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Blog

A postmodern take on transactional analysis

Posted on July 3, 2013 at 12:43 PM Comments comments (0)
Reading the work of psychiatrist and transactional analyst James R. Allen gives me great pleasure as I discover a knowledgeable and nuanced and autonomous thinker who seamlessly incorporates science and hermeneutics. In the article "Yeastlings" Allen uses the metaphor of rising dough to signify "the quiet pockets of transformation" in transactional analysis paradigm. He is talking about a shift from Berne's modernist project to a postmodern transactional analysis.  The article is available from the USATAA website. 

Fanita English: Episcript

Posted on February 7, 2013 at 11:13 AM Comments comments (3)
Fanita English is well known for her revision of script theory and the concept of "racketeering" and "episcript". In this Keynote address at the 1997 ITAA conference, she talks about how she came to understand the episcript as the "transmission of a lifelong obligation to fulfil a destructive task".

Can time structuring be used for differential diagnosis?

Posted on November 26, 2012 at 11:03 AM Comments comments (214)
A fellow TA trainee asked this interesting question: 

When putting together a differential diagnosis of personality disorder in therapy, has anyone used time structuring to choose one diagnosis over another? She said that her instinct was that someone with a narcissistic personality structure would spend more time in games while someone with obsessive compulsive personality structure more time in rituals.

I think this is an extremely interesting question but we need to be careful about how we use terms such as "ritual" or "withdrawal" which have different meaning in DSMIV from that in which we use them in transactional analysis. 

"Ritual" as a concept in TA to my mind is not the same as the sense in which it is used in the DSM IV. Rituals play a major part in Obsessive Compulsive Disorder (OCD), but these are not social rituals in the sense that we understand them in TA. They are repetitive compulsive behaviours. Rituals also play some part in Obsessive Compulsive Personality Disorder (OCPD) but to a lesser degree. Also, OCPD should not be confused with OCD. OCPD clients are concerned with rules, order, hoarding and overworking. OCD clients may not in fact have a personality disorder but an anxiety and compulsion disorder. OCD is on Axis I. OCPD is on Axis II.

A client with obsessive compulsive structure will feel entitled to a game of Uproar if someone else interferes with their order or rules (and perhaps in their thinking is playing Schlemiel -messing things up). They may constantly play this game with their partner.

I think Berne's concept of time structure is useful diagnostically. Enquiring about how a client structures their time in a social sense, alerts the therapist and the client to whether the client is mixing in all the ingredients that make her feel she's doing the things she wants to do in life and relationships. 

However, I would be cautious though about linking this with the personality diagnosis as I don't think the correlation is straightforward to make and one could end up with generalisations that don't fit all clients with the same diagnosis. Perhaps it's better to keep time structure as a useful diagnostic tool, but not insist on an over-arching theory that links it with personality disorders. 

The truth is we all need and do a combination of withdrawal, rituals, pastiming, games and intimacy and this is very much guided by our temperament (introverts will shy away from too much stimulation from other people) and culture (some cultures value separateness more than others). 

This is the first time I've ever considered what an extreme preference for one form of time structuring would look like, but here it is: 

Generally others will not allow us to persist with one form of social structure beyond what the unspoken norms dictate. Therefore, I do think that that someone whose entire time is structured around one activity only may be extremely mentally disturbed. 

Withdrawal
For instance, a client with catatonic schizophrenia will be in complete withdrawal and not acknowledge another in any way. Deeply traumatised clients, clients suffering with PTSD or clients on the autistic spectrum may also show extreme withdrawal. Again - caution - this isn't the withdrawal we talk about in TA terms. Social withdrawal at a gathering may simply mean that you're burying your head in a book and not that you've literally left your body as happens in dissociation.

Rituals and pastimes
Can one be a pathological ritualizer or pastimer (in the social sense not the OCD or eating disordered sense)? I remember talking with someone suffering from dementia, who spent most of the hour re-setting our conversation at the stage of ritual. She kept saying "Hello" and "What is your name?" as she couldn't remember that we'd already covered this. 

Games
Clients addicted to the thrills of violent of three degree games may well have an antisocial personality disorder or borderline personality disorder or be addicted to mind-altering substances. 

How about when clients are incapable of playing games? I think they do exist. Such clients may suffer from a form of learning difficulty (perhaps retardation as lying requires intelligence) or be on the autistic spectrum (not adept at picking ulterior transactions or transacting at an ulterior level because they are limited in making sense of subtle non-verbal communication such as facial expressions.) 

Intimacy

Can an excessive preference for intimacy be indicative of something gone wrong? Someone who is prematurely intimate in the sense of being uninhibited in disclosing the entire content of their mind from the word "go" without any concern about censorship. This could again be a patient with Schizophrenia (but again you also have to watch out for cultural differences).