Institute for Integrative Psychotherapy

Integrative Psychotherapy Articles

 Introjection, Psychic Presence
and Parent Ego States:

Considerations for Psychotherapy

Richard G. Erskine, Ph.D.
Institute for Integrative Psychotherapy
& University of Derby, U.K.

In a memorial tribute to Eric Berne, Franklin Ernst (1971) declared that Berne’s most significant contribution to the profession of psychotherapy was in identifying Parent ego states and differentiating them from Adult or Child ego states.  This significant differentiation provides a theoretical framework for clinical Transactional Analysis that suggests a psychotherapeutic focus that may relieve many manifestations of anxiety, depression, and low self-esteem stemming from intrapsychic conflict.  Yet, most of the clinical Transactional Analysis literature has either focused on freeing the Child ego states from a compulsion to adapt, strengthening Adult ego state control, replacing a lethal introjected message with a benevolent introjected message or making behavioral changes that facilitate Adult to Adult “ego state” transactions.  A few articles or books have emphasized an in-depth psychotherapy of Child ego states.  Very little has been written on the treatment of Parent ego states and the resolution of intrapsychic conflict.  The purpose of this chapter is to clarify and elucidate the intrapsychic functions of Parent ego states and to outline methods of an in-depth, integrative transactional analysis psychotherapy of introjected Parent ego states.  The chapter that follows, “Resolving Intrapsychic Conflict: Psychotherapy of Parent Ego States”, is co-authored with Rebecca Trautmann; it includes a verbatim transcript of an actual psychotherapy session along with my annotated comments about the process of the psychotherapy.

Prior to Berne’s writings on ego states (1957, 1961) previous psychoanalytic writers had identified the distinction between adult-like and child-like “personalities”, “conditions”, or “states” and had developed the analytic methods of free association, non-gratification and interpretation as a means of both providing understanding and alleviating internal distress.  Much has been written on the psychological effects of “parental influence” or Superego, however, the psychoanalytic literature lacks in an adequate description of the treatment of the Superego whether it is called internalized object, parental influence, anti-libidinal ego, introjected other or unconscious fantasy.

In 1895, Josef Breuer and Sigmund Freud wrote in Studies in Hysteria about Anna O’s “two entirely separate states of consciousness”, which alternated frequently and spontaneously – one relatively normal and a keen observer, the other was child-like and naughty.  In the case they presented about Emmy von N., Breuer and Freud described how she alternated “states of consciousness” between describing her primal experiences and making comments to Freud about how he was conducting the analysis (1950).

In Ego Psychology and the Psychosis, Paul Federn (1953) observed that his patients exhibited a current ego that both identifies with internal sensations and at the same time, identifies with or discriminates from environmental stimuli.  In addition, this ego manifests a feeling of identity and a response to the environment which is like that of a young child.  He described these different manifestations as subdivisions or states of the ego, i.e., different identities.  In addition, he referred to the internalization of parental figures in his patients as “acquired ego attitudes” and related this constant psychic presence to the psychoanalytic concept of the superego.  Federn’s views on the ego and states of the ego significantly differed from those of other ego psychologists within the psychoanalytic movement, such as Hartmann (1939, 1964), Kris (1951, 1979), and Rapaport (1967).  Although using somewhat different terminology, Federn influenced the theories of Guntrip (1961), Berne (1957, 1961), Jacobson (1964), Kernberg (1976), Kohut (1977), Watkins (1978), and Winnicott (1965).

John Watkins, like Eric Berne, also studied with Federn but developed his ideas of ego states without an awareness that Berne was developing similar concepts.  John and Helen Watkins’ book, Ego States: Theory and Therapy (Watkins & Watkins, 1997) defines an ego state as “an organized system of behavior and experience whose elements are bound together by some common principle, and which is separated from other such states by a boundary that is more or less permeable” (pp. 25).  They describe both a “core ego” as that which the person and others perceive as “self” and “other ego states” as “segments of self” that are “differentiated for adoptive purposes”.  These consist of either “introjects of significant others” or ego states “split off from the core ego because of trauma” (pp. 26).

In An Outline of Psychoanalysis, Freud described the development of the Superego as occurring in the long period of childhood, during which the growing human being lives in dependence upon his parents.  This dependency forms within the child’s ego a special agency in which this parental influence is prolonged.  The parents’ influence includes not merely the personalities of the parents themselves but also the racial, national, and family traditions handed on through them (1949).  In essence, because of the child’s dependency, internalized elements of the parents’ personality influence the ego (the person’s sense of “me”) and cause the person to psychologically function differently and under stress.

In the development of psychoanalytic object-relations theory Fairbairn (1954) and Guntrip (1961, 1968) dispensed with Freud’s concept of Superego.  Instead they theorized that in the presence of fear a child may split off parts of him or herself and form an ego state that is a combination of an internalized parental control and a child’s fearful compliance with that control.  They termed this state the “anti-libidinal ego” to emphasize how it suppresses and controls the “libidinal ego” – an ego state that has the remnants of what would have been the natural nature of the person.  They describe this conflict as occurring interpsychicallyfor the purpose of maintaining a semblance of relationship by keeping the natural nature of the person suppressed.  Their “central ego” is the state which functions in the external world and may serve as a cover for intrapsychic conflict.

Edoardo Weiss prefers the term internalization since to him it refers to an “inclusion within the ego” of an identification with aspects of the others personality (1950, pp. 76).  “Internalization is complete when it substitutes, within one’s own ego, the bodily and mental aspects of a person.  This substitution may be an autoplastic egotized duplication or only the egotized imagination of the physical and mental features of another personality” (1950, pp. 95).  In 1912, “Ferenczi introduced the term introjection, as a synonym for “incorporation” to indicate the egotization of the autoplastic duplication of the object” (Weiss, pp. 76).  Weiss does not like the term “introjection” because in his way of thinking it does not adequately describe how the person is both changed by the other and how the internalization is also not exactly the same as the other.

In Gestalt Therapy the concept of psychological introjection - the internalization of elements of another person - is central to understanding the core theory of the need for internal and external contact.  Introjection is defined as an unconscious defensive identification with another.  The maintenance of an introjection prohibits full contact with both self and others (Perls, Hefferline & Goodman, 1951).

The concept of the Parent ego state may indeed be Berne’s great innovative gift to our profession.  In 1957 Berne quoted Freud’s description of Superego and added that both Superego and Parent imply that a portion of the external world has become an integral part of the internal world, hence both are in origin exteropsychic.  Berne often uses the term exteropsyche interchangeably with Parent ego states.  Berne states that the idea of an exteropsyche has interesting neurological connotations but he does not say what they are (Berne, 1957).  Forthcoming research in neurobiology may map the basic circuits and identify the brain’s defensive identifications with others, or their psychic presence, and perhaps even identify second and third levels of exteropsychic material. 

Berne (1961, chapter 16) described theoretically the second and third order of the Child and Parent ego states.  He referred to the second and third order Parent ego states as containing “genealogical material”.  It is my opinion that this influencing material can be brought to the client’s awareness through a respectful and attuned therapeutic relationship and a phenomenological inquiry that facilitates the client’s discovering their experiences, fantasies, ideas and meaning making about their present lives.  This is accomplished through an analysis of the transference and is often the prerequisite to an in-depth theory of a Parent ego state.  Berne’s “particular interest” in working with characterological problems was in “the persistent stringency” of a Parent ego state, specifically “the Child segments of the Parent and the Adult parts of the Child” (1961, pp. 196-197).

The Latin origins imply that the word introjection means “thrown inside”.  However neither the Latin nor the Greek “exteropsyche” – outside the sole or mind – explain how it happens.  In Integrative Psychotherapy (Erskine and Moursund, 1988; Erskine, Moursund and Trautmann, 1999) the following definition is used as an operational definition based on child development literature and clinical observations: Introjection occurs in the absence of relational needs being met; it is a defensive unaware identification with elements of the personality of the other as compensation for unmet relational needs.  All introjections, because of their defensive nature, are dysfunctional in meeting today’s relational needs, even though the content may sometimes be nurturing or effective.  When external behavior or interpsychic influence is the result of introjection, it is the manifestation of a defensive internalization of a foreign object and is an impediment to full internal and external contact  (Gobes & Erskine, 1995).

Eric Berne (1961) extended psychoanalytic thought with his elaboration and application of Paul Federn’s (1953) concept of states of the ego.  Berne’s contribution to the theory of ego states produced the possibility for a dramatic change in the practice of psychotherapy and predated by several years the more recent changes in psychoanalytic theory and practice (Bollas, 1979; Greenberg & Mitchell, 1983; Guntrip, 1968; Kernberg, 1976; Kohut, 1971, 1977; Masterson, 1976, 1981; Miller, 1981; Stolorow, Brandchaft & Atwood, 1987).

In the popularization of transactional analysis that has occurred since Berne’s death in 1970, many of his original theoretical concepts have been presented simplistically.  Often, Berne’s examples and explanations have been used as definitions of ego states and the therapeutic richness and depth of his original concept of ego states has been overlooked.

In this chapter, we will begin by returning to Berne’s original conceptualization of ego states as the theoretical base for the psychotherapy of the contact-interrupting, defensive process of introjection and the resolution of the resulting intrapsychic distress.

 

The Ego and States of the Ego

In Ego Psychology and the Psychoses, Paul Federn (1953) described the ego as a real, experienced state of feeling and not simply a theoretical construct.  The Latin word “ego,” as used in the English translation of early psychoanalytic writings, replaced Freud’s “Das Ich” – “the I.”  The ego is the identifying and alienating aspect of the self; it is our sense of “This is me” and “That is not me.”  The ego discriminates and segregates internal sensations from those originating outside the organism.  The ego is our identity – the “I am hungry,” “I am a psychotherapist,” or “I am not a bus driver, although I can drive a bus.”

Berne assumed throughout his early writing (pre-1966) that the reader was familiar with a working definition of ego; he described a state of the ego “phenomenologically as a coherent system of feelings related to a given subject, and operationally as a set of coherent behavior patterns” (Berne, 1961, pp. 17).

Berne further used a colloquial description of ego states (Parent, Adult, and Child) to refer to phenomenological manifestations of the psychic organs (exteropsyche, neopsyche, and archaeopsyche), whose function it is to organize internal and external stimuli.  Exteropsyche, archaeopsyche, and neopsyche refer to the aspect of the mind taken from an external source, the early mind from a previous developmental period, and the current mind.  Throughout Transactional Analysis in Psychotherapy (1961) Berne used the psychic organ terms interchangeably with the term “ego state” to “denote states of mind and their related patterns of behavior” (pp.30).

Berne (1961) stated, “The Adult ego state is characterized by an autonomous set of feelings, attitudes and behavior patterns which are adapted to the current reality” (pp.76).  In this description Berne’s use of the term “autonomous” refers to the neopsychic ego functioning without intrapsychic control by an introjected or archaic ego state.  When in the Adult ego a person is in full contact with what is occurring in a manner appropriate to that developmental age.  This neopsychic (current mind) function of the ego accounts for and integrates: 1) what is occurring moment-by-moment internally and externally, 2) past experiences and their resulting effects, and 3) the psychological influences and identifications with other significant people in one’s life.  This Adult ego consists of current age-related motor behavior; emotional, cognitive and moral development; the ability to be creative, and the capacity for full contactful engagement in meaningful relationships.  Berne (1961, pp. 195) emphasized these aspects through the use of the Greek terms Ethos and Pathos – to which I add Logos, the ability to use logic and abstract reasoning, and Technos, the ability to create – to describe the full neopsychic capacity of the Adult ego to integrate values, process information, respond to emotions and sensations, and be creative and contactful (Erskine, 1988).

The term “Adult ego” is used in Integrative Transactional Analysis theory rather than the more popular “Adult ego state” to denote that it is not a state of the ego but symbolizes the full neopsychic capacities of an individual without the intrapsychic control of introjected parent or archaic child ego states.  Parent and child ego states are non-integrated fixations of unresolved previous experiences that drain psychic energy and distract an individual from spontaneity and flexibility in problem solving, health maintenance or intimate relationships with people.  Through corrective life experiences or an effective healing psychotherapy Child and Parent ego states can be fully integrated into the adult’s ego.  With integration the past experiences of childhood and the introjected experiences of significant others are now in one’s awareness, are de-energized as separate entities, and no longer serve their defensive functions. They can now function like a valuable resource library rather than as separate states of the ego that influence, control, and produce intrapsychic conflict.

The neopsychic ego was contrasted by Berne with archaic ego states which consist of fixations at earlier developmental stages.  In Berne’s (1961) words, “The Child ego state is a set of feelings, attitudes, and behavior patterns which are relics of the individual’s own childhood” (pp.77).  When in a Child ego state the person perceives the external world and internal needs and sensations as he or she did in an earlier developmental stage.  Although the person may appear to be relating to current reality, he or she is actually experiencing what is happening with the intellectual, social, and emotional capacities of a child at the developmental age of unresolved neglect, trauma, or confusion, i.e., a psychological fixation.

It should be noted that using the term Child ego state in the singular form is somewhat misleading.  A child develops through a number of phases and stages (Erikson, 1950; Mahler, 1968; Mahler, Pine & Bergman, 1975; Piaget, 1936/1952; Stern, 1985), and repression and fixation may occur at any of them.  Under the influence of one set of stressors, we may think, feel, and act much as we did when we were six years old; under another we may perceive ourselves or the world around us as we did as infants.

The archaeopsychic state of the ego is much more complex than implied by various writers who use simple examples of spontaneity, intuition, compliance, or emotive capacity to describe the Child ego states.  The Child or archaic states of the ego are the entire personality of a person as he was in a previous developmental period of time.  This includes the needs, desires, urges, and sensations; the defense mechanisms; and the thought processes, perceptions, feelings, and behaviors of the developmental phase where fixation occurred.

The archaic state of the ego is the result of developmental arrest which occurred when critical early childhood needs for contact were not met.  The child’s defenses against the discomfort of the unmet needs became egotized – fixated; the experience cannot be fully integrated into the Adult ego until these defense mechanisms are dissolved.

Berne (1961) also explored Federn’s observations that in many of his clients there was a constant psychic presence of parental figures influencing their behavior.  This parental influence is from real people who years before interacted with and had responsibility for this particular individual when he or she was a child.  This parental presence is more tangible than the Freudian construct of “superego” (“Uber-Ich”).  Through historical investigation it is possible to trace what was actually said or done, by whom, and at what time during the person’s childhood.  Through introjection (an unaware defensive identification and internalization) the child made the parental person part of the self, i.e., ego.

Berne (1961) concluded that the introjected parents also became a state of the ego which he defined as “a set of feelings, attitudes, and behavior patterns which resemble those of a parental figure” (pp. 75).  However, the phrase “resemble those of a parental figure” is somewhat misleading.  From Berne’s examples and descriptions in Transactional Analysis in Psychotherapy (1961) and from my own clinical observations it is apparent that Parent ego states are an actual historical internalization of the personality of one’s own parents or other significant parental figures as perceived by the child at the time of introjection.  Berne emphasized this point:

“The patient whose (mother) parent habitually or at a given moment is not acting as though her mother “observes, orders, corrects, and threatens,” but instead is acting just like how mother did, perhaps even with the same gestures and intonations.  She is not acting with one eye on her Mother, so to speak [which is likely to be Child ego state]; she is reproducing her mother’s total behavior, including her inhibitions, her reasoning, and (this is a crucial factor) her impulses” (1957, pp. 300).

 

Parent ego state contents are taken in, i.e., introjected, from parenting figures in early childhood – and, to a lesser degree, throughout life – and, if not reexamined in the process of later development, remain unassimilated or not integrated into the neo-functioning ego of an adult.  Since the child’s perceptions of the caretaker’s reactions, emotions, and thought processes will differ at various stages of development, so also will the actual content and intrapsychic function of the Parent ego state vary in relation to the developmental age when the introjection occurred.

Introjection is an unconscious defense mechanism (involving disavowal, denial, and repression) frequently used when there is a lack of full psychological contact between the child and the caretakers responsible for his or her psychological needs.  The significant other is made part of the self (ego), and the conflict resulting from the lack of need fulfillment is internalized so the conflict can seemingly be managed more easily (Perls, 1978).

In addition to the various physical needs of childhood (Maslow, 1970), a child’s relational-needs require the attuned involvement of parents or significant others. (Erskine, 1998; Erskine, Moursund & Trautmann, 1999). These relational needs include: 

1) security within a relationship – a physical closeness and the freedom from humiliation and physical violence;

2) validation of the child’s feelings, thoughts, fantasies and various needs;

3) being in the presence of someone on whom the child can rely for protection, support and guidance;

4)  having a shared experience such as playing and learning together;

5) self definition within the relationship;

6) making an impact – influencing the other, at least some of the time to respond in accordance with the child’s wishes;

7) or desires and respond accordingly; and

8) the expression of gratitude and love to the caretaker – the manifestation of bonding and loyalty.

When these relational-needs are not acknowledged, validated and normalized by significant others there is a rupture in interpersonal contact – the bond between child and caretaker is disrupted and a conflict ensues between the caretaker’s mis-attunement, invalidation, emotional neglect, or physical abuse and the child’s desperate attempts to have his or her relational-needs satisfied.

As a biological imperative children require both a physical and psychological attachment to maintain psychological health (Bowlby, 1969, 1973, 1980). When needs are not met the resulting anxiety stimulates an unconscious defensive identification with the other. The external conflict is solved by internalizing the other and disavowing one’s own needs, thereby the child can stay attached, bonded and loyal.  This is often accompanied by a sense of resignation and  the formation of a compensating script belief such as “If I can’t get my needs met then I don’t need”  the external conflict of relational-needs not met becomes internal where it is handled within the individual rather than continue the external relational conflict.  Metaphorically, the conflict of needs-not-met is as though there was a psychological vacuum in the relationship.  That psychological vacuum – the absence of interpersonal contact – is filled by unconsciously identifying with the significant other.

Brown says, “Introjection allows a person to avoid her painful feelings associated with the loss of a person, place, or event by creating within herself an image of the lost object. Her unconscious fantasies maintain her association with the lost object and prevent her from working through the painful emotions connected to the loss” (1977, p.5).

Introjected elements may remain as a kind of foreign body within the personality, often unaffected by later learning or development but continuing to influence behavior and perceptions.  They constitute an alien chunk of personality, embedded within the ego and experienced phenomenologically as if they were one’s own, but, in reality, they form a borrowed personality (Erskine, 1988, 1997).

 

Ego State Determinants

Berne said, “Transactional Analysis consists of determining which ego state is active at a given moment in the exhibition of a transactional stimulus by the agent, and which ego state is active in the response given by the respondent” (1966, pp. 223).  Verification of which ego state is cathected is only possible with a four-part correlation of the behavioral, social, historical, and phenomenological determinants of ego states.  “The complete diagnosis of an ego state requires that all four of these aspects be available for consideration, and the final validity of such a diagnosis is not established until all four have been correlated” (italics mine), (Berne, 1961, pp.75).

Berne (1961, pp. 74-76) described the four diagnostic determinants of ego states in the order he saw them in psychotherapy: behavioral, social, historical, and phenomenological.  From a perspective of facilitating an integration of the fragmentation of the ego, I have supplementally defined the identifying criteria and listed them in the following order of clinical significance (Erskine & Moursund, 1988/1998):

1.      The identifying criterion of the phenomenological determinant is the subjective experience of the person.  It includes the sensations, desires and needs, feelings, and beliefs that shape the person’s perspectives – the how and what it is like to live in his or her experience.  Included in the phenomenological criteria are the physiological, emotional, and cognitive associations of significant life events and the times when elements of the personality of another were introjected.  Also included is the subjective experience of the internal defense mechanisms fixated at times of neglect, traumatic experience, or cumulative devaluation.

2.      The historical determinant is gleaned primarily from memories of the dynamic events between oneself and others, or the relationship between mother and father or other important family members.  These can provide essential information regarding early conflicts.  The who and when of early life may reveal memories of similar feelings and behavior in childhood or memories of the parental person who offered the prototype behavior.  Included is an inquiry into the distinction between the person’s own fixated childhood defenses and the defense mechanisms possibly introjected from significant others.

3.      The behavioral determinant involves a developmental focus (Berne, 1961, pp. 154) on gestures, posture, vocabulary, tone of voice, or other mannerisms, and the content of what is communicated.  The assessment of the person’s current observable behavior is compared with information about human development regarding early mother-child interaction; motor and language development; emotional, cognitive, and social development; defense mechanisms; moral development, and adult life transitions.  All of this comparative information provides a background of data to assist in determining the stage of development at which emotions, behaviors, or interactions have become fixated.  Behavior that is not congruent with the current context may have been normal and appropriate for a child at a specific developmental age or may be an indication of how the patient defended himself or herself in a traumatic situation.

Childlike behavior may be an indication of the person’s own active Child ego state, or just as likely, an indication of the Child ego state of an introjected parent.  Interweaving the developmental assessment with the historical or phenomenological may be necessary to determine if a specific defensive reaction, behavioral pattern, or emotion is the manifestation of an exteropsychic ego state or of an archaeopsychic fixation.

4.      The fourth determinant in verifying ego state cathexis is the social or transactional.   The analysis of transactions provides data to indicate which ego state is active, the nature of the intrapsychic dynamics, and what stimulus from the psychotherapist served to trigger the cathexis.  The intrapsychic dynamics include the influence of the introjected Parent ego state and Child ego state’s need for a contactful relationship.  Transactions between the person and psychotherapist, or, in group or family psychotherapy, between any two people, may reflect a transference either from an exteropsychic or archaeopsychic ego state.  These transferences may take the form of “roles” such as child-like “compliance,” “impertinence,” or “rebelliousness”; adult-like roles of “problem solver” or information exchange, or parental roles of “comforting” or “controlling” (Berne, 1961, pp. 93-96).  It is essential in diagnosing ego state cathexis and intrapsychic conflict to evaluate these transactional roles or social entities within the context of a correlated phenomenological, historical, and developmental (behavioral) assessment.  It is only through the careful and systematic use of the four-part correlated diagnosis that it is possible to verify which ego states are influencing and which are cathected and proceed with the appropriate psychotherapeutic interventions (Erskine, 1991/1997).

 

The Functions of Influencing and Active Parent Ego States

            An introjected Parent ego state may be either active or intrapsychically influencing.  An active Parent ego state communicates with the outside world while an influencing parent ego state operates internally.  Berne (1961) described the active Parent ego state as reproducing the feelings, attitudes, and behavior of the introjected parent or other significant persons in actual transactions with people.  The psychological function of an active Parent ego state is that the person diminishes anxiety and experiences some interpsychic relief from the internal influence of the introjection.  For example, a mother may scream at and criticize her children in the same way her father screamed at and criticized her when she was young.  She is able to feel some temporary relief from the pressure and anxiety of father’s psychic presence and internal criticism by externalizing the verbal abuse.  Others in her life, such as her children, may suffer the effects of the rage and criticism that is an expression of an active Parent ego state.  She most likely remains unaware that the quality of her contact both with self and others is under the dominance and control of a Parent ego state.  Clients seldom describe this externalization as a problem except to report their discomfort regarding what others say about their behavior.  Family members may complain how “mother acts just like or even worse than grandfather.”

            In psychotherapy, it is much more typical that the client will describe the phenomenological experience of self-doubt, a constant sense of being controlled, the loss of knowing what one desires, and/or chronic anxiety, and/or depression.  The phenomenological experience of some clients is as if they were criticizing themselves or under an internal control.  Other clients may be aware of the presence of an influencing introjection or psychic presence of another person; they hear another voice that is criticizing, warning, or rule-making.  Berne referred to the influencing Parent ego state as “the voice of an actual person” that the client may misidentify as a hallucination (1961, pp.32).

            “The Parental influence can be inferred when the individual manifests an attitude of child-like compliance” (Berne, 1961, pp. 76) and/or may make use of childhood defenses such as avoidance, freezing, or fighting (Fraiberg, 1982/1983); ego splitting (Fairbairn, 1954); transformation of affect and reversal of aggression (Fraiberg, 1982/1983), and archaic fantasy (Erskine, 1988/1997, Erskine & Moursund, 1988/1998).  The “child-like compliance” resulting from parental influence may be evidenced in the reactions of shame:

·        a sadness at not being accepted as one is with one’s own urges, desires, needs, feelings, and behaviors;

the fear of abandonment because of who one is;

·        a diminished self-concept, a lowering of one’s self-worth in compliance with introjected criticism, and

·        a sense of “something’s wrong with me”.

Shame is often an internal expression of an intrapsychic conflict between a reactive Child ego state and an influencing Parent ego state (Erskine, 1994/1997).  When a Child ego state is either active or internally cathected (either behaviorally observable or subjectively reportable), by theoretical inference a Parent ego state is cathected and intrapsychically influencing.  Berne (1961) described the intrapsychic dynamics of ego states as representing “the relics of the infant who once actually existed, in a struggle with the relics of the parents who once actually existed” for it “reduplicates the actual childhood fights for survival between real people, or at least that is the way the patient experiences it” (pp. 66).

The intrapsychic conflict emerges from a child’s need for relationship (Fairbairn, 1954), attachment (Bowlby, 1969), or contact (Erskine, 1989/1997).  When those needs are repeatedly not satisfied, a child may defend against full awareness of contact, attachment, and relationship needs and the resulting psychological discomfort.  These needs are evident in a Child ego state’s psychological loyalty to an intrapsychically influencing Parent ego state (Erskine, 1988/1997, 1991/1997).  The loyalty is in the defensive avoidance of the realization “My psychological needs were unmet” or in the unconscious fantasy “If I’m good enough, I’ll be accepted and loved” (Stolorow & Atwood, 1989).   The interpsychic functions of forming Parent ego states is to lessen the external conflict and have a semblance of relationship – at least an illusion of being accepted and loved – but the price of the internalization of the conflict is a loss of valuable aspects of self – a loss of spontaneity, flexibility and intimacy.  The psychic presence or Parent ego state is maintained over the years because, like script beliefs and obsessions, the intrapsychic conflict functions to provide a sense of predictability, identity, continuity, and emotional stability (Erskine, 2001).

 

            Theory into Practice

Berne stated that “the ultimate aim of transactional analysis is structural readjustment and reorganization...  Reorganization generally features reclamation of the Child, with emendation or replacement of the Parent.  Following this dynamic phase of reorganization, there is a secondary analytic phase which is an attempt to deconfuse the Child” (1961, pp. 224).  Most of Berne’s descriptions of psychotherapy emphasize his first phase, the decontamination of the Adult ego from Child or Parent ego states.  Berne (1966) defined eight therapeutic operations; six are interventions used to facilitate decontamination and strengthen ego boundaries – the structural readjustment of phase one.  Only one therapeutic operation, psychoanalytic interpretation, is used to “decode and detoxify” the Child ego states’ past experiences, “rectify distortions, and help the patient regroup the experiences” (Berne, 1966, pp. 242-243).

It is primarily through his clinical examples that one can infer Berne’s use of a second analytic phase, a therapeutic deconfusion of the Child ego states.  In the chapter on “Regression Analysis” Berne rather poetically says, “when a previously buried archaic ego state is revived in its full vividness in the waking state, it is then permanently at the disposal of the patient and therapist for detailed examination.  Not only do ‘abreaction’ and ‘working through’ take place, but the ego state can be treated like an actual child.  It can be nurtured carefully, even tenderly, until it unfolds like a flower, revealing all the complexities of its internal structure” (1961, pp. 226).  The reader is left to assume that Berne is applying psychoanalytic methods in this “secondary analytic phase”.  Yet he also experimented with and encouraged an active psychotherapy: “The optimal situation for the readjustment and reintegration of the total personality requires an emotional statement from the Child in the presence of the Adult and Parent” (1961, pp. 224).  Other Transactional Analysis writers have developed or described active treatment methods effective in deconfusing child ego states (Goulding & Goulding, 1979; Clark, 1991; Clarkson & Fish, 1988; Cornell & Olio, 1992; Erskine, 1974/1997, 1993/1997; Erskine & Moursund, 1988/1998, Erskine, Moursund & Trautmann, 1999; Hargaden & Sills, 2001). 

In all of Berne’s writing he says surprisingly little about therapeutic methods.  He does not adequately describe a course of treatment for the Parent ego states.  He writes about an “emendation” – an alteration designed to correct or improve – “or replacement of the Parent” (Berne, 1961, pp. 224).  But, no guidelines for an in-depth and integrating treatment are suggested.  It is as if Berne, like many in both the psychoanalytic and Gestalt therapy traditions, did not know what to do with the pain, fear, anger, and defensive strategies of an influencing Parent ego state and the intrapsychicpressure and distress it causes in the client.  He primarily follows the psychoanalytic tradition of identifying the interpsychic influence and then goes a bit further with therapeutic operations such as confrontation and explanation aimed at decontaminating the Adult ego.  He also suggests the use of a therapeutic interposition such as illustration or confrontation, “an attempt by the therapist to interpose something between the patient’s Adult and his other ego states in order to stabilize his Adult and make it more difficult for him to slide into Parent or Child activity” (Berne, 1966, pp. 237).  In Berne’s writings the theory of Parent ego states is not sufficiently related to or correlated with therapeutic methods that decommission the influence of an introjection.

For Transactional Analysis to be a comprehensive theory of personality and methods, it is essential to integrate the theories of personality with a theory of methods: The development of an in-depth therapy of Parent ego states would be one example of the further refinement in the congruence of methods and theory in Transactional Analysis.  To this end I would like to propose an addition to the quotation from Berne used earlier about “the ultimate aim of Transactional Analysis”: following, or in some cases concurrent with, a deconfusion of the Child ego states there may be an additional psychotherapeutic phase which decommissions a Parent ego state for the purpose of eliminating its toxic influencing effect on Child ego states and eventually integrating it into the Adult ego as a memory and historical resource.

The decommissioning of a Parent ego state may be described by paraphrasing Berne’s (1961, pp.226) poetic comment on the treatment of Child ego states: when a previously introjected exteropsychic ego state is revived in its full vividness and made conscious, it is then available to the client’s full awareness and to the therapist for either an in-depth therapy of the Parent ego state or at least an effective introposition.  The Parent ego state can be treated like an actual client – even a client in regression.  It can be nurtured carefully, or confronted or guided in how to adequately parent in accordance with his or her actual child’s needs.  This is one aspect of a comprehensive theory of methods (Erskine, 1997/1998) for an active, in-depth psychotherapy “for the readjustment and reintegration of the total personality” (Berne, 1961, pp. 224).

I think that the “replacement of the Parent”, as Berne (1961, pp. 224) phrased it, with another introjection is not therapeutic.  This would be akin to replacing one toxic introjection with another somewhat more benign introjection – but it is still a contact interrupting introjection.  Rather, I would like to augment Berne’s (1961, pp. 224) previous statement about an in-depth psychotherapy of Child ego states: “the optimal situation for readjustment and reintegration of the total personality requires” in addition to “the emotional statement from the Child in the presence of the Adult and Parent,” an emotional statement from a Parent ego state that either apologizes to or deconfuses Child ego states.  This allows egotized and fixated identifications – introjections – to be externalized, decommissioned, and integrated into an Adult ego.  An in-depth psychotherapy for “reintegration” of the total personality includes relaxing the Child ego states’ defenses, allowing the natural inclination of the client to be expressed, decommissioning the introjections, resolving the intrapsychic conflicts, and facilitating an awareness and integration in the client of his other need-fulfilling experience with parents.

I have been using parents in this text, but the reader is to be aware that parents may not be the only ones introjected; teachers, clergy, aunts, uncles, grandparents, older siblings, any one in authority, even other teenagers, may be introjected in the absence of need-fulfilling contact.   The chapter, “Robert: Challenging a Cultural Script” in Integrative Psychotherapy in Action  (Erskine & Moursund, 1988/1998) is a detailed example of a psychotherapy for an introjection of a culturally imposed value.

 

Experiential and Written Background

            In 1974, I was conducting a weekend therapy marathon with another therapist.  He informed me that one of the women in the group was severely depressed and she was convinced that she was possessed by the devil.  Halfway through the evening the woman began to snarl and growl at me and then in a harsh low voice threatened to kill “her”.  At first both group members and I were shocked!  I then remembered hearing a similar voice before at a Pentecostal religious-healing service I attended as a child on the Southside of Chicago.  One of the evangelists was well known for “casting out devils”.  I had watched with child-like awe as a person was brought in restraints, snarling, growling, threatening. The evangelist “called out the devil” and proceeded to “pray over him”.

The memory of the healing-evangelist’s active encounter with the “devil” person was swirling in my mind.  At the same time, I was also thinking about how to make sense of the client’s bizarre behavior.  I wondered if this “devil” person was a manifestation of the Gestalt therapy concept of introjection and Berne’s concept of Parent ego states as representing the personality of another.  I began to talk to the “devil” voice.  He continued to curse at me, repeatedly threatened to kill me or “her”, hissed, growled, and raged.  He refused to talk to a “crazy therapist”.  I continued to talk to “him”, inquiring about his message and purpose.

During the next half hour, the voice gradually became that of an angry, drunken man – a man with a secret.  He had threatened to kill his daughter if she ever revealed the incestuous rape and choking he had inflicted on her.  After about two hours of a combination of both empathetic and confrontative therapy the “father” began to apologize to his “daughter”.  Subsequently, that confession and apology stimulated in the women client, over the next few months, several memories that had previously been repressed.  The active therapy directly with a Parent ego state opened the door for the client to do some intense regressive therapy both in individual sessions and subsequent weekend marathons.  The Child ego state regressions were accompanied by the slower, ongoing work at resolving her experiences of distrust and a lack of protection as it emerged both in the transferential transactions and the absence of interpersonally contactful transactions.

This serendipitous therapy experience with the “devil” who was a manifestation of the psychic presence of her father opened a whole new perspective for me in doing psychotherapy.  I no longer saw a Parent ego state only as a depository of injunctions.  Nor could I any longer see the resolution of serious intrapsychicconflict as occurring in a 20 or 30 minute two-chair dialogue alternating between the client’s Child and Parent ego states.  Rather, I became increasingly aware of the possible complexity of psychic presence or introjections to include not only the attitudes and thoughts of significant others, but also their emotions, defensive processes, physiological reactions, age regression, and relational needs.  This can all be internalized by a child through an unconscious defensive identification when there is an absence of need-fulfilling contact, and the child’s dependency is such that the other is introjected as a way to have a semblance of relationship.

The Transactional Analysis literature provides a few theoretical articles on Parent ego state problems, but there is not much written about an in-depth therapy.  Bill Holloway described theoretically the “crazy child in the Parent” and related the harshness, frequency, and consistency of the parent’s “craziness” to the formation of hamartic life scripts (1972, pp. 128).  In 1976, John McNeel published “The Parent Interview” which described a two-chair therapy with a Parent ego state wherein the therapist elicits feelings and experiences of a Parent ego state in response to requests made by a son or daughter.  “In this way, the therapist demonstrates to the client how his wants or behavior were once threatening to the parental figure.  This investigation is based on the belief that the original parent did not act with malice” (pp. 66).  McNeel designed the Parent Interview to be part of the final stage of psychotherapy, where the individual becomes aware of the internal conflicts of the internalized Parent and, through understanding him or her, achieves some level of forgiveness and acceptance of that person.  McNeel warned that if the client’s introjected other was “crazy” then the therapist should not engage in a parent interview.

Dashiell (1978) also described therapy with a Parent ego state.  She wrote about “minimal resolution” wherein the therapist provides permission or reparenting to a Parent ego state that allows for an introjection to be disconnected.  Such interventions free Child ego states for further therapy.  “Maximum resolution” included working with a Parent ego state to resolve archaic events in the parent’s life, the release of stored feelings in the Parent ego state, or challenging the crazy or hostile Parent ego states while not abandoning the client’s Child ego states.  Concurrently, (1978/1997) I wrote a theoretical synopsis about the necessity of doing Parent ego states therapy in which I describe the “Fourth Degree Impasse” as representing the confusion within the client between the feeling introjected and forming a Parent ego state and the person’s own feelings in a Child ego state.

Mellor and Andrewartha (1980) expanded on working with the emotions in a Parent ego state and gave several short examples.  Their focus, like Dashiell’s, was also on reparenting – providing a new program for a Parent ego state.  They also advocate making direct interventions with the internalized parent: confronting, supporting, and giving permission as necessary, to facilitate a redecision being made by the client.  This was seen by Mellor and Andrewartha as especially important when a Parent ego state was experienced as having the power to sabotage or exert a harmful influence on the individual who was about to change his or her life decisions, usually decisions which maintained the family system or protected the parent.  Unlike McNeel who warns against working with a “crazy” Parent ego state they suggest that the technique works well when the Parent ego state is “disoriented, confused, and/or ‘crazy’ … the ‘craziness’ goes when the needs, feelings and wants stimulating apparently incoherent or bizarre responses are identified and are accounted, when the ‘craziness’ is affirmed as the person’s best effort to deal with these feelings, needs and wants, and when new methods, experienced as effective, are provided and tried” (Mellor & Andrewartha, 1980, pp.201). 

Bruce Loria in his careful review of Berne’s writings made a plea for clinicians to remain consistent with Berne’s original “core concepts” (1988, pp. 39) and to be mindful of the interpsychic complexity of both child and Parent ego states.  Loria summarizes: “Berne is stating that a person takes into their Parent ego state the complete personalities of significant parental figures, including their level of pathology (contamination).  Therapists working to decontaminate the Adult ego state are likely to succeed only after they have assessed fully the extent of the introjected parental figures.  Concomitantly, specific treatment strategies are needed for resolving the contaminations of the introjected Parent and archaic Child in the Parent ego state in the offspring” (1988, pp. 41). 

In writing about the therapy of relationship problems, Landy Gobes identified that the treatment of abandonment or engulfment issues involve an evaluation of “the form and the degree of pathology in the Parent ego state” and then possibly “therapy with the Parent ego states of the client” (1985, pp.217).  In describing how she does Parent ego state therapy Gobes says, “The therapist can proceed as though the entire personality of mother or father were in the person’s body and can ask the person to sit in another chair and be mother or father … A client who is her mother seems to experience greater depths of mother’s thoughts and feelings than one who role-plays her mother” (1990, pp. 164).

 In Beyond Empathy: A Therapy of Contact-in-Relationship, the methods of an in-depth psychotherapy of both Child and Parent ego states are provided in detail (Erskine, Moursund & Trautmann, 1999).  The client’s gaining an awareness and appreciation of the psychological function of introjection is essential to the process of an indepth psychotherapy of Parent ego states. Fred Clark identified an intrapsychic function of introjection: “What is internalized is the thinking, feeling and behaviors of significant others (Parent ego state) as a defense against the loss of relationship with those persons. This concept, common to object relations theory, differs from psychoanalytic theory where defenses are used in service of protecting against Id drives. In relationship therapy, defenses are understood to be used in service of avoiding the pain or loss of contact (neglect) or painful contact (abuse), both being disturbances in relationship (1990, p. 42).

 

The Fantasy Parent

In Integrative Psychotherapy in Action, (Erskine & Moursund 1988/1998) we described Berne’s original theoretical model of ego states and how to use his four-part diagnostic system to identify Parent ego state influence in clients’ lives.  Four chapters are devoted to both an explanation of the Parent ego state psychotherapy and verbatim examples from actual clients; the other chapters emphasize psychotherapy with Child ego states.  The concept of a “self-generated Parent” – the fantasy of a young child that functions like a controlling or punitive Parent ego state, was also described (pp. 21-23).

As a normal developmental process in early childhood, children will often create an imago, a fantasy figure, as a way to provide controls, structure, nurturing, or whatever that young person experienced as missing or inadequate.  Some children create their own personal “boogeyman,” a frightening creature who threatens them with dire consequences for minor misdeeds.  Investing the “fantasy parent” with all the bad and scary aspects of being parented allows them to keep Mom and Dad as perfectly good and loving.  Throughout his elementary and junior high school years, Richard was haunted by the boogeyman.  As he developed into a teenager, the boogeyman ceased to be a concern; however, there was always the possibility of a stern teacher or policeman who could punish him if he got out of line.  In his late twenties, Richard’s grandmother died and he helped the family clean out her house.  As he cleaned under her bed and in her closet, he felt extremely anxious.  He anticipated some terrible punishment and, although he told himself that his thoughts were not rational, he kept expecting to find the remains of the boogeyman.  Working with his therapist, Richard began to remember that as a young child he thought the boogeyman “lived” in grandmother’s bedroom, and that he also had the capacity to follow Richard to school or at play.  If Richard misbehaved, the boogeyman was sure to punish him.  In the process of therapy, Richard began to remember a spanking at age 4, which was administered by his mother, in grandmother’s bedroom, during a family party.  Shortly after the spanking, Richard developed his belief in the boogeyman and could then turn to his mother for comfort, protection, and reassurance.  The fantasy of the boogeyman helped the four-year-old Richard remain adapted to external parental controls and at the same time experience his mother as all loving and fully tolerant of his behavior.

Others may create a fairy godmother sort of fantasy parent who loves and nurtures them even when the real parents are cold or absent or abusive.  This created image serves as a buffer between the actual parental figures and the desires, needs, and feelings of the young child.  The inevitable discomforts of growing up in an imperfect world are more tolerable because the fantasy figure provides what was missing with the real parents.

Anne-Marie, for example, had periods of depression in which she would eat a large amount of food.  During this time, she would long for her dead grandmother, whom she described during her therapy as affectionate, understanding, consoling, and who she said used to bring her wonderful food to eat.  The therapist, our of curiosity, asked how old Anne-Marie had been when her grandmother died and she replied, “14 months”.  A fourteen-month-old infant was not likely to have the experiences with a grandmother that Anne-Marie reported.  As the therapist began to explore the discrepancy between Anne-Marie’s longing for her grandmother and the fact that the grandmother had been dead since infancy, the client began to remember experiences from childhood that had been lost from memory for many years.  Anne-Marie had repeatedly been abused by both mother and father and had often been locked in the wine cellar for days at a time without food.  Anne-Marie related how the grandmother would “appear” to her after the beatings or in the dark wine cellar to comfort her, to encourage her, and to promise her wonderful meals.  By creating these images of grandmother, Anne-Marie was able to satisfy in fantasy some of the needs for appropriate nurturing that were drastically lacking in her parents’ behavior toward her.

As they mature to later developmental phases, children often let go of their self-generated images.  But when the child represses his or her awareness of needs, feelings, and memories in order to survive in the family, the self-created image is fixated and does not become integrated with later developmental learning.  Whatever the characteristics of the fixated self-created Parent, over the years it comes to operate similarly to the Parent ego state described by Berne.  It functions like an introjected personality; however, it is often more demanding and illogical and unreasonable than the actual parent was (after all, it had its origin in a small child’s fantasy).  The self-created parent made from fantasized images provides and encapsulates, a nonintegrated package of thoughts and feelings and behaviors to which the person responds as if they were truly internalizations from the big people of early childhood.

 

Treatment Planning

Psychotherapy of an introjected ego state or a self-generated parental fantasy may become part of the psychotherapist’s treatment plan after much therapeutic work has been done on the various Child ego states.  Such Child ego state therapy may include the use of a wide variety of methods to facilitate the client’s:

·        relaxing of habitual defenses;

·        increased awareness and perhaps expression of feelings and needs that were

repressed, and

·        resolution of both specific or cumulative traumatic experiences.

Although some of this Child ego state therapy may include active methods, such as redecision work or the dramatic expression of sadness or anger, much of the therapy occurs by working within the client-therapist relationship.  By working with the unconscious process of the client’s transferences, the developmentally aware and affectively attuned psychotherapist can help the client identify the archaic interruptions to either internal or interpersonal contact.  These minute interruptions to contact and their related images and fantasies constitute the subtle dynamics of transference.

Transference is a constant attempt by the client to reparatively enact fixated childhood experiences by simultaneously repeating both archaic defenses and developmental needs in a current relationship.  These subtle unconscious enactments are an expression of an intrapsychicconflict between elements of an influencing Parent ego state and the developmental needs thwarted and fixated in Child ego states (Erskine, 1991/1997).

The intrapsychicconflict between Parent and Child ego states continues years later because of a child’s biologically-driven needs for relationship and the resulting, though often unconscious, loyalty to his or her parents or significant others.  Therefore, it is essential to establish a solid therapeutic relationship with any client prior to therapeutically engaging Parent ego states: the psychotherapist must be fully protective of the Child ego states’ vulnerabilities.  The effectiveness of a therapeutic relationship is built upon the therapist’s: 

·        attunement to the client’s affect and psychological rhythms;

·        sensitivity and responsiveness to both various Child and Adult ego state needs;

·        a constant inquiry into the client’s phenomenological experience;

·        facilitating the client’s appreciation of his or her style of coping, as well as,

·        honoring of the vulnerabilities of both childhood and adulthood.

Much of this is accomplished by working within the transference and by the therapist not personalizing the client’s defensive reactions.

Just as effective psychotherapy of Child ego states produces major reorganization of psychological processes, experiences, and meaning making, so also psychotherapy of a Parent ego state produces major psychological reorganization.  The client’s Child ego states have been loyal to the intrapsychicinfluence of Parent ego states because of children’s natural need for contact, attachment, and relationship.  This biological imperative for relationship must be accounted for and respected by the therapist and, in most situations, a sufficient therapy relationship established prior to the treatment of Parent ego states or a self-generated fantasy.  It is generally advised to only engage in decommissioning a Parent ego state when the client has an ongoing experience of “this therapist is there for my welfare”.  If therapists engage in an in-depth psychotherapy that decommissions Parent ego states without such an involved relationship, then the Child ego states may be without a significant other to whom they feel a sense of protection and attachment.  Metaphorically, it is akin to creating an orphan and may result in increased anxiety or depression. In some clients, the intrapsychic relationship disrupted by a premature intervention may result in increased clinging to the intrapsychicallyinfluencing Parent ego state or self-generated fantasy out of a desperate need for attachment.  The quality of the therapeutic relationship, as experienced by the client, is a central factor in determining when to proceed with treatment of either a self-generated fantasy or a Parent ego state.  The therapist’s phenomenological inquiry throughout the duration of the therapy and the constant investigation and repair of breaches in the therapeutic relationship are two of the best monitors for both identifying the subtle transferences and determining the degree to which the client can rely on and draw emotional support from the therapist.   

In the “devil” example at the beginning of the previous section I actively intervened with a Parent ego state prior to developing a consistent and reliable therapeutic relationship.  This is a rare situation where neither my colleague nor I, during the early hours of the therapy-marathon, could establish a therapeutic alliance with her Child ego states.  Her Parent ego state was interfering with the psychotherapy, primarily through intrapsychic influence and then in the marathon group, by externalization - the active cathexis of the “devil voice”.  The client had been in therapy with my colleague for the treatment of her depression and she had gained a trust in him and, by association, a degree of trust in me.  This was coupled with an idealized hope for “therapy magic”; such idealization is often an expression of the relational need to be in the presence of someone who is both protective of the Child ego states’ vulnerabilities and potent enough to stop interpsychic abuse.

The therapy of her depressed Child ego states had reached an impasse.  In the process of witnessing other people’s therapy in the marathon the psychic presence or influencing Parent ego state became externalized.  It was an opportune moment to actively engage the Parent ego state: to keep it externalized rather than allow it to retreat to a position of interpsychic abuse, and to provide psychotherapy to that psychic presence just as I would with an actual client.  This instant intervention with an active Parent ego state is particularly helpful when the influencing Parent ego state is interfering with the psychotherapy, psychologically beating up on a Child ego state, or is so controlling that the Child ego states cannot express or even sense feelings or needs.  In most clinical situations, psychotherapy with a Parent ego state is initiated only after a protective therapeutic alliance is established with various Child ego states.

In some situations, a Parent ego state may become threatened by or envious of the blossoming relationship between the client’s Child ego states and the psychotherapist’s reliable, consistent, and dependable involvement.  This may result in an increase in anxiety, the activation of internal voices, or self-criticism that interferes with Child ego state therapy.  It may then be effective to identify the internal criticism through the interweaving of a phenomenological, transferential, and historical inquiry.  Such a detailed inquiry is to determine if the internal voice or criticism is either that of a specific other person, a self-generated Parent-like ego state based on a child’s fantasy, or a self-criticism that preempts another’s criticism.  Such identification and differentiation of these possibilities along with a well-timed explanation may provide the client with cognitive awareness of the source of the internal conflict and anxiety and thereby some temporary respite.  A description of the treatment of self-generated Parent-like ego states or self criticism that preempts another’s criticism is beyond the scope of this chapter. However a differential diagnosis may be useful before proceeding with Parent ego state therapy.  Sometimes the self-generated fantasy is clearly evident after the Parent ego state therapy is successfully completed. The Child ego states hold on to a fantasy as an expression of attachment. Preemptive self criticisms are related to shame and self-righteousness (Erskine, 1994/1997).

Sometimes a Parent ego state is continually or even increasingly influencing, particularly following regressive therapy, a redecision, or the resolution of a transferential expression of conflict and needs.  I have found it more effective to address the criticizing voice on behalf of a Child ego state by speaking as though the actual parent were sitting next to the client.  An example of what I have said with one woman’s father is: “Stop talking to her like that; I will not let you berate her.  Don’t punish her for having normal child needs; let her be natural.  I know life is hard for you, but you cannot solve your problems by taking it out on her.  Be quiet now; later you and I can talk.”  This is but one of many examples of an interposition wherein the therapist protectively interposes him or herself between the client’s Parent and Child ego states.  This often provides a large measure of relief from the intrapsychic influence, particularly if the therapeutic relationship is well developed.  The client’s sense is often one of the therapist being fully protective.

It is essential that the therapist make such a confrontation caringly and with respect.  After all, this influencing voice represents the client’s parents or significant others and any disrespectful comment or arrogant tone may threaten the client’s loyalty and thereby reinforce the Child ego state’s attachment to a Parent ego state.  When making an interposition I often silently paraphrase for myself an old cliché: “blood is thicker than therapy”.  With this cliché in mind I remain respectful of the Parent ego state even when I may feel disgusted by or ferociously angry at his or her behavior.  For the sake of the child I’m often both firm and empathic with the Parent ego state.

The interposition has two purposes: to temporarily stop the intrapsychicconflict until such time when an in-depth psychotherapy of the Parent ego state is both possible and therapeutically prudent; and, primarily, to create an opportunity to further establish the therapeutic relationship so that the client’s experience is: “This therapist is thoroughly invested in my welfare.”

Once deconfusion of Child ego states is accomplished, survival reactions relaxed, and script beliefs relinquished then it may be essential to engage in treating the Parent ego states.  There are also times when the client experiences not being able to change; they are still depressed, anxious, or oppressed in response to the intransigent and destructive nature of a Parent ego state.  In either of these situations, it may become necessary to actively treat the Parent ego state and later engage in further treatment of Child ego states. 

In conducting Parent ego state therapy the client is invited to cathect the relevant Parent ego state, in essence to “be” mother or father and to engage in conversation with the therapist as mother or father might.  This involves the client in taking on the body posture, the facial expression, the attitude, the feelings, and the style of relating of that particular parent.  In essence, the internalized parent becomes externalized.  The therapist first establishes a safe and accepting emotional climate that allows the internalized other to begin to open up and become more revealing.  This is often accomplished by realistic, straight talk in the Parent ego state’s frame of reference.  The quality of the interaction gradually begins to shift to a more therapeutic focus.  Because the therapist already has a previous knowledge about the actual parent and some of the family dynamics, he or she is able to make very personal and pointed interventions which reveal areas of conflict or emotional difficulty in the introjected parent.  The Parent ego state is then invited to work through those issues with the therapist. 

John McNeel’s (1976) “Parent Interview” was designed the last stage of a short term redecisional therapy. The goal of the recent interview was forgiveness and acceptance of the parent through understanding his or her internal conflicts. McNeel’s therapeutic caveats included a warning against working with a “crazy” Parent ego state.

Sharon Dashiell (1978) as well as Mellor and Andrewartha (1980) encourage therapy with the “crazy” Parent ego state. However, their approach is one of reparenting the Parent ego state; this involves replacing a lethal introjection with a more benign introjection.  As stated earlier in this chapter the replacement of a Parent ego state with another introjection is not therapeutic. Rather, this chapter describes both the theoretical necessity and the practical considerations of an in-depth psychotherapy of introjections for the purpose of relieving intrapsychic conflict in our clients.  In my clinical experience, I have found that an empathetic, relationally-oriented psychotherapy aimed at dissolving defenses, honest expression of attitudes and feelings, and therapeutic respect for the individual’s desires, frustrations, and conflicts provides for the decommissioning of Parent ego states, the end of intrapsychic conflict and the opportunity for the person to engage life with awareness, spontaneity and intimacy.

The same methods of inquiry, attunement, and involvement that are used with many clients may be used to treat a Parent ego state, including regression therapy and even, sometimes, treatment of the parent’s Parent ego states.  Examples of in-depth therapy of a Parent ego states include: 1) psychotherapy for a frustrated and angry 35 year old mother dealing with an alcoholic husband and blaming her kids for her plight, 2) facilitating a regression to a father’s childhood experiences, and working through memories of early physical abuse, 3) using the variety of methods suitable for deconfusion or redecision, and 4) psychotherapy for the Grandparent or Great-grandparent ego states – 3rd and 4th generational therapy.  If the Parent ego state is unwilling to engage in this process and continues to be destructive, the therapist may then continue to relate with that ego state in order to advocate for the client’s Child ego state.  This is often experienced by the Child ego states, especially in situations of child abuse,  as a kind of protection the child never had and can be a very powerful experience that brings about change.

The historical accuracy of the portrayal is not particularly relevant.  What is important is the parent-as-experienced by the client.  A person introjects not so much what his or her parents “actually” thought and felt and did, as what he or she experienced them thinking and feeling and believing about the child, about themselves, and about the world.  As the Parent ego state begins to respond to the therapeutic challenges to his or her life script, the introject loses its compulsive, entrenched position and the client begins to experience that it doesn’t have to be this way.  “The thinking process, attitudes, emotional responses, defense mechanisms, and behavioral patterns that were introjected from significant others no longer remain as an unassimilated or exteropsychic (Parent) state of the ego but are decommissioned as a separate ego state and become integrated into an aware neopsychic (Adult) ego.” (Erskine & Moursund, 1988/1998).

 

Conclusion

The experience of treating a Parent ego state feels very real: to the therapist, to observers, and most especially to the client.  It is not an “as if” experience once the person gets fully involved.  Therefore certain precautions are suggested:

1.      It is essential that the client experience a therapeutic alliance with the therapist first.  As a client’s Child ego states, though not active, observe the understanding, sometimes empathic interaction between therapist and Parent ego state, he or she may experience that the therapist is taking the parent’s “side” and has effectively abandoned the child.  For this reason it is also imperative that the therapist come back to both Child ego states and the Adult ego of the client before the work is completed in order to re-establish the relationship.  It also re-affirms that the purpose of the procedure is only for the client’s benefit (although benefits to the actual physical parents have been reported as a consequence of this experience).

2.      After the therapeutic work with Parent ego states, make sure that the client, whether in Adult ego or Child ego states, has an opportunity to respond to the Parent ego state.  This strengthens the sense of self as separate from the parent and allows for meaningful interpersonal contact that may have been interrupted or perhaps never present.  Failure to do so sometimes results in headaches or a sense of confusion and disorientation.

3.      Keep in mind the loyalty of a child towards its parent, no matter how abusive that parent may be or have been.  Even if a client is angry at or ambivalent about a parent, if the therapist confronts too strongly or is in any way disrespectful to the parent the client is likely to feel a pull to protect the parent.

Treating a Parent ego state can take place in one session, an extended session, or over a number of sessions.  After a successful process, the client generally feels a combination of feelings: relief and freedom, yet often a deep sadness as a result of knowing the parent’s experience so closely and having it responded to empathetically by the therapist.  Often anger is stimulated and is best dealt with immediately by having the client address a Parent ego state, as in Gestalt two-chair work.  People usually need plenty of time to process the experience, express any residual feelings, and talk about the meaning they have derived from it.

In the process of treating a Parent ego state, the conflict with that significant person is claimed, experienced, and dealt with (albeit in fantasy, since the real parent is not actually present).  The result is that the client regains the self that was lost in the process of avoiding the external conflict by internalizing it instead.  They are less likely to act out their Parent ego states towards others and, without the internal influence, will also be in a Child ego state less.  In addition, as the content of the Parent ego state becomes integrated with the Adult ego the client now has the possibility of dealing with the real person of the parent differently.  Therapists may also find that previously unresolved transference issues with the therapist are now more easily resolved.  In-depth, reintegrating psychotherapy of Parent ego states is Transactional Analysis’ most significant contribution to the profession of psychotherapy.


REFERENCES

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Bowlby, J. (1980). Loss: Sadness and depression. Vol. 3 of Attachment and loss. New York: Basic Books.

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Copyright © 2002 Institute for Integrative Psychotherapy.
Published on the website IntegrativeTherapy.com 2002.
Subsequently published in C. Sills and H. Hargaden (eds.) Ego States: Key Concepts in Transactional Analysis, Contemporary Views, pages 83 - 108, Worth Publishing: London, 2003.

 

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