Transactional Analysis Psychotherapy Research Articles

A Therapist’s Review of Process: Rupture and repair cycles in relational transactional analysis psychotherapy for a client with a dismissive attachment style: ‘Martha’

This article is a therapist review of the process that occurred during a systematic case study of psychotherapy with ‘Martha’, a female client who presented with depression, anxiety, alexithymia and dismissive/avoidant attachment style. Assessment, diagnosis of the client and treatment direction is described, followed by a detailed account of the therapeutic process through 12 sessions and 2 post-therapy interviews. Analysis team results are summarised, indicating support for the therapist’s identification of issues during the process of the therapy. Particular attention is paid by the analysis team two points of rupture and repair, with pragmatic evaluation confirming that the relational struggles between therapist and client seemed pivotal in generating positive change.Citation - APA format:Baba Neal, S. (2017). A Therapist’s Review of Process: Rupture and repair cycles in relational transactional analysis psychotherapy for a client with a dismissive attachment style: ‘Martha’. International Journal of Transactional Analysis Research & Practice, 8(2), 24-34.

Listening to the Voices of Women Suffering Perinatal Psychological Distress

This article suggests that transactional analysis can be an effective treatment approach for women suffering from mental health conditions and the emotional and life disturbances that may occur during the perinatal period. It offers a brief introduction to perinatal psychological distress followed by a description of the use of transactional analysis psychotherapy for this condition. The article outlines a new model for a research project that aims to ascertain women’s views on the helpfulness of the treatment and to gain a better understanding of the stigma often associated with perinatal mental health issues. The author argues for the necessity of qualitative research to assess the efficacy of transactional-analysis-based treatment and to increase our knowledge about the change process in transactional analysis psychotherapy with this client population as well as to inform future transactional analysis treatment protocols.

Empirical Evidence for Transactional Analysis Psychotherapy for the Treatment of Chronic Pain

Chronic nonmalignant pain is a biopsychosocial problem for which psychological and psychotherapeutic interventions are crucial, and there is empirical support for the effectiveness of cognitive behavioral approaches in such cases. The aim of the study reported here was to show transactional analysis (TA) interventions as possibly effective for chronic pain. The author reports on the case of Ana, a 23-year-old student with chronic low back pain who participated in 15 sessions of transactional analysis therapy. The introductory diagnostic part of the therapy revealed a low pain tolerance and difficulties in her identity. Ana’s pain symptomatology was strongly connected to a traumatic event. The therapist worked outward from an empathic inquiry and validated and normalized Ana’s sensations. Using transactional analysis theory and some other techniques, she helped Ana to understand the importance of body-mind connections and their influence on pain. Ana was able to be aware of some of these connections, understand them, and recognize her power to control the pain. At posttreatment assessment, Ana reported not feeling pain most of the time. In addition, there was a reduction in her kinesiophobia (fear of movement) and pain catastrophizing. She also reported a higher self-concept and better mood. Therapeutic gains were maintained at 6-month follow-up. Implications and clinical considerations are discussed.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Deborah’

This study is the third of a series of seven, and belongs to the second Italian systematic replication of findings from two previous series (Widdowson 2012a, 2012b, 2012c, 2013; Benelli, 2016a, 2016b, 2016c) that investigated the effectiveness of a manualised transactional analysis treatment for depression through Hermeneutic Single-Case Efficacy Design (HSCED). Major Depression and Subthreshold Depression are often in comorbidity with Anxiety disorders in childhood and adolescence and represent a risk factor for ongoing mental health problems in adulthood. The therapist was a white Italian woman with 15 years of clinical experience and the client, Deborah, was a 15-year old white Italian female adoloscent who attended sixteen sessions of transactional analysis psychotherapy. The conclusion of the judges was that this was a good-outcome case: the depressive and anxious symptomatology clinically and reliably improved over the course of the therapy and these improvements were maintained throughout the duration of the follow-up intervals. Furthermore, the client reported significant change in her post-treatment interview and these changes were directly attributed to the therapy. In this case study, the transactional analysis manualised treatment for depression in adulthood has demonstrated its effectiveness also in treating depressive and anxiety symptoms in adolescence.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Caterina’

This study is the second of a series of seven, and belongs to the second Italian systematic replication of findings from two previous series (Widdowson 2012a, 2012b, 2012c, 2013; Benelli, 2016a, 2016b, 2016c) that investigated the effectiveness of a manualised transactional analysis treatment for depression through Hermeneutic Single-Case Efficacy Design. The therapist was a white Italian woman with 10 years of clinical experience and the client, Caterina, was a 28-year old white Italian woman who attended 16 sessions of transactional analysis psychotherapy. Caterina satisfied DSM-5 criteria for major depressive disorder with generalized anxiety disorder. The conclusion of the judges was that this was an outstanding good-outcome case: the depressive symptoms showed an early clinical and reliable improvement, maintained till the 6 months follow-up, accompanied by reductions in anxiety symptoms, global distress and severity of personal problems. Adherence to the manualised treatment for depression appears good to excellent. In this case study, transactional analysis treatment for depression has proven its efficacy in treating major depressive disorder in comorbidity with anxiety disorder.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Anna’

This study is the first of a series of seven, and belongs to the second Italian systematic replication of findings from two previous series (Widdowson 2012a, 2012b, 2012c, 2013; Benelli, 2016a, 2016b, 2016c) that investigated the effectiveness of a manualised transactional analysis treatment for depression through Hermeneutic Single-Case Efficacy Design (HSCED). The therapist was a white Italian woman with 8 years of clinical experience and the client, Anna, was a 33-year old white Italian woman who attended 16 sessions of transactional analysis psychotherapy. Anna satisfied DSM-5 criteria for mild persistent depressive disorder (dysthymia) with anxious distress. The conclusion of the judges was that this was a good-outcome case: the dysthymic symptoms improved over the course of the therapy and were maintained in the ‘healthy’ range at the 6-month follow-up, the client reported a positive experience of the therapy and described important changes in intrapsychic and interpersonal patterns. In this case study, transactional analysis treatment for depression has proven its efficacy in treating persistent depressive disorder.

The Many Faces of Transactional Analysis: A Survey Study of the Practice and Identity of Transactional Analysis Therapists in the UK

An online survey method was used with a sample of 99 therapists who had completed at least 4 years of transactional analysis psychotherapy training to investigate factors including their views on the most and least practised TA psychotherapy approaches based on the ‘schools’ of Classical, Redecision, Cathexis, Integrative, Psychodynamic and Relational. Demographic information on gender, age, therapeutic activity and professional associations was also collected, and the survey explored subjects’ willingness to diversify their knowledge of therapies other than TA, how much they integrated across therapeutic modalities, and their commitment to a TA Identity.Statistical analysis was conducted on the TA Identity and Integrative Identity scales within the survey, which were shown to have good reliability and internal consistency. Statistical analysis of results indicated that participants displayed significantly higher levels of Integrative Identity than TA Identity, although it was not clear whether that related to the TA Integrative approach or to the general integration of different approaches. Attainment of the international TA qualification as Certified Transactional Analyst (Psychotherapy) was shown to be related to commitment to TA and commitment in the TA community.

Paradoxical Alliances in Transactional Analysis Psychotherapy for Anxiety

This article considers the use of the technique of paradoxical alliances in transactional analysis psychotherapy with a 37-year-old white French woman over two sets of sessions. The authors hypothesize that this technique, which has not yet been widely used in TA, can be effective in the treatment of anxiety disorders and offers a useful addition to existing transactional analysis methods. The first set of sessions with the client occurred before the paradoxical alliances approach had been developed, and although therapy had some benefits, it did not result in lasting change for the client. In the second set of sessions, the paradoxical alliances technique was applied and resulted in a deep, lasting improvement in the client’s anxiety attacks.

Comparison of Transactional Analysis Group and Individual Psychotherapy in the Treatment of Depression and Anxiety

This article compares outcomes of transactional analysis individual and group psychotherapy for depression and anxiety within two public clinics in the United Kingdom. The research was a naturalistic, open-label trial with no control group and limited randomization. The analysis focused on treatment outcomes for clients who presented for therapy within the clinical range for depression (PHQ-9 = 10) and anxiety (GAD-7 = 8). The outcomes show the reduction of symptoms with a large effect size for both depression (individual ES = 1.22; group ES = 1.14) and anxiety (individual ES = 1.67; group ES = 1.05). There were no significant differences between group and individual therapy in the length of therapy, effect size, or the Reliable and Clinically Significant Change Index (Individual RCSI for depression: individual = 44.1%, group = 1.4%; for anxiety: individual = 36.8%, group = 37.1%). These outcomes are consistent with national health benchmarks within the United Kingdom (Gyani, Shafran, Layard, & Clark, 2013) and suggest that transactional analysis psychotherapy is a good treatment option for moderate anxiety and depression as either individual or group therapy. A replication or a larger, controlled trial would be needed to further investigate full efficacy of these approaches. Further qualitative research would be beneficial in understanding the depth of the therapeutic process and clients’ choices to engage in either group or individual therapy.

An investigation into the factors that influence the perceived experiences and outcomes for students training in Transactional Analysis Psychotherapy in the UK and USA

Interpretative Phenomenological Analysis (IPA) (Smith, 1995) was applied to data from 21 out of 50 participants who had shared their training experiences during semi-structured interviews. Subjects were chosen from trainees and trainers in the USA and UK, to include ‘generations’ from those trained by transactional analysis originator Dr Eric Berne through to recently qualified transactional analysis psychotherapists, and including some who had ceased training before qualifying.Results suggest that TA psychotherapy training is experienced by some as a transformational, life enhancing and reparative experience that culminates in a satisfying and rewarding career, whilst for others it is perceived as an abusive, punitive and punishing experience, bringing disillusionment, disappointment and dissatisfaction. The main contributing factors were the students’ personal belief systems, motivations for undertaking the training, and relationships with the trainer, peers and the profession as a whole. Analysis of the themes suggested that subsequent anxieties raised by participants concerned lack of information, inconsistencies in training offered by different establishments, reasons for trainees entering training and trainers’ reasons for accepting them, and the significant time and resource requirements of the training. The paper includes recommendations aimed at making the training experience one that upholds the basic philosophical principles and values of TA, and promotes, develops and enhances TA psychotherapy training.

Transactional analysis psychotherapy of mixed personality disorder

The paper presented here demonstrates what transactional analysis can achieve in the treatment of mixed personality disorder and points out to the challenges. The approach in question is integrative transactional analysis which also incorporates, in its diagnostics and choice of interventions, the theories and techniques from other modalities, dynamic and systemic. The concepts from transactional analysis that have proven resistant to postmodernist critique, unlike other concepts, such as games, transactions, or ego states, are the concepts of life script and personal adaptations. Script analysis and working on changing one's personal adaptations classify contemporary transactional analysis in the group of narrative therapies.

Quantitative and Qualitative Outcomes of Transactional Analysis Psychotherapy with Male Armed Forces Veterans in the UK presenting with Post-Traumatic Stress Disorder

This paper presents findings from a two-year research project conducted within a live-in residential charity setting in the UK, examining clinical outcomes of TA psychotherapy among 15 male armed forces veterans presenting with severe PTSD (post-traumatic stress disorder) and other comorbid disorders. Outcomes were measured for short-term (24 sessions) and long-term (52 sessions) transactional analysis (TA) treatment using the quantitative CORE-OM (Evans, Mellor-Clark, Margison, Barkham, McGrath, Connell & Audin, 2000), PHQ-9 (Kroenke, Spitzer & Williams, 2001) and GAD-7 (Spitzer, Kroenke, Williams & Löwe, 2006) questionnaires and the qualitative Change Interview (Elliott, Slatick, & Urman, 2001, as cited in Frommer & Rennie, 2001). Quantitative findings show that positive Reliable Change on global distress, depression and anxiety has taken place within both the short-term and long-term treatment groups with some clients achieving Clinically Significant Change on these measures. Qualitative findings arising from thematic analysis (Braun & Clarke, 2006) indicate that a broad spectrum of therapist factors and psychotherapy process factors within the TA therapy delivered were beneficial for this particular client group. The negative influence of a number of psychosocial factors on the veterans' well-being is also discussed based on numerical data and interview responses. Overall, these results suggest that TA psychotherapy can be effective in the treatment of PTSD among combat veterans.

Preliminary Evaluation of Outcomes of Transactional Analysis Psychotherapy for Armed Forces Veterans presenting with Post-Traumatic Stress Disorder

This brief outline presents some initial findings from a pilot project conducted within a charity settingin the UK, examining clinical outcomes for a cohort of armed forces veterans presenting with post-traumatic stress disorder (PTSD). Outcomes were measuredusing CORE-OM (Evans et al 2000), PHQ-9 (Kroenke et al 2001) and GAD-7 (Spitzer et al 2006). Preliminary findings show that positive Reliable Change on global distress and anxiety had taken place within 16 sessions. These results suggest that transactional analysis psychotherapy has promise for treatment of PTSD with this client group and that further research is warranted.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Linda’ - a mixed outcome case

Hermeneutic Single-Case EfficacyDesign (HSCED) is a systematic case study research method involving the cross-examination of mixed method data to generate both plausible arguments that the client changed due to therapy and alternative explanations. The present study is the fourth article of a case series which has investigated the process and outcome of transactional analysis psychotherapy using Hermeneutic Single-Case Efficacy Design (Elliott 2002). The client, Linda, was a 45 yearold white British woman with mild depression who attended nine sessions of therapy. The conclusion of the judges was that this was a mixed-outcome case:whilst the client improved over the course of therapy and was positive about her experience of therapy, her changes did not last when she experienced considerable stressful events during follow-up. Linda provided a detailed and idiosyncratic description of the aspects of the therapy which were most helpful for her. A cross-case comparison with other cases in this series suggests several interesting features which are worthy of further investigation. Specifically, the use of a shared theoretical framework and an egalitarian therapeutic relationship were helpful. As with other cases in this series, the client experienced positive changes in her interpersonal relationships suggesting that this outcome of TA therapy warrants further investigation

Combining Traditional Ego State Theory and Relational Approaches to Transactional Analysis in Working with Trauma and Dissociation

This article explores the treatment of dissociation that originates in childhood trauma. Specifically, the article examines how both structural (Steele & van der Hart, 2009) and relational theories (Schwartz, 2000) of trauma and dissociation can be applied in transactional analysis psychotherapy. Many of the concepts and constructs of structural theories blend well with traditional transactional analysis theory (Berne, 1961) while relational perspectives on childhood trauma resonate with the contemporary relational approaches in transactional analysis (Caizzi, 2012). The author provides an overview of both theories of trauma and dissociation and links them with transactional analysis. This leads into a clinical case presentation that emphasizes how the author integrates both theories into his work with traumatized and dissociated clients.

Transactional Analysis Psychotherapy With a Woman Suffering From Multiple Sclerosis

Living with a long-term health condition can lead to anxiety, depression, posttraumatic stress disorder, and relationship difficulties. This article uses a systematic case study approach to examine the process and outcome of transactional analysis psychotherapy with a woman suffering from multiple sclerosis. Hermeneutic analysis of a rich case record was used to evaluate the outcome of the intervention. A set of factors contributing to change were identified and are discussed in relation to previous research into psychotherapy for long-term health conditions. It is concluded that transactional analysis psychotherapy may represent an effective means of allowing different facets of the experience of illness to be explored and resolved. The implications of this study for practice and future research are discussed.

Perceptions of Psychotherapy Trainees of Psychotherapy Research

The present study was conducted by the researcher to explore the perceptions and feelings that Transactional Analysis (TA) psychotherapy trainees had about psychotherapy research. The researcher was also preparing to conduct a practice research based project involving TA psychotherapists, and wanted to use the findings from the present study to inform the design of that project and anticipate and respond to the possible training and support needs of participants.

“Special Fields”

This article argues that Eric Berne’s professional anxieties and biases were the ground in which counseling in transactional analysis came to be assigned a second-class professional status. The author examines the impact of Berne’s investment in creating a transactional analysis psychotherapy at the expense of other modes of facilitating learning and growth.

Two studies on the effectiveness of Transactional Analysis Psychotherapy in an inpatient setting

In this lecture I will present two studies on the effectiveness of TA Psychotherapy in an inpatient setting.

The mutually beneficial process of research and practical work

The focus of this workshop will be on the cons and pros of doing research on your own clinical practice.
 The workshop will be based on my work with my PhD dissertation titled Transactional Analysis Psychotherapy – Three Methods Describing a Transactional Analysis Group Therapy. This is described in some detail in the paper produced to accompany my Keynote Speech, and included at the start of this Proceedings document, so I will not repeat that content here.