Tony White

Today is a Monday holiday!!

WooHoo!!

Oh yes and it is Australia day as well.

The day we were colonised by our British ancestors. So the aborigines call it invasion day and want the holiday changed.



I have just been to a local recreation area to do some exercise and buy some supplies and there was every type of water craft known to mankind in use. Every one is having - fun. fun. fun!!!

I have never seen so many flags, cricket bats, Aussie tattoos, BBQs, eskies full of beer in one place at one time. This is a day to enjoy for many in Oz.



A bit hot as well today so we could have that old tradition of setting a bush fire or two. Each summer we Australians do that you know and the old arsonists crank up their lighters and head bush to start a blaze or two. Been a few good ones this summer already.

OK I will start banging on, what I usually bang on about!

Psychologically fire is most interesting because of its extreme destructiveness. If your house gets flooded it probably will survive, or if it gets caught in the wind of a cyclone then it probably will survive to some degree, or if there is an earthquake it may survive to some degree. But if you get a good fire going in the house then it is nitey night, sayonara and toodle-oo. Of all the elements fire is the one that will destroy more so than say wind or water.

So if a person destroys something with fire it is seen as the expression of an intense desire to destroy. Rage and all that sort of thing. We all know this and so when we see out of control fire it is attention grabbing and stimulating in that way. Hence we have the psychological basis of the arsonist or the pyromaniac.



As Freud would have said the pyromaniac lights the fire, then get sexually aroused and this is the nature of the true pyromaniac. Now we know he was a bit obsessed with sex but he was also a very good observer of human nature, so lets change what he said just a little bit.

When the pyromaniac lights a fire he gets physical arousal in his body. In some people that state of arousal will get sexualised and for others it will not. However they are all placed in a state of heightened physical arousal. Hence we have the addiction of the pyromaniac or the serial arsonist.

It is like the self harmer who is so continually numb or psychologically anethesitized that they cannot take it anymore. So they go and cut self in order to get some feeling (ie physical arousal). The serial arsonist can be the same. They get such arousal from lighting the fire, hiding and watching the destructiveness of the fire that the ever present numbness goes a way for a time. Problem is it comes back and thus the strong urge to do the same again.

The other reason why the career of an pyromaniac can be a short one is they have to hang around. It’s no use lighting the fire and then running away because you don’t get the same physical arousal which is the whole purpose of the exercise in the first place. So they lurk around and are often identified and caught. In some instances they will get so excited they will need to urinate which is very symbolic in itself.



There may at times be considerable advance preparation of the fire setting which of course adds to the tension build up and feeling. Then as the fire happens and the person watches there is the release of tension and a sense of normality appears for a period of time. The same can happen for others like the kleptomaniac. First the numbness, then the tension build up followed by the release and then a sense of normality or realness for a period of time.



I knew a serial arsonist once when I worked in a prison. He was brought to me because one day he trashed his cell and I mean he trashed his cell. Every possible thing that could be smashed, broken or ripped up was. I went and had a look at it and it was a demolition site.

So as the psych I am supposed to fix him up which really meant monitor him and act as a release valve so the next time he would only trash his cell a little bit rather than do a complete demolition job. So I got to know him quite well. Some other inmates had been picking on him for some time and finally he just exploded and wrecked his cell.

I found him to be nice man and we had many good conversations. But he looked like he had just come in from the jungle. One day I said to him that he looked like the “Wild man from Borneo”, which he found most entertaining and indeed would refer to himself as that from time to time.



Often prisoners will try and intimidate and threaten you so as to gain the upper hand in the relationship. He never did any of this with me and was pleasant and indeed polite to me most of the time. But he also had a rage deep inside him. If the rage button got pushed, out it would come and that was the time not to be around. Interestingly he never had any convictions for assault so it seemed he could direct his rage at property and with the use of fire. Which is good in a round about sort of a way. He would be out by now. Wonder if he has joined this years fire lighting season.

Graffiti

In the newspaper today there was this article about a snake oil salesman. This story has been running for some time now and he is accused of running a cult and being this charismatic person who gets followers and abuses or uses them in various ways. Apparently one of his techniques of control is that he is said to give counselling to his followers and apparently he uses this as a way of keeping them ‘obedient’.


Obedience.



Well the journalist Colleen Egan calls for more regulation on ‘counsellors’ to make them accountable to some form of professional body. Whilst I am sure her intentions are well meaning the last thing we need is more regulation of this kind. It simply is ineffective.

All this does is stop people using the word, in this case ‘counsellor’. Counselling is not a word but is a style of relating and you simply cannot regulate that. Everyday mothers counsel children, bosses counsel employees, teachers counsel students, wives counsel husbands and so forth.

If such regulation came in then the charismatic figures would simply change the title of what they do to such things as therapy, coaching, life coaching, facilitating human development and so on. It is not going to stop this man relating to his followers in a counselling type of way which the problem is, and it can lead to exploitation.



But that is life and it goes on day in and day out. In the work place it is called office politics. That is people are setting about changing office relationship so one gains some dominance or ‘power’ over the others. In the counselling relationship that can happen as well and it can be used for good or evil.

One also needs to be careful of the corollary. If one sees regulation of the title as the solution then many will automatically assume that because a person has such a title then they are competent and ethical. Unfortunately that is not always true. I know some highly qualified and titled counsellors who I would not refer my dog to.

To get a qualification or title means you have passed an exam, it does not mean you are competent as a counsellor. It can help a little bit, but as I said counselling is about a style of relating and I am not aware of how one can examine such a thing effectively. I am yet to see an examination system for counsellors that can do such a thing and I have been involved with credentialling counsellors for the past 25 years.



It does however raise another interesting point. Can a husband and wife counsel each other? My answer to that is, “No”. What they can do is listen empathetically and compassionately and give some bits and pieces of advice perhaps. But it must be kept to a moderate level. The quickest way to destroy a marriage is for the wife to stop being a wife to her husband and become her husband’s counsellor. If that happens its, good-bye marriage.

Counselling is not only listening and passing on wise counsel but it is a way of relating as I mentioned before. The power structure in the relationship is not equal and thus if the wife counsels her husband then she is moving into the powerful, psychologically dominant position. Sooner of later that is going to incense his Child ego state and then the shit hits the fan and the relationship is on the rocks.



If the husband is struggling emotionally then there is nothing wrong with the wife helping empathetically. But it cannot go on too long or get too intense because then the marriage changes into a counselling relationship.

Graffiti

On December 30th I displayed my panic attack monologue on this blog.



I have discovered that some woman is using this bit of YouTube video on her website. Whilst she is not actually selling it she is using it in the free give-a-way section of her website. She has it and other bits and pieces on her website for all to see.

Then she has another section where you have to pay to go and see the contents. She is selling various books, DVDs and so forth on how to beat your depression and over come your panic attacks. That sort of thing.

I suppose that is life on the internet. I have no trouble with people using it, in fact I hope they do, but to sort of make money out of it is a little different. However this is not really my main concern.


Me doing co-therapy. I am a mainstream sort of a guy!

The content of the monologue is sound. Panic attacks can result from disturbed attachments where the person develops the hurried child syndrome. This would be mainstream thinking in psychology these days. Then the part about loving your panic attacks would not be widely stated but it is based on sound logic and the science of psychology.

So whilst the content is sound the method of presentation is somewhat unorthodox. Not exactly what one would find in a scientific journal. Not the most common way one would present the theory of panic attacks. So I am not really sure what to think about that as to weather it is a good thing or bad thing. There is my face on the video on her website next to other books and so forth that are mainstream thinking presented in a mainstream style.

It has forced me to think about why did I do the monologue like that in the first place?

Graffiti

INTRODUCTION
Transference is one of those things in psychology that everyone has something to say about. The problem is however that many people have differing definitions of transference. Therefore when they talk about transference they are often talking about different things. As they have the same label - “Transference” - people assume they are talking about the same thing and thus disagreements are rife and at times bitter. So if you are ever having a discussion with others about transference it is wise first to work out if you are actually talking about the same thing!
Others have stated this point before:
Silverberg(1948) says that transference has been defined as either being
1) the whole relationship between two people
2) only a bit of repetition

It is pleasing to see that one of the main articles on Transactional Analysis and transference makes this distinction as well (Carlo Moiso(1985)). He notes that in transactional analysis transference has been correlated with life scripts and on the other hand transference is connected to the analysis of specific transactional stimuli and responses. So transference is connected to a whole life script and at other times it is seen as a specific transaction.

The whole relationship:
This means that when you enter into a relationship with another person then the whole way you begin to think, feel and act is determined by what you have learnt about relationships in the past - mainly from your parents in childhood.

A bit of repetition:
A good example of this is how Eric Berne talks about the transference transaction. So in this instance transference is not the whole relationship but a single transaction commonly called the transference transaction.

Transference transaction
The supervisor transaction is a type of transference transaction.



Diagram 1.


This is a transference transaction - a crossed transaction. The supervisee mistakenly sees the supervisor as a parental figure and will react to that person in the same way that they reacted to their mother or father as a child. So in childhood when a child was told it had done something wrong it often felt bad or angry, sad and so forth. So if a supervisor has to tell a supervisee they have done some wrong or needs to be improved (Stimulus 1) the supervisee will often feel the same way. So information may not be perceived as being information but seen as an accusation (Stimulus 2). Consequently the supervisee does not respond back to S1 but to S2 with either rebellion or compliance (Response 1).
So as you can see - transference - in this instance are just a single transaction that gets repeated over and over again. This is often called game playing. It is definitely not the whole relationship. So ‘curing’ the transference in this instance is quite easy. The supervisee simply strengthens the Adult ego state and responds from that rather then the Child ego state. So with this definition transference is seen as a ‘unhealthy’ thing that needs to be avoided and it is possible to relate without transference.
Where transference is seen as the whole relationship ‘cure’ is far less clear. It also raises the issue of can you have a relationship that is free from transference or do all relationships have transference with healthy and unhealthy transference being the main point.
So in discussion with others it would seem wise for the discussants to make sure they have defined transference the same way or the discussion is doomed to go around and around in circles.

THE THREE TRANSFERENCES
Eric Berne in his book ‘The structure and dynamics of organisations and groups’ developed a diagram called the “Group Imago Diagram” (Berne (1963)). This he referred to as the private structure of the group and is shown below in diagram 2.



Group Imago Diagram
Diagram 2


Every person in a group has one of these. It shows how they position themselves in relation to others. They may see someone in the leadership position (slot) and others in peer or equal slots (Differentiated slots). Then there will be others who are just ‘there’ and have no significant psychological meaning for the person. So for these people there is no emotional investment whereas for the differentiated ones there are emotional reactions. These emotional reactions occur from the past experiences of the person. So these are the ones that the person will transfer onto. Particularly the person in the leadership slot.
So the individual (Self) develops these slots or images in childhood and carries them around and as he meets new people some will transferred into the various positions (slots). Those others who do not ‘fit’ will remain in the ‘Others’ position.


Tony White(1985) expanded this diagram into the “Script Imago Diagram” and it is shown below in diagram 3:


Script imago diagram
Diagram 3

Again we have the self in the middle and then we have others placed in various positions in relation to the individual. We have others as either:
1. Transference figures (Parent figures)
2. Sibling-transference figures (Sibling figures)
3. Counter-transference figures (Dependent figures)

The transference figures we perceive as those who are in some way more powerful or psychologically potent than us. The sibling-transference figures are seen as our peers on an equal basis and the counter-transference figures are those who we see as having less power or less psychologically potent than ourselves. It must be remembered that this is the person’s private view of the world not the public or formal view. For example, your boss at work is in the formal transference slot. However in your own mind that may not be so at all. If you have a close friendship with him you may in fact perceive him as an equal figure. Or if you see him as needy or incompetent you may see him as a dependent figure or less psychologically potent.
This imago is developed in childhood and provides us with a set of ‘images’ or prototypes for relationships that we will carry around with us in our lives. Whenever we develop an attachment to someone then we will classify them into one of these ‘images’ and transfer our past onto the the person in the here and now.
There are some common factors that people will tend to use to categorise others into one of the 3 types of transference.
* Economic factors: Parents have economic control over children. Employers have economic control over employees and as a result an employee is likely to see the employer as a parental figure. Logically the employer is likely to see the employee as a dependent type figure.
* Legal factor: Parents have legal control over children. Those who have legal control over others such as judges, police and umpires are likely to see the underlings as dependants and vice versa the other way around. Whereas two policemen of equal rank will tend to see each other as sibling figures of equal potency.
* Information factor: Parents have more information than children. So in adulthood when you come into contact with an ‘expert’ such as a doctor, lawyer, psychologist you will tend to view that person as a parent figure at least in those circumstances. Again two lawyers will tend to see each other as equals.
* Nurturing factor: Parents nurture children. So if one goes to see a counsellor who is nurturing then the client will tend to see that person as a parental figure and the counsellor will tend to see the client as a dependent figure.
* Individual personal factors: despite all the above there maybe other things which make your perception of another person different than what it is expected to be. For instance the way a person looks, has their hair done, they way they speak or gossip you have heard about them may remind you of someone from your childhood and thus you will tend to slot that person into a particular image of that ‘old’ figure regardless of how many formal controls they may have over you.
Regarding treatment the goal is to transform or create new slots or images in the client’s script imago. If the client had a mother who never listened to her (“Don’t be important” injunction) then she will develop transference figures in the here and now who either do not listen to her, or she perceives them as not listening to her. As she forms a transference relationship with the therapist the client will begin to gain reinforcing memories of when the therapist did not listen to her and ignore or forget those times when the therapist did listen. Thus the client will recreate the same relationship with the therapist in the here and now that she had with her mother in the past. This is sometimes called the transference neurosis: the same quality of relationship is recreated by the client in the counselling room.
Working with the transference the therapist confronts the transference neurosis by a variety of means and over time the client will begin to create a new slot or image. As it becomes more practised by the client experiencing being listened to it gains in its strength and the other slot of not being listened to begins to fade. Consequently the client will then begin to form new types of relationships with others where she feels listened to and the new imago image is created. In this sense ‘cure’ is achieved.
For those training to be psychotherapists, one of the gaols is to create a dependent figure or counter-transference slot that represents a healthy way of relating to clients. So when new clients arrive they are perceived in a way that will allow the therapist to relate to them is a health promoting way. A counter-transference issue will evolve when the client for some reason is slotted by the therapist into a dependent figure slot that is unhealthy . Thus the therapist will relate to that client in a way that confuses the treatment.

HOW THE THREE TRANSFERENCES DEVELOP?
How do the images or slots in the script imago develop?. How do we create them in childhood so that when can transfer them onto others in adulthood? This is one of those things in psychology that looks relatively clear on the surface but as you look in more detail it gets more complicated.
These slots or images are somewhat like muscles. When constantly used they grow and become strong and vital. If they are not used they tend to atrophy. They can never completely die away, yet when not used for long periods of time they can become quite insignificant.
It is probably safe to say that the images develop within the first decade of life and will become fully formed when four conditions are met.

1. The child observes how others relate (modelling). The more affect laden they (the model) are the more powerful the effect. If a girl sees her mother relating to others in a nurturing way then that girl will develop a slot or image of dependent figures or counter-transference figures that are related to with the Nurturing Parent ego state. If a boy sees his father relate to his peers in a competitive way then he will be forming slots in his script imago with sibling-transference figures that are competitive in nature.
2. The child get stroked for particular types of relating. If the young boy is given lots of attention and strokes for being competitive with his peers then he will develop strong sibling-transference slots that are again competitive in nature. If a girls is stroked for taking charge and being critical of others then she will tend to develop counter-transference images that are critical and controlling in nature.
3. Attributions also play a role here. If a young girl is told “You are the nurturing one” that will encourage her development of counter-transference images where she sees them as requiring nurturing. If a young boy is told, “He is the fun loving one of the children” then he is likely to develop sibling-transference slots that are of that nature.
4. The child can practice the relating style first hand. This is often done through play. Psychologists have long recognised that humans and animals use play as a way of learning how to be with others. Practising how to be.
This is the most important of the four conditions for without actual practice in childhood the slot formation will be retarded. For instance if a mother strongly models nurturing behaviour but then the child has no opportunity to practice such behaviour first hand with others then that ‘image’ will tend to remain dormant and unpractised. Children can often find a way however. For instance girls playing with dolls is a modified version of practising first hand. It is not as strong as with a real life person but it is better than nothing.
This of course highlights the problem for the only child in a family or children who are raised in some form of isolated environment. Their options for practice are limited. In this way the best thing parents can do is:
* Provide good role models
* Provide the offspring with access to a variety of other children/people of their own age and different ages
* Remain aloof during the practice. Don’t play for them.
* Stroke healthy relating
This will allow for the formation of the most healthy transference, counter-transference & sibling-transference images.

POSITIVE AND NEGATIVE TRANSFERENCE
Whilst the process of positive and negative transference technically occurs in all relationships that gain some degree of emotional depth, it is most notable in the client-therapist relationship. To explain this I will follow what Freud(1966) said about how the transference relationship between client and therapist alters over time.
If a person enters counselling and ends up working through the transference relationship with the therapist then there are 6 stages in which that relationship progresses. Diagram 4 below.


Changes in the transference relationship
Diagram 4


Initial contact
All relationships including the relationship between client and therapist begins with the initial contact stage in diagram 4. The two individuals meet for the first time and at this point they are only acquaintances with no emotional bond between them. It should also be noted however that at this point most clients will have the therapist to some degree in the transference or parental slot in the script imago.
To understand this consider what confronts the client even before they have walked in the door. The client has asked the therapist for help, so the client makes an appointment - the therapist decides what times he is available and usually the client has to fit in with that. The therapist decides finishing and starting times, how long treatment will run for, what form the treatment will take, how much the client will pay, how payment is made, if there are any coffee breaks, their length, what coffee will be drunk and what food will be eaten, the therapist defines the ground rules and in some cases the the therapist may have legal control over the client such as in court ordered treatment. As you can see an awesome set of circumstances that will inevitably effect the client’s perception of the therapist.
This initial contact stage is where the two parties begin to sort out where they fit for each other in their script imagoes. At this stage the slotting or psychological understanding of each other is brittle and fragile. There can be considerable changes as the client and therapist get to know each other better. That is, as they begin to form a bond or attachment. As any counsellor will know there are those clients who you just click with and there are others who you do not. This can be explained by the script imagoes of both connecting. The therapist fits well in one of the client’s script imago images and the client fits well in one of the therapist’s script imago images. So the connection between them has a ‘natural’ feel or a feeling that they understand each other.
Bond formation
As the contact continues the bond or attachment between the two increases. It should be noted however that the client-therapist relationship is unique in this way in that it is not an equal relationship as say are friends or partners can be. The therapist has more emotional meaning to the client than the other way around or at least that is how it is meant to be. Put somewhat crudely the client needs the therapist more than the therapist needs the client for their emotional well-being.
This is similar to what happens with a parent and a child. It is without a doubt devastating for a parent when a child dies but it is not in the same league of devastation for a child when a parent dies. So the client will develop a more important attachment than the therapist.
Some therapists and therapeutic theories will actively resist attachment development on the therapist side. They believe that the treatment must be clinical and one should stay out of it personally. Obviously forming an attachment means it is getting personal. So they try and keep distant from the client in this way and to keep their own humanness out of the counselling.
This also applies for some trainers who believe that if you are training a person to be a transactional analyst then you cannot also be their therapist as well. The usual reason given is that the attachment achieved in therapy will confuse the teaching relationship. To my mind this is a silly flat rule to have. There are people who I have as clients who I would never enter into a training relationship with and vice versa. Then there are many others who benefit greatly from it both ways - clients who become trainees and trainees who become clients. It seems likely that those who just have a flat rule indicates some counter-transference issues on the therapist’s or trainer’s behalf so they need to create a organisational boundary to deal with it.
Positive transference
Once the attachment is beginning to form many move into what Freud called the positive transference. He states that during this time the patient develops a special interest in the therapist where the patient’s relationship is most agreeable. Changes in the patient seem to occur swiftly and appear to result from what the doctor says.
There may be the disappearance of peripheral problems. For instance the person looses weight, gives up smoking, their sexual relationship improves or they start sleeping better when these were not the main presenting problems. The therapist must treat such changes with caution and be careful to avoid diagnosing them as ‘real’ changes as they can quickly disappear when the next stage appears.
However I am not suggesting that these changes are fake or manipulative for some reason. Instead in this stage of positive transference the Free Child of the client sees hope for finally resolving the needs and wants they have had for their whole life. For example a person who always felt not understood by mother or father may see in the therapist some who is finally going to understand them and thus their lifelong unmet need is finally going to get met. Thus a great deal of hope is engendered and such spontaneous changes can result along with a positive attitude by the client towards the therapist.
Negative transference
Alas the positive transference stage comes to an end as the client moves on. Freud also spoke about this at some length. The change from positive transference to negative transference can be quite rapid and he states that all the spontaneous cures of the positive transference stage are “blown away like spray before the wind” (Freud(1966)). It is typified by feelings of negativism, resistance and anger or conflict in the client. The client who once thought you the therapist could do no wrong in a strong positive transference all of a sudden sees you as the enemy and a poor therapist who does not know what he is doing. As a consequence difficulties arise in treatment such as arguing over appointment times, missing appointments, breaking agreements, questioning what the therapist is doing, arguing over money and so forth. The client may start smoking again or sleeping poorly again and the therapist may get the blame for that also.
As with all transference it is imperative that the therapist does not take it personally. If they do then difficult counter-transference problems will arise within the therapist. It maybe very nice for the therapist to hear in the positive transference stage that they are ‘the best thing since sliced bread’ and that the client loves you. Unfortunately they don’t because how can they love you when they do not know you. They only know you in a very specific way in the counselling room and very little about your personal habits or ideas and the whole rest of your life. The client does not love the therapist but loves what they believe the therapist to be.
Fortunately the same applies for negative transference. When the client views you in a very dim light it’s not really you, but what you represent to them. You are an image in the client’s mind and script imago that is being transferred from the past onto the here and now. Again the client does not know you.
This negative transference is the beginning of the separation which some move through relatively easily and some others struggle with tremendously. In the positive transference the bond or attachment is being built up and the client gains the therapeutic value from such a healthy attachment forming. Then it all turns around with the negative transference where the bond is being broken down and the person is separating and moving away. This is similar to what happens with teenagers who develop a negative attitude to their parents, they are also breaking away.
As diagram 4 shows the positive transference precedes the negative transference. I discovered early on in my study of transference that it is usually more productive to drag the negative transference into the positive transference stage. As I say to trainees sometimes: in the positive transference the client puts you on a pedestal and then in the negative transference they shove you off and at times the fall can be painful. It seems wiser for the therapist to take charge and jump off the pedestal in their own way and in their own time.
So during the positive transference I will ask questions of the client like:
“What is there about me that you do not like?”
“What have I done that has irked you or annoyed you?”
A situation may arise where I as the therapist miss an appointment or am late for some reason. When such a circumstance arises I will focus on it to allow the client to be aware of and understand their negative reactions to me because of the event. (Please note that at this point I am often asked the question, “Do I create such situations for the reasons I just mentioned?” My answer is a resounding, no. To go down that path would be most counter-therapeutic for obvious reasons.)
By bringing the negative transference into the positive transference stage the process is speeded up and does not allow the mistaken image building by the client in the positive transference to become too big of a problem. In this sense it keeps the relationship between the client and the therapist more real.
Good-bye
Eventually the therapist looses the emotional value that they once had for the client and at that point the client says good-bye and moves away. Some do it abruptly and others move away in a stepwise fashion. Other people in the client’s life start to take on much more emotional importance to them as the therapist becomes less and less important. For most this is the last time that the client and therapist see each other. On the odd occasion there is post therapy contact usually because the client is in the counselling field anyway and they run into each other as a matter of course.
Hello
If there is post therapy contact then the client and therapist have to say hello to each other in some form. This is usually harder for the client than it is for the therapist because the therapist had more emotional significance for the client than the other way around. So some sensitivity in relation to this on the ex-therapsits behalf is probably called for.
CONCLUSION
In this article I have examined some aspects of that very diverse subject called transference. In particular I have shown that the historic way of viewing transference and counter-transference as the only two types of transference is incomplete. There is indeed a third type of transference called sibling-transference. This is done by expanding Eric Berne’s group imago diagram into the script imago diagram.

REFERENCES
Berne, E.
1963. The structure and dynamics of organisations and groups. Grove Press: New York.
Freud, S
1966. Introductory lectures on Psychoanalysis. Norton & Company; New York
Moiso, C.
“Ego states and transference” Transactional Analysis Journal. 1985, Vol 15, 194 - 201.
Silverberg, W.V.
“The concept of transference”. Psychoanalytic Quarterly. 1948, Vol 17, 303 - 321.
White, T.
1985. New Ways In Transactional Analysis. TA Books: Perth.

There is often conjecture over the relationship between self harm behaviour and attention seeking. It gets all mixed up with how people want it to be, politics and how it actually is. I have mentioned before that there are 8 alternative reasons why people can self harm:

1. Gang behaviour tattooing type of self harm
2. To make self feel real. Dissociation, detached from reality. Cutting closes the gap.
3. To make self feel something. No feelings at all just numb
4. Tension relief and pressure stress build up
5. Physical expression of emotional pain. Cutting provides concrete evidence of pain
6. Cutting as self nurturing. Allows caring of self. Munchausen Syndrome
7. Self punishment and self hate
8. Manipulation and to get attention

Of course these are not all mutually exclusive. People can be driven by varying combinations of the different motivations. But as mentioned before attention seeking behaviour (ASB) is a particularly difficult one.



So what is the problem? It is well stated by Kahless who says:

I think people react to self harm being called ASB when it is presented as the sole reason and given that most people associate the term ASB as being selfish, self asorbed, etc etc.
(End quote)

I think she has identified one of the problems well. I understand that politically the self harm support groups want to deny people self harm as an ASB because it can reflect badly on all self harmers for reasons like Kahless says.

My view is that some people do self harm as an ASB. I have worked with self harmers and when you build up a good relationship some have told me to my face that they do self harm to get attention or to manipulate circumstances. Clearly some do not and keep their cutting well hidden for long periods of time.

This picture below took me three minutes to find on the net.



I went to my Flickr, went to search all photostreams, typed in “self harm” and then hit search. I was then given thousands of hits of photographs titled - “self harm”. I simply clicked on one of these and went into that person’s pohotostream. There were other photographs with her face displayed for all the world to see along with her cuts. In her profile there is the name of the city she lives in, a bit about what she does and who she is. There are thousands and thousands of people doing the same and this was only in Flickr, imagine how many there are on the entire web. Why would a person do such a thing and display their cuts and their face on the web? ASB?

When a loved one dies at some point many of those left behind will at times reflect on their own mortality. As I have mentioned before people are very good at lying to themselves. Whilst we all know intellectually that we are going to die sometimes our Child ego states manage to some how trick us into believing that it kind of, really wont, somehow happen to me.

At the funeral we are slapped in the face with a reminder of our own mortality. So some do things like thinking about their priorities in life and for a while some stop the pursuit of the almighty dollar in favour of spending more time with family. However it usually is only temporary as the Child ego state sets about getting the person to lie to them self again. The point is, that when a close loved one dies were are slapped in the face with a reminder of our own finiteness.



Consider a hypothetical client. A nurse who works in a local hospital comes to a session with me and reports how two days ago she had to deal with a teenage girl who had ‘slashed up’ on her arms. The client reports that when she saw this girl she felt a surge of anger and treated her with disdain. One of the first things I would do is search for her own self destructive and self injurious urges. It is quite possible that seeing the girl had slapped the nurse in the face with a reminder of her own self injurious feelings.

So back to the reason given by Kahless as to why those who do ASB are viewed poorly - because they are seen as self absorbed and selfish. With self harm there maybe another reason why some react particularly negatively to them - they are reminded of their own self destructive urges. The teenage self harmer scared the nurse and she dealt with that scare by getting angry at the source of the scare.

Finally, assuming I am correct and there are some people who self harm as an ASB, at least in part, then these people have a very big problem. Not only does some of society view them negatively the self harm support groups further damage them.

Its like going to the doctor and saying I have a pain in my back to which the doctor replies no you don’t really its just that your hungry. Such a patient would leave feeling confused.

If a self harmer discloses to her support group that sometimes she slashes up to get attention only to be told that she does not really do it for that reason then she is also going to be left confused. She will walk out thinking that she does not cut self to get attention but in the back of her mind she knows she does, because she in fact does. She is now worse off because of the political agenda of the self harm support group.


Self harm

In addition to this she is also left untreated. The treatment goal of some one who cuts self to get attention is clear. For the Child ego state to learn how to get attention by others means than damaging self. Much easier said than done but the gaol of treatment is defined. If one is told they do not self harm for attention then of course it can never be treated.

Like all self harmers those who do it as an ASB are struggling in life and doing the best they can with the psychological resources they currently have. No different than the person who reports depression or panic attacks. No more or less valid and human. They just need to be treated for a different condition.

Graffiti

By now I have just about everyone’s attention and for those of you who I don’t, then you need therapy. Also my number of hits for today is just about to shoot through the roof with all those deviants out there who repeatedly trawl the net for porn. And I will probably get bombard with all sorts of spam over the next few days as well.

I told you I would get a lot of attention.



The real title for this post was meant to be attention seeking behaviour (ASB). CinicallyClueless made a good comment on the last post. I have talked before about self harm with the motive of seeking attention and the comment that CC made usually comes up sooner or later. I recall one woman who stated that she would never return to this blog again because of my contention about ASB and self harm. She stated that such comments were neither helpful nor true. One problem with her comment is that just because something may be unhelpful does not make it untrue.

However CinicallyClueless has provided an opportunity to talk about the whole area of ASB in general. I am forever surprised about some people’s aversion to others who apparently seek attention from others. For heavens sake we all do it day in and day out. All humans engage in ASB regularly.

Why did I mention sex in the title because I knew it would grab your attention. So what do we humans do? We get scantily clad women to lie on top of cars and hold up big power drills because we know that it will grab men’s attention and thus they are more likely to buy the product.


Sex and attention



Then we have the press who do ASB all the time. Why? Because that is what their business is about. More attention means bigger circulations and higher ratings on television and radio. So what do they do? The press sell fear.

They know that humans are hard wired to be hypervigilant to fear. For the survival of the species we need to be vigilant about danger and it is our feelings of fear or anxiety which alerts us to that. So if the press can highlight something as dangerous then they know humans will react with fear and thus they will get their attention. So the press use fear as an ASB.

We are lead to believe that there is a pedophile behind every bush just waiting to jump out on our children. The dangers of the road toll are grossly over exaggerated and here where I live in Australia we have the press funding helicopters to fly over our beaches looking for sharks in the middle of summer when everyone goes swimming. And you know what? They find them every now and then and lots of pictures are taken. They go looking for sharks in the ocean and they find them. Why do they find them? Because that’s where they happen to live. But they have a business to run and their product is fear. So they use it and they get lots of attention.



Now I have cohabited with a few females in my time and there is just one thing that us guys don’t get. You’re at home doing one’s domestic duties and you go into the bathroom open the cabinet to get the tooth paste and there it is! You are confronted with a huge array of bottles, tubes and squeegees of every colour and type. Nail polish, rouge, brushes, eyeliner, lip stick, combs, powders, creams, tweezers, scissors, eye lash curlers and other devices that defy explanation. The poor guy just gives up his search for the tooth paste, shakes his head, closes the cupboard door and goes and has a lie down.

What is that all about? ASB.

The other thing about cosmetics is that it is actually a ‘double banger’ for the woman. This probably explains why it is a multi zillion dollar a year industry and throws more light onto the concept of ASB. Whilst allowing her to seek attention it also allows her to do endless self grooming with the never ending series of beauty treatments. It allows her to give attention to herself. It gives her a valid reason to do so and thus some do for many hours indeed. They are enabled to do self ASB as well as others ASB

(Perhaps an interesting concept in regards to ASB via self harm)


Beauty treatments! The nemesis of every male.

What is the gift you can give to someone who has everything? Indeed what is the best gift of all to give?

Attention.

And again humans have managed to turn this into a money spinner as well. They are called greeting cards. You could give someone another CD or the latest kitchen time saving device for their birthday. Or you could give them a birthday card with some lovely words in it. Which one is going to feel the best to the receiver? What are you giving them?

Attention.

Finally I have to mention therapy and ASB. Clients can do ASB by buying it from a therapist. They can go to a therapist and get all that attention for hours on end. If they go to group therapy then they can even get much more for the same price.

So what’s my point? If someone self harms to seek attention they are doing nothing different to what all people do every day. However doing ASB via self harming does have some unique features. That will be the topic of then next post which I will probably write tomorrow.

Graffiti

I knew there was something else going on but I just could not actually articulate it. In the previous post I mentioned the eight different types or motivations for self harming and these were:

1. Gang behaviour tattooing type of self harm
2. To make self feel real. Dissociation, detached from reality. Cutting closes the gap.
3. To make self feel something. No feelings at all just numb
4. Tension relief and pressure stress build up
5. Physical expression of emotional pain. Cutting provides concrete evidence of pain
6. Cutting as self nurturing. Allows caring of self. Munchausen Syndrome
7. Self punishment and self hate
8. Manipulation and to get attention



I have had a question in my mind since first considering the oxymoron of harm minimisation for the self harmer. If a person who self harms has the harm minimisation information would they use it and if they did what does that actually mean?

The self harmers that are the type from number 2 to number 7 one could say when they get to the point of actually cutting, one could draw this sort of ego state diagram for them.



They would be seen to be in a regressed state and in a highly emotional state of mind. Even if that emotion is numbness or dissociation. To actually consciously cut oneself with a blade of some kind one has to have quite a distressed Child ego state.

Harm minimisation information is going to be by and large an Adult ego state exercise. That is why I wonder if they would use it because at the point of cutting the Adult ego state is so decathected and the personality is dominated by the Child.

I think most who work with self harmers would agree with this. So there is almost an experiment to conduct here. Provide a self harmer with the harm minimisation information and see what happens. If such individuals did use the harm minimisation information then that means at the point of self harming it is less of an ‘out of control’ act than the theory would currently describe. It is a more calculated act than many would currently believe.



Despite this with this oxymoron one may have inadvertently ended up with a method of treatment for the self harmer. Without a doubt when many people cut them self they are in a highly emotional state. The self harmer maybe able to learn to use the harm minimisation information over time at least on occasion.

For instance, provide the information and then the person goes away and cuts. After that discuss what was going on in the person’s mind at the point of cutting and how did they not use or only partially use the harm minimisation information. Then go through the same process the next time the self harming happens.

This could have two effects. If they just think of and even use the harm minimisation information at the point of cutting then that means they are cathecting more Adult at the point. This could be seen as a good thing because it means the individual will tend to be drawn more out of their regressed state and more out of the Child into the Adult. That in therapeutic terms that would be seen as a healthy move.



I have an old saying for psychotherapy “Work with the pathology not against it”. Hence I do things with my anxious clients like getting them to have a panic attack in the counselling room with me. Thus I am working with the pathology, not against it at least at that juncture. Or I get my bulimic clients to make homework contracts to throw up this week.

A common type treatment of the self harmer could be doing things like confronting the thinking errors at the point of cutting self. Getting the person to say in their own mind or even out aloud, “Don’t do this”, “You are worthwhile” and so forth. Whilst good options at times they are of limited use.

If a self harmer does employ harm minimisation information when they cut what does that mean? Well it means they are harming self less and thus that would mean that they are valuing self more. So one is working with the pathology to allow more self affirmation. By the very act of cutting self in a different way one is achieving two things. The urge to cut self is satisfied and ones sense of worth is increased. Eros and thanatos are both satisfied in the one single act!

In addition many self harmers report a loss of control and may even say that they are addicted to cutting and they can’t stop them self. If such a person cuts self using harm minimisation information then they are cutting self in a controlled way. Thus one gets more of a sense of having some control over what they are doing.

Graffiti

Harm minimisation for the self harmer

As one wanders around the internet one stumbles onto some varying ideas. One the other day that I happened upon was someone who was suggesting some harm minimisation strategies for self harmers.

When you think about it that is almost an oxymoron. If a person sets out consciously to inflict physical harm on themselves why would they be thinking of harm minimisation techniques. But it does raise some pertinent questions about the whole area of self harm and could indeed even further our knowledge and understanding of the self harming individual.



So I have set my self a goal of coming up with a a set of harm minimisation strategies for self harmers. I have contacted a number of my medical colleagues to start to gather information on such harm minimisation information. I want to be cautious with this and cross check the information as I want the information to be based on sound medical knowledge. So this list I hope will come about some time later and I will place it on my blog

However as an example there are these things called Langer lines and here is a picture of some of them.



These were developed by Carl Langer, an anatomist. They are the structural orientation of the fibrous tissue of the skin, forming the natural cleavage lines that, though present in all body areas, are visible only in certain sites such as the creases of the palm. These lines are of particular importance in surgery. Incisions made parallel to them make a much smaller scar upon healing than those made at right angles to the lines.

Thus we have one possible harm minimisation strategy. If you cut along the lines then there should be less subsequent scaring. However one needs to be cautions with such information. Whilst it could be used for good it could also be used for evil.

In a previous blog post I wrote of the different reasons people self harm. Here is a list of them:

1. Gang behaviour tattooing type of self harm
2. To make self feel real. Dissociation, detached from reality. Cutting closes the gap.
3. To make self feel something. No feelings at all just numb
4. Tension relief and pressure stress build up
5. Physical expression of emotional pain. Cutting provides concrete evidence of pain
6. Cutting as self nurturing. Allows caring of self. Munchausen Syndrome
7. Self punishment and self hate
8. Manipulation and to get attention

With number 1 we can have the teenage girl who cuts her forearm because it is what her friends are doing and makes her belong with them. In such instances harm minimisation information could be useful as her goal in self harming is to belong to the group and not so much to actually damage self.



With number 7 there could be the opposite effect. A person who cuts their arm as an expression of self loathing may purposefully cut right across the Langer lines because it allows them to express more self hatred.

The other one of particular interest is that self harmer who says they get a feeling of relief or a sense of reality from seeing the blood flow from the cuts. Now one can make blood flow from such cuts if they go along the Langer lines or across the Langer lines. Which one would such a self harmer do if they they had such information prior to such cutting? An engaging question in itself which could indeed through more insight into the psyche of this type self harmer.

Then there is number 8. The person who cuts self and then goes and displays the cuts to someone so as to get a particular type of reaction. Harm minimisation information could be useful with this type one could surmise. Again it would be interesting to see if such a person actually used such harm minimisation information in their cutting of self.

Finally there are those where the scarring is very important. The more scars the better. So one would assume they might use such information to increase the scarring effect on the body.

Graffiti

I am reading this book at the moment and it is a sort of how to do counselling type of thing. It makes the following statement about talking with the client. It presents the following four rules:

1. Ask only those questions that are needed
2. Whenever appropriate, use open questions in preference to closed questions.
3. Avoid asking ‘Why” questions, unless there is a good reason to do so.
4. Never ask a question just to satisfy your own curiosity.



With regard to the fourth rule, as a counsellor, before you seek information, check whether you really need it. If you don’t really need it then the desire to ask the question is probably from your own needs or curiosity.
(End quote)


Opps!!! I break rule 4 all the time. I often ask questions out of curiosity.


That's curious.



Hey what do they expect! Counsellors are professional voyeurs, they are paid to pry into people’s private lives. I spend each working day prodding and poking around in peoples lives and families and relationship and their most inner thoughts and feelings.

I have always been an observer of humans because I just find them interesting. Yes I am curious about people.

I live near an area where there a lots of cafes, restaurants, bars, shops and so forth. Not uncommonly I will go down to a cafe at a busy time by myself and get a cup of tea. I find it pleasant to just sit and watch people walk by, watch people sitting and talking, families and friend and couples all doing their stuff. I often stay there for about an hour simply doing that.



My interest is in how they are getting on, their behaviour, what they appear to be feeling, the dynamics of what is going on between them and so forth. I just find it fun to sit there and watch them, just observing all the stuff. If I can eaves drop in on a conversation or two all the better!

I recall many years ago being in Bali on a holiday with my then girlfriend. One of these luxury resort type of things and we were down by the pool for breakfast one day. I noticed this family of westerners come and sit at a table near by. Mother, father and two daughters if I recall correctly. I observed them and there did not seem to be any great difficulties or angst between any of them. They were simply sitting there, ordering and eating their breakfast and just taking in the surroundings. However for the full hour they were there, I did not see any of the four of them say anything to another, not even once. What sort of life script would that breed in the children assuming they were not just having a quite day.

So that is what I find fun to do.
Holley molley do I sound lame!

There is no way I could not ask clients questions out of pure curiosity.

However what the author of the book is trying to say is that you need to let the client tell their story. That is you have to give the client the opportunity to direct the conversation and the therapist is not meant to do that all the time. Every time a therapist asks a question it interferes with a client having the opportunity to tell their story their way.

This is true and I agree with it. But please only some of the time! If a client is deep in the middle of telling about an important event in their childhood I am not going to interrupt with a curiosity question I may have.


Beauty



On the other side of the ledger. If I ask curiosity questions of clients at the right time what does that say to the client? It says I find you curious (interesting). Is that a good thing for a therapist to say to the client? It also says that the therapist has Free Child wants and he can get that met in the relational, like with the client when he asks a curiosity question. Is that a good thing to show to a client?

Graffiti

Self destruction or stress leave?

Graffiti