The pre-verbal client - Part 2**

Self soothing and pre-verbal clients.

Sara says:

“I do want to hear what self-soothing means not as a bunch of activities, but on a more basic level.”(end quote)

You are right, self soothing in the way I am using the term is related to attachment theory. Yes one can soothe self by having a bath or with music or with some other pleasant experience. That would be included with what I am saying but only be 10% of it

The soothing I am talking about is much more intertwined with relationship, security, and the soother must be content as well. The soother can’t fake it. The look on mother’s face in this picture is just as important as the child’s because soothing in this context is a relational experience for both parties. The child experiences its own soothing and it also experiences mother feeling soothed as well by it. Which of course is even more soothing for the child!

If this happens many times the child of course incorporates this and introjects it into its own Parent ego state. If as an adult it is feeling anxiety or depression it can then call on the sensory and somatic experience of feeling soothed but it also recalls mothers face as being happy and soothed by it as well and hence has a relational experience or understanding of soothing. Obviously a warm bath, or pleasant music can’t provide such relational experiences.

The thing is however, is that it wears off. Say that child got good parenting and soothing from its parents and then at age 20 leaves home. It can then use those early life experiences to self soothe when it is feeling distressed. But its not enough. As adults we continue to need soothing relational contact to keep filling up the bucket. We need ongoing relational contact with others where we feel soothed and we see in the others face that they are feeling soothed by us as well. If we don’t get such relational contact in adulthood then the bucket runs dry I’m afraid.

However the type and degree of refills required in adulthood is different depending on early life experiences. For instance that baby in the picture is getting pre-verbal soothing experiences. If one never got these then the refills in the adulthood bucket are needed much more and have less soothing effect.

The self soothing of oral needs in adulthood.

But will it be enough?

The adult needs to some how get such pre-verbal soothing relational experiences. If she does then those fill up the bottom of the bucket and the subsequent adulthood refills are more effective in soothing the adult with unpleasant emotions.

However this raises an interesting notion. As I said before a mother soothing a child can’t fake it. If an adult person seeks a therapist to get some of these pre-verbal relational soothing experiences then the therapist cannot fake it!. So the therapist needs to have some sort of their own personal emotional investment in the client which the client can soothe in some form.

Thus one is left with a very fine line for the therapist to walk. The mother in the picture is using the child to meet her own emotional and relational needs just as much as the child is using the mother. Mother has needs and wants to ‘nest’, have babies, be a part of a family, be ‘clucky’ and nurture the infant. She has maternal instincts that she wants to be met. If she gets that then she feels her needs are met and is soothed herself. That is why she can’t fake it.

A child learning how to self soothe oral needs

A therapist has to be very careful about using a client to meet his or her own emotional needs and to use the client in such a self soothing way. However if the therapist views the client in a very clinical way and has no emotional investment in them then such relational soothing experiences will not happen for the client. The therapist can’t fake it. If a therapist is going to work with clients pre-verbal (or quite young child) issues then they have to walk the fine line just described.

On the other hand most people would get many of their adult fill ups from their partner. This is fine and is a good way to achieve such a thing. They can’t get their pre-verbal fill ups from their partner. If that begins to happen then your partner stops being your partner and starts becoming your therapist and that usually equals divorce at a later point.

Graffiti

Life script analysis - Part 3

For a larger verion of this go to my flickr.

Scene: A water pipe has exploded outside the kitchen window and water is spraying everywhere, including in through the window into the house. We have just moved into this new house and no one knows where the water main shut off line is.

Dad: flies into rage, screams at us, eyes wide, trying to be both angry and as terrifying as possible. Yelling. Swearing. Looking for someone to blame.

He feels: rage, like he is personally wronged by the pipe, like just when he couldn't take any more (his chronic mood), this happened, personally, specifically to him.

He wants: no idea, he is fucking crazy.

Mom: scared of father but also sees humor in the situation. Scared of potential violence in scene. And yet, it is kinda funny, water is spraying everywhere, there is a slapstick element to all of this.

Mom says, "I think the shut-off might be in a pipe that is in those vines outside the front door."

Dad roars: "Oh yeah? HOW WOULD YOU LIKE TO GO PUT YOUR HAND IN THAT FUCKING...FUCKING...SNAKE PIT?" (We had recently discovered that there were snakes in the area we had moved too and all around the house.)

Me and Mom share a look and almost get the giggles. Though he is our personal torturer, he is sorta ridiculous.

Me, age 13 or so: I am scared of John's (not his real name, but I in my mind always refer to my father by first name) rage, but also trying hard not to laugh because that will just make it worse. It's scary. He turns violent quickly. He's probably sorta drunk.

I feel: afraid, hate this situation, hate my father. I want: for him to just go away and leave us alone and never come back. I want out of this crazy life, where everything is scary and something as simple as a broken pipe is the scene for major drama and angst.

I want: someone to just act like a fucking adult and handle things. For my mom to leave him. I want to be able to laugh at this without being afraid; it IS funny.

My brother, age 10 or so: watching horrified yet also appreciates the humor. He wants: to go to a friend's house and get the hell away from it all. Not sure what he feels specifically - like fear or anger or whatever.

Things I notice about the drawing after doing it:
- the way it is the three of us huddling away from John, it was always like this.

- that I am between my mother and him - I didn't do this deliberately, but it is true, I had to take the brunt of his rage and the adult role. I was the focus of his negative attention more than anyone. I fought back while she ignored or avoided.

- my brother is sort of an afterthought - his usual place in the family.

- and I guess I did write in there, without thinking, "I want out of this crazy life..." I think that thought had appeared long before this age though. I should do a younger one. Similar scene, age 3.

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Response

Which way is your father facing?

The first thing I notice about the drawing is that it is asymmetrical. It is not balanced. In this instance the placement on the page could be important. Here are the usual interpretations of page placement:

So masculine features dominate and controlled behaviour with depression and insecurity. You actually even go so far as to do what is called ‘Paper basing’ You run out of space on the bottom of the page and have to squeeze things in

Paper basing - Generalised insecurity, depression - from HTP test

S says

“I had to take the brunt of his rage and the adult role” and your mother and brother did not.

This is an example of the masculine features. There maybe a tendency for you to ‘wear the pants’ in relationships particularly with men.

This would equate to early decisions like “Don’t be a child” or “Don’t get your needs met”.

Your father looks like something out of the terminator movies and heavy sharp lines are often associated with aggression. This could be you perceiving him as angry or you are angry at him or both

An early demand of your life script is clear:

“Someone to just act like a fucking adult and handle things”

“Stop yelling at me and just give me a hug, hold me”.

“therapy fantasy just to have someone hold me when I cried...as no one ever really did. Just once.”

If this script early demand still remains unsatisfied in your life today then this may mean that you have trouble self soothing and provides clear goals for a treatment plan.

Second there may be a contradiction in you and why there may be problems in relationships with males, which is why I asked you before if your new counsellor was a male.

One part of you will want to take the dominant male control position in relationships and yet your early demands are to be passive and be taken care of by others. If your father’s face is projected by you onto your therapist then these contradictions in wants in the relationship may manifest.

I am not suggesting you look for a female therapist, indeed I suppose the best scenario would be a male therapist who has the focus and ability to handle a complicated transference relationship with a client.

Other Early Decisions could be:

“Everything is scary”

“I want out of this crazy life”,

Before you have talked about a possible Don’t exist decision.

S: “And yes, I could imagine, not quite my father telling me it would be better if I were dead...... And also that anything I might want was useless. I was going to be what he wanted me to be, period. Nothing of my needs or wants was relevant, and, in fact, whenever I expressed them, I was harshly punished (ie hit with iron when I stated that I didn't want to go to the special education program in second grade). Maybe that's a kind of "don't exist" command.” (end quote)

Your statement - “I want out of this crazy life” - is an interesting one and raises an interesting question about the suicide decision (Don’t exist)

The seven usual suicide decisions are:

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.

They are all active statements (decisions) about killing, being killed or dying. Your statement is not this as it has a passive quality - “I want out of this crazy life”. It does not contain any statement about killing self or dying. Some however do argue that there can also be passive suicide decisions and this would be one of them. Others one hears are, “I just want to go to sleep and never wake up” or “I just want to leave and get away from everything for good”. My personal view is that they do not constitute suicide decisions (The don’t exist injunction), however it is an interesting distinction to make. It is probably safe to say that the more passively worded the early decision statement is the less likely it will result in a serious suicide attempt.

The other thing about the drawing is the odd combination of emotions. There is the whole funny humorous feelings mentioned by you and mother. Then there is the scare (horror) and anger feelings also mentioned. An odd combination to say the least. Usually if one was feeling strong fear then that would clearly dominate over any humorous feelings. I would be interested to discover how you manifest funny, humorous feelings as an adult.

Other drawing interpretation points are:

Stick man - those who find interpersonal relationships distasteful

Paper basing - Generalised insecurity, depression

Feet long - need for security and to demonstrate virility

Profile - withdrawal and oppositional tendencies.

Hands absent - Reluctance to make intimate contact

Centrality: who are the central figure(s). These are seen to have the predominant power in the personality of the drawer.

Placings - who is between whom and who is in the middle

Alliances - Who is allied with whom and who against who.

Action relationships. Are the various people engaged in some way. Conflict, acceptance, withdrawal, eye contact.

Size. Accounting for developmental expectations who is the large and small ones.

These of course provide the relationship templates that you will take into life. When you get involved in or start to feel part of a group of people then these templates will tend to manifest. Your Little Professor ego state will be endeavouring to re-establish the same kinds of relationship dynamics from the past (drawing) onto the group you are involved with in the here and now.

The angry, scary father figure. The emotionally impotent mother figure who you sort of end up looking after rather than the other way around and the aloof peer figure who wants to move away and feels scared.

Graffiti

Working with the pre-verbal client**

A blogger states:

“Ok, another interesting thing came up - how do you treat pre-verbal trauma? I think most of the stuff I actually remember, I dealt with well both at the time and later in life when reflecting back, but a lot of my general unsettled-ness comes from really early abuse...what can be done about that?”(end quote)

Some suggest that pre-verbal issues are more difficult to treat than a client who has problems from that stage of development where the child has gained mastery of language. (ie verbal issues). My personal view is that this is not the case. It is easier to do psychotherapy with someone who has problems from an age where they did not have language. One could say it is more primitive but those therapists who do not like it may perhaps feel insecure because they cannot do the interpretation of language. To my mind that makes things easier because you are dealing with more obvious and basic communications. It is non-fancy therapy and non sophisticated therapy and that requires the therapist to be non-fancy and sophisticated.

For a therapist working with pre-verbal issues is not hard in the

technical sense but can be hard in the emotional sense

Pre-verbal psychological maladaption means the person has suffered significant disruption to the parent/child relationship before the child has gained substantial mastery of language. Let’s say that is from birth to 18 months of age. This corresponds to what Freud defined as the oral stage of development: 0 - 18 months of age.

This disruption can occur because of obvious neglect or physical abuse of a child. Or it can occur because the child is physically looked after but there is a significant disruption to the attachment between the child and the main parenting figure. This can occur because there is some problem in the child or for some reason the parent is not available to the child. That can be because the parent is significantly effected by drugs or alcohol, is consumed with anxiety or depression, is physically ill and cannot see the child much or for what ever reason is emotionally unavailable to the child.

A minority of adults can just feel this age. It is a natural thing for them.

In attachment theory, for a successful attachment to occur the mother’s Free Child must be involved. In other words she can’t fake it. The newborn is so sensitive it will pick up that mother does not want to (or can’t) attach. If this is the case then the attachment will not happen in a successful way and pre-verbal difficulties will result.

This stage of development is actually divided into two separate stages. The oral sucking stage (0 - 8 months) and the oral biting stage (6 - 18 months).

Oral sucking stage - this is all about the mouth, lips and tongue, sucking, swallowing, passivity and dependency. In adulthood this is typified by cigarette addiction which involves sucking and taking in. The person who smokes cigarettes for these reasons will find it particularly hard to break the addicition. The dependent personality can result from this as can the narcissist and the schizoid personalities. The pleasure principle dominates as does autoeroticism.

Oral biting stage - relevant to teeth gritting and grinding and is about the teeth and jaws as any breast feeding mother will tell you. Biting, eating, destroying, sadism and aggression. Conduct disorders in children and the antisocial personality in adults may manifest from a fixation at this stage of development. This person is not so much into sucking on cigarettes but more into biting as with chewing gum or chewing pencils, finger nails and so forth.

If a client presents with such problems what does one do. The first thing one does is assess the level of regression that the client is capable of. If the client is able to regress significantly then preverbal fixation is a possibility. That is they can regress into their Child ego state to a degree more than the average person can not. They have that ability to be very child like although this can at times be well hidden in their day to day presentation.

The client will have that ability to naturally regress whereas others simply will not. As a result one often ends up working on a mat on the floor with the client. Some clients will naturally gravitate to this and others will not. They will feel a natural need or repulsion to be held and others will not. When doing two chair work they will say thing like. “I have no words or nothing to say”. When working they will naturally put their feet up in the chair or request to sit on the floor. They need of get off the chair and get onto the floor and curl up or lash out in a temper tantrum.

With preverbal clients one has to deal with strong emotions and thus one does things like rage work on a mattress on the floor. Or the client curls up frozen with terror. If one has ever seen such a thing they will know what I am talking about.

Then of course there is rebirthing. Which one can see here.

Unfortunately what happens with many therapeutic techniques is they get commercialised. Rebirthing can be most useful with the client who has conflicts from the first year of life. The client is given the opportunity to simulate their birth. This can either be a wet rebirth in a hot tub or a dry rebirth on the floor.

Unfortunately tend people seize on such things and set up places like rebirthing clinics. On a Saturday morning one can wander down to the local rebirthing clinic and get a rebirth if they want. It’s like ordering a hamburger. Obviously the meaning of such a therapeutic process is lost. For the pre-verbal client a few rebirthing experiences can be most therapeutic if correctly placed within the context of the overall treatment of the client.

With pre-verbal clients one is working on a mat on the floor. More noises than words are expressed. One is suggesting to the client things like curling up at home in bed and sucking on their thumb or using dummies or pacifiers as they are known here. (Interesting term that - pacifier). One asks of the client do they tend to suck on their pacifier or bite it. Thus one can gain insight into if they are at the oral sucking or oral biting stage.

Clients can do such “homework” and some have requested that I record a CD (or audio tape as it used to be) reciting bed time stories that a parent would do to a child. I have done this. Of course it would be better if I could do this in real life but the professional organisations and press would immediately sexualise it and thus it can’t happen.

Clients can also use baby food where feeding issues are indicated. The eating of such foods and monitoring the reaction. And finally one of the more prominent methods of working with the pre-verbal client is the holding of them. As with rebirthing this is not done in a mechanical way but has its place in the overall therapeutic process.

In such holding of the client by the therapist the Child ego state of the client gets soothed in a somatic and non-verbal way. A decisive aspect of any such relationship and attachment. Whilst the Child ego state is being soothed the Parent ego state of the client also takes in the soother for future self soothing. In my view one of the more important ways by which the client can develop the ability to self soothe.

Graffiti

Life script analysis - Part 2

To get a bigger version of this drawing go to, Picture and click on ‘All sizes’.

What do you mean about the comment for the cat?

In this situation I would do the script analysis through a dialogue with Kahless. I don’t know you well enough to use a purely interpretative approach. If I do know the person well then I am prepared to make more interpretative statements. I know I have done a family photographs script analysis with you in the past so I do know a bit about your life script but I by no means know you well. Thus I will make statements or ask questions and if you have a response (its OK if you don’t) then from that we will come up with the early decisions you made and thus identify your life script. So it is a collaborative process rather than a purely interpretative one by me.

The whole incident is about oral issues. The force feeding of a child. The fact that it happened 4 times a year for a number of years gives it much more psychological weight and could be quite a significant event event in terms of the development of your life script.

I must say I did delight in your sister’s response to such ‘feeding’. Such defiance! She didn’t reject such feeding by vomiting the purple medicine in the toilet bowl or even on the floor but she managed to get the kitchen curtains.

As it suggests oral issues that means we are talking about an early stage of development, indeed the earliest as the oral stage is the first stage. This suggests the potential for a significant level of maladjustment. Potentially a third degree impasse and preverbal issues.

This can be viewed in terms of Erik Erikson’s theory of the 8 stages of psychosocial child development. The first stage being the stage of trust vs mistrust thus there is the potential for our first early decision - “Don’t trust”. This can manifest as being too under trusting or too over trusting or trusting untrustworthy people. What ever it might, there is the potential for problems around trust in human communication.

The only facial features shown on any of the people is a mouth on mother and it looks like there is a mouth on the sister? Which might indicate further evidence for the significance of oral issues. If these exist then one is looking for problems around feeding, the mouth, eating and so forth. Eating disorders, problems with weight, problem with defiance and authority. As the scene is food related it could also result in digestion problems as you mention the feeling you had when confronted with this scene was “a horrible stirring in the pit of my stomach”.

The other potential difficulty one looks for with oral issues is addictions particularly where the mouth is involved. That is alcohol or an addiction to cigarettes. If the cigarette addiction is based on maladjustment at the oral stage then the treatment would be the amelioration of such issues. That may require preverbal treatment methods such as holding.

Graffiti

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Response

I put the cat in the picture a little bit tongue in cheek, although the need to take this medicine was blamed by my parents on the cat. I tend to steer clear of cats as an adult if I can and avoid touching and stroking them.

At the time I was horrified by my sisters behaviour but as an adult I, too delight in her defiance with a wry smile. I have learnt as an adult that all her 'God Squad' religious behaviour as a teenager (she hung out with such types) was really a front to get out of the house. So she had a cover story (as did my brother) to stay out late. I wasn't that smart.

"Don't trust" isn't something I must say I am actively aware of, though I am an extremely private person. Whilst I have absolutely no problem sharing whatever here and I am not bothered in the slightest if anyone asks me anything here. But then again my on-line life here is compartmentalised and no-one in my RL everyday world know's I am Kahless. I have a number of on-line identities too. I could vanish whenever I wanted. People at work don't know much about my life. So I guess I am wary of trust. I am definitely not over trusting and I assess people before I trust them, so generally don't trust untrustworthy persons. I also 99% of the time don't reveal anything to anyone that I would be concerned about other people knowing.


Yes there is a mouth on my sister. Funny really, I hadn't noticed lack of facial features until you pointed it out. What I think it is worth saying is that - in general terms - my brother and I tend to be more like our father and my sister tends to be more like my mum.

My brother is obese as an adult.

My father tended to be on the chubbier side and my mother always nagged him about his weight.

I remember my mum always saying my sister was 'picky' with her food.

I am within my normal weight range but at the moment probably at the high end, though I tend to vary within a stone weight range.

I do actually have a motto around food. "I eat what I want, when I want." I guess I didn't have that control as a kid so I certainly am going to have it as an adult. There are certain foods - like ham sandwich, bowls of cereal and pizza (my favourites) which I like to prepare myself. Mrs K will offer to do it, but I like to do it myself. I will only eat certain foods. I hate it if people touch my food. I eat fast. I prefer to eat alone and don't like to talk while I eat. And I eat what I want, when I want!

I have a digestive disease - Crohn's Disease - which was first diagnosed when I was 16. I was pretty ill until around 21 when I had 4 foot of large intestine removed. The disease isnt active now but I do have issues due to a shortened bowel - ie I live with diarrhoea.

My father had in later life (after my op) a part of bowel removed due to a blockage. His twin brother has had bowel cancer.

I have no problem with authority - I was always a good child and obeyed. I do so generally as an adult too.

I nearly drew the scene when I opened the door to the local newsagent holding both my brother and sister by the scruff of the neck and wanting to speak to my parents - he had caught them stealing sweets. My brother also had another such incident as a teenager when the school caught him stealing money from the tuck shop.

No-one in my family have criminal convictions so I guess ultimately tow the line. BTW my brother is an accountant now!

I am a smoker - I had my first cigarette at 18.

Neither my brother nor sister have ever smoked.

My parents gave up smoking when I was about 5.

I would not feel comfortable with a treatment method of "holding" - I am not really a touchy feely person - except of course with my dogs where I shower affection and allow them to adore me! I also don't do intimacy very well.

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My response:

It seems I have missed the original point of the exercise which was a thought about early decisions. So there that young girl is and all those things were going on in front of her.

What sense did she make of it all?

With all that, what conclusions did she come to?

How would she finish this sentence, “It just goes to show you that....”?

What did she decide about herself and others and life as a result of this repeated event?

If you can answer these questions then you have an early decision. It is the cognitive conclusions that the child comes to in reaction to such adverse circumstances.

In the HTP test one would notice that all the figures have no facial features except for the two with mouths and also there are no hands drawn. The brother does not even have arms. Such things are all about human contact and the exchange of strokes one could say.

This combined with the fact that the house is drawn basically like a box and has very little homeliness about it. These things could indicate something like human relationships that are emotionally bereft and possible stroke deprivation.

This would immediately highlight for me your comments about preverbal therapy such as holding and your aversion to it. If you should ever end up in therapy it might be something to look at. In addition a therapy style can also allow the client to develop the ability to self soothe. Those who cannot do such things when they get into emotional distress find it very hard to get out because they have difficulty soothing self and hence they tend to stay in the emotional turmoil for longer.

The early decision here would most likely be something like, “Don’t be close” or “Don’t feel”, “Don’t get your needs met” and so forth.

The other point from the HTP test is the centrality of the figures. You are font and center and the actual incident is off to the side. You have also circled your name unlike anyone else. I know from the family photograph script analysis we did that in the photos you were also often front and center. In the HTP test this would indicate psychological importance of the figures in your mind.

I know from what you have stated in the past one could at times also see for you a “Don’t be important” early decision. This is inconsistent with what I am saying now so you may be a contradiction in this way. The good child who does the right thing often is also not noticed much they tend to be a wall flower. From what I have seen of you, you are not that! You will be ‘front and center’ at times being quite noticeable. So any early decisions about lack of importance or worth are certainly not 100%.

Graffiti

Who dares wins - Life script analysis

Kahless, Roses and Sara have asked about early decisions that we all make as young children.

If there is someone out there who wants their life script analysed and thus the process of early decisions articulated then you can do the life script exercise called "The bad day at black rock".

Think back in your childhood and remember an occasion when something bad happened that involved members of your family. Some event that you were involved in either directly or indirectly with your family. It upset you and you found it distressing.

Then draw the scene or event on a piece of paper indicating the various people, animals, items and what ever else was there and relevant. Show the various people doing the various things they did.

Indicate who they are (including you) and write words next to them on what they are saying (if anything).

Then write what they are feeling.

Then indicate what you are feeling

Then write what you were wanting (and what others may have wanted).

What did you want mother (father, siblings, or anyone else there) to do or not do.

Then post the picture on Flickr so I can get a big picture of it and see the detail. I will then analyse your life script and this will show what early decisions are all about.

Early childhood trauma - TMI

Graffiti

The suicide attempter**

An interesting permutation of the thesis on suicide versus accident comes from the person who is the suicide attempter. One hears stated that there are two main groups who exhibit suicidal type behaviour.

The suicidal person

The suicide attempter

They have different motives. The suicidal person wants to die and the ‘suicide attempter’ does not want to die. However the suicide attempter can die by accident in that they did not mean for the suicide attempt to be completed.

I had an example of that happen recently. A woman in her early 20s had sent an email to her boyfriend that she had taken an overdose. She knew he was very likely to get the email and save her as he had done so a number of times before. He never got the email and she died. As she had a history of doing this one can conclude that her motive was not to kill self. Her goal was to manipulate him to act a certain way which had worked on many occasions before. She wanted him to come and save her thus demonstrating his love for her in her mind.

Would this grab your attention if you saw it? I think so.

However one needs to look at this situation more closely. If in her attempts at suicide she engages in acts that are highly dangerous then she is repeatedly engaging in high risk behaviour. On suicide risk assessment scales she would score on this point thus indicating that she is possibly suicidal to some degree.

It seems that the type of suicide attempt is significant for understanding the suicide attempter. If the attempts are clearly non-lethal then one can more safely conclude that the person is not motivated to kill self. They are making suicidal gestures for other reasons such as a cry for help or to manipulate others.

If the attempts are potentially quite lethal then the situation is less clear. Whilst the person may be acting in a suicidal way to gain attention there may also be some genuine desire to kill self. The individual may have made the suicide decision in childhood and thus in the psychological sense be ‘truly’ suicidal. However they may also have other motives as well such as manipulation and so forth. If they die in one of these suicide attempts then it may be partially a suicide and partially an accident. They are both a suicidal person and a suicide attempter at the one time.

Indeed one could argue that all suicidal people are suicide attempters to some degree because of the idea of suicidal ambivalence. I have postulated this before.

All suicidal individuals are ambivalent to some degree. They all have an internal dialogue which states: “I do want to die vs I do not want to die”.

All suicidal people have this contradictory set of thoughts and urges inside self. If a person is 100%, “I do want to die” then it wont be too long before they are. If a person is 100%, “I do not want to die” then there would be no suicidal thoughts or urges in the first place. The suicidal individual has percentages of both with the levels waxing and waning over time. Sometimes it will be 50/50 and then on other days it might be 60/40 or 30/70.

The individual shown in the diagram above would be classed as a suicidal person not a suicide attempter because they have made the suicide decision which is known in Transactional Analysis terms as the “Don’t exist” injunction. However they also have a Free Child aspect of their personality and thus they don’t fully want to die. So their suicidal actions are therefore at least at times going to be half hearted, quarter hearted or third hearted depending on how much energy is in the FC and how much in the AC at the time of the attempt.

For instance a man reported to me a suicide attempt of a few years ago. He plunged a large fishing knife into his abdomen, then rang his mother on the phone. He could have very easily died and almost did. He definitely had made a suicide decision in early life and his AC energy was high at the time of the attempt. However he also rang his mother which in my view was an expression of his Free Child desire to live. So in this way one could say he was a suicide attempter and he was trying to manipulate his mother.

Graffiti

Ending therapy

Some insightful blogger recently said

“Still questioning the therapy - wondering how I will recognise when I am done.”(end quote)

It is a good question that sometimes does not have a clear answer. I always suggest to clients that they often ask self the question - “Am I getting what I want from therapy”. This needs to be answered from the Adult ego state as much as from the Free Child. Those two parts of the personality will know. It’s just a matter of the client listening to them and of course the therapist must not be interfering as well.

For personal reasons (counter transference) the therapist may complicate the client getting their answer and may suggest the client ends therapy before the right time. For personal reasons or financial reasons the therapist could suggest the client remain in therapy longer than necessary.

How long to hang on?

This is particularly so in the longer term treatments where the therapist has the time to develop an attachment to the client. If the therapy ends with some kind of angst, argument or acrimony between client and therapist then the time to end was not right. Either the therapist has hung onto the client too long as they find it hard to end their own attachments or for some personal reason they push the client away too soon. If the longer term therapy ends without any enmity then that is a good sign that the time was probably right.

Also therapy is very much related to the stage of development that the client is at. In initial interviews I always ask the client if they have been in therapy before and if so what happened. Not uncommonly it is reported that as a teenager they ended up in counselling for some reason. One then sometimes hears comments like, “But it just was not the right time and I was not receptive to it”.

My point being that ending therapy is relevant to the client’s current stage of development. As they move further through the life cycle they may be again ready for some kind of therapy.

Ending therapy is also dependent on what the problem is. For instance grief work and trauma debriefing are finite things. Right from the beginning it is necessary for the therapist to have the attitude that trauma debriefing and goodbye work are finite. That the person will ‘get over it’. It does not go on for ever and this is automatically assumed by the therapist.

Indeed it is a good idea to get the client to identify the time when it is over. That may not be during the counselling but some time after. However, have it placed in the client’s mind to make such an identification and that such a point will be reached. I sometimes ask clients to make a contract to send me a letter when they have ‘moved on’ and over the years a few have indeed done that. This leaves the client with this notion in the back of their mind that there is an end.

Some object to this idea and will say things like, “I can’t gain closure until the trial is over or until they have found him or until she apologises”. All these are not true, as one can gain psychological closure (ie Get over it) without any of them happening. These are what is known in Transactional Analysis as waiting for santa claus. The client is conning self and finding a reason to halt their progress.

Waiting

In the literature one sees lists like:

“Instead of moving on in my life I am waiting for...”

Santa claus (Magic)

Others to change

Understanding

A push or a kick

Certainty

Consensus

My turn

Fairness

Justice

Revenge

Hitting rock bottom

More time

The right feelings

The right reasons

The right words

Someone else to be here

A certain age

These are particularly the case with things like trauma debriefing and grief work. Of course people enter therapy for many other reasons such as depression which is different from things like grief work. However it is still important for the client to have a sense of finiteness about the therapy.

The best scenario is when the client responds well to treatment and the depression decreases. Sometimes that does not happen and then I suggest the client accept that this is as good as it gets, at least at this time, and live with the disability of depression just like an amputee has to learn to live with one leg.

The goal is for the client to have a sense that therapy is finite and this will end one way or another. If there is no significant reduction in the depression then the therapy goals change to learning to live with the disability and how long will the client keep banging their head against the brick wall called therapy for very little therapeutic outcome.

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Website update

In recent times I have made 6 more additions to my blog post compilations on my website. These can be seen at Blog posts.

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