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!
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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!

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Childhood mental health problems

Most common mental health issues encountered in 6 to 12 year olds
Reported by school psychologists

Anxiety - 73.1%
Challenging behaviour - 71.8%
Family/parenting concerns - 65.4%
Peer relationships - 59%
Anger and conflict - 55.8%
Bullying - 41.7%
Self esteem - 38.5%
Child safety and protection - 31%
Depression - 21.1%
Trauma - 19.2%

Challenging behaviour = Autism spectrum disorder, ADHD, oppositional disorder, learning difficulties and conduct disorder

Ref: [Inpsych - Bulletin of the Australian Psychological Society, June 2011]



My work with children has mainly been in the private practice setting. Children are brought to me by their parents usually. The list cited above would be quite similar to how I would rate the children I have seen over the years.

One thing that has always interested me in my work with children, and what this data supports, is the low rate of depression as compared to the other mental health problems presented. I have found this surprising as I expected it to be higher. I expected anxiety to be as high as it is but I also expected depression to be the same. Which it is not. The rate of depression is much lower.

Why I expected this is because with adults and adolescents they tend to be about the same.

Adults in Australia (Department of health and ageing statistics)
10% anxiety at some point in adult life
20% depression (6% major depression)

One needs to be careful with such statistics as they can vary quite considerably depending on how one defines depression and anxiety. However, it seems safe to say that in adults there are similar amounts of depression compared to anxiety unlike in childhood. They are at similar rates whereas in childhood that is not the case with anxiety being much more prevalent than depression. According to the research above anxiety is three to four times more prevalent than depression in children seeking help from school psychologists.



This of courses raises the question as to why this would be so. I don’t know of any explanation that has been given to answer this question. So I thought I might do some hypothesising of my own.

Anxiety in childhood
It could be that diagnosing depression in children is harder than in adults. Thus the rates of depression are higher in children but are not recognised because the children do not present to school psychologists with that difficulty. I suppose this could be the case but it seems a bit dodgy to me as depression is not that hard to diagnose. Even if the child does not report the problem emotions found in depression the body language of a depressed child is not that hard to detect. It would also seem reasonable that a depressed child is just as likely to report unpleasant emotions as an anxious child. Why should there be any difference between those two?

It seems more reasonable to me that childhood by its very nature is more likely to produce reactions of anxiety rather than depression, whereas in adulthood this is not the case. It is simply a matter of when god made us, she stuffed up. The way humans reproduce the species is by giving birth to very small versions of adults that take almost two decades to fully mature.

As adults it is easy to forget just how vulnerable a child is. A child is like living in the land of the giants. Take a minute to lie face up on the floor, get someone to stand over you and remind yourself of how a child sees her relationships with adults.




One of my favourite TV shows in childhood - Land of the giants.

This could partly explain why anxiety is the highest of all mental health issues in childhood. A child’s life is on the line each day. Its actual physical existence is out of its control and is determined by those adults around her. Indeed a threatening state of affairs even if the child is treated well. Those around it can kill it at any time and of course children don’t understand about laws against murder and so forth until much later in life.

It has been postulated that you can roughly determine the difference in strength between two people by taking the fourth power of the ratio of their heights.
Ref: [S. Gould. 1977. Ever Since Darwin. New York: W.W. Norton Company.]

The height of the average female is twice that of the average two year old so she is (24 = 16) sixteen times stronger than the child (2 to the power of 4). A very large difference in power and strength I think one could say. It has been postulated that around that age of 10 - 12 years is the first time where a child could probably start to look after itself in terms of acquiring the food and shelter necessary to live. Up until that time the child’s physical well being in terms of food and shelter is dependent on the adults around it. Of course the child knows that the adults can withdraw that food and shelter should they choose to do so.



Despite these physical threats we also have all the psychological causes of anxiety. If a child is psychologically abandoned in some way, which many are to varying degrees, anxiety is a common reaction to such abandonment. Children are much more psychologically dependent on those around them than adults are and thus anxiety may be more prevalent in childhood as a result.

Every parent also has a Child ego state of their own. Sooner or later there are going to be situations where their own Child ego state needs are going to take priority over the needs of their biological child. A classic example is post natal depression. In this case the mother’s own Child ego state needs may be to sleep for extended periods of time in bed as a consequence of the depression. When she does this her biological children’s psychological needs are secondary and thus anxiety can result when the children experience this psychological abandonment.

Finally normal human development requires the child to master scary developmental tasks. Most obviously the separations from mother and father. Such as going to school, handling difficult circumstances without mother’s help, getting a job and just becoming psychologically independent is an anxiety producing process.



There we have it. This could explain to some degree why childhood is more of an anxiety producing stage of human development as compared to adulthood. It does not seem possible to develop an argument for why childhood would be a more depression producing stage of development. Indeed the level of depression in childhood in the first piece of research cited put it at 21%. The statistics from the Department of health and ageing put the level of depression in adulthood at 20%. They are the same. Whereas anxiety in children seeking help was around 70% and in adulthood put around 10% of adults in general.

Nothing like a bit of hypothesising on a Friday!

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Sexual dysfunction (Part 3)

In this third part of the series on sex and sex counselling I arrive at what was the original motivation for addressing this area in the first place. I have been working recently with a man who presents with the problem of premature ejaculation (PE). This is not an uncommon problem to come across as a counsellor however in this instance there are a few noticeable differences.

In this case it was the main up front presenting problem which he sought counselling for. Most often PE will arise as a kind of side issue raised by the man a few weeks or months after counselling has commenced. This may be because he is embarrassed about it and hence procrastinated about bringing it up or it may be that it is seen as less of a problem. In this case it was brought up near the end of the first session after much struggle. He was clearly distressed by it much more so than one usually finds.



To my mind the whole area of PE is a dodgy one. It is included in the mainstream literature on abnormal states. Indeed the DSM-IV has it there included with all the other sexual dysfuctions. However unlike some of the other dysfunctions listed it is based on an assumption. The assumption that good, correct, normal, psychologically OK sex has to involve intercourse. This need not be so at all. Emotionally and physically satisfying sexual contact between two consenting adult does not have to involve intercourse.

So why does this assumption exist? I can think of three possible reasons.
1. Biologically the reason for having sexual contact is for procreation and thus intercourse is required.
2. Historically religion has had some clear views on the purpose of sexual contact and the sin that comes from simple pleasure of the flesh.
3. Historically psychologists have defined healthy sex in such a way that intercourse is required. Sex without intercourse has historically been defined as a psychologically abnormal act. Now it becomes clear why I wrote the previous post - Sexual repression (Part 1) - where I address this precise point.



In the DSM-IV the diagnostic criteria for PE includes two points.
1. Ejaculation after minimal stimulation and before the person wishes it

PLUS

2. Marked distress caused by this.

Thus the DSM is at least partly agreeing with the point I am raising here. The premature ejaculation itself is not considered a problem. It must also be accompanied by psychological distress.

That distress will be caused sometimes because of the assumption I have just described. If one removes the assumption there is not going to be so much distress if any at all.

The problem I have with the DSM-IV and hopefully this will be changed in the DSM-5 is the title of the disorder. It is titled - Premature ejaculation - which is a misnomer. This title implies that it is simply the premature ejaculation that is the problem regardless of the distress or lack of it. It would be more aptly named, ego dystonic premature ejaculation. This is more accurate and would also help people like my client when they come across statements about abnormal psychology such as found in the DSM.



The suggested title comes from the DSM-III. This book published in 1980 included the category, ego dystonic homosexuality. As late as the 1970s homosexuality was still considered an abnormal psychological state in the mainstream literature. In its efforts to extract homosexuality from the pages of the texts on abnormal states the DSM chose this interim measure and coined the condition - ego dystonic homosexuality. By the time the DSM-IV arrived in 1994 even that had disappeared and mainstream literature no longer viewed homosexuality as an abnormal state.

Treatment
Back to the point at hand about PE. The manuals on the treatment of PE invariably focus on behavioural methods such as the stop and squeeze technique. Whilst certainly useful in some cases, I also suggest working on the assumption the man has in his Parent ego state, that ‘proper’ sexual contact must include intercourse. I cannot recall ever seeing such a proposal in a PE treatment manual. If the Parent ego state belief about ‘proper’ sex can be altered this can significantly disempower the PE problem in the man’s mind,. If that occurs then any technique like the stop and squeeze method is more likely to be successful and even if it isn’t that doesn’t matter anyway.

Thus we have addressed the behavioural treatment and changing the Parent ego state assumption about ‘proper’ sex. Also often apparent is some kind of Child ego state decision. With my client this was the case. His distress was based on his Child belief that the PE meant he could not function properly as a male. Thus it brought his sense of his maleness into question and this was what was so distressing for him.



There can be many other Child ego state beliefs related to the PE. There may have have been some kind of sexual assault on him as a child or ridicule by his peers that related to sexual matters when engaged in sex play and experimentation as a child. Indeed sometimes PE is an aggressive act against the woman - “I am going to satisfy myself and not you”.

However despite all this, if one chooses not to accept the assumption aforementioned then PE as a problem ceases to exist.

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The expression of shame & blushing (Part 5)

Thanks to all those people who kindly sent me bits and pieces on shame when I requested any information on the physiology of shame. That information still remains quite elusive. That is, what physical bodily changes occur when a person experiences shame or embarrassment. I have for the moment given up on my pursuit of that information and will seek to produce a statement about what happens to the person when they feel shame.

I am referring to here and now shame rather than neurotic shame at this juncture. We all go through life and sooner or later circumstances arise where we will feel shame which is appropriate to the events. For most this is probably not a common occurrence and as I mentioned before the experience of embarrassment is probably much more common for most. People who were shamed as children will feel shame in response to a wider variety of events in adulthood because they have been ‘programmed’ to have that reaction.



What happens when a person feels shame or embarrassment?

Common body expression and attitudes when one experiences shame include a bowing of the head, an attempt to hide the face possibly with the hands, a blushing of the face and possible sweating, body bent over on itself and possibly a closing of the eyes. It is like the person is endeavouring to make self as small and as invisible as possible and as a result there will be a strong drive to remove self from any company and seek to isolate self for a while.

The other interesting feature of shame and embarrassment is blushing. In this instance there is a reddening of the face, neck and possibly the upper chest. This is seen to be a reaction of the sympathetic nervous system that causes the blood vessels in the face to dilate. The cheeks tend to have more capillaries and blood vessels than other parts of the body and the vessels also tend to be wider in diameter and closer to the surface. The increased blood flow results in a colour change in that area from light pink to dark red. As it is involuntary it is something that cannot be controlled which may cause even further disquiet.

It is believed that everyone has the physical capacity to blush. The whiter the skin the more observable it is. In dark skinned people it is almost impossible to notice but they do blush the same as lighter skinned people. Women tend to blush more than men. It is reported to occur in kindergarten aged child but some report that a child as young as two years old can blush. Adolescence is the stage at which it is most prevalent due to it being a period of high self consciousness. As one grows older it tends to decrease as people start to become less self conscious (in normal circumstances) and the stimulation of the blood vessels decreases with age.



From a human communication point of view blushing is an interesting phenomena. Blushing is body language like any other kind of body language and people can use it to communicate. What does it communicate to the observer of the body language? Perhaps one could draw the blushing transaction as such:


Blushing transaction

1. The blusher receives some kind of information from the other person or from the environment in some way. A woman at a party has a wardrobe malfunction in front of a group of others and exposes her breast. She does not realise until someone brings it to her attention. A wife may mention to others in front of him how her husband now has to wear a ‘nappy’ since his bladder operation.

2. In response to the incoming information the person blushes with a reddening of the cheeks. This communicates back to the observer that the blusher thinks he has broken some moral boundary or sense of personal dignity as defined by the Child ego state and he is currently feeling very bad and uncomfortable about it. They will also know he is highly motivated to end the precipitating event either by withdrawal or changing the subject and so on.

This response will be a Free Child transaction if the shame or embarrassment is an appropriate reaction to the incoming information. If the shame is not an appropriate response that would be seen as an Adapted Child reaction and form the basis of neurotic shame. The two examples cited in number 1 above could be seen to be examples where it is appropriate to feel shame.


Unfortunately many teachers have learnt that shame is a good way to control children. Whilst parents may be careful not to shame a child at home it can be happening in the classroom.

A good example of the AC (neurotic) response can be found with some social phobics. A person with such a phobia can have self defeating internal talk. When in conversation they may start thinking that the observer can see they are blushing and thus how much of an idiot they look or how embarrassing they are. They may or may not be actually blushing but the person feels they are. This makes them more uncomfortable and thus the blushing increases or is felt to increase more so.

Note the lack of Parent ego state involvement in the transactions which is typical of the difference between shame and guilt. Like guilt, shame has the capacity to curb human behaviour most notably the Free Child. Whereas guilt comes from a Parent ego state introject shame is a Child ego state driven process and hence tends to be more potent and destructive. Shame feels very unpleasant to the person and thus they will be highly motivated to change their behaviour. Shame is experienced as being more in the core of the person as compared to guilt.

Do people blush alone, is an interesting question. People certainly can feel shame whilst being alone. The woman cited above who had the wardrobe malfunction can recall that event the next day whilst alone in her home and feel shame about it. However would her feelings of shame result in blushing? She is aware she is not being observed by anyone in that instance. I am unsure of the answer to this question. I would tend to think that she would not blush or certainly any blushing that did occur would be less intense. However I have no data on which to base this conclusion.


Making children perform on stage can easily produce a shame reaction. Parents need to take care when the child is required to make some kind of public performance.


Does anyone out there have personal experience with being alone and blushing or not blushing?

Whilst my parents were by no means perfect they never did shame me as a child. Thus I have few incidents where I can recall when I felt shame as a child or an adult. There are a couple and if I recall them I do not think that I demonstrate any blushing.

This leads us to the next stage in the process of our discovery of the various components of shame. Many a client will recount incidents where they felt shame in the past. If a client experiences shame in front of the therapist what does the therapist do? Watch this space.

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Shaming in child development (Part 3)

As one endeavours to increase their understanding of what shame is one needs to isolate what can be shaming practices by adults on children. There are certain critical times and events that occur in a child’s life where shaming by the parents can be particularly influential. I am reminded of an example with a client a few weeks ago.

A mother whom I had seen on and off for about a year raised a concern she had about her daughter who was five years old at the time. She reported that when checking on her daughter asleep at night she observed that her daughter often had her hand down her pants touching her genitals.

She wanted to know if I thought it was psychologically OK for her daughter to be touching her genitals in a masturbatory way. I suspected the real question she was building up to was, do I think this is a sign that she has been sexually abused?


Dissociation

The reason why I suspected this is because Australia is a pedophobic society. There is almost a hysteria around pedophillia in Australia. Male school teachers are a slowly dying breed as a result. I was also recently amused by the report of a health official who publicly announced that perhaps we could reduce childhood obesity in Australia by getting more children to walk to school. Initially there was much “oohhing and aahhing” about such a proposal. What a good idea it was and why hadn’t we thought of it before. A few days later there were those saying it was too dangerous as the pedophiles may get our children as they walked to school. People suggested counter proposals of having meeting points where children could walk in groups to school or having special wardens to walk with the children. The upshot of it was that it got too complicated and guess what - children still don’t walk to school.

Somebody forgot to mention that the likelihood of a complete stranger sexually attacking a child is about 2%. The vast, vast majority of sexual assaults on children are by someone in the family, known to the family or in some position of trust with the child. But that does not seem to matter as Australia has convinced itself that there is a pedophile hiding in every bush waiting to jump out and abscond with our children.



I informed my client of this Australian cultural pedophobia and also that almost all children touch their genitals and masturbate at times. And thus we arrive at the point at hand. This is a critical point in the development of shame problems in a child’s psychological development. As a result of their own beliefs and taboos about masturbation a parent could quite easily use shame as a means of attempting to stop the child from doing such a thing. Shaming around sexual matters is particularly powerful. Thus one would be suggesting to parents that they do not engage in such shaming practices as it can seriously impact on a child's sense of shame and effect their self esteem. This is also particularly relevant in young teenagers as well.

In situations like this I sometimes provide a little information about the misunderstandings of childhood masturbation to concerned parents. When Freud originally proposed the idea of childhood masturbation it was met with much horror and aghast. How could such a thing be true many asked!!



Well children grow up and have other feelings like sadness, anger, fear just like adults do so why can’t they have sexual feelings as well. Of course they do. However there is another common misunderstanding because adults will assume that a child’s comprehension and perception of masturbation is the same as an adults. It is however different in significant ways.

As a child grows it discovers its body. It learns that if it has a itch on its backside and scratches it that feels good. If it has a booga up its nose and pries it out with a finger that also feels good. It also learns that if it touches its genitals that feels good. In a child’s mind touching its genitals and scratching its backside are the same kind of thing. In an adults mind they are very different because the child does not yet understand all the connotations that go along with masturbation as compared to scratching its backside. So a child’s comprehension of masturbation is very different to the adult.

Secondly, the vast majority of people report their first orgasm occurred after puberty. The vast majority of children who masturbate do not do so with the goal of orgasm. Obviously very few children even understand what an orgasm is. They simply touch their genitals because it feels good. Another significant difference between adult masturbation and what has been unwisely called childhood masturbation.


Its every where you know!


When communicating with children about sexual matters parents must be vigilant to avoid any shaming. The other critical point with children and shaming is in their toilet training. Watch this space.

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Strokes and discipline

From a child development workshop

Strokes and attachment are intimately related (of course). The quality, strength and psychological health of an attachment between mother and child is directly influenced by the types of strokes that are exchanged between them. As we know there are 4 types of strokes
Positive unconditional
Positive conditional
Negative conditional
Negative unconditional



If mother (and to a lesser extent the child) is giving positive strokes to a child then the quality and strength of the attachment between them will increase as is shown in the diagram. When there is an exchange of negative strokes then the quality and health of the attachment decreases. Thus the quality of the attachment is directly influenced by the nature of the stroking patterns between mother and child.

When there is no exchange of strokes from mother to child there is a plateau effect initially as is shown in the diagram. The longer the period of no strokes continues then there is a decrease in the quality of attachment at an exponential rate. Initially it is nil, then slow and then fast as is shown in the graph.

When a parent disciplines a child it is giving the child a negative stroke. Discipline causes a child pain. If the transaction does not cause pain then it is not discipline but something else. As discipline is a negative stroke that means it will subtract from the quality and psychological health of the attachment with the child.



If in the past there has been a lot of positive strokes then the attachment quality will be high up on the graph. Thus the negative strokes from the discipline has minimal impact on the relationship quality between mother and child. If the attachment quality is already low on the graph then the discipline has a more devastating effect on the relationship.

Most parents who present with discipline problems with their children have an attachment quality that is already low on the graph. One sees endless books on the disciplining of children which discuss the different types and styles and the pros and cons of both. When I work with parents on discipline I am mostly looking at what they are doing when they are not disciplining the child. The most important part in disciplining a child is what you are doing when you are not disciplining it!

This may seem a little odd and parents at times find this hard to accept and will try to bring it back to how to discipline the child and see the non disciplining periods as inconsequential. However I would assert that if the attachment between mother and child is high up on the graph then discipline problems will be negligible or quite transitory.



Other points.
One negative strokes is five times more powerful than one positive stroke. If a parent gives one negative stroke to get the graph back to where it was prior to that the parent has to give five positive strokes.

This however is just a general rule of thumb. The negative relationship effects of negative stroking vary greatly depending on the type of negative stroke (discipline) given. However negative strokes are more powerful than positive strokes as described above.




Main types of discipline

1. Physical - Hit the child, bite child, pinch child, pulling hair.

2. Behavioural - Loss of privileges. This is the consequences of behaviour
approach. “If you don’t clean your room then no TV tonight”, “If you don’t get
home by 12 midnight then you are grounded”.

3. Emotional -
Anger at the child. All people have a natural aversion to anger because the
consequences of anger are never pleasant and can even be physically threatening.
“If you don’t get ready for school mummy will get angry”.
Withdrawal of love. Very powerful in changing behaviour. “If you draw on the
walls mummy wont love you any more”. Or the parent who gives the silent
treatment or the cold shoulder to the child who misbehaves.
Abandonment fear. Also a very powerful discipline technique. “If you don’t stop crying I will get a policeman to come and take you away”. Or the parent who simply walks away from a misbehaving child.
Shame. The cinderella of the destructive emotions. “You should be ashamed of
wetting your bed”. “I am going to tell your friends how horrible you are for
drawing on the walls.” A powerful form of discipline indeed

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Temper tantrum (editted)

A temper tantrum is an uncontrolled expression of anger or tension. It can include arms and legs thrashing about, arching of the back, crying, screaming, stamping feet, throwing self onto the floor.

4 common reasons for temper tantrums
1] Tension outlet. The child becomes like a pressure cooker and it does not have a more sophisticated way of releasing that tension.

2] Manipulation or intimidation to get something or assume the powerful position in the relationship with mother. This can be particularly so if the child has a tendency to throw a temper tantrum in public, like in a supermarket.

3] Temper tantrums are dramatic displays of emotion especially when done in public view. So they can represent the precursors for the development of the ‘drama queen’ personality types such as the hysteric, narcissistic or borderline personality types.


Tantrums? Not this good girl.

4] The child is learning about anger and assertion. Temper tantrums can be a crude expression of these feelings. Most people as the grow learn about their feelings of anger, how to manage them and how to express them in a socially acceptable way. The first thing a child must learn is to focus its anger at the source of frustration or the stimuli of the anger. This is shown in the two diagrams below.



The first shows temper tantrum anger. It is directionless and thus goes in all directions including being directed at self. The child angrily lashes out and will hit those around himself as well as himself. When working with the child one seeks to get the child to identify the source of its frustration. Who or what lead to the angry response? It maybe mummy saying “No”, a sibling getting the last piece of cake, having to go to school, not being able to tie its shoe laces and so forth.

One needs to assist the child to achieve the cognitive task of understanding what caused its frustration. Once done the child can learn to direct its anger at the source as the diagram shows. Then to show the anger at that ‘thing’ in a socially acceptable way.



Responses parents can have to children who are engaging in a tantrum:
The primary problem with a temper tantrum is the lack of control by the child such that they can physically hurt self. If a child is in a hysterical state the parent needs to assess if it’s in danger of hurting self. If it is, then the parent must adopt the first strategy of restraining the child. If the child is not in any danger of hurting self then the parents can adopt strategy 1 or 2. If there is more thinking ability in the child then parents can adopt strategies 3, 4 & 5. The response can also be sequential. Do 1 & 2 first and when the child calms one can do options 3, 4 or 5.


Directing anger

1. Hold or restrain the child physically. Dabbing a wet cloth on the face can also defuse the anger
2. Ignore it. If possible it is best to give the behaviour as little attention (strokes) as possible
3. Distract the child
4. Isolate the child (Time out)
5. Compromise.

Tantrums in adulthood
Sometimes people never properly learn how to have directional anger and thus can have tantrum like anger as they grow into adolescence and adulthood. As I mentioned before this can happen in the emotionally labile and acting out type of personalities such as the hysteric, borderline, narcissistic and maybe the anti social personality type as well.

The problem is with an adult having a tantrum is the circumstances are very different. Compare the young child to a fully grown man who is six foot tall, solidly built having a temper tantrum. The potential danger increases significantly and this could explain some types of domestic violence. However the problems do not end there a fully grown adult also has far more ability to plan and is much more capable of using weapons. So the tantrums can be much more physically violent.

This may explain those situations one hears about from time to time when a disgruntled individual walks into a place where many others are and simply starts shooting people and eventually ends up killing self. We hear of teenagers going into high schools doing such things. These situations do have the directionless expression of anger quality that one finds in a tantrum and thus could be an adult display of a temper tantrum.

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Encropesis

When counselling children and parents sometimes one has to deal with the basics of life. That includes what goes in one end and what comes out the other and all the psychological problems that can be associated with either. What goes in one end can result in the eating disorders and what comes out the other end can result in the elimination disorders like enuresis (bed wetting) and encropesis (soiling).


Kahless, in the previous post comments about people taking control of their body through eating.

When the little child enters the world it has no control. Instead its life is controlled by mother and father. Well it hopes they control it because if they don’t then the child suffers and can even die. For instance it needs mother to control its eating by the provision of nutritious food or it dies. It needs mother to provide love or it psychologically suffers.



However as it grows and develops it begins to need less control by mother. Until one day it realises that it does actually have some control. It begins to realise that it has something that mother wants. Mother wants it to take food into its mouth and then swallow that food. It now can exercise control over mother by choosing when to do that and when not. Hence food refusal can be a child exercising its control. This can form part of the eating disorder of anorexia.

As the child grows more so its little brain develops even further and when it reaches about 2 years of age it begins to make a major shift from maternal control to self control. This is a major and very important psychological task for the child to make. If it does not successfully achieve it then all sorts of psychological problems can develop.

Around the same age the child becomes ready for toilet training. When it learns to take control of its bladder and bowel. Up to that point it didn’t need to as it had a nappy and mother took care of those sorts of things.



So the important psychological shift from maternal control to self control and control of the bladder and bowel can all get mixed up with each other. This makes it a potential psychological nightmare where numerous life long psychological problems can evolve from. And the child cannot do it just by itself, it is the mother child relationship that has to successfully traverse this rickety bridge over the river full of crocodiles.

If not successful the child can develop conditions like enuresis (bed wetting) and encropesis. Encropesis is the unintentional or intentional act of defecating or soiling self in places that are not appropriate.

(Note: There are a whole array of reasons when a child may become encropetic and I will only discuss a couple here).

I have always found the definition cited above a bit odd as in my view unintentional encropesis and intentional encropesis are two quite different psychological conditions that involve alternative psychological structures in the personality. However diagnostic systems like the DSM include them under the one title which probably leads to people using the wrong treatment at times. Maybe I should express my views to the DSM 5 people?



Two types of encropesis can either be anxiety based or anger based. The counsellor needs to make an assessment of the emotional basis of the child’s personality structure. Anxiety based encropesis with tend to result in unintentional soiling whereas anger based encropesis will tend to result in intentional soiling.

The human body is designed such that if people are placed under extreme stress then they can loose control of their bladder and bowel. Hence we hear people make statements like, “I was so scared I almost shat myself” or, “If you go on that roller coaster ride make sure you wear your brown pants”.

Some children who are anxious can develop encropesis and enuresis as an expression of this natural reaction of the body

Other children may be encropetic because they are angry. For a child (or adult) to intentionally defecate in its pants or on the floor can be a very oppositional and defiant act. Indeed it is hard to think of an act that is more oppositional to authority.

However there is one and that involves faecal smearing. This is where the child (or adult) smears its faeces over a wall of clothing or bedding and so forth. If a child displays a pattern of faecal smearing this indicates significant psychological maladjustment and professional assistance is required. It is such an anti social act and hence tends to be anger based rather than anxiety based.



Encropesis can also be caused by a child not defecating for a many days. The child continues to eat so its bowel fills up such that it can no longer keep the faeces in. This is where the line between anger based encropesis and anxiety based encropesis can get blurry. Some children are very anxious so they develop a pattern of holding their lower abdomen and pelvic region very tight such that bowel movement is interfered with. Hence one gets the unintentional encropesis from anxiety based problems.

Some children refuse to defecate for the same reason other children do food refusal. It is a defiant act where it rebels against what mummy wants and thus takes control of its body in this way. This can result in unintentional encropesis as the bowel simply gets too full and this could be seen to have an anger basis to it. So there can be one type of unintentional encropesis that is anger based if these are the circumstances. However on most occasions unintentional encropesis is anxiety based and intentional encropesis is anger based.

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Family structure and child development

Emeshed and distancing families

Families are structured in differing ways and here I look at two varying structures and the psychological consequences of those structures on the child’s psychological development.

There are emeshed and distancing families. They can be diagrammed as such.

Emeshed family

Scary outside

Distancing family



These can be seen to be the extremes of the continuum with the ‘normal’ family existing in the middle. The closer the family is structured to represent the end points of the continuum the more maladaptive psychological consequences there will be for the child growing up in them.



Emeshed family
The diagram shows the family members represented by the circles. In this family there is a very clear boundary between the inside of the family and the outside and the member have a sense of closeness and belonging but overly so. There is a script belief by the family, “Don’t trust” others (outside the family). There can be paranoid beliefs about non family members. “Us and them” thinking. The world outside the family is seen as a scary and dangerous place and you can only trust family - is the ethos.

Group think creates self perpetuating beliefs. Along with the introjection of beliefs particularly about others. This can result in fighting with others out side the family. Neighbourly disputes over fences or barking dog. Family feuds use the group dynamics of the combat state which can foster a strong emeshed family structure.

There can be faulty thinking - grandiose delusions about the specialness of the family or one member may be identified a special due to what is believed to be exceptional ability (sport, music academic), appearance, power, wealth and so on.



Family gatherings such as birthdays, holidays, christmas and so forth occur regularly and non attendance is viewed in a very dim light. There can also be (but not always):

Infantilization of the children
Excessive contact - sleeping together, working together, socialising together
Prevention of independent behaviour
Parental - system control. Intolerant of variation or deviation of the members where members do not behave how they are supposed to. A child who refuses to eat dinner, performing poorly at school or a parent displaying anger, power being challenged. The response to correct deviations are swift and intense by other family members.

Distancing family
In this instance there are tenuous connections between family members and often there is no contact for long periods of time. There is little sense of belonging and the family being a close knit group with a clear sense of boundary between it and the rest of the world.

No sense of belonging or community leaves people feeling isolated. There can be one person who holds the family together and when they die or move away the family disintegrates. Don’t belong injunction.

Little interest or frequency of family gatherings. Can easily geographically move away from each other and there are long periods of little or no communication with few protests from anyone.

The distancing family tolerates variation and deviation to the extent of not even noticing or caring. Responses to variations may not even occur even when required such as with a truanting child.



Mixture
Mixture of family structures can occur at times if there is a number of people like in-laws cousins and so forth. One get subgroups in the family that can be structured like this.

Potential problems resulting form these structures
Emeshed
Relationship problems - Spinsters, bachelors & divorcees. Children may have a series of failed relationships that never work. No one is ever good enough for me or they all have some bad point that negates them as a potential partner. Maybe a short dysfunctional marriage may occur. A long term affair with a married man is another possibility (ie selecting an unavailable partner). When these relationship end where do they go then? Go back to the family of course.

This raises a point that I sometimes see in counselling with those who are entering a stage where marriage is in the foreground. When you marry someone you marry the individual person but you also marry their family structure all their attachments and relationships as well. The family structure and attachments were there long before the potential spouse came along and these things tend to be inert and do not readily change. Indeed in an emeshed family they are very resistant to change. If one is marrying into an emeshed family structure they better get used to the idea and it will take them a long time to be fully accepted into the family structure. Sometimes they never are and will always seen as an outsider to some extent.


Gothic wedding

This raises the issue of a person’s motivation for marrying a spouse. People get married for lots of reasons. The overt reason is because they have fallen in love with the partner and want to spend the rest of their life with him/her. Underneath there can be a whole variety of other covert psychological reasons.

People from an emeshed family can marry to get out and away. They see it as one of the few ways to get out of an oppressive family system especially when the newly weds geographically move away from the original family unit. The family will use all sorts of mechanisms to stop this happening such as financial ties, gifts, emotional black mail and so forth.

If you are marrying a person from a distancing family one may wish to consider such possible motives of their partner. It also works the other way. People from a distancing family can marry a person from a ‘closer’ family because they crave the feeling of belonging to a family. In their mind they are marrying the family attached to the partner just as much as they are marrying the partner, if not more so.

Other problems that can result from an emeshed family
School phobia
The child who is aggressive or unpopular to his peers ends up isolating self
Enuresis & encropesis = cannot stay away from home over night with out complications and embarrassment
Paruresis
Anxiety disorders - agoraphobia, panic attacks, means of travel such as a fear of flying or public transport. Any kind of anxiety that makes movement away from the home or family difficult can have some of its basis in the emeshed family structure. It should be noted that there are also other causes of these problems. However if a client presents with this kind of problem then the counsellor needs to investigate the type of family structure the person grew up in.



“Leaving home” problems are typical of the emeshed family. When the children reach the age where they are ready to (supposed to) leave the home and family. Twenty somethings or thirty somethings. When the family reaches this developmental stage it can restructure it self to make one or more of the children an identified patient. The young adult develops a problem like a drug problem, becomes suicidal, develops a mental illness of some kind, or something else like anorexia or other kinds of eating disorders.

When this happens the family bonds together for the good of the identified patient when the real reason underneath is to propagate the emeshment.



Distancing
The schizoid personality type is the most obvious product of this type of family structure. There may be a sense of despair due to lack of emotional attachment, commitment phobia and difficulty with forming close attachments. The ‘gypsies’ of the world who can travel and never really settle down into some kind of group or family unit. At times some find drugs can fill the void of the lack of attachment.

The anti social or narcissistic personalities can also manifest from this kind of background. Both these have attachment difficulties and either don’t understand what attachment is or simply find human attachment too overwhelming.

As mentioned before sometimes these people can attempt to solve their distress by marrying a family. The man may actually be attracted to and in love with the woman's family more so than her. This may lead to marital problems later on.

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Jealousy and narcissism **

I have mentioned before that sibling rivalry and jealousy are a normal part of child development. Indeed one could go even further and say that these feelings and the disruption they can cause in the family are an integral way by which the child resolves its primary narcissism.

Primary narcissism, as distinct from secondary narcissism, is the state of mind a child has from birth to 5 years of age. It perceives itself to be the centre of the universe, omnipotent and all valuable. The child believes it is more important than others, that it is special and that it should get favourable treatment.

This attitude is meant to decline as the child learns that it is not the centre of the universe and there are others on the planet that are of equal value and importance. Realising the importance of others reduces primary narcissism.

Most theorise that the narcissistic person has the life position of I’m OK, You’re not OK (I+U-). As a result they behave in a way where they view their own needs and self as more important than others. Others are therefore treated as being of less worth and value.

I have questioned this else where. I propose that the narcissist has the life position of I’m OK, You’re irrelevant (I+U?). If this is the case, others are not viewed as second class or of less value, instead their worth and needs are not even considered in the first place. The person has such a focus on self that they never actually get around to thinking about the other. Or the other is only considered in a superficial way.

This makes sense from a child development point of view. The young child in a state of primary narcissism is very self focussed. When they are dealing with others their focus is on how does this effect me. They are not yet capable in any substantive way of seeing it from the others perspective, thus displaying empathy.

Due to this high degree of self focus it does not even consider the question of, Are others OK or not?

Me, me, me

How does the child learn that others are relevant and are of importance. This is where the child’s jealousy and disquiet achieves importance. It is one of those things in life that just does not feel good but you have to go through it any ways. Its like going to the dentist. Nobody likes going because it feels bad but you have to go anyway.

If left to its own a child will not naturally evolve out of its narcissism. The child will learn that others are relevant when it is imposed on them and children don’t like that. It does not feel good and it means their here and now needs do not get met.

There is one piece of cake left and the younger brother has it because he has not had any cake yet. The older sister has already eaten her piece but she wants the last piece as well. The parent intervenes and gives the last piece to the brother much to the loud protestations of the sister. The brother ‘relevance’ and worth is imposed onto the psyche of the sister in this instance by the parents intervention. When this happens the sister’s primary narcissism reduces a little bit more. This feels unpleasant to her so she protests with anger and crying.

Hence we have the developmental importance of sibling jealousy, rivalry and envy. The pain the child feels with the jealousy and rivalry is what she remembers and thus she understands a little bit more that her brother is relevant in her psyche. If she did not feel the pain of the jealousy the process would flounder and she would never learn about the relevance of others and remain in the state of primary narcissism. As I mentioned before if a child is left to its own devices it will not naturally evolve out of its narcissism.

This not only happens with siblings or peers but also in the child’s relationship with mother and father. As the child grows mother begins to express her own Child ego state needs to the daughter. More and more the girl learns that mummy has needs and at times her needs are second and mummy’s needs are first. Again this happens because the mother imposes it onto the daughter and as any parent will tell you there can be loud and long protest when this happens. The mother forces her own ‘relevance’ onto the child to which the child feels ‘pain’ and then can get angry and so forth. The child is forced to recognise that others do exist in the world and they impinge on what it wants at times.

With sibling rivalry and jealousy most parents fail to see the developmental importance of these feelings as I have just described. They tend to simply react to the disquiet being expressed in such a ways that it ceases as expeditiously as possible. Their usual goal is to circumvent the rivalry or have it quickly resolved by some means. They fail to see that the children are using it in an endeavour to move through the developmental stage of primary narcissism. Hence they impede the child’s psychological development in this way.

When asked I usually highlight three things to parents in how they can assist the child to use its feelings of jealousy and rivalry to master this developmental stage.

1. Allow the child to experience the jealousy and rivalry feelings. To be aware of and experientially understand the feeling and that this shows that others do exist in the world and are relevant. Obviously this is presented to the child in a way that it can comprehend for its age.

2. Adult information is given to the child about what is happening

3. Role plays are a great way for a child (and indeed and adult) to learn the skill of empathy which is also needed to master narcissism.

These are not meant to stop at age 5 years but I would suggest carrying these on all the way through childhood and adolescence. Indeed there can be considerable feelings of rivalry and jealousy in adolescence which is a fairly narcissistic stage any way.

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What’s in a name? - Part 2

In the Transactional Analysis world over the years there has been sort of a tradition or cultural norm to change one’s name. Many have changed their name - christian name and/or surname, some have done it a number of times. I never have but at times it has been a bit of the thing to do.

However there is a theoretical basis for this tradition evolving. Eric Berne in his book, “What do you say after you say hello” talks about names and the role they can play in determining a persons life script. In therapy groups sometimes you get people who want to do some work on their name.

Over the years in many workshops and therapy groups I have begun with the round question for each participant - What is the story behind your name? Who named you and why? What does your name mean to you, your mother, and so on? Nicknames also can be very important, how they got them and what they mean to the person.

One never ceases to be amazed at some of the answers you get. Some people have whole elaborate stories or information that they know about their name and how they became named what they did. Some people come to realise that they know all this stuff about their name that they did not know they knew.

A man may report that he was named after uncle Harry and then describes how uncle Harry was a drunkard and a womaniser. As a 6 year old boy learns this what sort of impact is that going to have on his script. Or a woman reports that she is named after grandma Merle who was a spinster who spent her life doing good work in sub Saharan Africa. What sense is a little 6 year old girl going to make of all that?

Then there is the whole area of sex role scripting when a father wanted a boy and got a girl so he gives her a name like Kim. That type of thing can often result in a sense that there is something wrong within the child. In one sense your name is your public signature and thus it is seen as having some importance in one’s sense of identity as Eric Berne described.

My name is actually, Anthony Gilbert Browning White. Gilbert comes from my grandfather on my mother’s side - Gilbert Troup. What I have been told about him is that he was a very learned doctor and anaesthetist in this state for many years. My mother had a special attachment to her father and in one way revered him. When he died they created an award named after him that is given each year to the most successful student of anaesthesiology at a medical school here. On a side note about 5 years ago at a dinner function I attended, I discovered that the woman sitting opposite me had actually won it. Bit of an odd situation really.

I have spent my work life in the helping professions. Is this my life script from my naming?

However it is not all cheese and biscuits I may add. Whilst she revered him and felt a special connection to him I have learned over the years from her that he had a tendency to neglect his domestic duties. Whilst he was much loved by his patients he at times would tend to them before he tended to his own family. This as one can imagine resulted in some disquiet amongst family members including my mother who named me after him. Has this had an impact on my life script? Such are the vagaries of child development.

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Who gives counsel

Hello Zbig,

I suppose its a bit cold in Poland at the moment being winter and all.

You stated: “And having read this blog entry I ask myself: isn't it supposed that we have problems, overcome it, and the therapist helps us not only with the immediate relief but also should give us a "fishing rod" so we can deal with our future problems without repeatedly going to the therapist. And your entry suggests that it's the opposite - I have my therapist and my children will have problems so they will have to go to the guy like me? Isn't it that I, being experienced and kind enlightened, can help my children (I mean in most typical situations, of course I don't cover extreme traumas here) to cope with their every day struggle on their own?

What do you think?”

(end quote)

This started out as a response to your comment but became longer so I made it a post

You make a good point about therapy and fishing rods. I have a number of responses to it.

The majority of my clients I would see for less than ten sessions. Most come with some difficulty and want it fixed up and then they leave satisfied to varying degrees. This probably fits with what you presented as your understanding of the therapeutic process.

However regarding fishing rods I disagree with you to some extent. My personal view is that it is a sign of psychological health to have a therapist (unofficial or official) in your life from birth to death. That is someone whom you can go to, to emotionally unload when need be, be kind of a mentor or confidant.

For most people in adulthood this would usually a be a partner or perhaps a close friend or relative. To have a dependency on this person in this way to some degree and thus to have completely your own fishing rod in my view is a retrograde way to live life.

This confidant is what I see as an unofficial therapist. That is they fulfil some of the functions that an official therapist does. For most people this works OK but it has some potential pitfalls. It is most important for a husband to remain a husband and not become a surrogate therapist to a wife, as that will quickly kill a marriage. So a wife can confide in him and emotionally unload with him but only a little bit such that he remains a husband and does not become the wife’s therapist.

When friends and partners advise each other they will always have an agenda of their own.

Also when someone seeks me out for counsel I have no other relationship to them so I do not have any other agenda. If a wife seeks advice (counsel) from her husband then his advice may be tarnished by his own agenda in that he will advise her to do what suits him also. If a wife is having difficulty in her relationship with her mother the husband’s advice maybe for her to withdraw from her mother but that can be partly due to his own dislike of his mother in law rather than what is best for his wife. He has a conflict of interest and that will influence his counsel to his wife even if he is trying to avoid such a thing. With an official therapist this does not (or at least should not) occur.

Also there is the confidentiality issue and a therapist is far less likely to gossip than a friend or spouse will about your inner thoughts and feelings you have disclosed to them. For most however these are minor complications and their unofficial therapist will suffice. For others they may have access to an official therapist who they feel comfortable with and thus they are used in that role as some may use a spouse to be a confidant or sounding board.

Sometimes in the psychotherapy or counselling subculture to have a therapist is like having a fashion accessory. It is the acceptable behaviour in that subculture and thus some people can seek counselling partly for these reasons such that they feel like they fit into their subgroup in society. People like Dr Phil have made a significant contribution to this development in attitude in some societies. He has made it trendy to have a therapist.

Sometimes people come from backgrounds that were very dysfunctional and thus the giving of a fishing rod to the client becomes a much more difficult and protracted process. Some times the problems resulting from their early life have left scars on the person’s very core or sense of who they are. It takes time, sometimes a very long time to assist the person to reduce such scars and the effect they have in their day to day life. Realistically very few of them will ever really get their own rod in a fully substantial way.

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