Tony White

Again it is in the press and around for public comment. The issue of recreational and performance enhancing drugs in sport. The mis information being stated by people such as head coaches who obviously should be keeping to their area of expertise is awesome.

Statements to the effect that a football player who takes amphetamines recreationally could also have a performance enhancing effect on the playing field. This is a misunderstanding of what the terms recreational and performance enhancing drugs mean.

It is not the drug that is performance enhancing or recreational, it is why and how the drug is taken that makes it recreational or performance enhancing. It is the goal of taking the drug in the first place.

If an elite footballer is going to take a stimulant like amphetamines to enhance their performance then they are going to have to approach it in a very well planned and meticulous way for there to be any chance of success. They would have to be very careful about what they consume, the amount they consume and the timing of the consumption of the drug. If one is not going to do this then there is no reason to take the drug in the first place.

Once they have done such a thing, they are then going to do all the other things to assist with their performance such as proper sleep, proper diet, not taking any other drugs like alcohol and so on.

If one is going to take amphetamines recreationally then the goal is to get wasted, and the more wasted you get the better. That is the whole point of the exercise in the first place. So what they do is get with their friends for a night out and then go and meet some guy who somebody knows. They give him money and he gives them some powder. They have no idea if the powder is what it is meant to be but they take it anyway.

Now one takes a stimulant because they want to go out and partee. One does not take amphetamines to veg out at home. To do that you would smoke marijuana. So after you snort the powder they go out to some ‘full on’ night spot such as a club of some kind. The amphetamines make you feel indestructible and like you can handle anything. That is why you take it. It also allows you to party for long periods of time with out rest or sleep. So the footballer goes out to a club where there are lots of people and will usually drink alcohol as well and will stay out very late. That is the goal of recreational amphetamine use in the first place.

If someone does that then it is very unlikely that their performance on the football field a day or two later is going to be enhanced at all. In fact it is very likely that it will lead to a significant fall in performance.

It is not the drug that is performance enhancing or recreational. It is how and why the drug is being used that makes it performance enhancing or recreational.

Graffiti

The previous posting on how the therapy relationship ends raised some ideas in the comments. One was by Karen who notes that the ending of counselling is a difficult transition without any guidance. This of course raises the question of how does a client end the counselling relationship, and indeed how the therapist ends it as well. What is the formula for doing such a thing?

Unfortunately such a formula does not exist. There is no clear answer but a whole variety of opinions. Of course each therapy is related to a different theory and thus there are many different definitions on what constitutes psychological ‘cure’. It can be assumed that the point at which one is meant to end therapy is when the client is cured.


There are always different approaches



“Cure” is a very unclear thing or at least a thing on which there is very little agreement throughout the profession of psychotherapy. There are many differing definitions of it.


Something humans continually seek but it often remains quite elusive.



So all I can do is offer my ideas or thoughts on the formula or offer some form of guidance as to what can indeed be a difficult transition from client to non-client.

The first part of the formula for me is the underlying principles on which the relationship between the client and therapist are based. My thoughts are that the relationship is largely obligation free. Or there is one out of four obligations required.

1. The client has no obligation to see a particular therapist
2. The therapist has no obligation to see a particular client
3. A client has no obligation to explain to a therapist why they wish to end therapy.
4. If the client requests it, a therapist has an obligation to explain to the client why they wish to end therapy.


The Pitts. Human relationships and obligation.



In the next step of the formula one must distinguish between two types of counselling. Sometimes people seek counselling with a specific short term goal. In such instances terminating counselling is fairly easy. I recently was visited by a parent and her 12 year old daughter. The daughter was having some difficulty socialising at school. So the counselling was to discuss strategies with the parent on how to deal with the girl in this difficult time. Also to work with the girl on her thoughts and feelings about herself and her peers. To establish a few strategies with the girl to cope better with her peers. I saw them for 5 sessions and she was starting to cope better and so the counselling ended.

Where more of a problem exists is when a client enters into a longer term treatment contract with a therapist, (months or years). When this happens the client is working at a deeper level than the short term therapy solution. Of course when a client sees a counsellor for some time then the client and therapist develop some kind of attachment and bond. As I have mentioned before breaking that bond can be quite difficult especially when the other person has been of some particular emotional significance to you, like a therapist is meant to be for a client.


John Bowlby.
The father of human attachment.



This is where my second part of the formula comes in. People tend to behave in patterns and that means their relationships will tend to have patterns. In their relationships they will have a tendency to do the same thing over and over again. The most important factor in the termination phase of counselling, is that the client does not leave the therapeutic relationship in the same old self defeating relationship patterns that they have.

For example if a client has a history of being rejected they may start to do a few things that will get the therapist angry or tired of them. They may start to not pay the bills, they may consistently keep attacking the therapist personally, they may all of a sudden appear at the therapist’s home one night because they just have to see them then and there. It is up to the therapist to identify and anticipate these relationship game manoeuvres by the client so that the therapeutic relationship does not end up in the same old way for the client.

On the other side the therapist will also form an attachment with the client to some degree. This is usually not a problem if the therapist can manage their attachment so they do not also get ‘locked’ into their own same old self defeating relationship patterns. Sometimes they do get locked in and then the whole process can get complicated indeed.

For example if in the therapist’s background they were undermined and put down by the parents then he/she can have some doubts about self. The therapist’s mother may have told her that she never did well enough at school and her sisters were always better than her at their studies. So with a particular client these feelings and memories start to come up for some reason in the therapist. The therapist may then feel quite threatened if a client starts to make noises about ending counselling. The counsellor may start to unconsciously think, “If this client leaves then mother was right I am no good”.


Perhaps if I do this then mummy will love me and tell me that I am good.



As I said in the previous post any time there is an attachment between two people then there is the potential for considerable difficulties. Attachments are not a easy thing to end for humans no matter what kind of relationship it is.

Some therapists become quite clinical and thus the attachment from the therapist to the client is kept to a minimum. The down side of this is you loose the considerable therapeutic power of the client - therapist relationship. If the therapist is going to allow himself or herself to develop some attachment to the client then one gains the advantages of the therapeutic relationship. However they also need to be aware of their own tendency to get into their old self defeating relationship patterns.

So that is the formula for me.


The terminator
"I'll be back"

Graffiti

Kahless recently wrote a post about ending counselling and how she made a contract that when she decided to do so she would have another last session with her counsellor. An interesting contract and raises the whole area of terminating counselling.

See
http://kahlessnoise.blogspot.com/2007/08/maybe.html


I like how Kahless has given some very good insight into the soul searching that can go on for the clinet who ends counselling. It is very easy for therapists to forget or minimize this.



As I have mentioned before when one employs a counsellor it is different to employing a plumber because you have to take the relationship into account as well. Indeed it is unique when compared to others in the ‘helping’ professions. When one goes to a doctor, surgeon, dentist or physiotherapist the relationship is clear. One goes for a specific goal and when that goal is achieved the relationship ends. Both parties know this from the beginning of the contract between them. Counselling is not like this. Firstly because the goals are usually much less concrete and clear and the relationship between the client and counsellor is just as important (if not more important) than any treatment techniques applied.

As I have mentioned many times recently, ending a relationship (attachment) is not an easy task. It does not matter what that relationship is, be it siblings, spouses, friends and of course client/counsellor. It can be quite difficult for both parties no matter what the relationship is.


The ended relationship



Of course I cannot comment at all on the circumstances for Kahless but I find it an interesting contract that the counsellor suggested to her. So I will comment generically and this of course does not relate specifically at all to her situation as I have no idea what her counsellor’s motives were.

I can not recall ever making such a contract unless it was a “No run” contract. So why would a counsellor suggest such a contract to a client:
Before you terminate counselling you make one last appointment with me.

I can come up with three reasons:

1. Financial. A loss of a client equals a loss of income if it is in private practice. Whilst this could be true I would imagine that this would be an infrequent motive.

2. A “No run” contract. I certainly have used this contract in the past, and it is that the client makes at least one more appointment before ending treatment. The motive behind it is that for some reason you want to lock the client in to this relationship. That maybe to close the escape hatch of running from a relationship when you feel reliance or for some other reason. The counsellor is seeking to increase the clients distress by not allowing them to ‘run’. Or indeed it may heighten a sense of security for the client. There could be a whole range of motives for a therapist to suggest such a contract to a client.

3. Personal. This I would see as the most common cause for such a contract. As I have said before ending a relationship can be difficult and that is no different for a counsellor or anyone else on this planet. It is just hoped that the counsellor has some kind of supervision available to them should a difficult termination arise. I have supervised many trainees and the most common difficulties would be as such.


The termination transaction

Transaction 1 is the overt Adult to Adult transaction that the therapist and client make with the contract to make one more appointment.

In conjunction with this the therapist can also have ulterior, covert and (probably) unconscious motives. (ie The therapist may not even be aware of it).

Transaction 2. The covert Parent to Child transaction: “Explain yourself!”, “Don’t you dare get out of my control!”.
Transaction 3. The covert Child to Child transaction: “Please don’t reject me”, “Show me I am a good counsellor”.


In the human psyche, underneath the surface there are always powerful forces at work and sometimes they sneek up on you and bite hard.



These are some of the more common personal feelings counsellors can have when a client ends treatment. Some of them are fairly normal. If a client says they want to stop, it is not all that odd for a counsellor to question themselves and their abilities particularly for the the trainee counsellor. I remember I could do that in my earlier days but as the years roll on one sees clients come and go for all sorts of reasons. So I don’t take it as personally now but I not uncommonly will reflect on what I did and how I did it and hopefully turn it into a learning experience for my self. I certainly will never stop the peer supervision I get nowadays for this precise reason.


If I just do a really good job then that means I am OK and they will never reject me.



My overall view of this is that a client never has an obligation to see a particular counsellor and a counsellor never has an obligation to see a particular client. If a client simply cancels or just does not turn up and does not say why, I would rarely phone them or seek them out to find why. I know many counsellors who do ring the client in such circumstances, so there are definitely differing views on this. They would say they are doing that to check if the client is OK and to get proper closure for the client and self. Valid reasons one could argue. The problem I have with it is the client has no obligation to give me a reason and it could be pressuring them a bit for some ulterior reason as I mentioned in the termination transaction.

It is also my view that whilst I, as the therapist have no obligation to see a particular client I do have an obligation to offer a current client the opportunity to get my reason should they want it. Over the years this has happened only rarely. I have referred some clients to others over the years in such circumstances. I certainly have come into contact with clients who I personally don’t like. What usually happens I think, is they pick up the ‘lack of connection’ and don’t reschedule with me.

Graffiti

Graffiti

Graffiti

The enmeshed and distancing families.

These can lead to feelings of anxiety and panic



The enmeshed family can also lead to marital problems.

The person may have had a series of failed relationships. Or they may have had a short and abrupt marriage that did not work. When the marriage fails where does the person go? Back to mother and father. They seem to never be able to get a relationship to work so in the end they finally give up.

With an enmeshed family what is mother going to feel when a new woman comes along and 'takes' her son away. It will be met with resistence. Finally the husband will let it slip and say something to his wife like, "I called in at home on the way to the supermarket". 'Home' is where his mother and father live, not where his wife and children are! This of course will anger the wife no end, and that is that. She will repeatedly try and get him to see her and the kids as number one and not his mother. If the enmeshment has been successful then that will never happen and she will either have to leave or accept that she will always be number two.

Graffiti

I have talked a lot about counsellors and counselling in recent times but probably one of the more difficult types of counselling is couples counselling. It is automatically more complicated because there are three people involved rather than the customary two in individual counselling. In individual counselling the motives of the person seeking the counselling can be difficult to ascertain at times but it is obviously more complicated with couples.


Couples come in so many shapes and sizes.



This is not a criticism of the client as many are unaware of what their basic psychological motives are. For instance sometimes at least one party agrees to counselling because then they can later think, “Well I gave counselling a go and it didn’t work so now I have permission to end the marriage”. People may not even be aware of this until two months after counselling ceased. Some times however the counsellor does get the feeling that they are just a piece of furniture in the room that has the temporary function as described.

One of the problems is that not uncommonly by the time the couple get to counselling it is too late. They usually get there after a ‘bad’ patch often a very ‘bad and long’ patch. By that time the psychological scars on the Free Child of each party are deep. This means of course that the Free Child of both parties are some what untrusting of the other and guarded against further damage and ‘cuts’.


Free Child

Very commonly the couple have been side tracked into their issues and the wall of trivia. These are a smoke screen and most commonly comprise of the big 3 as they are known. What is the big 3? Couples can argue or disagree about many, many different things but by far the most common ones are - money, sex and children. How children should be raised, dealt with, punished and so forth. About sex or the lack there of it. Or finally about money and how it should or should not be spent. These are by far the three most common themes in marital disharmony.

These are really all a smoke screen and just form part of the wall of trivia. So what is the wall of trivia?




It is what the couple talk about and thus they actually forget to talk about themselves and each other. These issues form a brick wall between the two Free Child ego states and this stops them communicating. Why would the couple do this? Because not communicating FC to FC is much more emotionally safer and by the time they get to counselling many don’t even want to anyway. When asked most will say that they want to but their actions can certainly say otherwise. Indeed the couples counselling itself can become a very big brick in the wall of trivia. It is a perfect thing to discuss over and over and thus avoid discussing and connecting FC to FC.

I have mentioned before there is a very big difference between loving and liking your partner. The question, “If your weren’t married to him would you actually want to go to the movies or out to dinner with him”. That is, do you actually like him. Does your Free Child want to hang out with him?. If the Free Child interest is lost to a significant degree then that couple is in trouble. One way to deal with the loss of Free Child attraction to your partner is to distract onto other things like the wall of trivia. It allows you to avoid the question because the answer might be too painful to contemplate.


Why would someone make up such an excuse about their homework?

So in couples counselling it is a wise thing for the counsellor to first assess how much the Free Child of each party is involved in this relationship. Sometimes that is not an easy thing to do as the parties may say they do have FC interest when in fact they don’t. Again they are not usually lying to you but are lying to themselves instead and thus the counsellor is inadvertently given the incorrect information. However by the third session it is usually fairly clear when one hears the outcome of the couples ‘homework exercises’. If there is Free Child involvement then the couple will find a way to achieve what they want. If there is not FC involvement (or liking) then they will find all sorts or reasons why this and that could not work or seek to distract onto other issues and the wall of trivia.

There is one other thing of note in couples counselling. In western societies marriage has changed. To some extent it has ceased to be primarily a means to have a family and raise children. Marriage has become far more of a recreational exercise in the minds of many who live in such societies. If the recreation ceases to be enjoyable (FC disappears) then why continue in it. In some(many) instances one can raise children outside the nuclear family structure without significant hardships. Thus we have the reason why couples counsellors need to assess the degree of Free Child in the relationship presenting for counselling.


Sometimes the counsellor feels like they are looking through one of these at the couple who's motives may be less than clear.

Graffiti

Roses says:

I tried to ask if you needed different styles to address the different personalities being addressed hidden within the ego states of a client.
------------------------------

I always find it interesting when counsellors and psychotherapists as a group get together for conferences and the likes. One question that is often asked: “What is your orientation or approach to counselling”. The possible answer is wide and varied from client centred therapy, psychoanalysis, gestalt, transactional analysis, cognitive behavioural therapy and so on endlessly. And even in each of these there are many, many sub approaches.


Gestalt is.



There are often some, maybe many who say that their approach is eclectic. What is that? Well first I looked it up in the dictionary and found

Eclectic - “choosing what seems to be best or most useful from several different sets of ideas or beliefs, rather than following one complete set of ideas or beliefs only”
(It’s always nice to find that the word you have been using for the past 15 years is actually the right word for what it means!!)

So the counsellor who is eclectic does not subscribe to one particular approach but uses bits and pieces from a variety of approaches that he has found useful. For me personally I have always had a difficult with that and have considered it at some length.

In counselling there is an approach called the 3 Ps and they are:
Permission
Protection
Potency

All parents give their children self defeating messages to some degree. Because of their own insecurities they may tell the child that the world is an unsafe place and not to trust anyone. They may model feelings of depression, shame, inferiority and so on. All parents have a very significant influence on a child’s perception of itself, both good and bad.


Parents are embuded with tremendous potency by children



Why is this so? Because in the child’s eyes the parents have tremendous emotional potency. Indeed their entire physical and emotional existence depends on the parents. They define the world for the child.

In the 3Ps approach, as the adult client develops a trust in the counsellor, then the counsellor is given the same type of emotional potency by the client. When the critical point is reached and the client sees the counsellor as more potent than the original parents, then the change can occur. Then the counsellor can give permissions and protection to the client such that they are important, their feelings are OK and so forth. Because the client perceives the counsellor as more potent than the original parents the client will take on the new permissions and give up the old self defeating belief systems.


Will the client trust the counsellor more than she trusted her parents?


The key to all this of course is the ‘potency’ of the counsellor. In this is the question of does the therapist simply adjust their treatment approach to suit the client. With out a doubt in psychotherapy one size does NOT fit all. One has to constantly modify their approach to fit with the particular individual client. One could say that this means the eclectic approach is the way to go.

But there is a problem. One thing a counsellor must not become is a chameleon. If a therapist is able to continually redefine self to fit a particular client at a particular time then I would see that they would lack considerable potency. To me this is the problem with the eclectic approach. If you are a whole variety of things then which one are you?. You end up being none of them. You end up being a bag full of approaches but not really any of them.


Trying to be what we think others want us to be. Does it work?


So what is potency for a counsellor?. Well probably the same as for most other professions. The more the counsellor says I am me and here is me the more potency there is. Potency is a belief in self, a confidence in what you are doing, an ability to see your downside and to work within the confines of that, an acceptance of self.

If this is presented to the client then they will tend to see an emotional potency in the therapist. The eclectic therapist watches the client to see how they are and then modifies self to fit in with that. To my mind this is contrary to the potent therapist. The eclectic therapist does not say “This is me”, they say “I am what you need me to be”.


Weather you like her or hate her she is unashamedly who she is.



Without a doubt I modify what I say and do with each client in each consultation. But I am always going to be me and have my basic approach that fits for me. So in this way it’s not about the client but its about me. This has a downside of course. If the basic ‘me’ does not fit with the clients basic needs then the counselling will at best be mildly successful. The client may have more success with the eclectic therapist.

Graffiti

Well it is big news here in Australia today. The leader of the opposition, the man who is putting himself forward as the alternative leader of this country at next years elections has been exposed. This man, Kevin Rudd, who is so impish in presentation and so nerd like in appearance has reluctantly admitted that a few years ago he went to a very expensive strip club, got very drunk and allegedly felt up a few pole dancers. So there you have it!

However on talk back radio today I heard an interesting comment by one of the announcers. He stated that he did not like strip clubs himself and felt that it exploited the women in them. This is the point that interests me.

Having counselled many people over the years I have come to know the thinking behind some of the men who attend such establishments and the thinking of some of the women who perform in them.


Selling square watermelons, is that exploitation?



The men think they are exploiting the women - “All I have to do is wave a $100 note and then I can make her take her clothes off”. So I am the one in control who is doing the exploiting. I have spoken with many such women who don’t think that way at all. They think - “This man is so primitive in his thinking and urges and so primate like in his behaviour that all I have to do is take my clothes off and I can make him give me $100 of his hard earned money”. She sees herself as exploiting him.


Now here is a true homewrecker!

Is it possible for two humans to relate in such a way that neither party is being exploited and that both parties believe they are exploiting the other?

It seems so.


A matter of perspective?

Graffiti

A non-directive approach is not my natural style I suppose I could say. Although it has its uses with a particular type of client as I mentioned before.

On the other hand I certainly not a ‘teacher’ type of counsellor. So what am I?


Teacher style therapists who just tell clients stuff can end up with clinets who feel like this.

If one is not being non-directive, it is also not a matter of telling the client stuff. Some information is good and can be therapeutic but if it was just a matter of communicating information to the client then they could read that in a book.


One problem with being a directive therapist is, what if you give the wrong directions?

I think it is safe to say that self discovery of information is the most therapeutic. Maybe it is similar to teenagers. You can certainly guide them a lot because they do lots of stuff they are not experienced in. Their confidence outstrips their abilities and knowledge and that can be a dangerous combination. Sometimes worse comes to worse and they die or get badly hurt. Most often that does not happen though.

The process of falling over, grazing the knee, getting up and carrying on is of course the best thing for the teenager in terms of psychological development. Is that the same process of self discovery for the adult client? Maybe, but it is much more than just that and at this point the explanations become voluminous and varied.


From what I have seen with psychological change is it tends to be a step wise process (Thin line) rather than a consistent upward trend (Thicker line) as is shown in the graph. It will seem that at times the therapy is floundering and not much is happening and then all of a sudden there will be a change in how the client views self. This is often associated with a couple of other changes that were not even being discussed.

For example the client may start sleeping better or change thier diet spontaneously and loose some weight, or the sex life might take a change for the better and none of these were even being mentioned. Indeed I have noticed over the years that when one of those steps occur in a female clinet she can sometimes have a major makeover in her hairstyle or presentation at that time. These behavioural spontaneous changes are a very good sign as it does show a significant shift in the persons veiw of self. Of course if one does make such a shift then one would expect a collection of behavioural changes rather than just one solitary one as the human personality is so intertwined.


Why do teenagers change and do new and different stuff? Because they can.

I kind of think of it like a Rubics cube (and wasn’t that Professor Rubic a tormenting son of a bitch). If you are looking at one side and you turn one section so that this side becomes all one colour that seems good, but of course that also changes the colurs on three other sides of the cube at the same time. Human personality is the same. If you change one part then that automatically causes changes in other areas of the personality and thus you can get the unexpected spontaneous changes occuring in counselling. These are the new configurations on the three other faces of the cube.

Graffiti