Anger and forgiveness in psychotherapy

On occasion there is the need for some anger expression in therapy. A recent example brought this to the fore.

A woman in her 50s had a life time of being ignored by her mother. But to make matters worse her two sisters were often highlighted by her mother at times in front of her. In public the mother may talk about the exploits and successes of her two sisters but never of her. It seems safe to say that there was favouritism in this way.

The woman would at times recount such situations that had occurred many times in her life and often felt anger as she did remember. When this happened it was not long until she would mention that she did not believe that her mother did this on purpose. That she was probably unaware that she was even doing such a thing. And from what I was told I tended to agree with her. In addition her mother was now quite elderly and frail and the client would say that how could she be angry at such an elderly person. Her goal was simply to forgive her mother for the mistreatment that she had received over the years in the way described above. However this meant she was directly avoiding being angry. Unfortunately this kept reappearing, her anger at her mother kept resurfacing.

As a therapist I am all in favour of the idea of forgiveness. I think it is a very wise psychological goal to aim for. Forgiving ones parents for that they did or forgiving ones abuser for the abuse received is a wise psychological goal. However sometimes this is the situation:



At times in order to get from the hurt to the forgiveness you have to go through a period of anger. If it is only a minor transgression then one does not have to. If it was significant especially at a young age and especially when over a period of time then one cannot go straight from the hurt to the forgiveness. They have to go through a period of anger.

This is where a lot of people get stuck, in one of two ways. Firstly, as in the case cited above the person is uncomfortable with anger and finds it difficult to go through that stage. They try all kinds of ways to avoid it and the example above shows some of the rationalisations that people will come up with in order to do that. Secondly, the other individual does not avoid it but gets stuck in it. This is not an uncommon scenario to come across in therapy. Some one who is chronically angry at their abuser. Quite often they never see their abuser now or the abuser may even be dead. The client may be carrying around a sack of anger on their back towards some one who died years ago. What does that achieve, and more importantly who suffers from the sack of anger - certainly not the dead person.


Some find forgiving their abuser this hard to do.




If the person does successfully transverse the anger then they are well on their way to achieving a sense of forgiveness. Once done, their life in the here and now is more pleasant and they are capable of more staisfying relationships in their current world. Indeed their current relationships are much less likely to be damaged by such unresolved past events.

However the difficult part for the therapist is to judge how long the angry period is meant to last. This is not an easy thing to gauge. As is often the case in therapy it is usually best to leave it up to the client and they will tell you in one way or another. However this is not always the case. For instance it is highly likely that the client described above will be saying she is ready to pass the angry stage before she is.


Living in the here and now. Can't enjoy this if your head is stuck in the past.



But she may tell the therapist in another way. Over time one will notice that she spontaneously brings up the issue of anger at mother less and less. When this happens she is ready to begin the forgiveness work and the therapist starts that phase of therapy.

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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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Anger work in psychotherapy

Preliminary notes

It is necessary to use anger work in a context in counselling. In some areas such as the bodywork approaches this is not done and anger work can be used just as an exercise in itself. It must be relevant to the contract at hand and have a clear role in assisting the client to achieve that contract.

For example a client could say, “I want to shout at my father because of the way he treated me the other day”. In order for a therapist to go along with such a contract he needs to be aware of what happened between the two people as the anger work could be just a part in the game. What is the client’s script messages about anger and its expression. The client may be chronically angry and to go ahead and do the anger work would be contraindicated.

Anger work is a regressive technique. That is it encourages the client to ‘regress’ into the Child ego state and out of the Adult and Parent ego states. This has obvious uses for the individual who is stuck in his Parent and Adult and excludes the Child ego state, which many people are who attend psychotherapy. On the other hand there are people who are too much in their Child ego state and exclude the Parent and Adult, clearly one would need to be careful in doing such anger work with these individuals. For example the chronically angry person, and the hysteric personality type.



Anger work also destabilises the personality. This is one of its great therapeutic advantages. A client’s script becomes set and solid over time after many, many rehearsals and reinforcements day after day. Anger work can be used to shake it up and loosen the concrete holding it together. Once loosened one can then restructure the script into another form that allows the individual to live a more emotionally liberated life. That is, less script bound and more autonomous.

The down side of this destabilisation is that what if the client is already destabilised such as can be the case with schizophrenia, dependent personality, borderline personality and the obsessive/compulsive personality. One would need to be cautious using anger work in such situations.

Another difficulty with anger work is that anger always has the potential to turn into physical violence. So if the client is impulsive and has a tendency to be explosive then one needs to be very careful with anger work particularly if the client is bigger than you.


These women need to do some anger work, for sure!


In all my years of counselling I have never had a client express their anger in a way which hurt me or any of my property. One can use “Stop” techniques if necessary. Another advantage of this is with the client who comes from a physically violent back ground. By doing anger work they get first hand experience that there can be anger without physical violence.

Anger expression can be self validating. If one feels they have been wronged, then the act of saying so , especially to the face of the other party says to the individual - “I am worthwhile”. So to say such things with the expression of anger can assist with the self esteem.

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Final fantasy 6

Up to this juncture I have maintained the following psychological functions fantasy can provide

Fantasy as a defence mechanism
Fantasy in the schizoid personality structure
Fantasy to alter mood - self soothing
Fantasy as a source of strokes - positive and negative
Fantasy and life script reinforcement

It would seem that there are others

Fantasy in the narcissistic personality structure
I have mentioned this before that one feature of the DSM-IV criteria of the narcissistic personality is:

“Preoccupation with fantasises of unlimited success, power, brilliance, beauty, or ideal love.”

Thus it can be stated that fantasy is used by some narcissistic people to maintain that personality structure.



Fantasy as a reflection of current events in a persons life
As with sleep dreams, day dreams can occur as a reaction to events in a person’s life. If one is entering a new relationship they may have fantasies about how it will go or things the two people may do together and so forth. If the person gets a new job they may fantasise various scenarios about what might happen. This also happens in sleep dreams sometimes. When it does this reflects the psychological importance the current event has to the person.

Fantasy as wish fulfilment
This also occurs in sleep dreams. The daydream may be about what the person wishes. A relationship, money, success, sporting ability, their team winning the grand final, finding a lost child, to be the dependent one in a relationship and so forth.

Thus we have some of the ways fantasy can be used by the fantisizer. There may be others that come to light subsequently but at the moment we have this:

Fantasy as a defence mechanism
Fantasy in the schizoid personality structure
Fantasy to alter mood - self soothing
Fantasy as a source of strokes - positive and negative
Fantasy and life script reinforcement
Fantasy in the narcissistic personality structure
Fantasy as a reflection of current events in a persons life
Fantasy as wish fulfilment



There is one other point that must be made. This does not relate to the function of fantasy but how fantasy can be used in therapy. This I mentioned in final fantasy 5. If one maintains that daydreams are expressions of the unconscious or they arise from the unconscious, one can use them therapeutically the same way one would use dream analysis with sleep dreams. It is a way of understanding the unconscious of the individual.

For example Kahless stated:

“I used to day-dream being a secret agent, or a fireman, or Lara Croft”(end quote).

A therapist may ask of her,
What are the qualities of Lara Croft that are important in the fantasy?
What does Lara Croft do in the fantasy?
What is her relationship to others in the fantasy?

Of course the answer to each of these questions if simply a reflection of the psyche of Kahless. As with sleep dream work they each are part of her in some way. The therapist seeks to find out what those are and then finds a way to use them therapeutically. For instance it may become apparent that Kahless is not owning the Lara Croft in her. Some of the qualities she sees in Lara Croft she has in her own personality but is in denial about them at the moment. One could then use two chair to facilitate her accepting that part of her personality. As I also said in final fantasy 5 it is the theme that the therapist is looking for. The character of Lara Croft is not important. It is what that character means to Kahless that is important. The theme of the character and the theme of what the character does.

Of particular note with this is sexual fantasies. Whilst fantasy of heroic deeds or of great wealth can be used to understand the psyche, sexual fantasises have the extra feature of involving very close, intense and intimate relating. They involve at least two people interacting in a very close and intimate way. Fantasy about winning the grand final or being dux of the school does not have the same feature. Thus sexual fantasises assume extra importance in this way.

In using sexual fantasises in this way one firstly takes the sex out of the equation.
Forget about the sex and how are these two people relating?
If they were relating with the same theme in a non sexual way, what would they be doing?

Thus the unconscious wants, fears and needs involving intimate relationships becomes more defined. What the person’s unconscious feels about self and others and their relating becomes clearer.

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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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Doing bad therapy - client information.

KYLady states

“According to your diagram, as long as you never catch your client in a lie or he doesn’t admit lying to you, you can provide good therapy. What if the problem he comes to you with is that he lies all the time. Can therapy help somebody like that?” (end quote)


Here, I discuss therapists doing bad therapy when what they believe about the client is not true.

One can do bad therapy when the information they have is inaccurate and thus they believe things about the client that are not true.


Clients lie all the time. Indeed people lie all the time.



I have said before there are similarities between a police interview with a suspect and a therapist interview with a client. Both are seeking to identify the lies but for quite different motives. One is constantly cross checking information provided by the client to identify inconsistencies. The same question asked in different ways, in different contexts two weeks apart. At the beginning of a session I might begin with chit chat therapy as this is a good way to cross check information and just get information about the client. Their defences are more down compared to the interview situation of therapist and client.

For example, as I meet the client at the door she may talk a bit about what she did last night and may mention a restaurant she went to that I know. As we chat about it I may ask her about the meal she ordered. She reports a meal that is high fat and high calorie and she is skinny. What is going on there? The little bell rings in the therapists head - to be revisited later on!

By simply chatting about an evening at a restaurant one can get a lot of information about a client and their relationship to food, eating and so forth. Chit chat therapy is good as the defences are down. police so the same with good cop, bad cop. If they can create that situation in the crims mind the person will be less defended with the good cop person.



Now, I am not suggesting that clients are a group of pathological liars. When one meets a new client for the first time one has got to expect they are not going to get the truth or at least the whole truth. Clients sometimes talk about very intimate things and I am a complete stranger to them. If a woman is talking about a bad marital situation I may ask her if she has had an affair. At that point I know she may not be fully candid simply because she does not know me and there has not been the time for trust to develop. I would be the same if I was in her situation.

Secondly clients lie all the time because they lie to themselves. This is the lie the therapist is most often looking for. The client who says she loves her husband whilst shaking her head. She is lying to her self about her love for her husband. If the therapist does not see the lie then he will believe something about the client that is not true and do bad therapy.


Fake sun tan! Even body language can lie.

Coerced clients could be seen as more likely to tell falsehoods. If I was told I had to go to counselling I would be resistant at some level as well.

However in my situation where clients pay money to see me one can expect more truths to be told. The client knows if they tell me falsehoods, I will do bad therapy which they are paying for. However this does not always happen. I wrote a long time ago of a man I saw semi regularly over a 4 or 5 year period.

In the last 3 months of our meetings he told me that he required a heart lung transplant and it was quite likely he would not survive the operation. I had noticed he had trouble breathing at times and he said he was asthmatic. He wasn't. This piece of information significantly changed the course and form of therapy and he didn’t tell me for 4 years. So I did bad therapy for 4 years. It’s like working with someone to give up smoking when they are on death row. What’s the point.

Why he did that I am not too sure as I never got a clear answer to that question either. However as he slowly disclosed further information it became apparent that he was not doing all that he could, medically. Refusal of treatment for a life threatening illness? A suicidal act? Maybe?



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PS. Oh! about my comment that clients lie all the time. I am just being a bit obtuse. I like clients.

Therapy venn diagram

Over here, Major did a venn diagram from the client’s perspective. I thought I would do one from the therapist's perspective.



It is interesting how things look different depending on your own perspective. Whilst I am only looking here at the client therapist relationship one could say the same of all human relationships. Is it really any wonder there can be mis-communication in relationships?



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Introjection in the therapy process

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

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

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

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



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

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

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

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



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

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

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


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

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

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



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

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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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The 'x' factor in therapy

I was reading a book on counselling the other day and it discussed the therapeutic alliance. These two guys had done a meta analysis of the literature on what are ‘important therapist attributes’ for the development of a strong therapeutic alliance. They came up with:

Therapist attributes - flexible, honest, respectful, trustworthy, warm, confident, interested and open.

This seems like a reasonable list and includes some of the things one would expect to find. But this is indeed an elusive and indefinable topic. The quality that allows a good therapeutic alliance to develop between client and therapist. I have discussed this before and talked about the ‘x’ factor.

This is usually mentioned in relation to singers and musicians. There is a quality that the very good ones have that the not so good ones do not have. What that is however is largely indefinable, but you know when it is there and when it is not. A bit of an odd situation really - you know when it is there but you can’t define it (easily).

The same applies for the the therapeutic relationship. Some therapists have a ‘presence’ where they can have that special connection with clients, but what that is, is hard to define.

The list above is good and accurate but it’s one dimensional. It is a list of things and this will not define the ‘x’ factor. One cannot produce a list of things to do that. Instead one has to talk in more general terms that are less concrete because the ‘x’ factor itself in not concrete.

Theoretically it is quite easy to explain, it can be called the Free Child. This is best explained by looking at the training of therapists.

When therapists begin their trade they learn lots of things like how to do therapy and how to be a therapist. They learn the basic techniques and the basic process to follow. As they master these they become a therapist which undoubtedly is a positive thing. However it is an adaption and thus forms part of the Adapted Child ego state. They learn to be a certain way and a kind of professional role or way to be. They adapt to what authority is teaching them. The down side of this is they loose a sense of who they are and how to be themselves in the therapy setting. They are moving away from their Free Child part of the personality and becoming something else - an adaption.

This is not conducive to forming a connection with the client. The client will feel a sense of connection when the therapist simply be’s who they are. When they be them self which theoretically is the Free Child.

When client’s see the highly trained therapist they get good therapy that is of much assistance but that extra bit is not there. They do not get to meet the therapist as a person.

Some therapists never move beyond this because either they don’t particularly want to or they are not prepared to take the personal risk in doing so. To put the Free Child out in any relationship is a risk including the therapeutic relationship.

To move beyond ‘just’ being a therapist the person has to kind of unlearn what they have just spent the last few ( or many) years learning. They have to unlearn being a therapist and learn again how to be them self as a person in the therapy setting. If they achieve this then the Free Child again becomes accessible to the client and thus a special sense of connection can again occur. In my view this is part of the ‘x’ factor in the therapy setting.

The therapist moves away from being a therapist and becomes a person who happens to do therapy in the relationship with the client. The person comes first and the therapist part comes second. They have already acquired the therapy skills and now they relate to the client and happen to use those skills when necessary.

If the therapist allows self simply to be who they are in the therapy relationship then in my view the client experiences an extra dimension to the therapeutic relationship.

Just being who we are is surprisingly difficult. Most in childhood loose that ability.

Allowing self to just be who you are sounds simple, but is not easy. Indeed I would say that most people loose this after childhood and never achieve it again in adulthood, let alone those who have it trained out of them as happens in the training of therapists.

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Client's asking difficult questions

I bought a book the other day on addictions counselling and it is quite good. Most Australian produced books on this topic stick with CBT and that’s it. This book does the CBT but also looks at the therapeutic alliance as they call it. They deal with the process between the client and therapist as well which is good to see.

In it they make a interesting comment which one finds from time to time. In discussing the client therapist relationship they look at what does a therapist say if a client asks the therapist if he/she is sexually attracted to them. They say the therapist should respond by neither confirming or disconfirming any sexual attraction to the client. Instead the therapist should ask why such a question is important to the client and explore the thoughts and feelings the client has about wanting to know and so forth.

They state that for the emotionally robust client this will permit a much deeper exploration of their reactions, hopes, fears and wants than if the therapist revealed their exact feelings. For the emotionally fragile client they say it would be too anxiety provoking for the therapist to answer directly.

This is a view held by some approaches that one sees from time to time. The problem is I don’t believe their reasoning behind not answering the question. It has too much of a flavour of a therapist ducking for cover by hiding in their theory. It is a very convenient response for the therapist that keeps them emotionally safe and allows them to slip side ways out of a difficult series of transactions.

Whilst one gets this question from time to time the more common one is when the client asks the therapist if he/she is angry at them. The approach cited above would do the same in this instance. They would not answer the question and seek to know why such a question is important for the client, explore feelings and so forth.

Regardless of your theory or beliefs about the therapeutic relationship the bottom line is one person has asked another person a direct question and the other person refuses to answer it. Most often the client will ask because they think they are picking up an ulterior transaction from the therapist. If this is the case then client is doing good open direct communication. If you sense something in a relationship then asking about it in an open and direct way is good communication.

So the client does this and then the therapist blocks it by not answering in a direct and open way. At the very least the therapist is modelling bad communication styles and saying, “Do as I say, not as I do”.

In addition to this I think the client’s question of are you attracted (or angry) to me, carries another question imbedded in it. The client is asking the therapist to be a human with the client in that instance. The client is asking for a simple piece of human to human communication. In response the therapist refuses and answers as a therapist. In my view this is disrespectful to the client.

The therapist not answering the question

Regardless of not respecting the client as a human in my view not answering the question is bad from a therapeutic point of view anyway. If you ask someone a question and they respond by giving you lots of words that does not answer the question what then happens in side you? It immediately builds up FC curiosity. If you ask a question and don’t get an answer the FC stills wants its question answered and now it also wants to know why you didn’t answer the question in the first place. That seems like a natural reaction if you don’t get a question answered.

After all the analysis and exploration the client is still going to wonder what the therapist feels about them. But now they know not to ask the question as they wont get an answer.

It makes it an issue when it doesn’t have to be. If you answer the question directly it defuses it and then the relationship can move forward. If you don’t answer the question it makes it an issue in the relationship that just complicates matters. If answered directly in a careful way no client is going to be damaged by it. Their intuitive Little Professor ego state knows the answer anyway.

Body language. Client’s watch the body language of the therapist very closely.

Theory smeary! Throw away all your theory and therapeutic explanations and asks self:

What does my FC feel towards this client at this time?

What’s in it for my FC not to answer the question?

This is what the client will be asking self after you refuse to answer the question. - What does the therapist’s FC feel about me and what’s in it for their FC to not answer my question?

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Transference and projection

Roses asks, “Is projection a lot different to transference then?”

Many do say that transference involves a good deal of projection but that is not actually accurate in the technical theoretical sense.

Projection was originally hypothesised as a defence mechanism. Its goal is to allow the person to maintain a positive self image. It allows the person to view self in a positive light which we all want to do.

We all have Child ego state urges that our Parent ego state does not think is right, good or proper. If we consciously acknowledge these in our Adult ego state then we feel bad about ourselves. They usually involve things like sexual thoughts, greed, envy, revenge and even feelings which some see as bad such as anger.

A good example of this is the passive aggressive personality. A woman has angry and aggressive feelings in herself which her Parent ego state thinks is bad. To maintain a positive view of self she must push these feelings into her unconscious so she is not aware of them. She can use projection to do this and will start to see those around her as being angry and aggressive as the passive aggressive personality tends to do. They tend to feel poorly and unfairly treated by the angry others around her and tends to view self as righteous and decent.

Of course her unconscious anger does not go away so she will also express it in a passive way such as with sarcasm, bitchiness, slight ridicule and so forth. With the proficient passive aggressive person, after talking with them for a time you start to feel bad (and maybe even angry) and you kind of don’t know why. They are so good at hiding the expression of their anger you don’t even know it is happening. That is one of the tell tale signs of the passive aggressive personality you come away from then feeling bad about something and you can’t really figure out why.

However getting back to the point. The passive aggressive personality often uses the projection of their anger out onto others so as to defend their own self perception.

Transference involves “placing mother or father’s face onto the therapist or another person”. That does sound very projection like and often the person is quite unaware they are doing it which is also a feature of the defence mechanism of projection.

However in transference the wife’s projection of father’s face onto her husband is not to defend ones self perception. She is not doing it to keep some unwanted urge or feeling in her unconscious. Hence it is not a defence mechanism in the technical sense of the word. Thus one could argue that it is not projection which is a defence mechanism which is designed to keep something out of the conscious.

So what does one conclude? It seems to me that humans are capable of projecting out internal feelings, thoughts, urges and relationship prototypes and so forth onto others in the world. We are all capable of the psychological process of projection. However there are a variety of reasons why a person would employ the process of projection of which all humans are capable. Thus we have two aspects of projection.

1. The psychological projection process.

2. The psychological motive behind the projection.

If the motive is to keep some undesirable feeling in the unconscious then we have the defence mechanism of projection.

If the motive is to place a relationship template onto another person then we have transference projection.

In answer to your question Roses. In transference people will use the psychological projection process but for different motives than it is used in the defence mechanism of projection.

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Adult ego state strengthening **

This post is on the Adult ego state for my Serbian friend Mirko.

This will be a work in progress. I will write some now and then add to it as the days go by and I think of things to say.

The Adult ego state is suggested in many psychological theories as the state of psychological health. In the Adult ego state the person sees the world as it is in the here and now and the person is not reacting to the world as they did when they were a child. (i.e. not in the here and now but reacting in an archaic fashion).

Living in the here and now

As a result many psychotherapies are designed to give the person more access to their Adult ego state. They aim to assist the person to get into their Adult ego state and to stay there. In these approaches awareness is seen as facilitating cure. The assumption is awareness is cure, and thus some fall down a bit on this assumption.

The first and most obvious example is Freud and psychoanalysis. One of the main goals in psychoanalysis is to make unconscious material conscious. For instance through dream interpretation one can access the client’s unconscious. Once done the client can become aware of it (i.e. make it conscious ) and then they will be cured because they will understand the unconscious and can act in a conscious way (the Adult ego state).

CBT is the same. You seek the irrational thoughts or thinking errors and once discovered the person then can think about them and then use certain strategies to nullify them so as to remain in a rational state of mind. With feelings in CBT one thinks about them. What lead up to me feeling this? What irrational thought is underlying the feeling? And so forth. Once discovered one can be in the Adult ego state and fix things and avoid such situations in the future.

Classical TA is all about Adult awareness as well. One analyses games and scripts. Once understood one is more aware of them and thus can choose to stay out of games and so forth.

Whilst there are some significant difficulties with the idea that Adult equals health or cure without a doubt the more one has access to their Adult ego state and can stay in their Adult ego state when under stress the more they are going to deal with difficult situations in a productive way.

People can move out of their Adult ego state in two ways because there are only two other ego states. The Parent and the Child. If the person stops thinking in Adult and moves into the Child ego state that is called regression. The person regresses to an earlier state of being. They start to think and feel like they did when they were 7 years old. They will adopt their old problem solving styles from those early years which most often are not effective and lack logical problem solving.

Regression

The person may also move out of their Adult ego state by moving into their Parent ego state. This is sometimes known as crystallisation, because the persons thinking and problem solving becomes crystalline and thus lacks any flexibility which the Adult ego state think has.

For example, the person may say we drive this way to work because we always drive this way to work on a Monday. This is a Parent ego state solution to the problem of which way to drive to work. It has no flexibility. The Adult ego state solution is, “We drive this way to work today because the man on the radio said the other way has a traffic jam.” It is flexible depending on the current environmental conditions.

In older age when one starts to loose the Adult ego state functions with a bit of dementia people will go either into regression or crystallisation. With crystallisation they can be quite infuriating to debate with because they will not be willing to see any new information or other ways of thinking.

Which ego state?

Of course some people will move out of Adult thinking much earlier in life and start problem solving with regressive or crystalline thinking. This can occur for many reasons and what is required is Adult ego state strengthening exercises. That is ways and means of strengthening the Adult ego state such that the person can maintain it better under stress.

I will outline various ways of doing these over the next few days as I add to this post. But for starters one would usually begin with awareness of the ego states and that can be done with the “Parts Party” exercise.

One gets three pieces of paper and writes Child, Adult, Parent on one of them each. They are placed on the floor. The therapist gets the client to stand on the piece of paper with Adult written on it. They are given something to talk about such as a person, a relationship, a difficulty they are currently having at work. Usually it is related to the reason why they came to therapy in the first place.

I think they are fairly sure to get their wish

When standing on the Adult ego state paper they can only say things from their Adult. If they start talking from their Parent or Child ego states the therapist brings this to their attention and they move to that bit of paper and speak from that ego state that they moved into. They move to the various bits of paper as the exercise goes on and are allowed to only speak from that ego state.

This lets the client get some idea of what the various ego states are like and is allowed to begin to differentiate the three. They start to experience what it is like being in Adult, then Child and then Parent. They get a first hand experience of each ego state.

In addition they may have thought they were being in Adult when in fact they were in Child or Parent. So this can be an ego state decontaminating exercise as well. It will also show the client and the therapist what ego states they are most comfortable with and know the best. If they move onto the Parent piece of paper and find it very difficult to say anything one knows they spend little of their time in that ego state. If they move to the Child ego state and speak freely they are comfortable in that ego state.

After time as the client gets used to this exercise they can begin to correct self. If they are talking in Adult and feel self slip into Child then they can self correct which is the whole idea of Adult ego state strengthening. They begin to get an understanding of what it feels like to move out of Adult into the Parent or the Child and thus they can then self correct. Thus if they are in discussion with someone they can do the same and thus avoid communication difficulties.

One can do this exercise with other ego states like, NP, CP, FC, RC, CC & A.

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Family systems and illness

Family systems theory as described by Haley (1980) provides further insight into how people can display suicidal behaviour and not necessarily have made the suicide decision. In any relationship with two or more people there is a ‘system’ that develops between them. When the two (or more) personalities meet, over time they work out how to be in the relationship for them. For example one party will take over some roles and the other party will take over other roles.

This can be described in terms of ego states. In a relationship between mother and son the mother may take over the Parent and Adult ego states in the relationship and the son may respond primarily from Rebellious Child ego state. Over time they will work this out often with both parties not even being aware of it. In a family of five members each one will also work out their various roles and positions in the family.

All families develop a system that works for them

Some family systems operate such that one party needs to be ill. If the daughter of the family is ill then all the other family members know what to do in terms of their roles and responsibilities. Examples of types of illness that can originate from a dysfunctional family system can be self harming, drug use, depression and panic attacks eating disorders and suicidal behaviour.

In such circumstances if the daughter is making suicidal statements, gestures or attempts then that is how that family functions. For instance mother and father may start to co-operate and unite against the common cause of the daughters suicidal ‘illness’. It allows them to focus on the daughter and thus they can put to the side their own marital problems.

If the daughter stops making suicidal gestures then mother and father are again confronted with their own relationship so there can be subtle pressure on the daughter to remain suicidal. Having worked in drug rehabilitation this is not an uncommon scenario when one hears the drug user refer to himself as the black sheep of the family.

In such situations when working with the suicidal daughter one can encounter resistance from other family members because if the daughter changes (ie stops being suicidal) then the whole family system has to change. Every person has to alter to some extent and systems will resist change as they strive to achieve homeostasis. Some only have to alter slightly and those who have considerable psychological investment in the daughter being suicidal may be quite resistant to the change.

Treatment of such suicidal people is thus complicated as it involves the person restructuring their relationship with the other family members and that maybe difficult especially if the child is living at home and cannot move out. This also provides an extra avenue of investigation when making a suicide risk assessment.

As is common in the field of psychology often the different approaches whether they may be psychodynamic, organic or systems all tend to take the stance of one size fits all. In this instance all suicidal people are a result of a dysfunctional family system. It is indeed unfortunate how the alternative theories do this as with the human psyche, rarely one size fits all. From my experience of working with the suicidal sometimes the family system is very important and at other times it is only a minor influence. However in assessing and understanding the suicidal person it is very wise to make an assessment of how the suicidal thoughts and behaviour fit for the family system that the person currently lives in.

It is also possible for the individual to have made the suicide decision in childhood and be in a family system where they take the sick role of being suicidal. If that is the case then the risk level of a suicide attempt would certainly increase.

In systems theory every system is naturally homeostatic and will seek to balance itself. Thus it will also avoid or resist change as the balance is disrupted and it is not homeostatic.

So if family member number two changes then that forces all other members to change in some way as well. That change can be anything such as becoming depressed, stop being bulimic, start taking drugs, winning the lottery to becoming assertive. If you change then the system becomes unbalanced and all others have to change so that they system can become homeostatic again.

If you are feeling depressed or anxious that means all those in your ‘family system’, or your inner circle of closest people, are in some way contributing to your depression or anxiety. Indeed if you are feeling happy and joyous they are also contributing to that as well. In systems theory there is no such thing as an ill person, instead it is the system that is ill. If your partner is suffering depression then you are contributing to that in some way as part of the system.

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The copy cat suicide

The phenomena of copy cat suicide has been documented for some time. It is noted that there can be clusters of other suicide attempts after a suicide by those known to the deceased directly or even through the internet. It can also happen when a suicide for some reason gets a lot of publicity or a particularly high profile person suicides. This can lead to a spike in suicides and attempts by people who knew of the deceased through the publicity but was not know them personally.

It should also be noted that the copy cat effect could apply when some one is just talking about and demonstrating suicidal behaviour not only when a suicide is completed. For instance if one has a peer or relative who makes suicide attempts, talks about their suicidal thoughts and plans, displays suicide notes, displays stock piled medication, a tube for gassing self in a car or a rope for hanging self and so forth then there can be a copy cat effect.

Why would a person copy another individual who has suicided. It would seem that there are three possible psychological phenomena at work with copy cat suicides. It seems reasonable to conclude and the research would agree that the more emotional importance the suicidal person has to the individual the more likely the occurrence of a copy cat attempt. The most obvious one being a parent, a close loved one or with teenagers a close friend, member of his gang or community.

Look at how the man and boy are standing

Modelling. The term copy cat means precisely that, copying. People copy each other’s behaviour, thoughts and feelings especially of those who are important. Humans model on each other and in transactional analysis terms the modelled behaviour is placed in the Parent ego state as a tape. If the two other aspects of the personality, that is the Child and Adult ego states are consistent with suicidal behaviour then modelling suicidal behaviour could result in a copy cat suicide attempt being undertaken.

Parent ego state tapes

Permissions. In order to behave a certain way people sometimes seek permission from others to do so. This often happens in counselling. The client has decided on a course of action but feels unsure about it and thus seeks out a counsellor to get permission to do it. That may be to leave a marriage, change jobs, confront mother and so forth. If someone else says its OK to do it then the person feels more confident and secure in taking the course of action.

This of course can also apply for suicidal behaviour. If one has a parent or close friend who is talking about suicide, displaying methods of suicide, attempting suicide or even completes a suicide attempt this can be permission giving. By watching another person act in a certain way can be taken as a permission by the individual to behave in the same way. Again, if the rest of the personality is prone to suicidal behaviour then such permissions can lead to suicide attempts by the person.

This permission giving aspect of copy cat suicide attempts can lead to angst amongst parents of teenagers who listen to rock music that have lyrics about suicide. The parents see the rock stars as possibly giving permission to the teenagers to behave in suicidal ways. If the rock star is idolised by the teenager then the permission giving can be quite strong indeed. However rock music lyrics have never made anyone suicidal but it could play some sort of role in permission giving as is described here. If the rest of the personality is not consistent with suicidal acts then it is not going to happen.

Normalising behaviour. If a teenager is in a peer group where others are getting tattoos then the actual act of getting a tattoo become normalised. It is no longer seen as an abnormal act in the eyes of the teenager and thus he is more likely to get a tattoo of his own. If a teenager listens to a peer talk about and plan a suicide then that makes the behaviour more normal. If one sees mother complete a suicide that makes the behaviour more normal for the child.

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