neuropsychotherapy a neuropsychotherapy …...cozolino, l. (2014). the neuroscience of human...

11/09/2016

1

Peter Janetzki © 2016

Peter [email protected]

A Neuropsychotherapy

Approach with Couples

A Neuropsychotherapy

Approach with Couples

PACFA, CCAA, SCAPE, ACCAPE, APECA Conference September 2016


NeuropsychotherapyNeuropsychotherapy


Case Illustration

Early 40’s

Early 30’s

Young Teen

M 2yrs amicable

Infant

Xleft left controlling passive

CSA

CSA

CSAJail


Everything is Inter-connectedEverything is Inter-connected


COPINGMEANING WORTH

COPINGMEANING WORTH

COPINGMEANING WORTH

COPINGMEANING WORTH

IF

THEN

CONTENT

INTER-personalPROCESS

Inter-personal interaction

Inter-personal interaction

Intra-personalIntra-personalIntra-personalIntra-personal

Black ZoneRed Zone Red Zone


Because EVERYTHING is connected what happens

between a couple IMPACTS and is IMPACTED by

what is going on within each individual.

Therefore use what is going on in the BLACK

zone (Interpersonal) to find out what is going on

in the RED zone (Intrapersonal)

11/09/2016

2


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 PrinciplesNeuropsychotherapy Principles


SURVIVE&

THRIVE

Neuropsychotherapy Principle #1Neuropsychotherapy Principle #1


Bottom Up Approach

THE 3 PART BRAIN



Survival Brain – Brainstem

– 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


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 – Limbic System


Smart Brain - PFC

– 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

11/09/2016

3


When my

Impulsive Brain FIRES UP my

Smart Brain Switches OFF


Peter Janetzki © 2016 Peter Janetzki © 2016


11/09/2016

4




11/09/2016

5




11/09/2016

6


UP Regulate

DOWN Regulate


The SURVIVAL task of our brain easily overrides

the THRIVING task of our brain. Therefore the

antenna of the LIMBIC system is always

monitoring for perceived threat. Hence why

couples become reactive to one another.


THE POWER OF

PROCEDURAL LEARNING



Procedural Learning

Procedural memory does not involve conscious

thought.

• talking • walking

• playing a musical instrument

• sport skills • riding a bike• driving a car


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)

PastPastPast PresentPresentPresent FutureFutureFuture


Including our responses to

PERCEIVED THREATS

FIGHT

FLIGHT

FREAK

FREEZE

Procedural memory does not involve conscious thought

11/09/2016

7


UP Regulate

DOWN Regulate


Procedural memory is at play particularly with

clients who have had significant past hurts.

Reactive couples are constantly reading their

past experiences into how they are perceiving

the here and now as well as what they expect

will happen next.


THE BRAIN’S RESPONSE

TO PERCEIVED THREATS



Spinal Cord

Polyvagal – Sympathetic & Parasympathetic System

Hypothalamus

PituitaryACTH - Adrenocorticotropic hormone

Hormonal System

CytokinesImmune System


THE CRITICAL NATURE OF

THE POLYVAGAL SYSTEM



The Polyvagal System

Balanced Controlled by

Autonomic Nervous System (ANS)

Sympathetic Parasympathetic

Activation Calming

Fight-or-Flight Rest-and-Digest

Social Engagement

Social Disconnection

11/09/2016

8


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-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


The Ventral Vagus Nerve & the Autonomic Nervous System (ANS)

Head Movement

Vocalisation

Facial Movement

Our Environment

Auto

nom

ic N

ervo

us

Syst

em

Adapted from Porges SW., Cleveland Clinic Journal of Medicine. 2009 Apr; 76(Suppl 2): S86–S90Adapted from Porges SW., Cleveland Clinic Journal of Medicine. 2009 Apr; 76(Suppl 2): S86–S90

Neuroception


When couples are in conflict they are constantly

activating each others sympathetic nervous

system, therefore reading into facial movements,

eyes, vocalisations and head movements threat

that may not be intended. This in turn reduces

social engagement.


THE WINDOW OF

TOLERANCE



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

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


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.2Adapted from Ogden, Minton, & Pain, 2006.p.27,32; Corrigan & Nutt, 2010, p.2

EMOTIONAL

AROUSAL

11/09/2016

9

Peter Janetzki © 2016 Adapted from Ogden, Minton, & Pain, 2006.p.27,32; Corrigan & Nutt, 2010, p.2Adapted 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’


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

Peter Janetzki © 2016 Adapted from Ogden, Minton, & Pain, 2006.p.27,32; Corrigan & Nutt, 2010, p.2Adapted 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


Helping couples to engage at the edges of their

window whilst maintaining social engagement is

what produces individual and relational growth.

This facilitates dysregulation followed by a

corrective emotional experience rather than just

spinout or shut down.


THE PILLARS OF

NEUROPSYCHOTHERAPY



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

11/09/2016

10


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

THRIVING

SURVIVING


Therapy can provide a couple an enriched

environment that can enable them individually

and relationally to face the challenges of life and

thrive.


Putting it All Together

With Couples


Warlow J. (2010). Living wholeness: The Christian wholeness framework for professional counsellors. Carindale, QLD, Australia: Living Wholeness. Pages 11-15. Used with permissionWarlow J. (2010). Living wholeness: The Christian wholeness framework for professional counsellors. Carindale, QLD, Australia: Living Wholeness. Pages 11-15. Used with permission

CCUU

RREE

ConnectConnect

Understand Understand

RespondRespond

Engage Others & EvaluateEngage Others & Evaluate


IF

THEN

CONTENT


Same Themes

BehaviourallyOpposite

COPINGMEANING WORTH

COPINGMEANING WORTH

COPINGMEANING WORTH

COPINGMEANING WORTH


COPINGMEANING WORTH

COPINGMEANING WORTH

IFCOPINGMEANING WORTH

COPINGMEANING WORTH THEN

CONTENT


CONTENT


IMPULSIVE BRAIN

MEANINGMEANING

SURVIVAL BRAINCoping Behaviours

IMPULSIVE BRAIN


11/09/2016

11


COPINGMEANING WORTH

COPINGMEANING WORTH



CONTENT


IMPULSIVE BRAIN

MEANINGMEANING


IMPULSIVE BRAIN


Circuit BreakCalm Down

Connect & Challenge

ClarifyWanting & Desire Now


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


IMPULSIVE BRAIN



Case Illustration

Early 40’s

Early 30’s

Young Teen

M 2yrs amicable

Infant

Xleft left controlling passive

CSA

CSA

CSAJail


• Early sessions;‒ focused on safety‒ understanding and normalising their

responses to each other‒ 3 part brain‒ hijacking of her impulsive brain

PastPastPast PresentPresentPresent FutureFutureFuture


• Next few sessions;‒ her overshooting and his undershooting the

window‒ hypervigilance, and their procedural learning‒ key triggers/themes worthlessness – not

being important

Shut Down

Spin Out


• Session around finances

What Clients Bring to the Room

Co

ntr

ol

What Clients Experience in the Room

SAFE

UNSAFE

Out of Control = Agro, Scared, Fear, Powerless Helpless, Harm,

Lack of Safety = Others Control, External Control

Unloved, Unworthy, Guilt ∴ I am UNLOVABLE, I am UNWORTHY, I DON’T DESERVE

Beat myself up Self Blame

Spiral Down


Spiral Down


Spiral DownBe HonestBe HonestBe Honest

I Want a Future Together



We are in Control of US, Take the Reigns, Face Fear, A Internal Sense of Control

Past Present Future

11/09/2016

12


• Next few sessions;‒ Themes underpinning their Red Zone/ Black

Zone‒ Control‒ Love‒ Respect‒ Insecurity

COPINGMEANING WORTH

COPINGMEANING WORTH




References & Readings

Cozolino, 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.


References & ReadingsPorges S.W. (2009). The polyvagal theory: New insights into adaptive reactions of

the autonomic nervous system. Cleveland Clinic Journal of Medicine. 76(Suppl2): S86–S90

Rossouw, P.J. (Ed.). (2014). Neuropsychotherapy: Theoretical underpinnings and clinical applications. Sydney: Mediros.

Warlow J. (2010). Living wholeness: The Christian wholeness framework for professional counsellors. Carindale, QLD, Australia: Living Wholeness.

Journals

International Journal of Neuropsychotherapy

Neuropsychotherapy

Neuropsychotherapy in Australia

The Neuropsychotherapist


www.peterj.com.auwww.peterj.com.au

www.facebook.com/peter.j.associates1

www.facebook.com/PeterJanetzki

neuropsychotherapy a neuropsychotherapy …...cozolino, l. (2014). the neuroscience of human...

Documents