Ego States and Transference Carlo Moiso

Abstract

The structural analysis of two types of transference is presented accompanied by clinical examples.

P2 transference is presented as tile reenactment 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.

P, transference (PI + and P,-) are presented as projections of good objects or bad objects owing to Immature P, functioning (mainly borderline conditions and pathological narcissism). These conditions are not accessible to A2 decontamination, to C2 redecision or to reparenting; therefore, we describe a new methodology, the TA Psychodynamic Approach, for use in these cases.

Introduction

In the last five years the theoretical and clinical research at the Institute ofTA ofRome has been devoted to the analysis of transferential and countertransferential aspects in the therapy with border! ine and narcissistic patients (Moiso, 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 of transference. 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 expression of the transferred material is indicati ve of secondary process thinking. The latter is characterized by a regression to primary process thinking, (Rapaport. 1957) mainly ex-

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pressed indirectly in fantasies, dreams, slips of tongue and directly through acting out. This second type is present in borderline and narcissistic patients. Each transference is typical of a diagnostic category, even though regression may be manifested in tile course of therapy by every patient.

There is a distinct feature differentiating the regressive quality in P2 projection from PI projection: 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 provoking 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 internal object,

Analysis of transference within the framework of TA was begun by Eric Berne. In Transaaional Analysis in Psychotherapy (1961) he affirms that "scripts belong in the realm of transference phenomena" (p. 116). 111 Principles 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 patient "is a matter of careful and svstemaric analysis of the psychodynamics ofhi~ transactional 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 primitive object relationships project« OIUO the therapist his own Parental Ego States (P2 or P,).

TrollsactJonm Analyst, Journal

Therapist

Patient

Figure 1.

Analysis of Transference Transactions

These are projected onto a screen superimposed 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 (P2) and unconsciously projected Parent (PI) is a vital component of script treatment. I believe Ihis analysis is 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-

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ship; 2) material projected onto the therapist can be a pre-Oedipal introject (P1) or postOedipal (Pz); and 3) in order to achieve structural cure, i.e. a stable Adult identity through restructuring impaired ego states, often it is indispensable to analyze and resolve the transference 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 ability [0 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 mentioned before, there are two ego states that can be projected: PI and P2- The P2 ego state is the iurrojection of the parental figures in toto, that is, of their Parent, Adult and Child ego states (Berne, 1966). This process takes place following the Oedipal resolution, i.e., after the onset of secondary process thinking. The projection of P, is then present and active in neurotic patients. 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 A2 thinking (Wallerstein, 1967).

The P1 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) divided into two substructures (P, + and PI _). These two substructures will be more or less integrated and acknowledged depending on tbe 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 (PI + and PI _) is a maturational phase resulting from the lack of integrative capacity in AJ• This assumption about P t is congruent with both the T A theory that. the Parent in the Child is self-generated in response to the Somatic Child-Little Professor elaborations following parental reactions (Woollams &

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Brown, 1978), as well as with the psychoanalytic theory of object relations (Klein, 1957). Further-more, this splitting into "good" and "bad" was also recognized by Eric Berne (1972) who called them the "Fairy Godmother" and "Witch mother. "

The congruence described above forms the specific theoretical bridge between structural analysis in T A and the psychoanalytic theory of object constancy. Thus it is possible to describe and apply a TA approach to both borderline personality organizations and narcissistic personalities (Kern berg, 1981), when the use of other T A approaches with early structural pathology seldom provides satisfactory 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 (Az) from intrapsychic conflicts. This is achieved by keeping apart libidinally determined introjections and identifications from those aggressively determined. The defensive splitting is maintained 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 extreme anxiety owing to un resolvable ambivalence.

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. Fur 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 internalized objects, is necessary to fulfill his tendency to idealize the therapist from whom he expects narcissistic supplies (Kernberg, 1981).

It is worth emphasizing IMt 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 PI- because the narcissist uses the denial defense mechanism against this substructure. In the case

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of the borderline personality organization, the denial is alternating, because evolutionary arrest took place earlier than in the narcissistic personality, 1. e., when PI... and PI - were still cathectable one at a time so as to be perceived as a single PJ that takes an "all bad" or "all good" aspect. The borderline patient then projects alternately PI ... and P, _. PI + is projected because of the desire to obtain a symbiotic 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 aggressive 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 relationship for both borderline and narcissistic pathologies, with their un integrated 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 diem, where splitting was established 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 P, 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 can the Psychodynamic 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 transactions) to unveil the exact nature of the transference relationship and the content offhe projected Parental structure (P2 or Pd. The therapist must keep a keen eye on countertransference 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 multiple parent, Of whatever constitutes the struc-

Transactianai A"u/Y.lis Journal

mral content of the parental projected structure.

In T A 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 materia]. After the patient has reached an A2 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 patient's problems far more than any specific aspect of the analyst's script. The general principle is to carefully present the therapist's emotional response to the patient, acting purposefully as an "active transference mirror. " This process favors both the establishment of Adult ~ Adult transactions and the reappropriation of the projected material. The countertransference reaction can be of two major types: identification of the therapist with the corresponding ego state of the patient, and/or identification of the therapist with the projected part of the patient. These findings correspond with Racket's (1957) concepts of "concordant identification" and "complementary identification. " The principle is that the more the patient is experiencing C\ primitive impulses, the mom the therapist will sense them (concordant identification) and will react and struggle with them either with his own PI Of P1 (complementary identification). Herein lies a great opportunity for the skilled T A therapist to help his/her patient to change the script protocol by bringing in C2 changes using the corrective experience of the treatment situation.

The final goal of the work on both P, + and PI _ transferences is to permit the patient to recognize and then to integrate PI + and PI _ into a single Ph where "negative" and "positive" aspects exist together. This process will later allow [he redecisional work necessary to solve the problems connected with impaired functioning of P2 and A2• The dynamic and

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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 projects the ego states of the real parents onto a screen in front of the therapist by externally expressing an internal dialogue between P2 and C2, He then feels and acts out toward the therapist those feelings, manifests those needs and puts into action those kinds of racket'> and games which are an example of his original relationship with the parental figures.

a

a = i~ le rna I dialogue

b = P roiec ted struct u ra c = soc i al nansacfion

d = transterence message

(u I te rior I rans action)

(The Parent or the Ih era pis! is s how" as a dotted line to ina i cate that its actual existence or slgnific-artcB is d i scou nted by the p anent.)

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 processes intended to promote the experiences that further his script (as well, of course, as the conditional strokes which reinforce it). At the same level we can identify a positive transference when the patient seeks to obtain those permis-

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sions and strokes from the therapist he did not receive from his original environment. The therapeutic approach requires an attentive analysis of the transaction!'. 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 projection 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.

Gillical 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 alw3)1S IIp to me to do everything by myself!" (Child % projected Parent transference transaction) (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: "PI1H, 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 J 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 malt must not depend 011 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 dear

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the phenomenon of (be transference projection using the scheme in figure 3.)

PI Transference Type A (P1+) (Rgure 4)

Here the patient projects the image of the ideal omnipotent Parent (PI +) Onto the therapist. Often this is an image of himself fixated at the culmination of the phase of normal

a '" int ern al tilalo g ue

b '" projected strucfu re (P d c '" socl al tr ansaenon

d = transl eren ell rnessaqe (u Iteri or transactiDn)

Figure 4.

PI Transference Type A (PI +)

narcissism (Kohut, 1971). TIllS is why this type of transference is most common in the narcissistic personality,

In PI + transference, the patient discounts the real personality of the therapist in an effort to avoid acknowledging the therapist's deficiencies, so as to protect himself from confronting his own needs and from the desperauon connected with a sense of abandonment. He thus projects onto the therapist an all-geed omnipotent self, source of immediate and eternal gratification as well as absolute model toward which he call strive. The therapeutic approach, at least in the first phase of therapy, is based on helping the patient to reappropriate the PI + he projects onto the therapist. This avoids a escape reaction which would follow the disapproprianon of the good object (P 1 +) with the persistence of the bad object (PI _) and of a helpless C 1. The mechanism which elicits the

Transactional Analysis Journal

escape reaction is that the patient. by projecting his PI + enters, in fact, a symbiotic relationship. Ifthe therapist does not accept the projection, 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" (PI _). As a defense he will then need to perceive the therapist in this way because of his "abandonment. "

The P, + projection and the resulting symbiosis are 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 awn perfection to protect himself from his aggressive impulses. 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 100 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 Ibis phase will be aimed at helping the patient reinforce his narcissistic defenses without injury to the idealization 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 + transference. The therapeutic strategy was to reinforce the client's defenses to allow him to recover a certain narcissistic equilibrium. In the second phase, PI _ transference was present, and will be illustrated by the next example:

MaximilJjan: (looking at therapist) "I see you are always in good form and understanding 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 activation 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 tran .. >~ action).

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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 hypothesis 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).

Pt Transference Type B (P,_> (Figure 5)

PI - transference is evident in regressive outbursts of acting out when the patient is typically transacting directly from C J 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 _.

a ". internal dialogue

b = projected structure (PI _) C = tren sf erence traasac lion

FigLife 5.

Pl Transference Type B (Pl-)

The therapist is then seen as a sadistic object, all bad, the source of the most serio us 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

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example I will use the same case I used to illustrate 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 (his group you understand everybody except me" (transference transaction).

Therapist: "Repeat that and let your feelings come out."

Maximillian: (Vlith 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 discounting 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."

Maximillum: (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 pronounced 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

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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. u should be remembered that the two types of transference are structurally different even though their functional manifestations can be similar. In P2 transference the projected material had been incorporated from the external world (the real parents). In the PI transferences the projected material, hence the analyst, represent part of the patient's grandiose self (P! + transference in narcissistic personalities) and of primitive self and primitive object-representations (P1 _ and PI + in borderline condition and regressed narcissists).

In order to effectively deal with these patients it is important to let them establish a transference relationship with the therapist; the transference projection is the necessary condition for the establishment of such a relationship. 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 internal dialogue of which the person is not conscious. He is either reliving an unclosed Gestalt with dle parental figures, projected as they were incorporated (Pl- preconscious transference), or reexperiencing the same experiences of attachment, detachment and reattachment that led to the formation of PI (PI unconscious transference). In this case the projected Parent can be all good (PI +) or all bad (Pl-). I want 10 emphasize that the more severe the diagnosis, the more emotional charge invested by the patient in the therapist will be projective. A cornerstone of success with severely regressive pathologies is the use of countertransferential material.

This requires permission to have a countertransference and to analyze it. III this perspective, using the T A Psychodynamic Approach requires the recognition of specific replies to diverse transferentiai messages. In this way we will know, for example, when to confront and when to support Of 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 Anatysis Jouma!

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 Transactional Analyst, Instructor/Supervisor, lives in Rome and works as training director of the Institute for TA (JAn He is visiting trainer in several seminars in Europe and the U.S.A.

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EGO STATES AND TRANSFERENCE

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