Hurried child & personality types

The hurried child syndrome is a common phenomena in society. The transactions involved in it are shown here.



A child falls over, cuts its knee and seeks out mother for assistance. The youngster asks for help in the first transaction. The child has two problems, first it has the physical problem of a cut knee that needs a bandage put on it. Second it has a psychological problem. It is experiencing pain, perhaps shock of the fall and then the sight of the blood and it is generally feeling distress.

To respond successfully to the request the parent must at some point respond from their Nurturing Parent ego state to solve the psychological problem and the Adult to solve the physical problem. The hurried child syndrome occurs mainly when the psychological problem is not dealt with. Some parents do not do this and this can occur in a variety of ways.

1. The parent simply not respond at all. The mother may be in bed suffering severe PND and is simply too depressed to respond. The mother may be alcohol or drug affected which also does not permit her to respond or there may be some kind of severe mental illness or she is simply so consumed with her own emotional torment that she cannot respond.


Body language of a competent parent?



2. Others may respond but only from the Adult ego state. The physical wound is tended in the proper way, but it is done is a purely problem solving way with no nurturing involved. The psychological problem is left unsolved.

This most often occurs in parents who do parenting by the book. They will have a manual or some kind of book on parenting. When a difficulty occurs they will seek out the manual to find out what the author says is the right way to respond to it. It typically has chapters on discipline, toiletting, use of a dummy or not, getting a child to sleep, eat and so forth. Good information to have indeed but it is only Adult ego state and may reflect an insecurity in the person about their parenting.

3. The parent responds from their own Child ego state. In this case the youngster will feel unsatisfied because the parental response is child like and has no competent grownup nurturing quality to it. The parent responds from their own Child ego state with some kind of magical thinking about how to treat a wound or may simply try and jolly the youngster in some child like way.


Some parents are dominated by their own Child ego state



If there is no competent Nurturing Parent and Adult ego state response then the child is forced to hurry up and grow up emotionally. The most common reaction to this is one of anxiety. The child has a sense of being emotionally alone in the world and there is no big person around that they can emotionally rely on. There may also be some anger but the primary response is one of anxiety and scare.

Below is a list of personality types. The hurried child dynamic can occur in most of them but is more likely in a some than others. Obviously it will be more common in those that tend to be anxiety based personality types. This will include:

Obsessive/compulsive
Schizoid
Schizotypal
Avoidant



Personality type Adaptation

Paranoid The world is hostile so don’t trust anyone and deal with people by being angry and attacking

Schizoid The world is scary so withdraw from it (people) and don’t show any of your feelings

Schizotypal The world is scary so withdraw from it (people) and don’t think clearly by being a bit crazy

Antisocial You can’t trust anyone & life’s unfair so take advantage of people and do what you like

Borderline Relationships & life are very unreliable so frantically do anything to keep people around

Histrionic I must be the centre of attention so I will be dramatic, flirtatious and highly emotional

Narcissistic I have always been told that I am very important and the best so I will behave and feel like that

Avoidant Life is scary and rejecting so I will withdraw and feel worthless

Dependent I can’t cope with life and am worthless so I will cling to others and do what they tell me

Obsessive/compulsive I have to feel in control of life and myself so I will be orderly and perfectionistic

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Treatment plan - part 3

The treatment plan with micro and macro counselling.


As I said in the previous post one can counsel at the micro or macro levels. As an example consider the hysteric personality type. This individual who is most often female has a basic problem with feelings and thinking. The feelings are overly strong and she needs to have more considered feelings. Also often when she feels she will stop thinking so at times she has to learn how to think and feel at the same time.

In addition she often has an overly romantic perception of her relationship with father. I wont use the word sexualized because people add in all sorts of things when you say that, but the girl has feelings for father that can be of a romantic nature. This may or may not be fostered by others in the family by commenting on the relationship between father and daughter. If this does exist, typically the woman will have trouble in adulthood with her males partners as she will see that these men never measure up to the ‘perfect’ relationship she has with father. She has never significantly detached from father which also disrupts her current relationship with men. She is fixated at the phallic stage of development.



Her sexual relationships with men tend to be all or nothing. In the beginning of the relationship she may be highly sexual and then at some point becomes completely asexual and looses all interest in sex. The switch may come when in her mind she realizes that the man does not meet the high standards that father set for a (romantic) relationship.

Upon enquiry one can begin to ascertain if some of these features form the core personality structures I mentioned in the previous post. For example one could enquire about her history of relationships with men and get her to talk about her relationship with father. How does she perceive him and so forth. If these seem to be a very dominant and pervasive aspect of her then it may be one of the core personality structures.

Alternatively if her strong and dramatic feelings and the inability to think and feel at the same time are also pervasive and quite resistant to change then they may also form core personality structures. One has now established part of the long term treatment plan for her.



If one ascertains these to be the case then one can see how macro counselling can take place. As I said before counselling at the macro level involves not what you do with the client but how you do it. For example a client may present with the complaint of insomnia. After some discussion it is ascertained that the person has injunctions like Don’t get your needs met and Don’t be a child and these are related to the insomnia.

One needs to address these injunctions in order to relieve some of the symptoms of insomnia. With the non hysteric person that can involve redecision work that may involve some significant feelings and regression by the client. With the hysteric client one does not do this so much. One changes how they work at the macro level. Therapy with the hysteric client is more cognitive and involves much less feeling work. Yes the therapist may encourage the hysteric client to experience and express emotions but will always be corralling the client to only have considered emotions. At times the hysteric client may even complain that therapy is boring because they are missing the excitement of having intense emotions.

The overall treatment plan with the hysteric client is to only have considered emotions and to do a much more cognitive type of work. When working with a paranoid or schizoid client this is not required in their treatment plan. So what one does with the paranoid and hysteric client is the same but how you go about it is different because the macro level are different. The overall treatment plan is different. One works with the same injunctions but in a different way.


The paranoid client



Anyone who has studied the writings of Freud will know that hysteria and the hysteric client were very important in his formulations of the foundations of the theory of psychoanalysis. He discovered that working with hysteric clients seemed to work using his new theory of psychoanalysis. Psychoanalysis is a thinking style of therapy. It encourages the client to think about who they are and why they are. There is very little emphasis on intense emotional expressive work. At the macro level psychoanalysis works with the hysteric because it encourages them to think rather than to feel.

The point at hand is to describe how the macro approach or the treatment plan can be defined. In other circumstances what may begin as micro counselling eventually turns into macro counselling. The other day I was working with a woman who would be of a schizoid personality type. It became apparent over time that her primal response to stress was flight. Of the three - fight, flight or freeze - when she was highly regressed she had a very strong drive to flight. It was seen that one of her primal personality structures was the mechanism of flight which she had used consistently throughout her life when placed under considerable stress.

Of course my next step was to suggest a No Run contract to her. This was a micro counselling technique, to remove her primal response of flight from her relationship with me and then to work through her reactions to that. She did that and we discussed the various psychological ramifications of that for her. However the No Run contract still remains. I will raise it from time to time but it sits there ever present in the background.


The schizoid client

She is now involved in a therapeutic relationship with me where one of her core personality structures - the mechanism of flight - has been nullified. It can no longer be used by her and this persists day after day in her relationship with me. This can be seen to be therapy at the macro level as it directly addresses her core personality structures. It is part of the overall treatment plan for her, to let go of the mechanism of flight as a problem solving technique.

Thus we have an example of a specific micro counselling technique evolving into part of the macro counselling approach or part of her overall treatment plan.

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Developing a treatment plan - part 2

I have spent the last few days working with clients. In that time I have consciously listened to the thinking in my head that I do about clients. Thinking I would normally do but not really been aware of. I have been listening to the thinking I do about formulating a treatment plan.

In the previous post I talked about micro issues and macro issues. This of course leads to micro counselling approaches and macro counselling approaches. I have tried to conceptualize this diagrammatically as such.



This diagram shows that the personality rests on a few basic structures. As a young child develops it will establish a few core personality structures and this can be seen to form the basic character of the child. This of course will be a combination of the child’s natural temperament plus the early decisions it makes from the Little Professor ego state (A1 ego state).

The term treatment plan as used here is that plan which addresses the core personality structures of the client. This will identify the overall direction the client can go in therapy and this is shown as the macro counselling approach. Macro counselling addresses these core structures directly. Micro counselling does not focus on nor address the core structures, instead it will address the personality features which rest upon the basic core structures.

Micro counselling is the vast majority of activity that occurs in counselling. Macro counselling is not so much what therapist does and are not the techniques employed but it is how the therapist goes about what he does or the basic parameters the therapist imposes on the therapy.



As I said before I have listened to my thinking in the past few days as I developed an understanding of the core personality structures in the client and then how I go about devising the macro counselling approaches.

The first thing I noticed was there was not much of a plan to how I went about this. Instead my thinking was quite haphazard as I discovered the core structures. What ever the client happened to be talking about defined what I thought in my formulations. The ones I thought of are added to the list I started to construct in the previous post.

Personality types - I use these a lot.
Fixated developmental stage
Current developmental stage
Attachment style
Compulsion to either thinking, feeling or behaviour
Primal reaction of flight, fight or freeze.
Behaviour patterns that have been consistent through childhood, adolescence and adulthood.
Six basic temperament features formulated in the New York study
(I am sure there are more and I do not fully understand the nature of the list I am creating here)

Of particular interest is when a client becomes highly regressed in therapy. This is when one will see the core personality structures being displayed. The more regressed a client becomes the more they will resort to their primal ways of problem solving. If a client’s primal response to stress is flight one will see this expressed more openly when they are in a highly regressed state.



Below is a list of some of the core decisions of the personality types. Much more is involved in the personality types but this does provide some of the core structures one would find in the different personality types.

Paranoid - The world is hostile so don’t trust anyone and deal with people by being angry and attacking

Schizoid - The world is scary so withdraw from it (people) and don’t show any of your feelings

Schizotypal - The world is scary so withdraw from it (people) and don’t think clearly by being a bit crazy

Antisocial - You can’t trust anyone & life’s unfair so take advantage of people and do what you like

Borderline - Relationships & life are very unreliable so frantically do anything to keep people around

Histrionic - I must be the centre of attention so I will be dramatic, flirtatious and highly emotional

Narcissistic - I have always been told that I am very important and the best so I will behave and feel like that

Avoidant - Life is scary and rejecting so I will withdraw and feel worthless

Dependent - I can’t cope with life and am worthless so I will cling to others and do what they tell me

Obsessive/compulsive - I have to feel in control of life and myself so I will be orderly and perfectionistic



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Developing a treatment plan

(This post is definitely a work in progress)

I was talking with a supervisee two days ago about psychotherapy as one tends to do! Somehow the topic of treatment plans came up. A treatment plan is a plan that is formulated by the therapist which provides the therapist (and client) with the overall direction of therapy. It identifies the general direction the client needs to go.

When a client presents at a session usually they have some matter they wish to address. This can be seen as a micro issue. This is different to the treatment plan which is a much more global understanding of the client and their psychology. One deals with the micro issue presented by the client but it is seen to form only one part of the overall marco issue or the treatment plan. Whilst dealing with the micro issue the therapist does this in the context of the overall treatment plan. It’s like the therapist has the treatment plan always in the back of his mind and all discussions are done within the context of that plan.


Don't get lost in the micro issue




My supervisee then asked how one formulates such a plan and I was a bit flummoxed by the question. I did not have an answer and it seems I had never been asked that question before.

I presented a few responses as I thought on my feet at the time and have subsequently given it more deliberation. Again I find myself doing something in therapy that I did not know I was doing. I can not recall ever reading about such a thing. All I know is that in my early days as a psychotherapist in various training groups we always talked about treatment plans but I can not recall ever talking about their formulation, which seems a bit odd now. Maybe we did and I just cannot remember.

What I came up with was a short list of things which I consider when developing a treatment plan. I suspect this is by no means a complete list.

Client core issues versus secondary presenting issues - characterological structures of the personality.

Personality types - this relates to the core issues.

Fixated developmental stage

Current developmental stage




I will certainly muse on this some more as it is an important idea for therapists and I am intrigued by the fact that as a young therapist we used to often talk about treatment plans but one hears them not mentioned much at all these days.

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