tr a nsactiona l a na lysis 10 0 k e y p oi n ts & t ech n iqu e s

m a r k w i d d ow s o n 100 key points series series editor: windy dryden

Transactional Analysis

Transactional Analysis (TA) is a versatile and comprehensive system of psychotherapy. Transactional Analysis: 100 Key Points synthesizes developments in the ®eld, making complex material accessible and offering practical guidance on how to apply the theory and re®ne TA psychotherapy skills in practice. Divided into seven manageable sections, the 100 key points cover:

·

the philosophy, theory, methods and critique of the main approaches to TA

· · · ·

TA perspectives on the therapeutic relationship diagnosis, contracting and treatment planning using TA a trouble-shooting guide to avoiding common pitfalls re®ning therapeutic skills

As such this book is essential reading for trainee TA therapists, those preparing for examinations as well as experienced practitioners who will ®nd much practical guidance on the skilful and mindful application of this cohesive system of psychotherapy. Mark Widdowson is a Teaching and Supervising Transactional Analyst and a UKCP Registered Psychotherapist. He is Director of Training at CPTI Edinburgh, Associate Director at The Berne Institute, Kegworth and Senior Lecturer at The Athens Synthesis Centre, Greece. He lives in Glasgow where he has a private practice, offering supervision and psychotherapy for individuals and couples.

`Widdowson has not only produced a book which is essential reading for anyone interested in contemporary TA, but also offers a critical reading of TA in the context of the wider and changing ®elds of psychotherapy and psychology.' ± Keith Tudor, Teaching and Supervising Transactional Analyst; Senior Lecturer, Department of Psychotherapy, Auckland University of Technology, Aotearoa New Zealand `Consistently stimulating and informative, this book is essential reading for anyone interested in learning about current developments in Transactional Analysis theory and practice. The structure of the book makes it easy to identify ways in which TA addresses fundamental practice issues, and is highly accessible both to TA specialists and those trained in other orientations who are seeking to integrate TA perspectives into their work with clients.' ± John McLeod, Professor of Counselling, University of Abertay Dundee `Mark Widdowson provides us with a wise and engaging presentation of contemporary Transactional Analysis in theory and practice. Throughout this text are the constant reminders of the importance, clinically and ethically, of the therapist's necessity to engage in self-examination. While written in the voice of a psychotherapist, this book has much to offer fellow professionals engaged in other aspects of human relations work.' ± William F. Cornell, Independent Private Practice, Pittsburgh, USA

100 Key Points Series Editor: Windy Dryden ALSO IN THIS SERIES:

Cognitive Therapy: 100 Key Points and Techniques Michael Neenan and Windy Dryden Rational Emotive Behaviour Therapy: 100 Key Points and Techniques Windy Dryden and Michael Neenan Family Therapy: 100 Key Points and Techniques Mark Rivett and Eddy Street

Transactional Analysis 100 Key Points and Techniques

Mark Widdowson

First published 2010 by Routledge 27 Church Road, Hove, East Sussex BN3 2FA Simultaneously published in the USA and Canada by Routledge 711 Third Avenue, New York NY10017 (8th Floor)

Routledge is an imprint of the Taylor & Francis Group, an Informa business Ø 2010 Mark Widdowson Typeset in Times by Gar®eld Morgan, Swansea, West Glamorgan Paperback cover design by Andy Ward All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. This publication has been produced with paper manufactured to strict environmental standards and with pulp derived from sustainable forests.

British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Widdowson, Mark, 1973± Transactional analysis : 100 key points and techniques / Mark Widdowson. p. ; cm. Includes bibliographical references. ISBN 978-0-415-47386-6 (hardback) ± ISBN 978-0-415-47387-3 (pbk) 1. Transactional analysis. I. Title. [DNLM: 1. Transactional Analysis. WM 460.6 W638t 2010] RC489.T7W53 2010 616.89©145±dc22 2009014438 ISBN: 978-0-415-47386-6 (hbk) ISBN: 978-0-415-47387-3 (pbk)

Contents

Introduction

Part 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

APPROACHES IN TRANSACTIONAL ANALYSIS (TA) PRACTICE Three modes of therapeutic action The classical school: foundations The classical school: methods The redecision school: foundations The redecision school: methods The cathexis school: foundations The cathexis school: methods Radical psychiatry: foundations Radical psychiatry: methods Integrative TA: foundations Integrative TA: methods Cognitive-behavioural TA: foundations Cognitive-behavioural TA: methods Psychodynamic TA: foundations Psychodynamic TA: methods Relational TA: foundations Relational TA: methods

xiii

1 3 7 11 13 17 21 25 29 33 35 39 43 47 51 55 57 61 vii

CONTENTS

Part 18 19 20 21 22 23 24 25 26 27 28 29 Part 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 viii

2 THE THERAPEUTIC RELATIONSHIP 63 The initial sessions 65 Therapeutic inquiry 69 The centrality of empathy 71 Accounting for the impact of diversity in the therapeutic relationship 75 Conceptualizing the therapeutic relationship 79 Strengthening the working alliance by attention to tasks, goals and bonds 83 Considering Adapted Child responses as indicators of alliance rupture 87 The therapeutic alliance: rupture and repair 89 Important TA concepts relating to transference and countertransference 93 The drama triangle as a tool to explore countertransference 97 Transference and countertransference: an aide-meÂmoir of TA models 101 Ending TA therapy 105 3 DIAGNOSIS The importance of observation Intake assessment and case formulation Assessing suitability for TA therapy Using Berne's four methods of diagnosis Applying the four methods of diagnosis Developing a conversational interviewing technique Being thorough in structural analysis Adding in ego state dialogue to develop dynamic structural analysis Accounting for cultural and religious Parent Accounting for oppression Levels of script: protocol and script proper Identifying structural level Building up the script system Exploring counterscript Analysing games

109 111 115 119 123 127 131 135 139 143 147 151 153 155 159 163

CONTENTS

45 46 47

Escape hatches as a framework for understanding client safety Suicidal ideation: a brief introduction Diagnosis checklist

Part 4 CONTRACTING 48 Contracting for the tasks and goals of therapy 49 Contracting: developing `lightness of touch' 50 Using a standard written business contract 51 Contracting with the unsure client 52 Behavioural contracts 53 Dealing with resistance or non-compliance with behavioural contracts 54 The `good enough' contract 55 Contracting: preparing for con¯ict and negative transference

167 171 175 181 183 187 189 193 195 197 201 203

Part 56 57 58 59 60 61

5 TREATMENT PLANNING Comparative treatment sequences Formulating individualized treatment plans Monitoring and revising treatment planning Psychotherapy as a grieving process Treatment sequence: a relational view Awareness, spontaneity, intimacy and autonomy

205 207 209 213 215 219

Part 62 63 64 65 66 67 68

6 AVOIDING COMMON PITFALLS Being realistic about treatment length Avoiding premature contracting Avoiding the pitfall of `certainty' Reducing the risk of iatrogenic shaming Avoiding racket `OK-ness' Avoiding marshmallowing Teaching TA concepts sparingly

225 227 231 235 237 241 245 249

223

ix

CONTENTS

Part 7 REFINING THERAPEUTIC SKILLS 69 Balancing challenge and support 70 Optimizing therapy by assessment of where the client is open, and where they are defended 71 Deepening affect 72 Promoting healthy expression of emotions 73 Promoting emotional literacy with `homework' assignments 74 Encouraging journaling to promote self-re¯ection 75 Differences between decontamination and deconfusion 76 How clients con®rm script beliefs in therapy 77 Using alliance rupture and repair for deconfusion 78 Using metacommunicative transactions 79 Therapy of games 80 Therapy of injunctions 81 Interventions and approaches to therapy of injunctions 82 Escape-hatch closure revisited 83 Client protection 84 Potency and permission 85 Impasse theory revisited 86 Two-chair Parent ego state work: some guidelines 87 Two-chair Parent ego state work: contraindications 88 Confrontation 89 Enhancing effectiveness with audio recordings 90 Evaluating interventions and enhancing skills 91 Record keeping in TA therapy 92 Promoting mentalization 93 Cultivating mindfulness 94 Script development: an ongoing process 95 Helping clients identify and build on their strengths 96 Exploring therapist's motivations x

253 255 257 259 263 267 271 273 277 281 285 287 291 293 297 303 307 311 315 319 321 323 325 329 331 335 339 341 343

CONTENTS

97 98 99 100

Self-re¯ection and appropriate self-disclosure The Adult ego state revisited TA as an existential psychotherapy Analysing transactions

References Author index

347 351 355 359 361 372

xi

Introduction

Transactional Analysis (TA) has a thriving international community made up of a dynamic body of practitioners who are developing their theory and innovating in practice. TA has developed into a therapy that is now proudly psychodynamic, and yet also ®ercely humanistic. TA therapists consider many of their methods to be similar to those of cognitive-behavioural therapy. TA is also viewed as being an existential psychotherapy. I introduce some concepts from existential psychotherapy in this book, and invite the reader to explore how they can inform our use of transactional analysis and how we think about various TA concepts, and more importantly, how we relate to our clients. The history of TA reveals the origin of this range of approaches ± Berne developed TA from his knowledge as a psychoanalyst. His development of the theory of the Adult ego state, and concepts such as contamination also enabled him to develop a cognitive approach to therapy which did not exist at the time of Berne's innovations (Schlegel, 1998). There is the most incredible diversity among TA psychotherapists, and in how we use TA. We share a common body of theory that has shown in this diversity its wonderful versatility. To me, what de®nes a transactional analyst is not what they do (which may be indistinguishable from other types of psychotherapy), but rather why they do what they do and how they

xiii

INTRODUCTION

think. Transactional analysts of all types use the concepts of ego states and scripts as their most basic thinking structures. Following the work of Tudor and Hobbes (2007) I discuss cognitive-behavioural and psychodynamic applications of TA in practice and also include the modern TA approaches of integrative TA and relational TA. This book attempts to develop the readers' skills and knowledge in effective use of all approaches to TA. A word about the level of this text: this is not an introductory book, and I assume that the reader has a familiarity with TA concepts and methods. For those readers who do not have that knowledge, I would advise reading the following books ®rst: Lister-Ford, C. (2002) Skills in Transactional Analysis Counselling and Psychotherapy. London: Sage. Stewart, I. (2007) Transactional Analysis Counselling in Action. London: Sage. Stewart, I. and Joines, V. (1987) TA Today. Nottingham: Lifespace. Expecting the reader to have such background knowledge enables me to move directly into an intermediate level of discussion without need to explain the basics, which are adequately covered in other books. This book is calibrated at an intermediate level, to bridge the gap between introductory texts and advanced texts and will be particularly useful to TA students who have completed their foundation year. I hope that more experienced practitioners will also ®nd the book to be interesting and stimulating. Part 1 covers the philosophy, theory, methods and some critique of the main approaches and schools of TA in practice. Readers who are not so interested in this theoretical background can go directly to Part 2. Part 2 deals with the therapeutic relationship. Psychotherapy research has consistently shown that the therapeutic relationship is critical to the outcome of the therapy, and is a precondition for effective therapy work (Norcross, 2002). In line with this research, this section includes material on the effective `ingredients' of the therapeutic relationship including empathy, transference and countertransference and also alliance xiv

INTRODUCTION

rupture and repair. It has been my intention to make some of these complex concepts more accessible to newcomers. Parts 3, 4 and 5 take the reader through the process of diagnosis, contracting and treatment planning from a TA perspective. Part 6 deals with common pitfalls in TA practice, suggesting ways of avoiding them. The book concludes with Part 7, the longest part, which is on re®ning therapeutic skills. Each part contains new and original material that I hope will be of immediate practical use to the reader. Many of the points in this book are ®rmly grounded in evidence-based practice, and are supported by psychotherapy research as being `effective ingredients' in psychotherapy. Psychotherapy research demonstrates the effectiveness of empathy, attention to alliance rupture and repair, skilful transference interpretation, accounting for the client's cultural context, wider relationships and strengths, developing a personally tailored treatment approach for each client, goal consensus and collaboration, appropriate self-disclosure, and all are empirically supported. The discussion of such research is beyond the scope of this book, and the interested reader is recommended to read Psychotherapy Relationships That Work, edited by John Norcross (2002). It has been my intention throughout to write a book that is practical and promotes the development of thinking, rigorous clinicians. Rather than present a whole book of techniques, I have been more interested in writing a book that stimulates and engages the reader's thinking. When one is well versed in the theory . . . it is not even necessary to know a lot of techniques, as ideas for interventions will arise from understanding and applying theory to a particular client, at a particular moment . . . when a therapist is well versed in theory, it becomes possible to adapt the therapy to the needs of the client rather than requiring the client to adapt to the demands of a particular technique. (Rothschild, 2000: 96) In many ways this book is similar to a Greek meze, or Spanish tapas meal. Readers may ®nd some of the `appetizers' xv

“widdowson has not only produced a book which is essential reading for anyone interested in contemporary ta, but also offers a critical reading of ta in the context of the wider and changing fields of psychotherapy and psychology.” keith tudor, teaching and supervising transactional analyst; senior lecturer, department of psychotherapy, auckland university of technology, aotearoa new Zealand. “consistently stimulating and informative, this book is essential reading for anyone interested in learning about current developments in transactional analysis theory and practice.” John mcleod, professor of counselling, university of abertay dundee. “mark widdowson provides us with a wise and engaging presentation of contemporary transactional analysis in theory and practice.” william F. cornell, independent private practice, pittsburgh, usa. transactional analysis (ta) is a versatile and comprehensive system of psychotherapy. Transactional Analysis: 100 Key Points synthesizes developments in the field, making complex material accessible and offering practical guidance on how to apply the theory and refine ta psychotherapy skills in practice. divided into seven manageable sections, the 100 key points cover: • the philosophy, theory, methods and critique of the main approaches to TA • TA perspectives on the therapeutic relationship • diagnosis, contracting and treatment planning using TA • a trouble-shooting guide to avoiding common pitfalls as such this book is essential reading for trainee ta therapists, those preparing for examinations as well as experienced practitioners. mark widdowson is a teaching and supervising transactional analyst and a ukcp registered psychotherapist. he lives in Glasgow where he has a private practice, offering supervision and psychotherapy for individuals and couples.

100 key points series series editor: windy dryden psychotherapy/counselling www.routledgementalhealth.com/100-key-points

27 Church Road, Hove, East Sussex BN3 2FA 270 Madison Avenue, New York, NY 10016 www.routledgementalhealth.com Printed in Great Britain