7 ate 9: The Upper FEDL Levels ICDL Southern California DIR/Floortime Regional Institute October 9, 2010 Josh Feder, MD
The Southern California DIRŽ/Floortime™ Regional Institute Pasadena, California October 2010- May 2011 Josh Feder, MD jdfeder@pol.net Mona Delahooke, PhD mdelahooke@socal.rr.com
Diane Cullinane, MD diane@pasadenachilddevelopment.org Pat Marquart, MFT patmarquart@aol.com
Support Parent Choice Today! www.dirfloortimecoc.com
circlestretch Help the child be… • Calm enough to interact • Truly connected to others • In a continuous expanding balanced back and forth flow of interaction “Go for that gleam in the eye!” http://www.circlestretch.com
Joshua D Feder MD DFAPA
Assistant Clinical Professor, Dept of Psychiatry, University of California at San Diego School of Medicine Faculty, Interdisciplinary Council on Developmental and Learning Disorders
Acknowledgements The ideas in the talk are from the podcasts and writings of Drs. Stanley Greenspan and Serena Wieder. Any and all errors of omission, comission, or misinterpretation are mine and mine alone. Please refer to the various podcasts, videos, books and other resources available at ICDL.com for more information.
Disclosures ICDL Faculty – minimal - review of clinical write ups, travel and room for meetings, token honorarium for co-writing and running Southern California Institute NIMH/ Duke University – minimal – administrative time for pharmacogenetic research NIH R21 grant/ San Diego BRIDGE Collaborative – minimal – token honorarium for ongoing consultation and participation
How I Spend My (clinical) Time.. • 90 % on I, II, and ‘the rest of them’ • 10% detailing ‘the rest of them’ • Circlestretch.com process is set up to get people to get started at the most important foundational places…
circlestretch Help the child be… • Calm enough to interact • Truly connected to others • In a continuous expanding balanced back and forth flow of interaction “Go for that gleam in the eye!” http://www.circlestretch.com
In Books and Lectures We Usually Talk About Functional Emotional Developmental Levels I-VI I – co-regulation, ability to attend II – engagement, gleam in the eye, warmth III – circles of interaction IV – flow/ behavioral organization in social problem solving V – symbolic thinking (critical to tolerating affect) VI – logical connections between ideas
Functional Developmental Growth Chart (Now Part of the Bayley Scales)
Functional Emotional Developmental Levels I-VI I – co-regulation, ability to attend II – engagement, gleam in the eye, warmth III – circles of interaction IV – flow/ behavioral organization in social problem solving V – symbolic thinking (critical to tolerating affect) VI – logical connections between ideas
Sample FEDL 1 (not there)
2 (barely)
3 (islands)
4 (ok w/ support)
5 (comes back)
Regulate
11/05
11/06
11/07
11/08
Engage
11/05
11/06
11/07
11/08
Circles
11/05, 11/06
11/07
11/08
Flow
11/05
11/06, 11/07
11/08
Symbols
11/05
11/06, 11/07
11/08
Logic
11/05, 11/06
11/07, 11/08
6 (ok unless stress)
7 (ok)
Now Let’s Look at the Expanded Model: Functional Emotional Developmental Levels I-IX I – co-regulation, ability to attend II – engagement, gleam in the eye, warmth III – circles of interaction IV – flow/ behavioral organization in social problem solving V – symbolic thinking (critical to tolerating affect) VI – logical connections between ideas VII – multicausal thinking VIII – grey area thinking IX – reflective thinking, stable sense of self, and an internal standard
Charlie’s FEDL over time: social problem solving, from managing vigilance to stepping back, and then critical thinking Not there
Co-regulate
Islands
5/05, 5/05
Engage Circles
Barely
5/05
3/06,
Flow
5/05,
3/06
Symbolic
5/05, 3/06
Logical
5/05, 3/06
Multicausal
5/05, 3/06, 3/07
Grey area
5/05, 3/06, 3/07,
3/08,
Reflective
5/05, 3/06, 3/07
3/08,
3/07
3/06 3/06
Expands
3/07 3/07
3/07 3/07, 3/08 3/07, 3/08
3/08, 3/09 3/09
3/08
3/09 3/09 3/09
3/08 3/08
3/08 3/09
Comes back
3/09
3/09 3/09
Ok if not Ok stressed for age
7 ate 9: FEDL LEVELS VII, VIII, and IX
VII: Multicausal thinking: there is more than one reason, more than one feeling. VIII: Grey area thinking: there are different intensities of emotion. IX: Reflective thinking: we can compare situations to each other, and we can compare ourselves to who we want to be
What We Are Doing with these FEDL’s:
Solving the Social Problem of the Moment
• Every moment is a social situation • Think about the ‘here and now’ • FEDC’s are the capacities we use and need to address the current situation and solve the social problem of the moment
Putting it all together: FEDL I-VI Example: Assertiveness at a Glance (tell the other person what you are feeling, why you are feeling that way, and what you want the person to do) “I’m mad at you.” “I’m mad at you because you didn’t listen to me.” “I want you to listen when to me when we talk to each other.”
Functional Emotional Developmental Levels I-VI in the Assertiveness example
I – co-regulation: Are you settled enough to do this? (you can’t if you are too stirred up or too fuming mad)
Functional Emotional Developmental Levels IVI in the Assertiveness example II – engagement: Are you connecting with the other person? (doesn’t work if there is no emotional connection at that moment)
Functional Emotional Developmental Levels IVI in the Assertiveness example III – circles of interaction: Is there a response (gestural or verbal) from the other person? And do you use that as a way to continue the interaction? If you merely say the words and are done with it, you have no idea whether the message (affective/ cognitive) was received and accepted.
Functional Emotional Developmental Levels IVI in the Assertiveness example IV – flow/ behavioral organization in social problem solving: Are there enough circles to be able to work toward an average expectancy of the emotional tone for the situation, one that gives you the sense that what the other person says or means is reasonably reliable?
Functional Emotional Developmental Levels IVI in the Assertiveness example V – symbolic thinking: Do you have shared meanings of the words, such as ‘mad’, ‘want’, and ‘listen’? This is critical to tolerating affect because it gives you both a space to resolve the problem of the moment where you can work with emotional ideas without having to be stuck reacting to each other in isolation.
Functional Emotional Developmental Levels IVI in the Assertiveness example VI – logical connections between ideas Do we both understand ‘because’? Order of difficulty responding: why>> how come>> if/then>> when [this happens..that happens]
Functional Emotional Developmental Levels IVI in the Assertiveness example Results: • Mutual Recognition of the Problem • Mutual Resolution of the Problem • Avoids either person stewing alone and/ or ‘acting out’ : hitting, sulking, withdrawal, revenge, etc. • Promotes a sense of self competence, confidence, and builds a stronger relationship
FEDL VII: Multicausal Thinking (beginning ages 4-6)
So what’s the problem now?
Most, if not all situations in life are, in fact, far more complex. They are multicausal and multidimensional.
Example: ‘Masked Depression’ Angry on the outside Sad on the inside “You are so angry, but underneath that I think you are very sad” Patient cries, talks of loss, is less angry, case closed. (a therapist’s fantasy…)
There is Always a ‘Back Story’ Past experiences create expectancies that shape our responses in the moment and lead to trouble tolerating affects and repairing rifts in communication. On the positive side, we bring a lot with us into any situation that allows a complexity that can contribute to a solution too.
“Superman knew that Lex Luthor had lost his mother at an early age. Luthor was understandably enraged when Superman found his fortress (womb). Superman respected, to a point, Luthor’s need for a place to hide and hold himself. But Superman couldn’t have Luthor coming out of with blast rays and destroying cities and then running back to hide in his lair.
Motives in Human Experience: (Murder, She Wrote) The Seven Sins and Virtues Sins
Virtues
Lust
Self-control
Pride
Humility
Greed
Generosity
Envy
Love
Anger
Kindness
Sloth
Zeal
Gluttony
Temperence
Emotions and Motives Combine
In Infinite Varieties
Ideas on Understanding Multicausal Thinking • Now a child can understand that mom is mad because she had a bad day at work but wonders if there are other reasons too. • Remember that there are infinite combinations of emotionally grounded motives • Differential Calculus: infinite slopes to a curve • Every situation is different • We adjust to each one because of past experiences creating expectancies • When it isn’t there, people have more rigid, discrete emotional tones and reactions • Our job is to elucidate and help expand the range of these emotional motivations • This is about solving the emotional problem of the moment
FEDL VIII: Grey Area Thinking (beginning ages 6-10)
By the way, why comic books? • Age when people start to think in multicausal fashion • Beginnings of sorting intensities of emotion – hierarchies!
Back to Peter - uh, I mean Spiderman • He nearly always has to choose between going after the bad guy and saving Mary Jane • The relative intensity of his fear for Mary Jane’s safety often over-rides his anger at the bad guy. Fear > anger. • Parker, among superheroes, is ambivalent, conflicted, always weighing and brooding (Level VII back story: remember his guilt at not saving his uncle?) • Conflicting emotions require a lot of sorting out – hence all the sitting on rooftops and pondering.
Ambivalence is a hallmark of Level VIII
Intensities of Affect: Sadness
Intensities‌for Every affect
How Sad? How Scared? How Angry?How Happy? • No longer all or nothing. Sublety is everything, nuance is possible • DIR works to expand and add nuance, because EVERY situation is different, every time. • Makes all the difference in appreciating, enjoying and resolving the everyday, continuous flow of social problems of the moment (think Integral Calculus)
The ‘Real’ Picture: We are moving about, in a generally continuous fashion, on a Field of Infintesimal Variations of Quality and Intensity of Emotion and Motive
Characteristics of Level VIII: • Hierarchies, playground politics • The best time for disappointment – better to lose now and have mom’s support than to lose as an adult and have no experience to fall back on. • Emotional experiences define, expand, and deepen the boundaries for the self. Without anger we don’t know what annoys us, without joy we don’t know what makes us happy. • Refining the gradations of these emotions • This expanded and deepened appreciation for emotional experience makes us more able to appreciate it in others.
Ideas about Level VIII: • Look at the picture of mixed motives and emotions • Think about all the nuances • Try to help the other person experience and appreciate the nuances in the context of your interactions • Enjoy the ride
Renoir:
Take a minute‌think about nuance and intensity
Renoir Two Girls at the Piano Notice the implication in the picture of the presence of shared attention (FEDL I) all the way through nuanced flow of interaction (FEDL VIII)
What Comes Next?
FEDL IX: Intermittent Reflective Thinking, A Stable Sense of Self, and an Internal Standard (9-12 yr and beyond)
• We can compare situations to each other: “In this kind of situation I can usually figure it out” • We can compare ourselves to who we want to be (ego ideal): “I want to be able to sort out this new kind of problem.” • Concrete Ex: College student knows how to study but needs to learn how to develop a schedule for managing day to day life away from home. • More abstract Ex: Middle schooler who can assert himself in class but is sort of lonely and wants to be able to hang out with people at lunch
Characteristics of FEDL IX: • Really adolescence and beyond… • the ability to empathize in a truly reflective manner • able to understand a range of feeling in others and compare it to your stable sense of self, retaining who you are • helps you to be truly a great friend or partner. • Reflecting on yourself and others w/o taking over nor removing yourself • Expanding sense of empathy, more and more inclusive: other kids, groups, school, country, … the world (other races, religions, etc.).
Example at Level IX: Novice’s Guide to Modern Dance • The pieces all contain motions and rhythms, music and colors that bring up all kinds of feelings and ideas, some pretty straightforward, some a little more complex • At times these pieces send me off, thinking about something in my life that resonates with what I’m seeing and hearing, and I let that happen and often I learn something from it. • Other times these pieces pull me into their own story, which, to me - it might be different to you - might be about friendship or about competition or about just a really fun day. If that’s what’s happening, I just it them pull me in and share the experience.
Levels of Defense Mechanisms from Psych 101 • Very Primitive: Denial, Delusional Projection • Primitive: Defensive Projection, Somatization, Passive Aggression • Neurotic: Repression, Intellectualization, Reaction Formation, Fantasy escape • Higher Level: Altruism, Sublimation, Humor, Creating Meaning- Possible with FEDL IX
Managing the toughest Affects • • • •
Spats, Love, War Humor: Tom Lehrer on Pollution Mel Brooks on The Spanish Inquisition Levels of Defense Mechanisms
Example FEDL over the years: Rigid and Rocking to Problem Solving the Job Hunt (and still rocking) Not there
Co-regulate
5/97 5/97
Engage Circles
Barely
5/97
Islands
Expands
Comes back 6/09 6/09 6/09
Flow
5/97
6/09
Symbolic
5/97
6/09
Logical
5/97
6/09
Multicausal
5/97
6/09
Grey area
5/97
6/09
Reflective
5/97
6/09
Ok if not Ok stressed for age
How I Spend My (tutoring) Time: DIR as a REFLECTIVE Enterprise • 10% supporting people to get settled to be reflective, i.e., I-VIII, (coffee, readings, talking together) • 90% Reflective Process • DIR® demands reflective process • Everyone, from parents to faculty and everyone in between, needs to be engaged in an ongoing reflective group or set of relationships to think about our work together • ‘Level IX’ is our life blood.
Beyond IX… • The Spinal Tap made it to “11” • Dr. Greenspan had an anthropologist helping on a project to explore for FEDL Level X and beyond. • Stay tuned!