Hair pulling (Tictotelemania) Part 2

Question
After I wrote you, before I received your reply, I saw her again-----this time she expressed feelings of "not wanting to sit still and just talk"--to which I replied that we don't have to do that next time---that she can bring her beloved drawing materials and we can do some art work together---(By the way---you mentioned this in your reply to me---do you have any images which draw the focus in, which she could color? I would be happy to pay you if you could fax/send/email one or more to me) Then she remarked that she doesn't like to just "relax" and listen to the tapes (Though I had suggested she simply 'plug in with earphones while falling asleep)----but, my suspicion is that she is trying to tell me that, for whatever reasons, she may not really WANT to be done with this problem--So, maybe it's just truly an issue of her needing to be more "active" in our actual sessions, which I could certainly accommodate------OR----she may be pulling back from "therapy" ?? I had assured her that even after she has completely stopped pulling her hair, that she and I can always have a phone relationship. I do know (based on what the mother and the child herself have told me that the father is abusive. To what extent, I 'm not sure---but the mother excuses his tirades against the daughter by saying he's frustrated at not being able to help her. According to her, he has grabbed the child, jerked her to a mirror and yelled at her to LOOK at herself and to SEE what she's doing to herself!!!! Yesterday when she arrived for her session she was visibly upset and mother explained that dad had yelled at her again before they came---of course, according to mom---dad is putting down the whole idea of hypnosis being of any help------even though she has, for the first time since she started pulling 8 months ago been able to go for a week at a time without pulling---I have explained to mom that it is a process and she seems willing so far to give it time. I started seeing my client with sessions two weeks apart, but have changed to weekly visits at the mother's request and with my agreement that the weekly sessions may work better. I have some intuition that somehow the underlying "gain" that she may be experiencing is kin to the type of "control" that the anorexic feels------that is, what seems like it could be an abusive household, she has found this "area" which she has "control" of-------does that make any sense to you? Remember, I have NO psychology experience, and am going mostly on instinct here. In fact, I think if it hadn't been for the reading I've done of your script books, and having discovered you on the web, I might not have ventured into the arena of working with children at all ! I do love them, and they seem to relate quickly and easily to me----so the rapport is never a problem. It's just knowing the best ways to help them! This session I was able to have her tell me in more detail about the actual episodes themselves. Sometimes it's when she's looking in the mirror and just touching her hair---the next thing you know she becomes fascinated with one and begins pulling and then "clicks out"(her term) mentally for a while---until she realizes she's doing it. Other times it happens while she's watching TV. Once she told me that it would happen when she was playing with her Barbie's hair---when one of Barbie's hairs would come out it would "trigger" her to pull her own. Sometimes it has to do with light hitting a specific hair in a certain way that will "attract" her to pull it---other times it's the feel of a certain one that gets her started. She has gone at times for 30 minutes before she has "clicked back in" and realized she was in that pulling trance-she even admits to one episode lasting an hour by the clock. I asked her if she has any insight into times when she's more likely to pull and she said it does matter what kind of day she's had-----if it has been stressful at school or if she has argued with her dad at home. When I asked her this session to list the things she most wants to change about herself, she listed her "attitude" in talking back to Dad, as one. So, when you really don't know for sure what's happening at home---how do you know whether the child is being manipulative with you or when you are hearing the truth?? Is it that the truth as she perceives it is the ONLY truth I need to be concerned with?? Do I need to spend some more time with mom trying to get more facts? My client claims that she uses the self-hypno technique I taught her (focusing her mind on a single digit number while touching two fingers together, taking two deep breaths and on the second exhale telling herself to "let go and relax"). I have used the direct suggestion in one session that any time her hand reaches for her hair, it will become very relaxed and just be able to touch the hair without pulling. When do I know when I am at the end of what I am able to do for her? I know it will be difficult to answer so many questions that appear here in no order. But thank you for your time and for any and all advice you have for me.

Answer
Your insights seem right on target to me, and would have been where my own mind would have gone if this were my client. Father is obviously a big problem. This is the difficulty working with children - you always have the parents to deal with. Just as with adults, you are left with the child's perceptions of a situation. We never really know the "truth" whether with adults or children, although I think most children may be more direct and open than adults with us, for the most part. I'd get really direct and STRONG with Dad, telling him that his reactions to his daughter only aggravate the situation. Also, it's no surprise that she would have difficulty with the hypnosis when Dad probably is pretty vocal about his opinion concerning it. An addition to what you're doing, since she's not a "listener", is to create a box with some shiny magic stones (various colored polished stones from your nearest crystal store) and have her choose one that she'll carry in her pocket to remind herself of "NOT' pulling her hair. Or, she can sleep with it under her pillow, making a wish upon it that she will have hair like Cinderella or Sleeping Beauty, or the like. Just a thought. The diagrams are yours - there are several that the kids like. I'll run off some and you can send a buck to handle the time and cost if you want to. Just let me know your snail mail address. Good luck, Del