Thursday, December 31, 2009

Me and my epiphany

I had an epiphany today which I suppose is a good thing to have on the last day of the decade.

On my facebook I have been having a recent discussion with Ljiljana who I met in Serbia earlier this year. In recent times I have been getting some translations of my articles from English to Serbian and then placing them on my Serbian Translations Blog

In our FB discussions of these translations I stated to her how it felt odd to see my writing presented in another language. It is not unpleasant or anything it just feels a bit strange.

This got me thinking as I found it hard to articulate what the odd or strange reaction was. I couldn’t really understand what it was and what it meant to me.

Then I had my epiphany!!


It came to me, at least in part, what the odd feeling was. The word that suddenly popped into my mind was - “disjointed”. It was like I felt disjointed from the writing or there was a lack of connection to it when I saw it in a language that I could not understand.

This surprised me somewhat as I had been quite unaware of it. I suppose that as I usually saw my writing in English I never realised that I also had a psychological connection to what I wrote. It was not until I experienced the ‘oddness’ a number of times in a close succession when setting up and posting on my Serbian Translations Blog that I realised something was awry.

It’s like I expect to meet with

myself but it just doesn’t happen.

It seems that when I write stuff part of me psychologically goes into it and when I read it later on I feel a connection to that part of me that originally went into it. However when I see it later in another language that I cannot comprehend, I cannot make the connection to the part of me that originally went into it. I feel disjointed from it.

I love epiphanies!!


Wednesday, December 30, 2009

Self harm as self punishment

One of the eight reasons why some people self harm is because of a self hatred or as a form of self punishment. As a result of childhood experiences some people end up with a self hatred or with a sense of self loathing. This may be because they were told precisely that. They were told they were useless, worthless, not wanted, hated and loathed by the parent figures.

In other circumstances the child may have been physically and sexually abused. When this happens sometimes the child has faulty thinking and believes the reason why they were abused is because there is something wrong with them. It was because of their inherent badness that the parents physically abused them. The child thinks that it is their fault and thus a sense of self loathing and hatred can evolve in their perception of self.

If a person has a basic sense of self hatred that does not mean they are going to be suicidal. A person will be suicidal if they have made the suicide decision and thus see suicide as a viable solution to their problems. There are plenty of people who have a basic self dislike who do not see suicide as such a solution.

Those who do have a very low self perception will self harm in some form but maybe not in the usual sense of the word. That is they will not self harm by cutting, burning or stabbing self but will self harm by the lifestyle they live. For instance a woman may prostitute herself at least partially because she hates herself. This could be seen as a type of self harm in terms of the life style she lives.

Any person who has a sense of self loathing will somehow live a life style where they treat self very badly either physically and/or psychologically. For instance the drug addict type of drug user can be taking drugs in such a way that it amounts to physical self harm. Such as with intravenous drug use where they share dirty needles with high risk others and so that their veins eventually become essentially mutilated.

Most drug addicts also hate themselves for being an addict. They know society views a junkie as being at the lowest level of society. They are seen at least by some as the useless crap at the bottom of the pile and often view themselves in a similar light. This can amount to psychological self harm. Thus the drug addict may hate self and that is expressed by self harming physically and psychologically.

Despite this there are a group of self harmers such as ‘cutters’ who harm self as an expression of their self hatred and self loathing. They cut self as an expression of these thoughts and feelings about self. Some self harmers will talk of bloodletting as a way to getting rid of some of their badness. As the blood flows out they see their inherent badness also flowing out.


Sunday, December 27, 2009

The great road toll lie

I can’t take it any more. The bullshit that I and all others have had to endure over the festive season. The great road toll lie perpetuated over and over and drummed into us relentlessly through the press and huge government safety campaigns.

Here are the statistics from the Australian bureau of statistics of the underlying causes of death in 2004 for the state that I live in

Cancer 3409

Testicular cancer 218

Endocrine metabolic diseases 474

Diabetes 346

Mental illness 239

Nervous system diseases 486

Heart disease 3704

Lung disease 894

Digestive system disease 406

Road accidents 201

It is one of those unfortunate situations where the press and the politicians both want the same thing. As a result they never question each others motives for lying to the public about the road toll. They both want the dangers of road deaths greatly exaggerated. It is to both their advantages to have the public believe that road fatalities are a significant threat to us. They aren’t. Road accidents amount to one thousandth of one percent of the states population each year.

More men die of testicular cancer than the entire road toll for both men and women. Thus testicular cancer is more of a threat to us but you just never hear the press and politicians talk about it.

Cancer and heart disease are a far more serious threat to us than car accidents and you hear about them much, much less often. Why?

Dangerous curves

Reporting the road toll obviously sells for the press. It makes them money. If it didn’t they certainly wouldn’t report it at least as much as they do. Over the festive season it is reported relentlessly. It also works for the politicians. If they can get in the public eye talking about the road toll and say things like zero tolerance and mandatory sentencing they know they are on a winner which they are as they know the public believe the great road toll lie.

Then there is the police commissioner who is forever huffing and puffing about the road toll. He actively and knowingly misleads the public about the dangers to it. Remember - one thousandth of one percent. Why? Because it is he and his department that are the main recipients of all that public money wasted on the road toll when it could be spent on far more serious threats in the community. In this years festive season an extra 5000 police man hours are being funded for policing the roads we are told. How much does that amount to in wages?

So the police, politicians and press never publicly question each other as to why they are misleading the public and unfortunately it is the public who suffer by having vast quantities of public money unwisely spent. I can’t recall ever hearing a politician state this view presented here or ever recall hearing this argument being presented in the press.

Every time you see one of those huge booze buses crawling with truck loads of police think of one thousandth of one percent and all those who are dying from cancer, heart disease and so forth as all that public money is wasted on a far less dangerous threat to us.


Wednesday, December 23, 2009

Family systems and illness

Family systems theory as described by Haley (1980) provides further insight into how people can display suicidal behaviour and not necessarily have made the suicide decision. In any relationship with two or more people there is a ‘system’ that develops between them. When the two (or more) personalities meet, over time they work out how to be in the relationship for them. For example one party will take over some roles and the other party will take over other roles.

This can be described in terms of ego states. In a relationship between mother and son the mother may take over the Parent and Adult ego states in the relationship and the son may respond primarily from Rebellious Child ego state. Over time they will work this out often with both parties not even being aware of it. In a family of five members each one will also work out their various roles and positions in the family.

All families develop a system that works for them

Some family systems operate such that one party needs to be ill. If the daughter of the family is ill then all the other family members know what to do in terms of their roles and responsibilities. Examples of types of illness that can originate from a dysfunctional family system can be self harming, drug use, depression and panic attacks eating disorders and suicidal behaviour.

In such circumstances if the daughter is making suicidal statements, gestures or attempts then that is how that family functions. For instance mother and father may start to co-operate and unite against the common cause of the daughters suicidal ‘illness’. It allows them to focus on the daughter and thus they can put to the side their own marital problems.

If the daughter stops making suicidal gestures then mother and father are again confronted with their own relationship so there can be subtle pressure on the daughter to remain suicidal. Having worked in drug rehabilitation this is not an uncommon scenario when one hears the drug user refer to himself as the black sheep of the family.

In such situations when working with the suicidal daughter one can encounter resistance from other family members because if the daughter changes (ie stops being suicidal) then the whole family system has to change. Every person has to alter to some extent and systems will resist change as they strive to achieve homeostasis. Some only have to alter slightly and those who have considerable psychological investment in the daughter being suicidal may be quite resistant to the change.

Treatment of such suicidal people is thus complicated as it involves the person restructuring their relationship with the other family members and that maybe difficult especially if the child is living at home and cannot move out. This also provides an extra avenue of investigation when making a suicide risk assessment.

As is common in the field of psychology often the different approaches whether they may be psychodynamic, organic or systems all tend to take the stance of one size fits all. In this instance all suicidal people are a result of a dysfunctional family system. It is indeed unfortunate how the alternative theories do this as with the human psyche, rarely one size fits all. From my experience of working with the suicidal sometimes the family system is very important and at other times it is only a minor influence. However in assessing and understanding the suicidal person it is very wise to make an assessment of how the suicidal thoughts and behaviour fit for the family system that the person currently lives in.

It is also possible for the individual to have made the suicide decision in childhood and be in a family system where they take the sick role of being suicidal. If that is the case then the risk level of a suicide attempt would certainly increase.

In systems theory every system is naturally homeostatic and will seek to balance itself. Thus it will also avoid or resist change as the balance is disrupted and it is not homeostatic.

So if family member number two changes then that forces all other members to change in some way as well. That change can be anything such as becoming depressed, stop being bulimic, start taking drugs, winning the lottery to becoming assertive. If you change then the system becomes unbalanced and all others have to change so that they system can become homeostatic again.

If you are feeling depressed or anxious that means all those in your ‘family system’, or your inner circle of closest people, are in some way contributing to your depression or anxiety. Indeed if you are feeling happy and joyous they are also contributing to that as well. In systems theory there is no such thing as an ill person, instead it is the system that is ill. If your partner is suffering depression then you are contributing to that in some way as part of the system.


Monday, December 21, 2009

Sameness in relationships **

In relationships of any depth there is a natural tendency for both parties over time to become more the same. They will tend to become more like one another.

When any two people spend time together they will tend to model and introject each other. This is inevitable and indiscriminate and can not be avoided. Humans will instinctively do it whether they are aware of it or not.

This process is easily explained in transactional analysis

This shows how the wife models or introjects her husband’s personality into her own Parent ego state and of course he does the same with her over time. As mentioned before this process can not be avoided and will happen instinctively.

The copying relates to the behaviour, thoughts, attitudes and feelings of the other. All these parts of the others personality become our own after time. However husbands and wives do not end up as clones of each other and they do remain different over time. Of course the Parent ego state is but just one aspect of the personality and we all also have an Adult and Child ego state and these can be quite different between the two partners. However there is a tendency to sameness in the way described and this does not have to be an equal process.

Modeling can even occur between animal and human

People will tend to model more on those who are of more perceived potency and emotional importance. Thus the introjection between the married couple may be at different degrees. That is, one does more introjection than the other and generally speaking it is the more dominant party in the relationship who will be introjected more than the other way around.

This has been studied in some depth before and is presented in the DSM-IV by the American Psychiatric Association (1994) who discuss the Folie a Deux or a shared delusional disorder. In this case two people who are in a close relationship over time develop the same delusional belief system. There tends to be one dominant party and the more submissive party takes on the delusion of the other. This means that should the relationship end the more submissive party will tend to drop the delusion over time even though the submissive party probably has a tendency to have the same delusional beliefs.

Of course they don’t have to be delusional beliefs but can be beliefs or views about anything including religious views, political views, attitudes to neighbours, relatives, friends and so forth.

It should be noted that even after the introjection has taken place there are other potent psychological processes at work that further develop the sameness in a couple. The most obvious example of this is the phenomena of group think. In this situation when two or more people get together there is internal pressure in the group towards uniformity which leads the group to come up with same consensus that maybe false or not.

Group think can result in:

Illusion of invulnerability that can encourage excessive optimism and risk taking

Unquestioned belief in the group’s morality and goals which can result in the group members ignoring the consequences of their actions

Self censorship of deviations in the group’s beliefs and goals

Suppression of dissent by more powerful members in the group

Feelings of anonymity

Discount self responsibility

As two people talk and discover that they tend to have the same attitude or opinion about something this can give them a false sense of security as is described above. “If others think the same as I do then that makes my views more correct or right” is the reasoning behind group think. Thus if a husband and wife have introjected similar views from the other about something, group think can play a part in further fostering the sameness.

Most often this does not matter all that much if they are political views, religious views or dislike for their next door neighbours. However if the views will tend to incite racial hostility or religious persecution then there is a much more serious problem.

This can also involve similar views about suicide. That is, views like suicide is an OK solution to a problem, everyone has the right to choose and so forth. If they have introjected these from each other and then have a sense of group think, in extreme cases one can end up with the suicide pact. Both parties agree to suicide at the same time.

Even if there is no suicide pact it will make suicide a more easy choice for one of the parties in the relationship for the reasons just mentioned. Thus in working with the suicidal it is instructive to make an assessment of the relationships that the suicidal individual is involved at that time to see if any of these psychological processes are at work.


Saturday, December 19, 2009

Check in therapy

Had a good check in this week. A guy in his late 20s whom I saw for about 2 or 3 years. Once a week regular as clockwork. When I first saw him he was in bad shape heading for a major depression if not being there already. Now he does not even take anti depressants. It’s always good when you get to see one who has done very well. And besides that I liked him at a personal level as well. We definitely had a good connection.

He developed quite a strong transference with me and I was very much a father figure for him. When he finished he went travelling for about 18 months and as I always do I asked him to send me some postcards. Some clients do and some don’t but I have a board in my office where I pin up the postcards that I do receive and I always point it out to clients who are about to go away.

Anywise he got back and I get a phone call from him and he makes an appointment to see me. I like these kind of appointments as I get to hear what has happened in his life. Some times as a therapist I can get to know some one very well and can even play an important part in their life at the time and then most stop seeing you and you never get to hear what happened in their lives or hear how they turned out. Occasionally I will get a letter or these days an email out of the blue from a past client giving me an update on their life which is always nice.

So he turns up at the appointment and I am waiting to hear what his current difficulty is and as it turns out there isn’t one. It was just a check in to see that I am still there, and still the same, and still like him, all of which is true.

Most people who do a check in will make up some sort of dodgy excuse problem to come and see me. They are having trouble sleeping or they had an argument with some one or they had a series of vivid dreams. When the real reason is to do a check in. Well he didn’t even have the excuse problem which was kind of nice.


Thursday, December 17, 2009

Tiger and the lies we tell

How can one go by without saying a few words about Tiger. Firstly what about all the jokes currently doing the rounds about Tiger and his wayward putter!

However he does present an interesting phenomena due to the length of time of his infidelity. There are different types of affairs. There can be the one off where the man and the woman get drunk at the office christmas party and have a quickie in the photocopying room. The next day they rue their actions and it is never repeated again.

Then there is the affair that persists over a long period of time that has to include ongoing and persistent deception to the marital partner. But the thing about Tiger is how his affairs went over such a long period of time and because of who he is, that is his fame.

He would have known that sooner or later that he would get caught and what would happen. Which is what has precisely happened. It will be highly publicised and the effect that would have on his business.

Will she ever get her 15 minutes?

He would have known for a long time that at least some of the women were financially motivated or at least motivated to get thier 15 minutes of fame, which at last count 13 of them have done. But he still persisted over a long period of time knowing what was eventually going to happen.

That is the interesting part. How can one psychologically do that. I used to see that a lot in the prison. Talking with the guys and reading about thier crimes sometimes you could see that it was inevitable that they would get caught eventually. Whether they were embezzeling money or selling drugs or lighting fires in such a fashion that it was very likely they would get caught.

How could they do that over an extended period of time when they know what is the inevitable outcome. Most people when they realize what they have done and the likeihood they will get caugt will stop and try and cover their tracks. But there are some who don’t and Tiger is one of them.

It could be just massive denial and they some how rationalize to self that they wont get caught. Maybe Tiger lied to himself that he could just pay everyone off and he would thus never get caught. There are others who are just so much in the here and now that the future is just kind of ignored. This is not uncommon in the criminal mind and is quite a childlike appraoch to life. Children are very here and now focussed and the future simply does not register all that much in thier conscious. It is less likely that Tiger is like this because such adults with such a child like approach usually end up in disarry quite quickly. They would not do all the training that Tiger obviously has done over the many years.

Sometimes they want to get caught as they can not see any other solution to their predicament. This can happen with affairs and you get the affair which is a unsophisticed way of saying I am very unhappy in this marriage and I want out. Or I at least want it to change significantly. It is possible Tiger did this as he was unhappy in marriage and thus set himself up to eventually get caught.

Anyway if I was providing counsel to Tiger I would say, “Tell all your minders and advisers to get fucked and go and enjoy life”.


Sunday, December 6, 2009

The copy cat suicide

The phenomena of copy cat suicide has been documented for some time. It is noted that there can be clusters of other suicide attempts after a suicide by those known to the deceased directly or even through the internet. It can also happen when a suicide for some reason gets a lot of publicity or a particularly high profile person suicides. This can lead to a spike in suicides and attempts by people who knew of the deceased through the publicity but was not know them personally.

It should also be noted that the copy cat effect could apply when some one is just talking about and demonstrating suicidal behaviour not only when a suicide is completed. For instance if one has a peer or relative who makes suicide attempts, talks about their suicidal thoughts and plans, displays suicide notes, displays stock piled medication, a tube for gassing self in a car or a rope for hanging self and so forth then there can be a copy cat effect.

Why would a person copy another individual who has suicided. It would seem that there are three possible psychological phenomena at work with copy cat suicides. It seems reasonable to conclude and the research would agree that the more emotional importance the suicidal person has to the individual the more likely the occurrence of a copy cat attempt. The most obvious one being a parent, a close loved one or with teenagers a close friend, member of his gang or community.

Look at how the man and boy are standing

Modelling. The term copy cat means precisely that, copying. People copy each other’s behaviour, thoughts and feelings especially of those who are important. Humans model on each other and in transactional analysis terms the modelled behaviour is placed in the Parent ego state as a tape. If the two other aspects of the personality, that is the Child and Adult ego states are consistent with suicidal behaviour then modelling suicidal behaviour could result in a copy cat suicide attempt being undertaken.

Parent ego state tapes

Permissions. In order to behave a certain way people sometimes seek permission from others to do so. This often happens in counselling. The client has decided on a course of action but feels unsure about it and thus seeks out a counsellor to get permission to do it. That may be to leave a marriage, change jobs, confront mother and so forth. If someone else says its OK to do it then the person feels more confident and secure in taking the course of action.

This of course can also apply for suicidal behaviour. If one has a parent or close friend who is talking about suicide, displaying methods of suicide, attempting suicide or even completes a suicide attempt this can be permission giving. By watching another person act in a certain way can be taken as a permission by the individual to behave in the same way. Again, if the rest of the personality is prone to suicidal behaviour then such permissions can lead to suicide attempts by the person.

This permission giving aspect of copy cat suicide attempts can lead to angst amongst parents of teenagers who listen to rock music that have lyrics about suicide. The parents see the rock stars as possibly giving permission to the teenagers to behave in suicidal ways. If the rock star is idolised by the teenager then the permission giving can be quite strong indeed. However rock music lyrics have never made anyone suicidal but it could play some sort of role in permission giving as is described here. If the rest of the personality is not consistent with suicidal acts then it is not going to happen.

Normalising behaviour. If a teenager is in a peer group where others are getting tattoos then the actual act of getting a tattoo become normalised. It is no longer seen as an abnormal act in the eyes of the teenager and thus he is more likely to get a tattoo of his own. If a teenager listens to a peer talk about and plan a suicide then that makes the behaviour more normal. If one sees mother complete a suicide that makes the behaviour more normal for the child.


Saturday, December 5, 2009

The act of dying

This also illustrates another point that one hears mentioned from time to time by suicidal individuals. Some people are just too scared or simply can not ever imagine themselves going through with the actual act of killing self. They do not see it as a thing they could ever do whilst at the same time having quite strong self destructive urges.

However the self destructive urges will continue to demand to be expressed regardless, so one has to find another way of expressing them. One way is to have an 'accident' or alternatively to have someone else kill you which is sometimes colloquially referred to as 'death by cop'. This phenomena has been discussed many times in forensic and police journals (see Jenet and Segal (1985)). That is, one behaves in a way such that the police will kill you. Some murders in domestic violence could also be this kind of suicidal act.

There is a insightful article By K. van Wormer and C, Odiah (1999). These writers describe a phenomenon called “Suicide-murder” (not the usual “murder-suicide”), because in this instance suicide is not viewed as a consequence of murder but as its cause. They cite research evidence based on case studies done in prisons with males who committed murders in states where the death penalty existed for such crimes.

They suggest that in some instances part of the motivation to commit the crime was so the state will kill them by execution. They were motivated at least in part by suicidal urges but felt they could never actually go through with the suicidal act so they behaved in such a way that the state would kill them. Many of the men presented in the case studies were clearly suicidal and some demonstrated they had clearly plotted their deaths long before arriving on death row.

In addition they discuss what they term voluntary executions. In the United States there were two hundred and twenty three executions between 1976 and 1993. Twenty nine of those were consensual or at the inmates request. In another study they report sixteen examples of men on death row who volunteered for the death penalty, usually by refusing to fight appeals of their cases. Indeed another two of individuals who had requested an execution were subsequently found innocent and released!

Each of these men chose death as a solution to their problems. They did not die by their own hand but chose to die by having the state kill them. Clearly these cases involved a conscious decision to die that persisted over a significant length of time and was carried out. This is a strong indicator that these men had made the suicidal decision early in their lives and it remained in their psyche until circumstances they created resulted in them enacting that solution to solve their problems.


Sunday, November 29, 2009

Three reaction to stress & suicide

Solutions to problems or high stress. It is generally acknowledged that the more a person is placed under stress the more they will revert to their childhood solutions to problems and the more they will regress, as it is known. This means they move from the Parent and Adult ego state into the Child ego state as is shown in the diagram 1 below.

Diagram 1

This illustration shows that as one is placed under more and more stress, the more they will revert to their early ways of thinking, feeling and behaving. The more childlike they will become in their thinking and behavior and the more obvious their early decisions become in how they behave. They move from their grownup Adult and Parent ego states into the Child ego state part of self. This is supported by research in neuro-psychology as is shown by Johnston (2009). When people are placed under stress they are less able to access the pre-frontal cortex of the brain which is associated with the more developed functions like problem solving, decision making and stress management. Instead people will tend to access the more primitive part of the brain in the amygdala.

When this happens the early decisions about how they should think and feel become more pronounced. These early decisions influence the current decision making much more than if the Parent and Adult ego states were fully operational. As a result one finds such people making decisions that may seem quite out of character for them Decisions can be made which seem odd and even bizarre based on the facts at the time because it is the early child like thinking that is dominating in the personality.

Generally there are regarded to be three main responses to high stress. In 1915 an American physiologist called Walter Cannon described the fight or flight response. This is a fundamental response to a threat or perceived attack where the person will either fight the attacker or flee from them. Since that time another response has been added and that is the freeze response where the person does not either attack back or flee they just freeze and end up doing nothing. This freeze response is seen as the ‘playing dead’ reaction. In the animal kingdom sometimes an animal will play dead so that its attacker thinks it is dead, becomes bored and then moves away. A good example of this is the mouse who is caught by a cat. It plays dead in the hope that the cat will tire of it all and become distracted onto something else.

Everyone has used all three at some time but we all will have one basic response that we use when there is a very high threat or very high level of stress. It is our last bastion when all other options have been tried. Our most basic response to stress of course will be the one that we decided upon as a young child and which fits most with our basic temperament. Our temperament will effect our decision making to varying degrees and thus will effect wether we choose fight, flight or freeze as our primary solution to problems and stress.

Fight, flight or freeze?

Below are some behavioral examples of how a person may respond to threat in each of the three ways.

Fight - this person may physically hit out (as can be the case in domestic violence), verbally hit out, fight for their rights, put in a complaint or sue somebody. In childhood this is the child who will hit out, shout in their defense, maybe break property or try and hurt the other person in some way. The primary response is to fight up against the adversary either overtly or covertly. When under great stress this person will tend to hit out at others physically or verbally. In childhood the child may voice disapproval at mother and father or seek to angrily get change in some way in the home. If mother and father are fighting the child may actually seek to intervene in some way between them.

Flight - This solution may include things like using alcohol, drugs or prescription medication. All these are a way of getting away from the problem as a means to solving it. The person who quits their job and simply goes elsewhere. Here one chooses to geographically relocate or to move away from the problem thus solving it in their mind. In childhood the youngster may display running away from home behavior or the child may go and hide under their bed as a response to stress in the home. Unlike the fighter this child does not seek to change the conditions in the home or express their disapproval instead they move away from the problem and wait for it to subside. They want to ‘slide under the radar’.

Freeze - In earlier times this person would have been diagnosed as having a nervous breakdown. In essence the person collapses in on self and goes into a state of incapacitation. They simply fall to the ground or crawl into bed and go into the fetal position. These days people go on stress leave from work, they may seek hospitalization, some can have panic attacks and agoraphobia which are both incapacitating conditions that can keep them home bound. In childhood the child just stands there and simply does not know how to respond. In the extreme they can loose bowel or bladder control. Whereas fight is primarily an angry response, freeze is mainly an anxiety response.

Suicide primarily is a flight response. One solves the problem by getting away from it and suicide does indeed do that. Interestingly enough in the histories of suicidal individuals it is not uncommon to hear of them report running away from home behavior which of course is the flight response as well. Most often if a child says they are going to run away from home, when asked where they are going to run to they has no answer. In essence the child is running away to oblivion.

Suicidal individuals are in a state of considerable distress and often confronted with some very difficult problem whether that be a recent event that has occurred or just an increasing state of malaise, melancholy and distress that has evolved over time. Thus they will act in more child like ways as mentioned before. When taking a client's history they reports flight as a main way of dealing with stress then this is another point to note when making a suicide risk assessment.

All people fight suicidal urges to some degree. If they did not then it would not be long before their did indeed die. If however the person has a primary flight response then they will be more willing to give up on the fight and take the flight solution of suicide. If the person has a strong fight response then you know they will be less likely to give up and make a serious suicide attempt. The no suicide contract can be particularly useful for this type of indidivual. They can use it as part of their fight response.

Counselling generally speaking is a fight response. Client's wish to identify the problem, find the cause of the problem and then change it rather than simply moving away from the problem. However this is not always the case. Some people will use counselling to identify the problem and then seek ways of getting away from it. Depending on what the problem is, either approach can be useful.

For instance if the client has a primary fight response and has a problematic relationship with mother they will tend to try and alter that relationship by changing self or by negotiation. Those with the flight response will not try so much to alter the relationship but will tend to take the solution of simply never seeing mother again. Some people come to counselling to get permission to do precisely that. To get approval from the counsellor and make a decision to terminate the relationship with mother. Obviously as a therapist it is conducive to work out which of these responses the client is essentially looking for.

Those with the flight response are much more likely to seek a purely medication approach to their problems of emotional distress. For instance the medication approach to depression is a example of a flight response. If it is found to be successful then that person would have little interest in seeking a counselling approach as well. On the other hand one not uncommonly meets clients who say they don't like taking medication as it does not solve the problem and they will seek to find the cause of the problem and try and remediate that.

Sometimes the fight response can be the problem in the itself. If the person has a toxic relationship with their mother that brings them great angst they can seek to change it. The problem with changing relationships is it usually requires both parties change. If mother refuses to then there is not much you can do about that. The person with the fight response will tend to continue to try to change the relationship (mother).

Sometimes it is very hard to accept

that things can not be changed

Some things you cannot change and the person with the fight response will have trouble identifying those times and will get stuck trying to change the unchangeable. The therapeutic goal in these circumstances is for the person to give up their fight which some can find very hard to do.


Friday, November 27, 2009

Highs, lows & life

I like it when an idea comes together. This post has its roots in two separate writings that are far apart but that I did just happen to read at about the same time. They worked as a catalyst for each other and bingo!! I ended up with this.

My delay in writing this is because it comes from a Parent ego state contract given to me by Kahless - yes it’s all her fault!

She wrote about her teenage years (see here) and then said that I had to because she did. She says that her teenage years were a bit boring. Well I must admit, from what she wrote one could conclude that but I suspect there were bits that she deleted or didn’t elaborate on that could have spiced it up a bit.

So I thought about my teenage years and what I could write. As I did this I also read a brief article written by a psychologist about what in essence amounts to a meditation and relaxation approach to therapy. It stated that when ever one had a negative emotion (she actually used that phrase) like anger or sadness or fear then one can basically meditate it away, and she describes how that is done.

This disturbed me and made me question what I do as a therapist.

My teenage years weren’t boring, like some others may have been. It was charged with a lot of highs and a lot of lows (and a few mediums as well). There were not a lot of dull moments and there was plenty of action both physically and emotionally. The good times were great and the low times were sometimes very low.

Then I thought, well if I successfully did the meditative therapy as suggested by this woman then there would be very few low times. I would of only had highs and mediums in my teenage years.

OMG!! Is that what I am doing with my clients? I hope not.

But then I was left with another conundrum. As I reflected on my teenage years I felt good about them because there were highs and also because there were lows. I wouldn’t want a life where I only had highs and mediums so I felt good about the lows as well. It made me feel like I had lived that part of my life such that it had texture and varied experience which is what I want in my life. It gave me a feeling that my life at least at that time had some depth and was full flavoured. I liked that.

But then came the conundrum. The low times gave my life some depth and also it allowed me a more fuller and complete understanding of the highs and the mediums. If I had never had any lows then my understanding of the highs and mediums would be limited and one dimensional.

Upon reflection I was glad that I had had the lows but at the time of the lows I was not glad at all and wanted the lows to go away. If I had successfully done the mediative therapy then I would have achieved that but then on later reflection my life would only have highs and mediums and thus be one dimensional and boring.

So are the lows a good thing or a bad thing?

As a therapist am I stopping clients having lows so their lives are more one dimensional, lack a depth and rich texture?


Monday, November 16, 2009

Website update

My website has had a massive make over.

It can be found at:


Wednesday, November 11, 2009

European Tour - Part 2

You all know how I am a student of graffiti in modern society. What it represents and says about our current society.

On my recent visit to Belgrade, Serbia, I was walking for a post workshop meal and we came across this piece of graffiti. Just had to get my photograph next to it!


Tuesday, November 10, 2009

The European tour

Here is a video of me and others at the beginning of a workshop in Novi Sad, Serbia on the suicidal individual. Zoran is making an inital statement, he has created a very active and growing community of therapists using the Transactional Analysis approach in a number of countries in the Balkans. It really is very impressive. A most interesting man. Beside me is the interpreter who worked all 4 days and did a great job.

Here is me in Zagreb

Here is me in Dalmatia


Tuesday, October 20, 2009

Small talk therapy

OLJ in the last post mentioned that at times she seems to engage in small talk in therapy that can last up to 20 minutes. This I found interesting as I, as a therapist, can also spend the first period of time in a session in apparent small talk. It got me thinking about why I do that, or what am I doing in the small talk that is going to end up being of benefit to the client.

Whilst I am engaging in small talk with a client, there is a lot of ‘other’ talk going on inside my head. In this way it is quite different when I do small talk in a normal social situation where there is not the same cognitive calculations going on inside my head.

Upon reflection, I think I use small talk therapy in a variety of ways. As OLJ says sometimes the small talk can lead to ‘hard’ talk. I would say that at times I am doing the same in small talk. It buys me time where I can assess the client’s current mood and allows me time to plan a strategy to follow for that session. As they talk I am constantly looking for a therapeutic angle where I can make a small switch of direction or make a connection they may not be aware of to their life script. Once done then the small talk becomes hard talk and sometimes clients will say things like, “How did we end up here”, or “I didn’t expect to be doing this today”.

It is also a good opportunity to give positive strokes to the client which builds the relational and then that can always lead into work on the client’s stroke filter. It is also a time where I might slip in some self disclosure which again helps build the relational with the client.

As I think about it, it is also a good way to take a psychological history from the client and do cross checking at the same time. I have always said that there are certain similarities between a therapist interview of a client and the police interview of a suspect. They seek some of the same goals but for different motives.

Positive strokes? These three women seem to have

a distinct dislike for each other

I worry myself at times how I never believe anything anyone tells me anymore, at least with client’s that is. Now don’t take that the wrong way. I am not saying that client’s are a group of pathological liars, but having been in the therapy business for 30 years I know how well people lie to themselves regularly. If they are lying to self about some thing and I ask a question then they are going to lie to me about it. In addition, at times I am asking people very personal questions and they may choose not to be fully candid in their answer with me at that juncture. There is nothing wrong with that and if I was in their shoes I would probably do the same.

In police interviews they can ask suspects the same question three times in three different ways. When doing small talk at times I am doing the same. Not to catch them out but to be able to identify incongruencies and bring them to the client’s attention.

Therapist: Did you go out on the weekend?

Client: Yes we went to a restaurant called ‘x’.

T: I know that one, they have great fish there

C: Oh do they, for my meal I had.....

I am now going to get all sorts of information about this persons eating. In my initial history taking with the client I may have asked about their diet and eating. I am just about to find out how consistent or inconsistent that information was. The client may be quite skinny and report eating a high fat meal or they may be over weight and report ordering just a salad. This is the other kind of information I may pick up.

Therapist: Were you there with family?

Client: Yes, my mother and sister......

I am now going to get all sorts of information about the client’s family dynamics and will be able to compare it with previous information the client has given me. I am also going to get lots of information about their social life which is important in any mental status examination.

I definitely use small talk for such psychological history taking and to cross check information.

Sometimes I just forget stuff about the client and small talk allows me to remember it without the client realising I had forgotten. I am sitting looking at a client and I can’t remember if her mother is dead or alive, if she has a father or brothers and sisters so I might say, “Have you caught up with any family lately?”. As I get a little bit of information a whole heap of information can comes rushing back as I recall it. Its like I just need that little prompt and then I remember lots of stuff about the client. So in this sense small talk therapy is like me reading my notes on the client that I should have done more diligently before they arrived

Well there you have it! I just discovered that I know all this stuff that I never knew I knew. Thanks OLJ.