The anorexic relationship - Part 2.

The internet really does provide some interesting insights into the human psyche at times. An example of this is the Pro-ana (Pro-anorexia) websites. I had look at these a few years ago and then a couple of days ago. There are now hundreds which I found in a few minutes so there are probably many thousands of them out there.

For example:

Pro Ana Tips and Tricks

Pro ana sites here’s a list of great sites

A most interesting social phenomena to arise via the internet.

Here is some information from them

There is no such thing as an eating disorder. People have anorexic and bulimic life styles because they pursue perfection. Just like elite athletes, musicians and others pursue it. Perfection is beauty

Pro-ana 10 commandments
1. If you aren't thin you aren't attractive.
2. Being thin is more important than being healthy.
3. You must buy clothes, style your hair, take laxatives, starve yourself, do anything to make yourself look thinner.
4. Thou shall not eat without feeling guilty.
5. Thou shall not eat fattening food without punishing oneself afterwards.
6. Thou shall count calories and restrict intake accordingly.
7. What the scale says is the most important thing.
8. Losing weight is good/gaining weight is bad.
9. You can never be too thin.
10. Being thin and not eating are signs of true will power and success.



Secrecy tips
Don't bring up the subject of food around other people. Have your excuses for not eating ready in case they should bring the subject up. Some excuses I use : "My stomach's a little upset", "I'm too (tired, excited, nervous, busy, etc) to eat", "I don't feel like (whatever food it is), I'll get something later", "I did eat, didn't you see?", and "I stopped by (Burger King, Subway, etc) earlier".

Don't deny everything if confronted. People will believe a little truth with a big lie much easier than a huge lie. Act as if it's no big deal instead of reacting emotionally and people will tend to believe you.

Watch where you dispose of uneaten food or other "evidence", make sure that it isn't going to be seen or found by anyone. Wrap food up and throw it away outside the house. If you live alone, always take the trash out before anyone else comes over.

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In the previous post on the anorexic relationship I mentioned how food refusal was a very primal and basic act of rebellion. I think it is safe to say that these comments placed for public viewing on the internet are a rebellious and defiant act at least in part. These people know how some others will react to them and that will be with the Critical Parent ego state.

Guess what?
Now we have Anti Pro-ana websites or comments on the internet

Anorexia on the internet

Pro-ana website dangerous to young women

Pro-ana websites

This last one makes the interesting statement
“Many sites treat eating disorders as lifestyle choices, rather than the illnesses they truly are”. (end quote)

Two things I would like to say. First this demonstrates the anorexic relationship dynamic of the RC and CP transactions. The pro-ana sites are being ‘naughty’ and doing things which they know authority wont like and that authority will respond by ‘scolding’ them.

RC: “I am going to hurt myself in front of you and you try and stop me”.
CP: “You shouldn’t do that and I will try and stop you, (in this instances by trying to ban Pro-ana websites)”.



This transactional dynamic will perpetuate the anorexic behaviour such that the psychology behind the anorexic behaviour is reinforced. In this case the dynamic is being played out over the internet instead of between counsellor and anorexic in the therapy room or hospital and anorexic on the inpatient ward. This model presents anorexia as a relational experience.

It also shows how the anorexic can force the authority to become involved. The anti pro-ana sites are correct. The information provided by the pro-ana sites will adversely affect some young girls who read them. So what does the authority do?

If they do nothing, thus avoiding playing into the anorexic relationship and thus don’t reinforce the anorexic behaviour young girls will continue to be adversely effected. If they act to have the information stopped then they play into the anorexic relationship. Then it is highly likely the authority will be perceived as CP by the anorexic even if they are not being CP.

In addition.
Why aren’t there pro-depressive or pro-insomniac websites which provide secrecy tips or promote insomnia and depression? Why are there no websites promoting an insomniac or depressive life style?

Maybe because these conditions do not have a rebellious aspect like anorexia and anorexia involves a style of relating whereas depression and insomnia do not. Depression and insomnia don’t need an insomnia relationship or depressive relationship for the condition to continue like anorexia does.




There is however also a healthy aspect to pro-ana websites. A person with anorexia has been told over and over either covertly or overtly that she is sick, dumb, naughty, bad, selfish, neurotic and so on endlessly.

At least some of the Pro-ana websites are saying:
“I’m anorexic and I’m OK”, with comments that follow the statement before:

“Many sites treat eating disorders as lifestyle choices, rather than the illnesses they truly are”.

This may be the Free Child aspect of the anorexic saying, “I want to survive and grow towards health”. They reject what the helping professionals say to them about being sick, neurotic and so forth. They say I am a good person even if I choose the anorexic life style. From a therapeutic point of view this is a most positive move. It is going to reduce the psychopathology due to the acceptance of self as OK no matter how they live.

This exposes an inherent contradiction in all psychotherapy and counselling. On the one hand the therapist says to the client that they are ok and good and acceptable. However, the therapist also says there is actually something wrong with you or you wouldn’t need to come to therapy in the first place. By the very act of me being a therapist I am saying to the client that there is something in you that needs to be changed and the Child ego state of the client is very likely to take this as it having something wrong with it or is bad about it.

The pro-ana websites are rejecting this contradiction and thus it is a healthy move by them.

As you can see the pro-ana movement is a most interesting phenomena which is quite complex and has both good and bad aspects to it.

Graffiti

Cannabis and self medication.

Four types of drug use are commonly cited.

Experimental use

Recreational use

Symptomatic use

Dependent use

Symptomatic use is when the person uses the licit or illicit drug so as to solve a problem or treat a painful symptom. They discover that by using a certain drug they feel better because it treats a symptom. For instance heroin is an opiate. It is a pain killer. What better way to deal with your pain than to ‘kill’ it.

A person may have grown up in an abusive home and as a consequence they suffer pervasive depression and anxiety through their life. One day they try heroin and discover that that it makes them feel better because it gets rid of their depression and anxiety. So they try it again and obtain the same result. Thus they become a regular user of heroin because it alleviates their pain. This is sometimes called self medication. That is the person uses the drug to self medicate so as to ‘treat’ the symptom.

There is one type of self medicating that I have noticed over the years. These people use marijuana to self medicate. I would not say that it is a large group but you do come across them from time to time. This has recently been highlighted for me because I am working with a man where this type of drug use is quite obvious.

Marijuana for some people is effective in dealing with adulthood ADD or ADHD. I can’t say if it is for children as most people don’t start using cannabis until well into their teens. These people report that when they stop using they start to display the classic symptoms of ADD. The lack of focus, disorganisation, hyperactivity, insomnia and so forth. When they use marijuana the symptoms can subside significantly.

As a result of this they develop a particular pattern of use. It is different from the recreational user where the goal is to get stoned and experience the euphoria of the marijuana. This persons use is very intermittent. The cannabis user to self medicate for ADD uses much more consistently throughout the day and day after day.

The first use often occurs early in the day and then there is semi regular use throughout the day. This person does not get really stoned because they are continually half stoned all the time. Being continually stoned becomes their normality and they can function better due to the reduction of ADD symptoms. This is quite a different pattern of use compared to the recreational cannabis user.

Now one would usually say that the solution is obvious. This person needs to go to a psychiatrist, have a correct diagnosis of ADD made and then prescribed the appropriate ADD medication. Unfortunately it is not that simple.

Some have even done this but found that medications like dexamphetamines are not as effective. From what I have heard reported, marijuana can be a very effective treatment for the ADD symptoms. Just because its illegal is not a reason to stop in many a users mind.

Secondly, this type of marijuana user must have good connections in the drug scene. They have established a consistent supply over a long period of time. Now one thing you do not want to do when working with a drug user is introduce them to yet another drug, whether it is legal or not. Especially a drug like dexamphetamine which is very saleable in the drug subculture and can be used to make some good money.

The solution to this type of cannabis user is a difficult one indeed. I have yet to find a good one really. Maybe some other management skills for their ADD symptoms could help and just learning to live with it.

Graffiti

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

Check in therapy

Had a good check in this week. A guy in his late 20s whom I saw for about 2 or 3 years. Once a week regular as clockwork. When I first saw him he was in bad shape heading for a major depression if not being there already. Now he does not even take anti depressants. It’s always good when you get to see one who has done very well. And besides that I liked him at a personal level as well. We definitely had a good connection.

He developed quite a strong transference with me and I was very much a father figure for him. When he finished he went travelling for about 18 months and as I always do I asked him to send me some postcards. Some clients do and some don’t but I have a board in my office where I pin up the postcards that I do receive and I always point it out to clients who are about to go away.

Anywise he got back and I get a phone call from him and he makes an appointment to see me. I like these kind of appointments as I get to hear what has happened in his life. Some times as a therapist I can get to know some one very well and can even play an important part in their life at the time and then most stop seeing you and you never get to hear what happened in their lives or hear how they turned out. Occasionally I will get a letter or these days an email out of the blue from a past client giving me an update on their life which is always nice.

So he turns up at the appointment and I am waiting to hear what his current difficulty is and as it turns out there isn’t one. It was just a check in to see that I am still there, and still the same, and still like him, all of which is true.

Most people who do a check in will make up some sort of dodgy excuse problem to come and see me. They are having trouble sleeping or they had an argument with some one or they had a series of vivid dreams. When the real reason is to do a check in. Well he didn’t even have the excuse problem which was kind of nice.

Graffiti

Elective mutism and the non-talker

Been working with a guy for the past 6 weeks. He is a non-talker. I never know which is worse, the client who has verbal diarrhoea where you can’t get a word in, to the other client who says hardly nothing.

I like this guy. He has virtually no sense of self worth. I mean unusually so and self deprecating to the same degree as well. Presentation is depression and some history of suicidal ideation.

His natural temperament response to stress is flight - as in fight, flight or freeze. He has a GAF response to a degree that I have not seen before. GAF comes from the life positions and stands for “Get away from”. It means that he will have a tendency to get away from others in his life script and thus he is likely to end up alone or with very few social contacts.

In this instance there is actually no problem with this. He enjoys his own company and can spend long periods of time by himself in the country, which he does. That is not the problem. The problem is that he does not tell anyone anything about what he is thinking and feeling. He never has for as long as he can remember. When ever he has a distressing thought or feeling he withdraws and says nothing to anyone. The technical diagnosis for this is elective mutism.

This worked fine at first except that humans cannot keep doing that for too long and eventually they collapse in on self. They will start to either hit the alcohol, drugs, prescription medication, get depressed, develop anxiety and so forth. The Child ego state simply needs the human contact and communication when it is distressed about something. If it does not get it over an extended period of time it has a ‘nervous breakdown’ as they used to call it.

Human communication. Some try to live without

it for long periods but it never works in the long run

The problem for him (and thus me) is that it is completely and absolutely antithetical for him to talk to anyone about his inner thoughts and feelings. But he comes to see me for precisely that goal, to talk about his inner world and hence he ends up as a non-talker (sort of).

The first sessions were difficult because he said so little and there were often prolonged silences. I thought that he would simply decide that it was all too much and I would not see him again. However at the end of each appointment he has initiated the request for another appointment and there has been another change in the last few sessions.

For the first 45 minutes he is his usual muted self. Then as I am thinking of winding things up (a little early) he starts to talk and even initiate conversation. In the last few sessions he has even gone over time (and I have allowed it). I don’t think it is a game about getting more time but he is starting to not want the conversation to stop. And indeed that is what we are doing. We have done very little therapy in the usual sense of the word. We basically just have a conversation. Mostly about him and his life but we are by no means doing the usual therapy things like setting contracts and so forth.

Some seem to feel like they just don’t fit

in with the rest of the human race

Graffiti

Group therapy with children

In the previous post I mentioned how I originally trained in group therapy with children. Historically play therapy rooms have been set up with a whole array of apparatus that allows a child to express itself. For instance there can be drawing equipment, a sand tray, clay, paint, water play area and so forth.

The theory behind this is that the child through the use of such expressive opportunities will begin to display their internal conflicts or emotional distress. For instance with drawing the child can draw conflicts in the family or between its own internal ego states. This allows for the therapist to begin to understand what the child’s internal conflict and emotional state is like.

Some then hypothesise that as the child displays its angst through play that will allow it to express them and thus they will reduce. This is typical of the theory behind art therapy and some psychoanalytic perspectives. Alternatively those who follow more of the Carl Rogers approach see play as a means by which the child can express itself in the presence of a therapist. That therapist provides an environment that is safe, empathetic and unconditionally accepting of the child. It is the theorised that the child in such an environment will naturally begin to grow and develop towards health.

The woman whom I did my first two years of play therapy group training with was quite psychoanalytic in her perspective. The psychoanalytic, art therapy and Rogerian perspectives described above to me certainly hold merit. When running play therapy groups I use those approaches.

After I finished my training in play therapy I went out on my own and ran groups. Over time I noticed that they changed from the style of my original training. As I worked with children I found myself moving onto other techniques that seemed to have a result. This was not a cognitive process on my behalf but more of an intuitive process that just evolved over time

Three techniques that developed over time.

1. The approaches described above one could call quite passive approaches. The child is simply left to its own devices and would proceed and progress at its own pace with little direction from the therapist. That is indeed why Rogerian therapy is sometimes called non-directive therapy. Over time I found myself becoming more action oriented with the children which more suited my personality as a therapist. Instead of just letting a child express itself through drawing or clay I would be much more interactive in my questioning and comments with the child as he played. Asking what this and that was, requesting that they draw word bubbles for the people they were drawing, asking them to write what the various parts or people were thinking and feeling. Getting them to include pets and various other people and objects in the drawings or plasticine.

This allowed for more diagnosis and also I was getting the child to identify its internal conflicts and to basically do two chair. Offering them the opportunity to expressed the unexpressed feeling or thought or need.

2. Whilst the techniques being employed tended to be more action oriented so was the relational. The therapeutic relationship between the child and myself moved away from the passive “blank screen” therapist that one would find in the psychoanalytic and Rogerian approaches. When a child made some kind response to me directly I would seize upon it and use it to some therapeutic advantage.

For instance if an anxious child with a high Conforming Child ego state said or did something a bit rebellious to me I might highlight it and request that she do it again or some other derivative of it to me directly. Alternatively if there was another child in the group who expressed some defiance of me I might ask the conforming child to see if she could say the same thing to me. Once done she gets to experience the new behaviour and sees that my response back to her is not catastrophic or demeaning and so forth.

The relational contact between the child and the therapist became very interactive and goal oriented with myself manipulating it in various ways for various means. Over time this became a point of significant departure from how I was originally trained.

Again this was not a conscious goal of mine but it just evolved over time. As I became more adept and confident in working with children in the group therapy setting I think I just allowed my own natural personality to come out in that forum. This is certainly what I say to trainee therapists. Initially you begin as a technique based therapist. What you do with the client is based on what techniques you have learnt in your training. As one gets more confident then you the therapist as a person enters into your therapeutic style. One transforms from being a therapist named ‘Tony’ to being “Tony’ who happens to be a therapist. Hence the client will experience you as a person who also happens to be a therapist rather than the other way around.

3. Finally there was the development of romp play. By far the most common approach in play therapy with children is as I described before. A low key, meditative, self explorative type of approach. Over time I developed this thing called romp play which is a far more cathartic approach. It is high energy, boisterous, jumping, rough and tumble, very interactional type of play. From what I have seen of the literature this is quite unusual. Whilst some other approaches do have some cathartic methods they are nothing like the romp play described here.

Originally it evolved as a method for children to develop their own internal Parent ego state controls. It is structured such that the group proceeds with - romp play on, romp play off, romp play on, romp play off and so forth.

Romp play is high energy Free Child behaviour. Whilst that is all good and well the problem with high Free Child is people can end up getting hurt physically and emotionally. Unrestrained Free Child can be dangerous. One needs to develop a Parent ego state that can control it when necessary. In the group any child could put a stop to the romp play at any time by using a prearranged word and all the romp play would stop. Those children who found it hard to stop would be stopped by the therapist. This allowed the children to begin incorporating this into their own Parent ego state. They learnt how to be Free Child and how to contain it when necessary. They were learning the internal controls to do that by their own Parent ego state.

However I think there is more to romp play than just this, although it is hard for me to articulate what that actually is. I could just recite the theory and say that the Free Child is that natural part in all of us and thus when expressed we are being our natural selves in this way. One can assume that when such expression is achieved this will be therapeutic in itself. This is probably all true but there is something that nags in the back of my mind about this. There is something more to this romp type of play for children that I feel the theory is yet to enunciate. When children have an opportunity to do a very free type of play and relating there is some kind of therapeutic effect on them that I cannot yet describe.

Graffiti