CHAPTER 1
Necessity and Invention in Counselling
Suzieâ had experienced five suicide attempts.1 Her previous therapist said the seventeen-year-old had been compliant with treatment but remained âhigh risk.â She obtained elevated scores for low self-esteem, anger, suicide ideation, and depression on a standardized measure of suicide probability administered during our first session.
I attempted to normalize some of Suzieâs experiences and reframe others so as to place responsibility on the perpetrator of emotional and physical abuse (her father) and to help her see herself as a competent actor and increasingly able problem solver over time. We co-developed behavioural âhomeworkâ assignments that included positive affirmations, meaningful and enjoyable activity, regular physical activity, and reality testing to discover the accuracy (or inaccuracy) of perceived slights from teachers, family, and peers. I had her retell her âstoryâ with suggested amendments to engender hope. Eye Movement Desensitization and Reprocessing (EMDR) was used to deal with specific instances of childhood trauma. Suzie participated in all suggested activities, but her increasing levels of distress led me to conclude the methods we were using were not being effective. A re-referral at this point would have further accentuated the youthâs sense of hopelessness, so with an affected air of assurance, I suggested that we create a map of her self to find what was keeping her from responding to treatment.
Mapping and Modifying the Self of a Client in Therapy
Viewing the self as a representational cultural construct (Blustein & Noumair, 1996; Dennett, 1995; Mead, 1912/1990; Shotter, 1997), I asked Suzie to prioritize four lists: 1) self-defining roles, 2) qualities she liked about herself, 3) changes she would make to herself if she could, and 4) things she believed to be true. Each unit of self-representation represented a small unit of culture. Following the lead of Dawkins (1976), I called these elemental units âmemes.â In the physical world, the existence of nuclear, electromagnetic, or gravitational forces leads to a structuring of matter, so I looked for analogous mental forces that could similarly result in mental structures. Shared affective, behavioural, and connotative characteristics present as forces of attraction. For example, a meme given the title âheart-shaped boxesâ was associated, in the clientâs mind, with romantic love, and an âattractive forceâ was represented as a line connecting the two in figure 1.1. She experienced wistfulness coupled with feelings of emptiness and loss associated with these boxes, which she collected and displayed. I viewed this behaviour as a dramatic expression of her associated emotions, so the meme was linked to another labelled âdramatic person.â By linking memes sharing connotative, affective, or behavioural dimensions with those prioritized by the client as more difficult to change closer to the centre, the self-structure pictured in figure 1.1 emerged.
Some readers will recall that grunge rock artist Kurt Cobain committed suicide in 1994 after recording a song titled âHeart-Shaped Box.â Given Suzieâs worldview, Goth-like appearance, and taste in music, it is likely she was influenced by this recording, but in adopting the meme, she necessarily gave it her own interpretation. Suzie also made a connection with popular culture in reporting that she compulsively rereads The Bell Jar, a book about a depressed and suicidal youth; the book title is represented in figure 1.1 as a self-identifying meme connected to memes labelled âsuicidalâ and âwriter.â
The meme labelled âdepressed personâ forms a hub or core connected to eight other memes, such as âugly,â âsuicidal,â and âfather hater.â Rumination may be predicted once consciousness is focused on this depressive cluster since the number of cognitive pathways to other parts of the self is limited. Figure 1.2 illustrates this ruminative cycle.
This clientâs cognitions could begin at any point along the paths reproduced in figure 1.2 and lead to suicidal thoughts. A feedback loop is illustrated leading from âdependentâ to âinsecureâ to âdepressed personâ and returning to âsuicidal.â Rumination is thus circular, leading to increased client distress. While the most common pathway to suicidal thoughts is through depression, an alternate route leading from the clientâs beliefs in Wicca to reincarnation to suicide ideation is also illustrated.
FIGURE 1.1. Initial self-map of Suzie with edges between memes representing shared connotative, affective, or behavioural dimensions.
FIGURE 1.2. An illustration of memetic self-map paths or routes leading to suicide ideation in the self of âSuzie.â
Sequentially linked memes, as illustrated above, may be viewed as cognitive scripts leading to patterned behaviours within an overarching self-defining narrative. The self that is the protagonist in such narratives may be mapped so as to identify and graphically represent internal relationships and thematic possibilities. Returning to the total representation in figure 1.1, it can be seen that the removal of âdepressed person,â âsuicidal,â and âangry,â without first preparing alternatives, would lead to fragmentation of the self as pictured. Operating on the assumption that most people, especially those who are depressed or suicidal seek self-stability (De Man & Gutierrez, 2002), I recommended that Suzie restructure her self in some ways before focusing on removing her depression and suicide ideation identifiers.
The meme âanimal rights activistâ in figure 1.1 was an earlier reframe of angry client behaviour associated with perceived cruelty to dogs and cats. Although animals are not human, we used this meme to inspire and inform a new thematic core, âhuman rights,â in figure 1.3. That new meme included a behavioural injunction to fight for social justice.
The preparation of a new core meme involved examining, and in some cases reframing, those memes already present. Suzie had challenged teachers and other adults over the rights of children and youth, which resulted in her seeing herself as âoutspoken.â She believed that females generally suffered from sexism, and she embraced feminism. She believed that the Christianity of her parents was oppressive, and she embraced an alternative religious belief system (Wicca). She described herself as emphatic and empathetic.
Established memes were conscripted to support the new persona. For example, she had written prose and poetry focusing on her depression, and she read books that reinforced a negative and pessimistic view of life. With this new human rights shift, she began to read material that supported her views about animal, childrenâs, and womenâs rights, and about her emerging views on spirituality. With encouragement, she began to write poetry and prose in support of her passionately held beliefs. She published some of her writings in a student newspaper and was surprised by the positive regard she was given by peers. Her anger, which had been directed inwardly, reinforcing her depressive and suicidal self-representations, now became increasingly focused externally in the service of social interest. These changes are represented in figure 1.4.
FIGURE 1.3. A revised memetic self-map of a suicidal youth showing the location of a co-
constructed new meme, âhuman rights,â with supporting memes tinted in grey.
FIGURE 1.4. Self-map illustrating changes in self-definition resulting from âhomework assignmentsâ designed to support the new core meme âhuman rights.â
Suzie developed a plan to move in with an aunt in a neighbouring community. She found that her writing, which still had an anti-establishment flavour, was accepted by a new group of friends with similar views. She began dressing differently and discovered that she was considered attractive. The meme âhostile to peersâ withered and then disappeared. Suzieâs mother and sister followed her in leaving her father, who at one time loomed quite large in her life, though now appeared as a pathetic derelict who could not take care of himself. Suzie lost much of her anger, but a level of disgust remained. She now saw herself as empowered to positively affect her future.
Over the course of about seven months, the new core we had developed became increasingly central to Suzieâs self-definition, while those memes supporting her âdepressed personâ meme became fewer in number. We were then able to eliminate âdepressed personâ from her identity and reframe depression as an emotional state that we may sometimes experience without it defining who we are. She subsequently scored within the nonclinical range on a standardized test for suicide risk, and therapy was terminated. Suzieâs mother called a year later to say that her daughter was doing very well socially and academically.
The method of preparing memetic self-maps described here may be understood using a branch of mathematics called Graph Theory (Robertson & McFadden, 2018). In GT the units represented in ovals (memes) would have been called âverticesâ or ânodes.â Connecting lines are called âedgesâ or âarcs.â Proximity between memes gave the sense of greater attraction, and with GT it would be possible to quantify that attraction using edge line weight. In figure 1.1 we saw that the meme âdepressed personâ is connected to eight adjoining memes (in GT, degree = 8), supporting its designation as a core of the self-structure. As we saw in figure 1.2, sequential patterning can be observed between proximate memes with routes identified for habitual thoughts. Seen through the lens of GT, memetic self-mapping is a mathematical way of visualizing a naturally occurring phenomenon. As we shall see, it is also compatible with various heretofore competing lenses within the discipline of psychotherapy.
The Call of This Research
Notions of self-concept, self-esteem, self-actualization, and self-validation predominate in psychology, yet the core concept to which these constructs refer is less well understood. Eric Erikson wrote, âThe ability to form intimate relationships depends largely on having a clear sense of selfâ (2003, p. 98). William Bridges (1980, 2001) tied his theory of adult transition to changes in this âself.â The self was one of four pillars that Schlossberg, Waters, and Goodman (1995) used to understand how individuals cope with life transitions. According to Seigel (2005), the self âdistinguishes you or me from others, draws the parts of our existence together, persists through changes, or opens the way to becoming who we might or should be (p. 3).âHow do we come to have a particular understanding of our selves? What keeps selves sufficiently stable that they are recognizable to their âownersâ and others? If it is a matter of belief, why is it difficult to change unwanted aspects of the self? To what degree did the mapping exercise contribute to the successful outcome in Suzieâs case?
The idea of self as used here is intertwined with the notion of culture. We are defined according to information provided by our families, friends, communities, and society in conceptual units learned within our cultural milieu. Mapping the self is thus a relational activity concerned with both internal structure and external influences or determinants.
Readers will recall that Suzie was asked to prepare and prioritize four lists of self-descriptors. Memes were defined as having an affective dimension. Was this dimension sufficient to understand the emotional pain experienced by Suzie during initial stages of treatment? What mechanisms serve to maintain dysfunctional selves irrespective of the emotional pain invol...