Friday, March 18, 2016

Using the 10 StEPs as a Somato-Sensory Psychotherapy for Impulsive Reactivity to Environmental Triggers

An extensive description of the 10 StEPs of Emotion Processing is provided at http://pairadocks.blogspot.com/2015/04/the-10-steps-of-emotion-processing.html.

Building upon the platforms of

1) Erik Erikson's eight-stage developmental schematic (see link below),
2) Karl Menninger's "mentalizing" (see link below) and
3) Jon Kabat-Zinn et al's "mindfulness" (see link below);




...it seems worth hypothesizing that the 10 StEPs can be utilized to "redevelop" the neural linkages that were both under- and mis-constructed during Erikson's trust, autonomy, initiative and competence stages of psychosocial development. I was looking into a "dysfunctional family" schematic handily described in object relations terminology by Shapiro, Shapiro, Zinner and Berkowitz in Jill Scharff's Foundations of Object Relations Family Therapy. In it, I was able to see how the 10 StEPs could be utilized to provide a developmentally retarded adolescent with the tools to not only work out of her over-socialized family of origin's subtle, very well-disguised double binding (see link below) but also deal with the affecting re-triggering of it one encounters in the common culture. (Because one will encounter such paradoxical injunctions as "be dependent on us" vs. "don't be dependent upon us" at least daily in the common culture.)


Dealing with such re-triggering is crucial for those who have been double-bound into neurotic, borderline and psychotic conflicts. Because while psychoanalytic interpretations (see below) of such dynamics in the family of origin may clear up the *original* problem, the cognitive-affective-behavioral energy tends to remain stored in somato-sensory channels in the PTSD fashion described by Bessel van der Kolk, Pat Ogden, Peter Levine, Robert Sapolsky, Bruce McEwen, Sonya Lupien et al. The construction of neural "hard-wiring" that resulted from the original trauma is not changed -- or de-constructed -- by insight psychotherapies. It is still there. And it can -- and probably will -- be re-activated by environmental challenges that deliver the same, subtle, typical well-disguised, "do this" but "do don't do this" message in the future. (The dynamic was well described by Martin Seligman in his work on "learned helplessness," see below).



I have seen (and heard) the particular dynamic described in Scharff in almost every Alanon, Co-Dependents Anonymous and Adult Children of Alcoholics 12 Step meeting I have ever attended since 1986 (see links below). I have heard it so many times now that I suppose that it must lay at or very near the essential etiology of the clinical depression, anxiety, PTSD and obsessive-compulsive behavioral presentations one can so easily observe in such meetings.




It is my notion that the acquisition of reality-based and effective ego functions is rendered difficult if not impossible by repeated family of origin conditioning ("socialization") of the sort described above to the point of unconscious internalization, repetitive habituation (in Watsonian / Skinnerian fashion; see link below) and normalization. In simple terms, the habituee is never conscious, mindful or aware of the automation of a cognitive-affective-behavioral chain and feedback loop he or she "ingested" over the course of years or decades. And this chain becomes an unconscious filter through which the habituee sees, hears and senses interpersonal relations, as well as the emotional energy -- or "force" -- that propels his or her automated, reactive behaviors.  


Worse, it is likely that those who are unconsciously double-bound in such fashion will feel increasingly stigmatized, invalidated, humiliated, demonized, rejected, bused and abandoned. And not only by the behavior of the family of origin, but by the reactions of those outside of and beyond the nuclear family in whom they project images of family members because these outsiders may in some ways resemble or remind them of the originals in ways that range from subtle to obvious... but to whom the habituees are "strangely attracted." (As Freud and Harry Stack Sullivan suggested decades ago, one with unresolved issues from the nuclear family is often drawn to those who seem "pathologically normal" to them.)

As stated above, it is generally useful to get the essential, pathologizing dynamic down via some form of insight work (as is often done in the 12 Step programs mentioned above). But unless the habituee has 1) the capacity to see him- or herself walking into the same old Karpman Drama Triangle (see link below) yet again, and 2) the ability to deal with the cognitive, emotional and behavioral upshots of it, the clinical manifestations are likely to flood back into florid reactivation.

https://en.wikipedia.org/wiki/Karpman_drama_triangle

So here's the suggested ACTion (as per Stephen Hayes, Victoria Follette, et al):

Learn how to...

1) observe (look, listen, feel) to
2) notice (perceive) to
3) recognize (identify) to
4) acknowledge (be aware of) to
5) accept (as being what is) to
6) own (as being what is in one's own mind) to
7) appreciate (why this is happening yet again) to
8) understand (in such depth that one can do the following) to
9) detach / defuse and digest / metabolize / discharge the affects (emotions, feelings, sensations) that drive the impulse to re-act in pretty much the same way one did as a child, masking off "intolerable" shame (for insufficiency and incompetence), guilt, anxiety, worry, remorse and regret to
10) get up out of the habituated cognitive / affective / behavioral box.

Rather than... fall into the twin traps of...

1) semi-consciously attempting to *suppress* the uncomfortable (believed to be "intolerable") experience with "behavioral control" or "stuffing" or "thought-stopping" or "changing the subject" or elective distraction; or

2) un-consciously trying to *repress* the uncomfortable experience with some form of acting out which could include anything from obvious, defensive hostility or "cooperative caving in" to sudden expositions of dissociation from the present moment into descriptive re-experiencing of other more pleasant events in the past.

The suppression and/or repression of the affective energy fueling the impulse to re-act is precisely what keeps the cycle of abuse (see link below) going.


Suppression and/or repression make it effectively impossible to transit the necessary stages of observation, perception, recognition, acknowledgment, acceptance, ownership, appreciation and understand that have to be transited to reach the then automatic result of de-fusing / detachment from the cognitive-affective-behavioral cycle and digestion / metabolization of the neurochemistry of the affects (emotions, sensations, feelings) that produces the release.

That neurochemically-fueled energy has to be "bled off." And the only way to do it is through 1) pharmacological intervention or 2) some form of conscious -- or "mindful" -- continuing awareness of it as sensory experience in the manner described by Marsha Linehan and the afforementioned van der Kolk, Ogden, Levine; all experts in the effective treatment of PTSD. The problem with the former, of course, is that it actually prevents the processing described here... and, thus, the long-term "de-pressurizing" of the thought-feeling-behavior cycle. Medication use will put the kybosh on the current cycle... but not the triggering or cause of its ultimate (and repeated) re-cycling. 

The 10 StEPs is a way to do that, but moreover, it is a way to compress the required ACTions in such treatment schemes into a mnemonic that can be easily memorized and recalled when potent affects creep into the greatly increased and improved self-awareness such therapies as those listed below tend to produce in those who commit themselves to acquiring such awareness... or "mindfulness."




One can find the references mentioned in this article below the original article on the 10 StEPs at http://pairadocks.blogspot.com/2015/04/the-10-steps-of-emotion-processing.html. Additionally, a later article in this series on the use of Ogden's Sensorimotor Psychotherapy for Trauma in conjunction with the 10 StEPs appears at http://pairadocks.blogspot.com/2016/07/the-10-steps-ogdens-sensorymotor.html.

© 2016 by Rodger Garrett; all rights reserved. Links are permitted. Please contact not.moses@outlook.com with comments or questions. Thank you.


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