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Transactional Analysis Journal

Depression: An Integration of TA and Psychodynamic Concepts
Raman Kapur
Transactional Analysis Journal 1987 17: 29
DOI: 10.1177/036215378701700206

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Their high external Critical Parent I've done this for so many years allows them to externalize responsibility for I don't know who I am. This parent- psychotherapeutic treatment of depression is child interaction has been called a bargain rela- presented. a sister. and a longitudinal view of the proval from the dominant other. Cameron. remarked that it was pointless to trust others most often a spouse. since they constantly disappointed her. To fit in where I can 1980. the personality traditional pharmacological interventions as structure of depressed persons reveals the well as psychotherapeutic approaches. This underlying passivity characteristic of their day- paper focuses on the latter by integrating con. he or she feels guil- I wish to thank Charles Hand. 151). 2014 . superego (Bellak. For example. This occurs through criticizing signifi- This poem by a client highlights the dynamic cant others and perceiving them as betraying of the dominant other identified by Arieti and the depressed person's trust. Semrad (Rako & Mazer. tionship. understanding of depression.sagepub. a structural analysis reveals several characteristics. including therapists. University of Ulster. Thus. The Parent ego The Dynamics of Depression states of depressed individuals exhibit several I'm trying to be someone else fundamental flaws (Loomis & Landsman. cepts from TA. Vol. This feature of the Hodkinson of the Student Counselling Centre. its treatment encompasses Upon closer examination. For example. Gill Ingram. an adult child. 1981). distress. not for themselves but for others. through using the dominant other as an in- namic concepts in order to provide a fuller termediary to reward any activity (Bemporad. " (p. at a clinically oriented model of depression. dysfunctional Parent ego state is further im- (Although this pattern predominates. to-day functioning (Brown. 1981). psychodynamic psychotherapy. 40-year-old mildly depressed nurse often dividuals by Ana Farcas on May 22. for providing me with opportunities Parent ego state is often referred to by to develop my interests in TA and psychodynamic psychoanalytic theorists as the harsh or severe psychotherapy.2. each time the person fails. Later they often Introduction attempt to reestablish this pattern with unwit- Depression is one of the most common forms ting transference objects. April 1987 29 Downloaded from tax. 1963). depressed persons deny themselves autonomous gratification in return for accep- tance by the dominant other. 1977.. or a father. North Ireland. No. these and expectations are firmly established. other paired by a high internal Critical Parent which depressed persons live for an inaccessible aim ensures that unreasonable personal standards called the dominant goal. Depression: An Integration of TA and Psychodynamic Concepts Raman Kapur Abstract people were encouraged to seek gratjfication This article integrates TA and psychody.) As children. and Chris ty and more depressed. From a TA perspective. 17. a Bemporad (1976) in which depressed in. The major 1977). less frequently a mother. 1980) and Arieti and Bemporads' (1978) model of describes this as "getting someone else to do severe and mild depression in order to arrive something they're not doing .. This a lover. impressive educational issues in treating mild and severe depression achievements are hotly pursued to gain ap- are reviewed. of psychopathology.

cannot find out maladaptive relationship strategies. As with sification of one or more behaviors in a client all aspects of treatment planning. 1968). 1971) is useful for clari- borderline conditions. and the self-image is of being all-bad. that is. although hurting back those perceived to be the cause not in such a manner that clients can interpret of the person's distress. the latter being dis. There is rarely a it as an acknowledgment of their helplessness. and initial therapist trans- Adapted Child invites rescuing from others. healthy expression of Free Child energy. treatment is to maintain a high level of depen- cessful treatment. who is often invited to cathect his The foundations laid during this initial stage or her own Adult to defuse this ambivalence. passive in the face of any commitment. JACK BIRNBAUM The imbalance in depressed persons' Nurtur. The depressed person's dysfunctional Adult Initial Phase of Treatment promotes considerable ambivalence (Benedek. 1977) must be closed by a thorough the primary defense mechanism used by examination of the contract since clients are in- depressed people to manage anxiety (Bellak. 2014 . fying the mechanisms clients use to maintain 30 Transactional Analysis Journal Downloaded from tax. the Arieti suggests the therapist initiate by saying. Depressed clients are often reluctant to make In particular. "Most probably you do not know why you are ed both inward and outward in an unhealthy depressed. found without exception that there are reasons placed on to significant others. The in how they see themselves or significant psychoanalytic work of Kernberg (1975. 37-38) people tend to become dependent on others and Cathexis of some degree of Adult from to use these relationships as sources of by Ana Farcas on May 22. Denial. with little or no change to considerable resistance (Weiner. 1976). sion. evitably apprehensive about proposed changes. of depression. the intensity of the helpless therapeutic contact. and failing to do so can lead dence on the therapist. actions need to contain what Loomis and and the therapist often ends up enacting roles Landsman term realistic Nurturing Parent in the Drama Triangle (Karpman. the therapist. depressed himself. "dominant other" model of depression. a relationship depression in which traditional TA and psycho- strategy with an often masochistic flavor. 1982). (1981). (Holloway. they demand love and therapeutic contract. predominant emotion of anger tends to be turn. It is important to note that mak. portant for maintaining the painful status quo. At this point the Schiff model of sym- covers in greater detail the assessment of biosis (Schiff & Schiff." (p. 1980) others. The following sections of this paper outline ing Parent ego states ensures that they take care a longitudinal view of the treatment of clinical of others to their own neglect. But in my professional work I have way (Birnbaum. The Free Child for every depression. Effective psychotherapy depends on the 1975) and conveys a feeling of frustration to therapist making successful contact with clients. clients allows the therapist to formulate a cissistic nutrients. One of the primary unconscious aims of ing a clear differentiation between depression depressed clients during this initial stage of and borderline states is required to ensure suc. The Adapted Child is used as a way of which the therapist is compassionate. He needs help. They dynamic concepts are integrated into the feel unable to love and take care of themselves. maneuvers when venturing out of their fragile Arieti (1978) suggests similar transactions in shells. come out of the blue. prevents premature exploration of the However. 1981).sagepub. 1981). contract agreement is often pragma- more unconscious reasons behind the person's tically dictated by the intensity of the depres- distress. the negative effect of offer- Depressed persons who are unable to find ing a heavy Nurturing Parent with no Adult authentic ways of dealing with relationships messages is that depressed clients may feel that often resort to powerful Adapted Child the ideal and fantasied dependency now exists. severely depressed clients will be very In terms of differential diagnosis. The anguish and suffer- To deal with the inevitable rejection and ing stem from sources that a person like you. damaged self-esteem that results from these at a certain period of his life. emotional growth which occurs at later stages. The depression does not remains neglected and starved for strokes. However. the inten. often dictate the strength and structure of the The Child ego state performs functions im. All escape hatches reassurance from others (Bellak. evaluation is may lead the clinician to question the diagnosis required on an individual basis.

fac- tertransference. They terminology. the easing of resistance. overall the first phase of treatment is discounts and redefinitions become minimal. transference (Chessick. 17. ing glass 1966). During the first phase of treatment. Using Arieti and Bemporad' s ance reveals the games these clients use. April 1987 31 Downloaded from tax. Defenses and resistances may be peutic alliance (Bugental. 1977. clients come to rely on the therapist's within the context of the total therapeutic rela- Parent and Adult to take care of and think for tionship. depressed clients go through stand the reasons behind their distress. Breen. Their apparent unwill- dominant other. ances are dictated by the emotional issues under ance to change. In relation to symbiotic processes." They exhibit what Schmale other so that the original transference can be and Engel (1975) term the conservation." they can begin taking care of themselves. games lessen and Thus. they become inac. emotions are glad A potent therapist who provides permission and Love is a window filled with gleam. thus looking after their Child needs. However. security. Its a period of resistance while they assess the risk length depends on the severity of the depres- in trusting yet another authority figure.sagepub. them. and can range from six months in mild Resistance is a defense expressed in the trans. 1977). activated to combat what clients see as further intrusion and penetration into their lives. this con- But with a passion and joy and a tinues to be a delicate stage for these clients. tive and disengage from an environment that a person who is able to share experiences with they perceive as no longer providing the needed clients without aiming for control or domina- nutrients. and the fundamen- Resistance in depressed clients is character. A REPLACEMENT THERAPY FOR THE HISTRIONIC PERSONALITY DISORDER this dependency. countertransference issues. characterized by a healthy Nurturing Parent The duration and intensity of temporary resist- from the therapist along with a focus on resist." "Kick Me. this resistance.e. this middle stage of treatment. sion. resolved. therapeu- as well as to any potentially unhealthy coun. cases to three years in more severe by Ana Farcas on May 22.. tors influencing outcome. or comfort. Watchel. i.e. Verbal analysis of the resist. 1982). depressed 1976. No. i. and Bemporad call the significant third (1978). Clients are allowed to under- Vol.2. Clients resist clients see the therapist as possessing the change because it involves taking significant features of the real-life dominant other. 1970. 1978). the therapist now becomes the attempt to maintain their passivity by function- dominant third in addition to the client and the ing only from Child. 1977). consideration. and following paragraphs outline the major themes consequently the therapist must be sensitive to at this stage of treatment. focusing on the the individual anxieties of depressed individuals transference. The risks. Since Middle Phase of Treatment their previous experience with authority figures This phase of the work can be called-the work has been inevitably characterized by hurt and phase because during it clients begin to under- disappointment. and "Wooden Leg" among others (Birnbaum. protection is important at this stage (Crossman. tal shift depressed clients must make before ized by the games "Yes But. and they have usually made an internal therapist's task is to shift to maintain a more decision based on previous experience: "Once flexible position than the real-life dominant bitten. 2014 . rather the goal is developing a thera- client's life. mind that is sane and the therapist needs to allow them time to I speak to tell you it's not only bad develop their full resources under the emotional It brings love and tenderness and umbrella of the therapist's Parent and Adult. twice shy. no attempt is made at this stage transference develops in which the therapist is of treatment to explore the reasons behind their perceived as another authority figure in the distress. The ference (Singer. As the therapeutic relationship ingness to trust the therapist can be understood develops. As one client tion. clients wrote: shift from the passive role to cathecting Parent But I speak not only with anger and and Adult with simultaneous disengagement of pain Adapted Child maneuvers. It's also a chamber filled with a dead. the transference and counter- . Resistance is considerably dissolved during ly gas. In the face of As the therapeutic relationship progresses. The therapist becomes what Arieti withdrawal reaction. tic technique. Kemp.

tertransference and use such material maximal. "The to deal with is his or her response to the client's affirmation of one's own life. and Rubin- and interested in understanding themselves. happiness. Parental injunctions are 32 Transactional Analysis Journal Downloaded from tax. motivated to change. severely depressed clients suffer from treatment and an increased duration of the marked cognitive impairment with associated presenting problem are reliable indicators of low psychological functioning. Pilkonis.. Eric Fromm clients. in care. Giving dissolving their destructive injunctions. a no-suicide contract The therapist is now in a strategic position (Goulding & Goulding. and in. the most crucial feeling for the therapist tional growth. They are less poor outcome for psychotherapy. suicidal behavior. shells. 1974) to search for the reasons why clients are dis. the therapist Be. Steiner's (1974) suggestion of break. and thus require an in. themselves is often one of the most important tion are positive stroking in conjunction with and significant moves in therapy with depressed interpretations about why they have such clients. and knowledge. Early script issues surround the ''I'm tial facilities are offered if that is practical. 1979) are more appropriate to reject therapeutic parenting because it is ex- for mildly depressed clients who maintain perienced as intrusive and harmful. (1980) calls the backward pulls and forward To overcome an immediate suicide crisis at pushes of psychotherapy. 1978. As a transferential parent the therapist unhealthy self-concepts. If an individual is able to love productively. 130) clients with hope and possibilities for change In summary. the main work at this stage of (Lesse. the therapist should transfuse he cannot love at all. they can become active therapy. including Don't take his or her own life. this stage of treatment. i. Don't Be Close. Don't Trust." (p. (1967) discusses this issue in detail: A lack of ing down the existing stroke economy to allow self-love and an exaggerated concern for others them to receive and give strokes is effective in often implies a devaluation of oneself. 2014 . Imber. he ly to resolve the situation. As these clients are encouraged therapy is exploring the historical reasons for to come out of their fragile but safe emotional the client's distress. responsibility. free- suicidal tendencies. The two factors that have most bearing on The type of therapeutic technique used to the severity of a depression relate to the client's facilitate these new internal decisions depends early childhood experience and the previous on the severity of the presenting by Ana Farcas on May 22. The clients permission to love and take care of most useful therapeutic tools with this popula. treatment history.e. there junctions are carefully examined. to their Adult ego states. Don't Be must be clear about issues of personal respon- You. even with these precautions. Lewis. However. relatively good psychological functioning.JACK BIRNBAUM stand themselves at a mutually agreeable pace. This phase is characterized by what Fried requires reinforcement from the therapist. In addition. As Fromm (1967) writes. During the middle phase of therapy clients tervention that gently encourages them to make often question the validity of self-love and ex- new decisions about how they see themselves press the fear that concern for themselves could (Kapur. Goulding and are instances in which a severely depressed Goulding (1979) identified several injunctions client will perform the final script payoff and common to depressed patients. Don't Feel. regardless of how small. any change. should encourage clients to make this radical With both mild and severely depressed shift because it forms the basis for future emo- clients. this requires an ongoing review of the of the therapy thus becomes encouraging clients therapist's own grandiose rescue fantasies and to make new decisions about how they see a realization that he or she cannot rescue all themselves based on new information available clients (Pfeffer. Ramage.sagepub. Steiner. When faced with loves himself too. Therefore. In sky (1984) demonstrate that a long history of contrast. With these be interpreted as selfishness. & Walker. is made with the depressed client and residen- tressed. The therapist must be alert dom is rooted in one's capacity to love. Not OK" basic position are explored. 1975). to his or her own rational and irrational coun. respect. and Don't Make It. 1984). 1986). the type and length of prior treatment can Since their cognitive functioning is not significantly impact the success of current significantly impaired. The focus sibility. Clients suffering from severe The redecision techniques developed by the parental rejection and abuse in childhood tend Gouldings (1978. if he can love only others.

American Journal of helplessness as a primary way of dealing with Psychotherapy. not approach it by any path whatsoever. The ly want from relationships. therapists. power of their previous helpless behavior. when he writes on suffering: This requires an optimally functioning Adult The shedding of the past all the time with a nurturing and permission-giving Parent. American Journal ofPsychotherapy. not abused. Boston: Little. 17. This can land which cannot be approached along any create many difficulties. Holland). J. & Bemporad.. (1981). Ommen. when you see yourself is the freedom Clients are encouraged to deal with relation. A new channel of communication ex. 1959) in which there is constant and human existance. As this hap. Brown. this understanding is listen to themselves to find out what they real. by any Often. "cure" can be viewed as a pathless moving from submissive to dominant. 1974). This Final Phase of Treatment involves new decisions about their perceptions A major goal in treating depressed clients is of themsleves and others and accepting respon- to foster awareness of those past events that sibility and authority for their own lives. By offering an in- tionships with others in order to receive tegration of concepts from various therapeutic gratification. in order to arrive at what could be described as the middle way of relationships.J. As a unrealistic expectations and can relinquish the transferential parent in the significantthird rela. S. T.. (Eds. The internal Nur.). and you can- own efforts.. the former taking care of the latter's The message inherent in the psychotherapy needs for warmth. L. in their assumptions about themselves and the world in which they live (Frank. crippled them emotionally and thus restricted Krishnamurti (1971) describes this eloquently their options for dealing with relationships. we respect their individuality and in- tion and refined decision making are required crease the chances of success in psychotherapy. E. Other characteristics of the final phase of Arieti. by any sect" (public comment. In the therapeutic terns of dealing with relationships. Depression (Humphreys.. As comfort. ing our clients different instruments to heal their tionships. and this light is not only lit by one One of the most significant changes de. internal Critical Parent and an Adapted Child Bellak. London: Tavistock.e. Psychotherapeutic treatment of depressed pens the transference is dissolved and clients clients requires a radical change in their perceive the therapist without distortions from psychological make-up. . 3.2. 33-47. by endeavor. the author echoes Krishnamurti's state- dependently and obtain pleasure through their ment that' 'truth is a pathless land. models. Brief psychoanalytic psychotherapy of that is less prominent and does not use non-psychotic depression. our concern is for how our clients ists between these ego states. XXXI/(I).com by Ana Farcas on May 22. No. (1975). be met. August treatment they radically reverse previous pat. 2014 .sagepub. XXXV(2). they can function in. . This balance REFERENCES is similar to ideas found in traditional Buddhism Anthony. when clients reach the final stage of religion. 1929. 160-171. wounds. A psychotherapeuticapproach to severely pursuit of the right balance between the depressed patients. Rather. April 1987 33 Downloaded from tax. i. Through offer- for finding a balance in how they deal with rela. Severe and mild depres- therapy with depressed clients are a less strict sion: The psychotherapeutic approach. and they need support specific or predetermined path. They no longer adhere to clients see themselves and others. S. A REPLACEMENT THERAPY FOR THE HISTRIONIC PERSONALITY DISORDER examined and new decisions made about how relationships. Sorrow ends only when ships in ways that allow their Child needs to there is the light of understanding. tionship the therapist encourages clients to look after themselves and gives them permission to Conclusion deal with relationships differently. (1978). & Benedek. Arieti. security. lighting itself all the time . 109) together. countless opposites in human relationships. There must be a shift the past. from the past. experience or by one flash of pressed clients experience is in their ability to understanding. (1978). flicted emotional injuries. Clients no longer can best recover from past and currently in- need to engage in potentially masochistic rela. understanding of yourself is the end- turing Parent and Free Child now work ing of sorrow. Vol. (p. Careful Adult appraisal of the situa. and emotional of depression is that life is worth living.

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