Tony White

As a child did you ever have an imaginary friend?

I never did.

I have been in the therapy business for 20 years so there is not much that comes up new but there was one today. Sometimes I get a new one that grabs the attention.

This woman was reporting to me an event in her childhood, with great grief and angst. She was about 6 years old and she had this teddy bear that was her best friend. She used to sit and play all sorts of games with it and she would have long discussions with it and it would talk back to her.


My imaginary friend did it!




One day she was playing in her bedroom and for some reason her father was there and he was angry at her. Eventually he grabbed the bear from her and threw it against the wall and the teddy bear’s head fell off.

So by this time I am conscientiously hold back my smile, and managing to maintain a serious look of empathy.

Well she was shattered and in a state of disbelief at what her father had done. She took the bear to her mother and showed her the terrible event. Her mother sought to console her considerable distress and told her it would be all right as she sewed the head back on.

So by now I am smiling but still managing to maintain the decency not to laugh.



So the bear was repaired and life got back to normal. Then the woman stated that ever since that event the bear never ever spoke to her again. It was punishing her for making her father get angry and knocking the its head off

Ok, so by now I am laughing!

Then finally after we both calmed down she said that the bear did actually talk to her one more time many years later but she said that it spoke in a adults voice not a child’s.

Graffiti

Transactional analysis provides a good example of the hydraulic theory of personality. This is where the personality is described as a set of forces or energies. Some times those energies work in unison and sometimes they are opposed.



Take this example of the bed wetting child. It wants to feel secure but internally the Parent ego state tells it to stand on its own two feet and it is emotionally on its own (because that is what it perceives the real parents are doing in some way).

So we have two forces in the personality that are opposed and thus they collide. This collision of two forces creates an off shoot or third force which provides the energy or force behind the formation of the symptom. In this case it is feeling of anxiety and the behaviour of bed wetting. (There are also other causes of bed wetting I may add. It can at times be shame based or even a rebellious act as can be encropesis).

In such hydraulic theories the treatment goal is to halt the collision, thus the third force created ceases to exist and thus the symptoms go away. However other approaches treat the symptom on its own like with the bell at night when the child starts to urinate in bed. This according to the theory should simply lead to symptom substitution. Because the collision of forces has not reduced then either the symptom will resist extinction by the behavioural treatment or another symptom will simply arise.



From what I have seen behavioural treatments of bed wetting can be quite successful in stopping the child wetting the bed at night. Is the child cured? Well that is for another post.

I met a guy the other day who as a teenager and young adult had been a flasher. He had a strong compulsion to go out into public and expose his erect manhood to women in public places. He got caught a number of times, charged and convicted. This caused him great distress because he stated that his family suffered by such convictions. He said that he went and got aversion therapy which included him being given small electric shocks when various stimuli were presented to him. I had never before come across someone who was a recipient of such aversion therapy. He reports that after such treatment he never did it again. Cured or was there symptom substitution?

Aversion therapy was the big thing in the 1960s and 70s and was popularised in the movie A Clockwork Orange were Alex was given aversion therapy to quell his violent impulses. It has been used for a number of ‘symptoms’ and apparently was quite successful for helping people to quit smoking.



It got a lot of bad press because it involves punishing the client with electric shocks or using emetic medications. Also it was for a time seen as the wonder solution to homosexuality. This was in the era when homosexuality was considered a mental illness. So many, particularly male homosexuals, were given aversion therapy usually with small electric shocks to try and turn them into heterosexuals. Many professional organisations now ban their members from using aversion therapy although I do believe it is still used in some circles.

Some times I use symptom substitution as a form of treatment. For many years there has been the a debate in drug treatment circles about AA and other ‘addictions’. I have never understood this debate and it seems pointless to me but there are some who will speak disparagingly about the person who has a heroin addiction and stops using only to become ‘addicted’ to some religion. To my mind it is much better to be addicted to religion than it is to heroin. Some say AA involves an ‘addiction’ to a higher power and thus is not a ‘proper’ solution to a drug problem.

To my mind if someone can substitute are really bad symptom to a benign symptom then substitute the damn f**king thing! What’s the problem with that! In fact I think it is a quite a good solution because again it is another example of working with the pathology and not against it. So symptom substitution as a form of treatment? Seems OK to me.



Graffiti

Often in suicide assessment workshops people are taught about the lists of protective factors.

For instance no history of mental illness, or no history of substance use, or no history of prior suicide attempts. These are seen as good signs and thus the person is less likely to attempt suicide and is more ‘protected’ in that way.

Another one which I have always found a bit dodgy is that family is seen as a protective factor. That is the person who has family of some kind and is involved with and included in the family is more protected. The person with no family and family support is seen as being at a greater risk of suicide.



Family as a protective factor is seen to work in two ways. First a person who belongs to some form of group such as a family is usually in a better psychological state that the person who is isolated in this way. There is truth to this but that involves any group and it does not have to be a family. The other protective feature of a family works on the component of guilt. It is seen that the person will not attempt to take their own life because it will hurt those left behind and thus they feel guilty about attempting suicide.

It is on this second component that in my view it is over rated as a protective factor. To the average person who is not too suicidal they will often think such things like, “I could never do it because it would hurt the kids too much”. But this person is unlikely to attempt suicide in the first place anyway


The kids

From what I have seen if a person gets to the point of seriously contemplating a suicide then the family left behind is of little concern. So in this way suicide could be seen as a selfish or narcissistic act. The guilt feelings carry very little weight in the decision making of a person in this frame of mind

I was working with a guy recently who got very close, about a year ago, to making a serious suicide attempt. It was well planned, well thought out, he had the necessary implements and he was a DSR. The kind of guy who when he decided to do something it would get done and done properly. When I asked about his family left behind he stated, “They would be better off without me”.

This was not a glib comment but a realistically reasoned out statement. They would grieve and be considerably hurt in the shorter term but in the longer term their lives would be less dragged down and of less poor quality if he was not there. And indeed there was some truth to that.


Amy would be a wonderful to have in the family!



So in this case family was not a protective factor but a factor that actually increased the likelihood of a suicide attempt.

Graffiti

Fantasy or day dreams as a means of thought substitution or thought management.

A great deal, particularly in the psychoanalytic literature has been written about fantasy and it is indeed included in the list of defence mechanisms. However there is also many ‘normal’ types of fantasy as well.

Comment made:

“When I had a more agile body, then I would be athletic like lara croft...As I get older, well tonight I spent the drive home from work enacting out a plane crash. Trying to understand what I would feel, think etc. Whiled away the time. I hate driving; so boring.” (end quote)


Home wrecker!



Here we have a description of two types of fantasies. Firstly the heroic or the megalomaniacal fantasy. This includes heroic fantasies like Lara Croft and other fantasies of great achievement, heroic displays, attaining world peace, great wealth or power and so on. It only becomes a problem when it is over used and thus one gets a Walter Mitty situation where the fantasy is used as a means to compensate for a flagging self esteem. But I think it is safe to say that many have this type of fantasy and it is not indicative of any sort of problem

Also described is the stimulation type fantasy in this instance to deal with boredom. The sexual fantasy would also fit into this type of thought management. One picks a situation that is highly stimulating for them and then fantasises about that as a thought management technique

Another type of fantasy is the masochistic fantasy. I am reminded of one fellow who I treated for a long time who would have very such vivid fantasies. He would fantasise himself being hit, beaten up, stabbed, burned and so on. Very vivid and quite elaborate fantasies which he often had as he was in bed going to sleep. These disturbed him quite a lot as he did not know what they meant. He also felt quite embarrassed about them, however they also gave him a sense of relief and solace and hence he continued to do it. He tended to do it when he was feeling particularly bad about himself and he just felt he deserved it so it is the right thing to fantasy. I tended to view it as a kind of self harm that was all in fantasy. I would also suggest that it is not a particularly good sign and may be indicative of quite significant maladjustment.



Then one can have fantasy on a much more personal level often involving personal relationships. These can be either realistic or imaginary fantasies. About how things are or about how one would wish them to be.

Thought management and one size fits all.

Comment made:
“I debated for a while whether or not to comment on this at all because it makes me feel sad and defeated that 'normal' solutions do not work for me. Not only do they not work, but they were quite destructive. Thought stopping and 'changing the channel' and all of that sort of thing only fed my dissociation and helped me find new ways to keep it propped up a little longer. That fact that therapists were unwittingly helping me to do it also fed my belief that my thoughts and feelings were not okay and were something to be gotten rid of at any cost. . Unfortunately, when the walls finally began to crumble, it was a terrible shock to say the very least. And now that I know what I know, I think all those techniques that were applied to my secret 'habit' of forgetting made it so that full-blown flashbacks were the final recourse of a most desperate unconscious. I really think therapists should try to find out if there is existing trauma and dissociation before they get too carried away with helping people find ways to escape themselves.”(end quote)



This is an interesting comment indeed. One sees thought management and thought substitution mentioned a lot in the literature. It is one of the key parts of a widely accepted approach. I can not recall ever seeing a comment made about the contraindications of thought management. Statements made about how thought management for some can in fact detrimental. Again there is a belief that in counselling one size fits all when it never does. So this is a most pertinent point and when it is contraindicated obviously has to turn to Plan B. That is not hard for me to do as I can simply change to some kind of regressive technique. However those who use the CBT model solely would not tend to do such a thing and thus they may struggle to find a Plan B. An interesting area that needs to be elucidated by defining when thought substitution is contraindicated.

Thought management and going with what the client presents:

Comment made:
“Tony suggested that a good way to deal with your internal critic and to stop harassing yourself is to have a sexual fantasy....I eased back into traffic and felt myself getting very anxious and panicky and starting to want to cry.

But I remembered Tony’s advice to have a sexual fantasy. A-ha, I thought, this is a good time for that. So I started thinking about Brad Pitt, he was the first one to come to mind, but then I realized that I would never let Brad Pitt see me naked, so this wouldn’t work. George Clooney? Same problem. How about someone older? Clint Eastwood? Ugh - he’s sexy, but he’s my father’s age. Adam Sandler would have worked, but he reminds me too much of someone I know in real life. Bruce Willis? Bruce might work, let me think about this. Bruce is older than me, but he has an amazing body and I don’t think he would appreciate my flabby middle aged body especially after he’s had Demi Moore. I’m thinking and thinking, and I got to the train station, but never started the fantasy. My anxiety did go away due to all of this deliberation about who should be in my fantasy. I mean, I wanted my fantasy to be romantic and sexual, not to have a guy be grossed out by me and run away screaming.” (end quote)



A good example about letting people find their own thought management techniques rather than imposing one on them. There was no actual fantasising done and yet the anxiety was avoided due to changing from the usual thoughts. As mentioned this example involved thinking about the construction of the fantasy rather than having the fantasy itself.

If this was in a counselling setting I probably would say nothing and see if the actual fantasy was used next time. Or did the individual again think about the construction of the fantasy rather than having the actual fantasy. It should be noted that the actual person for the fantasy was never selected, they are all ruled out for some reason. So the next time there is still no one for the actual fantasy to occur.

But of course that does not matter. All that matters is this person has discovered a way to avoid anxiety by using thought management. So I would suggest that in the future this person use fantasy construction rather than having the actual fantasy. We know she can make that work.



The other interesting point about this is how the internal critic was used for the fantasy construction. There is quite a lot of Critical Parent ego state used in it. The stated goal is to use fantasy to avoid the internal critic and thus the resultant anxiety. As I keep banging on about, in counselling it is always better to work with the pathology than to fight against it. No one ever wins wars weather they be between nations or between different parts of an individual’s personality.

So my suggestion in counselling would be in the future to use the internal critic (Pathology) in the fantasy construction to avoid the internal critic generating anxiety in the person. Working with the pathology. Both the person’s eros and thanatos are satisfied in the same single act. That is far more likely to be successful than trying to get eros to triumph over thanatos. Lillith never looses a fight in the long run.

Graffiti

Hello Harriet,

You state
What ever works?



Exactly right. In fact what a therapist should do is ask the client for their solution first, such as with "When you are having anxious thoughts what do you think you could do". If a person says they could sing the ABC song then the therapist is better going with that and refine how it is used rather than imposing their own one onto the client.

Indeed you provide a good example of the point I was making in the previous post with the ABC song. I assume the ABC song is that song children sing when they learn the alphabet. I can hear it in my head as I write this now. You came up with a Child ego state solution, but most importantly an archaic Child ego state solution. It is ingrained into your personality. It was part of your Child ego state long before you even entered therapy.


Solution to anxiety learnt in childhood.




Harriet you state, “Stop thought was one of the first techniques I learned when I was in therapy for anxiety and phobias. It took me a long time to get it to work, I really had to practice. I know some people in my group gave up and said it didn't work, but the key for me was practice.” (end quote)

So we could say that practice is the process of getting it ingrained into the personality. If one takes one of the therapist’s thought management techniques then they have to go through this practice phase. Instead I could get you to do a Child ego state interview (similar to the parent interview) and have found the solution there.


There's always a solution



If there is one there then the practice phase is much shorter or maybe none at all. The ABC song is deeply imbedded in your personality as it has been there for years and was ‘implanted’ when you were a child and thus when the whole personality was forming. So it comes from the foundations of the personality and is thus likely to be much more potent than one that comes from today.

Another example of this that one hears from time to time in therapy circles is the statement to deal with a client's big internal critic. If you are harassing self then the therapist might say, “Stop harassing self and have a sexual fantasy”. Again a very Child ego state solution as sex is a very Child ego state function. Far more potent than thinking about cool lakes, serene sunsets, or gentle breezes.



Maybe a more male oriented solution, I don’t know, but a good example of a very Child distraction solution. Even with this it is much better if the client comes up with the solution than the therapist. However the therapist can assist the client to come up with such a solution by doing a Parent ego state or Child ego state interview.

Graffiti

Thought management exercises are useful when a person is troubled by ongoing or recurring distressing thoughts. There is a range of thought management techniques.

Distraction: using pleasant thoughts can help take attention away from unpleasant thoughts.
Mindfulness techniques to redirect attention from negative thinking.
Thought replacement or coping statements. Develop a set of statements that will counteract worrying thoughts (e.g., "This is difficult but I have been through it before and have got through it okay", "Hang in there, this will not last much longer"). Substitute one of the reassuring or coping statements for the troubling thought.
Thought stopping: The person states the word “Stop!” in response to troubling thoughts.



These are most useful when the individual has problems that are not too ‘deep’. They can be quite effective and useful for the person who has trouble with a big internal critic and so forth. For those where there is more serious maladjustment such as with the personality disorders or character problems then such thought management is much less useful. Someone who hates and loathes self is not going to be able to change that attitude around by altering specific thoughts they have. This requires the use of other treatment methods as well.

However such strategies do have their use but one can add to those above with other thought management methods. For instance regressive techniques of thought management can be used.

Rather than creating new thought patterns as described above one can often find that they already have such alternative thinking styles. Some of these can already be ingrained in the personality and thus will tend to be much more impactful than learning a new thought style from scratch.



One can use regressive techniques to almost “hunt” around on the personality. One way of doing this is with the parent interview technique.

So it is better if you already have someone there
1. Identify who is in your Parent ego state tapes
2. Do a parent interview to elicit what they think, feel, do and say. One is accessing the Parent, Adult and Child ego states of mother and father.


The parent interview allows the client to define and experience mother's and father's own Parent, Adult and Child ego states.




Quite often there already are some good messages in those that the person is unaware of. Some times in counselling so much focus is on the damage that the parents may have done that there can be other ‘good’ stuff that is forgotten or pushed to the side. If some is there and can be found then they can be quite impactful as they are already deeply ingrained in the personality. They have been there since childhood.

If there is none then one better way to create new thinking styles is to make editions to the Parent ego state. The thought management techniques cited above are primarily an Adult ego state function. To have them ‘implanted’ in the Parent or Child ego state is going to make them much more potent.



How does a young child get Parent ego state tapes? It simply surveys its environment and copies other parental type figures around them. It then behaves, thinks and feels like that person. It copies them and practices being like that. If this persists then it will become part of their Parent ego state.

This happens at times naturally in the therapy setting. Clients will report things such as, “The other day I was dealing with my mother and I found myself saying things like you (the therapist) would say”. This means the client has introjected the therapist partly into their Parent ego state. So taking on new thoughts and behaviours via introjection is going to be much more powerful than by simple Adult ego state based thought management techniques.

In addition to this. In doing a more overall approach to thought management one needs to address the client’s reinforcing memories and script based fantasies.

Graffiti

Despair is commonly misdiagnosed as depression which leads to incorrect treatment such as with anti depressants.




If you want to see the proper version of this go to my Face Book.
You tube are Mother f**kers



Graffiti