Gary Sibcy, II, Ph.D. Licensed Clinical Psychologist, Piedmont Psychiatric Center Director, PhD...

Gary Sibcy, II, Ph.D.Licensed Clinical Psychologist, Piedmont Psychiatric Center

Director, PhD Program in Professional CounselingLiberty UniversityLynchburg, Virginia

Tim Clinton, EdD, LPC, LMFTPresident, AACCExecutive Director, Liberty University Center for Counseling and Family Studies

The Mind and the Brain are completely separate from each other

The embodied process that regulates the flow of energy and information

◦ Energy the physical properties that propel us to take action

◦ Information is the representation of something other than itself (e.g., words and ideas)

The neuro-circuitry through which energy and information flow—◦ Concentrated primarily in the head, but extends

through the entire body

How energy and information is shared as we connect and communicate with one another

Relationships are co-regulators of energy and information

I Corinthians 12: 12ff

General Systems Theory—how complex systems develop◦ Undifferentiated

◦ Differentiated—separate/individuated with specialized functions and sovereignty

◦ Integration—linked together but retains separateness in specialized functions

The whole is greater than sum of parts

Disintegration and Fragmentation

The brain is open system-

◦ Open systems of capable of being influenced by external factors

◦ Dynamic, nonlinear, complex systems

◦ When integrated, this type of system is most flexible and adaptive

FlexibleAdaptiveCoherentEnergizedStable

A river, with an ever changing central channel of integration and harmony

On one bank is Rigidity-- On the other bank is Chaos—

Screen clipping taken: Siegel, Mindsight

Psychospiritual health is the function of integration

Psychopathology is a deviation from integration◦ Rigidity◦ Chaos

Re-experiencing Symptoms Hyperactivation Avoidance/numbing/Dissociation Associated Tension Reduction Behaviors

◦ Alcohol, drugs, other addictions◦ Cutting◦ Suicide Rehersal

As we grow older the number of neurons decrease but the brain actually grow larger

How the brain grows◦ Bottom to top; right to left

Integrated, regulated brain◦ Top to bottom; left and right

Finding the Zone—◦ Support—safe, regulated◦ Challenge—emotional activation◦ Think—label, communicate, problem solve◦ Relate—attend, back-and-forth, collaborative

Brain wires itself based on experience Asks several questions:

◦ Is the world a safe place?◦ Can I count on my caregiver’s to help me in time

of need?◦ Can I get the care I need when I need it?

Right Hemisphere==◦ Develops first◦ Imagery, emotional, holistic thinking, nonverbal

language, autobiographical memory Left Hemisphere

◦ Develop later, logic, verbal, linear

Horizontal Integration is linking these two sides of the brain

Nervous system ascends from bottom (our bodies and gut) to top (brain stem, limbic system, prefrontal cortex)

Vertical integration is about linking these different areas together, bringing bodily sensation up into awareness

Autonomic Nervous System◦ Two Branches

Sympathetic—Gas pedal Fight Flight

Parasympathetic—Break Freeze

http://brainandgender.files.wordpress.com/2011/03/limbsys2.jpgScreen clipping taken: 9/26/2011 11:57 AM

Emotional Control Center in Brain encodes emotionally charged experiences Forming of key mental models/schemas

about◦ Self◦ Others◦ World

Conditioned Emotional Responses Associative learning

The middle prefrontal cortex◦ Anterior cingulate◦ Orbital prefrontal cortex◦ The mediate prefrontal◦ Ventral lateral◦ All work together as a team

Body regulation-- Attuned communication-- Emotional balance-- Response Flexibility-- Insight— Empathy

Theory of mind

Mindsight--mentalization

Fear modulation Accessing intuition Morality

Implicit Memory—◦ Present at birth◦ Includes behavioral, emotional, perceptual, body◦ Mental models—states become traits◦ Conscious attention not required for encoding◦ No sense of recollection when memories recalled◦ Does not involve hippocampus—mostly amygdala

Explicit Memory◦ Emerges in second year of life◦ Sense of recollection when recalled◦ If autobiographical, sense of self and time present◦ Includes semantic (factual) and episodic

(autobiographical)◦ Requires conscious attention◦ Involves hippocampus—converts to context◦ If autobiographical—involves prefrontal cortex

Mind is the container/organizer/regulator of content, but is not the same things as the content itself

You are not your thoughts!

Just because you have a thought doesn’t mean its true

Just because you think a thought doesn’t mean you believe it

Intentionality/Volition/Agency Focused attention Belief—epistemic evaluation Endorse/promote Entertain

Hub

Sensation

images

feelings

thoughts

Attachment Relationships

Sensitive, timely responses to child’s distress

Enhance regulation, brain stem, limbic system

◦ Stimulate integration of these systems

◦ ultimately through integration of these systems with the middle prefrontal cortex

Secure Base

Self-Confidence/Exploration

Perceived Threat

Felt security

Attachment System

Signaling

Proximity Seeking

Safe Haven

Caregiver’sSignal detection

Secure Base

Perceived Threat

Felt security

Attachment System

Signaling

Safe Haven

Caregiver’sSignal detection

Sense of Self

Sense of Other

Balancing

Inconsistent/Role reversal

Responsive/Attuned

Avoidant

Ambivalent

Disorganized

Secure

Frightening/Threatening/Dissociated

Rejecting/disengaged/overly Intrusive

Parent Responses Themes Attachment Style

AAI Classifications

of Pre-term Mothers in Third

Trimester of Pregnancy Child Strange

Situation Classification

At Twelve –Months

AAI Classification 16 To 20

Years Later

70% ACCURACY

75% TO 78%

ACCURACY

Self Other

•Am I worthy? •Am I capable?•Am I willing?

•Are you trustworthy?•Are accessible?•Are you capable?•Are you willing?

Secure AttachmentSecure AttachmentSelf DimensionSelf DimensionI’m worthy of loveI’m worthy of loveI’m capable of getting the love I needI’m capable of getting the love I need

Other DimensionOther DimensionOthers are willing and able to love meOthers are willing and able to love meI can count on you to be there for meI can count on you to be there for me

Avoidant AttachmentAvoidant AttachmentSelf DimensionSelf DimensionI’m worthy of love (false pride)I’m worthy of love (false pride)I’m capable of getting love I want and need I’m capable of getting love I want and need (false sense of mastery)(false sense of mastery)

Other DimensionOther DimensionOthers are incompetentOthers are incompetentOthers are untrustworthyOthers are untrustworthy

Ambivalent AttachmentAmbivalent AttachmentSelf DimensionSelf DimensionI am not worth of love (I feel flawed)I am not worth of love (I feel flawed)I’m not able to get love I need without being I’m not able to get love I need without being angry or clingyangry or clingy

Other DimensionOther DimensionCapable but unwilling (bc my flaws)Capable but unwilling (bc my flaws)May abandon me (bc my flaws)May abandon me (bc my flaws)

Fearful AttachmentFearful AttachmentSelf DimensionSelf DimensionI’m not worthy of loveI’m not worthy of loveI’m unable to get the love I needI’m unable to get the love I need

Other DimensionOther DimensionOthers are unwillingOthers are unwillingOthers are unableOthers are unableOthers are abusive, I deserve itOthers are abusive, I deserve it

Other

Sel

f

+

_

+ __

Secure AttachmentSecure Attachment Full rangeFull rangeGood controlGood controlSelf-soothesSelf-soothesShares feelingsShares feelingsOk with others’ feelingsOk with others’ feelingsCapable of accurate empathyCapable of accurate empathy

Avoidant AttachmentAvoidant AttachmentRestricted RangeRestricted RangeToo much controlToo much controlUses things to soothe self, prone to Uses things to soothe self, prone to addictionsaddictionsKeeps feelings at a distanceKeeps feelings at a distanceDoesn’t share feelingsDoesn’t share feelingsRestricted empathyRestricted empathy

Ambivalent AttachmentAmbivalent AttachmentFull rangeFull rangePoor controlPoor controlCan’t self sootheCan’t self sootheShares Feelings too muchShares Feelings too muchOverwhelms others with their feelingsOverwhelms others with their feelingsUses feelings instrumentally to gain Uses feelings instrumentally to gain proximityproximity

Disorganized AttachmentDisorganized AttachmentFull Range, but few positive feelingsFull Range, but few positive feelingsPoor controlPoor controlCan’t self-sootheCan’t self-sootheCan’t really share with othersCan’t really share with othersOverwhelmed by others feelingsOverwhelmed by others feelingsDissociates when in face of strong emotionDissociates when in face of strong emotion

Secure AttachmentSecure AttachmentComfortable with closenessComfortable with closenessShares feelings and dreamsShares feelings and dreamsWilling to commitWilling to commitBalances closeness and distanceBalances closeness and distance

Avoidant AttachmentAvoidant AttachmentNot comfortable with closenessNot comfortable with closenessWithholds feelings and dreamsWithholds feelings and dreamsDifficulty with commitmentDifficulty with commitmentDistances Distances

Ambivalent AttachmentAmbivalent AttachmentDesires closeness, but never seems to Desires closeness, but never seems to have enoughhave enoughWants to merge with otherWants to merge with otherPreoccupied with abandonmentPreoccupied with abandonmentClings and criticizesClings and criticizesCrisisCrisisattachmentattachment

Disorganized AttachmentDisorganized AttachmentDesires closeness, but fears and avoids Desires closeness, but fears and avoids ititWants to merge, then wants to Wants to merge, then wants to distancedistanceTerrified of abandonmentTerrified of abandonmentSabotages closenessSabotages closenessAttracted to people who victimizeAttracted to people who victimize

Kirkpatric◦ Reframes attachment within religious context

Christian conception of God satisfies Ainsworth’s attachment criteria:Seeks closeness in times of troubleSafe Haven ExplorationSeparationanxiety/angerLossGrief

Christian Attachment Therapy 48

Philippians 4:4-7 Rejoice in the Lord always. I will say it again: Rejoice! Let your gentleness

be evident to all. The Lord is near. Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.(NIV)

Ps 17:6-10I call on you, O God, for you will answer me; give ear to me and hear my prayer. Show the wonder of your great love, you who save by your right hand those who take refuge in you from their foes. Keep me as the apple of your eye; hide me in the shadow of your wings from the wicked who assail me, from my mortal enemies who surround me. They close up their callous hearts, and their mouths speak with arrogance.(NIV)


Ps 46:1-4God is our refuge and strength, an ever-present help in trouble. Therefore we will not fear, though the earth give way and the mountains fall into the heart of the sea, though its waters roar and foam and the mountains quake with their surging. Selah


Attachment style impacts how God is viewed◦Secure: He is there, I can count on Him. He will

accepts me, in spite of my flaws◦Avoidant: He isn’t there for me when I need

Him. I will have to go at life alone. I don’t really need Him.

◦Ambivalent: I’m too flawed; God is sure to reject me. I probably committed the unpardonable sin

◦Disorganized: I’m flawed, beyond repair. God will strike me down if I turn toward Him. He will surely reject or punish me.


The “Secure” Model of Change

Cooking a good soup◦ Know the essential ingredients◦ How the ingredients interact with other,

compliment each other◦ How they may behave differently, each time you

use them◦ A good soup—I love chili—is more than the sum of

its parts//tomatoes, onions, meat, beans, seasoning, etc.

Are you called to do this work God uses those who have been wounded You must come to terms with what has

happened to you— God will work all things to the good of those

who are called according to his purposes Your reliance on God and sensitivity to the

Spirit is essential Take care of yourself—this is hard work

Fostering therapeutic alliance Nurturing collaboration—exploring the story

of “why are you here?” Create a “safety zone” (McCallough) Information gathering, assessment,

diagnosis, goal-setting Structuring sessions—agenda setting,

specificity, secure commitment Instilling hope

More than just Psychoeducation—conveying relevant information—Key to Alliance

Learning new skills—distress tolerance, emotion regulation, interpersonal effectiveness, problem solving, impulse control, behavior activation

Spiritual disciplines—mindfulness-- Neuroempathy—understand problems in

light of underlying neurocircuitry

neuroempathy◦ Your mind and brain are different. You are not

your brain◦ You are not your thoughts◦ Your thoughts are produced automatically by your

brain. ◦ Your mind can chose to believe them or to

engage in brooding

Extends the safety construct Creating a balance between emotional

activation and emotion regulation The therapeutic window

◦ When in this window— Teaching skills in context of emotion Modify old schema

Implicit beliefs about self and others About how to deal with strong emotions Breaks patterns of avoidance

Length of session

15 30 45

2

4

6

8

10

Dealing with treatment relationship ruptures

Helping desensitize toxic implicit relational beliefs that are activated by emotional activation

Helping clients engage in narrative repair— Telling their stories, linking current patterns of

thinking, feeling relating, and communicating with previous relationship experience

How relationships are two way transactions (especially therapy relationship)

How old patterns of relating were healthy at the time, but maladaptive now…

Appreciate the consequence of their interpersonal and intrapersonal behavior

They create much of the pain they experience now Differentiating between toxic others of past and

current therapeutic relationship

Significant Other History Transference Hypothesis Identification of transference hot spots Interpersonal Discrimination Exercises

Schema reconstruction—highly intentional process—understanding personal narrative in light of God’s redemptive story in their lives

Modifying maladaptive, self-defeating patterns of thinking, feeling, behaving—cognitive restructuring, problem-solving skills

Learn to engage in personal experiments that can generate new “data” that may unfreeze negative, rigid, globally negative beliefs—both in and out of session

Practice new patterns of relating to others and giving up old patterns of avoidance, blame, and defensiveness

Fostering forgiveness—self-others

Dealing with resistance and therapeutic ruptures

Begin differentiating between old, toxic relationships and therapy relationship (Interpersonal Discrimination Exercises)

Fostering generalization from safety of therapy office to other context

Anticipating and dealing with relapse prevention

Gary Sibcy, II, Ph.D. Licensed Clinical Psychologist, Piedmont Psychiatric Center Director, PhD...

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