Problems with the SelfDr. Louise McHugh

University College Dublin

Know thyself!

Where is your ‘self’?

Ferrari et al 2008

YOU ARE HERE!

I was so stressed

yesterday, I wasn’t myself!

Then who were you?

Social animals…

Charles Cooley

• ‘Looking Glass Self’

• We notice how people act towards us and derive what others opinion must be

George Herbert Mead

• Symbolic interactionism

• Humans act toward things on the basis of the meanings they ascribe to those things

• Meaning is derived from social interaction with others and society

My ‘self’ changes with context

• Imagine you had 30 seconds to describe your ‘self’

• An interview for a marketing position

• To serve jury duty

• On a first date

• What does contextual behavioural science say?

A sense of self?

• Only humans have a sense of self

• Why?

Symbolic relationships between things…

• Is what allows us to make sounds that other people understand rather than simply pointing and grunting at things

‘HAT’‘Kelly’

Relationships based on cues

Physical Relationships

=

CONTEXTUAL CUE

=

CONTEXTUAL CUE

IS SAME AS

CONTEXTUAL CUE

Nic

BAD OK GOOD

BADNic

THE JUMJAW EXERCISE

Readily answer questionsLittle or no reaction

CONTEXTUAL CUE

BEFORE AFTER

Is a jumjaw the same as a cat?

Is a jumjaw bigger than a tractor?

Does a jumjaw have ears?

ETC.

Is a jumjaw the same as a cat?

Is a jumjaw bigger than a tractor?

Does a jumjaw have ears?

When children are taught to name objects, they areprovided with masses of explicit bi-directional training

CUE

Clue for ‘Name-Object / Object-Name’ responding

After thousands of such interactions, the child no longer requires explicit bi-directional training

• Same as (‘Jumjaw is the same as dog’)• Opposite (‘Day is opposite to Night’)• Different (‘Boys are different from Girls’)• Comparison (‘£1 is more than 10p’)• Causal (‘If anxious then I will mess up’)• Temporal (‘Bad now worse later’)• Perspective (‘I am here and you are there’)

We can relate in many ways

Relating is great it can help me solve problems!

Especially important problems!

•Think of three single digit numbers (you can repeat numbers) and write them down in random order

•Now answer the following question, using the first number to pick the word in the first column, the second number to pick the word in the second column, etc.

And we can relate everything!

•How is a. . .

•(e.g., banana) (e.g., the cause of) (e.g., candle)

•1. Banana 1. like 1. prostitute?

•2. Race car 2. unlike 2. war?

•3. Kangaroo 3. better than 3. chair?

•4. Foreman 4. different from 4. candle?

•5. Priest 5. worse than 5. house plant?

•6. Football 6. the father of 6. book?

•7. Hat 7. the cause of 7. mud hole?

•8. Computer 8. the partner of 8. baby?

•9. TV 9. the opposite of 9. toilet?

… the cause of…

Causal Relations can be tricky!

Emoti

ons

Prob

lem

s

That

pro

blem

with

the

gove

rnm

ent,

your

nei

ghbo

rs, y

our b

oss,

etc

.Th

at p

robl

em w

ith y

ou

Technical Term Alert!

Function

basically means the ‘effects something has’

Psychological

Function

Transformation of Functions

‘DOG’

is a

‘Dog’Psychological

Function

‘DOG’

‘Jumjaw’

is a

‘Jumjaw’Psychological

Function

produces

produces

produces

produces“Small Dog”

“Average Sized Dog”

“Enormous Dog”

produces

produces

produces“Tall Jumjaw”

“Grande Sized Jumjaw”

“Venti Jumjaw”

produces

produces

Relating and the Transformation of Functions

-3

-2

-1

0

1

2

3

Mic

rosie

men C

hange

rela

tive to B

B - Sixshocks

A - Single1/2 strength

shock

C - DerivedLarge

Relational Training No Relational Training

Dougher, Hamilton, Fink, & Harrington (2007)

15 normal subjects

Establish this relational network in half of them using arbitrary stimuli:

A < B < C

Give B a CS shock function and then present a single ½ strength shock in the presence of A

Test the C stimulus . . .

Derived Relations of Comparison

MORE THANMORE THANuniversity class corner

storeliving room

Panic attack in one’s own living room results in increased arousal and avoidance of corner store and university class

And deriving explodes…

Try this exercise: Learn four relations and see what happens. . .

LISA

OLDER THAN

HOMER

RELATION 1:

RELATION 2:

LISA MAGGIE

OLDER THAN

RELATION 3:

HOMER

YOUNGER THAN

ABE

RELATION 4:

YOUNGER THAN

ABE MONTY BURNS

From 4 Trained Relations. . .

OLDER

OLDER

OLDER

OL

DE

R

OLDER

OLDER

OLD

ER

OLDER

YOUNGER

YOUNGER

YOUNGER

YOUNGER

YOUNGERYOUNGER

OLDER

OL

DE

R

YOUNGER

YO

UN

GE

R

With age comes…

• Wisdom

• Beauty

• Regret

• Freedom

• Responsibility

• Strength

• Weakness

Language

We also learn to manipulate it through sound and symbols

Milk Please!

Just as we learn to manipulate the environment with our body and hands

• So language is responding to abstract relations

• So what does that have to do with the ‘self’?

‘I think therefore I am’

No Rene – you learn to verbally discriminate your own behaviour from others

behaviour - therefore you are

I had a banana for breakfast

No silly I had a banana for

breakfast

What did YOU have for breakfast?

I feel happy

I am happier than you!

I am a happy person!

As a child begins to relate more and more of their own behavior…

…and to compare it with that of others…

…they begin to have a concept of self

I feel sad

I am not as happy as you

I am a depressed person!

I eat breadI eat ice creamI eat a steakI eat chocolate

I hear musicI hear a driving carI hear birds singingI hear my mother calling

I see a deskI see you comingI see a bright futureI see and hear a dog

I touch the screenI touch my faceI touch into the waterI touch the hot pan

I go to my officeI go homeI go into the darkI go back to school

I think of my workI think of your painI think of lunchtimeI think of my father

I am goodI am badI am a husbandI am a doctor

I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother calling

I see a deskI see you comingI see a bright futureI see and hear a dog

I touch the screenI touch my faceI touch into the waterI touch the hot pan

I go to my officeI go homeI go into the darkI go back to school

I think of my workI think of your painI think of lunchtimeI think of my father

I am goodI am badI am a husbandI am a doctor

I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother callingI see a deskI see you comingI see a bright futureI see and hear a dog

I touch the screenI touch my faceI touch into the waterI touch the hot pan

I go to my officeI go homeI go into the darkI go back to school

I think of my workI think of your painI think of lunchtimeI think of my father

I am goodI am badI am a husbandI am a doctor

I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother callingI see a deskI see you comingI see a bright futureI see and hear a dogI touch the screenI touch my faceI touch into the waterI touch the hot pan

I go to my officeI go homeI go into the darkI go back to school

I think of my workI think of your painI think of lunchtimeI think of my father

I am goodI am badI am a husbandI am a doctor

I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother callingI see a deskI see you comingI see a bright futureI see and hear a dogI touch the screenI touch my faceI touch into the waterI touch the hot pan

I go to my officeI go homeI go into the darkI go back to school

I think of my workI think of your painI think of lunchtimeI think of my father

I am goodI am badI am a husbandI am a doctor

I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother callingI see a deskI see you comingI see a bright futureI see and hear a dogI touch the screenI touch my faceI touch into the waterI touch the hot pan

I go to my officeI go homeI go into the darkI go back to school

I think of my workI think of your painI think of lunchtimeI think of my fatherI am goodI am badI am a husbandI am a doctor

I eat breadI eat ice creamI eat a steakI eat chocolateI hear musicI hear a driving carI hear birds singingI hear my mother callingI see a deskI see you comingI see a bright futureI see and hear a dogI touch the screenI touch my faceI touch into the waterI touch the hot panI go to my officeI go homeI go into the darkI go back to schoolI think of my workI think of your painI think of lunchtimeI think of my fatherI am goodI am badI am a husbandI am a doctor

Noticing Perspective

‘The key to a happier world is the growth of compassion’

Dalai Lama

Understanding others?

Theory of Mind Module

I Know what you are thinking! I have a ‘module’ in

my brain that tells me!

I versus YOU HERE versus THERE NOW versus THEN

• Perspective relations specify a relation in terms of the perspective of the speaker

Consider the three relations of:

CBS Approach to Perspective-Taking

Each time a child is asked or answers questions such as:

“What are you doing here?” “What was I doing then?” “What am I doing now?” “What were you doing there?”

the physical environment will likely be different… The only constant across such questions are the

relational properties of: I versus You

Here versus There Now versus Then

CBS Approach to Perspective-Taking

Relation Type• I / YOU• HERE / THERE• NOW / THEN

Complexity• Simple Relations• Reversed Relations• Double Reversed Relations

Two important variables:

McHugh, et al., (2004)

CBS Approach to Perspective-Taking

A Simple Relation Task I have a white brick and you have a red brick

Which brick do you have?

Which brick do I have?

I am sitting here on the blue chair and you are sitting there on the black chair

and YOU were ME

Where would I be sitting?

Here: There:

A Reversed Relation Task

If I was YOU

Where would you be sitting?

Yesterday I was sitting there on the black chair, today I am sitting here on the blue chair

and NOW was THEN and THEN was NOW

Where would I be sitting now?

Now: Then:

A Double Reversed Relation Task

Where would I be sitting then?

If HERE was THERE and THERE was HERE

Here: There:

McHugh, et al., (2004) - Developmental Profile – appears at same age as ToM

Rehfeldt, et al, 2006 – those diagnosed with ASD less proficient

Villatte, et al. (2010) – patients with schizophrenia less proficient

Villatte et al (2008) – link between deictics and social anhedonia

Weil et al (2011) – training in deictics with children with ASD produces gains on Theory of Mind tests

Vilardaga et al (2009) - Link between deictic relational responding and empathy

Empirical Support

Laura Skye & Dave Barmy

So how does this link to ACT?

Psychological Flexibility•Contacting the present moment fully and without defense, as a conscious human being, and based on what the situation affords, changing or persisting in behaviour in the service of chosen values

•Be present •Open up•Do what matters

Psychological Inflexibility

• Not fully contacting experience• Limited experience of the self• Avoiding experience• Even when it’s getting in the way

of what we want and the person we want to be

Double Edged Sword

Verbal self-knowledge is a two-edged sword

Were as smart as

Steve

Comparison is a bitch

‘I wish I…’

Were as young as I am in this

photo!

Had great hair like Russ

Were as good at presenting as

Robyn

Even if you are a mega star…

1969

I am not good enough as I am.In order to be good enoughI need to look a certain way

1979

1989

2009

3 Selves in ACT

• Self as content Story

• Self as process Contacting the present

• Self as context Flexible Perspective Taking

ME

BAD

NOTHING BUT TROUBLE

STUPID

WORTHLESS

EVERYONE LAUGHS AT ME

NO-ONE LOVES ME

UNWORTHY OF THE

AFFECTION OR TRUST

OF OTHERS

MUST AVOID INTIMACY

FEELINGS OF LONELINESS

LONELY SAD INDIVIDUAL

Lack of contact with social contingencies

Exercise

• What kind of self-descriptive ________ does the client fuse with?– judgements e.g., about body, personality,

weaknesses, roles– beliefs– self-limiting attitudes – e.g., I can’t do X because

of Y– predictions about the future

The conceptualized self trap

I slept all day. I am a lazy person.

Result: The only way to change your

future is to change your past. You’re Stuck!

Exercise

• Why is attachment to both NEGATIVE and POSITIVE conceptions of self detrimental?

• What ACT technique helps us let go of our attachment to our self concept?

• Now select a judgment about yourself…

Put a self judgment into one word• Now say:

X is goodX is badX is ruthlessX is beautifulX is a bananaX is positiveX is trueX is falseX is awful X is uplifting

X is scaryX is evilX is prettyX is a fishX is a girlX is hopelessX is disgustingX is boringX is safeX is menacing

Defusion is salience of many functions with no one function dominating

Focus on process not content

Highlight the non-literal quality of the client’s thoughts

Defusion

I’m not good enough

I’m having the thought that I am not good enough

Perspective relations in defusion

Respond to our thoughts as I HERE NOW - caught up in them

Respond to our thoughts and feelings as I THERE THEN - they are seen as thoughts and feelings that we had

Self as Content

I am a worthless person

Self as Process

I feel so worthless right now

AND

I HERE NOW notice that I am having the thought that I am worthless

I HERE NOW am noticing that I am having the feeling that I am worthless

Fusion and Defusion

SELF AS CONTENT

I’m not good enough.I am too anxious

SELF AS PROCESSI HERE NOW notice my

thoughts and feelings and what I can see, hear, touch

taste and smell

EMPATHYI HERE NOW

notice that you are feeling sad

SELF COMPASSIONI HERE NOW

notice my pain and respond with

kindnessTRANSCENDENT

SELFI HERE NOW am the

observer of my thoughts and

feelings

SELF AS CONTEXT

What about the other?

• Other as content

• Other as process

• Other as context

ACT Self Goals

1. Undermine attachment to conceptualised self

2. Help client notice continual flow of experience

3. Help client increase the availability of flexible perspective taking

Clinical example - Jessie

Jessie says she’s “finally” seeking therapy because she’s “sick of feeling so awful all the time.” She says it’s been five years since she felt something other than “depression and shame.” She describes her life in terms of “the real me, before I got depressed,” and “this person I’ve become.” She says she doesn’t go places or do things because “I’m just too ashamed,” and “that shame takes away anything that used to be good about it.” She gives the example of hating for her family to see her “this way.” In session, Jessie is persistently tearful and has trouble following directions and giving contingent responses.

Broadening Her Experience of Self

• Expand her contact with stimuli in the world and her range of responding to stimuli

• Self as more than depressed• World as more than source of shame• Shame as more than thing to be avoided

John• John struggles with chronic pain and spends much of his

time trying to come up with a fool-proof strategy that will ideally get the pain to go away, or at least to let him get some control over it. He firmly believes that he has tried everything, but that nothing has worked. The pain and the struggle with it have gained such dominance over his life that much of who John is psychologically is about pain. In other words, John knows himself first and foremost to be a sufferer of chronic pain and many other aspects of his life have become secondary to this sense of self (not just in terms of his overt behaviour). As such, the identification with the problem has become almost the whole person that he resides in, and other aspects (e.g., husband, father, worker) have fallen away (e.g., “I can no longer play with the kids because my back will get sore”).

Hopelessness

Acceptance

Struggling and avoidance

Obstruction

Self and fusion

Values

JohnThe solution has become part of the problem

and isn’t this what has actually been the case for the last few years?

Pain is perhaps inevitable, struggle is not

Avoiding the struggle controls his behaviour more than actual pain

He knows himself first and foremost to be a sufferer of chronic pain and many other aspects of his life have become secondary to this sense of self

The pain has been allowed to take John’s life off in a direction that he did not see himself choosing

TIP - No need to win the conceptual war!

• The problem solving mind: sense making, prediction, and story telling

Reduce its dominance by distinguishing

thoughts vs thinkeremotions vs feeler

TIP - Give examples of perspective

• Therapist can self disclose to give an example of perspective

‘When I get hurt, like you, I find it difficult to just step back and let the hurt be there, and instead see it as part of me’

Inner Child Exercise

Training Flexible Perspective TakingStep 1. Basic Perspective Training ‘If I were you, where would I be?’

‘If I were you and here was there, where would I be?’

Step 2. Empathy Training ‘I feel sad. If you were me, how would you feel?’

‘I’ve won a prize. If you were me, how would you feel?’

Step 3. Self-as-Context ‘I watch thoughts and feelings come and go. Who is it that is watching them?’

Vilardaga& Hayes, 2009

Exercise

• For Step 2 design an intervention in session could that could target the transfer of emotions across perspective relations (empathy)

Transfer of emotions across perspective relations

• Think of a time when you were in distress that someone invalidated your pain?

• Contact how you felt at that time

• Think of a time when you invalidated someone else’s pain when they were distressed

• Now contact how they felt then

Self and the failure of empathy

• Narcissistic personality disorder – such strong fusion with a particular conceptualised self that events tend to be universally framed in terms of their relevance to this self and thus taking the perspective of another is made less likely

• High levels of anxiety - empathy is sometimes possible but it often results in such distress that it produces not sympathy for the other but self-concern and thus the result is the absence of overt empathic responding

• Burn out - Low levels of empathy can be produced by avoidance of the level of distress experienced during previous episodes of empathic responding

Context matters!

• There are a number of contextual variables that may make empathic responding more or less likely for any individual: – similarity between observer and observed– familiarity – social dispositions– cooperative versus competitive context – how much the observer likes the observed

• Disconnected self

• Underdeveloped self

• Labeled self

Classifying Self Problems

Disconnected self

• Perspective taking repertoires lacking

• Example: Autistic spectrum conditions

• Intervention – perspective training

Underdeveloped self

• Doesn’t have a clear idea of who they are and what they stand for

• Example: Trying to please others, social anhedonic

• Intervention: self as process work

Labeled self

• Fused with negative self narrative– Example - depression

• Fused with positive self narrative– Example - Narcissistic

• Intervention – self as context work

What looks like depression can be three different problems with self…

Underdeveloped Self – Depression

• Passive• No sense of ‘what I want’• People pleaser • Directionless

Self as process

Isolated self - Depression

• Aspergers / ASD / Social anhedonia / poor social skills – rejection isolation

Deictic (perspective training)

Labeled Self

• Fusion with I am bad / worthless

Self as context

Think of a client you have that fits one of these categories

• Disconnected self

• Underdeveloped self

• Labeled self

Informing intervention?

Signs self work are needed handout

Signs of Progress

1. Client reports sense of observing private experiences

2. Laughing at oneself in earnest

3. When they begin using these centering processes spontaneously in their own lives

Flexible self exercise

• Future you

For more on this…

• Thank you!