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Nigel Denning, M.Psych, MA - Guest
Nigel Denning, M.Psych, MA is a Counselling Psychologist and Director of Integrative Psychology and Medicine in Melbourne, Australia. Nigel is Research Fellow at Australian National University. Nigel has been involved in developing the Three Pillars of Attachment Repair and Integrative Attachment Therapy with David Elliott and Traill Dowie and developing the IAT Training Program. Nigel is a nationally recognized expert in family violence, institutional abuse, trauma and attachment-focused practice. Nigel is also clinical lead in several psychedelic medicine trials and a trainer in psychedelics and holotropic breathwork, having studied under Stanislav Grof. In addition, Nigel is a long-term meditation practitioner and teacher in the Tibet Bon Dzogchen tradition. Nigel has a profound understanding of how Eastern practices affect the mind and their subsequent connection to psychotherapy. Nigel is a jovial and kind person who is passionate about improving the world one mind at a time. |
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W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton, Psy.D. (00:24):
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:32):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, Psy.D. (02:19):
Today I'll be speaking with Nigel Denning, who is a counseling psychologist and director of Integrative Psychology Medicine in Melbourne, Australia. Nigel is Research fellow at Australian National University. He has been involved in developing the three pillars of attachment repair and integrative attachment therapy with David Elliot and Traill Dowie, and developing the IAT training program. Nigel is a nationally recognized expert in family violence, institutional abuse, trauma, and attachment focused practice. Nigel is also clinical lead in several psychedelic medicine trials and a trainer in psychedelics and holotropic breath work having studied under Stanislav Grof. In addition, Nigel is a long-term meditation practitioner and teacher in the Tibet Bon Kin tradition. Nigel has a profound understanding of how eastern practices affect the mind and their subsequent connection to psychotherapy. Nigel is a jovial and kind person who is passionate about improving the world one mind at a time. Let's listen to the interview. Well, hi Nigel. Welcome.
Nigel Denning, M.Psych, MA (03:25):
Hi, Keith.
Keith Sutton, Psy.D. (03:27):
Oh, thanks. Yeah, thanks for coming on. So, yeah, so I have learned a little bit about the integrative attachment therapy, and somebody had actually recommended the book to me some years ago, which I got, which I hadn't broken into. And then you had reached out and contacted me about maybe being involved with the podcast, and it was just perfect because I, I was talking to a therapist at a networking event and they're like, you gotta read this book for adult attachment and really helping to heal and, and shift those attachments. So I was really interested in that. So I'd love to hear about the work that you all are doing but if you were, before we even get to that, I always like to hear about people's kind of path to what they're doing, you know, the evolution of your thinking to get you over to where you're at now and the work.
Nigel Denning, M.Psych, MA (04:14):
Yeah, thanks. Well, I'm I've been involved in, in psychotherapy. I'm a counseling psychologist here in, Melbourne, and I run a clinic called Integrative Psychology and Medicine. And we've been, oh, we've been thinking about how to think about therapy for a very long time. I studied about 15 years ago with, with Dan Siegel for about a year. He did an online supervision group.
Keith Sutton, Psy.D. (04:42):
Oh, wow.
Nigel Denning, M.Psych, MA (04:43):
Some other stuff. And interestingly, he was the first kind of high profile therapist that raised the issue of what is a mind, you know, what, what is it that we are working with, what are we agreeing with, what are we disagreeing about, given that there are, what, 500 or so evidence-based therapeutic techniques out there, all of which fail to have any kind of coherent agreement on the subject matter.
Nigel Denning, M.Psych, MA (05:10):
So we've just been really interested in how to approach you know, the mind. We've the integrative psychology and medicine label. It's also kind of attached to the, the training we do in psychedelic medicine. I'm a lead clinician in three trials here in Melbourne. And so I'm also a meditator and I've been involved in the Tibetan zen tradition for 20 years. So all these kind of different pathways kind of interesting kind of entry points to, to what a mind is, how it works, what it's about. We're very good at identifying pathological features of mine. Now we've got that one down to a fine art, but what is it that we know about how to develop the mind, how to optimize the mind.
Nigel Denning, M.Psych, MA (06:04):
That's really an important feature in psychedelic medicine, but it's also a really important feature in attachment work because what we're trying to do is construct something that hasn't previously been activated. So you know that's been my journey for many years. I've studied with Stanislav Grof who developed LSD psychotherapy at Harvard with a number of clinicians. I've been lucky enough to work with a number of kind of leaders in the field until I then eventually came along. Dan Brown's work and Daniel P. Brown and David Elliot. The authors of the text that you're referring to published in 2016 on treating attachment disturbance in adults. And Dan was a really interesting guy, sadly passed away during COVID, but he kind of carried two hats on one level. He was a translator of Tibetan texts, and at the other level, he was a clinical psychologist at Harvard Med School. So he had a really interesting perspective on, on this idea of what is a mind.
Keith Sutton, Psy.D. (07:16):
Yeah, tell me about it. What is a mind? Now I'm dying to to know your definition or your conceptualization.
Nigel Denning, M.Psych, MA (07:22):
Well, I mean, what we've sort of it's, it's still a work in progress, but essentially, mind rather than it being a noun, we think more of mind as a verb, as a collection of processes. And so if you take one of the areas that we really we're big on is taste formulation. And so understanding the way that a mind emerges from a brain and interacts with the world around it becomes then a set and series of processes that we can then observe, and then we can talk about different therapeutic techniques as affecting different parts of that process. So it becomes then just a kind of a fluid developmental orientation, which takes us into, you know, the importance of the attachment work. As you know, one of the very first kind of organizational features of basically the biology of the brain is what's being affected in attachment.
Nigel Denning, M.Psych, MA (08:23):
But of course, it creates the basis then for the development of the mind, because Bowlby's, internal working model is really a set of predictions that that come from, you know, the phenomena or bottom up experience that creates a predictive model based on intuition that we then carry into our adult relationships forever. Until we start to observe, start to recognize that, you know, there's something not quite working here, and almost half the adult population has an attachment disturbance, which means, you know, there's probably something that we are not providing in the education of parents and families about the importance of really, really focused features of mind at the level of the development of brain between 8 months and 24 months of age. So, mind is a process, it's a process that emerges from the brain and it emerges through relationship, you know, as Alan Stru says, you know, we're a self because of our relationship with other selves.
Keith Sutton, Psy.D. (09:36):
Very cool. So there's, so you were mentioning there's three processes and one is attachment, and what are the other two?
Nigel Denning, M.Psych, MA (09:46):
Other processes of development? Oh we've kind of done quite a bit of work with Jean Carle Diaggio from the Rome School of Behavioral Sciences, and you know, the work that they've done through ti. And he talks about, it's more than three. So attachment, then there's care and nurturance, there's social rank, there's sexual identity, there's safety. They're fairly key developmental kind of processes. He describes as developmental motivational schemes.
Keith Sutton, Psy.D. (10:25):
And these are all pieces of kind of the aspects of mind or that kind of verb aspect of mind?
Nigel Denning, M.Psych, MA (10:30):
Yeah. So, you know, we are trying to kind of regulate who we are and how we interact. In group, that's a lot of our kind of primary orientation, you know . Based on, you know, this, this evolutionary wetwear that we are carrying around in our skulls.
Keith Sutton, Psy.D. (10:46):
Yeah. Yeah.
Nigel Denning, M.Psych, MA (10:47):
300 million years of you know, constant upgrading that we've been kind of bringing into service of civilization for about 14,000 years
Nigel Denning, M.Psych, MA (10:59):
So we are asking ourselves to do quite a lot.
Keith Sutton, Psy.D. (11:02):
Yeah. Definitely
Nigel Denning, M.Psych, MA (11:03):
With biology, that's really more oriented to surviving than it is to, you know, filling in your tax returns or you know, providing psychotherapy or any of the other kind of complex tasks. That we're involved with.
Keith Sutton, Psy.D. (11:19):
So tell me about the adult attachment disturbances and, you know, kind of how that's conceptualized and how that's treated. I was looking up some information and reading more about it, and there was kind of I guess three pillars that of the therapy where our dressing change.
Nigel Denning, M.Psych, MA (11:37):
Yeah, that's what what our work at the IAT Institute has been about, is really trying to understand three pillars from a more of a global perspective. So, when Dan wrote the book, the novel part of the book was Ideal Parent Figure Work. So using imaginal work to repair what had or hadn't been established. And what we started working on when we looked at started training this. We've been working with David Elliot quite extensively on this, is looking at the first two pillars of collaboration and metacognition as a meta psychological approach. So it's sort of common factors work. But how do we operationalize and how do we identify common factors and match it with specific outcomes. So the specific features are the ideal parent work collaboration is a very specific and overt process here around, you know, ensuring that, you know, the therapist and the client are, you know, congruent with diagnosis, congruent with treatment plan that we have, you know, adequate rules and understanding of how we are going to communicate.
Nigel Denning, M.Psych, MA (12:58):
Because as we go into attachment repair, we are going to bring up unconscious material, which is going to lead to projective identification. And so how do we kind of work with that without going through classic transferential processes . So we work with collaboration and adverting and, and conversing, and then we are using mentalization. And this is something that Dan Brown innovated in the mentalization field. He'd described mental metacognition, I should say as a developmental process, mentalization being the process of mind that works through sensate material, affect material cognitive material, symbolic material through the relationships. So the mentalizing is this kind of you know, kind of working through that metacognition is the view that we attain.
Keith Sutton, Psy.D. (13:57):
What was that part? It's the view
Nigel Denning, M.Psych, MA (13:58):
That we attain.
Keith Sutton, Psy.D. (14:01):
We attain, yes. The view we attain.
Nigel Denning, M.Psych, MA (14:03):
Cognition is how we see things. For instance, you know, someone who's grown up in a traumatic environment may only have a perspective of their life as being threatened by the world around them. That becomes their metacognitive view, and that becomes a way they you know, come transact with the world. When they start to move through that trauma, they start to see things from a broader perspective, and they see that's suffering from a different orientation. I mean, I've done this work with another one of my areas of work, was with the the Australian royal inquiry into childhood institutional sexual abuse. So a lot of people that were coming out of that work, their time of reporting trauma to the time of getting treatment was an average of 38 years. So that had a huge amount of, you know, kind of reinforcement of traumatic experience in that time, using a three pillars approach, and using ideal parent figures in some of those cases, gave people an experience of their bodies that they'd never previously had. They come out of a session going, "oh, that's what trust is." Suddenly they had a cognitive view had expanded from one of suffering and entrapment. To one of a view of their progress through life. And these are people that have been able to achieve things professionally and familiarly, even though they were carrying on processed trauma all that time.
Keith Sutton, Psy.D. (15:35):
Tell me about the ideal parent interventions. What do you do? I know this reminds me of Milton Erickson's, like February man hypnosis, or you know, sometimes in EMDR we might bring in the adult selves, take care of them, or IFS bringing in self.
Nigel Denning, M.Psych, MA (15:53):
Exactly.
Keith Sutton, Psy.D. (15:54):
Yeah. Tell me a little bit about what your version is or, you know.
Nigel Denning, M.Psych, MA (15:58):
Yeah. Well, I mean, all of these models, aren't they access that kind of symbolic organization of mine. They enter into that place that you know, object relations really has spent a lot of time, how do we form up symbolic other, you know, in this really abstracted way. You know, the young child whose mother leaves is able to to calm and soothe themselves because they have a representational model of that mother that lingers whilst the mother's not physically present. So drawing on, you know, this really early developmental feature of mind. So when we think about attachment disturbance, what we're talking about is someone who, you know, is we're all born hyper aroused and we look to the parent to sooth. So the preoccupied or the, the anxious attached child or adult is one who's in a perpetual state of hyper arousal.
Nigel Denning, M.Psych, MA (16:56):
They've never had an opportunity to downregulate. And so their central nervous system is constantly seeking through the other, the corrective relationship to learn down regulatory capacity. For instance, one of the features in the dismissing adult who would be the anxious avoidant child, their brain has found its way too hypoarousal. So they've been able to numb, detach, switch off. They're sometimes described by parents as good children because they're quiet. What we've only in kind of recent decades recognized is those children are often highly affected by cortisol. They're switched off, and so they grow into adults who, whenever vulnerability appears, there's a natural reduction diminishing on that process. And then of course we have then the disorganized attached, or the fearful avoidant, which is that person who unfortunately swings between hyper and hypo arousal throughout life.
Nigel Denning, M.Psych, MA (18:09):
And it's more likely to get kind of personality disorder diagnoses and other serious diagnoses. So what we do is we identify the attachment style of the adult, and we get some understanding of how that's manifest in the person's life. And then we use like what would be a very similar kind of process to people that are familiar with IFS or EMDR or hypnosis and those kind of processes. We get someone to relax, close their eyes, take a few deep breaths, and just come to an imagining of themselves as a five-year-old.
Nigel Denning, M.Psych, MA (19:01):
If they can't get to five, somewhere between five and 12, we ask them to imagine or to get a sense of, because not everyone can visualize particularly immediately. So whether they, they visualize or whether they just get a sense of, but to be in a place that's safe and comfortable and not of their memory. So we don't take people back to the household they grew up in or something like that. They go somewhere neutral. We get them to experience the neutrality of the sensate qualities of that area as you would with any kind of, you know, relaxation technique, smell, the, you know, smelly air, feel the the sun on your skin and the, and really amplify the, the experience of being in that, that place. And then we get them to imagine two parents who are not their memory parents who are ideal parents.
Nigel Denning, M.Psych, MA (19:59):
Now, we've done a bit of psycho ed prior to going into this because it's a little bit of you know, kind of a strange orientation. But what we are really trying to work with is using the imaginary system to override the memory system. So we're not trying to draw into memory. We're not trying to create this imagery as sort of overlaying new memory or anything like that. We are trying to create imaginal process, so using the symbolic or organization of mind to create a new experience. And these two ideal parents are suited to the needs of this child. And so we, we really build on, we've already identified prior to the imaginary process, we've, we've gone through an interviewing process and we've asked the person to offer five adjectives that describe their relationship between them and their mother, them and their father growing up.
Nigel Denning, M.Psych, MA (20:56):
And if there's, you know, they only have one parent, if there's any other significant adults, but we are asking five adjectives that describe their relationship between mother and child, father and child. And we've asked them to demonstrate, give an example of those adjectives. So for instance, someone with a dismissing attachment style will generally idealize their relationships. But not have much memory to back up the adjectives. So when we come to the imaginary process, we are armed with some ideas of what the memory system holds. And so these ideal parents are doing the positive opposites. So if the or they're really embodying the positive features. So, you know, how are they loving? They're there with you. They want to encourage you, they want you to explore, you know, and so we are really using this kind of imaginal process to amplify features that were either not developed at that age or were developed in an inappropriate way.
Keith Sutton, Psy.D. (22:03):
So is that the adult attachment inventory that you're doing with clients and then kind of identifying those aspects and then basically bringing in the replacement kind of yeah.
Nigel Denning, M.Psych, MA (22:18):
I've been trained in the adult attachment interview, the Mary Main model, and that's probably, you know, the best way to get a really detailed quality of someone's attachment system. But you know, we've got modified versions of that, and then there's, you know, other models that people have been trained in. Yeah, there's a few other attachment some people use,
Keith Sutton, Psy.D. (22:44):
So they're imagining this or they're thinking about these adjectives, and then they're, this is like a resource they go back to at other times, or?
Nigel Denning, M.Psych, MA (22:55):
Yeah. So what we do is we record the session so that, you know, between sessions, they can reply it, listen, reinforce it. So the idea is, and the important part is again, we're not trying to, you know, fashion, false memory. What we're trying to do is create a new experience. So as they're coming out of the imagining scene, we ask the person present to us to really relax into those feelings, identify those feelings, those sensations that that child has just experienced, breathe them into your own body experience. them, You know, that, that sense of trust or that that sense of curiosity or whatever it is just really kind of working to get the felt sense of what Dan and Dover described as the five conditions of secure attachment. And so really wanted to get this sense of embodied trust of safety, that I'm good enough that it's okay to explore that I can down regulate that, you know, I'm a good person, you know, these sort of five, five real qualities that people that are lucky enough to have, you know, really good parenting naturally develop inside themselves and which are, you know, inadequate in people that have had more kind of traditional parenting.
Keith Sutton, Psy.D. (24:23):
Sure. Okay. So that's embodied trust, safety... did you say good enough? The ability to explore and downregulating.
Nigel Denning, M.Psych, MA (24:35):
Yeah.
Keith Sutton, Psy.D. (24:35):
And that all kind of together, elites that sense of a good person.
Nigel Denning, M.Psych, MA (24:40):
Yeah. Yeah. So, you know, activating the exploratory system, for instance, you know. That's, you know, encouraging dopamine production. That's encouraging people to safely enter the world similarly, safely enter their own experience and their own memory. So take this as a three pillars model. We do the kind of collaborative work in setting up a session. We do the imaginal work in the session, and then we do the mentalizing. Towards the end of the session generally. So helping people kind of recognize what these features are like in their adult self, based on how they'd just imagined them. In this this imaginable ideal parent session that people, you know, have experience. That's what trust is. That's what safety feels like.
Keith Sutton, Psy.D. (25:34):
Can you talk a little more about the mentalizing? It's interesting. I was reading some more and seeing that I've heard of it before and was looking into it, and I think I've heard that term about three or four times in the last two weeks as I'm reading different things. And I would love to hear how you describe mentalizing.
Nigel Denning, M.Psych, MA (25:53):
Yeah. I've done some training with you know, the people that popularized this were Bateman and Fonagy through their mentalization based therapy that they run out of the Anna Freud Center in London. But they've also worked and published a number of books with John Allen, who's down your way. It's an American who's at the manager clinic in Boston, Texas. And John Allen's probably the type of mentalizing that, you know, we are most inclined towards, which is really, you know, extending on the more structured approaches that, that Bateman and Fonagy offer. And it's really just taking an attitude of curiosity towards the working of mind. So mentalizing is really you know, being able to identify and name that I'm feeling shame, I'm feeling angry, I'm feeling, you know, sad, I'm feeling grief.
Nigel Denning, M.Psych, MA (26:52):
I remember I learned how to deal with this grief because this is how I was taught by my parents to deal with it. That's how they dealt with it. This is what happened in that relationship. Oh, I notice now what's happening in my mind as I'm talking about this. I'm having sensations and I'm feeling, you know, a bit of tension in my stomach or it's being able to know, name and note, all that. You know and we all do this, you know, all therapists, you know that they know this work. Because It's the kind of hallmark of good therapy is being, being attuned and responsive, but mentalizing is just bringing this into a level of awareness and really making it very, very clear. So it's Bateman and Fonagy have really kind of popularized the term and John Allen, I'd recommend kind of reading for people that are, you know, kind of interested in this as a process.
Keith Sutton, Psy.D. (27:49):
Yeah. So it's kind of like insight as well as like kind of a mindfulness.
Nigel Denning, M.Psych, MA (27:55):
Yeah. Yeah. It's inside it's mindfulness, but it's in a really kind of active, this is how my mind is working. This is, so mindfulness is good in that kind of, you know, based on a thein Buddhist sort of technology of observing phenomena as it arises. Mentalizing is more active. It's understanding how the patterns are working, how the patterns have emerged. So it becomes quite sophisticated as well. We move.
Keith Sutton, Psy.D. (28:34):
Got it.
Nigel Denning, M.Psych, MA (28:34):
Just doing your psychoanalysis.
Keith Sutton, Psy.D. (28:36):
Yeah. And you were saying that, you know, that this is also kind of moving you through the protective identification, the you know, transference, countertransference. Can you say more about that?
Nigel Denning, M.Psych, MA (28:52):
Yeah. Well if we've got a collaborative relationship, then we are able to name things, we are working with mentalizing, we are naming things as they occur. We are naming and processing information as it arises. So I'm feeling this right now. I'm feeling like you are judging me. And we're encouraging that to be an open conversation rather than the more passive kind of orientation towards stimulating the transference. At some point down the track offering interpretation of it. So it becomes more here and now processing of phenomena as it arises. So the transference doesn't build in the traditional way that it would in psychoanalytic work.
Keith Sutton, Psy.D. (29:40):
Yeah.
Nigel Denning, M.Psych, MA (29:41):
Constantly named, constantly discharged, constantly kind of oriented to curiosity about it, so that we're seeing it operate in situ.
Keith Sutton, Psy.D. (29:51):
That's interesting. I had a colleague that kind of talked about, you know, you can work through your issues through the transference with the therapist, or if you bring in a partner or a family member, you know, within that dynamic or between yourself and your mind as you might in cognitive behavioral therapy or it sounds like also in this mentalizing being able to, you know, kind of noticing and your relationship between your mind and yourself.
Nigel Denning, M.Psych, MA (30:18):
Yeah, yeah. I mean the traditional way to do it, of course, is that it just builds across time. We project and project and project, and then that creates some affective response. We're overwhelmed to kind of work that through. So this is catching it all as it emerges.
Keith Sutton, Psy.D. (30:35):
Okay. Very cool. And and then that third pillar, that was the nervous system piece.
Nigel Denning, M.Psych, MA (30:46):
So pillar one is collaboration, pillar two is metacognition, and pillar three is the treatment.
Keith Sutton, Psy.D. (30:52):
Is the treatment. Oh, got it. I see.
Nigel Denning, M.Psych, MA (30:55):
And in this model, the treatment is the ideal parent.
Keith Sutton, Psy.D. (31:00):
Got it. Okay. So that is the kind of, so having collaborative relationship, like the alliance piece, that common factor, and then you're having that mentalization, that insight, that kind of, you know, reflect on what's happening right now and then doing all that, those processes while then doing the idealized parent work.
Nigel Denning, M.Psych, MA (31:25):
Exactly. Exactly. You know, and so it's like any good therapy, you know, CBT works better when you've got good relationship and people understand.
Keith Sutton, Psy.D. (31:34):
Sure. Of course.
Nigel Denning, M.Psych, MA (31:35):
You know, all good therapy is based around, you know, that kind of relational component and also that kind of, you know, skill development, empowerment component that develops in the client when the work's going well. And so, yeah. In this particular model, we're using imagery to refashion an experience. Of what we know to be good parenting experience.
Keith Sutton, Psy.D. (32:02):
Yeah. And I'd like to go back to that piece that you were talking about with that you know, that sense of self as you're talking about it in the development piece, and then also you know, where you were saying kind of when you have all those different aspects of the attachment that you're then kind of getting, that all puts together of feeling like I'm a good person. Can you talk a little bit about that and that sense of self and you know, how that, how you think about that? I've been thinking about that lately about the sense of self as its development, and yes, through attachment and like Cooley's looking glass theory of self and those pieces that kind of play in. And I work with a lot of clients with complex PTSD. So oftentimes attachment trauma of course, and their sense of self is not very well, it's not so constant because oftentimes they grew up in an invalidating environment, right. They were kind of determining I'm either good or bad, depending on my parents' reaction to me. And then I also do a mostly focused couples therapy. So that oftentimes plays out in the couple relationship when a partner is upset with me or so on the reaction, because then either I am bad going to that internalized shame, that toxic shame, or going into blame like, I'm not bad. And that this is threatening to my sense of self that my partner is upset with me about X, Y, or Z. Yeah.
Nigel Denning, M.Psych, MA (33:36):
Yeah. I did the, the Sue Johnson EFT pathway many, many years ago. . It's a lovely model. So I guess the way one of the most important things from our perspective is really good formulation. And really good formulation comes from understanding developmental history. And so, if you think about the way, you know, we're born into the world, you know, we all start, you know, birth human beings are not much more progressed than amoeba. You know, we can move towards positive phenomena and we can kind of protest negative phenomena, but we can't move it. We're functionally blind. We have to, you know, learn our reflexes, you know, after birth we learn to hear, we learn to identify. And it's only when you know, that kind of basic biology stabilized that the limbic brain starts to wire.
Nigel Denning, M.Psych, MA (34:38):
And so affective processes come online again a few months after birth in relationship to another. And they're purely felt they're physiological, you know, there's nothing conceptual about it at the start of life. And so we build this kind of experience to our body in the world through relationship at a bottom up level. And then, you know, we go into that kind of, you know, object relational stage, that kind of imaginative stage where we move from being a little animal into a little human, and we start symbolizing. And that is all based on how we feel, how we experience mom, and how we experience dad determines how we experience ourselves. You know, one of the difficult things as you know, in trauma work is, you know, when people, it's not so much the commission side of trauma that that becomes problematic, but it's the omission is people kind of not being able to recognize, it's really hard to understand what you haven't ever experienced.
Nigel Denning, M.Psych, MA (35:46):
So this kind of self sense of self is often emerging from the body in relation to what we haven't got as much as what we've got, you know, incorrectly. And that just informs, you know, the complexity of organization in the symbolic, and then we enter into the linguistic. And so we start to absorb all of the, you know, the complexities of the family system, the education system, the cultural system, that's all embedded in language, but that's all being informed by how we experience ourselves. And so it's like the internal working model that Bowlby talks about, you know, it sets up a whole set of bottom up predictions. About how the world's going to treat us. And so when we get into adulthood, people who've adapted to an environment that is problematic, but they've often found capacity and skill and ability that allows them to get through.
Nigel Denning, M.Psych, MA (36:42):
So, you know, I've worked with a lot of people with severe trauma that, for instance, have been able to establish career, been able to establish family, you know, they've been able to do certain tasks based on some kind of inherent capacity that they have in spite of their experiences. And so a lot of this kind of traumatic input creates a hole, it's based on body memory. It's stuff that's literally happened or hasn't happened. So that's stuff that's framed up in their body that's creating a bottom up kind of in bottom up influence on how they're thinking about themselves. And so how they think about themselves then reinforces, so the top down reflections, reinforce the bottom up. So, I've failed at another relationship. I must be a bad person. So you get this kinda looping reinforcement that's always happening.
Nigel Denning, M.Psych, MA (37:40):
So that's where, you know, kind of sometimes just talking through things doesn't change things because the experience of the body is always, you know, that's, you know, 300 million year olds adrenal cortical system, a 200 million year old, you know, limbic socializing system, you know. There's a, it's been on the planet for a long time, and so they can be compelling if we don't give people, you know, an experience. And that's why, you know, one of the common features of lots of good therapies now are things like empty chair and, you know, episodic processing, you know, in a child work. Because what we are kind of starting to ensure poor name is that bottom up features become really important in helping reframe, but it has to be in such a way that it matches top down recognition. That generally happens relationally. It's very hard to send people off to, you know, heal their trauma by themselves.
Keith Sutton, Psy.D. (38:44):
Yeah.
Nigel Denning, M.Psych, MA (38:44):
It needs to be some kind of mirroring, some kind of relational difference that's allowing the bottom up and the top down to merge.
Keith Sutton, Psy.D. (38:53):
What's making me think too about so I also do cognitive behavioral therapy, so I've oftentimes thought of that as top-down and what you're talking about reminds me of kind of, right, the core beliefs, the schemas and the reinforcing. Right. Kind of that we're taking selective attention. We're taking in that information that confirms our underlying thinking. But that only gets you so far, then you need something bottom up such as you know, that's where the EFT experiential, you know, kind of stage two work with a partner or doing EMDR or, you know, all these different kind of approaches, to kind of bring those two together, that kind of top down and that bottom up.
Nigel Denning, M.Psych, MA (39:37):
Exactly. And that that's exactly what we're targeting in the ideal parent figure.
Keith Sutton, Psy.D. (39:42):
Yeah. Yeah.
Nigel Denning, M.Psych, MA (39:43):
We're creating, and we are going into that most primitive organizational feature of the mind, which is the imaginal, the symbolic, you know, the object relational, it's where Yung, you know, kind of, and that's what we're entering into this really kind of primitive symbolic register, which has an incredibly powerful organizing kind of feature on the bottom up material beneath it, but also is very impactful on the top down material above it.
Keith Sutton, Psy.D. (40:09):
Yeah. Yeah. Definitely.
Nigel Denning, M.Psych, MA (40:11):
Probably, you know, if people remember what they feel, not what they think
Keith Sutton, Psy.D. (40:14):
Now tell me too about how many sessions and what's the research like around this approach?
Nigel Denning, M.Psych, MA (40:25):
Yeah, so sessions they vary. A lot of the work that Dan and David were doing at Harvard they were working with people that were failing other clinical programs. So they weren't being positively impacted through the main one was the dialectic behavior therapy program, but so two years for someone presenting with complex trauma on a weekly basis. So that might be, you know, 50 or 60 imagery sessions, but towards the later part of treatment, much more around mentalizing and metacognition. So really getting the bodily experience embedded and then kind of generalizing that into how they operate in the world when people are less troubled. You can see extraordinary kind of movement in five to 10 sessions. You know, people, you know, are having really positive sort of outcomes.
Nigel Denning, M.Psych, MA (41:44):
In terms of research. There's only a few part published papers outside of the main text. Main text carries quite a bit of material. So one of our kind of challenges moving forward is to encourage more research into the work. So we've got some programs, I won't name them yet because we haven't achieved our funding yet.
Keith Sutton, Psy.D. (42:06):
Sure, sure.
Nigel Denning, M.Psych, MA (42:06):
But you know, they're certainly on the burner and we're encouraging, you know, our therapists now to kind of collect green post data so we can start to really generate some good research. Unfortunately, Dan passed away before a lot of his work was published. So, it operates as an experimental company.
Keith Sutton, Psy.D. (42:32):
Yeah. Yeah. Oh, great.
Nigel Denning, M.Psych, MA (42:33):
It's solid.
Keith Sutton, Psy.D. (42:36):
And tell me about your I don't know if it's the general model that also integrates any of the psilocybin or the ketamine work, but or LSD work, or is that your own integration?
Nigel Denning, M.Psych, MA (42:50):
Yeah. So I mean, integration it's like the ideal parent figure work where what you are doing is trying to mentalize new phenomenon, new experience into a different metacognitive view. That's exactly what we do in psychedelic work, and that's where psychedelic work is, you know, kind of challenging, you know, the pre-existent skills of therapists because it's not about identifying and diagnosing and then suppressing symptoms. It's about creating the conditions for people to integrate experiences in a different interpretive map of their experience. I'll give you an example. In a suicidal session, a client has this really battling through the session keeps opening their eyes, staring at the ceiling. They're obviously in discomfort, but very little verbal, and we tend not to intrude, you know, we check to see that they're okay, but you know, they weren't interested in dialoguing it terribly much other than to have reassurance as they emerge from the psilocybin session.
Nigel Denning, M.Psych, MA (44:10):
They start to talk about what they'd experienced and what it had been is a universal suffering, universal death like a really terrible set of broad visions. Now, the usual way of working with that kind of thing, of course, would be to try and, you know, placate and down regulate and normalize and that kind of thing. But in the integration work with this client, what happened, because we were just supporting and creating curiosity about the interconnectedness of this, what we would call a broad metacognitive view of suffering. She was suddenly able to say, oh, my depression comes from my mother's treatment of me. I'm not the depressed person. I'm part of this system that I've reacted to. So she was able to take from this broad metacognitive view as something that seemed completely abstract. To apply it to herself with some cut encouragement and coaching. And then the therapy becomes an integration of this recognition that what had previously been treatment resistant depression becomes a normal response to an abnormal environment. So the depression becomes a protective factor against her distress and constant abuse from the other. So you get this kind of integration of a different state. We mentalize that to create a different metacognitive view.
Keith Sutton, Psy.D. (46:02):
Great.
Nigel Denning, M.Psych, MA (46:02):
Which is exactly what we do with the ideal parents. So what we're trying to do is we're trying to activate resources. That are available to that person. So we are really working towards, you know, the goal is autonomy and self-mastery. You know, that person can then recognize the onset of symptoms in response to stimulus. And rather than interpret them as, you know, a disease that's attacking them randomly, they can start to recognize if we elongate the process enough, they start to recognize, ah, this stressor is occurring. I'm starting to react this way. So they're mentalizing their way through it and avoiding, you know, the recurrent loop of that developmental kind of pattern.
Keith Sutton, Psy.D. (46:51):
So like, this person was just kind of believing themselves to be depressed, and this kind of, I've had a number of clients like that, like I just woke up this way or so on, rather than necessarily seeing it as seeing triggers and how it might be related to their trauma. And then, you know, so feeling less out of control or like helpless to do anything or, you know, kind of feeling just like this cloud or fog or so on that was there sometimes. And not without rhymer.
Nigel Denning, M.Psych, MA (47:26):
And because, you know therapists, you know, when someone presents with that level of depression, they want to deal with the symptoms. Primarily. That's what had been reinforced across, you know, treatment life is, you know, you are the depression and I am the treatment, you know, it's very much like, you know, I am the unloved child.
Keith Sutton, Psy.D. (47:44):
Yeah.
Nigel Denning, M.Psych, MA (47:46):
I'm the adult who's always going to be abandoned in relationship or, you know, whatever other kind of stories that we construct that are, you know, some kind of complex interaction between our genetics and our biology and our environment.
Keith Sutton, Psy.D. (48:02):
And so the psychedelic addition, do you feel like that creates more lasting change, quicker change, deeper change than just on its the therapy particularly on its own or? Yeah.
Nigel Denning, M.Psych, MA (48:22):
Look, I think it's sort of early days with with psychedelics you know, we've got a few papers we are in the process of publishing at the moment, but psychedelics offer an opportunity. And it's not dissimilar to the opportunity that visualizing an ideal parent. It creates something different in the body. It affects what, you know, Robin Carhartt Harris calls the default mode network. You know, which is this kind of prevalent interaction between brain regions that's established through experience. Psychedelics create new opportunity, but so does any experiential intervention, anything that you're doing episodically in EFT?
Keith Sutton, Psy.D. (49:18):
Yeah.
Nigel Denning, M.Psych, MA (49:18):
Anything that you're doing in EMDR, IFS, you know, when someone has an experience of something that's different to the norm. You're right out of the default mode network of creating a new opportunity. And so the integration is about the new opportunity, and that's what I think, you know, psychedelics do very intensely. They create, they shut down executive function, they've shut down salience network in the way that it's habituated, shut down this default mode network or dampen it to allow novelty to emerge. Which is where, you know, the skill of the therapist is become very important and the understanding of the therapist not to intervene too strongly in a place where, you know, you've got so much neuroplasticity.
Keith Sutton, Psy.D. (50:08):
Exactly.
Nigel Denning, M.Psych, MA (50:09):
So much new opportunity that people are extremely impressionable. So, you know, we really kind of, we do a lot of metacognitive training and mentalizing training around therapists moving into that space.
Keith Sutton, Psy.D. (50:24):
Yeah. Is it legal there? Because I know in there's only a couple places in the United States where psilocybin or, you know, there's yeah, Ketamine is legal to be able to use in these settings, but not psilocybin so much.
Nigel Denning, M.Psych, MA (50:40):
So we, our national body similar to your food and drugs administration, are equivalent gave the go ahead for treatment under certain conditions. So the conditions are predominantly trials, but you know, they're also now emerging prescribers so people can access it through private health now. It's very expensive. But it's been accepted now, I think MDMA treatment for PTSD. Accepted by our military, so veterans may be able to receive treatment and a couple of our insurers have now accepted it as a treatment. It's still highly contentious and all sorts of criticisms.
Keith Sutton, Psy.D. (51:36):
Sure. Sure.
Nigel Denning, M.Psych, MA (51:38):
But it's just, it's creating novelty. Yeah. I think the important thing is really for us as therapists to recognize that, you know, it's that that novel experience, well integrated is one of the most important, you know, aspects of transformation and healing.
Keith Sutton, Psy.D. (51:58):
Yeah. And particularly I know with psilocybin oftentimes, like all the assumptions that one has, you know, oftentimes kind of falls away and, you know, then the person is kind of like, you know Yeah. Noticing things in a different light that they just kind of just kind of assume or took for granted or so on. So is that kind of what you mean about that novelty, like.
Nigel Denning, M.Psych, MA (52:21):
Yeah. You know, like in a psychedelic sort of session, you know, someone feeling, you know, that they're resting in the arms of God and they have this profound experience, what they're having is an experience of trust and safety. Yeah. I'm not going to, I don't, you know, I'm not interested in, you know, their belief systems around God or Buddha or anything like that. I'm just interested in what they're experiencing and what that means for them and how they're going to implement that in their lives in a different way. Exactly as we're doing with the ideal parent visualizations, we are creating experiences. That we're then trying to help people to mentalize their way into stabilizing.
Keith Sutton, Psy.D. (53:07):
And how many sessions of the idealized parent are happening? Is that multiple sessions? With kind of imagining this? Or is that one session and then kind of processing it?
Nigel Denning, M.Psych, MA (53:21):
Well we try to keep it to a reasonable consistency. So, you know, first part of the session collaboration, second part of the session, visualization, third part of the session, mentalizing metacognitive view. There might be some times where we spend more of the time in the collaboration and mentalizing aspect if there's work that needs to be done. But it's an unusual kind of process for therapists to not be the relational fulcrum of the session. And so to actually coach people to have an inner process, so get that intrapsychic material happening. What we find is people learning the technique will often collude with the client not to do the visualization. A little different, or if something negatively occurs in the visualization to bring the client out and back into the therapeutic.
Keith Sutton, Psy.D. (54:22):
So interesting. It makes me think a lot about the EMDR that oftentimes new EMDR therapists are like, oh, let's go to your safe place, or so on. And really a lot of it is just creating the space for the mind to do its own healing. And therapist is really not there much, and except for a small cognitive interweaves here and there as needed. But really it's creating that space for the mind to do the work it knows, it knows how to do,
Nigel Denning, M.Psych, MA (54:50):
And what a profound empowerment that is for clients to recognize that they can gain that mastery over whatever the experiences that they've had, and that they can gain that autonomy while staying in relationship. You know, they don't have to withdraw from the world. They can be in good interpersonal relationships whilst also being self-directed. It's just a beautiful, beautiful gift to offer clients.
Keith Sutton, Psy.D. (55:17):
Brilliant. So for folks that want to learn more, where can they go? I know that there's an online training, there's also the book.
Nigel Denning, M.Psych, MA (55:25):
So we are at iat-institute.com and yeah you can find out about our trainings there. We've got an online training that consists of about a hundred hours and that runs through theory, different treatment approaches to attachment, assessment of attachment, and then we've got video demonstrations of working with people with preoccupied attachment, with disorganized, with dismissing attachment. There is another feature that emerges that we haven't talked about which is unresolved grief or trauma. Which has a slightly different orientation to disorganized attachment. And we lead people through a whole series of demonstrations of those in video. And then if people are particularly interested, they can come to our in-person training where we do more advanced and specific treatments in-person on each of the attachment disorders, disturbances, I should say.
Keith Sutton, Psy.D. (56:32):
Yeah. Wonderful. Well, thank you so much for your time. This is great. I loved learning about the work, and it just sounds amazing and it really helped come to light in this conversation. So thank you so much. I really appreciate it.
Nigel Denning, M.Psych, MA (56:45):
Yeah, yeah. Lovely spending time with you.
Keith Sutton, Psy.D. (56:46):
Take care. Bye-Bye.
Nigel Denning, M.Psych, MA (56:48):
Bye now.
Keith Sutton, Psy.D. (56:49):
Thank you for joining us today. If you'd like to receive continuing education credit for the podcast you just listened to, please go to therapyonthecutting edge.com and click on the link for CE. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, where we provide trainings for therapists in evidence-based models through live and online workshops, on-demand workshops, consultation groups, and online one-way mirror trainings. To learn more about our trainings and treatment for children, adolescents, families, couples, and individual adults, with our licensed experienced therapists, in-person in the Bay Area, or throughout California online and our employment opportunities, go to sfiap.com. To learn more about our associateships and psycho ships and low fee treatment through our non-profit Bay Area Community Counseling and Family Institute of Berkeley, go to sf-bcc.org and familyinstituteofberkeley.com. If you'd like to support therapy for those in financial need and training and evidence-based treatments, you can donate by going to BACCs website at sf-bacc.org BACC is a 501(c)(3) nonprofit, so all donations are tax deductible. Also, we really appreciate your feedback. If you have something you're interested in, something that's on the cutting edge of the field of psychotherapy, and you think therapists out there should know about it, send us an email. We're always looking for advancements in the field of psychotherapy to create lasting change for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:32):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, Psy.D. (02:19):
Today I'll be speaking with Nigel Denning, who is a counseling psychologist and director of Integrative Psychology Medicine in Melbourne, Australia. Nigel is Research fellow at Australian National University. He has been involved in developing the three pillars of attachment repair and integrative attachment therapy with David Elliot and Traill Dowie, and developing the IAT training program. Nigel is a nationally recognized expert in family violence, institutional abuse, trauma, and attachment focused practice. Nigel is also clinical lead in several psychedelic medicine trials and a trainer in psychedelics and holotropic breath work having studied under Stanislav Grof. In addition, Nigel is a long-term meditation practitioner and teacher in the Tibet Bon Kin tradition. Nigel has a profound understanding of how eastern practices affect the mind and their subsequent connection to psychotherapy. Nigel is a jovial and kind person who is passionate about improving the world one mind at a time. Let's listen to the interview. Well, hi Nigel. Welcome.
Nigel Denning, M.Psych, MA (03:25):
Hi, Keith.
Keith Sutton, Psy.D. (03:27):
Oh, thanks. Yeah, thanks for coming on. So, yeah, so I have learned a little bit about the integrative attachment therapy, and somebody had actually recommended the book to me some years ago, which I got, which I hadn't broken into. And then you had reached out and contacted me about maybe being involved with the podcast, and it was just perfect because I, I was talking to a therapist at a networking event and they're like, you gotta read this book for adult attachment and really helping to heal and, and shift those attachments. So I was really interested in that. So I'd love to hear about the work that you all are doing but if you were, before we even get to that, I always like to hear about people's kind of path to what they're doing, you know, the evolution of your thinking to get you over to where you're at now and the work.
Nigel Denning, M.Psych, MA (04:14):
Yeah, thanks. Well, I'm I've been involved in, in psychotherapy. I'm a counseling psychologist here in, Melbourne, and I run a clinic called Integrative Psychology and Medicine. And we've been, oh, we've been thinking about how to think about therapy for a very long time. I studied about 15 years ago with, with Dan Siegel for about a year. He did an online supervision group.
Keith Sutton, Psy.D. (04:42):
Oh, wow.
Nigel Denning, M.Psych, MA (04:43):
Some other stuff. And interestingly, he was the first kind of high profile therapist that raised the issue of what is a mind, you know, what, what is it that we are working with, what are we agreeing with, what are we disagreeing about, given that there are, what, 500 or so evidence-based therapeutic techniques out there, all of which fail to have any kind of coherent agreement on the subject matter.
Nigel Denning, M.Psych, MA (05:10):
So we've just been really interested in how to approach you know, the mind. We've the integrative psychology and medicine label. It's also kind of attached to the, the training we do in psychedelic medicine. I'm a lead clinician in three trials here in Melbourne. And so I'm also a meditator and I've been involved in the Tibetan zen tradition for 20 years. So all these kind of different pathways kind of interesting kind of entry points to, to what a mind is, how it works, what it's about. We're very good at identifying pathological features of mine. Now we've got that one down to a fine art, but what is it that we know about how to develop the mind, how to optimize the mind.
Nigel Denning, M.Psych, MA (06:04):
That's really an important feature in psychedelic medicine, but it's also a really important feature in attachment work because what we're trying to do is construct something that hasn't previously been activated. So you know that's been my journey for many years. I've studied with Stanislav Grof who developed LSD psychotherapy at Harvard with a number of clinicians. I've been lucky enough to work with a number of kind of leaders in the field until I then eventually came along. Dan Brown's work and Daniel P. Brown and David Elliot. The authors of the text that you're referring to published in 2016 on treating attachment disturbance in adults. And Dan was a really interesting guy, sadly passed away during COVID, but he kind of carried two hats on one level. He was a translator of Tibetan texts, and at the other level, he was a clinical psychologist at Harvard Med School. So he had a really interesting perspective on, on this idea of what is a mind.
Keith Sutton, Psy.D. (07:16):
Yeah, tell me about it. What is a mind? Now I'm dying to to know your definition or your conceptualization.
Nigel Denning, M.Psych, MA (07:22):
Well, I mean, what we've sort of it's, it's still a work in progress, but essentially, mind rather than it being a noun, we think more of mind as a verb, as a collection of processes. And so if you take one of the areas that we really we're big on is taste formulation. And so understanding the way that a mind emerges from a brain and interacts with the world around it becomes then a set and series of processes that we can then observe, and then we can talk about different therapeutic techniques as affecting different parts of that process. So it becomes then just a kind of a fluid developmental orientation, which takes us into, you know, the importance of the attachment work. As you know, one of the very first kind of organizational features of basically the biology of the brain is what's being affected in attachment.
Nigel Denning, M.Psych, MA (08:23):
But of course, it creates the basis then for the development of the mind, because Bowlby's, internal working model is really a set of predictions that that come from, you know, the phenomena or bottom up experience that creates a predictive model based on intuition that we then carry into our adult relationships forever. Until we start to observe, start to recognize that, you know, there's something not quite working here, and almost half the adult population has an attachment disturbance, which means, you know, there's probably something that we are not providing in the education of parents and families about the importance of really, really focused features of mind at the level of the development of brain between 8 months and 24 months of age. So, mind is a process, it's a process that emerges from the brain and it emerges through relationship, you know, as Alan Stru says, you know, we're a self because of our relationship with other selves.
Keith Sutton, Psy.D. (09:36):
Very cool. So there's, so you were mentioning there's three processes and one is attachment, and what are the other two?
Nigel Denning, M.Psych, MA (09:46):
Other processes of development? Oh we've kind of done quite a bit of work with Jean Carle Diaggio from the Rome School of Behavioral Sciences, and you know, the work that they've done through ti. And he talks about, it's more than three. So attachment, then there's care and nurturance, there's social rank, there's sexual identity, there's safety. They're fairly key developmental kind of processes. He describes as developmental motivational schemes.
Keith Sutton, Psy.D. (10:25):
And these are all pieces of kind of the aspects of mind or that kind of verb aspect of mind?
Nigel Denning, M.Psych, MA (10:30):
Yeah. So, you know, we are trying to kind of regulate who we are and how we interact. In group, that's a lot of our kind of primary orientation, you know . Based on, you know, this, this evolutionary wetwear that we are carrying around in our skulls.
Keith Sutton, Psy.D. (10:46):
Yeah. Yeah.
Nigel Denning, M.Psych, MA (10:47):
300 million years of you know, constant upgrading that we've been kind of bringing into service of civilization for about 14,000 years
Nigel Denning, M.Psych, MA (10:59):
So we are asking ourselves to do quite a lot.
Keith Sutton, Psy.D. (11:02):
Yeah. Definitely
Nigel Denning, M.Psych, MA (11:03):
With biology, that's really more oriented to surviving than it is to, you know, filling in your tax returns or you know, providing psychotherapy or any of the other kind of complex tasks. That we're involved with.
Keith Sutton, Psy.D. (11:19):
So tell me about the adult attachment disturbances and, you know, kind of how that's conceptualized and how that's treated. I was looking up some information and reading more about it, and there was kind of I guess three pillars that of the therapy where our dressing change.
Nigel Denning, M.Psych, MA (11:37):
Yeah, that's what what our work at the IAT Institute has been about, is really trying to understand three pillars from a more of a global perspective. So, when Dan wrote the book, the novel part of the book was Ideal Parent Figure Work. So using imaginal work to repair what had or hadn't been established. And what we started working on when we looked at started training this. We've been working with David Elliot quite extensively on this, is looking at the first two pillars of collaboration and metacognition as a meta psychological approach. So it's sort of common factors work. But how do we operationalize and how do we identify common factors and match it with specific outcomes. So the specific features are the ideal parent work collaboration is a very specific and overt process here around, you know, ensuring that, you know, the therapist and the client are, you know, congruent with diagnosis, congruent with treatment plan that we have, you know, adequate rules and understanding of how we are going to communicate.
Nigel Denning, M.Psych, MA (12:58):
Because as we go into attachment repair, we are going to bring up unconscious material, which is going to lead to projective identification. And so how do we kind of work with that without going through classic transferential processes . So we work with collaboration and adverting and, and conversing, and then we are using mentalization. And this is something that Dan Brown innovated in the mentalization field. He'd described mental metacognition, I should say as a developmental process, mentalization being the process of mind that works through sensate material, affect material cognitive material, symbolic material through the relationships. So the mentalizing is this kind of you know, kind of working through that metacognition is the view that we attain.
Keith Sutton, Psy.D. (13:57):
What was that part? It's the view
Nigel Denning, M.Psych, MA (13:58):
That we attain.
Keith Sutton, Psy.D. (14:01):
We attain, yes. The view we attain.
Nigel Denning, M.Psych, MA (14:03):
Cognition is how we see things. For instance, you know, someone who's grown up in a traumatic environment may only have a perspective of their life as being threatened by the world around them. That becomes their metacognitive view, and that becomes a way they you know, come transact with the world. When they start to move through that trauma, they start to see things from a broader perspective, and they see that's suffering from a different orientation. I mean, I've done this work with another one of my areas of work, was with the the Australian royal inquiry into childhood institutional sexual abuse. So a lot of people that were coming out of that work, their time of reporting trauma to the time of getting treatment was an average of 38 years. So that had a huge amount of, you know, kind of reinforcement of traumatic experience in that time, using a three pillars approach, and using ideal parent figures in some of those cases, gave people an experience of their bodies that they'd never previously had. They come out of a session going, "oh, that's what trust is." Suddenly they had a cognitive view had expanded from one of suffering and entrapment. To one of a view of their progress through life. And these are people that have been able to achieve things professionally and familiarly, even though they were carrying on processed trauma all that time.
Keith Sutton, Psy.D. (15:35):
Tell me about the ideal parent interventions. What do you do? I know this reminds me of Milton Erickson's, like February man hypnosis, or you know, sometimes in EMDR we might bring in the adult selves, take care of them, or IFS bringing in self.
Nigel Denning, M.Psych, MA (15:53):
Exactly.
Keith Sutton, Psy.D. (15:54):
Yeah. Tell me a little bit about what your version is or, you know.
Nigel Denning, M.Psych, MA (15:58):
Yeah. Well, I mean, all of these models, aren't they access that kind of symbolic organization of mine. They enter into that place that you know, object relations really has spent a lot of time, how do we form up symbolic other, you know, in this really abstracted way. You know, the young child whose mother leaves is able to to calm and soothe themselves because they have a representational model of that mother that lingers whilst the mother's not physically present. So drawing on, you know, this really early developmental feature of mind. So when we think about attachment disturbance, what we're talking about is someone who, you know, is we're all born hyper aroused and we look to the parent to sooth. So the preoccupied or the, the anxious attached child or adult is one who's in a perpetual state of hyper arousal.
Nigel Denning, M.Psych, MA (16:56):
They've never had an opportunity to downregulate. And so their central nervous system is constantly seeking through the other, the corrective relationship to learn down regulatory capacity. For instance, one of the features in the dismissing adult who would be the anxious avoidant child, their brain has found its way too hypoarousal. So they've been able to numb, detach, switch off. They're sometimes described by parents as good children because they're quiet. What we've only in kind of recent decades recognized is those children are often highly affected by cortisol. They're switched off, and so they grow into adults who, whenever vulnerability appears, there's a natural reduction diminishing on that process. And then of course we have then the disorganized attached, or the fearful avoidant, which is that person who unfortunately swings between hyper and hypo arousal throughout life.
Nigel Denning, M.Psych, MA (18:09):
And it's more likely to get kind of personality disorder diagnoses and other serious diagnoses. So what we do is we identify the attachment style of the adult, and we get some understanding of how that's manifest in the person's life. And then we use like what would be a very similar kind of process to people that are familiar with IFS or EMDR or hypnosis and those kind of processes. We get someone to relax, close their eyes, take a few deep breaths, and just come to an imagining of themselves as a five-year-old.
Nigel Denning, M.Psych, MA (19:01):
If they can't get to five, somewhere between five and 12, we ask them to imagine or to get a sense of, because not everyone can visualize particularly immediately. So whether they, they visualize or whether they just get a sense of, but to be in a place that's safe and comfortable and not of their memory. So we don't take people back to the household they grew up in or something like that. They go somewhere neutral. We get them to experience the neutrality of the sensate qualities of that area as you would with any kind of, you know, relaxation technique, smell, the, you know, smelly air, feel the the sun on your skin and the, and really amplify the, the experience of being in that, that place. And then we get them to imagine two parents who are not their memory parents who are ideal parents.
Nigel Denning, M.Psych, MA (19:59):
Now, we've done a bit of psycho ed prior to going into this because it's a little bit of you know, kind of a strange orientation. But what we are really trying to work with is using the imaginary system to override the memory system. So we're not trying to draw into memory. We're not trying to create this imagery as sort of overlaying new memory or anything like that. We are trying to create imaginal process, so using the symbolic or organization of mind to create a new experience. And these two ideal parents are suited to the needs of this child. And so we, we really build on, we've already identified prior to the imaginary process, we've, we've gone through an interviewing process and we've asked the person to offer five adjectives that describe their relationship between them and their mother, them and their father growing up.
Nigel Denning, M.Psych, MA (20:56):
And if there's, you know, they only have one parent, if there's any other significant adults, but we are asking five adjectives that describe their relationship between mother and child, father and child. And we've asked them to demonstrate, give an example of those adjectives. So for instance, someone with a dismissing attachment style will generally idealize their relationships. But not have much memory to back up the adjectives. So when we come to the imaginary process, we are armed with some ideas of what the memory system holds. And so these ideal parents are doing the positive opposites. So if the or they're really embodying the positive features. So, you know, how are they loving? They're there with you. They want to encourage you, they want you to explore, you know, and so we are really using this kind of imaginal process to amplify features that were either not developed at that age or were developed in an inappropriate way.
Keith Sutton, Psy.D. (22:03):
So is that the adult attachment inventory that you're doing with clients and then kind of identifying those aspects and then basically bringing in the replacement kind of yeah.
Nigel Denning, M.Psych, MA (22:18):
I've been trained in the adult attachment interview, the Mary Main model, and that's probably, you know, the best way to get a really detailed quality of someone's attachment system. But you know, we've got modified versions of that, and then there's, you know, other models that people have been trained in. Yeah, there's a few other attachment some people use,
Keith Sutton, Psy.D. (22:44):
So they're imagining this or they're thinking about these adjectives, and then they're, this is like a resource they go back to at other times, or?
Nigel Denning, M.Psych, MA (22:55):
Yeah. So what we do is we record the session so that, you know, between sessions, they can reply it, listen, reinforce it. So the idea is, and the important part is again, we're not trying to, you know, fashion, false memory. What we're trying to do is create a new experience. So as they're coming out of the imagining scene, we ask the person present to us to really relax into those feelings, identify those feelings, those sensations that that child has just experienced, breathe them into your own body experience. them, You know, that, that sense of trust or that that sense of curiosity or whatever it is just really kind of working to get the felt sense of what Dan and Dover described as the five conditions of secure attachment. And so really wanted to get this sense of embodied trust of safety, that I'm good enough that it's okay to explore that I can down regulate that, you know, I'm a good person, you know, these sort of five, five real qualities that people that are lucky enough to have, you know, really good parenting naturally develop inside themselves and which are, you know, inadequate in people that have had more kind of traditional parenting.
Keith Sutton, Psy.D. (24:23):
Sure. Okay. So that's embodied trust, safety... did you say good enough? The ability to explore and downregulating.
Nigel Denning, M.Psych, MA (24:35):
Yeah.
Keith Sutton, Psy.D. (24:35):
And that all kind of together, elites that sense of a good person.
Nigel Denning, M.Psych, MA (24:40):
Yeah. Yeah. So, you know, activating the exploratory system, for instance, you know. That's, you know, encouraging dopamine production. That's encouraging people to safely enter the world similarly, safely enter their own experience and their own memory. So take this as a three pillars model. We do the kind of collaborative work in setting up a session. We do the imaginal work in the session, and then we do the mentalizing. Towards the end of the session generally. So helping people kind of recognize what these features are like in their adult self, based on how they'd just imagined them. In this this imaginable ideal parent session that people, you know, have experience. That's what trust is. That's what safety feels like.
Keith Sutton, Psy.D. (25:34):
Can you talk a little more about the mentalizing? It's interesting. I was reading some more and seeing that I've heard of it before and was looking into it, and I think I've heard that term about three or four times in the last two weeks as I'm reading different things. And I would love to hear how you describe mentalizing.
Nigel Denning, M.Psych, MA (25:53):
Yeah. I've done some training with you know, the people that popularized this were Bateman and Fonagy through their mentalization based therapy that they run out of the Anna Freud Center in London. But they've also worked and published a number of books with John Allen, who's down your way. It's an American who's at the manager clinic in Boston, Texas. And John Allen's probably the type of mentalizing that, you know, we are most inclined towards, which is really, you know, extending on the more structured approaches that, that Bateman and Fonagy offer. And it's really just taking an attitude of curiosity towards the working of mind. So mentalizing is really you know, being able to identify and name that I'm feeling shame, I'm feeling angry, I'm feeling, you know, sad, I'm feeling grief.
Nigel Denning, M.Psych, MA (26:52):
I remember I learned how to deal with this grief because this is how I was taught by my parents to deal with it. That's how they dealt with it. This is what happened in that relationship. Oh, I notice now what's happening in my mind as I'm talking about this. I'm having sensations and I'm feeling, you know, a bit of tension in my stomach or it's being able to know, name and note, all that. You know and we all do this, you know, all therapists, you know that they know this work. Because It's the kind of hallmark of good therapy is being, being attuned and responsive, but mentalizing is just bringing this into a level of awareness and really making it very, very clear. So it's Bateman and Fonagy have really kind of popularized the term and John Allen, I'd recommend kind of reading for people that are, you know, kind of interested in this as a process.
Keith Sutton, Psy.D. (27:49):
Yeah. So it's kind of like insight as well as like kind of a mindfulness.
Nigel Denning, M.Psych, MA (27:55):
Yeah. Yeah. It's inside it's mindfulness, but it's in a really kind of active, this is how my mind is working. This is, so mindfulness is good in that kind of, you know, based on a thein Buddhist sort of technology of observing phenomena as it arises. Mentalizing is more active. It's understanding how the patterns are working, how the patterns have emerged. So it becomes quite sophisticated as well. We move.
Keith Sutton, Psy.D. (28:34):
Got it.
Nigel Denning, M.Psych, MA (28:34):
Just doing your psychoanalysis.
Keith Sutton, Psy.D. (28:36):
Yeah. And you were saying that, you know, that this is also kind of moving you through the protective identification, the you know, transference, countertransference. Can you say more about that?
Nigel Denning, M.Psych, MA (28:52):
Yeah. Well if we've got a collaborative relationship, then we are able to name things, we are working with mentalizing, we are naming things as they occur. We are naming and processing information as it arises. So I'm feeling this right now. I'm feeling like you are judging me. And we're encouraging that to be an open conversation rather than the more passive kind of orientation towards stimulating the transference. At some point down the track offering interpretation of it. So it becomes more here and now processing of phenomena as it arises. So the transference doesn't build in the traditional way that it would in psychoanalytic work.
Keith Sutton, Psy.D. (29:40):
Yeah.
Nigel Denning, M.Psych, MA (29:41):
Constantly named, constantly discharged, constantly kind of oriented to curiosity about it, so that we're seeing it operate in situ.
Keith Sutton, Psy.D. (29:51):
That's interesting. I had a colleague that kind of talked about, you know, you can work through your issues through the transference with the therapist, or if you bring in a partner or a family member, you know, within that dynamic or between yourself and your mind as you might in cognitive behavioral therapy or it sounds like also in this mentalizing being able to, you know, kind of noticing and your relationship between your mind and yourself.
Nigel Denning, M.Psych, MA (30:18):
Yeah, yeah. I mean the traditional way to do it, of course, is that it just builds across time. We project and project and project, and then that creates some affective response. We're overwhelmed to kind of work that through. So this is catching it all as it emerges.
Keith Sutton, Psy.D. (30:35):
Okay. Very cool. And and then that third pillar, that was the nervous system piece.
Nigel Denning, M.Psych, MA (30:46):
So pillar one is collaboration, pillar two is metacognition, and pillar three is the treatment.
Keith Sutton, Psy.D. (30:52):
Is the treatment. Oh, got it. I see.
Nigel Denning, M.Psych, MA (30:55):
And in this model, the treatment is the ideal parent.
Keith Sutton, Psy.D. (31:00):
Got it. Okay. So that is the kind of, so having collaborative relationship, like the alliance piece, that common factor, and then you're having that mentalization, that insight, that kind of, you know, reflect on what's happening right now and then doing all that, those processes while then doing the idealized parent work.
Nigel Denning, M.Psych, MA (31:25):
Exactly. Exactly. You know, and so it's like any good therapy, you know, CBT works better when you've got good relationship and people understand.
Keith Sutton, Psy.D. (31:34):
Sure. Of course.
Nigel Denning, M.Psych, MA (31:35):
You know, all good therapy is based around, you know, that kind of relational component and also that kind of, you know, skill development, empowerment component that develops in the client when the work's going well. And so, yeah. In this particular model, we're using imagery to refashion an experience. Of what we know to be good parenting experience.
Keith Sutton, Psy.D. (32:02):
Yeah. And I'd like to go back to that piece that you were talking about with that you know, that sense of self as you're talking about it in the development piece, and then also you know, where you were saying kind of when you have all those different aspects of the attachment that you're then kind of getting, that all puts together of feeling like I'm a good person. Can you talk a little bit about that and that sense of self and you know, how that, how you think about that? I've been thinking about that lately about the sense of self as its development, and yes, through attachment and like Cooley's looking glass theory of self and those pieces that kind of play in. And I work with a lot of clients with complex PTSD. So oftentimes attachment trauma of course, and their sense of self is not very well, it's not so constant because oftentimes they grew up in an invalidating environment, right. They were kind of determining I'm either good or bad, depending on my parents' reaction to me. And then I also do a mostly focused couples therapy. So that oftentimes plays out in the couple relationship when a partner is upset with me or so on the reaction, because then either I am bad going to that internalized shame, that toxic shame, or going into blame like, I'm not bad. And that this is threatening to my sense of self that my partner is upset with me about X, Y, or Z. Yeah.
Nigel Denning, M.Psych, MA (33:36):
Yeah. I did the, the Sue Johnson EFT pathway many, many years ago. . It's a lovely model. So I guess the way one of the most important things from our perspective is really good formulation. And really good formulation comes from understanding developmental history. And so, if you think about the way, you know, we're born into the world, you know, we all start, you know, birth human beings are not much more progressed than amoeba. You know, we can move towards positive phenomena and we can kind of protest negative phenomena, but we can't move it. We're functionally blind. We have to, you know, learn our reflexes, you know, after birth we learn to hear, we learn to identify. And it's only when you know, that kind of basic biology stabilized that the limbic brain starts to wire.
Nigel Denning, M.Psych, MA (34:38):
And so affective processes come online again a few months after birth in relationship to another. And they're purely felt they're physiological, you know, there's nothing conceptual about it at the start of life. And so we build this kind of experience to our body in the world through relationship at a bottom up level. And then, you know, we go into that kind of, you know, object relational stage, that kind of imaginative stage where we move from being a little animal into a little human, and we start symbolizing. And that is all based on how we feel, how we experience mom, and how we experience dad determines how we experience ourselves. You know, one of the difficult things as you know, in trauma work is, you know, when people, it's not so much the commission side of trauma that that becomes problematic, but it's the omission is people kind of not being able to recognize, it's really hard to understand what you haven't ever experienced.
Nigel Denning, M.Psych, MA (35:46):
So this kind of self sense of self is often emerging from the body in relation to what we haven't got as much as what we've got, you know, incorrectly. And that just informs, you know, the complexity of organization in the symbolic, and then we enter into the linguistic. And so we start to absorb all of the, you know, the complexities of the family system, the education system, the cultural system, that's all embedded in language, but that's all being informed by how we experience ourselves. And so it's like the internal working model that Bowlby talks about, you know, it sets up a whole set of bottom up predictions. About how the world's going to treat us. And so when we get into adulthood, people who've adapted to an environment that is problematic, but they've often found capacity and skill and ability that allows them to get through.
Nigel Denning, M.Psych, MA (36:42):
So, you know, I've worked with a lot of people with severe trauma that, for instance, have been able to establish career, been able to establish family, you know, they've been able to do certain tasks based on some kind of inherent capacity that they have in spite of their experiences. And so a lot of this kind of traumatic input creates a hole, it's based on body memory. It's stuff that's literally happened or hasn't happened. So that's stuff that's framed up in their body that's creating a bottom up kind of in bottom up influence on how they're thinking about themselves. And so how they think about themselves then reinforces, so the top down reflections, reinforce the bottom up. So, I've failed at another relationship. I must be a bad person. So you get this kinda looping reinforcement that's always happening.
Nigel Denning, M.Psych, MA (37:40):
So that's where, you know, kind of sometimes just talking through things doesn't change things because the experience of the body is always, you know, that's, you know, 300 million year olds adrenal cortical system, a 200 million year old, you know, limbic socializing system, you know. There's a, it's been on the planet for a long time, and so they can be compelling if we don't give people, you know, an experience. And that's why, you know, one of the common features of lots of good therapies now are things like empty chair and, you know, episodic processing, you know, in a child work. Because what we are kind of starting to ensure poor name is that bottom up features become really important in helping reframe, but it has to be in such a way that it matches top down recognition. That generally happens relationally. It's very hard to send people off to, you know, heal their trauma by themselves.
Keith Sutton, Psy.D. (38:44):
Yeah.
Nigel Denning, M.Psych, MA (38:44):
It needs to be some kind of mirroring, some kind of relational difference that's allowing the bottom up and the top down to merge.
Keith Sutton, Psy.D. (38:53):
What's making me think too about so I also do cognitive behavioral therapy, so I've oftentimes thought of that as top-down and what you're talking about reminds me of kind of, right, the core beliefs, the schemas and the reinforcing. Right. Kind of that we're taking selective attention. We're taking in that information that confirms our underlying thinking. But that only gets you so far, then you need something bottom up such as you know, that's where the EFT experiential, you know, kind of stage two work with a partner or doing EMDR or, you know, all these different kind of approaches, to kind of bring those two together, that kind of top down and that bottom up.
Nigel Denning, M.Psych, MA (39:37):
Exactly. And that that's exactly what we're targeting in the ideal parent figure.
Keith Sutton, Psy.D. (39:42):
Yeah. Yeah.
Nigel Denning, M.Psych, MA (39:43):
We're creating, and we are going into that most primitive organizational feature of the mind, which is the imaginal, the symbolic, you know, the object relational, it's where Yung, you know, kind of, and that's what we're entering into this really kind of primitive symbolic register, which has an incredibly powerful organizing kind of feature on the bottom up material beneath it, but also is very impactful on the top down material above it.
Keith Sutton, Psy.D. (40:09):
Yeah. Yeah. Definitely.
Nigel Denning, M.Psych, MA (40:11):
Probably, you know, if people remember what they feel, not what they think
Keith Sutton, Psy.D. (40:14):
Now tell me too about how many sessions and what's the research like around this approach?
Nigel Denning, M.Psych, MA (40:25):
Yeah, so sessions they vary. A lot of the work that Dan and David were doing at Harvard they were working with people that were failing other clinical programs. So they weren't being positively impacted through the main one was the dialectic behavior therapy program, but so two years for someone presenting with complex trauma on a weekly basis. So that might be, you know, 50 or 60 imagery sessions, but towards the later part of treatment, much more around mentalizing and metacognition. So really getting the bodily experience embedded and then kind of generalizing that into how they operate in the world when people are less troubled. You can see extraordinary kind of movement in five to 10 sessions. You know, people, you know, are having really positive sort of outcomes.
Nigel Denning, M.Psych, MA (41:44):
In terms of research. There's only a few part published papers outside of the main text. Main text carries quite a bit of material. So one of our kind of challenges moving forward is to encourage more research into the work. So we've got some programs, I won't name them yet because we haven't achieved our funding yet.
Keith Sutton, Psy.D. (42:06):
Sure, sure.
Nigel Denning, M.Psych, MA (42:06):
But you know, they're certainly on the burner and we're encouraging, you know, our therapists now to kind of collect green post data so we can start to really generate some good research. Unfortunately, Dan passed away before a lot of his work was published. So, it operates as an experimental company.
Keith Sutton, Psy.D. (42:32):
Yeah. Yeah. Oh, great.
Nigel Denning, M.Psych, MA (42:33):
It's solid.
Keith Sutton, Psy.D. (42:36):
And tell me about your I don't know if it's the general model that also integrates any of the psilocybin or the ketamine work, but or LSD work, or is that your own integration?
Nigel Denning, M.Psych, MA (42:50):
Yeah. So I mean, integration it's like the ideal parent figure work where what you are doing is trying to mentalize new phenomenon, new experience into a different metacognitive view. That's exactly what we do in psychedelic work, and that's where psychedelic work is, you know, kind of challenging, you know, the pre-existent skills of therapists because it's not about identifying and diagnosing and then suppressing symptoms. It's about creating the conditions for people to integrate experiences in a different interpretive map of their experience. I'll give you an example. In a suicidal session, a client has this really battling through the session keeps opening their eyes, staring at the ceiling. They're obviously in discomfort, but very little verbal, and we tend not to intrude, you know, we check to see that they're okay, but you know, they weren't interested in dialoguing it terribly much other than to have reassurance as they emerge from the psilocybin session.
Nigel Denning, M.Psych, MA (44:10):
They start to talk about what they'd experienced and what it had been is a universal suffering, universal death like a really terrible set of broad visions. Now, the usual way of working with that kind of thing, of course, would be to try and, you know, placate and down regulate and normalize and that kind of thing. But in the integration work with this client, what happened, because we were just supporting and creating curiosity about the interconnectedness of this, what we would call a broad metacognitive view of suffering. She was suddenly able to say, oh, my depression comes from my mother's treatment of me. I'm not the depressed person. I'm part of this system that I've reacted to. So she was able to take from this broad metacognitive view as something that seemed completely abstract. To apply it to herself with some cut encouragement and coaching. And then the therapy becomes an integration of this recognition that what had previously been treatment resistant depression becomes a normal response to an abnormal environment. So the depression becomes a protective factor against her distress and constant abuse from the other. So you get this kind of integration of a different state. We mentalize that to create a different metacognitive view.
Keith Sutton, Psy.D. (46:02):
Great.
Nigel Denning, M.Psych, MA (46:02):
Which is exactly what we do with the ideal parents. So what we're trying to do is we're trying to activate resources. That are available to that person. So we are really working towards, you know, the goal is autonomy and self-mastery. You know, that person can then recognize the onset of symptoms in response to stimulus. And rather than interpret them as, you know, a disease that's attacking them randomly, they can start to recognize if we elongate the process enough, they start to recognize, ah, this stressor is occurring. I'm starting to react this way. So they're mentalizing their way through it and avoiding, you know, the recurrent loop of that developmental kind of pattern.
Keith Sutton, Psy.D. (46:51):
So like, this person was just kind of believing themselves to be depressed, and this kind of, I've had a number of clients like that, like I just woke up this way or so on, rather than necessarily seeing it as seeing triggers and how it might be related to their trauma. And then, you know, so feeling less out of control or like helpless to do anything or, you know, kind of feeling just like this cloud or fog or so on that was there sometimes. And not without rhymer.
Nigel Denning, M.Psych, MA (47:26):
And because, you know therapists, you know, when someone presents with that level of depression, they want to deal with the symptoms. Primarily. That's what had been reinforced across, you know, treatment life is, you know, you are the depression and I am the treatment, you know, it's very much like, you know, I am the unloved child.
Keith Sutton, Psy.D. (47:44):
Yeah.
Nigel Denning, M.Psych, MA (47:46):
I'm the adult who's always going to be abandoned in relationship or, you know, whatever other kind of stories that we construct that are, you know, some kind of complex interaction between our genetics and our biology and our environment.
Keith Sutton, Psy.D. (48:02):
And so the psychedelic addition, do you feel like that creates more lasting change, quicker change, deeper change than just on its the therapy particularly on its own or? Yeah.
Nigel Denning, M.Psych, MA (48:22):
Look, I think it's sort of early days with with psychedelics you know, we've got a few papers we are in the process of publishing at the moment, but psychedelics offer an opportunity. And it's not dissimilar to the opportunity that visualizing an ideal parent. It creates something different in the body. It affects what, you know, Robin Carhartt Harris calls the default mode network. You know, which is this kind of prevalent interaction between brain regions that's established through experience. Psychedelics create new opportunity, but so does any experiential intervention, anything that you're doing episodically in EFT?
Keith Sutton, Psy.D. (49:18):
Yeah.
Nigel Denning, M.Psych, MA (49:18):
Anything that you're doing in EMDR, IFS, you know, when someone has an experience of something that's different to the norm. You're right out of the default mode network of creating a new opportunity. And so the integration is about the new opportunity, and that's what I think, you know, psychedelics do very intensely. They create, they shut down executive function, they've shut down salience network in the way that it's habituated, shut down this default mode network or dampen it to allow novelty to emerge. Which is where, you know, the skill of the therapist is become very important and the understanding of the therapist not to intervene too strongly in a place where, you know, you've got so much neuroplasticity.
Keith Sutton, Psy.D. (50:08):
Exactly.
Nigel Denning, M.Psych, MA (50:09):
So much new opportunity that people are extremely impressionable. So, you know, we really kind of, we do a lot of metacognitive training and mentalizing training around therapists moving into that space.
Keith Sutton, Psy.D. (50:24):
Yeah. Is it legal there? Because I know in there's only a couple places in the United States where psilocybin or, you know, there's yeah, Ketamine is legal to be able to use in these settings, but not psilocybin so much.
Nigel Denning, M.Psych, MA (50:40):
So we, our national body similar to your food and drugs administration, are equivalent gave the go ahead for treatment under certain conditions. So the conditions are predominantly trials, but you know, they're also now emerging prescribers so people can access it through private health now. It's very expensive. But it's been accepted now, I think MDMA treatment for PTSD. Accepted by our military, so veterans may be able to receive treatment and a couple of our insurers have now accepted it as a treatment. It's still highly contentious and all sorts of criticisms.
Keith Sutton, Psy.D. (51:36):
Sure. Sure.
Nigel Denning, M.Psych, MA (51:38):
But it's just, it's creating novelty. Yeah. I think the important thing is really for us as therapists to recognize that, you know, it's that that novel experience, well integrated is one of the most important, you know, aspects of transformation and healing.
Keith Sutton, Psy.D. (51:58):
Yeah. And particularly I know with psilocybin oftentimes, like all the assumptions that one has, you know, oftentimes kind of falls away and, you know, then the person is kind of like, you know Yeah. Noticing things in a different light that they just kind of just kind of assume or took for granted or so on. So is that kind of what you mean about that novelty, like.
Nigel Denning, M.Psych, MA (52:21):
Yeah. You know, like in a psychedelic sort of session, you know, someone feeling, you know, that they're resting in the arms of God and they have this profound experience, what they're having is an experience of trust and safety. Yeah. I'm not going to, I don't, you know, I'm not interested in, you know, their belief systems around God or Buddha or anything like that. I'm just interested in what they're experiencing and what that means for them and how they're going to implement that in their lives in a different way. Exactly as we're doing with the ideal parent visualizations, we are creating experiences. That we're then trying to help people to mentalize their way into stabilizing.
Keith Sutton, Psy.D. (53:07):
And how many sessions of the idealized parent are happening? Is that multiple sessions? With kind of imagining this? Or is that one session and then kind of processing it?
Nigel Denning, M.Psych, MA (53:21):
Well we try to keep it to a reasonable consistency. So, you know, first part of the session collaboration, second part of the session, visualization, third part of the session, mentalizing metacognitive view. There might be some times where we spend more of the time in the collaboration and mentalizing aspect if there's work that needs to be done. But it's an unusual kind of process for therapists to not be the relational fulcrum of the session. And so to actually coach people to have an inner process, so get that intrapsychic material happening. What we find is people learning the technique will often collude with the client not to do the visualization. A little different, or if something negatively occurs in the visualization to bring the client out and back into the therapeutic.
Keith Sutton, Psy.D. (54:22):
So interesting. It makes me think a lot about the EMDR that oftentimes new EMDR therapists are like, oh, let's go to your safe place, or so on. And really a lot of it is just creating the space for the mind to do its own healing. And therapist is really not there much, and except for a small cognitive interweaves here and there as needed. But really it's creating that space for the mind to do the work it knows, it knows how to do,
Nigel Denning, M.Psych, MA (54:50):
And what a profound empowerment that is for clients to recognize that they can gain that mastery over whatever the experiences that they've had, and that they can gain that autonomy while staying in relationship. You know, they don't have to withdraw from the world. They can be in good interpersonal relationships whilst also being self-directed. It's just a beautiful, beautiful gift to offer clients.
Keith Sutton, Psy.D. (55:17):
Brilliant. So for folks that want to learn more, where can they go? I know that there's an online training, there's also the book.
Nigel Denning, M.Psych, MA (55:25):
So we are at iat-institute.com and yeah you can find out about our trainings there. We've got an online training that consists of about a hundred hours and that runs through theory, different treatment approaches to attachment, assessment of attachment, and then we've got video demonstrations of working with people with preoccupied attachment, with disorganized, with dismissing attachment. There is another feature that emerges that we haven't talked about which is unresolved grief or trauma. Which has a slightly different orientation to disorganized attachment. And we lead people through a whole series of demonstrations of those in video. And then if people are particularly interested, they can come to our in-person training where we do more advanced and specific treatments in-person on each of the attachment disorders, disturbances, I should say.
Keith Sutton, Psy.D. (56:32):
Yeah. Wonderful. Well, thank you so much for your time. This is great. I loved learning about the work, and it just sounds amazing and it really helped come to light in this conversation. So thank you so much. I really appreciate it.
Nigel Denning, M.Psych, MA (56:45):
Yeah, yeah. Lovely spending time with you.
Keith Sutton, Psy.D. (56:46):
Take care. Bye-Bye.
Nigel Denning, M.Psych, MA (56:48):
Bye now.
Keith Sutton, Psy.D. (56:49):
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