Transactional Analysis of Schizophrenia

The Naked Self

Zefiro Mellacqua

• Publisher: Routledge
• Year: 2020
• ISBN:
  9780429624346
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

In Transactional Analysis of Schizophrenia: The Naked Self, Zefiro Mellacqua presents a full assessment of the relevance and value of transactional analysis in understanding, conceptualizing and treating schizophrenia in contemporary clinical settings.

Opening with a review of Eric Berne's ideas, Mellacqua applies theory to the understanding and psychotherapeutic treatment of people suffering from first-episode schizophrenia and to those already living with more long-lasting psychotic levels of self-disturbance. The chapters address a series of crucial methodological themes, including the need for both intensive and extensive analytic sessions; the therapist's tolerance of uncertainty and not knowing; the informative quality of both therapist's and patient's embodiment(s); the emergence of the transference-countertransference relationship; the link between silent transactions and unconscious communication; dream analysis; and the value of regular supervisions. Mellacqua's approach incorporates meetings with family and caregivers, as well as emphasising multidisciplinary work with patients in a variety of settings, such as in hospitals, outpatient clinics, and psychiatric home treatment. The book is illustrated with engaging clinical case studies throughout, which illuminate the schizophrenic experience and provide examples of how these tools can be used to help patients.

Transactional Analysis of Schizophrenia demonstrates how those who suffer from acute schizophrenia, especially those at their very first episode of psychosis, can make an effective recovery and live a satisfying life through the therapeutic application of transactional analysis. It will be essential reading for transactional analysts, psychodynamically oriented psychotherapists, psychologists, psychiatrists, nurses, social workers, academics and all mental health professionals working with people suffering from schizophrenic psychoses.

See the below link for an interview about the book with Gianpiero Petriglieri and series editor William F. Cornell:

https://vimeo.com/499800269

1

The transactional ego in contemporary clinical practice

Epistemological foundations and the legacy of Eric Berne’s theory of ego states

Transactional analysis regards human subjectivity as a unique, unrepeatable set of ego states. In the view of the creator of transactional analysis, Eric Berne (1970), ego states are, in fact, “its foundation stones and its marks” in as much as “whatever deals with ego states is transactional analysis, and whatever overlooks them is not” (p. 223).

In the uninterrupted flow of each of our inner and relational lives, the ego is the part of the human personality that is able to observe itself, “much as the parts of the body can feel one other” (Berne, 1969 [1957], p. 87). Berne distinguished three parts within the ego, each of which is able, insofar as it is all one ego, to be aware of the others. These three parts are fundamental ways of existing, the result of the human experience of being and being in the world, a world that from the beginning of life is populated not only by a “me” and many “other-than-me” but also by an “us,” by “many-Other(s)-within-me,” and by a “me-through-the-Other(s).” In other words, there is no original “me” without a historical “Other” so that the “we,” like the “me,” inevitably carries a trace of the “Other.”

Berne called the “me-through-the-Other(s)” the Child ego state—a kind of “residual infantile ego state of the adult person” (Weiss as cited in Berne, 1975b [1961], p. 19)—recalling how every individual carries inside him or her the child that was and continues to be in the present, as well as in the future, in relation to the important others of the past.

Another part of the ego is the Parent, or “the-Other(s)-within-me,” a “psychic presence” (Weiss as cited in Berne 1975b [1961], p. 19) deriving from the internalization of parental figures or reference figures in loco parentis. These, over the course of the subject’s past as well as throughout his or her life, are created, or not, through multiple and changing identifications and internalizations into normative and emotional authorities.

The Adult ego state, or the “me” (that is not the other), is the part of the personality that enables contact between the ego and the new other—also understood as environment and nature—thereby forming a “we.” It is thanks to the Adult that the individual not only responsibly experiments with being a subjective ego with a history but accesses external reality, and primarily the psychological reality of the new other, with renewed curiosity, capturing the wonder and mystery of it in current experience—of both the here and now and the “not yet” (see Figure 1.1).

Figure 1.1 Ego states (adapted from Berne, 1975b [1961], p. 31)

These three parts of the ego—Parent, Adult, and Child—operate within the healthy personality as discrete systems. Each is capable of operating both autonomously and together with the others, and has, on the one hand, its own internal organization and being, and on the other, is in continuous relationship with external reality.

The substance that makes an ego state is life that throbs with emotion, which is further expressed in thoughts and articulated in bodily experiences and visible behaviors. An ego state is, by Berne’s definition, a consistently structured way of thinking, feeling, and behaving at any given moment. Moreover, as phenomenological realities, ego states are not “roles” (Berne, 1975b [1961], p. 33; 2008 [1964], p. 23) but living parts of the self with history and ever-evolving subjective experience. One could therefore say that ego states are innumerable but still related to each of the three parts of the ego that, according to the experience of psychological and social life, we call in transactional analysis Parent, Adult, and Child.

The clinical and theoretical perspective adopted by Berne is marked by the influence from the 1940s and 1950s of the psychoanalytic psychology of the ego developed by Paul Federn (1953[1952]), Edoardo Weiss (1950), and Ronald Fairbairn (1952). In particular, the Bernean definition of ego state decisively contains the original contribution introduced by Federn (1953 [1952]) and Weiss (1950) into the analytical tradition as a phenomenological critique of Freud’s vision of the ego as a psychic entity that originates from the id. For Federn, as for Berne, the ego is a phenomenological reality that can be experienced directly by the subject: “The ego is felt and known by the individual as a lasting or recurring continuity of the body and mental life in respect of time, space, and causality, and is felt and apprehended by him as a ‘unity’” (Federn, 1953 [1952], p. 94). This formulation of the ego, originally produced by Federn, corresponds to the concept of ego state expressed by his greatest pupil, Edoardo Weiss (1950): “Every ego state is the actually experienced reality of one’s mental and bodily ego with the contents of the lived-through period” (p. 141).

Furthermore, the theoretical perspective used by Berne regarding the tripartite idea of the ego—classified into Parent, Adult, and Child—found in Fairbairn’s work (1952) is “one of the best heuristic bridges between transactional analysis and psychoanalysis” (Berne, 1975c [1972], p. 162). In fact, Fairbairn was the first to recognize a plural ego that is structured and differentiated—into a central ego (directed toward external relationships, especially if they are rewarding), a libidinal ego (linked to the search and hope for a relationship), and an anti-libidinal ego (linked to the hostility and rejection of relationships)—directly through more or less rewarding multiple relationships with real relational objects.

One could even say that Berne’s theory, which is set out formally in Transactional Analysis in Psychotherapy (1975b [1961]), boosted and radicalized Fairbairn’s thesis of the nonindivisibility of the ego, showing, rather, how the individual is populated by ego states on the inside (i.e., made up of internal objects that result from being constantly in relation to and identification with real, external others, the world, and surrounding nature).

Berne, following in the footsteps of the aforementioned authors, went further, boldly demonstrating four routes to forming knowledge—or diagnoses (from the Greek dia-gnosis, from διά “through” and γνωσις “knowledge”, and therefore “to know through”)—in a given moment of one’s own or another’s ego state and thereby meeting oneself as well as truly meeting the other in one’s own uniqueness.

The first route to knowledge is observing behavior—one’s own and other people’s—in its myriad manifestations, such as body posture, gait, tone, volume and rhythm of the voice, breathing, vocabulary, gestures, and facial expression.

The second route to knowledge is social observation or the kind of behavioral response requested by the individual from the other during an interaction and vice versa. Social knowledge of an ego state is based on the assumption that one often forms a relationship starting from complementary or symmetrical ego states. For example, it is possible to work out if someone is in a Parent ego state by observing that his or her interlocutor is responding to the person from a Child ego state or from a Parent ego state in symmetrical competition.

The third way to recognize an ego state is by means of a historical (or psychobiographical) investigation of the person’s traceable memories regarding the who and when of relational experiences from childhood and early adolescence with parental reference figures and significant others from the individual’s past. Historical investigation facilitates an exploration of whether the ego state observed in the here and now is, in fact: (1) an expression of thoughts, emotions, and behaviors used by the reference parent(s) (Parent ego state); (2) inner experiences of the child that the person was in that particular historical moment (Child ego state); or (3) a response to the current situation (Adult ego state).

The fourth way to identify an ego state is through phenomenological exploration. More than the other ways, this route enables the greatest participation in the inner world of the other, introducing us and exposing us in all its intensity to the most distinctively subjective and idiosyncratic experience of the person in front of us. For example, a Child ego state or a Parent ego state is phenomenologically accessible when the subject does not simply remember but re-creates with all his or her expressive potency the cognitive, bodily-emotional, and relational experiences of a situation from his or her past and relives them in the present.

Berne (2008 [1964], p. 42) added to these means of knowing (or recognizing) ego states as observable psychological and social entities a description of how each part of the ego—Parent, Adult, and Child—can function in relation to the other parts (influencing ego state) and in social interaction with others (active ego state). In particular, in What do you say after you say hello?, Berne (1975c [1972], p. 32) showed in greater detail how the Parent can be described as Nurturing Parent (e.g., as provider of care, protection, and/or permission) or Controlling Parent (e.g., as a source of abuse, criticism, and/or prohibitions). On the other hand, the Child has also been classified by Berne (1975c [1972], p. 32) in descriptive terms such as Adapted Child (e.g., usually compliant toward parental or primary figures), Rebellious Child (e.g., openly hostile and rebellious toward regulatory others), and Natural Child (e.g., in tune with the person’s own needs and acknowledged in respect of these by significant others).

Unlike the other parts of the ego, the Adult ego state did not have ascribed to it as many descriptive definitions by Berne. Instead, he attributed to and recognized in the Adult the unique possibility of a genuine approach to internal (one’s own ego states) and external (ego states of others and the social world) contingent reality with all the cognitive, emotional, and relational resources permitted to the Adult ego state by the biology of the individual’s central and peripheral nervous system up to that moment in his or her development.¹

Consequently, if the behavioral, social, historical, and phenomenological investigations lead to an actual presentation of an ego state (“Who am I?” “Who are you?” “Who is speaking, feeling, acting?”), then the description of the relational function of an ego state—as in the case of the Natural, Adapted, and Rebellious Child as well as the Nurturing and Controlling Parent—is, in fact, a phenomenal (i.e., behavioral) representation of it (“How am I?” “How are you?” “How am I speaking, feeling acting?” “How are you speaking, feeling, acting?”)².

In essence, with the functional representation of ego states, Berne wanted not only to emphasize once again the observable behavioral aspects of each ego state but also to describe the type of function that an ego state plays in the ecology of the human mind, which is to maintain a sort of homeostasis of the subject’s inner and relational (and therefore social) world.

Transactions: The mind in action

It is precisely in the acknowledgment of the existence of ego states within every personality that Berne showed us a new way of observing and understanding an encounter between two or more people. He deliberately chose the word transaction to show what is happening in a social exchange. It was not interaction or interpersonal connection or even relationship but transaction that was Berne’s favored object and on which he focused. That was because transaction involves each individual engaging in something in every encounter, and, at the same time, something is exchanged, and what we get out of it is the reason each of us engages in it (Berne, 1975b [1961]).

With these as the premises, it is not surprising to find in Berne’s writings diagrams and vectors that are means, and certainly not ends, for rendering not just a surprisingly creative and powerful vision of the intrapsychic and interpersonal worlds of the individual but for making this world understandable and accessible to the person himself or herself. Berne’s revolution was, therefore, to have woven his own ideas about human subjectivity around a real philosophy of hope: the hope of being able to share the almost ineffable human experience of being an “I” with a more or less large group of people, including those who are mentally suffering.

The epistemological roots of this Bernean hope sink once again into the fertile soil of ego psychology, the central thesis of which is founded—starting from the work of Heinz Hartmann (1939), one of its greatest exponents—on the recognition of a core of the ego that is free from driving intrapsychic conflicts with their Freudian overtones. This part of the ego would consequently form an innate core of the personality, one that is able to develop in an independent way—unlike Freud’s id—following precise neurophysiological bases and mediating, along the various phases of psychophysical development, the fragile connection of the individual with internal reality (intraegoic reality), his or her own body and those of others (intrabodily and interbodily reality), external relational reality (preobject relational world and interegoic reality), and the surrounding world and nature more generally.

These foundations of post-Freudian—or, as Berne wrote, para-Freudian—analytical knowledge converged in Berne’s elaboration of the Adult ego state. He conceived of the Adult as a structure of the individual’s personality that would be able to maintain areas (even if these are minimal, as in cases of serious psychopathology) that are notably free from both intrapsychic conflict and structural deficits. In this way, and also through the psychotherapeutic process, the person’s Adult would become the part of the personality that is able to structure itself more and more extensively as an observing, self-reflective, self-analyzing, and integrating ego. In Berne’s conception of the Adult ego state, there are echoes of the contemporary observations of Fenichel (as cited by Berne, 1977d [1966]) on “the division of the ego into an observing portion and an experiencing portion” (p. 293).

In other words, it is due to the operation of our psyche’s Adult that, in Berne’s view, a transactional analysis proper is possible. This involves analyzing the transactions between the egos of the various participants in a social encounter. Particularly in the clinical arena, this approach clearly retains its validity not only in a group setting but, given the plural nature of the ego, also in encounters between just two people, as, for example, in individual psychotherapy.

Since there would be no tr...

Table of contents

• Cover
• Endorsements
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of illustrations
• On Burroughs’ Work
• List of cases
• Abbreviations
• Foreword
• Acknowledgments
• Credit lines
• Introduction
• Special introduction to readers with schizophrenia
• 1. The transactional ego in contemporary clinical practice
• 2. Schizophrenia or schizophrenias?
• 3. Transactional psychopathology of schizophrenic psychoses
• 4. Forms of transference and countertransference in encounters with so-called “schizophrenics”
• 5. The naked self
• 6. The body in action: Protocol analysis in schizophrenia
• 7. Countertransference in the face of psychosis
• 8. Therapeutic transactions
• 9. Dreaming reality
• 10. Don’t hide the madness
• Index