Monday, September 27, 2010

Male mid life crisis

This of course is generalising about men but I think it is representative of a significant group of men.

The young adult male can have a large Free Child ego state which he enjoys in his activities as a young man. There are two events in his life which significantly change this. First when he becomes a husband and the second when he becomes a father.

In both these events there is a loss of Free Child as he assumes a more responsible role in life. Usually this happens spontaneously in his own mind. He sees that this is the right thing to do as a husband and father. The woman in his life does not have to say anything for him to make this change in his personality. In other instances the woman may exert pressure on him to assume this more responsible role in life.

Sleepy soldiers
Doing the right thing

The bottom line of this change however is the Free Child will feel unsatisfied to some degree. For some men that is just a little and for other men it can be much more pronounced. As I said before the man will often do this in his own mind himself as he thinks it is the right thing to do. Sometimes the wife may also exert pressure for this to happen.

As a result of this change in his mind there is a crucial period from the mid 20s up until about 40 years of age. In this period there maybe a change in his life where slowly there is a loss of contacts and activities that were Free Child related. Then he reaches about 40 years of age. Some men at that point will look back over the past 20 years and it becomes apparent to him the transformation that occurred over those years in the way just described.

Then he looks forward to the next 30 years and he sees fairly much the same. He is then faced with the question of the meaning of his life. If he sees 30 years more of high responsibility and low Free Child that may come as quite a shock. It is this that can precipitate a psychological shift, sometimes quite sudden, back to an adolescent psyche similar to what Eric Berne called antiscript phase of adolescent development.

Men rowing

He may end a marriage, buy a sports car, date women half his age, take up sport he played 20 years ago, loose weight, dress in a way that is quite unbecoming and by and large live in an adolescent way on the singles scene.

He is doing the same as the teenager does from a psychological development point of view. The direction his life is going (his life script) scares him and this is a loud and unsophisticated attempt to do something about it. He does not know what else to do.

What to do seems quite clear. The Free Child needs to get satisfied over the long period when it was neglected. How this is done of course varies from man to man. What does the boy want? It maybe something that he did all those years ago from fishing, to hunting, to golf, to surfing, to the football, to having a regular night out with his mates. Or it maybe something else that is less boyish but still meets the Free Child needs.

Leap frog

The hard part is keeping this in his life with all the pressures of fatherhood and mortgages and then there is his relationship with his wife. She may have a problem with him doing such things. In Australian culture you don’t often hear of a wife who regularly encourages a husband to do such things. This is probably most often due to the fact that she simply does not realise what is happening in his psyche over such a long period of time. How can she when he probably is not even aware of it himself.

However one thing is true for all members of the human race, if the Free Child needs are not met in a satisfactory way over a long period of time then sooner or later something drastic is going to happen. There will be a psychological explosion of some kind. Just go ask the Catholic church.


Saturday, September 25, 2010

Three suicide relationships

Suicide pact relationship

Suicide pact transaction

Suicide relationship 2

Suicide relationship 2

Suicide relationship 3

Suicide relationship 3

A work in progress.

Cat leaping


Thursday, September 23, 2010

The suicide relationship

My pommy mate Kahless mentions in her comment on the last post about suicide pacts. A suicide pact is a thing which most people find a really bizarre thing for people to do. Indeed that is one of the reasons why it gets the press coverage it does as my good friend Kahless directs us to here.

But as with so many things like this in psychology if you take a closer look it is not all that weird. It ends up being just a slight modification of normal human behaviour.

I refer to a thing called the suicide relationship. In one instance this can be a relationship where two people make a plan to suicide together and thus we end with what is commonly known as a suicide pact. However there are derivatives of this.

One of the ‘protective’ factors in suicide risk is if the individual has family or other close attachments in their life. Such as person is seen to be at less risk of suicide than the person who has no close relationships. Having close attachments makes for a more psychologically robust person.

Kiss stealing

However this can be very misleading and when making a suicide risk assessment one needs to enquire deeper into the nature of such relationships. For some people suicide is seen as every persons right to choose. Every person has a right to die when and how they want to. And this view can put up a substantive argument to support itself and it is a view held by a section of the community.

If a suicidal individual has a close attachment with a person who thinks like this then the protective factor in the relationship is not protective at all. In essence you have a suicide pact between two people where only one is suicidal but the psychology of the relationship is not all that different to a suicide pact where both are suicidal.

Now I am not suggesting that this non suicidal party in the relationship is an evil and uncaring person. They may have great affection and love for the suicidal individual. They may have seen their suicidal ‘partner’ go through great angst over a long period of time and there is an argument for the view that people have the right to choose when to die. Ongoing physical pain is no different than ongoing psychological pain.

Rope woman

There is indeed a further variant of this suicide pact relationship. In the relationship just described the non suicidal party ‘advocates’ suicide for the relief of the other. Under some circumstances the non suicidal party advocates suicide for the other so as to gain relief for self. This may seem abhorrent to some and a very selfish act but it is just natural human psychology.

For instance living with a suicidal person is a very emotionally taxing thing to do. It is a very stressful set of circumstances to live under. If a husband has been living with as suicidal wife for a couple of years and he can see that this is not going to change in the near future his own Free Child will want the stress to end and the only realistic way that is going to happen is if she dies. Thus in this way he has entered into a suicide pact with her as one part of his personality will ‘advocate’ for her suicide.

Now before you go away thinking how terrible this all is just ask yourself how you felt when a close loved one to you had a terminal illness and hung on and on for a long period of time. As the time extends the Free Child in everybody gets more and more vocal in wanting the other party to die because it wants the relief. Indeed even with the mother of a terminally ill child has a Free Child ego state that is wanting the child to die so it can have relief. It’s just human nature. How much that want is and how it is expressed consciously or unconsciously will vary from person to person but it will be there.


In doing a suicide risk assessment of someone who has been suicidal for some time then you know their close loved ones to some degree want the person to complete the suicide they keep talking about. Their Free Child has entered into a suicide pact relationship with the suicidal person. All of a sudden the protective nature of the close loved one is not so protective at all!

As we can see the psychology behind the suicide pact is not as weird as it initially seems as is so often the case with these things. Thank you my good friend Kahless for raising this issue.


Sunday, September 19, 2010


When counselling children and parents sometimes one has to deal with the basics of life. That includes what goes in one end and what comes out the other and all the psychological problems that can be associated with either. What goes in one end can result in the eating disorders and what comes out the other end can result in the elimination disorders like enuresis (bed wetting) and encropesis (soiling).

Kahless, in the previous post comments about people taking control of their body through eating.

When the little child enters the world it has no control. Instead its life is controlled by mother and father. Well it hopes they control it because if they don’t then the child suffers and can even die. For instance it needs mother to control its eating by the provision of nutritious food or it dies. It needs mother to provide love or it psychologically suffers.

Big hair

However as it grows and develops it begins to need less control by mother. Until one day it realises that it does actually have some control. It begins to realise that it has something that mother wants. Mother wants it to take food into its mouth and then swallow that food. It now can exercise control over mother by choosing when to do that and when not. Hence food refusal can be a child exercising its control. This can form part of the eating disorder of anorexia.

As the child grows more so its little brain develops even further and when it reaches about 2 years of age it begins to make a major shift from maternal control to self control. This is a major and very important psychological task for the child to make. If it does not successfully achieve it then all sorts of psychological problems can develop.

Around the same age the child becomes ready for toilet training. When it learns to take control of its bladder and bowel. Up to that point it didn’t need to as it had a nappy and mother took care of those sorts of things.

hands connect

So the important psychological shift from maternal control to self control and control of the bladder and bowel can all get mixed up with each other. This makes it a potential psychological nightmare where numerous life long psychological problems can evolve from. And the child cannot do it just by itself, it is the mother child relationship that has to successfully traverse this rickety bridge over the river full of crocodiles.

If not successful the child can develop conditions like enuresis (bed wetting) and encropesis. Encropesis is the unintentional or intentional act of defecating or soiling self in places that are not appropriate.

(Note: There are a whole array of reasons when a child may become encropetic and I will only discuss a couple here).

I have always found the definition cited above a bit odd as in my view unintentional encropesis and intentional encropesis are two quite different psychological conditions that involve alternative psychological structures in the personality. However diagnostic systems like the DSM include them under the one title which probably leads to people using the wrong treatment at times. Maybe I should express my views to the DSM 5 people?

Hippo chase man

Two types of encropesis can either be anxiety based or anger based. The counsellor needs to make an assessment of the emotional basis of the child’s personality structure. Anxiety based encropesis with tend to result in unintentional soiling whereas anger based encropesis will tend to result in intentional soiling.

The human body is designed such that if people are placed under extreme stress then they can loose control of their bladder and bowel. Hence we hear people make statements like, “I was so scared I almost shat myself” or, “If you go on that roller coaster ride make sure you wear your brown pants”.

Some children who are anxious can develop encropesis and enuresis as an expression of this natural reaction of the body

Other children may be encropetic because they are angry. For a child (or adult) to intentionally defecate in its pants or on the floor can be a very oppositional and defiant act. Indeed it is hard to think of an act that is more oppositional to authority.

However there is one and that involves faecal smearing. This is where the child (or adult) smears its faeces over a wall of clothing or bedding and so forth. If a child displays a pattern of faecal smearing this indicates significant psychological maladjustment and professional assistance is required. It is such an anti social act and hence tends to be anger based rather than anxiety based.

shit creek

Encropesis can also be caused by a child not defecating for a many days. The child continues to eat so its bowel fills up such that it can no longer keep the faeces in. This is where the line between anger based encropesis and anxiety based encropesis can get blurry. Some children are very anxious so they develop a pattern of holding their lower abdomen and pelvic region very tight such that bowel movement is interfered with. Hence one gets the unintentional encropesis from anxiety based problems.

Some children refuse to defecate for the same reason other children do food refusal. It is a defiant act where it rebels against what mummy wants and thus takes control of its body in this way. This can result in unintentional encropesis as the bowel simply gets too full and this could be seen to have an anger basis to it. So there can be one type of unintentional encropesis that is anger based if these are the circumstances. However on most occasions unintentional encropesis is anxiety based and intentional encropesis is anger based.


Monday, September 13, 2010

Anorexia and loss of control - Part 4

Some anorexics report a sense of being out of control. They may say things like:

“I had to gain some control back from my body while I could.”

In Transactional Analysis terms this is quite clear to explain.

Weak A & P

The diagram shows a person with weak Adult and Parent ego states. This leaves the Child ego state on its own and it will feel a sense of anxiety. It may also feel a loss of control because the Child ego state does not have the ability to regulate itself.

In the usual functioning personality it is the Parent and Adult ego states that regulate the Child. It is the Adult and Parent who tell it what time to go to bed, what foods to eat and not eat, when to be polite, courteous and so forth.

Even if the Child ego state protests against the restrictions it will also like them because it gives a sense of stability and a sense of control in its life. What would happen if you said to a six year old girl, “You can eat what you like and go to bed whenever you like?” It is quite likely the child would live on lollies, soft drink and pizza and go to bed at any hour of the night or day. The Free Child ego state runs rampant. Whilst that may feel good for a little while sooner or later the youngster is going to have a sense of loss of control because it is out of control.

Woman & fruit

With the anorexic for some reason the same situation is being played out in adolescence and adulthood. For some reason a strong Adult and Parent did not develop. Or at least for some reason they are not currently functioning in a robust way.

This is quite easy to diagnose and a treatment plan is quite clear. There is a need for Adult ego state strengthening such as described here.

One also would want to develop the Parent ego state. This can be done by the client introjecting the therapist into their Parent ego state. Alternatively the person can practice imitating others who function well in their Parent ego state. This will build up the strength of the Parent ego state tapes. This is described in much more detail here.

As the Adult and Parent ego states develop the individual will report more of a sense of safety inside and thus the sense of internal control increases.

To observe how the three ego states or parts of the personality are relating one can set up a simple 2 chair exercise. In one chair sits the Child ego state or the small child in the client. In the other chair sits the big person which is a combination of the Parent and Adult ego states.

Ego states 2 chair

The person then sits in each of the chairs and speaks from that part of self reporting what they think and feel and dialogues to the other chair. Those who sense a lack of control when asked to speak from the P/A will present as ineffectual, lack a potency or be at a loss to say much at all. Then when in the C chair the person will report a lack of trust or faith in the P/A to look after them or deal with life's problems as they present.

This is quite an easy and simple technique to do and can be used reasonably often to assess what is happening between the different parts of the personality and to do self parenting exercises to build the Parent and Adult. Once the person has done it once or twice they can easily slip into the parts of the personality and perform the exercise.

Girl vomit
Loss of control?


Friday, September 10, 2010

Anorexia - Part 3

Usual age of onset - Early teens to mid to late 20s
Most commonly there is a single episode
Mortality rates are around 10%. One needs to be careful of this figure as it relates to people who are formally diagnosed as anorexic. There are many who have anorexic features who would not meet the formal definition. If you include these as well then it will be much less than 10%.
95% of anorexics are female

Common psychological factors
Results from oral stage of development problems. It results from the earliest development stage 0 - 18 months. Counselling needs to deal with oral stage issues.

Possibility of sexual issues. The woman is turning her self into a non sexual being. Whilst they may say that thin looks attractive the Child ego state aspect of her personality knows that being very thin is not attractive at all and thus no man will approach her sexually. (Some obese women can do the same with weight). They are also making themselves almost physically unable to get pregnant and to carry a child. Counselling needs to deal with the “Don’t be sexual” injunction and their thoughts and feelings of self as a sexual being. This will need to include an assessment of any parental messages about sex and the child becoming a sexual being. Anorexia in essence desexualizes the the girl or young woman making her a non sexual being by infantilizing herself. Also probably a “Don’t get your needs met” injunction.


Family emeshment. Family subsystem boundaries are weak and easily crossed, members intrude on others. There may be over protectiveness where a symbiosis does not allow the child to develop competence to deal with the outside world. Cognitive and behavioural infantilization by parents. Counselling needs to address Adult and Parent ego state development and the establishment of boundaries.

Suicidal behaviour. Death from anorexia can be viewed as a suicide. One needs to make an assessment of the anorexic and the suicide decision (Don’t exist injunction). Then work with the self destructive part of the individual.

(TAJ 1985 was a theme edition of eating disorders. Whilst it is old it does have some good material in it) Lois Achimovich writes on anorexia, parental depression and the suicide decision. She notes that often the mother or father report chronic depression and suicidality. One also needs to make an assessment of depression in the anorexic.
Pre morbid personality - obsessional, perfectionism and need to conform covering a highly rebellious individual. Possibility of a personality disorder and a third degree impasse

In counselling one needs to avoid the RC of the client. A RC can only exist if the other party (therapist ) is CP.


One needs to avoid this at all costs and this can be very hard to do at times as the client will try all sorts ways to entice the therapist into this set of transactions. If the therapist can avoid it then the anorexic relationship can not be established.

As anorexia has its origins from the oral stage of development they will be receptive to transference based approach to counselling. Often they will quickly see the therapist as a parent type figure and thus the transference neurosis will play out. As the client forms an attachment to the therapist they will be very sensitive to emeshment type of relating and expect the therapist to relate to then in an infantilizing way.

One will get contradictory transactions form the client. Some of the transactions from the anorexic will invite the therapist to emesh and infantalize them. If the therapist obliges initially this may be well received but eventually the client’s RC will kick in and then the anorexic relationship will be played out again.

Dinner time

If the therapist does not oblige and ‘rejects’ such invitations by the client they may initially get a hostile reception but if maintained in the longer term the client will experience the benefits from it.

One would also be suggesting ways by with the anorexic can stimulate themselves orally. Thus using a pacifier or thumb sucking in bed at night or even as the therapist does holding work with them. It may take some time before the client will agree to such a thing.

This may sound like the therapist is infantilizing the client. The therapist does invite the client to at times be quite regressed such as with holding work or making homework contracts to suck their thumb and so forth. However such regressions are for a specific therapeutic goal as I have described. Overall however the therapist expects (one could even say demand) that the anorexic solve her own day to day problems, resolve their own conflicts and so forth.

To further address the oral stage fixation one could also get the anorexic to place something in their mouth like a small marble which they can play with in their mouth for extended periods of time. Others usually do this with something like chewing gum but the anorexic wont agree to that because it would result in calorie intake. A small marble obviously will not result in any calorie intake and this can provide the person with ongoing oral stimulation. In addition it gets the anorexic used to the feel of having something in their mouth.


Thursday, September 9, 2010

The anorexic relationship - Part 2.

The internet really does provide some interesting insights into the human psyche at times. An example of this is the Pro-ana (Pro-anorexia) websites. I had look at these a few years ago and then a couple of days ago. There are now hundreds which I found in a few minutes so there are probably many thousands of them out there.

For example:

Pro Ana Tips and Tricks

Pro ana sites here’s a list of great sites

A most interesting social phenomena to arise via the internet.

Here is some information from them

There is no such thing as an eating disorder. People have anorexic and bulimic life styles because they pursue perfection. Just like elite athletes, musicians and others pursue it. Perfection is beauty

Pro-ana 10 commandments
1. If you aren't thin you aren't attractive.
2. Being thin is more important than being healthy.
3. You must buy clothes, style your hair, take laxatives, starve yourself, do anything to make yourself look thinner.
4. Thou shall not eat without feeling guilty.
5. Thou shall not eat fattening food without punishing oneself afterwards.
6. Thou shall count calories and restrict intake accordingly.
7. What the scale says is the most important thing.
8. Losing weight is good/gaining weight is bad.
9. You can never be too thin.
10. Being thin and not eating are signs of true will power and success.

Amy winehouse..

Secrecy tips
Don't bring up the subject of food around other people. Have your excuses for not eating ready in case they should bring the subject up. Some excuses I use : "My stomach's a little upset", "I'm too (tired, excited, nervous, busy, etc) to eat", "I don't feel like (whatever food it is), I'll get something later", "I did eat, didn't you see?", and "I stopped by (Burger King, Subway, etc) earlier".

Don't deny everything if confronted. People will believe a little truth with a big lie much easier than a huge lie. Act as if it's no big deal instead of reacting emotionally and people will tend to believe you.

Watch where you dispose of uneaten food or other "evidence", make sure that it isn't going to be seen or found by anyone. Wrap food up and throw it away outside the house. If you live alone, always take the trash out before anyone else comes over.


In the previous post on the anorexic relationship I mentioned how food refusal was a very primal and basic act of rebellion. I think it is safe to say that these comments placed for public viewing on the internet are a rebellious and defiant act at least in part. These people know how some others will react to them and that will be with the Critical Parent ego state.

Guess what?
Now we have Anti Pro-ana websites or comments on the internet

Anorexia on the internet

Pro-ana website dangerous to young women

Pro-ana websites

This last one makes the interesting statement
“Many sites treat eating disorders as lifestyle choices, rather than the illnesses they truly are”. (end quote)

Two things I would like to say. First this demonstrates the anorexic relationship dynamic of the RC and CP transactions. The pro-ana sites are being ‘naughty’ and doing things which they know authority wont like and that authority will respond by ‘scolding’ them.

RC: “I am going to hurt myself in front of you and you try and stop me”.
CP: “You shouldn’t do that and I will try and stop you, (in this instances by trying to ban Pro-ana websites)”.

Dogs and pig

This transactional dynamic will perpetuate the anorexic behaviour such that the psychology behind the anorexic behaviour is reinforced. In this case the dynamic is being played out over the internet instead of between counsellor and anorexic in the therapy room or hospital and anorexic on the inpatient ward. This model presents anorexia as a relational experience.

It also shows how the anorexic can force the authority to become involved. The anti pro-ana sites are correct. The information provided by the pro-ana sites will adversely affect some young girls who read them. So what does the authority do?

If they do nothing, thus avoiding playing into the anorexic relationship and thus don’t reinforce the anorexic behaviour young girls will continue to be adversely effected. If they act to have the information stopped then they play into the anorexic relationship. Then it is highly likely the authority will be perceived as CP by the anorexic even if they are not being CP.

In addition.
Why aren’t there pro-depressive or pro-insomniac websites which provide secrecy tips or promote insomnia and depression? Why are there no websites promoting an insomniac or depressive life style?

Maybe because these conditions do not have a rebellious aspect like anorexia and anorexia involves a style of relating whereas depression and insomnia do not. Depression and insomnia don’t need an insomnia relationship or depressive relationship for the condition to continue like anorexia does.

Gemma Ward

There is however also a healthy aspect to pro-ana websites. A person with anorexia has been told over and over either covertly or overtly that she is sick, dumb, naughty, bad, selfish, neurotic and so on endlessly.

At least some of the Pro-ana websites are saying:
“I’m anorexic and I’m OK”, with comments that follow the statement before:

“Many sites treat eating disorders as lifestyle choices, rather than the illnesses they truly are”.

This may be the Free Child aspect of the anorexic saying, “I want to survive and grow towards health”. They reject what the helping professionals say to them about being sick, neurotic and so forth. They say I am a good person even if I choose the anorexic life style. From a therapeutic point of view this is a most positive move. It is going to reduce the psychopathology due to the acceptance of self as OK no matter how they live.

This exposes an inherent contradiction in all psychotherapy and counselling. On the one hand the therapist says to the client that they are ok and good and acceptable. However, the therapist also says there is actually something wrong with you or you wouldn’t need to come to therapy in the first place. By the very act of me being a therapist I am saying to the client that there is something in you that needs to be changed and the Child ego state of the client is very likely to take this as it having something wrong with it or is bad about it.

The pro-ana websites are rejecting this contradiction and thus it is a healthy move by them.

As you can see the pro-ana movement is a most interesting phenomena which is quite complex and has both good and bad aspects to it.


Wednesday, September 8, 2010

The anorexic relationship (editted)

OLJ asks:
does the adapted child take over as a protection for the free child?

My response:
One could say that the AC protects the FC. If a child is confronted with adverse parenting its first thought is to survive. It will make a decision on what it needs to do so as to survive physically and psychologically.

For instance, a child does not eat its dinner to which mother gets very angry and hits it. The child is then forced into a position where it has to make a decision on how to survive. That decision can be anything and they will vary widely between children. The decision results in the Adapted Child behaviour. The Free Child part of the youngster senses danger and thus it makes some adaption to the environment as a response to that danger.

For instance the child may decide that mother’s anger is very frightening so it will conform, behave and eat up all its food. It does this as a short term solution to the danger. This is the AC

Another child may decide that mummy is bad for getting angry, it is being unfairly treated and throws its plate full of food on the floor. The AC response in this case is an angry rebellious response that fights back which the child sees as its solution to the problem. This is the AC.

Strong girl

As we know the AC is divided into the Conforming Child (CC) and Rebellious Child (RC) ego states. Both these adapt to authority. The CC by doing what it is told and the RC by doing the opposite to what it is told. Neither is what the child wants fro itself (the FC).

Hence we end up with an eating disorder like anorexia. This person adapts to the authority by swinging between CC and RC responses to authority. At one level these people are often quite nice people who seem to conform (CC). On the other hand anorexia is one of the most basic rebellious responses a child can do to a parent. Food refusal.

Mother puts the spoon full of food into the mouth of the young child to which it closes its lips tightly. One of the most primal forms of rebellion a person can do. Mother pushes the spoon harder onto the lips to which the child squeals in defiance and ‘accidentally’ knocks the plate of food off the table onto the floor.

The anorexic is highly rebellious individual. However often when you meet them they will not appear so. This may explain why the majority of anorexics are female (95%). In our child rearing patterns open angry rebellion is usually less acceptable for girls than it is for boys. The girl has to express her rebellion in a more disguised way. She says, “I just don’t feel hungry and I can’t eat”. Angry rebellion expressed in a polite way. Whereas the rebellious boy is more likely to hit our angrily in a direct and open way.


The other feature of all this is the Free Child is no where to be seen. It has been lost long ago in the past. The anorexic and authority get deeply engrossed and locked into CP to AC transactions The FC is forgotten about.

The anorexic is not lying when she says she does not feel hungry. In this instance hunger is a function of the FC. She has been so out of touch with her FC for so long she can no longer even recognise it. Thus she does not feel the hunger sensations when they come. Thus we end up with the dynamics of the anorexic relationship.

Anorexic relationship

The anorexic comes from a background where she perceives the parents to be overly controlling and authoritarian and thus perceives transactions coming from their CP to her Child ego state (1). She responds to this with two transactions at one time.
2 - she will appear to be CC and compliant
3 - underneath she is highly rebellious and uses a most primal form of rebellion against authority, food refusal.

At the same time she has become so divorced from her FC over a long period of time she no longer can even recognise when she feels hungry.

So what does the counsellor do
1. Establish a relationship with the anorexic that includes other transactions besides CP to Child. This may be hard to do as the anorexic will perceive you to be CP even when you are not. Secondly she is so rebellious that she may kill herself from starvation. This can force the authority to intervene in an authoritative way even when they don’t want to.

This is one reason why I have a general rule of thumb when working with client’s who have eating disorders. I will not spend more than 50% of the consultation discussing food, weight and eating. We will spend at least 50% of the consultation discussing other matters unrelated to these areas. Some clients find this hard to do at first because food, eating and weight is all they ever talk (and think) about.

This allows the client and me to get away from the CP to C transactions and introduce other kinds of transactions into the therapeutic relationship. Also I don’t want to have a relationship with the client that is food obsessed. I want a more normal relationship with the client were we can talk about good things sometimes that feel nice for the client and me.

2. Assist the anorexic to reconnect with her FC
If one can get some FC to FC transactions going in the therapeutic relationship then that is a very good start indeed. If this happens then the anorexic relationship is already starting to morph into something else.


Monday, September 6, 2010

Family structure and child development

Emeshed and distancing families

Families are structured in differing ways and here I look at two varying structures and the psychological consequences of those structures on the child’s psychological development.

There are emeshed and distancing families. They can be diagrammed as such.

Emeshed family
Emeshed family
Scary outside

Distancing family

Distancing family

These can be seen to be the extremes of the continuum with the ‘normal’ family existing in the middle. The closer the family is structured to represent the end points of the continuum the more maladaptive psychological consequences there will be for the child growing up in them.

Family continumn

Emeshed family
The diagram shows the family members represented by the circles. In this family there is a very clear boundary between the inside of the family and the outside and the member have a sense of closeness and belonging but overly so. There is a script belief by the family, “Don’t trust” others (outside the family). There can be paranoid beliefs about non family members. “Us and them” thinking. The world outside the family is seen as a scary and dangerous place and you can only trust family - is the ethos.

Group think creates self perpetuating beliefs. Along with the introjection of beliefs particularly about others. This can result in fighting with others out side the family. Neighbourly disputes over fences or barking dog. Family feuds use the group dynamics of the combat state which can foster a strong emeshed family structure.

There can be faulty thinking - grandiose delusions about the specialness of the family or one member may be identified a special due to what is believed to be exceptional ability (sport, music academic), appearance, power, wealth and so on.


Family gatherings such as birthdays, holidays, christmas and so forth occur regularly and non attendance is viewed in a very dim light. There can also be (but not always):

Infantilization of the children
Excessive contact - sleeping together, working together, socialising together
Prevention of independent behaviour
Parental - system control. Intolerant of variation or deviation of the members where members do not behave how they are supposed to. A child who refuses to eat dinner, performing poorly at school or a parent displaying anger, power being challenged. The response to correct deviations are swift and intense by other family members.

Distancing family
In this instance there are tenuous connections between family members and often there is no contact for long periods of time. There is little sense of belonging and the family being a close knit group with a clear sense of boundary between it and the rest of the world.

No sense of belonging or community leaves people feeling isolated. There can be one person who holds the family together and when they die or move away the family disintegrates. Don’t belong injunction.

Little interest or frequency of family gatherings. Can easily geographically move away from each other and there are long periods of little or no communication with few protests from anyone.

The distancing family tolerates variation and deviation to the extent of not even noticing or caring. Responses to variations may not even occur even when required such as with a truanting child.


Mixture of family structures can occur at times if there is a number of people like in-laws cousins and so forth. One get subgroups in the family that can be structured like this.

Potential problems resulting form these structures
Relationship problems - Spinsters, bachelors & divorcees. Children may have a series of failed relationships that never work. No one is ever good enough for me or they all have some bad point that negates them as a potential partner. Maybe a short dysfunctional marriage may occur. A long term affair with a married man is another possibility (ie selecting an unavailable partner). When these relationship end where do they go then? Go back to the family of course.

This raises a point that I sometimes see in counselling with those who are entering a stage where marriage is in the foreground. When you marry someone you marry the individual person but you also marry their family structure all their attachments and relationships as well. The family structure and attachments were there long before the potential spouse came along and these things tend to be inert and do not readily change. Indeed in an emeshed family they are very resistant to change. If one is marrying into an emeshed family structure they better get used to the idea and it will take them a long time to be fully accepted into the family structure. Sometimes they never are and will always seen as an outsider to some extent.

gothic wedding
Gothic wedding

This raises the issue of a person’s motivation for marrying a spouse. People get married for lots of reasons. The overt reason is because they have fallen in love with the partner and want to spend the rest of their life with him/her. Underneath there can be a whole variety of other covert psychological reasons.

People from an emeshed family can marry to get out and away. They see it as one of the few ways to get out of an oppressive family system especially when the newly weds geographically move away from the original family unit. The family will use all sorts of mechanisms to stop this happening such as financial ties, gifts, emotional black mail and so forth.

If you are marrying a person from a distancing family one may wish to consider such possible motives of their partner. It also works the other way. People from a distancing family can marry a person from a ‘closer’ family because they crave the feeling of belonging to a family. In their mind they are marrying the family attached to the partner just as much as they are marrying the partner, if not more so.

Other problems that can result from an emeshed family
School phobia
The child who is aggressive or unpopular to his peers ends up isolating self
Enuresis & encropesis = cannot stay away from home over night with out complications and embarrassment
Anxiety disorders - agoraphobia, panic attacks, means of travel such as a fear of flying or public transport. Any kind of anxiety that makes movement away from the home or family difficult can have some of its basis in the emeshed family structure. It should be noted that there are also other causes of these problems. However if a client presents with this kind of problem then the counsellor needs to investigate the type of family structure the person grew up in.

girls on bridge

“Leaving home” problems are typical of the emeshed family. When the children reach the age where they are ready to (supposed to) leave the home and family. Twenty somethings or thirty somethings. When the family reaches this developmental stage it can restructure it self to make one or more of the children an identified patient. The young adult develops a problem like a drug problem, becomes suicidal, develops a mental illness of some kind, or something else like anorexia or other kinds of eating disorders.

When this happens the family bonds together for the good of the identified patient when the real reason underneath is to propagate the emeshment.

The schizoid personality type is the most obvious product of this type of family structure. There may be a sense of despair due to lack of emotional attachment, commitment phobia and difficulty with forming close attachments. The ‘gypsies’ of the world who can travel and never really settle down into some kind of group or family unit. At times some find drugs can fill the void of the lack of attachment.

The anti social or narcissistic personalities can also manifest from this kind of background. Both these have attachment difficulties and either don’t understand what attachment is or simply find human attachment too overwhelming.

As mentioned before sometimes these people can attempt to solve their distress by marrying a family. The man may actually be attracted to and in love with the woman's family more so than her. This may lead to marital problems later on.


Wednesday, September 1, 2010

Introjection in the therapy process

On July 30th, 2010 I wrote a post about Carl Rogers and his therapy. He proposed that a therapist needs to display 3 qualities when working with a client. These are:

Genuiness - Therapist is aware of his own feelings, thoughts and attitudes and these are not concealed from the client.

Empathy - Understanding the client’s experience from the client’s point of view.

Unconditional positive regard - Conveying to the client that they are worthwhile humans no matter what they do.


If these happen then over time this positive relationship is seen to bring alive the person’s natural desire to grow towards health. The Free Child aspect of the personality ‘sparks’ up and the person naturally grows towards psychological health. A reasonable hypothesis that has been widely accepted by the therapeutic community one could say.

However there is another aspect to this. Another feature of the therapeutic process and that is the mechanism of introjection. Any two people who form any sort of relationship then introjection will occur between them. It will happen unconsciously and relentlessly. It will happen to everyone but the extent and rate of introjection can vary between people and circumstances.

The therapeutic environment is a prime breeding ground for introjection of the therapist by the client. It is well designed for this to happen at least in some ways.

Introjection can be explained theoretically as the incorporation of the therapist into the client’s Parent ego state. Over time the client will incorporate the therapist’s personality into their own via this mechanism. The therapist’s personality becomes part of the client’s personality. It will happen back the other way but to a lesser degree.

Introjected therapist

I recall a number of years ago I used to run a respite programme for an organisation called ARAFMI (Association for Relatives and Friends of the Mentally Ill.) We took away on a holiday 7 people with chronic mental illness so their carers at home (usually their parents) could have one week respite from caring for them. So myself and an assistant lived in close contact with 7 people for a week who usually were diagnosed with either chronic schizophrenia, bipolar or psychotic depression. I tell you what, it was one of the best learning experiences I ever had about these types of mental illness. I learnt more about how they think, feel and function that I ever could with a 5 year degree.

However my point is I lived in close contact with a group who were heavily medicated, had been for a long time and were probably going to be for a long time. Because of the medication many were quite over weight or obese and they generally had this slow moving sort of swaying way of walking. By the end of the week I would be walking like them! Without even knowing it I began to walk like them. The introjection process on display.

In the counselling setting introjection will occur more, the longer the client has been seeing the therapist, the more frequent the client sees the therapist and the stronger the transference the client has for the therapist. The more these three conditions are met the more the client will introject the therapist as part of their personality.

Kids bike transport 2
Will these children wear helmets when they ride a bike in the future?

If the therapist is being genuine, empathetic and giving positive unconditional regard then the client will introject that. If the client starts to take this in as part of their own personality then they are going to treat their own Child ego state in these ways as well. If that happens then the person will start to feel better about self and thus grow in a more psychologically healthy way. Another explanation why the Rogers therapeutic approach may be successful.

However unfortunately it works both ways. If a therapist uses painful therapeutic techniques then that attitude or ‘permission’ will be introjected as well. Many therapeutic techniques are painful to some degree and involve the client regressing and experiencing painful emotions and confronting old painful memories. If the therapist allows this to happen and indeed promotes it as most do then the client will introject that into their Parent ego state as shown in the diagram. I use such techniques at times and thus one needs to be cautious of such therapeutic techniques and the introjection that occurs.

Bubble blower

Then there are the pharmacotherapies like methadone for heroin addiction. There is an inherent contradiction in these approaches. The therapist says “Take these drugs, so you don’t take drugs”. The permission to take drugs is introjected by the client by the very actions of the therapist. Again, I am not anti methadone and have seen it be useful for some opiate users. However in any over all treatment plan one must be at least aware of this contradiction and introjection occurring in the client.