How to encourage change? Systemic Therapy and Marte Meo

Transcription

1 How to encourage change? Systemic Therapy and Marte Meo Sydney, July 28/29th, 2010 Rainer Schwing Diplom-Psychologe 1

2 1. Neuroscience: a quarry and lots of visitors 2. Biology of change! Neurobiological suggestions for change work! Charming triads: Systemic therapy, Marte Meo, and Neurobiology 2

3 Potential experiential space I can t do it Building Relationships: focus problem trance anxiety failures tensions I can do it courage withdraw former successes relaxed friends 3

4 ! Activating these three systems enhances therapeutic effect Building Relationships:! CARE bonding, trustful relationship! SEEKING curiosity, novelty, exploring! PLAY joy, humour! stabilizing, prerequisite for change! motivational priming, seeking solutions! creativity, acivates weak circuits 4

5 ! Trustful emotional relationship is key factor for therapeutic change Positive connectedness appreciation Reframing, Cheer leading Mood for development Good face, good tone Emotions and motives have a strong effect on furthering neural synchronization (Schiepek 2007) 5

6 Therapieverlauf OCD Tagklinik (Schiepek u.a. 2010, im Druck) Building Relationships: Komplexität Flooding Krit. Instabilität Y-BOCS

7 Therapieverlauf OCD Tagklinik (Schiepek u.a. 2010, im Druck) Building Relationships:! Clinical or personal change requires stable environments, above all in relationships! Crisis and instability is preceding pattern change! Motivation for change correlates with relationship quality! Degree of instability correlates with relationship quality! Outcome correlates with degree of instability! Symptomatic change coincides with phases of instability

8 Marte Prefrontal Meo cortex and Systemic Therapy Dopamine and change nucleus accumbens! Cortical Neuroplasticity only happens, when the dopamine system has been activated (Spitzer 2007) Ventral tegmental area! Dopamine system gets activated when something surprisingly new happens; helps also: chocolate, beautiful music, nice words, nice looks. 8

9 Seeking system: go for the new, amaze, dazzle, baffle Building Relationships: Focus on former or new positive experiences on what is there, the strengths you can build on Help patient to discover this that often amazes and touches Take time with solution patterns! neuroplastic changes need time to unfold hold the positive moments (Maria Aarts) e.g. with frozen images in videos 9

10 1. Neuroscience: a quarry and lots of visitors 2. Biology of change! Neurobiological suggestions for change work! Charming triads: Systemic therapy, Marte Meo, and Neurobiology 10

11 Common grounds of MM and ST: Out of ones own strength <--> self-organization Build on what is there <--> build on resources Meet the client in his frame of reference, and begin there Mood for development <--> discover new possibilities Stance: appreciative, optimistic, curious, researching Reframing message behind the behavior meaning of the symptom 11

12 Good moments Freeze images in video Look for solution patterns stay with them, allow time no fast changes of topics future pacing: paint inner images Long time potentiation Activation of dopamine system 12

13 Mood for development Joining Motivational priming Emotions und motives are strongly enhancing neuronal synchronisation (Schiepek 2007) 13

14 Small steps Small successes open the doors Activates dopamine system Strengthens Self efficacy (PFC) 14

15 Good face, good tone Appreciative stance Dopamine system Strengthens neuronal approach, reward and attachment systems 15

16 Videofeedback Utilization of social system Mirror neurons Context embedded change work 16

17 ! Video therapy with stroke patients (Binkofski u.a. 2004, Ertelt 2008)! Watching videos with everyday movements before practicing " Motorical progress much better as in normal physiotherapy " Significantly stronger activation of relevant motorical areas in cortex! Marte Meo: clients watch their own successes 17

18 ! Capoeira, Ballett und Marte Meo (Calvo-Merino u.a. 2005, 2006) 18

19 ! Capoeira, Ballett and Marte Meo (Calvo-Merino u.a. 2005, 2006)! Stronger brain activation, when we look at familiar movements! Unexpected result! Watching the familiar dance activates emotional areas of brain (e.g. cingular cortex)! Marte Meo: clients watch scenes that are relevant and familiar! strong neuronal activation 19

20 Attachment and behavior Shaver and Mikulincer Insecure attached persons are! less compassionate! Less altruistic, involved in helping activities! Less tolerant and accepting! More prejudiced, more negative reactions to out groups 20

21 Attachment and behavior Shaver and Mikulincer Now the good news: this can be changed attachment-security priming changes the immediate reaction!subliminal priming: words on a screen!reading stories of helpful others!imagining helpful others!experiencing being helped This even works for rats, too 21

22 Mentalization oriented therapy. Fonagy (2004) Mentalisierung! Ability to recognize and perceive own! Ability to recognize and imagine other s moods, sensations, feelings and thoughts How does the ability to mentalize develop? 22

23 Visual acustic perception mirroring answer understand baby Unspecific physical arousal Nonverbal expression perceive Attachment -person 23

24 Mentalization oriented therapy(mbt) Fonagy (2004)! Questions enhancing ability for mentalizing reconstruction of neuronal circuits between affective and cognitive areas! Friendly, appreciative interested stance of not knowing! Clients work hard exploring sensations, feelings, thoughts and actions! MBT with Borderline-patients: 8-year follow up: high psychosocial stability (work, friends, activities) much less hospitalizations, self injuries, suizides, medication (Bateman/Fonagy 2008) 24

25 Mentalizing-enhancing questions: connect emotion, cognition, action Client works hard: success and self efficacy Images + enhance mentalizing + show successes Strong neuroplasticity when challenge has been met and success has been appreciated (Hüther/Rüther 2003) 25

26 Change and development needs more than talking,,... In order to learn better, you should work with all senses... (Comenius 17. century) The brain does not store isolated facts, but constellations (Hüther 2008) action and context oriented change work leads to faster and better results! multiple neuronal systems are being activated simultaneously! Enhances neuroplasticity, especially in convergence areas (e.g.. Hippocampus, PFC) (Schiepek 2007) 26

27 Change and development needs more than talking Building Relationships: Substance abuse: alcohol Brain atrophy wider Sulci and Ventricles volume reduction in PFC and Hippocampus as compared to a healthy person (MRT, sagittale Darstellung Heinz/Mann 2001) 27

28 Change and development needs more than talking Building Relationships: Reconstruction of brain anatomy via abstinence and action oriented treatment holds true also for Depression (Grawe 2004) treatment! Motivate patients to new activities (seeking)! Engage in pleasurable activities (play)! Offer challenges in small steps,! enhance self efficacy (Heinz/Mann 2001, Heinz/Beck 2007) 28

29 Close to everyday living Manageable challenges Trying out new things Go for successes Coffee, cookies and the dog Small steps Video-Feedback Activates dopamine system Repetetive successes Reconstructing circuits in PFC 29

30 Resumé! Images and action! Success and encouragement! Love, curiosity, play are strong ingredients for propelling change and development 30