Continuity and
Discontinuity:
cognitive science and
psychotherapeutic
perspectives.
Isabel Clarke
Consultant Clinical Psychologist.
What I hope to cover:
• Outline the discontinuity hypothesis
• Ground this in cognitive theory
• Implications for therapy –
– Third Wave Cognitive therapy
– my additions to CBT for psychosis
• Wider Vision of the person
Instead of psychosis and
spirituality, I propose two ways
of operating in the world:
• The everyday
• The transliminal
Both of these are available to all
human beings.
THE DISCONTINUITY exists between
these two states.
The Everyday
• Ordinary
• Clear limits
• Access to full memory
and learning
• Precise meanings
available
• Separation between
people
• Clear sense of self
• Emotions moderated and
grounded
TheTransliminal
• Numinous
• Unbounded
• Access to ordinary
knowledge/memory is
patchy
• Connections abound - or
all is meaningless
• Self: lost in the whole or
supremely important
• Emotions: swing between
extremes or absent
Looking at this cognitively
• Two complementary approaches
• Kelly’s Personal Construct Theory
• Interacting Cognitive Subsystems
(Teasdale and Barnard).
Constructs
• Are based on past experience/memory
• New experience is filtered through our
constructs
• They colour and help to define our world
• Each person’s construct system is unique
to them.
Transliminal Experience =
operating Beyond the Construct
System
• No means of anticipating or
discriminating
• A state without boundaries
• Both/and - two contradictory things can
be simultaneously valid
Beyond Constructs and
Boundaries
• Liberating; ecstatic; one with the universe
– BUT
• Mind is no longer private
• Open to any influence or “insertion”
• Loss of the construct “safe/dangerous” - danger can
come from anywhere.
• The boundary between inner and outer is lost.
Interacting Cognitive Subsystems:
Teasdale & Barnard 1993.
• An information processing model of cognition,
developed through extensive research into
memory and limitations on processing.
• 9 subsystems, each with its own type of coding.
• Some deal with sensory perception - auditory
and visual
• Some deal with language processing
• There are two higher order systems: the
propositional and the implicational.
Interacting Cognitive Subsystems.
Body
State
subsystem
Implicational
subsystem
Implicational
Memory
Auditory
ss.
Visual
ss.
Propositional subsystem
Propositional
Memory
Verbal
ss.
Important Features of this model
• Our subjective experience is the result of two
higher order processing systems interacting –
neither is in overall control.
• Each has a different character, corresponding to
“hot” and “cool” cognition.
• The IMPLICATIONAL Subsystem manages
emotion – and therefore relationship.
• Presumabley, the verbal, logical,
PROPOSITIONAL ss. gives us our sense of
individual self.
Two Ways of Knowing
• Good everyday functioning = good
communication between implicational/relational
and propositional
• At high and at low arousal, the relational ss
becomes dominant
• This gives us a different quality of experience –
one that is both sought and shunned.
• Managing that good communication is key –
Teasdale was a pioneer in introducing
Mindfulness to CBT.
I suggest
• Both ways of encountering reality are
equally valid
• Both are intrinsically incomplete
• Human beings have always honoured the
transliminal
• Made space for the sacred.
Advantages of this model
• It clarifies the characteristics of the transliminal;
– both/and, not either/or
– paradox
– numinosity
• It brings psychosis into the realm of universal human
experience
• It helps to explain common psychotic experiences, such
as:
– thought insertion
– distortions in the sense of self
• It raises interesting questions around scientific enquiry
into the transpersonal.
“Third Wave” Cognitive Therapies
• Developments in CBT as it tackles personality
disorder, psychosis etc.
• Therapeutic relationship important
• Past history is significant
• Change lies not so much in altering thought to
alter feeling, but in altering the person’s
relationship to both thought and feeling
• Mindfulness is a key component.
• Role of mindfulness in managing the threshold
between the two ways of knowing.
“Third Wave” – term coined by Hayes
(Acceptance & Commitment Therapy)
• Kabat-Zinn. Applied mindfulness to stress
and pain.
• Segal, Teasdale & Williams. Mindfulness
Based Cognitive Therapy (relapse in
depression.)
• Linehan. Dialectical Behaviour Therapy
(BPD)
• Chadwick. Mindfulness groups for voices.
• Hayes
Parallel Developments in other
modalities
• Bateman and Fonagy – Mentalisation.
Promotes theory of mind,collaboratively
and through skills training.
• Developments in Cognitive Analytic
Therapy for severe personality disorders.
DIALECTICAL BEHAVIOUR THERAPY:
Linehan’s STATES OF MIND
EMOTION
REASONABLE
WISE
MIND
MIND
MIND
IN THE PRESENT
IN CONTROL
Working with Psychosis using the
Discontinuity Model
• Managing arousal – the transliminal is
accessible at both high and low arousal
• Validate the experience
• Validate the feeling
• Persuasion to join “shared reality”
• “Sensitivity” – normalisation based on
Claridge’s work on schizotypy.
The Relational Mind
• Developmentally, we make sense of ourselves
only in relation to others.
• We grow, and are moulded, through relationship
– all relationship.
• The self sufficient, atomistic, mind is an illusion
• Our verbal, propositional ss. sets a limit on what
we can know precisely
• We can reach out in relationship beyond that
limit.
Web of Relationships
In Rel. with
earth:
non humans
etc.
primary
care-giver
In Rel. with
wider
group etc.
Self as
experienced
in relationship
with primary
caregiver
Sense of
value comes
from rel. with
the spiritual
• Spiritual Crisis Network.
www.spiritualcrisisnetwork.org.uk
My website (publications)
www.scispirit.com/Psychosis_Spirituality/
Chris Clarke Ed.2005.” Ways of Knowing: science and
mysticism today”. Exeter: Imprint Academic.
Clarke, I. Ed. (2001) Psychosis and Spirituality: exploring
the new frontier. London: Whurr.