Hunger For Love- Webinar

Hunger for Love Webinar Wednesday, November 16 th , 2011 Mark Schwartz, Sc.D. Castlewood Treatment Center for Eating Disorders 800 Holland Road Ballwin, MO 63021 636-386-6611 www.castlewoodtc.com

Castlewood
Levels of Care Offered:
Residential
PHP with free housing
IOP
We Treat:
Eating Disorders with the following co-occurring disorders:
Anxiety Disorders & OCD
PTSD/Trauma
Treatment Approaches
Internal Family Systems Therapy
Attachment Based Psychotherapy
CBT/DBT
Exposure & Response Prevention
Expressive Therapies
Please visit our website: www.castlewoodtc.com for more information

INTRODUCTION

Developmental Psychopathology
Seeks to understand the developmental roots of adult disorder; experiences that leave individuals vulnerable or buffered with respect to stressful life circumstances and the capacity if individuals to draw strength form available social support.

Treatment of ED Premises Philosophically
Different developmental trajectories
Symptom has developed as a survival strategy
Symptom is logical, rational and adaptive
Symptom remission is dependent on understanding the logical development and allowing for a more optimal solution

ED: An Intimacy Disorder Phobia of Food, Anxiety, anxiolytic Obsessive-Compulsive, Social Anxiety Attachment Disorder, Attachment Trauma, Can’t Bond, Destructive Relationships and Sexuality Neglect, Being Alone, Self-Cohesion, Self-Agency, Self-Esteem, Unfinished Childhood Trauma, PTSD, Complex Trauma, Trauma Cognitions Body Dysmorphia, Perfectionism, High Reactivity to Others, Social Confusion Affect Dysregulation, Affect Tolerance, emotional immaturity

Depression Affect Regulation Psychiatric Comorbidity Depression, Obsessive Compulsive Disorder, Social & Generalized Anxiety 21

Anticipated Recovery Issues
Dating
Friendships
Problems Solving
Relapse Prevention
Sexuality
Finances
Alcohol and Drugs
Clothes buying
Diet talk
People commenting on body
Perfectionism
Disappointing others
Assertiveness
Play and fun
Balanced living
Saying No/Yes
Cravings
Social Anxiety
Anxiety and emotional management
Exercise
Recreation
Marital stress
Job issues
Meal festivities
Verbalizing internal states
Anger expression
Boundaries with family/others
Grounding
Financial management
Surrender vs. control
Environmental issues
Anticipated school issues
Spirituality and religion
Spirituality and religion as it pertains to fasting
Time management
Decision making skills
Nurturing self care
Ability to assess safety
Loneliness

ED AS INTIMACY DISORDER

Violence
The soul needs love as vitally and urgently as the lungs need oxygen. It may not be self-evident to healthy people just how literally true this is, for healthy people have resources of love that are sufficient to tide them over periods of severe and painful rejection or loss. Similarly, one does not realize how dependent the body is on oxygen until one has nearly suffocated, or has had to resuscitate someone who is gasping for breath. But when one has worked with deeply and seriously ill human beings, the evidence of the need for both oxygen and love is overwhelming.
The kind of man I am describing protects himself from the emotional suffocation of living in a loveless atmosphere by withdrawing the love he has begun to feel from everyone and everything, in an attempt to reserve for himself whatever capacity for love he may have. But his supply of self-love is also deficient. And it cannot grow to the dimensions that are necessary for health when it is not fed by love from others. If it were not deficient, he could afford to love others. But his withdrawal of love from everyone and everything around him not only protects him from emotional pain, it also condemns him to the absence of emotional pleasure or joy; for we cannot enjoy the people who make up our world, cannot enjoy being with them, except to the degree that we love them. So the person who cannot love cannot have any feelings – pain or joy.
But a joyless life is a synonym for hell. A man who does not love and cannot love, is, in effect, condemned to hell. His entire environment from which – without love – he is cut off, is without enjoyment for him, and thus the world he “lives” in is a source of emptiness and emotional suffocation for him. Both the world and the self are experienced and perceived emotionally as being dead, inanimate, without a soul – without feelings.
From: Gilligan, J. (1996). Violence: Our Deadly Epidemic and Its Causes. New York: G. P. Putnam’s Sons, pp. 51-52.

“ The calming or stimulating effect which the addict obtains from the drug is…impermanent. Whatever the chemical nature of the substance that is employed…No psychic structure is built, the defect in self remains. It is as if a person with a wide open gastric fistula were trying to still his hunger through eating. He may obtain pleasurable taste sensations by his frantic ingestion of food but, since the food does not enter that part of the digestive system where it is absorbed into the organism, he continues to starve.”
(Kohut, 1977)

Many young people feel just as I did, hopeless and empty, not knowing what to do with their lives…My alienation took the form of sleeping all the time, bulimia, and deep conventionality. Drugs, acting out, drinking, and driving too fast are escapes other young people turn to in order to feel they actually exist, in the absence of a sense of self.
Jane Fonda
My Life So Far, p. 111

Over Indulgence
Feeding without nutrition
Treated like an infant, rather than as a capable adult.
Parents preoccupied with work and themselves, and at the same time are over-focused on children.
Parents irresponsible and over-responsible:
Absent and hovering.
Give little of themselves and shower with material goods.
Uninvolved with homework or do homework for kids.
Child raising child. Parenthood is ego dystonic.
Only as good as last accomplishment. Don’t derive mastery and efficacy from last accomplishment.

At the core of eating disorder is family…
and at the core of that relationship with the mother.

Table 8-3 Psychological Control Item Bank
Constraining Verbal Expressions
(Bar) Changes the subject whenever our child has something to say
(Bar) Interrupts our child when he/she is speaking
(Bar) Finishes our child’s sentence whenever he/she talks
Invalidating Feelings
(Bar) Tries to change how our child feels or thinks about things
(Bar) Acts like he/she knows what our child is thinking or feeling
(Bar) Would like to tell our child how to feel or think about things
NOTE: Sch = Schaefer items used by Barber (1996); Bar = Barber items; New = new items developed by early childhood experts; Block = block items

Personal Attack
(Bar) Brings up our child’s past mistakes when criticizing him/her
(Bar) Tells our child that his or her behavior was dumb or stupid
(Bar) Blames our child for other family member’s problems
Erratic Emotional Behavior
(New) Shows impatience with our child
(New) Shows erratic emotional behavior around child
(Bar) Goes back and forth between being warm and critical toward our child
(New) Doesn’t like to be bothered by our child
(Bar) Changes mood when with our child
(New) Loses temper easily with our child

Love Withdrawal
(Sch) Will avoid looking at our child when our child has disappointed him.
(New) Ignores our child when he/she tries to get attention
(Sch) If our child has hurt our feelings, stops talking to our child until the child pleases him/me.
(Sch) Is less friendly with our child if our child does not see things his/my way
(New) Doesn’t pay attention when our child is speaking to us
Guilt Induction
(Block) Lets our child know when he/she has disappointed him/me
(New) Tells our child he/she is not as good as we were growing up
(Block) Lets our child know when we are angry with him/her
(Block) Makes our child aware of how much we sacrifice or do for him/her

(Sch) Says, “If you really care for me, you would not do things that cause me to worry.”
(Sch) Tells our child of all the things he/I have done for him/her
(New) Acts disappointed when our child misbehaves
(New) Tells our child that he/she should be ashamed when he/she misbehaves.
(New) Tells our child that we get embarrassed when he/she does not meet our expectations
(New) Makes our child feel guilty when our child does not meet our expectations
(Block) Informs our child that punishment will always find him/her when misbehavior occurs
(Block) Lets our child know how disappointed we are when he/she misbehaves
(Bar) Tells our child he/she is not as good as other children

Temperament
Temperament involves automatic impulses in response to basic associative stimuli (i.e. novelty, reward, punishment), which give rise to basic emotions such as fear, anger, disgust, and determination. Dimensions of temperament are heritable biases in procedural learning…
(Cloninger, 1998)
14

Woman’s Desire
The “sexy” woman – an image that intimidates women, whether or not they strive to conform to it – is sexy, but as object, not as subject. She expresses not so much her desire as her pleasure in being desired; what she enjoys is her capacity to evoke desire in the other, to attract. Her power does not reside in her own passion, but in her acute desirability.
From J. Benjamin, The Bonds of Love , New York: Pantheon Books

Split off “False Self”
Gain acceptance
Compliant
Care Taking
Approval-seeking
Submissive
Scanning for rejection and disapproval

Middle Adolescence
“ What am I as a person? You’re probably not going to understand. I’m complicated! With my really close friends, I am very tolerant. I mean I’m pretty understanding and caring. With a group of friends, I’m rowdier. I’m also usually friendly and cheerful but I can get pretty obnoxious and intolerant if I don’t like how they are acting. I’d like to be cheerful and tolerant all of the time, that’s the kind of person I want to be, and I’m disappointed in myself when I’m not. At school, I’m serious, even studious every now and then, but on the other hand, I’m a goof-off too, because if you are too studious, you won’t be popular. So I go back and forth, which means I don’t do well in terms of my grades. But that causes problems at home, where I’m pretty anxious around my parents. They expect me to get all A’s and get pretty annoyed with me when report cards come out. I care what they think about me, and so then I get down on myself, but it’s not fair! I mean I worry about how I should get better grades, but I’d be mortified in the eyes of my friends if I did too well. So I’m usually pretty stressed out at home, and can even get very sarcastic, especially when my parents get on my case. But I really don’t understand how I can switch so fast from being cheerful with my friends, then coming home and feeling anxious, and then getting frustrated and sarcastic with my parents. Which one is the real me? I have the same question when I am around boys. Sometimes I feel phony. Say I think some guy might be interested in asking me out. I try to act different, like Madonna. I’ll be a real extrovert, fun-loving and even flirtatious, and I think I am really good-looking. And then everybody and I mean everybody else is looking at me like they think I am totally weird! They don’t act like they think that I’m attractive so I end up thinking that I look terrible. I just hate myself when that happens! Because it gets worse! Then I get self conscious and embarrassed and become radically introverted, and I don’t know who I really am. Am I just acting like an extrovert, am I just trying to impress them, when I am really an introvert? But I don’t really care what they think, anyway. I mean, I don’t want to care , that is. I just want to know what my close friends think. I can be my true self with my close friends. I can’t be my real self with my parents. They don’t understand me. What do they know what its like to be a teenager? They treat me like I’m still a kid. At least at school, people treat you more like you’re an adult. That gets confusing, though. I mean, which am I? When you are 15, are you still a kid or an adult? I have a part-time job and the people there treat me like an adult. I want them to approve of me, so I’m very responsible at work, which makes me feel good about myself there. But then I go out with my friends and I get pretty crazy and irresponsible. So which am I, responsible or irresponsible? How can the same person be both? If my parents knew how immature I act sometimes, they would ground me forever, particularly my father. I’m real distant with him. I’m pretty close to my mother though. But it’s being distant with one parent and close to the other, especially if we are together, like talking at dinner. Even though I’m close to my mother, I’m still pretty secretive about some things, particularly the things about myself that confuse me. So I think a lot about who is the real me, and sometimes I try to figure out when I write in my diary, but I can’t resolve it. There are days when I wish I could just become immune to myself!
The Construction of Self

Love and Compulsion Cannot Coexist
Love is willingness and ability to be affected by another human being and to allow that effort to make a difference in what you do, say, become.
Compulsion is the act of wrapping ourselves around an activity, a substance, or a person to survive, to tolerate and numb our experience of the moment.
Love is a state of connectedness, one that includes vulnerability, surrender, self-valuing, steadiness, and a willingness to face, rather than run from, the worst of ourselves.
Compulsion is a state of isolation, one that includes self-absorption, invulnerability, low self-esteem, unpredictability and fear that if we faced our plan, it would destroy us.
Love expands; compulsion diminishes
Geneen Roth, 1991

Multiple contradictory internal working models

Multiple Internal Working Models
Reciprocally incompatible and segregated or dissociated models of self and of the attachment figure are constructed and, thereby, interfere with integrative functions of memory, consciousness and identity. This suggests that dissociative is more than a defense against trauma. The results are sequential simultaneous or trance-like contradictory behavioral systems. Disorganized infants are unable to synthesis their overall experiences of their interaction with the caretaker into cohesive mirroring structure.

Structural Deficits
There is good reason to believe that large segments of the population lack many critical capacities, such as self-observing abilities, necessary for mental health, and that even patients who have them, have them only in part. These capacities which can be called “structural capacities” (Greenspan, 1989) have to do with critical abilities such as self-regulation , relating , presymbolic-affective communicating , representing and differentializing experience , representing internal experiences and self observation.
From Greenspan, S. (1997). Developmentally Based Psychotherapy , Madison: International Universities Press, Inc.

Developmentally Based Psychotherapy (Mobilize Developmental Process)
Self-regulation (security, control) – look, listen, attend, feel calm, modulate affect and behavior.
Forming intimate relationships (optimism, security, dependence).
Engaging in boundary-defining gestures (mastery) and complex, self-defining communication (self-other).
Representing internal experience (wishes, intentions, affects, complex sense self)

Love Map
Personalized, developmental representation or template in the mind and in the brain that depicts the idealized lover and the idealized program of sexuoerotic activity with the lover, as projected in imagery and ideation or actually engaged in with that lover.

ED & Trauma

Central Characteristics of Trauma Re-Enactment Syndrome
The sense of being at war with one’s own body.
Excessive secrecy as a central organizing principle of life.
Inability to self-protect, often evident in a specific kind of fragmentation of the self, and
Relationships in which the struggle for control overshadows all else.
Dusty Miller, 1994

A survey of 1,699 children receiving trauma-focused treatment across 25 network sites of the National Child Traumatic Stress Network (Spinazzola et al, 2005) showed that the vast majority (78%) was exposed to multiple and/or prolonged interpersonal trauma, with a model 3 trauma exposure types;
Less than ¼ met diagnostic criteria for PTSD. Fewer than 10% were exposed to serious accidents or medical illness.
Most children exhibited posttraumatic sequelae not captured by PTSD: at least 50% had significant disturbances in affect regulation; attention & concentration; negative self-image; impulse control; aggression & risk taking.
The National Child Traumatic Stress Network (NCTSN)

Percentage of Children Experiencing Cumulative Traumas The National Child Traumatic Stress Network (NCTSN)

Met Full Criteria for PTSD The National Child Traumatic Stress Network (NCTSN)

Baseline “Real World” Indicators of Problems The National Child Traumatic Stress Network (NCTSN) Somewhat or Very Much a Problem Academic Problems 41.4% Behavior in School/Daycare 37.2% Behavior at Home/Community 47.7% Attachment Problems 30.6% Suicidality 11.3% Criminal Activity 5.3% Running Away 4.8% Substance Use (Alcohol/Drugs) 8.7%

Trauma Survivors Have Symptoms Instead of Memories
Chronic over-activation of the adrenaline stress response system
Chronic states of fear and dread
Heightened fears of abandonment
“ Disorganized attachment”
Hypervigilence: Constant “looking over one’s shoulder”
Attention becomes narrowly focused on potential threat
Overwhelming affects and arousal
Difficulties with “stimulus discrimination”
Impairments in self-care and self-compassion
Distorted cognitive schemas
Trauma results in an increased risk of victimization
Harvey, 1990

Re-Framing the Meaning of Symptoms
Start with the assumption that every symptom is a valuable piece of data!
Use psychoeducational material to make educated guesses about the meaning of symptoms, as a symptom-memory or a valiant attempt to cope.
Ask her, “How would this ________ have helped you to survive in an unsafe world? Helped you to feel less overwhelmed? Less helpless? More hopeful?
Look for what the symptom is still trying to accomplish: i.e., chronic suicidal feelings might offer comfort or a “bail-out-plan;” cutting might help modulate arousal; social avoidance could be an attempt to avoid “danger.”
Once it is clear what the symptom is trying to accomplish, then the therapist and patient can look for other ways to accomplish the same goal in a context that describes the patient as an ingenious and resourceful survivor, rather than a damaged victim.

Burdens
The concept of “burdens” is brilliant in its widespread application. It sidesteps the need to compare, contrast, count symptoms to diagnose, and postulates instead more of a “no one escapes unscathed” framework. Thus, “burdens” can encompass beliefs, feelings, and energetic residue of events and experiences that overwhelmed the internal and/or external accessible resources of the organism and its attachment environment at the time, thereby creating constraint.

Trauma Recovery Domains
Self-Injury is the container for unmetabolized traumatic stress and underlying unresolved trans-generational trauma and loss.
Self-injurious/destructive behavior is functional and is always an attempt to protect the client (system).
Expresses (communications) underlying dynamics and need and is “trance logical” (“hurting releases pain”).
Because behavior dissociated from sensation affect and knowledge, linkages to specific meaning, function or intent, will typically be unclear.
Mary Harvey, Ph.D.

Trauma Recovery Domains
Self-Esteem - Capacity for self-care and regard, properly eat, exercise, sleep, self-soothe.
Self-Cohesion - How one experiences oneself, fragmented, compartmentalized, self-trust
Safe Attachment - Negotiate and maintain safety in relationships.
Making Meaning - Making meaning of their experiences.
Mary Harvey, Ph.D.

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Hunger For Love- Webinar

by Castlewood Treatment Center on Nov 16, 2011

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Hunger For Love- Webinar — Presentation Transcript