Transactional Analysis Journal

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Deconfusion of the Child Ego State: A Relational

Perspective

Helena Hargaden & Charlotte Sills

To cite this article: Helena Hargaden & Charlotte Sills (2001) Deconfusion of the Child
Ego State: A Relational Perspective, Transactional Analysis Journal, 31:1, 55-70, DOI:
10.1177/036215370103100107

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 Deconfusion of the Child Ego State:
A Relational Perspective
Helena Hargaden and Charlotte Sills

Abstract present with symptoms that require resolution

This article proposes a theory of self within the Child ego state (as noted by Clark,
based on Berne's (1961/1986)original struc- 1991), especially those who manifest schizoid
tural model of ego states and on elements of processes. It has, therefore, been increasingly
object relations theory and self psychology. necessary to pay attention to the phase of treat-
Consideration is given to the implications of ment known as deconfusion of the Child ego
this theory for psychotherapeutic method- state.
ology-including the therapist's use of self There is already a distinguished body of
-as they relate to understanding and work- work in the transactional analysis literature that
ing with the internal dynamics of the Child considers deconfusion work (Blackstone,
ego state. The authors suggest that a con- 1993; Clark, 1991; Erskine, 1991,1993,1994;
gruent methodology for deconfusing the Erskine & Trautmann, 1996; Haykin, 1980;
Child involves using the transferential rela- Moiso, 1985; Shmukler, 1991). We seek to
tionship as the vehicle for deconfusion, and build on this tradition by expanding transac-
they identify four interrelated steps in this tional analysis theory to incorporate a theory of
process. Transference and countertransfer- self that is useful in mapping the complex pro-
ence are defined and explored, case material cesses involved in the deconfusion phase of
is presented to demonstrate the therapist's treatment. Using our theory of self inthe Child
use of self, and figures based on the struc- ego state, we have integrated into transactional
tural model of ego states are offered for analysis some principles from object relations
each step. When we refer to the therapist's and self psychology, theories that also focus on
interventions and behavior we mean to im- a notion of the self. In doing so we have en-
ply that the therapist always functions in riched our understanding of primary processes
the Adult. The authors demonstrate how and complex mental states while remaining
Berne's therapeutic operations provide a within the transactional analysis model. We
valuable skeleton for mapping the processes suggest that the transferential relationship is
of decontamination and deconfusion. the vehicle for deconfusion and that the work
is facilitated by a detailed analysis of this re-
lationship.
Eric Berne (1961/1986) implied that decon-
fusion was an integral part of structural analy- Structural Analysis and Deconfusion
sis: "Psychoanalytic cure in structural terms In proposing our theory of self we recognize
means deconfusion of the Child with a largely that our thinking is, of course, simply a story.
decontaminated Adult as a therapeutic ally" (p. We find it useful, however, for making sense
162). However, he also revealed an ambivalent of some of the complex processes involved in
attitude toward working with the dynamic psychotherapy of the Child ego state. We pro-
Child, sometimes referring rather dismissively pose that C2 is the whole "self' and that the in-
to the "luxury" (p. 149) of analyzing the Child ternal organization of the "self' is comprised
and other times suggesting deconfusion as a of Cj, AI, and PI. We link the internal organi-
phase of treatment. zation of the self in C 2 with Stem's (1985) do-
In our clinical work we have noticed an mains of the self. This is to underline the dy-
increase in the prevalence of patients who namic, constantly evolving, interactive nature

Vol. 31, No. I, January 2001 55

HELENA HARGADEN AND CHARLOTTE SILLS

of the internal relational world as symbolized enables the infant to integrate his experiences
by PI' AI' and C 1 (palCo)' sufficiently to be able to tolerate his most
primitive feelings and to instinctively develop
C.: The Core Self self-esteem and appropriate grandiosity. The
We suggest that C I contains Coand Po (Sills, cohesive self grows from the interplay between
1995). From this perspective we understand Co the child's potential and the parents' selective
to be the emergent self (Stem, 1985) wherein responses. When there are sufficient experi-
the baby "is thought to occupy some kind of ences of attuned interplay between the child
presocial, precognitive, preorganized life phase" and the environment, he develops internalized
(p. 37). Co is experienced as bodily-affective representations of self and mother (C/P o) to
states that include the sense of being contacted support the healthy development of a core self
by the environment (mother), the latter of (A o)' However, when the infant experiences
whom is represented in Figure I as Po. Cois the cumulative misattunement and nonattunement
seat of the child's mirroring and idealizing from the environment, he has no way of deal-
yearnings. This constellation hints at the fragile ing with this except by splitting off the "undi-
yet dynamic nature of very early primitive pro- gested" experiences (Klein, 1986). This can be
cesses, which are not accessible to memory but understood as the schizoid process.
may only be uncovered through phenomeno- The Child, therefore, remains in a sense in-
logical inquiry based on careful attention to complete and unintegrated (A o) despite the fact
transferential phenomenon. The infant's expe- that she may have a coherent and consistent,
rience of the mutual interaction with a self- though limited, sense of self. The split-off, un-
regulating other (Stem, 1985) becomes, in our integrated experiences are walled inside Co or
view, an integral part of the child's sense of a form PI (Figure 2) along with the internalized
cohesive OK self, which we visualize as being
contained in a type of amniotic sac of the Ao
created by C/Po (see Figure I).
The purpose of the self-regulating mother/
other is to enable the child to manage his feel- pz
ings and experiences and remain feeling OK.
When the mother is "good enough" (Winni-
cott, 1960), this task is completed in a way that

Az

walled
coherent oft)
senseof ~_7;~~.L-.--":::'splitoff
self
experiences
Figure 1 Figure 2
The Self: The Child Ego State The Development of the Self

56 Transactional AnalysisJournal
 DECONFUSION OF THECHILD EGOSTATE: A RELATIONAL PERSPECTIVE

the internalized representations of the other

(described by Goulding and Goulding [1979]
as injunctions). In this view of child develop-
ment, it seems to us that C I is the foundation
on which the rest of the self-AI and PI-is
built.

At: The Verbal and Intersubjective Self

Al represents the child's attempts to make
sense of self, others, and the world based on C I
experiences and the subsequent patterns of his
relationships. It is the foundation of the per-
sonality and has two faces: A I+ and A I_. A I+ is
the "I'm OK if I ..." and consists of the
child's successful adaptations to the parents'
counterscript messages. A 1_ is the child's mak-
ing sense of those moments of feeling that he
has fallen from grace. He feels not-OK and ex-
periences negative injunctions. If the infant's
needs are adequately met and his fundamental
sense of OKness is intact, these two sides are
reasonably successfully integrated and the All indicates
adequately
child feels OK about himself and his activities. cohesiveself
For example, John learned that he could
••••.•.. permeable
please his parents in many ways. As a baby he divisionin
was loved and cherished, and this experience AI + PI indicates
possibil!ty of
formed the basis of an OK sense of self (C 1) . mtellrallon
When he was a toddler, his parents approved
of his curiosity and intelligence, received his
love with joy, and were particularly gratified Figure 3a
when he showed thoughtful caring for his baby The Cohesive Self
brother. His sense offalling from grace, of not-
OKness, occurred when they reacted not only
with disapproval but with shock at his expres- exaggerated sense of her own worth, or, para-
sion of jealous rage toward the loved brother doxically, an exaggerated humility, often ac-
or when he was rough and competitive with companied by a sense of omnipotence (A I+).
friends. He felt shame (AIJ and at these mo- For example, Mary's alcoholic mother was
ments connected with primitive shame (C I). alternately abusing and neglecting. Mary
However, his parents knew how to reach out to quickly shut down not only any grief, fear, and
him again, to forgive him and repair the rup- rage that she might have experienced, but also
ture between them, so his shame never became her needs for love and prizing. The only posi-
unbearable. He was able to accept and inte- tive attention she received was from her father,
grate both A 1+ and A J_ into his sense of self who was mainly absent but praised her for car-
(Figure 3a). ing for her mother on those occasions when he
In contrast, when the infant's relational was home. The defensive self-image Mary cre-
needs are not adequately met, the child com- ated was of the flawless angel who selflessly
pensates by clinging to the positive image of cared for others and catered to their needs. She
herself (A I+) and excluding the unmanaged, trained as a nurse, married, and was the perfect
unaccepted feeling (C 1) . She may develop an wife and mother. She anticipated every need of

Vol. 31, No. I, January 2001 57

HELENA HARGADEN AND CHARLOTTE SILLS

her friends and family, controlling them all

with her love and care while simultaneously
discounting her own needs and position. This
inflated sense of worth/humility was designed
to disguise her deep sense of worthlessness pz
(A I_ and C 1) .
Such script decisions in AI are born out of
and built on the infant's experience (C 1) and
therefore cannot truly be changed without prior
or simultaneous change in the early bodily
affective processes (C I). For instance, if any-
one complained of being controlled, or if Mary
was found to be inadequate, she lost her sense
of OKness. In this place (AIJ she experienced Az
again the rejecting and abusive mothering in
the form of injunctions such as Don't Exist,
Don't Be You, and Don't Look After Your
Needs (PI} We would understand these pro-
cesses as Mary's racket system.
When experiencing these feelings, Mary
could be heard to complain that no one appre-
ciated or understood her and that her needs
were not important. We hypothesize that the Cz "Split off"
psychological purpose of Mary's ongoing ex- core self.
-impenneable
pressions of discontent were to keep her from division in AI +P,
experiencing the emptiness and despair in the implies more
fragmented self.
core repressed (C 1) part of herself. While
Mary's racket feelings may have been avail-
able for cognitive change, unless attention was Figure 3b
paid to the underlying grief and desolation, sig- The Undeveloped Self
nificant aspects of her personality would re-
main walled off and isolated from contact.
Clearly, the greater the extent of the parent- PI: The Internal Object Representation
ing deficit (and this could include intrusive PI is comprised of Pj, and P I_. When the in-
parenting), the greater will be the split within fant has experienced gross misattunement from
AI and the more excluded will be C 1• Figure 3a the environment, she is unable to make sense
shows a relatively cohesive self in Ao and a of what is going on inside. For instance, when
permeable division line in AI and PI' Figure 3b the child projects anxiety outward she needs
demonstrates someone with more damage to the environment to soothe and make sense of
the self. This is indicated by an "empty" self in her experience. All those feelings that have not
C I and an impermeable split in AI and PI' been adequately processed, including primary
Since few people have ideal parenting, most unscreened introjections, are intolerable to the
have an element of this defensive organization. infant, and to manage them she makes them
Individuals who are permanently depressed, part of self but splits off from them (pushing
anxious, and so on are stuck in A 1_, only too them into PI)' This intrapsychic process en-
painfully aware of feelings of worthlessness. ables the infant to manage feelings that other-
Part of the therapeutic task is to develop wise would threaten to overwhelm her. We
healthy narcissism, that is, A I+ built on a sense find it useful, therefore, to think of PI as con-
of self-esteem developed in C I. taining both introjects and denied parts of the

58 Transactional Analysis Journal

 DECONFUSION OF THE CHILDEGO STATE: A RELATIONAL PERSPECTIVE

natural self. In the example of Mary, her P l - affective processes while retaining an observ-
contains the injunctions from her mother ing, objective Adult ego (see our later discus-
(Don't Exist, Don't Be You, Don't Be Close.) sion about transference and countertransfer-
and her own rejected hostile responses to her ence).
abusing mother. However, Mary managed to To achieve deconfusion, the therapist needs
split offher P 1- most of the time, only falling to incorporate four interrelated steps, which
prey to vicious self-hatred when the A 1+ image form the treatment plan. Although these steps
failed. Her P 1+, however, contained a self- are neither linear nor meant as a definitive de-
constructed, idealized "other" who appreciated scription, they are presented here in what we
and admired her virtues. It contained elements believe is the most logical order.
of her father's adoration but was fleshed out by
her own grandiose defense. PI' therefore, con- Step One: Development of the
tains both introjected images of the other and Empathic Relationship
also elements of the self that have been re- The Empathic Transaction: "An empathic
jected or created. transaction occurs when the therapist commu-
In this model, when the child has had a nicates ... understanding of what the patient is
healthy enough childhood, the internal organi- experiencing and the patient experiences being
zation of C, is comprised of all these elements understood" (Clark, 1991, p. 93). We see this
in a way that permits the person to grow and process initially (Figure 4 ) as a series of com-
develop with a cohesive sense of self. In such plementary transactions between the patient's
cases, the Child, while certainly being limited Adult and the therapist and complementary ul-
by the imperfections of parenting and environ- terior transactions between the patient's Child
ment, contains a solid sense of core self. and the therapist's Adult. "This is a necessary
In contrast, in our practice we are seeing but not the sole condition for a 'good relation-
more people with disorders of the self ranging ship' "(Berne, 1966/1994, p. 225). The thera-
from mild to the more fractured sense of self pist, therefore, needs to think about how to
seen in a personality disorder. When the inter- keep the transactions complementary in order
nal organization of the Child ego state is frag- to establish an empathic bond between patient
ile, integration can only take place within a re- and therapist.
lationship in which the therapist is willing to
take part in the different psychological posi-
tions required of him or her. Such a need arises
from the internal object world of the infant and
materializes within the transferential relation-
ship. Deconfusion, therefore, requires that the
therapist be emotionally available and open to
letting the relationship impact him or her.
When defined within the transferential rela-
tionship, the therapist's task in deconfusion is
two-fold. First, the therapist must be available
for the impact of the patient's unintegrated ex-
periences and projection, to help make sense of
the material, and to enable the patient to inte-
grate the split-off parts. Second, he or she must
pick up the unmet relational needs transferred Client Therapist
from the Child and respond appropriately
within the relationship. Both of these tasks of Figure 4
deconfusion involve a willingness on behalf of The Empathic Transaction
the therapist to engage himself or herself in

Vol. 31, No. I, January 2001 59

HELENA HARGADEN AND CHARLOTTE SILLS

For example, a patient may be saying that combination of skill and technique and a re-
she is angry although the therapist senses sad- flection of who we are and how we are our-
ness. If the patient experiences her sadness as selves. Before we can imaginatively immerse
anger, she needs to feel heard at this "racket" ourselves in another's experiences, we need to
level of communication before she will feel have an empathic relationship with our own
safe enough to go deeper. Thus, it is important Child ego state since it will be our use of our
initially to respond to the patient's felt mean- own process that will most inform how we un-
ing; although ultimately the therapist's task derstand someone else.
may be decontamination, she must respond For example, if I have an empathic relation-
with empathy and respect to the patient's con- ship with my own despairing Child, I will be
taminated Adult (Figure 5). more likely to recognize and tolerate this state
in my patient and not try to resolve or change
it into something else. Thus, empathy involves
the therapist in an introspective process in
which she is required to use herself imagina-
tively, allowing time for reflection and being
prepared to share her understanding of the pa-
tient as a type of offering for consideration
rather than as a fact or a theoretical certainty.
Empathic Inquiry: One variant of the em-
pathic transaction is the process of attuned in-
quiry described by Erskine (1993). He argues
that the therapist needs to begin by assuming
that he or she does not know about the patient
and therefore respectfully seeks to understand
the patient's subjective experience. Not only
will the therapist listening empathically, as al-
ready described, but he or she will be open to
Figure 5 exploration from a place of genuine inquiry.
Responding to the Patient's Felt Meaning The patient and therapist will thus coconstruct
the meaning of the patient's subjective experi-
ence as it emerges from the combination of
Eventually the empathic bond makes it pos- empathic understanding and inquiry. This com-
sible for the patient to feel secure enough to munication also allows trust to develop as the
revive unmet needs and suppressed develop- patient experiences the therapist's respect for
mental needs. For her to feel safe enough to do and genuine interest in her innermost psycho-
this, she must trust that the therapist is capable logical experiences.
of understanding her most profound emotional Empathic transactions and empathic inquiry
states (Clark, 199 I). As the relationship deep- need to continue throughout the deconfusion
ens, the therapist will use more advanced em- phase to provide an "umbrella" of empathic
pathic transactions (Rogers, 1961/1967), and ambience to the transferential relationship. We
since there is no such thing as "the immaculate emphasize the use of empathy when making
perception," empathy will involve the thera- any intervention and suggest that empathy pro-
pist's imaginative use of self. vides the container for the therapeutic relation-
Kohut (1984) defined empathy as "the capa- ship. We do not mean that empathy means we
city to think and feel oneself into the life of should always "get it right" for the patient or
another person" (p. 82). Rycroft (1995) defines that we never confront. With the best will in
empathy as "the capacity to put oneself into the the world it is still not possible to understand
other's shoes" (p. 47). Empathy is, therefore, a completely someone else. Paradoxically, it may

60 Transactional AnalysisJournal
 DECONFUSION OF THE CHILD EGO STATE: A RELATIONAL PERSPECTIVE

be that in feeling misunderstood, the patient Research by Schore (1994) indicates that the
moves to a deeper understanding of herself. links between feelings and thought is devel-
For instance, understanding our patient's frus- oped in right brain-left brain connections. It
trations with us for our limitations, or hearing therefore seems logical to assume that the emo-
our patient's anger with us when we unwit- tional availability of the therapist is central to
tingly rupture the empathic relationship, or try- an understanding of the unconscious. Under-
ing to understand a patient's apparently incom- stood in this context, the transferential relation-
prehensible annoyance with us is, in our view, ship becomes the gateway to the unconscious.
part of empathic understanding. Drawing on the work of Menaker (1995), we
have identified three domains of transferentia1
Step Two: The Transferential Relationship phenomenon. We develop Moise's (1985)
There are many definitions of transference, transference model to distinguish between the
which, when loosely summarized, suggest that three types of transference (Figure 6) as fol-
it describes the patient's emotional attitude to- lows:
ward the psychotherapist. In deconfusion, the
patient attempts to communicate within the
context of the therapeutic relationship unar-
ticulated experience of which she is unaware-- Key:
that is, reproduce unmet needs and early rela- a. • projected PI
b. • Idealizing,mirroring
tionship patterns and experiences in the rela- or twinning
tionship with the therapist. It is a type of "inar- transferences
ticulate speech of the heart" (Morrison, 1983)
that communicates to the therapist through be-
havior and coded language what cannot be
verbalized directly. Many clinicians will recog-
nize the increasing number of patients who
present with this type of disturbance, which
can best be understood as a disorder ofthe self
that shows itself most commonly in narcissistic
and borderline traits. In this context a useful
definition of transference is supplied by Stolo-
row, Brandchaft, and Atwood (1987): "Trans-
ference is conceived ... as the expression of a
universal psychological striving to organize Client Therapist
experience and construct meanings" (p. 46).
We view transference as the vehicle by Figure 6
which the therapist finds out about the uncon- Projective and Introjective Transferences
scious aspects of the patient. "The neurological (Based on Moiso 1985)
evidence simply suggests that selective absence
of emotion is a problem. Well-targeted and
well-deployed emotion seems to be a support 1. Introjective Transference (Co longings):
system without which the edifice of reason In this type of transference the patient seeks to
cannot operate properly" (Damasio, 1999, p. enter a symbiosis (Schiff et al., 1975) with the
43). These findings seem to suggest that it is therapist to meet developmental needs (Co),
untenable to separate feelings from emotions, "Introjection is both a defense and a normal
and further, that feelings are inextricably developmental process; a defense because it
linked to reasoning. Damasio's research on the diminishes separation anxiety, a developmental
brain demonstrates how feeling is always process because it renders the subject increas-
present, although not necessarily conscious. ingly autonomous" (Rycroft, 1995, p. 87).

Vol. 3/, No. t. January 200/ 61

HELENA HARGADEN AND CHARLOTTE SILLS

Neuroscientists confirm this perspective when lized transference. Such ruptures occur either
they describe how genetic systems program the because circumstances are unfavorable, such as
development of the brain and are activated and the mother's postpartum depression or a be-
influenced by the quality ofthe infant/environ- reavement in the family, or for reasons of par-
ment relationship. When such a relationship is ental ineptitude, which can range from mis-
problematic, the person is left with an undevel- attunement to physical and emotional abuse. A
oped sense of self because important structures significant amount of therapy involves dealing
in the brain are left unactivated (Schore, 1994). with some trauma and associated aspects of
The undeveloped self is, therefore, unable to disassociation. A central feature of posttrauma-
be autonomous until certain structures in the tic stress is that there is a realization that no
brain are activated through the relationship. adult is powerful enough to stop dreadful
This neuroscientific research provides us with things from happening: II1usions are shattered.
a context in which to understand the psycho- After trauma there is a need to reconstruct il-
logical need for a transferential relationship. lusion: "I'm important, you are omnipotent:
Kohut (1971) described the emergence of The world is a safe place." The idealizing
archaic needs for symbiosis in the therapeutic transference enables the patient to occupy a
relationship as selfobject transferences. He state of illusion, a creation of the Garden of
understood the development of such transfer- Eden before the Fall. From this position, which
ences as attempts by the patient to get his self- in such cases was prematurely interrupted, the
object needs met. The terrn selfobject refers to patient can be assisted to assimilate a more
a group of psychological functions that enables functional reality. The therapist, of course,
a person to maintain self experience. When must be able to let go of the idealization when
these needs are thwarted in the infant he will the patient is ready. Otherwise the patient is
continue as a grown up to try and get these infantilized indefinitely and never learns to
needs met in the environment. They include the deal with the empowering experience of han-
following: dling betrayal and disillusionment, which
Mirror Transference: The mirror transfer- ultimately can lead to maturity and the possi-
ence involves two types of transferring. One is bility for growth.
the merger-mirroring transference, a complete Twinship: The twinship transference refers
first-order symbiosis (Schiff et aI., 1975) in to what might be called fellow feelings, a sense
which the therapist is experienced as part of that we are like others. The child wants to "do
the patient's grandiose self (Co and Po)' For what mummy does." She wants to identify and
such patients, who experience the need for take part in the big world. In this transferential
prolonged self-involvement, the therapist's domain, the therapist will feel a pull from her
subjectivity can feel, at best, irrelevant and, at patient to affirm a sense of essential sameness.
worst, an intrusive rupturing of the therapeutic The selfobject need is for the patient to feel
need to be fully and completely heard without validated and to experience a sense of belong-
interruption. ing and connectedness so that she can develop
The other type of mirror transference occurs her mix of intelligence and talents into usable
when the therapist is perceived as separate and skills.
the patient seeks her approval and admiration. 2. Projective Transferences (Pj+/Pj-)-The
The patient has a need to be mirrored for some- Defensive Transferences: The selfobject trans-
thing she recognizes as authentic so she feels ferences do not quite explain the projections of
seen, met, and understood. the patient onto the therapist. We think that
Idealizing Transference: If there has been these features, when displayed in the transfer-
too early a rupture in the child's perception of ence, are better understood in terrns of projec-
his powerful adult, this unconscious need to tive or defensive transference. It is, of course,
participate in the strength and calm of the "per- possible for both transferences to overlap.
fect" other will communicate itself in the idea- While still wanting merger experiences, the

62 Transactional AnalysisJournal
 DECONFUSION OF THECHILD EGO STATE: A RELATIONAL PERSPECTIVE

patient may also need the therapist to contain negative charge. This can be a difficult situa-
and deal with projections. In this transferential tion for therapists who find it hard to do any-
domain the patient projects P,+/P,- onto the thing other than feel warm, positive, and sym-
therapist in order to work through unintegrated pathetic toward their patients. However, it
experiences. "Owing to the influence of Mela- could be therapeutically ineffective to deny
nie Klein, projection has been accepted as a feelings of anger when hatred is attempting to
normal developmental process" (Rycroft, manifest itself in the therapeutic relationship.
1995,p.140). 3. Transformational Transferences (C J
In a misattuned environment the infant splits (Projective Identification) (Figure 7): We refer
between "good" and "bad." "Splitting of both here to the process of projective identification,
ego and object tends to be linked with denial particularly as it is defined by Ogden (1992),
and projection, the trio constituting a schizoid who amplified Klein's (1986) original concept.
defence by which parts of the self(and internal Ogden proposed that the infant induces a
objects) are disowned and attributed to objects feeling state in the other that corresponds to a
in the environment" (p. 173). The projective state that he is unable to experience for him-
transference is the patient's mechanism for self. The recipient allows the induced state to
keeping a coherent sense of self while project- reside within, and by reinternalizing this exter-
ing repressed internal conflict onto the thera- nally metabolized experience, the infant gains
pist. Patients who require this transferential ex- a change in the quality of his experience (Og-
perience often flip back and forth between den, 1992). In this transference the therapist is
good and bad. The idealizing aspect of this required to transform the experience by making
transference is dissimilar from the idealizing
merger transference described earlier in that it
usually communicates a significant amount of
anxiety to the therapist. She knows only too
well that the "love" will tum to "hate."
Faced with a patient's anger, it can be help-
ful to distinguish between at least two different
types of negative transference. A patient may
feel angry and enraged because the therapist
has unwittingly "missed" him or her, and in-
deed the therapist may well be at fault. Such
ruptures, often seen as mistakes, can be very
beneficial to the therapy since the patient has
an opportunity to connect with deep affective
experience and express it, for the first time, in
the company of a concerned, caring, and ap-
propriately apologetic other. However, some-
times the negative transference may need to be
sustained over a longer period of time to sup- Client Therapist
port psychological integration. Winnicott (1949)
warned us not to deny our feelings of hate in Poand Co material
the countertransference but to find ways to projected into therapist
contain them and keep them for interpretation
purposes.
If a patient's primary attachment was experi-
enced through hatred, he may have difficulties Figure 7
in attaching securely enough to the therapist to Transformational Transferences
do the work unless he can feel some of that

Vol. 31. No. I, January 2001 63

HELENA HARGADEN AND CHARLOTTE SILLS

it containable and meaningful. This suggests defense evaporated, and he spoke movingly
that the patient's core or split-off self is "felt" from an authentic place of a painful sense of
by the therapist, who finds himself containing worthlessness and a profound need for emo-
and feeling something which is hard to identify tional connection. The scene was now set for
as "other" than the patient. further work in deconfusion of the Child.
Projective Identification is a concept that If we think of the transferential relationship
addresses the way in which feeling-states as the interactional field between two people,
corresponding to the unconscious fanta- then the therapist's response within this energy
sies of one person (the projector) are en- field--eommonly known as countertransfer-
gendered in and processed by another per- ence-will be significant. Her receptivity to
son (the recipient), that is, the way in her subjective responses to the patient and her
which one person makes use of another willingness to engage with her experience is a
person to experience and contain an aspect central feature in relational psychotherapy.
of himself. (Ogden, 1992, p.I). Such a process necessarily involves a type of
This suggests to us that the therapist must be introspective musing because information can-
receptive to feeling something that she experi- not be forced from the unconscious; it only
ences as foreign and yet that clamors for her emerges if we allow the space for it.
attention. It is through the transferential process that
we as therapists are invited into the uncon-
Step Three: Examination of scious world of our patients. Therefore, a care-
Countertransference ful examination of our countertransference is
Case example: A male patient arrived for vital to the growth and change of mental states
group and sat in the therapist's chair. The within the patient. In the context of a therapeu-
therapist responded by sitting in another seat tic relationship the therapist's own primary
while containing feelings of apprehension and anxieties will often be provoked. Although this
some anger. The patient looked slightly un- process can feel unsettling and disturbing, it is
comfortable but began to boast about his newly actually a sign of health in the therapeutic re-
acquired "power" and how he was now in the lationship. It may even be the first time that the
"driver's seat." His manner seemed to show patient's Child has been able to impact another
contempt toward the therapist, who began to and have that person remain constant and con-
feel powerless, infuriated, and engulfed by sistent within the relationship.
rage. As the session evolved, group members It is in this way that our patients seek to use
challenged the patient's belief that he was us in order to integrate the unconscious con-
gaining power by sitting in the therapist's seat, tents of the Child ego state. In therapy this pro-
and the patient began to look defeated. As her cess follows the same rules and functions as
own angry feelings subsided, the therapist be- those followed in normal child development.
came aware of feeling powerless and humili- When the mother/other/therapist is good
ated. Alive to her own distress, the therapist be- enough, he or she is able to deal with the in-
gan to imagine how the patient might have felt fant's/patient's frustrated feelings or experi-
as a child in some of the situations that he had ences and help the infant/patient to manage
described from his past. (There was ample his- them. This is achieved through a process re-
torical evidence for a scenario in which the de- ferred to as "projective identification" (Klein,
fiant child had provoked an authority figure 1986) but that is also understood by self psy-
and been severely beaten and humiliated as a chologists (Kohut, 1971) in terms of empathic
result.) Becoming aware, too, of the potential immersion in oneself in order to understand
for humiliation within the group situation, the and help another make sense of his or her ex-
therapist intervened to make contact with the perience.
hurt, distressed, isolated child hidden under- Moiso and Novellino (2000) have argued
neath the grandiose defense. The client's that in transactional analysis the "enormous

64 Transactional Analysis Journal

 DECONFUSION OF THE CHILD EGOSTATE: A RELATIONAL PERSPECTIVE

methodological and clinical consequences of sooner, then later. There is no resting place!
accepting and working with the transferential The therapist often feels connected with an in-
and countertransferential dimensions oftransac- tense sense of her own vulnerability, since her
tions" (p. 184) have sometimes been neutral- own primary processes will be stirred up by the
ized by considering transference as only one volatile interpersonal dynamics. The therapist
dimension of the therapeutic relationship. They will often feel under extreme provocation to
point to Berne's original criticism of psycho- act out her countertransference, and although
analysis as a theory that was too detached from apparently calm, she may be tempted to make
problems of a phenomenological nature. Trans- a particularly "hostile" interpretation under the
actional analysts gained the phenomenology guise of being "therapeutic."
but were often diverted away from the transfer- 3. Transformational Transferences (C J:
ential relationship. Countertransferential reactions in this domain
We now seek to redress this balance and ar- are diverse and often profound. When the pa-
gue that by making the transferential relation- tient projects archaic and unprocessed distress
ship central to the work, we have access to an out into the therapeutic environment, the thera-
exciting and complex emotional dynamic. In pist's primary processes will be mobilized. The
accepting the validity of the therapist's emo- previous case study conveys some of this ex-
tionallife, we have a rich source of data avail- perience.
able to us about the nature of the patient's
problems. The three transferential domains Step Four: Responding to the Patient Using
outlined earlier can be useful in tracking the Empathic Interventions
therapist's countertransference and supporting In Principles of Group Treatment, Berne
treatment direction. For reasons of space we do (1966/1994, pp. 233-258) outlined his "thera-
not explore this further except to indicate some peutic operations"-which constitute eight
of what the therapist may experience in these forms of therapist intervention-along with
transferential domains. specific instructions about how to use them.
I. Introjective Transference: When the The eight operations are: interrogation, specifi-
therapist is required to be introjected or "co- cation, confrontation, explanation, illustration,
opted," then she can be prey at times to feel- confirmation, and, for deconfusion of the Child
ings of boredom and even sleepiness. The ego state, interpretation and crystallization.
therapist may find that her own narcissistic However, we view this as an artificial split be-
needs may get in the way, and unless alert to tween deconfusion and decontamination. We
this countertransferential response, she may think that the process of deconfusion is an in-
insist on her presence in a way that will not be tegral aspect of the therapeutic alliance and
effective in the therapy. If she persists in mak- therefore begins immediately.
ing interventions, then a Child-Child competi- A close reading of these instructions sug-
tion can emerge that is nontherapeutic. At the gests that Berne attended carefully to the trans-
same time, the therapist will be required to be ferential relationship without referring to it as
emotionally attuned so that she is alert to nam- such. This demonstrates that he was aware of
ing and reflecting emotional responses without the skill, sensitivity, and intuition required
being intrusive. when choosing how to respond to a patient.
2. Projective Transferences (Pj+IPj-)-The For instance, he warned of how an ill-wishing
Defensive Transferences: These transferences Parent ego state might misuse an intervention.
are more reflective of borderline features and He also stressed the importance of not humili-
disorders. In extreme cases the therapist will ating the Child, which again implies his under-
feel as though she is on a roller coaster-up standing of how easy it can be to misuse these
one minute and down the next. In less extreme operations if one does not consider the trans-
cases, when she is "up" she will nervously an- ferential meaning. As highlighted in the last
ticipate that the "down" will follow, if not case cited, it can be relatively easy to fall into

Vol. 31. No. I. January 2001 65

HELENA HARGADEN AND CHARLOTTE SILLS

this trap and offer, for example, an interpreta- brought together in the relationship. The per-
tion or confrontation out of unconscious hostil- son who is the therapist not only matters, but
ity toward the patient. When Berne directed us his or her personal history, capacity for emo-
toward ensuring a valid working alliance with tional involvement, empathic understanding,
the Adult and the Child, he was implicitly ac- and skill for relatedness will shape the therapy.
knowledging the existence of multiple levels Thus we believe that it is the sensibility of the
within the therapeutic relationship. therapist that matters; not a set of techniques.
We believe that Berne undersold his own ex- The defining feature of this work resides in the
cellent theory by presenting it in a somewhat therapist's capacity for continuing sensitivity,
facile way with the result that readers may and it is this that will inform the prowess and
easily miss the clinical acuity and also the incisiveness or otherwise of her interventions.
therapeutic care that he manifested. To address In proposing the following set of techniques,
this problem, we have articulated our own de- therefore, we are aware that they will, of ne-
scription of his operations, which we have re- cessity, need to be adopted and adapted by the
named "empathic interventions." therapist to become part of his style and way of
Since Berne's day, research has indicated working. In other words, we suggesting that a
time and again that empathy is central to thera- technique is not powerful in and of itself, nor
peutic understanding (Kohut, 1971; Rogers, does it carry any extra weight except in the
1961/1967), and, indeed, for some it is the sense of how and when the therapist chooses to
single component in therapy that correlates use it. Instead, we propose the use of empathic
with a positive outcome (Kirschenbaum & interventions as a way of accessing these
Henderson, 1990). Therefore, we emphasize deeper states of experience. The techniques are:
the use of empathy when making any interven- inquiry, specification, confrontation, explana-
tion and suggest that empathy provides the tion, illustration, confirmation, interpretation,
container for the therapeutic relationship. As crystallization, holding, invitation, self-disclo-
such, we view empathy as both a cognitive and sure, and echoing (R. Little, personal commu-
a feeling process. nication, June 2000). Because of the dictates of
We do not mean to imply, however, that em- space, we limit our description of these em-
pathy requires that we always "get it right" for pathic interventions as follows:
the patient or that we never confront; rather, Inquiry and specification: The first two op-
we suggest that regardless of the intervention, erations described by Berne are interrogation
we make it with a view to understanding how and specification, which we referred to in the
we can best enable the patient to feel under- section entitled "Step One: The Empathic
stood. Even with the most positive intentions, Transaction." We prefer the word "inquiry" to
clearly it is not possible to understand someone "interrogation," in part because of the unfortu-
else completely. This, in our view, offers em- nate link between the word "interrogation" and
pathic understanding in itself. While an effec- forms of stressful examination. Inquiry is a
tive analysis of the therapist's countertransfer- gentler word, one usually associated with phe-
ence provides her with a vast range of informa- nomenological inquiry, and it encompasses the
tion about her patient, we may well ask how sensitive exploration of all ego states (Erskine,
we are supposed to use this information. 199 I; Erskine & Trautmann, 1996). This in-
We have already established that the trans- tervention is also very much an expression of
ferential relationship is at the heart of the the therapist's identity. He will ask those ques-
therapeutic work. Any methodology will, tions of the patient that make the most sense to
therefore, arise from an understanding that the him. Specification, we believe, is a type of ac-
therapeutic work must be firmly embedded in curate empathy that can include the more ad-
the relationship between therapist and patient. vanced empathy outlined in step one. The thera-
For us, the meaning of such a relationship re- pist's way of organizing and understanding
sides in the fact that there are two subjectivities his emotional experience will fundamentally

66 Transactional Analysis Journal

 DECONFUSION OF THE CHILDEGO STATE: A RELATIONAL PERSPECTIVE

influence what and how he chooses to use this decided were unacceptable when she was de-
intervention. veloping her script. She can feel "toxic" and
Explanation and interpretation: Throughout may consequently fight against allowing her
this article we have stressed the importance of mirroring or idealizing transferences to emerge
empathic understanding of the patient's feel- clearly in the relationship with their concomi-
ings and attitudes. However, this alone is in- tant neediness or natural rage if they are
sufficient. It is important to assist the patient thwarted. She may use all manner of other stra-
ultimately in making sense of her experience in tegies to have contact and feel OK without re-
therapy. While it may be healing to feel and vealing the depths of her yearnings.
express an unmet need or emotion, without Transactional analysis offers us excellent
understanding and integration a patient may be ways of understanding these defensive strate-
doomed to play and replay her reenactment of gies (e.g., games [Berne, 1964]; racketeering
the past. An important part of this process of [English, 1976]; passive behavior [Schiff et
integration is explanation and interpretation. aI.,1975], and so on). If the therapist were to
Knowing when to offer these interventions is meet these defensive strategies with affective
not easy. Meaning needs to emerge through the empathy alone, the patient might feel good, but
relationship; it is articulated through a process she would not necessarily change her script.
of empathic resonance and will require decod- For therapy to be successful there must be an
ing. increase in understanding and self-contain-
Explanation attempts to describe in Adult ment. This involves explanation and interpreta-
terms the dynamics of the patient's experience. tion on the part of the therapist.
It can relate to any situations and relationships Nevertheless, we reiterate our original point.
in the patient's life and refers to previously We have found that interpretation is therapeuti-
specified material. An example might be: "So, cally more effective when empathic resonance
when other car drivers hoot at you, for a mo- is maintained. Comprehension without com-
ment you are aware of a scared Child ego state, passion for self does nothing to detoxify the
and then you kick straight into Parent and patient's position in relation to her Child. We
think, 'They're going to pay for that!' " believe that understanding, which can include
Interpretation involves trying to find a voice naming and voicing the meaning of the dynam-
for the Child. It is an attempt to "decode and ics, is one of the deepest forms of empathy.
detoxify" (Berne, 1966/1994, p. 243) the pa- Figure 8 shows the therapeutic transaction.
tient's communications. An example might be, The arrows from the therapist's Adult into her
"You say you think I will reject you. I think own C 1 indicate her use of her own Child ego
that when you showed your mother how much states to analyze her countertransference and to
you needed her, she pushed you away. It must help her choose one of the empathic interven-
be frightening to let yourself make me impor- tions.
tant." Thus, interpretation is not simply orga-
nizing what is known between therapist and Three Additional Operations
patient; it is giving a voice to a part of the pa- Holding: Knowing when it is appropriate to
tient that seems to her to be literally unspeak- offer an explanation or an interpretation is a
able. This deepens the Adult's understanding constant challenge. It is important to be aware
of her own self. that sometimes the patient simply needs "hold-
We are intrigued with Berne's use of the ing" instead of explanation or interpretation or
word "detoxify," which we believe encapsu- indeed any intervention aimed at doing more
lates an important factor in the process of than offering the steady containing presence of
deconfusing the Child. At a fundamental level a nonjudgmental therapist who is perceived as
the Child can feel shamed and terrified by the having the potency to offer the protection and
strength of her need for mirroring or for an permission needed. We refer here to a meta-
idealized other and by the feelings that she phorical holding within the energy field of the

Vol. 31, No. I. January 2001 67

HELENA HARGADEN AND CHARLOTTE SILLS

Here is my problem

..
You want to be heard .Jr
~ • • • • • •: :. , « :

&'e:te~.····:.··~i·
~\. , .... O·~·
C ,, \t~ . ·
!oJ .'
•..e
. ' "'{o\). ~
······::·O~·
.....:....~;~ .
. ..' \.
At"

Client Therapist

Figure 8
The Therapeutic Transaction

relationship rather than a physical holding. therefore projected onto the therapist to relieve
Slochower (1966) described three major times the patient and restore equilibrium in the Child.
when this type of holding is essential: (1) when At these points it can be useful to accept the
the patient has regressed to total dependence; projection as if it were true and invite the pa-
(2) when the patient's need for mirroring is ab- tient to explain how the therapy could be im-
solute and anything other than affirmation and proved (Epstein & Feiner, 1979). This offers
empathy would seem like an attack; and (3) the patient the opportunity to reintegrate the re-
when the patient is connected with Pl. rage and pressed experience at a nonthreatening pace.
hate and any attempt to explain or interpret For example, if the therapist can survive an
could be experienced as punishing, rejecting, angry attack without becoming hostile or ac-
or irrelevant. cept the account of his imperfections with
Invitation: It can be appropriate to encourage equanimity, he models a way of containing
the patient to voice her feelings and thoughts what is most threatening and engulfing for the
about the therapist. This encouragement can patient.
take the form of an explicit invitation or by the Selfdisclosure of the countertransference:
therapist noticing and commenting on the pa- Sometimes the therapist may decide to offer an
tient's nonverbal reactions to the therapist's account of her countertransference to her pa-
interventions. A particular form of invitation tient, even when the feelings may be difficult
can be used when the patient reconnects with or uncomfortable. This can be a form of em-
repressed feelings stored in PI.' Such feelings pathic understanding of the original protocol.
can threaten a cohesive sense of self and are The therapist is, in a sense, offering back the

68 Transactional Analysis Journal

 DECONFUSION OF THE CHILD EGO STATE: A RELATIONAL PERSPECTIVE

projected material, which makes the timing of London, where she has her clinical practice,
the intervention crucial. Berne did not often Her special interest is in advancing the theory
suggest that a psychotherapist share his own oftransactional analysis with a particular fo-
responses. However, we believe that the deci- cus on the use ofimagination in the therapeu-
sion to talk about one's countertransference in tic relationship.
order to illuminate the dynamics and link them Charlotte Sills, MA., MSc. (Psychother-
to the patient's childhood can sometimes be the apy), Dip. Integrative Psychotherapy, is a
most empathic response possible. It can also Teaching and Supervising Transactional
open up the possibility of examining the co- Analysis. trainer, and supervisor in West Lon-
creation of the experience in the therapeutic don, England. She is head ofthe transactional
relationship. This means the therapist is willing analysis department at Metanoia Institute in
to reveal her own attitudes in order to explore London.
how she might be contributing to the patient's Please send reprint requests to Helena
experience. Hargaden and Charlotte Sills, c/o the Meta-
While we have expanded the operations by noia Institute, 13, Ealing, London W5 2QB,
adding three interventions to the list, we have England.
omitted confrontation, illustration, confirma-
tion, and crystallization here. We believe that
REFERENCES
they, too, can be extremely valuable in the de- Berne, E. (1964). Games people play: The psychology of
confusion process and will explore them more human relationships. New York: Grove Press.
in future publications. Berne, E. (1986). Transactional analysis in psychother-
apy: The classic handbook to its principles. Guildford:
Billings & Sons. (Original work published 1961)
Conclusion Berne, E. (1994). Principles of group treatment. Menlo
We have offered a model of psychotherapy Park, CA: Shea Books. (Original work published 1966)
using an analytic approach grounded in trans- Blackstone, P. (1993). The dynamic child: Integration of
actional analysis. In doing so we have been in- second-order structure, object relations, and self psy-
chology. Transactional Analysis Journal, 23, 216-234.
fluenced by transactional analysts such as Clark, B. (1991). Empathic transactions in the deconfu-
Haykin (1980), Moiso (1985), Novellino sion of the child ego state. Transactional Analysis Jour-
(1984), Clark (1991), Blackstone (1993), nal, 21, 92-98.
Erskine (1991, 1993, 1994), and Shmukler Darnasio, A. (1999). The feeling of what happens. Lon-
don: Heinemann.
(1991). We have developed our model from English, F. (1976). Racketeering. Transactional Analysis
the structural model of ego states to provide a Journal, 6, 78-81.
theoretical basis that includes a theory of the Epstein, L., & Feiner, A. H. (1979). Countertransference.
self. We have emphasized the importance of Northvale, NJ: Jason Aronson.
Erskine, R. (1991). Transference and transactions: Cri-
the transferential relationship as the vehicle tiques from an intrapsychic and integrative perspective.
through which deconfusion of the Child is Transactional Analysis Journal, 21, 63-76.
achieved. In addition, we have offered an ima- Erskine, R. (1993). Inquiry, attunement and involvement
ginative development of Berne's therapeutic in the psychotherapy of dissociation. Transactional
Analysis Journal, 23, 184-190.
operations as the basis for the methodology. Erskine, R. (1994). Shame and self-righteousness. Trans-
We believe that this work offers significant actional Analysis Journal, 24, 86-102.
theoretical implications for transactional ana- Erskine, R. G., & Trautmann, R. L. (1996). Methods of an
lysts wishing to work with in-depth consider- integrative psychotherapy. Transactional Analysis
Journal, 26, 316-328.
ation of the Child ego state. Goulding, M. M., & Goulding, R. L. (1979). Changing
lives through redecision therapy. New York. Grove
Helena Hargaden, a Teaching and Supervis- Press.
Haykin, M. (1980). Typecasting: The influence of early
ing Transactional Analyst, is on the faculty in
childhood experience upon the structure of the child
the MSc. program in transactional analysis ego state. Transactional Analysis Journal, /0. 354-364.
psychotherapy at the Metanoia Institute in Kirschenbaum, H., & Henderson, V. (1990). The Carl
West London, England. She lives in South East Rogers reader. London: Constable and Company.

1'01.31, No. I, January 2001 69

 HELENA HARGADEN AND CHARLOTTE SILLS

Klein, M. (1986). The selected Melanie Klein (1. Mitchel/, Schiff, 1. L., with Schiff, A. w, Mellor, K. Schiff, E.,
Ed.). London: Peregrine Books. Schiff, E., Schiff, S., Richman, D., Fishman. 1., Wolz,
Kohut, H. (1971). The analysis ofthe self: A systematic L., Fishman, C, & Momb, D. (1975). Cathexis reader:
approach to the psychoanalytic treatment ofnarcissis- Transactional analysis treatment of psychosis. New
tic personality disorder. New York: International Uni- York: Harper & Row.
versities Press. Schore, A. (1994). Affect regulation and the origin ofthe
Kohut, H. (1984). How does analysis cure? Chicago: Uni- self. Hillsdale, NJ: Lawrence Erlbaum Associates.
versity of Chicago Press. Shmukler, D. (1991). Transference and transactions: Per-
Menaker, E. (1995). The freedom to inquire. Northvale, spectives from developmental theory. object relations,
NJ: Jason Aronson. and transformational process. Transactional Analysis
Moiso, C. (1985). Ego states and transference. Transac- Journal, 21, 127-135.
Sills, C (1995, August). From ego states and transference
tional Analysis Journal. 15, 194-201.
to the concept ofsetting in transactional analysis: Re-
Moiso, C; & Novellino, M. (2000). An overview of the
viewing the healing relationship. Panel presentation
psychodynamic school of transactional analysis and its
presented at the annual conference of the International
epistemological foundations. Transactional Analysis Transactional Analysis Association, San Francisco.
Journal, 30, 182- J91. Siochower, J. A. (1996). Holding and psychoanalysis.
Morrisson, V. (1983). Inarticulate speech of the heart. Hillsdale, NJ: The Analytic Press.
Polydor, 839604-2. Instrumental and Song. On CD of Stem, D. N. (1985). The interpersonal world ofthe infant:
same name A view from psychoanalysis and developmental psy-
Novellino, M. (1984). Self-analysis and countertransfer- chology. New York: Basic Books.
ence. Transactional Analysis Journal, 14,63-67. Stolorow, R. D., Brandchaft, B., & Atwood, G. E. (1987).
Ogden, T. (1992). Projective identification and psycho- Psychoanalytic treatment: An intersubjective ap-
therapeutic technique. Northvale, NJ: Jason Aronson. proach. Hillsdale, NJ: The Analytic Press.
Rogers, C. R. (1967). On becoming a person: A thera- Winnicott, D. W. (J 949). Hate in the countertransference
pist's view of psychotherapy. London: Constable & International Journal of Psycho-Analysis. 30. 69-74.
Constable. (Original work published 1961) Winnicott, D. W. (1960). The maturational processes and
Rycroft, C. (1995). A critical dictionary ofpsychoanalysis the facilitating environment: Studies in the theory of
(2nd ed.). London: Penguin. emotional development. London: Hogarth Press.

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