Drug use ambivalence

Using the drug use ambivalence technique with those drug users who are in remission.

I have been using this technique now for some time. I have developed it over a number of years and kind of did not realise that until I spoke with my supervisee the other day and she raised some concerns.

It is a two chair exercise where the client sits in a chair and experiences that part of their personality - either the FC or AC.



I have used it recently with two women who had been clean for some time but they had both expressed some concern about relapse. They were fine doing the FC chair and gave the usual responses of why they do not want to use - their lives are better, healthier, save money and so forth.



When asked to go to the AC chair both expressed an instant strong fear reaction. One woman even stated,

“That bit does not exist..... if it does exist it is only very tiny”.

After a bit of discussion she stated that she did not want to acknowledge that it existed because then she might use again. Indeed we had spent a good deal of time in the previous weeks discussing the idea of relapse and she was quite open about it. She was fully aware in her Adult about her desire to use drugs again but to actually experience that part of self was an entirely different thing. Her statement about it not existing or only being very small was highly incongruent. This however does show the difference between her Adult being aware of her desire to use again and her first hand experience of that part of her personality that wants to use. Which supports the validity of this technique.



However this raises an interesting question, What was she actually scared of? Does the bigger fear reaction mean the more likelihood of relapse or the closer the person is to a relapse.

Or it may simply mean that the person is scared of relapse even if they are not at any great risk of doing so.

I do not know the answer to that question. However my supervisee expressed some concern at this technique. She reported that by asking the person to experience the part of self that wants to use drugs may in fact increase the likelihood of them doing so. Another interesting proposal and one that I do not agree with.

The fear reaction, along with the reluctance to ‘be’ that part, (with one person even denying its very existence) means that she had repressed that part of her personality. She had become unintegrated in that way. She had locked away this part of her personality and kept it hidden from her conscious.



Psychological theory states that the more you integrate parts of the personality the less trouble they will be. By keeping it unintegrated the more likelihood there is that she will relapse. By experiencing it and integrating it, the less problematic it remains in the personality.

Also with her being the AC part of self it allows me to relate to it directly. This is a most important thing to do. Whilst sitting in the AC chair I can dialogue directly with it. Thus we have the opportunity to develop some relational contact. It allows us the option of building up some kind of relationship. This is a very good thing as it allows the AC to stop feeling so isolated. It defuses it and people are always in better psychological shape when they feel they are in some kind of relational contact with others.

Any time I come across some kind of self destructive aspect in a client my first goal is to establish some kind of relational contact with it.

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Drop a feeling

Some people report experiencing feelings that they don’t want. In such circumstances the psychological process of dropping the feeling is required.


For small feelings



1. Child ego state experiences the feeling
2. Adult becomes aware of the feeling
3. Adult decision to drop feeling


For large feelings



1. Child ego state experiences the feeling
2. Adult becomes aware of the feeling
3. Child expresses feeling the number of times needed
4. Adult decision to drop feeling (May need two chair)

Barriers to dropping feeling



The racket value of the feeling
The strength of its connection to a script decision
Secondary gains associated with it.

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Using drugs dangerously

In order to use drugs dangerously such as with injecting drug use one has decommission their Adult ego state whilst doing so. This can be done by using what are called defence mechanisms. Humans are very good at lying to themselves and defence mechanisms are one way they can do that.



If a person has the Adult ego state information that sharing injecting equipment is a most unwise thing to do then in order to do it that, the Adult needs to be tricked some how. The Child ego state in some way needs to temporarily trick the Adult. If it can not do this then the person will not share injecting equipment on that occassion.







Below is a statement by a 37 year old doctor who shared needles on this occasion.



“Never in wildest dreams did I EVER IMAGINE that I would share needles. Some of the details around these circumstances I can’t recall. I spose it was so traumatic, having a medical background and a deep moral code around sharing fits it still seems unbelievable.



I would ask the people who had used the fit before me if they had HIV or hepatitis and I chose to believe their response of no. Truth has no place in this world, if it shows up then is gets distorted, ignored or disproven because truth and drugs cannot be in the same room. The thought of not being able to get the drugs into me as quickly as possible especially when watching the others getting relief from their angst was something I could not take. This anxiety/fear far outweighs the fear for my own health and life. It was like trying to resist the sound of a newborn baby crying when you’re breast feeding.



I would disassociate from reality, time and space changed. I would wash the fit out with alcohol or bleech the whole time repeating a mantra of please God please God. I would think who cares anyway, you’re fucked and life is fucked and you’re all fucked. Self loathing and the fear of not getting that rush would fuel me on.



Then the ritual of mixing up would begin and my mind would start bargaining “you’re not really going to do it” “you’ll stop before you whack it” but there is no stopping by this stage you’re like a robot and this thing has you in its grasp. I would cry as I found a vein, wishing I could stop, jacking it back, holding in the sobs so I didn’t shake too much, then pushing it down the relief flooding over like a lover holding you in their arms no more aghhh and once again I’m cleaver and funny, all worries dissolve, I am a sex goddess and philosopher, brave and complete, all fears drift away.” (end quote)







Can you spot the defence mechanisms?

Or the ways her Child ego state temporarily tricks her Adult ego state.

I can count 4, possibly 5.



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Book update.

With the negotiations completed and the contract signed I am in the process of writing the next book. Although the title is yet to be decided it is about counselling drug users.



The last book - Working with suicidal individuals - was meant to be 70,000 words and it ended up being 90,000 and I was asked to reduce it. I finally got it down to 87,000 words and it was accepted. This time however I have been asked to keep it to 70,000.







The first chapter I have almost completed is probably going to be chapter four and it is on Harm Reduction. This topic will be found in the vast majority of books on drug counselling. It is usually quite dry and has been said a hundred times before but you really do need to have it in there.



I thought it was going to be about 1,500 words but it ended up being 7,000 and I am really happy with it. I mean really! It has ended up with a really good structure, looks at the overall area and then has lots of new and applicable stuff on the area. Most of it I have never seen in the literature before.







It was one of those situations, that as you start writing you begin to find out that you knew all this stuff, you did not know you knew. It just kept coming out as I wrote along. Problem is one tenth of the book is taken up with this one chapter!



Other than this, as with the first book the initial stages are quite taxing and hard. I have the outline of the book and I keep thinking of things I have written or know of in the literature and frantically putting them in all sorts of folders on my computer. But it’s like at times you have to keep four different things in your head at the one time as you don’t want to miss any. This happened with the last book and should slow down a bit soon I hope as I get most of it together in the right places.



But all in all it is good to have a new project like this. It certainly has my interest and I am motivated to do it. As with the last one when I write I have to let my Free Child run wild at times and then get it all down and together in the right structure and format.





Free Child





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The two ego state model

Tony White
Transactional Analyst
June 21st, 2011.

Introduction
Ernst (1971) believes Eric Berne's most significant contribution to psychotherapy was the delineation he made between the Parent and Adult ego states. This, he says, allowed us to distinguish opinions from objectivity. This view is consistent with the general view that science has held up to date. However sat present, the social sciences are experiencing much confusion in certain areas. (Strauss and Hafez [1981], Morgan [1983], John [1984], Eysenk [1983]). It is this distinction between the Parent and Adult ego states that illustrates why the confusion exists.

Steiner (1971) defines the Adult ego state as essentially a computer, an impassionate organ of the personality, which gathers and processes data for the purpose of making predictions. The Adult gathers data through the senses, processes them according to a logical program, and makes predictions where necessary. The Parent ego state is essentially made up of behaviour copied from parents, or authority figures. It is taken as a whole, as perceived at an early age, without modification. A person in his Parent ego state, is merely playing back a tape of of early internalized parent figures. It is a repository of traditions and values.

The above definition of ego states implies that the Adult is not a collection of tapes, that it is not comprised of the incorporation of parent figure information. this paper contends that the above proposal, simply stated, is incorrect. When a child attends school he acquires information, this involves the incorporation of the teacher's instructions. Later on in high school, when the child has more knowledge, he may critically evaluate what he is being taught, yet he can only do this if he has previously incorporated, or learnt how to critically evaluate.

The acquisition of language and basic mathematical principles also involves the incorporation of tapes. The most obvious example is the rote learning of multiplication tables and the alphabet. Brunner (1964) agrees with this, stating that all the techniques of data processing are passed down from generation to generation, in each culture. Each child incorporates data processing methodology from his parents.

The Adult and the Adult in the Parent.
It now becomes apparent that the Adult ego state and the Adult in the Parent ego state are the same. Thus the two ego state model may be represented geometrically as in Figure 1b


Figure 1

For further elaboration, it is necessary to examine Stuntz's (1972) paper on the second order structure of the Parent ego state. He states that the Adult in the Parent (AP) "is an external program of how to use the computer (Adult)" (p. 60). It is the contention of this paper that the Adult in the Parent (AP) is the Adult, and that any division is unnecessary and leads only to confusion. Stuntz suggests that each time Adult processing is required that ego state must consult the Adult in the Parent. See Figure 2a and Figure 2b illustrates that the Adult ego state outside the Parent is redundant, doing only what it is told by the AP. Thus it is an unnecessary middelman that creates four process instead of two.


Figure 2

In Figures 1b and 2b, it is seen that the two ego state model places the Adult ego state inside the Parent ego state. This is meant to indicate that those internalized tapes, specifically referring to data processing and manipulation, are encompassed with in the A2. Those tapes not referring to data processing are encompassed within the P2 but outside the A2. Processing which is not based on taping, falls within the realm of the 'Little Professor' or A1.

The Adult as a computer
The Adult ego state is often described as being a computer, this metaphor illustrates the notion presented in Figure 2. Computers are programmed by computer programmers. A computer's computational ability is entirely dependent on the computer programmer's logic. (In this case the 'computer' is defined as that part of the whole system which the computer user communicates with - most commonly the keyboard and visual display unit. The computer will only process data according to the instructions from the 'tapes' or 'disks', to which it is connected. It is these tapes that contain the computer programmer's logic (that is, his opinions, assumptions and beliefs on correct data processing).

As an obvious example assume the computer user asks the computer, "What is 1 + 1?". As indicated in Figure 2a, the computer now asks the tapes, "How do I respond to the stimulus, 'What is 1 + 1?'". If the computer programmer believed the answer or response should be '3', then the computer will respond with '3'. It will see nothing wrong with this. The computer blindly and unquestioningly accepts anything that it is told from the tapes held in its head as does the Adult outside the Parent. The only function the computer (i.e. the keyboard and visual display unit) serves is to convert computer language into human language. If humans could 'talk' computer language, then they could talk directly to the magnetic tapes. Parent ego state tapes are stored in human language, which allows us to talk directly to them. We do not need a conversion process, therefore the Adult ego state outside the Parent serves no purpose.


Tony presenting the two ego state model in his TSTA examination in Hawaii, 1989


Assumptions of this presentation
Logically, this paper is written from the Adult in the Parent. It is based on beliefs, programming and information, that is different to those used by Berne, when he outlined the three ego state model. There does appear to be a definite informational difference. When Eric Berne first published his paper outlining three ego state theory, it was the mid 1950s, (Berne [1957]), at that time, there was little evidence to suggest that the great promise of science, was not true. Scientists and theoreticians generally believed that reality could be viewed free from parental programming. However, with the knowledge explosion over the past one and a half decades, it has become obviously apparent that the promise has not, and will not ever be fulfilled.

It is the assumption, belief and opinion of this writer that an Adult external of the Parent illustrates the great promise of science, and the Adult internal of the Parent illustrates why this promise has not been fulfilled. The basis of this belief is presented in the preceding pages.

The second assumption of this presentation is that it believes it is necessary to propose an ego state theory which considers the problems of contemporary social science. This is based on the belief that it offers something to the scientific community, both theoretically and therapeutically, that is not already offered by the three ego state model. The reasons for this assumption will become evident over the next four or five presentations. There are undoubtedly many more assumptions of this presentation, these will become more obvious as the concept of the two ego state is further discussed.


Originally presented in:
Tony White. 1984.
New Ways in Transactional Analysis. TA Books: Perth.

References
Berne, E. "Ego states in psychotherapy". The American Journal of Psychotherapy. 1957, 11, 293 - 309.

Brunner, J.S. "The course of cognitive growth". The American Psychologist. 1964, 24, 1 - 15.

Ernst, F.H. "The diagrammed Parent. Eric Berne's most significant contribution". Transactional Analysis Journal. 1971, 1, 49 - 58.

Eysenk, H.J. "Personality as a fundamental concept in scientific psychology". Australian Journal of Psychology. 1983, 35, 289 - 304.

John, I.D. "Science as a justification for psychology as a social institution". Australian Psychologist. 1984, 19, 29 - 37.

Morgan, A.H. "Editorial". Australian Psychologist. 1983, 18, 7 - 8.

Steiner, C. 1971. Games Alcoholics Play. Grove Press: New York.

Strauss, J.S. & Hafez, H. "Clinical questions and "Real' research". American Journal of Psychiatry. 1981, 138, 1592 - 1597.

Stuntz, E.C. "Second order structure of the Parent". Transactional Analysis Journal. 1972, 2, 59 - 61.

Two chair in the therapeutic process.

In this procedure the client projects some aspect of their personality out onto an empty chair and then dialogues with it in some form or the therapist can dialogue with it in some form. This can add an extra dimension to the counselling process.

A good deal of the usual counselling process involves presenting something to the client that may be new and then waiting for the client to do something with it. In this way it can be seen as a passive process.



This diagram shows how the therapist can present a variety of new or different actions, communications or relationship styles to the client. Once done the therapist then remains inactive to see what the client does with them, if anything. It is hoped that the client will take them and then alter something within their personality thus leading to psychological change. However as far a the therapist is concerned it remains as a hope. The therapist simply has to wait and see.

Two chair techniques allow the therapist to be more active. It allows the therapist to actually directly delve into the personality of the client. To get right into the personality of the client and change things around by stimulating various parts, highlighting them to the client and so forth. It also allows the therapist to establish relational contact directly with various aspects of the client’s personality.



This diagram shows that with the client’s permission the therapist can move beyond the exterior of the client’s personality and delve into the actual personality of the client using therapy processes such as two chair.

An important aspect of two chair is that the person does not take the role of the other party. If a client puts his mother in the other chair and then moves to be in mother’s chair he is not role playing mother. In that chair he is being the projection of his introjected mother. It is part of his personality in the chair not his memory of mother. In psychodrama one can role play other parties. In the two chair being described one is being part of their own personality in the other chair and not playing a role.

Two chairs techniques are also regressive techniques. It encourages the client to regress into their Child ego state from many years ago. This is a good thing as it provides a relatively easy way to get the Child ego state into the therapy room which should happen in most sessions. Generally speaking the focus of therapy is approximately:



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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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Parent contract and counterscript action (Part 2)

In Transactional Analysis terms a contract can be made from any of the three ego states. They are worded in three different ways. A client is contracting to loose weight.



If the novice client comes to therapy and says, “I should loose some weight” the therapist knows that is a Parent contract. A contract that is motivated by the Parent ego state. The bottom line of human nature is that the Child ego state will always win out in the long run. What the Child ego state wants is what the person will end up doing in the long run.

In Parent the client may say they should loose weight and from their Adult ego state confirm that it makes sense to loose weight, which it does. This will all amount to nothing unless the Child agrees in some way or form. If the Child ego state says it likes food and does not like exercise then in the long run it is going to eat nice tasting food and not do much exercise.



In most cases the Child ego state wants will predominate fairly quickly. The person may start a new diet and within a week or two or three it is pretty much forgotten. The person may take out a new six month gym membership and after a month they don’t get there very often. In each case the power of the Child in the personality dominates over the influence of the Parent and Adult ego states. Even when the Adult thinks it is perfectly rational and sensible to loose weight, which it usually is, that does not matter as far as the Child aspect of the personality is concerned.

There is an exception to this which is called counterscript action. Some people can exert considerable influence over self from the Parent ego state. They may be highly self controlled people or have a severe self punitive attitude. They are capable of depriving their own Child needs for an extended period of time.

If this is the case then the Parent contract will work for longer periods of time than the customary few weeks or months. The person may loose 20 kilos for a year or two. However still the Child will win out in the end and the weight goes back on as the Parent ego state looses dominance in the personality over time. In these cases one gets what is called yo-yo weight loss. They can loose significant weight for an extended period of time but eventually is put back on. People who do this are capable of severely clamping down on their own Child needs which indicates some significant psychological maladjustment. It can indicate significant self loathing or anger.


Child ego state

One can now see how important it is for the therapist to identify when a client is presenting a Parent contract. If missed the client can do work on a piece of behaviour over a number of weeks and it is never going to work in the end. Indeed if the therapist gets a sense of the work not going anywhere this may be a sign it is a Parent contract and thus one goes looking for it.

Some are easy to identify. In any contract to loose weight, exercise more, stop drinking, reduce drug taking, working harder it is highly likely there is a Parent contract in there somewhere. They are easy to identify when a client makes a contract that uses Parent ego state language. “I should loose weight”, “I must go to work on Saturday mornings”, “My wife says I need to say what I am feeling” are all relatively easy to identify as Parent ego state contracts.

These are contracts which obviously the Child ego state will not like. Other Parent contracts come from a significant rather than one the client wants to make. For example, “My wife says she will leave me if I don’t get counselling” is very likely to be a Parent contract. With any coerced client there at least partly a Parent contract to the therapy.


The Child ego state will always win out in the end



Novice clients make it easier to identify Parent contracts because of the language they use. That is Parent ego state language as stated above. With the experienced client it is not so easy. As the client learns about Parent contracts and the words used by the Parent ego state they can then change the language. They learn the culture of the therapy approach and fit in with that and that includes using the language.

What the therapist is wanting a client to say in a contract is something like, “I want to stand up to my mother” or “I want to take some time off work”. “Want”, is a good word to have in a contract as it reflects Child ego state investment in the contract. As clients become more experienced they learn the language and may unconsciously change the language to fit the culture or to try and convince self they want it when really they don’t.


The Child ego state wants what it wants - whether good or bad


The experienced client may say, “I want to complete my thesis” when underneath the real contract is, “You should finish your thesis you lazy bum”. A Parent ego state contract is presented as a Child ego state contract because the experienced client knows the language and culture of the therapy. They are not setting out to deceive the therapist they are just wanting to do the right thing.

Any contract can have a Parent contract hidden in it. A mother may come to therapy and say she wants to learn boundary setting with her son. That seems like a very reasonable request. Behind it however there is the belief, “I am a bad mother who is hurting my children and should know better”. The therapist needs to ascertain if there is any Parent ego state involvement in the contract being presented.

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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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Expressing internalized anger

The internalised anger transaction can take two forms.



Firstly the person receives information of some kind. It is disturbing information to which the person reacts in an angry fashion. The person may have been criticised at work, they may have got a “B” for an assignment when they expected an “A”, they may have been rejected by someone or many, many other possibilities.

Once the information has been acknowledged by the Adult ego state the internalised anger can be expressed in two ways which are indeed quite different in their origin and indicate two quite different psychological processes.

The person can express such anger at the Child ego state from the Critical Parent ego state (CP). This person can be said to have a large internal critic inside their head which at times actively scolds and derides them. The origin of this comes from an introjection in childhood of the parent figures around them.

The child may have observed mother and father being critical of others and themselves and he copies that. However the more potent source of an active internal CP is when the parents have expressed criticism of the person when they were a child. The young child is criticised directly by mother and father. This criticism is then internalised by the youngster and stored in their Parent ego state through the process of introjection.



Often the words the person says inside their head as an adult are exactly the same words that were expressed to the person as a child by mother and father. Or the self criticism is about the same kind of things mother criticised the about child as a youngster.

This type of self directed anger is the least pathological and the easier of the two to treat. As with all treatment contracts it is better to look at increasing some behaviour rather than decreasing behaviour. One would not want the contract to be - “I will decrease my Critical Parent comments”. Instead one would want the contract - “I will increase my Nurturing Parent comments”. If one increases their Nurturing Parent ego state then the Critical Parent will naturally go down. One focuses on the Nurturing Parent rather than the Critical Parent.



Interestingly if a person has a high internal critic directed at self then there is always the potential for it to be directed at others as well. If one is working with a client who has a high CP for self then one also wonders if there are high CP thoughts about the therapist as well.

Some with a high CP for self can also have a high CP for others. Those critical thoughts of others may be openly stated or they may never be stated and just remain internal thoughts. But the potential is always there compared to the individual who does not have a high internally directed CP.

Child ego state anger
As the diagram shows the other type of internally directed anger comes from the Child ego state and is directed at the Child ego state. As a consequence these angry statements are not introjects from our parent figures. Instead they result from decisions that the Child has made about itself. These represent more serious psychopathology and thus the person can be seen to be more ‘damaged’.



The nature of the CP statements tend to be; “I am bad because...”

The Child ego state angry statements may also be precipitated by an event and thus one gets statements like: “I am bad because..... and there is an inherent badness in me anyway”. At other times there may be no precipitating event and the person simply expresses anger at self for no obvious reason. At times this can result in self harming type of behaviour.

Whilst an internal directed CP is common, almost every one has an internal critic of some kind. The internally direct Child statements are far less common. It requires the person to believe and feel there is something basically and intrinsically bad about self. This probably represents 5% of the population. As a result it is much more difficult to treat as one is looking to remediate a basic belief about self and not simply encourage NP statements to counter the CP statement from the Parent ego state.

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Sleep, regression and hypnosis.

KYLady says
“You mentioned that hypnotic suggestions work better when the person is distracted and this raises a question. A lady I work with has lost almost 15 pounds over the past 6-7 months and gives credit it to a CD she listens to every night that is hypnosis for weight loss (i.e. meaning the suggestions have encouraged her to exercise more and eat differently). I bought the CD a month ago to see if it would work any wonders for me, but so far no results whatsoever that I can identify. The instructions on the CD jacket say it works best to listen to it before going to sleep or first thing in the morning. It seems to me that these are times when a person is less distracted”

Good comment KYLady.

The first response I would have to it is: what is hypnosis?
This was originally a technical term that described a specific type therapeutic procedure that was highlighted by Freud. Ever since then it has fascinated the general public and thus the term was been used in a wide variety of ways over the years and now can many different things.

Using the word ‘hypnosis’ to sell a weight loss CD may be something quite different to what the term means in the technical therapeutic sense. Having said that however, I would tend to agree with what you have written.



As I said in the previous post if one can remove the Parent and Adult and communicate with the Child ego state alone then that has considerable therapeutic potential. One way to do that is to distract the Parent and Adult or use regression.

In counselling clients can often regress significantly and they become very child like. When in that state the Parent and Adult are decommissioned and the Child ego state is left alone. Hence the statements in my previous post about methods for communicating with the Child ego state when the client is regressed.

There are other ways to get the same kind of functioning in the ego states as the diagram shows



Hypnotising someone, distracting them in some way, being intoxicated and being asleep are all regressive states for us. This is why Freud placed so much emphasis on dreams. It gives us an way of listening to the persons unconscious. Dreams are literally the unconscious talking which it is freed up to do when the person is asleep and the Adult and Parent are gone.

If a person is asleep then I am afraid they are not going to hear the words on the CD and thus any hypnotic suggestion is not going to work because it wont be heard. However it is interesting to read you say:

“The instructions on the CD jacket say it works best to listen to it before going to sleep or first thing in the morning”

As the diagram below shows between being awake and asleep there are actually 5 different levels of consciousness. In the middle ones people are kind of half awake and half asleep. The more asleep you become the more the Adult (& Parent) go down and the more the Child ego state assumes prominence in the personality.



So maybe the CD maker is wanting to use this. By suggesting the times of just before and just after sleep the person may be still awake enough to hear it but still having the Adult decommissioned enough. Other than that it maybe just another snake oil salesman selling a dodgy CD.

Weight loss while you sleep sounds almost too good to be true, so it probably is.

However the CD maker has done his or her home work. In between being fully awake and fully asleep some people can do odd things. Somnambulism or sleep walking is one example. EEG studies show that sleep walkers can have an odd mixtures of delta and alpha waves. This means that the person is sort of in two different levels of sleep at the one time. Most people do not do this. The sleep walker maintains enough Adult ego state to managing walking but also has the regressed Child ego state in charge so they are “unconscious” at the same time. Hence they can walk and be asleep at the same time.



The other thing about sleep walking is that it usually originates in childhood and most people grow out of it. The Adult ego state in children is weaker than in grownups. Maybe as the Adult ego state gets more robust in fully grown people the influence of the Child ego state in the unconscious state diminishes. Thus when the Adult ego state is awake it is awake and the half state of being in Adult ego state is less possible. Maybe?

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Discipline and strokes - Part 2.

As was mentioned in Part 1 of this topic, discipline involves the exchange of negative strokes from the parent to child. Discipline is in part always involves a negative stroke of some kind. A common way of disciplining involves using the Critical Parent ego state.



This ego state is expressed when the discipliner is telling off, criticising and putting down others. This is sometimes used in the discipline of children but lets use a workplace example here.

The problem with CP discipline is that it works. If a boss tells his secretary that she is doing a bad job and is not working up to expectations in a CP kind of way then it is quite likely that her work performance will increase very rapidly. Quickly she will put in a better workplace performance.

So it would seem that in the workplace at least the CP type of discipline is the way to go to produce a productive organisation. If a parent wants a child to change its behaviour quickly then CP discipline does work. However this is not the case in the longer term and consider the graph below.



Line A is what happens with CP discipline. Initially there is a rapid increase in performance followed by a slow reduction in performance. Why would this be so? Here is the CP discipline transaction.



1. The CP discipline is given
2. The person responds from CC and complies to what is demanded. Work performance increases.

Whilst this may seem good the problem is the background relationship is harmed.

3. At the same time as conforming the FC also feels anger and resentment at the criticism and being treated with little respect.
4. When the FC feels this and the person is being conforming it is highly likely that at some point the person being disciplined will switch ego states from CC to RC and respond back.

When this happens the boss may have won the battle but he has lost the war. The employee will fight back in some form and express the anger or resentment. That may come as open defiance or more subtle and even unconscious undermining of the boss and the organisation.

If you surround yourself with people who resent you and dislike you, they are not going to go out of their way to help you or assist you if they can get away with it. Thus the organisation starts to flounder.



Line B. The other way to increase performance is with the boss using Adult and Nurturing Parent to deal with the under functioning employee. This is usually seen as the ‘counselling’ type of management. However this style does have its draw backs.

As you can see from the graph the increase in performance is much slower. Also it takes more time, effort and money than a quick short telling off. And there is no guarantee of a significant increase in the performance level in the long run. Some people simply do not have the natural abilities required or they just don’t have the belief in self or the motivation.

However with those who do respond to the A & NP approach then you are going to have a person who feels better about self and feels respected by the boss. If you surround your self with people who like you and feel respected by you then they are going to go out of their way to assist you and they will be keen to help and make the organisation function well.



Child rearing and discipline is the same. If a mother uses a Critical Parent type of discipline then the relationship with the child is damaged. The child will feel worse about itself and angry and resentful to the parent. More problems are created than the original discipline attempted to solve even though there is an initial quick positive change in behaviour.

Disciplining a child with out belittling it of course results in the relationship and attachment increasing in its psychological quality. CP discipline may get quicker short term results but the war has been lost.

In addition with parents and children one must make the distinction between loving and liking. As I have mentioned before here, loving and liking are two different psychological processes. All children love their parents, in that children are biologically programmed to develop and attachment to the parent but there are some children who don’t like their parents. The different discipline styles will in particular effect the liking aspect of what we are discussing. NP & A discipline will result in a child loving mother and liking mother. CP discipline will result in a child loving mother but not liking mother.


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Introjection in the therapy process

On July 30th, 2010 I wrote a post about Carl Rogers and his therapy. He proposed that a therapist needs to display 3 qualities when working with a client. These are:

Genuiness - Therapist is aware of his own feelings, thoughts and attitudes and these are not concealed from the client.

Empathy - Understanding the client’s experience from the client’s point of view.

Unconditional positive regard - Conveying to the client that they are worthwhile humans no matter what they do.



If these happen then over time this positive relationship is seen to bring alive the person’s natural desire to grow towards health. The Free Child aspect of the personality ‘sparks’ up and the person naturally grows towards psychological health. A reasonable hypothesis that has been widely accepted by the therapeutic community one could say.

However there is another aspect to this. Another feature of the therapeutic process and that is the mechanism of introjection. Any two people who form any sort of relationship then introjection will occur between them. It will happen unconsciously and relentlessly. It will happen to everyone but the extent and rate of introjection can vary between people and circumstances.

The therapeutic environment is a prime breeding ground for introjection of the therapist by the client. It is well designed for this to happen at least in some ways.

Introjection can be explained theoretically as the incorporation of the therapist into the client’s Parent ego state. Over time the client will incorporate the therapist’s personality into their own via this mechanism. The therapist’s personality becomes part of the client’s personality. It will happen back the other way but to a lesser degree.



I recall a number of years ago I used to run a respite programme for an organisation called ARAFMI (Association for Relatives and Friends of the Mentally Ill.) We took away on a holiday 7 people with chronic mental illness so their carers at home (usually their parents) could have one week respite from caring for them. So myself and an assistant lived in close contact with 7 people for a week who usually were diagnosed with either chronic schizophrenia, bipolar or psychotic depression. I tell you what, it was one of the best learning experiences I ever had about these types of mental illness. I learnt more about how they think, feel and function that I ever could with a 5 year degree.

However my point is I lived in close contact with a group who were heavily medicated, had been for a long time and were probably going to be for a long time. Because of the medication many were quite over weight or obese and they generally had this slow moving sort of swaying way of walking. By the end of the week I would be walking like them! Without even knowing it I began to walk like them. The introjection process on display.

In the counselling setting introjection will occur more, the longer the client has been seeing the therapist, the more frequent the client sees the therapist and the stronger the transference the client has for the therapist. The more these three conditions are met the more the client will introject the therapist as part of their personality.


Will these children wear helmets when they ride a bike in the future?

If the therapist is being genuine, empathetic and giving positive unconditional regard then the client will introject that. If the client starts to take this in as part of their own personality then they are going to treat their own Child ego state in these ways as well. If that happens then the person will start to feel better about self and thus grow in a more psychologically healthy way. Another explanation why the Rogers therapeutic approach may be successful.

However unfortunately it works both ways. If a therapist uses painful therapeutic techniques then that attitude or ‘permission’ will be introjected as well. Many therapeutic techniques are painful to some degree and involve the client regressing and experiencing painful emotions and confronting old painful memories. If the therapist allows this to happen and indeed promotes it as most do then the client will introject that into their Parent ego state as shown in the diagram. I use such techniques at times and thus one needs to be cautious of such therapeutic techniques and the introjection that occurs.



Then there are the pharmacotherapies like methadone for heroin addiction. There is an inherent contradiction in these approaches. The therapist says “Take these drugs, so you don’t take drugs”. The permission to take drugs is introjected by the client by the very actions of the therapist. Again, I am not anti methadone and have seen it be useful for some opiate users. However in any over all treatment plan one must be at least aware of this contradiction and introjection occurring in the client.

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Functional drug use

I have written before about the footballer Ben Cousins in the post, Drug use and prohibition. He has done a biographical documentary type of thing which gives some good insight into a particular type of drug use and the psychological dynamics behind it. He refers to himself as a functional drug addict.

The term drug addict is an nebulous term that is used in a wide variety of ways. Functional drug addict, usually refers to a person who can use recreational drugs regularly, in significant quantities and still maintain their life style, in particular their work life, in a functional way. The drugs do not debilitate the person in the place of work in any significant way.

This is a bit of a contradiction in terms because the term addict often means a person whom is consumed by their drug use. The person who wakes up in the morning and the first thing they think of is how are going to get their next hit. And if they manage to find some drugs then they take it. That means they will take it before going to work or even in the work place. This will effect their performance in the work place and thus they cannot remain functional in this way as sooner or later this will be noticed and they will be ‘sacked’ from the job or at least their performance on the job will be significantly reduced.




Ben Cousins functioned at a very high level in the workplace (the football field) over a long period of time. He was amongst the best of the best in that occupation. He states in his biopic that he never took drugs on game day or the day before game day. This must have been true most of the time because any drug use would quickly reduce his level of performance at such an elite sporting level.

So he is not a drug addict in the usual sense of the word. Just go and meet a few such addicts and one quickly sees they are physically wrecked. The drugs quickly take their toll on the physique. There is no way a drug addict can function at an elite physical level. They can’t even function at a moderate physical level. They would struggle to run around a football field a couple of times let alone run a marathon every game of football they play.

The other thing about him which he states in his biopic and has been reported by others on many occasions is his work ethic. It was unparalleled. He would train longer and harder than all other footballers and thus his fitness was at the highest level amongst a group of very fit men. This is where the psychology behind his drug use starts to become apparent.



To train in such a way means he has a driven quality that others do not have. He can deprive his Child ego state more than most others. When others are exhausted and stop he keeps going. To do that he must have a very large internal critic inside his head. It pushes his Child ego state relentlessly and thus he has that driven quality about him such that he can keep training when others can’t.

The problem with such a psychological structure is it can’t continue on for too long without some symptom developing. The Child ego state is being deprived of pleasant feelings and comfort such that sooner or later some symptom will develop and thus we have the psychological basis of such drug use. He even says this, that the drugs were his reward after training so hard. The good feelings provided by the drugs were the relief for his Child ego state. After training so hard he allowed himself to party and thus he could continue on psychologically. The Child aspect of the personality felt looked after and thus the sense of deprivation subsided. In this way he would be described as a symptomatic drug user rather than a drug dependent user. The drugs solved the problem of physical and psychological deprivation.



If he had not found the drugs worked then some other symptom would have developed. This applies for any person who is highly driven in any kind of workplace. It cannot continue on for any length of time with out something happening. If the drugs or alcohol did not work for him he could have developed depression or had panic attacks which is the Child ego state stating that it can no longer handle the deprivation. It is the Child ego state putting up its hand and saying, “Hello!! I am still here, take notice of me” as indeed any child will do when it is being ignored. If it cannot get noticed for being good it will start doing bad behaviour to get noticed.

This type of drug user does not have the ability to self regulate. As shown in the diagram the Critical Parent ego state is so dominant in the personality the Child ego state is overwhelmed and its needs are lost under a tsunami of parental directives from the CP.

Thus the treatment strategy for this type of drug user is clear. Reduce the CP allowing the Child ego state to gets its needs met, then the desire for the drugs looses its importance, or the depression lifts or panic attacks subside. The person learns how to listen to their Child ego state thus allowing them to self regulate.

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