Workshop dynamics

A good friend was recently telling me about some workshops she had run. In it she mentioned there were some people who caused some difficulties and how they were dealt with. It got me thinking a bit about how I ‘operate’ when running a workshop. I have run a few workshops in my time and often there is always 1 who can do some difficult transactions.

Even before the group starts I am assessing the culture of the group. The personalities of the participants and how those personalities combine make each group a unique one. I get a good deal of this information in watching people especially before the workshop has started and in the breaks. Who talks to who and you get some idea of the sub groups in the workshop. 

Of course it can make a big difference if the group is voluntary or are the participants forced to come along. In a lot of organizational groups the participants are sent along by the company and that can make things more difficult. 

I will be alert for the attention seeker(s). This person is usually very vocal. Asking questions, making statements or reporting on them self during the group. They will often engage the leader a good deal and sit up the front or in some central position. This person can be good for the workshop as they can get others talking and asking questions. If the group persists over a couple of days or longer they usually start to irritate some of the other participants as they do get a lot of attention and this can bring up many childhood sibling issues. This can be a good thing for the group.

I am also looking for the joker. The person(s) who says funny things and makes people laugh. Once identified I will engage them and encourage them. I am wanting to establish a culture of Adult + Free Child. If I can help the group develop that culture then the workshop is on a much stronger footing.

Also I am on the look out for the troublemaker(s). As I said before there is usually at least one. Occasionally you get a group where there are none and that is good but most often there is at least one. 

They maybe high RC. Obviously the workshop leader is the authority figure in the mind of most participants and this will bring out the RC in those who are prone to that. They may challenge the leader in some form by questioning their ability, qualifications, personal experience, the truth of what you are saying and so forth. Or they may simply complain about things. They may do things like yawn openly and loudly or seek to disrupt the group in some other way.

Then there is the high CP troublemaker. They will verbalize their criticisms of the leader, content, workshop setting or some other thing.

Then there is the person who is simply high Parent ego state. This person may say they want to ask a question but it ends up being a statement. They have trouble adopting the student role in the student - teacher relationship. As I said before the more participants who are in A + FC the better. The high Parent person finds it difficult to adopt this position and in this way can be disruptive to the group process.

How I have dealt with the troublemakers has changed over the years. In the early times I would see them more as a challenge. Probably being less confident in myself I may have felt a bit threatened by them. This is less so now. I will tend to let them have their say and give them positive strokes. If they are interjecting quite often I will let them do that for a time and they tend to hang themselves. Basically I don’t ‘fight’ them and they tend to fade away and by half way through the day they are by and large silent. Take the ‘wind out of their sails’ rather than getting ‘on top’ of them and give them lots of positive strokes for their comments, suggestions and questions.

What will they be like when they are 30 years old and attending a workshop?

Finally one thing I have always found useful to group process is to make part of it quite personal, even in organizational groups. If teaching egograms I will get them to do their own egogram. If teaching life scripts I will get them to do their own life script analysis. If they ask a personal question even if it is a bit off topic I will answer it and go off topic for a while. If talking about symbiosis someone asks a question about how to deal with their troublesome teenager I will let them and give an answer even if it is not really on the topic. Very helpful in conducting a workshop I have found.

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Drug and alcohol use history of the therapist - Part 2.

A comment in the previous post (here), provided interesting insight on how to respond to a client who asks a therapist:

“What is your drug and alcohol use history?”

I have found that other groups do ask similar questions. A client going through a divorce may ask if I am married and have I been divorced. A client with problem teenagers may ask if I have children and teenagers. I don’t find the question all that odd in itself.

It is interesting to read your response. If I asked the question as a client of yours and you said you preferred not to answer it as you felt it was personal, how would I respond? First I would feel validated and respected. That is I have asked a direct question and you have acknowledged it an answered it. Or at least dealt with it by saying you preferred not to answer. I would have no problem with that and feel respected in the transactions.

The response I would have trouble with is when the therapist only responds with:

“Why is that important to you?”

I find this an underhanded response. The therapist finds self feeling awkward with the client and they side step out of it by pathologising the client. I find that disrespectful to the client. Their response is to jump into the safety of their therapy and get out of it by indicating to the client that their question must be the result of some unconscious conflict in them. When their motive at least in part is their own feeling of discomfort and unwillingness to deal with it in a direct way with the client, unlike you did.

Having said this you still have not answered the question and the client may then ponder if the reason you gave is the real reason. There could be other reasons you may have

1. You do have an extensive drug and alcohol use history and are ashamed of it.

2. If you have used drugs and excessive alcohol in the past you may feel the client disrespects you for that.

3. You have no drug use history and fear the client may loose confidence in you because you don’t really know what you are talking about.

However as a client I personally would find these minor issues and it is more important that you have validated me originally by dealing directly with my question as you did.

One other point I would like to mention that I referred to in my previous post is the response that the question is not relevant. When you think about it is not all that irrelevant.

In the transference, what a therapist does in their personal life can be most important to the client.

Whilst I said that I have been asked the question only infrequently I think it is quite likely that lots of clients have pondered the question and just not verbalized their musing. If one is a transference figure then the client will think about the therapist and their personal life. Indeed their personal life can assume considerable importance to the client. So it is not irrelevant in this sense.

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Thinking and doing

A recent article in InPsych magazine of the Australian Psychological Society (2012) concluded that in the literature there is wide disagreement about the negative effects of watching violent video games and other violence on TV. Researchers have tried forever to find a link between watching violence and subsequent aggression and it has just not been forthcoming. The results are very varied and have been so for years.

My personal view on this is one I have stated before. There is a very big difference about thinking or fantasizing about something and actually doing it. They are two quite separate things that involve two quite different psychological processes. 

Fantasy is an important part of human psychology

Confusing this however is the fact that we all think about things we have done and will do again in the future. We may daydream and fantasize about going on a holiday, getting angry at the boss or even some sexual behaviors and then go and do them. This however does not make them similar psychological processes. All it means is that it is acceptable to the individual to think about doing something as well as doing it. That does not make them the same and here I will provide some examples of how they are different.

The following list was present by the Australian Psychological Society (2006). It is a violence risk assessment tool being devised based on the various research about physically violent people and the characteristics of them:

Historical

Previous violence

Young age at first violent incident

Relationship instability

Employment problems

Substance use problems

Major mental illness

Psychopathy

Early maladjustment

Personality disorder

Prior supervision failure

Clinical

Lack of insight

Negative attitudes

Active symptoms of major mental illness

Impulsivity

Unresponsive to treatment

Risk management

Plans lack feasibility

Exposure to destabilizers

Lack of personal thought

Noncompliance with medication attempts

Stress

Interestingly, thinking or fantasizing about violence is not included.

It may look a bit aggressive but that does not mean they will act aggressive.

Thinking is a completely personal event that has no impact on anyone else. Others will only ever find out about it if the thinker discloses their thoughts. Behaviour is a public event that can effect others directly. One may try and hide the behaviour but there is always the danger they will be found out or secretly observed by someone else.

Thinking of being aggressive to another, as I said before, has no impact at all on the other. If one behaves aggressively towards someone that has a direct impact on the other person. Thus we have a major difference in the psychological processing between the thinking and behaving. 

Most people are capable of empathy. 

Thinking has no impact on others so empathy is not a consideration in choosing to have the aggressive thoughts or not.

Aggressive behaviour has direct impact on others so empathy is a key consideration in choosing to behave aggressively or not.

The same applies for legal considerations and damage to reputation. As thinking is completely private the legality of what one thinks and the possible damage to their reputation are not considerations at all. Behaviour being public, the legal considerations and damage to reputation may be very significant factors.

These two diagrams show the different psychological processes involved and as one can see they are quite different.

Video games and movies are pure fantasy as any player knows so their FC can be let free to run wild. To hit (let alone shoot) another person in reality is a very different process where empathy and Adult ego state considerations will significantly curtail any expression of the Free Child want.

This is supported by the violence risk assessment measure such that it does not even include thinking violent thoughts as a risk factor in expressing violent behaviour.

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Drug and alcohol use history of the therapist

In my book I discuss a situation that all drug and alcohol counsellors fear. It lurks in the back of the mind and can surface at any time. The client can raise it at anytime and leave a conundrum for the counsellor. The client can ask, 

“What is your drug and alcohol use history?”

In my experience I have not been asked this question often but it does happen from time to time. How does one answer? There are two schools of thought on this.

Should I choose the red or the blue?

First the counsellor can in essence refuse to answer the question and say that it is not relevant and move onto another topic. Others may use the distraction technique and answer the question with another question:
Client:  “What is your drug and alcohol use history?”
Therapist: “Why is that important to you?”
Sooner or later however the client will realize the therapist is not going to answer the question.

Second the counsellor answers the question and does some self disclosure about their history of alcohol and drug use.

I think the first response is not a wise one to take. It in my view builds intrigue you do not want. The client is left wondering why you ‘really’ refused to answer. Is there something you are ashamed of or maybe your drug and alcohol use history has been extensive. Also you are asking the client to disclose many things, some of them quite intimate and then you refuse to disclose something to the client. This may leave them feeling problematic emotions about your refusal.

If you take the second option and answer that you have had little or no history in this way then some clients will feel you are somewhat ignorant about such matters. To most it probably make little difference but there is a group to which it is quite important and it can damage your potency as a therapist in the eyes of the client.

If you answer that you have used drugs and alcohol at times in the past then that can leave some clients feeling that you do know what they are talking about. However it is also permission giving to the client to take drugs. If you are a strong transference figure to the client this can be particularly so. If you stopped using drugs when you were 30 and the client is only 25 some could take this as permission to keep using for 5 more years. Other clients may view you as hypocritical. You are suggesting a client do something that you did not do yourself. 

Then of course there is the situation of the counsellor who is currently using significant amounts of illicit drugs or abusing alcohol. That can also provide permission to the client and is a more delicate clinical scenario.

On the positive side it can engender trust in the client towards the therapist. If the therapist reports a history of drug and alcohol use the client may respect the therapist for being honest with them by reporting previous ‘bad’ and ‘unprofessional’ behaviour. If you say you don’t have any significant drug and alcohol use history the client is going to wonder if that is true or are you lying to them. To tell such a truth can build respect of you in this way.

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Shame - What it is and working through

(Originally presented in

“Thoughts on Shame”. The Transactional Analyst. The quarterly magazine of the Institute of Transactional Analysis. Summer 2012, Vol 2 (3), Page 21 - 24.)

Introduction

I have always found shame somewhat of a perplexing emotion. It has some unique features that separates it from the rest of the emotions especially in how one deals with it therapeutically. This has lead me to research and study this emotion and hence the motivation behind this article. Writing on shame abounds in the literature including Wright, Gudjonsson and Young (2008), Gao, Wang and Qian (2010) and Wolf, Cohen and Insko (2010). In the transactional analysis literature an excellent statement on shame is made in a theme edition on shame in the Transactional Analysis Journal (April (1994)). Including articles by the likes of Erskine (1994) and English (1994).

Shame the emotion

In surveying the literature on shame one quickly comes across a debate about the nature of shame and what it actually involves. In this article the terms emotion, feelings and affect are used interchangeably. One commonly finds three concepts mentioned in relation to shame - internalized anger, guilt and shame itself. There are differing views on these such that one finds confusion in the literature about the nature of and definition of shame. For example Goss and Allan (2009) in their discussion of shame state, "It blends the different emotions of anger, anxiety and disgust, involves social comparison and can have different foci,…"(p303-304). Others have disagreed with this and attempted to distinguish the various emotions involved with shame including guilt and anger, (See: Gao, Wang and Qian (2010) and Wright, Gudjonsson and Young (2008)). This is also well summarised by Wolf, Cohen and Insko (2010) who state, "What are shame and guilt, and how do they differ? Within psychology, as well as everyday conversation, the terms shame and guilt are often used interchangeably. There is a general confusion about the distinctiveness of these emotions, possibly because of their many similarities."(p337-338)

As mentioned before anger and guilt are often mentioned as relating to shame or being part of shame. My own view is that each of these constitute three separate psychological processes. They are three separate entities. However they can and often do occur contemporaneously. This could then explain why some see guilt as being part of the shame experience or internal anger being defined as shame on other occasions. If one can define the three separate psychological processes this would clarify the nature of shame and its associated processes. Fortunately Transactional Analysis theory allows us to come up with quite clear statements about the distinct psychological processes involved in each of these three emotions.

Internalized anger

There are two ways in which internal anger can occur in ego state theory. See diagram 1.

Diagram 1

People can express anger at themselves from their Child ego state. When this occurs people will do negative internal self talk such as I am stupid, I was a geek talking to that girl and so on....

Anger can also be expressed from the Critical Parent ego state to the Child of the person. In this case the internal self talk starts with a “You” statement when an internal chastisement occurs. Examples may be “You were such a jerk talking to that boy”, “You can’t even get a simple report right”, “You stupid jerk” and so forth.

Guilt

Guilt occurs when the person has a sense of breaking an internal rule which they have for themself. If a husband thinks the woman next door is hot and foxy but has a rule inside his Parent ego state which says, “Thou shalt not covet thy neighbour’s wife” then he can end up feeling guilt for having such thoughts.

Or a person may steal money from his brother and later feel guilt about it because he has the rule in his Parent that you don’t steal from your brother. People can feel guilty the next day after a night of drinking too much. Alcohol decommissions the Parent ego state and thus people behave in ways that they usually wouldn’t. The next day after the alcohol has worn off they feel guilty because the Parent ego state becomes active again. Diagram 2 shows the transactions.

Diagram 2

Shame

Finally we have shame which is a natural feeling reaction to particular environmental stimuli. Often, but by no means always, it is associated with sex, nudity or intimate bodily processes such as urinating or defecating. A prime example is the enuretic child who wets his bed at night. When the child wakes up and realizes he has wet the bed it is very easy for him to feel shame and he can go to extensive lengths to try and hide it. Indeed parents need to be very careful not engender a sense of shame in a child when he wets the bed. It needs to be dealt with carefully so as to avoid this. What is being suggested here is that shame is one of the innate feelings that all humans can experience. Others such as Adams (2008) and Kaufman (1992) have suggested the same. In this way shame is a natural Free Child reaction to certain events. Thus we have the shame transaction in diagram 3.

Diagram 3

As you can see this differs from the guilt transaction in that there is no Parent to Child transaction before for emotion is experienced. This is consistent with Freud’s presentation on shame which is probably best summed up by Lynd (1958) who notes that guilt is usually more related to transgressions of clear moral codes and rules. No better example of this is found in religious texts which define what behaviors, thoughts and feelings are regarded as sinful. These are incorporated into the Parent ego state by the young child and when transgressed the individual most often will experience guilt. 

With shame the rules are much less codified and clear. Transgressions of them are more by tactlessness, errors in taste or bad luck. As a result the Parent ego state is much less involved in the process. Again the example of the enuretic child demonstrates this. Wetting the bed does not break a Parent ego state rule and generally would not be regarded as sinful. Instead it results from bad luck or factors outside the child’s control.

Presented here are three separate psychological processes – inward directed anger, guilt and shame. They can occur on their own or they can occur together. However if we see them as separate processes then we are afforded the opportunity to understand shame without the usual confusion of guilt and inward directed anger.

Unique qualities of shame

What does a therapist do when a client presents with feelings of shame? One knows what to do when a client is angry. They feel the anger, they express the anger and when ready they drop the anger. When a client feels sad the therapist acknowledges the feeling, the client expresses the sadness with some kind of crying usually, one listens to the client, empathizes with them and is compassionate. Then the sadness is dealt with. 

The natural Free Child reaction to anger and sadness is a therapeutic one. There is a natural desire to talk about it, to have some kind of catharsis and release the emotion. This natural urge will result in the feeling being ‘worked through’ often with the support of a compassionate other. The feeling is naturally dealt with and resolved which of course is a desirable state of affairs and makes the therapy process clear.

However shame is different. When people feel shame there is a strong desire to withdraw or change the topic. The person wants to go into hiding in some way. Common bodily expressions when one experiences shame include a bowing of the head, an attempt to hide the face possibly with the hands, a blushing of the face, possible sweating, body bent over on itself and possibly a closing of the eyes. It’s like the person is endeavoring to make them self as small and invisible as possible and there is a strong drive to isolate self. This seems to be the natural Free Child reaction to shame. The problem with this, is it does not deal with it in the therapeutic sense unlike anger and sadness.

In essence it is an avoidant, ‘Lets try and forget about it’, approach. Therapeutically this does not resolve the difficult feelings. They need to be brought out into the open, experienced and then one can ‘get over it’. The Free Child reaction with shame is to hide and avoid. With most other feelings the Free Child reaction is a therapeutic one that will bring resolution of the painful event like expressing sad feelings when one’s cat dies. With shame the natural Free Child reaction will not bring resolution or closure to the event. Thus shame is somewhat unique in this way.

Society likes a temperate woman

Working with shame in the therapeutic process. 

Paradoxically therapists are often working with shame even before being aware they are. For instance clients with bulimia or those who self harm often feel shame about their behaviour. As the natural response to shame is to hide often the client will not disclose such behaviour for some time. The goal here is to establish relational contact such that the client feels ready to disclose what they see as shameful behaviour but the therapist will only know that in retrospect. However when the client does finally disclose such feelings then one knows that successful relational contact with the client has been established. White (1998) discusses this in detail in his paper on transference and humanness of the psychotherapist. Such transferential and counter transferential contact is made when the therapist allows himself Free Child ego state contact with the client. This as he points out is surprisingly difficult to do but if done then the transference established will promote the client to expose their sense of shame to the therapist. Thus achieving one of the first crucial steps in working with shame in the therapeutic process.

The next step in this method of working with shame is to diagnose what is actually happening. As I said before shame, guilt and inward anger are often confused. The therapist needs to question the client to ascertain which of the three processes is occurring to see if the person is actually experiencing shame. Indeed one of the indicators that shame is present is the fact that the person has been reluctant to bring it up. Often there will be more than one process occurring concomitantly. Once established this can be explained to the client so they are aware of what is actually happening with their emotions in this way. Which of the three processes they are actually experiencing.

If inward anger is diagnosed then of course the therapist deals with that appropriately as he does if guilt is indicated. The main problem emotion here is shame because as I mentioned before the natural Free Child reaction to shame is not a therapeutic one. 

The therapeutic response I have developed is really quite simple. As the natural response to shame is to go into hiding one invites the client to do the opposite. To come out of hiding and bring the behavior and feelings of shame into the relationship with the therapist. Basically they talk about it and the therapist responds in an empathetic way, also disclosing their Child reactions to the behaviour and feelings of shame. The therapist expresses his Free Child responses to what the client is saying. The goal is to normalize the shame response in the client.

Once the client has made such a disclosure the therapist can also raise the events at the appropriate times. One needs to be somewhat forthright in this way as this assists the normalizing process. The more it is brought up, talked about in an open way with no ‘shock and horror’ responses from the therapist the less shameful it becomes. The shame loses its potency over time. If the therapist always waits for the client to bring it up then the normalizing process can be very protracted. If mentioned only very occasionally there may be little if any normalizing occurring at all. 

Often the therapist needs to be proactive here and raise the shame producing events especially if the client never initiates talking about it. This is where clinical skill comes to the fore. One does not want to be always bringing it up but it does need to be raised from time to time. How often that is, depends on the client and the circumstances. If successfully managed then over time the shameful event becomes something that can be easily discussed with little or no shame reaction. At this point it can be said that the shame has been worked through.

Conclusion

While the Free Child of the client has a natural drive to work through feelings like anger and sadness this is not the case with shame. Hence the therapist needs to intervene to halt the natural hiding away reaction by the client to their shame. The therapist brings out the shaming experiences at appropriate intervals, they are discussed and over time the potency of the shame significantly reduces such that open discussion can occur and there is little sense of shame in the client.

References

Adams, S.A. (2008) “Using transactional analysis and mental imagery to help shame-based identity adults make peace with their past.” ADULTSPAN Journal. 7, 1, 2-12

English, F. (1994) "Shame and social control revisited." Transactional Analysis Journal. 24, 2, 109-120.

Erskine, R.G. (1994) "Shame and self righteousness: Transactional analysis perspectives and clinical interventions." Transactional Analysis Journal. 24, 2, 86-102.

Gao, J. Wang A. and Qian, M. (2010) "Differentiating shame and guilt from a relational perspective: A cross cultural study." Social Behaviour and Personality. 38, 10, 1401-1408.

Goss, K. and Allan, S. (2009) "Shame, pride and eating disorders." Clinical Psychology and Psychotherapy. 16, 303-316.

Kaufman, G. (1992) Shame: The Power of Caring (3rd ed.). Rochester, VT: Schenkman Books.

Lynd, H.M. (1958) On Shame and the Search for Identity. London: Routledge & Kegan Paul.

Wolf, S.T., Cohen, T.R. and Insko, C.A. (2010) "Shame proneness and guilt proneness: Toward the further understanding of reactions to public and private transgressions." Self and Identity. 9, 337-362.

White, T. (1998) "Psychotherapy and the art of being human." Transactional Analysis Journal. 28, 4, 321-330.

Wright, K., Gudjonsson, G.H. and Young, S. (2008) "An investigation of the relationship between anger and offence-related shame and guilt." Psychology, Crime & Law. 14, 5, 415-423.

Terminating counselling with a client.

Introduction

When one employs a counsellor it is different to employing a plumber because you have to take the relationship into account as well. Indeed it is unique when compared to others in the ‘helping’ professions. When one goes to a doctor, surgeon, dentist or physiotherapist the relationship is clear. One goes for a specific goal and when that goal is achieved the relationship ends. Both parties know this from the beginning of the contact between them. Counselling is not like this. Firstly because the goals are usually less clear and the relationship between the client and counsellor is just as important (if not more important) than any treatment techniques applied.

Ending a relationship (attachment) is not an easy task. It does not matter what that relationship is be it siblings, spouses, friends and of course client and counsellor. It can be quite difficult for both parties no matter what the relationship.

Obligations between client and therapist

At this point it seems cogent to remember the underlying principles on which the relationship between the client and therapist are based. My thoughts are that the relationship is largely obligation free. (It should be noted that there would certainly be other counsellors who are of a different view on this matter). There is one out of four obligations required.

1. The client has no obligation to see a particular therapist

2. The therapist has no obligation to see a particular client

3. A client has no obligation to explain to a therapist why they wish to end therapy.

4. If the client requests it, a therapist has an obligation to explain to the client why they wish to end therapy.

The exit consultation

Sometimes a therapist will ask the client to contract to make an exit consultation. To agree to not just suddenly cancel an appointment or simply not show up and never contact the therapist again. They contract to make one final (exit) consultation should they choose to end therapy. The usual reasons for this are:

For a sense of completion of the gestalt for both the client and the therapist

To make sure the client is not leaving in a bad place

Counter transference and the exit consultation

These reasons seem reasonable and valid and if the client does agree to an exit consultation then this seems like a therapeutic thing to do. However there can be other motives why the therapist may make such a request and these can be due to counter transference issues in the therapist.

As mentioned before ending a relationship can be difficult and that is no different for a counsellor who may have developed some level of attachment to a client. It is hoped the counsellor would have some kind of supervision available should a difficult termination arise. The therapist may feel such thing like:

“I will use the exit consultation to try and talk the client out of it because I am insecure about my abilities and I take it as a personal rejection”.

The therapist may even be unaware they are feeling such things.

The counter transference termination transaction

Transaction 1 is the overt Adult to Adult transaction that the therapist and client make with the exit consultation contract. 

In conjunction with this the therapist can also have ulterior, covert and (probably) unconscious motives. 

Transaction 2. The covert Parent to Child transaction: “Explain yourself”, “I don’t like ti when my influence is reduced”.

Transaction 3. The covert Child to Child transaction: “Please don’t reject me”, “Show me I am a good counsellor”.

Normal counter transference reactions

It seems safe to say that with some clients there will always be some kind of counter transference reaction when treatment ends. Especially if there has been quite a long period of treatment and if the therapist has developed some degree of psychological attachment to the client. When the relationship ends the therapist will have some level of a grief reaction. Hopefully the therapist is aware of this and may even communicate it to the client and then the termination can proceed relatively easily. The Free Child of the therapist will feel the pain of grief and bereavement in varying degrees.

Some therapists view this as a negative aspect of therapy and seek to avoid this normal counter transference by ‘keeping it clinical’. Some therapists become clinical in their view of the client and therapy and thus the attachment from the therapist to the client is kept to a minimum. The down side of this is you loose the therapeutic power of the client - therapist relationship. If the therapist is going to allow himself to develop some attachment to the client then one gains the advantages of the therapeutic relationship. However they also need to be aware of their tendency to get into their old self defeating relationship patterns that can interfere in the therapy process and make the outcome worse for the client.

Life script and terminating therapy

People tend to behave in patterns which means their relationships will tend to have patterns as well. In their relationships they will tend to do the same thing over and over again. The most important factor in the termination phase of counselling, is the client does not leave the therapeutic relationship in the same old self defeating relationship patterns. If this happens the client is using the ending of this relationship as a way to further their life script. They are ending the therapeutic relationship in a script bound way. It is most wise for the counsellor to raise this issue if they suspect it may be heading that way. Indeed some counsellors raise the issue with every client early on in the therapy.

For example if a client has a history of being rejected they may start to do a few things that will get the therapist angry or tired of them. They may start to not pay bills, they may consistently keep attacking the therapist personally, they may all of a sudden appear at the therapist’s home one night because they just have to see them then and there. It’s up to the therapist to identify and anticipate these relationship game maneuvers by the client so that the therapeutic relationship does not end up in the same old way for the client.

The No run contract

A “No run” contract is similar to an exit consultation but the reasons for it are different. The client contracts to make at least one more appointment before ending treatment. The motive behind it is that for some reason you want to lock the client into the therapeutic relationship. That may be to close the escape hatch of running from a relationship when the client feels reliance developing which may be their life script pattern. The counsellor is seeking to increase the clients distress by not allowing them to ‘run’ and then use those feelings in a therapeutic way. Or indeed it may heighten a sense of security for the client. There can be a whole range of motives for a therapist to suggest such a contract.

For the person who uses flight (compared to fight or freeze) as a basic coping mechanism such as the schizoid personality, it can be advantageous to introduce the idea of a no run contract quite early on, but it depends on how they do their flight. Some schizoids can 'flight' with physical relocation and hence the no run contract can be quite useful. Others don't have to move anywhere and will simply 'flight' in their mind and feel distance when they are sitting in the same room as the therapist. It is possible to have a psychological no run contract but that is harder to create and manage.

When the client terminates therapy without discussion

Sometimes a client will leave a message canceling an appointment and not making another one. Other times they simply do not turn up for the appointment and you do not hear from them again. The therapist is not given a chance to speak with the client when they terminate the therapy.

What therapists do in these circumstances varies greatly. Some will do nothing at all and others will actively pursue the client to talk with them directly. My own view is to take it on a case by case basis. Sometimes I do nothing and other times I will try and contact the client to speak with them.

This comes from CARMHA (2007) who are discussing working with suicidal clients.

“A client’s lack of follow-through with treatment may reflect hopelessness, pessimism, and cynicism regarding the value and benefit of treatment, and may be affected by the stigma of mental illness and suicide... Clients who reject help and withdraw prematurely from treatment tend to view interpersonal situations as risky and ripe for potential humiliation and emotional hurt”... (p10)

Speaking generically and not just about suicidal clients my view is that one needs to be careful not to harass or pressure a client. If that happens the client will either move into Conforming Child ego state and approach therapy from a conforming stand point which means the therapeutic process is significantly compromised. Or they shift into Rebellious Child and you never see them again.

This pressuring can happen particularly with the treatment of the suicidal where the therapist becomes a bit scared of a possible suicide attempt. This results in a change in the therapist’s behaviour such as how they deal with a client who drops out of therapy. The unusual behaviour of the therapist can result in outcomes one does not want. The therapist panics and ends up doing ‘poor’ quality therapy. When working with the suicidal one needs to often ask the question:

“If this client was not suicidal would I be doing what I am doing?”

Unlike the quote above I would suggest a significant number of clients stop attending because they are not ready to deal with what they are working with. Whenever I take a history of a new client I always ask if they have been been to counselling before and if they have, what happened and why did they stop. Not uncommonly they will say  things like:

“I just was not in the right frame of mind.” 

“I just wasn’t ready to do what was required at the time.” 

“I had had enough by that time and needed a break.”

“I felt I was not getting what I wanted.”

I would say that rarely would a client report it was because they were afraid of interpersonal risk, because of stigma or because of the potential for humiliation. The examples I provide above I would say are much more common reasons.

Over the years I have had clients cancel appointments or just not turn up. Some I never see again and others come back later on. Indeed when a client ‘drops out’ that can be a used for therapeutic gain later on when they re-engage. One can use No run contracts, No engagement contracts, Phratry contracts and the like to create a variety of therapeutic scenarios for the gain of the client.

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Reference:

Centre for Applied Research in Mental Health and Addiction. (CARMHA)

2007. “Working with the client who is suicidal : a tool for adult mental health and addiction services”. Simon Fraser University: British Columbia

Why kids kill

I wrote an article some time ago on why kids kill. The possible psychology behind why young people can become mass killers.

On FaceBook Lesley made the comment

Some very interesting points there Tony. The only thing, and I hope you don't mind me adding my 5 cents worth, with regard to teens acting like a small child having a temper tantrum when they kill. Temper tantrums are not planned. They seem very spontaneous and it would appear that the massacres that teens carry out are planned over a long time. I do agree about the uncontrolled anger all the same.

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I take your point Lesley that temper tantrums of a two year old are not planned. And the psychology of a 2 year old and 20 year old are obviously different. The point I was trying to make was that in some way kids who kill like this, display some qualities of a temper tantrum and that of course is going to be different to a 2 year old temper tantrum

Even in murderous acts there will still be a quality of childlike innocence.

In both the cases of Martin Bryant and the Adam Lanza they began with what seemed like premeditated and planned murders. Bryant killed those two people in their house he had a grudge against and Adam Lanza began with killing his mother.

Matricide! Now there is about four blog posts worth of material. Matricide is probably one of the most abnormal behaviors humans can display. For children mother is the most important person in the world by far. Mother is the key to a child’s psychological and physical survival (even if she abuses the child). I think it is safe to say that the offspring of any mother take this psychological position. Whether that be a human offspring or the offspring of a seagull.

The death of mother is the one thing a child fears most. Even when the child is in adulthood it seems safe to say that mother still occupies a unique and very special position in their core of their psyche. To kill mother is an act so against the very biological programming in us humans, one could argue. Hence the view that it is a very abnormal piece of human behaviour. It is so completely against nature and millions of years of evolution. 

For a child to kill a mother is completely antithetical to human evolution

Clearly the first killings were not of a temper tantrum style. It seems after the initial event then there was more of an indiscriminate temper tantrum display of anger. One could say both young men switched ego states in some way from the 20 year old planning style to a kind of 2 year old emotional state of mind in the expression of their anger. One can say that the will display a combination of 20year old and 2 year old behaviour mixed in together.

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Hierarchies - Core beliefs and script decisions

Cognitive behavioral therapy (CBT) and Transactional analysis (TA) have a number of commonalities. One obvious example being the similarity of what CBT calls automatic thoughts to the TA idea of early decisions. Automatic thoughts are faulty beliefs one develops in childhood, which result in problem behaviour and feelings later in adulthood. The faulty beliefs become ingrained patterns of thinking such that the person is often unaware they are influenced by them.

A recent significant contribution to the literature on CBT therapy and theory is presented by:

Judith S. Beck

2011. Cognitive Behaviour Therapy: Basics and Beyond. Second Edition. The Guilford Press: New York.

In this book she presents the idea of what is called a “hierarchy of cognition” (P36). This provides a hierarchical structure to core beliefs and automatic thoughts shown below, (P35)

The nature of core beliefs is described by Beck (2011) in the following:

“Core beliefs are the most fundamental level of belief; they are global, rigid, and overgeneralized. Automatic thoughts, the actual words or images that go through a person’s mind, are situation specific and may be considered the most superficial level of cognition. The following section describes the class of intermediate beliefs that exists between the two”. (P34)

“How do core beliefs and intermediate beliefs arise? People try to make sense of their environment from their early developmental stages. They need to organize their experience in a coherent way in order to function adaptively (Rosen, 1988). Their interactions with the world and other people, influenced by their genetic predisposition, lead to certain understandings: their beliefs, which may vary in their accuracy and functionality. Of particular significance to the cognitive behavior therapist is that dysfunctional beliefs can be unlearned, and more reality-based and functional new beliefs can be developed and strengthened through treatment”. (P35)

“People develop these beliefs from an early age, as children, with their genetic predisposition toward certain personality traits, interact with significant others, and encounter a series of situations”. (P228)

Put a child under significant stress and its natural temperament will begin to show. Is this flight, fight or freeze?

This sounds very similar to what the Goulding's presented in 1976 with their theory of early decisions. (Goulding & Goulding 1976. Injunctions, Decisions, and Redecisions. Transactional Analysis Journal, 6(1), 41 - 48.) As children develop they are from time to time confronted with distressing situations. When these happen the child will feel a need to make sense of them and this results in making early decisions which result in the injunctions which are automatic ways of thinking about self, others and the world. They proposed eleven injunctions in all:

Don’t exist

Don’t be you (sex you are)

Don’t be a child

Don’t grow up

Don’t make it (succeed)

Don’t

Don’t be close

Don’t belong

Don’t be well (sane)

Don’t think

Don’t feel

This in essence, is a list of automatic thoughts which the Goulding's observed occurred repetitively.

Hierarchy of cognition

What Beck (2011) provides is a hierarchical structure to core beliefs and automatic thoughts as was described above. This can be adapted to Transactional Analysis theory leading to a hierarchy of inborn temperament, life positions (core beliefs) and early decisions (Automatic thoughts). 

A similar model could be presented here

To explain further, examples of this are provided here in relation to the suicide decision. The suicide decision is included in what the Goulding's called the Don’t exist injunction. This one injunction actually includes a subset of seven different types of suicide decisions as shown here

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

When confronted with distressing circumstances some children will make a suicide decision similar to one of the above. The two examples presented below show how this can occur in a hierarchical structure.

We all have a natural temperament of some kind whether that be flight, fright or freeze. Then at a young age, probably preverbal we develop a basic belief (Core belief) about ourselves and others which in transactional analysis terms can be seen as the life positions. Sometimes this can also include an injunction that is especially influential. These in the past have been called core injunctions and the other injunctions are seen to be especially influenced by these. A good example of this can be the Don’t trust injunction which can become one of the core components of the personality.

After the core belief has been established the young child then makes a series of early decisions in times of particular distress and these are influenced by their temperament and the core beliefs. The two examples above show how the temperament in particular can influence the decisions made and then the final behavioral outcome.

In a similar way this hierarchical model can be used to demonstrate the development of physically violent behaviour as is shown below.

When people make the suicide decision they decide that suicide is an option for them in times of high stress. The same applies for people who use physical violence as is found in domestic violence. The young child decides that to physically hit others is an option in times of high stress. If one has not made this decision then they will rarely use physical violence.

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