149
SECTION III: CLINICAL APPLICATIONS
SIX STAGES OF TREATMENT
Richard Gordon Erskine, Ph.D.
Berne1 and Breen 2 have considered the
assessment of behavior change as an
important component in treatment. There
are six signposts whereby the therapist can
judge the level at which the patient has
accepted responsibility for his behavior.
These six therapeutic stages can serve as a
guide in shaping the course of treatment and
in making termination decisions.
Stage I - Defensive
The first stage is marked by defensive
behavior which is evident during structural
analysis when the patient is identifying his
rackets and their source. Either the CP or
AC is cathected and both the patient's
rackets and the rackets of his parents are
defended as authentic feelings.
A typical statement in this treatment
stage is, "Doesn't everybody feel this way
(my racket)?"
Stage II - Anger
The stage of anger comes when the
patient is aware that he is repeating rackets
in his own life which were learned from his
parents, and the realization that many of
the desires of his childhood were not met.
The position taken in this stage is, "I'm OK,
parents are Not OK." By offering protection
and permission to be aware of feelings the
therapist can deconfuse the angry Adapted
Child.
Stage III - Hurt
After anger the patient moves into feeling
hurt that his needs as a child were not met.
He takes the position, "I'm not OK, parents
are OK." With the use of rubberbands 3 the
Natural Child can now become aware of
early life decisions to feel not - OK when
hurt.
TransactionalAnal. J. III:3, July 1973
The patient may equate insight into the
cause of problems with the cure and attempt
to leave therapy at this point.
Stage IV - SelfAs Problem
The fourth stage of treatment involves
the patient's recognition that his parents give
many messages but that phenomenologically
he chose to incorporate only selected
messages. When the patient says, "I wrote
my own script," he has begun to recognize
the symbiosis with his parents.
Through script analysis the therapist can
help to decontaminate the Adult.
At this stage the patient becomes aware
that he is responsible for his behavior and
may attempt to terminate treatment in order
to avoid rewriting the script and to maintain
the symbiosis.
Stage V - Taking Responsibility
The fifth stage involves a commitment to
change. With permission and protection to
change, the patient owns his treatment
contract with three ego states - Nurturing
Parent, Adult, and Natural Child. This Free
Child can now exclaim, "I don't have to do
script behavior."
Stage VI - Parents are Forgiven
The last stage occurs when the patient has
full energy flow between all three ego states'
and says from each, "My parent did the best
job they were capable of doing."
A patient may enter therapy at any of the
six stages. Although the stages are linear in
their progression towards autonomy a
patient may recycle back through one or
more stages before progressing.
Richard Gordon Erskine, Ph.D. is a Clinical
Member of the ITAA, an Assistant Professor
17
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