Teenage supervision

Its not a good week to be a parent in the city in which I live. Parents have come under considerable criticism by the police and parts of the press, most notably Jane Marwick in today’s daily newspaper.

As 14 - 16 year olds end the school year they go to holiday resorts and some of them get drunk and so forth. Whilst these are undoubtedly the minority they attract attention from the police and the press. The police in particular are scathing of parents who they say are not taking any responsibility as they put it and letting these teenagers run riot.



One thing the police do not say is how it should be done differently. At some point the teenager has to be left unsupervised. That is how a young person develops a sense of responsibility. If you are supervising them then they are not being responsible for them self and thus can never develop a sense of self responsibility. Sooner or later you have to let them go and do it on their own.

I have been counselling teenagers and their parents for 25 years and I am not aware of another way by which a teenager can become self responsible without being left unsupervised at some point. If Jane Marwick or the police have some idea on how to do that I would be very interested to hear it.

At what point do you let them be unsupervised and to what degree - there is no clear answer. It varies depending on the personality of the child and the relationship with the parents. It is a very difficult path for parents to walk as often it is trial and error and involves changing the plan of teenager management as you find what works and what does not.



At times parenting teenagers involves two bad choices and it is a matter of picking the less bad choice. A strong willed 15 year old who is reacting against parental supervision can simply get up and walk out of the house. You cannot stop them. You can call the police who can find them and bring them home but then they just walk out again. This can only happen a certain number of times before they end up on the streets. A horrible scenario for parents.

Such a teenager is demanding to be unsupervised and most teenagers do this in varying degrees. When I counsel such parents and teenagers the parents again have to walk a tightrope. You certainly don’t want them being on the streets so you have to give them more unsupervised periods than you may like. The parent has to pick the lesser of two bad choices in order to maintain a relationship with the child and some degree of control. If those criticising these parents have a better solution I would be very glad to hear it.



As the relationship transitions from parent/child to parent/teenager a quality of bargaining and negotiation enters into it. Almost all teenagers will do this to varying degrees. If the teenager is of a complaint nature then it may be minimal. If they are of a strong willed adversarial nature then it can be very pronounced. At times parents have to let teenagers do what they don’t want them to do in order for the longer term goals to be achieved.

At some point parents have to let teenagers be unsupervised if they are to grow into functional members of society who can self regulate. Those unsupervised times often involve undesirable behaviour, that is how the teenager learns what is desirable and undesirable.

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Book award party

Last week we had a party for the book award I recently received.

Here is a photograph of myself with the award certificate.


Note the Toblerone and the strawberrys!

Here is what the publisher had to say about the award.

The list of university and college libraries that stock the book contuinues to grow. I must admit that I am a bit surprised at the size of the list as the book is still not even one year old. I would have assumed that psychology, social work and psychotherapy degrees would have to plan more on what texts they would use for next year and so forth.

University of Waterloo (Canada)
University of Manitoba (Canada)
Saint Francis Xavier University (Canada)
University of Victoria (Canada)
Vancouver Island University (Canada)
Ryerson University (Canada)
Royal Roads University (Canada)
Simon Frasier University (Canada)
St. Clair College (Canada)
Universite de Montreal (Canada)
Memorial University (Canada)
Mount Saint Vincent University (Canada)
Mount Royal University (Canada)
Wilfrid Laurier University (Canada)
Cambrian College (Canada)
Kwantlen Polytechnic University (Canada)
University of Lethbridge (Canada)
Concordia University (Canada)
University of Guelph (Canada)
Library and Archives Canada (Canada)

Maribor General Hospital Library (Slovenia)

Stellenbosch University Library (South Africa)

Mitt hogskolan library (Sweden)
Stockholm University (Sweden)

PJ Library (Norway)
University of Bergen (Norway)
Norges teknisk-naturvitenskapelige universitet (Norway)
University of Oslo (Norway)
University of Tromso (Norway)

Freie Universitat Berlin (Germany)
Humboldt University of Berlin (Germany)
State and University Library of Dresden (Germany)

University of the West of England (UK)
Derbyshire library (UK)
University of Plymouth (UK)
Manchester Metropolitian University (UK)
Lancaster University (UK)
University of Hull (UK)
University of East Anglia (UK)
University of Cambridge (UK)
Oxford University library (UK)
University of Exeter (UK)
Coventry City Council library (UK)
Bromley Library service (UK)
Cadbury Heath Library (UK)
Kingswood Library (UK)
Nottingham Central Library (UK)
Yate Library (UK)
British Library (UK)
Ebook library London (UK)
Hounslow Library (UK)
Barnet London Borough Library (UK)

National library of Scotland (Scotland)

University of California San Diego (USA)
Open Library. California State Library (USA)
University of Washington (USA)
Norwich University (USA)
Ithaca College (USA)
Marquette University Raynor Memorial Library (USA)
University of Massachusetts Amherst (USA)
Williams College Massachusetts (USA)
National Library of Medicine Maryland (USA)
Illinois State University (USA)
Loyola Marymount University California (USA)
University of Michigan (USA)
Central Michigan University (USA)
University of North Carolina Chapel Hill (USA)
University of Missouri-Columbia (USA)
Akron-Summit County Public Library, Ohio (USA)
University of California Merced (USA)
University of North Carolina Greensboro (USA)
Library of congress (USA)
University of California San Franisco (USA)
Mt. Hood Community College Library Oregon (USA)
National College of Natural Medicine Oregon (USA)
Oregon Health and Science University (USA)
Northeast WI Public Libraries (USA)
College of DuPage Illinois (USA)
Boston College (USA)
University of Chicago Illinois (USA)
University of North Texas (USA)
Laredo Public Library Texas (USA)
University of Texas-Pan American (USA)
University of Texas at Austin (USA)
University of Puget Sound (USA)

Executive Counseling and Training Academy (Singapore)
Ngee Ann Polytechnic Library(Singapore)
Singapore Polytechnic Library (Singapore)
National University of Singapore (Singapore)

LaTrobe University (Aust)
Murdoch University (Aust)
Monash University (Aust)
Victoria University (Aust)
Bankstown Campus library (Aust)
University of Sydney (Aust)
Queensland University of Technology (Aust)
Deakin University (Aust)
University of Adelaide (Aust)
University of Western Australia (Aust)
University of Ballarat (Aust)
University of New England (Aust)
University of Western Sydney (Aust)
Charles Sturt University (Aust)
Curtin University (Aust)
Australian Catholic University (Aust)
University of Newcastle (Aust)
Bond University (Aust)
University of Melbourne (Aust)
James Cook University (Aust)
National Library of Australia (Aust)

Trinity College Dublin (Ireland)
Dublin Institute of Technology (Ireland)

University of Auckland Library (New Zealand)
University of Canterbury (New Zealand)
Lincoln University (New Zealand)
Northtec library (New Zealand)
Auckland University of Technology (New Zealand)
Unitec Institute of Technology (New Zealand)
Eastern Institute of Technlogy (New Zealand)
University of Otago (New Zealand)
Rotorua District Library (New Zealand)

City University of Hong Kong (China)
National Cheng Kung University (Taiwan)



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Strengthening the Adult ego state

Today is Saturday and that means laundry washing day for me. Hey I am a regular kind of guy! As I embarked on this most OCD of all OCD tasks I discovered that my laundry powder had run out so I went to the supermarket to buy a new box of clothes washing laundry powder.

When I got there I was confronted with this wall of different types of laundry powder boxes all different shapes and sizes and colours all claiming different sorts of things. I thought

“S**t, all I want is a box of washing powder and I am going to have to make 30 decisions to end up with the one I want”.

Now I know what home work exercises to give my clients who are tormented with indecisiveness. To hone their decision making skills just go and buy some laundry powder.



So I started the process and decided on the size I want and the kind of money I want to spend. The rule of thumb with this kind of product in the supermarket is never buy the cheapest as the quality is crap. Also never buy the most expensive as they use the psychology that people will assume it is the best quality when it is no better than the average priced brand.

On a side note sometimes people ask me about how to pick a therapist, to which there is no easy answer but there is one thing I tell them not to do. Never pick the one with the biggest and most expensive advertisement. Now if one is choosing a plumber or an accountant it may be OK to pick the most expensive advert. But in choosing a therapist there is something not just right about the one with the most expensive advert. I can’t articulate why it’s just an intuitive conclusion. Having been in the counselling industry for 30 years, to me there is just something wrong with a therapist who presents self in the biggest advert.

However back to the topic at hand. I finally reached the point where I had decided on two possible items to buy. One was called Bam and the other was called Blast. That was my choice - Bam or Blast. Who thinks up these names? Some psychologist would have done a PHD on this. Someone would have received a doctorate for a study on the marketing psychology of laundry powder and concluded that names like Bam and Blast are the ones that would sell. Hey it worked on me!


OCD



Also as I pondered this decision one is confronted with a paradox. There are questions one muses over such as what does my life mean and who am I? And then I realise I am in a supermarket pondering on which product to buy - Bam or Blast!

So I made my decision and Blast it was. However there was still one decision to go. What scent do I want - lemon or frangipani? Do I want to smell like a lemon or smell like a flower when I wear my clothes? Last time I chose lemon because it seemed more manly to smell like a lemon as compared to a flower. But this time I chose frangipani because of late I have been developing my feminine side.



Today I have been walking around smelling like a flower. And after all that decision making I feel like I have to have a valium and have a lie down.

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Kahless script currency analysis

Results



One and only ++

Reverse status ++

Drugs ++

Booze ++



Analysis





Booze and drugs



Games: alcoholic, cops & robbers

Psychosexual stage: Oral

Lifestyle/occupation: Gourmet, wine taster, narc, temperance league, junkie

Illnesses: Gastrointestinal, oral problems

Therapist: Addiction counselling

Personality: Antisocial, schizoid, narcissistic

Issues: Can be more severe in terms of life threatening, despair rather than depression









Tends to result from pre-verbal quite early problems with the primary attachment figure. Primary attachment figures may be emotionally absent in some way.



May have a tendency to move to a position of non life if not obviously self destructive. Stroke deprivation can result when the individual enters periods of incapacitation (non life) which may last many months.



Possibility of openly self destructive behaviour with the use of alcohol and drugs but also by other means as well. Possible suicidal urges.





The sophistication of smoking Peter Styvestant thins.





Quite amenable to psychotherapy but needs to find a good attachment figure in a therapist. If achieved then considerable psychological gains can result but it takes time.



Needs to structure life such that social isolation does not result even though there maybe a constant pull to that position.



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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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Goals of therapy - practical

Kahless says:

Well I look at where I am at the moment. I am in my early 40s. I exist in a state of not happy and not unhappy thanks to the medication propping me up. I am thankful to the anti depressants that I am not in that low point of nothingness that I felt earlier this year.
I don't know what I want not what I don't want. You suggest a don't get my needs met injunction, but I don't even know what my needs are. I am by most people's standards, successful. I don't have to worry about money and I have a successful career and am in stable relationship with a partner who cares deeply for me.
But I am not happy. I do not know what will make me happy.

--------------------------

Her comment raises three interesting points for me.
I will address the first one here and do the other two at a later time.


I saw a piece of research once that outlined the best predictors of the outcome of psychotherapy. Or the importance of things in psychotherapy. It isolated three aspects of it
1. the techniques employed
2. the relationship between client and therapist
3. the practicalities of one’s life at the time

The results were something like
1 = 20%
2 = 40%
3 = 40%



However you can’t quote me on this because I can’t find it so these may not be fully accurate. I recall looking at it and being a bit surprised about the practicalities of life being that influential, but after some consideration it does make sense. This includes things like having a decent income, having relationships in life that are reasonable, living circumstances are OK such as having a home that is reasonable, diet that is OK, having a social life and so forth.

The more one has of these the better the prognosis when the client enters therapy. This is a bit sobering because it is easy for therapists to get lost in their fancy therapies and fancy techniques and so forth. It notes that therapists should initially at least focus on such practicalities in the treatment plan. This may seem a bit basic, and it is, but it is most important at least at times.



Many years ago I recall working in drug rehab with this guy who had a long term heroin problem. He was a nice guy and we established quite a good working relationship over some time. I recall we used to laugh a lot together. At one point he came into quite some money. Of course I did not ask how he came across the dollars, I just noted that he did.

Since our first meeting I had noted that his top front teeth were not too good, being quite discoloured and somewhat decayed. He had never mentioned them as a problem. I was the one who brought it into therapy. I suggested that he use some of the money to have his teeth repaired, whitened and so forth. He responded that he did not care what his teeth were like and he was unconvinced by my suggestion. I persisted with the suggestion through a couple of sessions and he finally did seek out the appropriate dental work, had it done and it did look decidedly better. Whilst I did think it was a good idea, one reason I suggested the dental work in the first place was because if he did not spend the money on his teeth it is highly likely that it would go on drugs.

However the surprising thing was the therapeutic results that it caused. He said that after it was done he felt so much better about himself. He reported that when ever he looked into the mirror he saw a reflection of himself that he liked. He had not not even aware of how this had effected him for so long. That he had disliked the image of himself every time he looked at it almost everyday.



I have never forgotten that. I could have spent my time doing fancy relationship building and fancy techniques to assist him to express his anger at his mother and so forth, when one of the things which turned out to be significant in the therapy was getting his teeth fixed. Something that simple. One of the simple practicalities of life turned out to be a significant factor in his recovery.

And my point is?

When Kahless says:
“I don't have to worry about money and I have a successful career and am in stable relationship with a partner who cares deeply for me.”

I know this is a good prognostic sign should she ever decide to take up therapy with a male therapist

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Doing bad therapy - Therapist role

Major and I, have both discussed how at times the therapist can believe things about clients which are factually untrue. For some reason the therapist comes to some conclusion about the client such as a diagnosis which is not accurate. Obviously this is not a good thing. If a diagnosis is incorrect then of course the treatment is not going to be productive and bad therapy will ensue.

This diagram shows how therapists make diagnoses of the client. It is a function of the Adult ego state (A2) and the Little Professor ego state (A1).



Therapists are making diagnostic conclusions all the time. This can be formal diagnoses such as OCD, PND, DID, PD, ADD. (that is an awful lot of Ds) or all sorts of little diagnostic conclusions in each therapy session. What the body language may be saying, the client maybe seen as minimising, rationalising, displaying racket feelings and so on many, many times each session.

It seems safe to say that all therapists will believe things about clients that are not true. Most often they are things which are not of any great significance. Occasionally they are and then there is a problem.

Over the years I have received referral notes from a whole variety of different professionals. At times the referral note includes a diagnosis of the client being referred. After getting to know the client a bit I sometimes find my diagnosis is different to the referrer. We both can’t be right.


What is the diagnosis?

Diagnosis involves receiving Adult information and then making conclusions based on that. However as this diagram shows humans receive a huge amount of information unconsciously. In Transactional Analysis terms this information is processed by the little adult of the Child ego state (sometimes referred to as the Little Professor ego state). If therapists use this in their diagnosis then they are using hunches and feelings to decide on the diagnosis.



At the Adult ego state level misdiagnosis can occur because there is misinformation, a lack of information or the therapist is mistaken about what the information means.

Diagnosis with the A1 unconscious information is a double edged sword. It can result in more swift and insightful diagnoses but it also has the potential to go more awry than an A2 diagnosis.

Each of us also have our blind spots - our own personal issues and script. Some people see sexual abuse every where, if one has personal issues about the opposite sex then diagnosis in couples counselling can be way off, people who lack a sense of trust themselves will tend to see trust issues more often in their clients, or alternatively they may miss an obvious diagnosis of trust issues.

Another cause of misdiagnosis is inter-professional rivalry - “My theory is bigger and better than your theory”. In some circumstances there is considerable money, power and prestige invested in making certain diagnoses and particularly believing in a particular aetiology for the diagnosis. One needs to be careful that their Child ego state does not take over here and the client suffers or becomes secondary to proving ones diagnosis for professional pride. A diagnosis must always remain changeable in the mind of the diagnostician, when one resists such a change it is necessary to look at ones real motives.


Unruly child = ADD?

Psychology is subject to fashion and trends like any other area of human endeavour. There will be fashions in diagnosis as well. An example of this is ADD. Once upon a time ADD was a discrete and identifiable diagnostic condition. In recent years in Australia it has become a very fashionable diagnosis and now any unruly child can be diagnosed with ADD. Another example of this is the diagnosis of drug induced psychosis. This is a very politically correct and fashionable diagnosis in Australia at this time. Hence it is over diagnosed and thus the therapist believes something about the client which is untrue.

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People’s expectations

I had another person ask me the other day about this video that I have on my YouTube. Why did I do it, how I did it?



The glasses, the solarized effect and the apparently odd manner of my presentation on a serious topic like panic attacks. People apparently who know me or have seen my work as a psychologist in some way expect a video presentation of a more ‘professional’ style. So I get asked why did I do it like that? To which I answer, there is an old rule of psychotherapy - don’t give people what they expect. Its really a rule of human communication in general - don’t give people what they expect.

After they hear this explanation they seem to be satisfied because no more is said or asked by them. This has struck me as a bit odd because my answer I think begs another question - why not?

Why not give people what they expect?



If anyone ever asked me this I am not sure what I would answer. My first thought is that it would depend on the situation where the unexpected communication occurred. In psychotherapy I think it certainly has its place. If a client comes to therapy they will have an expectation of what is going to happen what they will say, what I will say and so forth.

If they leave with what they expected then the session was OK to average, to not much good. If the person gets what they did not expect in the session then it is much more likely that the session was more effective. Of course not every session a client attends can provide some kind of profound epiphany. But in the overall approach there needs to be at times unexpected communications by the therapist.

This will stop the therapy becoming routine. In one way psychotherapy is about unbalancing the client or putting them in a state of disequilibrium. They enter therapy with a psyche or psychological makeup that is a functional whole. That functional whole may be causing them pain but it still is a functional whole. If therapy can destabilise that functional system then the parts of that system are more able to be rearranged such that a new structure is obtained. That new structure can then lead to less pain being experienced by the individual. It seems reasonable to conclude that if the client gets something they did not expect then that will have a destabilised effect.



Society is like personality. Revolution destabilzes it. Once done then change is more likely to occur. Psychotherapy can be seen as creating a revolution in the personality.



Another reason is something far less ethereal and recondite. It gets the Free Child of the client into the room and that is something you certainly want in therapy. If that video was of me standing there is psychotherapist type clothing, in a psychotherapist type manner in front of a white board with a pointer what ego states of the viewer are going to be elicited. Probably Adult with maybe some interested Child if the topic of panic attacks was of interest.

Because of my presentation I would suggest that much more Child ego state in the viewer is elicited. First they are far more likely to remember it than if it was done in the other way. As indeed would happen in a therapy session if something unexpected happened. If I can get the client’s Free Child into the communications with me that is a very good thing for a successful outcome for the session.



However we now have another problem. Because I have let out one of my trade secrets people will now begin to expect the unexpected. Thus we end up back to where we were before.

However there are ways and means to deal with these things and I can’t tell all my trade secrets. Well not all at once.

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The male anorexic

Last year I ran a workshop in Serbia where I did an in-depth examination of anorexia nervosa and a variety of other clinical states. At the beginning of each different condition I gave the usual statistics about the condition. For anorexia one was that 95% of anorexics are female.

A little later on in the workshop one of the participants asked me about the nature and psychodynamics behind the male anorexic to which I had to answer that I did not know. I cannot recall ever reading such a thing nor recall ever working with such a person.

Well as it happens in the last month I have a new client who could be considered to have some of the criteria of anorexia and he is male. As you can imagine he is of considerable interest to me. Upon some reflection it seems that the way anorexia is currently defined it rules out the vast majority of males. So one reason why 95% are female is simply because how the condition is defined.



Thus one could argue that there are indeed more anorexic males but they are not diagnosed because of how the condition is currently defined. Its not that male anorexics don’t exist its simply a definitional problem for the condition that is heavily weighted towards the female psyche.

The usual criteria of anorexia is:

Refusal to maintain a minimal normal body weight for age and height
Intense fear of gaining weight or becoming fat
Disturbance in the way one perceives ones body weight, shape and size.
In females the absence of at least three consecutive menstrual cycles.

This man is in his late 20s and is currently quite thin. He reports that he has had trouble gaining weight since his late teens. At times he has been dangerously thin. He has never been hospitalised but he has always led a very isolated life so he is unlikely to be identified as in danger of dying. He reports that he simply does not eat. There have been times where he has eaten nothing for up to 5 days at a time.



He states that this is a rebellious act as in childhood mother was very forceful about him and his siblings eating all their food at the dinner table. There are many memories of mother demanding that he eat up all his food. Physical punishments were used when food was not correctly eaten. He has a low self esteem, a self hatred and passive suicidal urges. That is he does not actively plan suicide attempts but he has consistent and strong wishes that he was dead.

If one looks at the four criteria of anorexia, obviously number 4 is about females. Number 2 & 3 one could argue are much more female oriented. As a group women are more interested in how much they weigh and about their body shape and size. One simply has to survey the media and one sees endless images about female weight, body shape and size. In comparison there are very few images involving men. Cosmetics, clothing, plastic surgery all indicate the same. That women are much more focused on weight, body shape and size compared to men.



As a result one could say that the current definition of anorexia is sexist. Very few men are going to meet the criteria because the intense focus on body weight, shape and size is much less common in the male psyche.

However there maybe men out there who refuse to maintain a minimal normal body weight for age and height but the other criteria are different. Maybe I have begun to identify some of the other criteria with my single male client. Low self esteem, self hatred and suicidal urges. He is but one person and thus one is most cautious in generalising. However, when I run my next workshop on eating disorders and I get a question about the male anorexic I can now at least give a partial answer.

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Singapore workshops

Last week I ran four workshops in Singapore.

Here is a picture of the organizing committee.

From Graffiti

To my left and right are Jessica Leong (President of TAAS) and Irene Yong. Both these women were instrumental in developing Transactional Analysis in Singapore in the early 1980s.

I ran one workshop on personality disorders to the psychatric staff at the Tan Tock Seng hospital.

Then two demonstration therapy groups to the students at ECTA who are seeking their Masters as psychotherapists and counsellors.

Finally I did a workshop on suicide and the suicidal client. Below is a picture of me being introduced at the start of that workshop.

From Graffiti

Met lots of old friends whilst I was there and made some new ones.

It was a great trip!

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Why are some drugs legal and others not?

I bought a new book the other day on addictions counselling. It is quite good and has some useful information in it. It is the usual sort of thing reflecting mainstream thinking on the topic at the moment. In chapter two it makes a statement that one would not uncommonly find in such a document.

“Contrary to popular belief, most people who use substances do so in ways that cause them relatively little harm”
(end quote).

Why would this be so? Not that it causes relatively little harm but that it would be contrary to popular belief. Why would the wider community have a contrary belief to this?

There are a number of reasons for this which in part answer the question which is the title of this paper. The Australian Psychological Society (APS) has done a position paper on substance use. Now the guys that put these position papers together hard nosed MFs, who eat, sleep and s**t science. You can be sure they know the area very well, they are relatively free of any political pressure so you are going to get a pretty good statement about the science of the area under investigation.

To quote them:

“In Australian history, laws regarding the legality or illegality of certain drugs have been politically driven, and had little to do with the level of use or possible harms that the substances themselves might cause.” (p3)



This creates a problem for government because they say to the public that they are making some drugs illegal because they are dangerous to people’s health. They profess that it is a health issue and what they are doing is for the good of the public. Unfortunately this is not so. They are doing it at least in part for their own political well-being not for the good of the public.

To sell this to the public they then have to set about demonising illegal drugs. They have to exaggerate the dangers thus trying to convince the public that they are acting for their well-being and not for their own political survival.

Thus they demonise illegal drugs in all sorts of ways and hence one ends up with the contrary belief in the wider community that I mentioned earlier. The general public believe illegal drugs are much more dangerous than they actually are and the government has made them illegal to protect us.



From a pure lethality point of view consider this chart below. This was put together by two psychologists who work at Liverpool University in the UK. They looked at the official causes of death through the 1990s and then calculated the risk of death per 100,000 people. They came up with a chart that shows which things are risky for us and which things are less risky for us. Included in it are various drugs.

Very high risk
Tobacco, methadone, injecting drug use, BASE jumping, grand prix racing, cancer, heart disease, space travel

Quite high risk
Heroin, Morphine, barbiturates, alcohol, hang gliding, parachuting, motorbike racing, sudden infant death, working in mining, asbestos poisoning, strokes, prostrate cancer, shaking of babies, off shore oil work

Medium risk
Solvents, benzodiazepines, motor sports, water sports canoeing, diabetes, skin cancer, influenza, suicide, giving birth, helicopter travel, liposuction, working in farming, being in police custody, working in construction

Quite low risk
Ecstasy, MDMA, speed, cocaine, contraception pill, GBH, fighting sports, snow sports soccer & rugby, Asthma, AIDS. meningitis, cervical cancer, food poisoning, air travel, being murdered, chocking on food, electrocution, drowning, passive smoking, factory work

Very low risk
LSD, magic mushrooms, viagra, fair ground rides, swimming, riding sports, food allergies, syphilis, malaria, appendicitis, pedestrian crossings, clothes catching fire, falling out of bed, vaccination, abortion, storms, terrorism

Extremely low risk
Marijuana, cannabis resin, indoor sports, playgrounds, peanut allergy, measles, insect stings, copulation, starvation, dogs, lightening, nuclear radiation, police shootings

Negligible risk
Caffeine, nitrous oxide, ketamine, computer games, masturbation, small pox, leprosy, sharks, cats, meteorites, executions, volcanoes




If the government was acting purely for the health of the community it would change the laws on which drugs were illegal. It would make tobacco and alcohol illegal and make marijuana, LSD and ecstacy legal. There is as much chance of dying from ecstacy as there is from choking to death on your dinner or being blown up in a plane by a terrorist. In addition as far as drugs go marijuana is the safest drug you are going to get.

Then some will argue that marijuana may not kill you but it can make you go crazy with a cannabis induced psychosis. Unfortunately as time rolls on the science has simply not backed up this hypothesis. Yes it is very unwise for a person with a propensity for psychotic symptoms to use marijuana and the vast majority of marijuana users will suffer no mental health problems at all. Hence back to the original quote from my newly purchased addictions counselling book and the APS position paper.

Is a government going to make such legislative changes with illegal drugs? I don’t think so. If they did they wouldn’t be in government for very long which is why they have to exaggerate the dangers of illegal drugs and thus mislead the public in this way. Pretend to act for the good of the public when they are actually acting for their own political survival.

However despite all the politics this does raise some interesting questions for the drug counsellor and indeed parents of children who may use drugs. Does a drug counsellor (or parent) use scare tactics with the client (child).





One way to try and stop a person using drugs is to make such a thing very scary for them. Get them to believe that drugs are much more dangerous than they actually are so they get scared and don’t use. Commonly known as scare tactics.

To do this you have to lie to them even if only lying by omission. Is it OK and therapeutic for a counsellor to lie to a client? Most would argue no. To my mind you have to tell the drug user the truth even when you don’t like what the truth is.

If you tell them that marijuana can make people go crazy the first thing they will do is make their own observations. With the vast majority of marijuana users they will think - “Well I have smoked marijuana and I haven’t gone crazy”. Then they will look around at all their marijuana using friends and see that none of them have not gone crazy as well. After making these observations what is the drug user going to think - “My counsellor is lying to me”, as indeed he is.

As a result trust is broken, the therapeutic relationship is damaged and the counselling suffers, at times significantly. Besides this most drug users have heard it all before anyway. Their parents, teachers, the police, the press, the government and drug counsellors have all exaggerated the dangers of drugs to them many times before. So if you, the current drug counsellor comes along and tells the user the truth and the WHOLE truth they are going to be surprised and maybe even shocked by such a transaction from you. Thus the therapeutic relationship is placed on a much more robust footing and the drug counselling is more likely to be successful.


If you lie to the teenager can you expect them to tell you all of what they are doing?

In particular they are more likely to be truthful with you about what they are doing and why they are doing it. Can you really expect a client to be truthful with you, the counsellor, when you are lying to them in the first place. If you lie to them you have to expect them to lie back to you.

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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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Using FaceBook in the therapeutic process

I now regularly use FaceBook and Google Earth with clients usually as a home work exercise. When ever I hear an angry client say they are going to cut up and burn all the photographs of their ex-partner, I usually counsel them to save at least a couple. Such photographs can be used in a therapeutic way later on.

As I have said before I have always used photographs in therapy with clients. They can be most helpful therapeutically. With the proliferation of the internet I now use FaceBook and Google Earth (along with blogs, websites, linkedin, YouTube, TrueLocal and all the other networking sites) almost on a daily basis.

For homework I may suggest a client does a search on FaceBook for a person they have been discussing or suggest they search on Google Earth for a particular place or location. This can form the same therapeutic function as suggesting the client to get some photographs they may have of a person or a place that is psychologically important for them.



These can serve a number of therapeutic functions. Whenever a client says, “I am never going to see him again”, the first thing they need to do is see the person again. One way to do that is through a FaceBook search. Even if the search comes up with nothing, therapeutic gain has been achieved. The person has actively set out to find the feared or disliked other by the very act of doing the search and thus there is psychological impact on their Child ego state.

Why is there a psychological gain? In Gestalt terms it brings the issue to the foreground of the psyche. It makes the person or place front and centre in the persons psychology. Over time people will unconsciously neatly pack away the painful person, event or relationship into a safe place in the psyche. By searching for them and maybe finding them on FaceBook or seeing the place on Google Earth that painful person, event or relationship is unpacked from the psyche and comes to the fore front of the mind.



When this is done the personality is destabilised and the person is primed for psychological change. They are placed into a frame of mind where psychological change is more likely to occur. I have discussed this on YouTube before.



By searching for the person, maybe seeing their picture and even talking to them the Child ego state is destabilised and thus ready for change. By seeing the place (house) where the abuse occurred the Child ego state is destabilised and ready for change.

Secondly, when an event occurs, over time the Adult ego state memory of it fades. When that happens the Child ego state will start to fill in the gaps, but the person will perceive these as Adult facts not Child ego states ‘fill ins’. As the Child ego state fills in the gaps it will structure the memory of the person or event such that it fits the life script and thus problems are solidified by a past memory that isn't even true at least to some degree. FaceBook and Google Earth can allow for an Adult ego state update.

Say the person was bullied by someone at high school. That bully may be remembered 20 years later as a big and overpowering person. To be seen years later on FaceBook the new Adult facts obtained can significantly reduce the Child ego state memory of the over powering person they were.

A person involved in a car accident at a particular intersection. Since then they avoid that intersection by driving other ways to get home. Google Earth is a good way to go and see that intersection again. Thus FaceBook and Google Earth have direct therapeutic uses in the trauma debriefing process.



Related to this it can help in doing goodbye work. In working with a recent client it became apparent that she still had a significant attachment (and love) to the first real love of her life. A teenage 3 year relationship that was semi abusive, where she fell deeply in love with him. In the past I would normally suggest she does a ‘drive by’. That is go and drive by the house where he now lives. However in this instance she did a FaceBook search, found him and became his FaceBook friend.

She saw some old photos that he had on his FaceBook and saw him as he is now. The Child ego state fill ins of her memory were dissolved. After a number of discussions with him she came back to therapy and said, “How did I ever fall in love with him!”. Combining this with 2 chair regressive goodbye work in therapy and that chapter in her life was quickly closed. The attachment was dissolved and she was this more able to attach with her current partner.

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Drug use and prohibition

At last Ben Cousins can take as many drugs as he likes. The David Beckham of Australian Rules Football has spent the last 5 years being the bad boy of football. The governing body, the AFL have been drug testing him almost every week for recreational drugs. Never tested positive but he has been banned from playing on a number of occasions for a variety of misdemeanours off the field in a highly publicised way.

However the AFL holds the sword of damocles above all players. If they take recreational drugs and test positive they risk loosing their income and right to play football in that league. Ben Cousins retires in two weeks and thus the sword of damocles disappears and he can take as many drugs as he likes. And you know what, he now has the chance to really deal with the drug issues he has. This raises the issue of the difference between externally driven prohibitions and internal choices in the want to use drugs.

The problem if you have an external force whether that be a spouse, a parent or the AFL, pressuring you to stop using then it does not allow you to make your own decisions. Or at least it makes it harder to make your own decisions as this diagram shows.



If an outside person or organisation gives the directive “Don’t use” (particularly if they are using some kind of punishment like loss of income) then the user is pressured to respond from an AC (Adapted Child ego state) position. They can adapt to the directive in two different ways. They can either conform and don’t use or rebel and the use simply goes under ground and they try and outsmart the detection system.

The problem with both of these responses is neither is about what the user wants. The external prohibitor makes it much harder for the user to find out what they actually want. That comes from the Free Child aspect of the personality and it is here that one gets the possibility of the user deciding that drugs are not for him or he uses recreationally or he is OK with his current drug use. The decision comes from inside the psyche of the drug user and not as a reaction to some outside pressure.

Now the AFL can no longer pressure Ben Cousins about his drug use, he is much more likely to be able to find out what he actually wants in relation to using drugs. And that is his decision.



As I mentioned before, with pressure from out side the person can continue using by rebelling against the pressure and the use simply goes under ground. This is why drug counsellors need to be careful not to present themselves as an outside pressure because the client will simply stop telling the truth about their drug use. Then the counselling starts to flounder.

Others respond to the outside pressure by conforming and do stop using. But this is fragile because the use depends on the other remaining present. In this sense the person becomes addicted to the outside force which at times can be something like a religion. If the person drifts away from the ‘force’ then the risk of using significantly increases and thus we have the new “addiction”.



Having said this sometimes this approach can work in the longer term with AA being an example. In the initial stages the person becomes addicted to AA, the sponsors and uses them to stop drinking by responding from a conforming position to the ‘pressure’. If the conforming non use can persist for a long time then the person can construct quite a solid non drinking type of life style. Such a person is less likely to fall off the wagon because their whole life style and family are structured to ‘pressure’ them not to drink. And some remain sober for the rest of their lives. A good result indeed.

However in my view, by and large it is better for the user to be given the opportunity to take a look at self with no outside pressure. Then they can begin to decide what they want out of life and one is more likely to get longer term change in their drug using patterns. Again it is their decision.

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Gambling addiction and regression

In the previous post I talked about drug users and how some of them could have a child like quality because drugs are an efficient and effective way for a person to regress. Most alcohol and drugs will remove the Parent and Adult ego states to varying degrees thus leaving the person in a child like state.

Any person prone to regression in the sense of using the defence mechanism of regression could be seen to be a potential problem drug user for the reasons just described. However even when not intoxicated often such people will still have a child like quality in the sense of being irresponsible, some times unemployed, perhaps endlessly sick or perhaps incapacitated by some form of physical or psychological illness and establishing relationships with others who tend to take the parental role.



A good example of this regressed quality in relationships comes with the addicted gambler. These people could be seen as being financially irresponsible. They do not know how to manage their finances. From a psychological point of view I would see gambling addicts as no different from the person who mismanages money by accruing large credit card debt or investing in dodgy business deals where they end up broke and in debt. A person who ends up broke from share trading is no different from a gambling addict at least in the psychological sense.

They both end up in a child like position or in a state of regression in this way. A young child does not know how to manage its money and if left to its own devices will end up in financial trouble. Thus it has a person, usually the parents who will manage it for them. Many a gambling addict will end up in the same kind of relationship where someone else basically gives them pocket money once a week. The person who spends all their money and ends up with large credit card debt may be compelled to see a ‘financial’ counsellor who ‘guides’ them on how to mange their money. All these individuals end up in the same kind of position in relationships.

The psychologically interesting part of this person compared to the drug user is the thing they are addicted to does not regress them. Drugs remove the Parent and Adult ego states whereas gambling does not. Thus even while they are engaged in their addiction (at the casino, share trading or on a shopping spree) their Parent and Adult ego states are still quite cathectable whereas the drug user’s is not.

Treatment will tend to have some different features. While engaged in their addiction (at the casino, share trading or on a shopping spree) how do they disconnect their Adult and Parent ego states. They know they are going to end up broke by doing their addictive behaviour so whilst in the actual act of unwise spending they much be able to disconnect at least their Adult ego state to some degree. How they do that is critical to dealing with the addiction.

As with the drug user the regression they are prone to is also necessary to address.

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Drug use and regression

Regression historically has been seen as a defence mechanism. It involves the person reverting to an earlier state or mode of functioning. This is done because in the here and now the person is experiencing anxiety for some reason. In order to deal with that anxiety the person ‘escapes’ by regressing and becoming child like.

For instance if the person is involved in some kind of conflict, the person is being approached sexually, or the person is required to look after a child or become responsible for some reason. If these situations result in the person feeling anxious they can deal with their anxiety by ‘running away’ and becoming child like. Once done they don’t have to deal with the here and now situation and the anxiety is avoided.

Usually the stage to which the person regresses is determined by a fixation point. As we grow through our developmental stages we usually have trouble at some of them and thus don’t completely resolve them. These are then seen as fixation points so when the person regresses they will regress to the stage at which they are fixated. That maybe 3 years old for some or 8 years old for another.

Every person is capable of regression, but some are more liable than others. There are many ways to regress. Those with significant fixations can regress spontaneously as in the situations described above. The more pressure and stress applied to a person the more likely they are to regress.

As I have written before

The mechanism of regression is supported by research in neuro-psychology as cited by Johnston (2009). When people are placed under stress they are less able to access the pre-frontal cortex of the brain which is associated with the more developed functions like problem solving, decision making and stress management (Adult ego state). Instead people tend to access the more primitive part of the brain in the amygdala (Child ego state).

In psychotherapy sometimes regressive techniques such as two chair are used. Indeed the therapeutic relationship in itself will pressure the client to regress and become more child like in the relationship with the therapist.

However one of the more efficient ways to regress is to consume alcohol and drugs. When done this situation evolves.


Firstly the alcohol will diminish the Parent ego state and the person becomes disinhibited. The Parent ego state makes us behave in socially appropriate ways and thus people can become aggressive when drinking because their prohibitions against physically hitting out are diminished.

This is also the reason why some men like their female ‘dates’ to drink alcohol because they know it will lower the woman’s own internal prohibitions about sexual behaviour.



With more consumption of the drug the Adult ego state is then decathected such that one is only left with the Child ego state and the regression is complete. Thus we have the link between drug use and the mechanism of regression. It seems reasonable to conclude that some drug users may have this motivation in their substance use. They are unconsciously motivated to regress.

If this is the case then there are treatment implications. As mentioned before the person will regress to that stage of development where they are fixated. Their normal psychological development for some reason got stuck at a particular stage and thus the Free Child seeks to return to that stage in the hope that somehow it will be resolved this time around.

The chronic alcohol user is often fixated at the oral stage of development which would require some kind of therapeutic resolution of the fixation there. That is to work through the developmental issues relevant to that stage with the therapist. If the person is using drugs for the need to regress then one would not expect the usual behavioural techniques to be all that effective.



The thing about regression is that it is a running away or an escape from the here and now. Like the scared young child who simply closes her eyes and puts her hands over their ears as a way to deal with stress. In this sense regression as a defence mechanism is a very child like solution. Compared with intellectualisation which is sort of a more grown up reaction or other defence mechanisms where the Adult and Parent ego states do not disappear.

Of course a person who is regressed will attract others who will take on the parental role in a relationship with them. Thus we end up with people who are called enablers, co dependants and so forth. Of course they will say they want to husband to stop drinking, being child like and irresponsible but the other side of the wife does not.

With regression and drug counselling

Adult and Parent ego state development
Working through the fixation in the therapeutic relationship with the therapist
Altering relationships which encourage the regressive behaviour

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