Two book reviews

Tony White, 2012

Working with Drug and Alcohol Users, London, Jessica Kingsley Publishers.

This is one of those reviews that are more about the reviewer than the book. At least the first 50% is about him and his woes. The person at error here is the book review editor of the British Journal of Social Work. He/she should not have allowed the review to be included as is. A book review is meant to be a review of a book. In this ‘review’ the book does not even get mentioned until over half the way through. The first half should be in a letter to the editor section of the British Journal of Social Work not in the book review section of the journal.

At one point he states:
“Those of you familiar with the issues surrounding this topic will find little here but the basics—however, skip the first three chapters and you will be rewarded with an unusual and engaging account of the use of TA in this field.”

The book is written for the social work student and hence we have some of the basics. I could write a book for the experienced drug and alcohol counsellor which would be more relevant to him but then that book would be of little use to the student. 

However there are some interesting comments made.

Second review by Bruce Ritson.

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Sensitizing a child to an emotion (racket)

As children grow and develop they come across events where they will experience the full range of emotions. This of course is a natural thing for a child to do. However sometimes they will be hyper sensitized to an emotion which means they will feel it more often and more intensely.

This sensitizing process happens by parents encouraging that emotion in the child. For example this can happen with shame if the parents raise the child using shame. 

For example the parent may say

“You should be ashamed of yourself for...”

Or the parent in some way derides or humiliates the child in front of its peers or siblings as a means of socializing the child.

Or if the child wets the bed and the parent uses some kind of shaming process in an effort to get the child to stop wetting the bed. For example getting the child to wear its wet underpants on its head for a period of time.

If a child is raised with this then it becomes sensitized to the emotion of shame and this becomes a function on the Adapted Child ego state rather than the Free Child ego state. As children go through life they come across situations where they feel shame or embarrassment. This is Free Child. The child who is sensitized to shame will have many more situations where they feel shame than the non sensitized child. In addition when they feel the shame it will usually be more intense. This is a racket and a function of the Adapted Child ego state.

Of course this can happen with any emotion like anger, sadness, happiness and fear. When working with clients the therapist needs to diagnose if they are dealing with an FC or AC emotion as they are dealt with differently.

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Racket feelings and manipulation

In my upcoming workshop on racket feelings I look at the role feelings can play in human relationships. Especially how people use feelings to manipulate each other. The three most common feelings used to manipulate others are fear, guilt and shame.

For example, many men and women have had a covert unwritten agreement for many generations. Most of the time they are unaware they are even doing so. Women have learnt that in conflict with a male if they start to cry some men will tend to give them what they want, at least to some degree. They are behaving in such a way that the man will feel guilt and this motivates him to change his behaviour in such a way that suits the woman.

On the other hand men have learnt that if they begin to raise their voice and show some level of anger then some women will have a fear response and this motivates her to change her behaviour such  that it suits the man to some degree.

Then there are parents and children. Parents learn quickly that to get a child to do what they want using fear, guilt or shame is much more effective than the usually prescribed methods of time out and consequences of behaviour. The only difficulty with using the feelings method of parenting is there are some negative side effects for the child.

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Fantasy and meditative anger work

Anger work or the cathartic release of anger in therapy is a contentious issue. Some actively support it and others see it is a retrograde step that will just lead to more anger and violence. There are many ways to release anger in therapy ranging from the quite mild to restrained rage work on a mat.

Fantasy anger work is an interesting procedure and somewhat of a contradiction. In terms of cathartic release it is the mildest of all in that the person writes down or draws pictures of them self being angry. On the other hand it can be of a very violent and aggressive quality unlike any other type of anger work. Indeed it is limitless in its aggression and violence and people can do this type of anger work and think of things that are murderous and so forth. So on the one hand it is a very mild cathartic release of anger but at the same time it can be highly aggressive and violent.

Below is a statement of this type of anger work. After that is a paper sent to me recently by a friend. It uses a meditative or guided fantasy type of anger work. I have not seen this before in this way and adds an interesting addition to the area of anger work in psychotherapy.

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Video of London conference May, 2013

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Violence and aggression in youth

Adolescent aggression

Anti social  behaviour during adolescence is statistically normal, and only a small proportion continue to behave in an antisocial way into adulthood. Criminological research shows that the prevalence of criminal involvement peaks during middle to late adolescence then declines rapidly and tapers off for most by their early twenties.

(My response:  One wonders what is the evolutionary advantage of having a criminal youth? Perhaps they give society a spark that results in change if need be. Keeps society on its toes so to speak?)

Anger management

Four core components of anger management.

1.  Exposure to provocation that leads to some level of emotional arousal.

2. Cognitive change that mediates the automatic thoughts which lead to angry feelings.

3. Self management skills that lead to the development of appropriate coping skills

4. Relaxation to reduce physiological arousal  and manage stress.

Engaging the violent client

One of the biggest challenges in working with the aggressive and violent client is engaging them in the process of change. Some (many) will resist taking responsibility for their own feelings and violent behaviour. Some steadfastly maintain they were justified in their behaviour  and it was appropriate for them to act violently. Habitually aggressive people can be hostile towards treatment providers.

Youth violence: family risk factors.

Poor behaviour management practice by parents such as poor supervision

High levels of family conflict

Family history of antisocial behaviour

Childhood abuse and neglect

All of the above comes from:

 InPsych: Bulletin of the Australian Psychological Society,  June 2013.

Transactional analysis and youth violence

One would propose the presence of an early violence decision. This is similar in nature to the suicide early decision that I discuss in detail in my book - Working with suicidal individuals. 

When a young child makes the suicide decision it means it decides that suicide is a viable option as a problem solving technique should it to choose to use that option later in life. The violence decision is the same. The young child makes an early decision that violence is a viable option to solve a problem. If this decision is not made then that person will be very unlikely to use violence as a solution to a problem in adulthood. As is the same with the suicide decision.

Three aspects of violent behaviour

One can look at two further aspects of the violence decision which can be made in childhood and  are presumed to be a prerequisite for any pattern of violent behaviour exhibited by youth or adults.

It seems reasonable to assume that the child who is likely to make the early violence decision would have a natural temperament of fight, versus flight or freeze. That child who has an inbuilt propensity to deal with stress and adversity by fighting rather than fleeing or using the 'play dead' response. 

It seems plausible that the individual who has a natural temperament of fight is more likely to adopt the life position of You're not ok. Hence we have an interaction  between three variables. The temperament of fight, the life position of You're not ok and the early violence decision. Each one supporting the other thus making the violent individual quite resistant to therapeutic interventions because of this intertwined effect between these three personality factors.

The violence decision

This allows us to formulate a hypothesis on the psychology behind the violent and aggressive client. It shows a process of how the factors of temperament, life position and early decision could be seen to combine.

The suicide decision

Contemporaneously we can propose a similar process for suicidal behaviour. The temperament type in suicidal behaviour could be seen to be primarily the flight response. One could also argue that Fight can result in some of the suicide decisions. Debate on this exists though, as some argue that fight is simply used as a means to fulfill the primary response of flight.

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DSM-5 definition of suicide

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Male and female attitudes to sex

In the workshop tomorrow night the participants will be compiling a list of how men and women view sex differently and have different attitudes to sex. This is to present some thoughts about the topic.

The sexual strategies theory highlights that men and women have different responses to sex, have different views and attitudes about sex and different meanings that it has for a relationship. Some (many) men and women do not understand this. Instead they automatically think the opposite sex has the same reactions and attitudes which they do. This can lead to sexual difficulties which really are just the result of a misunderstanding of the meaning of sex for the opposite gender.  In the workshop we will begin to articulate these differences in a way that men and women can easily understand and thus can assist couples with the sexual aspect of their relationship and indeed with their marriages in general.

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The sexual strategies theory (SST) Buss & Schmitt (1993) has been very influential in a number of fields including anthropology, social psychology and attachment theory. In recent years it has impacted areas such as these in a profound way.  

It is based on a feature of human biology.

Men are able to reproduce their genes with as little investment as a few minutes and a few sperm

For women the cost is much higher involving years including gestation, lactation and childcare. 

This asymmetry has resulted in different sex specific strategies for achieving reproductive success.

The mating behaviors seen today reflect the psychological mechanisms that evolved to solve specific adaptive problems faced by each sex. Unlike many female primates who has obvious sexual swellings to signal fertility in human females ovulation is concealed. Ancestral males had to therefore solve the problem of how to identify fertile partners. Given that female fertility declines with age, youth is one possible clue.

Another is physical attractiveness, the markers of which are hypothesized to correlate with health. In theory, the ancestral solution to the male problem of identifying fertile partners was an evolved preference for young and attractive mates. In addition the relatively small investment required for gene replication supposedly resulted in the male preference for multiple partners.

The situation is different for human females in that every sexual encounter is potentially quite costly and as a consequence she is far more cautious and choosy. The problem for ancestral females is to find a mate who possess the resources and was willing to commit to her and her offspring. According to SST, the most favorable female strategy is to hold out for one high status male who will provide for her and her children.

SST acknowledges that males and females can alter their strategies under certain conditions. A man can agree to long term mating in order to obtain a high value mate. A woman may accept a short term mating arrangement in order to extract needed resources.

According to SST mate selection is inherently strategic. Men and women are equipped with specific mate choice mechanisms that guide them to the best available mates. The male will look for the young attractive female and the female will look for the male with status, ambition and resources.

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Some of my thoughts about the SST. 

 Firstly most of the couples I know are of a relatively similar age which does bring into question the extent to which the SST applies. Also if the SST was more universal then there would be a large group of men who are of low economic standing and of low status who don’t have female partners. To my knowledge such a group does not exist.

Having said this I think one could say that in those relationships where there is a significant age difference there are far more men as the older person rather than the cougar female.

The SST does make the good point that the consequences of sex, which is possible pregnancy has much more significant consequences for the female than the male and this means the male and female view sex quite differently on this basis. The woman will be far more cautious about having sex. 

With the advent of the contraceptive pill and other means of contraception like a tubal ligation and vasectomy the probability of sex resulting in pregnancy is almost nil. These forms of contraception have now been around for about 60 years and it could be said that in that time this has not resulted in many women significantly changing their more cautions attitude about having sex. This could support the SST theory that this cautious attitude of women is hard wired into their psyche through the evolutionary process and hence it will not alter in such a short space of time like 60 years. Perhaps after 60 generations this may alter but we will have to wait and see.

A related idea could be how society in general views men and women sexually. It could be said that the highly sexual man and the highly sexual woman are viewed quite differently. He gets called a stud and she gets called a slut. It could be said that many societies around the world have this ‘unfair’ view of women as compared to men. However this would support the female being more cautious about having sex as compared to the man which also supports the SST idea.

Throughout my years of counselling women I have seen that the woman who goes through a promiscuous phase is often in poor psychological shape. She usually is using sex to achieve some kind of emotional gain such as a sense of acceptance, a feeling of love or some sense of self worth. After a period of time she comes to realize that this is a mistaken belief and gives up on the idea. Males may also become sex addicts but it could be said that the man who has a significant number of different sexual partners is not necessarily in such poor psychological condition as the female.

With the advent of HIV in the 1980s one of the things that came to notice in the general community was the high degree of promiscuity in some sections of the male gay community. With gay men neither party has the inbuilt cautious attitude to sex that many females do and this could also be seen to support the SST. Also the presence of gay ‘beats’ where two gay men unknown to each other meet, have sex and then leave, supports the idea that men are capable of having sex with no relationship involved. Men engaging the female prostitute also supports this notion.

I am not aware if female homosexuals have the same level of promiscuity and have such ‘beats’ as well.

The archetype of the nymphomaniac and to a lesser extent the archetype of the prostitute have a special place in the male psyche. The woman with an insatiable sexual desire has a particular interest to the male mind and yet at the same time can be frightening to him. It is probably safe to say that these two archetypes do not exist in the same way in the female psyche.

The child’s grief process

In the DSM-5 it is proposed that the normal time frames for grief in an adult is 12 months and in a child is 6 months. Regardless of whether you agree with the time frames or not what they are saying is that the grief process for an adult and a child is significantly different and thus the child grieves for half the time that an adult does.  This is a interesting proposal that I have mused on since reading it, (I like using that word ‘muse’, it makes me sound intelligent).

In my musing it seems to me that the age of the child would be important. In the DSM-5 they do not make this distinction so maybe that is for the DSM-6 to take into consideration. As we know at age 8 the child suffers an existential crisis. It is at age 8 that a child first begins to understand that death is irreversible. Prior to that age it believes that death is reversible in some form.

What children do.

It seems reasonable to suggest that if you believed that the deceased person was somehow going to return one day then that would effect how you grieve and indeed the entire grief process. In essence you would not really be grieving because you believe the person has not really died in the first place. This could explain why the grief process for a child under 8 years old could be so much shorter.

Secondly in some ways a child is like a psychopath. As a child grows mummy falls in love with it and develops a strong and deep bond to the child. As I have said before all humans tend to automatically assume that others in the world think and feel the same way they do. So many mummys assume that the child will feel the same  way back to them as they feel for the child. Unfortunately this is not the case even though many mummys are convinced their child loves them like they do.

A child's reality is different to an adult's reality. Sometimes we forget that.

I read some where (I wish I had kept the reference) that it would be about the age of 10 years when a child would first be able to look after its own physical survival. Prior to that age the child is not able to get its act together enough to allow it to organize shelter, food and protection for long term survival. This means that children need mummy in order to physically survive. A fully grown mummy does not need a child for its physical survival and thus we have an important difference between what mummy feels for a child and what a child feels for mummy.

If a child is 6 years old and mummy gets run over by a bus then one of the highest, if not the highest priority for the child is to get a mummy replacement. If it does not then it will physically die, let alone psychologically survive. In a child’s mind mummys are replaceable. If mummy number 1 dies then it will get mummy number 2 to fill the role it requires. In this sense we see the psychopathic nature of the child’s psyche as that is how the psychopath thinks about human relationships. The psychopath sees people as replaceable items.

Of course to the mummy the child is irreplaceable. Yes they can have another child but that does not replace the first, instead it is another completely different child. And the mummy does not have the very dire need to have a quick replacement which the child does. This would explain how the feelings and bond between the mummy and the child are different to the feelings and bond between the child and the mummy and thus how the grief process for the mummy and the grief process for the child can be quite different. 

Santa claus is replaceable

Psychopaths do not suffer grief. They do not form the bond and attachment necessary to have a grief reaction when the person dies. They can just go and replace the deceased person with someone else. This also would perhaps explain why a child can grieve so much faster than an adult. The shorter time frame does suggest the attachment is less so in some way for the child. And I am sorry to all the mummys out there who like to believe that their child loves them deeply and that they are the one and only in their child’s mind.

Thus endeth this Sunday morning musing.

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Child bereavement

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The misnomer of the heroin overdose

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Experimental drug use

Experimental drug use is common with teenagers. The gateway drug idea focuses on this type of drug use. Alcohol and marijuana are the gateway to a life time of drug use is the argument. For the vast majority that is not the case but there is a small group it does happen with.



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Self medicating ADD with marijuana

Uxma Javaid B said.

Great observation Tony I would like to share my observation here that Marijuana is not just effective in ADHD but also for those who suffer from Schizophrenia and Bipolar disorder, they also tend to use some form of drugs (smoking, marijuana are more in use) to subside their symptoms and interestingly they get benefit from such drug use (feel more calmer and thought process in control). Marijuana (a mind-bender drug) has some significant properties which slower our thought process and gives us a temporary sense of calmness. People learn to use these drugs for their benefit through experimentation or on a friend's recommendation. It seems a perfect remedy for such psychiatric illnesses thus far.

But the other side of the fact is that illicit drugs do have a great susceptibility for addiction. The person can go into double jeopardy if he also has a predisposition to addiction along with a psychiatric illness such as ADHD, Schizophrenia, Bipolar Disorder or Depression. It's not very uncommon for professionals to treat Dual Diagnosis at Rehabs.

So, it's being wise not to use marijuana or other illicit drugs to self-medicate one self for any Psychiatric illness. People should take proper medication suggested by health care professionals (Doctors, Psychiatrists) to get long term benefits.

I replied

Thank you for your good comments Uxma and I would agree with you that some sufferers of schizophrenia do report a lessening of their symptoms after smoking cannabis.

I also think you make a good point that illicit drugs do have a susceptibility for addiction and the process of self medicating is a hazardous on indeed and one I do not suggest to anyone as using properly prescribed medications does seem the best path. Having said that one must also be aware that plenty of legal prescriptions drugs are quite addictive as well.

Also some times it is difficult path for the drug counsellor to walk. The client I talk about in my statement I have not suggested he go and get prescription drugs for his ADHD which in Australia would be dexamphetamines. He knows about this any way himself, but I have not encouraged it because I know what is likely to happen. It will just add one more addictive drug (dexamphetamine) into the cocktail of drugs that he already uses. He is unlikely to stop smoking marijuana and he would just also start taking dexamphetamines which also are very easy drugs to sell on the black market which he could then start doing to get more money to by his marijuana.



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Phobophobia.

This phobia which is the fear of fear, is often undiagnosed. A place where it is commonly found is with those suffering panic attacks. It is probably safe to say that the majority of people who suffer panic attacks also suffer from phobophobia. As many report as soon as they have experienced a panic attack they then live in dread of another one coming and hence we have the phobophobia. The intense discomfort that panic attack sufferers report leave them living in fear of the next one coming which it often does. Often panic attacks come whenever they want and are quite unpredictable hence heightening the fear of the impending fear which will appear at some unknown time in the future.

Most conventional approaches to panic attacks and the phobophobia would seek to contain the feelings of anxiety in some kind of way. To work on ways of stopping them. Whilst the goal is for the panic attacks to stop and the phobia to stop how one goes about achieving that can done in a variety of ways.

Alternatively the client is invited to experience the symptoms of the panic attack in the therapy room with the therapist. This has a number of productive therapeutic effects on the client and their relationship with the panic attack. This approach in particular addresses the phobophobia and can have quite a significant impact on the phobia for a variety of reasons.

As one can see from this treatment plan for the treatment of GAD the focus is on getting rid of it, stopping it, gaining control over it, avoiding it and so forth. This has some significant contra indications and leads to other difficulties. The alternative approach being suggested here is to engage the neurosis and to establish relational contact with it.

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The psychology of racism

With the AFL now using their racism reeducation program on members of the public and not just footballers anymore, it seems an opportune time to examine this issue.

In the counselling room one hears people express all kinds of views, prejudices and so forth. When the client realizes you are not going to judge them if they make statements that are bigoted and they know because of confidentiality their statements will never leave the room they can open up at a deep level in this way. They express thoughts and views which they would rarely express in public because they know they would be seen as racist or bigoted in some way.

I would suggest there are two different types of racism of perhaps two different ways that racist views can fit into the personality. I was actually working with a man recently who expressed this exact point. He was raised in the United States and reported that as a boy when he was with his father often in the car together, the father would express quite racist views about african americans (I think that is the term to use these days). 

He reported that as he grew up he took these on and became quite racist in how he viewed blacks and other ethnic groups. However as a young adult he joined the military and reports that this cured him of his racism. He was forced to live in close quarters with people of a wide range of ethnic groups and indeed to rely on them for his very survival in combat situations. He discovered first hand what many of them were actually like. He reports that now he has good friends that are African American and so forth.

Children will automatically and instinctually take on those attitudes that are expressed around them especially by the parents and other parent like figures. If parents make open racist comments around children then children will introject those at least to some degree.

This type of racism would probably be suited for systems like the AFL reeducation program. These attitudes are usually not that hard to deal with, in the sense that they are not deeply rooted in the personality. 

However there is another situation where the racist attitudes are more insidious and form a more integral aspect of the personality. This is shown by the life position I+U- (I’m OK, You’re not OK). In my reexamination of the life positions I have shown that this weltanschauung or world view is more accurately represented by the life position I-U-- (I’m not OK, but You’re worse).

Some children grow up with a basic feeling or sense of not OKness. They feel bad in themselves and about themselves. To cope with this they project it out onto others. The thinking goes, “If I can prove they are bad then that means I am good.” This person’s  racist views are how they maintain some sense of self worth and thus will be very resistant to change. Often the bully type person has this structure in his personality. The AFL reeducation program will be of very limited use in such circumstances.

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Being sent to counselling

So Eddie McGuire has been sent to counselling by Andrew Demetriou for his racist comments last week. He apparently is going to be educated on racial vilification. 

Counselling is such a convenient solution. It’s a feel good solution. It’s not really a punishment like a fine but it is kind of a punishment because the person is being sent and they are meant to be contrite with their tail between their legs. Kind of like being sent to the headmasters office at primary school. Here is a grown man, Eddie everywhere, being treated like a child so it is a pseudo humiliating process and hence we have the punitive aspect of being sent to counselling in this instance.

However, having been a counsellor for 30 years I would love to be a fly on the wall and see what happens in Eddie’s counselling session(s). 

True counselling is a collaborative process particularly around the goals of the counselling. The counsellor and the client together work out what are the goals the client wants to achieve. What this means is no better illustrated than with a person who has been sent by the drug courts for counselling. The logic behind this is that the counselling is somehow going to correct the client and then they will not want to take drugs anymore.

I have counselled many such people and not uncommonly the client will say, “I see nothing wrong with taking drugs and I intend to keep taking them”. The goal of the counselling has been clarified. From then on the counselling sessions are not about the person stopping taking drugs which contradicts the logic behind the whole process.

The logic behind Eddie’s counselling is that he will come to see making racial comments is wrong and then he will want to stop making them or having that negative view point of other racial groups. The goal is to change his perception of the value or worth of himself and others.

That is a very difficult thing to do. To change ones basic values, view of racial groups and people in general is a difficult thing to do. And of course in his counselling Eddie may say that he has no intention of changing his views in this way and that he is quite happy with them. From that point on the counselling is no longer about Eddie becoming less racist. So in this way the whole process becomes a farce as the AFL has sent him to counselling so he will in some way come out less racist.

At that point it could stop being counselling and become a (re)education process for Eddie. It is no longer a counselling session but changes into an education session. These are two quite different things. Having said that counselling often does have an educative aspect but it is not a teacher - student relationship. That relationship is quite different to the counsellor - client relationship.

If someone is of the view that other racial groups are more primitive and ape like, simply giving them information (teaching them) that this is not so and why will have very little, if any impact on their racist views. One’s basic value system does not change by simply acquiring factual information.

Even if one goes to the extent of ‘Brain washing’ that they tried in the 1950s and 1960s, that was a failure as well. It was discovered you cannot change people’s basic view of societies or racial groups unless the person to some extent wants them to be changed. If that basic motivation is there then the counselling process can begin. If it is not there then Eddie’s counselling session is going to be a waste of time as far as the AFL is concerned. The best outcome that could happen in the reeducation of Eddie is it allows him to become more subtle in how he expresses such views (hopefully keeping his views entirely to himself) but his basic views do not change.

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