Relational selves Socially constructed selves Ecological selves 7. Causes of feelings and emotions Internal physiological needs and necessities Past relational experiences Past environmental influences Present relational experiences Present environmental influences All experiences and impressions are the result of a multitude of economic and psychosocial influences that impact children, their caregivers, other important people, and the rest of society. 8. Conventional views on developmental traumas Mothers fail to provide the tangible love required for successful attachment (Bowlby) Mothers lack attunement with their babies as result of their own trauma history 9. Social ecology informed views Social and emotional exploitation of parents and people in general Manipulation of parents by using their own selfesteem problems Inclusion of addiction producing substances in conventional foods and drinks Lifestyle choices Stress from unemployment and underemployment All of these problems may interact to form signs and symptoms of emotional distress (see ADD/ADHD) 10. Factors contributing directly to a childs emotional and physical wellbeing Parents ability to function as good-enough self objects in a childs life Available and affordable lifestyle choices including built environments Access to nature and natural ambient sounds Opportunities to play with companion animals Access to members of the extended family and friends of the family Sustainable financial resources Wholesome diets Education and child minding facilities 11. How are these factors represented in neuroscience? Let us explore the various approaches to neuroscience to find answers to this question. Neuroscience is not a unified approach to generating understandings on mental and physical health and wellbeing. It differs both in terms of perspectives and worldviews. The next slide briefly outlines the wide range of perspectives. 12. Neuroscience areas Molecular and cellular neuroscience Affective neuroscience Cognitive and behavioural neuroscience Neuropsychiatry Developmental neuroscience Social neuroscience Cultural neuroscience Critical neuroscience 13. Neuroscience The decade of the brain Neuro-disciplines Neuro-cultures (Ortega and Vidal) Neuroscience as cultural activity embedded in the modern medical model Neuro-ethics (Fukuyama, Illes) 14. Emotional learning Some of the most impressive evidence for brain plasticity is emotional learning (LeDoux, 1996). Plasticity in the neural circuitry underlying emotion is also likely to play an important role in understanding the impact of early environmental factors in influencing later individual differences and risk for psychopathology (Meaney et al. 1996). http://psyphz.psych.wisc.edu/web/pubs/2000/Emotion 15. Points of criticism Brain centrism Focus on insight rather than outsight (Black box) Focus on individuality and interiority Focus on excluding rather than including the wider world Promotion of individual choice and autonomy Explaining the complexity of life in terms of scanable brain functions Slaby (2010) 16. A narrow focus Secure attachment depends not on the mothers psychobiological attunement with the infants cognition or behaviour but rather on her regulation of the infants internal states of arousal, the energetic dimension of the childs affective state. Schore, A. (2209). Relational trauma and the developing right brain, p. 20. (www.allanschore.com/pdf/SchoreIMHJTrauma01.pdf). 17. Jan Slaby: The neurosciences are bringing upon the horizon new technologies that are mobilized in the name of educational improvement, treatment, illness prevention, and security: new pharmaceutical drugs, brain-based methods to boost intelligence, attention and happiness as well as screening devices with potentially wide-ranging medical, civil, and military uses. Slaby (2010, p. 398) 18. Departures from neuroscience informed mental health Health and complexity science (Sturmberg and collaborators) Ecotherapy (Clinebell and others) Ecopsychology (Conn, Kanner, Roszak, Winter, and others) Ecologically aware counselling and psychotherapy (JNI - Sattmann-Frese) Perspectivism (Nietzsche) PREMIUM, PRIME, SHARE (Patel) 19. Handbook of Systems and Complexity in Health Editors: Joachim P. Sturmberg, Carmel M. Martin ISBN: 978-1-4614-4997-3 (Print) 978-1-4614-4998-0 (Online) 20. Mary-Jane Rust & Nick Totton Ecopsychology Anthology out now: Vital Signs: Psychological Responses to Ecological Crisis Editors: Mary-Jayne Rust & Nick Totton. Karnac Dec 2011. 21. Paperback Publisher: Pccs Books (February 1, 2011) Language: English ISBN-10: 1906254362 ISBN-13: 978-1906254360 22. Psychoanalysis and Ecology at the Edge of Chaos: Complexity Theory at the edge of chaos Joseph Dodds (Sep 15, 2011) 23. The Psychology of Environmental Problems: Psychology for Sustainability Paperback: 504 pages Publisher: Psychology Press; 3 edition (March 18, 2010) Language: English ISBN-10: 1848728093 ISBN-13: 978-1848728097 24. Learning for Sustainable Living by Werner J. SattmanFrese and Stuart B. Hill Paperback: 348 pages Publisher: Lulu.com (March 19, 2009) Language: English ISBN-10: 1409251020 ISBN-13: 978-1409251026 25. Cynefin model of knowledge It is more properly understood as the place of our multiple affiliations, the sense that we all, individually and collectively, have many roots, cultural, religious, geographic, tribal, and so forth. We can never be fully aware of the nature of those affiliations, but they profoundly influence what we are. The name seeks to remind us that all human interactions are strongly in fluenced and frequently determined by the patterns of our multiple experiences, both through the direct influence of personal experience and through collective experience expressed as stories. Kurtz & Snowdon (2002, cited in Sturmberg, 2013, p.41) 26. Perspectivism Perspectivism is the philosophical view developed by Friedrich Nietzsche that all ideations take place from particular perspectives. This means that there are many possible conceptual schemes, or perspectives in which judgment of truth or value can be made. This is often taken to imply that no way of seeing the world can be taken as definitively "true", but does not necessarily entail that all perspectives are equally valid. http://en.wikipedia.org/wiki/Perspectivism 27. Complexity informed therapy Complexity informed therapy is atheoretical since the imperative is not to look for causes in a particular theoretical framework, but to question, explore and remain curious and open to all possibilities. Evans, (2003, p.1) 28. Complexity science in psychotherapy Individual lives and patterns of human relationships are always unique. No one individual is the same as another in this world (Raelian cloning claims notwithstanding!) and even if that were the case, there is no pattern of human relationships which is exactly the same as another pattern. Evans, (2003, p. 1) 29. Complexity informed therapy If a therapist has only one lens, as provided, say by strict adherence to a particular theory of change, then it is likely that complex problems will be reduced to a simple problems. This may be good only in that it simplifies the therapists life but it probably does not help appreciate the complexity of the patients life. Evans (2003, p. 1) 30. Complexity informed therapy One of the important ramifications of adopting this meta lens is that the same principles of change which apply to the patient must also apply to the therapist himself/herself. This is captured in the concept of fractal wherein there is self-similarity at different levels of scale. It must therefore be acknowledged that the therapist changes by the action of participating in therapy process. Evans, (2003, p. 11) 31. Key Features of Ecologically Aware Counselling and Psychotherapy (EACP) 32. Summary of Features Somatic awareness Cultural awareness Awareness of power relations Awareness of clients ecological footprints Awareness of past and present environmental influences Awareness of the effects of lifestyle choices Spiritual awareness Understanding, reflection, and action 33. Somatic Awareness EACP conceptualises and utilises anawareness of clients embodied (somatic) reality, of the somatic expression of trauma, but also of body sensations and symptoms sensations associated with healing and change. 34. Somatic Awareness Practice Work with body awareness Mirror the clients physical emotionalexpression Encourage and work with the effects of deep breathing Use exercises to facilitate the experience of body-mind and person-planet unity 35. Cultural Awareness EACP promotes the awareness of cultural differences, their potential for conflict, but also for learning and change 36. Cultural Awareness Practice Facilitate the awareness of cultural empathy, the awareness that we cannot impose our values on people form other cultural backgrounds Seek to learn from other people about what is important to them Do not idealise the features of other cultures they all have their light and dark sides 37. Awareness of Power Relations EACP promotes and utilises the awareness of power relations in counselling and psychotherapy. 38. Power Relations Practice Be aware that your client needs you over time to embody many different roles. These include being: a role model to look up to a container to hold his or her difficult feelings a mirror a person to cope with his or her anger and rage a wise mentor and educator a generous friend ready to share power. 39. Environmental Awareness EACP aims to facilitate healing and change with an awareness of the clients ecological footprint. It asks deep questions when most other therapeutic approaches do not question the ecological consequences of therapy outcomes. It may also encourage people living in a state of guilt to take more from life and the world. 40. Environmental Awareness Practice Work from the assumption that what is good for the environment is also good for the client. Assist the client to feel and understand the deep needs behind his or her unsustainable wants. Assist the client in learning to satisfy these deep needs thereby making the wants redundant. Keep asking deep questions to achieve all this. Do not hijack the clients process for the greater good of the planet. Remember that some clients may need to take more from life. 41. Awareness of Past Environmental Influences EACP places value in inquiring about the clients early traumatising or selfsupporting environmental living conditions. 42. Past Environmental Influences Practice Inquire about environmental factors that influenced your family of origin including the effects of wars and ecological catastrophes. Inquire about environmental features that may have compensated for empathic failures and attachment difficulties of primary caregivers such as access to nature and companion animals. 43. Awareness of present environmental influences EACP places value in inquiring about the influences of present urban, suburban, or rural environments on clients mental and physical health and wellbeing. 44. Issues Affecting the Health and Well-being of Human Beings 45. Present environmental influences practice Inquire about environmental health hazards the client may be subjected to. Inquire about his or her lifestyle choices and diet. Use the questionnaire as a guide. Explore what may have influenced the clients well-being on the way to your office such as heavy traffic, smog, and road rage). 46. Awareness of the effects of lifestyle choices EACP facilitates the understanding of the effects of lifestyle choices, including diets and exercising, on clients (mental and physical) health and wellbeing. 47. Lifestyle choices - practice Inquire about the clients lifestyle choices such as exercising and diet. Explore the effects of possible addictions to drugs, nicotine, coffee, and prescription drugs. Use the questionnaire that will be supplied as a guide. 48. Spiritual awarenessEACT facilitates the exploration of spiritual needs and a felt sense of person-planet unity 49. Spiritual awareness - practice Explore with the client his or her spiritual needs within the framework of his or her spiritual or religious orientation Facilitate through mindfulness exercises the developing of a felt sense of person-planet unity 50. Understanding, reflection, and action EACP places value in deepening the understanding of the effects of political decisions and cultural practices on a clients life. EACP promotes political and social action designed to address the causes of unsustainable perceptions, behaviours, and practices. 51. Understanding, reflection, and action practice Assist the client in deepening his or her understanding of the effects of political decisions and cultural practices on his or her daily life. Promote and encourage political and social action designed to address the causes of unsustainable perceptions, behaviours, and practices. Promote collaboration and assist the client in identifying people and organisations to join. Be proactive yourself to be able to function as a role model. 52. Responses to changing environments With global warning and other factors having an increasing financial impact even on developed societies collaborative learning and healing may become the practices of the future. Responding to treatment gaps in mental health: PREMIUM PRIME SHARE 53. PREMIUM PREMIUM aims to develop culturally appropriate psychological treatments for Depression and Harmful Drinking that can be delivered by non-specialist health workers in low resource settings. PREMIUM will be implemented through a partnership between Sangath, a mental health NGO in Goa, India and the Centre for Global Mental Health, London School of Hygiene & Tropical Medicine. Other partners are: the Directorate of Health Services, Government of Goa; the South Asia Network for Chronic Diseases of the Public Health Foundation of India; and Oxford University. PREMIUM is fully funded by the Wellcome Trust. Vikram Patel, (email: vikram.patel@lshtm.ac.uk) 54. PRIME The majority of people living with mental disorders in low- and middle-income countries do not receive the treatment that they need. PRIME includes a strong emphasis on capacity building and the translation of research findings into policy and practice, with a view to reducing inequities and meeting the needs of vulnerable populations, particularly women and people living in poverty. 55. References Clinebell, H., (1996). Ecotherapy, Minneapolis, IL: Fortress Press. Evans, B. (2003). The fifth wave: Psychotherapy and complexity science. www.plexusinstitute.org. Kurtz, C.F. & Snowdon, D.J. (2003). The new dynamics of strategy: Sense making in a complex and complicated world. IBM Syst. J. 42(3), 462-483. Slaby, J. (2010) Steps towards a critical neuroscience.Phenom Cogn Sci 9:397416 Sturmberg, J.P. & Martin, C.M. (eds.) (2013). Handbook of systems and complexity in health. New York: Springer 56. Links www.lfsl.com.au www.sangath.com 57. Acknowledgment Some of the views presented here were developed as part of my work for the Jansen Newman Institute, Sydney. I would like to thank JNI and students in the PSY609 Master of Counselling and Applied Psychotherapy program for their generous contributions.