Transcript Slide 1

Facilitating the Capacity for Intimacy and
Connection from the IFS Perspective
IFS Conference
Friday, October 22nd
Mark Schwartz, Sc.D.
Castlewood Treatment Center for Eating Disorders
800 Holland Road
636-386-6611
www.castlewoodtc.com
[email protected]
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Inter-Psychic Intimacy (between the couple)
vs.
Intra-Psychic Intimacy (within the individual)
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Intra-Psychic Conflict
Extension of intra-psychic conflict onto the stage of the outer
world often manifests itself in interactions with others that
cannot strictly be called interpersonal, because they are
essentially extensions of the individual’s problems from the
past. These problems are played out using another, not for his
or her real self, but as an involuntary actor cast in a role from a
scenario the patient repeats in the present in order to avoid past
memories and feelings.
From Masterson, J & Orcutt, C. (1989). Marital Co-Therapy of a Narcissistic
Couple. In J. Masterson & R. Klein (Eds.), Psychotherapy of the Disorders of the
Self. New York: Brunner/Mazel
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The fantasy bond is formed originally in early childhood as a substitute for
love and care that may be missing in the infant’s environment. It is highly
effective as a defense because a human being’s capacity for imagination
provides partial gratification of needs and reduces tension. The illusion of
being connected to the mother (or primary caregiver), together with selfgratifiying, self-soothing patterns such as thumb-sucking, nail-biting, and
excessive masturbation are an attempt to heal the fracture in separation
experiences and compensate for emotional deprivation. Such behaviors
lead to a posture of pseudoindependence in the developing child, an
attitude that “I don’t need anyone, I can take care of myself.” The irony is
that the more an individual relies on the fantasy process, the more helpless
or ineffective he or she becomes in the real world. The more seriously
children are deprived, the more they depend on the fantasy bond as a
compensation and reject genuine closeness and affection from others.
Fireston, Robert W., Creating a Life of Meaning and Compassion
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People go to great lengths to maintain the illusion of connection.
Many select mates who remind them of their parents to try to
recreate their past. They ignore their children’s individuality and try
to mold them into an image of themselves in an attempt to achieve a
kind of immortality. Others work compulsively, take refuge in
routines, or choose addictions to avoid real experiences that threaten
their illusions. In contrast, individuals living a self-actualized
existence discover what lies beyond defenses and illusions of
connection. They make real contact and establish genuinely loving
relationships with actual people in real life in spite of the awesome
specter of existential aloneness and interpersonal pain.
Fireston, Robert W., Creating a Life of Meaning and Compassion
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Attachment Trauma
The psychologic distress underlying the craving is the result of
an inability to metabolize negative emotions utilizing the
attachment system (Fosha, 2003; Neborsky, 2003). Successful
therapy restores secure attachment which allows for intimate
relationships to utilize for self-soothing. Injury to the
attachment system is the result of difficulties between the
caregiver and child that results in segregated systems of
attachment and dissociated self-systems. The result is a variant
of narcissism or a false-self personality organization as a means
of avoiding the need for attachment.
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Assumptions Regarding Relationships
Freeman, 1992
Unfinished business - is a present emotional reaction shaped by a
past experience. It is a reactive response guided by strong emotional
feelings based on past experience of anxiety. Unfinished business
does not allow for a thoughtful, creative response to a here and now
situation; rather, it triggers an emotional, reactive response. Who we
bring into our life, our major life decisions, how we embrace
important people and the amount of closeness and distance we need
emotionally are all shaped by unfinished business carried into adult
life. Relationship problems are more a reflection of unfinished
business than expressions of lack of commitment, caring and love.
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The child’s first relationship acts as a template, and it molds
the individual’s capacities to enter into all emotional
relationships. Development essentially represents a number of
sequential, mutually driven, infant-caregiver processes which
occur in a continuing dialectic between the maturing organism
and the changing environment. It now appears that affect is
what is actually transacted within the mother-infant dyad, and
this highly efficient system of emotional communication is
essentially non-verbal.
(Alan Schore)
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Secure Attachment I
L.Alan Stroufe, 2000
• Because their caretakers have been routinely available to them,
sensitive to their signals, and response with some degree of reliability
(though by no means is perfect care required), these infants develop a
confidence that supportive care is available to them.
•They expect that when a need arises, help will be available. If they do
become threatened or distressed, the caregiver will help them regain
equilibrium.
•Such confident expectations are precisely what is meant by attachment
security.
•Secure Attachment (earned) with self.
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Secure Attachment results from a “critical mass” of
Self-led Parenting.
The “Template” is less constrained because there is greater:
Attentiveness
Attunement
Accurate Responsiveness
Access to a range of affect
Acceptance for that which is normative and healthy in children
and humans in general
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Secure Attachment thereby requires:
Less “Exiling” in order to obtain the available
resources of the Attachment Environment.
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In Secure Attachment
Burdening is lessened. When loss or trauma or life’s harshness
occur, mitigation and assimilation are more possible.
Experiences can be absorbed due to the availability of the attachment
figure to:
1.
2.
3.
4.
5.
6.
7.
8.
Patiently connect with the child
Compassionately witness
Register the impact of events upon the child at the time
Affectively abide with the child without merging or abandoning
Allowing the totality of child’s feelings: including fear, sadness, grief, fury,
powerlessness, etc.
Assist the child in arriving at accurate attributions
Reinstate safety
Remain in ongoing relationship
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Attachment Process in Eating Disorder and Depression
Main, 1990
Deactivation (avoidant) can be maintained through actively
diverting attention from attachment issues and distressing
childhood memories. A second major type of defensive
strategy develops when an individual perceives attachment
figures as inconsistently responsive. To maintain the
relationship with this type of caregiver, an individual
hyperactivates (pre-occupied) the attachment system to
constantly monitor the attachment figure and maximize the
output of the attachment system.
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In Avoidant Attachment, Protectors Dominate, to
- Minimize needs
- Dismiss necessity for intimacy
- Create pseudo-independent or pseudo-mature stance
- Keep vulnerability and longing at bay
- Restriction
In Pre-occupied Attachment, Exiles are allowed expression,
however, satiation is not possible due to unavailability of Self,
first in caregiver, later internally. So, while there seems a heavy
emphasis on relationship, there is a going through-the-motions
quality an orchestrated pseudo-self as-if quality: food without
nourishment, relationships between objects.
- Get all you can, but it’s never “enough.”
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Disorganized Attachment
Drawing close to the other is thus accompanied by the
expectation of re-experiencing the anxiety of unpredictable
availability, the fear that allowing oneself to ask for and
obtain care may mean giving up one’s identity and
independence.
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Ogawa Research
• 126 children with disorganized attachment followed until age
19. Prediction of Dissociative Disorder from maternal
unavailability and disorganized attachment in the first 24
months of life was more predictive than trauma. Trauma
history did not add to the prediction, of dissociation after
disorganized attachment.
• Specifically maternal Dissociative symptoms, disrupted
maternal affective communication, maternal lack of
involvement at 12 months, significantly contributed 5 other
measures non > 19.
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Disorganized Attachment
The difficulties encountered during the complex process of
social adjustment, poor flexibility and resilience in facing
life’s painful events, the possibility of building a sense of
self that is coherent and integrated, of producing a fluid and
coherent narration, ultimately psychopathological suffering
itself, seem to point to the attachment pattern as an
important aetiopathogenic factor.
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Dissociation
( Liotta, 2000)
• Early dyadic processes lead to a “primary breakdown” or lack
of integration of a coherent sense of self, i.e. Unintegrated
internal working models.
• Disorganized attachment is the initial step in the development
trajectory that leaves an individual vulnerable to developing
dissociation in response to trauma.
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Disorganized Attachment in the Internal System
•
•
•
•
•
•
•
•
•
•
Chaotic Internal System
Extremists
Inconsistency
Who am “I”?
Rigidity (in lieu of consistency)
Air-Tight Compartmentalization
Warring Factions
Repetition
New Learning Difficult to Integrate
One Miserable Thing Leads to Another
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“Trauma related to structural dissociation then, is a
deficiency in the cohesiveness and flexibility o the
personality structure. The lack of cohesion and integration
of the personality manifests itself most clearly in the
alteration between the vivid re-experiencing of the
traumatic event and avoidance of reminders of the
traumatic experience.”
(van der Hart et al., 2006)
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Repetition
Alice Miller
Nevertheless, the need to repeat also has a positive side.
Repetition is the language used by a child who has remained
dumb, his only means of expressing himself. A dumb child
needs a particularly empathic partner if he is to be understood at
all. Speech, on the other hand, is often used less to express
genuine feelings and thoughts than to hide, veil or deny them
and, thus, to express the false self. And so, there are often long
periods in our work with our patients during which we are
dependent on their compulsion to repeat - for this repetition is
then the only manifestation of their true self.
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Every deep desire, every powerful emotion, gives a trail
into the unconscious. Usually there is only one-way
traffic: outbound, toward the world of sensation and action.
But we can follow the trail to its source by going against
the current. With this desire to go against desire, to buck
the demands of biological conditioning, the journey of selfrealization begins in earnest.
Meditation in Action
Eknath Easwaran
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“…it is normal and healthy for the individual to be able to
defend the self against specific environmental failure by a
freezing of the failure situation. Along with this goes an
unconscious assumption (which can become a conscious
hope) that opportunity will occur at a later date for
renewed experience in which the failure situation will be
able to be unfrozen and re-experienced, with the individual
in a regressed state, in an environment that is making
adequate adaptation.”
(Winnicott Collected Papers, p. 281)
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“SELF-EMPATHY” - The internalizing
(evoking) of the attentive, validating, caring
relationship to oneself. This involves
helping the client articulate her experience
and bring it into her own internal relational
context.
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Parts of Self
Therapy involves helping the client reclaim parts
of self that were sacrificed to gain safety.
In therapy, we create a context and relationship
where pain, anger and difficulty can be safely
acknowledged while maintaining a connection.
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Target Symptoms For “Earned Secure Attachment”
1.
2.
3.
4.
5.
6.
Turning towards other people for self-soothing and
intimacy.
Establishing a coherent narrative regarding one’s
life.
Establishing metacognitional thinking in relation to
family of origin.
Minimize idealization and family loyalties.
Establishing clarity with regards to self and self in
relation to significant others
Resolution of significant losses in one’s life.
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Adult Attachment
1. Describe your relationship with your parents as a young child (i.e., derogation,
relevance violation, loving).
2. 5 adjectives to describe your relationship with mother/father as young child (i.e.,
idealization, dysfunctional).
3. Your first remembered separation from parent.
4. Ever frightened or worried as a child?
5. Did you tell your parents?
6. Any close relatives or loved one die?
7. How did you respond?
8. Do you think loss has had an affect on your personality?
9. What is your relationship like with your parents now?
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Refer to Handout on
Adult Attachment
Protocol
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Affect and Cognition I
Van der Kolk, Brown & van der Hart, 1989
Janet believed that traumatized individuals became
phobic about memory because they have failed to
develop narratives about their traumata, instead
experiencing posttraumatic amnesias and hyperamnesias
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State of Mind Regarding Attachment
COHERENCE: (truthful, succinct, relevant, clean)
Steady flow of ideas, intent thoughts, feelings, clear truthful, consistent,
plausible responses, completed, but not long.
COLLABORATIVE:
Speaker appears to value attachment relationships and experiences
CONSISTENCY:
Descriptions of relationships with parents are supported by specific
memories.
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Metacognitional
Metacognition means treatment of one’s mental contents
as “objects” on which to reflect, or in other words
“thinking about one’s thinking.” Distinct skills
contribute to its characterization, such as the ability to
reflect on one’s mental states, elaborating a theory of the
other’s mind, decentralizing, and the sense of mastery
and personal efficacy.
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Intra-Relational
• Relatedness
1.
2.
3.
4.
5.
6.
Fostering empathy for dissociated parts of self.
Tracking of intra-relational patterns – internal abandonment, ridicule.
Understanding survival function of parts of self.
Resolution of internal conflicts.
Internal witnessing, reduces shame and aloneness.
Affect regulation between internal dyads.
• Emotional Processing
7.
Recognition that different parts of self encompasses different defense strategies, divergent
emotions and divergent attachment schemes.
• Meta Therapies
8.
Recognition that different parts of self encompasses different defense strategies, divergent
emotions and divergent attachment schemes.
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Attachment Therapy for Groups: Concepts and Methods
Week 1: Idealization and Family Loyalty
Definition: Idealization – the discrepancy between the overall picture or presentation of the parent and the readers
inferences regarding actual behavior of the parent.
Week 2: Rejection and Neglect
Definition: Define rejection and neglect by AAI standards
•
Reject – child goes to attachment figure with tender feelings and emotions and parents turns away the child’s
expression of the emotions “I’ll give you something to cry about…”
•
Neglect – parent is physically available but inaccessible emotionally/psychologically unavailable
Week 3: Loving Behaviors
Definition: The attachment figure is dedicated to the development of the child as a person and is emotionally supportive
and available. Loving behavior vs. instrumental love vs. non-loving behaviors.
Week 4: Involving and role reversal
Definition: Define involving and role reversal by AAI standards
•
Involving – parent uses child attachment system to become the object of the child’s attention
•
Role reversal – more severe form of involving behavior; the parent uses the child in the role of a spouse or parent, for
their own emotional needs
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Attachment Therapy for Groups: Concepts and Methods
Week 5: Caretaking behaviors
Involving behavior on the part of our “caretakers” (parents, other attachment figures) can lead us into unhealthy caretaking behaviors in our
relationships. Ex. From Alcoholics Anonymous language – Alcoholic as dependent, partner as codependent
Definition: Caretaking behaviors deceptively (to self and others):
• Keep people in a dependency relationship with you
• Keeps you from dealing with your own issues
• Require that everyone you care for must conform to your set of rules and norms about their life
• Look good and proper on the surface but in reality are a subtle way of manipulating others to keep them under your control
• Make you valuable to others who need your assistance, rescuing and help.
Week 6: Caretaking vs. Supporting behavior
Definition: Review from Week 5
Week 7: Involving Anger
Definition: Involving anger is the reason that when a thing happens in relationship, all the past hurt comes in and it feels as if it is a
continuation or what always happens.
Involving anger sounds like this… “ she was always trying to make me into a little doll that was always doing what she wanted, and she
dressed me that way, and for awhile I acted that way, but I’m onto her now and I know what she’s up to and I’m sorry but I am not your
little baby doll anymore.”
Often longer, but even though it’s a short passage it would score a 6/9 for involving anger on the AAI
Week 8: Passivity
Partial Definition: The speaker appears unable to prevent sounds or phrases from arising while unable to specify it’s presumed intent or
content
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Therapist >
SELF
Parts > Protectors > Exiles
First Level
Second Level
Intra-Psychic Intimacy
Secure Attachment with Self
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Attachment Therapy for Groups: Concepts and Methods
Week 1: Idealization and Family Loyalty
Definition: Idealization – the discrepancy between the overall picture or presentation of the parent
and the readers inferences regarding actual behavior of the parent.
Purpose: How dismissive clients idealize their family-harmful effects for treatment
Intervention: Role played a mini-AAI:
Can you give me three adjectives regarding relationship with a parent and then specific
supporting memories? (3 glowing adjectives with very little specific memories)
When you were upset as a child what would you do? (Not go to parents due to their unloving
behaviors)
How do you think your overall experiences with your parents have affected your adult
personality? (either is hasn’t or they made me stronger)
Expressive: 3 chair expressive Narrative concerning struggle with family or parental loyalty; 1st
chair-the loving nurturing parent, 2nd chair-the polar opposite behavior of the parent, 3rd client.
Client sits any or all chairs and acts out all three parts.
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Attachment Therapy for Groups: Concepts and Methods
Week 2: Rejection and Neglect
Definition: Define rejection and neglect by AAI standards
• Reject – child goes to attachment figure with tender feelings and emotions and
parents turns away the child’s expression of the emotions “I’ll give you something to
cry about…”
• Neglect – parent is physically available but inaccessible emotionally/psychologically
unavailable
Intervention: Clients discuss these experiences in their childhood
Expressive: Expressive around scene where child was rejected or neglected. Work
with parts around this. Have self validate feelings.
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Attachment Therapy for Groups: Concepts and Methods
Week 3: Loving Behaviors
Definition: The attachment figure is dedicated to the development of the child as a
person and is emotionally supportive and available. Loving behavior vs.
instrumental love vs. non-loving behaviors.
Intervention: Hakomi exercise: Bring to mind a loving individual in your life that you
are willing to share with peers. Get in groups of 3-4. Each person gets 7 minutes to
speak about this person with no interruption or feedback. When everyone shares, the
last 7 minutes is for the small group to give feedback concerning how each person’s
story had an impact on them.
Group reconvenes and shares their experience of focusing on loving people and
behaviors in their lives. If time permits, write down as many loving behaviors as
possible and place them in the rating categories of the AAI loving scale.
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Attachment Therapy for Groups: Concepts and Methods
Week 4: Involving and role reversal
Definition: Define involving and role reversal by AAI standards
• Involving – parent uses child attachment system to become the object of the child’s attention
• Role reversal – more severe form of involving behavior; the parent uses the child in the role of
a spouse or parent, for their own emotional needs
Intervention: Pre-determined client shares a narrative regarding parental involving behavior.
Questions for discussion:
• What function do they serve?
• Where do these behaviors lead to (present strategies)?
• What can you do now (to step away from caretaking behavior)?
Expressive: Laura
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Attachment Therapy for Groups: Concepts and Methods
Week 5: Caretaking behaviors
Involving behavior on the part of our “caretakers” (parents, other attachment figures) can lead us into
unhealthy caretaking behaviors in our relationships. Ex. From Alcoholics Anonymous language – Alcoholic
as dependent, partner as codependent
Definition: Caretaking behaviors deceptively (to self and others):
• Keep people in a dependency relationship with you
• Keeps you from dealing with your own issues
• Require that everyone you care for must conform to your set of rules and norms about their life
• Look good and proper on the surface but in reality are a subtle way of manipulating others to keep them
under your control
• Make you valuable to others who need your assistance, rescuing and help.
Intervention: Make a list of caretaking behaviors from the group and allow discussion as needed. Have clients
answer the following (in writing):
1.) What caretaking behaviors do I engage in? 2.) What purpose does this role serve for me personally and/or
emotionally? 3.) How does this practice look like healthy behavior? 4.) How is it not healthy behavior for me
and what are the consequences? 5.) Where/how did this behavior originate in my life?
Expressive: Laura
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Attachment Therapy for Groups: Concepts and Methods
Week 6: Caretaking vs. Supporting behavior
Definition: Review from Week 5
Intervention: Caretaking demonstration acted out by staff – three scenarios, and
discussion of each.
1. Typical caretaking by clients in group
2. Consequences of using your voice with a caretaker (shows what “strings” are
attached)
3. Appropriate resolution of issue between caretaker and the usually dependent person
who decided to use their voice.
Expressive: Laura
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Attachment Therapy for Groups: Concepts and Methods
Week 7: Involving Anger
Definition: Involving anger is the reason that when a thing happens in relationship, all the past
hurt comes in and it feels as if it is a continuation or what always happens.
Involving anger sounds like this… “ she was always trying to make me into a little doll that
was always doing what she wanted, and she dressed me that way, and for awhile I acted that
way, but I’m onto her now and I know what she’s up to and I’m sorry but I am not your little
baby doll anymore.”
Often longer, but even though it’s a short passage it would score a 6/9 for involving anger on
the AAI
Intervention and Expressive:
1. Revisit – a scene from more recent adult life with an attachment figure (someone you care
about, have emotions that could become vulnerable around) where a disproportionate amount
of anger arose within you, seen in what you said or what you thought in the moment.
2. Reinterpret (the anger) – break the scene down, view it in slow motion and see what parts are
activated and find the origin of the involving anger. Attend to the angry parts as well as the
injured parts that the angry one(s) protect.
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Attachment Therapy for Groups: Concepts and Methods
Week 7: cont.
Intervention and Expressive:
3. Reevaluate the actions and intentions of the parties in the present scene from this new
metacognitive perspective.
4. Release – the anger towards the appropriate targets (e.g. two chair work)
5. Revise – imagine a scene in the near future where involving anger could rear it’s ugly head…
6. Rewrite – the script in coherent and collaborative form and read it aloud.
7. Reintegrate
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Attachment Therapy for Groups: Concepts and Methods
Week 8: Passivity
Partial Definition: The speaker appears unable to prevent sounds or phrases from arising while unable to
specify it’s presumed intent or content.
One of the most surprising finds in early AAI’s was an implied passivity of though processes manifested by:
• Overtly vague expressions suggesting an inability to find words or focus on a topic
• Failure to complete sentences and lapse into silence or start a new one
• Odd words or phrases added to the end of sentences
• Wandering to irrelevant topics with no apparent reason
• Indeliberate use of child speech or parental style of speech
• Pronoun confusion between self and parent in recounting past episodes
• These are not dysfluencies and common space fillers like “you know” or “like”…
A hand reaches for a book, hesitates, then grabs it is a restart. A hand that reaches for a book and changes
direction and grabs a glass is a redirection. These are also common in conversation. But a hand that reaches
for a book, stops, then drops limp on the table is analogous to a sentence which is passive.
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In I.F.S., the more unburdening of these
“legacy” and personal burdens, the more
space for Self to re-enter. Decreasing
compartmentalization leads to an increase
in metacognitive capacities and
establishment of a coherent, cohesive
narrative.
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Stuckpoints
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
How am I avoiding remembering?
How am I avoiding feelings?
How am I avoiding talking about it?
How am I minimizing?
How am I avoiding focusing on enjoying parts of life?
How am I avoiding noticing triggers that cause me to hurt
self?
How am I avoiding dealing with current life stresses?
How am I still protecting those who hurt me?
How am I avoiding being close to others?
What secrets have I not yet discussed?
How am I fighting my therapist and working my program?
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Schema-Focused DX of Personality Disorders
Other Directedness
Emphasis on self-denial
people pleasing, over
emphasis on needs and
opinions of others
SCHEMAS: self
sacrifice approval and
recognition seeking
Hyper-Criticism &
High Expectations
Subjugation &
Inhibition
Over-Protection &
Over-Involvement
In areas of performances
& achievement,
hypercritical, high
expectations for
achievement, shames or
unloved for inadequate
performance.
Over controlled by
others restrained
emotionally inhibited,
rule-bound given little
freedom of expression
Parents over involved in
life situations, fostering
dependence,
discouraging autonomy,
enmeshing, worried,
over concerned with
danger
SCHEMAS: unrelenting
standards, failure, error
Disconnection &
Rejection
Over-Indulgence
In area of intimacy &
Spoiled, undisciplined
closeness, child is
emotionally deprived,
socially isolated, made to
feel bad, unlovable
SCHEMAS: emotional
deprivation, social
SCHEMAS:
Subjugation, over
control, punitiveness
SCHEMAS:
Dependence/incompeten
ce, vulnerability to harm
and illness enmeshment.
Lack of Safety & Stability
Mistreated, abused, lied to, betrayed, manipulated,
humiliated, abandoned, environment characterized
by instability, unpredictability, danger.
SCHEMAS: mistrust and abuse
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