A brilliant young man I know has been stuck in a pattern of self-destructive behavior and constant and terrifying self-criticism. Nothing seems to be helping him get out of this cycle. We have thoughtful conversations about the problem and come up with various solutions but then, the next time we get together, the behavior remains unchanged.
I often feel as though in my conversations with him we are talking about a third person – this mysterious other Paul, who is such a tough nut to crack….
Thinking about this pattern I decided I would try to diagram what was going on as though we were talking about the interactions of several people. And used the model that I often find helpful of an internal Child, Adult and Parent.
This is what I came up with:
Paul’s internal Parent has struck a deal with his internal Child – you get to do all the acting out you want to, staying up late at night, not doing your work, using drugs and drinking too much, if I can mercilessly chastise you in the morning.
Thinking about this some more I realized that this “deal” was actually just a recreation of the pattern from his childhood.
His mother suffered from debilitating depression and was often not around to prevent Paul from getting into trouble, but then would come across the unavoidable evidence of his misbehavior and would tear into him with a ferocity no doubt driven by anxiety and guilt. 
Missing in action in this equation is, and was, the competent adult.
And my own discussions with Paul often involved this Adult who seemed baffled about what to do…
As is often the case, the value of this conceptualization will revolve around its ability to call attention to a process that has been happening largely outside full awareness. Will Paul be able to notice the cycle of acting out and then self criticism in real time and change that pattern? Time will tell.
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