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The Foundations of the model

Foundations of the
Relational Intelligence® model of psychotherapy®

I - Origin

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

In this position, he had the opportunity to apply the Internal Family Systems (IFS) (Schwartz 2019) psychotherapy method (Schwartz, n. d.) to patients with medical disorders (migraines, multiple sclerosis, functional neurological disorders...). IFS has proven to be particularly well suited for the application of psychotherapy to people with medical disorders. He has progressively deepened his mastery of the IFS model by becoming a trainer in this model and has also 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 psychic multiplicity on the one hand, and self-regulation on the other.

After about ten years, he identified difficulties in apprehending certain problems such as attachment disorders with this method. Indeed, these disorders develop at a period of life when the brain's maturity does not allow it to produce a so-called episodic memory, i.e. one that refers to a spatio-temporal context that can be apprehended later through the paradigm of the parts. At this stage of an individual's development, only implicit memory can be mobilized. It proves to be independent of the spatio-temporal context and therefore not or badly evocative through the paradigm of the parts.

His meeting with Deborah Dana and Deirdre Fay gave him theoretical elements to go beyond this limit. These two people have indeed developed methodologies to better understand the issue of co-regulation. Co-regulation, if one sticks to the therapeutic relationship, deals with the mechanisms at play in the inter-human relationship and communication. IFS insists on the primacy of the intrapersonal relationship (between the Self of the individual and his own parts) as a therapeutic lever in relation to the intersubjective relationship. However, neuroscience data show that brain organization responds to a hierarchy based on the autonomous nervous system, which is modelled from the first childhood experiences in the relationship with others (the so-called attachment figure).

II - Theoretical foundations

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 to which IFS refers to, applies principles of systems theory developed in the fields of physiology and biology to the psychological life of individuals. It apprehends psychological functioning as the attempt of subsystems (called parts) to return to the internal equilibrium perturbed by the potentially traumatic external situation. This systemic conception is also a way to situate the individual as a system within other larger systems (couple, family, country, society,…) interdependent and interacting with each other.

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

The study of the neuropsychological, but above all neurobiological processes underlying human memory, makes it possible to establish that the traumatic memory that was thought to be indelible is in fact repairable. The brain, through its neuroplasticity capacities, has the means to reconfigure itself in a perennial way by giving up emotions and beliefs that are no longer useful and by replacing them with information that allows it to update itself.

The Polyvagal Theory (PPT) 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 hazardous situations. 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 fine mechanisms and the management of psychological trauma in general and attachment disorders in particular. PPT offers a very efficient conceptual and operational framework, as it allows to decode the body imprints of these traumas and, thanks to the use of neuroplasticity, to promote a stable reconfiguration of the ANS to ensure relational security.

The IR model recognizes, in the work of Bessel van der Kolk synthesized in his book Le corps n’oublie rien (2018),the neurobiological theoretical references on which it is based. Among these is the notion, known in the past and taken up by him, of the importance of considering, from a therapeutic point of view, the fact that the organization of the SN responds to a hierarchy. Numerous authors have referred to it, such as MacLean (MacLean 1972), Panksepp and Perry (Perry, n.d.). This hierarchization has its origin in the phylogenesis of SN, which leads us to consider that the SN of human primates is made up of successive strata. The polyvagal theory accounts for this, which considers the ANS constituted successively during the 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 unique sorting 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 … It is accepted that the oldest phylogenetically (anatomically located in the lower parts of the NS) constitute a kind of foundation on which the most recent structures are based. The conditionings of the lower part of the NS are stronger than the learnings of the more recently developed upper part of the NS. The flow of information in this network of interconnected structures has two directions:

  • This is mainly based on the top-down regulation pathway. (du haut vers le bas)
  • the bottom-up way (du bas vers le haut).

In the early stages of life, the mature structures are the lowest the bottom-up way 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 attack or escape (as do all vertebrate animal species). The SN is intended to return to regulated social functioning once the danger has been removed. Human beings, unlike other animal species (whose SN can return to the regulated state on its own) need, especially in children, external regulation to effect this return to the basic state. 

This regulation, which involves interaction with another human whose SN is regulated, is called co-regulationIt is therefore through co-regulation that the deregulated SN of an individual exposed to a hazard returns to regulation. If the danger persists or if the individual does not find co-regulation, deregulation takes place over time at the cost of adaptations that involve brain regions devoted to emotions and social interactions: development of automatic patterns that condition behavior, based on belief systems, 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 each other. 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) and which could not be restored. These new internal balances (but which remain fundamentally imbalances) most often manifest themselves in the form of psychic states experienced as polarizations or antagonisms.

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

Co-regulation, because it brings into play, as a priority, the oldest structures of the NS (devoted to survival mechanisms), constitutes a key factor in mobilizing the possibilities of the NS to proceed with this association process.

From the perspective of the IR model, it is the peritraumatic dissociation mechanism that accounts for the development of the parts as described in IFS, and their organization in rigid interaction patterns. When it is deep and involved from the period of attachment, it accounts for dissociative personalities according to Ono Van der Hart's theory of structural dissociation (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 constituted by peritraumatic dissociation and not, as represented by the IFS vision, by the detour from the normal functioning of parts that the individual would be endowed with at birth. The IR model, like the IFS model, however, recognizes the modular functioning of the psyche (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 primordial 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 neuronal plasticity, reprogramming 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 the GNP is to heal an organ, the brain, in order to treat the psychic difficulties that the individual encounters. 

The objective of the RI method can be considered both clinically (improvement of symptoms) and neurobiologically. The priority axis 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. It is not a symbolic work, or one 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 information stored within it, but kept (due to the traumatic nature of the individual’s experiences) at a distance from one another.

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 to secondarily apply the adapted 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)
  • either 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. the bottom-up way.

If the dissociation appears to be non-structural (i.e. manifesting itself in the form of parts of which the patient is aware) the therapist brings self-regulation into play. This is mainly based on the top-down regulation pathway.To put it simply, 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, p 293). For Brown et al. the more secure the attachment, the more developed the capacity for metacognition.

The practice of RI is largely based on the use of MC according to a methodology specific to this method. MC used between the therapist and the patient proves to be a very effective tool in situations where co-regulation proves to be 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 at first sight by the patient’s psychic system as well as by his 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, thus developing an indirect co-regulation approach allowing to deal with the initial trauma.

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

This is not a tool so to say, but the result of the implementation of co-regulation in the RI model. Indeed, the recalibration of the ANS and metacognition used in association in the framework of co-regulation, lead the therapist to engage 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 to overcome important difficulties during therapy, linked to structural deregulations of the NS. 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 neurosciences 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 psychotrauma resolutely anchored in neurobiology. It involves an original methodology because of its 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’ need to leave the survival modalities generated by past experiences and to regulate itself with the information of the present.

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

  • BROWN, Daniel P., et 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., et Onno van der Hart. 2011. « Dissociation in Trauma: A New Definition and Comparison with Previous Formulations ». Journal of Trauma & Dissociation 12 (4): 416‑45.
  • https://doi.org/10.1080/15299732.2011.570592.
  • Perry, Bruce D. s. 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, éd. 1995. Internal Family Systems Therapy. New York: The Guilford Press.
  • Schwartz 2019. Système familial intérieur: blessures et guérison. Elsevier Masson.

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