Saturday, January 23, 2010

Engage the enemy in therapy.

I have talked before about certain treatment strategies that I do with things like panic attacks and eating disorders.

If a person presents with panic attacks I will at some point ask them to have a panic attack there in the session with me. Some look at me in disbelief, state that they came here to stop having panic attacks and refuse but most will go through with it and produce the panic to varying degrees.

Others who may be bulimic I will get them to make a homework contract to throw up at least once this week. If their purging is not a physically harmful levels that is.

In the past I have tried to explain the theory behind this and never really felt that I have explained it adequately. I have not been satisfied with my explanation. The other day I was relaxing in front of the TV, surfing the channels with my remote and I happened on an interview with Mel Brooks.

He talked about a number of things including the parody that he does of Adolf Hitler in one of his comic sketches called the Hitler Rap.

This has caused quite a controversy as some argue that making fun of Hitler trivialises what he did to the Jews in the second world war. As he explained why he did such a parody I realized he was explaining exactly why I ask the panic attack sufferer to have a panic attack. There he was saying precisely why I do what I do.

If one gets to know thy enemy and engage thy foe then it disempowers them. If one only ever addresses the topic of Hitler in very sombre and serious ways then that is making him to be more important. To engage Hitler in a funny way reduces his impact and importance was the basis of Mel Brooks’ argument.

When a client comes to therapy the first thing they do with the therapist is spend a great deal of time and energy defining the problem, discussing its causes, seeking to stop it, remove it, side step it and so forth. All this focus on the problem in one way empowers it. It makes it even more important in the person’s mind.

Hence I suggest the client at times engage the foe and produce a panic attack, or for the bulimic to go and purge. Panic attacks come and panic attacks go, nobody has ever gone crazy or died from a panic attack, throwing up is throwing up, not the end of the world. It disempowers the enemy (the symptom). It is not something of great awe and immensity.

The other point that is different from Mel’s parodies is that it also defines the therapeutic relationship. If I as the therapist also hold the problem in great awe and dread, such that it must be avoided at all costs, then the client has the therapist and the therapeutic relationship confirming the belief in the power of thy enemy. If I suggest to the client they go and do purging homework they see that I am not overawed by it.

I certainly understand that it is a painful problem for the individual and empathise with that but it does not fill me with fear and dread. This will also have a disempowering effect of the problem in the client’s mind. Hence my rule of thumb about treating eating disorders, never spend more than 50% of any session discussing food, weight, eating and so forth. Talk about other non food related matters.



  1. Yes, i truely enjoy the way you think like that. I also like the way you encourage your clients to 'face their fears'. Though they may not at first, the idea has been suggested to them for later development.

    As a side note... i'm really glad that you're enjoying writing the book. Its nice when that happens.. enjoyment that is.

    Ps. I can relate to the little boys in the picture - i'm a mum and i have a big ass!


  2. Hello to you Roses, and as you insightfully note even though they may not like the idea at first and refuse the mere fact that I have suggested it carries the same point that I am talking about in the post.

    I never actually said that I am enjoying writing the book Roses. In fact I would say that I have a love hate relationship with it. There have been times in the last 3 months when I have despised it which has never happened to me before in my writing.

    But I have never forced myself to write any of it. I have always waited for the time when my FC has wanted to engage with it. On occasion that has involved breaks of writing for 1 or 2 weeks which also has never happened to me before in my writing pursuits.


  3. "But I have never forced myself to write any of it. I have always waited for the time when my FC has wanted to engage with it. On occasion that has involved breaks of writing for 1 or 2 weeks which also has never happened to me before in my writing pursuits."

    So... this is one of the times that you're doing something for the first time? Well, i hope you're enjoying that. Good for you.

    Happy weekend to you...

  4. "I never actually said that I am enjoying writing the book Roses. In fact I would say that I have a love hate relationship with it. There have been times in the last 3 months when I have despised it which has never happened to me before in my writing."

    Hmm, quite the relational person aren't you. It sounds almost as if you're married to the thing - 'duty' and all that. Just imagine when you're finished. There'll be so much that you'll feel so dissatisfied with and want to change over and over again.

    Unless of course, you're a little like me on your blog site. Mostly I simply (though it's not really as simple as it probably looks) close my eyes and press 'send'. It's a really bumma when I do that and lose a whole rave into the cyber black hole.

    Enjoy the new 'love/hate' thing. It will help give a spark and life to your thinking and writing. A bit like a steel blade against flint rock - its passionate and enticing to read.

    I'm just so glad you're alive!

  5. Hello Roses,

    Yes it is good to be alive.

    I have reflected on these FC forced intermissions in the writing and how I have not just forced myself to keep writing. At least at this point I am letting my unconscious Free Child structure the chapters. When it says stop I stop, but in my mind there is a great deal going on. I think what I am doing is thinking of how to structure the chapter, what is in and what is out and so forth. But I was not aware I was doing that I was just concerned about the stopping as I have never done that before.

    I am certainly much happier with the results than if I had just kept writing in the direction I was, but it has meant that at times i have had to back track and ditch some stuff as well.

    and it is good to know you as well Roses


  6. *Giggles* I love the 'behind the scenes' glimpse (Man that word looks wrong! - glimps, glim...) of your writing. Like the 'making of (insert name of book or movie here)'. You know, like they do for some movies.

    Its nice also to see that you're caring for yourself. No one else can - in reality (the here and now) you're it for you.

    Yeah... its nice for us to see our mentor, family member, friend (the many things you are to the many people in this world) modelling that. Its pretty rare these days you know?

    Thankyou for that Tony.

  7. Ohh, by the way... we just got back from watching a movie and the picture theater (that one looks wrong too! Sheesh!) where we watched 'the lovely bones'. I was expecting a chick flick type thing and apparently Steven King wrote it. I think it was him. *Shrugs* Someone like him anyway.

    It was lovely - nothing like it but reminded me of 'what dreams may come' i don't know why. It just did.

    Happy sunday to you and have a great Australia Day! Cheers...

  8. You are right Roses,
    I suppose it is a behind the scene glimpse. Hadn't thought about it like that.

    It is just another book on the suicidal client and there have been many before and I am sure there will be many afterwartds. But it is the first time I have done this. I have written many articles and I suppose I expected it to be a bit like that but it is quite different.

    Go Grrrlll!


  9. So - do most of your patients have a "defined" issue that they are working on? I can see how this might work in those situations. Sometimes - the goal or the "problem" is not as concrete.

    I can't imagine writing a book - although I think you will do a good job. I do like to read a lot.


  10. Oh my goodness Tony! I'm so excited (even though it may not happen in which case you'll know cause i'll be so disappointed {or angry} which ever word you'd like to use). If the weather is good and the sea is not too scary... I think i'm going out there to do some fishing! Oh my goodness!! I'm so scared that i'll get so sick so i'm taking a tablet in a minute (just before i go to bed) and one again in the morning, and ... oh my goodness!

    What if i catch a fish or something like that! What if its a octopus or ... something like that! Oh my goodness! Isn't it so exciting!?!?!

    I hope the boat doesn't sink.. ohh i hope the motor doesn't konk out! Ohh gosh! I hope i don't get sick or need to do a wee. There will be a male friend on board too. *Blush*

    I'll let you know how we go on the morrow sometime. Gosh... isn't it fun!

    your roses

    Oh my goodness!!

  11. Hello OLJ,

    That is a good point and sometimes a significant part of the therapy process is simply defining the problem. But most often it does not take too long to get a clear understanding of what the basic issue is. That maybe quite different than what the client originally presented as the problem though.

    Yes the book writing is/has been an interesting episode in listening to my unconscious OLJ


  12. So Roses did you catch anything like an occy or some thing?

    Happy Australia day


  13. No occies today. I caught some fish but they're the kind that we have to throw back in, so they got chucked back in. It was lovely! I got a sunburned face but I didn't know i was getting burned until we got home. It was so cool out on the water but as soon as we started up the river the temperature warmed up heaps.

    I didn't get sick, i didn't need to wee. Gosh it was fun but my eyes are fighting to stay open now so i'm going to have a shower and catch a nap. Gosh - it's only 12.30pm but they say that's what the tablets do... they can make one drowsy. I'm so drowsy right now.

    Hope your Australia Day is a good one. I hope your enjoying some food company, fare, liquid refreshments and rest.

    Cheery cheers to you and yours

  14. Hope your Australia days was successful Roses, mine was OK.

    All of a sudden I am back into full on writing and maybe our discussion about this has had an influence. I am still just going with the unconscious flow and the flow as the moment seems to be tapping the keybord with great vigor.


  15. My sister has just been airlifted to Canberra hospital (I still call it Woden Hospital) There's bleeding on her brain somewhere somehow.

    Gosh... its a bit yucky.

  16. I hope she is OK Roses,
    I am sending you good soul energy from the west


  17. Hi Tony,

    A few years ago i had a client which proves your thesis. gee, lookin back now... the mistakes i made. We spent so much time stroking the fear and dread around the panic attack...altho' i think this guy would've resisted pnick attacking in the therapy. I think now we should have worked on cathecting some Child energy? This guy was so tense and stressed, i think letting his hair down might have helped.
    Experience is a wonderful thing, i guess.

    Nice to see u again Tony.

    Best wishes,


  18. Oh Tony,

    Well, we arrived in Canberra at around 8pmish and she (my sister) was in surgery. Then when she got out of surgery they had a bit of a meeting and decided to go back into surgery again. So we went to our accommodation, ordered pizza, watched movies and rested. We didn’t sleep very well and so we kind of sat around on the Thursday morning like slugs waiting for a call to come to the hospital. The call came and when we arrived the roll-a-coaster ride began.

    Long story short, the machines were turned off late last night (Friday night) and some people received some much needed organ donations.

    It was wonderful! Everything went according to how she said she wanted to die (well, when that time finally arrived). She slept for a while and now is dead - but got to the ‘dead’ bit pretty much just how we talked about the way we (she) said she would like it to happen.

    I remember telling her (while she lay there in the ICU hospital bed pretending to be alive) how pleased we both were feeling about how amazingly everything was happening exactly how we’d imagined the perfect death! I know she was not conscious and only the machines were keeping her body happening and stuff, but I just couldn’t get all excited over all this amazing stuff with anyone else – they just wouldn’t understand; you know what I mean? I guess they just didn’t see it the way we did.

    I cried sometimes (kind of) and sobbed once in the room with her. Hadn’t slept since the little bit on Wednesday night, so by Friday night (holy smokes) it was like I was on something! Geez! I was slightly ‘off centre’ if you know what I mean *giggles*.

    Then last night we arrived home at around 1 – 2am and slept till a friend called in at 8am to visit us and well wish us. We had a huge emotionally big job to do today (we had to go tell mum and dad) so I was grateful for the wakeup call.

    This morning I cried a lot. Like waves, they build up, wash over and then just leave you in their wake. Had no control over it so I just let it happen and it did – over and over.

    Now we’re home again from dad and mum’s place, and my body hurts (it actually hurts, there’s sand in my eyes or so it feels and my bones can’t get comfortable) – yeah, I’m going to bed. I’m doing some visiting with friends tomorrow morning – though I feel dog tired – but then that’s done and I can maybe sleep straight through till the funeral. Well, it’s a nice thought – I haven’t a clue when the funeral is. *Giggles* That may be one whopper of a nap!

    We were best friends – my sister and I. It’s the same with my younger sister too, and my brother and I sat holding hands for the longest time today. I love them all. Not like a non-family person is though – we were too close for that. I think I’ve got this great big hole in my being now. I don’t know how to mourn a dead person. I think I’m about to learn. Gosh I’m glad I cancelled University – now I can do this mourning thing and my counselling course. That should keep me busy for a little while. What do you recon?

    Good night, sleep tight and dream the nicest dreams... I intent to

  19. Tony! Tony! Guess what!

    It’s not so frightening - death that is. Don’t get me wrong... it’s pretty bloomin big, but I’m not scared about it (so much) anymore! This morning my cry time was a bit bigger – you know... not just crying anymore but where you roll about and, well – writhe... i think that’s the word. I think I’m in pain but can’t feel it or something – yes... I’m finding it a bit strange. When that was over I hopped up and had breky with hubby (who is doing remarkably well considering he’s living here with me at this time – a bit funny really if you’re NOT him *giggles*) and then got in the car and went to a coffee shop and had a coffee with a friend. I talked a lot – yeah... that’s probably not unusual (cheeky!).

    Every one reacts differently to everything! Oh my goodness! It’s like this huge adventure into a realm of life that I didn’t (couldn’t) know existed until now. I’m learning that we have to be super careful who we smile around, who we talk to and what about, and when to get teary – weird huh? But not so frightening anymore. I realise now that I’m the target for people to shoot their mourning ammo at because in this society, no one is allowed to mourn (or more likely, people feel awkward in their mourning state and don’t know what to do) so when there’s a time to be allowed to mourn that’s the only time for them to let it out – and at this time, someone like me is ‘it’. That, then, makes it ok for them and me; kinda nice really.

    Having said that, I can now begin to understand something about the fear – it’s just a protocol thing! That’s all it is! Gosh – why doesn’t someone just say that? Not everyone knows or understands the rules. Not knowing and understanding something – is ok. It’s ok. We’re ok. That seems to be so normal for me (the not understanding ‘thing’), so I’m ok with that.

    AND!!! Some people are GREAT at cooking! Wow! YUM!!

    Holy smokes Tony – this is just like a big adventure; some things are nice, some outrageously amazing, and as with everything, some really yucky. Yeah... here it comes... “Such is life”.


  20. Hello Roses,

    I find those two comments of yours very good and I feel as though you really are saying to me how you feel and think and do. Good stuff!!

    I ike it how you are taking the death of your sister and all the mourning and all the masses of other stuff that happens like funerals and so forth, like a big adventure. what a grand way to look at it and approach it. That seems, well, just so - Roses!

    let me hear more about your adenture as it happens my good friend.