Tony White

Hello Shruti,

You ask about the passive-aggressive personality. Yes I have known a few in my time and they are interesting people. First I think I can say it is one of those psychological terms that sounds unpleasant. To be told that one has a passive-aggressive personality type would not sit well with most, one could say. However having said that it is there, or perhaps it is.

If I recall correctly the DSM-III included the passive-aggressive personality disorder but by the time we reached the DSM-IV it had been removed. However it is a diagnosis that one comes across not uncommonly. Thus I can discuss it in the way I have seen the term used.



The passive-aggressive is precisely that, they display their aggression (anger) passively. Thus the treatment goals are clear, to go from passive anger expression to active anger expression. The problem is most of them are completely unaware that they are angry and that they thus show there anger in a problematic way. Often their persona or public presentation is sweet and nice and kind. But it is not long before one feels bad or angry when being around them.

This often is a result when one communicates with them, you walk away feeling angry or upset and you often don’t understand why. It is almost like the anger gets somehow transferred from them to you. This is often done via games like NIGYSOB (Now I have got you you son of a bitch).


Look how tentative the woman on the right is.



Their anger can often be projected and thus you can be convinced by the PA (as they are sometimes known) that you are angry for some reason. Often you will be accused of being angry at them and they will feel misunderstood and unfairly treated. This is a very common clinical feature, being convinced they are being harshly treated by you or others and that they are the innocent party just standing by.

As I said the treatment goals are clear. Firstly getting the PA to recognise they are angry and then getting them to express that anger in at least a semi straight way. However that is easier said than done. Not an easy task usually.



The other thing that I have learnt over the years is to simply give them positive strokes. They will not know what to do with this as it is so unusual for them. They are much more used to people feeling bad around them and to be feeling misunderstood. To suddenly have some one being positive to them is unknown. Of course their Free Child craves such a thing and it is this that can sometimes cause the chink in the armour and provides the therapeutic way in to further achievements.

Graffiti

In those instances where a person has a psychological basis for depressive symptoms there are often a collection of common clinical features that lead to some treatment possibilities.

If a person is very depressed then counselling will be of little use as the person is so ‘down’ they can participate very little in the counselling. As a result, not uncommonly clients who are being counselled for depression can at the same time be taking antidepressants. This can at times work well but sometimes the client may need to try a number of different antidepressants.



From what I have seen over the years sometimes a particular antidepressant can be a ‘wonder drug’ and make a great difference, but at other times they can make the person feel worse. So there may need to be some trial and error with this type of medication. The other difficulty is that antidepressants can make people emotionally flat. The depression subsides but so do all the other emotions and this can hinder counselling, as counselling often requires the expression of emotion. This is particularly true for anger in the depressed client, but also can be a problem for showing emotions like sadness in instances such as a bereaved client who is depressed.

Inward turned emotion.
Depression is a sodden emotion. It is an emotionally inactive emotion and an inward turned emotion. The antithesis of this is anger. It is an active emotion. When people get angry often something happens or changes, this is not the case with depression. People do not tend to sit with their anger. If they do then it starts to turn into depression. This is a important point because it means people cannot be angry and depressed at the same time. Angry people are mobile and active. Depressed people are immobile and inactive.

However sometimes depressed people are angry but they turn the anger in on self as the diagram shows.



This indicates some counselling options. The diagram on the left shows how the depressive will tend to direct their anger at self and this commonly manifests in the person doing negative self talk. This can be a self directed angry act. One option is for the person to identify a ’thing or person’ out there who they are angry at. Then begin to express that anger at ‘it’ and this can result in a reduction of the depressive feelings. However it must be guilt free anger expression. If the person expresses the anger and then feels guilty or bad about it the point of the exercise is lost.


Action and anger commonly go together



Passive behaviour
Because of the ‘stuck’ quality of depression it lends it self well to being a passive behaviour. (Often a secondary gain discovered by the depressed person) Children can learn in childhood that: “If I am sad enough for long enough then ‘X’ will do ‘Y’”. Mother will give me attention, father stops being angry at me, and so forth.
Thus we have a situation where the depressive does nothing, then someone else does something and thus we have a psychological symbiosis. If you stay very depressed for a long time then you cannot look after yourself and eventually the state will intervene and become the Parent and Adult ego state. So depression lends itself well to being used as the fourth passive behaviour of incapacitation.



Thus treatment revolves around breaking the current symbioses in the depressed person’s life. Often there is also a historical symbiosis to be dealt with as well.

Strokes
Some people are depressed simply because they are stroke deprived. This is common in socially isolated individuals, they simply do not get enough strokes. Indeed some who develop depression will then become socially isolated and thus the stroke deprivation increases the depression.

In this case the treatment looks at the stroking patterns in the person’s life, how they filter positive strokes and so forth. Sometimes such depressed people will be very resistant to acknowledging and accepting positive strokes from others. In such instances I often switch to plan B. The client then contracts to find and give others positive strokes. This is kind of a back door way of getting the person to begin looking for positives in the world rather than the negatives.

Graffiti

It is the age old question of one of the dilemmas of parenting.

If your child or teenager is doing something dodgy what do you do? This question came up again in a supervision I was recently doing with a supervisee and there was quite a good discussion about it.

This of course is particularly relevant to alcohol and drug use but does indeed relate to any behaviour. However with schoolies week upon us much is being publicly said in various forums about alcohol use. Indeed in the magazine called Outlook (Summer 2008) goes into great detail by asking the question, “The alcohol dilemma, Should you let your teenagers drink”.

The two sides of the argument is as follows.
1. You express to the child that drug or alcohol use is wrong and that they must abstain
2. You don’t chastise the child instead you listen and discuss things. You do not tell them to abstain.



The good part of 1 is that the child gets a clear message that drug use and underage alcohol use is wrong and thus the child can develop that attitude in them self. With approach 2 the parent is condoning the drug use by not expressing the requirement for the child to take no drugs and thus they are not developing the attitude that drug use is wrong.

In the magazine article they present Two case studies. the first is of a father who has a 15 year old son. He is not allowing his son to drink alcohol until he is 18 (the legal age). In relation to this he says, “And that is the rule and, if he breaks it there will be consequences...I think that means being his parent rather than trying to be his friend.”

Unfortunately the father’s statement is not completely correct and should read, “If he breaks it (and gets caught) there will be consequences”. Thus we have the downside of number 1. In addition this highlights a common flaw in many psychological theories. They rest on the assumption that one size fits all.



If your child is quite conforming and is in with a crowd that is not into alcohol then approach 1 may be a good approach to take. If you have a teenager who is strong willed and rebellious then it could be a hazardous path to take.

The problem with number 1 is that it easily breeds deception into the parent child relationship. The child will lie about what he is doing when asked if he is drinking or taking drugs. Psychologically this is not a good thing particularly in the parent adolescent relationship. As it is quite likely that the deceptive attitude will generalise into other areas of the relationship with the parent as well. The youngster will be less than candid about other things they are doing besides drug or alcohol use.

This is not a good thing at all from a psychological point of view for the adolescent stage of development. Sometimes teenagers get caught into things that are illegal or dangerous and feel they cannot get out. Thus the parent wants as open as possible relationship with the adolescent. If the child has been lying to a parent about alcohol use then they are less likely to discuss other matters as openly. For instance a 15 year old girl who is in with a sexually promiscuous crowd and feels she can’t do anything about it.


Some teenagers get into difficult situations and feel like this.




This of course is an advantage of the number 2 approach. The teenager will be more likely to be truthful with the parent about what they are doing, thinking and feeling. The parent child relationship is on a stronger footing and that is most important with a child who is in the adolescent stage.

But as mentioned before approach 2 condones drug use at least in part. Also it raises the point that the father of the 15 year old boy said. The difference between being a teenager’s friend and being their parent which is quite a good point.

It seems safe to say that a parent would not want to become a friend to their teenage son. That this would not a good thing to do psychologically. I have two teenage sons and whilst I am friendly to them I would not say that I am their friend. At least in the sense that I have friends my own age. I certainly do do parental things with them and act as a confidant and so forth. I have always liked this list below and would see myself as by and large doing it.



Finally there is another group of teenage alcohol and drug users that the magazine article does not even mention. They are by no means the majority but from what I have seen they are of a significant number. This group are mixed up, angry, confused, often with things like anxiety and/or depression. Some of these teenagers are simply going to use drugs and alcohol no matter what parents or anyone else says.

Weather parents use approach 1 or 2 does not matter. One can forget about requesting abstinence or saying their views on drug use. In these cases it is advisable to get some professional input and take the attitude of management of the teenager to get them through the rough years where they will at times use drugs and alcohol excessively. If managed successfully then at the end of adolescence some can come out successfully.

Graffiti

Hey Colin,

Grand to hear from you my pommy mate and fellow blogstreamer.



Here is a picture from the twilight zone, or is that the relegation zone? Are they are almost in it?. I never did discover what blowin' bubbles ever had to do with the West Ham FC. I do follow them a bit when I hear about the league on sports channel over here.

Yes, as you know I left blogstream. Just got all a bit too 'tight' for me and with those conflicts and people seeming to get into hassles with each other. So I decided to move to other pastures. Mind you I did miss the likes of you and good old Six Foot Blonde. (I am sure she would not like me referring to her as 'old'). A damn good bit of crumpet she was.

So I joined Blogspirit in 2006 when it was free. I think now one has to pay to be a member, but pre-existing members still get old frenchy for free. I have a Blogger blog I occasionally post on and am just keeping it there in case Blogspirit decides to change his mind and screw me out of a couple of Euros each month.

However where ever you go let me know so I can come and comment and find out what deviant acts are going on in the weedy shack.

All the best to you my friend

Graffiti

There is another excellent post over at Myalterego (See Myalterego link in my Blogs I like list) titled, “Why I don’t fire the shrink, and follow up”. In it she asks the question about why she does not fire her current shrink and find a new one. This is an interesting question.

I regularly ask my clients if they are getting what they want from the therapy, why are they still coming here, and so forth? I am asking them if they want to continue therapy at all, which is different from Myalterego’s question. She is asking - I want to continue treatment but do I change shrinks?. A different question and one which I am sure I will steal from her and use it myself with clients in the near future.



Anyway she comes up with an interesting list of 8 reasons why she wont change therapists at this point. She essentially comes up with a list of some of the therapist’s characteristics and some qualities of their therapeutic relationship. I would in fact add a number 9 reason.

Question: One reason why am reluctant to change therapists
Answer: Because I have developed a psychological attachment to the current one.

As readers of this blog would know, I am often banging on about how one must never underestimate the power of human attachment. It is a very powerful motivator of human behaviour to maintain a proximity to the attachment figure.


Maintaining proximity



Also raised is the question of when does a client give up looking for a therapeutic solution to ones troubles such as anxiety and depression. When does one accept that this is as good as it is going to get at this point at least. To learn to live with one’s depression or anxiety rather than trying to find a therapeutic solution to decrease it. To accept that there is no hope for any further cure to ones neurosis.

In considering these questions raised by Myalterego I realised that in all my years of training as a psychologist and all my subsequent training in various psychotherapies I have never received any training on such a point. Indeed I can never recall a time when such a thing was even discussed. So like I usually do I will have my say on such a topic.

Perhaps one reason why it is never or rarely discussed is because of the way psychological theories are structured. In most if not every psychological theory there is always a solution defined. There is always a theoretical therapeutic solution to depression or anxiety. Hence forth if there is always at least theoretically a solution then there is no need to consider how to work with a client who has no hope of getting less anxious or less depressed.

Very simplistically
In psychoanalysis one cures anxiety by making unconscious material conscious.
In transference based therapies one cures depression by the client forming an attachment to the therapist that is secure and healthy.
In transactional analysis one cures anxiety by getting the Child ego state to make a redecision.
And so on endlessly.


All clients have choices, don't they?



If these are done and the client is still anxious or depressed then the theories will also have an explanation for that. Either the therapist is not doing the treatment right, or it is simply going to take more time, or the client is blamed as being resistant and so forth.

I am not aware of any psychological theory that says sometimes clients are ‘incurable’ and the gaol is for them to accept their disability and live the fullest life they can with the disability. Perhaps these need to be included in the such theories. Once done, then one is in a position to work with the client from that theoretical basis.

One down side of such an ‘incurable’ concept being included in psychological theories is the self fulfilling prophecy and the highly suggestible client. If a therapist starts to question if the client will ever be anxiety free then the suggestible client can quickly take that on when in fact there may still be considerable hope left.



Another problem is at what point does one accept that treatment is no longer going to be any use? When does a person begin to accept that this is as good as it gets?

What are the answer to such questions I am not sure, yet.

Graffiti

KazzaB asks where my books have gone?

Last night after a few chardonnays I got a bit nervous and shy.

Showing those books in my private book shelves all got too much for me.

To me that is an intimate thing.

Holley Molley do I sound like a nerd!

If you wish to have a closer look at the books in my book shelf at home just click on the picture and it will take you to my Flickr. Then click on the "All sizes" button.


Books 1


Books 2


Books 3


And no, the sex ones were not all mine originally.

Graffiti

For a very good blog post go to Myalterego in my “Blogs I like list”. The post is titled - Does long term, non-remitting mental illness need a psychiatrist. A very nice statement from the client’s perspective about some of the basic assumptions that mental health professionals work from. And comes to a conclusion that I happen to agree with, which always helps!

Also Myalterego asks a question to my post, Transference - the good and the bad, about characterological problems. At the moment I am writing a lot of case studies and have one that clearly illustrates a characterological problem so I thought I would use it here. As usual some of the client data is fictionalised.



The term ‘character’ and ‘characterological’ has been used in a variety of ways over the years. The way I use the term and which is not an uncommon way originally comes from the writing of Wilhelm Reich (Now there is a guy you could do a couple of very good blog posts on, and I probably will).

He wrote a landmark book called Character Analysis (third edition). Now I highlight the title ‘third edition’ as he had a very bad literary habit. Originally he wrote a book called Character Analysis. It was very popular and so the publishers wanted to do re-runs of it. However before this was done he rewrote significant parts of it as his thinking had evolved on the topic. The problem is he still kept the same title - Character Analysis. Then they did the same later again when he rewrote it for a second time and still named it - Character Analysis!!. So he essentially ended up with three different books all with the same title. This, as you can imagine has caused much difficulty over the years.

Over time his writings on character have been very influential especially in areas like Gestalt therapy and all the body or energy therapies. Many of these have based their theories on the work of Reich.

When one talks about a person’s character one is usually referring to the basic sense of who they are, not the changing behaviours or feelings which come and go many times a day. A person’s character is much more stable and resistant to change. It refers to who they are and their basic beliefs and feelings about the world.


World view



There is a german word - Weltanschauung - that translates as, world view, in english and that’s what character in this sense means. Our basic world view, natural disposition and temperament. So a neurosis is not a character problem. A character problem is deeper in the personality.

So people with a characterological problem are often seen as having what is sometimes called a Personality Disorder. A characterological problem is a developmentally based disorder of a person basic character. This needs to be distinguished from biologically or genetically based emotional disturbances. The term characterological problem refers to psychological problems that have been caused by problems in a persons normal psychological development and not because of their genes. It has been caused by aberrations in the primary parent child relationship or attachment, not because of the biology that the child was born with.

Take the case of M. A 12 year old boy who is very disruptive. Been suspended from school on numerous occasions, at times he has assaulted others and damaged property in many instances. Has been diagnosed as Oppositional- defiant by just about everybody and even gets the occasional diagnosis of Aspergers just for good measure.


Oppositional - defiant



Whilst his mother works very hard at her mothering she has many of her own emotional demons. She has had numerous psychiatric hospitalisations since he was born. In earlier days they were one or two weeks in length and now they tend to be for a few days at a time. M’s response to this has been to form a very strong and singular attachment to her. As far as attachments go she is IT for him. The one and only.

Of course this has been most problematic because it means he has been psychologically abandoned numerous times since as early as he can recall. Thus he has developed an strong insecure attachment to her. He is very angry about the abandonments and thus the aggressive behaviour. However he also uses this aggression to isolate him and his mother so that they can be together.

When he is suspended from school where does he go? He stays at home with mother. If they go out to visit friends and relatives he breaks their property so they are not asked back. He has no interest in seeing friends on the weekends and prefers to stay at home with mother. He makes frequent requests for homeschooling. The magical thinking is that if he can finally create the situation when he and mother are alone together then at last he will feel secure in his attachment to her. This will not happen as the mother will be repeatedly hospitalised for many years to come.



Because this problem began when he was an infant and it involves a disturbance in the basic attachment with mother then it could be diagnosed as a characterological problem. The anxiety, anger and insecurity are part of his basic character.

I have now been seeing him for 18 months. The treatment goal is for him is to form a basic attachment to me. If he does that then he will be developing a secure attachment because there wont be abandonments by me. If he achieves that then he will begin to get a sense of security in his basic character. If he does that then his need to isolate him and mother using aggression will subside.

Whilst he is doing well, indeed better than I had anticipated, there are a lot of “ifs” in that. Treating a characterological problem takes a lot of time and takes money as well. So only time will tell how much success M will have in the long term.

Graffiti

In recent times I have been working with a depressive man. It is only early days and have seen him on three occasions. Things seem to be going OK and he states that he wants to return and has he been 20 minutes early on each occasion.

I am hearing the usual stuff as one would expect from a person with depression. Self debasement, life has passed him by, negative self talk, quite a strong pessimistic attitude and so forth.



I am feeling OK with him and quite like him, his Machiavellian view of life and his caustic sense of humour. But I am surprised at how I relate to him. It has not been premeditated but is just how I am and I am not usually like this. Although I squirm as I say this, I am being jolly. I find myself being jolly with him! I don’t like being jolly.

In the therapy that I usually do there is often laughter and it can be quite fun at times. But I would not say that I am jolly usually. Jolly to me is like santa claus and his “Ho, ho, ho”. Whilst that is OK to see at Christmas time I don’t particularly like seeing myself as being jolly. It is a bit too trite for my liking. It’s a bit too cheesy for me.

However I find I am being jolly with him and I don’t know why, but that is what is happening at this stage. Now one could say that perhaps I have reacted to him this way because of his pessimism and gloomy attitude that is present at times for sure. That I have spontaneously reacted this way in the hope that some of it sort of rubs off on him and he becomes a bit more happier.

It does inject some of that into the therapeutic relationship and does stop the sessions becoming just a down and gloomy state of affairs. But I feel there is something else lurking in the background. I feel that at some point in the not too distant future I am going to switch from jolly to something else, and that is still yet to be defined in my mind.


Who am I?



It is like I am being the way I am now and it is establishing a base of some kind in the therapeutic relationship. Once that is established then I can switch to something else for some unknown reason.

Mind you this is all conjecture and crystal ball gazing at this stage. But I just feel there is something going on and I am being jolly which is not usually me. Maybe I am just hoping that do I switch in the future as I don’t particularly like seeing my self as jolly.

Oh well, I will just go and be me as I relate to him and will see what unfolds.

Graffiti

With the comments of fellow bloggers it seems we are developing a sound theory of the psychology of swearing.

We hear comments like swearing may keep the client on the left foot or that swearing can be good shock value. I agree with these comments and so why would this be so?

Swearing it seems begins as a function of the Parent ego state. In our Parent we have all the rules and mores of society. That includes a statement of what is good behaviour, feelings and indeed speech. It would then seem that by swearing one is breaking those rules. There maybe a whole variety of motives to break such rules.


Bansky artwork sold for thousands.

Perhaps it could be that many swear words are short and impactful words - the four letter word. This of course means that perhaps swearing can be associated with anger and indeed is an expression of anger by the swearer. This maybe one reason why people notice it. Some theorise that people are hardwired to be alert to anger as anger always has the potential to be physically damaging. So as a survival mechanism people notice anger more than other emotions. Thus this could be seen as a Free Child expression by using cursing to express anger.

There may also be a Conforming Child aspect to cussing. In some subcultures swearing is the norm and indeed not to do it would be considered deviant. However in that subculture it may not even be considered swearing but in the wider culture it is and the subcultures would know that.

The other interesting thing about swearing is that at least in english the words tend to be of a particular type. They commonly relate to the human sex act or the male and female anatomy used in the human sex act. Otherwise they relate to the human elimination of the bowel or bladder or the various parts of the anatomy involved in human elimination.


Swear word related to the male sexual anatomy?

In general society one does not talk about the sex act or human elimination in public company. To do so could be considered crude, offensive and perhaps even disgusting in some circles. Thus if one swears in public they can be attempting to be offensive and crude. Why would one do that?

To make an impact about what you are currently saying and indeed a psychotherapist may do such a thing.

Generally one could say that the public tends to see psychotherapists as people who are good citizens and even of some social standing. Thus to let fly with a good cuss could also put the client onto the left foot because they are not expecting a therapist to do such a thing. It can have shock value as a blog commenter mentioned. Some may even take it as, “That means the therapist is being real with me and they are not trying to be above me”.



Finally as swearing can be crude and disgusting to some one could swear so as to get ostracised from a particular group. If their life script is to be rejected and ostracised then swearing in an offensive way would make sure that that is going to happen.

Graffiti

Should the psychotherapist swear?

Damn right you mother fuckers!
(Do I have your attention now?)

I have been known to swear, cuss, blaspheme and utter profanities. Its just that I don’t do it all that often. I have no major moral or philosophical stand point against swearing or those who do utter such profanities. Heavens, if you work in a prison and were offended by such cursing one would not last long at all. Everyone, prisoners and staff alike swear and one hears such profanities regularly.



Swearing can be an effective way of making a point under the right conditions. So it can be an effective way to communicate.

Sex and swearing are similar in that people desensitise quickly to them both. Over the years I have attended a few sex therapy workshops and the first thing they do at such workshops is show movies of people having sex. Why? No its not a front for pornographers it’s so the workshop participants desensitise to seeing sexual acts. Once the desensitisation has been achieved then the workshop can proceed without the sniggers and joke making that would happen if such desensitisation had not happened. It takes about 5 to 10 minutes usually.



Swearing seems to be the same. If you are talking with someone who cusses a lot then at first one notices it but quickly it is no longer in the fore ground and moves into the background of the attention of those communicating. But that is the thing about swearing (like seeing sex DVDs), if there has been none for a while and suddenly you do swear then it is very noticeable to the listener. People naturally notice it and remember it.

That is how I am in my private life and as a psychotherapist. I am known as a person who curses irregularly because I do curse irregularly. However I do swear at times and when I do it is because I feel passionately or emotive about the thing I am currently discussing. Its not a premeditated act it is just what I do from time to time.


Onanists rule.




So from a psychotherapy point of view, if I cuss the client will know that I am emotional or feel quite strongly about what I am saying, Thus it is a good way to make a point. If one cusses all the time then they loose that ability to make a strong point with the use of swearing.

Graffiti