Transactional Analysis Journal

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The Structure and Sequence of Psychotherapy

Harry S. Boyd

To cite this article: Harry S. Boyd (1976) The Structure and Sequence of Psychotherapy,
Transactional Analysis Journal, 6:2, 180-183

To link to this article: https://doi.org/10.1177/036215377600600226

Published online: 28 Dec 2017.

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 THE STRUCTURE AND
SEQUENCE OF PSYCHOTHERAPY
Harry S. Boyd, Ph.D.
This paper describes one clinician's
view of the steps of psychotherapy and
the problems that develop when sequence
is overlooked. This structure is empirically
derived from several years of case col-
lection; as such, it is open and developing.
STAGE ONE: Reparenting
The first step of therapy can be called
first-order reparenting.' During this stage,
the patient needs to develop the freedom.
to decide that something is the matter and
to declCle1Ilat he or she has Permission to
change. The patient can't start therapy
until lie has made these two decisions, at
which point the patient can be called
"psychologically minded." The term
"reparenting" seems appropriate, since
the patient can operate from an A2-
programmed Parent once successfully
through this stage.
Some patients will have reparented
themselves prior to the initial meeting
w1Th tlie therapist. PatL~nt~~
vOIUIltarily in the private practitioneu
office are more likely to have taken this
step for themselves than those referre
a menta ealth clinic by the court, for
iilSfailce. Thus in some practices, a
therapist may have a high success rate
without having dealt overtly with first-
stage reparenting, while in others he or
she may need to re-educate/reparent
almost all patients. It is probably in-
appropriate to assume that the new
180
patient's expectations match those of the
therapist without checking. When the
therapist takes note of the patient's level
of awareness and "psychological minded-
ness," the therapist's consistency and
effectiveness can be improved.
Ways people may be encouraged to
make reparenting decisions, range from
the obvious to the subtle. The obvious
ways include attendance at a ~aching
workshop prior to beginning therapy, or a
brief" l O'l-type " presentation. Most
importantly, the therapist includes in his
presentation the key ideas that people are
responsible for their behavior and feelings
buCare not to blame, and that tliey can
change. By pIocessing thIS message
through the Adult, the patient forms the
basis for the P2 self-protection he needs.
First-order reparenting may also be
started during the initial interview when
the nature of the questions can directly
imply the patient's power and right to
change. For instance, the question,
"What about yourself, would you like to
change?" implies almost all the basic
first-order reparenting information.
STAGE TWO: Decontamination
- --
The second phase of psychotherapy, as
I see it, is decontamination. A successful
outcome involves the patientls..Ber«
mission to think and feel his own thoughts
andfeelings. This is "first-order" decon-
taE:i~tion. The whole point IS to Iiave a
Trans. An. J., 6:2, April 1976
 THE STRUCTURE AND SEQUENCE OF PSYCHOTHERAPY
clear uncontaminated Adult in the patient
on the side of the therapist. The patient
needs to be able to experience and identify
the neurosis as neurosis without blame or
guilt. In other words, the patient ceases to
identify the self with the neurosis/script.
As long as the patient cannot tell when he
is in uncontaminated Adult, the danger is
great that subsequent contract work will
'be biased heavily by the Adapted Child
(diagrammatically, I show the Adapted
Child as contaminating A2). Inadequate
work in this stage of therapy results in
premature terminations. Closing the
script exits by making a "no-crazy,
no-kill, no-suicide decision" aids both in
decontaminating the Adult and in pro-
vRIing interim Protection for the p_~~"-,
STAGE THREE: Contract
The third stage is contract. Iherapy
does not begin with a contract: it is highly
unlikely that a straight cont!1LC-i--£or
change will be dev¢loped until after the
patient has a cl~[ Adult ia-the-area in
which he is going to work. The goal for
bc>ththerapist and patient is to have a
clear understanding of the nature of the
kinds of changes the patient wants to
make, what consequences will follow, and
what the criteria are for knowing when
the changes are made. In many cases,
serious and sudden readjustment prob-
iems, marital crises and the like ~e
avoided by anticipating and preparing for
the consequences of chang~.
STAGE FOUR: Exploration _
The fourth step is exploration. The
patient needs Permission to feel what he
feels, to express those feelings, and t~
in touch with what's going on inside This
isthe"bcing aware" part of therapy. Up
until this point, the patient has alternately
fought and given in to Adapted Child
behavior. The __goal is for the patient to
safely and appropriately experience (with-
oUt--blaming) the Adapted Child. The
-----------=
Trans. An. J.• 6:2. April 1976
level of operation is entirely within the
Child of the patient with the patient's
Adult passively monitoring. The therapist
is largely in Adult or Free Child, paying
careful attention to his own Child
feelings. The therapist facilitates the
deconfusing of the Adapted Child
t e person is no lQ!!.&.e.[ locked into
aeclslons tharwer:emade in childhood
~
and that are no longer useful or helpful.
--
STAGE FIVE: Redecision
During the fifth step, redecision, the
therapist's role is to help the patient in
redeciding the life script. During the pre-
ceding stage the second-order structure,
PI/AI/CI, has become ~ntaIDinated
and IS no longer confused. Now the
patient can make some new deCISIOns
about how he IS gomg to live. Script, inner
structure, and behavior are open to choice
and deliberate re-orientation. Some of the
programs and rackets which were in the
Adapted Child cease to exist as separate
entities. They are not "gotten rid of";
they merge and become part of tie
lieaIthy functioning of the ego states. For
instance, the "rackety child," who
operates on special rules about going on
with certain feelings forever until other
people change, now no longer has those
rules. The rackety operations become a
part of the patient's regular repertory of
behavior and feeling and are no longer
self-blocking but appropriate. In other
words, if the patient has had an anger
racket, he will stop having an anger
racket; stopping the racket does not mean
that the patient is incapable of anger but
that the old rules about staying angry and
not doing anything constructive with the
anger no longer app.!r. Thunger now has
ge~(i.e., to prepare the body for
fight or flight), serves its function and
e~. The Adapted-Child simply .
ceases to exist as a separate functional
entity.
181
HARRY S. BOYD. Ph.D.
STAGE SIX: Relearning>
The sixth stage (often left out) is re-
learning. Relearning involves integration
of the new decisions and acquisition of
slnIl 10 their practice. For example, a
plIT1ent had made a redecision (in stage
five) about a "Don't get close" script
injunction. He no longer had to drive
people off with "Kick Me" games, but at
the same time he did not have many
genuine skills in relating to people in
positive ways. Such skills had not been
taught. Within the group, the therapist
providing sufficient Protection, the
patient can experiment both with gettin8.
close to someone and with guilt-free with-
drawal.
--sciTjii free or OK script? Two possi-
bilities exist: The person cafi~e a new
OK script or can learn to live without a
script at alh Either solution has its
problems.
Living without a script means goal-less,
here-and-now life, which is counter to our
basic culture, with its future-oriented,
carrot-and-stick scripting.
Living with an.9K scripLmeans to
accept some limits on awareness and
choices.
Whkhever solution is chosen, when a
script is broken, the patient may suddenly
have a great deal of unstructured time. At
this point many patients get into a so-
called "script-free depression." The
script-fre'eaepression is not so much the
result of heavy negative stroking as it is
the absence of any stroking. The patient
may feel "flat" or "empty" During such
a period he may be tempted to return to
games, which can provide the missing
strokes. The "relearning" period can aid
in avoiding this outcome.
I consider Stage Six a crucial point in
therapy because in two or three weeks the
patient can really consolidate and practice
what he is doing concretely and get feed-
back from the group. The therapist may
help by suggesting during the initial con-
182
tract work that the patient begin to con-
sider, for instance, what he is going to do
with all those hours Ifiathe spent fighting
with his wife whenh!~-~o-Cflght}l1gFiih
her anymore.
JUMPING STAGES
When the therapist "jumps" stages,
two general classes of error become
evident: those produced by the therapist's
being under theTIluSion that he can fit the
patient to the therapy, and those r~§ulting
from the therapist's misun~ding_QL
whichStage the patient is in. I have
observed a prominenfgestalt therapist,
who could (and did) start with the fourth
stage - exploration of the feelings,
thoughts and opinions associated with the
neurosis. Of course, by the time a patient
had arranged to see this therapist the
earlier stages had frequently already been
worked through. On the occasions when
the patient had not worked through the
first three stages alone, the treatment was
correspondingly ineffective and the
therapist accused the patient of "bear-
trapping" or "sabotage," thus attempting
to make the patient solely responsible for
the difficulties in therapy. After the
therapist and the patient had completed
the exploration, the patient was left alone
to make a new life decision, and to learn
how to implement it.
Probably 90 percent of the difficulties
whicfi therapists get into with patients -
where nothmg IS happening are a result
of the therapISi thinking the process is in
the fourth, or exploration, phase of
therapy, whereas it actually needs to be in
the second, or decontamination, phase.
Exploration with acoriiaiilliiai~lt
and no contract is futile. The therapist
expectS a redeclSlon and resolution but
really needs to aim toward a clear
contract.
Patients, bless their hearts, try to make
their therapy work even when the
therapist is relatively inept. If the
Trans. An. J., 6:2. April 1976
 THE STRUCTURE AND SEQUENCE OF PSYCHOTHERAPY
therapist skips a stage, the patient may
salvage the therapy by taking care of the
missing work. When the therapist has a
clear idea as to how therapy can proceed
most effectively, he can have successful
outcomes with patients who would other-
wise leave therapy unsatisfied or have
inordinate emotional pain.
Harry S. Boyd, Ph.D., is a Clinical
Teaching Member in the ITAA and Presi-
dent of Consultant and Training Asso-
ciates in Norman, Oklahoma.
REFERENCES
I. This term comes from Schiff, J. "Reparenting
Schizophrenics," Trans. An. Bull., 8:31, July
1969, pp. 47-63.
--------e--------
DIFFERENT STROKES FOR
DIFFERENT FOLKS
Geraldine Wallman, M.S. W.
When I use McKenna's Stroking
Profile;' I ask clients to check out
variations in their profiles based upon
such social factors as sex, age, or race.
Most frequent and important distinctions
in stroking patterns appear to depend
upon whether the other is male.or female.
Some clients find distinctions in social
position to be important; whether the
other is a social superior or has more
authority (e.g., boss, professor, parent,
group leader), an equal, or an inferior
alters stroking considerably. How often
clients give, take, ask for and refuse to
give positive and negative strokes may
vary widely with the age, race, ethnic
Trans. An. J .• 6:2, April 1976
[EDITOR'S NOTE: The concept of "self-
reparenting" is open to question. Though
James, too, talks about how people can
reparent themselves, at least on one level
the notion involves serious contradicting
in terms. "Rf!:l!arent," as Q!jgjna/ly used
byS~hif.£fl'if!{l~§~~'jiiQvirJe a total new
JJf:lc,.~nt." Such an operation clearly
requires a second person (therapist or
other) to be and/or provide the new
parent. If the word "reparent " is used in
the sense of "provide a new Parent, " then
here, too, a Parent, by definition - in
TA and Psychotherapy - originates
outside the individual whose Parent is
thus formed. So either way, re-parent or
re-Parent, it is contradictory and loose to
say "the patient will reparent himself. ''j
group, or class of others. This kind of
checking out has proven useful, makes the
Stroking Profile a more specific tool, and
leads to a more precise understanding of
script decisions and to a clearer contract
for change.
Geraldine Wallman, M.S. W., is a
Regular Member of the ITAA and a staff
member of the Gotham Institute for TA
in New York.
REFERENCES
I. McKenna, J. "Stroking Profile: Application to
Script Analysis," Trans. An. J., 4:4, October
1974, pp. 20-24 and "Errata," Trans. An. J.,
January 1975, pp. 80-81.
183