 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 the next episode of The Therapy Show and this week we're back to normal with Mr Bob Cook after having his wonderful wife here doing a guest appearance last week. So this week, Bob, we're going to be looking at working with the histrionic or hysterical client. Is hysterical an old-fashioned way of talking about histrionic? Oh yeah, yeah, hysterical really well, yes that's right and no, I mean we forget. In the good old days, those women used to get called hysterical and put away in mental institutions for lots of things, didn't we? Yeah, I think I had an apple and the skin's left there. We go right the way back in time. Freud had the term hysteric and included everything almost all went under the sort of label of hysterics, you know, anxiety, depression, manic depression all went under the term hysteric and you're quite correct actually. In the good film, talking about Freud and Young and I can't remember who was in it, but they talked a lot about different diagnosis and it seemed like it was a hysterical sort of catch phrase from many diagnosis, correct in a way, but today's a bit different. People talk about hysteronic and they talk about hysteronic personality disorders and hysteronic traits, you've done that in your training. Yes, yeah, yeah, so one of the things is kind of over-emotional a lot of the time, would you say? The enthusiastic overreactor, it's it's sometimes known as. Yeah, in the book by personal adaptations by Van Joins and Ian Stewart, talk about the different channels and different diagnosis is when they talk about hysteronic, that's how they talk about it and they talk about the major way of contacting hysteronic, if they come in the room, it's through feelings. Yeah, as you see somebody who's sort of a paradigm in nature, you would contact them through thinking. Yeah, so yes, that's the way that hysteronics will conduct their narrative through feelings. Everything's through feelings, the way you've talked about and often the hysteronic traits we're talking about will be people 17 and 18 onwards, so it's more of a later diagnosis developmentally and usually people have problems with emotional regulation. Yeah, and everything is through feelings just as you've said it and of course part of the treatment plan is to help them think and feel. Yeah. Now, so Eric Byrne, who's the creative transaction analysis, would talk a lot about helping the hysteronic, developing not only thinking but a grounded adult where they can use their thinking rather than just coming from an all feeling place. Yeah. Which I've worked with clients at Hysteronic and it's really visual. You can see it happening before your eyes, which I think you don't always see that with the other traits. There's a confused look when you're trying to get them back into their thinking. Yeah, absolutely. So Love Island, which is a sort of well known reality television program which is quite popular at the moment, isn't it? And it's that program where the sort of, well they aren't adolescents but they act that way. They regress that way from about 19 to 26 year olds on there, 19 to 20. Yeah. A villain in Mallorca and they sort of have to spend five or six weeks there. I was watching an episode last night and I wish I could put that episode on now for you when we're talking about Hysteronic traits because this person was a perfect example of Hysteronic traits very lacking in any emotional regulation and everything goes about feelings and thinking have gone out of the window. Yeah. And if I could have stepped into that villa I would have encouraged it to actually integrate a feeling and a thinking, which is really the treatment plan for people with this type of personality trait. You're absolutely right. They're very visual aren't they and they're very extravagant and very emotional and there's a lot going on that's very dramatic and most of the issues that they come with will be from relationships. Yeah. How to be and how not to be in relationships. That's usually what they come with. Yeah. Because they have tremendous difficulties with emotional regulation so relationships become a difficult area for them. So I was looking up some of the characteristics because I'll read out here. I'll read them out. So here we go. The DSM-4 that's the Diagnostic Statistical Manual defines Hysteronic traits in this way. One, exhibitional behaviour. Yeah. It's a bit like you were just describing there. They're highly intense in their behaviour and highly exhibitionist. That's good for a dyslexic person like me to say but any such business behaviour. Yeah. And you are quite right. They appear quite dramatically visual in the process. Would you think of it that way? Yeah. Yeah. Would you imagine on a night out they'd be the one that's dancing on the table and being you know very exuberant and larger than life a lot of the time? Very dramatic. Yeah. Yeah. Yeah. And if somebody said something it would cut them through to the core and it would be a massive deal that they probably wouldn't get over. Yeah. So they're highly sensitive people. Yeah. In the toilets crying at the end of the night. So second one here. They're consistent or those you know constant in seeking of reassurance or approval. So they need constant reassurance or approval. Yeah. Now in the transactionalised literature that is one of the big hallmarks of the Hysteronic traits if you like, is that they have had, haven't had enough stroking or positive stroking in their parenting process. So they're significant that people haven't stroked them consistently in a positive way. So in relationships these types of people that we're talking about here are constantly seeking positive in TA again strokes is a unit of social recognition. They're always seeking constant approval or reassurance from the other. Yeah. So in a relationship they like putting it in layman's turns they'd be really needy. They would need a lot of attention and asking all the time whether that was okay and am I good enough and all those sorts of things. Yeah. A negative frame might be that their attention seekers. Yeah. Which is a shame really to label these this person with that label of attention seeking but for the sake of this podcast that's the case. Yeah. Would you connect that with those sense of self that because they didn't get recognition and validation when they were growing up that they can need the narrative to know that what they're doing is okay. Correct. To keep checking in with the other person. Yeah. They're so sensitive to criticism. Yeah. And any slight criticism they take very very personally and it's as if their world has collapsed. Yeah. So a therapist will need to be very careful in this process because you need to enable them to or encourage them to think as well as feel. So it isn't enough to just give these people a consistent positive stroking pattern or consistent reinsurance. I mean that has to go there but there needs to be a narrative around what's the deficits. Where's this sort of reputed behavior come from. What's beneath all this lot. Yeah. You need to go into their parenting processes. But they're very very distraught with any criticism comes their way. Yeah. That's not that one. Yeah. Would you say that even if they get praise that they'll seek even more of it. Yes. That when you do they do get it they kind of discount it and go in for another hit of it if that makes sense. Yeah. I mean you described it very well when you said over needy. Yeah. It may appear over needy and you're quite right. They discount often the level of recognition and reassurance they might get and what they remember avidly is anything they may take as criticism. Yeah. So if you watch say five minutes of discussions in this Love Island program talking about somebody who's hysteronic. They may be told many many times that they are okay or positive smoking in that way but they'll remember the negative criticism. Yeah. So you're correct. That's why they become nothing satisfies them really. Yeah. Because of the deficit in the parenting which is sad. Yeah. You know some of the ones that I can remember working with there's lots of overthinking they'll go back you know if they've been out with the mates say during the day they will overthink every conversation that they've had during the evening whether it was good enough or did I say the wrong thing was that right. You know they avoided me they didn't say to after me whatever it is. Yeah. And they'll remember the criticism. Yeah. They see as critical behavior. Yeah. So they have a high internal negative critic. Yeah. And they have a real big need for approval as we talked about before. So another characteristic we've got through to is what I just you and I have just been talking about excessive sensitivity to criticism or despicable. Over that next pride of own personality and unwillingness to change viewing any change as a threat. So in other words that they're quite though they've got an expansive personality. They often stuck in black and white thinking. Yeah. Around the lines we're talking about. Yeah. So change is often threatening for them. Yeah. Which is a catch 22 situation when they come into therapy. Yeah. Very much so. And I would recommend you know especially if you run psychotherapy groups is that you put them in a group. Would they want to be in a group though? I think it's the best place for them in sense of this is all about relationship issues. Yeah. And therefore they will see how other people relate to other people and they will see what is in a vertical as normal and not normal. And they'll get more clarity around how appropriate behavior is actually within relationships. And I think what you're hinting at really is and I didn't mean to actually say go straight in a group because I'm very much believing in attachments and attachment theory. Yeah. I think that there needs to be maybe three or four months with the therapist but not to stay like an individual therapy for particularly long time because I think they're getting more in groups. They need to have a strong relationship with the therapist so they can handle what might be perceived as negative criticism and always be able to have a constant object in terms of positive recognition. But I do think I see more growth in groups. Yes. Yeah. I can see them kind of straddling with that transition. However, if they've attached to you and they can hold on to you as a positive supply of recognition of you like. Yeah. A positive supply of appreciation and you are able to help them think through their emotions rather than always spontaneously dealing with emotions. But if you can help them think their way through this so they can think and feel at the same time, it will become a value. The whole process becomes invaluable. Yes. Oh yeah. Yeah. Yeah. I can see why that's a really good thing to do. I think I was just thinking that they might see that as I don't want to say you abandoning them but not having that important one on one relationship if suddenly they were with a group that you I don't know. Do they think that they're overwhelming? Do they? Yes. Yeah. You see that's why I think normalisation in a group is really important. Yeah. You see I think the personality traits carried to be you wouldn't put in a group until you've done a lot of work would be the narcissistic traits where they have to see themselves as special. Yeah. And they will feel very abandoned by you. Yeah. So this see when people want psychotherapy groups I think they need to think very carefully about what personalities they put into a group and when they put them into groups and the timing of when they put them into groups for the various reasons you're talking about. So I would hesitate putting anybody with narcissistic traits into a group very early in therapy if ever actually. Yeah. Yeah. Yeah. It would be in the later stages of therapy treatment anyway. Well some is histrionic. I've got those types of traits we're talking about here. I think if they've got a good detachment of their therapist then a group's very good ground to learn the normal and normalising processes of relationships. Yeah. But it is an interesting one to consider as the therapist is would they feel abandoned by the therapist moving from individual to group. The question I the way I look at is that most of the categories and the styles we're talking about here would run the potential of feeling abandoned by the therapist. So it's the transition. Yes. The cost which becomes really important. Yeah. Because I see that that moving into either moving into the ending of therapy or moving from individual into a group is kind of like a transition like we do when we're growing up that individuation is separation. You know they don't become dependent on the therapist to a certain extent. Yeah. That's a nice way to look at another way to look at is this is developmentally. Yeah. So borderline to we're going to talk about another the podcast. They have problems in developmentally in the individuation separation phase dramatically. Narcissistic the same really. Antisocials I think very similarly. But when we're talking about the historic person there issues are really later developmentally. And because they're later developmentally I think they will get more out of group. Yeah. Yeah. So if you're saying later developmentally do they do a lot of comparing and contrasting. Then is that kind of the stage that they're at work? Yeah. That's absolutely correct. Yeah. A lot of the hurts and traumas have come from the adolescence period for the historic. Yeah. And therefore they will get a lot out of being in groups. Yeah. Yeah. Yeah. Be built that sense of belonging and being in a group and things. Yeah. Working things through. Yeah. Yeah. I always think I do tremendously well in terms of you know how healthy processes in groups. Whereas somebody's narcissistic, broad line, even schizoids with drawn people have more challenges in groups I think. You know I think somebody's withdrawn and somebody's histrionic you think would balance each other off and they do in a way. And so I know possibly a podcast on it what we need to consider when we put people in a psychotherapy group because I think there is a lot to consider certainly in the levels of developmental processes. Yeah. That we need to think about when working with people. We could do a whole series on that. Yeah. Yeah. We could go on to one. I ran psychotherapy groups for 31 years. I've never run a group. So that should be a good podcast. I could get an awful lot from that. I run groups online like you know things but not therapy group. I've never done one. So I count me in on that one, Bob. Yeah. It'd be a wonderful podcast and something I'd like to do. You need to have two podcasts. I mean so much to concentrate on. One would be obviously who you know who goes into a psychotherapy group but you've got all the things about how long a psychotherapy group should be. What's the major criteria, advantages, strengths, weaknesses of groups versus individual therapy. I could go on. We could do a whole series on thought to just on doing groups. Yeah. So I did run it for a long time and it was quite a sad process for me when I ended my last psychotherapy group. No. No. The same people weren't in it for 36 years. I just want to sort of like tell the viewers that. People will be glad to hear that. It didn't sort of be the whole of the 31 years or 36 years whatever it was. People didn't move on. It wasn't the same people. Except for me of course. So looking at all of these personality types that we've done and maybe the histrionic one you know about building attachments. Is there a time scale for the length of time people should be in therapy as far as you're concerned? Well, let's take the word should out. But as a sort of, I don't want to say is a should but in terms of reflecting on the level of the more, there are some things I think about. One of them would be the level of trauma. Yeah. So if somebody's had a high level of trauma and it probably will take quite a lot of time in terms of healing. Yeah. More trauma somebody's had the more time they are likely to stay in therapy. The more disturbed a person is, which is often linked to the level of trauma they've had. Yeah. More likely they'll need more time in therapy. So when we talk about the actual personality disorders rather than traits, they'll probably need more time in therapy. Yeah. It's a going off track with a topic. It's just something that kind of came up for me this week that I was curious about that, you know, some clients I've seen for four years, you know, and it's kind of like they could be okay out in the world, but they come to me on a weekly basis as part of their self care routine. And I just wonder what your thoughts were on that, you know, if you're talking about the groups that you had that people attend groups on a monthly basis for quite a long time as part of their self care, like going to the gym. You're right. It's a completely different level of podcasts, but I can answer that very straightforward. I run groups weekly, not monthly. Right. So I run groups, you know, and often I run groups two, three, four, five times a week, but my groups tended to be two hours once a week. Yeah. And you know, some people came to those groups in terms of the way that you're just talking about it. They did tremendous lot of healing and curing and healthiness and often would might stay for maintenance. Yeah. Yeah. That's one way to look at it. That's a nice word. I like that word. I don't take that away. And then you have the balance to reflect on as a therapist. And that is how many of those people might be staying there because they are dependent on the therapist growing up, developing adult thinking and grounding and moving on in the world. Yeah. So it's a thing for, it's a process that the business needs to think about because one of the criticisms could be related to the therapist's feet, if that's not addressed, is that they stay dependent, young and infantile and never grow up from the therapist. And then they're there for eight, nine, 10 years. And in fact, all that's happened is that the actual developmental issues that we're talking about get stroked while the person developing autonomy and growing up. In fact, at another level completely, therapists could then be accused of, and this is another level completely, Jackie's, perhaps another podcast, is taking money off the clients when actually they should be promoting them to develop autonomy, adulthood and move on. Yeah. And maybe again, you know, that would be another good topic to do, you know, around endings and whose job is it to decide when enough is enough, the client or the therapist. Yeah. And it's a really good podcast because it's actually, many people say it should be the therapist's duty. And then many people might say it's a crime. So, and then many other people say it should be a joint issue. So that's the whole podcasting itself. Can I go on to another? You can. This is an interesting one when I read it. And it reminds me of this very, very strongly, and especially when I watched Love Island the other day. And this is it, inappropriately seductive appearance or behavior of a sexual nature. Hmm. In other words, they're inappropriately sexual within the relationship and they do it. I'm going to add something on this. This is really a desperate attempt for praise. Yeah. Yeah. And I would add that, I guess, with the females, maybe the males as well, that they got recognition for being beautiful or having good posture or whatever it is. That's right, because this is another huge podcast as well. But, you know, because a lot of the statistics and research talk about histonic traits mostly from the female perspective. And they talk about, I think it's a lot of cultural scripting in this rather. I'd like to do research in this. And a lot of the schizoid behavior with all kinds of mean from a male perspective. So, but it's an interesting one about inappropriate sexual seductiveness. And I think it's true they attempt, but it comes from a desperate attempt for praise. Yeah. And they get confused. And I agree with you, society might stroke them for this. Yeah. Especially females. Yeah. Yeah. I went, as you're talking about it, my kind of narrative that I'm running is, you know, a little girl and a daddy. Do you know what I mean? Daddy's little princess type. Yeah, absolutely. Thing. Yeah. Yeah. And of course, unless the, you know, I'll take my parent myself and your parents and there's no such thing as perfect parents and everything else goes with that. But unless the father sort of reflects on this or understands it, they may encourage this type of behavior inadvertently. Yeah. Yeah. Yeah. With the best of intention, you know, it's not that we, as parents, we intentionally want to harm our children. 99.9% of the time. Yeah. But it can become problem for the the client or the person if it leads them into dangerous or inappropriate situations and relationships. Yeah. Yeah. Yeah. So, so that's an interesting one. Another trade we've got here. We've talked about craving attention. This is an interesting low tolerance for frustration or delayed gratification. Oh, interesting. Yeah. You know what I mean by that, Jackie? Yeah. Yeah. That everything has to be now. Instant. Yeah. Yeah. Nutaniously. Gotta have, gotta have it. Gotta have it. I always love for my self indulgence place. Yeah. So again, I don't know why I'm, you know, stereotyped and everything, but it's kind of like that shopper-holic instant gratification. You know, if I'm not feeling that good, I'm going to go out and spend money so that I can feel better and get my head on, get my nails done, all that kind of stuff. Yeah. And then myself, the steam will be better. And of course, it's a trap, isn't it? Yeah. And it doesn't last. Yeah. Doesn't last at all. And that's why they would learn a lot from groups. Yeah. Yeah. Yeah. Again, they can normalise things as relationships. And they're the one tendency to believe that relationships are more intimate than they actually are. So I said again, tendency to believe that relationships are more intimate than they actually are. So when you're talking about intimacy, are you talking about the relationship as opposed to the sexual side of a relationship? Yeah. I'm talking about the relationship. Yeah. Yeah. Yeah. Yeah. Which I would imagine, for history only, it does play a big part in it, but it's more about the connection of being intimate and authentic and all that stuff. Yeah. Yeah. So they sort of misjudge it. Yeah. Misjudge levels of intimacy. Yeah. Again, another reason for groups. Yes. Yeah. Yeah. It's all going towards groups for me. Very highly spontaneous. They often making rash decisions. They're blaming personal failures or disappointments on other people. They're easily influenced by other people, especially those who treat them with high praise. They're very dramatic, very emotional, and they're highly influenced by suggestions of other people. Yeah. I can see all of that in some places that I've worked with. I have some work colleagues as well, to be fair. You know, yeah. So the treatment is to help them really integrate thinking and feeling, and from that introduce new behaviours. Yeah. So thinking is a really big part of the treatment. And prison recognition for thinking as opposed to the feeling side of things. Correct. Yeah. Yeah. Even though you will, especially when you work at the beginning with people, you will increase rapport and build a relationship through the discourse of emotions. But where you need to get to is to integrate thinking and feeling. So there's new opportunities for more healthy behaviours. Yeah. Especially in relationships. Yeah. They come mostly, they will come with confusion and relationship issues. Confusion is a word that I would use a lot around this personality trait. When you're trying to connect with them through their thinking, there's a lot of confusion. They always want to go back to feelings. Yes. Yeah. Yeah. I know what this is. You're asking me to think and I don't know how to do that, particularly not when I'm in an emotional state. I can't think. It kind of shuts down. Yeah. That's right. So you build up the relationship through feelings, but it's all timing. Again, you need to move. Yeah. So you have to integrate thinking and feeling. And also this will come down usually to a developmental arrest in the adolescence stage of development. Yeah. Say a bit more about that. Well, just think of the adolescence. I know you do a lot in this area. Yeah. Yeah. Yeah. The adolescence period. Yes. Think of the dramaticisms and highs and lows. And my daughter, I could, you know, I could count on many, many, many, many fingers. I've only got 10, about 20, 30, 50 times. And how many times my daughter in the adolescence periods has come to me in tears about what people have said to her on Facebook or on Instagram or whatever it is. And they're attempting to work out how to be in relationship. Yeah. And get your needs met within that relationship. Yeah. Yeah. That's where the problems come from, the histrionic. Yeah. Yeah. It's a nightmare, isn't it, to be a teenager and to feel that emotional about things. I can kind of relate to that. Yeah. So I like working with these people, but I think they, I move them into groups. I don't run a group anymore. But in my practice for all that time, I retired clinically a couple of years ago, but I, I only stopped groups a year before that. So really until the last ebbers of my clinical life, I was running groups and I used to put people with histrionic traits quicker than most into a group because it's all about relation issues. And it's all about working out their confusion and emotional regulation in groups. And they, they, they had a lot of vicarious learning. Now for people out there aren't in groups, it doesn't mean that you can't work with people with histrionic traits individually. But you need to enable them to think as well as feel. And one of the best ways to do that, I think, is to actually start using your own sense of self as a therapist in the relationship and to help them normalize what happens in a relationship and doesn't happen in a relationship. So that would demand the therapist using their sense of self from a clinical perspective to help the histrionic sort out what they didn't sort out in that adolescent period we're talking about. Yeah. Yeah. The thinking is the really important thing here to help them to think about their emotions rather than just feel them spontaneously. Yeah. Yeah. I don't know why when you're talking and the thinking and everything, I just keep going back to journaling, you know, that, that's something I would say to, you know, that sort of client is to write down in journal and maybe bring that into the session the next time. And we'll talk about it. Yeah. Yeah. Yeah. I think with these clients, more than any other adaptation or style that we, the therapist's use of themself is so important. Yeah. Because it's a relational disturbance that we're talking about. Yeah. It's, it's, it's all very interesting stuff, this psychotherapy, isn't it, Bob? Yes. I hope my wife talked avidly about antisocials because they can go together. I don't know if she touched about that talk, but you know, I, I think antisocials and histrionics can go, can get slightly misdiagnosed. But the thing about, because of their charming ability of the antisocial, but the histrionics really are going to be people 18, 19, 20, 20, and it's going to be after that sort of, it's that developmental period. And it's all about relationships and normalization. And the therapist can use their sense of self to help the person sort out the confused relationship. Yeah. And they're very, I tell you about these type of person, I find the very, I like working with them because they bring their emotions and what's going on is very dramatic. And if I don't think about it, I can get drawn into the drama and the excitement and the seduction and goodness knows what. And that might be right at the beginning to help building up the relationship. But your job is not to get dragged along with that. It's to enable them to think about all this. Yeah. Also to go back to the history and to talk about, you know, helping them think what was missing in those times. And some of the things you're going to come across is how, how often may they've been bullied or gaslighted or whatever. And they're face, they're very sensitive to all these criticisms and they attempt to sort all this out by, you know, the urban need, the neediness or the sexual inappropriateness or whatever we want to phrase this. But, you know, I think therapists can step into the relationship and really help here to help the person sort out their confusion. Yeah. They're thinking position. Yeah. Yeah, I quite like working with them, but I'm a thinker. So I go in there thinking anyway. Oh, so for you, it's quite a, it's quite a delight, I would think, to help them, help them looking at the, how to think and feel at the same time. Yeah. Yeah. I like journaling. I think you can do homework with these people quite well. Well, that's one of the things that I, I do do with that type of person. And I've often, you know, I do get curious about my part in the relationship as well, whether I get them to journal because I sometimes find it difficult to connect when they're very emotional because I'm a very thinker, you know, to me. And so it's good for me as well to get something from the client when we're working together. Okay. Sometimes feel a bit overwhelmed in the room when there's lots of emotions going on. Yeah. Yeah. Work well with these people. Yeah. I love working with them. Yeah. So what we're doing next week, Bob, we've, we've talked about maybe anxious and depressed for the next two weeks. Yeah. We have to work with the depressed client and how to work with the anxious client over the next week. We've got things like eating disorders and we've got sexual abuse survivors and we've got quite a lot of topics, but let's make the next two, uh, working with the depressed client and working with the anxious client. Brilliant. Let's sort of go together in a way. Yeah. Yeah. Until the next time, Bob, thank you so much. You're welcome. Bye bye. Speak to you soon. Bye.