Asa nilsonne power point presentation iCAAD Stockholm

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Gesundheit & Medizin

BUILDING SKILLS
FOR LIFE AND
RECOVERY
Åsa Nilsonne
Psychiatrist, psychotherapist, professor emeritus

MACHIAVELLI (1469-1527)
ON CHANGE:
It ought to be remembered that there is nothing
more difficult to take in hand, more perilous to
conduct, or more uncertain in its success, than to
take the lead in the introduction of a new order of
things. Because the innovator has for enemies all
those who have done well under the old
conditions, and lukewarm defenders in those who
may do well under the new.

QUOTE FROM A
PRACTITIONER
”When you get people off their medication, you
have to give them the skills they lacked in the
first place”.

THREE CHALLENGES
Gaining a better understanding of our emotions,
and emotion regulation skills
Helping health professionals understand the
difference between an unhappy/frightened
person and a person with depression or anxiety
disorder, especially when that person is young
Understanding the effects of trauma on
subsequent coping strategies and emotional
development

HIPPOCAMPUS
The left hippocampus is one of the areas of the
brain that seems to be affected by trauma.

TRAUMA
Trauma has been shown to be associated with
ADHD, auditory hallucinations/hearing voices,
depression, anxiety, psychogenic nonepileptic
seizures, personality disorders, eating disorders,
illicit substance use, alcohol use disorder and
other psychiatric conditions.

LIFE SKILLS
Being able to adjust your behaviour to the
situation you are in in, a way that leads you
closer to your desired goals.

I BELIEVE THAT
We need to understand the consequences of
traumatic/adverse life events, and how to give
relevant support and help.
Universal prevention efforts should begin early in
life, and not be targeted at specific disorders.

LET US MAKE
PSYCHIATRIC CARE
GREAT (AGAIN)!

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Traditional methods employed in psychotherapy have limited effectiveness when it comes to healing the psychological effects of trauma in particular complex trauma. While a client may seem to make significant breakthroughs in understanding their feelings and experiences on a rational level by talking with a therapist this will make no difference to their posttraumatic symptoms if the midbrain is unable to modulate its activity in response. The Comprehensive Resource Model argues for a novel therapeutic approach which uniquely bridges neuroscience and spirituality through a combination of somatic therapy traditional psychotherapy and indigenous healing concepts to provide effective relief to survivors of trauma. The Comprehensive Resource Model was developed in response to the need for a streamlined integrative therapeutic model one which engages a scaffolding of neurobiological resources in many brain structures simultaneously in order for clients to be fully embodied and conscious in the present moment while processing their traumatic material. All three phases of trauma therapy resourcing processing and integration are done simultaneously. Demonstrating a nested model and employing brain and bodybased physiological safety as the foundation of healing chapters describe three primary categories of targeted processing implicit and explicit survival terror 8216Little T Truths8217 and 8216Big T Truths8217 all of which contribute to thorough healing of complex trauma and an expans

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The Psychiatric Interview: Evaluation and Diagnosis, First Edition. Allan Tasman, Jerald Kay and Robert J. Ursano. © 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd. This chapter is based on Chapter 1 (Paul C. Mohl) of Psychiatry, 3rd Edition. Listening to the Patient1 Listening: The Key Skill in Psychiatry It was Freud who raised the psychiatric technique of examination – listening – to a level of expertise unexplored in earlier eras. As Binswanger (1963) has said of the period prior to Freudian influence: psychiatric “auscultation” and “percussion” of the patient was performed as if through the patient’s shirt with so much of his essence remaining covered or muffled that layers of meaning remained unpeeled away or unexamined. This metaphor and parallel to the cardiac examination is one worth considering as we first ask if listening will remain as central a part of psychiatric examination as in the past. The explosion of biomedical knowledge has radically altered our evolving view and practice of the doctor–patient relationship. Physicians of an earlier generation were taught that the diagnosis is made at the bedside – that is, the history and physical examination are paramount. Laboratory and imaging (radiological, in those days) examinations were seen as confirmatory exercises. However, as our technologies have blossomed, the bedside and/or consultation room examinations have evolved into the method whereby the physi- cian determines what tests to run, and the tests are often viewed as making the diagnosis. So can one imagine a time in the not-too-distant future when the psychiatrist’s task will be to identify that the patient is psychotic and then order some benign brain imaging study which will identify the patient’s exact disorder? Perhaps so, but will that obviate the need for the psychiatrist’s special kind of listening? Indeed, there are those who claim that psychiatrists should no longer be considered experts in the doctor–patient relationship, where expertise is derived from their unique training in listening skills, but experts in the brain. As we come truly to understand the relationship between brain states and subtle cognitive, emotional, and interpersonal states, one could also ask if this is a distinction that really makes a difference. On the other hand, the psychiatrist will always be charged with finding a way to relate effectively to those who cannot effectively relate to themselves or to others. There is something in the treatment of individuals whose illnesses express themselves through disturbances of thinking, feeling, perceiving, and behaving that will always demand special expertise in establishing a therapeutic relationship – and that is dependent on special expertise in listening (Clinical Vignette 1). All psychiatrists, regardless of theoretical stance, must learn this skill and struggle with how it is to be defined and taught. The biological or phenomeno.

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I have always found the following quote from Gary Schwartz’s 1999 The Living Energy Universe to be inspirational: “One of science’s greatest challenges is to discover certain principles that will explain, integrate, and predict large numbers of seemingly unrelated phenomena.” So too my goal has long been to be able to tease out overarching principles – themes, patterns, and repetitions – that that are relevant in the deep healing work that we do as psychotherapists. Drawing upon concepts from fields as diverse as systems theory, chaos theory, quantum mechanics, solid-state physics, toxicology, and psychoanalysis to inform my understanding, on the pages that follow I will be offering what I hope will prove to be a clinically useful conceptual framework for understanding how it is that healing takes place – be it of the body or of the mind. More specifically, I will be speaking both to what exactly provides the therapeutic leverage for healing chronic dysfunction and to how we, as psychotherapists, can facilitate that process? Just as with the body, where a condition might not heal until it is made acute, so too with the mind. In other words, whether we are dealing with body or mind, superimposing an acute injury on top of a chronic one is sometimes exactly what a person needs in order to trigger the healing process. More specifically, the therapeutic provision of “optimal stress” – against the backdrop of empathic attunement and authentic engagement – is often the magic ingredient needed to overcome the inherent resistance to change so frequently encountered in our patients with longstanding emotional injuries and scars. Too much challenge (traumatic stress) will overwhelm. Too little challenge (minimal stress) will serve simply to reinforce the dysfunctional status quo. But just the right combination of challenge and support (optimal stress) will “galvanize to action” and provoke healing. I refer to this as the Goldilocks Principle of Healing. And so it is that with our finger ever on the pulse of the patient’s level of anxiety and capacity to tolerate further challenge, we formulate “incentivizing statements” strategically designed “to precipitate disruption in order to trigger repair.” Ongoing use of these optimally stressful interventions will induce healing cycles of defensive destabilization followed by adaptive restabilization at ever-higher levels of integration, dynamic balance, and functional capacity. Behind this “no pain, no gain” approach is my firm belief in the underlying resilience that patients will inevitably discover within themselves once forced to tap into their inborn ability to self-correct in the face of environmental challenge – an innate capacity that will enable them to advance, over time, from dysfunctional defensive reaction to more functional adaptive response.

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