Monday, July 26, 2010

Transactional Analysis

Eric Berne, MD is probably most famous for his group therapy. One of his lasting contributions was to take Freud's 'unconcious' formulation of the mind as having 'superego', 'ego' and 'id' to simplifying this into 'parent', 'adult' 'child'.
He then went on to show that each individual's 'parent', 'adult', and 'child' functions might be underdeveloped. In today's jargon, a person with an over developped parental function would be uptight, overly anxious, judgmental and defensive whereas a person with an over developed child function would be immature, self centered, disruptive. The adult function could only attain full expression if both parent and child developments were balanced.

Berne saw the 'context' in which a person was as defining the appropriate mode a person would mostly show. Hence, in the operating room, the surgeon's "parental" and "adult" functions would be uppermost whereas at the dance the 'child' and 'adult' function would be most 'appropriate'. Berne would see a surgeon juggling instruments over an open abdomen as clearly inappropriate but would also see another surgeon discussing shop and not joining joining in the dance at a party as clearly inappropriate. Indeed it's hard to think of the word 'appropriate' in human interaction without considering Berne's work in this regard.

Berne's group therapy addressed the 'games' people played. He saw much of human miscommunication as failure of individuals to respond on the same 'wavelength'. Hence I might speak to you in a 'parental' tone and naturally if the 'context' didn't clearly designate me as having a 'parental' role you might rather naturally respond from a 'bad child' position, simply not accepting my 'authority' in that context.

Sexual miscommunication is easily understood by studying Berne. For instance I say, "pass the sugar" in a simple 'adult' manner and you respond 'you don't need any more, sweetie' as one 'child' to another rather than staying in the 'adult' wavelength. This is a 'new' game and could be played out to the bedroom or be a 'bait and switch' maneuver whereby when I respond "would you like some too" you act with shock and horror.

Berne's 'Transactional Analysis' model has retained it's robustness as a means to understanding human interactions. Evidence based studies of it's usefulness in addressing a variety of psychiatric illness have been done. Berne early ran groups for the treatment of alcoholism and showed that alcoholics tended to have overdeveloped 'child' aspects and literally attracted partners (male or female) with overdeveloped 'parental' qualities. An inherent resistance to the treatment of alcoholism in the individual was the components in the system that for their own sake 'required' the alcoholism to persist.

Berne described people obtaining 'rewards' in these games. The overdeveloped parent, underdeveloped child would get 'strokes' for condemning the alcoholics 'overdeveloped child, underdeveloped parent' and indeed would be very threatened if the alcoholic were to actually 'quit' since this meant their role as parent would be severely threatened.

Alcoholics Anonymous recognized the systemic nature of Alcoholism and Al Anon groups for families of alcoholics developed with the realization in time that 'untreated al anon's"were as sick if not more sick than the alcoholic. As one Al Anon said, "he was drunk when he picked me, whereas I had no such excuse for picking and staying with him." Today it's been shown repeatedly that membership of a spouse or family member in Al Anon can be the most important step for an alcoholics recovery.

In Transactional Analysis group therapy people became aware of the 'repetition compulsion' in their interactions, often playing out unresolved family 'games' from each individuals 'childhood'. Eric Berne described the 'roles' that people took such as 'scapegoat' and 'black sheep' and 'good girl' and how they'd only play the games in reality if they could play their 'favourite role'. Hence 'victims' became very angry if they didn't get to be 'victims' and 'victimizers' wouldn't remain in relationships in which their 'bad child' behaviour wasn't rewarded.

The success of this model was proven over and over again in therapy but it tended to upset the authorities as it 'pricked' alot of hot air balloons. Just suggesting that a doctor and patient were playing 'doctor' roles from childhood or 'judge and criminal' were carry overs from childhood games could easily get one put in an asylum or locked up for challenging the 'parentalism' of society with it's heavy punishment reward for any questioning of authority especially 'authority' that is way out of context.

Transactional Analysis' success could be summed up today in the expression "this isn't a game, it's real". Game theory is real and it's continued efficacy as a model for understanding all manner of interaction has spread far beyond the realms of therapy. Economics, politics, business management all have been studied in the light of models similiar to Berne's therapeutic groups.

There's a decidedly 'whimsical' quality that comes with seeing adult behaviour as an extension of the 'play' of children. Further, seen in this light, explored in this light, many new options for therapy can be derived.

Modern marriage therapy benefited immensely from the 'hide and seek' 'he loves me, he doesn't' game explanations for what at first appeared simply 'insane' interactions between adults supposedly in love yet really 'misbehaving'. Berne was the true 'scientist' in his work, seeking understanding and helping people learn more games and have alternative ways to 'play'. He wasn't judgemental and didn't bring his own 'game' to the table and insist everyone 'play' by his 'rules'. In the classic analytic tradition he first helped people see what they were doing in the light of this model and quite frankly asked if they really wanted to continue.

Transactional Analysis groups were one of the first groups to show solid evidence based results for 'behaviour change' in the area of alcoholism when people generally thought alcoholism was simply untreatable. Yet what better game than 'bad child' and 'good parent' for a whole group of people to play in relationships. Al Anon certainly understands this game well and when Al Anon's get together they talk about themselves and what they need to change. It's all different from the societal norms of 'blame and shame'. It's highly therapeutic and society at large is only therapeutic in the sense of 'toughlove' and 'hard knocks'. Transactional analysis in contrast offered a safer and wiser way of addressing 'behaviour change'.

Looking back today it's amazing to consider how far ahead of his times Eric Berne and the Transactional Analysis groups were.

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