How to stimulate practitioners to be interested in research?

1. Workshop at the 2nd EATA TransactionalAnalysis Research Conference, Putteridge Bury Conference Centre, Luton, UK 12-13 November 2012The mutuallybeneficial process of research and practical work.PhD Roland Johnsson Howtostimulatepractitionersto be interested in research?

2. Workshop overview • Lectureabout George Strickers Scientist – PractitionerModel (S –R Model) • Lecture from my research about Alliance and especiallyhowtouse the CCRT, CoreConflictualRelationalThemeMethod by Luborsky. • Exercise by observing a therapyroleplay and coding from the Standard CCRT Categories (Barber, Crits-Christoph & Luborsky, 1990, pp 45-49)

3. The Scientist-PractitionerModel The practitioner as a ”Scientist-Practitioner” or the ” Local Clinical Scientist” (Stricker, 2000; Stricker & Trierweiler, 1995) by building a bridgebeteweentwo different attitudesconnectedto the scientist and the practitioner. • Two different attitudes Idiographicapproach Nomotheticapproach • SpecifyGeneralize • Human science Naturalscience • SubjectiveObjective • UniquelifehistoryLaws, Patterns, Traits • DiscoverConfirm • ProcessEffect • ”Frog” perspective ”Eagle” perspective • QualitativeQuantitative

4. The affective dimension ofalliance in transactionalanalysispsychotherapy Research articleaboutalliance Roland Johnsson och Gunvor Stenlund International Journal of Transactional Analysis Research Vol 1 No 1, July 2010 Article available on: www.ijtar.org

5. Questionsposed • Howcan the affectiverelationalpatternsof different clients be characterized? • To whatextent do thesepatterns manifest themselves in the relations and interactionsbetween the client and the therapist? • Howdoes the therapist deal with the clientwhen the latter displays behaviourreflectiveofsuchrelationalpatterns?

6. Investigated material • Transcriptions of 24 videorecorded sessions • Strategic selection: 10 sessions of 24 representing beginning, middle and end of the therapy. • Randomised selection: 5 of 10 clients

7. Outcomefactors in psychotherapy From Lambert and Berley (2002) and Norcross and Lambert (2011)

8. Outcomevariance in psychotherapy From Norcross and Lambert (2011)

9. The Alliance concept(common terms) • Alliance refersto the quality and strengthof the collaborationbetween the client and the therapist in the therapy. • The conceptincludes: • Positive affectivebondsas mutualliking, trust, respect and caring. • Mutual agreements and commitmentsabout the goal and waystoreach it.

10. The Alliance concept (History) • No universal definition • Freud origin (1912) whostressed the positive transferencerelationship. • Sterba (1934) ego-alliance, stressed the reality-testing, observing ego • Greenson (1965) ”workingalliance” and ”therapeuticalliance” • Henry, Strupp, Schacht & Gaston (1994) Different views: Rational or Emotional • Stenlund (2002) Describesalliance in affect-theoretical terms (Tomkins, Luborsky) • Bordin (1976) stressed it as a pan-theoreticalumbrellaconcept

11. ALLIANCE (Bordin, 1979) • Agreement about TASK and GOAL of the therapy • Emotional BOND Four dimensions Working alliance - COLLABORATION Therapeutic alliance - BONDING Therapists empathy - ACCEPTANCE Therapeutic contract - GOAL

12. Two dimensions ofalliance • Agreement about TASK and GOAL of the therapy Rational level Emotional BOND Affective level

13. TransactionalAnalysistherapy (TA) • Stresses the Rational level Following an egopsychological tradition the TA therapist adresses the clients reality-testing, concious part (Adult) to collaborate in dealing with the unconcious irrational (affective) parts (Script-bound Child). Rational here doesn´t mean lack of feelings.

14. Defining TA as rational • Berne’s original critiqueof a traditionalpsychoanalytic approach has contributedtoeffortstoreducethe roleofspontaneous regression in therapy and thus the time it requires as well. • Thishas beenaccomplished by useofvarioustechniques and approachesthatencourageactive, consciouschoices on the part of the client. • Choices leading totreatmentgoalsexpressed in the treatmentcontract. The emphasis in the TA method has thusshifted from thatof long-term effortsinvolvingwhatareoftenunarticulated, emotional and chaotictransferencerelationships tothatofobservablepatternsofbehaviour and manifest signsofunconsciouscommunicationprocesses.

15. The TA Redecision Approach in short • Contracts (mutual agreement) • Double-chair (contractual regression) • Experential techniques (tasks, exercises) • Responsibility model (Autonomy, Change) • Short-term psychotherapy

16. Methodological Design • Individual reading and coding • Common discussion and assessments to consensus • Reliabilitytest: Two separate sessions

17. Operative Approach • Identify Relational Episodes (RE) • Code all components into tailor-made categories. • Transfer this to Standard categories. • Formulate every clients CCRT • Identify enactments (= test) • Code therapists response on the ”tests”

18. To measure the affectiveinteraction METHODS

19. How the methodsareused • Identify affective relational patterns CCRT Investigate how therapist is respondonding to clients ”pathological” beliefs (plan). Plan-diagnosis method

20. CCRT – Core Conflictual Relationship Theme Repetetive patterns in the clients narratives that often are in conflict with each other. Two classes of components RA = Response from Others RS = Response from Self

21. The Plan-diagnosismethodHypothesis Client is testing CHANGE Therapist Refutes (successful) Anxiety decreases

22. Result • Identified176 RE(Relational Episods) • Coded539 CCRT components(W,RA,RS) • Identified44 Enactments • Enactmentsthatmatched the clients CCRT(”test“) 35 • Therapistrefuted“successful”24½ tests • Therapistconfirmed“failed”10,5 tests

23. Numbersof CCRT components (W, RA & RS)

24. Total numbersofRE and Enactmentsand the numbersthat match the clientsindividual CCRT (”test”). Note. The clients individual CCRT is decided from at least one of the CCRT W, RA and RS

25. Therapistsresponseto the clients”test”

26. Qualitativedata • To give a deeperunderstandingof the affectiveinteractionour interpretation procedure is shown from twoexamples • ClientAgnetawhentherapistfails in the ”test” • ClientDanielwhentherapistsucceed in the ”test”.

27. Exampelwhentherapistfails in the ”test”. • Quotation, page 52(session 4, RE 1). • Agneta: “I feelawfullyafraid. I’mhavingheartpalpitations. Theycame from yourforcingmetodecidewhat I wantedtotakeuptoday....begin... (Therapist: Mm) It feelsalmost as thoughI’ddecidedto make a speech, that I wasforcedto do something, as thoughothersweredependent on me in someway (.) Earlier in the week, though, I thought a lotaboutwhat I couldbringup and that sort ofthing. I’d still like to, although I feelafraid...” • Therapist: “Will youonly try, or do you plan to do it?”

28. Clients(Agnetas) individual CCRT • W: To assert myself, To be helped • RA: Are controlling, Are rejecting • RS: Am not open, Somatic symptoms

29. Ourinterpretation(of the”test”between the therapist and clientAgneta) • The therapist is maintainingcontrol and is tryingtosteer. Hisresponse is at a rationallevel. Heshouldinsteadhaveacknowledgedheranxiety and fear, as well as herheartpalpitations – and thushaveresponded at an emotional level so as togiveher the possibilityofsteering on herown, and in thatwayhaveprovidedher the possibilitytooofassertingherself. • Events following the test. Agneta responds in an abrupt way, sayingshewantsto talk aboutthat later on in the therapy. Acting as thoughshe’sclenchingherteeth, shesays,...”I wasforcedto be strong just now.”

30. Exampelwhen the therapist is successfulwith the ”test” • Quotation, page 54 (session 19, RE 11) • Daniel: “Yes, butI’mwonderingwhyyou’resmilingthe wayyouare.” • Therapist: “How do youfeel?” • Daniel: “I was set back a little by the wayyousmiled. I don’tknowwhat it was, but I felt a little bit irritated at it.” • Therapist: “Yes, I smiled feeling that it wassomewhatexaggerated, and realizingthatyouwereexperiencing it thatway.” • Daniel: “That’swhat I felt, that it wasn’tcompletely as it should be.” • Therapist: “I wasbeingironic. What do youthinkofthat.” • Daniel: “Aboutbeingironic in general?” • Therapist: “No, aboutwhat I did.” (laughter) • Daniel: “No, it was okay...” (laughtergenerally and small talk) • continuingnextpicture

31. Continuing: Daniel • Daniel: “It wasdirt-cheaptoo. It didn’tcostmuchofanything. In thatconnection, I like it a lot, if it gets metostandup for what I want. I realizeverymuchthat I needto do that, and takeadvantageof the little bit I’vegottenhere, thingsaren’t neutral anymore, but I feelsomething for it all. That’sreallyimportant, as I see it. Feeling for things...” • Therapist: “I don’twanttoseemrejectingofyouto make youfeelthatway.” • Daniel: “That I understandperfectlywell. It doesn’tseemthatway at all. I sensedthat I understood the meaningof feeling for thingsgenerally.” • Therapist: “Good. How do youfeelnow?”

32. Clients(Daniels) individual CCRT W: To be open, To be understood RA: Are controlling, Are rejecting RS: Feel anxious, Feel angry

33. Ourinterpretation(of the”test”between the therapist and clientDaniel) Daniel darestoquestion the approach the therapisttakes and to test him still further, possiblybecause the therapist, in connectionwithDaniel’searliertestingofhim, repaired and thusstrengthened the alliancebetweenthem. In the caseconsideredhere, Daniel becomesupset at the therapist’ssmiling at him, makinghimfeelthathewasbeingmocked. The therapistagainrepairs the alliancethroughadmittinghehaddone it in ironicintent. The therapist is ableto show thateventhisseemingtriviality is meaningful – that Daniel daredtoopenhimselfup in connectionwith it. The repair the therapistperformsthen makes the contactbetweenthem still closerthanbefore.

34. Conclusion • In TA therapy rational aspects of alliance are emphasized. • The results of our study showed that affective dimensions of alliance played a considerably stronger role than would be expected if alliance were based on a predominance of rational considerations. • It appears that emotional aspects of the alliance between the client and the therapist represent an important factor in TA therapy. • Results of the study thus appear to be of clear clinical relevance to transactional analysis psychotherapy.

35. Clinical implications The numberof ”tests” is the same as in individualpsychodynamic short-term therapy (Stenlund, 2002) whichmeansthereare no differenceifyouemphasis a rational or an affective approach. The affective dimension ofalliance is an important part of TA therapy, evenifits not emphasised. It´s not possibletoreduce the affective elements. Maybe the rationalperspectiveonlycan be reached from an affectiveinteraction = Are the affects the primarymotivational force (Tomkins)

36. Exercise Observing a roleplayedtherapy session for 10 minutes from a scientifical ”Eagle-perspective” Using the CCRT componentsWish (W), Response from Others (RO) and Response from Self (RS) from the lecturetocode and analyze the client. Using the StandardizedCategories and Classificationtocode the CCRT of the client.

37. A Guide to the CCRT Standard Categories and TheirClassificationStandard CCRT Categories (Edition 2) (Barber, Crits-Christoph & Luborsky, 1990. In UnderstandingTransference: The CoreConflictualRelationshipThemeMethod, (pp. 45-49). New York: Basic Books.

38. Table 1, Wishes, Needs, Intentions . 1 To be understood. To be comprehended; to be empathizedwith; to be seenaccurately. • 2  To be accepted. To be approvedof; to not be judged; to be affirmed. • 3  To be respected. To be valued; to be treatedfairly; to be importanttoothers. • 4  To accept others. To be receptive toothers. • 5  To respectothers. To valueothers. • 6  To have trust. Othersto be honest; othersto be genuine; • 7  To be liked. Othersto be interested in me. • 8  To be openedupto. To be respondedto; to be talkedto. • 9  To be open. To express myself; tocommunicate. • 10  To be distant from others. To not express myself/my feelings; to be leftalone. • 11  To be closedtoothers. To be included; to not be alone; to be friends. • 12  To helpothers. To nurtureothers; togivetoothers. • 13  To be helped. To be nurtured; to be given support; to be given somethingvaluable; tobe protected. • 14  To not be hurt. To avoid pain and aggravation; toavoidrejection; toprotect/defendmyself. • 15  To be hurt. To be punished; to be treatedbadly; to be injured. • 16  To hurtothers. To get revenge; torejectothers; to express anger at others. • 17  To avoidconflict. To compromise; to not anger others; to get along; to be flexible. • 18  To opposeothers. To resistdomination; tocompeteagainstothers. • 19  To havecontrol over others. To dominate; tohavepower; tohavethings my ownway. • 20  To be controlled by others. To be submissive; to be dependent; to be passive; tobe given direction. • 21 To haveself-control. To be consistent; to be rational. • 22  To achieve. To be competent; to do well; towin. • 23  To be independent. To be self-sufficient; to be self- reliant; to be autonomous. • 24  To feelgoodaboutmyself. To be self-confident; to accept myself; tohave sense ofwell-being. • 25  To bettermyself. To improve; to get well. • 26  To be good. To do the right thing; to be perfect; to be correct. • 27  To be like other. To identifywithother; to be similartoother; tomodelafterother. • 28  To be my own person. To not conform; to be unique. • 29  To not be responsible or obligated. To be free; to not be constrained. • 30  To be stable. To be secure; tohavestructure. • 31  To feelcomfortable. To relax; to not feel bad. • 32  To feel happy. To havefun; toenjoy; tofeelgood. • 33  To be loved. To be romanticallyinvolved. • 34  To assertmyself. To compelrecognitionofone’srights. • 35  To competewithsomeone for another persons affection.

39. Table 2. Responses from Others. • 1  Areunderstanding. Areempathic; aresympathetic; seemeaccurately. • 2  Are not understanding. Are not empathic; areunsympathetic; areinconsiderate. • 3  Areaccepting. Are not rejecting; approveofme; includeme. • 4  Arerejecting. Aredisapproving; arecritical. • 5  Respectme.Treatmefairly; valueme; admireme. • 6  Don’trespectme.Don’ttreatmefairly;don’tvalueme; don’tadmireme. • 7  Don’t trust me.Don’tbelieveme; aresuspiciousofme. • 8  Are not trustworthy. Betrayme; aredeceitful; aredishonest. • 9  Like me.Areinterested in me. • 10  Dislikeme.Are not interested in me. • 11  Areopen. Are expressive; aredisclosing; areavailable. • 12  Aredistant. Areunresponsive; areunavailable. • 13  Arehelpful. Aresupportive; givetome; explain. • 14  Areunhelpful. Are not comforting; are not reassuring; are not supportive. • 15  Hurtme.Areviolent; treatmebadly; arepunishing. • 16  Arehurt. Arepained; areinjured; arewounded. • 17  Apposeme.Arecompetitive; deny/block my wishes; go againstme. • 18  Arecooperative. Areagreeable. • 19  Areoutofcontrol. Areunreliable; are not dependable; areirresponsible. • 20  Arecontrolling. Aredominating; areintimidating; are aggressive; take charge. • 21  Givemeindependence. Givemeautonomy; encourageself-direction. • 22  Aredependent. Areinfluenced by me; aresubmissive. • 23  Are independent. Areself-directive; are not conforming; areautonomous. • 24  Are strong. Aresuperior; areresponsible, areimportant. • 25  Are bad. Arewrong; areguilty; are at fault. • 26  Arestrict. Are rigid; arestern; aresevere. • 27  Areangry. Areirritable; areresentful; arefrustrated. • 28  Areanxious. Arescarred; areworried; arenervous. • 29  Are happy. Arefun; are glad; enjoy. • 30  Loves me.Is romanticallyinterested in me.

40. Table 3. Responsesof Self. • 1  Understand. Comprehend; realise; seeaccurately. • 2  Don’tunderstand. Amconfused; amsurprised; havepoorself-understanding. • 3  Feelaccepted. Feelapprovedof. • 4  Feelrespected. Feelvalued; feeladmired. • 5  Like others. Amfriendly. • 6  Dislikeothers. Hate others. • 7  Amopen. Express myself. • 8  Am not open. Aminhibited; am not expressive; amdistant. • 9  Amhelpful. Amsupportive; try topleaseothers; amgiving. • 10  Hurtothers. Amviolent; acthostile. • 11  Opposeothers. Amcompetitive; refuse/denyother; conflictwithothers. • 12  Amcontrolling. Amdominating; aminfluential; manipulateothers; amassertive; am aggressive. • 13  Amoutofcontrol. Amirresponsible; am impulsive; amunreliable. • 14  Amself-controlled. Amresponsible. • 15  Am independent. Make my owndecisions; amself-directive; amautonomous. • 16  Amdependent. Amsubmissive; am passive. • 17  Amhelpless. Amincompetent; aminadequate. • 18  Feelself-confident. Am or feelsuccessful; feelproud; feelself-assured. • 19  Amuncertain. Feel torn; am ambivalent; feelconflicted. • 20  Feeldisappointed. Am not satisfied; feeldispleased; feelunfulfilled. • 21  Feelangry. Feelresentful; feelirritated; feelfrustrated. • 22  Feeldepressed. Feelhopeless; feelsad; feel bad. • 23  Feelunloved. Feelalone; feelrejected. • 24  Feeljealous. Feelenvious. • 25  Feelguilty. Blamemyself; feelwrong; feel at fault. • 26  Feelashamed. Amembarrassed; feelabashed. • 27  Feelanxious. Feelscarred; feelworried; feelnervous. • 28  Feelcomfortable. Feelsafe; am or feelsatisfied; feelsecure. • 29  Feel happy. Feelexcited; feelgood; feeljoy; feelelated. • 30  Feelloved. • 31  Somatic symptoms. Headache; rash; pain.