The Foundations of the model

Foundations of the
psychotherapeutic Relational Intelligence® model®

I - Origin

The Relational Intelligence® (RI) model was born from the clinical and personal experience of its founder, François le Doze, a neurologist by training who started to practice psychotherapy as part of his work in a hospital setting.

In this position, François le Doze had the opportunity to apply the Internal Family Systems (IFS) (Schwartz 2019) psychotherapy method to patients with medical disorders (e.g. migraines, multiple sclerosis, functional neurological disorders). IFS proved to be particularly well suited to the application of psychotherapy to people with medical disorders. He progressively deepened his mastery of the IFS model by becoming a trainer in this model, and acquired indispensable knowledge in the field of psychopathology and neurobiology of psychological trauma. 

The IFS model is based on two foundations and a therapeutic lever: the Self and psychological multiplicity on the one hand, and Self-regulation on the other.

After about ten years, he identified difficulties in treating certain problems such as attachment disorders with this method. These disorders develop in a period of life when the brain's maturity does not allow it to produce a so-called episodic memory, that is, one that relates to a spatio-temporal context that can later be grasped through the paradigm of parts. At this stage of an individual's development, only implicit memory can be mobilized. As it is independent of the spatio-temporal context, evoking it through the parts paradigm is not – or barely – feasible.

François le Doze’s meeting with Deborah Dana and Deirdre Fay gave him theoretical elements to transcend these limitations. These two therapists had developed methodologies to better understand the issue of co-regulation. In the therapeutic relationship, co-regulation deals with the mechanisms at play in the inter-human relationship and communication. IFS emphasizes the primacy of the intrapersonal relationship (between the individual’s Self and their own parts) as a therapeutic lever within the intersubjective relationship. However, neuroscience data show that brain organization responds to a hierarchy based on the autonomic nervous system, which is modelled from the first childhood experiences in relationships with others (primarily the so-called attachment figure).

II - Theoretical underpinnings

The Internal Family Systems (IFS) model offers an operational model of consciousness called Self. It is the involvement of consciousness (especially body consciousness) and not language that constitutes the therapeutic lever in this method.

The systemic thinking underlying IFS applies principles of systems theory developed in the fields of physiology and biology to the psychological life of individuals. It understands psychological functioning as the attempt of subsystems (called parts) to restore the internal equilibrium disrupted by the potentially traumatic external situation. This systemic conception is also a way to situate the individual as a system within other larger interdependent systems (couple, family, country, society, etc.) that interact with one another.

Attachment theory is not detailed here. It is mentioned because it provides a frame of reference for the IR model, insofar as the IR therapist acts explicitly as a secure attachment figure. From this reference posture, it is possible to identify and treat the attachment disorders on which relational security and the progression of therapy are based.

The study of the neuropsychological and particularly neurobiological processes underlying human memory made it possible to establish that traumatic memories, thought to be indelible, are in fact repairable. The brain, through its capacities for neuroplasticity, has the means to lastingly reconfigure itself by letting go of emotions and beliefs that are no longer useful and replacing them with information that allows it to update itself.

The Polyvagal Theory (PVT) proposed in 1994 is the result of the work of Stephen Porges (Porges 2011) who conducted neurophysiological research to study the responses of the autonomic nervous system (ANS) in situations of threat. He described responses common to both animals and humans that are part of the phylogenesis of the construction of their ANS. These discoveries have already had a considerable impact on the understanding of subtle mechanisms and the treatment of psychological trauma in general and of attachment disorders in particular. PVT provides a very efficient conceptual and operational framework, as it allows one to decode the imprints of these traumas in the body and, by means of neuroplasticity, to promote a stable reconfiguration of the ANS to ensure relational security.

The IR model recognizes the theoretical neurobiological references on which the work of Bessel van der Kolk – synthesized in his book The Body Keeps the Score (2014) –is based. From a therapeutic point of view, these include the importance – known in the past and taken up by van der Kolk – of considering that the organization of the NS corresponds to a hierarchy. Numerous other authors have referred to this hierarchy, including MacLean (1972), and Panksepp and Perry (Perry, n.d.). This hierarchy has its origin in the phylogenesis of the NS, which leads us to consider that the NS of human primates is made up of successive strata. The Polyvagal Theory accounts for this, considering that the ANS was constituted successively, during evolution, of the dorsal parasympathetic component (reptilian period), the sympathetic component (fish) and finally the ventral parasympathetic component (mammals). 

It is therefore accepted that within the ANS and within the NS more generally (MacLean’s triurne brain) (MacLean 1972), the influence of brain structures on each other is conditioned by their date of appearance during evolution. The older they are (archaic brain, ANS), the more automatically they function (vegetative life, relational security). The more recent they are (cerebral hemispheres), the more consciously they function (language, abstraction, creativity, learning, etc.). It is accepted that the phylogenetically oldest structures (anatomically located in the lower parts of the NS) constitute a kind of foundation on which the most recent structures are based. The conditioning of the lower part of the NS is stronger than the learning of the more recently developed upper part of the NS. The flow of information in this network of interconnected structures has two directions: top-down and bottom-up.

  • This is mainly based on the top-down regulation pathway.

In the early stages of life, the mature structures are the lowest is the most solicited. In the course of life, as the higher structures mature, they will become more and more important in the NS and the This is mainly based on the top-down regulation pathway. route will develop. In adulthood these structures are interconnected, but their reciprocal influence is not symmetrical, because the Bottom Up path dominates over the other, since it is on it that the survival processes (physical and psychic) are based. 

Psychic trauma is known to affect the entire NS. Concretely this implies taking into account in the field of psychotherapy that the neurobiological stigmas of the trauma on the lower structures are more decisive on the course of therapy, than those left on the upper part. Neurobiological psychotherapy (Cf. infra) will take this into account and seek to prioritize the ANS deregulations.

The NS has an innate program to respond to danger by attacking or escaping (as do all vertebrate animal species). The NS is intended to return to regulated social functioning once the danger is no longer present. Human beings, unlike other animal species (whose NS can return to the regulated state on its own) need external regulation to effect this return to the basic state. This is especially true of children. 

This regulation, which involves interaction with another human whose NS is regulated, is called co-regulation. It is therefore through co-regulation that the dysregulated NS of an individual exposed to danger returns to regulation. If the danger persists or if the individual does not find co-regulation, dysregulation sets in over time, at the cost of adaptations that involve brain regions devoted to emotions and social interactions: the development of automatic patterns that condition behavior, based on belief systems and repressed (non-metabolized) emotions. This is fundamentally an adaptive mechanism based on dissociation.

This corresponds to a fundamental adaptation mechanism at the neurobiological level, which explains the development of personality sub-compartments that are independent (to varying degrees) of one another. These sub-compartments organize themselves to maintain an internal equilibrium and thus try to replace the lost equilibrium (the one that existed before the danger occurred) which could not be restored. These new internal balances (but which fundamentally remain imbalances) are most often manifested in the form of psychological states experienced as polarizations or antagonisms.

There is only one alternative to dissociation, and that is association. This can be seen as one of the main functions of the NS: to integrate in a coherent and meaningful way the different components of an individual's experiences. This work involves the NS as a whole.

Because co-regulation brings into play, as a priority, the oldest structures of the NS (devoted to survival mechanisms), it constitutes a key factor in mobilizing the possibilities of the NS to carry out this association process.

From the perspective of the IR model, it is the peri-traumatic dissociation mechanism that accounts for the development of the parts as described in IFS, and their organization in rigid interaction patterns. When the dissociation is deep and present from the period of attachment, it leads to dissociative personalities or structural dissociation as theorized by Ono Van der Hart(Nijenhuis and van der Hart, 2011). From this point of view, the vision of the IR model differs from that of the IFS model in that the fundamental psychopathological mechanism is peri-traumatic dissociation and not, as represented by the IFS vision, the diversion of the normal functioning of parts that the individual is claimed to be endowed with at birth. The IR model, like the IFS model, nevertheless recognizes the modular functioning or multiplicity of the psyche.

Dissociation appears to be more fundamental than traumatic memory (which also proceeds from dissociation through the fragmentation of memory elements). This element is essential in the treatment of attachment disorders which do not give rise to episodic memories, but are immediately inscribed in the brain in the form of dissociative memory.

III - The fundamental characteristics of the RI model :

The criteria for defining neurobiological psychotherapy (NBP) are :

– the methods used respond to a representation of the psyche and its traumas as proposed by advances in neuroscience;

– the methods used aim at bringing into play neuroplasticity, reprogramming of the NS, and reorganizing it based on present day data.

 

This is a new heading in the field of psychotherapy, which the founder of the RI model conceptualizes.

NBP focuses on the body: the wounded body, conscious of itself, in relation and with the to heal. Its objective: to take advantage of the psychic wound to allow the individual to bring coherence between the body and mind thanks to a Nervous System (NS) which regains the ability to regulate itself. It is about a transformative approach whereby the individual is considered in his bodily dimension, relational and social.

The objective of NBP is to heal an organ, the brain, in order to treat the psychological difficulties that the individual encounters.

The objective of the RI method can be considered both clinically (improvement of symptoms) and neurobiologically. The priority of RI intervention at the neurobiological level is to treat dissociation. Dissociation can occur structurally (Nijenhuis and van der Hart 2011) or in the form of parts in the IFS sense. Neuroplasticity is what allows association work to be established. This is not symbolic work, or an approach that aims to suppress traumatic episodic memories. The tools developed, at the forefront of which is co-regulation, aim to enable the NS to find the conditions in which it can associate different pieces of information stored within it but kept separate from one another (due to the traumatic nature of the individual’s experiences).

The therapist does not approach the patient with a preconceived notion of the level of dissociation. The therapist learns to detect the clinical signs that will indicate this and then only to apply the appropriate tools.

If the dissociation appears to be structural,the therapist brings into play co-regulation in the form of therapeutic involvement (see below):

  • either physical with recalibration of the ANS inspired by the work of Deborah Dana (Dana 2018)
  • or cognitive/emotional with metacognition inspired by the work of Deirdre Fay

These interventions aim at restoring relational security and thus internal security through the correction of attachment disorders.

Co-regulation is primarily based on the use of bottom-up regulation. .

If the dissociation appears to be non-structural (i.e. manifesting in the form of parts of which the patient is aware) the therapist brings self-regulation into play. This is mainly based on top-down regulation. In short, the disorders that are treated here fall within the field of post-traumatic stress syndrome. The methods used in this context are largely inspired by the IFS model.

Avec cette méthodologie, il apparaît que le plus souvent le SN des patients nécessite beaucoup de corégulation avant de pouvoir accéder à l’autorégulation. Ce constat est cohérent avec la hiérarchisation With this methodology, it appears that most often the SN of patients requires a lot of co-regulation before self-regulation can be achieved. This finding is consistent with the bottum-up hierarchy of SN.

Metacognition (MC) is the ability to be aware of mental operations and mental states for oneself and others, and to apply this awareness to a variety of mental operations (Brown and Elliot 2016: 293). Brown et al. argue that the more secure the attachment, the more developed the capacity for metacognition will be.

The practice of RI is largely based on the use of MC according to a specific methodology. MC used between the therapist and the patient proves to be a very effective tool in situations where co-regulation is appropriate because the disorder to be treated is an attachment problem, but where the patient’s defense system is opposed to this intervention. These situations are characteristic of the attachment disorder, which appears to be a dead-end since the appropriate remedy is rejected outright by the patient’s psychological system and by their NS.

These frequent situations do not in fact testify to a rejection of co-regulation as such, but to a rejection of co-regulation in a direct mode, because it reactivates the initial trauma. MC allows the therapist to reflect a regulated state, thus developing an indirect co-regulation approach allowing the initial trauma to be dealt with.

The methodology developed in this model is original. It allows the direct treatment of dissociation by using co-regulation as a mediator of neurobiological association between two pieces of information that, due to the trauma, have been kept separate in the psyche and the NS.

This is not a tool per se, but the result of the implementation of co-regulation in the RI model. In the recalibration of the ANS and metacognition, used together for the purposes of co-regulation, the therapist engages physically and/or cognitively (or even emotionally) with the patient. The methodology developed here is very rigorous, as it must imperatively avoid counter-transference. On this condition, it allows major difficulties linked to structural deregulation of the NS to be overcome in therapy. The neutral position of the therapist, often advocated in psychotherapy, proves to be counter-productive in these cases, because it is perceived by the patient’s ANS as similar to the deficient engagement of their own attachment figure.

 

IV – Conclusion

The RI method is rooted in the neuroscience of attachment and trauma and is in line with the IFS model. However, it is not a simple combination of techniques. It is based on a vision of psychological trauma that is resolutely anchored in neurobiology. It involves an original methodology characterized by flexibility, which aims to adjust to the patient’s NS configuration at each moment of the session and during the course of the therapy. In addition, it offers unique tools (metacognition and relational association) that allow the therapist to treat particularly difficult situations. These respond to the NS’s need to let go of the survival modalities generated by past experiences and to regulate itself with the information of the present.

This is a recent method, developed at the end of 2017. It is the subject of keen interest from practitioners in France and French-speaking Canada.

  • Brown, Daniel P., and David S. Elliott. 2016. Attachment Disturbances in Adults. W. W. Norton & Company.
  • MacLean, Paul D. 1972. “Cerebral evolution and emotional processes: New findings on the striatal complex”. Annals of the New York Academy of Sciences 193 (1 Patterns of I): 137‑49. https://doi.org/10.1111/j.1749-6632.1972.tb27830.x.
  • Nijenhuis, Ellert R. S., and Onno van der Hart. 2011. “Dissociation in Trauma: A New Definition and Comparison with Previous Formulations”. Journal of Trauma & Dissociation 12 (4): 416‑45.
  • Perry, Bruce D. n. d. “The Neurosequential Model”, 18.
  • Porges, Stephen W. 2011. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation (Norton Series on Interpersonal Neurobiology). WW Norton & Company.
  • Schwartz, Richard C. (ed.) 1995. Internal Family Systems Therapy. New York: The Guilford Press.
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