Impulsivity and Its Bioenergetic Relationship to ADHD
Peter A. Crist, M.D.
Reprinted from the Journal of Orgonomy, Vol. 29 No. 2
The American College of Orgonomy

Family Therapy

While addressing J's impulsivity in his individual sessions, it was also essential to improve the emotional environment at home and change the family dynamics that perpetuated his behavior. To accomplish this, J's mother was seen individually. This began in the first year of J's therapy and continued throughout. In addition, intermittent sessions with the parents were held and were valuable in getting them to work together in addressing J's behavior.

Initially, the mother's therapy focused on educating her and giving practical advice about how to deal with J. She needed to learn and accept that his behavior was not just a variation of normal liveliness and that for his sake she must stand up to him. In her heart she knew both of these things to be true but did not want to believe so. This was an example of a typical pattern throughout her therapy. She usually had good instincts as to what to do but became anxious about the implications of following through. She then thought of numerous possible responses and became confused. She lost sight of the import of her original instinct and talked herself out of acting on it. J's mother either minimized his behavior or reacted to each new incident as if it were an overwhelming crisis: being aggressive with other pupils at school, stealing while on a field trip or at home, yelling out whenever he did not get his way, striking out at and being mean to his younger sister, etc. She was encouraged to look at each situation as part of an overall pattern of impulsivity that required containment but also as a discrete problem that could be addressed practically. She gradually gained perspective about J's problems and an ability to tolerate her anxiety looking at them without becoming overwhelmed. Over the course of the first months of her therapy, J's mother began to see how his impulsive behavior was aggravated whenever she gave in to his demands. She needed a great deal of encouragement to stand firm in the face of his neurotic behavior (because when she disciplined him she felt guilty that she had made him feel badly and had not made everything "good" for him).

She also came to see that rather than feel guilty for her presumed role in the genesis of J's problems, she clung to the illusion that they were not so severe. When she saw how serious they indeed were, she blamed herself for having caused them and felt she had to make up for it in some way. I told her that blaming herself and trying to make up for the past was not helpful and interfered with J taking responsibility for his actions. I encouraged her to stand up to his misbehavior because that was what she could constructively do. It also became clear to her that J was instinctively aware of her guilt and played on it manipulatively. I explained that the health in him expected and needed discipline. If it were not forthcoming he would have contempt and lose respect for her which would, in turn, fuel his neurotic arrogance and lead to further misbehavior.

Helping her to tolerate feeling guilty and seeing its destructive function led her to face the anxiety that drove her to assuage her conscience by trying to take care of everything for J. She also had to be encouraged to stand her own anxiety for allowing J to fail when he did not take responsibility for a school project. She began to see that trying to protect him from discomfort relieved him of responsibility. As she let J take more responsibility and felt more secure that her husband would spend more time with him, she no longer felt overwhelmed and became calmer. She saw how her life was consumed by taking care of J and attending to his problems. She dared to think about making a life for herself beyond child care.

Meanwhile, both parents were seen in couples therapy to help them work together in raising J. The polarization of their views on J was addressed but this was only minimally successful in overcoming the serious marital tensions between them. Their relationship was of a volatile type (5). In the first session they were shouting recriminations at each other about who was to blame for J's problems. This made it impossible to directly address their marital difficulties. To be of value, therefore, these sessions had to be kept focused on practical issues that required working together to overcome J's misbehavior. Early on, the issue of how they were dealing with his dishonesty came up for discussion. J often spun elaborate cover-up stories for his behavior. His father wanted to punish him for his misbehavior once the truth was known. His mother wanted to be understanding and show him they trusted him in order to get him to be trustworthy. I pointed out that the lying about his misdeeds had to be dealt with before the deeds themselves were addressed, and that trust was to be earned not granted. Punishing misbehavior without first addressing the dishonesty would cause J to become sneakier and more devious in hiding his behavior. A step-by-step approach to his dishonesty was developed in my discussions with them. First, they needed to make him aware of his dishonesty by consistently telling him they did not trust him or what he said. Second, they had to encourage him to come clean about his lying by praising him when he was truthful and withdrawing a privilege when he was caught in a lie. Finally, it was essential that they wait to discipline him for misbehavior until he had been consistently honest about it. With this approach they found that he became more inclined to reveal when he had lied. By the fourth year of therapy, although he occasionally lied, he more consistently acknowledged the truth.

It was emphasized that they needed to model the behavior they expected of him. If they wanted him to be as good as his word they had to be as well. Their past actions showed otherwise. When J misbehaved, the mother tried to reason with him and then finally, out of frustration, often threatened dire consequences. Rarely did she follow through. Also, the father harangued J endlessly about present and future consequences of his misbehavior. The sheer quantity of their words rendered them ineffective.

I also informed them that if they expected J to listen to them, they had to listen to him. By the time they brought him for therapy, they no longer believed anything he said and no longer really listened to him. They were not even aware when he said something genuine. I encouraged them to pay attention to how J was saying things and to respond to that rather than to what he said. If they did not believe him, I advised them to simply tell him so. The parents were also at a loss as to how to discipline J when he was first brought to therapy. He acted unconcerned about their personal disapproval or praise. They came to see that J, a physical, quick-reacting, action-oriented person, would most likely respond to communication with similar qualities. They were advised to try, as much as possible, physically restraining him or taking immediate actions that set limits on his behavior. Verbal cajoling, long explanations, and lectures by either parent were pointed out as being of no benefit. Finally, as much as he might provoke them, physically striking him was to be avoided because this gave the message that striking out was an appropriate way to handle anger. More importantly, as a response to his provocative (masochistic) behavior, it would actually gratify his neurotic reactions.

Over the five years of J's therapy tension between his parents eased noticeably. Much of this resulted from the mother being able to respond to her emotions without reacting so intensely to her husband and from the father taking practical steps to resolve stressful complications of his work. In J's third year of therapy his father sold his company, took a partial early retirement, and began to work more from home. Only then did he begin to see and experience for himself the day today difficulties in dealing with J. He developed a better appreciation for what his wife was confronted with but still had difficulty letting go of the view that his was the best way to manage J. At the same time this change meant that he became more available and was more involved with J, disciplining him, helping with homework, and taking him to his various sporting events.

In his fifth year of therapy J, now age eleven, still acted rebelliously toward authority figures on occasion. His distrust and contempt of me as an authority figure became even more pronounced. I told him he was treating me with disrespect and that I thought he caused himself a lot of trouble by being disrespectful. He responded, "Well, I treat my parents with respect." When asked how he could say that he replied, "If I didn't they'd ground me." This made it clear that he expected to be disciplined by his parents, but remarried unaware of the quality of his behavior.

He became increasingly defiant with me while simultaneously acting more responsibly at home and in school. For a number of weeks I held him more to my expectations about lying still on the couch and called him on his attempts to sneak out of doing so. He was more fidgety and would not stop moving about. His resistance became increasingly emotional in character and he was, in effect, saying, "I won't lie still" rather than "I can't lie still." By physically restraining him at this point, a deeper defiance was brought to the surface. While restrained as much as possible, he continued at each opportunity to sneak some movement with a defiant expression on his face. I told him to just be direct and say, "No." Now he refused to even do this. He gave me his usual sly look and closed his eyes. I said, "Go on, be straight about your feelings. Say "No way, I won't,' because that's what your actions are saying." He defiantly turned his head away without a word. I managed to hold his arms with one hand and grasped his chin and moved his head back and forth in an expression of "No" while telling him, "That's it; go on and let the 'No!' out." He looked flustered, off balance, and a little anxious at not being able to control the situation.

These expressions quickly changed to a more defiant attitude. I continued to shake his head and as he resisted, I persisted. He became flushed and gave me a furious look. I encouraged him saying, "Go on. Let it come out of your eyes and mouth. Say what you want to say to me." He continued angry at me, with a greater intensity than ever, and gave me murderous glances. When I ended the session, he left seething with anger. Later in the week the mother asked, "What did you do with J? For a day and a half after his session he kept telling me and his father about how he was angry with you and had told you how much he hated you. He was different about this than ever before. He didn't just say he wasn't coming back. He was explicit about being angry and how he told you off. He was so clear about it that I wondered what really happened." I told her, "Yes, he was angry with me but he never said a word. I think what he said to you was partly his bravado about what a brave 'big-shot' he was with me." She also reported that for the next several days after that session he was able to sit down more focused than ever and got his school work done without the usual delaying tactics and struggle with her.

The following week he promptly came into the treatment room when I called him. He lay down and spontaneously began talking to me quite openly, as one human being to another, "A lot happened this week." I replied, "Like what?" "My godfather died but I didn't know he was my godfather because I don't remember ever seeing him. He was a good friend of my parents. My mom was upset and crying all the time with red eyes and stuff. I didn't cry. I didn't really feel anything. I didn't really know him. I felt a lot sadder when my fish and my dog died. Is that weird?" I said, "No, of course not. You knew them and they meant something to you." He had not previously acknowledged sadness to me either in himself or in others. His mother later reported that he was mostly well-behaved for the rest of the week. She did say, "He drove me crazy though, by putting off a big homework project until the last minute. I have to admit that he really buckled down and worked hours and hours the two days before it was due, even though the last night his father and I were out and he was with a babysitter."

At his next session his defiance of me was back in full force. He again required physical restraint to stay still. When I persisted, he became angry again but this time was near tears by the end of the session and walked out visibly shaken. He quietly went and sat in a corner of the waiting room. Later his mother reported that she let him sit quietly for a while and then on his own he came over to her and with tears in his eyes asked for a hug. He told her I had hurt him by grabbing his jaw where he had braces. She told me he rarely came to her for comfort. I told her he was clearly upset by what had happened with me but evidently found it far easier to complain about being physically hurt than emotionally hurt. In fact, I had not applied pressure over his teeth and had held his jaw less tightly than two weeks earlier. This was an important event because he had let himself be emotionally vulnerable in asking for comfort.

At his next session he came in, lay down, and began the conversation. He said quite excitedly and proudly that he thought he would get a top grade on his next report card for the first time ever. I told him I looked forward to seeing it and he must feel good about himself. He responded quite genuinely, "Yeah, I've been doing much better at school for a few weeks. I've also been good at home. I think I've turned over a new leaf. Even my dad thinks so." Then, for the very first time, he told me of his disappointments with his parents. "They don't keep their promises. My dad is quick to promise something but then decides later to change his mind. My mom doesn't keep her promises not because she changes her mind but because she gets so distracted that she doesn't remember what she said." (Both of these observations were quite accurate.) His mother was now reporting that he was "like a new kid." He had come to her for a hug on a number of occasions just to make physical contact. He also was well-focused on his school work. He had been promised that he could play in the intramural sports program if he got his schoolwork done. When he failed to do so the previous week and was told he could not play, he responded with disbelief, "You're not really going to keep me from playing are you?" She said it was difficult for her to hold him to their agreement because he was so upset. His response, however, was very different than other times when he did not get his way.

There were no angry outbursts and he did not become devious. Instead he told her just how much he wanted to play. She said it was the first time she ever saw him show, emotionally, that something mattered so much to him. He then got very busy and made sure that his schoolwork was done so that he would be able to play the next week.

The central theme and process of J's therapy were played out in this fashion. When his defensive actions were stopped, emotions were stirred up spontaneously. He would then lash out or assume an "in-charge-tough-guy" attitude of defiance to avoid these feelings. When he was able to experience his emotions (whether desire, anger, anxiety, or sadness) and directly express them, he calmed down and could focus on his school work or on what he needed to do to get what he wanted. The most lasting effect came when he tolerated anxiety and sadness, the emotions associated with energetic contraction. He was then able to feel genuinely good about himself and take responsibility for something that mattered to him. It also meant that he could more accurately perceive and express himself about other people (as he did about his parents).

Case Discussion

J's behaviors such as calling out, having angry outbursts, hitting his sister, lying, and stealing represented a deeply ingrained defense mechanism to prevent the development of any emotional tension. When he was first brought to therapy, his impulsive behavior was the problem that caused him most trouble at home and in school. It was also the central mechanism his character that had to be addressed in the course of his therapy. Therapeutically, the task was to bring him in contact with his underlying emotions by preventing him from behaving neurotically. He had phallic narcissistic character defenses (such as acting like a "big-shot," and trying to control everybody including teachers, parents and me), but these determined the quality of how he behaved impulsively rather than being representative of his central character structure. It is reasonably certain that his central defense of impulsivity defines his character structure as an impulsive, but because he is still a child, and has not passed through puberty, we cannot yet be sure how this will manifest in his final personality.

It appears that J's pathological character evolved from qualities that were inborn. We know from his mother's account that J was highly demanding, insistent, bright, and emotionally changeable from birth. These basic natural qualities manifested in distorted, exaggerated, and pathological form in his impulsivity, pushiness, sneaky cleverness, and conning behavior. He evidently was born with a high-energy charge and by nature was giggly reactive to internal and external stimuli. These reactions became automatic defenses against anxiety and were further reinforced by the parents' inability to cope with his intense emotional responses. It is worth noting that J did not have the dramatically chaotic upbringing often associated the impulsive character, but the amount and kind of discipline he received was evidently inadequate for his individual needs. [Footnote 3]

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