Wednesday, March 24, 2010

Erotic transference

It was a good episode of the Sopranos last night. Not only did a few people get whacked but a good deal of the show was dedicated to Tony Soprano’s relationship with his therapist. He finally came clean and told her directly in his mobster type way that he was in love with her, deeply!

Now for a female therapist that would be a hazardous thing to have happen! He had developed a fully fledged erotic transference with her. He tried his usual intimidation tactics with her to again gain control as he was the needy one in this instance, but she stood her ground. He suddenly started having erotic dreams about her and suddenly started to have some erection problems with his mistress and wife. The episode really did capture the psychology of it quite well even if it was overly dramatised a bit. I wonder if the movie makers have ‘experts’ on such matters giving advice on the psychology of it all, as technically it was quite sound.

The whole concept of erotic transference is an interesting area of study. In such transference the client falls in love with the therapist and that love gets sexualised to varying degrees. Some a lot and others very little. However I have found it to be a bit more complex than that.

Lots of things can happen to the love and sexualization of the therapist. For instance I have had clients desexualize me. I recall one woman recite a long monologue one day on how bad men were. At the end of it I stated that I was a man and not like what she reported to which she replied, “Oh you’re not a man, you’re a Tony”.

She had desexualized me to be genderless and thus she could form a attachment to me because her misandry would have otherwise not allowed that to happen.

Then there is the relationship between love and sex in the client’s mind. People usually over correlate the two and if the client mentions love then that of course it is assumed means sex as well. If they state that it does not then of course they are in denial according to many. I don’t particularly agree with that.

Without a doubt some clients do develop strong feelings of love and sexualised feelings to the therapist as well. As was shown in the Sopranos that can involve sexual dreams and fantasies about the therapist that are quite vivid.

However there maybe another type of love for instance between siblings or parents and children. This is where there can be strong feelings of love and attraction that by and large does not get sexualised. There would be some, maybe many who would definitely disagree with this view. They would say that deep down in the id or very small Child ego state there are sexual feelings. That it is normal for teenage siblings to have sexual feelings at times to each other and people who say they don’t do so because their moral system does not allow them to recognise such sexualised feelings. They are simply repressed into the unconscious.

These women dislike each other but do they

allow themselves to be aware of such things

The problem with this is it’s a circular argument. As soon as one disputes such a position one can then be told they are simply in denial as well.

However love feelings and sexual feelings are two different and discrete emotions like other feelings such as anger and sadness or scare and embarrassment. I think there are few who would dispute this.

Thus it seems not unreasonable that love and sexual feelings can behave like any other feelings. Sometimes feelings are closely linked and sometimes they are not. For some sexual feelings and feelings of love are closely linked and for others they are not.

Thus one needs to be careful with the term erotic transference as erotic specifically relates to sexual or salacious matters. It seems that it is possible to have a strong sense of love and attraction for a therapist without it necessarily being highly sexualised thus the term erotic would be a misnomer in such cases.


Thursday, March 18, 2010

Men and sex workers

I was working with a woman the other day and she stated that her partner of about a year told her that he had been to some prostitutes when he separated from a partner before. This had caused her some concern, as a female she could not understand it and thus we had a discussion about what it means for men to seek out a sex worker (prostitute). They tend to prefer being called sex workers.

Women mix up sex and relationships. The two are intimately intertwined for them. For men it can be the same but they are also capable of having sex without any relationship, hence we have prostitution.

I have subsequently thought more about her concern and what it means to the male psyche. This comes from the men I have spoken to over the years and the female sex workers I have spoken to about their thoughts on their clients where they make some very interesting observations. They do have quite a unique view into the male mind.

It seems there is a number of reasons why men may employ the services of a sex worker

1. Curiosity. This would tend to be the young adult males and they either find that it is something they like or could do again or others learn that it is not something that interests them or are repulsed by it.

2. For release. Some men with strong libidos and no current partner may seek out a sex worker for simple sexual release. When they have a partner they will tend to not seek out a sex worker.

Associated with this some men have unusual sexual interests such that it is hard to find a partner who is willing to participate and thus a sex worker is employed.

3. For TLC. Some men who want sexual release also find they can get a bit of tenderness and physical closeness from a sex worker who they get on with. These men don’t want a relationship with the woman just a bit of kind, close physical contact that goes along with the sex. At that particular point in their life they are for some reason particularly needing such nurturing contact and they find they can get it in this way.

4. For a relationship. These are the men who become long term clients of a particular sex worker. Besides paying the fee they will often bring extra gifts and they develop love feelings and an attachment with the woman. These are the clients that the sex worker particularly wants to cultivate as they provide regular income and they know them thus reducing the danger component.

To achieve this the sex worker has to convince the man that he is the special client that is different from all her others. He also manages to convince himself of the same and thus the relationship in his mind develops.

4. Some men report that they get addicted to sex workers. Whilst this may some times be a sex addiction it may not always be. The sex in other ways can fulfil some psychological function for the man. Just like some self harmers report they are addicted to self harming. Some of the reasons for self harming can be found here.

These people are not so much addicted to the self harming but addicted to the psychological benefit they obtain from the self harming. It seems to me that for some men the same situation applies. They are not addicted to the sex but the psychological benefit they get from it.

Some self harmers suffer dissociation and depersonalisation. They discover that if they cut self then that temporarily allows them to stop the dissociation and they get a sense of reconnection with the world again. For some men the same may apply but they use sex instead of self harm.

Instead of dissociation some find that the sex (like self harmers) allows them to get a sense of feeling something and thus their pervasive sense of numbness is temporarily relieved. Or they may use it to get a sense of tension release or as a means to self nurture just as self harmers can also do. So the man is kind of addicted to these rather than to the actual sex.


Monday, March 15, 2010

Help would be better than public criticism

In the city where I live there has been a coronial inquest going on into the death of Charmaine Dragun who apparently suffered depression for a number of years most of it in silence. She was a high profile, pretty, young news reader who had the world at her feet. However it all came to an end with her dying by her own hand last year.

This is getting considerable press coverage which seems reasonable because of her profile and the fact that she is one of their own. The problem is that her mother Estelle Dragun who has been very vocal and widely reported in her direct criticisms of how the suicidal are managed in Australia. She has been continuously reported as saying there needs to be more monitoring of the suicidal, more breaking of confidentiality and more hospitalisations of depressed and suicidal people.

With her ongoing criticisms of the medical and psychology professions in this way does she think she is the first to have come up with such ideas. Of course it would be an advantage to have more public money spent on such fragile people, but its not that simple.

I have worked with very suicidal people over the past 25 years and for 3 years co-ordinated a suicide assessment and management program in the prison system. I would be very interested to hear Estelle Dragun’s views on how such monitoring should take place that is not already being done. She has been very public in her criticisms and very lean on any detail about how she thinks it could be improved.

And on her call for more hospitalisations, one needs to be careful with such simplistic solutions. All a hospitalisation does is move a suicidal person geographically from one location to another. If the person is quite isolated then that can indeed be helpful but it can also make matters worse.

Some people don’t want to be removed from their home environment and become even more distressed when they are. Some people do not want all the fuss that goes along with a hospitalisation. Hospitals are simply buildings full of people. There is a view in the community by some and some in the hospital system that self harming and suicidal people improperly use up limited hospital resources. Hospitals are meant to be for real patients who are there due to either disease or accidents. Some cultures in some helping insitutions can be a bit difficult and then there can be just simple personality clashes as well.

Managing a suicidal person is not as simple as just putting them in a hospital and Estelle Dragun’s vocal criticisms hopefully will not result in the coroners recommending more people be forced or pressured into hospitalisation unless other factors agree with that happening.

As for depression and what Mrs Dragun says about how such people should be monitored more so. There are many out there already who are doing a very good job doing precisely that already. Of course giving them more money will help but again dealing with a depressed or suicidal person is not a simple venture. It is often grey and murky where one works on hunches.

Firstly when getting information from a suicidal person you can never assume you are being told the truth. I am not suggesting they are a group of pathological liars but they are very unhappy people who sometimes do not make good decisions. They will tell untruths and certainly not the full truth at times which of course makes monitoring difficult. If anyone has ways by which such monitoring of the truth can be improved I would be very interested to hear it instead of global criticisms of current monitoring.

Then there is the depressed and the suicidal as Charmaine Dragun reportedly was. 50% of depressed people are not suicidal at all. They do not even think about it let alone plan anything. The research hovers around the 7% and 8% mark for depressed people who will die by suicide. Charmaine Dragun was in a small group of depressed people who will complete a suicide. Then of course there are all those who aren’t depressed and still yet suicidal.

More money would help but monitoring is not an easy thing to do. There is also this thing called the suicide secret. The research says that about 75% of people will disclose to others about their suicidal thoughts prior to an attempt so monitoring could help here. This means of course that 25% don’t disclose. 1 in 4 will keep the suicide secret and do not disclose to others their desire to die prior to a suicide attempt. How one monitors them is often an oblique and beclouded exercise.


Sunday, March 7, 2010

Who gives counsel

Hello Zbig,

I suppose its a bit cold in Poland at the moment being winter and all.

You stated: “And having read this blog entry I ask myself: isn't it supposed that we have problems, overcome it, and the therapist helps us not only with the immediate relief but also should give us a "fishing rod" so we can deal with our future problems without repeatedly going to the therapist. And your entry suggests that it's the opposite - I have my therapist and my children will have problems so they will have to go to the guy like me? Isn't it that I, being experienced and kind enlightened, can help my children (I mean in most typical situations, of course I don't cover extreme traumas here) to cope with their every day struggle on their own?

What do you think?”

(end quote)

This started out as a response to your comment but became longer so I made it a post

You make a good point about therapy and fishing rods. I have a number of responses to it.

The majority of my clients I would see for less than ten sessions. Most come with some difficulty and want it fixed up and then they leave satisfied to varying degrees. This probably fits with what you presented as your understanding of the therapeutic process.

However regarding fishing rods I disagree with you to some extent. My personal view is that it is a sign of psychological health to have a therapist (unofficial or official) in your life from birth to death. That is someone whom you can go to, to emotionally unload when need be, be kind of a mentor or confidant.

For most people in adulthood this would usually a be a partner or perhaps a close friend or relative. To have a dependency on this person in this way to some degree and thus to have completely your own fishing rod in my view is a retrograde way to live life.

This confidant is what I see as an unofficial therapist. That is they fulfil some of the functions that an official therapist does. For most people this works OK but it has some potential pitfalls. It is most important for a husband to remain a husband and not become a surrogate therapist to a wife, as that will quickly kill a marriage. So a wife can confide in him and emotionally unload with him but only a little bit such that he remains a husband and does not become the wife’s therapist.

When friends and partners advise each other they will always have an agenda of their own.

Also when someone seeks me out for counsel I have no other relationship to them so I do not have any other agenda. If a wife seeks advice (counsel) from her husband then his advice may be tarnished by his own agenda in that he will advise her to do what suits him also. If a wife is having difficulty in her relationship with her mother the husband’s advice maybe for her to withdraw from her mother but that can be partly due to his own dislike of his mother in law rather than what is best for his wife. He has a conflict of interest and that will influence his counsel to his wife even if he is trying to avoid such a thing. With an official therapist this does not (or at least should not) occur.

Also there is the confidentiality issue and a therapist is far less likely to gossip than a friend or spouse will about your inner thoughts and feelings you have disclosed to them. For most however these are minor complications and their unofficial therapist will suffice. For others they may have access to an official therapist who they feel comfortable with and thus they are used in that role as some may use a spouse to be a confidant or sounding board.

Sometimes in the psychotherapy or counselling subculture to have a therapist is like having a fashion accessory. It is the acceptable behaviour in that subculture and thus some people can seek counselling partly for these reasons such that they feel like they fit into their subgroup in society. People like Dr Phil have made a significant contribution to this development in attitude in some societies. He has made it trendy to have a therapist.

Sometimes people come from backgrounds that were very dysfunctional and thus the giving of a fishing rod to the client becomes a much more difficult and protracted process. Some times the problems resulting from their early life have left scars on the person’s very core or sense of who they are. It takes time, sometimes a very long time to assist the person to reduce such scars and the effect they have in their day to day life. Realistically very few of them will ever really get their own rod in a fully substantial way.


Tsunami alert

Now this one is really funny. It did make me laugh.

As most would have heard there was a large earthquake in Chile lately. Since the earth quake produced tsunami near Indonesia a few years ago the Australian government set up a multimillion dollar tsunami early warning system. Again the government was there to protect us so we could all feel safe again.

Well they were able to give warning system its first try out as the earthquake in Chile could have produced a tsunami that was going to hit the east coast beaches of Australia. It swung into action and the government warnings were produced on radio, TV and so on. The beach life savers ran around warning everyone to get out of the water and leave the area.

There was just one problem. Few people left the area and after they got out of the water some went back in much to the angst of the beach life guard. They are well meaning people but they are also just yet another obvious example of the government nanny state in Australia. They feel they have to protect us from ourselves at the beach because we obviously can’t manage such a thing on our own.

The latest in tsunami proof swim wear

However there is more! Not only did just a few heed the life guard tsunami warnings, many of those who were at home and heard the media generated tsunami warnings headed for the beach to watch the tsunami roll in. So crowds started to gather at the beach to watch the tsunami arrive which it did, all 90cms of it. Three foot in the old language so what a fizzer that was!

The government early warning system worked in that people were given an early warning but the result was for more to go to the beach. As you can imagine this has left the government dismayed, they had a prime time example to once again be that lovely nanny state and protect us all but very few wanted the protection. People really did vote with their feet on this one.

The government response to this is to assume that the reason why people did not leave the beach is because they are uneducated and thus they need re-education. Now there are proposed million dollar public education programmes in schools and over the airwaves to educate people about the dangers of tsunamis. People know the dangers already as they have seen endless images of the recent Indonesian tsunami destruction. Also the government is proposing proposing new laws which give the police powers to forcibly move people away from the beach in a tsunami alert. That is just what we need, the police to have more powers!! For heavens sake allow people the right to make their own choices!!

I grew up at the beach. I have spent much of my life at the beach and was a surfie for many years. At times I have been in some very big surf and the ocean and the beach is something that is very dear to me and I know the ocean well.

One of the first things a surfie learns is to identify when the monster wave is approaching. For two reasons. First so you can try and get into a position to catch it and if you can’t do that to then get over the wave so it does not munch you. Let me tell you that can be quite frightening when is a very large wave heading your way.

If one is waiting for a wave and one feels the water level drop quite significantly then you know there is a big one heading your way. So the wave you can see coming your way you know is going to get bigger and bigger if the water level drops and drops. This is because the water preceding the wave gets sucked up into the wave. Thus the bigger the wave the bigger the water level drop. If you are at the beach and someone tells you a tsunami is coming but you see no water level drop then the tsunami is only going to be a little baby tsunami.

Me surfing

I wonder if the government will include this in their re-education programs or will it be more like: just listen to the warnings and obey them because you are not intelligent enough to make your own assessments and decisions.

The other thing about waves is the bigger the wave the earlier it will break. Bigger waves break in deeper water. This is the curse for every surfie. You place yourself where the waves are generally breaking but if a large one appears then it will break further out from the shoreline which means you have to start paddling very fast or you will be munched by it.

At most Australian beaches you will never get a very large tsunami breaking on the shoreline smashing houses and so forth unlike you could get in Hawaii. There the land rises very quickly out of the deep ocean whereas in Australia the water depth slowly get less and less as you approach the shoreline. Thus a very large wave will break a long way from the shore and roll in. There may be a very large volume of water following the broken wave and thus in most of Australia a tsunami will cause damage by flooding not so much by smashing and crashing on the shoreline. Thus one is afforded an earlier visual warning and you are not going to get a monster wave suddenly appearing out of nowhere crashing on the shoreline at most Australian beaches.

I wonder if the government re-education program will include this or will it show more of the Hollywood style huge wave crashing in on our cities.

If caught in the wrong place at the wrong time then it hurts!


Saturday, March 6, 2010

A psychotherapist's life

Sometimes the life of a psychotherapist is a funny old thing! I had a bit of a strange one the other day.

I saw this woman who is in her 40s. I have know her for about 20 years, counselled her husband, kids and I am sure I will counsel the grand children in the not too distant future. I know her very well and we have had a good therapeutic relationship over a long time.

Anywise I had not seen her for about 6 months and she makes an appointment. When she gets there she starts to give me an update of her life, what has happened with her relationships and other significant life events. This is always a good thing for the therapist as we are all professional busy bodies and nosey parkers who like to pry into people’s private lives.

I got my curiosity satisfied and during her talking I asked her a few times what was she wanting out of this consultation. I never really got an answer to my question on each occasion. So as the end came closer I had decided that this was a check in consultation and an ‘I am just wanting a bit of security’ consultation.

She had been widowed about 7 or 8 years earlier and since that time she had had a few relationships but nothing serious. However in the last 6 months she met a guy and he was shaping up to be quite serious and in her mind this could turn out to be quite a long term relationship.

Right near the end of the session I asked again what was she wanting out of this meeting and she said, “I want your approval” (about her new man). This took me back a bit as I wasn’t expecting such a thing from her as it was not really her style to assume that position in relationships - seeking approval.

Will this get approval?

So firstly I had to quickly jump into my Parent ego state to work out if I did approve or not, as I hadn’t even thought about such a thing. Then I thought, well what happens if I don’t approve! I can’t lie to her.

But the point at hand is here we have a 44 year old woman, who is quite competent and has been successful in her career, coming to see me and wanting my approval about her new boyfriend. I find it just a bit odd. Such is a psychotherapist’s life I suppose.


Friday, March 5, 2010

Life script analysis 4

For a larger version of this go to here. And click on "All sizes"

Story of drawing.

Mother is busy in the kitchen. The baby is waiting to be taken care of. It is crying, crying and crying. The baby is noisy and needy but it does not get picked up.

It’s not mother’s fault because she is simply busy. It’s the baby’s fault.

Father is working and mother is overloaded. She is just young and has duties that she never had to deal with before. The baby is just one extra duty on a long list. The baby is not 1 year old yet. It is not an emotional priority.

Why should this baby come first. Mother was overloaded and creates a sense of guilt in the child.

It thought, “I don’t deserve to get my needs met”. “I make mother’s life harder, it would be better if I was not here”.


Comment on story

In terms of the fight, flight or freeze response to stress there is clearly no fight response in this case. It shows how the suicide decision can result in such circumstances as it did here. The baby does not view mother as treating it unfairly which would tend to be the fight response, “I am not being treated in the way that I should be, so its their fault” (anger).

Instead the response is to see mother as being over burdened with her domestic duties already and the baby is simply making mother’s life harder, thus it is the baby’s fault for it not being picked up. Thus it is not hard for the child to make the decision that things would be better for all concerned if it was not here. One could see this as the flight response and the feeling reaction is one of sadness and passive acceptance.

In being questioned on this scene the individual found it hard to say what her thoughts and feelings were. She stated that there were very few words and there was more feelings and noises instead. This gives the indication that the suicide decision in this case could be pre-verbal which also fits with the child being less than one year old.

If this is the case then one knows that the decisions made in this scene, including the suicide decision are going to be very resilient because they were made at such a young age before the child even had language. This implies that this individual will to some extent be potentially suicidal all her life. These very early decisions form the foundations of the personality and thus they are hard to alter through counselling compared to decisions made at older ages. The impact of the decisions can be changed but to expect them to be completely altered would be quite unusual and unrealistic. Thus there will always be a suicide decision there to some extent.

Of course a person of less than one year old can not recall such events as described and drawn here. For the purposes at hand it does not matter if it actually happened or not. These drawings and descriptions are really just visual, cognitive and kinaesthetic representations in the person’s mind, of the structure of their personality. This event describes part of the personality for instance in cognitive behavioural therapy terms, the thinking errors the person has. It does not matter if the event even occurred as it is the visual, cognitive and kinaesthetic representation the person currently holds in their mind which allows them to have consistent personality structures. It is what the person uses to actually have a personality.

I have always been surprised at how easily people will produce these early distressing scenes as well as being convinced of their authenticity. There is never a sense of people making up a story or telling a tale and so forth. Instead they produce a drawing of what they believed happened to them and as has been seen at times they can be quite elaborate and detailed. In addition the feelings and early decisions which were made as a result of the event can also be quite easily articulated.