People’s expectations

I had another person ask me the other day about this video that I have on my YouTube. Why did I do it, how I did it?



The glasses, the solarized effect and the apparently odd manner of my presentation on a serious topic like panic attacks. People apparently who know me or have seen my work as a psychologist in some way expect a video presentation of a more ‘professional’ style. So I get asked why did I do it like that? To which I answer, there is an old rule of psychotherapy - don’t give people what they expect. Its really a rule of human communication in general - don’t give people what they expect.

After they hear this explanation they seem to be satisfied because no more is said or asked by them. This has struck me as a bit odd because my answer I think begs another question - why not?

Why not give people what they expect?



If anyone ever asked me this I am not sure what I would answer. My first thought is that it would depend on the situation where the unexpected communication occurred. In psychotherapy I think it certainly has its place. If a client comes to therapy they will have an expectation of what is going to happen what they will say, what I will say and so forth.

If they leave with what they expected then the session was OK to average, to not much good. If the person gets what they did not expect in the session then it is much more likely that the session was more effective. Of course not every session a client attends can provide some kind of profound epiphany. But in the overall approach there needs to be at times unexpected communications by the therapist.

This will stop the therapy becoming routine. In one way psychotherapy is about unbalancing the client or putting them in a state of disequilibrium. They enter therapy with a psyche or psychological makeup that is a functional whole. That functional whole may be causing them pain but it still is a functional whole. If therapy can destabilise that functional system then the parts of that system are more able to be rearranged such that a new structure is obtained. That new structure can then lead to less pain being experienced by the individual. It seems reasonable to conclude that if the client gets something they did not expect then that will have a destabilised effect.



Society is like personality. Revolution destabilzes it. Once done then change is more likely to occur. Psychotherapy can be seen as creating a revolution in the personality.



Another reason is something far less ethereal and recondite. It gets the Free Child of the client into the room and that is something you certainly want in therapy. If that video was of me standing there is psychotherapist type clothing, in a psychotherapist type manner in front of a white board with a pointer what ego states of the viewer are going to be elicited. Probably Adult with maybe some interested Child if the topic of panic attacks was of interest.

Because of my presentation I would suggest that much more Child ego state in the viewer is elicited. First they are far more likely to remember it than if it was done in the other way. As indeed would happen in a therapy session if something unexpected happened. If I can get the client’s Free Child into the communications with me that is a very good thing for a successful outcome for the session.



However we now have another problem. Because I have let out one of my trade secrets people will now begin to expect the unexpected. Thus we end up back to where we were before.

However there are ways and means to deal with these things and I can’t tell all my trade secrets. Well not all at once.

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Madness, genius and creativity

A fellow blogger of mine recently said


“So, what did I think of having no computer on Sunday? Hated it but loved it and will do it again this Sunday. It made me very productive and creative.”

She has imposed on herself a regime where she does not use the computer on Sundays and that was her response to the event.

I think it was the first blog post I ever did. It was titled Madness, genius and creativity. It examined how these three groups of people have some interesting similarities. These groups of people all think about and view the world differently than the normal or average person.



My thesis is that creativity is not borne out of peace, happiness and harmony. If the Free Child ego state is content then creativity will diminish. It is in a state of disquiet, angst and disequilibrium when creativity will occur. Under such conditions the Free Child is more likely to view the world differently, think and behave differently such that creative acts are more likely to occur and be more profound.

However it is a fine line to walk because if the disquiet and angst gets too much then the personality will deteriorate too much and nothing creative will be produced. Hence the creative person can have times when they go over that line and descend into “madness or neurosis” and produce nothing then at other times they can have productive periods where a good deal of creative material can be produced.



The creative act is an odd combination of Adult and Free Child. Most people have too much Adult and too little Free Child and hence loose a lot of their creativity. People are trained to be like that. School is all about Adult strengthening. Children are encouraged to think logically and given lots of strokes for doing so.

The other thing about creativity is it comes how and when it wants to. At school, you can’t have creativity classes where the students be creative when the lesson starts and stop being creative when the lesson ends.

Indeed on the one hand we tell our children to be free thinkers and creative and then at the same time we can chastise them when they do. A prime example is graffiti. Decent quality graffiti is a creative act. Its about young people drawing pictures which is creative. As I said before creativity will come how and when it wants. Some do not like this but you can’t have it both ways if you want our youth to have the mind set of free speech and creativity you have to accept that sometimes the creativity will come in a way you do not like.


It is not possible to have controlled creativity which means sometimes the creative acts will assault our senses.

However it seems safe to say that a good deal of creativity is not offensive to many. But the same remains. These people need to be nonconformist in how they view the world and express themselves. If they were being conformist then they would not be being creative. The Free Child part of the personality is that part of us that expresses who we are without conformity to rules. This can be especially the case when a person is suffering in some way as my blogger friend notes with her comment.

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Drug user relationships

It is an interesting exercise for anyone to do. Identify those 4 or 5 people who you are closest to and then describe the quality of the relationship that you have with them. Are they good quality relationships and what are the psychological agendas underneath the surface?

This raises another question. How do you relate to a problem drug user (or really anybody who is doing self destructive behaviour)? Much has been written about this over the years and there are a number of possibilities. Is it possible to relate to a habitual drug user and not encourage them to use simply by the way you relate to them?

In a problem drug users life there can be a number of different people.



Other drug users
First there are the other drug users. Most people who use drugs in a problem way will have relationships with others who also use drugs. Often the persons drug supplier is a drug user as well but most will have peers who they use drugs with on a regular basis. They use together, talk about using and also talk about things like drug availability, scoring, cost and so forth.

This type of relationship is very supportive of the persons problem drug use. Much has been written and said about this relationship and what one can do about it. It is often a major problem for the person who is wanting to stop using. Often stopping using means one must terminate the relationship they have with their fellow drug users and as we know ending a relationship with a strong attachment can be a very difficult thing to do. This is particularly so if you have a married couple who have children and they are both problem drug users. Sometimes realistically the person has to get a divorce and leave the relationship if they are to stop using long term. Obviously this is a very difficult thing to do.


Enablers
Another relationship in the drug users life that has had a great deal said about it are the enablers or co-dependents as they are sometimes called. Those people who relate to the problem drug user and in some way seek to ‘help’ them. Often a partner to the drug user is this person and they can either be the critic, a rescuer or they switch between both.



They may at times actively criticise and berate the user for their drug use. Others may look after the user by cleaning up their vomit or picking them up late at night from a bar and making sure they get safely home. Some can even provide financial support when they know at least some of the money will be spent on drugs.


The enabler relationship does precisely that - it enables. It creates a relationship that supports the drug use. Consider these two examples. In many of these relationships the drug user becomes like the naughty little child who is being irresponsible by getting stoned or drunk. On the other hand the enabler or co-dependent becomes the parent in the relationship who either tells off or rescues the user. The more such a relationship pattern becomes the norm the more likely the user will continue to be irresponsible and use.

If the critic part is particularly active in the enabler this will assist the user to feel worse about self and lower their already low self esteem. Hence the drug use is likely to continue. Or the user may initially agree with the critic and chastise self. However if this happens it is very likely that at a later time the person will get angry at being told of by the ‘parent figure’ and switch into rebellion and go on a bender or the drug use goes under ground and is hidden from the other.



The bystander
The bystander is that person who maintains a relationship with the drug user, does not use them self and does not become a critic or rescuer. They in essence do nothing. They stand bye and simply observe. This can be a non drug using peer or perhaps relative or partner. By doing this the person is giving tacit support to the drug use. By doing nothing and remaining in the relationship one is saying that I accept you and what you are doing at least to the extent of not ending the relationship or taking some other decisive action. The bystander is passively sanctioning in the drug use by the other.

In one way it could be argued that the drug counsellor takes the bystander role with the drug user and thus gives passive support for the drug use. If you discover that someone is using drugs and find that reprehensible then one can take decisive action such as going and beating up the drug dealer, staying by the persons side 24 hours a day to stop them taking drugs, contacting the police or telling them what you think and ending the relationship.

The drug counsellor does none of these things (well at least most drug counsellors do not). Actions speak much louder than words. The drug counsellor may say many things to the user about the disadvantages of drug use, self destructive behaviour and so forth but they do not take any decisive action as I have described above. What does that say to the drug user?



If you had a friend who you discovered was having ongoing sexual contact with children and was not going to stop, what would you do? I think that most people would terminate the relationship at least. That behaviour is a decisive act that communicates to the other party that the behaviour is unacceptable and they are not prepared to remain in contact with the person.

But the drug counsellor does not do that with the drug user. Instead the drug counsellor says by his actions to the drug user, “I will stand bye while you use drugs”. This to some degree gives support for the persons ongoing drug use.

Finally we have those who some how get psychological gain in their own Child ego state by the other person using drugs. For instance this can happen when the drug use is a ‘leaving home’ problem. When a child reaches the age where it is time to leave home sometimes they will suddenly develop some kind of problem. That maybe anorexia, a significant mental illness, suicidal behaviour or drug use. This can happen in emeshed family structures who find it very difficult to allow one party to leave. By developing such a problem the child is stopped from leaving home. At least some of the other family members are supporting the drug use by maintaining the emeshed family structure in what ever way they do that.

Then there is the concept of the ‘Hot potatoe’. Some parents can avoid their own self destructive urges by passing them onto others with children being a convenient receptacle.



Finally there is the idea of Munchausen syndrome by proxy. Some parents, siblings or partners can gain considerable strokes, community compassion, be seen as a martyr and so forth if they are ‘looking after’ a habitual drug user or drunk. Thus we have a derivation of Munchausen syndrome by proxy where the other party is supportive of the problem drug users use for their own personal gain.

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Fish steaming

I think I am kind of lucky really. I am a natural people watcher. I observe people and like doing it. So I am suited for my job in that way. Sometimes I will go to a cafe or restaurant by myself and get food and sit back and watch people going about their business. Or if I am at some holiday resort hotel I like going to the pool side and lie back in the chair and watch people interact. I do enjoy it.

Today I had a meeting with a stranger and found the whole thing fascinating. I want to buy a fish steamer. I want to cook some fish by steaming them. I went to one of those kitchen ware shops and the owner comes up to me and I tell him what I am looking for. He takes me to the items and shows me this fish steamer.


People do interesting stuff


I am looking at this thing and it is not a fish steamer it is an implement for poaching fish. I tell him that I am after a thing to steam fish. He then assures me that it is a fish steamer and proceeds to explain how it works. One part pulls out, you put the fish on it and lower it into the pan type of thing. As he explains it I am responding that it means the fish will be cooked in the water and not in the steam coming off the water. He is again reassuring me that this is a fish steamer. I am looking at this guy and he is lying to my face and he is not even blinking. I am not angry or anything but more surprised and amazed.



This goes on for a few minutes and then he changes his story. He says that I am right, it is a fish poacher and there is no such thing as a fish steamer. If I want to steam fish I have to buy a vegetable steamer and steam the fish in that. He then proceeds to show me one of those.

By this time he has got me smiling. He has spent the first few minutes telling me to my face that it was a fish steamer and now he is saying that it is not a fish steamer. But the interesting part was how he didn’t even blink as he told outright lies to me and how he changed his story and then carried on like that meant nothing.




Needless to say I did not purchase any items but what an interesting way to spend a Saturday afternoon.

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The male anorexic

Last year I ran a workshop in Serbia where I did an in-depth examination of anorexia nervosa and a variety of other clinical states. At the beginning of each different condition I gave the usual statistics about the condition. For anorexia one was that 95% of anorexics are female.

A little later on in the workshop one of the participants asked me about the nature and psychodynamics behind the male anorexic to which I had to answer that I did not know. I cannot recall ever reading such a thing nor recall ever working with such a person.

Well as it happens in the last month I have a new client who could be considered to have some of the criteria of anorexia and he is male. As you can imagine he is of considerable interest to me. Upon some reflection it seems that the way anorexia is currently defined it rules out the vast majority of males. So one reason why 95% are female is simply because how the condition is defined.



Thus one could argue that there are indeed more anorexic males but they are not diagnosed because of how the condition is currently defined. Its not that male anorexics don’t exist its simply a definitional problem for the condition that is heavily weighted towards the female psyche.

The usual criteria of anorexia is:

Refusal to maintain a minimal normal body weight for age and height
Intense fear of gaining weight or becoming fat
Disturbance in the way one perceives ones body weight, shape and size.
In females the absence of at least three consecutive menstrual cycles.

This man is in his late 20s and is currently quite thin. He reports that he has had trouble gaining weight since his late teens. At times he has been dangerously thin. He has never been hospitalised but he has always led a very isolated life so he is unlikely to be identified as in danger of dying. He reports that he simply does not eat. There have been times where he has eaten nothing for up to 5 days at a time.



He states that this is a rebellious act as in childhood mother was very forceful about him and his siblings eating all their food at the dinner table. There are many memories of mother demanding that he eat up all his food. Physical punishments were used when food was not correctly eaten. He has a low self esteem, a self hatred and passive suicidal urges. That is he does not actively plan suicide attempts but he has consistent and strong wishes that he was dead.

If one looks at the four criteria of anorexia, obviously number 4 is about females. Number 2 & 3 one could argue are much more female oriented. As a group women are more interested in how much they weigh and about their body shape and size. One simply has to survey the media and one sees endless images about female weight, body shape and size. In comparison there are very few images involving men. Cosmetics, clothing, plastic surgery all indicate the same. That women are much more focused on weight, body shape and size compared to men.



As a result one could say that the current definition of anorexia is sexist. Very few men are going to meet the criteria because the intense focus on body weight, shape and size is much less common in the male psyche.

However there maybe men out there who refuse to maintain a minimal normal body weight for age and height but the other criteria are different. Maybe I have begun to identify some of the other criteria with my single male client. Low self esteem, self hatred and suicidal urges. He is but one person and thus one is most cautious in generalising. However, when I run my next workshop on eating disorders and I get a question about the male anorexic I can now at least give a partial answer.

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Book - Working with suicidal individuals

This book is now available



It took 7 months to write the 80,000 words. Then one has to wait 6 months for the publisher to do her stuff and at last it is ready.

Here is a video about the book



Some background to the book can be found here

If you want a copy here's how you do it.


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Definition of suicide rate

As the previous post noted, last week I ran a workshop on working with suicidal individuals. Whenever I begin such a workshop I usually begin with a few statistics. For example I might say that in Australia today 8 people have ended their life by their own hand.

I then go onto say that these figures are conservative possibly very conservative.

The first reason I cite for such a hypothesis is that governments usually will define suicide in such a way that it is difficult to attain. It is defined such that the official cause of death by suicide is hard to make. The logic behind this is usually governments want the suicide rate as low as possible because it is not a good look for them if the numbers of people killing themselves is high.



By pure coincidence I today came across a statement about the official classification of suicide in Western Australia. And reassuringly it supports what I have been saying in workshops for a long time which is a good thing really. It’s always nice to find out that what you have actually been saying for all these years is actually true!

This comes from the “Occasional Paper Number 2” which is a state government publication produced by the Western Australian Drug Abuse Strategy Office. It states,

“In Western Australia the Coroner’s Act requires a verdict of suicide if the Coronial investigation reveals the death was intentionally self inflicted. If there is any doubt the case will not be classified as a suicide and the benefit of the doubt is given to the deceased. “Suicide should never be presumed, but must always be based on some evidence that the deceased intended to take his ( or her) own life” (Mathews & Foreman, 1993, p.13). In effect, this means that there must be overwhelming evidence that the deceased intended to take their own life.” (p19)



In addition to this there are three other reasons why the official rate of suicide is conservatively low.

1. People do not want to leave their loved ones with the stigma of having a member of the family who died by suicide. So they make it look like an accident.

2. People do not want to leave their loved ones with guilt and doubt about how they should have seen the signs and should have somehow done more to help. So they make it look like an accident.

3. Some life insurance policies do not pay out on suicides. So they make it look like an accident.

One of the easiest ways to make a suicide look like an accident is with a car crash. I have had many suicidal people over the years say this directly to me. That they will use a car crash to suicide for some combination of the reasons cited above.

Last year in this state 193 people died due to car crashes. I would suggest it is quite possible that half of those could be “car suicides” rather than “car accidents”.



We see the police classifying crashes due to things like fatigue because there are no skid marks. Maybe there are no skid marks because the person was quite awake and simply drove off the road directly into a tree.

At other times we see the police state that alcohol was a factor in the car crash. Suicide research clearly shows that at the point of making a suicide attempt many if not most people are intoxicated.

Then there is the area where suicides and accidents blur into one another. Some people are in great pain and can be feeling suicidal or self destructive to varying degrees. Whilst they do not specifically set out to end their own life they will put themselves in situations where the possibility of a fatal accident significantly increases. If such an fatality should occur, was it an accident or a suicide? It’s a bit of both and again car suicide/accidents are an easy way to achieve such a death.

With the coroner requiring overwhelming evidence for a suicide to be recorded there are going to be a significant number of car suicides recorded as car accidents. So what do you do? You can’t legislate for this. Are you going to lower the speed limit or legislate such that you can take away the persons drivers licence for drink driving. Of course for the suicidal individual such things are a nonsense.

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Singapore workshops

Last week I ran four workshops in Singapore.

Here is a picture of the organizing committee.

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To my left and right are Jessica Leong (President of TAAS) and Irene Yong. Both these women were instrumental in developing Transactional Analysis in Singapore in the early 1980s.

I ran one workshop on personality disorders to the psychatric staff at the Tan Tock Seng hospital.

Then two demonstration therapy groups to the students at ECTA who are seeking their Masters as psychotherapists and counsellors.

Finally I did a workshop on suicide and the suicidal client. Below is a picture of me being introduced at the start of that workshop.

From Graffiti

Met lots of old friends whilst I was there and made some new ones.

It was a great trip!

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Tony's new year resolution

From Tony White - Graffiti

To live 2011 like this.

Would life be worth living if one didn't?

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The psychology of gift giving - Part 1.

With the festive season winding down I thought it was an opportune time to discuss the psychology of gift giving. This seemingly simple piece of human behaviour is indeed quite complex and fraught with all sorts of twists and turns that one finds in all forms of human communication. And indeed can lead to quite significant distressing feelings and conflict in relationships.

This is the first part of a two part series on the psychology of gift giving.

With all those christmas gifts now having been exchanged one is confronted with that most heinous of human behaviour - Regifting

Now lets face facts, who has never regifted?
Very few will say they have never regifted and those who do are partial to fabrication.



Someone gives you a gift that is not liked all that much. You keep it and at a later time you give that same gift to someone else as a present. The unstated transaction when you regift is that you thought of a gift for the receiver, you went out and bought it with your hard earned dollars, wrapped it and then gifted it to the receiver. That is the great regifting lie.

What really happened is someone gave you a present that you did not particularly like, you kept it and simply passed it on to someone else at a later time. You save the money because you don’t have to buy it and all the time and effort going into deciding on the present, purchasing it and then wrapping it.

However regifting can be a dangerous thing to attempt as you can be exposed as a regifter and thus suffer considerable shame and humiliation that goes along with such an unmasking. You must make sure the gift you are about to regift is clear of any identifying signs that will show regifting has occurred. If you are regifting a bottle of wine in a carry bag you must make sure there is no little card down the bottom thanking you for something by someone else. The regift receiver may find it and then you are exposed. Some times it may have been regifted half a dozen times and the people mentioned on the card are completely unknown to you.



Regifting a book can also be hazardous. You must make sure the gift giver has not written a little message to you somewhere in the book. You must check more closely than just the cover page. Sometimes the gift giver may suspect that you will attempt to regift it and write a note to you in a less obvious place. Or if you simply want to stop any attempt to have your gift regifted later simply write your loving little statement obviously on the cover page and that will stop any subsequent regifting.

Then one can simply forget who gave you the gift in the first place, especially if you regift on a large scale. And you regift back to the person who gave you the gift in the first place. If they recognize such a thing then you have been found out as a regifter.

As I mentioned before regifting can lead to embarrassing and painful feelings by all concerned. So what do you do if you discover that you have received a present that has been regifted?

An ominous question forebodes - Do you expose the regifter? My wise counsel to such a person considering such a question is to recall the words once said by a very wise man.

He who is without sin cast the first stone.

1. If you have regifted in the past how can you live with yourself if you now expose someone else as a regifter.

2. If you expose a regifter as the heinous individual she is, that leaves you open to subsequent exposure as a regifter in the future. Should that happen then ones sense of shame and humiliation at such exposure is magnified ten times as you painfully fall from the high moral ground upon which you have placed yourself.


Be careful you don't end up like this.

On that biblical note here endeth Part 1.

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