 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to episode 101 and what we're going to be talking about this time Bob is working with the isolated client. I love the numerals 101 and I love them because I think it's to do with the two-day course I teach on the concepts of transaction analysis and it's called 101 course. I've been teaching for 37 years. Is that how long you've been doing it Bob? I remember that as if it was yesterday. There we are. I was so nervous and so anxious about not only coming into Charlton because I don't like big towns and things like that but actually walking into the Institute. It was like walking in the first day at school. Yeah, that 101. And 101 is used the hour with about 14 to 16 people. They're learning the early concepts of transaction analysis and I used to love teaching that course. I don't do as many now. My colleagues do them more but it was one of my favorite two-day courses. So when you said 101, I just liked that thought because it made me think about all the 101s I've taught. Yeah and you must have done a fair few over 37 years Bob. Certainly 101 of them. Yeah, exactly. So the university clients. Yeah, I was thinking about this. It's a fabulous topic and it's also an interesting topic for therapists because it's one of the major questions that the therapist needs to ask about their clients. They need to know how isolated they are. In other words, having a support network. In any assessments that you do and I do a lot of assessments before I pass them on to therapists, I will always ask and inquire about a person's support system. Because when they isolate themselves or live alone, they tend not to have the same sort of support networks or they are what I call self-reliant loners. Yeah. It means there are people who rely basically on their internal self and if that internal self is pretty negative, then you know it's not a good indicator of health. No. Mental health I'm talking about. Yeah, absolutely and I think that support network is vital particularly when you're in therapy. So there's several questions I ask. That's one of them. I'm always looking at the capacity clients have for play and humour as well but I think checking out their levels of support and how isolated they are is really important in terms of mental health indicators. Yeah. And in some ways that will shape the therapy. Yeah. So how would you be different with a client if you found out that they didn't really have a support network that they were on their own? What would be different? Well that information would have been indicated for me around the type of therapy in terms of certainly start off with individual therapy but we'd be looking at how come a person's arrived in that position. In other words, have they decided that isolation is the best way for them to survive? Yeah. So three choices. Yeah. As it comes from an isolated childhood? Yeah. Is it the way that they see the world? Is the self-reliant what I call self-reliance loner a way of living the world for them and what does that mean for them? So I need to start learning about their script. In other words, how they've become this way today. Yeah. So choices in life being that they've ended up isolating themselves. Yeah. And how do they understand that for themselves? Yeah. I also always think about stroke theory. So for non-TA people listening, stroke is a sort of, you know, means in TA language, you know, positive strokes, negative strokes, but basically it's a unit of social recognition a stroke, whether it's positive or negative. And strokes are a bit like oxygen. We need them. Yeah. Positive strokes, we look for negative strokes because they're units of recognition. Yeah. We don't have them. We usually, it's not long before we, you know, move away from a sense of reality. If you go into any prisons or any sort of torture regimes, locking a person away insulted. Yeah. This is what they do. Yeah. Absolutely. And with young babies or whatever, you know, it's fairly to thrive if they're not getting another human connection. We are, you know, sociable creatures, human beings. We like to be around other people. That's correct. And less, of course, in our histories. Yeah. In dangers to be social. Yeah. And then we survive by being isolate and relying only on ourselves because outside relying on ourselves, it's not been safe. Yeah. So we've had a history that's been so toxic and traumatic. That's being social is dangerous. And that gives us an understanding of the isolation of the person and what that means. Yeah. So it's, you know, on a positive note, it's really good if they do come in the therapy room because they're wanting something to change. I know the last podcast episode was about change, you know. So noticing maybe that they are on their own too long. Because, you know, there's loads of television programs and films about, you know, people being a recluse and, you know, never coming out of the house and all that sort of stuff. Usually because there has been some past trauma or they've been repeatedly let down or whatever it is, you know, I don't know, there's under one different reasons. But it's always seen in a really negative light. Usually that type of person is seen as eccentric. Yeah, yeah. That type of person who's withdrawn, isolating themselves is seen as, you know, antisocial, eccentric, odd, all those words. Yeah. Yeah. That person to actually come to therapy. Now, I know we're in a continued mental health continuum here, but that person to come to therapy that's isolated, withdrawn, hasn't got a support network. You have to then think, oh, crikey. So how come they've got motivation to actually want to change in the first place? Yeah. Or actually to pick up the phone, to recognise that their needs are being read at some level, recognise that the discomfort, there's more to life, perhaps, all those things they might say to themselves, you know, it's very positive indicators if they can come to therapy. Often those people, by the way, are often sent the therapy or their friends tell them they need therapy. Yeah. And sometimes they might realise themselves, but it's not how they're so sort of isolated. Now, you know, I also think that when the therapy begins, by the way, as people start to make changes, they may sometimes move to isolate themselves, almost like a script backlash against the change or a backlash against the script. Yeah. They move away from what was a support network to isolating themselves, believe it or not. That's something I think a therapist always needs to look out for if they see the client somehow isolating themselves. Yeah. And of course, I can think of one particular client here who I think came and I'm thinking particularly of this guy who, but I could think of many more about him thinking this one, came into therapy, the profile will be self-reliant loner, started to make a lot of changes. To the extent I decided they wouldn't be overwhelmed if we put them into a small group because I think they needed more interaction with people. And I started to see the changes. They've less started to isolate themselves more. They even moved into a home share and all the indicators for changes in mental health started to be more positive. And then we started to see, believe it or not, and if it was after a dramatic piece of therapy, they started to change again and they were more unkempt. They moved out of the shared house. They started to not find being in a group very positive of themselves. And we need to know, we need to notice these things of service. Yeah. This is an indicator that therapy isn't working. Yeah. Something's happening. And it's usually a rebelliousness against the change. Yeah. Yeah, because it is, you know, change is difficult and scary. And, you know, often that's what happens. They'll go so far down the road and then come to an abrupt standstill and, you know, either need to just take it slower or it will take a backward step. I think I did that in therapy. It's like, you know, the old saying one step forward and two steps backwards is kind of like, sometimes that's how it feels. As I ran groups for a long time, and I wanted to do two podcasts, perhaps, you know, later on sometime on relational group process one and relational group post, relational group process two. But I, but I was given somebody supervision and they're just starting groups. And one of the things we talked about is what sort of people go into groups. Now, people have been isolating themselves. He don't suddenly just tell them to go into groups. No, to overwhelming for them. They have to have some individual therapy, quite a lot of individual therapy with you first. And when you start to see those people make these changes, or when you start to see these people being able to accept what I call positive strokes or positive recognition without being overwhelmed. And when you see these pieces, people start to increase their support network, or go to the theater, go to the dance hall or go out with friends. So that behavior starts changing. And usually their self care starts to change. Then you may start thinking about the usefulness of a group. Yeah. Because it's a big difference in individual therapy and group therapy. Group therapy can often be the transition from individual therapy and going into the world. Yeah. I being totally honest now, I found it really easy to hide in group therapy. And I was quite happy to hide in group therapy for many a week. Yeah. And some people don't go into group therapy and some people go into group therapy and hide in group therapy. But what I'm saying is I think group therapy can be very useful as a transition and interact and experiment with all these changes before they go leave therapy and go into their own world in a way. Because again, it's a safe space. Yeah. But what usually happens for somebody who's made all these changes, that space, it's something the therapist needs to be very careful about and check out and think about changes and think about these things. Because if they then move that person who's made all these changes, suddenly they're in their group and they feel so overwhelmed, it can be counterproductive. Yeah. And they also have to go backwards. Yeah. Yeah. Because there's also I don't want to say safety concerns, but being highlighted that if they don't have anybody at home, if there isn't a support network, I know we touched on it a few podcasts ago, but I always make sure I have an emergency contact number. What about the clients that haven't got anybody that suddenly stopped coming to therapy, maybe? And we don't know what's happened where they are, whether they're okay or anything. There's also those sorts of concerns with clients that are quite isolated. Absolutely. Absolutely. And, you know, we need to do all the things that you've just said, by the way. Have emergency phone numbers, find ways that we can contact them. Yeah. But there's a fine lining, not being responsible for the client and ethically being mindful of, especially if, like you said, there's been a traumatic episode or whatever in a therapy session and then they don't come back or they've taken a backwards step or whatever, you've noticed a change in the behaviour. How far do we go as therapists? That's interesting. If you talk to most people coming to issues like this and bring them to supervision, usually nine out of 10 therapists do feel responsible for their clients. Yeah. Yeah. Now, I hear what you say that it isn't a job for therapists to be responsible for clients. I understand that balance you're talking about. And I still think we need to be aware of the journey the client's taken to be where they are at that moment in therapy. Yeah. You see, I often think therapists are too eager, or some of them, too eager for the person to change and they miss what's happening on the inside of the client. And, you know, I think they can adapt to clients so quickly that the person may miss what's happening on the inside. Yeah. Yeah. Because we don't know what's going on on the inside. We can't see. So, you know, for something for us that might be an everyday occurrence for a client, might have a significance to them that, you know, the reaction is completely different to ours. In 1945, Eric Byrne, the transaction now, you know, and yeah, it was 1945, the originator of TA, he was a psych, he was a psychiatrist in the army. And TA was born out of the idea that by observing people's behaviors, you can make hypothesis about what ego state they've moved to. In other words, by observing external behaviors or the manifestation of external behaviors, you can hypothesize about what's happening internally. Yeah. TA was born from that idea. So, as TA therapist, I think we've got a head start on a lot of therapists. Yeah. Because we should be looking for the behavioral signals that indicate script change and what ego state they're in. Yeah. Yeah. We should be really keen on looking for observation, behavioral change or not. Yeah. I think that's really important to be mindful of making assumptions or presumptions about a person's behavior because we've all got our own past as well. And we might think, oh, well, last time somebody behaved that way, it meant X, Y and Z. That's not necessarily always going to be the case. That's right. I've had quite a few letters and emails from past clients. So, my clinical journey. And I'm a geologist, I've been positive. And I had one the other day from somebody who said something like, you know, he probably won't remind me, remember me, it's a quarter of a century ago. Wow. Three years therapy with you. And you were so important to me. And I would like you to just know that. Oh, that's lovely. Yeah. That makes me remind why I'm in the job I'm in. And I think I remember the person. I mean, it's going back a quarter of a century. But I probably, I think it's probably to this, that I haven't put as much emphasis as perhaps I could have done in the importance of their changes. In other words, I've understood they've changed. I've understood their life has changed. And perhaps I never knew how much intel change happened. Yeah. Yeah. You're right. It's quite hard to know what's happening internally. Yeah. I know Eric Byrne from his first writings, intuition, psychotherapy, to his first book in 1961 TA Psychotherapy and onwards would talk and emphasize deeply that observation and puts a real premium on TA therapy, observing what's happening with behavior so they could hypothesize what ego state the person had moved to. Yeah. And then from there treatment can happen. Yeah. It makes sense. So for example, somebody who isolates themselves, or is like I say, self-reliant loner, though it might not mean a lot to somebody. Sorry, therapist. But a small thing like say, for example, somebody coming in and talking about their needs or talking about how they missed somebody or talking about what they remember from last week or talk to you about, do you know I was thinking this, they're all big things. Somebody having the motivation to reach out. And I think the therapist needs to really share with the isolated person the impact of you know what they're having on them. Yeah. Now with that comes the caveat of overwhelming someone. Yes. But understanding that, that concept of the isolated person being overwhelmed by the recognition of the way we're talking. I think that's a really valid point because it can be even just a small recognition can be overwhelming. Yeah. So this is all what TA is built on though, I think. It's the analysis of internal and external transactions. Well, first of all, it's the analysis of external transactions to get to the internal transactions. Because external transactions, external transactions are the manifestation of internal transactions. In other words, something is happening on the inside. Yeah. Then you can ask them. Yeah. Where that you were talking about how you felt and I realize that's the first time in three months you've ever talked about what you're feeling. And has that meant that there's been things happening for you in your world at home? X, X, X, X. Yeah. Because yeah, it's really, it kind of goes in when changes in behaviour are noticed and seen. You know, the client feels like they've been seen and heard and things like that providing it isn't like you said too overwhelming for them. But it will be overwhelmed and I think it's the job of the therapist to be aware of what's happening. And I don't like the word drip feed, but to just, you know, gently make a transaction, which, you know, you might know is too overwhelming for them or might be. So you say, and you know, when I say this to you, I really appreciate you coming here every week. Is this too overwhelming for you? Do you move away from that transaction when I say it's at an internal level? Yeah. Do you check out what's happening internally in response to the external transaction? Yeah. Because it, you know, particularly I would imagine with somebody who is, you know, a loner that it's a very slow process, very slow process. Yeah. Yeah. And even to be in a room for 50 minutes with somebody and having a communication, I would imagine would be quite exhausting for them. It's not something that they would do regularly. Yeah. They go home to four bear walls. Yeah. Yeah. They go home to spiners. Yeah. Their comfort is science often. So to actually make a positive transaction is deafening to them. Yeah. Because when you first said this topic, my interpretation of it was, you know, in the therapy room, having the client who was isolated in the therapy room rather than in the outside world, you know, the one that kind of shuts down or disconnects or whatever it is in the therapy room. That's another complete, that's another complete story, but let's approach that story. So people will only isolate themselves, shut down for a reason. Yeah. Somebody that's isolated outside is more likely to do it in the therapy room as well, if they're feeling overwhelmed, if it's too much. It was when you were saying about going home to silence and, you know, that being quite comforting for them. In the therapy room, it would probably be comforting for them too. I was just pondering on the word most likely, that you said that. I was pondering whether it was more likely. I think it's more familiar. Yeah. What you're talking about is very important though, that is the person who closes down, cuts off with doors and isolates themselves from you or others in a group. Yeah. Now that is a, that is a really big signal or should be for the therapist that something is happening. Yeah. Like a red flag, isn't it? Yeah. Yeah. Yeah. There's been a shift of something going on. Yeah. Usually a shift of Nego states and the therapist is really, really important for the therapist to inquire. What's happening for you? If you seem to have moved away from me, is that, is that true? Not to make an assumption. Yeah. Yeah. Check out the assumption. You seem to have moved away from me. Is that true? So the client said, yes. And then you don't stop. You say, wow. Could you tell me a little bit more behind the word, yes. It's actually happening at the moment. So it's the job of the therapist to be aware of the change and for the therapist to inquire. Yeah. Yeah. And again, very delicately without blaming and shaming or anything like that because, you know, when they are seen, it could be quite overwhelming. The fact that somebody's noticed that they've disconnected or whatever. Yeah. Well, these are the pivotal moments in therapy. Yeah. Absolutely. We are talking about pivotal moments in the therapy process. What happens behind closed doors? What does the therapist do? And you are completely correct that the therapist needs to inquire and attune sensitively. Yeah. They need to inquire and inquire and inquire. Yeah. Because there's something as well about not mimicking the behavior, but being on the same energy level maybe sometimes is what the client is. I know you like pacing and things like that, but if you've got a, you know, an isolated client who's quite withdrawn and quiet and everything, for me it's important that I come in at that energy level rather than being completely exuberant and over the top. I'd frighten the life out of them. Oh, well, you know, I'm a fan of attunement, don't you? Yes. Yes. Accurate pacing and attuning to where the client is. And of course, that means energetic attuned. Yeah. Yeah. Absolutely what you've just said there. If you did what you've just said there, you would lose the person in front of you. They would close down, they'd go underground, and you perhaps might never know what's happened, but I do know one thing that therapy will happen. Yeah. The defenses will just come up and you'll lose the client. Yeah. So there's a skill, a definite skill, and I know like you touched on it being behind the therapy room doors, but when people say, oh, you just chat, you're just sat in a room, and you're just chatting, there's so many different levels to everything that's going on in that room. When I first took up therapy training, I thought I'd be quite good at this because I'd had a year of my own therapy by then. Yeah. And I don't know if I thought I'd be just good at chatting. Yeah. Probably. I don't know if I ever thought of it that way round, but either way, but you are correct. You know, it's like, if you're going to just chat or pass time, therapy will never bloody happen. The skill, it's a way of thinking, it's about attuning by involving, inquiring, thinking about the external internal worlds of the person in front of you. Yeah. That's a way of thinking, a therapeutic stance. And actually, it's a way of training. In other words, you need to be trained to start thinking this way and then experience starts to. I was just about to say that and a lot of experience in it because we do get it wrong sometime and we do make mistakes. I think it's inevitable in the human encounter. Yeah. I think on another past podcast, we do so many, I made a plea for, you know, ruptures and being able to recover from mistakes. Yeah. Inquiring what's happening. Yeah. Sort of pretend they've never happened. Yes, yeah, yeah. The snake has happened. Yeah. That's what's about. And I think what these types of class we're talking about, people, you know, class isolate themselves, you need a lot of patience. That'd be very slow by definition. Yeah. Because they may feel overwhelmed, shut down internally, and you might never know. Yeah. Yeah. But again, wonderful work can be done if you see somebody coming out of their shell, you know, and being more connected and, you know, less isolated. It is wonderful to see somebody. Yeah, but what you don't do is say, hi in a very exuberant way. It's really good to see you. That's a complete opposite of what you do. Yeah. You need to go out gently and go to the same energetic attunement that you talked about. There's a lot of work to be done, but the skill is a recognising, you know, the external movement. Yeah. Or the internal change. Yeah. And for somebody to come into a therapy room and, you know, take up space is, you know, wonderful, really. Yeah. I could talk about this forever. I come from a frame in my life where, you know, isolation was my home. Yeah, I'm the opposite, Bob. I don't like silence. I don't like quiet. No, I don't mean. Very uncomfortable for me. I don't mean now. Yeah. Yeah. About for the first 15 years of my life, isolation was my home out of necessity. Yeah. That's what I mean. Yeah. It was a choice because to be the opposite was like an alien world. Yeah. I think, you know, if you have had that experience, then you are more easily attuned to somebody and understand the reasons why maybe somebody does that. And yeah. For me, I refer to myself more recently as an introverted extrovert. It depends literally. I can be one way or the other. Well, I certainly wish I'd had the choice to be like that, but for survival's sake, I couldn't be. I had to remain hidden. Yeah. Because with someone talking about it, usually these types of people talk about the hidden self. Yes. Yeah. Yeah. What a wonderful podcast. I know. From number 101. 101. Yes. So what we're going to talk on one or two is how to confront clients. That will be an interesting one. Oh, that. Yeah. How we work with the techniques, if you want to call them techniques anyway, with the style of confrontation. Yeah. Yeah. I'll be interested in that. It's the next one, is it? That's the next one. That's what I've got written down for the next one. Look forward to that. Yeah. Okie doke. Right. Until next time, Bob. See you next time. Bye-bye. See you soon. Bye. You've been listening to The Therapy Show. Behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.