Tony White

If I can't get to this tomorrow


Happy birthday to me,
Happy birthday to me,
Happy birthday dear Graffiti,
Happy birthday to me,

Hip, hip, horray!



Me on Left with my older brother at a holiday resort. Also there is the nanny with her young charges.

Graffiti

Last week I went to Hobart on the east coast of Australia to run a two day Transactional Analysis workshop.


Tony teaching on the Free Child ego state

It was a most productive workshop


Tony doing a role play of Adult ego state, asking about global positioning systems

Graffiti

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