"Transformative "Transformative and/or Destructive: and/or Destructive:

Exceptional Exceptional Experiences from the Experiences from the Clinical Perspective".Clinical Perspective". Isabel ClarkeIsabel Clarke

Consultant Clinical PsychologistConsultant Clinical PsychologistHampshire Partnership NHS Foundation TrustHampshire Partnership NHS Foundation Trust

Normalizing Unusual Normalizing Unusual ExperienceExperience

Extraordinary experience has always Extraordinary experience has always been part of being human - part that has been part of being human - part that has always been both feared and valuedalways been both feared and valued

Simply pathologizing is not the answerSimply pathologizing is not the answer Research: new and not so new: can offer Research: new and not so new: can offer

a more balanced perspective – a a more balanced perspective – a perspective that is less crushing than perspective that is less crushing than dismissing the experience as ‘illness’dismissing the experience as ‘illness’

A Word about WordsA Word about Words ‘‘Exceptional’ – neutral in that it can Exceptional’ – neutral in that it can

describe both positive and negative describe both positive and negative experiences – but veers to the positiveexperiences – but veers to the positive

Psychosis and spirituality – obviously Psychosis and spirituality – obviously loaded!loaded!

Transpersonal – better, but often used to Transpersonal – better, but often used to exclude the shadow experiencesexclude the shadow experiences

Spiritual emergence/emergency – still a Spiritual emergence/emergency – still a suggestion of dichotomysuggestion of dichotomy

I adopt Thalbourne’s ‘transliminal’I adopt Thalbourne’s ‘transliminal’

Evidence for a new Evidence for a new normalisationnormalisation Schizotypy – a dimension of experience: Gordon Schizotypy – a dimension of experience: Gordon

Claridge.Claridge. Mike Jackson’s research on the overlap between Mike Jackson’s research on the overlap between

psychotic and spiritual experience.psychotic and spiritual experience. Emmanuelle Peter’s research on New Religious Emmanuelle Peter’s research on New Religious

Movements.Movements. Caroline Brett’s research: having a context for Caroline Brett’s research: having a context for

anomalous experiences makes the difference anomalous experiences makes the difference between whether they become diagnosable between whether they become diagnosable mental health difficultiesmental health difficulties

and whether the anomalies/symptoms are short and whether the anomalies/symptoms are short lived or persist. lived or persist.

Wider sources of evidence – e.g.Cross cultural Wider sources of evidence – e.g.Cross cultural perspectives; anthropology. Richard Warner: perspectives; anthropology. Richard Warner: Recovery from Schizophrenia.Recovery from Schizophrenia.

““Third Wave” Cognitive Third Wave” Cognitive TherapiesTherapies

Developments in CBT as it tackles Developments in CBT as it tackles personality disorder, psychosis etc.personality disorder, psychosis etc.

Therapeutic relationship importantTherapeutic relationship important Past history is significantPast history is significant Change lies not so much in altering thought Change lies not so much in altering thought

to alter feeling, but in altering the person’s to alter feeling, but in altering the person’s relationship to both thought and feelingrelationship to both thought and feeling

Mindfulness is a key component.Mindfulness is a key component. Recognition of a split or incompleteness in Recognition of a split or incompleteness in

human cognition – which mindfulness can human cognition – which mindfulness can bridge.bridge.

Separate pathways in the Separate pathways in the brainbrain

Developments in CBT come up with 2 or more Developments in CBT come up with 2 or more separate types of processing – the split in human separate types of processing – the split in human cognition!cognition!

There is one direct, sensory driven, type of There is one direct, sensory driven, type of processing and a more elaborate and conceptual processing and a more elaborate and conceptual one.one.

The same distinction can be found in the memory.The same distinction can be found in the memory. Direct processing is emotional and characteristed Direct processing is emotional and characteristed

by high arousal.by high arousal. This is the one that causes problems – e.g. This is the one that causes problems – e.g.

flashbacks in PTSD.flashbacks in PTSD. The two central meaning making systems of ICS The two central meaning making systems of ICS

provides a neat way of making sense of this.provides a neat way of making sense of this.

BodyState

subsystem

Auditoryss.

Visualss.

Interacting Cognitive Subsystems.

Implicational subsystem

ImplicationalMemory

Propositional subsystemPropositionalMemory

Verbalss.

2 Ways of experiencing 2 Ways of experiencing ICS gives us a normalizing way of ICS gives us a normalizing way of

understanding exceptional experiences/ the understanding exceptional experiences/ the transliminal.transliminal.

When the imp.ss and the prop.ss are working When the imp.ss and the prop.ss are working together, that gives us an ordinary, grounded together, that gives us an ordinary, grounded quality of experience.quality of experience.

When they become desynchronized, the imp. When they become desynchronized, the imp. temporarily takes overtemporarily takes over

This feels different; in extreme forms leads to This feels different; in extreme forms leads to openness to anomalous experience.openness to anomalous experience.

This quality of experience is also sought and This quality of experience is also sought and valued!valued!

Linehan’s STATES OF MIND Linehan’s STATES OF MIND (from (from Dialectical Behaviour Therapy) – Maps onto Dialectical Behaviour Therapy) – Maps onto

Interacting Cognitive SubsystemsInteracting Cognitive Subsystems

EMOTIONEMOTION

MINDMIND

(Implicational (Implicational subsystem)subsystem)

REASONABLE

MIND

(Propositional Subsystem)

WISE

MIND

IN THE PRESENTIN CONTROL

A challenging model of the A challenging model of the mindmind..

There is no boss – our unitary sense of self is There is no boss – our unitary sense of self is an illusion!an illusion!

The mind is simultaneously individual, and The mind is simultaneously individual, and reaches beyond the individual, when the reaches beyond the individual, when the implicational ss. is dominant.implicational ss. is dominant.

This happens at high and at low arousal.This happens at high and at low arousal. There is a constant balancing act between There is a constant balancing act between

logic and emotion – human fallibilitylogic and emotion – human fallibility Dysynchrony between the systems explains Dysynchrony between the systems explains

anomalous experiences – psychosis!anomalous experiences – psychosis! Mindfulness is a useful technique to manage Mindfulness is a useful technique to manage

the balance.the balance.

Being Porous: therapeutic Being Porous: therapeutic approachapproach

Some people are more open to this type of Some people are more open to this type of experience than others – cf. Schizotypyexperience than others – cf. Schizotypy

People high on the schizotypy spectrum are People high on the schizotypy spectrum are more sensitive and “open”.more sensitive and “open”.

Leading to the need to regulate stimulation.Leading to the need to regulate stimulation. This can lead into an avoidance cycle; social This can lead into an avoidance cycle; social

isolation and withdrawal = the other isolation and withdrawal = the other ‘reality’ takes over.‘reality’ takes over.

Sensitivity and openness to anomolous Sensitivity and openness to anomolous experience – continuum with normalityexperience – continuum with normality

Positive side as well as vulnerabilityPositive side as well as vulnerability

Normalising the difference in quality of Normalising the difference in quality of experience as well as the continuityexperience as well as the continuity

Validating the person’s experienceValidating the person’s experience• Helping people to manage the threshold – Helping people to manage the threshold –

mindfulness is keymindfulness is keyUnderstanding the role of emotion and arousal – Understanding the role of emotion and arousal –

the feeling is real, though the story might be the feeling is real, though the story might be suspect.suspect.

All this helps with building a therapeutic alliance.All this helps with building a therapeutic alliance. Persuasion to join “shared reality” – motivational work. Persuasion to join “shared reality” – motivational work.

Realistic about the risks of “unshared reality”.Realistic about the risks of “unshared reality”. Recognizing the attraction of “unshared reality” for Recognizing the attraction of “unshared reality” for

many – offering specialness, buzz and a handy escape many – offering specialness, buzz and a handy escape Mobilising and nurturing strengthsMobilising and nurturing strengths Creative expression Creative expression

Shared Reality Unshared Shared Reality Unshared RealityReality

OrdinaryOrdinary Clear limitsClear limits Access to full memory Access to full memory

and learningand learning Precise meanings Precise meanings

availableavailable Separation between Separation between

peoplepeople Clear sense of selfClear sense of self

Emotions moderated Emotions moderated and groundedand grounded

Logic of Either/OrLogic of Either/Or

SupernaturalSupernatural UnboundedUnbounded Access to propositional Access to propositional

knowledge/memory is knowledge/memory is patchypatchy

Suffused with meaning Suffused with meaning or meaninglessor meaningless

Self: lost in the whole Self: lost in the whole or supremely or supremely importantimportant

Emotions: swing Emotions: swing between extremes or between extremes or absentabsent

Logic of Both/AndLogic of Both/And

What is real & what is not?: What is real & what is not?: about the programmeabout the programme..

A 4 session group programme for an Acute A 4 session group programme for an Acute inpatient setting.inpatient setting.

Run by a clinical psychologist and one or two Run by a clinical psychologist and one or two others – trainees, nurses, OT etc.others – trainees, nurses, OT etc.

Builds on the Romme and Escher ‘Voices Group’ Builds on the Romme and Escher ‘Voices Group’ traditiontradition

Is different from other CBT approaches in Is different from other CBT approaches in normalizing the difference in quality of normalizing the difference in quality of experience in psychosis, as well as thinking style. experience in psychosis, as well as thinking style.

This normalization attacks stigma by associating This normalization attacks stigma by associating psychosis with valued areas such as creativity psychosis with valued areas such as creativity and spirituality. and spirituality.

Attempts to mitigate the damage to self concept Attempts to mitigate the damage to self concept of the traditional, diagnosis, based approach.of the traditional, diagnosis, based approach.

Session 2. The role of ArousalSession 2. The role of Arousal shaded area = anomalous experience/symptoms are more shaded area = anomalous experience/symptoms are more

accessible.accessible.

Level of Arousal

Ordinary, alert, concentrated, state of arousal.

Low arousal: hypnagogic; attention drifting etc.

High Arousal - stress

Session 2 cont. DIALECTICAL Session 2 cont. DIALECTICAL BEHAVIOUR THERAPY: Linehan’s BEHAVIOUR THERAPY: Linehan’s

STATES OF MIND applied to STATES OF MIND applied to PSYCHOSISPSYCHOSIS

reasonable mind

Ordinary thinking

Shared reality.

wiseMind –in touch With both

in the presentin control

emotion mindor open to other waysof experiencing

Non-shared reality

Shared and Non-shared Reality

Discussion of Ways of coping suggested by this approach – management of arousal and distraction.

Transformative PotentialTransformative Potential Mike Jackson’s problem solving theoryMike Jackson’s problem solving theory Loosening constructs - both/and thinkingLoosening constructs - both/and thinking Link with re-experiencing traumaLink with re-experiencing trauma Encounter with whole can seduce - effect on selfEncounter with whole can seduce - effect on self Importance of context and holdingImportance of context and holding Clinically encouraging people to join shared Clinically encouraging people to join shared

world; work in shared world world; work in shared world Failure of society to provide adequate Failure of society to provide adequate

containment to allow transformative process - containment to allow transformative process - Spiritual Crisis NetworkSpiritual Crisis Network

Contact details, References and Contact details, References and Web addressesWeb addresses

isabel@scispirit.comisabel@scispirit.com

Clarke, I. (Ed.) (2001) Clarke, I. (Ed.) (2001) Psychosis and Psychosis and Spirituality: exploring the new frontier.Spirituality: exploring the new frontier. Chichester: Wiley Chichester: Wiley

Clarke, I. ( 2008) Madness, Mystery and the Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester:'O'Books.Survival of God. Winchester:'O'Books.

www.SpiritualCrisisNetwork.org.ukwww.SpiritualCrisisNetwork.org.uk www.isabelclarke.orgwww.isabelclarke.org