My golden rule of therapy

I grew up in a family where psychotherapy was the norm. Both my parents where psychologists and psychotherapists. My father was actually a bit of a trail blazer as well and was very much a psychotherapy type of psychologist. Originally psychoanalytic and Rogerian in his approach. In the state where we lived he was one of the first to go out into the world to learn the new psychotherapies being practiced and bring them back to where he worked. Very few, if any other psychologists would do such a thing. 

He was the first psychologist to go into private practice in the city where we lived. And besides what was then called the “Marriage guidance council” (which later became know as Relationships Australia) he started the first private psychotherapy training institute in the state. The Marriage guidance Council was a government funded body which people could go to to get marriage counselling and he was heavily involved in the training of counsellors for that organization.

Here is a photograph of my father at a workshop in Australia with Carl Rogers in 1965. He is in the back row third from right. As you can see he got the other participants to sign it including Carl. Also notice the ratio of men to women. Nowadays it would be the other way around.

The point at hand is I grew up with this and psychotherapy was nothing odd for me like it was for many people. I recall when I was about 17 (still at school) I got into some trouble and my parents suggested I might try a therapy group. So I went along and it was run by two female cotherapists and there were about 6 clients, all young people so it was probably a therapy group for that age group. I recall finding it quite helpful. I never rebelled against therapy or going to a therapists like some teenagers or children can do. 

I then started training as a psychotherapist at about age 22. As many therapists did then (and do now) I did some personal therapy in groups and individual therapy. There was probably a period of about 5 to 10 years when I did a fair bit and I am glad I did. I think I am much less of an uptight and tense person as a result of it. Less of an obsessive thinker and this also has helped me in life.

An uptight obsessive thinker?

There was this period where I did concentrate on my own personal work and then after that I felt less of a need to and that is when I made a golden rule for myself. I never asked anyone about this or even talked to anyone about it but I decided that I would always have a therapist of some kind. There were two reasons for this.

First it is always good to have an outside person who you can reflect with and get their feedback about your thinking and feeling about things at the time. It kind of helps to keep you grounded and realistic. Second, as I was a psychotherapist I discovered it was very easy to forget what it was like for the client. If one is always in the therapists chair one can forget what it is like for the client. I found it was most helpful to be reminded from time to time what it is like sitting in the client’s chair. I found it certainly did help me as a therapist to do this, at least intermittently.

In more recent times this has been done on more of an informal basis as compared to when I was in my 20s. I have a colleague whom I meet with from time to time and every now and then we do a bit of therapy on each other and this satisfies my need for the two reasons I listed above. Interestingly if I look back at my history of personal therapy I notice a pattern. Three therapists stand out in particular, who I think have had the most impact on me and they are all strong willed women. Just an interesting observation.

But in retrospect I am glad that I spontaneously made my golden rule of therapy for myself. I think it has served me well over the years. Maybe because I grew up in a family where psychotherapy was the norm rather than the abnormal, that helped in making this spontaneous decision.

Graffiti

The psychology of danger

Danger - the risk of injury or death - has important or even essential psychological effects for normal human development. If one does not experience and live through danger then they will never fully psychologically develop. To become a fully psychologically developed individual one has to survive dangerous situations at least at some point in ones life.

Why would this be so?

A good example of this is overseas travel especially for Australians as Australia is such a paternalistic place where the government and organizations like the AMA are constantly trying to make everything safe. As soon as a young person is hurt or killed it immediately sets about changing laws and any other thing it can think of to eradicate that danger or reduce it to its barest minimum.

The only way to get away from this is to travel overseas to other countries where governments are not so paternalistic. When that happens you have to learn to survive on your own. The young person is putting self into a more dangerous situation where they have to make observations of the environment, make correct decisions about how to act and then they survive. Of course because the danger is increased more of them will be hurt and occasionally some will die. This shows to all the others that they survived, they did make it on their own and they lived through a dangerous situation.

Unfortunately there is no way around it. Sooner or later the youngster has to fly from the nest. When they do some will fly and some will fall to the ground and die. What the Australian government would do is put a big soft mattress under the nest to protect all the ones that fell. As soon as you do that you take away the danger and flying out of the nest looses its psychological significance and benefits. In essence you haven’t really flown from the nest, at least psychologically anyway. All those that did fly no longer get the psychological benefits because they knew there was no danger in flying.

Hence we have one of the first psychological benefits of living through danger. It allows the youngster to psychologically separate and individuate as they say. They have seen themselves enter a dangerous situation (with out paternal protection), deal with the danger and survive. Thus showing them self that they can survive on their own hence the development of psychological separation and individuation from the parents. Along with this goes a increase in ones self esteem and a sense of achievement is experienced. Finally it also allows the youngster to develop skills in dealing with the world. If one never puts self in danger they are never going to develop the skills to deal with that danger. 

At this point we can thus see three important psychological consequences of putting self in dangerous (potentially life threatening) situations.

1. Development of psychological separation and individuation

2. Increase in self esteem

3. Obtaining important life skills.

The reason why I have chosen the topic of overseas travel is because in recent times the press have been in a big flurry over a young Australia who dank contaminated alcohol in Indonesia and died. This is getting massive coverage in the press. Without a doubt a very tragic situation to have a young Australian die like that. An instance of one who flew from the nest but fell to the ground and died.

This is a quote of the first paragraph written in a newspaper article by Steve Pennells. 

“The bar that allegedly served the drink that killed Perth teenager Liam Davies remained open yesterday as Indonesian police revealed that no investigation had been launched into his death.”

When I first read this I chuckled as it is such a culturally egocentric point of view. The Indonesian government have far larger social issues to deal with than this. If Australia was in the same position as Indonesian society we would not be investigating it either. There are far more important social issues to spend the scare resources on, than such an investigation.

Secondly it typifies the Australian solution to the problem - remove the danger. The solution of putting the mattress under the nest. Hence we are creating a generation who are not getting the essential psychological benefits that come from allowing young people to go into dangerous and potentially life threatening situations.

Graffiti

The machinations of developmental psychological theory

This comes from a book on developmental psychology. 

“Although many people cope with old age gracefully and meet death with dignity, this is not always so.”

Developmental psychologists often present human development as a series of tasks that have to be dealt with or mastered at the various stages in life. This is no better illustrated than with the developmental theory of Erik Erikson and the 8 ages of man as it has become to be known.

The diagram shows the various conflicts and tasks each person tries to resolve at each stage. For example as a child reaches adolescence he has to master the stage of leaving home. That means psychologically breaking away from the parents and developing his own social world. At the same time the parents have to master the task of letting the child go and restructuring their life as necessary as their parenting of children comes to an end.

People who complete the different developmental tasks are said to be developing normally. Those who don’t would be seen to develop a neurosis of some kind and this is where therapy is meant to intervene to assist the person to get through the developmental tasks and to move onto the next stage of human development.

According to the original quote I cited above if one enters old age gracefully and meets death with dignity then they are said to be finally completing their last stage of development. This means of course that the elderly person who is not being graceful or dignified would be neurotic and in need of some counsel to assist them to be so.

I am reminded of a time a few years ago when two sisters came to seek my counsel on a matter just like this. Their mother was in her mid eighties and in reasonably good health physically and mentally. She lived in her house where she had lived the last 50 years of her life and indeed one of the daughters lived with her at that time.

The problem presented was that the mother was being recalcitrant and obstreperous. She was hard at hearing and refused to get a hearing aid, she had no intention of leaving her house for a old people’s home and basically did very little of what the daughter’s suggested she do with her life and circumstances. This had the two daughters fatigued, at a total loss for what to do, exasperated with their mother and hence they came to see me.

According to developmental psychology the mother was neurotic and not successfully adjusting to her final stage of development. She certainly was not being graceful and had no desire at all to meet death with dignity.

After much discussion I presented to the sisters that perhaps it was mother’s rebellious, defiant and hard headed attitude that was keeping her alive at this juncture. Perhaps the mother knew (probably unconsciously) that if she ‘gave in’ to their wishes and became more graceful and dignified she could quickly deteriorate and die. If this was the case then one could understand the mothers gritty determination in that she was scared of dying.

The sisters did not know what to make of my suggestion and did not expect me to make such a determination about their domestic situation. They left some what perplexed and decided to think some more on my proposal before they decided about what path to take with their mother in the future.

Human psychological theory can sometimes be a precarious and malevolent thing. One needs to be clear that such theories of human development are not really a mechanism of social control. The study of human psychology is meant to be about how the human functions psychologically not about how society says they should function psychologically.

If an elderly person is meeting their final time of life with grace and dignity who benefits from that? The children and loved ones of the elderly person are feeling stressed and scared as they know their mother is going to die and that will be a painful event for them all. If mother is graceful and dignified about the ending period of her life that will certainly make it much easier for the children and loved ones than if she is being recalcitrant and obstreperous.

Assuming my proposal to the sisters was accurate then the mother’s own Child ego state was scared of dying and she was coping with that fear in the best way she knew.

A psychological theory which says the last stage of life is meant to be graceful and dignified, is that because it is better for those others around the elderly person than for the elderly person. If it is, then it is no longer a theory of human psychology instead it has become a system of social control of a particular group in the society.

Graffiti

Psychology 101 and suicide

The following comes from an article about factors in suicide printed in the journal - Australian Institute of Criminology. It cites various research findings

Locality. For much of this century suicide rates have been higher in Australian cities than in rural areas.

Media. The average daily rate of suicide in Australia increases significantly after the publication of suicide stories in the Australian media.

Economic Cycles. In this century suicide trends in Australia show a strong correlation

between unemployment and the suicide rate.

Occupation. The general pattern in Australia is that those in unskilled and semi-skilled blue-collar occupations which are characterised by low job autonomy, greater external supervision, less on-the-job training, poorer promotional possibilities, lower wage levels and greater sensitivity to market forces tend to have high suicide rates.

Migration and Ethnicity. The suicide rate of overseas-born is significantly higher than Australian born and among the immigrant groups from different countries suicide rates also vary considerably.

Temporal Variation. The incidence of suicide appears to follow a distinct weekly cycle. Monday tends to have the highest average daily suicide followed by Tuesday, and Saturday has the lowest average.

-----------------------

When I was a young, fresh faced psychology student we were taught about the science of psychology. This was serious business I can assure you. One thing that they drilled into our little, pliable, malleable brains was the difference between correlation and cause and effect. This we were told was one of the basic principles of science and one must always, and at all times keep them separate. It was tattooed in our little minds for ever. And quite rightly so, one could say.

The six factors listed above are all correlations, none of them are statements about cause and effect. Most suicides occur on a Monday. This is a statement of correlation and one must never, I was told in psychology 101, assume this means Mondays for some reason cause people to suicide. That would be a statement of cause and effect.

What causes odd behaviour is different to what correlates with odd behaviour. "Wearing hats makes men try and mow the roads".

Media reports on suicide correlate with an increase in the suicide rate. This is not saying that media reports cause people to be suicidal. Again one differentiates between correlation and cause and effect. Unfortunately in the area of suicide people often mix up correlation with cause and effect. This is commonly done when depression is discussed. One often hears comments like depression causes suicide.

Depression has never caused suicide. We are cited statistics like 5% to 10% of people with major depression will die by suicide. Major depression is the worst kind of depression where the person is really, really depressed. 

However, and this is major problem in the literature on suicide, these statistics also tell us that 90% to 95% of people with major depression do not die from suicide. If depression caused suicide how come the vast majority of people who are the most severely depressed never kill themselves in suicide.

Some people with depression suicide and some do not. In the vast majority of the literature you never get this explained. They can’t explain it because they mix up cause and effect with correlation. However in my book - Working with suicidal individuals - I provide a clear explanation for it, which I discuss at length. A suicidal person is one who has made the suicide decision early in life. Some people make such a decision and some do not. 

This is now a statement about cause and effect. What causes people to be suicidal is they have made one of the seven possible suicide decisions. What depression, media reports, Mondays, stress and so forth do do, is make an already suicidal person more likely to act on the suicidal urges. Thus one can say depression has never made anyone suicidal. If someone has not made the early suicide decision then no matter how depressed they get they will not suicide.

This has significant implications for treatment. To deal with a person’s suicidality one must not get distracted into treating the depression, one needs to treat the early decision that was made.

Graffiti

People’s expectations

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



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

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

Why not give people what they expect?



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

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

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



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



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

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



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

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

Graffiti

The psychology of the bitch **

I was shopping in the supermarket the other day as you do. Going up and down each of the aisles and there were two women coming the other way talking to each other. We crossed by a number of times as we went up and down each aisle.

They passed me quite slowly in the first aisle and I overheard what they were saying. I wasn’t going out of my way to eaves drop on them! They were just talking and it was quite close as we passed each other. They would have been in their 50s and they were talking about some other woman who obviously had small children.

Well! They were savaging her, they were tearing her to shreds. A full on character assassination it was. Firstly about how bitchy she could be. Which was a bit ironic as they were bitching about her bitchiness. Then when we crossed two aisles later they were still at her, about what a bad mother she was, how she never controlled her children, always let them run amok and so forth.

So I wondered about all that. What was all that about? Why did it happen?

I suppose one could see it as a display of anger or aggression. Of all the emotions, it would seem that anger is the one that it would most closely be aligned to. However it is the expression of aggression in a feminine way - that is verbally. I think one could say that the more masculine expression of aggression would be less verbal and more physical.

So one could say that bitching can be a form of feminized aggression. Thus explaining why women (and gay guys) tend to engage in it more than straight males do, or at least one could argue that.

However since musing on this topic I have had discussions with two female colleagues of mine. They came up with some ideas that as a male I had not understood or even considered. They said that for females sometimes bitching about someone allows for a connection to be made between the two discussants. To say such confidential thoughts and secrets to the other means that you are trusting them and taking the relationship to a deeper level sort of thing. A most interesting idea that as a male one does not tend to experience at all. In this way the psychology of bitching is about relationship formation and maintenance.

I would suggest that males are not so bitchy in these ways but males certainly can be competitive. Whilst that is about winning and beating the other it is not so much about putting the other person down or creating some sort of connection between two men.

There is one other point that I would like to mention. In the Transactional Analysis literature one comes across the concept of four life positions:

I’m OK, You’re OK - (I+U+)

I’m not OK, You’re OK - (I-U+)

I’m OK, You’re not OK - (I+U-)

I’m not OK, You’re not OK - (I-U-)

I have since developed the theory of life positions further and this can be found at Life Positions.

I think one could say that the bitch would be adopting the life position of

I’m OK, You’re not OK - (I+U-)

In the article I state that it is more accurate to conceptualise this life position as:

I’m not OK, but You’re worse (I-U--)

The person in this position does not feel OK about self (I’m not OK). They deal with this is by trying to prove to self that others are worse than them. If they can prove such a thing then they feel better about self. It would seem reasonable to hypothesise that at least for some, this is one of the psychological functions of bitching.

“If I can prove to myself that some one else is bad, not doing the right thing and so forth then I wont feel so bad about myself” is the thinking of the bitch.

Now this formulation provides for an interesting theoretical off shoot. This last psychological function of bitching could be seen as a defence mechanism as was conceived of by Freud. The goal of the defence mechanism is to fend off anxiety provoking threats to the person. The belief - I’m not OK - would be such an anxiety provoking threat that the person would seek to fend off using one of the defence mechanisms.

To my knowledge no such defence mechanism like bitching has been previously suggested. There is a defence mechanism called - self negation. In this case the person wards off anxiety by getting in first with self criticisms and derogatory remarks. This is done in the hope that others will refute such claims with comments like - “Oh you’re not silly at all”.

Bitching could be seen as a derivative of this. It is not self negation, but others negation. By negating others the focus of attention is taken off self and this fends off the anxiety about ones own self doubts. In addition by convincing self that others a very negative then one’s own negative characteristics are minimised. Again the anxiety provoking threat is fended off.

So perhaps we need to add to Freud’s list of defence mechanisms with - The bitch defence mechanism.

Graffiti

Monologue on emotional neglect

This monologue describes a child's emotional reactions to psychological neglect by the parents. There will be a range of emotional reactions depending on the degree of the neglect.

Trauma management **

This post will not make sense unless you have read the previous two before it.

The previous post on a model for trauma debriefing relates to only one type of trauma. That is either single incident trauma or an ongoing trauma that has since ceased.

Single incident trauma is just that, a single incident. Examples may be an abduction, serious car accident, airline or train accident, an assault or rape, or some life threatening incident such as a terrorist bombing. Usually these are unpredictable, occur quickly and then end in a relatively short space of time. That is they do not continue over weeks or months or years. It is not uncommon to get clients with this type of traumatic experience presenting for treatment.

Indeed the research indicates that it is best to begin the debriefing process within 72 hours of the event occurring, if that can be arranged. If the debriefing does not occur within 6 weeks then it is seen that the personality adjusts and incorporates the traumatic reactions into it. Thus the reactions become ego syntonic and do not remain ego dystonic and thus they are harder to remedy.

The model described below is particularly relevant to this type of trauma . I would suggest however that most trauma is not of this kind. Most often the traumatic event(s) extend over a prolonged period of time and involve a whole series of single traumatic events collected together. So one ends up with not a single traumatic event but a period of time where there was a number of traumatic events collected together.

Examples of this may include ongoing legal battles, marital problems, bullying, imprisonment, difficult pregnancy, protracted life threatening illness, political harassment and can occur in some occupations such as in the military, the police or the ambulance service.

The model described below is relevant for these ongoing trauma periods as long as it is definitely over. For instance the person has left the military, the marriage is over, the baby has been born healthy, or the legal battles or bullying have ended. One can then set about resensitizing the Free Child again using the model described before.

Not uncommonly however a therapist will be dealing with a client who is in the middle of a series of traumatic events and not at the end of it. Such as employees who are sent for counselling because they are on stress leave from work. In such circumstances the therapist is not suggesting trauma debriefing. Even if they did it would not happen because the Free Child of the client simply will not go there. As mentioned before the FC has partitioned itself off and it simply will not even consider coming out of hiding until it sees that the environment is no longer threatening like is has been.

Balancing act

The therapist does not seek to resensitize the Free Child like described before. One does not do trauma debriefing but instead does trauma management and this can require some therapeutic skill at times. One walks that fine line with the client between assisting the Free Child to hide but also wanting the Free Child to be resensitized enough so as to avoid some of the PTSD symptoms that will develop is the Free Child hides too deep for too long.

Graffiti