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A Murderous Impulse Page 3

After a seemingly interminable number of calls, I finally did locate a psychiatrist who met these criteria.  He was prepared to prescribe the needed stabilizing medication immediately, to work with Roland on the emotional issues after that, and to see him right away. I phoned Roland and explained to him that it would be more satisfactory for him to work in therapy with the person who would be prescribing his medication and that I had told the psychiatrist all that Roland had told me (he had signed a disclosure form when he came into my office), and that this doctor thought he could be of real help.   I thought it would comfort Roland to know that the psychiatrist would be seeing him with “eyes open”, so to speak, with respect to the seriousness of his condition and the imminent situation.  He might not have gone to him otherwise.

Fortunately the referral worked out.  Roland did not harm anybody.  He continued to see the psychiatrist for quite a while.  He really got along with him and my assessment of his underlying positive motivation was correct – Roland cooperated both with the medication regime and with the treatment.

But the aftermath of this incident, for me, was great self-questioning and thinking through. What did my mistake in using EFT in the manner I did with Roland have to teach me and others about this wonderful technique?  I discussed the case extensively with colleagues who highly value EFT as I do, and eventually arrived at some conclusions and instituted some guidelines with respect to the use of EFT with clients who have serious problems with impulse control.  I will put these out here for all of you to react to, and I would be interested in receiving any feedback you may have with respect to your own cases where you have used EFT with clients who were suffering from poor impulse control. What has been your experience with this?

My experience has been that EFT can be highly effective for dealing with bouts of unreasonable anger and that it can and should be used for this purpose.  However, I feel that certain precautions should be followed when applying EFT to angry or murderous impulses.  When we use it for clients who have a tendency to “act out” their aggression in real life in a violent manner rather than suffering from it internally or expressing it verbally, we need to be careful not to make the mistake I did with Roland and which some of my supervisees have reported making as well.

I find that with such impulse-laden clients, often the only thing that lies between them and acting out their rage is their fear of never being able to live with themselves, were they to act out their aggression and hurt or kill someone.  In this instance “guilt” has a great practical usefulness, destructive as it usually is and one of our great trouble makers under so many other circumstances; it can literally be a life-saver here.

[Note from Gary Craig:  I have had several conversations over the years regarding whether or not guilt is really a deterrent to inappropriate or criminal behavior.  One could argue, for example, that guilt is the CAUSE of violent behavior--not its protector.  Why?  Because someone who has been taught by their parents, church, etc. that they are sinful and guilty can build intense anger about themselves that cries for expression in violent behavior.  Is it possible in Roland's case that a guilt ridden psyche had causal effect on his paranoid schizophrenia?  Who knows?  It would be speculation at this point.  This is not to detract from Pat's comment, however.  This man appears to be seriously ill and thus debate over labels may not mean much.]

Pat continues:  The problem arises when someone like Roland, who had a delusional system which made him feel “bugged” by a man he hated in his office (persecuted by him) has been controlling their wish to kill that person by some form of self-confrontation and self-condemnation for their murderous impulse. To attempt to remove the self-condemnation FIRST (as I mistakenly did with Roland) might be to invite the irrational delusional system to take over and convince the person that their explosive impulses are fine, justified and acceptable.  Obviously this is distorted reasoning on the client’s part and a misinterpretation of the Reminder Phrase, but psychosis is a form of distorted thinking to start with.  The point is that we don’t want to inadvertently aid the irrational process.

What was inappropriate in my application of EFT to Roland is not that I used EFT with him, but how I did so.  I made the mistake of having him say set-up and reminder phrases which encouraged him to accept his RAGE toward his daughter, rather than accepting the daughter herself or any pain he himself may have suffered in the past around these issues.  I reasoned that acceptance of an emotion such as anger would make it more manageable for this is often the case with people who have good control over their own impulses -- I have seen EFT work many times to clear anger for such people by helping them to accept it.  In a person with a serious disturbance of impulse control, however, an altogether different situation occurs and I recommend using EFT in one of the following ways.

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