Transactional Analysis for Depression
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Transactional Analysis for Depression

A step-by-step treatment manual

Mark Widdowson

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eBook - ePub

Transactional Analysis for Depression

A step-by-step treatment manual

Mark Widdowson

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About This Book

Transactional Analysis for Depression is the first research-based, transactional analysis psychotherapy manual. Developed from the author's research into TA therapy for depression, the book also draws upon a wide range of contemporary research findings relating to depression and its treatment. Mark Widdowson provides the reader with a solid understanding about the nature of depression and clear guidance about how to provide effective psychotherapy for depressed clients.

The book is a step-by-step guide to therapy, from the point of first contact through to ending, and covers:

The theory and practice of TA therapy

Understanding factors which maintain depression

Conceptualising depression using Transactional Analysis

Original material on the mechanisms of therapeutic change

Optimising the psychotherapy process

Key therapeutic processes in the therapy of depression

Tailoring the therapy to client needs

An introduction to neuroscience and the medical treatment of depression

Complete with an additional resources section, including downloadable material designed to be given to clients to enhance the therapeutic process and strengthen the working alliance, Transactional Analysis for Depression provides structured, practical guidance to TA theory for therapists in practice and training.

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Part I TA theory and depression

DOI: 10.4324/9781315746630-2

1 The theory and practice of transactional analysis psychotherapy 1

DOI: 10.4324/9781315746630-3
TA is probably the most comprehensive theoretical framework currently available in the field of counselling and psychotherapy. (McLeod, 1998)

A brief history and context of transactional analysis

The founder of transactional analysis (TA) was Eric Berne, a Jewish Canadian neurologist who emigrated to the USA in 1935 in order to train as a psychiatrist. Between 1941 and 1943 Berne commenced training in psychoanalysis in New York. His training was interrupted for a few years whilst he served as an army psychiatrist during Second World War. After the war, he moved to the San Francisco area and resumed his psychoanalytic training.
Berne was particularly interested in social psychiatry, and ran weekly seminars on the subject from his home. By 1956 he had developed the basic elements of his theory, which he had named transactional analysis. In 1959, his application to join the San Francisco Psychoanalytic Institute as a full member was rejected. This event acted as a catalyst and inspired Berne to develop his theories in conjunction with the colleagues who had joined him in his seminars. Culturally, San Francisco is well known as being a hub of subversion and counterculture and this spirit of rebellion no doubt influenced Berne. By 1961 his first book on TA was published and his theories started to gain popularity.
TA has grown and flourished over the years into an international community of practitioners. The European Association for Transactional Analysis currently has over 7,500 members, of whom around 1,500 are based in the UK.

The theory of transactional analysis psychotherapy

Berne was passionate about demystifying the psychotherapy process and the importance of engaging the client as a collaborative partner in the therapy. This passion was evident early in his career as a psychiatrist. Berne was one of the first psychiatrists to invite patients into case conferences in hospitals, and he actively invited them to participate in choices about their treatment (Berne, 1966). One aspect of the demystifying process that Berne emphasised was his insistence on using colloquial, everyday language for the theoretical concepts of TA. While the use of accessible language and concepts have likely contributed to TA’s popularity, some TA professionals have speculated that the colloquial labels typically used in TA theory might give an impression of lack of academic substance or even amateurishness. Despite this, some authors argue that the use of accessible language and the diagramming of internal and interpersonal processes are among TA’s strengths (McLeod, 2009; Stewart & Joines, 1987).

The theory of personality – structural analysis

Parent, Adult and Child ego states were first systematically studied by transactional analysis, and they are its foundation stones and its mark. Whatever deals with ego states is transactional analysis and whatever overlooks them is not.
(Berne, 1972: 223)
Berne’s theory of ego states developed from the theories of his analyst, Paul Federn (1952), and those of Eduardo Weiss (1950) and Ronald Fairbairn (1952). Federn was particularly interested in understanding one part of Freud’s tripartite structure of the personality – the ego. Federn’s definition of an ego state was of the entirety of an individual’s internal subjective experience at any given moment (Federn, 1952).
Berne developed this definition of an ego state to include the element of observability (Berne, 1961), which posited that an internal shift of an individual’s ego states might be directly observed (or inferred from observations of shifts in an individual’s behaviour) by an external observer (in this context, the therapist). Berne developed Federn’s theory that an ego state could be a direct response to the here-and-now situation the individual was presently experiencing, or one re-experienced as a regression to a childhood state to include an ego state which the individual had ’taken in’ or introjected from external sources (generally, parents or parent figures). Thus, he developed his theory of a tripartite structure to the ego which was both internally experienced and directly observable (Berne, 1961).
Within TA theory, the personality (ego) can be manifested in three ways, known as ego states. An ego state is defined as a ‘consistent pattern of feeling and experience directly related to a corresponding consistent pattern of behaviour’ (Berne, 1966: 364). Ego states are divided into three categories, which are called Parent, Adult and Child. The Parent ego state is a repository of introjected ‘others’ – usually primary caregivers but also influences from the social and cultural environment which were internalised by the infant during personality development (Stewart & Joines, 1987). This internalisation process is shaped by the quality of the relationship with caregivers, which is ‘recorded’ in the infant’s psyche. The Parent ego state is believed to have a powerful influence on an individual’s behaviour and internal process (Figure 1.1). Berne defined the Parent ego state as ‘a set of feelings, attitudes and behaviour patterns which resemble those of a parental figure’ (Berne, 1961: 66), a definition he later extended to include aspects of the individual’s personality which were ‘borrowed’ from others (Berne, 1966: 366).
Figure 1.1 The first-order structural model of ego states (Berne, 1961; Stewart & Joines, 1987, reprinted with permission).
The Adult ego state stems from here-and-now reality and was described by Berne as ‘an autonomous set of feelings, attitudes and behaviour patterns which are adapted to the current reality’ (Berne, 1961: 67).
The Child ego state is comprised of an individual’s historical experiences and acts as a source of regression from a repository of subjective memory systems, including the affective components of experiences. Berne defined the Child ego state as ‘a set of feelings, attitudes and behaviours which are relics of an individual’s own childhood’ (Berne, 1961: 69).
Fairbairn’s theory of the ego proposed a tripartite structure (Fairbairn, 1952) which Berne described as being ‘one of the best heuristic bridges between transactional analysis and psychoanalysis’ (Berne, 1972: 134). Fairbairn argued that the ego is composed of an observing ‘central ego’, an object-seeking ‘libidinal ego’ and an ‘antilibidinal ego’ which he described as the internalised persecutory aspect (Fairbairn, 1952). A key difference between Fairbairn’s theory and Berne’s was that Berne’s theory included nurturing and caring functions within the Parent ego state (Clarkson, 1992). Also, Berne’s theory asserted that ego states are directly observable phenomena rather than abstract theoretical constructs (Stewart, 2010a).
TA therapists pay considerable attention to analysis of the content of the different ego states and to the internal interaction between ego states, such as internal dialogue (which is often presumed to be pre-conscious or unconscious) (Berne, 1972).

The theory of communication – analysis of transactions

Berne’s interest in social psychology led him to explore group therapy as an adjunct or alternative to individual therapy. It is from his experiences as a group therapist that he developed many of TA’s theories relating to communication and interpersonal processes. In TA theory, individuals are said to be communicating from a particular ego state at any given moment and these interpersonal communications are referred to as transactions (Berne, 1961). The nature of the transactions between individuals and groups is then analysed. Using the ego-state diagram (Figure 1.1) as the basis for analysing transactions, communication between individuals can be diagrammatically represented in terms of the source and recipient of each particular communicative transaction and the subsequent communicative response (Figure 1.2). Berne’s model of analysis of transactions can also be used for the analysis of transference and countertransference reactions and responses (Berne, 1972; Erskine, 1991).
Figure 1.2 Analysis of transactions (adapted from Berne, 1961; Stewart & Joines, 1987).

The life script theory of the genesis of psychopathology

The life script is an ‘unconscious life plan’ (Berne, 1966: 368), or ‘a life plan made in childhood, reinforced by parents, justified by subsequent events and culminating in a chosen alternative’ (Berne, 1972: 445). Erskine describes the script as ‘A life plan based on a decision made at any developmental stage which inhibits spontaneity and limits flexibility in problem solving and in relating to people’ (Erskine, 1980: 102). The script determines how an individual experiences and interprets the world, and interacts with others and the environment. Berne’s theory of life script was influenced by Adler’s (1956) theory of ‘style of life’, which Adler described as an unconscious and repetitious pattern of living (Ansbacher & Ansbacher, 1956). Berne was also influenced by Erik Erikson (with whom Berne was in analysis for several years), and Erikson’s theories of psychological development through the lifespan (Erikson, 1950, 1959). The theory of life script also has clear parallels with the cognitive-behavioural therapy theory of schemas, which are underlying structures that determine how an individual experiences self, others and the world (Beck, Rush, Emory & Shaw, 1979; Young, Klosko & Weishaar, 2003).
TA theory assumes that an individual adopts a life position which is a fundamental orientation the infant develops, usually in response to very early interactions with his or her caregivers. It establishes the sense of relative worth and value of the self and others. In characteristic TA style, the life position is described using everyday language. The ideal, healthy position is one where an individual develops an ‘I’m OK – you’re OK’ life position. Unfortunately (often in response to interactions in these early relationships), individuals may develop an ‘I’m OK – you’re not OK’, ‘I’m not OK – you’re OK’ or an ‘I’m not OK – you’re not OK’ life position (Berne, 1972). These link to Klein’s (1975) concept of the Paranoid, Depressive and Schizoid positions, respectively. This life position is to some extent malleable, but it is largely consistent and ‘reinforced’ throughout life. Life positions have similarity to attachment patterns (Ainsworth & Bowlby, 1965; Bowlby, 1979, 1988; Hobbes, 1996, 1997; Holmes, 2001).
The protocol (Berne, 1972) refers to the very earliest relational (unconscious/preconscious) ‘blueprint’, which sets out the ‘rules of engagement’ that individuals determine from their early interpersonal experiences about how self and others interact. There are clear parallels here with Stern’s (1985) concept of representations of interactions that are generalised, and to Luborsky’s (1984) core conflictual relational themes.
Early TA (during the late 1960s) was particularly concerned with the script and script analysis, and the conscious elaboration of script. However, more recently, TA therapists have turned their attention towards understanding and working with the protocol. This shift in focus has been shaped by an increasing interest in implicit memory and early child development theory (Stern, 1985) that has influenced recent psychotherapy theory.
Life positions, protocol and script can be considered to be satisfying structure hunger (see below), and as part of an inherent tendency amongst people to organise the world psychologically and make meaning. The theory of life script (as well as life positions and protocol, which are subdivisions of script theory) serves to describe how human survival is preserved by the development and maintenance of relationships. The infant is entirely dependent on his caregiver(s) and will adapt very early to the needs of the caregivers to ensure he gains the optimal care. ‘Script decisions represent the infant’s best strategy for surviving in a world which often seems hostile, even life threatening’ (Stewart & Joines, 1987: 101–102).
Life script decisions are, however, often deeply irrational and overgenera...

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