Suicidal ambivalence

Monologue by me about the concept of suicidal ambivalence that I discuss in my book - Working with suicidal individuals. What it is and how it can be used in therapy with clients.





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The Be Perfect driver - editted

KYLady asked a good question that anticipated the next part of this post I was going to do.

Perfectionism is most often found in conditions like depression, OC and eating disorders.

Perfectionism can have both positive and negative outcomes and has been shown to be associated with adjustment, academic achievement and self-efficacy.

Perfectionism can be

Self oriented perfectionism

Other oriented perfectionism

Socially prescribed perfectionism

Self oriented perfectionism endeavors to avoid self criticism (I’m not OK)

Socially prescribed perfectionism endeavors to avoid the criticism of others (I’m not OK)

Other oriented perfectionism involves having unrealistic standards for others (You’re not OK)

The six principle components of perfectionism are

Personal standards

Organization

Concern over mistakes

Doubts about actions

Parental expectations

Parental criticism

Most have two or three of these areas which they feel driven to be perfect in. Interestingly enough the Be Perfect driver person will often have a particular place in their life where it is chaos, disorganized and very ‘imperfect’ such as a room, a cupboard, their car, their paperwork or the like.

Perfectionism and performance

As mentioned before perfectionism can have positive consequences in that it can result in an increase in performance at work or at school. However this needs to be considered in more detail as perfectionism can also result in a reduction in the level of performance.

The graph shows the average person will have a satisfactory level of performance. Those who are subject to the Be perfect driver will initially have an increase in performance as the degree of perfectionism increases. The job at hand gets done better the more ‘perfectly’ it is done. The more perfectly done the more energy has to be expended on the job compared to the person who does the job at an average level.

As the degree of perfectionism increases it reaches a critical point where the level of performance starts to decrease. This can be seen to occur in one of two ways.

1. If one is writing an assignment at school on the different perspectives about feminism in the currant millennium the average person would write it and that would be that. The Be Perfect student would write it but consider more people’s perspectives and consider each perspective from many more perspectives and different people’s perspectives on each of those perspectives. As you can see a point is reached where the need to be perfect makes the assignment worse because each and every variable are considered. Hence the level of performance decreases than if it had been done in an average way.

 2. The more perfectly a job is done the more energy is required. The student given the assignment knows how he operates in doing such tasks. Most importantly his Child ego state knows the level of perfection required by his Parent ego state and he knows that reaching that level of performance is exhausting and very tiring. As a result the Child ego state starts to avoid doing the task and hence we end up with one cause of procrastination. He delays it for as long as possible because he knows how much he will suffer whilst doing it. As a result the level of performance goes down because jobs don’t get done or only get done at the very last moment.

However this situation can go even further. In some cases the degree of perfectionism can be extreme and when that happens one can end up with a thought disorder and other psychotic behaviour. A common one is the thought disorder known as overdetailing. When the person talks they go into so much detail that it becomes incomprehensible. In their thinking they constantly consider many different perspectives, factors and permutations such that eventually the thinking becomes disordered to the extent that the person is not capable of looking after them self or performing basic day to day tasks. At this point the person can only achieve a very low level of performance due to the degree of perfectionism.

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Further consideration of the OC

The obsessive compulsive’s primary way of dealing with life is by thinking. As a young child the OC decided that to survive in the world one must think. It was chosen as the way to deal with things and solve problems. The opposite to this is the hysteric personality type who has decided to deal with the world by feeling, the young child decided that this is the way to deal with the world and to solve problems. Hence, to put it somewhat unkindly the hysteric is an ‘airhead’ who can’t think and the OC is ‘dead from the neck down’ who cannot feel.

Sometimes the hysteric and OC will marry each other because they are attracted by the other having the thing which they feel complements them and provides the thing they do not have. Needless to say they can end up in counselling at some point.

As with all personality types the goal is not to change the OC personality into something else. Firstly, what would it be to changed it into? Everybody has a personality and it must be of a particular type. It is impossible to not have a personality type. There is no such thing as the ‘normal’ personality type - which is probably a very good thing. Instead there are the following personality types:

Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Histrionic
Narcissistic
Avoidant
Dependent
Obsessive/compulsive

As you can see there is no ‘normal’ personality type defined.


Is it possible to have the normal personality type?


The goal is to modify how the personality type is expressed such that it is used in life to help the person rather than to cause them difficulties. For example the person piloting the plane of which I am a passenger I want to be an OC. The surgeon about to cut into me on the operating table I want to be of an obsessive compulsive personality type. As you can see there are occupations where it is a positive to be able to think, be very precise and orderly. On the other hand the hysteric can be a good people person because they can be outgoing, and the ‘life of the party’. They can work well in public relations or other occupations like sales.

OC and indecisiveness
Of course if not managed well then there can be a downside to each of the personality types. For example one feature of some OCs is indecisiveness where the thinking results in problems rather than having a positive outcome. The cause of this indecisiveness provides a good illustration of the decision making process. The decision making process is diagrammed below as a four part process.


The decision making process



The person initially receives information via the Adult ego state. Next they internally listen to what the Parent and Child ego states have to say about the information and then the Adult makes a decision based on these three pieces of information. For example the person may be deciding on whether to take a new job.

1. The Adult gets all the information like the job description, level of pay, place of work and so forth.
2.The Parent then makes its assessments about the job. It may think, is it a good job such as helping people by being a counsellor or a not so good job like becoming a tree logger that destroys the forrest.
3. Next the Child has its input. It may think that it likes the tree logging job because it pays much more and you get to be outside a lot rather than sitting in an office all day.
4. The Adult then assesses these three pieces of information and makes its decision.

In good decision making this process is meant to happen. With the OC it can fall down in two ways. Firstly the OC can overwhelm self by over researching. In part 1 of the process they simply get a mass of information. Due to their insecurity they think the more information they have the better informed decision they can make. What actually happens is they get swamped by a tsunami of information. For example in deciding which new car to buy the OC can get lost in all the technical information of the various models. As the saying goes, “They loose sight of the forrest for the trees”. They loose sight of the overall picture and find it hard to make a decision.


FC mud therapy for the OC?


The second way the OC can be indecisive involves the third part of the process. Due to their inability to access feelings and remain only with thinking they can loose contact with the Child ego state. If the choices are reasonably equal then the Free Child has the answer. The Free Child knows what is the right decision for the person. Those who are out of touch with the Free Child, like the OC can be, find it hard to make a decision because they lack the Free Child input.


OC and family relationships
I recall counseling a couple where the wife was an OC. She had strong needs for cleanliness and also strong contamination fears. The husband liked to garden but was never allowed to use any pesticides or chemicals in the garden. If he ever entered the kitchen or prepared any food he would be watched very closely. She tried to not make it obvious but he knew he was being closely watched on everything he did in the kitchen. She was very scared of possible contaminations by not cleaning correctly and ‘improper’ food preparation.

However the outcome of this was that his domestic life was significantly effected. He did not want her to feel anxious which meant he had to behave in very specific ways in his own home. This is an aspect of the OC that often does not get much consideration. The family dynamics aspect of treating the OC. The OC can end up with a very controlling presence in the family and home and those living there will have to adjust in some way. That can either be a sympathetic response where they become controlled in the home or there can be an angry response to the restraints where little consideration is given to the OCs fears.

This is a very real and difficult situation which can lead to marital and family breakdown where there are no winners. The OC has real and at times strong anxieties about what are usually mundane things in the home. On the other hand it is not fair for the various family members to have to live in a home that can be highly restrictive and indeed tense. When working with the OC, at times it is wise to meet with the other family members to find out the family situation and how they cope with it.



Obsessions and compulsions as a defense mechanism
Whenever I meet a client who tells me how they are constantly on the go, always doing things and never seems to have any spare time the first thing I think is, “What are they hiding from”. One way to avoid painful feelings or memories is to distract self. If one has a very full and busy life that can be a technique for distraction. Another way to do it is to have obsessive thinking. One way to keep painful feelings out of the conscious is to repress them with obsessive thinking. There is no space left for them to come up into the conscious.

The counselling approach here is clear and is often needed with the OC. Ask the client,
“If you stopped obsessing what would happen?”
“If you had to sit still and not do any thing what would happen?”

Most report some kind of feeling would come up which they are trying to avoid. With most OC client’s the therapist is wanting them to start feeling and expressing their emotions. If they achieve this then they tend to start to relax more and the obsessions and compulsions lessen.

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Magical thinking & the obsessive compulsive personality type

The person believes his thoughts, words or actions will in some way cause a specific outcome that defies the normal laws of cause and effect. For example a man believes that if he prays three time at night that will prevent his mother from dying. A woman believes that if she checks the doors three times at night then she will be safe.

Magical thinking may be part of ideas of reference or may reach delusional proportions when the individual maintains a firm conviction about the belief despite clear evidence to the contrary. Magical thinking is found normally in children and with the OC personality type.

Magical thinking is a battle between the grown up Adult ego state (A2) and the Adult ego state in the Child ego state (A1) sometimes known as the Little Professor ego state. The young child is born without an A2 ego state, all it has is its Child ego state.



Thus all the thinking it does is via the A1 or Little Professor ego state which means it will at times have quite illogical thoughts and come to quite bizarre conclusions and decisions. The Adult (A2) is not really fully formed until adolescence. Jean Piaget’s theory of cognitive development has shown this. For example it is not until the age of about 8 years that a child finally realizes that death is not reversible. Up to that time it thinks death is a reversible process. This clearly is magical thinking and thus would be seen as a function of the A1 ego state not the A2.

Most grownups eventually form a strong A2 ego state and thus go through life without odd thoughts and beliefs about the facts of the world. However we never loose the A1 ego state, it remains with us until the day we die. So all grownups have the ability to have child like magical thinking.

Superstition is a good example of this. We all know that touching wood will not make good luck befall on us, however we all touch the wood anyway, (just in case). The same for black cats and walking under ladders. Most of us do not believe it has any effect but we avoid walking under ladders, (just in case).

However the magical thinking we all have is sometimes not so banal. People can at times spend significant sums of money based on magical thinking. Some beauty treatments have no scientific basis for them but people will spend significant money on them because they believe them to work. Some skin treatments and mud packs are of this kind. Conspiracy theories may also involve magical thinking that is not logical. Some believe that Lady Diana of the UK was either killed by MI5 or the egyptian mafia rather than her simply dying in a motor vehicle accident. Magical thinking is particularly susceptible to the phenomena of group think.



In group think people start to believe the same illogical thing, because others around them believe the same thing which makes them more secure that their thinking must be true. When conspiracy theorists get together to discuss their theories, they find others have the same magical thinking which makes it more true in their minds. “The end is nigh” groups can also be of this kind, where a group of people have the same magical thinking. Because others around them believe the same that makes it more true in the mind of each individual. The phenomena of group think can particularly happen with magical thinking.

Every “The end is nigh” group has been wrong so far (but beware the next one may be true!). Often they have an elaborate belief system about why the end is nigh that is based on significant evidence which they can produce or explain how it works. The point being that significant thinking has been engaged in before the conclusion that the end is nigh is reached. It is not simply based on a whim or a hunch.



Magical thinking is be no means solely for the neurotic and the disturbed. We all can and do engage in magical thinking because we all have that ego state in our personality. Many normal good members of society can have significant areas in their life that are based on magical thinking.

However the OC personality type in particular uses magical thinking especially with compulsive behaviors and it shows how the A1 and A2 can coexist at the same time in the personality. A client recently reported to me an elaborate ritual on checking if a door was locked. He would check the door could not be opened by trying to turn the knob to open the door. He would then walk to the other side of the room, turn around, look at the knob walk back to it and try it again. He did this three times and then he felt satisfied it was locked.

He knew clearly in his Adult ego state how illogical this was which caused him even more distress. However if he did not do the ritual he knew he would feel considerable disquiet and would have this constant urge to finally complete the ritual. The magical thinking was that if the ritual was performed then he could be sure the door was locked. His A1 was stronger in the personality than the A2 with regards to this specific piece of behavior.


OC personality type - cleanliness, perfectionism, orderliness, control.



Obsessive thoughts may also involve magical thinking. A long term client recently attended an appointment in great distress. The local council that morning sprayed herbicide along the street outside her house to kill weeds on the side of the road. She was convinced that could have been contaminated by the poisonous spray before she had time to close all the windows and that she will become quite ill and possibly die.

The fact that the council has been doing this for the last 20 years and no one before had ever reported getting ill had little effect. The fact that there was no wind and the sprayers are very close to the ground had little effect to reduce her angst. The fact the government health standards make sure there is no way such herbicides sprayed the way they are would ever contaminate anyone also had little effect for her.

Her Adult (A2) acknowledged all these as true but still she felt great distress about being contaminated because there was still a possibility that it could have somehow (magically) occurred. The A1 thinking dominated the A2 in this instance and she thought about it obsessively over the next week. Such A1 based contamination fears are common in the OC personality type.


OC - pro ana


Obsessive/compulsive
I have to feel in control of life and myself so I will be orderly and perfectionistic
Drivers: Be perfect, Be strong
Injunctions: Don’t enjoy, Don’t get your needs met, Don’t be a child
Life position: I-U+
Strokes given out: Positive conditional

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Drug use ambivalence

Using the drug use ambivalence technique with those drug users who are in remission.

I have been using this technique now for some time. I have developed it over a number of years and kind of did not realise that until I spoke with my supervisee the other day and she raised some concerns.

It is a two chair exercise where the client sits in a chair and experiences that part of their personality - either the FC or AC.



I have used it recently with two women who had been clean for some time but they had both expressed some concern about relapse. They were fine doing the FC chair and gave the usual responses of why they do not want to use - their lives are better, healthier, save money and so forth.



When asked to go to the AC chair both expressed an instant strong fear reaction. One woman even stated,

“That bit does not exist..... if it does exist it is only very tiny”.

After a bit of discussion she stated that she did not want to acknowledge that it existed because then she might use again. Indeed we had spent a good deal of time in the previous weeks discussing the idea of relapse and she was quite open about it. She was fully aware in her Adult about her desire to use drugs again but to actually experience that part of self was an entirely different thing. Her statement about it not existing or only being very small was highly incongruent. This however does show the difference between her Adult being aware of her desire to use again and her first hand experience of that part of her personality that wants to use. Which supports the validity of this technique.



However this raises an interesting question, What was she actually scared of? Does the bigger fear reaction mean the more likelihood of relapse or the closer the person is to a relapse.

Or it may simply mean that the person is scared of relapse even if they are not at any great risk of doing so.

I do not know the answer to that question. However my supervisee expressed some concern at this technique. She reported that by asking the person to experience the part of self that wants to use drugs may in fact increase the likelihood of them doing so. Another interesting proposal and one that I do not agree with.

The fear reaction, along with the reluctance to ‘be’ that part, (with one person even denying its very existence) means that she had repressed that part of her personality. She had become unintegrated in that way. She had locked away this part of her personality and kept it hidden from her conscious.



Psychological theory states that the more you integrate parts of the personality the less trouble they will be. By keeping it unintegrated the more likelihood there is that she will relapse. By experiencing it and integrating it, the less problematic it remains in the personality.

Also with her being the AC part of self it allows me to relate to it directly. This is a most important thing to do. Whilst sitting in the AC chair I can dialogue directly with it. Thus we have the opportunity to develop some relational contact. It allows us the option of building up some kind of relationship. This is a very good thing as it allows the AC to stop feeling so isolated. It defuses it and people are always in better psychological shape when they feel they are in some kind of relational contact with others.

Any time I come across some kind of self destructive aspect in a client my first goal is to establish some kind of relational contact with it.

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Drop a feeling

Some people report experiencing feelings that they don’t want. In such circumstances the psychological process of dropping the feeling is required.


For small feelings



1. Child ego state experiences the feeling
2. Adult becomes aware of the feeling
3. Adult decision to drop feeling


For large feelings



1. Child ego state experiences the feeling
2. Adult becomes aware of the feeling
3. Child expresses feeling the number of times needed
4. Adult decision to drop feeling (May need two chair)

Barriers to dropping feeling



The racket value of the feeling
The strength of its connection to a script decision
Secondary gains associated with it.

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Using drugs dangerously

In order to use drugs dangerously such as with injecting drug use one has decommission their Adult ego state whilst doing so. This can be done by using what are called defence mechanisms. Humans are very good at lying to themselves and defence mechanisms are one way they can do that.



If a person has the Adult ego state information that sharing injecting equipment is a most unwise thing to do then in order to do it that, the Adult needs to be tricked some how. The Child ego state in some way needs to temporarily trick the Adult. If it can not do this then the person will not share injecting equipment on that occassion.







Below is a statement by a 37 year old doctor who shared needles on this occasion.



“Never in wildest dreams did I EVER IMAGINE that I would share needles. Some of the details around these circumstances I can’t recall. I spose it was so traumatic, having a medical background and a deep moral code around sharing fits it still seems unbelievable.



I would ask the people who had used the fit before me if they had HIV or hepatitis and I chose to believe their response of no. Truth has no place in this world, if it shows up then is gets distorted, ignored or disproven because truth and drugs cannot be in the same room. The thought of not being able to get the drugs into me as quickly as possible especially when watching the others getting relief from their angst was something I could not take. This anxiety/fear far outweighs the fear for my own health and life. It was like trying to resist the sound of a newborn baby crying when you’re breast feeding.



I would disassociate from reality, time and space changed. I would wash the fit out with alcohol or bleech the whole time repeating a mantra of please God please God. I would think who cares anyway, you’re fucked and life is fucked and you’re all fucked. Self loathing and the fear of not getting that rush would fuel me on.



Then the ritual of mixing up would begin and my mind would start bargaining “you’re not really going to do it” “you’ll stop before you whack it” but there is no stopping by this stage you’re like a robot and this thing has you in its grasp. I would cry as I found a vein, wishing I could stop, jacking it back, holding in the sobs so I didn’t shake too much, then pushing it down the relief flooding over like a lover holding you in their arms no more aghhh and once again I’m cleaver and funny, all worries dissolve, I am a sex goddess and philosopher, brave and complete, all fears drift away.” (end quote)







Can you spot the defence mechanisms?

Or the ways her Child ego state temporarily tricks her Adult ego state.

I can count 4, possibly 5.



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Book update.

With the negotiations completed and the contract signed I am in the process of writing the next book. Although the title is yet to be decided it is about counselling drug users.



The last book - Working with suicidal individuals - was meant to be 70,000 words and it ended up being 90,000 and I was asked to reduce it. I finally got it down to 87,000 words and it was accepted. This time however I have been asked to keep it to 70,000.







The first chapter I have almost completed is probably going to be chapter four and it is on Harm Reduction. This topic will be found in the vast majority of books on drug counselling. It is usually quite dry and has been said a hundred times before but you really do need to have it in there.



I thought it was going to be about 1,500 words but it ended up being 7,000 and I am really happy with it. I mean really! It has ended up with a really good structure, looks at the overall area and then has lots of new and applicable stuff on the area. Most of it I have never seen in the literature before.







It was one of those situations, that as you start writing you begin to find out that you knew all this stuff, you did not know you knew. It just kept coming out as I wrote along. Problem is one tenth of the book is taken up with this one chapter!



Other than this, as with the first book the initial stages are quite taxing and hard. I have the outline of the book and I keep thinking of things I have written or know of in the literature and frantically putting them in all sorts of folders on my computer. But it’s like at times you have to keep four different things in your head at the one time as you don’t want to miss any. This happened with the last book and should slow down a bit soon I hope as I get most of it together in the right places.



But all in all it is good to have a new project like this. It certainly has my interest and I am motivated to do it. As with the last one when I write I have to let my Free Child run wild at times and then get it all down and together in the right structure and format.





Free Child





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The two ego state model

Tony White
Transactional Analyst
June 21st, 2011.

Introduction
Ernst (1971) believes Eric Berne's most significant contribution to psychotherapy was the delineation he made between the Parent and Adult ego states. This, he says, allowed us to distinguish opinions from objectivity. This view is consistent with the general view that science has held up to date. However sat present, the social sciences are experiencing much confusion in certain areas. (Strauss and Hafez [1981], Morgan [1983], John [1984], Eysenk [1983]). It is this distinction between the Parent and Adult ego states that illustrates why the confusion exists.

Steiner (1971) defines the Adult ego state as essentially a computer, an impassionate organ of the personality, which gathers and processes data for the purpose of making predictions. The Adult gathers data through the senses, processes them according to a logical program, and makes predictions where necessary. The Parent ego state is essentially made up of behaviour copied from parents, or authority figures. It is taken as a whole, as perceived at an early age, without modification. A person in his Parent ego state, is merely playing back a tape of of early internalized parent figures. It is a repository of traditions and values.

The above definition of ego states implies that the Adult is not a collection of tapes, that it is not comprised of the incorporation of parent figure information. this paper contends that the above proposal, simply stated, is incorrect. When a child attends school he acquires information, this involves the incorporation of the teacher's instructions. Later on in high school, when the child has more knowledge, he may critically evaluate what he is being taught, yet he can only do this if he has previously incorporated, or learnt how to critically evaluate.

The acquisition of language and basic mathematical principles also involves the incorporation of tapes. The most obvious example is the rote learning of multiplication tables and the alphabet. Brunner (1964) agrees with this, stating that all the techniques of data processing are passed down from generation to generation, in each culture. Each child incorporates data processing methodology from his parents.

The Adult and the Adult in the Parent.
It now becomes apparent that the Adult ego state and the Adult in the Parent ego state are the same. Thus the two ego state model may be represented geometrically as in Figure 1b


Figure 1

For further elaboration, it is necessary to examine Stuntz's (1972) paper on the second order structure of the Parent ego state. He states that the Adult in the Parent (AP) "is an external program of how to use the computer (Adult)" (p. 60). It is the contention of this paper that the Adult in the Parent (AP) is the Adult, and that any division is unnecessary and leads only to confusion. Stuntz suggests that each time Adult processing is required that ego state must consult the Adult in the Parent. See Figure 2a and Figure 2b illustrates that the Adult ego state outside the Parent is redundant, doing only what it is told by the AP. Thus it is an unnecessary middelman that creates four process instead of two.


Figure 2

In Figures 1b and 2b, it is seen that the two ego state model places the Adult ego state inside the Parent ego state. This is meant to indicate that those internalized tapes, specifically referring to data processing and manipulation, are encompassed with in the A2. Those tapes not referring to data processing are encompassed within the P2 but outside the A2. Processing which is not based on taping, falls within the realm of the 'Little Professor' or A1.

The Adult as a computer
The Adult ego state is often described as being a computer, this metaphor illustrates the notion presented in Figure 2. Computers are programmed by computer programmers. A computer's computational ability is entirely dependent on the computer programmer's logic. (In this case the 'computer' is defined as that part of the whole system which the computer user communicates with - most commonly the keyboard and visual display unit. The computer will only process data according to the instructions from the 'tapes' or 'disks', to which it is connected. It is these tapes that contain the computer programmer's logic (that is, his opinions, assumptions and beliefs on correct data processing).

As an obvious example assume the computer user asks the computer, "What is 1 + 1?". As indicated in Figure 2a, the computer now asks the tapes, "How do I respond to the stimulus, 'What is 1 + 1?'". If the computer programmer believed the answer or response should be '3', then the computer will respond with '3'. It will see nothing wrong with this. The computer blindly and unquestioningly accepts anything that it is told from the tapes held in its head as does the Adult outside the Parent. The only function the computer (i.e. the keyboard and visual display unit) serves is to convert computer language into human language. If humans could 'talk' computer language, then they could talk directly to the magnetic tapes. Parent ego state tapes are stored in human language, which allows us to talk directly to them. We do not need a conversion process, therefore the Adult ego state outside the Parent serves no purpose.


Tony presenting the two ego state model in his TSTA examination in Hawaii, 1989


Assumptions of this presentation
Logically, this paper is written from the Adult in the Parent. It is based on beliefs, programming and information, that is different to those used by Berne, when he outlined the three ego state model. There does appear to be a definite informational difference. When Eric Berne first published his paper outlining three ego state theory, it was the mid 1950s, (Berne [1957]), at that time, there was little evidence to suggest that the great promise of science, was not true. Scientists and theoreticians generally believed that reality could be viewed free from parental programming. However, with the knowledge explosion over the past one and a half decades, it has become obviously apparent that the promise has not, and will not ever be fulfilled.

It is the assumption, belief and opinion of this writer that an Adult external of the Parent illustrates the great promise of science, and the Adult internal of the Parent illustrates why this promise has not been fulfilled. The basis of this belief is presented in the preceding pages.

The second assumption of this presentation is that it believes it is necessary to propose an ego state theory which considers the problems of contemporary social science. This is based on the belief that it offers something to the scientific community, both theoretically and therapeutically, that is not already offered by the three ego state model. The reasons for this assumption will become evident over the next four or five presentations. There are undoubtedly many more assumptions of this presentation, these will become more obvious as the concept of the two ego state is further discussed.


Originally presented in:
Tony White. 1984.
New Ways in Transactional Analysis. TA Books: Perth.

References
Berne, E. "Ego states in psychotherapy". The American Journal of Psychotherapy. 1957, 11, 293 - 309.

Brunner, J.S. "The course of cognitive growth". The American Psychologist. 1964, 24, 1 - 15.

Ernst, F.H. "The diagrammed Parent. Eric Berne's most significant contribution". Transactional Analysis Journal. 1971, 1, 49 - 58.

Eysenk, H.J. "Personality as a fundamental concept in scientific psychology". Australian Journal of Psychology. 1983, 35, 289 - 304.

John, I.D. "Science as a justification for psychology as a social institution". Australian Psychologist. 1984, 19, 29 - 37.

Morgan, A.H. "Editorial". Australian Psychologist. 1983, 18, 7 - 8.

Steiner, C. 1971. Games Alcoholics Play. Grove Press: New York.

Strauss, J.S. & Hafez, H. "Clinical questions and "Real' research". American Journal of Psychiatry. 1981, 138, 1592 - 1597.

Stuntz, E.C. "Second order structure of the Parent". Transactional Analysis Journal. 1972, 2, 59 - 61.

Two chair in the therapeutic process.

In this procedure the client projects some aspect of their personality out onto an empty chair and then dialogues with it in some form or the therapist can dialogue with it in some form. This can add an extra dimension to the counselling process.

A good deal of the usual counselling process involves presenting something to the client that may be new and then waiting for the client to do something with it. In this way it can be seen as a passive process.



This diagram shows how the therapist can present a variety of new or different actions, communications or relationship styles to the client. Once done the therapist then remains inactive to see what the client does with them, if anything. It is hoped that the client will take them and then alter something within their personality thus leading to psychological change. However as far a the therapist is concerned it remains as a hope. The therapist simply has to wait and see.

Two chair techniques allow the therapist to be more active. It allows the therapist to actually directly delve into the personality of the client. To get right into the personality of the client and change things around by stimulating various parts, highlighting them to the client and so forth. It also allows the therapist to establish relational contact directly with various aspects of the client’s personality.



This diagram shows that with the client’s permission the therapist can move beyond the exterior of the client’s personality and delve into the actual personality of the client using therapy processes such as two chair.

An important aspect of two chair is that the person does not take the role of the other party. If a client puts his mother in the other chair and then moves to be in mother’s chair he is not role playing mother. In that chair he is being the projection of his introjected mother. It is part of his personality in the chair not his memory of mother. In psychodrama one can role play other parties. In the two chair being described one is being part of their own personality in the other chair and not playing a role.

Two chairs techniques are also regressive techniques. It encourages the client to regress into their Child ego state from many years ago. This is a good thing as it provides a relatively easy way to get the Child ego state into the therapy room which should happen in most sessions. Generally speaking the focus of therapy is approximately:



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Sexual dysfunction (Part 3)

In this third part of the series on sex and sex counselling I arrive at what was the original motivation for addressing this area in the first place. I have been working recently with a man who presents with the problem of premature ejaculation (PE). This is not an uncommon problem to come across as a counsellor however in this instance there are a few noticeable differences.

In this case it was the main up front presenting problem which he sought counselling for. Most often PE will arise as a kind of side issue raised by the man a few weeks or months after counselling has commenced. This may be because he is embarrassed about it and hence procrastinated about bringing it up or it may be that it is seen as less of a problem. In this case it was brought up near the end of the first session after much struggle. He was clearly distressed by it much more so than one usually finds.



To my mind the whole area of PE is a dodgy one. It is included in the mainstream literature on abnormal states. Indeed the DSM-IV has it there included with all the other sexual dysfuctions. However unlike some of the other dysfunctions listed it is based on an assumption. The assumption that good, correct, normal, psychologically OK sex has to involve intercourse. This need not be so at all. Emotionally and physically satisfying sexual contact between two consenting adult does not have to involve intercourse.

So why does this assumption exist? I can think of three possible reasons.
1. Biologically the reason for having sexual contact is for procreation and thus intercourse is required.
2. Historically religion has had some clear views on the purpose of sexual contact and the sin that comes from simple pleasure of the flesh.
3. Historically psychologists have defined healthy sex in such a way that intercourse is required. Sex without intercourse has historically been defined as a psychologically abnormal act. Now it becomes clear why I wrote the previous post - Sexual repression (Part 1) - where I address this precise point.



In the DSM-IV the diagnostic criteria for PE includes two points.
1. Ejaculation after minimal stimulation and before the person wishes it

PLUS

2. Marked distress caused by this.

Thus the DSM is at least partly agreeing with the point I am raising here. The premature ejaculation itself is not considered a problem. It must also be accompanied by psychological distress.

That distress will be caused sometimes because of the assumption I have just described. If one removes the assumption there is not going to be so much distress if any at all.

The problem I have with the DSM-IV and hopefully this will be changed in the DSM-5 is the title of the disorder. It is titled - Premature ejaculation - which is a misnomer. This title implies that it is simply the premature ejaculation that is the problem regardless of the distress or lack of it. It would be more aptly named, ego dystonic premature ejaculation. This is more accurate and would also help people like my client when they come across statements about abnormal psychology such as found in the DSM.



The suggested title comes from the DSM-III. This book published in 1980 included the category, ego dystonic homosexuality. As late as the 1970s homosexuality was still considered an abnormal psychological state in the mainstream literature. In its efforts to extract homosexuality from the pages of the texts on abnormal states the DSM chose this interim measure and coined the condition - ego dystonic homosexuality. By the time the DSM-IV arrived in 1994 even that had disappeared and mainstream literature no longer viewed homosexuality as an abnormal state.

Treatment
Back to the point at hand about PE. The manuals on the treatment of PE invariably focus on behavioural methods such as the stop and squeeze technique. Whilst certainly useful in some cases, I also suggest working on the assumption the man has in his Parent ego state, that ‘proper’ sexual contact must include intercourse. I cannot recall ever seeing such a proposal in a PE treatment manual. If the Parent ego state belief about ‘proper’ sex can be altered this can significantly disempower the PE problem in the man’s mind,. If that occurs then any technique like the stop and squeeze method is more likely to be successful and even if it isn’t that doesn’t matter anyway.

Thus we have addressed the behavioural treatment and changing the Parent ego state assumption about ‘proper’ sex. Also often apparent is some kind of Child ego state decision. With my client this was the case. His distress was based on his Child belief that the PE meant he could not function properly as a male. Thus it brought his sense of his maleness into question and this was what was so distressing for him.



There can be many other Child ego state beliefs related to the PE. There may have have been some kind of sexual assault on him as a child or ridicule by his peers that related to sexual matters when engaged in sex play and experimentation as a child. Indeed sometimes PE is an aggressive act against the woman - “I am going to satisfy myself and not you”.

However despite all this, if one chooses not to accept the assumption aforementioned then PE as a problem ceases to exist.

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Parent contract and counterscript action (Part 2)

In Transactional Analysis terms a contract can be made from any of the three ego states. They are worded in three different ways. A client is contracting to loose weight.



If the novice client comes to therapy and says, “I should loose some weight” the therapist knows that is a Parent contract. A contract that is motivated by the Parent ego state. The bottom line of human nature is that the Child ego state will always win out in the long run. What the Child ego state wants is what the person will end up doing in the long run.

In Parent the client may say they should loose weight and from their Adult ego state confirm that it makes sense to loose weight, which it does. This will all amount to nothing unless the Child agrees in some way or form. If the Child ego state says it likes food and does not like exercise then in the long run it is going to eat nice tasting food and not do much exercise.



In most cases the Child ego state wants will predominate fairly quickly. The person may start a new diet and within a week or two or three it is pretty much forgotten. The person may take out a new six month gym membership and after a month they don’t get there very often. In each case the power of the Child in the personality dominates over the influence of the Parent and Adult ego states. Even when the Adult thinks it is perfectly rational and sensible to loose weight, which it usually is, that does not matter as far as the Child aspect of the personality is concerned.

There is an exception to this which is called counterscript action. Some people can exert considerable influence over self from the Parent ego state. They may be highly self controlled people or have a severe self punitive attitude. They are capable of depriving their own Child needs for an extended period of time.

If this is the case then the Parent contract will work for longer periods of time than the customary few weeks or months. The person may loose 20 kilos for a year or two. However still the Child will win out in the end and the weight goes back on as the Parent ego state looses dominance in the personality over time. In these cases one gets what is called yo-yo weight loss. They can loose significant weight for an extended period of time but eventually is put back on. People who do this are capable of severely clamping down on their own Child needs which indicates some significant psychological maladjustment. It can indicate significant self loathing or anger.


Child ego state

One can now see how important it is for the therapist to identify when a client is presenting a Parent contract. If missed the client can do work on a piece of behaviour over a number of weeks and it is never going to work in the end. Indeed if the therapist gets a sense of the work not going anywhere this may be a sign it is a Parent contract and thus one goes looking for it.

Some are easy to identify. In any contract to loose weight, exercise more, stop drinking, reduce drug taking, working harder it is highly likely there is a Parent contract in there somewhere. They are easy to identify when a client makes a contract that uses Parent ego state language. “I should loose weight”, “I must go to work on Saturday mornings”, “My wife says I need to say what I am feeling” are all relatively easy to identify as Parent ego state contracts.

These are contracts which obviously the Child ego state will not like. Other Parent contracts come from a significant rather than one the client wants to make. For example, “My wife says she will leave me if I don’t get counselling” is very likely to be a Parent contract. With any coerced client there at least partly a Parent contract to the therapy.


The Child ego state will always win out in the end



Novice clients make it easier to identify Parent contracts because of the language they use. That is Parent ego state language as stated above. With the experienced client it is not so easy. As the client learns about Parent contracts and the words used by the Parent ego state they can then change the language. They learn the culture of the therapy approach and fit in with that and that includes using the language.

What the therapist is wanting a client to say in a contract is something like, “I want to stand up to my mother” or “I want to take some time off work”. “Want”, is a good word to have in a contract as it reflects Child ego state investment in the contract. As clients become more experienced they learn the language and may unconsciously change the language to fit the culture or to try and convince self they want it when really they don’t.


The Child ego state wants what it wants - whether good or bad


The experienced client may say, “I want to complete my thesis” when underneath the real contract is, “You should finish your thesis you lazy bum”. A Parent ego state contract is presented as a Child ego state contract because the experienced client knows the language and culture of the therapy. They are not setting out to deceive the therapist they are just wanting to do the right thing.

Any contract can have a Parent contract hidden in it. A mother may come to therapy and say she wants to learn boundary setting with her son. That seems like a very reasonable request. Behind it however there is the belief, “I am a bad mother who is hurting my children and should know better”. The therapist needs to ascertain if there is any Parent ego state involvement in the contract being presented.

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The expression of shame & blushing (Part 5)

Thanks to all those people who kindly sent me bits and pieces on shame when I requested any information on the physiology of shame. That information still remains quite elusive. That is, what physical bodily changes occur when a person experiences shame or embarrassment. I have for the moment given up on my pursuit of that information and will seek to produce a statement about what happens to the person when they feel shame.

I am referring to here and now shame rather than neurotic shame at this juncture. We all go through life and sooner or later circumstances arise where we will feel shame which is appropriate to the events. For most this is probably not a common occurrence and as I mentioned before the experience of embarrassment is probably much more common for most. People who were shamed as children will feel shame in response to a wider variety of events in adulthood because they have been ‘programmed’ to have that reaction.



What happens when a person feels shame or embarrassment?

Common body expression and attitudes when one experiences shame include a bowing of the head, an attempt to hide the face possibly with the hands, a blushing of the face and possible sweating, body bent over on itself and possibly a closing of the eyes. It is like the person is endeavouring to make self as small and as invisible as possible and as a result there will be a strong drive to remove self from any company and seek to isolate self for a while.

The other interesting feature of shame and embarrassment is blushing. In this instance there is a reddening of the face, neck and possibly the upper chest. This is seen to be a reaction of the sympathetic nervous system that causes the blood vessels in the face to dilate. The cheeks tend to have more capillaries and blood vessels than other parts of the body and the vessels also tend to be wider in diameter and closer to the surface. The increased blood flow results in a colour change in that area from light pink to dark red. As it is involuntary it is something that cannot be controlled which may cause even further disquiet.

It is believed that everyone has the physical capacity to blush. The whiter the skin the more observable it is. In dark skinned people it is almost impossible to notice but they do blush the same as lighter skinned people. Women tend to blush more than men. It is reported to occur in kindergarten aged child but some report that a child as young as two years old can blush. Adolescence is the stage at which it is most prevalent due to it being a period of high self consciousness. As one grows older it tends to decrease as people start to become less self conscious (in normal circumstances) and the stimulation of the blood vessels decreases with age.



From a human communication point of view blushing is an interesting phenomena. Blushing is body language like any other kind of body language and people can use it to communicate. What does it communicate to the observer of the body language? Perhaps one could draw the blushing transaction as such:


Blushing transaction

1. The blusher receives some kind of information from the other person or from the environment in some way. A woman at a party has a wardrobe malfunction in front of a group of others and exposes her breast. She does not realise until someone brings it to her attention. A wife may mention to others in front of him how her husband now has to wear a ‘nappy’ since his bladder operation.

2. In response to the incoming information the person blushes with a reddening of the cheeks. This communicates back to the observer that the blusher thinks he has broken some moral boundary or sense of personal dignity as defined by the Child ego state and he is currently feeling very bad and uncomfortable about it. They will also know he is highly motivated to end the precipitating event either by withdrawal or changing the subject and so on.

This response will be a Free Child transaction if the shame or embarrassment is an appropriate reaction to the incoming information. If the shame is not an appropriate response that would be seen as an Adapted Child reaction and form the basis of neurotic shame. The two examples cited in number 1 above could be seen to be examples where it is appropriate to feel shame.


Unfortunately many teachers have learnt that shame is a good way to control children. Whilst parents may be careful not to shame a child at home it can be happening in the classroom.

A good example of the AC (neurotic) response can be found with some social phobics. A person with such a phobia can have self defeating internal talk. When in conversation they may start thinking that the observer can see they are blushing and thus how much of an idiot they look or how embarrassing they are. They may or may not be actually blushing but the person feels they are. This makes them more uncomfortable and thus the blushing increases or is felt to increase more so.

Note the lack of Parent ego state involvement in the transactions which is typical of the difference between shame and guilt. Like guilt, shame has the capacity to curb human behaviour most notably the Free Child. Whereas guilt comes from a Parent ego state introject shame is a Child ego state driven process and hence tends to be more potent and destructive. Shame feels very unpleasant to the person and thus they will be highly motivated to change their behaviour. Shame is experienced as being more in the core of the person as compared to guilt.

Do people blush alone, is an interesting question. People certainly can feel shame whilst being alone. The woman cited above who had the wardrobe malfunction can recall that event the next day whilst alone in her home and feel shame about it. However would her feelings of shame result in blushing? She is aware she is not being observed by anyone in that instance. I am unsure of the answer to this question. I would tend to think that she would not blush or certainly any blushing that did occur would be less intense. However I have no data on which to base this conclusion.


Making children perform on stage can easily produce a shame reaction. Parents need to take care when the child is required to make some kind of public performance.


Does anyone out there have personal experience with being alone and blushing or not blushing?

Whilst my parents were by no means perfect they never did shame me as a child. Thus I have few incidents where I can recall when I felt shame as a child or an adult. There are a couple and if I recall them I do not think that I demonstrate any blushing.

This leads us to the next stage in the process of our discovery of the various components of shame. Many a client will recount incidents where they felt shame in the past. If a client experiences shame in front of the therapist what does the therapist do? Watch this space.

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Expressing internalized anger

The internalised anger transaction can take two forms.



Firstly the person receives information of some kind. It is disturbing information to which the person reacts in an angry fashion. The person may have been criticised at work, they may have got a “B” for an assignment when they expected an “A”, they may have been rejected by someone or many, many other possibilities.

Once the information has been acknowledged by the Adult ego state the internalised anger can be expressed in two ways which are indeed quite different in their origin and indicate two quite different psychological processes.

The person can express such anger at the Child ego state from the Critical Parent ego state (CP). This person can be said to have a large internal critic inside their head which at times actively scolds and derides them. The origin of this comes from an introjection in childhood of the parent figures around them.

The child may have observed mother and father being critical of others and themselves and he copies that. However the more potent source of an active internal CP is when the parents have expressed criticism of the person when they were a child. The young child is criticised directly by mother and father. This criticism is then internalised by the youngster and stored in their Parent ego state through the process of introjection.



Often the words the person says inside their head as an adult are exactly the same words that were expressed to the person as a child by mother and father. Or the self criticism is about the same kind of things mother criticised the about child as a youngster.

This type of self directed anger is the least pathological and the easier of the two to treat. As with all treatment contracts it is better to look at increasing some behaviour rather than decreasing behaviour. One would not want the contract to be - “I will decrease my Critical Parent comments”. Instead one would want the contract - “I will increase my Nurturing Parent comments”. If one increases their Nurturing Parent ego state then the Critical Parent will naturally go down. One focuses on the Nurturing Parent rather than the Critical Parent.



Interestingly if a person has a high internal critic directed at self then there is always the potential for it to be directed at others as well. If one is working with a client who has a high CP for self then one also wonders if there are high CP thoughts about the therapist as well.

Some with a high CP for self can also have a high CP for others. Those critical thoughts of others may be openly stated or they may never be stated and just remain internal thoughts. But the potential is always there compared to the individual who does not have a high internally directed CP.

Child ego state anger
As the diagram shows the other type of internally directed anger comes from the Child ego state and is directed at the Child ego state. As a consequence these angry statements are not introjects from our parent figures. Instead they result from decisions that the Child has made about itself. These represent more serious psychopathology and thus the person can be seen to be more ‘damaged’.



The nature of the CP statements tend to be; “I am bad because...”

The Child ego state angry statements may also be precipitated by an event and thus one gets statements like: “I am bad because..... and there is an inherent badness in me anyway”. At other times there may be no precipitating event and the person simply expresses anger at self for no obvious reason. At times this can result in self harming type of behaviour.

Whilst an internal directed CP is common, almost every one has an internal critic of some kind. The internally direct Child statements are far less common. It requires the person to believe and feel there is something basically and intrinsically bad about self. This probably represents 5% of the population. As a result it is much more difficult to treat as one is looking to remediate a basic belief about self and not simply encourage NP statements to counter the CP statement from the Parent ego state.

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Sleep, regression and hypnosis.

KYLady says
“You mentioned that hypnotic suggestions work better when the person is distracted and this raises a question. A lady I work with has lost almost 15 pounds over the past 6-7 months and gives credit it to a CD she listens to every night that is hypnosis for weight loss (i.e. meaning the suggestions have encouraged her to exercise more and eat differently). I bought the CD a month ago to see if it would work any wonders for me, but so far no results whatsoever that I can identify. The instructions on the CD jacket say it works best to listen to it before going to sleep or first thing in the morning. It seems to me that these are times when a person is less distracted”

Good comment KYLady.

The first response I would have to it is: what is hypnosis?
This was originally a technical term that described a specific type therapeutic procedure that was highlighted by Freud. Ever since then it has fascinated the general public and thus the term was been used in a wide variety of ways over the years and now can many different things.

Using the word ‘hypnosis’ to sell a weight loss CD may be something quite different to what the term means in the technical therapeutic sense. Having said that however, I would tend to agree with what you have written.



As I said in the previous post if one can remove the Parent and Adult and communicate with the Child ego state alone then that has considerable therapeutic potential. One way to do that is to distract the Parent and Adult or use regression.

In counselling clients can often regress significantly and they become very child like. When in that state the Parent and Adult are decommissioned and the Child ego state is left alone. Hence the statements in my previous post about methods for communicating with the Child ego state when the client is regressed.

There are other ways to get the same kind of functioning in the ego states as the diagram shows



Hypnotising someone, distracting them in some way, being intoxicated and being asleep are all regressive states for us. This is why Freud placed so much emphasis on dreams. It gives us an way of listening to the persons unconscious. Dreams are literally the unconscious talking which it is freed up to do when the person is asleep and the Adult and Parent are gone.

If a person is asleep then I am afraid they are not going to hear the words on the CD and thus any hypnotic suggestion is not going to work because it wont be heard. However it is interesting to read you say:

“The instructions on the CD jacket say it works best to listen to it before going to sleep or first thing in the morning”

As the diagram below shows between being awake and asleep there are actually 5 different levels of consciousness. In the middle ones people are kind of half awake and half asleep. The more asleep you become the more the Adult (& Parent) go down and the more the Child ego state assumes prominence in the personality.



So maybe the CD maker is wanting to use this. By suggesting the times of just before and just after sleep the person may be still awake enough to hear it but still having the Adult decommissioned enough. Other than that it maybe just another snake oil salesman selling a dodgy CD.

Weight loss while you sleep sounds almost too good to be true, so it probably is.

However the CD maker has done his or her home work. In between being fully awake and fully asleep some people can do odd things. Somnambulism or sleep walking is one example. EEG studies show that sleep walkers can have an odd mixtures of delta and alpha waves. This means that the person is sort of in two different levels of sleep at the one time. Most people do not do this. The sleep walker maintains enough Adult ego state to managing walking but also has the regressed Child ego state in charge so they are “unconscious” at the same time. Hence they can walk and be asleep at the same time.



The other thing about sleep walking is that it usually originates in childhood and most people grow out of it. The Adult ego state in children is weaker than in grownups. Maybe as the Adult ego state gets more robust in fully grown people the influence of the Child ego state in the unconscious state diminishes. Thus when the Adult ego state is awake it is awake and the half state of being in Adult ego state is less possible. Maybe?

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