Overdose

It is an interesting process. I just stopped writing for two weeks. There was no decision to, I just did. The previous month I produced a lot of words for the book I am writing on counselling drug users. I just started writing again today.

It was similar to the first book. I treat my Free Child with great care which is a good thing really, therapeutic as well. I listen closely to it or more just follow its lead. I don’t push myself at all to write. I don’t have a schedule of writing. I need to be very careful of my rebellious side and not to engage it in this large writing project.



I must admit I do start to wonder a bit as a week goes by and nothing has been written. But I sit back and let the FC take charge. I suppose I am trusting it a bit more as I know it will come back to the keyboard when ready. That happened last time and is happening this time.

Yesterday I mentioned this to someone and they asked if I had writers block. I don’t think so but then I don’t really know what writers block is. I didn’t feel blocked. It is more a feeling of I am taking very close care of that part of me and trusting it will do its stuff when ready.

Heroin overdose

One hears this term quite a lot but it is in fact somewhat of a misnomer.

Part of chapter 2



Poly drug use.
Anyone in the drug counselling field will come across the term poly drug use. This is seen to be the contrary of mono drug use. In real terms there would be very few mono drug users on the planet. The vast majority of people are poly drug users. If one has a wine during dinner and a cup of coffee at the end then they are a poly drug user using both alcohol and the stimulant caffeine. However the term poly drug use usually refers the use of illicit drugs maybe with alcohol at the one time. The person ingests a combination of drugs in the one session.

Where poly drug use assumes most importance is when considering the possibly of drug over dose. The drug counsellor needs to be cognizant with the effects of possible combinations of drugs. Over dose from one single drug is much less common that over dose from multiple drug consumption. One study of drug related over dose, Hickman et al (2006) found only one drug present in just eleven percent of deaths with the average being more than three drugs detected. The most common drugs found in over dose were heroin, cocaine, benzodiazepines, alcohol and methadone. The least common were amphetamines, ecstacy and cannabis. (Also see Newcombe and Woods (2010), McKenna (2002) and Giroud et al (1997))



As a matter of course any drug counsellor will enquire as to what drugs the client is using. They should specifically ask if the person uses heroin, cocaine, benzodiazepines, alcohol and/or methadone and in what combinations in any one drug taking session. If there is a combination used then the counsellor would obviously inform the client of the potential for over dose and look at ways by which the client can reduce the risk of a fatal over dose, such as not using alone and so forth.
(end quote)

As you can see it would be more correctly named as a poly drug overdose as only 11% of fatal overdoses result from the ingestion of one drug. 89% result from a combination of drugs taken. So how can you say which one was the fatal one or played the most part in the death? So heroin overdoses are rarely just heroin over doses.


This comes from chapter 5



Research study
Kerr, D., Dietze, P., Kelly, A. and Jolley, D.
“Improved response by peers after witnessed heroin overdose in Melbourne”. Drug and Alcohol Review. 2009. 28, 327 - 330.


Heroin related over dose
Current IDU recruited at a needle and exchange programme (ie not recreational users)
61% had reported they over dosed after injecting heroin with the median being 3 times
84% reported witnessing an over dose with the median being 4.5 times

46% reported witnessing an overdose in the last 6 months

These figures show that these people are really living on the edge of self destruction. To go that close to death that often would strongly suggest some suicidal or self destructive urges play a part in what they do.

It should be noted that the subjects in this study would be the dependent drug users and not the recreational heroin users because of how they were recruited for the research.

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Book award party

Last week we had a party for the book award I recently received.

Here is a photograph of myself with the award certificate.


Note the Toblerone and the strawberrys!

Here is what the publisher had to say about the award.

The list of university and college libraries that stock the book contuinues to grow. I must admit that I am a bit surprised at the size of the list as the book is still not even one year old. I would have assumed that psychology, social work and psychotherapy degrees would have to plan more on what texts they would use for next year and so forth.

University of Waterloo (Canada)
University of Manitoba (Canada)
Saint Francis Xavier University (Canada)
University of Victoria (Canada)
Vancouver Island University (Canada)
Ryerson University (Canada)
Royal Roads University (Canada)
Simon Frasier University (Canada)
St. Clair College (Canada)
Universite de Montreal (Canada)
Memorial University (Canada)
Mount Saint Vincent University (Canada)
Mount Royal University (Canada)
Wilfrid Laurier University (Canada)
Cambrian College (Canada)
Kwantlen Polytechnic University (Canada)
University of Lethbridge (Canada)
Concordia University (Canada)
University of Guelph (Canada)
Library and Archives Canada (Canada)

Maribor General Hospital Library (Slovenia)

Stellenbosch University Library (South Africa)

Mitt hogskolan library (Sweden)
Stockholm University (Sweden)

PJ Library (Norway)
University of Bergen (Norway)
Norges teknisk-naturvitenskapelige universitet (Norway)
University of Oslo (Norway)
University of Tromso (Norway)

Freie Universitat Berlin (Germany)
Humboldt University of Berlin (Germany)
State and University Library of Dresden (Germany)

University of the West of England (UK)
Derbyshire library (UK)
University of Plymouth (UK)
Manchester Metropolitian University (UK)
Lancaster University (UK)
University of Hull (UK)
University of East Anglia (UK)
University of Cambridge (UK)
Oxford University library (UK)
University of Exeter (UK)
Coventry City Council library (UK)
Bromley Library service (UK)
Cadbury Heath Library (UK)
Kingswood Library (UK)
Nottingham Central Library (UK)
Yate Library (UK)
British Library (UK)
Ebook library London (UK)
Hounslow Library (UK)
Barnet London Borough Library (UK)

National library of Scotland (Scotland)

University of California San Diego (USA)
Open Library. California State Library (USA)
University of Washington (USA)
Norwich University (USA)
Ithaca College (USA)
Marquette University Raynor Memorial Library (USA)
University of Massachusetts Amherst (USA)
Williams College Massachusetts (USA)
National Library of Medicine Maryland (USA)
Illinois State University (USA)
Loyola Marymount University California (USA)
University of Michigan (USA)
Central Michigan University (USA)
University of North Carolina Chapel Hill (USA)
University of Missouri-Columbia (USA)
Akron-Summit County Public Library, Ohio (USA)
University of California Merced (USA)
University of North Carolina Greensboro (USA)
Library of congress (USA)
University of California San Franisco (USA)
Mt. Hood Community College Library Oregon (USA)
National College of Natural Medicine Oregon (USA)
Oregon Health and Science University (USA)
Northeast WI Public Libraries (USA)
College of DuPage Illinois (USA)
Boston College (USA)
University of Chicago Illinois (USA)
University of North Texas (USA)
Laredo Public Library Texas (USA)
University of Texas-Pan American (USA)
University of Texas at Austin (USA)
University of Puget Sound (USA)

Executive Counseling and Training Academy (Singapore)
Ngee Ann Polytechnic Library(Singapore)
Singapore Polytechnic Library (Singapore)
National University of Singapore (Singapore)

LaTrobe University (Aust)
Murdoch University (Aust)
Monash University (Aust)
Victoria University (Aust)
Bankstown Campus library (Aust)
University of Sydney (Aust)
Queensland University of Technology (Aust)
Deakin University (Aust)
University of Adelaide (Aust)
University of Western Australia (Aust)
University of Ballarat (Aust)
University of New England (Aust)
University of Western Sydney (Aust)
Charles Sturt University (Aust)
Curtin University (Aust)
Australian Catholic University (Aust)
University of Newcastle (Aust)
Bond University (Aust)
University of Melbourne (Aust)
James Cook University (Aust)
National Library of Australia (Aust)

Trinity College Dublin (Ireland)
Dublin Institute of Technology (Ireland)

University of Auckland Library (New Zealand)
University of Canterbury (New Zealand)
Lincoln University (New Zealand)
Northtec library (New Zealand)
Auckland University of Technology (New Zealand)
Unitec Institute of Technology (New Zealand)
Eastern Institute of Technlogy (New Zealand)
University of Otago (New Zealand)
Rotorua District Library (New Zealand)

City University of Hong Kong (China)
National Cheng Kung University (Taiwan)



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Games children play

For the love or money


This is an associated game of Stupid and is sometimes called the game of Spoilt Child. Here love and money get mixed up. The parents believe they can express their love to a child by giving it things. They may even end up saying to the child, “Of course I love you look at all the things I have given (done) for you”.

The parent is for what ever reason unable to express feelings of love or affection to the child. (Their parents may have done the same to them, they have a “Don’t show your feelings” injunction, they may have their own closeness issues, they may equate affection feelings with sexual feelings and that scares them, they may just be self centred and have little interest in giving affection to the child because they want it themselves, and so on).



So the parents give things instead showing love or affection. A prime example can be boarding school in some instances. “I have sent my daughter to a very expensive boarding school so she gets the best education”, (and by the way it also gets her out of the way so I can go and do all my things).

In this game, over time the child’s bedroom begins to start looking like a shop of “Toys-r-us”. The child gets a never ending series of toys and things with which it can play or be entertained by. Computers, computer games, bikes, flat screen TV, pets, DVD player, CD player, overseas holidays, swimming pool, and so on endlessly. (This is of course encouraged along the way by all the marketing which often portrays the line that if you buy this gift for your child then he/she will feel loved by you.)




The problem with this game is that it half ‘hits the spot’. And that can trick both parties’ Child ego states. They think they are being shown love when in fact they are not. All humans have a need for love. That need can only be fully met when:

It is shown to the person first hand (so not mother telling the child that father loves her)
Is face to face (so not via email or even the phone to some extent)
Has emotion involved
Has some form of physical contact.

If these conditions happen then the Free Child need of the person for love is met and satisfied. Indeed the child will feel loved by its mother or father if the love is expressed to the child in ways like this.





I sometimes hear clients say; “I know my father loved me, even though he never told me that”, or “I used to over hear my father tell others how much he loved me but he never actually told me”. Unfortunately these only half meet that Free Child need for love.

Societies will even formalise times when the Free Child need for love is meant to be met. In our country it is often birthdays, and the birthday gift is meant to be an expression of love for the other person. But the physical gift is only a symbol of that love and to the Free Child that does not mean much.

This is summed up well by Coleman & White (1988), “To clarify this point, consider the example of a parent and child playing a game of cards. We would invite such a parent to consider the following question : Are you playing cards with your child, or are you playing with your child and that just happens to be cards at the moment? Toys, games and play activities can provide an effective way of avoiding contact with a child. They can allow the parent and child to become side-tracked into the activity and avoid closeness, contact or openness with each other. Parents who provide children with expensive toys particularly need to consider how they play with their children.”(P13).




In the wall of trivia ‘things’ get in the way of the two parties actually getting close and having intimacy. The Free Child to Free Child transactions get blocked. Indeed in some marital counselling, the counselling can become a thing that gets in the way as well. It gives both parties a ‘thing’ to talk about other than themselves and their feelings for the other party.

A derivative of the game, “for the love or money” is the game of “Childhood obesity”. In this game love does not get mixed up with an expensive gift but instead love gets mixed up with food. The parent has the mistaken belief that it can express its love to a child by providing it with food and the child begins to take this on and when it feels full it feels loved. So it is provided with lots of food and it eats the food in its desire to feel loved. Again this only half “hits the spot”. For a brief while the Free Child need for love is met when it eats but it does not last because the need is not really getting met in the way I described above. (Note there are many other reasons as well for the over weight child).



The other derivative of the game, “for the love or money” is the game of “Higher, faster, longer”. In this instance love gets mixed up with achievement in the child’s mind. “If I can jump higher, swim faster or run longer then mum will love me”. “If I can win the gold medal then dad will finally notice me” The child believes that if it can achieve success in sport, business, education and so on then the parental love that it craves will finally be given. I would suggest that many high achievers are of this ilk. Again, it works for a little while, and the parents may in fact provide the contact with the child when it does achieve. The problem is there is always another race, there is always more that could be achieved. So the child never gets to the end and often high achievers are left with a hollow feeling as they look at their trophy cabinet, investment portfolio or degrees hanging on the wall.

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Drug use ambivalence

Using the drug use ambivalence technique with those drug users who are in remission.

I have been using this technique now for some time. I have developed it over a number of years and kind of did not realise that until I spoke with my supervisee the other day and she raised some concerns.

It is a two chair exercise where the client sits in a chair and experiences that part of their personality - either the FC or AC.



I have used it recently with two women who had been clean for some time but they had both expressed some concern about relapse. They were fine doing the FC chair and gave the usual responses of why they do not want to use - their lives are better, healthier, save money and so forth.



When asked to go to the AC chair both expressed an instant strong fear reaction. One woman even stated,

“That bit does not exist..... if it does exist it is only very tiny”.

After a bit of discussion she stated that she did not want to acknowledge that it existed because then she might use again. Indeed we had spent a good deal of time in the previous weeks discussing the idea of relapse and she was quite open about it. She was fully aware in her Adult about her desire to use drugs again but to actually experience that part of self was an entirely different thing. Her statement about it not existing or only being very small was highly incongruent. This however does show the difference between her Adult being aware of her desire to use again and her first hand experience of that part of her personality that wants to use. Which supports the validity of this technique.



However this raises an interesting question, What was she actually scared of? Does the bigger fear reaction mean the more likelihood of relapse or the closer the person is to a relapse.

Or it may simply mean that the person is scared of relapse even if they are not at any great risk of doing so.

I do not know the answer to that question. However my supervisee expressed some concern at this technique. She reported that by asking the person to experience the part of self that wants to use drugs may in fact increase the likelihood of them doing so. Another interesting proposal and one that I do not agree with.

The fear reaction, along with the reluctance to ‘be’ that part, (with one person even denying its very existence) means that she had repressed that part of her personality. She had become unintegrated in that way. She had locked away this part of her personality and kept it hidden from her conscious.



Psychological theory states that the more you integrate parts of the personality the less trouble they will be. By keeping it unintegrated the more likelihood there is that she will relapse. By experiencing it and integrating it, the less problematic it remains in the personality.

Also with her being the AC part of self it allows me to relate to it directly. This is a most important thing to do. Whilst sitting in the AC chair I can dialogue directly with it. Thus we have the opportunity to develop some relational contact. It allows us the option of building up some kind of relationship. This is a very good thing as it allows the AC to stop feeling so isolated. It defuses it and people are always in better psychological shape when they feel they are in some kind of relational contact with others.

Any time I come across some kind of self destructive aspect in a client my first goal is to establish some kind of relational contact with it.

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Singapore workshop

This is a picture of the group of counselling students I worked with recently. I ran a workshop on the theory and practice of group psychotherapy.



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Rackets and feelings

This post is a work in progress and I will complete it at a later time. It is for the comments by KYLady and di345 who asked about feelings and rackets.

One of the problems with the concept of rackets is that it has had many differing definitions in the literature. Below are listed some of them.



So people use the term in different ways and mistakenly assume (often) that they are talking about the same thing when they are not. As you can imagine confusion results in such debates over feelings and rackets.

Also I have been remiss and excluded one of the more significant barriers to dropping a feeling. So the list has increase by the number of one.



Barriers to dropping a feeling

The racket value of the feeling
The strength of its connection to a script decision
Secondary gains associated with it.
Characterological basis of the feeling

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Self harm

This was sent to me today by a self harmer who did this to her leg.



It catches the emotional core of the Borderline personality. A mixture of anger and fear.

She makes an interesting distinction between ‘playing” self harm and ‘punishing’ self harm. This is playing self harm where the cuts a quite superficial but with punishment self harm the cuts are significantly deeper. And it is the bleeding that has the most psychological significance.



In my book - Working with suicidal individuals - I propose 8 possible motivations for self harming:

1. Self harming as part of gang tattooing behaviour.
2. Self harming to make self feel real which can be found in those who dissociate.
3. Self harming to make self feel something.
4. Self harming used as a means of tension relief and to release pressure build up.
5. Self harming as a physical expression of emotional pain. Self harming is seen as providing concrete evidence of the pain.
6. Self harming as a means to self nurture. It allows the person to care for self as can be found in Munchausen Syndrome.
7. Self harming as a means to punish self and an expression of self hatred.
8. Self harming as a means to manipulate others or as a cry for help.

It would seem that reason number 7 is part of the motivation to self harm. As for seeing the blood and bleeding one would need to enquire as to what it means for the self harmer. It could be a variety of things such as found in reasons # 2, 3, 4, 5 or 6.

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What personality type are you?

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Book review - Part 2

This comprehensive book review comes from the magazine of the Institute of Transactional Analysis which is a UK based association.

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Book review

From the newsletter of the International Transactional Analysis Association



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Drop a feeling

Some people report experiencing feelings that they don’t want. In such circumstances the psychological process of dropping the feeling is required.


For small feelings



1. Child ego state experiences the feeling
2. Adult becomes aware of the feeling
3. Adult decision to drop feeling


For large feelings



1. Child ego state experiences the feeling
2. Adult becomes aware of the feeling
3. Child expresses feeling the number of times needed
4. Adult decision to drop feeling (May need two chair)

Barriers to dropping feeling



The racket value of the feeling
The strength of its connection to a script decision
Secondary gains associated with it.

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