Interviewing the child - Part 2

In the previous post Kahless says

I have never drunk a cup of coffee in my life I dont have the inclination, though i do wonder if it is because as a kid, i distinctly remember my brother telling me i dont like coffee. powerful stuff eh!

This is exactly the next point I was going to make. In the previous post I referred to the idea of the leading question. One can also make a ‘leading statement’ as it could be called. Doing such a thing in interviewing a child can be positive or negative depending on the circumstances.

Children are more suggestible than adults because their Adult ego state is in a rudimentary form. As a result when an adult says something to a child it will accept it more freely than would an adult. The child cannot do the critical analysis or factual assessment of what is being said as effectively as an adult can.



Consider this clinical situation:

A child reports that it has a pet fish which it loved very much. The previous day the cat climbed up on the aquarium, managed to snare the fish and eat it.

The child psychotherapist then says: “Oh, that is sad for you”.

This is a leading statement as it defines reality for the child.

Loss of loved fish = sad feelings

However the child may not be feeling that at all. At that point the child may be feeling anger at the cat and not sadness at the loss.

This can be a bad thing as it may lead to confusion in the child. As the child is highly suggestible it will take on the ‘facts’ provided by the counsellor much more readily. After hearing the counsellor’s comment the child may think,

“I thought what I was feeling was anger but it must sadness as I was told it was”. This can result in the child becoming confused about what is anger and what is sadness. The leading statement has resulted in a problem. The counsellor at least initially needed to ask a question, rather than make a leading statement. For example, “What are you feeling about what happened to your fish?”



In another circumstance one may be counselling a child for anger management. The child who tends to be chronically angry. After some inquiry one discovers that the young boy has learnt that sad feelings are bad things and result in bad consequences. He may have been humiliated by his father when he cried at home. What he does is cover up his sad feelings with anger which is acceptable to his father. The problem is his sad feelings are never resolved and hence he ends up being chronically angry.

Thus the counsellor can make ‘suggestions’ to the child with leading comments such as, “People feel sad when their pet dies”. As they are more suggestible the child will take this comment on more so than an adult would. Such a statement gets planted deeper in the psyche of the youngster than the adult. In this case their suggestibility is being used for therapeutic advantage. (Of course one also makes sure there is not confusion about anger and sadness). The suggestion has affirmed that sad feelings exist, that the child does have sad feelings and that such feelings are appropriate at times



The key to such suggestions is for the counsellor to get the relationship with the child right first, get their timing right and deliver it in a way that will have the most impact.

Hence we get back to the comment by Kahless

I have never drunk a cup of coffee in my life I dont have the inclination, though i do wonder if it is because as a kid, i distinctly remember my brother telling me i dont like coffee. powerful stuff eh!
---------

It is possible this was a suggestion inadvertently given by her brother. The circumstances were right at the time when he made the suggestion and she took it on as a fact. When that happens it is powerful stuff indeed my pommy friend!

Graffiti

Working with shame in the therapy process. (Part 6)

What does a therapist do when a client presents with strong feelings of shame. One knows what to do when a client is angry. They feel the anger, they express the anger and when ready they drop the anger. When a client feels sad the therapist acknowledges the feeling, the client expresses the sadness with some kind of crying usually, one listens to the client, empathises with them and is compassionate. Then the sadness is dealt with.

However shame is different. Unlike sadness and anger, shame tears at the very sense of who we are in a way that other feelings do not. With shame one experiences a sense of painful self diminution. Their sense of worth, importance and sense of who they are as a person is painfully reduced. With shame there is a sense of ‘I am bad’. What does a therapist do with this?

When people feel shame there is a strong desire to withdraw or change the topic. The person wants to go into hiding in some way. This seems to be the natural Free Child reaction to shame. The problem with this, is it does not deal with it, in the therapeutic sense.


Now that's embarrassing!


In essence it is an avoidant, ‘Lets try and forget about it’, approach. This works with small ‘traumas’ but with big ones it does not work. They need to be brought out into the open, experienced and then one can ‘get over it’. The Free Child reaction with shame is to hide and avoid. With most other feelings the Free Child reaction is a therapeutic one that will bring resolution of the painful event like expressing sad feelings when one’s cat dies. With shame the natural Free Child reaction will not bring resolution or closure to the event. Thus shame is somewhat unique in this way.

I will cite how I have developed my approach to shame over the years.
The first step is to clarify the shame, the guilt and the internally directed anger. As I have shown before these can be articulated by three separate transactional diagrams:







These three transactions can coexist in various combinations at the one time and often do. The therapist needs to assist the client to untangle them. Sometimes when a client initially reports a feeling of shame one finds there is not a shame reaction but it maybe a guilt reaction or internal anger reaction.

One indicator that shame is present the client’s unwillingness to bring it up and discuss it. If there is a true shame reaction the client may be quite unwilling to mention it which is a problem in itself because the therapist may not hear about it for some time. Obviously if the therapist does not know about it then it cannot be dealt with. Examples of this can be self harm or bulimia. The shame that is felt about these activities may result in the client not mentioning it for some time.

However when the client does raise the shaming event the therapist knows this is a positive move indeed. It means the client now experiences the therapeutic relationship in such a way that she is prepared to raise such a sensitive and intimate issue. The therapist is now being trusted in way that he has not been before.



When this happens the therapist untangles the three possible reactions of inward anger, guilt and shame. The therapist then deals with the inward anger and guilt in the usual therapeutic ways. Whilst doing this the stage is being set for the shame to be dealt with.

The client is then asked to do something that is unnatural for them to do. With shame the Free Child wants to hide and withdraw but the therapist asks the client to come out into public (with the therapist) and talk about the shame and the shaming event.

This to my mind, is the first step to resolving the shame. As simple and unsophisticated as it is. The shame is simply brought out into the relational with the therapist and the therapist responds in an empathetic fashion. Once the shaming event has been disclosed the therapist can bring it out into the open at the appropriate time. This requires some caution such that one does not reshame the client in the therapy setting.

From what I have seen once the event and shame have been discussed a number of times it seems to loose its potency. The catharsis obtained from speaking about it with the therapist seems to reduce the need to hide it. Subsequently it can be raised much more easily by either party when need be.



Thus the initial therapy process is to come out of hiding, speak about the event and the feelings with another trusted person. If that person responds favourably the shame and embarrassment diminish over time.

However this is not the end of the story. Whilst it may be easier to discuss it with the therapist, the underlying damage that resulted from the shaming event still remains. With guilt one has the sensation of ‘I am bad because I did x’. With shame it is simply, ‘I am bad’.

This is treated with the usual various redecisions, awareness of the shame, acceptance of shame as a natural thing, hypnotic suggestions when the client is significantly regressed, working through the negative and positive transference reactions, forgiveness of self and so forth. This takes time depending on the depth of ‘badness’ the client experiences. However this process is significantly helped if the shaming event looses it impact in the ways I have described above such that the event can be more easily spoken about. The need to hide with the shame fades and diminishes.

Graffiti

The use of hypnotic suggestion in the therapeutic process.

There has been a lot written in the Transactional Analysis literature about permissions. Generally speaking they are statements given by the therapist from any ego state to the Child ego state of the client. examples could be

Parent - “Its safe to be close”
Adult - “It makes sense to be close”
Child - “I like you”

These are meant to counter the life script messages received from the parents in childhood. In the examples above the person would have received a “Don’t feel” injunction from the parents. The therapist then at some point gives the permissions cited above. Often stated in the literature, the key to therapeutic procedure of permission giving is getting the timing right but then not much ever is said about when that might be.



I have never thought much of this therapeutic technique as it seems too predictable and obvious to me. A bit like affirmations can be. I think affirmations are a good idea but as a transaction between client and therapist they are useful but maybe a bit limited.

Over time however I began to realise, without even knowing it, that I have in one way been doing such a thing with some clients. Some would argue that I am giving permissions to the client even though I do not see it that way myself. I would say I am making hypnotic suggestions to the client and do this when a very specific set of conditions exists with the client. Most notably when the client is in a highly suggestible state of mind.

When working with some clients they can become highly regressed which would be diagrammed as such



When looking at the client they appear very child like, usually in deep emotion. This it can be said is when a person is highly suggestible. They are particularly open to hypnotic suggestions at this point. With the Parent and Adult ego state decommissioned to a significant degree the therapist can communicate directly with the very young Child ego state. Thus one could say, communicate directly with the unconscious at least to some degree.

If they are not openly displaying emotion but tend to be silent and sitting quietly the conditions may be right to begin making such hypnotic suggestions. The statements I make are probably a combination of Adult and Parent transactions.
“Good to see the feeling”
“Good statements”
“Well done”

The client may then make statements about defying some parental directive which is met with the suggestion like:
“Good statement”
“Yes”
”Say what you feel/think”

The reason why they are kept short is because I do not want to distract the client with my presence. I am not not wanting the client to respond back in any way to me. I am not wanting them to say thank you or really any response back to me about my comment as that will weaken the regression at the most crucial of times. I am wanting the client to remain highly regressed. Some clients can do this and some cannot. Those who can would be seen to be better hypnotic subjects than those who can’t.


The key is for the person to be conscious but distracted, so you can communicate to them with out them realizing you are.




When these types of transactions have happened between client and therapist often the client’s memory of them is quite poor.

If this theoretical statement is accurate then one has a powerful means of facilitating change in the client. To find a way of communicating directly with the client’s unconscious is a fertile discovery indeed.

Graffiti

Hypnotic suggestion as a form of therapeutic communication

I had a supervisee ask the other day about hypnosis. In my early days I did a little bit of hypnosis in the usual sense of the word. Where the person lies on the couch and I wave a watch before their eyes. I found it pretty boring as I would much prefer to talk with people who are awake rather than those who are asleep.

So I have rarely done hypnosis in this way but I would say that I use hypnotic suggestion regularly in the way I communicate with the client. This is where you hypnotise the client and they don’t even know they are being hypnotised.

The more the Adult ego state is involved in communication the less hypnotic communication will go on. A person who has high Adult ego state in their communication will be a poor hypnotic subject. Those who have a lowered Adult ego state will be much more ‘suggestible’ as it is said. They make good hypnotic subjects.

Hypnotic communication occurs when the Adult ego state is distracted or lowered in some way. When this is the case the therapist can communicate more so to the Child ego state or directly into the unconscious of the person.

The therapist is in some way wanting to circumvent or by pass the Adult ego state and communicate directly with the unconscious which is one aspect of the Child ego state. If achieved one has a powerful mode by which to communicate and make therapeutic interventions.

I don’t want to give away too many of my trade secrets so I will start with an example that is a naturally occurring form of hypnotic communication. Modelling behaviour. Yes as simple as that.

Many years ago when I was a young trainee therapist I was getting some peer group supervision. That means I sit with a person who has agreed to be a client and work on a personal issue of theirs. The supervisor sits there watching you and makes comments. A great way to learn how to do therapy even if it can be a bit daunting because you have absolutely no where to hide. Most often trainees will do an oral presentation of a client or even present an audio or video tape. Of course all that is censored by the trainee who selects the parts to be listened to. Many trainee therapists simply never do peer group supervision as they find it too daunting as I mentioned above.

On one occasion the supervisor made a statement to me that I clearly remember to this day. He said, “You do a lot of self grooming”. This surprised me as I had been not aware of it at all. Over the years I have observed myself as a therapist and I do indeed do a lot of self grooming. A whole array of hand movements rubbing together, rubbing or scratching my arms, scratching my head, rubbing my chin and neck with my hands, playing with my ears, and so on. By no means excessively so but it definitely is there.

There is one particular idiosyncratic movement that I do with my fingers and guess what, over the years I have watched many a client doing exactly the same self grooming movement or some variant of it. By doing this I have been able to directly tap into the clients unconscious.

The client and I sit there talking in our Adult ego states and thus the Adult is distracted. At the same time I am communicating self grooming behaviour to the client through my own unconscious behaviour. That communication from me is going directly into the client’s unconscious because the Adult is being occupied elsewhere. It is a form of hypnotic communication.

Distracted Adult ego state

What is self grooming? It is the Nurturing Parent ego state looking after the Child ego state. It is the person giving self non verbal positive strokes. If a person does this what happens? Their sense of self worth goes up and their self esteem goes up. And of course because it is an hypnotic communication the stroke filter is non existent.

As it sit with the client they are giving self 50 unfiltered physical positive strokes per session. That is a very good thing from a therapeutic point of view. However it’s not just a matter of sitting back and letting it happen I am afraid. This unconscious communication whilst inevitable between any two people can vary greatly in the amount of material taken on by the imitator.

Generally speaking the more psychologically important the other is the more unconscious material will be communicated by this means. If the therapist is perceived as very important then there can be a great deal of hypnotic suggestion and thus the client will take on a considerable amount of information this way. If the therapist is perceived as not having much psychological potency then there will be minimal hypnotic suggestion like this.

Self grooming gives lots of positive strokes

What is such potency and how do you get it is a vexed question. Many have sought to define it and clear definition still remains elusive. It’s like the ‘X’ factor that is talked about with singers and musicians. Hard to articulate what it is but you know when it is there and when it’s not.

Anywise that is for another post as are the other means by which hypnotic suggestions can be made to a client. How to bypass the conscious Adult and communicate directly with the client’s unconscious.

Graffiti