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Sunday, 29 June 2008
Regression and solutions
Solutions to problems or high stress.
There is an exercise sometimes used in psychotherapy. It begins with a few questions. What was one of the lowest points in your life and what did you think, feel and do? When things had gone really, really bad for you how did you react? What was your way of solving the problem or dealing with these very adverse circumstances?
It is generally acknowledged that the more a person is under stress the more they will revert to their childhood solutions to problems. The more stress a person is put under then the more they will regress, as it is known. This means they move from the Parent and Adult ego state into the Child ego state as is shown in the diagram below
Regression
So when life was going really badly for you what did you think?
One way of defining this is to finish the sentence, “It just goes to show you that....” Finish that sentence and you will know some of what you thought as a young child.
What did you think about yourself, others and life? This will be what you also thought and decided when you were a young child because you are in a regressed state.
This child is at the point of making decisions on how to think, feel and act.
What did you feel? This will be your racket feeling, or your most familiar feeling. If it is sadness then one will tend to be prone to depression and is more likely to conclude that they are wrong and others are right. If it is anger then one will tend to see others as doing wrong to them and that others are not OK. Or such a person can conclude that both others and self are not OK.
Racket feeling is?
What did you do?
Sometimes these are divided into 3 different solutions.
Fight - physically hit out (DV), verbally hit out, fight for your rights, put in a complaint, sue somebody. In childhood the child who will hit something or shouted in their defence or broke something to try and hurt the other person. “I’m going to hurt you” is the childlike fight response.
In adulthood we call this justice which is really just revenge but we don’t usually like to acknowledge that when of course feeling vengeful is a normal human emotion. So when under great stress this person will tend to hit out at others physically or verbally or legally. In childhood the child may voice disapproval at mother and father or seek to angrily get change in some way in the home. If mother and father are fighting the child may actually intervene in some way.
Flight - This can include things like using alcohol, drugs or prescription medication. All these are a way of getting away from the problem, as a way of solving it. Or the person who quits their job and simply goes elsewhere. So one can simply geographically relocate to move away from the problem and thus it is solved in their mind. In childhood the youngster may do running away from home behaviour or the child goes and hides under their bed as a response to stress in the home. This child does not seek to change the conditions at home or express their disapproval instead they move away from the problem and wait for it to subside. They want to ‘slide under the radar’.
Freeze - In the olden days it would be said that the person has had a nervous breakdown. In essence the person collapses in on self and goes into a state or incapacitation. They fall to the ground and go into the foetal position. These days people go on stress leave, or they may seek hospitalisation, some can have panic attacks and agoraphobia which are both incapacitating conditions. In childhood the child just stands there and simply does not know how to respond. In the extreme they can loose bowel or bladder control. Where as fight is primarily an angry response, freeze is mainly an anxiety response.
So as adults regress more and more as the stress increases they will respond more and more in a childlike way. They will think the same as they did as a child and feel the same way as well. They will also be more prone to pick the behavioural solution that they used as a young child as well.
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At a assessing suicide risk workshop I ran last week I did this exercise with the participants and asked them the question, “If a person considers or attempts suicide then what response is that - Fight, flight or freeze?”
I will answer it soon.
Graffiti
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Madeleiine, Kahless and KazzaB make good comments.
Some saw suicide as a flight response which to me makes sense. One solves a problem by getting away from it and suicide does indeed do that. I also think there is a fight response in there. Suicide is a murderous act. It is an aggressive act. The line between suicide and murder is a fine one indeed. Psychologically they are quite similar processes. Both persons are prepared to step over the line of destructive thought and put it into action. That is a big step to take.
Research shows that those on death row have a higher rate of suicidal urges than the general population. So perhaps those are not able or capable of killing self, so they act in a certain way and then that gets the state to do it for them.
Interestingly enough in the early histories of suicidal individuals it is not uncommon to hear of running away from home behaviour which is a flight response. Most often if a child says they are going to run away from home when asked where it is going to run to it has no answer. So in essence it is running away to oblivion.
The overall point of the exercise was to demonstrate that suicide was just one possible solution to a problem just like going on a bender is or beating the wife is. That is the person has made a decision for this to be one of their options to a problem. Such a person is said to have a Don't exist injunction or message. In assessing suicide risk this is the definitive point and one does this by doing one of the four methods of the Don't exist interview.
Graffiti
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Saturday, 28 June 2008
The end of graffiti
Speaking of name changes Kahless and my now graffiti less title.
I saw a show on TV a few weeks ago. It was about these parties or 'exhibitions' that they are having in Melbourne (Aussie) now. The trendy set will set up a party in an alley way or derelict building. They all stand around sipping champayne, with classy music and commenting in appreciation at the graffiti on the walls.
OMG! I thought and felt a sense of loss.
All that angst of youth, their sense alienation and their disestablishmentarianism has now been taken over and is lost.
Graffiti - powerful imagery that is now pedestrian.
It has gone beyond taking the graffiti art into the art galleries. The establishment has now moved to the graffiti in the streets.
Like when punk rockers with their dirty torn jeans saw them appearing in the expensive boutiques. Punk rock died at that moment.
Perhaps now the graffiti artist is at the point of death as well. Society has assimilated graffiti into the mainstream. Their meaning in society has gone for ever.
Tony
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Friday, 27 June 2008
Mental illness
Francis Ford Coppola - Bipolar disorder
Kurt Cobain - Clinical depression
Winston Churchill - Bipolar disorder
Daniel Johns (Silverchair) - Anorexia
Kim Basinger - Panic disorder
Syd Barrett (Pink Floyd) - Schizophrenia
Issac Newton - Bipolar disorder
Charles Dickens - Clinical depression
Jim Carrey - Clinical depression
Karen Carpenter - Anorexia
Eric Clapton - Clinical depression
Ludwig van Beethoven - Bipolar disorder
Tennessee Williams - Clinical depression
Graffiti
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Thursday, 26 June 2008
Slingshot therapy
Kahless said earlier today:
“Tony,
I hope you were humane with your slingshot.”
This is in reference to the statement that I made to Roses that I had recently made a slingshot to shoot the birds in the trees in my backyard.
In Australia Kahless we have a bird called the Magpie. Here is a picture of one:
These are very Australian birds, as Australian as meat pies and kangaroos. Many of them fly around my place and move from tree to tree and have their squawks and disagreements and so forth.
For some unexplainable reason in the last 3 weeks the local magpies have decided to run their therapy groups in the tree right above my back yard out door table and setting. This is where we often sit and socialise during the warmer months of the year. I have had the out door setting there for at least five years and never had any trouble before. But in the last 3 weeks they have decided to run their therapy groups right there.
It must be a Gestalt therapy group that they are having. How do I know it is a Gestalt therapy group? In Gestalt therapy often when the client gets stuck at the point of impasse the therapist will say, “Will you either shit or get off the pot”. When the client does either, then impasse has been broken.
Well obviously many of the magpie clients in this group are choosing the option, to “Shit”! The problem is that their shit falls right onto my outdoor setting. This causes me great distress and I feel like I want to turn the Magpies into something like this:
So what I did to get them to relocate their daily therapy groups was make a slingshot and shoot them a few times and then they would find somewhere else to meet.
Now I am an experienced slingshot aficionado. Consider this picture below of me shooting my slingshot:
I am in the white shirt at about age 10. That is a friend of mine on the left and that is my sister bending down to pick flowers. I am just about to shoot the top off an ants nest and then run for cover. I must add that I don’t know why my mother made me wear my pants up that high but she did and I look like a right regular dork! (If you want to see this picture in much more detail click on it and got to “All sizes” on my Flickr - a very typical Australian bush scene).
I have by and large been successful in this method of getting them to relocate their group meetings. They are about 10 meters high up so it is quite difficult to get a direct hit, not that I even wanted to do that. The vast majority of times the pellet will whiz by very close and the Magpie gets disturbed by this. At other times the pellet has ricocheted off a close branch and again the Magpie does not like this at all. After a little of this they will all fly off as they know something is wrong. I have probably had about 6 direct hits and the magpie flutters about briefly and then flies off.
They are now there much less frequently and indeed when I am spotted by them coming out the door often they just fly straight off. I have actually been surprised at how quick they have made the connection between me and “lets get the heck out of here!” So hopefully the problem has been solved as I certainly don’t want to cause the Magpies distress and I want a clean place to socialise during summer.
Graffiti
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Wednesday, 25 June 2008
Client - therapist contact via the internet.
Most of the professional organisations of counsellors advise against dual relationships. This means that they advise that you only have a counsellor - client relationship with the client and no other contact or relationships.
In my view this is a major discount of the vast majority of counsellors and is throwing the baby out with the bath water. It is saying to the counsellor that we don’t think you are capable of handling any dual relationship problems so we will do it for you. To my mind that is treating the member counsellors with contempt and adopting a most supercilious attitude.
Most counsellors are not this and can manage at times quite complicated relationships.
As we know it is the relational or the therapeutic relationship between the therapist and the client that carries the most potent curative powers. So when a client sees a therapist most often that is for 1 hour per week. So the client gets to see the therapist and meet face to face with the therapist 1 out of 168 hours per week. That is not a lot of contact.
What has happened in the past in this part of the world is that some clients have taken on counsellor training with the counsellor who also happens to be a trainer. This allows the client to have much more contact with the therapist who is then in a training role.
Keeping the absolute 'single' relationship
Some of these clients who become trainees have no real interest in becoming a counsellor and of course I always get this out in the open so both parties are clear about it. So the client/trainee gets two benefits. First they are placing themselves in a training group that is therapeutic in itself. A good support group that is by an large positive stroking and encouraging of the person to grow and develop. Secondly they get much more face to face contact with the therapist and thus all the therapeutic flow on from that.
Of course some say that this dual relationship - client/therapist and trainer/ trainee - can lead to financial exploitation. Yes it can and I am sure that it has on occasion. But professional organisations want to get rid of it all just because of the actions a of a few. Thus many clients loose out in the ways I have just described.
However, with the development of the www we now have more occurrence of a new dual relationship - therapist/client and blog writer/blog reader(commenter). The client can have much more “contact” with the therapist via communication on the internet. They can read what their therapist is saying, maybe even comment on the blog, see photographs they take and place on the internet, read about their activities via facebook and twitter and all the other huge variety of things that can now be done via the internet.
This is the interesting part. What does the therapist do with this new dual ‘relationship’ with their client? They could do nothing or it could be used at times in some way should the circumstances be right? To my mind an area of much possible research and development.
I can only see one way that professional bodies can stop such dual relationships and that is by requiring the therapist simply not using the internet in these ways. Or they could take the view that their members are at least reasonable communicators and say, “we trust that you guys to have the expertise to deal with it”. I know that I do and can. I have already dealt with some problem situations that have arisen due to this new dual relationship. Like the client who complained to me that I write about others on my blog and not about him.
Graffiti
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Tuesday, 24 June 2008
Asking for comments
I am interested in what clients and trainees think and feel about accessing information about their therapist or supervisor on the www.
Of course this can be via weblogs, photoblogs, YouTube, google searches, websites, twitter, facebook, discussion forums, chat rooms and many many more.
Who's there?
Via these internet 'things' clients can access information about their therapist personally and professionally. They can do search google earth and see their actual home. They can also have online discussions with them. At times clients could be anonymous and talk with their therapist without the therapist knowing who they are.
Of course all of this also applies to trainers and their counsellor trainees.
Internet communication at times?
Some discussion of this has been done before on the blog Shrink Rap (See the link in my blogs I like list)
The following is stated in the comments section:
"April writes
I really like Tony Graffti, too. I love that his patients read his blog---but maybe that's because I wish I could read my shrink's.
Maybe it's not intimidation that prevents people from disclosing they found your blog---maybe they're using it as a reference, to see if you're the same person in 2 different settings.
Lee writes
My therapist wrote a book (a couple actually). I bought one of them and started reading it. Got bored, didn't really like it much. I haven't told him about that. It just seems weird. I just told him on Monday that I read the wikipedia article about him though. heh. It was right after he was bashing wikipedia.
one4theroad writes
i think if i found my therapist's blog, i wouldn't say anything to her just because i would be afraid that she would then start to censor herself, or feel like she should."
(end quote)
So if there is anyone out there who has a therapist or trainer. What do you think about this, what are your thoughts and feelings about seeing your therapists blog or website or having discussion with them in a discussion forum?
Any comment would be greatly appreciated.
Graffiti
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Sunday, 22 June 2008
When is a client a client?
Last Friday I was at a meeting. It was attended by therapists, trainers, workshop leaders and so forth. It is a bit of an odd community that one as within it people become therapists and clients to each other at various times. A therapist may ask another therapist who is a colleague if they could see them for counselling. So the relationships change in this way not irregularly.
At one point we were socialising, all standing around in small groups gas bagging to each other. I overheard this woman who was just behind me speaking in her small group and she said, “Tony is my therapist”.
This comment struck as a bit odd, which is indeed why I have remembered it I suppose. Firstly, I counselled this woman perhaps half a dozen times and it would be at least a year since I last saw her as a client. I did not think of this woman as being my client. So apparently I am her therapist and she is not my client. How can that be?
A matter of perception. Is he surfing waves or rapids?
Secondly, what about the statement:
“Tony is my therapist”
My reaction to that in this situation is that I am sort of like that bottle of medication that you keep forever in the medicine cabinet at home. You know you are very unlikely to need it but you keep it there just in case. Or perhaps it sounds like I am a hood ornament on her car or like that old photograph you keep in a draw somewhere at your home.
I had a another similar event recently. A client is going to have an operation which will keep her house bound for 6 weeks at least. She was expressing concern that she would not be able to see me should the need arise in that 6 week period. I said to her that that was not the case and that I could do a home consultation should she need it. She felt relief at this and said that she would probably not need it but she liked to know that it was there. Another instance of being that bottle of medicine that you never use. I am sort of being her therapist when I am not actually even there.
I always try and do at least one home consultation with clients. You get lots and lots of valuable information about the client by going into their home. You know the feeling when you have been e-mailing someone for ages and then you finally meet them face to face and they look and sound nothing liked you expected them to. Well the same applies for homes of people you have met many times and never seen their home before. The image of their home you have built up in your mind can be very different to the reality.
I just find it all a bit odd. How people can use their understanding of me as their therapist when they are not in session. Indeed in that woman’s case it was over a year that she had seen me as a client and I was still being used in that way. I wonder how long that can go on for and is it reflective of an attachment that has not been allowed to slowly die away?
In one way you could argue that there is a therapeutic relationship in existence but there is only one person in it - the client. That seems a bit odd to me.
It takes two to play ping pong. Maybe not?
Graffiti
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Saturday, 21 June 2008
Impasse theory
Taken from Mellor, K in "Skills in Transactional Analysis Counselling & Psychotherapy" (ed) C. Lister-Ford. 2002. Sage.
This views impasses developmentally. The type 3 impasse develops in the very young child, the type 2 in a less young child and the type 1 impasse in late childhood.
Graffiti
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Wednesday, 18 June 2008
Impasse - the third solution
In psychotherapy this is what is known as an impasse
An impasse is a clash between two different parts of the personality. They having opposing goals and wants and can be drawn as a collision between the Parent and the Child ego states.
For example a woman may be insulted by someone at work. As a result one part of her (the Child) wants to express her anger and displeasure at the other person for being insulting. As she is just about to do so she hears this voice in the back of her head saying, “Good girls don’t get angry” & “Girls who get angry are bitchy”. Just the type of thing she was told as she grew up in childhood. These voices may be seen as representing the Parent ego state.
So we have an intrapsychic collision inside the woman. Her Free Child wants to show anger and her Parent ego state wants her to be polite and pretty and not show anger. She is at an impasse in her own mind. Over time when there have been a number of similar impasses then a symptom will develop out of this. One can say that the collision between the two forces in the psyche provides the energy or basis for symptom development. A common symptom to develop out of such an impasse is depression. Some people who chronically hold in their anger can develop depression over time.
Historically there have been seen to be two solutions to an impasse. It occurs when one ego state dominates over the other it is opposing. If the Child finally gets up the strength and courage and defies the Parent and the woman expresses her anger then the impasse is broken, at least in that situation. If she repeatedly does that then it becomes habitual and she could at that point be said to be ‘cured’ of her problem.
This is what the majority of psychotherapists will attempt to do with the client. For the Child to break the impasse. This is what the vast majority of their therapy theories will define a psychological health
On the other hand the Parent may dominate or ‘win’ in the situation and the woman holds in her anger and does not show it to her colleague. If this happens then the impasse is broken by the Parent belief. Often when I do this in therapy, such as in couples counselling or when a client’s expectations are too high. I will produce what is the greatest single line in movie history. That excellent movie -As good as it gets.
Jack Nicholson walks into the full waiting room of his psychiatrist’s office, looks around at all the people and says, “What if this is as good as it gets?”. So I sometimes use that line and say to the client, “Perhaps this is as good as it gets”. If taken on, then the Parent breaks the impasse and the client’s Free Child need is not met.
There is however a possible third solution to an impasse. (This must be credited to my psychologist trainee, Nadja). The client accepts the Parent position of the impasse and then the FC want is redefined. I have discussed some of this before in a number of postings.
Undecided. At the impasse.
I once talked about a supervision question where I was asked about a client who was a teenage girl who had lymphodema. Her FC want was to have thin legs. The Parent stated that she can’t have that because she had lymphodema. I then supervised that her therapist call her elephant lady or lympodema lady (rhetorically of course). Accept the Parent part of the impasse and then it is redefined in a humorous way and thus the impasse is broken. Or when I work with clients and I get them to love their panic attacks or make friends with their depression. The Parent part of the impasse is accepted and then one ‘loves’ it. The impasse is broken and the FC want is redefined.
Graffiti
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Tuesday, 17 June 2008
Humour in the counselling process.
For KazzaB’s assignment
Laughter and fun. Well it is a fairly simple transaction and one which I certainly do in psychotherapy. There is often laughter in the counselling that I do.
Two people enjoying themselves and each other is what this diagram represents theoretically. In this instance it is the therapist and the client having FC to FC contact. So what impact does this have psychologically on both parties.
Well the first thing I think one can say is that it makes the counselling fun and enjoyable at least for some of the time. So the therapy becomes appealing. To my mind there is always a danger of therapy becoming too D&M (deep and meaningful). Obviously in therapy both parties are at times discussing serious and painful events and at times like this, there is much less laughter and humour. And it is good to get out of that sometimes with a bit of levity and it makes the situation light for the time being. Thus it also gives the counselling an appeal to the Child of the client.
Maybe this is why the footy is so popular - high FC
As we know it is the relationship between client and therapist that has a huge impact on the success or not of the counselling. FC to FC contact is a type of intimacy or contact and both parties will feel a sense of connection from such transactions. So this is a most important transaction or type of contact for the client and therapist to have in that it is true human to human contact. This of course builds the therapeutic alliance and thus the curative power of the transference is developed.
Indeed when the client and therapist are doing other therapeutic techniques, or contract setting, making a no suicide contract and so forth then they are actually involved in a wall of trivia situation.
The wall of trivia alienates the two people involved in the communication, it is a distraction. In terms of the therapeutic relationship this is a counter productive activity. It is seen as a distraction form the true human to human contact. So humorous contact between client and therapist dismantles the wall of trivia.
Secondly one notes in the literature many people talking about the natural human tendency to health and growth. If a client is placed in the right conditions then they will natural grow and develop psychologically. For instance Carl Rogers stated that if a client was placed in a setting of unconditional positive regard then they would naturally grow towards health. Abraham Maslow say that each one of us has a natural drive or urge to self actualisation. To achieve our full potential that is with in each of us. Then there was Freud who talked about the libido or life energy. He also said that each human has such a life force that propels them towards growth and creativity.
Creative energy in all of us.
Transactional Analysis has the same assumption of an innate life force in each of us. In theory terms that would be seen as a function of the Free Child. So if the therapist is encouraging the client into Free Child such as with laughter then he is inviting the client into that aspect of their psyche where the libido or life energy resides. Then according to the theory the client will slowly and surely grow towards psychological health.
Thirdly, one of the main difficulties in dealing with sad and depressed people is that they are low energy. They are ‘sodden’ or incapacitated as indeed are scared and frightened people. People are more likely to psychologically change when they are in a state of emotional disequilibrium or an unstable emotional state. Depressed people are not this. One way to get a person into an unstable emotional state is to invite them into anger. Anger is a mobile and vital emotion. The person is emotionally active and when anger is around often things happen or change. This is why anger is such a useful emotion in the psychotherapeutic process.
Anger often results in a change of some kind.
Like anger another active and vital emotion is ‘happy’ when a person is joyful, laughing, radiant, smiling and so forth. It is an ‘up’ rather than a ‘down’ emotion. Thus if there is humour in the counselling then the client is in this unstable emotional state rather than a more static or immobile emotion and hence psychological change and growth is more likely to occur. Or at least the therapist has a person sitting in front of them with whom they can much more easily work with to facilitate change.
Graffiti
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Friday, 13 June 2008
The world is like me
Everyone is deluded. Everyone thinks all others in the world think and feel like they do. In training psychotherapists this is one of the biggest ‘things’ to get over. Clients don’t think and feel like you do. To actually believe that takes some work adjusting of the Child ego state beliefs. The egocentricity of each and everyone of us.
We can never know what others feel. When someone says they are angry or displays anger how do we know what they are feeling? We automatically assume that their experience of anger is the same as our own. Of course we can never know if it is or not. Same for all the other feelings. All we have is our own experience of a feeling as a way of understanding others feelings. We can never actually know what another persons experience of a feeling is.
That is one reason I got the client to write about clinical depression in the previous post. Everyone has felt depressed at some time. So when someone else reports to you that they are feeling depressed we automatically assume that their experience of depression is the same as our own. This is an extra difficulty for the person who is clinically depressed which basically means they are really, really, really, really depressed. They are different from the ‘normally’ depressed person but most will assume they are the same.
And of course the solutions that the normally depressed person uses they think will work on the clinically depressed person.
Just think good thoughts and that will work
Just a bit of a kick up the bum and that sorts it out
I will be happy and ‘jolly’ them out of the depression
These can work with mild depression and when it does not work with the clinically depressed others start to think that they are just wallowing in it or attention seeking or being manipulative and so forth. Of course this just makes matters worse. But the same process is at work here, the egocentricity of human beings. The belief that the rest of the world thinks and feels like I do. In reality very few probably do.
I saw a TV show last nite about some photographs that have recently been discovered. They are taken at the Auschwitz concentration camp in WWII. Obviously very upsetting photos but also of great historical significance as there are so few pictures of such a place and time in history.
These are of the men and women who worked at the camp. The women were mostly the typists and secretaries and operated the switch boards of the camp and so forth. Most of the men it is assumed worked as prison guards of some kind. They were at place where they could eat and go at lunch times and so forth. Like a cafeteria and a place to relax. It was about 10 miles from the camp. All these people would have known fully well what was going on at the camp.
On the TV show various people were being interviewed and stating the horror of these pictures. How could these people be enjoying themselves so much when just 10 miles away they knew what was going on. These commentaries had made the incorrect assumption that others think and feel like they do.
It was stated that all these people must be psychopaths. Whilst that is probably untrue in that there are other ways these people could do such a thing than be diagnosed with psychopathy, it is quite likely that some of them were. Obviously the psychopath thinks and feels quite different to the vast majority of the population.
Where I live about a year ago there was a rape and murder of a 10 year old girl in a shopping centre toilet. A very bad crime indeed and they got the guy and he was imprisoned. I recall hearing on talk back radio all these people ringing in and saying that it was great he was in prison as now he could sit for all these years and think about what he had done. They felt satisfied in getting revenge, or justice as they more politely call it.
Sorry, it does not work that way. They don’t think and feel like most do. The psychopath lives very much in the here and now. What he did to that young girl would be long gone out of his mind. To him that would be very old news and occupy little of his current thinking. These individuals think about what happened in the last 24 hours and what is going to happen in the next 24 hours and that is about it. They are very child like in this way and they are very much Free Child.
When I worked in prison I recall one inmate who was HIV positive and he was getting no treatment for it. If he asked for treatment he would have been given it and for free. I discussed this a few times with him and he was fully aware of what the long term consequences were of no treatment. He still got no treatment. He knew the long term consequences but it had no meaning for him because he lived very much in the now. Another very childlike quality and Free Child.
Watch a young child walking in a busy shopping centre. It will simply walk in a direction and will maintain that direction until someone coming the other way meets them right in their face. It will then change direction to get past the person. On the other hand adults will look out and see what is coming from afar and change direction then so as to not meet the person directly face on. The psychopath has never learnt to do that and thus they maintain the childlike quality usually for their entire lives.
In this way often there is an honesty in relationships is prisons that you don’t get on the outside. As long as the inmate is not trying to manipulate for some reason then the relationship has a childlike straightness and truth about it. They have much less of a need to colour their communications like ‘normal’ adults can do to make them nice when underneath there is not niceness.
Graffiti
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A case of severe depression
I found this in the bowels of my computer. It was written by a client of mine. A very nice woman whom I saw for quite a long time. (Some client data is fictionalised). As you can see it was in 1995. At the time I was doing some writing on the topic of clinical depression. One of the problems for such people (as her) is people do not understand what she is going through or what she thinks and feels.
Everyone at some time has been depressed so we all know what it feels like. But clinical depression is different from ‘just’ depression and she wrote this to try and articulate that at my request.
Henna tattoo
Freda, 42 married mother of two, boy 14 years and girl 12 years.
"Depression is difficult to live with, because most people don't understand it, so you're reluctant to talk to anyone about it. It's also difficult to explain, because when you're depressed, everything in you're world looks different. Situations and events that once were very meaningful and important look meaningless. You feel indifferent to things going on around you. You don't feel anything, you just don't care, you just want to die - anything, to escape the horrible way you feel inside.
Sometimes it feels like you're in another world and you can't get back to the meaningful one. You can't break through the barrier between the two worlds.
Sometimes it feels like you're down a large dark tunnel, or well, and you can't see the top because it's so dark - you can't see any daylight at all and you can't find a foothold to climb your way out. It feels like you're being pulled down into a very dark, horrible place, and you can't see any way out. You can't see which way to go.
Also there's a huge heavy weight inside you and on top of you, pushing you down and keeping you down. It's suffocating, it slows you down, and makes you feel terribly tired. It's like you're a 'dead weight' walking around. Its an effort.
It's a state in which you're totally incapable of 'getting out of it' by your self, and you can't see how. Most people can't comprehend how someone could become so depressed that suicide looks wonderful. Life may be going relatively OK on the outside, but the feeling of depression can still envelope you, until you reach a state of hopelessness.
You feel in a state of confusion - you can't identify other feelings you have without difficulty.
Depression also affects the way you think. It's hard to think clearly. It's difficult to remember things or to think through a situation or problem to a logical conclusion. You become confused easily. Nothing looks exciting or interesting anymore. It's hard to think at all! You just want to sleep.
It's a lonely state, because you're reluctant to talk about it, because most people say, "snap out of it! Scrub the floors! Go for a walk! Go and do something! Don't sit around and mope!". tunnel any more And of course you'd like to be snapping out of it, etc if you could - you would if you could - then you wouldn't be depressed in the first place! You want to do things, but you've got no energy. Everything you do is an effort and needs over twice as much energy as normal.
When you're depressed it's difficult to function normally. Everyday, mundane things are an effort. You want to be with people but it's an effort to talk to them - and you don't want them to know you're depressed in case they tell you how lucky you are, how great your life is, or in case they give you that blank, uncomprehending look.
Depression can develop gradually, or it can hit you suddenly without warning. It's not just being very sad - it's different, much worse, because you know sad will eventually pass. But with depression, you can't see and end. You can't see what to do." [May 31st, 1995].
She was very suicidal over a long period of time. There were a few occasions when I wondered if I would ever see her again. She had all the items necessary to gas herself in her car. She reported once that after she left a session she was going to go away and do it. She then decided not to as she thought that would reflect badly on me. I hear from her occasionally and she reports doing well and now is far less depressed.
The other thing about her was her massive Valium addiction. All legally prescribed at a very high daily dosage and I recall the difficulty for her to get off the drug. I recall learning from her how Valium is a very nasty drug to withdraw from. But she managed it in the end and now reports she takes no Valium at all.
Indeed this is what the Rolling stones have to say about it.
Mother's little helper
What a drag it is getting old
Kids are different today,
I hear evry mother say
Mother needs something today to calm her down
And though shes not really ill
Theres a little yellow pill
She goes running for the shelter of a mothers little helper
And it helps her on her way, gets her through her busy day
Things are different today,
I hear evry mother say
Cooking fresh food for a husbands just a drag
So she buys an instant cake and she burns her frozen steak
And goes running for the shelter of a mothers little helper
And two help her on her way, get her through her busy day
Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old
Men just arent the same today
I hear evry mother say
They just dont appreciate that you get tired
Theyre so hard to satisfy, you can tranquilize your mind
So go running for the shelter of a mothers little helper
And four help you through the night, help to minimize your plight
Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old
Lifes just much too hard today,
I hear evry mother say
The pusuit of happiness just seems a bore
And if you take more of those, you will get an overdose
No more running for the shelter of a mothers little helper
They just helped you on your way, through your busy dying day
Graffiti
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Thursday, 12 June 2008
Typical Aussie girl
Look at this
Also guess what happened to me today!
Some man with an unpronounceable name from the Congolese Republic emailed me and said that he has $50 million US dollars in a bank and he is going to give it to me.
Wooohooo!!!
I'm rich!!
Me on the left in the egg and spoon race on the HMAS Himalaya on the way to Portsmouth.
Graffiti
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Tuesday, 10 June 2008
Dependency hump - Part 3
Lynn raises a good point with her comments in Dependency hump - Part 2. She questions the assumption that the hubby and wife relationship follows the same path as a child parent relationship. This has in fact been discussed in the literature. However I have debated about deleting the previous post (Dependency hump - Part 2) as I have confused a couple of points like she notes.
Dependency
Firstly, I have mixed up attachment and dependency. They are different and yet they are also related. The dependency hump is meant to indicate the dependency that a child goes through with its primary parent giver. Hopefully it will successfully negotiate it at the appropriate ages in childhood. If it does not then the person will continually suffer relationship difficulties until it is successfully negotiated it. Fortunately adults can sort of redo it later on, such as in a therapeutic relationship. Once done then their relationships will be more free of past difficulties.
This raises a long discussed issue in psychotherapy.
Is it OK for a client to become emotionally dependent on a therapist?
Is it OK for a therapist to encourage the client to develop such dependency?
Some answer yes and some answer no.
As usual the answer to my mind is more complicated than that. Those who answer “no” will cite argument along the lines that therapists’ can be motivated to encourage client dependency for financial gain. Dependent clients are more likely to attend regularly and stay for longer than they actually need to.
Then there is also the argument that the therapist could be motivated for personal gain. That is the development of cult figures or charismatic leaders who need a group of ‘followers’ rather than clients. History has shown us some clear examples of this and sometimes with very tragic results. Get your group dependent on you and then you can get them to do things they would normally not do.
However I would assert that one does not throw the baby out with the bath water. Yes some therapists may do such a things for financial or ego reasons but the vast majority don’t. So let’s stay alert for the megalomaniacs and let the other therapists use dependency for the emotional gain of the client.
One prime example of this is with the client who is the “Hurried child” as I described in the previous post. The client who is emotionally forced to grow up before they are ready. Mother and father are not there emotionally for the child. They may simply not really care all that much. They see that their job is to provide food and lodging and that is about it. The emotional life of the child is not considered and thus the child gets the sense that it has to deal with its emotions all on its own. Of course it is not capable of doing that. Indeed adults need others at some point to help them deal with difficult emotions. The boarding school child can often fall into this category. Fed and clothed and that is about it.
Sometimes the parents do care but are not emotionally able to manage this aspect of child development. A mother with a mental illness or a drug addiction can lead to the development of the hurried child . Or sometimes mother simply has too many of her own distressing emotions running around inside her she has not time or energy left to deal with the child’s troublesome emotions.
Being dependent is a risky activity.
Whatever the cause the hurried child is very suited to the dependency hump type of therapy. I usually make a PSP (Psychoseparation) contract with such people and that basically means that we (the client and me) will progress through the dependency hump. That is the client will develop a dependency on me and then resolve that dependency.
When a ‘hurried child’ is offered the option of a dependency they usually suffer an internal conflict. They crave the dependency and at the same time they dread it. So often the first part of the PSP contract is about dealing with their ambivalence to the dependency that is now within arms reach.
Then there is another part to dependency that continues though out the PSP contracted treatment. Dependency is a double edged sword. When someone is in a secure dependency with a reliable other (therapist) they will have two conflicting reactions.
Firstly there will be the secure and comfort feelings in reaction to the dependency. On the other hand they will also experience anger and resentment at their need for the powerful figure. Alas this, to my mind, is the natural human condition that any person who feels dependent on another will experience.
The natural human condition. Can't live without it.
Graffiti
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Sunday, 08 June 2008
Dependency hump - Part 2
Roses says of the post -The dependency hump and attachment:
“So you're saying that attachments all have a time limit?”
Yes that is what I am saying sort of. I am saying that in any significant relationship there is an attachment that is finite. Initially there is the ‘attraction’ period where the bond and attachment develops. After that period ends then both parties instinctively set about reducing that attachment. People achieve this with varying degrees of success. The more ‘successful’ they are the less there is a desire to maintain a proximity to the other person because the bond is reduced. This I say is one of the reason why the divorce rate is around 50% in western societies.
So yes, as you say life can be a series of relationship ‘humps’. Indeed the process of dissolving the bond has been discussed in great detail by psychologists over the years. None of less note than Margaret Mahler.
Here is a common model of relationships that illustrates the rise and fall of attachment in relationships:
The usual model of marriage type relationships as shown by the Bader Pearson model ("In Quest of the Mythical Mate" (Brunner Mazel 1988)).
1. Symbiosis. The stage of being madly in love. A merging of lives, personalities and an intense bonding. The main purpose is attachment ; Similarities between the couple are magnified and the differences are overlooked.
2. Differentiation. At this point differences emerge and partners come off the
pedestal. One partner may want more space than the other. They don't want to spend so much time together. They begin to emerge from the symbiosis by re-establishing their own boundaries.
Fishing is an individuating activity for men.
3. Practising. Each partner participates in activities and relationships away from the other and they may become self centred. Attention is directed to the external world. Rediscovering themselves as individuals. Developing self is more important that developing the relationship.
4. Rapprochement. At this stage vulnerabilities can emerge. After each has developed a well defined, competent identity it now becomes safe to look once again toward the relationship for intimacy.
5. Mutual Interdependence. After the two well integrated individuals have found satisfaction in their own lives . They know they can exist without the other but they want to be with the other. They have developed a bond that is deep and mutually satisfying and have built a relationship based on a foundation of growth rather than one of need.
It is the last sentence that I think is codswallop. It is stated out of the desire to have marriage as a one off life long event. Stages 2, 3 & 4 are all about the attachment breaking down. The relationship is becoming finite as the desire to maintain proximity reduces. This is very unpalatable to many so they develop this stage called Mutual Interdependence in the hope that they can con the world into believing it.
Everything is finite. Everything has an end. Why should human relationships be any different?
However there are some good quality marriages that do last for a life time and I would argue that is because the marriage changes from an attachment based relationship to a friendship based relationship. In an attachment based relationship people stay together because the attachment results in proximity seeking behaviour. In a friendship based relationship people stay together because it feels good and is pleasant to be around.
The 3 C’s of relating
This is a picture of a good friendship or companionship. It is highly likely that these two people will maintain a relationship over some time.
Compatibility between their Parental beliefs about life. Some similar goals and values in major areas of life.
Caring. Both parties are willing and able to be caring and considerate to the other. If the other is feeling upset then they will be nurtured and looked after. If the person is physically hurt then the other will come to the hospital and help them and look after them. This is rarely even in a relationship but just so long as it is not too uneven then this relationship is on a sound footing
Closeness. Both parties want and allow Free Child to Free Child contact. This allows for a sense of intimacy between them, good enjoyment and the expression of feelings in a relationship. When people say the ‘zip’ has gone out of their relationship then they have lost the FC to FC contact.
Friends hanging out. FC to FC.
When the attachment in a marriage has reduced the 3 C’s of relating achieve more importance. If they are there then the marriage is likely to persist. If they are not there then the marriage is more likely to conclude.
Graffiti
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Saturday, 07 June 2008
The dependency hump and attachment.
One of the tasks that a young child must complete is its journey through the dependency hump as is shown here.
When a child is born its psychological attachment is low and its understanding of dependence is low. As it goes through its first two years of life the child slowly develops an attachment and slowly develops an understanding of itself and mother. As it does this it develops an understanding of its psychological dependence on mother. By the age of two it has reached the top of the hump and then spends the next 18 years trying to get down the other side. That is it sets about reducing its attachment and dependency on mother.
Going up in the dependency is largely an affectionate and attraction process between mother and child. The slide down the dependency hump in line B is mostly and angry, defiant and breaking away process. This typically occurs in the 3 negativistic stages of 2 to 3 years of age, 4 to 5 years of age and adolescence. It is mainly in these three stages that the child breaks away and reduces its dependence and attachment with mother.
"Now I'm up here how the heck do I get down?"
If that is successfully achieved then the person has mastered the dependency hump and ends up at the point of interdependence and is capable of having normal relationships in terms of attachment style at least.
Sometimes that does not happen. Sometimes the child reaches the top of the dependency hump and for some reason never makes it down line B and thus continues along at line C. In adulthood this person will form strong attachments with others and then the relationship does not progress beyond that. The classic example is the dependent personality. For instance the wife who stays unduly dependent on her husband over a long period of time. In childhood this person is not allowed to separate by the parents and thus the parents force it to remain dependent. It is over protected.
The other problem is when the child never gets up to the top of the dependency hump in the first place. Line A. The classic example of this is what is called the “Hurried Child”. That child who is forced to stand on its own two feet emotionally before it is psychologically capable of doing so. It is under protected. The child may be well housed and fed but the emotional support is not there from the parents. It is forced to grow up too quickly in this way.
When a client enters longer term therapy it will progress through the dependency hump as well. In the early stages we have the harmonious or honeymoon period between client and therapist. This is often referred to as the positive transference stage. The therapist is idealised by the client. One could say they are put onto a pedestal which makes both the client and therapist feel good about each other and the relationship.
The positive transference is great for the therapist!
However, unfortunately this does come to an end when the client feels the need to ‘grow’ and be more independent from this therapist who it has developed an attachment and dependence on. When this happens it changes to the negative transference stage and the client sees the therapist in a negative light. In this stage the client tries to shove the therapist off the pedestal they just put him on. They get argumentative, see the therapist as doing incompetent therapy and generally become angry and disagreeable.
The purpose of this is the client is wanting to grow beyond the therapist. If the therapist does not get lost in it, or take it personally and so forth then the client can traverse the dependency hump and finally leave the therapist. Of course the client who is a “hurried child” will need extra help in making it up the dependency hump. The overly protected client will need extra help to get down the dependency hump.
Will he make it?
However if one is wanting normal type attachments then at some point it will need to traverse the dependency hump. If they do not do it during childhood then they can do it later in life with someone like a therapist. Unfortunately it is not an easy thing to do and it does take time.
Graffiti
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Thursday, 05 June 2008
Therapy with a hangover
I went to work today with a hangover, so today it was therapy with a hangover. Not a heave ho your guts into the toilet bowl type hangover. I haven’t had one of those for years. Also when I get a hangover I rarely have a headache, but I just feel seedy. So it was a feeling seedy type of hangover.
I have done this before on occasion. Not very often I may add. It used to happen a bit when I ran residential weekend therapy groups or trainee therapist groups. About 20 people plus therapist(s) would trundle off to the country somewhere from a Friday evening to the Sunday afternoon and do therapy all weekend.
In the evenings people would socialise and maybe have a wine or two. On occasion I would wake up on the morning of the Saturday or Sunday and feel a bit seedy and then do therapy all day.
One thing I noticed is that when I have a hangover I do good therapy, better than usual. This has always struck me as a bit odd as one would expect the opposite result. And I have wondered as to why.
Therapy with a hangover should be like this.
I think less about what I am doing. I make more intuitive interventions and fly more by the seat of my pants in dealing with the client. Also I find I ‘cut to the chase’ more and be more directive. So the clients today really did some therapy! My final client reported right at the end of her session that she felt all washed out and she had done some deep emotive work. That kind of summed up my days work with clients.
Intuitive interventions don't follow the 'right' path to take. They don't follow the logical path to take.
She also reported that during the session she had developed quite a strong headache across her forehead. This is always a good sign when a client develops a headache during a session. It means you are not scratching surface and you have been able to touch the somatic Child ego state in the client. The headache is the somatic Child reacting to what has been going on during the session. That is not an easy thing to do as it involves getting to the basement of the personality and people have all sorts of defences against doing that.
So that was my work day today
Graffiti
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Tuesday, 03 June 2008
Attachment and proximity
This comes from John Bowlby in his widely known book “Attachment” states:
It is not a direct quote but is very similar to what has been written.
During infancy and childhood the responsibility for maintaining proximity between mother and child shifts progressively from mother to the young. Initially the infants attachment behaviour is absent or very inefficient. He is not strong enough to grip and when he gets mobile he may stray imprudently far. So at this stage the maintenance of proximity is achieved by mother. This stage usually lasts until the child is six months of age or maybe a bit longer.
It is up to mother to make sure the infant does not get lost.
After this the infant may display a strong tendency to maintain proximity but his competency to do is consistently low. He will explore but with little discrimination or judgement so he may range unacceptably far or dangerously. So in this phase proximity is maintained by the mother as much as by the infant, or even more than by the infant. this phase continues until about the end of the third year.
The balance then shifts. The infant’s attachment behaviour is much more efficient and assessment of danger much better. Proximity is maintained by him as much as by mother. Indeed at this stage mother may even encourage him to stray further. This phase can last a number of years and in modern society the child is usually not allowed by it self for extended periods of time until it is 10 years of age.
To grow up and leave home can feel like this. To leave the nest is no easy task for us all.
After this in the final stage mother increasingly leaves the maintenance of proximity up to the juvenile, so she plays an increasingly minor role.
-------------------------------
As you can see the concepts of human attachment and separation are intimately intertwined with the idea of proximity. Indeed that is how they are defined. So in the original psychological definition proximity was the core part of an attachment.
It would seem that over time the word and concept of attachment have become used widely used in the general population. As one would expect this has resulted in the definition of the concept being altered. Some now use the term attachment when the desire to maintain proximity has become much less important. So people can have an attachment to another and not have a strong urge to seek them out and maintain proximity.
Is attachment with an animal possible?
Whilst it is probably better if this change in definition did not occur, it has occurred and it is not going to stop. Just like the term ADD has changed over time. Originally it was a specific psychological state where a small group of children fulfilled the necessary criteria for such a diagnosis to be made. Now any badly behaved child can be given such a diagnosis.
As the great man Ben Cousins once stated, “Such is life”. Lets go with the flow and accept these new definitions and just be aware that there was and is another definition of a specific psychological state in human relationships that is also titled attachment.
Indeed I, myself, have used this more common parlance definition in the past. In workshops when talking about attachment in relationships I have used an exercise called the Grief monitor scale.
On the line on the left you fill in those people whom if they suddenly died you would have a grief reaction. Put the person who you would most grieve for at the top. Then the next person down, and so on. The person at the bottom is going to be the man down the street who you hardly know at all. By doing this you are automatically defining who you are attached to. The more attached, the more you suffer grief if they should die suddenly and hence the middle line.
The line on the right is the should scale. Who are the people in your society that you should grieve for at their funeral. What are the societal rules on this. Then compare the line on the left with the one on the right. Are they similar or dissimilar?
This society has its rules on who you should have an attachment for and who should be less so.
So we end up with a continuum of attachment figures.
Graffiti
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Sunday, 01 June 2008
Internet counseling
Kahless states:
“If the therapeutic relationship is key to effective counselling then if i recall you have asserted previously that internet attachments are not really attachments?”
Thanks for your comment. I have copped a bit of flack over this one. My assertion that one cannot have this thing called “Internet attachment”. I sort of agree and don’t agree that one can. If that makes any sense - which it doesn’t.
Well I even went back to my old books to just check and see if my assertion was right. I was reassured that what I read last time which was at least 5 years ago I had recalled accurately.
John Bowlby in his widely known book “Attahcment” states:
“Attachment behaviour has been defined as seeking and maintaining proximity to another individual.”(P241)
Seeks proximity
So there we have it. If a person does not seek and maintain a proximity to another then they do not have an attachment of any great strength. Most fellow bloggers have never met the other person face to face and it is highly likely that most never will. So they do not have that incessant drive and urge to seek the other party out and to maintain a proximity to them that the person with a psychological attachment does have.
A good example of this is when two adults fall in love and go into the honeymoon stage of their relationship. It is at this point that the psychological attachment is growing and developing on a daily basis and is growing stronger and stronger. Of course they usually are constantly thinking about and contacting and seeking proximity to the other loved one. Often freinds and family complain as they are spending much less time with them and more with the loved one. Of course they are, they are seeking proximity to the lover because of the attachment. And as I have said human attachment is a very potent motivator of human behavior.
Attachment can be scary
Just have a look at the blogs of my two pommy friends Hullaballoo (http://hullaballoo-hullaballoo.blogspot.com/) and Bobo (http://bobodoll.blogspot.com/) for a clear example of the desire to maintain proximity. They are counting down the seconds until they have full time proximity.
So this means blogger internet attachment does not exist -IF - you wish to be consistent on what the word and concept of attachment has been defined to be in the past. Of course people can go ahead and use the term internet attachment. If that happens and is wide spread then we will end up with two different definitions for the one term. My view would be to not do that and instead use another term instead of internet attachment.
However I would like to add that I am by no means discounting what some people have called internet attachment. One only needs to wander for a short space of time in the blogosphere and one quickly sees that many express strong emotions to other bloggers and have a strong sense of support and belonging from them. I think that is great and I am glad those people have been able to find that for themselves. It clearly is very real and does exist and it is not psychological attachment in the usual sense of the word.
Human attachment does not discriminate
It seems to me that the psychology of the strong feelings and sense of belonging expressed between bloggers is yet to be articulated. It is yet to be explained and defined. Perhaps we should give old John Bowlby a call as we are in the same situation as we were 50 years ago when the psychology of human attachment had yet to be articulated.
So how can one have internet counselling? If it is deemed that the relationship between client and therapist is the thing that has the most curative power is asked by my good pal Kahless. Firstly the internet counsellor and the internet client do have a relationship. It is not the same as the face to face client and counsellor but it is a relationship none the less and as we have seen in the blogosphere it can be a relationship of substantive emotional impact.
Whislt huge libaries of books on transference with face to face counselling exist, there is very little written on the transfernce relationship between the internet client and counsellor. Its qualities and vicissitudes are yet to be defined or articulated. And its features are yet to be honed and shaped so as to provide the maximum benefit for the client. I think I am learning precisely how to do that myself with the use of blog communication to my face to face and internet clients. How can I use my communications on this blog to optimize the transferential impact on my internet clients?
Do what's been done before, just do it different.
I would like to add that as I think about the clients who I give internet counselling the majority (but not all) I have met face to face at some point. Usually for short periods of intnesive face to face counselling but I have met most of them at some time. Also again the vast majority is not just internet counselling but also includes phone counselling. So it is a combination of both but the internet counselling is by far the most prominent at least in some instances.
Thank you Kahless for prompting this post.
Graffiti
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