Transcription of case presentation with Colette

T - therapy transaction
C - client transaction

T Hello. This is Colette's case study. In this work you will see me work with
somebody who wants to quit smoking. In fact it's an addition really for her. I work
with her to close what is called her escape hatches so that she can work on in
psychotherapy without feeling that she will go crazy, harming herself or kill other
people. We see particularly here, underneath her addition, her fear of going crazy.
What I particularly concentrate on is exploring that fear and helping her build up her
sense of adult so she can keep herself safe and feel protected.
Title: Working with Addiction
T1 How are you and tell me what you'd like to change today in this piece of work?
C1 I would like to have an understanding of why I spoke and why I ... there's two
things that go ... I'm so hyper vigilant about safety and so aware of where doors are
and everything that's going on around me (expressing with hands), big survival
instinct, yeah, I smoke, I can't ... I think if I can get my head round it I will be more
successful in giving up.
T2 Okay.
C2 I need to know why I do it.
T3 Okay. Well first of all is it okay for me to congratulate you for being the part of you
that is hyper vigilant about being safe.
C3 (nods) Hmm.
T4 No, seriously, because you put them together and I wondered if you saw them
both as a negative?
C4 I don't see it as being negative (points to herself).
people ...

I think sometimes other

T5 Yeah, I'm not talking about the smoking side of it.

C5 Yeah, you're talking about the safety, safety, safety.
T6 You keeping it to yourself because I suspect, I don't know your history that much,
but I suspect that you needed to keep yourself safe.
C6 Yeah.
T7 So I just wanted to give you congratulations about that first.
C7 Hmm.
T8 And the smoking bit, probably is an offshoot of that, uhh, I should just check up
about your smoking because I don't know much about how come you smoke or have
you always smoked or ... tell me a little bit about your smoking pattern.
C8 I started smoking when I was 10.

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T9 10?
C9 Yeah.
T10 Wow, that's young.
C10 I've only just recently realised as soon as I stopped sucking my thumb I went to
smoking. There was a time ...
T11 Oh right.
C11 Yeah. If it's not smoking it will be something else. It ... you know, I've messed
about with drugs a lot in the 80's. If I have a drink, I can't have one drink, so I don't
drink any more. There's this ... for someone that wants to stay alive so much, there's
this real destructive side and I don't get it. I can't make sense ...
T12 So, for you, so just follow this through ...
C12 Yeah.
T13 For you, they seem polarised opposites do they?
C13 Yeah.
T14 Okay.
C14 To me, yeah.
T15 So, I'm following you logically.
C15 Okay.
T16 For you there's part of you that really wants to live and be in this life.
C16 Hmm.
T17 And then there's another part of you which is killing yourself.
C17 Yeah, I couldn't care less and it is a couldn't care less (shrugs shoulder).
T18 Well the way you did that was fairly dismissive.
C18 Hmm.
T19 So, besides smoking, from this part, lets take it from this part we're talking about
at the moment ...
C19 Yeah.

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T20 Are there other behaviours that you perhaps may go into, like you said, you
know, in the 80's you perhaps did some drugs and so there's a big part of you ... this
is just not smoking is it?
C20 No.
T21 It's part of you that just wants to no be here.
C21 Yeah, my driving, that's where it comes out as well.
T22 In what way?
C22 If I'm angry with myself, what ... if I get angry with somebody else ...
T23 Hmm ...
C23 I sort of take the anger ... instead of saying something, I take the anger, turn it
back on myself, so then I'll just drive like an idiot all the way home.
T24 Oh okay.
C24 Really push it, push it, push it.
T25 I know you're training in transactional analysis so is that okay if I use that
language?
C25 Yes. Yes.
T26 So if you think of ego states.
C26 Hmm.
T27 As a two ... you know, look at this part which wants to live and really be here,
and this part who couldn't care less.
C27 Hmm.
T28 Let's start here, what ego state are you in when you're in this dismissive part of
yourself, I couldn't really care less?
C28 Child.
T29 It sounds like the rebellious child for me.
C29 Yeah, it is the rebellious child.
T30 Couldn't care really.
C30 Yeah, couldn't care.
T31 And the part that really wants to live?

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C31 Hmm ... is ... it's an adult part, it's my adult, but the safety, the very hyper
vigilant, that's a child as well.
T32 That's child as well. Okay. I also wondered if the I really want to be here and
live ...
C32 Hmm.
T33 ... was also part of the child? I don't know.
C33 Yeah, yeah, yeah.
T34 So maybe they're both ... we can check that's a bit adult, a bit sharper, it
sounded really like the thrust of the essential part of you that wants to live.
C34 Hmm.
T35 To be here. To grow, to be healthy, to enhance my life.
C35 Yeah.
T36 To have charge of my own destiny.
C36 Yeah.
T37 To really be here.
C37 Hmm.
T38 Sounded like a very strong spirit of here.
C38 Yeah, and as you're saying that, it's umm ... I'm desperately trying to hang onto
your words, but the voices in my head can be so much louder, louder ...
T39 Louder than my words?
C39 Yeah. Yeah. I'm trying to shut that up.
T40 Okay, so I speak louder and say something a bit louder ...
C40 Yeah. (laughs)
T41 This is about living.
C41 Yeah.
T42 Taking charge of your own destiny.
C42 Hmm.

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T43 Being powerful. Being the woman you are. Essence that spirit of yours which
takes you through so much and taking charge of your own life. Are the voices getting
louder than my words or ...
C43 Yeah, obnoxious.
T44 They're louder than those ... I've just said.
C44 Yeah, they can really really shout, yeah, really.
T45 So are they shouting now?
C45 Yeah, aggressive now. You don't know what you're talking about.
T46 I don't know what I'm talking about.
C46 Yeah, you don't know what you're talking about and then I ...
T47 So if I said back to them well I do know what I'm talking about, I've known
Colette for at least three years, I know how successful she is in life, and I know her
real urge to live, what would happen?
C47 Just get really really angry.
T48 So they get louder.
C48 Loud ... really angry, yeah.
T49 Okay, so when I get louder, they'll get louder.
C49 Yeah, they just shout.
T50 So they get louder to match me.
C50 Yeah, and it would just go on and on and on (expressing with hands).
T51 And what about this side then? What happens to this side? As this side gets
louder, what's happening to this side?
C51 Which side's this, I'm confused.
T52 The side that doesn't want to live. The side that just wants to pack up, drive the
car erratically, couldn't care a toss, if I smoke 70 cigarettes so what.
C52 I suppose that part just goes off ...
T53 Shut up.
C53 Yeah, yeah, shut up, yeah, just ... yeah, I sort of want to go like that (head in
hands). Yeah, just ... just ...

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T54 Just shut up.

C54 Just shut up, leave me alone, yeah.
T55 So, in a way ...
C55 Yeah.
T56 Is this right, I'm going to check something out ...
C56 Hmm.
T57 Your adult has to mediate between those two parts does it?
C57 Yeah, yeah.
T58 Hmm. So you need a pretty strong adult to mediate between these two parts?
C58 Yeah, yeah.
T59 You do transaction analysis (laughs).
C59 Yeah (laughs).
T60 Good job we do transactional analysis psychotherapy then.
C60 Hmm.
T61 Because this is about a strength in your adult, so you can mediate between the
warring factions.
C61 Hmm.
T62 And has that been a central force of your therapy, strength in your adult, so you
can mediate between these two parts? Might be different language but is it about
strength in the adult at all?
C62 Yeah, there's been strength in the adult re-parenting and all that, yeah.
T63 How's it going?
C63 Yeah, it's going ... I'm in foster care actually at the moment (laughs).
T64 What do you mean?
C64 My therapist has put me ... she's took me away from my parents and now I'm in
foster care with nice people.
T65 I don't understand. Could you explain?

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C65 My therapist has ... we've been doing this piece of work where she is removing
me slowly but surely away from my parents.
T66 Your psychological parents?
C66 Yes.
T67 That were so destructive here?
C67 Yes. It's a slowly but surely.
T68 And where are you going?
C68 I'm fostering myself, if that makes sense.
T69 And what part does the therapist play?
C69 She is the support that I need when I don't know how to take care of myself.
She's there. She's the support (gesturing with hands). She's the social worker.
She's the one that can shout down the parents when they start to kick off.
T70 Oh they then get louder?
C70 Oh she can shout them down.
T71 Oh she can shout them down. Thank God someone can.
C71 Yeah, she can. It's took her a while but she can (laughing).
T72 She can act God though.
C72 Yeah, she tells them to leave the room.
T73 Thank God.
C73 They're not allowed in.
T74 Oh that's good.
C74 They're actually not allowed in. They have to get out.
T75 I'm glad somebody's supporting you.
C75 Yes.
T76 Taking control.
C76 Hmm.
T77 I'm really pleased to hear that. Hmm. Hmm. Has she tackled the part that
wants to smoke at the moment? Has she got anywhere near that?

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C77 No. No. I've ... No. (coughs) I just need ... I just need to know why and once
I've got my head round why, maybe I can just get rid of it.
T78 Rid of what?
C78 Rid of the smoking.
T79 Oh you mean stop?
C79 Yeah, stop and get rid of it. I don't want to do it but I do.
T80 The thing is you'd have to put something in its place by the sounds of it, so if you
stopped, what would you put in its place, because that's a mechanism to distract you
and take you away and to ....
C80 I really really don't know. There's something about smoking that if I take it away
I actually feel like I'm going to starve, like I'm not ... if that makes sense. If it gets
taken away .... (biting nails) umm ... I'd be sort of left starved of something, starved,
yeah, hungry, and then I might go crazy, hmm.
T81 So now we know why you smoke. By the sounds of it to stop you going crazy.
C81 Hmm.
T82 That's what you said wasn't it?
C82 Yes, yeah. To stop me from going crazy.
T83 You feel starved and then you'll go crazy.
C83 Hmm.
T84 So now we know why you smoke. That's how you ... that's what I've just heard
you say.
C84 Yes, that's ... that's it. Yeah, it is to stop me from going crazy.
T85 Hmm.
C85 Hmm.
T86 Now in transactional psychotherapy, again, I know you're a therapist is a
transactional analyst, has she closed your escape hatches?
C86 She tries.
T87 Do you know what I mean by ...
C87 Yeah, escape hatches, yeah, you go mad, go crazy, harm yourself.

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T88 Has she dealt with the crazy? Have you made a decision that you won't go
crazy?
C88 I make that decision my-self to not go crazy.
T89 Okay, have you made it with her?
C89 No.
T90 Would you like to make it with me so it's with the full witness rather than just
yourself, cause what I was thinking was that by making that decision with me, as a
witness ...
C90 Yes.
T91 It's like extra support for you, when you think about keeping the decision solid,
instead of having to make it by yourself and ...
C91 Yeah, yeah, yeah.
T92 And have only your own resources?
C92 Yeah.
T93 So how it would go, you'd say to me, uhh, I may feel like going crazy but under
no circumstances will I go crazy. You say that back to me.
C93 Yeah.
T94 And I'd confirm it and give you support or is it something that you would find
difficult to do and ...
C94 I don't know why, I don't want to go crazy, but I don't know why I find it hard?
(upset)
T95 That's why I thought you could do it with me, so you're not so alone in keeping to
that decision yourself, that I can support this in listening and validating your decision.
C95 (wiping eyes)
T96 Or, do you want to leave this to do with your therapist? I do think you need to
close the escape hatch and make this decision. I know you've kept it to yourself. I
understand that. Umm ... I would like you to have more support in it though. Like a
tissue?
C96 Hmm.
T97 Here.
C97 (wiping eyes)

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T98 Because, look, Colette, this is very important for you. This decision has to be
made securely before you can even start to stop smoking because if you look at
relativeness, which is worse, going crazy, being sectioned or smoking, keeping
yourself here, functioning, we can debate that, however, the way I look at it, lets
make sure you're in charge of your own sanity before you go on to the stop smoking
bit.
C98 (wiping eyes) (sigh)
T99 Now I believe in you.
C99 Yes.
T100 I've known you some time. I know you can make this decision and I hear that
you make it daily to yourself or frequently.
C100 Nods.
T101 And I'd like to support you in making that decision, umm, as a sort of witness.
C101 (sighs)
T102 You have to trust me of course, that I'm going to validate you and support you
and of course ... I think you've known me long enough now to trust me to do that.
C102 Yeah, there's part of me that's sort of screaming inside umm ... I won't go mad
will I, I won't go mad, I won't end up ...
T103 No you won't, no you will not go mad and you won't end up like that, you've got
a therapist who can shout them down.
C103 Yeah.
T104 So you've got lots of support there.
C104 Yeah.
T105 Maybe you need to make this with your therapist. Uhh ... so you don't have to
make it with her. I think it would be good to umm validate it with somebody who
means a lot to you, umm ... and can give you the support that you need.
C105 Hmm.
T106 You're not going to go, right then, known you for a while, your therapist can
shout them down, you've made tremendous strides psychologically since I've known
you and you're still here.
C106 (sighs) (nods)
T107 And ...

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C107 Yes ...

T108 To re-visit it, to say that to me, I think if you want to, I think it would be a good
idea, and if not, I would want you to take it back to your therapist and make that
decision, so you get some support, or both.
C108 Hmm, yeah. Umm ... (sighs) ... okay, okay.
T109 What you thinking?
C109 I'm thinking I will do it here with you.
T110 Okay.
C110 Okay.
T111 So ...
C111 So ...
T112 This is the words.
C112 Okay.
T113 Even though I feel I might go crazy, under no circumstances will I.
C113 Even though I feel I will go crazy, under no circumstances will I.
T114 Congratulations. Now just feel those words and is that true for you. Is that true
for you?
C114 (sighs) Yeah. Yeah. Yeah.
T115 Good, well done. I believe it is.
C115 Yes. (wiping tears)
T116 Congratulations.
C116 Hmm. Yes. (sighs)
T117 Bring in your therapist into your head a moment.
C117 Yes.
T118 Think about her.
C118 Yes.
T119 So she's here?

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C119 She's here. She's sitting right there.

T120 The other people, on this side, have heard you make that strong decision.
C120 Right.
T121 But even if you feel like going crazy, under no circumstances would you.
C121 Yes.
T122 What are they saying to you about that decision?
C122 (sighs)
T123 That you've made and I support you in?
C123 Who? Which people?
T124 The people who want to be so destructive to you on this side that you were
talking about, that are shouting you down ...
C124 They say we'll get her a different way then.
T125 We'll?
C125 Get her a different way.
T126 What I want you to do, with your therapist ...
C126 Yes ...
T127 Is get your therapist to shout them down now. Tell them to go away. We don't
want people like that in the room.
C127 Yeah, Pat would make them leave.
T128 Do it then. Now.
C128 Yeah.
T129 Think of her telling ...
C129 Yeah, she would, she'd say get out you're not coming here.
T130 Great, great.
C130 Yeah, she'd say out, leave this chid alone.
T131 Good.
C131 And she'd slam the door on them.

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T132 Good. Has she done that?

C132 Yeah, she's done it, yeah.
T133 Have they gone?
C133 Yeah, they've gone.
T134 Great.
C134 Yeah. (sighs) Yeah, they've gone.
T135 You took a big breath there didn't you.
C135 Yeah. Yeah, they've gone.
T136 Yeah, so the important thing here for you is that you can always bring your
therapist in.
C136 Yeah.
T137 And you can, with her, get rid of them for a while, if they shout you down.
C137 Yeah. That's true.
T138 Hmm.
C138 Yeah, that is true.
T139 It is true, I saw you do it.
C139 Yeah. Hmm.
T140 You did it well. And one thing ...
C140 Hmm.
T141 Both Pat and I wouldn't let them get you another way.
C141 Do you promise?
T142 I know Pat wouldn't and I know I wouldn't and I can promise, knowing Pat, I
can't speak for her, but I've known her for 24 years, I'm sure she would promise as
well.
C142 (nods)
T143 In fact I've known her longer, I've known her 25 years, and I know, absolutely,
she would be on your side, absolutely. She can shout them down and make sure
that won't happen.

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C143 Yeah. (sighs)

T144 Smoking isn't the only way to shut them up.
C144 (smiles) (laughs)
T145 (laughs) A smile appeared then. (laughs)
C145 (sighs)
T146 You see people who drink a lot do it primarily to knock out the parents in
transaction analysis language. Often people who smoke a lot want to smoke them
out. (laughs)
C146 (laughs)
T147 You know so I'm saying there's another way.
C147 Yeah.
T148 And now we've started this work and you've made that decision again, which I
think was great by the way, and I know you can bring Pat in and you can take the
work we've done here back to her so she can validate that as well.
C148 Yeah. Yeah.
T149 And I think real progress will happen and I think it has today actually.
C149 Yes. Yeah, I think you're right. Hmm. (nods)
T150 What you thinking, cause I know you think really well, so just tell me what
you're thinking?
C150 I was just thinking I've got Pat tomorrow at half nine.
T151 Great.
C151 Yeah, so I'm really ...
T152 Great.
C152 ... glad about that. I've just ... got to keep it okay until tomorrow morning.
T153 Got to keep what okay until tomorrow?
C153 Just the umm ... I've just got to keep them out until tomorrow morning, yeah.
T154 She's already doing that.
C154 Well yeah because I don't live with them any more.

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T155 Pardon?
C155 I don't live with them any more. I'm in foster care.
T156 Yeah. Yeah. You're in foster care. You don't have to be even near them.
C156 Yeah.
T157 So she's ... what position's your Mum now, is she your foster Mum or what sort
of ... when you say you're in a foster ...
C157 My ...
T158 What part does your therapist play?
C158 My therapist is the support to me. I'm fostering my child and she supports that.
T159 How could I come into this picture?
C159 You could stand beside Pat.
T160 Good. Will you allow me to?
C160 Yes.
T161 Great.
C161 Yes. Hmm.
T162 Great.
C162 Yes.
T163 When do I see you next?
C163 When do you see me next?
T164 You'll be one year in the institute then.
C164 Supervision on Thursday.
T165 Well is it okay if I check perhaps five minutes before, or five minutes after, just
check how things went.
C165 Okay.
T166 You know, on the ...
C166 With Pat.

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T167 With Pat. Is that okay?

C167 Yes, that's fine.
T168 Great.
C168 Yeah, thank you.
T169 Good, and how are you getting on with your understanding about how come
you smoke?
C169 I know. I do it to stop going insane.
T170 Yes.
C170 That's how it feels.
T171 Great.
C171 It feels ... and I know this ... I know, it makes no sense now because if my
cigarettes start to dwindle in the middle of the night, I'm going crazy, I've got to go to
the petrol station.
T172 Hmm. Hmm. So you know what's happening now.
C172 Panic, yeah.
T173 So now, well I've got a suggestion, especially when you talk to Pat about it, is
as you're sitting here tomorrow morning, you could ask before tomorrow morning,
bring Pat in, so in other words, you don't have to wait until 9.30 tomorrow morning.
C173 No.
T174 You can bring her in your head, just like I saw you do it.
C174 Yes. Yes.
T175 And bring me in as well.
C175 Yes. I will. Yeah, cause I think what's been helpful for me is because Pat's a
social worker, she knows all the laws and stuff like that.
T176 Yeah, she can tell what ... she knows it all.
C176 And she knows the laws and she's (26:13) them.
T177 Yeah.
C177 Yeah. Yeah.

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T178 And I'm quite a big hefty man as well, you know, I can stand there and support
her.
C178 Okay.
T179 I might not know all the social laws but I can shout pretty loudly.
C179 Yeah, yeah, you can.
T180 Perhaps not shout as loud as Pat but ...
C180 No, Pat's tough.
T181 I know. She's a tough cookie.
C181 Pat's a tough little woman, honestly.
T182 I've known her a long time.
C182 She's a tough woman.
T183 So I'll check up on all this, is that okay?
C183 Okay, that's fine. Yes.
T184 Well done, and thank you for bringing that here and also thank you for keeping
yourself safe.
C184 Thank you (shaking hands)
T185 I've never got a hand so quickly (laughs) Well done.
C185 Thank you.
T186 Thank you very much.
Title: Analysis - HOW TO FACILITATE "ESCAPE HATCH CLOSURE": How to
strengthen adult ego state and How to keep herself safe
T So here's a piece of work which is quite different from the other pieces that you've
watched. Here the decision was whether to go into the child ego state or not, now I
was quite clear in my head that I wasn't going to go far into that child ego state.
Why? Because of the level of craziness of her parents or the significant others that
brought her up. Now by definition, we touched on this slightly, especially with some
escape hatch work, but very quickly I made a connection for her to stay an adult as
much as I could, umm ... escape hatch work very important transactional is this
concept by Boyd and Boyd who were the first creators of it, and if you follow their
theory through, they talk about the decision not to kill yourself, not to harm other
people, and not to go crazy, so that's what I started to deal with here. Is it ... may ...
sort of ... I think will be even more solidified when she takes it to her therapist.

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Umm ... now ... I linked it back to smoking cause quite often that's what people do of
course, they smoke or drink to not have to go crazy.
T187 We know with that escape hatch work I was prepared for her not to make it.
C187 Hmm Yes. It was win win wasn't it, you created a win win ...
T188 Correct. It was win win. If she made it that's fine, even if she didn't, she still
had the potential and power to feel that she was going to take it back to her therapist.
C188 Or the power to not make it.
T189 Or the power not to make it.
C189 Yes. To make a choice.
Title: Why were you so persistent with Escape Hatch Closure?
T190 Because I wanted her to get some power in the side of herself that knew the
importance of living. I also knew I had Pat in her head and me. So I persisted and I
was within an inch of letting it go in a way, but you know, for her to have actually done
that, in the safety of a therapist and me, I thought was so important for her, so I
realised I was going that extra mile a bit but it was very much in the surface of her
own power, and then I was faced with the clinical process which is what I faced which
was what are these other persecutors going to say, when they realise she's made a
decision not to go crazy because they want her to be crazy, to be in a crazy family.
C190 Hmm.
T191 So that is why I said to Colette, what are they saying, what are they saying
now, what are these crazy persecutors saying, and then she said we'll get you
somehow, so it was very important who I brought in next, but I'd already knew I had
the safety of Pat who I could say, right, bring in Pat, she'll shut them up, she'll send
them out because they're crazy, and I brought me in as well to help. She, I don't
know if you all saw, once they'd gone, took a big breath of relief.
C191 Hmm.
T192 Now with escape hatch closure, though we only face one escape hatch, you
would do that with the next two. I didn't do that with the next two here which was
about keeping yourself safe and making sure she doesn't harm other people, but I
think they need to be visited umm and I'm sure Colette will take that back now. But
you always make sure that they say it back to you. They say it back, I know I may
feel XXX, but under no circumstances will I. Extraordinary powerful because they
start to take charge of their own destiny.
Title: Can you explain more about following the client's logic?
T193 You have to ... the works actually ... but specifically here, but I think it runs
across the psychotherapy style, ask them about their internal world.

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C193 Hmm.
T194 It's not your world.
C Hmm.
T194 It's theirs. Same in the last piece of work I did with Meg, same with the work I
did earlier on with Susie, how are you, what's going on for you, tell me about your
logic, lots of enquiry questions.
C194 Is there referring to frame of reference work?
T195 Finding out what their frame of reference is. Now Richard Erskin, who umm ...
developed a style of psychotherapy which he calls integrative psychotherapy, came
up with the three particular methods of integrative psychotherapy, embedded
throughout transactional analysis, which are enquiry, attunement, involvement, so
you enquire about a person's frame of reference, how was that for you, tell me a little
more about ... what's going on for you, and in the process, you are atuning to their
rhythm, their pace, their emotional world and you are involving yourself in the
process. Three methods of an integrated transactional analysis which you've seen in
all this work, now in this particular work a lot of my transactions were not ... though
they were enquiring, they weren't so enquiring to the child, because I wanted to
empower the adult, so they're quite half an adult transaction. I didn't go deeper and
deeper and deeper because I didn't want to go into that child ego state.
C195 Hmm.
T196 If this was about strengthening her adult, we established that really early in the
work, do you remember, when I talked about the adult and mediating the two parts of
her, we looked in terms of ego states.
C196 Hmm.
T197 this was about strengthening her adult with the help of her therapist and
hopefully me, so she could integrate us into her adult, which will be then be more
powerful, her psychological hole, which you're doing pretty well.

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