a neuropsychotherapy approach with couples€¦ · is how neural circuits distinguish whether...
TRANSCRIPT
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Peter Janetzki © 2016
Peter JanetzkiDip.T., Grad. Dip.Soc.Sc., M.Soc.Sc.(Counselling).
CCAA (Clin), PACFA Reg
A Neuropsychotherapy
Approach with Couples
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Peter Janetzki © 2016
Everything is Inter-connected
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Peter Janetzki © 2016
COPINGMEANING WORTH
COPINGMEANING WORTH
IF
THEN
CONTENT
INTER-personalPROCESS
Inter-personal interaction
Intra-personalIntra-personal
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Peter Janetzki © 2016
Neuropsychotherapy
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Peter Janetzki © 2016
1. The Two Primary Tasks of the Brain
2. The Bottom Up Approach
3. The Power of Procedural Learning
4. The Brain’s Response to Perceived Threats
5. The Critical Nature of The Polyvagal System
6. The Window of Tolerance
7. The Pillars of Neuropsychotherapy
Neuropsychotherapy Principles
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Peter Janetzki © 2016
SURVIVE&
THRIVE
Neuropsychotherapy Principle #1
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Peter Janetzki © 2016
Bottom Up Approach
THE 3 PART BRAIN
Neuropsychotherapy Principle #2
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Peter Janetzki © 2016
Survival Brain
– the first part of the brain to develop
– fastest part of the brain
– runs automatic functions that keep us alive i.e. breathing, heartbeat, digestion
– its #1 job is our survival
Automatic Brain
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Peter Janetzki © 2016
Emotional & Experiential Brain
– next fastest part of the brain
– runs on past experiences & emotions
– fear is it fastest trigger
– fires up our defences
– learns by repetition
Impulsive Brain
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Peter Janetzki © 2016
Smart Brain– the last part of the
brain to develop
– slowest part of the brain
– helps us to think through decisions
– the first to switch off when under stress
– has the power to override the impulsive brain
– last part to mature
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Peter Janetzki © 2016
When my
Impulsive Brain FIRES UP my
Smart Brain Switches OFF
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
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Peter Janetzki © 2016
UP Regulate
DOWN Regulate
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Peter Janetzki © 2016
THE POWER OF
PROCEDURAL LEARNING
Neuropsychotherapy Principle #3
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Peter Janetzki © 2016
Procedural Learning
Procedural memory does not involve conscious
thought.
• talking • walking
• playing a musical instrument
• sport skills • riding a bike• driving a car
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Peter Janetzki © 2016
Procedural Learning Facilitates Automatic Responding to Unconscious Future Predictions
“[Procedural] memory shapes how
we experience the present and how
we anticipate the future, reading us
in the present moment for what
comes next based upon what we
have experienced in the past.”(Siegel, 2006. cited by Fisher, 2014)
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Peter Janetzki © 2016
Including our responses to
PERCEIVED THREATSFIGHT
FLIGHTFREAKFREEZE
Procedural memory does not involve conscious thought
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Peter Janetzki © 2016
UP Regulate
DOWN Regulate
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Peter Janetzki © 2016
THE BRAIN’S RESPONSE
TO PERCEIVED THREATS
Neuropsychotherapy Principle #4
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Peter Janetzki © 2016
Spinal Cord
Polyvagal – Sympathetic & Parasympathetic System
Hypothalamus
Pituitary
ACTH - Adrenocorticotropic hormone Hormonal System
CytonkinesImmune System
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Peter Janetzki © 2016
THE CRITICAL NATURE OF
THE POLYVAGAL SYSTEM
Neuropsychotherapy Principle #5
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Peter Janetzki © 2016
The Social Engagement System
Head Movement
Vocalisation
Facial Movement
Our Environment
Bra
inst
em
Adapted from Porges SW., Cleveland Clinic Journal of Medicine. 2009 Apr; 76(Suppl 2): S86–S90
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Peter Janetzki © 2016
Neuroception: A Subconscious System for Detecting Threats and Safety at a Glance
http://stephenporges.com/index.php/component/content/article/5-popular-articles/20-neuroception-a-subconscious-system-for-detecting-threats-and-safety-
• Neuroception is the process of perception & evaluation • Neuroception is how neural circuits distinguish whether
situations or people are safe, dangerous or life threatening
• This rapid response hardware and software integration takes place in the primitive parts of our brain that work at a sub-conscious level
• Our neuroception determines our response of immobilization, mobilization, and social engagement/communication
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Peter Janetzki © 2016
THE WINDOW OF
TOLERANCE
Neuropsychotherapy Principle #6
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Peter Janetzki © 2016
Sympathetic Hyper-arousal:Too much arousal to integrate
Parasympathetic Hypo-arousal:Too little arousal to integrate
The Window of ToleranceAdapted from Ogden, Minton, & Pain, 2006.p.27,32; Corrigan & Nutt, 2010, p.2
Window of Affect Tolerance:Moderate, regulated arousal
EMOTIONAL
AROUSAL
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Peter Janetzki © 2016
SympatheticHYPER-arousal
ParasympatheticHYPO-arousal
Window of ToleranceOptimal Arousal Zone
Process & Respond- Uncomfortable Emotions can
be tolerated - Cogitative processing &
integration of information
“FIGHT or FLIGHT” (Spin Out)- Increased sensations- Emotionally reactivity- Hypervigilance- Intrusive Imagery - Disorganized cogitative processing
“IMMOBILISATION” (Shut Down) - Minimize sensations- Numbing of emotions- Disabled cogitative processing- Reduced physical movement
Adapted from Ogden, Minton, & Pain, 2006.p.27,32; Corrigan & Nutt, 2010, p.2
EMOTIONAL
AROUSAL
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Peter Janetzki © 2016 Adapted from Ogden, Minton, & Pain, 2006.p.27,32; Corrigan & Nutt, 2010, p.2
EMOTIONAL
AROUSAL
Shut Down
Spin Out
UncontrollableIncongruence
Dysregulated
Over-regulated
Window of Tolerance‘The Sweet Spot’
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Peter Janetzki © 2016
Uncontrollable & Controllable Incongruence
Controllable Incongruence
A Sense of DISEMPOWERMENT
Uncontrollable Incongruence
A Sense of EMPOWERMENT
We Move Forward RESILENCEWe Move Backward RETREAT
Patterns of AVOIDENCE
Patterns of APPROACH
Increase in DYSREGULATION Increase in REGULATION
Shrinking World Expanding World
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Peter Janetzki © 2016 Adapted from Ogden, Minton, & Pain, 2006.p.27,32; Corrigan & Nutt, 2010, p.2
EMOTIONAL
AROUSAL
Shut Down
Spin Out
UncontrollableIncongruence
Dysregulated
Over-regulated
Therapy that stays in the middle (too safe) will not access dysregulated arousal and subsequent regulation
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Peter Janetzki © 2016
Emotional Maturity involvesManaging my Impulsive/Survival Brain &Engaging my Smart Brain so that IChange my Procedural Learning &Respond from a position ofEmotional Security (the best in me) not Reactivity (often the worst in me)
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Peter Janetzki © 2016
THE PILLARS OF
NEUROPSYCHOTHERAPY
Neuropsychotherapy Principle #7
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Peter Janetzki © 2016
Bottom –up development
Safety (Physical/Emotional)
Co
nn
ect
Co
ntr
ol
Mo
tivati
on
Actualisation
Socially Integrated
En
vir
on
men
t
Base materials genetic make upFoundation SAFETY
Pillars (Needs)
Attachment (Connection)
Control
Motivation (Pain/Pleasure)
Integrated model of NeuropsychotherapyProf Pieter J Rossouw 2016 ©Used with permission
Top Structure (Actualisation)
Thriving, Learner
Enriched
Compromised
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Peter Janetzki © 2016
What Clients Bring to the Room
Co
nn
ect
Co
ntr
ol
Mo
tivati
on
What Clients Experience in the Room
SAFE
UNSAFE
Crumbling Pillars
Strengthening Pillars
AbandonmentDisconnectionGrief & Loss
DisempoweredLack of OptionsUncontrollable Incongruence
Overwhelmed buy Life's ChallengesStuck in Dirty PainUncontrollable Incongruence
Reason to Choose
Power to Choose
Motivation to Choose
Self-Validation ILOC Self-Soothing
TherapeuticAlliance & Validation
Controllable IncongruenceOptions
Controllable IncongruenceRegulation
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Peter Janetzki © 2016
Putting it All Together
With Couples
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Peter Janetzki © 2016
The Christian Wholeness FrameworkDr John Warlow (2010)
www.christianwholeness.com
CU
RE
Connect
Understand
Respond
Engage Others & Evaluate
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Peter Janetzki © 2016
IF
THEN
CONTENT
INTER-personalPROCESS
Same Themes
BehaviourallyOpposite
COPINGMEANING WORTH
COPINGMEANING WORTH
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Peter Janetzki © 2016
COPINGMEANING WORTH
IFCOPINGMEANING WORTH THEN
CONTENT
INTER-personalPROCESS
CONTENT
INTER-personalPROCESS
IMPULSIVE BRAIN
MEANINGMEANING
SURVIVAL BRAINCoping Behaviours
IMPULSIVE BRAIN
SURVIVAL BRAINCoping Behaviours
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Peter Janetzki © 2016
COPINGMEANING WORTH
IFCOPINGMEANING WORTH THEN
CONTENT
INTER-personalPROCESS
IMPULSIVE BRAIN
MEANINGMEANING
SURVIVAL BRAINCoping Behaviours
IMPULSIVE BRAIN
SURVIVAL BRAINCoping Behaviours
Circuit BreakCalm Down
Connect & Challenge
ClarifyWanting & Desire Now
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Peter Janetzki © 2016
MEANINGMEANING
Circuit BreakCalm Down By
1. Not reacting2. Not taking it
personally3. Breathing
Connect & Challenge
1. What is the meaning for me?
2. Is this valid for here & now?
Clarify & Share What I Want
Without Demanding
IMPULSIVE BRAIN
SURVIVAL BRAINCoping Behaviours
IMPULSIVE BRAIN
SURVIVAL BRAINCoping Behaviours
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Peter Janetzki © 2016
CONTENT
INTER-personalPROCESS
Window of Tolerance Window of Tolerance
MUSH
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Peter Janetzki © 2016
Case Illustration
Early 40’s
Early 30’s
Young Teen
M 2yrs amicable
Infant
Xleft left controlling passive
CSA
CSA
CSAJail
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Peter Janetzki © 2016
• Early sessions focused on safety and understanding as well as normalising her responses & the 3 part brain
• Exploring her overshooting the window & hypervigilance, his avoidance in relation to procedural learning. Also the underlying themes around worthlessness.
• Session around finances• Next session around Red Zone/ Black Zone• Next session the flow diagram
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Peter Janetzki © 2016
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References & ReadingsCozolino, L. (2014). The neuroscience of human relationships: Attachment and the developing
social brain (2nd Ed). New York, NY: Norton.
Cozolino, L. (2010). The neuroscience of psychotherapy: Healing the social brain (2nd Ed). New York, NY: Norton.
Cozolino, L. (2013). The social neuroscience of education: Optimizing attachment and learning in the classroom. New York, NY: Norton.
Grawe K. (2007). Neuropsychotherapy: How the neurosciences inform effective psychotherapy. New York, Taylor & Francis
Porges, S.W. (2004). Neuroception: A subconscious system for detecting threats and safety. Zero to three.
Porges, S.W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York, NY: Norton.
Porges S.W. (2009). The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic Journal of Medicine. 76(Suppl 2): S86–S90
Rossouw, P.J. (Ed.). (2014). Neuropsychotherapy: Theoretical underpinnings and clinical applications. Sydney: Mediros.
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Peter Janetzki © 2016
References & ReadingsJournals
International Journal of Neuropsychotherapy
Neuropsychotherapy
Neuropsychotherapy in Australia
The Neuropsychotherapist
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Peter Janetzki © 2016
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