Working w/ Cognitive Perceptual Disruption - Severe Trauma Split & Project | Jon Frederickson ISTDP
Channel: Visceral Gravitas
Date: 2023-04-26

excerpted from Repression seminar https://youtu.be/8k2lijaDp-g

transcript:
fragile these are patients that rely on splitting and projection 

so they separate mixed feelings 
and they'll relocate an internal feeling onto an external person right 
so they'll project onto you 
they'll split off a feeling that has nothing to do with me 
so they'll use splitting projection 
they'll use projective identification, that's where they try to make you feel angry so they don't feel angry 
they may split and regard you as all bad and engage in devaluation 
they may split and view us all good and idealize you 
or they may project on you and then they'll act out as if they're acting out toward a projection 
for instance if they judge themselves 
they may think you're judging them and so 
"What are you looking at!!" 
now they want to might want to punch this person who wasn't judging them 
and then we have discharge,
 which is why people oftentimes have trouble tolerating feeling inside so they'll yell to get the feeling out of them or they'll curse to get the feeling out of them 
and the result is patients will either be angry at a person they project on or they're scared of you because they've projected onto you 

their anxiety is in cognitive perceptual disruption 
this is where anxiety has risen to such an extent 
blood flow has dropped to the brain 
less oxygen is getting to the brain 
you actually have what we call hypoperfusion of the prefrontal cortex 
literally the part of your brain that does this thinking 
doesn't get enough oxygen 
patient actually has problems thinking 
has problems with memory 
you will see that the patient may lose track of her thoughts 
not due to defense 
just simply the anxiety is making her brain not work 
she'll report having blurred vision 
ringing in the ears 
maybe there's a loss of other senses 
they might start to hallucinate 
they frequently get dizzy 
due to the drop in blood pressure to the brain they get dizzy 
and they'll faint and we'll see the defensive conversion 

since there's no tension oftentimes your fragile patients will  appear physically calm but they're cognally confused 
you might think oh this patient is very relaxed 
no actually their anxieties go into cognitive perceptual  disruption and they look really flat 
because no anxiety is going into the striated muscles 
there's literally no tension that you see in the body 

their anxiety is in cognitive perceptual disruption 
they need a lot of anxiety regulation 
and where we need to help do a lot of work around the Triangle of conflict 
to build their capacity to tolerate feelings without splitting and projecting 
and to tolerate mixed feelings 
without cognitive perceptual disruption