Transactional Analysis Journal

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Ego States and Transference

Carlo Moiso

To cite this article: Carlo Moiso (1985) Ego States and Transference, Transactional Analysis
Journal, 15:3, 194-201, DOI: 10.1177/036215378501500302

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 Ego States and Transference
Carlo Moiso
Abstract
The structural analysis of two types of
transference is presented accompanied by
clinical examples.
P z transference is presented as the reenact-
ment of actual rackets and games played
with parents as they were perceived and
recorded by the patient; it is accessible to
treatment approaches directed at first order
structures.
PI transference (PI + and PI _) are pre-
sented as projections of good objects or bad
objects owing to immature PI functioning
(mainly borderline conditions and patho-
logical narcissism). These conditions are not
accessible to Az decontamination, to C z
redecision or to reparenting; therefore, we
describe a new methodology, the TA Psycho-
dynamic Approach, for use in these cases.
Introduction
In the last five years the theoretical and
clinical research at the Institute of TA of Rome
has been devoted to the analysis of transferen-
tial and countertransferential aspects in the
therapy with borderline and narcissistic patients
(Moise, 1983; Novellino, 1984).
While exploring the dynamics underlying
transference transactions (Berne, 1966) which
occur during transactional analysis therapy, I
have observed that there are two different types
oftransference. One is based on the projection
of material incorporated from external sources
(P2 transference), and the other is based on the
projection of earlier material derived from the
object introjects of the infantile ego (PI
transference) (Haykin, 1980). The former is
present in neurotic patients, where the expres-
sion of the transferred material is indicative of
secondary process thinking. The latter is
characterized by a regression to primary pro-
cess thinking, (Rapaport, 1957) mainly ex-
194
pressed indirectly in fantasies, dreams, slips of
tongue and directly through acting out. This
second type is present in borderline and narcis-
sistic patients. Each transference is typical of
a diagnostic category, even though regression
may be manifested in the course of therapy by
every patient.
There is a distinct feature differentiating the
regressive quality in P 2 projection from PI pro-
jection: accessibility to thinking process and use
of the projected material. In P 2 transference the
neurotic client will try to engage the therapist
in furthering the client's own script by provok-
ing a response or interpreting it as coming from
a negative Parent, Critical or Nurturing,
representative of an external introjected object.
In PI transference the patient's perception of
the therapist (and the projection) will be of an
omnipotent or a sadistically destroying inter-
nal object.
Analysis of transference within the frame-
work of TAwas begun by Eric Berne. In
Transactional Analysis in Psychotherapy (1961)
he affirms that "scripts belong in the realm of
transference phenomena" (p. 116). In Prin-
ciples of Group Treatment (1966), while
describing the group imago, Berne stresses that
the investigation of the transactional, functional
and libidinal roles the other members of the
group (especially the therapist) fill for the pa-
tient "is a matter of careful and systematic
analysis of the psychodynamics of his transac-
tional stimuli and responses" (p. 154).
To me this statement was an invitation to
analyze the psychodynamics of my patients,
beginning with the analysis of their transference
transactions (Figure I).
From this I moved to the analysis of the
transference relationship. This is clinically
defined as a relationship in which the patient,
in order to reexperience parent-child or primi-
tive object relationships projects onto the thera-
pist his own Parental Ego States (P2 or Pj),
Transactional Analysis Journal

Therapist Patient
Figure 1.
Analysis of Transference Transactions
These are projected onto a screen superimpos-
ed on the therapist (Child ~ projected Parent
messages) (Figure 2).
Patient Therapist
Figure 2.
Analysis of Transference Relationship
In clinical work I found that analysis of
preconsciously projected Parent (Pz) and un-
consciouslyprojected Parent (PI) is a vital com-
ponent of script treatment. I believe this
analysisis fundamental to becoming fully aware
of the boundaries between oneself and others,
i.e., of one's own projections.
Observation of these processes led to three
generalizations: 1) "transference drama"
(Berne, 1961) is a special adaptation of the
script that shows up in script therapy with the
appearance of a specific transference relation-
Vol. 15. No.3. July 1985
EGO STATES AND TRANSFERENCE
ship; 2) material projected onto the therapist
can be a pre-Oedipal introject (PI) or post-
Oedipal (P z); and 3) in order to achieve struc-
tural cure, i.e., a stable Adult identity through
restructuring impaired ego states, often it is in-
dispensable to analyze and resolve the trans-
ference relationship between patient and
therapist. Such a resolution is necessary for the
patient to comprehend his own motives and
motivations for choices and to develop the abili-
ty to select the best available options as well
as to handle effectively the frustration arising
from non-available options.
Overview of the Structural Theory
From a structural point of view, as mention-
ed before, there are two ego states that can be
projected: PI and Pz. The P z ego state is the
introjection of the parental figures in toto, that
is, of their Parent, Adult and Child ego states
(Berne, 1966). This process takes place follow-
ing the Oedipal resolution, i.e., after the onset
of secondary process thinking. The projection
of P z is then present and active in neurotic pa-
tients. During transactional analytic treatment
this projection will be dealt with in various
ways involving Adult awareness and thinking:
confrontations of discounts, game analysis, ego
state analysis, etc. All this is possible because
these patients develop a transference which is
without severe impairment of A z thinking
(Wallerstein, 1967).
The PI ego state is a very early structure, the
onset of which seems to start at the beginning
of the symbiotic attachment with the mother
(Haykin, 1980). Through the phases of
attachment-detachment-reattachment the Child
ego state forms a Parental structure (PI) divid-
ed into two substructures (P I + and PI _ ).
These two substructures will be more or less
integrated and acknowledged depending on the
efficacy of maternal parenting in the process
of separation-individuation (Haykin, 1980). It
is then theoretically correct to postulate that PI
is composed of internalized object relations in
which the division into good and bad objects
(P I + and PI _) is a maturational phase
resulting from the lack of integrative capacity
in AI' This assumption about P I is congruent
with both the TA theory that the Parent in the
Child is self-generated in response to the
Somatic Child-Little Professor elaborations
following parental reactions (Woollams &
195
CARLO MOISO
Brown, 1978), as well as with the psycho-
analytic theory of object relations (Klein,
1957). Furthermore, this splitting into "good"
and "bad" was also recognized by Eric Berne
(1972) who called them the "Fairy God-
mother" and "Witchmother."
The congruence described above forms the
specific theoretical bridge between structural
analysis in TA and the psychoanalytic theory
of object constancy. Thus it is possible to
describe and apply a TA approach to both
borderline personality organizations and nar-
cissistic personalities (Kernberg, 1981), when
the use of other TA approaches with early
structural pathology seldom provides satisfac-
tory results.
Clinical Theory
From a clinical perspective, the splitting of
PI into PI - and PI + , which was at first a step
in maturation and then a defect in integration,
is a defensive division protecting the Adult (A2)
from intrapsychic conflicts. This is achieved by
keeping apart libidinally determined introjec-
tions and identifications from those aggressive-
ly determined. The defensive splitting is main-
tained in borderline personalities by activating
alternatively contradictory PI ego states and in
narcissistic personalities by a denial defense
mechanism against PI _ . The maintenance of
the splitting is a necessary defense to avoid ex-
treme anxiety owing to unresolvable ambiva-
lence.
The individual who has not integrated PI +
and PI _ will tend, in therapy, to project onto
the therapist one or the other of these structures.
For example, in the case of narcissism, at the
beginning of therapy the client will project
PI + in order to form a pseudo-attachment that,
owing to an incapacity to depend on internaliz-
ed objects, is necessary to fulfill his tendency
to idealize the therapist from whom he expects
narcissistic supplies (Kernberg, 1981).
It is worth emphasizing that in narcissistic
personalities the PI + the patient projects onto
the therapist is an idealized image of himself
he has built up and assumed as a substitute for
the actual maternal image, and not of the more
mature idealization of a real nurturing Parent.
In the case of narcissism, in the first phase
of therapy there is no projection of P I-
because the narcissist uses the denial defense
mechanism against this substructure. In the case
196
of the borderline personality organization, the
denial is alternating, because evolutionary ar-
rest took place earlier than in the narcissistic
personality, i.e., when PI + and PI _ were still
cathectable one at a time so as to be perceived
as a single PI that takes an "all bad" or "all
good" aspect. The borderline patient then pro-
jects alternately PI + and PI -. PI + is pro-
jected because of the desire to obtain a sym-
biotic fusion with an idealized omnipotent "all
good" Parent and in order to be protected
against the "bad" object.. (In TA we would
say he searches for a mirror of his own Fairy
Godmother in order to be defended against his
own Witch.) The second kind of projection
(PI -) serves to externalize the all-bad ag-
gressive self and object images. The patient will
react to the therapist with anger, and possibly
violence, because of the projective perception
of the therapist as dangerous, retaliatory, and
both physically and emotionally absent.
The consequence of the transferential rela-
tionship for both borderline and narcissistic
pathologies, with their unintegrated PI ego
states, is the resistance to both reparenting and
invitational projective work (e.g. "Put your
mother in this chair and talk to her"). For the
borderline client, where splitting was establish-
ed at a very early stage of development when
ego boundaries were not stabilized and for the
narcissistic client, whose grandiosity extends
to include the therapist, this unintegrated PI
results in an extremely high level of anxiety in
the face of these therapeutic approaches.
A study of these resistances led to the
development of what we call the Psychody-
namic TA Approach. In this approach the
therapist, accepting a pseudo-symbiotic
transferential relationship, carefully analyzes
with the patient those ulterior messages that ap-
pear to be aimed at him (transference transac-
tions) to unveil the exact nature of the trans-
ference relationship and the content of the pro-
jected Parental structure (P2 or PI)' The
therapist must keep a keen eye on counter-
transference reactions and transactions,
especially to understand and give meaning to
the patient's efforts "to force the analyst to
behave exactly as the patient needs to see him"
(Kernberg, 1981). These can be to behave as
the real parent, the desired self as parent, the
meaningless parent, the mean parent, the multi-
ple parent, or whatever constitutes the struc-
Transactional Analysis Journal

tural content of the parental projected structure.
In TA terms, we begin with transactional
analysis proper, then carry out a game and
racket analysis where the aim is to identify the
transferential aspects and the reappropriation
of projected material. After the patient has
reached an A 2 understanding of the processes
present in the therapeutic setting and of the
script, we proceed with redecision work
(Goulding, 1979). With transference psychosis,
a characteristic complication in the treatment
of patients with borderline personality
organization, reparenting is used (Schiff, 1975;
Childs-Gowell, 1979).
A very rich and important focus in working
with the Psychodynamic TA Approach is
handling countertransference (Novellino,
1984). During supervision of well-trained
trainees and in staff conferences, transference
reactions have been found to reflect the pa-
tient's problems far more than any specific
aspect of the analyst's script. The general prin-
ciple is to carefully present the therapist's emo-
tional response to the patient, acting purpose-
fully as an "active transference mirror. " This
process favors both the establishment of Adult
~ Adult transactions and the reappropriation
of the projected material. The countertrans-
ference reaction can be of two major types:
identification of the therapist with the cor-
responding ego state of the patient, and/or iden-
tification of the therapist with the projected part
of the patient. These findings correspond with
Racker's (1957) concepts of "concordant iden-
tification" and "complementary identifica-
tion." The principle is that the more the pa-
tient is experiencing C I primitive impulses, the
more the therapist will sense them (concordant
identification) and will react and struggle with
themeither with his own PI or P 2 (complemen-
tary identification). Herein lies a great oppor-
tunity for the skilled TA therapist to help
his/her patient to change the script protocol by
bringing in C2 changes using the corrective ex-
perience of the treatment situation.
The final goal of the work on both PI + and
PI - transferences is to permit the patient to
recognize and then to integrate PI + and PI _
into a single PI' where "negative" and
•'positive" aspects exist together. This process
willlater allow the redecisional work necessary
to solve the problems connected with impaired
functioning of P 2 and A 2 • The dynamic and
Vol. 15. No.3. July 1985
EGO STATES AND TRANSFERENCE
social indication which is evidence the goal has
been reached is provided by the patient's new
capacity to continue to love the person toward
whom, at any given moment, he feels anger.
Clinical Aspects: The Various Types of
Transference
P2 Transference (Figure 3)
In this type of transference the patient pro-
jects the ego states of the real parents onto a
screen in front of the therapist by externally ex-
pressing an internal dialogue between P 2 and
C 2 • He then feels and acts out toward the
therapist those feelings, manifests those needs
and puts into action those kinds of rackets and
games which are an example of his original
relationship with the parental figures.
a
a = internal dialogue
b = projected structure
c = social transaction
d = transference message
(ulterior transaction)
(The Parent of the therapist is shown as a
dotted line to indicate that itsactual existence
or significance is discounted by the patient.)
Figure 3.
P2 Transference
In this situation we can identify a negative
transference when the patient, setting up games
with the therapist, tries to obtain the same
frustrations that he received from the actual
parents. He does this by activating those pro-
cesses intended to promote the experiences that
further his script (as well, of course, as the con-
ditional strokes which reinforce it). At the same
level we can identify a positive transference
when the patient seeks to obtain those permis-
197
CARLO MOISO
sions and strokes from the therapist he did not
receive from his original environment. The
therapeutic approach requires an attentive
analysis of the transactions as well as of the
functions of the racket system (Erskine and
Zalcman, 1979). At this point the patient reacts
emotionally and behaviorally to his own pro-
jection rather than to the actual behavior of the
therapist. The therapeutic strategy will be
bound to show up and lead to the resolution of
a first degree impasse (Goulding, 1974) or an
adaptation impasse (Moiso, 1979) marked by
an impasse with the therapist.
Clinical example
Phil: "Today I really feel down. Tell me what
I can do."
Therapist: "What would you like to do about
it?"
Phil: "There you go again! It's always up to
me to do everything by myself! " (Child
2f.I projected Parent transference transac-
tion) (At this moment Phil has redefined
the therapist's message because of the
projective distortion, in which he
perceives the reply coming from the
therapist's Parent ego state).
Therapist: "Phil, sit down here and imagine
that your Parent is sitting on the chair in
front of you. "
Phil: (C sitting in chair looking at P) "Today
I really feel down."
Therapist: "Tell him that you feel down until
you see who replies."
Phil: "There's my father."
Therapist: "Listen to what your father
replies. "
Phil: (Changes chair) "You've got to solve
your problems on your own. A man must
not depend on other people!"
Therapist: (Proceeds with redecision work, by
reexperiencing the situation, expressing
first his anger, then his fear, and finally
asking for help) (Moiso, 1984).
Phil: (Acquires permission to ask openly for
what he wants by recognizing he can so
do even if his father did not allow it
because of his own limitations and
script).
Therapist: "Phil, at this point let's analyze
together (reinforcing permission) the
transactions with which you began your
work. (Here proceed with making clear
198
the phenomenon of the transference pro-
jection using the scheme in figure 3.)
P1 Transference Type A (P 1 +)
(Figure 4)
Here the patient projects the image of the
ideal omnipotent Parent (P I + ) onto the
therapist. Often this is an image of himself fix-
ated at the culmination of the phase of normal
a = internal dialogue
b = projected structure (P1)
c = social transaction
d = transference message
(ulterior transaction)
Figure 4.
p1 Transference
Type A (P1 +)
narcissism (Kohut, 1971). This is why this type
of transference is most common in the narcis-
sistic personality.
In PI + transference, the patient discounts the
real personality of the therapist in an effort to
avoid acknowledging the therapist's deficien-
cies, so as to protect himself from confronting
his own needs and from the desperation con-
nected with a sense of abandonment. He thus
projects onto the therapist an all-good omnipo-
tent self, source of immediate and eternal
gratification as well as absolute model toward
which he can strive. The therapeutic approach,
at least in the first phase of therapy, is based
on helping the patient to reappropriate the P\ +
he projects onto the therapist. This avoids a
escape reaction which would follow the disap-
propriation of the good object (P I +) with the
persistence of the bad object (P\ _) and of a
helpless C\. The mechanism which elicits the
Transactional Analysis Journal

escape reaction is that the patient, by project-
ing his PI + enters, in fact, a symbiotic rela-
tionship. If the therapist does not accept the pro-
jection, thus refusing the symbiosis, the client
will be left without protection against his own
destructive PI _ . He will then perceive himself
as "awful," "dangerous" or "mean" (P I_).
As a defense he will then need to perceive the
therapist in this way because of his
"abandonment. "
The PI + projection and the resulting sym-
biosisare thus principally protective devices for
the patient who, only apparently, is seeking
perfection in the therapist. In reality he is in
search of a mirror of and for his own perfec-
tion to protect himself from his aggressive im-
pulses. The protective grandiosity contained in
the projection is generally observed as an
idealization of the therapist. If the game of
"Gee, You're Wonderful, Mr. Professor" is
confronted too early and too abruptly, it results
in a defensive abandoning of therapy. If the
therapist refuses to be perceived as a Mr.
Murgatroyd, he fails in his function of
transferential mirror for the patient (Kohut,
1971).
In conclusion, therapy in this phase will be
aimed at helping the patient reinforce his nar-
cissisticdefenses without injury to the idealiza-
tion he has of the therapist.
Clinical example
This example is composed of two distinct
phases in the therapy of a narcissistic patient.
In the first phase, about four months after the
beginning of therapy, there was a PI + trans-
ference. The therapeutic strategy was to rein-
force the client's defenses to allow him to
recovera certain narcissistic equilibrium. In the
second phase, PI _ transference was present,
and will be illustrated by the next example:
Maximillian: (looking at therapist) "I see you
are always in good form and understand-
ing of us." (Observe that the actualized
consequences of "Don't Be Healthy"
and "Don't Be" injunctions are denied
and the mirror transference reflect the ac-
tivation of a grandiose self.)
Therapist: "Max, what are you demonstrating
to yourself with this affirmation?"
Maximillian: "OK, that I'm in good form too,
and a loving person" (transference trans-
action).
Vol. 15. No.3, July 1985
EGO STATES AND TRANSFERENCE
Therapist: "This is certainly something that is
both good and useful. Think about those
qualities you have which keep you in
good form and understanding of others
(reinforcement of narcissistic defenses).
Maximillian: "I like and respect myself. I've
always been like that .... since I was
a little boy."
(Later regressive work confirmed the hypoth-
esis that the patient was not accepted by his
mother in the reattachment phase. Thus he
developed an idealized image of himself
because of the persistence of, the omnipotent
self-image at the detachment phase).
P1 Transference Type B (P1_)
(Figure 5)
PI _ transference is evident in regressive out-
bursts of acting out when the patient is typical-
ly transacting directly from C I to projected
PI - . In this situation the patient projects onto
the therapist the PI _ polarity of his C I -+ PI
dialogue and invests him with all the negative
emotions reawakened in his C I by the presence
of the PI _.
b
a = internal dialogue
b = projected structure (P1 _ )
C = transference transaction
Figure 5.
P1 Transference Type B (P1 _)
The therapist is then seen as a sadistic ob-
ject, all bad, the source of the most serious
frustrations, and thus a target of anger and
violence. The therapeutic goal in working with
this type of transference requires the patient to
reappropriate the projected bad object without
permitting its' 'destructiveness. " As a clinical
199
CARLO MOISO
example I will use the same case I used to il-
lustrate a Type A PI + transference.
Following one year of therapy, the client
became aware of the affective void in his life.
The therapeutic strategy then was to confront
his defenses and the acting out which he used
to avoid his suffering in order to help him make
contact with his feelings of anger, shame and
guilt and to finally accept these feelings.
Clinical example
Maximillian: (to the therapist with anger) "In
this group you understand everybody ex-
cept me" (transference transaction).
Therapist: "Repeat that and let your feelings
come out."
Maximillian: (With rage) "You're a shame to
your profession! You're an asshole. You
don't care. I'm leaving this therapy!"
Therapist: "Maximillian, you are not only dis-
counting me professionally, but you are
destroying the image of me that you carry
within yourself. Don't do that and ask for
what you want."
Maximillian: "I need to be helped."
Therapist: "By whom?"
Maximillian: "By you."
Therapist: "Repeat to me 'I need to be helped
by you' until you get in touch with what
you are feeling."
Maximillian: (follows directions and cries).
Therapist: "I know about your suffering when
you've discovered you don't know how
to do everything by yourself. And it's
good to know that you also, like every
other human being, has a need to give
and receive love. (The insert "like every
other human being" has been pronounc-
ed with a different tone of voice from the
rest of the phrase. This is done in order
to give the permission to be average
which is vital in the therapy of narcissism
and is also an example of the corrective
experience already mentioned).
Conclusions
The recognition of diverse transference
mechanisms allows the transactional analyst to
focus correctly on the transactions the patient
has with him. The objective is to develop an
approach powerful enough to act directly on the
200
structure and not only on the external
manifestations of the script. This is essential
to be effective in treating borderline personality
organization and pathological narcissism. It
should be remembered that the two types of
transference are structurally different even
though their functional manifestations can be
similar. In P z transference the projected
material had been incorporated from the exter-
nal world (the real parents). In the PI trans-
ferences the projected material, hence the
analyst, represent part of the patient's grandiose
self (PI + transference in narcissistic per-
sonalities) and of primitive self and primitive
object-representations (PI - and PI + in
borderline condition and regressed narcissists).
In order to effectively deal with these patients
it is important to let them establish a trans-
ference relationship with the therapist; the
transference projection is the necessary condi-
tion for the establishment of such a relation-
ship. This relationship is characterized by a
projection onto a physical figure perceived by
the patient to be of parental significance in the
Child-Parent internal dialogue. The form and
content of the relationship comes from an in-
ternal dialogue of which the person is not con-
scious. He is either reliving an unclosed Gestalt
with the parental figures, projected as they were
incorporated (P z preconscious transference), or
reexperiencing the same experiences of attach-
ment, detachment and reattachment that led to
the formation of PI (P I unconscious
transference). In this case the projected Parent
can be all good (PI +) or all bad (P 1 _ ). I want
to emphasize that the more severe the
diagnosis, the more emotional charge invested
by the patient in the therapist will be projec-
tive. A cornerstone of success with severely
regressive pathologies is the use of counter-
transferential material.
This requires permission to have a counter-
transference and to analyze it. In this perspec-
tive, using the TA Psychodynamic Approach
requires the recognition of specific replies to
diverse transferential messages. In this way we
will know, for example, when to confront and
when to support or when and how to reparent
following the phases of a therapeutic strategy.
On the other hand, we will avoid interventions
(e.g. the precise confrontation of a racket or
a grandiosity) that appear appropriate on the
Transactional Analysis Journal

spot but do not take into account the specific
needs related to the evolutionary damage
manifested by a specific type of transferential
projection.
Carlo M. Moiso, M.D., Certified Transac-
tional Analyst, Instructor/Supervisor, lives in
Rome and works as training director ofthe In-
stitute for TA (fAT). He is visiting trainer in
several seminars in Europe and the U.S.A.
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