Friday, February 25, 2011

Shame - edit #4 (Part 1)

This post will develop over a couple of days

When one reads the literature on shame one finds a bit of confusion as to what shame is and is not. Or perhaps it is better to say that people have differing views on it. One commonly finds three things mentioned in relation to shame.

Internalised anger
Guilt &
Shame

These three things are often mentioned as relating to 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.

woman pours paint

This would explain why some people may see guilt as being part of the shame experience or internal anger as defined as being shame on occasion. They can occur at the same time and often do. If one can define the three separate psychological processes this would clarify the nature of shame and its associated processes.

There are two ways in which internal anger can occur as shown in the diagram

Two types of internal anger

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 does not start with a “I” statement but with a “You” statement when an internal ‘telling off’ occurs. Examples may be “You were such a jerk talking to that boy”, “You can’t even get a simple report right”, You stupid f**k” and so forth.

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

Amy winehouse..

Or a person may steal money from a 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 such 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.

Guilt transaction

Finally we have shame which is a natural feeling reaction to a 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 realises he has wet the bed it is very easy for him to feel shame about that 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 very carefully so as to avoid this. Thus we have the shame transaction.

Shame transaction

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 presentations 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 behaviours, 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 expoerience 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 result from bad luck or factors outside the child’s control.

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


This indicates that there are three separate psychological processes - inward anger, guilt and shame. They can occur on their own or they can occur together. However if we see them as separate processes then the situation as to what shame is and is not can be kept more clear.


The separateness of these three psychological processes can be understood experientially as well. In therapy I may ask the client the following questions:

Recall a time when you felt guilty.
What happened and describe the feeling? Use a few words to describe what the experience of guilt feels like for you?

Recall a time when you felt shame.
What happened and describe the feeling? Use a few words to describe what the experience of shame feels like for you?

Recall a time when you felt angry at yourself.
What happened and describe the feeling? Use a few words to describe what the experience of self directed anger feels like for you?

Most people find this quite easy to do and report that the experience of shame and guilt are different which supports the contention that they involve discrete psychological operations.

If any one here wants to do this exercise I would be interested to hear your answers.

exposed self harmer


Shame and embarrassment

Under normal circumstances shame is not an emotion that is experienced all that often. The feelings chart shows there are various groups of feelings.

Feelings chart

I have purposely used the word “Family” because they are like that. There is a commonality amongst the feelings but they are also all different. Just like members in a family, they all have a basic commonality and they are also all different.

It is proposed that shame and embarrassment are like this. Embarrassment is a minor version of the full shame reaction and thus embarrassment is a much more common feeling for people to experience. It is safe to say that most people could relatively easily recite situations where they have felt embarrassed. Under normal circumstances there would be far less events to recall where the person felt shame.

They both come from the same emotion but vary in their impact. Whilst embarrassment is an unpleasant emotion to experience it does not have the devastating effect that shame can have. Charles Rycroft notes that shame is the cinderella of the destructive emotions. The experience of shame tears at the core of who we are. It effects us at a deep level and the understanding of who we are.

Tiger chaser

With guilt people can have the experience of,

“I am bad for doing that thing”

whereas with shame the person is more likely to end up with the feeling of,

“I am bad”
Whilst the shame will be connected to a certain event occurring the resultant comprehension of it is more about me as a person rather than about something I have done. Shame has far more destructive power than most other emotions.

As stated above under normal circumstances shame is infrequently experienced. It tends to only be experienced in relation to quite unusual circumstances, where as embarrassment is more frequently experienced in reaction to a wider range of events. There is however an exception to this.

sheep & kid
Will he feel embarrassed about ending up like this? Lots of people are watching!


Parents quickly learn that emotions are a effective way to get children to conform.

They can use guilt.

“Mummy will feel sad and hurt if you don’t eat up all your food”.

They can use fear by threatening abandonment.

“Unless you have your bath now mummy will get a policeman to come and take you away”.

These emotions cause pain in the child and thus the child will tend to behave in order to avoid the painful experience. The same applies for shame which can be a very unpleasant emotion to experience. Thus parents can say things like,

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

It works in getting a child to behave in a certain way but it is also particularly destructive in the ways described above. I would strongly advise parents not to employ this kind of child rearing practice.

dog attack
This will get people to conform, but at what long term psychological cost?

If you are working with a client who reports this kind of parenting in their childhood then you know the person may be damaged psychologically at quite a deep level. Also they will tend to report the experience of shame in the present more than average. They will tend to react to events with shame whereas others would tend to only experience embarrassment. This of course just amplifies the problem.

Rycroft, C.
1971. Reich. Fontana: Great Britain

The discussion about using shame as a parenting technique provides insight into the difference between neurotic shame and Here and Now (H&N) or reality based shame.

AC vs FC shame

This figure shows the two different types of shame are functions of two different parts of the personality. Reality based shame is a function of the Free Child aspect of the personality and the Adapted Child ego state is where neurotic shame would result from.

This proposal rests on the assumption that shame can be a normal and natural human emotion. An assumption that gets plenty of support. Firstly Freud (1942) notes that shame is “,,, organically predetermined...”(p.46). Then English (1994) discusses the topic in some depth. As she notes it would be impossible to instil shame in a child who did not already have the organic receptors for it. The ability to feel shame can be seen to have some evolutionary advantages as well.

English reports that Charles Darwin suggested that shame had certain evolutionary advantages. Shame is often around nudity and sexual matters and that covering up the genitals afforded more protection of them which also increased the likelihood of the propagation of the species. The expression of shame often involves blushing and a desire to hide which corresponds to the feeling of being dangerously exposed.

Borat Free Child
Why only cover up those parts of the body?



English, F. (1994) ‘Shame and Social Control Revisited.’ Transactional Analysis Journal. 24, 2, 109 - 120.

Freud, S. (1942) Three Contributions to the Theory of Sex. London: Imago.



As a result humans are so constructed that should a particular set of circumstances arise they will naturally feel shame. To make the assessment of reality based shame versus neurotic shame one needs to judge the appropriateness of the circumstances that have lead to the shame reaction.

Sometimes this is clear but at other times it is harder to assess. As said before shame is often, but by no means always, associated with nudity, sex or intimate physical and psychological factors. Below are some instances where many would feel shame as an appropriate H&N reaction.

The child who wets its bed or soils itself.
A woman discovers her ex-partner has placed intimate nude photographs of her on the internet for all to see.
A man is publicly exposed as an adulterer in his church group.
A man publicly jokes about his wife’s vaginismus.
A woman pokes fun at her husband about his baldness which she knows he is very sensitive about.

Lady rings on eyes

If a person reports feeling shame in such situations these could be diagnosed as Free Child shame reactions.

Some times the circumstances are less clear.
A teenager gets an F for his maths test.
A lecturer trips on steps as he walks up onto the stage to give a lecture.
Is it appropriate to feel shame in these examples, is harder to judge.

Many people with a social phobia report shame and embarrassment that is neurotic in nature. They feel as they walk into a social gathering that everybody is looking at them, they look awkward and odd such that they experience shame. Or as they talk they think they are blushing and saying stupid things and feel shame as a result.

These are likely to be Adapted Child ego state responses of shame. One reason why these occur can be due to the parenting styles as described above. If the parents have used shame as a method of punishment and said things like, “You should be ashamed of your self for...” the person is primed to have shame reactions as an adult. As a result they will have reactions of shame when most others would not.

Japanese lady

This leaves us at the next juncture of what does one do when they feel shame? Thus the distinction between neurotic and reality based shame assumes some importance.


Graffiti

Thursday, February 24, 2011

What is emotional literacy?

KYLady asks what is emotional literacy. Here is my answer.

Sometimes emotional literacy is referred to as the “Fourth R’. Children as they grow need to learn the “Three Rs” of reading, writing and arithmetic. Considerable time, effort and money is invested in making sure they learn these three things. Unfortunately much less effort is invested in making sure children learn the fourth R of relating or feeling.

There are a number of skills that need to be mastered before one can say they are emotionally literate. Humans are a verbal creature. We use speech as a primary way of communicating and thus we need to make sure that when we use a word it has the same meaning for the person listening to us.

Dancing girl

One of the problems with feelings is you can not see them or touch them. Instead you experience them. We can see behavioural manifestations of feelings which helps but that is also quite subjective. For example one child may hit another child. Some children will get to the point of physically hitting out only when they are very frustrated. They can be said to have ten units of frustration. Other children with much lower levels of frustration tolerance will hit out when they have only two units of frustration. The behavioural manifestations of emotions for people differ, at time differ significantly.

Whilst we can make some conclusions about their feeling state from observing the behaviour of a child it remains a very inexact science for reasons like cited above. Most humans automatically assume that others are like them. If I physically hit out when I have eight units of frustration I will automatically assume that others are the same. When I see a child hit out I will assume they have a particular level of frustration like mine. However that may not be so at all and often is not the case. Thus we already have the potential for miscommunication about feelings. If I should talk to the child about the hitting out he did and his feelings at the time then our communications may become confused. I can easily inaccurately assume he was feeling a certain way at the point of physically hitting out because that is how I would feel.

Two children

Children need to learn the correct words for the various feeling states. They need to learn that the word ‘anger’ fits for a particular emotional experience. Once done they need to learn the differences in that particular feeling state. The words ‘very angry’ mean a particular feeling experience that is different from the feeling state described by the words, ‘a little bit angry’, and so forth.

This is a most important task. If one is going to maintain workable and functional relationships they have to gain at least a satisfactory mastery of the literacy just described. If they do not develop such emotional literacy their relationships will repeatedly fall into disharmony and disarray. To establish some level of intimacy in a relationship one needs to be able to communicate to the other about their feelings in a satisfactory way.

Indeed some argue that relating and feeling should be the first R, not the fourth R. If one cannot maintain functional relationships then their life will remain in a poor state of health. If one can get such emotional literacy mastered then one has a much better basis upon which to learn the three other Rs.

Poodle man

The first step in emotional literacy is for the child needs to fit the right word to the right feeling state at the right level. However this is only part of the educational process. Once they are in a particular feeling state like anger, sadness or despair what do they do then?

With feelings the child is in a heighten state of readiness to act. When experiencing feeling the body is in a heightened state of tension and thus the person is motivated to engage in some kind of action. In other words how does the child express the feeling or perhaps defuse the state of bodily tension. Each society has appropriate and inappropriate ways of expressing and dealing with feelings. There is no universally correct way of dealing with ones feelings. Indeed psychologists disagree amongst themselves about how to deal with feelings.

The child needs to come to some conclusion about how to deal with its feelings that is acceptable to the wider society, to its parents and to itself. This is the second part of the educational process of emotional literacy.

Gun girl

The third part in the process is to isolate the ways by which the child is ‘misusing’ its emotions. This misuse can be done in wide variety of ways. Firstly emotions are a powerful way to get others to conform to what you want. Parents quickly learn this.

They can use guilt.

“Mummy will feel sad and hurt if you don’t eat up all your food”.

They can use fear by threatening abandonment.

“Unless you have your bath now mummy will get a policeman to come and take you away”.

These are effective and powerful ways to get a child to behave. Unfortunately they also leave psychological scars, at times deep psychological scars that can last a life time. If a parent threatens abandonment the child may grow up with a ever present fear of being abandoned. Eventually he marries a woman who has an affair and does indeed abandon him. However she is desperately unhappy because for the prior twenty years she has been subjected to his pathological jealousy because of his fear of abandonment.

Some times the society as a whole encourages children to use feelings for ulterior gain. In many societies boys are encouraged to be angry and not sad and girls are encouraged to be sad and not angry. As they grow up and eventually get married the man slowly learns that if he raises his voice a bit and presents a bit of anger then the woman will tend to back down and he gets what he wants. He learns, usually without even being aware of it, if he gets angry he is more likely to get what he wants from his wife.

Boxing woman

On the other hand as the girl grows she learns that if she starts to cry she is more likely to get what she wants. Again out of her awareness she finds that if she starts to cry when arguing with her husband he is more likely to back down and she is more likely to get what she wants.

This final part of the emotional literacy process seeks to identify all the permutations and problems that can get attached to feelings and seeks to untangle them.

If the three steps are achieved with some degree of success then the more emotionally literate the person will be and the less emotional and relationship difficulties they will have in life.

Graffiti

Tuesday, February 22, 2011

Emotional literacy

Anger
With drawing the four feelings one is wanting to know if the child (or adult) has the word A.N.G.E.R. (and the 3 others) connected up with the right emotional experience. One looks for these kind of things. Below are two drawings of anger and one searches for the right signs in the drawing.

Do they draw the appropriate facial expressions and body posture and paraphernalia?

Angry 2

Angry 1

These are two interesting drawings of anger. At least at the surface level they indicate a good level of emotional literacy with anger.

The second drawing has clenched fists, exposed teeth, eyes and eyebrows right for the emotion. This is a good sign that they have A.N.G.E.R. and the correct emotional experience connected together.

Further investigation would look into the BOOM and the swirling thing above the head. One is looking for the possibility of explosive anger with the boom and when angry the person experiencing a kind of swirling effect in the head or some kind of change in the consciousness. It is most likely this is not the case and one is kind of ruling the out possibility. But it may lead to something of this kind.

In the first drawing of anger we also have the teeth, the clenched fist and words that are appropriate to anger. Also we have the appropriate paraphernalia with an axe with what seems to be blood dripping from it. Again one would need to rule out the possibility of the inappropriate expression of anger with the use of physical violence as symbolised by the axe. Or the person may have come from a background where anger and physical violence went together. Or it may indicate a very intense level of the experience of anger for the individual.

However in summary both the drawings show a satisfactory level of emotional literacy with anger and areas where subsequent questioning could occur.

Happy
Happy 1

This is a good drawing of happy as the picture has a happy feel to it and the figure looks appropriate with the smile, relaxed posture, the cat and the serene surroundings. Thus indicating reasonable literacy levels with this emotion.

With this emotion one also wants to assess the persons social life. In this drawing the person is alone and not with others or engaged in interactions with others. Subsequent questioning would be on this area. However the instruction was to draw a happy person and not draw a happy person with others so that is the usual explanation one gets when questioning like this.

With such questioning one is looking for this emotion to be experienced in interactions with others particularly others who are of emotional importance to the child such as the parents, (or with adults the spouse).

In the picture the figure looks to be patting the cat. This could be a sign of the NP ego state. It is OK to experience happy feelings whilst in NP and I would be asking about the person experiencing happy just for them self and not when looking after some thing else like an animal or another person.

Scared
Scared 2
If you want to see it larger simply click on the photograph

This is an interesting drawing and reflects the possibility of some level of illiteracy with this emotion. The small figure, wanting to be alone and possibly hiding behind a wall. These are not good signs as in this emotion one is wanting the person to be seeking out others who can provide safety and support. Could indicate the beginnings of the hurried child syndrome.

Graffiti

Wednesday, February 16, 2011

Graffiti dissertation

I recently received an email from a person who is doing her psychology dissertation looking at the common denominators amongst graffers. She asked if I was willing to make a comment. Which I have now done and thought I might put it on my blog also.

So here it is.


I am more interested in the sociology of the graffiti movement rather than the individual psychology at least at this juncture, so I am not sure if my comments will assist you or not. However your comment that graffiti may result from a sense of invisibility in the individual graffer would make some sense form an individual psychological perspective.

To my mind if one is going to address the subject of graffiti then one must first deconfuse the political situation that surrounds it. This rarely happens and as a result very little ‘success’ has been achieved by the various bodies in the community because they can never get past first base, an emotive reaction.

Shadow face

Public commentators on the topic of graffiti almost unerringly use the subject as an opportunity to basically say how this section of the youth are a bunch of rat bags who wreck things for the wider community. If one is wanting to publicly vent their spleen, this is a great subject by which to do so especially at the youth of today.

The problem with this is one never gets to have a a clear and non emotive look at the subject. If one can cast aside at least temporarily their anger about the subject then one can begin to see some interesting sociological factors arise.

Strong girl

Firstly graffiti is not just a bunch of rat bag kids who run about at night drawing pictures on the walls. I have in recent years travelled to the US and parts of Europe. In almost every city I have visited the graffiti on the walls is the same. What I see on the walls of a variety of cities is consistent and the same that exists in my city where I live in Australia. This is a world wide sociological phenomenon that is taken up by millions around the world at least in modern westernised democracies. It is not just small localised areas where graffiti happens. The people are voting with their feet in this way.

Secondly, this is not just an over night event. The same graffiting has been going on for decades now in many cities around the world. This is not a transitory social movement.

Fishermen

Thirdly, and this relates to the previous point, public officials around the world in numerous cities have tried and continue to try a wide variety of strategies to halt graffiti usually with very little success. A great deal of time and effort and money goes into the task of ending graffiti occurring. So far it has been a dismal failure.

From a sociological perspective this speaks volumes. Here we have a social movement - graffiti - that is very resilient and very resistant to eradication. That does not happen by accident and would suggest, or perhaps demand, that the social forces behind the graffiti movement are intimately connected with the very structure of a modern westernised democracy.

Dont look

All societies are based on a series of assumptions and beliefs about what is valuable and not valuable to have in a society. It is likely that the fundamental basis behind this social phenomena - graffiti - is inextricably linked to these assumptions and beliefs about how a society should be structured. This would explain the very strong resilience of the graffiti movement. If this is so it is not going to stop until you start altering some of the basic assumptions of a modern western democracy and that is certainly not going to happen any time soon.

Writing

I had forgotten what it was like and how it worked. For the past two weeks the publisher had asked me (twice!) to put in the proposal for the book on emotions. I had thought about it, meant to start it, “ummed and ahhed” about it all and nothing had happened.

Camel
To all you smokers out there, remember the cool, smooth flavour of Camel.


Well stuff was happening but it was all behind the scenes. My mind, as I ate my dinner, went for my walking exercise, bathed and other such domestic tasks was slowly but surely getting it together. How do you put together an 80,000 word manuscript? What is the overall structure of the thing which of course is the most important part of all. It was not like I had set myself the task to ‘get the overall structure of the book’ it was kind of thinking about this bit here and that bit there. Definitely done in a non systematic way.

On my computer desk top is the folder which has all the stuff in it for what the publisher is wanting. It just sits there in the bottom left hand corner. Today I sat down at my computer and opened up the folder. I had no intention of doing that, it kind of just happened. Then three hours later it was done. It was one of those things where you start something and then you look at the clock and realise three hours have gone by. All of a sudden you realise you have that sort of numb feeling behind your eye balls because your concentration has been so intense for such a protracted period of time.

Walker

It reminded me of how I wrote the manuscript for the book on working with suicidal individuals. I never forced anything, it happened and came when it wanted. At times I was a bit concerned as I would go for a week or two with out writing anything. But then it would come and I would write a whole bunch of stuff.

Back to the current book.

I have an exercise for anyone out there who might like to do such a thing. You need to get four separate pieces of paper (Blank sheets with no lines on them).

On the first page draw a picture of an angry person
On the second page draw a picture of a sad person
On the third page draw a picture of a scared person
On the fourth page draw a picture of a happy person

Then if you like send them to me and I will analyse them.

Girls

Graffiti

Sunday, February 6, 2011

Emotional dysregulation

I was recently reading an article on emotional dysregulation. Sounds impressive eh?

The person who is capable of emotional regulation can initiate, maintain and modulate the occurrence, intensity and duration of internal feeling states. Impressive eh? In other words they are capable of self soothing.

Pregnant mother

In Transactional Analysis terms one could describe emotional dysregulation in the following ways

Child symbiosis

The child begins life in a symbiosis with mother. It has to do this or it will die as it has no Adult or Parent ego states to keep it alive. The child will use mother’s Parent and Adult ego states to get food and water and all the psychological needs it has for love and human contact.

As the child grows in its early days it learns that at times it will experience distress of various kinds. It has hunger, thirst, wind, a need to be changed and so forth. It learns or is programmed to let mother’s Adult and Parent ego states know of its needs by crying. When mother hears the cry she swings into action and sets about solving the child’s distress and thus the child is emotionally regulated as the distress eases.

When this happens the child learns four things
It learns that it is important, it has worth and people will help it out
It learns that it can get its needs met
It introjects a soothing Parent ego state into its own Parent ego state
It learns the experience the feeling satisfied and calmed down

Introject Parent

Sometimes this does not happen. For instance mother may be suffering post natal depression. She begins to find herself isolated in the house, lying in bed for long periods of time during the day. When the new-born cries she finds it very hard to get out of bed to deal with the child, at times she does not even recognise the child is crying. As a result the child has to cry for long periods before it is dealt with and sometimes the help never comes and the child just gives up crying.

When this happens the child learns
That it is of little worth
It develops the injunction, “Don’t get your needs met”
It does not introject an internal soothing parent figure
It has no experience of the feeling of being soothed

Combine this with certain inborn natural temperament qualities and the young person can be set up with a life of emotional dysregulation. Consider this list of temperament qualities.

Temperament

If the child is born with a negative quality of mood and an intense level of reaction combine this with a lack of internal self soothing ability, a “Don’t get your needs met” injunction, that it is of little worth and has no experience of what it feels like to be soothed then it is likely to suffer emotional dysregulation.

Should this happen then the person will develop other ways of coping with the dysregulation. Three common ways are:

Self harming. This is common with the borderline personality. As I mention in my book on working with the suicidal there are eight main reasons for self harming

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

Elephant woman

People who self harm as a way to cope with emotional dysregulation would most often be doing it for the reason cited as number 4.

Drug use. Some cope with emotional dysregulation by self medicating with drugs weather they be licit or illicit

Smoking girl

Comfort eating. One way to soothe self is to eat good tasting food. When this happens the person is said to engage in what is called comfort eating. They deal with ongoing painful emotions by self soothing using eating.

Therapy with such people is not all that complex. The therapist simply soothes the client when necessary. Of course this is easier said than done but the overall direction of treatment is quite clear. This soothing can range from lending a sympathetic ear and a soothing voice, to holding work, to the client learning methods of self soothing such as using a pacifier and so forth.

Graffiti

Wednesday, February 2, 2011

Inverse motivational interviewing

I devised this theory when I was working on alternative ways of doing what is known as motivational interviewing.

Motivational interviewing is a process that developed in the field of addictions counselling. It is designed to afford the client an opportunity to develop a higher level of motivation to change their behaviour, in this instance to increase their motivation to stop, reduce or somehow change their drug use.

Typically this can be done in two ways. It can be an Adult ego state exercise where the therapist helps the client list all the positives and negatives about their drug use. The purpose of this is the client will have the negatives highlighted and thus their motivation to change their drug use is heightened.

Woman drinking wine

The second way is more of a Child ego state exercise. In this case the therapist helps the client to understand how their drug use supports their life script. By using drugs the client is staying in their Conforming Child ego state. The therapist then uses what are called ‘heighteners’ to encourage the client to move into the Rebellious Child ego state. If achieved then the client's motivation to change is increased as the person rebels against the script message that involves them using drugs.

There is one other way one can work with this and it involves the ‘stuck’ client. Some client’s will report that they feel stuck in their life in some way and a drug user can be this. They will report that they are in a rut or habit or life style where they seem to be getting no where and have a sense of just going around and around. This can include the person who has a desire to alter their drug use but they are not changing that behaviour in any consistent way.

With people who reports a sense of stuckness I will search for some way in which they are psychologically stuck. This can be in a variety of ways.

Brick carrier

1. Some people are stuck in their feelings. That is they are stuck in a particular feeling or they are stuck in avoiding a particular feeling. For instance the person who carries around an anger at their ex partner. This person is stuck in their anger and if they can become unstuck by dropping it or getting over it then that person may experience a significant increase in their psychological readiness to change (in other terms their motivation to change increases).

Then there is the woman who is stuck in depression. She is angry at her husband but for some reason she is too uncomfortable to express it so she becomes chronically depressed. If she expresses her anger she becomes unstuck and thus her readiness to change increases.

2. Some people are stuck in a relationship. Instead of being stuck in a feeling this person is stuck in a relationship in some way. A woman may feel very unhappy about her marriage but she does not know what to do about it. She tries many ways to change things but none seem to amount to anything. Thus she has a sense of stuckness in her marriage and this reflects as a stuckness in her own psychology such as excessive alcohol use or depression. If she can make a change in her marriage then her motivation to change her alcohol use increases.

4 on bench

3. Some people are stuck in an event. Some traumatic event happened to them and they are not willing to deal with it. The loss of a loved one can be this. People who are not willing to discuss an episode are exhibiting a sense of stuckness about that event. Again this can be reflected in a sense of stuckness in their psychology.

People who abuse alcohol and drugs can exhibit this type of situation. They are contemplating changing in their drug use but it is just not happening. They are treading water or in a holding pattern as they say. They want change but they will not actually go ahead and do it. Thus one has a sense of stuckness. When this happens one can look for how they are stuck in their feelings, relationships or in reaction to a particular event. Once found then one can seek to facilitate a break through in that. If that happens then one is freed up in this psychological way.

If this happens then one has an increased motivation to change because the psychological block they have is reduced and it is easier for them to carry out the behavioural change they are contemplating. That can be a change in their drug use.

devils

This is an interesting addition to the various methods of motivational interviewing. The two methods first described seek to increase the level of disquiet or angst in the individual about their drug use. The method described here works another way. It does not seek to increase the disquiet but sees the non behaviour change in drug use as a reflection of some psychological impasse or stuck point in the persons psyche. If that impasse can be broken then it is easier for the person to alter their alcohol and drug use.

One can argue that their motivation to change has not increased but the level of motivation that is require for change has decreased. Thus we have a kind of inverse motivational interviewing.

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