By Jurriaan Plesman, BA (Psych), Post Grad Dip Clin Nutr
Psychotherapy differs from other kinds of counselling in that a change in behaviour and feelings is brought about with reference to a theoretical model. Thus there are a number of different types of psychotherapies depending on the models used by the therapist and client. The model used here is based on the concept of personality as consisting of layers of personality, the inner core of which is the biological self. A physical disorder, such as hypoglycemia, affects the biological self and can express itself as both a physical and psychological illness.
Treatment of the biological self must take precedence over the psychological disorder. No self-respecting therapist would attempt to treat a ‘behavioural’ problem, when in fact that behaviour is due primarily to an underlying physical ailment, such as hypoglycemia, diabetes, chronic fatigue syndrome, schizophrenia or manic-depressive illness.
However, this is not to say that personality is nothing more than a physical manifestation of the biological self. The next layers of personality may be seen as the psychological aspects of personality, which takes into account the self-image, the self in relation to other humans, his social skills, including communication, and perhaps more importantly his values system. The latter is often referred to as a person’s spirituality, whatever that means.
Many people who have recovered or are recovering from the ravages of a metabolic disorder are left with the scars of psychological damage left behind by their illness. This is especially so if the physical ailment dates back to much earlier times, even to childhood.
Recovering hypoglycemics have to restore relationships with significant others, possibly damaged by years of uncontrollable mood swings, depression and bouts of anger. Recovering alcoholics and drug addicts who’s personality development has stagnated from the time they first used their drugs are often faced with the necessity of completely overhauling their life-style. A person with a long and painful history of broken relationships due perhaps to initial ill-health needs a swift program aimed at restoring a severely injured self-esteem.
The treatment of one’s negative self-image is at the hub of psychotherapy and is the starting point of everything else that follows.
To gain a clear understanding of this therapy we need a language, easily understood by the client and that is free of emotional bias. After learning this basic language we will soon learn how we can change our negative self-image. We will then learn about the Assertiveness Training Program, move on to communication and values clarification.
I would like to give a very brief summary of Transactional Analysis based on the book by Berne,E.(1961), TRANSACTIONAL ANALYSIS IN PSYCHOTHERAPY, Ballantine Books, N.Y., but reinterpreted by me for the sake of simplicity in order to understand some very important principles in psychotherapy.
In Transactional Analysis (TA) it is assumed that when we think or talk we jump from one “ego state” to another. In Figure 1 we see that “Mary” has three egos: the PARENT, ADULT and the CHILD. So has Paul on the left.
When we speak from the PARENT ego state, you hear such things as “good”, “bad” “right”, “wrong”, “you should”, “you ought to”, “you have to”, “you must”, “you always…..”. In other words we speak as if we are a critical parent telling a child what it should, must and ought to do. This is often accompanied with gestures that reflect our authority such as when we point our finger or frown our eyebrows. Finger pointing is a sign when a person speaks from his/her PARENT ego.
When we are in our ADULT ego, we deal with the world as it is. Statements are either true or false and we usually come to a decision based on rational thinking: “because of X, which leads to Y, which leads to Z” etc. This is our analytical mind and source of our rationality.
When we speak from our CHILD ego we often say things like “I want”, “I need”, “I hope” and so on. The things we need are not always wanted, like vitamins and minerals, the things we want are not always needed, such as drugs and alcohol.
Some of our basic needs are: the need for security, respect, for shelter (a home), for food, sex, affection and love, for play and laughter. As adults in later life these needs are extended to a range of values we desire in civilized relationships.
A happy person is one, that can satisfy his needs without interfering with the need of others.
Referring figure 1, suppose that Paul is asking Mary: “Where is my coat?”
Mary can answer either as
1) “Your coat is hanging in the cupboard” or,
2) “If only you would put your coat where you should have put it in the first place, you would know where your coat is”.
In 1) Mary speaks from her ADULT to Paul’s ADULT, because whatever she says is either true or false. There is no judgment.
In 2) Mary speaks from her PARENT to Paul’s CHILD; she is not answering Paul’s question but gives him a lecture.
In 1) there is what is called an A-A message
In 2) Mary gives Paul a P-C message.
This is illustrated in Figure 1 above. You will see that the A-A arrow crosses the P-C message and hence this is called a cross transaction. In transactional analysis all cross transactions indicate a conflict in communication.
The above example AA –> PC comes in many forms, as in “Where is Sydney Harbour Bridge?”(AA) –> “You must be pretty stupid to ask that question!” (PC).
It is possible that the respondent may misunderstand the question and hears a criticism instead. This becomes AA–> CP. For example the conversation goes like this: “Where is Sydney Harbour Bridge?” (AA) –> “I wonder why he is asking this question, perhaps he thinks I am stupid” (CP).
In this example the person shows his suspicion about the question and this is called a paranoid response, for in fact instead of giving a straight answer “The bridge is in the middle of Sydney” the respondent reads the question to be a hidden criticism.
Many verbal arguments finish up in PC-PC messages, whereby opponents call each other by names, such as “You are a bum”, “You are a bitch:”.
Role playing can also be interpreted in terms of TA. For example:
“Doctor, what is wrong with my ears, it hurts” (A-A), the doctor might reply:
“Don’t worry about this I am your doctor and know exactly what should be done. You need a prescription” (P-C). The doctor doesn’t give an answer and plays doctor.
To become familiar with transactional analysis listen to conversations you hear around you and try to classify the transactions in terms of A-A, P-C, C-P.
THE NEGATIVE SELF-IMAGE
In Figure 2 we show how a person has acquired a negative self-image. The critical PARENT – the robotic judge – sends a constant stream of mental messages to the CHILD, saying such things as “I am no good”, “I am a failure”, “I am ugly and unlovable”.
In this illustration Mary firmly believes that “I am no good”. Whenever Paul makes a critical remark or a remark that is seen to be critical Mary has no defences because her PARENT agrees with Paul’s PARENT. The result is that Mary either attacks or withdraw which in either case may often result in aggression.
Her reaction against Paul – whatever it is – will confirm in Paul’s mind that there is something wrong with Mary. He may even come to think that “Mary is indeed no good”.
And so we have an example of a self-fulfilling prophecy.
It means that our behaviour creates images in other people that support our belief in ourselves as to whom we are.
THE “I AM RIGHT POSITION”
In Figure 3 we see a person in the “I am Right Position”. This represents the authoritarian personality, who tends to see the world in simple colours of black and white. He is good at making quick decisions, he appears confident, can be condescending. Often they are found at the head of organisations with a strict pecking order, a structure of command that goes from the top to the bottom. In the extreme form or in a pathological stage he can be aggressive and the remarkable characteristic is that they often lack insight. In terms of his self-image the transaction at the CHILD level he seems to be saying: “I am better than you are”, “My house is bigger than yours”.
The reason seems to be that he is driven by an extremely low self-esteem saying: “I am no good either” which is completely blocked from his awareness. Hence the self-image “I am no good either” is placed in double brackets in figure 2.
This person is often attracted to a shy partner – the person in Figure 2 – partly because that partner satisfies his “nurturing” but authoritarian PARENT ego. The partner may find an attraction in such a confident personality and compensates for her feelings of inadequacy and insecurity.
This goes to show an important principle in psychotherapy: “Hang-ups attract hang-ups”.
Problems often arise when one of the partners in such relationship grows up or changes personality. The mutual bond goes out of kelter.
In social situation the person in the extreme form of “I am right position” is difficult to handle, and are best avoided unless you are able to adopt a subservient role. In circumstances of social conflict they tend to see the problem as lying out there in the world, they seldom have insight into the effects of their behaviour on other people. The alcoholic who denies he is alcoholic is a typical example. They often adopt a “righteous” position and tend to be defensive. They feel that they are constantly under attack!!
Such a person usually gains a modicum of insight in a crisis situation as when their partners (wives or husbands) walk out of a relationship, they lose a job, or commit an offence, “which is out of character”. At such times when they have reached “rock-bottom”, or “crossed the red line”, they are often accessible to psychotherapy, for they may suddenly realize, that they did not have full control over their lives and need help.
It is essential that a person has some insight if he is to benefit from therapy.
The PARENT Ego source of inner conflict
When we see a man picking up an injured bird, or console a crying child he operates from what is called his “nurturing PARENT”. This is the source of our civilization, our cultural values or, as it were, the better side of human nature. The flip side of this ego is the punishing and critical PARENT. The latter is the root of our emotional problems. The aim in psychotherapy is to change the critical PARENT within us.
In our model the PARENT ego could be compared to the animal part of our mind that has learned to behave in a certain way by indoctrination. It has learned to quote negative “moral” sentences quite beyond the conscious control of the speaker or thinker.
When a teacher says to a child: “You are dumb….you are dumb”, the child comes to believe that “I am dumb…I am dumb, because the teacher says so..”.
After a few repetitions the child believes: “I am dumb….I am dumb, and I don’t need a teacher to tell me that, ….. because I damn-well know I am dumb”.
Now he has internalized that belief and it becomes part of his personality.
We may have met many authority figures in our childhood that could have implanted all sorts of negative ideas about oneself or the world and this has become part of our habitual thinking and behaving. It forms part of our attitudes.
Thus we may hear a prisoner, who has been sentenced for assault, say : “Well, I wanted to teach him a lesson”, he reveals with a slip of the tongue the origin of his thoughts.
The PARENT ego does not respond to a rational debate, stemming from the ADULT within us, just like a doggie does not learn from a verbal lecture given by his master. It has to be re-trained, by sheer repetition, persistence and determination. Thus when we go over to improving our our self-image in the next section, it must be emphasized that we are undertaking a retraining program of that animal part of the mind (the negative PARENT ego within us), with as much dedication as when we learn to play the piano, or any other skill we have learned.
We are now ready to have a closer look at the negative self-image and how we can change this in the article “How to Improve One’s Self-Image”.