At the Interface of Transactional Analysis, Psychoanalysis, and Body Psychotherapy

Clinical and Theoretical Perspectives

William F. Cornell

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429875618
• Edition: 1
• Topic: Psychologie
• Subtopic: Histoire et théorie en psychologie

At the Interface of Transactional Analysis, Psychoanalysis, and Body Psychotherapy revolves around two intertwined themes: that of the critique and expansion of the theory and practice of transactional analysis and that of the generative richness discovered at the intersection of transactional analysis, psychoanalysis, and somatic psychotherapy.

William F. Cornell explores the work of psychotherapists and counsellors through the lenses of clinical theory, practice, supervision, and ethics. The reader is thus invited into a more vivid experience of being engaged and touched by this work's often deep, and at times difficult, intimacy. The book is grounded in the approaches of contemporary transactional analysis and psychoanalysis, using detailed case discussions to convey the flesh of these professional, and yet all too human, working relationships. Attention is paid to the force and richness of the transferential and countertransferential tensions that pervade and enliven the therapeutic process. Unconscious processes are viewed as fundamentally creative and life-seeking, with the vital functions of fantasy, imagination, and play brought into the foreground.

In the era of short-term, cognitive-behavioural, solution-focused, and evidence-based models of counselling and psychotherapy, At the Interface of Transactional Analysis, Psychoanalysis, and Body Psychotherapy seeks to demonstrate the power and creativity of longer-term, dynamically oriented work.

Part I

Deepening our capacities for therapeutic work

Chapter 1

Opening to the vitality of unconscious experience

My view is that the analyst’s technique is his attitude actualized, and that what matters most is the passionate curiosity tamed in the service of the patient’s self inquiry, the analyst knowing a bit about how analytic work unfolds, not about how the patient should live his life.

(Poland, personal communication)

I trained simultaneously during the 1970s in transactional analysis (TA) and Radix, neo-Reichian body education, becoming a trainer in each modality. At the surface, these two methodologies were rather strange bedfellows, in that TA was profoundly cognitive and rational, with a strict rule against touching clients, while Radix was, to an equal and opposite extent, profoundly emotional, with touch and bodily expression at the core of the neo-Reichian techniques (Kelley, 1988, 2004). However, what these two modalities held in common was a positioning of the therapist on the outside of the therapeutic process as the one who assessed the client’s difficulties from a specific theoretical frame of reference and then acted upon the client’s way of being so as to promote change. It was the task of the TA therapist to identify games and scripts so as “cure” the client. It was the task of the Radix practitioner to confront the interpersonal and bodily character defenses so as to promote emotional catharsis and ultimately establish “orgastic potency.” This active, knowing positioning of the therapist had great appeal to me as a young, rather frightened, and overly responsible psychotherapist. It served me well, but I gradually began to see that it did not always serve my clients so well. I took my questions and clinical concerns to my TA and Radix supervisors. The supervisory responses were uncannily similar: the problems were rooted in the depths of my clients’ resistances and character defenses. I was doing fine; I was simply to do more of the same—longer, harder. I did as I was told, and some of my clients got worse. I decided to look elsewhere for consultation. I knew the fundamental difficulties were in my working style, not in the resistances of my clients. I sought supervision outside of transactional analysis and the Reichian worlds, and I began to read, searching for an understanding of the problems I was finding in my clinical work.

I began supervision with a Kleinian therapist, whose style was unlike anything I had ever known. I hated the process, and I hated her, but I knew she was up to something important. We worked from session transcripts. She said nothing about my clients—no diagnoses, no interpretations. She made no technical suggestions, nor did she challenge what I was doing. She essentially asked one question in seemingly endless variations, “What was going on inside of you that you chose to speak right then? Why did you feel the need to do something just then?” Gradually, reluctantly, I began to see how often my interventions—be they verbal, bodily, supportive, or confronting—were precipitated by my own anxiety and my need to do something. I also began to recognize that my affinity for these active methodologies was an enactment of my script. In my family of origin, I was the doer, the caretaker, and the problem-solver, so here I was again playing out these roles in my professional work, whether or not they suited the needs of my clients.

I then sought supervision from a Jungian analyst, in spite of my stereotype that Jungians were all overly intellectual and spent their time diagnosing archetypes and drawing mandalas with their clients. This man proved to be a gift to my professional development. He gave me my first lessons in listening rather than doing. He taught me to manage my anxiety and to soften my style. Most importantly, he listened for the more grow-oriented impulses of my clients, helping me to shift out of my habitual game/character/defense listening mode.

During this period of time, I suspended most of my Reichian-style therapy and invited several of my body-therapy clients to meet and read with me to see if we could figure out what was wrong with the way we had been working. It was our reading of the Vietnam-related literature on post-traumatic stress disorder (PTSD) that gave us our first insights into the impact of trauma and to distinguish dissociative defenses from those of the more classical repressive sort that both Berne and Reich emphasized. The result was an evolution in my understanding of working with body process, about which I’ve written extensively over the years (Cornell & Olio, 1992, 1993; Cornell, 2007, 2008, 2011, 2015).

Without my busy, allegedly empathic, “useful,” “good parent” therapist-self in high gear, I often fell into a muted, rather empty silence. I needed not only to learn how to listen differently, I needed to learn how to speak differently. I returned to the psychoanalytic literature, now exploring contemporary analysts. The discovery of the work of D.W. Winnicott (1960, 1971), Christopher Bollas (1987, 1989, 1999), James McLaughlin (2005), and Warren Poland (1996, 2012) was like a revelation to me. Here were accounts of the force and vitality of unconscious experience that stood in stark contrast to the classical psychoanalytic theories of the unconscious that Berne had rejected in his development of TA. Here were analysts who, each in their own way, described how to listen, to welcome and to tolerate uncertainty, and to spend long periods in attentive quiet. It was a fundamental task in classical psychoanalysis to render the unconscious conscious. For Bollas, the thrill of psychoanalytic explorations was that of enriching conscious experience with the depth, mystery, and vitality of unconscious experience.

My immersion in their writings, and my good fortune to work closely with both McLaughlin and Bollas, provided the basis for much of the work I will describe in this chapter. Jim McLaughlin and I were never in supervision or therapy together, our working relationship was around his writing and mine. As he became familiar with my writing, he made a pointed and unforgettable interpretation, “It seems to me that the closer something is to your heart, the quieter you become. It is as though you imagine that silence can best protect what you cherish.” In supervision with Christopher Bollas during this same period of time, he made the comment that I seemed to be afraid of the unconscious—of my own as well as that of my client. These were transformative interpretations.

My discovery a few years later of the writings of Muriel Dimen (2003, 2005) and Ruth Stein (1998a, 1998b) radically transformed my understanding of the meanings and functions of sexuality, returning attention to sexuality in my clinical work. My reading and meeting with these analysts made fundamental changes in my understanding of my work through the 1990s and the first decade of this century. The impact of these analytic perspectives on my work will be the focus of this chapter.

This chapter is based in my evolution as a psychotherapist. However, the force and vitality of unconscious realms are present whenever we work as professionals involved in facilitating psychological change, regardless of our particular field of application.

A brief pause with Eric Berne

Reading Winnicott and Bollas opened new ways of reading and understanding Berne, which led to a series of papers exploring both the richness and the limits of Berne’s writing (Cornell, 2000, 2005, 2006; Cornell & Landaiche, 2008). In re-reading Berne with a fresh perspective, I began to see a depth and an often conflicted wisdom in his work that had not been apparent to me in my initial study of his books or in the rendering of Berne that had been in my TA training.

I found in re-reading Berne a concept that proved to be a key in my unraveling the clinical dilemmas I was trying to find my way through. In his theory of games, Berne (1964, p. 64) made distinctions between what he called “first, second, and third degree” games, which I have further extended to the understanding and differentiations of script. By “first degree,” Berne was describing levels of intrapsychic and interpersonal defenses that were reasonably available to conscious awareness and change through cognitive interventions and understandings. Berne saw games at the first degree level as serving a “social” function, which is to say, to make relationships more predictable.

“Second-degree” games and scripts serve defensive purposes that operate outside of conscious awareness and control. At the second degree, Berne saw a split between the conscious level of communication and another, which is more psychologically significant, that represents more unconscious motivations. “Second-degree” games are understood as serving a more fundamental psychological function—i.e., maintaining script—rather than a social function. Defenses operating at this level are not so readily amenable to change through cognitive interventions. Berne (1966) developed his model of group treatment primarily as a means of helping clients identify and alter their second-degree games.

Berne characterized “third-degree” games and scripts as held and lived at the “tissue” level, by which he meant at the level of the body rather than the mind. Berne saw defenses at this third level as being extremely resistant to change and ultimately destructive. As I read Winnicott and Bollas, I came to see Berne’s pessimism for successful treatment of third-degree (and sometimes second-degree) defenses was a direct consequence of his turning away from maintaining a place for working with unconscious experience and motivation in transactional analysis.

My emphasis here is on the use of Berne’s differentiation of the “degrees” of games as an indication of intrapsychic organization. Stuthridge and Sills (2016) offer a further elaboration of Berne’s model, emphasizing the interpersonal implications and impacts of the degree of the game. It is important to recognize that while Berne framed his differentiations of the degrees of games in terms of levels of defense, these variations of psychic organization are not in and of themselves defensive or pathological. The fact, for example, that aspects of one’s experience are organized and experienced primarily at nonverbal body (“tissue”) level does not make them pathological.

When writing about script theory, Berne (1963) introduced the concepts of protocol and palimpsest:

A protocol or palimpsest is of such a crude nature that it is quite unsuitable as a program for grown-up relationships. It becomes largely forgotten (unconscious) and is replaced by a more civilized version, the script proper.…

(p. 167)

In this way, he described a level of unconscious, somatic organization without the attribution of defense and pathology that attended third-degree games (Cornell & Landaiche, 2006).

In the fifty years since Berne’s death, the study of attachment patterns, implicit memory processes, the subsymbolic mode of organization, transference/countertransference, and neuropsychological research have radically shifted our understanding of these somatic, and often unconscious, realms of experience. Protocol and palimpsest are not inherently pathological, but are grounded what we might call “the good, the bad, and the ugly” of our earliest experience that lives on within us in what we would now call implicit, procedural memory. At the “third-degree” level, living the experience with our clients precedes and informs whatever comes to be analyzed and spoken.

Berne’s differentiations helped me see that I needed to develop a much more varied approach to psychotherapy. I could see that while my more active, interpretive interventions, be they in the more cognitive style of TA or the more somatic interventions of the neo-Riechian modes, were often sufficient for clients whose defenses were organized primarily at the first and second degree levels, for other clients and the deeper, more troubled phases of treatment, there needed to be fundamental changes in my customary ways of working. I did not need to trash everything that I had been doing, but it was abundantly clear that I needed to expand my ways of working.

Two-person, separate

It was a painful period of learning in which I gradually shed my manic, overly active, relentlessly useful style of psychotherapy. In my personal psychoanalysis I was able to painfully face the defensive functions of my manic need for action and efficacy. Here was the mother’s presence in the unconscious motivations for my manic overdoing. My father’s absence underlay my dread of silence and separateness, which I felt to be the equivalent of neglect and isolation.

My consultants gently, but persistently, pointed out how often my apparent “empathy” for my clients served the needs of my self-image more than the needs of my clients. Bollas repeatedly spoke to how an over-investment in “empathy” foreclosed the experience of the client, taking away their right to self-exploration. McLaughlin argued, “Here I emphasize the working of two separate minds so that I can make clear that the central focus on the patient’s reality view does not mean seeking unbroken agreement and oneness in the dyad” (2005, p. 207). Poland (2012) emphasizes the fundamental separateness of the subjectivities of the therapist and client:

Whatever the analyst then says, from the most trivial clarification to the most profound interpretation, whatever the content of the words, a crucial message buried deep in the structure of the very making of the statement is one that states, “No, I am not you, nor am I one of your ghosts, but as separate people we can speak of what is involved. No, I am not part of your dream, but as a person who cares for what you are doing but who is separate, I can help you find the words to say it.

(p. 947; emphasis in original)

The willingness of the therapist to respect that essential separateness gives the client the space and freedom of self-discovery and self-definition. I came to see how a therapist’s self-disclosure or the valorization of mutuality further risks an impingement on the client’s psychic realities and struggles.

Gradually I learned to be informed by my countertransferences, and for the most part to keep them to myself, so as to allow my clients to inhabit their own intrapsychic wishes and struggles:

Psychoanalysis takes place between two people yet feels as if it lives within the deepest recesses of my private life.

… For every encounter with a patient sends me deeply into myself, to an area of essential aloneness processed by voiceless laws of dense mental complexity.

… the analyst and his patient are in a curiously autobiographical state, moving between two histories, one privileged (the patient) and the other recessed (the analyst), in the interests of creating generative absence, so that the patient may create himself out of [these] two materials.…

(Bollas, 1999, p. 11)

Bollas’ position often seemed frightening and alien to me as a therapist who habitually used his work with clients to escape himself. His sense of a “generative absence” was a startling and liberating contrast to the meanings of absence that I had internalized with my father.

Deeply depressed during her graduate school years, Catherine was desperate to have a place where she could figure out her life and her sense of self. She had lived her life being seen only through the demanding and judgmental eyes of those around her. It was with Catherine that I learned with particular poignancy the importance of keeping our histories separate and of tolerating my countertransference.

We had been working for four years when her mother was diagnosed with a recurrence of an earlier cancer that had metastasized to her bones and brain. During that same period of time, my sister was terminally ill with massively metastasized cancers. My sister died while Catherine’s mother was still undergoing treatment. Many times, as I listened to her, I thought of my sister, who was the same age as Catherine’s mother, and of my niece’s, my nephews’ anguish. At times I found it nearly unbearable to listen to her as I anticipated what lay ahead for her and her mother. I said nothing to her of my sister’s plight or the impact that listening to her had upon me. I could not, in the sessions themselves, sort out which of my reactions had to do with Catherine and which were mine—they were too immediate and intense. Her father was as emotionally self-absorbed and oblivious to his children as was my sister’s husband, so my countertransference was intense and risked being intrusive. I kept it to myself and worked it through with myself, so as to remain open to her experience.

Catherine’s parents were each in their own way so profoundly self-involved that there was no room for her struggles or needs as she faced her mother’s illness. She needed a space with me that was entirely hers. Her relationship with her mother had been turbulent and deeply conflictual but also loving and intimate. She felt an intense need to avoid conflict as her mother grew more ill. Catherine often said, “if my mother dies,” which I never corrected. However, when I spoke of her mother’s illness, I always said, “When your mother dies.” She asked me one day why I said “when.” I told her that her mother’s cancer was terminal, and that her mother undoubtedly knew that. When Catherine, her father, or other family said, “if,” they were lying. “It is a lie intended to comfort,” I said, “but it is a lie nonetheless. Perhaps it is a lie that comforts your father and family, but it signals to your mother that there are things that cannot be spoken, cannot be faced together and that she may be facing her death alone. I’m not willing to participate in the lie with you. You may make a different choice with your family.” In time, Catherine learned to speak freely to her mother, and her mother was able to respond in kind, and, fortunately, they did not lose their capacity to argue with each other. Catherine found her way to accompany her dying Mom. They could speak the truth to one another.

As her mother approached death, Catherine was often told that she was too emotional and that her feelings would upset her mother. As her mother became less and less able to communicate verbally, Catherine wanted des...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of figures
• Acknowledgements
• PART I: Deepening our capacities for therapeutic work
• PART II: When life grows dark
• References
• Index