Karen Woodall – Psychotherapist, Writer, Researcher, Trainer

17 responses to “Working with Primitive Defences and Part Selves: Understanding Treatment of Alienation in Children of Divorce and Separation”

1. Bob Rijs

   July 10, 2023 at 7:03 pm

   The Relationships of Antisocial Behavior With Attachment Styles, Autonomy-Connectedness, and Alexithymia (2007)

   Sex differences were expected in types of insecure attachment styles, patterns of autonomy-connectedness, and levels of self-reported antisocial and passive-aggressive behavior.

   https://www.researchgate.net/publication/6371018_The_relationships_of_antisocial_behavior_with_attachment_styles_autonomy-connectedness_and_alexithymia

   The construct of alexithymia: Associations with defense mechanisms (2008)

   Our results support the association of alexithymia with emotional inhibition, but extend those associations to immature defense styles and aspects of social desirability.

   https://www.researchgate.net/publication/5550659_The_construct_of_alexithymia_Associations_with_defense_mechanisms

   Roots of Alexithymia (2019)

   The concept was developed from clinical experience with psychosomatic patients that responded poorly to psychotherapy.

   https://hrcak.srce.hr/file/322903

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   The Impact of Past Trauma on Psychological Distress: The Roles of Defense Mechanisms and Alexithymia (2020)

   https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00992/full

   Dark Ladies: Maladaptive personality domains, alexithymia, and the dark triad in Women (2020)

   https://research.tilburguniversity.edu/en/publications/dark-ladies-maladaptive-personality-domains-alexithymia-and-the-d

   The Mediating Role of Alexithymia in the Relationship Between Defense Mechanisms and Tendency to High-risk Behaviors Among Adolescents (2021)

   Conclusion: In the relationship between dysfunctional defense mechanisms and high-risk activities, alexithymia played a mediating role. It can be inferred that dysfunctional defense mechanisms play a key role in high-risk activities by influencing alexithymia.

   https://www.researchgate.net/publication/349788684_The_Mediating_Role_of_Alexithymia_in_the_Relationship_Between_Defense_Mechanisms_and_Tendency_to_High-risk_Behaviors_Among_Adolescents

   Intergenerational Transmission of Alexithymia as a Predictor of Child Posttraumatic Stress Outcomes during COVID-19 (2022)

   https://scholarscompass.vcu.edu/cgi/viewcontent.cgi?article=8033&context=etd

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   The Relationship Between Alexithymia, Callous Affect, Aggression, and Emerging Adulthood (2022)

   https://digitalcommons.coastal.edu/cgi/viewcontent.cgi?article=1456&context=honors-theses

   Disguised Emotion in Alexithymia: Subjective Difficulties in Emotion Processing and Increased Empathic Distress (2020)

   https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00698/full

   Alexithymia and Self Differentiation: The Role of Fear of Intimacy and Insecure Adult Attachment (2021)

   https://www.researchgate.net/publication/349277715_Alexithymia_and_Self_Differentiation_The_Role_of_Fear_of_Intimacy_and_Insecure_Adult_Attachment

   Alexithymia, emotion dysregulation, impulsivity, and aggression: A multiple mediation model (2016)

   https://www.academia.edu/85035574/Alexithymia_emotion_dysregulation_impulsivity_and_aggression_A_multiple_mediation_model

   Being alexithymic: Necessity or convenience. Negative emotionality 3 avoidant coping interactions and alexithymia (2015)

   Click to access Bilotta-et-al.-2015-PAPT.pdf

   ALEXITHYMIA IN BORDERLINE PERSONALITY PATHOLOGY From Theory to a biosensor application (2022)

   Click to access Thesis_Y_Derks_Alexithymia_in_Borderline.pdf

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   Change in defense mechanisms and coping in short-term dynamic psychotherapy of adjustment disorder (2010)

   https://www.researchgate.net/publication/46171426_Change_in_defense_mechanisms_and_coping_in_short-term_dynamic_psychotherapy_of_adjustment_disorder

   The Relationship Between Alexithymia, Callous Affect, Aggression, and Emerging Adulthood (2022)

   https://digitalcommons.coastal.edu/cgi/viewcontent.cgi?article=1456&context=honors-theses

   Duet for life: Is alexithymia a key note in couples’ empathy, emotional connection, relationship dissatisfaction, and therapy outcomes? Pamela D. McNeill (2015)

   https://ro.ecu.edu.au/cgi/viewcontent.cgi?article=2671&context=theses

   Alexithymia and physical outcomes in psychosomatic subjects: a cross-sectional study (2020)

   https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1267&context=jmms

   Uncertainty, alexithymia, suppression and vulnerability during the COVID-19 pandemic in Italy (2021)

   https://www.researchgate.net/publication/350118697_Uncertainty_alexithymia_suppression_and_vulnerability_during_the_COVID-19_pandemic_in_Italy

   PROBLEMS IN SPECIFYING ALEXITHYMIA: A REVIEW OF THE EMPIRICAL LITERATURE (2018)

   Click to access A_prochazka.pdf

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2. Bob Rijs

   July 10, 2023 at 7:11 pm

   Incorporating Demoralization into Social Work Practice

   Lynne Briggs and Patricia Fronek (2019)

   https://www.academia.edu/81587575/Incorporating_Demoralization_into_Social_Work_Practice

   This article explores the relevance of demoralization to social work research and practice. Demoralization connects to the very core of being human. It is present in social work client groups and is an important but neglected concept in social work. Demoralization occurs when life becomes so overwhelming that daily functioning is affected and people lose all hope, agency, and the capacity to overcome their circumstances. Although a demoralized state is not recognized as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, it is often confused with psychiatric disorders and its presence can lead to clinical conditions and suicide. This article discusses demoralization and its place in social work practice, identification, and measurement, and appropriate psychosocial interventions are also explored. The article concludes that demoralization has particular relevance to contemporary social work and should be considered in social work practice and research.

   KEYWORDS: demoralization; social work practice; vulnerable people

   Demoralization connects to the very core of being human. It is experienced as existential distress and occurs when life becomes so overwhelming that it affects a person’s ability to function on a day-to-day basis. Although this concept originated in the early 1960s, it was not accepted in health and psychological disciplines until the last two decades (Clarke & Kissane, 2002;

   de Figueiredo, 2013; Frank, 1961; Kissane, 2004; Kissane, Clarke, & Street, 2001; Sansone & Sansone, 2010). Recent studies have focused on health care, the elderly, palliative care, and practitioners working in stressful situations (Bobevski, Rowe, Clarke, McKenzie, & Fisher, 2015; Gabel, 2011, 2012a, 2012b, 2013; Grassi et al., 2017; Kissane, 2014; Kissane et al., 2001; Townsend, 2018; Vehling et al., 2017). Perhaps due to its origins and the complex progression in psychiatric studies of mental illness, demoralization has not as yet become a widely accepted concept in social work practice (Briggs, 2011; Briggs & Macleod, 2010; Frank, 1961; McKenzie, Clarke, Forbes, & Sim, 2010). Briggs (2011, 2013) is one of the few social workers who has explored the relevance of demoralization to social work practice, particularly in relation to refugee mental health. Her research indicates that the key concepts of demoralization are relevant and useful in social work practice with any group of vulnerable people.

   Although social workers consistently work with individuals and groups in which the incidence of demoralization is high, it is often not recognized as such, as it can be confused with other conditions.

   For example, a recent study of 131 Australian refugees and asylum seekers explored demoralization as a concept distinct from diagnosed mental illness (Hocking & Sundram, 2015) and found that 79 percent of participants met the criteria for demoralization. External policies, political attitudes, racism, and incarceration combined with past and present experiences of trauma stripped these people of their sense of worth and possibilities for a hopeful future (Briggs, 2011, 2013; Briggs & Cooper, 2015; Briggs & Macleod, 2006; Briggs, Talbot, & Melvin, 2007; Briskman, Zion, & Loff, 2011).

   Demoralization is recognized in terminal or debilitating illness, family breakdowns, and other traumatic or abusive situations (Fang et al., 2014; Kissane et al., 2001). A range of internal and external factors (financial, social, physical, or psychological) and associated interactions all contribute to demoralization, which can affect even the most resilient person. For example, a decline in physical or psychological functioning may result in a withdrawal from social interaction. Kissane (2004) linked demoralization to elderly people who may wish to die. This is unsurprising when they are disabled, dependent, socially isolated, concerned with being a burden, and fear a loss of dignity or control. As such, demoralization casts an interesting layer of consideration in current debates about euthanasia, particularly in relation to the elderly tired of living (Florijn, 2018). Butterworth, Fairweather, Anstey, and Windsor (2006) provided insights into the experiences of people demoralized by living on social security benefits. They found that people with little perceived hope of changed future circumstances were demoralized.

   People experienced hopelessness, as sense of worthlessness, and dissatisfaction with life. Social security beneficiaries comprise the bulk of many social work caseloads. As such, demoralization is a useful concept for social workers in clinical and community practice to understand and intervene with people who are experiencing nonspecific psychological distress.

   DEFINING DEMORALIZATION

   Briggs (2013) described demoralization “as a change in morale spanning a spectrum of mental attitudes from disheartenment (mild loss of confidence) through to despondency (starting to give up) and to actually having given up” (p. 27). Demoralization, an enduring state of suffering, is now generally understood to be a normal part of the human condition rather than an abnormal state.

   Griffith and Gaby (2005) claimed that demoralization was not a psychiatric condition and should be seen as part of the human experience, and, therefore, does not require pharmacological treatment. There is disagreement in the literature on this point as demoralization can lead to mental health conditions such as clinical depression and suicidality. Kissane (2004) argued that demoralization should be included as a distinct diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM) because it is different from other conditions. As Cheuk, Chan, and Ungvari (2009) noted, it is the overlap with symptoms of other conditions that makes it so important to recognize demoralization for what it is, as either a diagnostic entity or a separate social or psychosocial phenomenon. Slavney (1999), resisting its medicalization, strongly argued that demoralization, like grief, is a normal reaction to adverse circumstances and is not a psychiatric disorder. According to some theorists, demoralization is multidimensional, occurring when the impact on daily life becomes debilitating, gradually building in intensity and becoming a perpetual state through a series of defined stages (Nanni, Caruso, Sabato, & Grassi, 2018; Tecuta, Tomba, Grandi, & Fava, 2015).

   Demoralization or Depression.

   Although demoralization should not be confused with clinical depression, it can progress to a depressive state and suicidality (Kissane et al., 2001). Thus, it is important for social workers to identify its presence.

   The main distinction between demoralization and depression is determined by the presence of anhedonia (an inability to feel pleasure), which is also present in grief. People who are depressed experience anhedonia whereas people who are demoralized experience subjective incompetence. Subjective incompetence and personal distress are the main features of demoralization (de Figueiredo & Frank, 1982). Subjective incompetence describes a person perceiving difficulty expressing emotions (as opposed to not feeling them) due to impaired daily functioning (de Figueiredo & Frank, 1982). People with depression know the direction of an action they want to take but lack the motivation to achieve it, whereas people who are demoralized may be motivated, but their sense of incompetency and uncertainty (or lack of direction) prohibits action. People who are demoralized can also feel happiness in the moment (consummatory pleasure) but cannot perceive anticipatory pleasure or possibilities of future happiness. Depression, distress, anxiety, grief, and adjustment (which have lower severity) can also coexist with demoralization.

   There is potential for mental health professionals to mistake demoralization for depression, anxiety, or adjustment disorders, which, in turn, can lead to ineffective interventions that cause further harm. Demoralization also differs from an adjustment reaction, a symptom-oriented diagnosis of reacting to a past or present problematic environment. The nature and chronicity of environmental and internal factors;

   lack of agency; and persistent experience of hopelessness, powerlessness, and existential distress distinguish demoralization from an adjustment reaction, which has been generally ill-defined and critiqued as a “wastebasket diagnosis” due to its indiscriminate application (Andreasen & Wasek, 1980; Tecuta et al., 2015). To date, how adjustment reactions and demoralization might coexist and interact is unexplored in the literature.

   Kissane et al. (2001) developed the following six criteria to distinguish demoralization from other conditions: (1) Affective symptoms of existential distress, including hopelessness or loss of meaning and purpose in life, are present. (2) Cognitive attitudes of pessimism, helplessness, a sense of being trapped, personal failure or lacking a worthwhile future, and conative absence of drive or motivation to cope differently are experienced. (3) Associated features of social alienation or isolation and lack of support are identified. (4) Emotional intensity fluctuates. (5) Symptoms persist for more than two weeks. (6) A major depressive or other psychiatric disorder is not the primary condition.

   Demoralization and Suicide

   Research has shown a strong link between demoralization and suicidality in the context of prolonged psychological distress in people with debilitating conditions, inadequate social supports, adjustment difficulties, and poor quality of life (Boursier, Jover, & Pringuey, 2013; Kissane et al., 2001; Vehling et al., 2017). As helplessness and hopelessness are the central links between demoralization and suicidality, it is these factors that require a specific focus in interventions (Clarke, Kissane, Trauer, & Smith, 2005).

   It is crucial for social workers to be able to identify demoralization to more effectively assess risk and to intervene. However, as demoralization is not recognized in the DSM (Clarke & Kissane, 2002), practitioners can be shackled as mental health services do not generally fund treatment for people who do not meet the criteria for a classified diagnosis, and health insurance may not cover demoralization in social work private practice. This creates a problem in meeting criteria for entry into a service.

   Demoralized people may therefore present repeatedly and remain on social work caseloads as their needs are not being met satisfactorily, creating a cycle of deprivation and, for some, a risk of suicide.

   Instruments

   A range of instruments used to measure demoralization have been developed for research and diagnostic purposes. In 2013, de Figueiredo identified five scales that have been used to measure demoralization.

   The early scales, for example Dohrenwend’s Psychiatric Epidemiology Research Interview Demoralization Scale and MMPI-2 Restructured Clinical Scale of Demoralization were developed to measure nonspecific psychological distress rather than demoralization specifically. However, sections of these scales were further developed to measure additional aspects and stages of demoralization. Tecuta et al. (2015) provided a succinct review of the instruments used to measure demoralization.

   A recent and most widely used instrument is the Demoralization Scale-II (DS-II). The DS-II is a self-report questionnaire, initially developed by Kissane et al. (2004) and revised by Robinson et al. (2016), consisting of 16 items that span the dimensions of nonspecific dysphoria, disheartenment, loss of confidence and development of subjective incompetence, loss of meaning, hopelessness and helplessness, social disconnectedness, and a desire to die. The DS-II has been used primarily, but not exclusively, with cancer patients. This scale is freely available, can be easily administered and scored, and is suitable for use in social work practice and research with a range of client groups (see Table 1).

   Table 1: The Demoralization Scale-II
   Item Never Sometimes Often
   1 There is little value in what I can offer others 0 1 2
   2 My life seems pointless 0 1 2
   3 My role in life has been lost 0 1 2
   4 I no longer feel emotionally in control 0 1 2
   5 No one can help 0 1 2
   6 I feel that I cannot help myself 0 1 2
   7 I feel hopeless 0 1 2
   8 I feel irritable 0 1 2
   9 I do not cope well with life 0 1 2
   10 I have a lot of regret about my life 0 1 2
   11 I tend to feel hurt easily 0 1 2
   12 I feel distressed about what is happening 0 1 2
   13 I am not a worthwhile person 0 1 2
   14 I would rather not be alive 0 1 2
   15 I feel quite isolated or alone 0 1 2
   16 I feel trapped by what is happening to me 0 1 2

   For each statement below, please indicate how much (or how strongly) you have felt this way over the last two weeks by circling the corresponding number.

   Scoring instructions:

   Total demoralization score: Sum all 16 items.

   Meaning and Purpose subscale: Sum items 1, 2, 3, 5, 6, 7, 13, and 14.

   Distress and Coping Ability subscale: Sum items 4, 8, 9, 10, 11, 12, 15, and 16.

   Adapted from S. Robinson, D. W. Kissane, J. Brooker, N. Michael, J. Fischer, M. Franco, et al., “Refinement and Revalidation of the Demoralization Scale: The DS-II-Internal Validity,”

   Cancer, 122, 2251–2259 (2016). Reprinted by permission of John Wiley & Sons, Inc.

   THE IMPORTANCE OF DEMORALIZATION IN SOCIAL WORK PRACTICE

   Although the literature on demoralization now spans almost 60 years, contemporary problems of conflict and war, global migrations of people, inequality, food security, climate change, and natural disasters make understanding demoralization of increasing importance to contemporary social work practice and very much relevant to changing world conditions (Frank, 1961; Fronek, 2017).

   Understanding demoralization, how it differs from mental illness, and how to respond are important for social work practitioners when working with vulnerable people for two main reasons. The first is to inform how we can best intervene at both interpersonal and structural levels. The second is to be able to fully assess risk factors for individuals given the potential for suicide and the risk of developing mental illness.

   Groups of people facing adversity and oppression such as those subjected to racism, homophobia, and other forms of discrimination are more vulnerable to demoralization (Young, 1990). Refugees, immigrants, or migrants who experience language barriers, culture shock, and loss of cultural identity and social status can experience an impaired ability to adapt to foreign environments (Briggs, 2011; Briggs & Macleod, 2006).

   Research with refugees and migrants found that unemployment was an important factor in demoralization, and people may be mislabeled as depressed through a nonrecognition of demoralization and cultural misunderstandings (Briggs, 2011, 2013; Kokanovic, Dowrick, Butler, Herrman, & Gunn, 2008). Lee et al. (2012) suggested that full-time employment protects against demoralization because it offers “a sense of usefulness and belonging.” Socio-economic status, age, education levels, loneliness, and other sociodemographic characteristics have been linked to higher rates of demoralization, suicidal ideation, and suicide attempts (Briggs & Cooper, 2015; Butterworth et al., 2006). People who depend on income support, especially the unemployed or those people with disabilities, are more likely to report adverse psychological outcomes and suicidal behaviors compared with those who do not depend on the provision of welfare (Butterworth et al., 2006). People affected by natural disasters can experience demoralization particularly when considerable human and material losses occur (Briggs & Roark, 2013). Kohn (2013) identified demoralization in those people affected by Hurricane Mitch and suggested that measuring demoralization might identify those people at risk of posttraumatic stress disorder.

   Interventions

   To date there is little empirical evidence for the effectiveness of specific interventions in working with demoralized people. There is support for psychotherapy, empathic dialogue, logotherapy, narrative therapy, and interpersonal therapy to normalize any sense of unfairness, to foster resilience and hope, and to adjust cognitive distortions, and social connections (de Figueiredo & Griffith, 2016; Frank, 1974; Griffith, 2018; Kimmel & Levy, 2013; Strada, 2009; Wein, Sulkes, & Stemmer, 2010). The best approaches to demoralization are talking therapies and other psychosocial interventions rather than pharmacological prescriptions, except in cases of concomitant mental illness that might require a combination of biomedical intervention and therapy in multidisciplinary practice (O’Keefe & Ranjith, 2007; Strada, 2009; Wein et al., 2010). Regardless of which theoretical perspective social workers use or where they practice, demoralization is not a redundant issue.

   In the medically ill, especially people with terminal illness, existential crises can trigger demoralization. Strada (2009) recommended an existential approach that addresses meaning-of-life concerns, religion, and spirituality. As existentialism has a close relationship with demoralization, existential approaches to therapeutic interventions are likely to be useful in working with demoralized people.

   According to Payne (2014) existentialism is not only linked to being human, it also focuses on the personal power that people have over their lives and their capacity to change the conditions in which they live. Loss of control is most heightened in those situations that precipitate demoralization, and in such situations people are most vulnerable.

   Demoralization can be triggered by an existential crisis so extreme, hope for the future is eradicated and people struggle to find meaning. Examples of this can be found in the writings of people like Viktor Frankl, who wrote about his survival experience in Nazi concentration camps, and studies on torture victims, prisoners on death row, and today’s refugees and asylum seekers in countries where they live for years in refugee camps or are incarcerated indefinitely (Frankl, 1959/2004; Fronek & Chester, 2016; Schwartz, 2005). An existentialist approach helps people adapt to their changed preexisting assumptions about meaning in their lives rather than seeking to take the pain away.

   Positive psychology provides a sound body of knowledge that can help social workers understand how we might intervene with demoralized people (Snyder & Lopez, 2002). Hopelessness is one of the defining characteristics of demoralization and when hope is lost, risks to the person’s physical and mental health are greater. The loss of hope provides a focal point for social work interventions that seek to regenerate hope to reestablish coping. Cognitive–behavioral therapy has been shown to be less effective for severe demoralization, but certain cognitive strategies have the potential to restore hope and a renewed sense of purpose (Connor & Walton, 2011; Snyder, 1999). Snyder (2000) suggested that people who are hopeful and cope well in adversity have the capacity to find alternative hopeful futures. In other words, they sustain generalized hope or have the ability to generate future visions of a better life while also holding on to smaller, achievable goals. They can hold generalized and specific hopes simultaneously even if they appear contradictory. Thus hope becomes functional.

   Snyder (1999) suggested cognitive strategies to address self-defeating thoughts. Work in palliative care would suggest that people do develop different pathways through demoralization, for example, hope for a good death and hope for their families rather than hope for a cure (McClement & Chochinov, 2008).

   Griffith (2018) suggested that brief psychotherapy is a useful method of intervention to engender hope and to counter demoralization in people with chronic illnesses. He documented discreet scenario-based training modules for psychiatry residency training. The modules are designed around single interventions that use evidence-based hope strategies for use across multiple settings. Assessment, formulation, and interventions are addressed using concrete practical strategies grounded in hope theory. Problem-solving, goal-seeking, emotional regulation, core identity, and relational coping are assessed. The formulation is concerned with mobilizing strengths and hope. Interventions focus on hope-building strategies.

   Saleebey (2000) identified a strengths approach as important in engendering hope and facilitating change for demoralized people. He emphasized how important it is to learn from people who have not become demoralized in the face of oppression and other traumatic situations, and how others have moved through a state of suffering to a more hopeful future.

   A social work perspective would also consider the reality of both external structural factors and interpersonal factors indicating a role for anti-oppressive, radical, and critical approaches that seek to address human rights, oppression, discrimination, and the misuse of power. The case of asylum seekers incarcerated in Australian detention camps who are living without any real hope of release, citizenship, or safety offers a pertinent example (Fronek, 2017). Social workers and other professionals in these settings provided clinical interventions and lobbied for policy change, risking criminal action and incarceration.

   Addressing structural inequalities or laws that breach human rights complements work conducted at an individual level and can be used concurrently with interpersonal approaches. Macro social work practices that seek change at societal and community levels are supported while providing depth to contextual understandings of person-in-environment approaches (Kemp, Whittaker, & Tracy, 1997). It can be argued that for particular groups of people, the prevalence of demoralization may be greatly reduced or indeed eradicated if oppression and injustice are addressed.

   An important factor in demoralization is social isolation and exclusion. A sense of meaning, belonging, and social interaction can be supported through involvement in community groups or volunteer organizations, or through employment (Lee et al., 2012; Strada, 2009). The need to address social support and positive family relationships points to important interventions such as the development of person-specific support systems and family therapies to build stronger relationships, find new life meanings, and combat demoralization (Boscaglia & Clarke, 2007; Walseman, Noblick, & Norris, 2011).

   CONCLUSION

   Demoralization clearly sits in the psychosocial sphere very much in the realm of social work practice.

   Demoralization is a useful concept for understanding nonspecific psychological distress in the people whom social workers see every day (Briggs & Macleod, 2006). As demoralization goes largely unrecognized in social work practice, we wonder about how social workers are intervening.

   Timely and appropriately targeted psychosocial interventions (individual, family, and community) are important to help vulnerable people who are demoralized or at risk of becoming so. To be truly effective social workers need to be able to identify the factors that affect people’s experiences and to know how to best respond to them. Although important, it is insufficient to limit the focus on demoralization to interventions with demoralized individuals or families. A sociopolitical, macro approach to address structural issues that create the external conditions of oppression and discrimination leading to demoralization is also required.

   Although tensions have long existed between micro and macro practices (Austin, Coombs, & Barr, 2005), we suggest that this is a false and unnecessary dichotomy. To work effectively with demoralization, to assess and intervene, social workers must navigate the tensions between approaches that work within systems and those that work toward social reform. Understanding demoralization in micro work requires developing a deep understanding of context, which is rarely achieved by focusing on interpersonal and intrapersonal factors alone. Likewise, the despair and hopelessness of demoralized people should not be forgotten or subsumed by social action. Austin et al. (2005) proposed an ecological approach as a means of bridging this divide and integrating social work practice.

   Clinician–activist and professional–activist identities have also been proposed (Fronek & Chester, 2016; Walz & Groze, 1991).

   Existing research and theoretical exploration suggest that there is a place for demoralization in social work practice and research. The demoralization literature provides clearly defined criteria and a measurement tool, the DS-II, that can be easily incorporated into social work practice and research. Given the dramatic social, economic, political, and environmental issues affecting the lives of people throughout the world, there is an urgent need for empirical research on demoralization in social work practice specifically related to its incidence, the utility and effectiveness of specific micro and macro approaches, client experiences, and how social workers navigate the tensions in practice. SW

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3. Kathy Mohrhardt

   July 10, 2023 at 7:33 pm

   Hello Karen,
   I have a question regarding the following concept:
   “Bringing that out of control object relationship under third party control is the first step in treatment of the issue, failure to do so will cause the child to remain in the double bind position of being asked to change their behaviours whilst still being under the influence of a frightening parent.”

   My daughter is 20 with a 14 month old baby of her own now. She came back to me while pregnant about 2 years ago. When she reunited with me her father pulled away from her (not returning her texts, being too busy for visits/walks, etc). About 3 months ago my daughter became upset with me over something minor and her father again became very involved with her. Since then she hasn’t spoken to me or allowed me to interact with my granddaughter for over 2 months now, in spite of still living here (I have 2 extra bedrooms but her father doesn’t have room for them). Her paternal grandmother is now babysitting when she needs it, and she is back to spending lots of time there.
   I believe that the pressure of her father’s absence when she’s accepting me in her life, has been too difficult for her to live with.
   I obviously have no control over the relationship she has with her father and have no parental influence on her at this point, but I still feel she is experiencing the splitting of self in the same way a child would.
   I’m not pressuring her by asking her to change her behaviour (it took some time to deal with the rejection again and it’s been heart breaking after I supported her, thought I had the relationship back, and bonded with the baby)
   My question is what do I do in this situation with an adult child using primitive defenses?

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   1. Bob Rijs

      July 11, 2023 at 5:56 pm

      That’s the biggest question how to deal with the primitive defense mechanism in a conversation.

      There is no ideal way to handle those conversations, but there is a big difference if the person has respect for the other person, and that’s the biggest problem.

      When there is no respect it is used as a weapon where they want to destabilize your authentic feelings and emotions because there is an allostatic load connected what transference to the other person and the is no time or space to process the allostatic load and own tensions together in those conversations, so they are building the allostatic load to the point that you get an emotional outburst or allostatic overload, anger, and rage will take over and has the function to restore the homeostases.

      Anger and aggression are not accepted because it’s not understood what the function is of those emotions, and there is always another way to deal with them, I can tell you there is non-accapteble way to deal with them because the solution is not accepted by them.

      It feels like a suffocating blanket of distorted reality that is thrown over your existence and has a demoralizing effect on your way of thinking every way you want to resolve the situation is sabotaged by those defense mechanisms, and you are not allowed to do a normal healthy mature reality testing because you are punished for doing that, but when you don’t you punish your self and have to survive in an unbearable situation that in long terms has the same result by the allostatic overload.

      That’s also a Double Bind!

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   2. Bob Rijs

      July 11, 2023 at 6:14 pm

      Self-Esteem and Positive Psychology: Research, Theory, and Practice Christopher J. Mruk, PhD Fourth Edition

      4. Major Self-Esteem Theories and Programs 127

      In addition, excessive avoidance leads to chronic defensiveness, which creates its own burden: In turning away from the truth, we are trapped by it because now we must manage both the conflict and the false solution we offer it. Ultimately, habitual avoidance results in a phenomenon the authors call “impression management,” which means having to maintain a facade as well as continuing to avoid the threat that gave rise to it. This stance toward the world and others requires a massive expenditure of perceptual, psychological, interpersonal, and behavioral energies.

      The more we choose avoiding over coping, the more likely serious distortions and unrealistic behaviors are to occur. If impression management continues long enough, then low self-esteem develops and with it comes an increased sensitivity to threats or even the possibility of threats.

      Eventually, this self-fulfilling prophecy leads to more serious difficulties, including the development of abnormal or pathological behavior.

      Of course, the healthy way to deal with conflict is to cope, and coping works the same way: Conflicts arise, we respond, and sooner or later these patterns also become self-fulfilling. The difference is that these dynamics are based on facing the problem honestly, tolerating discomfort and uncertainty while doing so, taking psychological risks associated with being open to one’s shortcomings, and, above all, taking responsibility for one’s actions. Either way, Bednar et al. make it clear that most of us eventually tend in one direction more than the other and the patterns become set.

      From this position, changing self-esteem must be based on the laws governing feedback, circularity, and self-regulation. The authors point out, for instance, that to survive, complex systems can never really be completely closed; they must always maintain the ability to adapt to changes in the environment because change is an environmental fact. Hence, new kinds of feedback can affect old patterns so that significant changes may occur. It is even possible for new homeostatic balance to be reached. In this case, the most effective way to increase self-esteem is quite clear: Stop avoiding conflicts and begin to face them. If this new and positive information is entered into the self-esteem frequently or powerfully enough (feedback), then the system ought to respond (circularity). Such an adjustment (self-regulation) would change the self-fulfilling nature to a more virtuous cycle of higher self-esteem instead of the vicious one associated with lower self-esteem.

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   3. karenwoodall

      July 12, 2023 at 7:50 am

      HiKathy,

      The first thing to do is to let go of the fear of losing your daughter and granddaughter which is the controlling factor in forcing you to accept this behaviour from your daughter whilst she is still living in your home. Whilst you have rebuilt the relationship only to find that the repair was fragile (evidenced by her continued vulnerability to her father’s influence on the basis of a minor issue with you), you also know that the attachment she has with you is not possible to break (as evidenced by the return to you when she was pregnant). The fear you feel is based upon a false belief that attachment is breakable and it isn’t, so lose the fear that if you act you will lose your daughter and granddaughter forever).

      Then you must begin to think about where to put boundaries in place and it seems to me that living in your home whilst blocking you from having any contact with your granddaughter is a violation of your boundaries. You do still have parental influence, she is living in your home and you must find a way to explain to your daughter that blocking you from having contact with your granddaughter whilst she is living in your home is not healthy and you are not going to accept it.

      Your fear of total loss is what is being used to control you in this situation but when you understand that this is an attachment maladaptation which is caused by her father’s power and control over her, you will begin to lose your fear of total loss and start to see that the boundary violations which are being carried out against you are part of a pattern of control over you exercised by her father and family and now continuing into the future via control over your granddaughter.

      So begin with a conversation with your daughter, however difficult, in which you explain that living in your home with you and preventing you from contact with your granddaughter is a form of control which will hurt your granddaughter who has bonded with you as well as you. Explain to your daughter that she is free to have a relationship with her father and his family of course she is, but you are a grandmother too and you gave her the support she needed and you always will be there for her as her mother, however you cannot and will not allow her to continue to cut you out of your granddaughter’s life whilst she is living in your home.

      You cannot be passive in a situation where primitive defences are in play, you MUST hold boundaries. Your daughter is still vulnerable to splitting as she is only 20 years old which means her capacity for perspective and decision making is poor and she is likely to shift back and forth in terms of splitting over the next years until she can make sense of what has been happening (which requires a fully developed capacity in the brain which matures at the end of the twenties).

      You can help her to move to an integrated place of understanding by holding boundaries whilst remaining open in your heart and mind to helping her.

      In our Holding up a Healthy Mirror course we focus on stabilisation of the self as an anchor for helping children of all ages to integrate the split state of mind. Working with the self first requires an understanding of what alienation is and how it impacts upon you as the parent in the rejected position. You will be able to watch on demand soon.

      Begin with the boundary violation in your home and speak firmly but kindly to your daughter. If her reaction is to threaten to leave your home stand firmly but gently up for holding the boundary in place. Do not get into pleading or entanglement with her allegations of blame but hold the line cleanly – you have bonded with your granddaughter, she is living in your home, there must be a compromise so that you can spend time with your granddaughter at least otherwise there is harm being caused and it is not ok to cause harm to others whilst living in your home.

      Asking her to change her behaviours is not pressuring her, it is holding the boundary that her father has taught her to violate, hold that boundary and expect her to respect you – primitive defences are not personality disorders and they often, in the case of children, respond well to holding boundaries firmly but kindly.

      I will write more about this in the coming days to help you and others coping in this kind of situation.

      K

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      1. Kathy Mohrhardt

         July 15, 2023 at 4:40 am

         Hello Karen,
         Thank you for your response and putting into words what I need to say. I understand the violation of my boundaries and the harm of her actions. I have spoken to my daughter about this and firmly but kindly said what you suggested.
         But she has let me know that she has the right to act in this way toward me and will continue to do so. Unfortunately she is getting a great deal of support from her grandma and father and from others, including a counselor.

         In order to hold my boundary I’m going to have to ask her to leave and then make that happen. This is extremely hard as I know I won’t see her again for a very long time after I do that. As much as I’d like to hope she might change her behaviour or compromise, It won’t happen at this time.

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      2. karenwoodall

         July 15, 2023 at 10:20 am

         Kathy, I am sending you my support, this is indeed very difficult for you but it is necessary to hold your boundary to prevent her father and his family from abusing you further through this mechanism.

         When you do hold the boundary, make sure that you write down your reasons for doing so in a truth letter, I am going to write this now for the blog so that you can see it and use it as a template. Sending you my very best Karen

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      3. Kathy Mohrhardt

         July 28, 2023 at 5:50 pm

         Thank you for your support Karen. It has helped me as the situation with my daughter has turned again. I do struggle with boundaries and even understanding how to hold boundaries without there being a “consequence” but I am learning.
         The counselling that both my daughter and I have recently received (separately) has actually made everything worse, unfortunately.

         I’m wondering if you know of any counselors in my area who understands the splitting and has training in these concepts. I’m from London, Ontario. If I had a name on hand then I might take advantage of any opportunity that may come up in the future with my daughter. Right now I don’t think there’s any possibility as she is convinced that I was a monster toward her in her childhood and she will not interact with me at all.

         Sincerely,

         Kathy Mohrhardt

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      4. karenwoodall

         July 29, 2023 at 10:25 am

         Kathy you will find our Holding up a Healthy Mirror course helpful I am running it live again from September – it covers all aspects of boundary holding, therapuetic parenting and working with the attachment maladaptations you are coping with, you will find out more at http://www.familyseparationclinic.co.uk

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      5. Kathy Mohrhardt

         August 18, 2023 at 9:18 am

         Karen, I did take the course “Holding up a Healthy Mirror” previously.
         Is there anything new in this upcoming one that would make it helpful to take again, or can I take the next course you mentioned that builds on these principals?

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      6. karenwoodall

         August 18, 2023 at 9:35 am

         yes I am running the Higher Level Course again on a week in November, details very soon. K

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      7. Kathy Mohrhardt

         November 26, 2023 at 2:23 pm

         Hello Karen. I appreciate how busy you are. I will keep this short in hopes you have a minute to read it.
         I ended up asking my daughter to leave. I had to change the locks. I had barely seen her for 2 months anyway so I knew she had places to go.
         After 6 months she still wouldn’t speak to me and was continuing to block contact between myself and my 9ne year old granddaughter while living in my home. And her paternal grandmother became involved so I knew I had no hope. After telling her and writing in a Truth letter how I cannot allow that kind of harm to happen in my home her only response was “what are you going to do?”.
         I acknowledged her birthday Nov 20 with a truth letter (according to your article on truth letters). I also sent her an e-gift card in the amount I would normally give for her birthday.
         My question is, should I continue to give her gifts on special occasions, or only a Truth letter? I’m not sure if it was right to give her a birthday gift. is that confusing to her? Because in her mind and I’m sure the minds of others supporting her, I abandoned her. Christmas is coming as well so I’d like to know I’m doing the right thing.
         My plan is to write her every fortnight.

         Sincerely,
         Kathy

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      8. karenwoodall

         November 26, 2023 at 4:15 pm

         Hi Kathy, I think it is always important to keep sending gifts as you would normally do but make them tokens rather than big gifts. When you send a gift send a short card to let hr know you will always be there, It isn’t confusing to give her a birthdaytgift, remember that part of her is still the healthy child you remember, you should also give a small Christmas gift and each time you communicate remind her she is loved and that you are there when she is ready. K

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      9. Kathy Mohrhardt

         September 8, 2023 at 3:01 pm

         Hello Karen,
         I’m wondering if taking the course again is necessary? I want to explain a scenario that just happened in my home that left me feeling helpless and astounded.
         My 20 year old daughter lives with me (hasn’t spoken to me in several months and won’t allow my granddaughter to see or interact with me). I held a boundary like you said, wrote it in a letter and her response was to go somewhere else for the summer but she’s back now as I’m now back to work therefore gone all day. She started receiving government financial assistance so she’s been paying rent. She paid rent while she was away. I tried to discuss this with her to say there’s no need to pay rent when she’s not here. She would not respond to me. She also insinuated that she had an apartment lined up and sent me a request for a “tenant review” which I gave positively. I assumed she would be moving at the beginning of September but then she sent rent again for September 1st and came back when I went back to work.
         This morning I had an appointment so came back home for a bit before I return to work in the afternoon. She wasn’t expecting me. When I walked in, she wisked my granddaughter upstairs and stayed there.
         Then a knock on the door and it’s paternal grandma who was very kind and chatty with me. Then my daughter brought my granddaughter down, hid her eyes from me and handed her to her grandmother to take to her home to babysit while my daughter goes to her college classes.
         I’m wondering as I write this if I should have sent the rent money back to my daughter when she was gone. And maybe I can still return the rent for the time she’s been away and for September since i had assumed she wouldn’t be back. She’s using the rent as a way to control my home.
         Very perplexed,
         Kathy

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4. Working with Primitive Defences and Part Selves: Understanding Treatment of Alienation in Children of Divorce and Separation – Het Verloren Kind

   July 19, 2023 at 6:00 am

   […] Working with Primitive Defences and Part Selves: Understanding Treatment of Alienation in Children o… […]

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   1. Kathy Mohrhardt

      July 29, 2024 at 12:57 pm

      Hello Karen,

      I’ve been checking your website for letter writing templates. I have one from your course, “Writing to Your Alienated Child”, but I understood you had different templates that you would be posting soon. I’ve been using the same one for a while now and I’d like to change it up a bit. I’m very worried about saying the wrong thing and making it worse.

      Also, I’ve been writing every two weeks for over a year. Is it OK to start writing more often?

      Sincerely with warm regards,

      Kathy Mohrhardt (Ontario, Canada)

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