 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 to this next episode of The Therapy Show with Bob Cook and Jackie Jones, only it's not Bob this week. We've got Bob's wonderful wife, Steph, who's also a psychotherapist and are you co-founder of the Manchester Institute? No, I'm just a co-director. Co-director. What they say about a great man behind a great man is a great woman. Even better woman, even better, not just great Steph. So we're gonna continue on the theme of working with different clients and this week we're gonna be talking about the anti-social clients. Steph's an expert in this field. So Bob's giving up his chair to Steph so that she can talk about this. So what we normally do with Bob is kind of talk about how the client presents and then maybe the treatment plan and how we work with the anti-social client. Okay fine. So over to you. What do you want to start off doing? First of all, only to say I've had experience in my early social work life working with anti-social. I wouldn't say I'm an expert but I quite like working with them actually because they're a challenge and they're quite good fun or they can be. What age would you say that you can start to see this personality type develop? I would say in their teens usually because you know that's the time of life. We expect kids to start getting it together and being responsible. Although teenagers have got reputation of being a bit riotous and you know getting into trouble but anti-social forever getting into trouble. They have no sense of boundaries so I would say it usually is more apparent in the teenage years. Yeah the reason why I'm asking that I think that was probably the first time that I came across anybody that I thought was possibly this was when I was fostering teenage boys. There was quite a bit that was kind of oh this is this is something different. Yeah well it's interesting that you're saying that you came across it whilst fostering because it's usually kids come into the fostering realm you know my experience anyways as a previously social worker because parents can't manage them and it's usually they've not been managed as they come into care and you end up having to deal with that and the fact that comes from a child who hasn't been consistently parented. Yeah and like you said the boundaries and things like that was an issue. And consequences not realising how their actions had a consequence. They don't really have you know what's it called they don't have a sense of their impact really. Yeah yeah. Have any sense of the other. I think that was the thing that I noticed more than anything yeah. Yeah well the the key issue really is that they come from a background where there is hardly any parenting minimal parenting or no parenting at all. So you know on the spectrum the middle is minimal that is none and that is hardly any. Yeah. And depending on that level depends on what kind of behaviour you end up having to manage. And so you know the clinical picture is actually I actually wrote an article so I've got the clinical picture is that they they tend to be a challenge to work with because they have no sense of the normal normal boundaries. Yeah. The boundaries are just so difficult to keep for than antisocial because once the damage is done you have to work so hard to reset the boundary. Yeah. And it takes an awful lot of energy and you know possibly near near or near enough saint-like patients to keep that continuum going. Yeah. Because you know they they they tend to do the acting out because it's a way of them dealing with feelings. So if you have an inconsistent parent you'll know that parent has not dealt with those feelings. Yeah. So what they do is they initially at a younger age act out to get attention then the acting out becomes really quite serious as they get older. Nice to know how the lesson acting out can can go into the realm of offending. Yeah. Yeah. So you end up with the police knocking on your door. Yeah. And you know they use their behaviour to protect themselves from feelings. Because one of the things that happens when they're very young is they usually come from a background where they have a very laissez-faire if you like laid that mother one-minute who is somebody who anything will go with and then they'll have a mother that's attentive or on the other extreme. So it's a bit like you know the the the three levels I said about slightly involving minimal and not at all. Yeah. That's the reflection of the mother who does the same thing and when she's at her worst she'll hit them or push them away or reject them and say get out you know I don't want anything to do with you and possibly even become violent with them. So you can understand how come they've got this this vessel full of anger and sadness they can't do anything about. So to manage it they act out. Yeah. Which is really really difficult to deal with if you're the one that's having to deal with the fallout. Yeah. So they tend to have a little bit of a tough guy outside sense of being and a real empty inside sense of being and they'll want high high stimulation because they cannot deal with boredom. So they'll always be wanting to do something. So you you know the the younger adolescent will get into mischief break windows you know nick things go stealing nick someone's bike the older adolescent will get into fights and that kind of high level stimulation and break in and do burglary. Yeah. Yeah. So they are very dependent on external stimuli very dependent so slightly narcissistic components if you think about it because it's all about them. Yeah I think that was the thing that I kind of struggled to separate out was is this narcissistic or is this antisocial there was definitely a crossover and that you know inability to take responsibility for things you know they did it because they did this to me or you know it was it they just never took responsibility for their actions. And again that's all about the defence. Yeah. More they build up. Yeah. But they don't want you to get through and they also have slightly sadistic components about them as well because they are really angry ragingly angry about the rejections you know so the antisocial male depending on the level would have had a really not just a really uninvolving mother but a really uninvolving father who's probably never been there to set the boundaries or to show this is what you know a male. Yeah. So they have a tendency to want to take it out on somebody. Yeah. And not really have any thoughts afterwards of the impact that has no conscience. Yeah. So what they do need is a really strong structure to be able to function and they don't have that they don't have that because it's not been more modeled for them. And when that happens is they tend to although you probably don't see it or you might just see a little bit of it go into extreme panic and fear if things don't go the way they thought they were going to go. Yeah. Yeah. The way they defend against that is violence or anger or acting out in some way but internally internally they are fearful and frightful of whatever's going on for them because they don't have that internal parent that says it's going to be all right you've got options you can go and get help from x, y and z. Yeah. Because the other decision they would have made fairly early on in their early life is they're never going to ever going to let anybody get close enough to let them down in the way that their parents have let them down. Yeah. So that's the bottom line. So they don't ask for support. They don't ask for help. So they live in this world where they need this you know real extreme stimulus to defend defend against the extreme fear and panic. Which is a nightmare for them. Yeah. You can understand when you're talking about it like the teenagers that I was working with the real extremes you know and not wanting to stereotype but particularly males will cover up fear and anxiety with aggression and anger anyway you know. So yeah it's a shame being on the receiving end of it is difficult but for them you know on the other side it's a nightmare. When you think about what the experiences must have been like for them as children to be in the role of having to parent themselves all the time. Yeah. So that way of being doesn't change in their adult life they're still parenting themselves from a child perspective. Yeah. Yeah. Something very black and white stuff. You're either nice or you're not nice. You see the good or it's bound. In TA terms if you think about it what how we talk about it is that in the child they've got in the child ego state you've got P1A1 and C1. Yeah. Mostly the decision making comes from P1A1. Yeah. Which is like a very undeveloped parent. Yeah. So I was thinking about a couple I worked with and the guy was typically antisocial and he parented his children from a small almost like a childlike way of parenting them. There was no leeway. There was no okay let's negotiate or you know no talking things through. It was you did this so you're going to have this because that's what I think you should have. Yeah. And that's that's how he thought it should be done and he was really functioning for a very small child place really. When I was doing my training the way that I kind of got my head around that was because I'm a nursery nurse that was one of my first jobs is to remember what it was like in the you know the role play corner when I was working in reception class when you saw you know and playing mums and dads with a baby if the baby didn't stop crying you know picking it up and smacking its head against the wall to shut it up. It's that real basic parenting that little kids do. Yeah exactly right you absolutely spot on Jackie so you know give the baby the mustard medicine. Yeah that's what when you're talking about P1 and A1 it's that kind of basic just stop doing what you're doing. Yeah and so Guy was squirting washing up liquid in their children's mouths for bad mouthing back at him. Yeah some real extreme stuff yeah it was quite shocking. Yeah yeah they told me about this. It can imagine the buttons it's pressed with me. Yes yeah safeguarding etc. But from their point of view it makes perfect sense that to me was one of the difficulties is that I don't see what the problem is that makes sense. Why is that not appropriate? Yeah and so they have an extreme fear if their behavior doesn't work and that's one of the ways they kind of kind of take back control. And you know from a from a parenting message a motherly message I guess or a female antisocial message it will be you need me I don't need you. Yeah and from a male clinical picture is I'll test you out but I won't believe you. So you can see how that would be a huge challenge in the therapy room for you and as you as a foster mother to kids who are antisocial how do you connect with those kids? How do you connect with those people who have that view of relationships? It's exhausting. Yeah because they have a low frustration tolerance they seek excitement and drama they have higher energy they also tend to be quite goal oriented as well because they're quite like the comeback and the strokes from achievement. Yeah yeah and they do think really well on their feet. It's just that they tend to be so they make such irrational decisions their decision making is not thought out decision making. Yeah yeah they tend to get themselves into problems. And there's different types of antisocial presentations so there's the impulsive type the explosive type there's also the perverted antisocial presentation as well where they become eroticized by other people's displeasure with the displeasure of others and being the bad object of another so it will be someone who will talk about things in a very sexual way in company to see people squirm. Yeah. The discomfort in the response to that gamblers that's another presentation because the rules of the game become their external structure so that gives them the boundaries and they tend to think about it in terms of well you can trust the roulette wheel but you can't trust the man. Yeah yeah and also the other presentation is addictions because that's another way of dealing with their feelings. So in the therapy room is that is that kind of where your target is is to you know encourage feelings as opposed to the behaviour? Well I think I think first of all I mean I always think about an antisocial as being like a very naughty child. Yeah. Really um and so what they need to know is how they impact you. If they're committed to change then you make that contract with them I mean I would make a contract in the therapy room and say okay you've come because you've lost your job or your relationship's not working let's have an understanding of what that's about and I'll get a sense of them being antisocial and I'll say well it seems to me like what might be useful is that you get some feedback about how I'm impacted about what you tell me. Yeah. Yeah. So I remember doing some supervision with somebody who had an antisocial client and he would come straight from McDonald's bring his drink, finish it very loudly you know when the straw reaches him. Gurgling. And then he would burp really loudly and she said he would do that every time and have no sense of the impact of the problem. Yeah. It was like for me in the room him coming in you know slurping his drink and then burping and I said well he's an antisocial so unless you say to him hey I just want to feed something back to you I just find that really uncomfortable when you do that I'd rather you didn't. How's he going to know? Yeah. Because very often they don't know. So it's a bit like you know if you're living in a house where nobody sets the boundaries in terms of making sure that you go out the house with a coat on. Yeah. Yeah. In the middle of winter you go out the house without a coat on you freeze and it's not until afterwards they go oh I'm cold and I'm freezing so they they have to have had those stepping stones put in place. So what the antisocial is the acting out of an antisocial isn't always something that they consciously plan to do it's just the way they think they have to be. Yeah. So the role of a therapist first of all is to bring that into their awareness and stroking them for doing it really and saying great I'm really glad I really appreciate you doing that. Thank you. Yeah. Yeah. Yeah. Sometimes paradoxical interventions are really good as well if you know what I mean. So you actually give them a negative but it's actually a positive. Yeah. So I've got to say a bit more about that. So you know they might when you when they turn up at your therapy room they're there before you and smoking. Yeah. Yeah. And shocking the you know the butt on the floor outside the therapy door. Now if you were to say don't do that please don't do that. That would trigger their antisocial response maybe and be rebellious about it. So you might want to say oh here we go again. Another nail in your coffin. Yeah. Yeah. Another nail in your coffin so that you have an early demise so you can do it in a jokey way. Yeah. So you're not hitting them head on. You're kind of going under the radar so to speak. Yeah. That's the paradoxical intervention. So I once was working with a young girl who was really antisocial and used to find it very difficult to connect with me when she came in the room and you know would mess about the king things and you know you know chuck things in the paper basket. And one day she came in and she put the blanket over her head and was giggling underneath blanket. So I got up off my therapy chair and got underneath the blanket with her. Bless. Therapy under the blanket. Like sit outside the box. It works. Yeah. So it's stuff like that. And it's not what they expect either. You know that can be a big thing. If you're a bit off the wall as well it kind of normalizes some of the behavior too. Yeah. Yeah. So you know high doses of negative stroking is very often quite effective. Yeah. Yeah. So you know when they say something like and you know what happened today. I got sent out the school room four times. Miss sent me out four times. Yeah. So you could say something like well somebody who wears the shirt hanging out and the tie hanging off looking like a Trump would get sent out the room four times. So nothing to do with this behavior but just a joke about his demeanor. Yeah. Yeah. Yeah. So and positive strokes really from the from a child ego state rather from adult. So if you're going to stroke them from child you stroke them for it's less threatening if you do it. If you try to hit the child part of them yeah. You know for example to say oh you know what I really like to do that and I'm sorry you had a hard time or something you know some kind of nurturing response rather than. Yeah. Oh great nice one which is an adult response. Yeah. Yeah. Because I would imagine you know if if you are trying to give them validation and recognition they're not going to trust it for one and they're probably going to throw it right back at you. You know the foster kids that we had it was like yeah well what do you know you know nothing. If ever I went in you know like you say with an adult praise or recognition they would it was yeah they'd just throw it straight back at me. A lot of it was humour a lot of it was banter it was that that was how we used to connect to them yeah. So you kind of have to do that oh my god you made your bed. Yeah yeah exactly yeah yeah yeah and even then you know you think yeah I've made a connection but the day after it had begun again you were constantly playing catch up all the time that lack of trust was yeah. So you kind of have to play it the same way as they are really and be unpredictable be zany yeah like getting under the blanket and having a giggle with them. Yeah and you know I would imagine even in the therapy room it's not taking it personally which you know it is easy said and sometimes it's difficult to do that it's not personal it's not yeah. Yeah it isn't personal it and it is it's really important to stay on track yeah and not be hooked on the subject either so you know to find ways of picking it up later on and letting things drop so you can come back to it. Yeah. So you don't hook that rebelliousness or that anti-social response towards you. And does that link in as well to what you were saying about them having you know a low tolerance you know for staying on track and and they need high stimulus to you know to expect to just be working on one topic in a session would be quite difficult for them to do so to be spontaneous and yeah obviously have a treatment plan but it's it's up to negotiation or adapting. Yeah so it's kind of still you know it's like saying things like to them you know we know when they shrug the shoulders or they don't answer you that you say god I'm bloody fed up with you now because I'm just you're getting you know I'm getting shrugs off you and not getting responses. Yeah. Which is true you are. Yeah. I'm not trying to nicey nicey and saying oh well I can understand you shrugging. Yeah. Well about boundaries in the sessions are you would you be quite firming the boundaries is that the one time where you would be quite you know parents here with the times finishing time start times what's acceptable within the sessions. Yeah. Yeah. If they came late I would say oh here we go again you're late aren't you you know and make a point of saying well we're still finishing on time and then the time comes saying bye. Yeah. Maybe 25 minutes but tough luck. Yeah. You're going to come for your full hour on time. Yeah. Yeah. That kind of thing and be very very strict on boundaries. Yeah. Let them know what what's acceptable and what's unacceptable for you because then they know where they are in the scheme of things because that's the one thing they've never had. No one's ever told them as a child exactly how things are going to be because one minute it's this way. Yeah. And then it's that way you know they've had very little parenting minimal parenting or no parenting. Yeah. So you have to use your positive controlling parents very clearly with them and make it clear that you will pay me when you come the session will last this long if you don't turn up on time um it still ends at the same time. Same time. Yeah. If you don't turn up at all you're gonna have to pay me next time you come. Yeah. Those kinds of things. Yeah. They're really clear. It's I think working with them as well is it's important to point out the inconsistencies between what happened to them in the past you know make it very clear to them how come they do what they do because I think they really need to understand that and again it's helping them become accountable for themselves. Yeah. Yeah. What they do now because of what happened then is not working. No. But they can do something different and they have got choices. Yeah. I mean that that's probably something that will take a bit of time in the therapy because obviously the one thing that they find difficult is staying in a relationship long enough for that to work. Yeah. Yeah. I was just going to say that because they do have quite a strong pleas others because they do like the attention and getting the recognition and the validation. So up to a point they are quite people pleasing in a manipulative kind of way to a certain extent. Yeah. Which I suppose that links into the narcissistic that we've talked about in the past. Well the manipulation has really worked for them. Yeah. In the past because that's helped them to get what they need. Yeah. So they'll have relationships with people who meet their needs. Yeah. Yeah. Rather than people they can feel connected to. So they won't really have a strong sense of what it's like to be in a healthy attaching relationship. Yeah. Is it would you say that there's quite a bit of self sabotage goes on then in relationships that you know if the other is starting to form an attachment that they will sabotage the relationship and get out of it because they don't know how to be in that relationship. I think what tends to happen is the partner feels frustrated because they don't appear to be as committed as they would like them to be and they put pressure on them and that then causes them to panic. Yeah. That's when they get fearful and panic and so they'll escalate their behaviour in some way to stop that of the person from getting closer and closer to them and you'll see that happening in the therapy room. They'll try and do things to sabotage the therapy. Yeah. What you have to do is bring that into their awareness and say you know what I think you might be doing something you might be doing a number on me unconsciously. So I'm bringing that into your awareness. Yeah. Yeah. And again you've got to be on your toes with them in the therapy room. Yeah. Yeah. Because they can be charming manipulator. They can be so charming and you know the boys that I work with I only work with a couple of girls who are like that but it was mainly young men actually. Yeah. Who are like that. We're very good at getting you on their side. Yeah. Because you know I did a lot of assessments for juvenile court and had to write and write a report. So of course they want the best sentence ever and they don't want to go down and get put away into juvenile halls. Yeah. So you know they would be on their best behaviour. Yeah. I think that was the relationship that I had with you know a lot of the foster children. You know I was attached to them. I did like them. The behaviour was really difficult at times but yeah I liked being around them. Yeah. For me it just felt like if you slept on it you started back from scratch the morning after it wasn't like they could carry on that nice relationship into the next day. It was like every day you were starting from scratch with them. That was what used to exhaust me. Yeah. Yeah. And I remember instances of working with the young boys. You know we used to take them on holidays and stuff like that in the summer. Yeah. Because they often hadn't been on holidays and they would go from being 16 year olds to like you know little boys 10 year olds. Yeah. It's been such fun because they've never never had that opportunity with the parents they were with. They would have fun with you. Yeah. And you would see that vulnerability for the next day it would start again. Yeah. Yeah. Probably do something to sabotage it in the evening by sneaking out and buying loads of alcohol and getting totally blottoed. Sounds familiar. Sounds very familiar. Yeah. I remember sleep taking some kids to a log cabin and quite a few were anti-social have quite high traits of anti-socialness. Yeah. And the you know the support workers were in one side of the cabin in the middle was the living area and the other side was their bedroom and they just kept us away most of the night three o'clock in the morning. I just got out of my bed and I and I yanked one of the kids out of their bed took them into my room chucked him in my bed and I slept in the room with the kids and that was it. They never made another sound all night long. Otherwise happy memories. He's funnier when when you look back on things you know you can see why they did what they did when you're in it I always found it quite difficult. Living with somebody who's displaying anti-social behaviour is is quite intense in a therapy room. I think it's it's different. Yeah. It is different. Because by the time they come to therapy they're realising that they need to do something about what's going on for them. Yeah. Yeah. What you get in I suppose in your in your foster home is kids who are reeling from the damage that they've experienced. Yeah. And you're getting the flak from that. What sort of thing do you think would bring an adult into therapy? What kind of would be the catalyst for them to seek help? Probably to do with relationship problems more than anything. Yeah. Problems at work. So you know stuff like fiddling the books and getting caught. Okay. Yeah. Yeah. That and then and then their relationship fell apart because the wife found out they'd lost the job because they were fiddling the books. Those kinds of things. Yeah. Yeah. So it would be that risk taking that breaking the law that on the verge of illegal activities type things. Yes it would. Yeah. When you think about think about the in terms of the what we call the TA present the TA style presentations. You know the games the games that they play the sort of high level games that they do plays cops and robbers. Yeah. Catch me if you can. Yeah. Yeah. That's the major game that they play. But and they do have very strong don't make it decisions don't don't be close don't feel don't don't think but do you think to our smart people? Yes. Yeah. So they're the kinds of things that you would be dealing with in the therapy room really that they they sell pretty close to the wind. Yeah. Exciting day's work though. Yeah. Oh thank you so much for doing a guest appearance Steph. I really appreciate it. Thank you. You're very welcome. You're very welcome. I'm good to speak to you too. Yes. No don't we'll have you back again. Take care. And you. 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.