Showing posts with label ego states. Show all posts
Showing posts with label ego states. Show all posts

Thursday, August 25, 2011

Crocus life script currency analysis

Results



Uniqueness ++

One & Only +

Feelings +

Power +++

Reverse Status

Sex +

Beauty +

Pied Piper

Booze ++

Food ++

Violence

Money ++

Words +

Drugs ++



Analysis



Power

Games: Cops & robbers, rapo

Psychosexual stage: Anal

Lifestyle/occupation: Politics, examiners, critics, the ‘boss’, police, doctors, psychotherapists

Therapist: Supervisor-supervisee disputes, industrial mediation

Personality: Paranoid, Antisocial

Issues: Control, penis envy, dependency.





Woman with balloons

Rapo is a power based game







The life script is lived out via power in relationships with others. This is what will become the issue in relationships and the means by which psychological games in relationships are played out.



In the winner’s life script the power is used for the benefit of self and others. In the loser life script, power will leave the individual with dysfunctional relationships and in an unhealthy state of mind.



Powerful lady



The Adapted Child ego state will seek the power position in relationships and the Free Child will crave dependency in relationships. Therapeutic goal is to get to the dependency and have the client satisfy the craving for the powerless position in relationships.



Graffiti

Saturday, July 23, 2011

Ego states in the counselling process

Three new articles have been uploaded. I would have done it here but Blogger cannot take Pdfs.


Number 1
The Child ego state in counselling

Paper 1 – Looking for the Child ego state in counselling
How Child is brought into the counselling session
1. Feelings
2. Contracts for taking the client out of their comfort zone.
3. Polarities.
Conclusion
Paper 2 – Psychological polarities
Paper 3 – Relational contact with the AC

Side woman


Number 2
Parent ego state

The Parent ego state

Sameness in relationships

How modelling occurs

Group think

Alanis


Number 3
Working with the Conforming Child, Rebellious Child and Free Child ego states

The highly conforming client

The highly rebellious client

Dealing with the difficult client – Free Child, Conforming Child & Rebellious Child

Pdf here.


Graffiti

Wednesday, June 22, 2011

Working with drug users

The other day I was talking with someone about psychotherapy matters especially in relation to working with people who use drugs or perhaps teenagers who may engage in antisocial and risky acts. I then got up and drew this picture on the board.

Me as therapist

This is how I would rate myself as a therapist on that continuum. Clearly up the permissive end especially when dealing with the clientele I just described. With that clientele it is quite easy to use ego states like Controlling Parent or Critical Parent and using Adult facts to support the Parental statements.

The person I was talking with was working in drug rehab. I made the statement that I never tell drug using clients not to use and this was of some surprise to him. Obviously he does make such statements to his clients. This I think makes me quite a permissive therapist at least with clients like this. I would rarely use Parent ego state statements with such clients. This however creates a dilemma.

The reason why I would never tell a drug user not to use or make statements about why drug use is bad is because you quickly loose the client. They will quickly slip into the Child ego state and either stop coming, attend sessions but don’t tell you what they have been taking or take more drugs because they have moved into a rebellious position against you.

Kiss

On the other hand I am tacitly giving them permission to use drugs and thus supporting their drug use in that way. Through the transference the client will introject me to varying degrees into their Parent ego state. If I am not saying, “Don’t do drugs” then they are not introjecting that so their Parental tape of me is in one way supporting their drug use.

So it seems we have the good and the bad. Obviously I see it as more important not to ‘loose’ the client as I described before, versus providing a Parent tape that is clearly against drug use being introjected into their Parent ego state.

Balance

On a side note:

As I looked at the diagram I drew I realised that if I was to rate my parents in this way on how they dealt with me in childhood and adolescence I would put them in almost the exact same position.

Graffiti

Saturday, June 18, 2011

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.

Therapy operations

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.

Ego states two chair

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:



Graffiti

Friday, May 27, 2011

Roses - Transactional Analysis Sentence Completion results

Name : roses
Age: Almost 49 years old
Sex: Female
Date: 17th May 2011

1. My favourite story or fairytale as a child was “Kimba the white lion”. We weren’t told stories so I first heard them via the telly.

2. I like when people are touchable: we can touch each other and it’s ok.

3. My mother always told me she loves me, that’s why she is saying this or doing this: whatever it was at the time.

4. I always try to not try – either do or don’t do.

5. Most men are male?

6. What bothers me more than anything is when I can’t and I want to.

7. If I could I would believe that I could do anything I wanted to do.

8. When I was a child, I wanted to fly.

9. My father always told me... I don’t think he told me anything. I think he just loved me.

10. I think I have a right to feel everything and anything all the time.

11. If I get angry enough I can and will hurt something... badly!

12. I shouldn’t... hurt anything.

13. Love is a lie.

14. I can’t touch everything. Some things are totally untouchable eg. Love, trust, truth...

15. I get depressed when that feeling happens... that feeling on the inside that makes me hurt so badly all over: my skin mainly.

16. A mature adult is a person who can control themselves regardless of how they’re feeling: regardless of what they want to do or be or say...

17. One of my most important rules is “Don’t be shy”.

18. My parents always told me that they love me.

19. I failed to listen to my parents.

20. My biggest fear in life is that I have, am or/and will hurt something beyond repair.

21. Someday I will die.

22. The child in me is always my friend.

23. Sometimes I think “if only I’d not been born”.

24. People like myself live.

25. I need to love.

26. Winners are people who keep going regardless of success or not.

27. Marriage is legal.

28. Death is good.

29. My role in my family is to love.

30. One thing I try to hide from others is me.

31. My dreams are usually about something that I want them to be about.

32. Most woman are female?

33. I really feel guilty when I do something I know goes against everything I’d like to think is good.

34. When things get tough I so severely get going! Like a dog protecting his/her bone or a bull at a red flag. LOVE IT, LOVE IT, LOVE IT!!!! Oh my goodness! BRING IT ON!!

35. When I was a child, my parents never hugged me.

36. Sex is lovely!

37. When someone disagrees with me I let them.

38. If I were an animal I’d be dangerous!

39. The last thing I want to do is to say that I love someone and not really love them.

40. What I really learned in school is that no one has the power to make me do what I don’t want to do. If I do something for them, it was only because I wanted to first.

41. I want my children to one day understand what it was that’s really important to them... not what ‘is’ important but what’s important just to them alone individually.

42. God is love.

43. A part of me wants to hug you.

44. Why can’t people be touched and it be ok?

45. The story of my life would be called ‘Wasn’t meant to be but happened anyway’.


snowmen
Touch


Roses - Transactional Analysis Sentence Completion results

2. I like when people are touchable: we can touch each other and it’s ok.

14. I can’t touch everything. Some things are totally untouchable eg. Love, trust, truth...

44. Why can’t people be touched and it be ok?

43. A part of me wants to hug you.

35. When I was a child, my parents never hugged me.


Results - Somatic conversion of psychological structures

Body armor


13. Love is a lie.

18. My parents always told me that they love me.

14. I can’t touch everything. Some things are totally untouchable eg. Love, trust, truth...

29. My role in my family is to love.

25. I need to love.

6. What bothers me more than anything is when I can’t and I want to.


Results - Ambivalence in relationships

Eve

23. Sometimes I think “if only I’d not been born”.

21. Someday I will die.

28. Death is good.

35. When I was a child, my parents never hugged me.


Results - Self destructive urges



Graffiti

Tuesday, April 19, 2011

Desensitization and dissociation

If one does not desensitize, when placed under stress they will relatively quickly collapse psychologically, become incapactited, incapbable of functioning at least in any significantly productive way. When confronted with very unpleasant or painful stimuli the person must desensitize in order to psychologically survive and remain a functioning individual. For instance, a soldier enters a war zone and sees his first mutilated body. In reaction to this his Free Child ego state will be shocked to some degree. The sensitive part of his personality gets damaged or injured.

In order to cope with this and remain functional he has to hide away the FC part of his personality. He has to desensitize or he will be overwhelmed and go into a state of incapacitation to some degree at least. This is shown in the two diagrams below:

Non desenstize dia
Diagram 1

Desensitize dia
Diagram 2

In the first diagram the Free Child can be open and exposed to the environment as there is no unpleasant stimuli confronting it. If painful stimuli does occur the person has to begin the process of desensitization and restructure their personality to a state indicated in the second diagram. That is meant to indicate the FC is hidden behind a wall or sealed off in some way. For most this is a natural and instinctive process that will automatically occur even without the person realizing it. If successful in making this transformation of the personality the person achieves a state where the FC is protected and thus is less sensitive to painful stimuli. The person is in a desensitized sate of mind. By the time the soldier sees his fifth mutilated body it has less impact on him because he has been able to restructure his personality as described above.

Some people cannot make this transition to a state of desensitization. They cannot transition from diagram 1 to diagram 2. This is likely to be found in those who are childlike to some degree. They have weak Adult and Parent ego states and may have injunctions like, “Don’t grow up”. In the desensitized state the Adult and Parent take over more of the functioning in the personality. If those ego states are weak the person will have a tendency to go into some kind of incapacitation rather than desensitize.

Angry girl

An example of this could be hysterical paralysis. This is sometimes found in soldiers who have been placed in very frightening and life threatening circumstances. They are simply overwhelmed with fear and develop a paralysis of the legs. There is no medical reason for the paralysis. Instead the FC is not adequately protected in the personality and thus it unconsciously incapacitates with the paralysis. The soldier then cannot function and is removed from the theatre of war.

The process of desensitization
Consider this graph

Desensitize graph
Diagram 3

In the initial stages there is no stress and thus the person will not desensitize and they can function in an effective way to deal with any situations life presents them with. If the person is placed into a ongoing stressful situatuion such as entering a war zone then he is subjected to stress and hence the desensitization process will instinctively begin. For instance seeing a mutilated body. This may cause in him some kind of shock and revulsion. When this happens the FC will automatically start to seal itself off. If there is no assault to the senses then the desensitization will not occur. Desensitiaztion will occur more significantly and rapidly if the person knows it is likely there is more painful stimuli to come.

The soldier in war knows it is highly likely there will be more horrible things for him to cope with probably quite soon. If it is just a one off situation desensitization may occur but in a less dramatic form as the FC knows it does not have to prepare itself for future asssaults. If you see a car accident where a child is killed it is highly likely that will not occur again tomorow so the desensitizing is less so.

The graph is meant to indicate that the desensitization occurs at an inverse exponential rate. Initially there is a rapid rate of desensitization as the shock and stress occur. As the desenistization develops subsequent shocks will have less impact and thus less subsequent desensitization will occur. It seems reasonable to conclude there is a direct correlation between the degree of shock experienced and the degree of desensitization that results. Eventually, it is hypothesized, one reaches their optimal level of desensitiaztion and then there is a plateau effect.

Fire monkey

Should the period of stress cease such as when the soldier is sent home then the need for the desensitization ceases. The FC does not need to be protected like it has in the past. It could be expected that over time the level of desensitization will slowly reduce. That process will be substantially facilitated if the person can do some ‘working through’. That is they talk to someone about what happened and how they felt and they are given a sympathetic response. That can be to an official therapist or to someone else who can take on that role to some degree such as a spouse, relative or close friend. The degree of shock and horror experienced dictates the degree of working through that needs to be done. The person is transitioning back from daigram 2 to diagram 1.

As mentioned before when desensitized the person hides away the sensitive parts of the personality. Humans can not survive for long periods without access to the sensitive aspects of them. If it does persist for an extended period of time then some other problem will evolve such as depression, anxiety, alcohol problems, insomnia, anger outbursts, flashbacks or simply an emotional coldness which leads to relationship difficulties. Common symptoms found in PTSD. Indeed part of the teatment of PTSD is to again resensitize the individual.

Dissociation
There is another way to cope besides desensitization which also hides the FC away from painful experiences. That is by dissociation. This can be seen as a more severe coping style. For some reason the person feels they must take more drastic action than just desensitizing. This can also occur in miliatry personell and is also not uncommonly found in people who have been physically and or sexually abused as children. It is also often reported by torture victims.

Dissociation dia
Diagram 4

With dissociation there is said to be a splitting of the personality. When this is the case the person will report in some form, “That is not me”. They will experience self or part of self as not belonging to them or as separate from them. When this is reported one can consider dissociation as an explanation. Desensitization and dissociation both serve the same function of protecting the Free Child from further assaults but operate in different ways.

Desenistization can be seen as a normal human response to trauma. The vast majority of people will engage in this psychological process instinctly as a way of protecting self. Dissociation could be considered less ‘normal’ and is used less commonly as a way of coping. It will usually be used when circumstances are more psychologically and physically dire. For example in childhood with physical and sexual abuse and in adult torture victims.

Saturday, March 26, 2011

The trust transaction

Body armor

She reports consistent tension in the neck and shoulders. At times it is painful and is very persistent. A history of regular headaches and at times migraines.

Has a considerable anxiety about letting self feel vulnerable with others. In her mind being vulnerable means one will be exploited. Trust issues.

This can manifest as never trusting anyone or at times trusting others who let her down or exploit her so as to reinforce the script belief of Trust = exploitation.

Some people are trustworthy and others are not
Identify associates who are trustworthy and those who are not. More correctly identify the ways and areas in which various associates are trustworthy and where they are not.

Kiss kid

Identification is done using
Adult ego state
Little Professor ego state
Consultation

Identify Bad day at black rock scene where the trust issues evolved.

Graffiti

Tuesday, March 15, 2011

Redecision flowchart - edit #1

Sometimes I do requests.
Here is one for my good friend.

Redecision flowchart

Children make early decisions about them self, others and life. These are mostly formed and set by the end of the first decade of life. Usually people do not alter these but by the process of redecision they can be altered.

Teletubby

Many years ago it was Freud who first coined the phrase, “repetition compulsion”. That is people have a compulsion to repeat the same behaviours, thoughts and feelings over and over in their lives. Since that time many have said the same in various forms and ways. People behave in patterns and this is no more obvious than in their relationships. People do the same things over and over in the ways they relate to others.

These early decisions are one explanation of how the basis for the patterns are formed. When the 4 year old child makes its decision they get set in the psyche and as I said often remain unchanged for the rest of their life. Redecision therapy is one means by which a person can change such decisions.

boy throw rock at tank
What decisions will this child make in this situation? The pattern is being set. When he is 30 years old how will he compulsively repeat the same pattern with adult behaviour.


Graffiti

Saturday, February 5, 2011

Emotional dysregulation

I was recently reading an article on emotional dysregulation. Sounds impressive eh?

The person who is capable of emotional regulation can initiate, maintain and modulate the occurrence, intensity and duration of internal feeling states. Impressive eh? In other words they are capable of self soothing.

Pregnant mother

In Transactional Analysis terms one could describe emotional dysregulation in the following ways

Child symbiosis

The child begins life in a symbiosis with mother. It has to do this or it will die as it has no Adult or Parent ego states to keep it alive. The child will use mother’s Parent and Adult ego states to get food and water and all the psychological needs it has for love and human contact.

As the child grows in its early days it learns that at times it will experience distress of various kinds. It has hunger, thirst, wind, a need to be changed and so forth. It learns or is programmed to let mother’s Adult and Parent ego states know of its needs by crying. When mother hears the cry she swings into action and sets about solving the child’s distress and thus the child is emotionally regulated as the distress eases.

When this happens the child learns four things
It learns that it is important, it has worth and people will help it out
It learns that it can get its needs met
It introjects a soothing Parent ego state into its own Parent ego state
It learns the experience the feeling satisfied and calmed down

Introject Parent

Sometimes this does not happen. For instance mother may be suffering post natal depression. She begins to find herself isolated in the house, lying in bed for long periods of time during the day. When the new-born cries she finds it very hard to get out of bed to deal with the child, at times she does not even recognise the child is crying. As a result the child has to cry for long periods before it is dealt with and sometimes the help never comes and the child just gives up crying.

When this happens the child learns
That it is of little worth
It develops the injunction, “Don’t get your needs met”
It does not introject an internal soothing parent figure
It has no experience of the feeling of being soothed

Combine this with certain inborn natural temperament qualities and the young person can be set up with a life of emotional dysregulation. Consider this list of temperament qualities.

Temperament

If the child is born with a negative quality of mood and an intense level of reaction combine this with a lack of internal self soothing ability, a “Don’t get your needs met” injunction, that it is of little worth and has no experience of what it feels like to be soothed then it is likely to suffer emotional dysregulation.

Should this happen then the person will develop other ways of coping with the dysregulation. Three common ways are:

Self harming. This is common with the borderline personality. As I mention in my book on working with the suicidal there are eight main reasons for self harming

1. Self harming as part of gang tattooing behaviour.
2. Self harming to make self feel real which can be found in those who dissociate.
3. Self harming to make self feel something.
4. Self harming used as a means of tension relief and to release pressure build up.
5. Self harming as a physical expression of emotional pain. Self harming is seen as providing concrete evidence of the pain.
6. Self harming as a means to self nurture. It allows the person to care for self as can be found in Munchausen Syndrome.
7. Self harming as a means to punish self and an expression of self hatred.
8. Self harming as a means to manipulate others or as a cry for help.

Elephant woman

People who self harm as a way to cope with emotional dysregulation would most often be doing it for the reason cited as number 4.

Drug use. Some cope with emotional dysregulation by self medicating with drugs weather they be licit or illicit

Smoking girl

Comfort eating. One way to soothe self is to eat good tasting food. When this happens the person is said to engage in what is called comfort eating. They deal with ongoing painful emotions by self soothing using eating.

Therapy with such people is not all that complex. The therapist simply soothes the client when necessary. Of course this is easier said than done but the overall direction of treatment is quite clear. This soothing can range from lending a sympathetic ear and a soothing voice, to holding work, to the client learning methods of self soothing such as using a pacifier and so forth.

Graffiti

Saturday, November 6, 2010

The use of hypnotic suggestion in the therapeutic process.

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

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

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

Jumping boy

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

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

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

Regression

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

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

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

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

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




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

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

Graffiti

Saturday, October 30, 2010

Impasse theory

Some one asked about impasse theory so I have included this.

Part 1

Taken from Mellor, K in "Skills in Transactional Analysis Counselling & Psychotherapy" (ed) C. Lister-Ford. 2002. Sage.

Three impasses

Three impasse statement
This views impasses developmentally. The type 3 impasse develops in the very young child, the type 2 in a less young child and the type 1 impasse in late childhood.


Part 2

In psychotherapy this is what is known as an impasse

Ego states symptoms

An impasse is a clash between two different parts of the personality. They having opposing goals and wants and can be drawn as a collision between the Parent and the Child ego states.

For example a woman may be insulted by someone at work. As a result one part of her (the Child) wants to express her anger and displeasure at the other person for being insulting. As she is just about to do so she hears this voice in the back of her head saying, “Good girls don’t get angry” & “Girls who get angry are bitchy”. Just the type of thing she was told as she grew up in childhood. These voices may be seen as representing the Parent ego state.

Child & fire
My imaginary friend did it.

So we have an intrapsychic collision inside the woman. Her Free Child wants to show anger and her Parent ego state wants her to be polite and pretty and not show anger. She is at an impasse in her own mind. Over time when there have been a number of similar impasses then a symptom will develop out of this. One can say that the collision between the two forces in the psyche provides the energy or basis for symptom development. A common symptom to develop out of such an impasse is depression. Some people who chronically hold in their anger can develop depression over time.

Historically there have been seen to be two solutions to an impasse. It occurs when one ego state dominates over the other it is opposing. If the Child finally gets up the strength and courage and defies the Parent and the woman expresses her anger then the impasse is broken, at least in that situation. If she repeatedly does that then it becomes habitual and she could at that point be said to be ‘cured’ of her problem.

pulling cats tail

This is what the majority of psychotherapists will attempt to do with the client. For the Child to break the impasse. This is what the vast majority of their therapy theories will define a psychological health

On the other hand the Parent may dominate or ‘win’ in the situation and the woman holds in her anger and does not show it to her colleague. If this happens then the impasse is broken by the Parent belief. Often when I do this in therapy, such as in couples counselling or when a client’s expectations are too high. I will produce what is the greatest single line in movie history. That excellent movie -As good as it gets.

Jack Nickolson2

Jack Nicholson walks into the full waiting room of his psychiatrist’s office, looks around at all the people and says, “What if this is as good as it gets?”. So I sometimes use that line and say to the client, “Perhaps this is as good as it gets”. If taken on, then the Parent breaks the impasse and the client’s Free Child need is not met.

There is however a possible third solution to an impasse. (This must be credited to my psychologist trainee, Nadja). The client accepts the Parent position of the impasse and then the FC want is redefined. I have discussed some of this before in a number of postings.

Gun in girl mouth
Undecided. At the point of impasse


I once talked about a supervision question where I was asked about a client who was a teenage girl who had lymphodema. Her FC want was to have thin legs. The Parent stated that she can’t have that because she had lymphodema. I then supervised that her therapist call her elephant lady or lympodema lady (rhetorically of course). Accept the Parent part of the impasse and then it is redefined in a humorous way and thus the impasse is broken. Or when I work with clients and I get them to love their panic attacks or make friends with their depression. The Parent part of the impasse is accepted and then one ‘loves’ it. The impasse is broken and the FC want is redefined.

Sleeping with the enemy is a great appraoch to take when dealing with your neurosis.

Graffiti

Monday, September 13, 2010

Anorexia and loss of control - Part 4

Some anorexics report a sense of being out of control. They may say things like:

“I had to gain some control back from my body while I could.”

In Transactional Analysis terms this is quite clear to explain.

Weak A & P

The diagram shows a person with weak Adult and Parent ego states. This leaves the Child ego state on its own and it will feel a sense of anxiety. It may also feel a loss of control because the Child ego state does not have the ability to regulate itself.

In the usual functioning personality it is the Parent and Adult ego states that regulate the Child. It is the Adult and Parent who tell it what time to go to bed, what foods to eat and not eat, when to be polite, courteous and so forth.

Even if the Child ego state protests against the restrictions it will also like them because it gives a sense of stability and a sense of control in its life. What would happen if you said to a six year old girl, “You can eat what you like and go to bed whenever you like?” It is quite likely the child would live on lollies, soft drink and pizza and go to bed at any hour of the night or day. The Free Child ego state runs rampant. Whilst that may feel good for a little while sooner or later the youngster is going to have a sense of loss of control because it is out of control.

Woman & fruit

With the anorexic for some reason the same situation is being played out in adolescence and adulthood. For some reason a strong Adult and Parent did not develop. Or at least for some reason they are not currently functioning in a robust way.

This is quite easy to diagnose and a treatment plan is quite clear. There is a need for Adult ego state strengthening such as described here.

One also would want to develop the Parent ego state. This can be done by the client introjecting the therapist into their Parent ego state. Alternatively the person can practice imitating others who function well in their Parent ego state. This will build up the strength of the Parent ego state tapes. This is described in much more detail here.

As the Adult and Parent ego states develop the individual will report more of a sense of safety inside and thus the sense of internal control increases.

To observe how the three ego states or parts of the personality are relating one can set up a simple 2 chair exercise. In one chair sits the Child ego state or the small child in the client. In the other chair sits the big person which is a combination of the Parent and Adult ego states.

Ego states 2 chair

The person then sits in each of the chairs and speaks from that part of self reporting what they think and feel and dialogues to the other chair. Those who sense a lack of control when asked to speak from the P/A will present as ineffectual, lack a potency or be at a loss to say much at all. Then when in the C chair the person will report a lack of trust or faith in the P/A to look after them or deal with life's problems as they present.

This is quite an easy and simple technique to do and can be used reasonably often to assess what is happening between the different parts of the personality and to do self parenting exercises to build the Parent and Adult. Once the person has done it once or twice they can easily slip into the parts of the personality and perform the exercise.

Girl vomit
Loss of control?

Graffiti

Sunday, August 8, 2010

Drug use and suicide

In the previous post it was suggested that what has been called a gambling addiction may not an addiction. It certainly is different from what would be called a drug addiction. Whilst in the act of gambling the personality is not transformed like it is with taking drugs. With drugs the Parent and Adult ego states are rendered null and void which could be seen to constitute a major personality change. With gambling this does not happen.

Instead repetitive gambling could be seen as more as what is known as the defence mechanism of regression. The person responds to stress by engaging in behaviour where they end up in a child like position such that someone else has to take over for them to cope. Whilst this happens with some drug takers there are those where it does not happen for instance with many recreational users and what are known as functional alcoholics.
Ice cream truck

The point at hand here questions the definition of addiction. Those people who feel a compulsion to engage in a piece of behaviour that they find very hard to resist. With some discussion it becomes apparent that there are many differing reasons why that compulsion may exist. This would seem to be important to articulate because the way of treating such an addiction could vary considerably than if they are all assumed to be of a similar nature. As mentioned above if this thing that have been called a “gambling addiction” is actually more of a defence mechanism than an addiction how one deals with it will vary. Another example of this is described below.

There are a group of people who use drugs, some of them in a habitual and addictive way that are different and separate from the mainstream type of drug addict. Drug use in this group is more of a suicide attempt than drug use in the usual sense of the word.
Woman drinking wine

The suicidal person has made one of seven suicide decisions:

If you don’t change I will kill myself
If things get too bad I will kill myself
I will show you even if it kills me
I will get you to kill me
I will kill myself by accident
I will almost die (over and over) to get you to love me
I will kill myself to hurt you

To summarise, some people have the ability to be able to take their own life if things get too bad or to hit back at someone and so forth. These people can imagine killing self, they have it in their behavioural repertoire to do such a thing.

For example
If you don’t change I will kill myself
If things get too bad I will kill myself
I will kill myself to hurt you

Some people do not have that. They cannot conceptualise of planning a suicide attempt, obtaining the items necessary and going through by acting out the plan. It is simply something beyond their imagination. However these people may still have made the suicide decision and thus they need to achieve it some other way.

For example
I will get you to kill me

These suicidal people can get others to kill them such as ‘Death by cop’ where the person behaves in such a threatening way to the police that they shoot him dead. They can voluntarily enter into a war zone and behave in such a way that the enemy kills them, or they can behave in such a way in a country that has the death penalty where the state kills them. The suicidal act is carried out by someone else.

Execution

Or there is another decision:
I will kill myself by accident

This person engages repetitively and voluntarily in high risk behaviour. This is where the line between accident and suicide gets blurry.
Iworks test

Some behaviour is a bit of both, an accident and a suicide and you can’t clearly distinguish between the two. This can include dangerous sports, driving cars at high speed (Peter Brock), working with dangerous animals (Steve Irwin), working in high risk occupations and also dangerous drug taking.

The type of drug taken and the method of ingestion can vary enormously. Smoking marijuana is quite safe compared to injecting heroin which is much more dangerous. If the person has had a few over doses where they were getting closer to the point of death then one could begin to diagnose that the drug taking has a suicidal motive underlying it. Alternatively one can do a life script analysis and ascertain if such a suicide decision exists in the person’s psyche.

If this is the case then there are significant treatment implications. Why would one work with a drug user to identifying the triggers for use, do motivational interviewing or work on relapse prevention with some one who could easily die a month or two latter by and ‘accidental suicide’ in a car accident.

In these circumstances they are suicidal first and a drug taker second and ones treatment plan would need to reflect this.

Graffiti

Thursday, July 8, 2010

Rebirthing as a therapeutic technique **


In my early years of training in psychotherapy I went around the world learning about and looking at different types of counselling and psychotherapy. One of the places I went to was San Francisco in the USA and other places in southern California. At that time the human potential movement was rolling along like a freight train and I trained in various things such as Transactional Analysis, gestalt, bioenergetics and rebirthing.


The leaders of the rebirthing movement at that time were Leonard Orr and Sondra Ray. They said birth trauma was experienced by us all and this was the cause of many psychological problems. They devised a way of returning to the womb and redoing ones birth. One could either have a wet rebirth or a dry rebirth.


In a wet rebirth the client would be placed in a hot tub (spa) that was 98 degrees which is the same temperature as the womb apparently. The person was then surrounded by others who formed the womb, they would then simulate contractions and the person was born out of the hot tub, through the vaginal canal to the waiting mother. Nobody had any clothes on so as to get the skin on skin effect that happens during birth and in the womb.



Rebirths in the hot tub


This type of psychotherapy could not exist today. The professional organisations and the press would sexualise it and that would be the end of that. The rebirths that I saw were not erotic at all and were not a sexual experience. I never experienced a rebirth myself.


It is unfortunate how those watching for any aberration would sexualise such a therapeutic process as it can be a powerful technique that can help people in distress. This can not now happen. Any ways at that time I saw many varied styles of therapy which I am glad I did. I saw types and ways of human relating that went beyond the average. I suppose that is why it was called the "human potential movement".


Dry rebirths in group therapy

In our early therapy groups sometimes clients would do a dry rebirth. We debated whether the people would be naked during the rebirths and decided against it for the reasons cited above.


In the process the client would lie on the floor curled up often sucking their thumb. A few other group members would sit next to the person and form a womb around him. At the baby’s head there was an opening left and two or three other group members would lie side by side to form the vaginal canal through which the baby was going to pass. The ‘womb’ would then begin the contractions. I remember at one point someone found an audio tape that was a recording of the noises inside the womb. You could hear the mother’s heart beat, blood flowing and so forth. This was meant to be played to new-borns to help them go to sleep. This tape was played during the rebirth.



This is at a month long training experience at the Western Institute for Group and Family Therapy in southern California which I attended. You can just see the top of my head right at the back. This is what is known in the US as a hot tub. In Australia we call them spas. Some nights the workshop participants would see if they could break the record for the most people in the hot tub at one time which is what was happening here.




As the womb started contracting there was a midwife who would begin pushing the baby on their backside forcing the head to the opening towards the vagina. The group members were meant to resist the movement as happens in a normal birth and the baby is slowly forced out of the womb and into the vagina struggling as it goes. Eventually it would be born with the whole process taking about 10 to 15 minutes. When born the baby would sometimes have a prearranged mother to be there who would breast-feed usually for about 5 to 10 minutes. And then the rebirth was complete.


And my point is?

First, I think it is safe to say that this would not be considered a mainstream type of therapy and hence many will write it off as fringe and wacky. Maybe it is and maybe not, but what it gave me was a better understanding of people and their psychology. It allowed me to see people involved in unusal therapeutic techniques, how they reacted and responded. In my view it allowed me to gain a wider and more robust understanding of the human psyche.


In this profession I am surprised at how quickly people will discard a therapeutic approach as nonsense. To my mind they see the trees but forget to see the forrest. In one way it does not matter if the therapeutic technique is effective or not. To see people behave as they do in differing therapies as I said allows for a deeper understanding of the human psyche. I have found that anyway. Perhaps people are a bit too willing to cathect their Parent ego state when they see something new or different.



The other point that rebirthing techniques can highlight is Child ego state magical wishful thinking. As a therapist one needs to be careful of this. The rebirthing process described could be seen to imply that you can redo a birth, have it be a good experience and this somehow negates the bad experience of the first time around.


Psychotherapy can add new experiences but it can never take away the bad ones and one needs to be careful that the client does not start to believe this. If one was abused as a child then one has memories of that which can never be taken away or some how extinguished or removed. The Child ego state in us all would very much like that to happen. One needs to be careful that the client does not start to believe that can happen.


Some clients can start to think, “If I do rebirth then I am sort of starting again and this time I can make it right”. This cannot happen as one cannot start such a thing again. When we did our rebirths in group therapy we were doing something but we were not redoing a birth. What we did, seemed to give good results but it did not allow the client to start all over again. Each of us gets only one chance to do birth and childhood. When the time has past it is gone forever. We can add in new contrary experiences through therapy but that cannot extinguish the past.


The other area where this type of magical thinking can occur is with the transference relationship. The wishful thinking of the client can be, “Through the new relationshiip with the therapist I can erase the old origianl parent-child relationship and have a new one”. As I mentioned before such erasure cannot happen and at times it seems the therapist would need to check if the client is doing such magical thinking.



Graffiti