Stroke deprivation

As Eric Berne said, “A stroke is a unit of attention” and one can have positive strokes and negative strokes. As a therapist it is easy to forget the importance of strokes and the important therapeutic role they can play.

The importance of them is no better demonstrated than by looking at a whole discipline or aspect of the science of psychology that is based on the psychology of strokes and that is behaviour modification.

Humans began to realize that how you respond to another person then influences how that person will think, feel and behave in the future. In behaviour modification terms you can respond to others with either positive reinforcement (strokes), negative reinforcement (strokes) or with no reinforcement (strokes) and that will influence how they behave in the future.

This remarkably simple discovery lead to the entire field of behaviour modification which has lead to probably millions of pieces of research on this very simple premise and has produced libraries full of books on the topic.

It is a huge area that is based on the premise, as I said, that how we respond to someone influences how they will behave in the future. Remarkably simple and yet remarkably powerful and of course the therapeutic implications are clearly evident.

If how I respond to a person can influence their future behaviour, this means as a therapist, I can respond to a client in a way which will influence how they behave in the future. Obviously a useful therapeutic approach to have.

Indeed this leads us to the basis of relational therapy. In therapy I will respond to a client with either a positive stroke, negative stroke, or no stroke. This then will influence their future behavior. The client will then respond back to me with either a positive stroke, negative stroke, or no stroke which in turn influences my future behaviour. The basis of relational therapy. It seems the psychotherapy of behaviour modification has been using a relational approach to therapy all along and it began in the 1950s.

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Furthermore as the research on behaviour modification has shown you can’t avoid it. We are effected by the strokes we get from others. We can’t avoid being influenced by the strokes we get from others and often it is unconscious.

A most useful discovery so we set about refining the therapeutic applications of this discovery. In transactional analysis we discover that strokes can be conditional and unconditional and these effect the future behaviour of others in different ways. For instance with stroke power, negative strokes are more influential than positive strokes.

As negative strokes are more powerful then as therapists we should give clients Critical Parent negative strokes and that will help them to stop a behaviour like panic attacks. But it is not that simple. First the side effects of negative strokes damage the psychology of the person whereas positive stroke do not. Second, negative strokes may help a person to stop the neurotic behaviour in the short term but in the longer term it may actually get worse. As so often happens with human psychology, as soon as you start looking a bit deeper it gets more complicated.

But the basic premise remains. Sometimes we forget how important strokes are in therapy. People have different levels of stroke needs. Some require a lot day to day and others require less. However the important point is, when taking a client history how many of us ask about any level of stroke deprivation. From what I have seen not many. Are they getting enough strokes to meet their daily needs? If not, that is important as stroke deprivation can have a devastating effect on the personality.

An obvious example of this is depression. Some people are depressed because they are stroke deprived. Try this yourself. When you next have the chance spend as much of a day as you can getting no (or very few) strokes from others. You get no attention from others. Spend one day, two days, three days doing this and you will quickly discover how stroke deprivation leads to psychological collapse such as depression. Some people live in a state of stroke deprivation for years!

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From what I have seen when a client presents with depression it would be uncommon for a therapist to look at stroke deprivation. Instead they start to look at internalized anger, high internal critic, changing internal self talk, history of depression in mother and father, potential suicidality, insomnia, eating problems, low self esteem and so forth?

In the DSM-5 the diagnostic criteria for major depression does not even mention stroke deprivation or psychological isolation. Hence my thesis that stroke deprivation is a significantly important aspect of psychological dysfunction and at the moment it is the forgotten relative and given little credence when the research clearly shows it is of significant psychological importance.

Of course therapy in itself is a big stroke. The client is getting a full hour of attention and can repeatedly do so on many occasions. If the client is reporting generally feeling better it could be partially due to the fact that the therapy is reducing their stroke deprivation.

One can use other techniques like the encounter exercise of stroke bombardment. To see that done is quite a moving experience and one again sees the value in simply reducing a person’s level of stroke deprivation which usually is not all that hard to do.

One can also separate strokes out into physical strokes and verbal strokes (both positive and negative)

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Physical strokes have much more potency than verbal strokes. This chart would seem to suggest that to modify behaviour one would obviously use a negative physical stroke. If parents want a child to behave a particular way a negative physical stroke is most likely to achieve it. But as I said before the the problem with negative strokes (especially negative physical strokes) is they have unwanted side effects on the overall personality and they will also cause ruptures in the relationship between the parent and child. Positive strokes also modify behaviour and also produce side effects but these are wanted ones. But the unfortunate fact remains, negative strokes are more powerful in modifying human behaviour than positive strokes. This is why some parents use them – they work (at least in the short term). They get the short term result the parent wants.

With a stroke deprived person the best thing one can do is give positive physical strokes. But as we know professional organizations discourage therapists from touching their clients. So they actually cause the clients more problems. All therapists are left with is positive verbal strokes, which as we can see is the least powerful of all four.

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