The Transactional Analyst in Action: Clinical Seminars

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This book represents a synthesis of more than thirty years dedicated to the spreading and teaching of transactional analysis, and will be useful to students, directors and professors of the schools of transactional analysis, and also to therapists of other schools, providing an up-to-date and complete idea of the current state of the analytic transactional methodology. The handbook describes the epistemological and methodological roots for a well-grounded psychotherapy with transactional analysis (TA): differences among method, methodology, therapeutic plan, and strategy and technique are all illustrated. TA is presented as a phenomenological branch of modern relational psychoanalysis. Transference and counter-transference are reconsidered in a Bernean perspective. The four strategic phases of alliance, decontamination, deconfusion, and relearning are presented, together with the well-known techniques of the eight Bernean therapeutic operations, two and three-chairs work, redecision technique, and dream-work. The major transactional analysis schools of psychodynamic TA, integrative psychotherapy, and redecison school are summarized and compared. The author's theory of unconscious communication and of 'six steps' for the first interview are introduced. Many clinical cases help the reader to assimilate the different concepts.The topics are presented in a way to offer both students and psychotherapists an integrated version of what the current panorama of transactional techniques offers, in particular those of a psychodynamic orientation, but giving ample space to the redecisional techniques.

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Chapter One: General Principles

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CHAPTER ONE

General principles

The Lobster

“A long time ago, when the world had been recently created, a certain lobster decided that the Creator had made a mistake. So he made an appointment with Him to discuss the question. ‘With all due respect’ said the lobster, ‘I would like to protest about the way you designed my shell. You see, no sooner do I get used to my outer covering than I have to abandon it for another uncomfortable one, and, above all, it's a waste of time.’ To this the Creator replied: ‘I understand, but do you realise that it is precisely the leaving of a covering that allows you to go forth and grow inside another one?’ ‘But I like myself the way I am,’ said the lobster. ‘You really decided that?’ asked the Creator. ‘Of course,’ replied the lobster. ‘Very good,’ smiled the Creator, ‘from now on, your shell won't change and you will continue to be as you are now.’ ‘Very kind of You,’ said the lobster and he left. The lobster was very happy to be able to wear the same old shell, but day after day, that which at first was a light and comfortable protection started to become a cumbersome and uncomfortable one. In the end, he got to the point where he could not even breathe any more inside his old shell. So, with great effort, he returned to talk to the Creator. ‘With all due respect,’ whispered the lobster, ‘contrary to what you had promised me, my shell has not remained the same. It tightens more and more.’ ‘Certainly not,’ said the Creator, ‘your shell might have become harder with the passage of time, but it remained the same size. You changed inside, inside of the shell.’ The Creator continued: ‘You see, everything changes continuously. No one remains the same. That is the way I created things. The most interesting possibility that you have is to be able to leave your old shell when you grow.’ ‘Ah…I understand!’ said the lobster, ‘but You have to admit that that is quite uncomfortable.’ ‘Yes,’ replied the Creator, ‘but remember…each change brings with it the possibility of discomfort…together with the great joy of discovering new aspects of yourself. But you can't have one without the other.’ ‘All of that is very wise,’ said the lobster. ‘If you allow me, I will tell you something more,’ said the Creator. ‘I pray you, do!’ replied the lobster. ‘Each time that you leave your old shell and decide to grow, you will construct a new strength inside of you. And in this strength, you will find a new capacity to love yourself and to love those who are near you, to love life itself. This is my plan for each one of you.’”

 

Chapter Two: Change in Transactional Analysis

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CHAPTER TWO

Change in transactional analysis

The change

Eric Berne, as a doctor, was interested in the recovery of his patients; his pragmatism was a rebellion, in many ways justified, against what he saw as the stagnation of the orthodox psychoanalytic method.

Presently, we should record different changes in the theoretical-clinical panorama, which make a revision of views which are radically opposite inevitable.

• The turning of clinical themes of classical neurotic and psychotic problems to situations of the narcissistic and borderline types, not always clearly delineated, has, in the last decade of the past century, caused notable changes to the different psychotherapeutic methodologies, from the psychoanalytic one to the transactional-analytic one;

• the assessment of psychotherapy in the field of practice instead of in metapsychology has produced interesting occurrences of convergence and often of integration;

• the increasing requests for training on the part of medical doctors and psychologists has caused changes in the way that training is conducted, although not always clear and justified conceptually;

 

Chapter Three: Defence and Resistance

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CHAPTER THREE

Defence and resistance

General principles

In constructing the “toolbox”, I consider an adequate understanding of the unconscious mechanisms that are at the base of therapeutic resistance to be indispensable.

Berne gave much space to the importance that the understanding and the awareness of the modality of functioning of the unconscious should have for the transactional therapist (1961).

The aim of this chapter, therefore, is to provide a synthesis of what is essential to know from a clinical point of view, without any pretence of entering into the delicate and complex questions of the order of metapsychology, which is the exclusive domain of the psychoanalyst.

By defence is understood the intrapsychic unconscious process through which a person protects himself from the emergence of material felt as dangerous for the conscious equilibrium and of a conflictual nature. The defences are, in other words, the strategies of the ego against anxiety.

In the literature, many defence mechanisms are described, even if often there is no agreement on which and how many there are, to the point where different names are often used for similar mechanisms.

 

Chapter Four: The Clinical Methodology

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CHAPTER FOUR

The clinical methodology

Therapeutic plan and methodology

First of all, the difference between therapeutic plan and methodology has to be explained: the latter, in fact, refers to the clinical theory, which relates to the strategic phases in which the transactional theory can be applied to the psychotherapeutic setting, while the plan consists in the realisation of methodological principles in a particular clinical case (Novellino, 1998). Therefore:

• methodology is the theory underlying the techniques;

• therapeutic plan is the practice of the techniques.

Furthermore, psychotherapy, to keep itself within the boundaries of effectiveness, has to follow a method which takes into account the unique nature of the situation: the therapist, in fact, has to base his data, which he collects gradually, on this; it is precisely this collection of data and its deployment in coherent and demonstrable hypotheses which confers on psychotherapy its “scientific rigour” and “reproducibility”.

Therapeutic contract and analytic contract: operative differences

 

Chapter Five: The setting

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CHAPTER FIVE

The setting

Premise: the six steps of the first interview and the setting in transactional psychoanalysis

The aim of this premise (Novellino, 2010) is to put straight the principles of transactional analysis, orientated in a psychodynamic sense and applied to how the phase of the initial interview is carried out. The concepts described by Berne are taken up again, integrated both with some of the literature of transactional analysis, and with Langs' methods of communicative psychoanalysis. The construction of the setting as a moment founded on an alliance of effective work is highlighted from both a methodological and a tactical point of view.

I present, first of all, the questions to which I requre an answer through a psychodynamic approach:

• In what way can transactional analysis proceed from decontamination to deconfusion?

• Which specific steps should be taken by transactional analysts in applying the Bernean principles (1966) to an individual setting?

• In the therapeutic relationship, what does working on the psychological script imply, referring to it in the way that Berne conceptualised it, or as a derived transference from infantile vicissitudes (1961)?

 

Chapter Six: The Therapeutic Contract

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CHAPTER SIX

The therapeutic contract

Contract as content and as process

In his works, Berne defines the contract as an explicit bilateral commitment for a course of defined action (1966). Transactional analysis is, therefore, a method of psychotherapy with a contractual character, which places particular care and precision in analysing and classifying the various possible forms of therapeutic contract and the possible relative developments in the treatment of the patient.

When we speak of contract, the first important distinction to consider is that between contract understood as content and contract understood as process (Novellino, 1998). We will use the following definition (Novellino, Eric Berne Institute Seminars).

Contract: agreement between patient and therapist on the AIMS and the HOWTOS of the therapy.

Speaking of contract as content refers to the classic definition of the term (Berne's professional contract, 1966), that is, to the agreement between patient and therapist on the objectives of the therapy. The objective is to be proposed by the patient and accepted by the therapist, even if it is important to clarify that it is not necessary for the person to come to therapy with a contract already prepared. Identifying which is the current situation and which is the desired one, defining the problem and the consequent aim, is an important part of the contractual phase and of the therapy in general.

 

Chapter Seven: The Bernean Methodology

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CHAPTER SEVEN

The Bernean methodology

The classic Bernean methodology: the therapeutic themes

The transactional analysis literature presents a series of themes expressed by Berne, half-way between methodology and philosophy (1966). These underline the general attitude that the transactional analyst must have, so that the techniques that he uses may be effective.

The Bernean theme that emerges is that of the patient as a real person.

In all of the works of Berne, considering the patient as a “person” is highlighted as important, and this implies a concept of responsibility of the patient. The patient constructed his script by himself; he did it for motives which were surely valid at the moment of the script decision, and precisely because of this he has the responsibility and the power to reconstruct himself with the help of the therapist.

Berne (1966) draws attention to the situation of a frequent game, which is described like this: a patient, after having different experiences of analytic therapy, presents himself to the transactional analyst with a precise manifestation. He has an Adapted Child, camouflaged by an Adult (pseudo Adult); the Adapted Child has learnt psychiatric language and uses psychoanalytic jargon; his main defence mechanism is rationalisation; he tends to respond to everything the therapist proposes to him with “already said”, and “already known”. In reality, what happens is that the Child of the patient is playing, at a deeper level, something that in Martian language (Berne, 1972) is translated as “fleece someone else”, or “fool someone else”. What the patient does, with his Little Professor, is to study the field to ascertain whether he is faced with a parent different from the previous ones, and, to be able to trust him, he investigates whether this “parent” will do something which the others were not capable of offering him. Therefore, the more frequent the patient's experiences of previous therapy were, the more resolute the analyst must be in this game.

 

Chapter Eight: Post-Bernean Re-decision Tactics

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CHAPTER EIGHT

Post-Bernean re-decision tactics

Impasses and re-decisions

In the 1970s, thanks to the integration of transactional analysis and Gestalt therapy (Goulding & Goulding, 1976, 1979), the first alternative to the Bernean interpretation for developing a deconfusion was conceived.

Re-decision therapy, as a system of techniques, is based on a specific conceptual model: the theory of impasse.

Impasse is a term taken from Gestalt therapy and means to be blocked, to be at a point in which the resistance of the patient to change blocks the therapeutic process; the impasse is experienced as an internal conflict, in which a person can feel “confused, uneasy, strange”, etc.

Robert and Mary Goulding theorised the existence of three possible impasses.

Theory of impasses (Goulding & Goulding)

First type: between P2 and A1.
Second type: between P1 and A1.
Third type: between AC and FC.

Impasse of the first type consists of a conflict between a counter-script message of P2 (for example “Work hard”) and a contrasting need of A1 (“I want to relax”); the intrapsychic relationship is I–You.

 

Chapter Nine: The Psychodynamic Approach

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CHAPTER NINE

The psychodynamic approach

Deconfusion in Berne

Berne wrote,

 

The ultimate aim of transactional analysis is structural readjustment and reintegration. This requires first, restructuring, and secondly, reorganization…Following the dynamic phase of reorganization, there is a secondary analytic phase which is an attempt to deconfuse the Child. (1961, p. 224)

He indicates regression analysis as an elective method that still remains at the prototype stage. In the case of Elise, a phobic patient, Berne (1966, p. 226) resorts to the individual treatment “on the couch”. Again, in Principles of Group Psychotherapy Treatment (1966), he recalls that it is the task of the analyst to “decodify and disintoxicate” (p. 186) the old experiences of the Child, in the presence of the Adult of the therapist. To do this, he invokes the use of interpretation, but dissociating himself from the Freudian themes, strictly Oedipal, of the interpretation (p. 206) and recalling clearly, therefore, the concept of re-decision.

 

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