Transcript CLOSING ESCAPE HATCHES

Adrienne Lee & Ian Stewa rt
ITA Conference
April 2012
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Each individual has four destiny choices…
1. Getting Better (Staying Well)
2. Getting Rid of People (Homicide)
3. Psychosis or Criminality
4. Despairing Self-Destruction (Suicide)
“Only by a clear understanding between the patient’s
Child and his Adult can the march towards doom
sometimes be reversed by the Adult taking control”
Life Path
CLOSE
the
Escape Hatch
“No matter what happens, I will not kill myself
accidentally or on purpose at any time”
Bob Goulding (1973)
“I will not hurt or kill anyone else in any way,
accidentally or on purpose, and I will not set up for
anyone else to do it for me.”
“I will live a healthy , full life and promote the same in
others.”
Ken Mellor (1979)
(1) … means DECIDING not to kill or harm
self or others, or go crazy.
(2) These are DECISIONS (and not contracts).
(3) These decisions are taken from Adult,
over-riding Child and Parent if necessary
(4) These decisions are UNCONDITIONAL.
(5) They are taken FOR ALWAYS.
(6) They are decisions for SELF (not
“promises” to the therapist).
 Myth No. 1:
‘Once the hatches have been closed, the client is
forbidden ever to speak about them again.’
 Myth No. 2:
‘Escape-hatch closure is done for the comfort of
the therapist, rather than the benefit of the
client.’
 Myth No. 3:
‘It is possible to close escape hatches from Child
as well as from Adult.’
 Myth No. 4:
‘In closing escape hatches, the client must
adapt to the therapist.’
 Myth No. 5:
‘The hatches must be closed in the first session’
(or ‘first few sessions’).
 Myth No. 6:
‘Hatch closure should be set as a rule.’
 Myth No. 7:
‘Escape-hatch closure is done by rote’
(or ‘is merely a ritual’).
 Closing escape hatches, and keeping them closed, is the client’s
responsibility, not yours. (Your tasks are to offer the procedure
to the client, then monitor and reflect back any incongruity.)
 Stay OK-OK. You and your client are both OK whether or not she
closes the hatches.
 Don’t press. Whether, and when, to close the hatches is a matter
for the client to choose.
 Stay in Adult yourself throughout the procedure. Keep
monitoring yourself for ego-state shifts and incongruities.
 You need to have closed your own hatches before you can
reliably facilitate others to do so.
 In the last analysis, you can never be sure that the client
has his hatches closed. The most you can do is to make a
professional judgment on the matter, in the form of an
acceptable probability.
 Be aware of, and abide by, the “3 Don’ts of Escape-Hatch
Closure”:
 Don’t try to set Hatch closure as a “rule”.
 Don’t try to get closure “by rote”.
 Don’t invite closure too early.
 a.
Explain what is meant by “closing escape
hatches” and offer wording the client can use if
she wants to close them.
(For example: “I will not, in any circumstances, kill or
harm myself, try to kill or harm myself, or set up to kill
or harm myself, accidentally or on purpose”).
 b.
For each of the three hatches separately, ask if
the client is willing to close that hatch.
If willing, proceed to steps (c) through (f).
If not willing, go to step (g) and complete steps (g) through (k).
 c.
Invite the client to make the statement for each
hatch separately. For each one in turn:
 d.
Look and listen for any incongruity, verbal or
non-verbal. Use Little Professor as well as Adult.
If in any significant doubt, assume the hatch has
not been closed.
 e.
If closure is congruent, test with: “Is that
statement true for you?”
 f.
If still congruent, reflect back that the client has
closed the hatch. Stroke the client (from Adult).
(The following steps will only apply if the client has
not congruently closed the hatch):
 g.
If unwilling/incongruent: register hatch not
closed. Underline that this is the client’s current
choice, and ensure OK-OK position is clear.
 h.
You may then move into inviting the client to
explore her scripty scare or other source of
unwillingness to let go of hatches. In any event,
before the end of the session you MUST proceed
with the following steps. Make sure you leave
adequate time to do so:
 i. Invite time-limited closure of whatever hatch(es) the
client did not close. For example, you might ask:
“For how long are you willing to keep the
suicide hatch closed?”
As the client replies, again look and listen for any
incongruities and reflect them back. In this process,
always address all three hatches at the same session.
(I.e. do not, for example, facilitate the client to close
the homicide and go-crazy hatches while leaving
suicide open; instead, you would invite time-limited
closure on suicide before the end of the session).
 j.
Record the agreed time-limit(s) in your case
notes.
Re-check time-limited closures before
the time-limit is up, and invite renewed timelimited closure or full closure.
 k.
If client is unwilling to close a hatch for even the
shortest time, initiate emergency procedure
appropriate to whatever hatch is open.
“It is of course possible that patients may interpret
such a decision procedure to mean that they cannot
explore their suicidal, homicidal or psychotic aspects
and fantasies. This can rob them of an existential
choice to take responsibility for their own lives (its
irritations, grief and beauty) of depth and poignancy.
Social control may be achieved, but experienced as a
prohibition from the psychotherapist to plumb such
depths of the human psyche even in long term
psychotherapy”
Petruska Clarkson
(1992)
AUTONOMY
SYMBIOSIS
Over Adaptation
Contract
Choice
P
P
P
P
P
A
A
A
A
A
C
C
C
C
C
“I promise….”
“I will not……”
“I choose not…”
SUICIDE
HOMICIDE
GOING CRAZY
JOYLESS
Overwork
Overeating
Smoking
Anorexia/O
besity
Dangerous
driving
Self
Harming
Suicide
attempts
SUICIDE
LOVELESS
Withdrawal
Arguments
Conflict
Verbal
Abuse
Road-Rage
Racism
Violence
HOMICIDE
MINDLESS
Running
Away
1st Degree
Lying
Wild Parties
Dropping
Out
Alcoholism
2nd Degree
Substance
Abuse
Drug
Addiction
GOING
CRAZY
3rd Degree
SELF ACTUALISATION
HEALTHY LIVING
RESPONSIVE RELATIONSHIP
COMPASSION
AWARENESS
RESPONSIBILITY
SUICIDE
HOMICIDE
GOING CRAZY
AUTONOMY - JOYFUL
SELF
ACTUALISA
-TION
Healthy
Living
Meditation
Healthy
Eating &
Drinking
Learning
Therapy
Exercise and
Fun
Positive
Thinking
INTIMACY – LOVE FULL
FULL
RELATIONSHIP
Compassion
Caring
Relationships
Service to
Community
Charity
Gratitude
Engagement
with others
Community
Awareness
Continuing
Education
Home
Building
Work
AWARENESS - MINDFUL
RESPONSIBILITY
Active and
Committed
Life
Eco
Awareness
and Practice
SELF ACTUALISATION
HEALTHY LIVING
JOYFUL
I+
SUICIDE
JOYLESS
RESPONSIVE RELATIONSHIP
COMPASSION
U+
LOVE FULL
HOMICIDE
LOVELESS
AWARENESS
RESPONSIBILITY
I+U+
MINDFUL
I-
UGOING CRAZY
MINDLESS
I-U-
“If you are capable of living deeply
one moment of your life
you can learn to live the same way
all the other moments of your life.”
Thich Nhat Hanh
Enjoy Life
Love
and
Responsibility