Problem definition and interventions for cure

STRUCTURAL PATHOLOGY

The past in the present

P

A

C

P

A

C

Contamination

A.Parent

contaminationB.

Childcontamination

C.Double

contamination

P

A

C

Parent prejudices and slogans mistaken for facts

Child delusions, phobias or superstitions mistaken for facts.

Diagnosis contamination• Parent Contamination: Prejudices or learned beliefs that are taken as facts such as cataloging

or discriminating a group of people by their race, sex, color, economic condition, occupation,– To talk about oneself saying “you” instead of “I”– Lack of thinking for oneself, the person’s ideology comes from family, religious or culturally learned

concepts.– Copies other people’s behaviors, without being aware of this.– Categorical opinions.– Frequent use of words such as “always”, “never”, “you should”, “you have to”.

• Child Contamination: Attitudes of overadaptation such as: a submissive self-devaluation or over-rebelliousness to any authority.

– Discrepancies between reality and fantasy or delusions.– Irrational thinking and behaviors based on childhood beliefs determining the self-concept of the

person, such as: I am ugly, stupid, disagreeable, clumsy, a bad person, etc.– Not listening to people.– Catastrophic expectancies.– Discussions defending or justifying irrational positions.

Exclusionwithdrawal of free and unbound energy

P

A

C

P

A

C

P

A

C

A.Excluded

Parent

B.Excluded

Adult

C.Excluded

child

Diagnosis exclusion• Excluded Parent

– Inflexibility.– Controlling attitudes.– Rules and limits are not respected, the person imposes its own rules.– Tempting and manipulative attitudes to achive what is wanted at any price– Intelligent, intuitive people with psychopathic traces

• Excluded Adult– Reality is denied.– In constant conflict.– Very resistant defenses.– Bizarre and strange attitudes with psychotic traces.

• Excluded Child– Childhood is not remembered.– Emotions are suppressed.– Fear that something terrible happens if one´s feelings are expressed.– Psychosomatic disorders.

Constant ego-states

P

A

C

P

A

C

P

A

C

A.Constant

(excluding)Parent

B.Constant

(excluding)Adult

C.Constant

(excluding)child

Diagnosis constancy• Constant or Excluding Parent

– Overcritical attitudes.– Overnurturing attitudes.– The person always believes he or she is right, trying to impose their thoughts on others, forcing them to accept their

opinions.– Resistance to change.– Likes to indoctrinate or pontificate others.– Authoritarian attitudes.

• Constant or Excluding Adult– Constantly involved in work or in trying to get others to work.– Attitudes of coldness and indifference.– Seldomly interested in playing and having fun.– Frequently intellectualizes– Functions by planning first, collecting information and processing data.

• Constant or Excluding Child– Narcissistic features.– Impulsive personality, very much in touch with their feelings.– Place more importance on their feelings than thinking clearly and having an objective evaluation.– The person always wants to be the center of attention, in every way.– Self-centered, selfish and vain person.

FUNCTIONAL PATHOLOGY

Ego state boundaries• Definition: semi permeable membrane through which psychic

energy necessary for effective functioning can flow from one ego state to another. Effective healthy flow can be a spontaneous response to a stimuli or can be deliberately shifted through an act of will (Berne, 1964)

• Shifts in ego states depend on the forces acting on ego state, the permeability of the boundaries and the cathectic capacity of each ego state (Berne, 1961)Spontaneity means the option, the freedom to choose and express one’s feelings from any ego state (Berne, 1964)

Psychic energy Only one ego state will have executive power over behaviour at any one

given time. Everyone has a supply of cathexis or psychic energy which is high when a

person’s need for stimulus, strokes and structure are being met. This psychic energy exists in three forms: less transferable bound

(monkey sits) or unbound (monkey falls) energy and transferable free (monkey jumps).

An ego state will take over executive power when unbound + free = active energy > than in the other ego states.

Ego boundaries are conceived as semipermeable under most conditions. They are relatively impermeable to bund and unbound cathexis, while free cathexis can pass with relative ease from one ego state to another (Berne, 1961).

An ego state will be experienced as real self when free energy > than in other ego states.

True autonomy is the ability of cathecting ego states at will.

Functional pathology

• Permeability of ego state boundaries: too rigid (exclusion) or too lax (loss of identity, disoganized, confusion, separaton anxiety, symbiotic, normal state at birth) or lesions (external sore spots that lead to eruption of feelings)

• Lability of cathexis: too sluggish or too quick• There are no weak ego states only weakly

cathected ego states.

CRITERIA FOR THE DIAGNOSIS OF LAXITY

When a problem is severe the person becomes dysfunctional and disorganized, instead of solving it.– Regressive and symbiotic attitudes.– Dependent and childlike personality.– To feel, speak and act in a confused way.– Easily influenced.– Difficulties separating thoughts from feelings.– Separation anxiety.– Fear of being alone.– Difficulties to think clearly.– Emotional instability.– Ambivalence.

CRITERIA FOR THE DIAGNOSIS OF LESION

• Ego control collapses with exaggerated and unexpected emotional explosions which may seem irrational to others.– Feelings of depersonalization, unreality and déjà vu.– Acting out behaviors, that might be destructive.– Some stimulus are experienced as intolerable.– Feelings of being hurt without justification.– Sudden unexpected outbursts when they feel that

their Parental values are threatened

INTERVENTIONS FOR CURE

Ideas about cure

• The therapist does not cure anyone, he only treats them to the best of his ability, being careful not to injure and waiting for nature to take its healing course. His metaphors for therapy included: you find a splinter and take it out. You accomplish the therapeutic aims in the treatment contract. Frog to prince transformation (Berne (1966) .

• Cure often results from the clients understanding of her current life event in the context of a life long pattern together with sufficient rage to initiate action. Berne (1972)

• Goals for TA treatment are (Berne (1978) : – 1. elimination of symptoms, – 2. support of the individuals health resources, – 3. decrease in those tendencies in a person’s psychic economy which are self

defeating and foster isolation from others

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Types of cure (Clarkson, 1988)1. OK change cure: break out of script entirely stable over time and under pressure “such a script

cure which changes character and destiny, is also a clinical cure since most of his symptoms will be relieved by his redecision (Berne, 1972). This type of script cure also causes discomfort: a. nostalgia for the person you sued to be, b. faced with existential problems of necessity, freedom of choice and absurdity all of which were previously evaded by illusions of script Berne, 1966). Archetype: Odysseus

2. Making progress (non change): The patient fights being a winner because he is not in treatment for that purpose but only to be made a braver loser (Berne, 1972) or what Steiner calls banal script. In response to change banal script is in constant state of stress, holding bund and unbound energy, avoiding true contact. Making progress should be encouraged where alternative is third degree pay-off. Archetype: Echo.

3. Disillusionment (impossible change) : The most painful task a therapist has to perform is to tell his patients finally that there is no Santa Claus (Berne, 1972). Much heartbreak can be avoided by confronting realism and achievability of contracts. No amount of redeciding can change the past or guarantee that other people will behave honorably. Archetype: Icarus.

4. Disintegration or casualty (Not OK change): a casualty is patient who as direct result of experience in therapy becomes more distressed or employs maladaptive mechanisms of defense more. Usually due to mistimed interventions, inadequate protection or chaotic treatment planning. Archetype: Medea.

5. Counter-script cure (illusion of autonomy): Jeder caries out his script even after parents have gone. It acts like a player piano roll..Jeder sits meanwhile before the piano moving fingers under the illusion that it is he bringing concerto to foregone conclusion (Berne 1972). Belief that one has changed fundamentally when the change is actually cosmetic and patient is still adapted or driven. Over-adaptation can sometimes be better than incapacitation or violence. Problem is not that it happens but that therapist and client may mistake it for the therapeutic goal. Archetype: Oedipus.

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Change pentagon (Clarkson, 1988)Type Subjective

experience of change

Characteristics Response to stress

archetype

Cure Change Satisfying & autonomous

Proactive & creative

Seeking learning & growth

Odysseus

Making progress Non-change Threatening & destabilizing

Homeostatic &r rigid

Reactive & avoidant

Echo

Disillusionment Impossible change

Impossible & frustrating

Inappropriate & stressful

Despair & breakdown

Icarus

Disintegration Not OK change Noxious & catastrophic

Destructive & disintegrating

Casualty Medea

Autonomy illusion Counter script change

Pseudo conversion

Adapted & driven Unstable Oedipus

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A: Berne’s eight operations decontaminate, deconfuse C, and decommission P

Categories Types

1 Interrogation Question points that seem clinically decisive. E.G. did you actually steal the money?

Use when A will respond. Don’t use is P or C likely to respond.

2 Specification Declaration categorizing certain information. E.G. so you always wanted expensive things?

Do use when anticipated that client may later deny. Don’t use if it will frighten Child.

3 Confrontation Use information previously specified to point out inconsistency to disconcert P, C or contaminated A.

Do use if client is apparently deceiving or playing stupid. Don’t use if you’re only trying to outsmart the client.

4 Explanation Offer theory or feedback to strengthen, decontaminate or reorient Adult. E.g. so you see your Child was threatening to become active and when that happens your Adult fades out.

Do use when Adult is listening. Don’t use when client is still playing games Yes but…

5 Illustration Anecdote, simile or comparison that follows successful confrontation and softens its possible undesirable effects. Do use when Adult and Child are listening. Don’t use with literal Parent.

6 Confirmation Use further material to confirm confrontation.

Do use is client’s Adult firmly established. Don’t use if previous confrontation or illustration unsuccessful.

7 Interpretation Question, paraphrase, specify, interpret, explore to further deal with pathology Child.

8 Crystallizing Statement from Adult to Adult e.g. so now you are ready to stop playing games.

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References K Armstrong, A short history of myth, canongate, 2005 G. Barnes, on saying hello: the script drama diamond and character

role analysis, TAJ 11:1 Jan 1981 E. Berne What do you say after you’ve said hello, the psychology of human destiny, grove press 1972

E. Berne, Beyond games and scripts, Grove Press, 1976 E. Berne, Mythology of dark and fair: psychiatric use of folklore. TAJ

13(4) Oct 1983 J Byng-Hall, Rewriting family scripts, Guilford press, 1995 J Campbell, The hero with a thousand faces, Princeton university

press, 2004 C Pinkola Estes, Women who run with wolves, ballantine books, 1992

L.P. Campos. Cure as finding the right metaphor. TAJ 10(2) 1980 H. Capers & L. Goodman the survival process: clarifications of the

miniscript, TAJ 13(3) July 1983 SR Caracushansky & AC Giampeitro, The use of myths and fairy tales

in a bernian approach to psychotherapy, TAJ vol. 17(1) Jan 1987 SR Caracushansky, Down to our mythical roots, TAJ 22(1) 1992 WD Cheney, The ego defensive function of life scripts, TAJ III:2 April

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a support for the future.TAJ 18(1) Jan 1988 P Clarkson Metanoia a process of transformation. TAJ 19(4) Oct. 1989 P Clarkson. I praise of speed, experimentation, agreeableness,

endurance and excellence: counter script drivers and aspiration. TAJ 22(1) Jan 1992

WF Cornell life script theory a critical review from a developmental perspective, TAJ 18(4) Oct. 1988R.E. Erskine. Therapeutic interventions: disconnecting rubber bands. TAJ IV (1) Jan 1974

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F. Gere. Developing the OK miniscript. TAJ 5(3) July 1975

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R.J. Goulding, decisions in script formation, TAJ 2:2 April 1972 H. Hagaden & C sills. Deconfusion of the Child ego state: a

relational perspective. TJ 31(1) Jan. 2001. D Helman, V Austin, Little professor’s mythology, TAJ 7:3 July 1977 M. James. Spot reparenting theory and process. TAJ 4(3) July

1974 T.Kahler & H. Capers, The miniscript. TAJ 4:1. 1974. S. Karpman, Fairy tales and script drama analysis, TAJ 1968 7(26)

39-43 S. Karpman 1972 Eric Berne memorial award lecture, TAJ 1973

3(3) 73-76 M. Kouwenhoven. Het miniscript. In: Leren en leven met groepen,

mei 1982. P. Levin Landheer a developmental script questionnaire, TAJ 11(1)

Jan 1981 RF Massey, Script theory synthesized systemically, TAJ19(1) Jan

1989 T. Novey. I’m OK and You are OK 5% cure. TAJ 10(2) April 1980 R.F. Osnes. Spot reparenting. TAJ 4(3) July 1974 L.C. Sprietsma, a winner script apparatus, TAJ 8:1 Jan 1978 C. Steiner, Scripts people live, Grove Weidenfeld, 1974 S. Swede. OK corral for life positions. TAJ 8(1) Jan. 1978 M. van Doorn, Leiderschap een reis in beeld, malpertuis ed. 1999 C. Vogler. The writer’s journey: mythic structure for writers. Michael

Weise productions. 2007. T.White. Life positions. TAJ 24(4) Oct 1994 S.J. Woollams, formation of the script, TAJ III Jan 1973 S.J. Woollams. Cure. TAJ 10(2) 1980.

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oct 1972– T. White, The developmental history of the Adult ego state