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Saturday, 31 May 2008
Clients and counseling
Two days ago I ran a training group and we had a grand old time. Lots of good laughing and lots of good learning. I know some of you trainees read this blog so I thought I would comment. One woman who is a very experienced teacher and educator presented on the stages of treatment which was interesting. But I was especially interested on how she presented it. She did it as a sort of group exercise. I am going to pinch that presentation style and use it my self!!
Amidst the various discussions one trainee asked how long had been my longest client and I said 14 years. I thought about it later and that was not actually true. There are two men who I have seen over a period of about 20 years. They have been less consistently seeing me than the woman but there has never been any very long breaks in that 20 year period.
I have seen another man for 11 years and that was some time ago now. A very paranoid man who just seemed to get on well with me. He stopped seeing me about 10 years ago. When christmas day arrived that year there was a knock on my front door at home. So I opened the door and he was standing there. He gave me a christmas card and a small gift. I had a brief chat with him and then he left. I thought about it for some time. Should I say anything about it to him as here was a paranoid ex-client appearing at the front door of my home. However I did not hear from him again so I left it. Then when the next christmas day arrived the same happened and has happened ever since. Some times he comes alone and sometimes he brings one of his sons. Each time he gives me a card, a small gift and we have a short chat. The rest of the year I hear nothing from him.
There was also a woman who I saw for about 7 or 8 years. For a significant period of that time she was seeing me three times a week - Monday, Wednesday and Friday. That is not an easy thing to do (for the therapist) for a number of years. What do you talk about when you see someone that regularly! But we managed and of course it was not the ‘talking’ that was important.
Another interesting development I have noticed in more recent times is my weblog. In pre-blog days a client would come for their one hour appointment and then wait a week for the next appointment. So there was a short contact with the therapist (me) and then a week long break of no contact. However, I know some of my clients read this blog as they tell me they do. This is providing a form of contact that was not possible in pre-blog days.
So the therapeutic relationship with me and some of my clients has been altered due to this weblog as it provides a form of contact. This has been particularly evident with clients who have a strong transference with me and in particular those clients with object constancy problems. That client with an insecure attachment style. This means the person never learnt that the primary attachment figure (originally mother and now it is me) was secure. So when the client moves away from the therapist it is like the therapist disappears and thus they can feel strong anxiety, anger and so forth. These clients can now watch this blog and see me do posts, make comments and so forth. So in one sense the primary attachment figure is “there” for them. So it provides a sense of security in this way. However the therapeutic relationship is changed by this blog and we will have to wait and see what are the long term effects of that change.
The outcome will be?
There was one client about a month ago who expressed some displeasure with me in his session. He stated that I write about my other clients on this blog but have never written about him. Why are they more special to me than he is he complained? So here is an instance of this weblog having an effect on the dynamics of the therapeutic relationship - sibling rivalry in action.
Expressing displeasure
Over time I find I am slowly doing more and more internet counselling and supervision. This is both directly and surreptitiously. Some of it is directly requested by the client or the trainee. In addition to this I know that it is highly likely that he will read this and he will know that it is him I am writing about. So by doing this I am sort of doing a piece of therapy right now. Or at least it will have an effect on our therapeutic relationship. As you can see a whole new area of study is evolving. The use of the weblog as a means of communicating with a client. Or the use of a weblog to do therapy and supervision.
Graffiti
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Friday, 30 May 2008
Change in the adolescent stage of development
Three generations ago some adolescents finished their schooling by age 12 or 13 and then went to work shortly after. They could then be married and starting a family anytime after age 16 and were maintaining themselves economically by age 18 or younger. Nowadays this is far less common.
In this day people turn adolescent around 11 (females) and 12 (males). Girls on average mature 2 years earlier than boys who do not catch up until the last years of adolescence. Adolescence can finish around 18 to 25 years of age, where they become economically and psychologically independent with a regular job and the establishment of a family of their own.
Once upon a time (30 to 40 years ago)
Nowadays
So why has this change occurred?. There seems to be a number of reasons for this.
* First, as a general rule the more educated a society is the longer adolescence will be. If one is receiving schooling then one is not working. If one is not working then one does not have economic independence which is a key feature in finishing adolescence - no longer being financially dependent on others, usually the parents.
Many in the western world do some form of post school education. This means, that if one studies full time they will not be in a position to earn a full income until they are about 22 to 24 years of age. To do this one would have essentially have been at full time ‘school’ from age 6 to age 24. No time to gain realistic financial independence and no time to have been out in the work force and dealing with life that did not involve full time education. Such a person at age 24 will be financially dependent and lack any significant life experience in the work force world. So for these people it could be argued that adolescence is not going to begin to end until the age of 24.
* Marriage is tending to occur later. One does not hear much about weddings occurring with 18 and 19 year olds as they did not so long ago. So in this way people do not have to be ‘grown up’ so early.
* Related to this is child birth occurring later and numbers of children is reducing. This allows people to be more irresponsible in this sense, all they have to do is look after self and not a child.
* As a society we tolerate this period called adolescence more so than in the past. In the city where I live every year there is a week or fortnight called ‘schoolies week’. This is where those who have just completed high school (17/18 year olds) go on vacation as soon as their last examinations end. On this vacation they drink too much alcohol, take drugs and engage in gratuitous sex. Whilst I am sure there are many who do not do such things, this is what is highlighted in the press year in and year out. In general it is tolerated by society and even viewed with amusement by some.
Not only do we as a society tolerate the adolescent but we go as far as to tolerate somewhat deviant and anti-social adolescent behaviour. We let them be this without trying to force them into being adults with the appropriate behaviour at an early age.
* As some societies becomes more affluent they do not need the group of ‘adolescents’ to be working so as to maintain a functioning society. Hence such societies are in a position to be come more educated, and governments like in Australia certainly have policies that promote a more educated society.
Another consequence of some societies becoming richer is that its focus changes. There is less attention on meeting the basic survival needs of food and shelter. This can result in more attention turning to the introspection of ourselves (more self actualising). One of these things can be more of a focus on psychology and human development. More time and money allows a society to do more navel gazing. So the humanities increase in influence and we have psychologists and others being more vocal and influencing thinking in society and in government policy making. So we become more understanding of the adolescent stage of development because it is being studied more and talked about more.
* Life span increases. Over that past 50 to 70 years the average life span has increased by about 20 years. So in this sense there is less of a need to hurry through the developmental stages. As people can now be adults for longer they can then proceed through adolescence at a slower rate.
So it would seem that changes like these in some societies over the past 50 years has resulted in the stage called adolescence becoming longer and longer. Not so much starting all that much earlier but taking much longer to complete.
Graffiti
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Wednesday, 28 May 2008
Popov - Graffiti script.
On September 23rd, 2007 I wrote about my life script and stated:
“One of the ways to understand who you are and why you are, is to look at the heroes, characters or figures that you relate to or identify with. This can be movie stars, singers, dancers or just characters from film, TV or the media.
When I did this exercise a long time ago I instantly came up with 3 characters.
Snorky the elephant from the Banana Splits
Eeyore from Winnie the Pooh
Marvin the martian”
(end quote)
Then later on I mentioned my admiration at the world famous mime artist Marcel Marceau who recently passed away.
I noted that one common theme of all this is that none of them speak and possibly the depressive like qualities of Eeyore.
In recent times I have come across Oleg Popov. Here is Popov in action
Thank the lord for Wikipedia! They have this to say on this very fine artist:
“Oleg Konstantinovich Popov (Russian) is an extremely famous Russian clown and circus artist. Popov is also called the "Sunshine clown".
He was born on July 31, 1930 in Moscow as the son of a clock-maker. He has studied elements of acrobatia, juggling and other circus skills in his youth. In 1949 he finished the Russian circus school in Moscow and started his career in the Moscow Circus on Tsvetnoy Boulevard. Six years later, he became the first clown from the Union of Soviet Socialist Republics to perform in the Western world. In 1969 he was honored with the title of the "People's Artist of the USSR". Popov's fame extended to Melbourne Australia where he was named King of Moomba (1971)”
(End quote)
Many years ago the Russian circus came to Australia and my mother took me to see it. I was absolutely captivated by Popov the clown and this is at the age of about 10 years. For many years I craved to be like Popov the clown and study at the Russian circus school in Moscow. I remember even at one stage, my want was so strong that my mother investigated how an Australian could go and study at clown school in Moscow. Alas it never came to be.
However here we have again another script figure who does not speak! Well they do not speak with words and yet they say so much.
Visual. No words, but says so much.
Like Marcel Marceau, Popov the clown is a performer. Maybe that is what a psychotherapist can be? I do know that I have some narcissistic qualities as I am sure they do as well. Perhaps this allows me to maintain the narcissistic gap that so many psychotherapists require?
Graffiti
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Sunday, 25 May 2008
Human attachment and marriage
In the previous post I mentioned that John Bowlby discovered this thing called human attachment. This begs the question - why is it there? Why does attachment exist in human relationships.
An attachment is a sense connection to another person. It is a merging of boundaries where one person’s identity and the other person’s identity are connected. The line or boundary between the two people is fused or unclear. When an attachment exists between two people they have a strong urge to seek each other out and to spend time with them. So why would this thing exist in the first place.
When one fall in love one looses a sense of boundary.
There are probably a number of answers to this question and I will look at it from an evolutionary perspective. Every society has the same problem. It has to create a structure by which a male and a female can get together and conceive a child. In my society this is most commonly done with either a marriage or a defacto relationship.
Every society then has another problem. It has to create a structure whereby that new born child can survive and grow into an adult so it can then also reproduce the species. In my society that is most commonly done by the nuclear family unit. A mother, a father and the children. Sometimes there may also be grandparents or others in the family unit but this is the most common structure in which a dependent child is raised. Obviously if a society can’t solve either of these problems then it is not going to be a society for much longer.
When a woman becomes pregnant the society and that woman have a problem. In about 7 months she and the child are going to need a fair bit of help for a number of years in order for the child to survive.
Remember we are talking evolution here. So like 500 years ago there was no single parents pension or health care systems and so forth. The problem is that the father of the child can simply walk away. If that happens then the likelihood of the child not surviving increases.
So what does evolution do? It creates this thing called attachment. What is one of the core features of human attachment? When a person forms an attachment to another, then it has a strong, indeed very strong urge to seek out and maintain a geographical proximity to that person. If the father of the child has an attachment to the mother then he has a strong urge to keep geographically near her. After the child is born if the father develops an attachment to the child then he has the same desire to keep geographically close to the child. If the father stays geographically close then the likelihood of the child surviving significantly increases. Of course after the birth the same applies for the mother.
So if the society can keep mother and father together then the child is far more likely to survive and thus the society survives. It is estimated that when a person reaches the age of 10 to 15 years then they are probably physically and psychologically capable of surviving by them self. If they are forced to look after self at age 14 then they might be quite neurotic in adulthood but they will be able to survive to reproduce the species.
In western society the divorce rate usually hovers around the 50% mark. Of the 50% who aren’t divorced probably half of them should be. But they stay together for financial or other reasons. Societies usually tell a man and a woman who marry that it is meant to be for life or the next 50 years. The problem is that half of them don’t and perhaps another 25% don’t want to be married but are for practical or moral reasons.
The explanation we are usually given for this is faulty child rearing practices, poor education on relationships and society makes it too easy to divorce and so forth.
There is another explanation that I propose in my serial monogamy model. I am somewhat reluctant to state this. Since I first presented it in August 2001 I have found that I need to have my battle fatigues on when I ever I publicly present it again. I have had conference a participant stand up, shout at me and walk out of the presentation on it. I have received hate mail related to my article on the serial monogamy model. There is a group of people who very much do not like the concept. And to KazzaB, if you are ever doing an assignment on human attachment it might be wise not to include this, as you might be given an “F”. This is certainly not mainstream thought on human attachment.
Earning a living
Perhaps an attachment between a male and female breeding couple is finite. After about 10 to 15 years it runs its course. From an evolutionary perspective it make sense for a couple to breed, raise the child together for 15 years and then breed again in a new couple.
In western society, for at least 50% of the population the attachment does precisely that. It ends. All I am doing here is providing an explanation for something that is happening right now. Just because it is unpalatable does not make it untrue, despite governments and particularly religions wanting human attachment in a marriage to not be seen as finite.
Original serial monogamy article:
http://www.ynot1.com.au/magazines/TAT%20serial%20monogamy%20[v6.0]%20(WP).pdf
Graffiti
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Saturday, 24 May 2008
Isolated attachment
In the 1950s the WHO (no not the rock band!) commissioned a guy called John Bowlby to look into the area of human attachment. People were noticing particularly after WWII with a lot of orphaned children that many of these kids raised in orphanages were coming out as damaged individuals. They were being fed and housed but they were still being “screwed up” psychologically. So they wanted to know why.
He took on this research and produced many documents with the 2 most famous being a book titled “Attachment” and a subsequent one called “Separation” (surprisingly enough). He has since become one of the most influential thinkers in the psychological literature in the past 50 years. His works have had a tremendous influence in the area of human attachment and child rearing practices.
He and his compatriots did lots of experiments like putting a mother and a young child into a room full of toys and then simply observed the movements of the child. The mother would stay stationary in a chair and then what would the child do?. What the child did varied on how secure it was in its attachment with the mother. For instance a child with an insecure attachment may never leave mother’s side even to go and look at some interesting toys even if it was really bored. (This child is seen as having separation anxiety). Then there was others with insecure attachments who would simply move away from mother to play with the toys and never return to her for long periods of time. (This is common in the development of the antisocial personality).
Those kids with a secure attachment would at first stay near to mother and then slowly move out to the toys. The child would regularly look back to see where mother was and go and ‘touch home base’ every now and then. This child is developing what is known as object constancy. He is learning that mother (the object) is constant and does not disappear when he moves away from her. Thus he is secure in his attachments.
Baptism - another human attachment style?
However one of the key findings of Bowlby was that when a child develops an attachment then it will seek to maintain a geographical proximity to mother and this is one of the central features of human attachment. When two people attach they will have a very strong drive to be together and to maintain contact.
Of course this has a corollary. If two people have an attachment and they slowly drift apart and spend less and less time together then the attachment will diminish in intensity. It slowly fades away. The husband and wife who progressively live more and more separate lives can finally separate without the intense grief or bereavement because they have spent the last 10 years detaching anyway.
At the week long workshop I attended about a month ago attachment styles were discussed at length and there was a mention of the isolated attachment style. I found this an interesting concept because it is an oxymoron or a contradiction. If one is isolated then they are not attached, or if one is attached then they are not isolated, so how can you have an isolated attachment.
If you see one of your primary attachments disintegrating then you can do things quite out of character.
It was explained as that attachment style like when a husband and wife live apart for long periods of time. Such as when the man works away from home and they maintain an attachment as such. The other example is when two bloggers meet in the blogosphere and develop a ‘relationship’ or attachment, having never met each other and it is highly likely they will never meet. How can these two people have an attachment when one of the most basic ‘conditions’ of an attachment is that they maintain a geographical proximity to each other. An attachment is when there is a very strong urge to be in each others company face to face. Contact by phone or email can maintain the attachment to some degree but over time there will still be the inevitable deterioration of the initial attachment regardless.
With subsequent thought I think the term and concept of isolated attachment is a misnomer. It does not exist. People mistake it for something else.
One only needs to ‘surf’ the blogosphere for a short space of time to discover that there are many who state that their blogger friends are very important to them. They talk about having strong feelings for each other and how important they are to them. Obviously something is going on. But what is it? Is it such a thing as an isolated attachment?
I would answer - no - as there is no urge to be physically close to the other. What has happened is two people have had strong emotional reactions to each other and find the other appealing and thus want to communicate with them. That is not a human attachment in the usual sense of the word.
Can these two people be in the relational?
To call it an attachment changes the definition of the term and I would suggest that it is better to keep to the original definition and call blogger bonding something else. So it is not seen as an attachment style. Thus you can not have the concept of isolated attachment. How about simply using the term, “distance relationship”. It can be defined as two people having strong feeling reactions to the other, they find each other attractive or appealing but there is no attachment in the psychological sense of the word.
Graffiti
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Friday, 23 May 2008
Vine swingers
Roses wants to know what happened at the all day training workshop last weekend. Well lots of things happened. One was that I did a presentation on different attachment styles. I got the participants to do a questionnaire to see what attachment style they used in their relationships. Afterwards most were silent and did not want to report what they got to the group. That is always a good sign that the exercise worked.
The other thing that I did was talk about the vine swinger. That person who is the tarzan of human relationships. They grab hold of the next relationship before they have let go of the last one just like tarzan did as he swung through the jungle from vine to vine. Why would they do such a thing? There are a number of reasons and one is shown in the diagram below.
The wife in the second diagram has a very big problem. She has a strong attachment to a person who is now deceased. Never underestimate the importance of human attachment. If one perceives such an attachment to be breaking down then that can make people do very strange things even to the point of murder and suicide.
The wife is about to suffer considerable pain. It is called grief or bereavement which can last for many months. If she does her bereavement well then she will finally get to the place of the last diagram. Because it is so painful then people will do all sorts of things to avoid it and one of those things is to become a vine swinger.
Some people find this a very difficult place to be in. Alone.
Hubby is now dead so she quickly grabs onto another one. Some times called the rebound relationship. And it works. It does lessen the pain of bereavement. The new person and the new relationship does take away some of the pain of grief about Hubby.
The downside of this is that it disrupts the grief process and thus she does not get to the third diagram. This can then result in:
1. The person stops living in the here and now. They are living in the past
2. The child part of them is thinking magically in that it believes at least partly that the person is still with us and they will behave at some level like the person is.
3. The attachment is not freed up so subsequent relationships are disrupted by that.
Unfortunately the old adage applies in such scenarios. Short term pain for long term gain. Have the pain of bereavement and thus the gain is less affected relationships in the future. Alas the vine swinger ends up with short term gain but long term pain.
One way people can formalize human attachment.
I might do more on the vine swinger in another post.
Graffiti
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Saturday, 17 May 2008
Binge drinking - Part 4
Kahless apparently was in good spirits last night enjoying a Bacardi or two.
But as the quotes below show if she drank 4 or more nips of Bacardi then according to her government she is drinking at dangerous levels.
The last quote is interesting and perhaps the Swedish government is the only one that is being a little bit realistic about what the term “Binge drinking” means and is not treating its constituents like they are morons as the Australian, UK & US governments do.
---------------------------------
A standard drink is defined as one that contains 10 grams of pure alcohol:
• One can (375mL) low-alcohol beer.
• One pot (285mL) regular beer.
• Three-quarters of a stubby (375mL) of regular beer.
• One glass of mixed drink (30mL spirits + mixer).
• One nip (30mL) of spirit or liqueur.
• 100mL (small glass) table wine.
• Three-quarters of a bottle (330mL) of alcoholic soda.
There is no internationally agreed definition of binge drinking, but in the UK, drinking surveys normally define binge drinkers as men consuming at least eight, and women at least six standard units of alcohol in a single day, that is, double the maximum recommended ‘safe limit’ for men and women respectively.
--------------------------------
One of the commonly used thresholds for binge drinking is five or more drinks for men and four or more for women per occasion. This is often reduced to ‘five or more drinks’, regardless of gender and obtains in many international reports and studies.
---------------------------------
Recommended limits for Guys
• No more than four standard drinks a day on average, with an occasional maximum of six standard drinks.
• One or two alcohol-free days a week.
Recommended limits for Girls
• No more than two standard drinks a day on average, with an occasional maximum of four standard drinks.
• One or two alcohol-free days a week
--------------------------------------
The epidemiological research literature shows a broad range of definitions of binge drinking.
4+ drinks per occasion for women / 5+ drinks per occasion for men (US)
5+ drinks per occasion on at least one in last 30 days (US)
Blood alcohol concentration raised to 0.08g/ml or above (US/ NIAAA)
1/2 bottle of spirits or 2 bottles of wine on the same occasion (Sweden)
6+ bottles of beer per session (Finland)
8 drinks within the same day (Canada)
----------------------------------------
Kenoath makes a very good point in his comment in part 3 of the binge drinking saga. He states:
“Seeing as though the health dept have hijacked the word "binge" for their purposes it makes sense to coin another phrase that suits.
Wasted Drinking perhaps? Why don't we all go and get Wasted tonight? Wasted Drinking sounds good. I can just imagine the headlines now. "Teenagers run amok and get wasted on several jugs of beer." "Wasted Drinking is becoming a problem in our society".
(End quote)
I agree with him that with these new definitions of the term “Binge drinking” it has now become a meaningless term. It is a bit like the term ADD. That used to be a realistic diagnostic psychological state. These days any unruly child is diagnosed as ADD and probably put on dexamphetamines. So what the term ADD originally meant was lost long ago.
So Kenoath’s suggestion of seeking a new term to mean what real binge drinking once was seems like a fruitful exercise. “Wasted” seems good. Lets see what Michael Hutchence has to say about it
Although Micheal did have excesses in other areas. Him and little demur Kylie Minogue used to really push the envelope it seems, with somewhat unfortunate consequences in the end!!
Graffiti
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Thursday, 15 May 2008
Binge drinking - part 3
Here is a picture of me binge drinking.
I am the third on the left. Looking right at the camera (of course!) with the black hair and ciggie and beer in hand. There are some really good friends in that picture, it gets me all a bit nostalgic.
This is a very Australian scene. It is in what is called a "Beer Garden". There are not many beer gardens left these days. In those days a hotel or "Pub" would have a grassed, garden area out the back. People could drink out there instead of inside the pub. On a Saturday afternoon in the summer time it was grand indeed to get out in the beer garden with your friends and do some solid binge drinking.
Notice all the 'jugs' on the table. You would buy a jug of beer and then people would pour the beer into their glass to drink. It was the sociable thing to do instead of buying just yourself a beer. There are two girls in this picture but it is male dominated and this would also be typical really. The girls tended to come more out at night time and would drink less than the males typically.
That bush behind is actually a grape vine. On occasion after some good old binge drinking had been done someone would decide to throw a grape at someone else. In a short space of time all out war would break out and a grape throwing fight would ensue with much vigor.
Really good days and great times indeed.
Graffiti
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Binge drinking - part 2
Roses says
When i want to get drunk or make the world bend my way for a bit, i just get a bottle of clear alcoholic liquid and drink it straight. Well sometimes i'd add an ice block to it so it's cooler than room temp. It tastes really bad and it feels really bad but it makes the world bend(1) for a bit. But then straight after for the next few hours i'd drink water and lots of it. Basically, hang overs are yucky. I just had to rehydrate my brain again so as to not get one - a hang over that is.
I consider that to be binge drinking. It's the intention, not the amount that is consumed.
----------------
I think you make a good point Roses, about the intent rather than the volume and I have actually seen that written elsewhere. That binge drinking is defined when the intent of the person is to drink to get drunk.
This raises an interesting point in itself.
If a someone drinks to get drunk what is wrong with that? Of course this is an assumption that underlies the vast majority of government policy on drugs in society.
It is automatically assumed that if a person smokes marijuana then they are somehow ‘sick’. It is assumed that they have some psychological problem and are thus sent to counselling to correct that problem.
Similarly if some one drinks to get drunk then it is also assumed that they have some psychological problem.
There is no doubt that some people takes drugs to self medicate and so forth. Thus there is an ‘underlying’ problem with these people. The vast majority don’t and use drugs recreationally as they say.
So if a young woman drinks a bottle of wine to get drunk in the company of her friends she is defined as a binge drinker. Is that a problem? Does she have a problem?
Again the government and the AMA will tell her she has a problem. But one can argue that she does not. If she wants to get drunk and have a hang over, so be it. If she sees it as OK then again she will see mass media anti drug campaigns will have little effect with her.
Graffiti
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Wednesday, 14 May 2008
Binge drinking in Australia.
There was a good article in the West Australian newspaper today (May 14th) by Tony Rutherford. He was discussing lifestyle campaigns. He states, “No day passes without there being either a new health scare or a new measure announced to improve our health or make our lifestyle healthier”. Then he goes on to mention the threat to health now reported about the binge drinking of young women in Australia. Many are asking why has the binge drinking in this group increased?
Why do they do it?
Recently released papers by the Australian Psychological Society (APS) on substance use and the 2007 National Drug Strategy Household Survey repeatedly mention terms such as “High risk drinking” and “Binge drinking”.
I have surveyed these documents in order to find out actually what is high risk drinking and binge drinking. The first thing I discovered was that this is no easy task. To find the definitions of such terms is difficult. I surveyed these documents and could not find a definition for these terms. I even contacted one of the authors of the 2007 National Drug Strategy Household Survey to ask him. He referred me back to a particular place on the website where I could find it. So I went back and had another look and I could still not find it!!
Of course after this frustrating exercise one begins to wonder why they are so hard to find? Why aren’t the definitions clearly and openly displayed for all to see? It does make one wonder about such things. Do they have something to hide?
However I have persevered and I have actually found some information on what these terms actually mean.
For instance I found - “While these guidelines equivocate on the definition of binge drinking, they imply that binge drinking occurs at five drinks or more for men; three or more for women. This definition obtains in almost all subsequent Australian studies.“
So if a woman has three standard drinks in a night then she is binge drinking or drinking alcohol at a high risk level. So lets work out what that means.
In your average bottle of wine in Australia (750 ml) there are 8 standard drinks. So binge drinking is 3/8 of a bottle of your usual wine. That amounts to 3 small glasses of wine in one session.
OK. So the 20 year old woman is going on a night out with her girl friends. The usual girls night out and she sets out to do the right thing with her drinking. She gets to the night spots at about 8pm and is due to be home by about 1am. A common scenario I think you would agree.
So at 8pm she gets a small glass of wine and drinks it in about 15 minutes. She then waits one and a half hours before she gets another one. She may even have a soft drink or water in between. She buys her second small glass of wine at 10pm and drinks it as well. Two hours later at midnight she buys her third small glass of wine. And then she goes home.
She is then informed by the government and the Australian health authorities and the Australian Medical Association that last night she went binge drinking and drank alcohol at a high risk level.
What is she going to think about all that? Just because the government and the health authorities tell us what unhealthy drinking is, does not mean that it is. They are treating the general public like they are stupid and that they just expect to be believed. People will not just accept such information. They will go out and make their own observations.
That young woman will think that the advice she was given about binge drinking is absurd and a nonsense, which indeed it is. Drinking at that rate she would hardly even feel the effects of the alcohol. She certainly would not have a hang over the next day. She will think, how can I go on a drinking binge on a big girls night out and have very little if any hangover the next day?
She will conclude that she is being lied to. She will conclude that the dangers of binge drinking are grossly exaggerated, as indeed they are. No wonder so many young women are now binge drinking. The health department has just redefined what it is, so it now includes more young women.
Can you believe the Lard Information Council?
Of course this has been going on for decades and I would suggest that the public mostly accept that health warnings are by and large exaggerated and thus they are dismissed by most people.
This quote comes from the Editorial of the “Medical Journal of Australia”, 2007, by A. Jorm and D. Lubman.
“Mass media campaigns in other areas of health have typically had very little
effect, including when drug misuse prevention has been the goal. In many cases,
the weak effect has been due to campaigns being insufficient in intensity.“
Perhaps the real reason why such mass media campaigns have little impact is because the public see that they are being treated like they are stupid and thus they will go out and make their own observations. And usually they will decide that the dangers are exaggerated as mostly they are.
Graffiti
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Monday, 12 May 2008
Prohibition history in the making
Last week the Australian Psychological Society (APS) release its various position statements on substance use in Australia. Being a member of that organisation I got a copy posted to me. These position statements are serious business that the APS looks at very carefully and they put a lot of work into them. The areas are researched in great detail.
Here is a few paragraphs from these substantive documents:
----------------------------
“In Australian history, laws regarding the legality or illegality of certain drugs have been politically driven, and had little to do with the level of use or possible harms that the substances themselves might cause. For example, the restriction of opium began in Queensland in 1897, with the Aboriginal Protection and Sale of
Opium Act (see Berkhout & Robinson, 1999). This Act made it unlawful for doctors, chemists and wholesale druggists to possess or supply opium, but only if it was intended for sale to Aboriginal peoples”. (Page 3)
“Importantly, prohibitionist and ‘drug war’ approaches have been shown,
historically, to have little impact on levels of substance use, and even less impact on the level of harm associated with substance use. The small gains that law and order campaigns and prohibition approaches have achieved have not been lasting (Lang, 2004). While effective prohibitions have resulted in temporary decreases in the use of targeted substances, other consequences of prohibition have negated this impact. These other consequences include: supply sources finding other destinations for their trade; supply sources eventually developing new supply routes into the original destination; and other substances filling the gap in supply.
Consequently, little reduction is achieved in the level of overall usage. Increased
money spent on supply reduction, through criminal justice and customs, has generally paralleled increased, rather than decreased, consumption of an ever- greater variety of substances, both licit and illicit. This does not mean that these approaches do not have their place, but rather that they cannot be the sole basis of substance use regulation”. (Page 4)
(End quote)
----------------------
Holley Molley
This as I said is from the APS, one of the peak bodies in Australia charged with guiding government on the psychological health of all Australian’s.
Back on October 27th, 2007 I wrote a post with this
The West Australian newspaper reported it today. This is extraordinary news!!! Fitzroy Crossing, a very remote town in northern Australia has a very bad history of alcoholism and domestic violence particularly amongst its aboriginal inhabitants. News laws, only a few months old now only allow for the sale of low strength beer in this very isolated town. Carl O’Callaghan reports that in the past few months there has been a 30 percent drop in domestic violence and many families and children have been able to enjoy a full nights sleep for the first time in years. This is due to the alcohol prohibition.
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Oh well. Either Fitzroy Crossing is going to end up worse off than it was before the prohibition was commenced or it will be an extraordinary social achievement in the entire history of Australia. I wonder which one it will be?
Graffiti
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Sunday, 11 May 2008
You said it
The most powerful word in the English language.
And one of the most useful words for counsellor and client.
Click on the picture so you get to my Flickr and then click on "all sizes" and you will see the large size. One of my better photographs I find.
Graffiti
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Chairs and counselling
This is my consulting room where I provide wise counsel
I sit in the floral chair on the right and the client usually sits in the one on the left. Sometimes clients pick other chairs and I adjust my sitting position accordingly at least temporarily.
Here is a picture of me providing wise counsel. Notice how empathetic I am and how attuned I am to the client at this point.
Here is a picture of me using humour in the counselling process. I am telling the one about the dyslexic guy who walked into a bra.
This is a picture taken from behind the counsellors chair and looking towards the chair that the client would usually be sitting in.
Notice how the chairs are not actually facing each other but are sitting in parallel. This provides for the narcissistic gap that counsellors require when conuselling over long periods of time
Graffiti
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WARNING, WARNING!!
Stay indoors!!
Do not leaves your homes!!
I just went out to get some supplies from my local supermarket. It is in a area where there is a plethora of cafes, coffee shops and restaurants.
I have never seen so many mothers and their corresponding offspring in one place at one time. It was soooo crowed with buskers, hawkers and the lot. It was packed.
What every one of those people want from their mother
Say you love me.
Those simple words that can give a mother so much power and/or so much angst.
Graffiti
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If the world had only 100 people
57 would be Asian.
21 would be European.
14 would be from the Western Hemisphere.
8 would be African.
52 would be female.
48 would be male.
70 would be nonwhite.
30 would be white.
70 would be non-Christian.
30 would be Christian.
89 would be heterosexual.
11 would be homosexual.
6 people would possess 59 percent of the entire world's wealth, and all
6 would be from the United States.
80 would live in substandard housing.
70 would be unable to read.
50 would suffer from malnutrition.
1 would be near death.
1 would be pregnant.
1 would have a college education.
1 would own a computer
This maybe a bit unfair on the US as Rupert Murdoch maybe one of the six and he became a US citizen for money reasons. Perhaps others have as well.
Graffiti
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Happy mother's day
I should write a post on mothers. As a psychotherapist you see them get a terrible onslaught in the counselling room. I do feel for them at times. The vast majority are just trying to do their best.
I should do a post on the Parent Interview technique. I always like doing those and that would help out mothers on this day of days.
Graffiti
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Friday, 09 May 2008
Juxtaposition of psychotherapy
This post is a work in progress and will evolve over a period of time.
In the workshop last Tuesday where we discussed aspects of the week long workshop of a few weeks ago (if that makes any sense) we covered the juxtaposition of psychotherapy which is:
When you give the client what they want, then they hurt.
The quote below is from:
“The paradoxical theory of change”, A.R. Beisser. In Gestalt Therapy Now. 1970. (eds.) Fagan, J. & Shepherd, I. L. Penguin Books: Victoria.
“...change occurs when one becomes what he is, not when he tries to become what he is not. Change does not take place through a coercive attempt by the individual or by another person to change him, but it does take place if one takes the time and effort to be what he is - to be fully invested in his current positions. By rejecting the role of change agent, we make meaningful and orderly change possible.
The Gestalt therapist rejects the role of ‘changer’, for his strategy is to encourage, even insist, that the patient be where he is and what he is. He believes change does not take place by ‘trying’, coercion, or persuasion, or by insight, interpretation. or any other such means. Rather, change can occur when the patient abandons, at least for the moment, what he would like to become and attempts to be who he is.” (P88)
This is what I like about the pro-ana movement as they are doing precisely this. These girls and young women have for decades been bombarded with huge volumes of medical and psychological information which relentlessly tells them how sick, maladjusted, deviant and attention seeking they are. The media also regularly tells the world that these people are sickos. Finally some stand up and say, I do starve myself and that is my choice and I am OK. I accept that part of me.
My Lebanese friend and fellow blogger Nikita once wrote on her blog:
“Most women set out to try to change a man,
and when they have changed him they do not like him”.
Marlene Dietrich
Then I wrote:
Not only do I like Marlene Dietrich, I like the meaning of the comment. I would even take out the gender distinction and then it becomes my quote!
Most people set out to try and change others,
and when they have changed them they do not like them.
From what I have seen of life it is so true. The best thing that a psychotherapist can ever hear from a client is the statement:
“I am comfortable being who I am”.
This is not a person who has it altogether and has discarded all neuroses. This is the person who has accepted who they are. The good bits and the other bits that others don’t like. (Such as one’s neuroses.)
This is where the second part of the quote comes in. From what I have seen if you can resist the pressure to be something other than what you are, then you become more ‘complete’ or just comfortable with self. Then you usually become more appealing to others. That is - the more people will like you if you stop changing to the wants of other people.
If that makes sense.
But
Not an easy thing to do. To accept the parts of yourself which you find repulsive or 'bad' can be a very difficult thing to do. To accept those parts that you have spent 20 years hiding from is by no means an easy task.
Graffiti
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Thursday, 08 May 2008
Permission and action
Parents give children permissions when they are growing up. When a permission is given the child gets the message that it is OK or they are permitted to do such behaviours.
There are 4 different levels of permission giving that parents can do to children
1. Doing nothing
2. Verbal permission giving
3. Directly observing the parents doing the behaviour
4. Parents doing the behaviour in the relationship with the child
Take the behaviour of giving encouragement or positive strokes.
1. The parents never give encouragement or make statements to the child about giving encouragement to others. A child from this background is getting the least permission to give encouragement so that in adulthood this person is the least likely to give positive strokes to others.
2. The parents tell the child that giving positive strokes is the good and right thing to do. This is a mild permission so it might occur sometimes when the person grows into an adult.
3. The child directly observes mother giving encouragement to others. This is a strong permission and the person is likely to do similar behaviour when they grow up.
When humans observe others doing something that is an instant permission to do so oneself
4. The mother directly gives the child encouragement. This is the strongest type of permission as the behaviour of giving encouragement is brought directly into the relationship between the mother and child. This is the strongest type of permission that a parent can give to a child and it is quite likely that as an adult this person in some way will do the same behaviour.
So if a parent is wanting a child to exhibit certain behaviours in adulthood, the more they give the stronger types of permissions the more it is likely to rub off on the child. Of course the same applies for feelings an attitudes as well. For instance racist attitudes and emotions such as depression or anxiety can be giving with varying degrees of permission.
Also the same applies with drug use. The parent who says to a child “Don’t take drugs” is giving a level 2 permission. If the child then sees first hand the parents drinking alcohol and taking tranquillisers then they are giving a level 3 permission to take drugs.
When I worked in a prison I was always in two minds about children visiting their fathers’ in prison. Such visits were great for the inmates psychological state and of course allowed the father and child to have an ongoing relationship whilst he was incarcerated. The problem is that it also normalised prison in the child’s mind and gave a level 3 and 4 type permission about going to prison.
This mother is giving a strong permission for her children to grow up and enjoy life.
Then there is the contentious area of hitting.
1. The child hears and sees nothing about one person hitting another. No permission to hit is being given.
2. The father advises his son that hitting people on the sporting field is OK and that one has to stand up for himself in the playground and punch others at times. A mild level of permission is being given.
3. The child sees father getting involved in physical fights with others. The child sees father hit mother. A strong permission to hit.
4. The child is hit directly by mother or father. The strongest permission to hit is given as it is directly in the relational of the child with the parent.
Please note that I have said here that the child is being given permission to hit. I have not said the child is being given permission to hit others. The person who was hit many times by their parents is probably less likely to hit others than those who were not, because being hit usually lowers the self esteem as raises the self contempt.
But hitting is in the psyche of the person. They will however tend to display that permission to hit in one of two ways. The first is that there will tend to be a pattern where they get involved in relationships with others who do hit. The girl who was physically abused by father, will marry a man who does the same. The woman whose parents never mentioned or showed hitting is far less likely to marry such a man as she has much less permission to do so.
She may not even be hit herself. I recall a client who was a small, timid and quiet type of woman. She was hit many times by mother throughout childhood. When she reached adolescence she became a skin head and reported seeing many quite severe beatings by others in the gang. She was never actually hit herself but she got herself involved in a violent subculture where there was a lot of hitting. Of course she did, because she had been given the strongest permission with regards to hitting.
The other thing that a person with a strong permission to hit can do is actually hit out, but they don’t hit others they hit them self. If they have a low self image then they are more likely to do this than hit others. The hitting can take the form of actually physical self harming, or more commonly such people have a very large and active internal critic sitting in the back of their head. At the slightest transgression the internal critic will launch into an angry tirade at the individual and verbally hit self in the most viscous of ways.
Most parents would wish that the levels of permission giving were in fact the opposite way around so that, “Do as I say, not as I do” was the rule of law in child development. Alas it is not. One of the most sobering things for a parent to do is to eaves drop on the children when they are playing with friends in the backyard. It can be an eye opener indeed!!
This post will be followed by another one on the paradoxical nature of change that came up in the Erskine workshop a few weeks ago.
Graffiti
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Wednesday, 07 May 2008
It shouldn’t be working but it is
I have been counselling a female client for about 6 weeks. From the moment I first met her I did not like her much and I still feel the same about her. It’s not a really big dislike such that I can not be in the same room as her but she is just not my kind of person. I have never suggested that she make another appointment to see me but at the end of each session she asks and I have agreed. If she didn’t ask for another appointment I would feel glad. When I look at my client list for the day and see her name I am certainly not uplifted at the prospect of meeting with her.
I find her to have a ‘sleazy’ quality. I didn’t know women could be sleazy but that is the feeling I get. She has quite bitchy relationships with her female friends. Whilst she reports being unfairly on the receiving end of their bitchiness I am quite sure that she gives out as good as she gets in that department. She has a nasty quality about her. I don’t mind people who are angry but when the anger gets nasty and they go out of their way to actively besmirch the character of a another person I don’t like that. She can also be a bully and whilst she is not abusive to her 10 year old son he will be in counselling in 20 years time for sure.
I don’t believe half of the things she tells me and the following a is typical example. Last week she asked for an appointment on Tuesday, but there were no places available so she took a time on Wednesday. Come Tuesday morning I get a phone call from her and the following conversation takes place:
Client: I was just wanting to confirm what my time is today.
Me: You don’t have an appointment for today, its tomorrow.
Client: Oh! I didn’t realise that. (Bit of silence) What time is it tomorrow?
Me: 2pm
Client: Oh! (Bit of silence) Do you have any times free today?
Me: No I don’t
Client: See you tomorrow then.
She lies. I don’t believe for a moment that she got the days wrong. She didn’t like the fact that I did not rearrange my schedule to fit in with her or make an extra appointment at the end of the day, so she tried it on this way.
So that is the deal. Not my kind of person. However, I don’t dislike her that much so as to never see her again. My chosen profession is as a counsellor so I see her and make a buck to support my kids and myself. In my mind it is a business transaction.
How some people hide.
However, over the six sessions she has done very good work, better than most. Her childhood was far from good and she really has taken on her demons with a strength of character that you don’t usually see. Her Child ego state is quite excluded and her main method of survival was to emotionally withdraw from people and relationships so as to avoid further hurt and rejection. She trusts others very little. The degree to which she challenges herself and makes redecisions is more adventuresome than most. Whilst I admire this I still don’t like her much.
The problem is that our therapeutic relationship is almost completely dysfunctional. I don’t like her, I don’t trust her, I have little empathy for her, and as far as being attuned with her there is virtually none!
The therapy should have ended up like this.
But she has done great therapeutic work and continues to do so.
It shouldn’t be working but it is.
Graffiti
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Friday, 02 May 2008
Pro-ana
From a pro-ana site.
There is no such thing as an eating disorder. People have anorexic and bulimic life styles because they pursue perfection. Just like elite athletes, musicians and others pursue it.
Perfection is beauty
Pro-ana 10 commandments
1. If you aren't thin you aren't attractive.
2. Being thin is more important than being healthy.
3. You must buy clothes, style your hair, take laxatives, starve yourself, do anything to make yourself look thinner.
4. Thou shall not eat without feeling guilty.
5. Thou shall not eat fattening food without punishing oneself afterwards.
6. Thou shall count calories and restrict intake accordingly.
7. What the scale says is the most important thing.
8. Losing weight is good/gaining weight is bad.
9. You can never be too thin.
10. Being thin and not eating are signs of true will power and success.
Gemma Ward
Pro-ana creed
I believe in Control, the only force mighty enough to bring order to the chaos that is my world.
I believe that I am the most vile, worthless and useless person ever to have existed on this planet, and that I am totally unworthy of anyone's time and attention.
I believe that other people who tell me differently must be idiots. If they could see how I really am, then they would hate me almost as much as I do.
I believe in oughts, musts and shoulds as unbreakable laws to determine my daily behavior.
I believe in perfection and strive to attain it.
I believe in salvation through trying just a bit harder than I did yesterday.
I believe in calorie counters as the inspired word of god, and memorize them accordingly.
I believe in bathroom scales as an indicator of my daily successes and failures
I believe in hell, because I sometimes think that I'm living in it.
I believe in a wholly black and white world, the losing of weight, recrimination for sins, the abnegation of the body and a life ever fasting.
Eating is this
Secrecy tips
Don't bring up the subject of food around other people. Have your excuses for not eating ready in case they should bring the subject up. Some excuses I use : "My stomach's a little upset", "I'm too (tired, excited, nervous, busy, etc) to eat", "I don't feel like (whatever food it is), I'll get something later", "I did eat, didn't you see?", and "I stopped by (Burger King, Subway, etc) earlier".
Don't deny everything if confronted. People will believe a little truth with a big lie much easier than a huge lie. Act as if it's no big deal instead of reacting emotionally and people will tend to believe you.
Watch where you dispose of uneaten food or other "evidence", make sure that it isn't going to be seen or found by anyone. Wrap food up and throw it away outside the house. If you live alone, always take the trash out before anyone else comes over.
Graffiti
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Extractive identification epilogue
Roses states: “Ohh my goodness! I like the pictures!”
Thanks for your comment Roses. I am learning how to listen.
I am very much a visual type of person so when I do a blog post I put in pictures which just seem to fit right.
I have a huge file of pictures in my computer. I obtain these at random usually, (Sometimes I go looking for a picture on a specific topic but mostly it is just random scouring of the web and the blogosphere). If it find one that I like, that just touches me in some way or just seems interesting then I will save it. So in this sense it is an unconscious process for me. I just go with whatever seems to fit for me at that time.
Sometimes it is not too hard to understand ones unconscious urges.
The best photographs you find are on the websites or blogs of the deviants, the tormented and the maladjusted. In recent times I have been scouring “ana” blogs. Those individuals who promote anorexia nervosa as a viable life style. You come across some very interesting people who have great pictures on ana sites. However I digress.
Oh, let me digress just a little more. On Flickr there are many sites of men who dress in women’s clothing, particularly women's underwear. These men upload pictures of them selves onto their Flickr site!!. They show their faces and often other quite revealing parts of themselves which is quite hard to take being a male myself. But I can’t believe they show their faces in such photographs, what if their neighbour comes across them!! I certainly don’t download any of these I may add.
However, getting back to the point. As I scour the blogosphere I choose most of these pictures through my unconscious with little or no though given as to why I pick that one. When I have written a post I go to my picture folders and choose pictures that just seem to fit for the post. Some times I will pick a specific picture that fits for what I am saying but mostly in the hundreds I often go through a few just jump out at me for some reason. Again more unconscious selection.
I intuitively selected this photograph
As I now look at the pictures in the post Extractive Identification - Part 3, I find your comment quite revealing for me Roses. These are the photographs which I would call D&M photos. They are deep & meaningful. They are the beautiful photographs which the serious photographer would take. They are the photographs that one could have a serious discussion about in terms of its artistic qualities.
As I now listen to my unconscious I hear myself use the word ‘serious’ twice. That has been a difficulty for myself about the approach promoted by Bollas and what I observed at the workshop a few weeks ago. This therapeutic approach seems to me to be largely D&M and often quite serious. To my mind this is a negative. They don’t have enough fun or humour in the therapeutic approach and thus miss out on the therapeutic value of humour and Free Child in the therapy. This I wrote about in a previous post titled Humour and human functioning.
Taking life seriously
So obviously as I take from these psychoanalytically oriented approaches their means of understanding and using unconscious communication, I will then weave it into my style which tends to use a good deal of humour. It keeps the therapy lighter at least at times and is repeatedly stimulating the Free Child. Which in my view is important in psychological change and growth.
Graffiti
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Thursday, 01 May 2008
Extractive identification - Part 3
This is from a lecture given by Christopher Bollas. At the workshop I went to a few weeks ago, he was the one credited with the term Extractive Identification.
-------------------------------
We all free associate; it is a natural way of thinking. It will not occur if the analyst is too talkative or hijacks the hour. There is the concept of a larger secret to be revealed. Freud believed if a person freely talked they will go on to many things, leaps, chain of ideas. If allowed to speak long enough you discover a line of thought in a chain of ideas, a logic sequence. We must go back to the one way Freud saw unconscious communication. The value is in discovering forgotten material. The analyst surrenders himself to his own unconscious mentation. He must not try to fix anything, but to catch the drift of the patient’s unconscious with his own unconscious. The engine of psychoanalysis is unconscious communication between analyst and the patient’s unconscious.
If you relax and listen, you will discover a tissue, a chain of thought, it is meditative, without ambition. You must trust that your unconscious mind will perceive a pattern. Certain things patients’ say will strike us, more often than other things. You can echo the word, repeat, active echoing their word, not yours. It may move or puzzle you, so have sincerity in questioning the word. The analyst can’t eradicate curiosity. The analysand may have a spontaneous and new arrival of fresh material if the analyst is the receptive unconscious other to receptive unconscious thinking. If the analyst is out of touch with the patient’s flow, material will stop.
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This piece says a lot to me about the type of psychotherapy that was being displayed at the workshop.
The client will give you their unconscious thoughts and feelings. But are you, the psychotherapist, listening or receptive to it is the question? To start listening to such communications from the client is somewhat of a narcissistic pursuit by the therapist. He must start listening more to his own unconscious thoughts arising in him. So in this sense the psychotherapist listens less to the client and more to self.
The unconscious communication between client and therapist is what is being sought as the means to understanding the client and the important mode of communication between the client and therapist. I particularly note such statements as:
“The analyst surrenders himself to his own unconscious mentation.“
“If allowed to speak long enough you discover a line of thought in a chain of ideas, a logic sequence”
“The value is in discovering forgotten material.”
“You must trust that your unconscious mind will perceive a pattern.”
“It may move or puzzle you”
“If the analyst is out of touch with the patient’s flow, material will stop.”
This is a diagram that can explain the unconscious communication. Again the therapy is very much about the relationship between the client and the therapist. How they communicate and relate, in this instance at an unconscious level.
How does the therapist do it on his side? That is why I like the statement of surrendering to his own unconscious mentation. One lets their unconscious thoughts appear along with the client’s and hence the interactive or relational quality in the psychotherapy. And a trust in self that you will perceive the unconscious pattern provided by the client. So the concepts of surrender and trust are important for the therapist in this approach.
When the therapist feels something like being moved or puzzled then you know you are on to something. Again this is a very relational approach where the therapist is ‘in’ the therapeutic relationship, not just analysing it form afar.
I particularly like the last sentence and I had personal experience with this in the work that I did as a client. I saw the workshop leader do this with other clients over the 5 days and then experienced it myself which is a real bonus to actually have had first hand experience with it at least on the receiving end.
The therapist is very much in tune with the tempo, tone and communication pattern of the client. This can get disrupted if the therapist makes a jump too fast or in the wrong direction with the client. I recall myself feeling a bit fuzzy and confused at a statement made by the therapist in my work. I don’t usually feel confused and then at that point the therapist mentioned that he had gone too fast, I think it was.
A very interesting and useful learning experience with a style of therapy which I am finding how to integrate into the approach that I use, at least with some clients. It is a very sensitive approach so it is particularly useful with clients who at that time need such a quality from the therapist and also quite fragile clients could benefit from it. In other situations I would never use it. If you counselled prisoners with this modality you would be considered a joke and thus wasting your own and the inmate’s time. Also clients with a good ego strength and a mental toughness you don’t need to always be so gentle and thus one can use more ‘strong’ interventions and achieve gains that would take much longer using the approach described by Bollas.
Graffiti
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