MIAMI UNIVERSITY The Graduate School Certificate for Approving the Dissertation We hereby approve the Dissertation of Julia Rachel Lonoff Schirm Candidate for the Degree: Doctor of Philosophy _____________________________________ Director Dr. Larry Leitner _____________________________________ Reader Dr. Ann Fuehrer _____________________________________ Reader Dr. Vaishali Raval _____________________________________ Graduate School Representative Dr. Paul Anderson ABSTRACT EXPERIENTIAL PERSONAL CONSTRUCT PSYCHOLOGY AND SEVERE DISTURBANCES: EXPLORING DEVELOPMENTAL/STRUCTURAL DISRUPTIONS IN SELF-OTHER PERMANENCE by Julia R. L. Schirm An experiential personal construct psychotherapy (EPCP) understanding of severe disturbances (e.g., “schizophrenia”) is based on the idea that early trauma (broadly construed) may disrupt children’s development of the ability to consistently experience self and others as permanent and persisting across time and space. Such developmental/structural disruptions in “self-other permanence” (SOP) may result in a range of subsequent difficulties including hallucinations and delusions because without permanence, one may experience things such as the self or external objects and/or persons (e.g., voices) disappearing and reappearing, seemingly at random. The purpose of the current study is to evaluate the usefulness of the EPCP concept of developmental/structural disruptions of SOP in understanding the experiences of people with severe disturbances. I interviewed five patients at an inpatient psychiatric hospital who were diagnosed with schizophrenia or schizoaffective disorder, asking about their earliest memories, traumatic experiences, early relationships, current relationships, the history of their psychological difficulties, and how they ended up in the hospital. I constructed narratives for the participants, weaving together portions of the transcripts and interspersing my interpretations based on EPCP theory. The participants’ narratives strongly supported EPCP theory of developmental/structural disruptions. Participants’ struggles could be meaningfully conceptualized in terms of disruptions in SOP. They experienced significant early traumas, and these traumas were connected to difficulties with SOP. I also offer additional implications for EPCP theory, possibilities for elaborating EPCP theory, and areas of future research. EXPERIENTIAL PERSONAL CONSTRUCT PSYCHOLOGY AND SEVERE DISTURBANCES: EXPLORING DEVELOPMENTAL/STRUCTURAL DISRUPTIONS IN SELF-OTHER PERMANENCE A DISSERTATION Submitted to the Faculty of Miami University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Psychology by Julia Rachel Lonoff Schirm Miami University Oxford, Ohio 2013 Director: Dr. Larry M. Leitner Table of Contents Introduction………………………………………………………………............………………..1 Experiential Personal Construct Psychotherapy…………...…………………............………..2 Positioning the Researcher…………………………………………………………............…..4 Developmental/Structural Disruption……………...…………………………………..............5 Childhood development of construing…………...………………………............….….....6 Attachment theory……………...………………………….…………...……............….....8 Suspension……………...………………………….…………...……………............…....9 Freezing and Developmental/Structural Disruption…………...……………..............….11 Self Versus Other……………...………………………….…………...…....…….............…..20 Self-other Permanence……………...………………………….………….................…...…..21 Developmental pathways……………...………………………….............………….......23 Multiple internal working models…………………….…………............…………....….24 Trauma and Schizophrenia……………………….………………............……….………….27 Associations between trauma and psychosis…………………............…….…………....27 Psychosis and PTSD……………………….……………………….…............…………31 Summary and Goals……………………….……………………….……………............…....33 Method…..…………………….……………………….……………………............….………..34 Participants……………………….……………………….………………………............…..34 Interviews……………………….……………………….…………............………............…36 Writing exercise……………………….……………………............….………………...37 Analysis……………………….……………………….……............………………….……..37 Structure of Results………………………………………............………………………..….38 Results…..…………………………………………………............……………………………..39 James……………………………………………………............………………………….....39 Brief description…………………………………............………………………….........39 Narrative………………………………………………………............………………....41 Summary……………………………………………………............…………………....79 Andrew……………………………………………………………............…………………..80 Brief description….…………………………………………............…………………....80 Narrative……………………………………………………............………………..…..82 Summary…………………………………………………............……………………..121 Alisha…………………………………………………………............……………………..123 Brief description……………………………………………………............…………...123 Narrative……………………………………………………………............…………..125 Summary………………………………………………………….............…………….172 Michael…………………………………………………………………............…………...174 Brief description……………………………………………………............……….......174 Narrative……………………………………………………………............…………..175 Summary……………………………………………………………………............…..202 Cara………………………………………………………………………………….............204 Brief description…………………………………………………............……………...204 Narrative…………………………………………………………............……………..206 Summary……………………………………………………............………………......238 Discussion…………………………………………………………............…………………....241 ii Limitations…………………………………………………………….................……………..243 Implications for EPCP Theory and Future Research………………............…………......…243 Developmental/structural disruptions are not absolute…………............………………245 Continuum of SOP accomplishment/disruption……………………………..................246 Understanding differences in SOP accomplishment/disruption………............……......247 Understanding differences in severity of disturbance and emergence of SOP difficulties………....…………………………............………………………………....253 Self-other permanence and adulthood………............……………………………....….257 Conclusion…………………………………............…………………………………..........258 References...………………………………………………………............…………………….259 Appendix A....………………………………………………………............…………………..266 Appendix B....………………………………………………………............…………………..268 Appendix C....…………………………………………………………............………………..269 Appendix D....…………………………………………………………............………………..270 Appendix E....……………………………………………………............……………………..271 Appendix F....……………………………………………….............…………………………..272 Appendix G....………………………………………………………………............…………..346 Appendix H....………………………………………………..........………………………..…..424 Appendix I....……………............……………………………………………………………...513 Appendix J....…………............………………………………………………………………...579 iii Acknowledgements I am profoundly grateful for the people who have supported me in getting to this point and in completing this project. First, I want to thank my mentor, Larry. Words cannot express how grateful I am to you for believing in, encouraging, teaching, and guiding me throughout this project and my years in graduate school. Without you, I would not be the clinician, researcher, or person I am today. John, thank you for your love, patience, and encouragement as you have supported me in pursuing my doctorate. It has been a long journey and I could not have asked for a more wonderful husband. Thank you for helping me make this dream, and so many more, a reality. Thank you Mom, Dad, and David, for your unconditional and unwavering love and support. Myev, Rachel, Rebecca, Stephanie, and Naomi, your friendship means the world to me and has sustained me throughout this process. Thank you for listening, sharing, loving and accepting me, and being the amazing women you are. I want to thank Alisha, Andrew, Cara, James, and Michael for courageously and generously sharing their experiences with me. This project would not have been possible without their participation. I am grateful to Ann, Paul, and Vaishali for serving on my committee(s) and providing thoughtful feedback. Finally, thank you to the Director of Psychological Services at Woodside State Hospital for helping me conduct my research there. iv Experiential personal construct psychology and severe disturbances: Exploring developmental/structural disruptions in self-other permanence There are many theoretical explanations for severe psychopathology (e.g., people diagnosed as schizophrenics, borderline, and bi-polar). An experiential personal construct psychotherapy (EPCP) understanding is based on the idea that early trauma (broadly construed) may disrupt children’s development of the ability to consistently experience self and others as permanent and persisting across time and space. Such developmental/structural disruptions in self-other permanence (SOP) may result in a range of subsequent difficulties including hallucinations and delusions. Leitner (2013) explained: “If neither myself nor others have a permanence I can depend upon, my experiences and my sense of self may fracture into disconnected segments. Hallucinations can come and go randomly, not tightly connected to outside events” (p.122). To date, no one has systematically tested this area of EPCP theory against people’s lived experiences. The purpose of the current study is to evaluate the utility of the EPCP concept of developmental/structural disruptions of SOP in understanding the experiences of people with severe psychological struggles. By presenting detailed narratives of participants early (traumatic) experiences and