Institute for Integrative Psychotherapy

Integrative Psychotherapy Articles

The Therapeutic Relationship:
Integrating Motivation and Personality Theories

Richard G. Erskine

Eric Berne’s writings have provided psychotherapists with a rich and thorough understanding of human behavior, psychological functioning, and communication. The concepts of ego states and intrapsychic processes, transactions and transference, and psychological games and life scripts are each a subset of a comprehensive transactional analysis theory of personality. These theoretical concepts dominate and shape an orientation to the clinical practice of transactional analysis by affecting our understanding of behavior and determining the method of intervention. Inherent in the integration of transactional analysis theories of personality and theory of motivation is a theory of method that emphasizes the importance of relationship.

Berne (1961, 1963, 1966, 1970, 1972) identified a transactional analysis theory of motivation when he wrote about human drives that he termed stimulus hunger, structure hunger, and recognition hunger. However, in spite of articulating these motivational factors, he based his methods of psychotherapy and communication exclusively on his personality theories, originally on ego states and emanating transactions (Berne, 1961, 1966) and later on the theory of life script (Berne, 1972). In fact, overall the transactional analysis literature has underemphasized the importance of a theory of motivation and the application of such a theory to forming both theories of personality and theories of method.

Berne (1966) applied his theory of ego states and transferential transactions in clinical practice when he asserted that the client will present his or her “past experiences in coded form to the therapist, and the therapist’s task is to decode and detoxify them, rectify distortions, and help the patient regroup the experience” (pp. 242-243). This statement regarding the therapist’s task is an organizing principle that serves to guide therapeutic interventions. Berne’s eight therapeutic operations—interrogation, specification, explanation, confrontation, confirmation, interpretation, illustration, and crystallization—are the specific methods he used to decontaminate ego states, deconfuse a fixated Child ego state, and decommission an influencing Parent ego state (Berne, 1966, pp. 233-247).

This set of methods or therapeutic operations is a direct outgrowth of Berne’s psychoanalytic background and original theory of ego states (1961) as derived from Federn’s (1953) concept of the ego and states of the ego. Although Berne did not directly relate these methods to a theory of motivation, his personality theory of the structuring or fragmenting of the ego into separate states is consistent with the idea that there is a dynamic interplay between structure hunger and relationship (recognition) hunger. Berne’s eight therapeutic operations apply to the original application of his conceptual model of ego states (Erskine, 1988). Other descriptions of ego states, such as second-order, functional, and structural (Trautmann & Erskine, 1981) lack a theory of methods and are not related to a theory of motivation.

The transactional analysis literature pertaining to script theory contains much that is concerned with the historical origin of an individual’s personality (Berne, 1972; Steiner, 1974) with a focus on parental programming (Steiner, 1971), decisions (Goulding & Goulding, 1979), conclusions (English, 1977), and survival reactions (Erskine, 1980). Writings about the elements of scripts, that is, games and miniscripts (Berne, 1964; Kahler with Capers, 1974), are also descriptions of a theory of personality. Berne’s methods for the treatment of script consisted of the confrontation of the programmed script, cognitive explanation, interpreting the function, contracting for change, and permission to change (Berne, 1972). 

Additionally, the transactional analysis literature is rich with an eclectic variety of psychotherapy methods, such as reparenting and self-reparenting (James, 1974; Osnes, 1974; Schiff, 1969); behavioral options (Dusay, 1972; Karpman, 1971); redecision, rubberbands, and disconnecting rubberbands (Erskine, 1974; Goulding & Goulding, 1979; Kupfer & Haimowitz, 1971); permission and protection (Allen & Allen, 1972; Crossman, 1966; Holloway, 1974); and the treatment of introjected Parent ego states (Dashiell, 1978; Erskine & Moursund, 1988). Erskine (1975, 1980, 1982; Erskine & Moursund, 1988) proposed a methodological orientation to script cure that integrates affective, behavioral, cognitive, and physiological therapeutic interventions, with specific interventions  determined by where the client is open or closed to contact. Ware (1983) and Joines (1988) applied this orientation to selecting methods suitable for clients with disorders falling into specific diagnostic categories.

A review of articles in the Transactional Analysis Journal from 1971 to the present reveals that most writers followed Berne’s emphasis on theories that categorize or describe behavior and that explain personality dynamics. Their contributions to the transactional analysis literature are a clarification, elaboration, and enrichment of descriptions, classifications, personality theories, and specific therapeutic interventions. Reading the literature just cited shows that most of the writing on the practice of transactional analysis in psychotherapy bases a specific method on personality theory: There is a need for a theory of methods that emerges from the integration of personality and motivation theories. The thesis of this article is that the practice of transactional analysis will be enhanced by a consistent and unified theoretical link between motivation and personality theories, from which methods are directly derived (Trautmann & Erskine, 1995).

Integrating Motivation, Personality, and Method

Theories of motivation provide a metaperspective that encompasses theories of personality. A theory of motivation determines which theories of personality can be integrated and which are conceptually inconsistent and do not integrate into a unified, comprehensive theory of human functioning. When theories of motivation and personality have an internal validity and consistency, they work together as a conceptual organization for a unified theory of method.

To be consistent, a theory of method must emerge from corresponding theories of human motivation and personality. The integration of Berne’s theories of personality (ego states and life scripts) and his theory of drives or hungers (stimulus, structure, and recognition) provides such a unified understanding of human functioning. This integration of personality and motivation theories explains individuals’ intrapsychic and interpersonal dynamics and leads to a theory of method that is consistent with both a theory of motivation and theories of personality.

Methods are the actual interventions that are used in psychotherapy practice. They are reproducible; that is, a therapist can model a specific intervention and another therapist can learn to create a somewhat similar intervention. A theory of method provides an understanding of how methods may be designed. It provides an orientation to the practice of psychotherapy, a therapeutic stance: supportive, analytic, relational, or replacement (Trautmann, 1981).  One such methodological orientation is the premise that healing occurs through the use of a therapeutic relationship that focuses on enhancing internal and external contact. This provides both an overall framework from which specific methods are designed and a conceptual beacon that serves as a guide to the therapist in the continual monitoring of observations, theories, hypotheses, and specific interventions (Erskine, 1982).

Overview of Motivation, Personality, and Method
in Other Schools of Psychotherapy

In classical psychoanalytic theory, motivation consists of the drives referred to as libido, aggression, and morbido. Id, ego, and superego comprise the structural theory. Conscious, preconscious, and subconscious are the strata of the topographic theory, the divisions of the human mind defined by Freud. Together these elements constitute the personality theory. The theory of method is composed of nongratification, neutrality, and interpretation in response to free association.

Beginning with Fairbairn’s (1952), Guntrip’s (1961, 1968, 1971), and Bowlby’s (1969, 1973, 1980) writings on object relations theory, the psychoanalytic understanding of human motivation shifted from Freud’s drive theory to an understanding that humans are motivated to seek attachment and relationship. Internalized object representations, split objects, and true and false selves are constructs of this updated psychoanalytic theory of personality. The playful use of free association, encouraging the client’s expression of true self, and the therapist’s countertransferential process are elements of its therapeutic methods (Bollas, 1987; Tustin, 1986; Winnicott, 1965). 

In the concepts of psychoanalytic self psychology people are thought to be motivated by self experience to form selfobjects whose function is to provide continuity, stability, and nurturance to the self. The personality theory of self psychology centers on the effects of the adequacy or failure of selfobject functions. Its methods have centered on empathy and interpretation (Kohut, 1977) and recently on the intersubjective experience of both client and therapist (Stolorow, Brandchaft, & Atwood, 1987). 

In client-centered therapy the central organizing construct is Rogers’s (1951) premise that people require unconditional positive regard. When the core conditions of unconditional positive regard, accurate empathy, and congruence are provided, people express themselves and grow. Rogers’s ideas emerged from Sullivan’s (1953) interpersonal therapy, which emphasized the importance of person-to-person communication, rather than being based on a theory of personality.

The behaviorist theory of motivation revolves around the cycle of stimulus-response. Personality is considered to be the result of learned behavioral patterns, and therapy methods consist of arranging operants and contingencies (Bandura, 1969; Dollard & Miller, 1950). 

In Gestalt therapy theory humans are motivated by both the urge for organism-environment contact and the drive to organize experience, that is, to form gestalten (Perls, 1944). Personality theory emerges out of an understanding of interruptions to contact and fixed gestalten. The theory of methods emphasizes experimentation that produces excitation and growth at the contact boundary of the organism-environment field (Perls, Hefferline, & Goodman, 1951). 

Within transactional analysis, English (1977, 1987, 1988) introduced a unique perspective on personality theory related to motivation that she refers to as “existential patterns.” Her personality theory emerges from three primary drives: survival, expressive, and quiescence. English (1987) equates Berne’s stimulus hunger to the expressive drive and recognition hunger to the survival drive. She does not refer to Berne’s ideas on structure hunger, although she does see individual personality or character as formed by a “defensive existential position, which develops around age three” (p. 93). English does not propose a theory of psychotherapy method; her approach is informative and concerned with how “drive[s] interact, to what extent one inhibits the other, [and]. . . what support or interference the third offers” (1988, p. 296).

Steiner (1974) emphasized a method of psychotherapy that focused on the importance of strokes and permission. Scripts were seen as the outgrowth of the drive or hunger for strokes. His theory emphasized the deprivation and manipulation of strokes as a method of social control that produced individuals with mindless, loveless, and joyless scripts.

Berne’s Theory of Motivation

As described earlier, the foundation for a theory of motivation was laid by Berne (1966) when he wrote about psychological hunger as that which “drives an individual to social action” (p. 230). He categorized drives as the hunger for stimulus, structure, and relationship. These hungers or drives of the human organism operate nonconsciously. The hungers are the motivations determining physiological, affective, cognitive, and behavioral responses.

Berne (1961, 1963, 1964, 1966, 1970, 1972) was consistent in his description of stimulus hunger as the basic need or drive of the human organism. He described stimulus hunger as originating in the reticular activating system of the brain stem and how such “hunger” requires constant stimulation. Berne (1964) cited Spitz’s writing on hospitalism and related “emotional deprivation” to the lack of sufficient stimulation.

Structure hunger, according to Berne, is a “psychological need” (1963, p. 221) involved in the organization of “perceptual experiences” (1972, p. 22). He identified the derivatives of structure hunger as leadership hunger (1963, 1966) and incident hunger, which are respectively the driving force in games and scripts (1970). Berne (1966) elaborated the concept of structure hunger into a six-order taxonomy of time structuring: withdrawal, ritual, pastimes, activities, games, and intimacy. 

Throughout his writings Berne referred to the urge for interpersonal relationships or relationship hunger as “a hunger for human contact” (1970, p. 208). He variously referred to the drive for relationships as tactile hunger (1966), recognition hunger (1970, 1972), and the need for verbal recognition (1970). Since relationships emerge from “the quest for special kinds of sensations that can only be supplied by another human being” (1972, p. 21), each of these various descriptions of human motivation may be generalized as a hunger or drive for relationship.

Berne often interwove the concepts of stimulus, structure, and relationship hungers. He described the interactive influence of stimulus, structure, and relationship hungers, yet inadvertently clouded the distinction between them. Berne (1961) initially described stimulus hunger as “represented by physical relationship” (p. 84). He explained the merged concepts of stimulus hunger and recognition hunger as the “original craving for physical contact” (1964, p. 14) with “a partial transformation of infantile stimulus-hunger into something that may be termed recognition hunger” (p. 14). Recognition hunger is referred to as “the first order sublimation” of stimulus hunger (Berne, 1961, p. 84). The satisfying stimuli in Berne’s examples are provided by another person who makes physical contact or recognizes an individual, as when he describes “tactile hunger” as emerging from the physical intimacy, tactile recognition, and stimulation given by the mother to a young child (1966, p. 282). Berne also referred to an adult’s version of the infant’s need to be touched as “recognition hunger” (1966, p. 230).

In Berne’s (1964) words, “structure-hunger has the same survival value as stimulus-hunger” and yet it is unique in that its function is to establish equilibrium (p. 18). He (1966) later wrote, “Structure hunger expresses the antipathy to monotony, stereotyping, and boredom” (p. 230); “The everyday problem of the human being is the structure of his waking hours” (1961, p. 85). Berne (1970) also defined structure hunger as the reason people play games. In the Hello book he (1972) stated, “The need to structure time is based on three drives or hungers. . . . Stimulus or sensation hunger, . . . recognition hunger, the quest for special kinds of sensations which can only be supplied by another human being . . . [and] structure hunger,” a hunger for “perceptual experience” (pp. 21-22). He (1966) called these hungers “particular needs” (p. 230) and described them as the basis for a taxonomy of time structuring. Intimacy, he asserted, is the “only completely satisfying answer to stimulus-hunger, recognition-hunger, and structure-hunger” (1964, p. 18).

Unfortunately, by writing about hungers as an introduction to his concepts of time structure Berne did not emphasize how the concept of stimulus, structure, and relationship hungers form a significant theory of motivation. He did not fully develop how these drives are related to ego states, intrapsychic processes, transactions, and life scripts. It is ironic that this theory of motivation, for which Berne did not claim (nor was he given) particular credit, can now be shown to encompass and give organization to his overall understanding of personality. 

An Integrative Theory of Motivation

The human drive or hunger for stimulus is necessary for survival. Stimuli operate both internally and externally and provide the informational feedback system that leads to the satisfaction of basic needs. The survival needs for oxygen, water, food—as well as psychological and relational needs—all begin with awareness of a discomfort or a deficit. As biological and psychological processes come to awareness a person must also become aware of the environment that can supply the resources for survival.

To satisfy that which is needed, the organism must make contact not only with its internal sensations and needs but also with the external environment. Survival and quality of life are ensured through the continual moment-by-moment interplay between internal and external stimuli and the capacity to make full contact both internally and externally. Stimulus hunger is satisfied through the interaction of the central nervous system and the proprioceptive organs. Our sensory system provides us with an orientation (Perls, 1973, p. 17) that makes external and internal contact possible. Full contact is essential for life—it satisfies the biological drive for stimuli that influences and regulates the drives for structure and relationship.

Structure hunger is the drive to organize experience, to form perceptual configurations—visually, auditorily, tactilely, and kinesthetically. The experimental Gestalt psychologists demonstrated that there is an innate drive to form perceptual patterns and configurations (Kohler, 1938; Lewin, 1938). The drive to structure perceptual configurations and the inevitability of figure-ground formation create and organize pattern, meaning, and predictability in our lives. This, in turn, makes concept formation, categorization, and language possible. 

The formation of perceptual configurations refers not only to auditory or visual patterns—such as the recognition of a familiar sound or the meaning in these written words—but also to tactile and kinesthetic patterns such as the habitual tightening of muscles in response to fear or anger. Stern (1985) referred to the three-day-old infant’s capacity to form an olfactory configuration that allows the baby to turn his or her head toward the smell of breast milk from his or her own mother rather than in the direction of milk from another woman.

This innate tendency to structure configurations that create meaning and predictability and to organize the continuity of experience over time also provides the possibility for perceptual variability and the creation of new organization and meaning. It is only because we form perceptual patterns that it is also possible to perceive novelty, variation, and contrast (Perls, Hefferline, & Goodman, 1951). 

Both continuity and variability in perception are necessary for stimulus hunger and relational hunger to be satisfied. If there is a disruption in the structuring (figure-ground formation) of sensations or perceptions then there will also be a disruption in the full processing of internal and external stimuli and/or the satisfaction of relationship hunger. Thus, the drive to organize and generalize patterns of experience (structure hunger) regulates the satisfaction of both stimulus and relationship hungers. 

A growing body of literature supports the premise that people are born relationship-seeking and continue patterns of bonding and attachment throughout life (see Erskine, 1989 for a review of the literature). Stern’s (1985) compilation of research on infant development supports the idea that the infant’s and young child’s sense of self emerges through interpersonal relationships. In addition, authors writing from a feminist perspective on psychotherapy emphasize the centrality of interpersonal connection and relationship in the formation of a healthy sense of self in both females and males (Bergman, 1991; Miller, 1986; Surrey, 1985). Sullivan’s (1953) interpersonal theory also places central importance on establishing and maintaining relationships. Recent writings in Gestalt therapy have emphasized the importance of a dialogical, healing relationship (Hycner & Jacobs, 1995; Yontef, 1993). Each of these theorists described a developmental thrust for relationship.

Relationship hunger is the drive for intimacy. Berne’s “recognition hunger” (1964, p. 14), “tactile hunger” (1966, p. 282), and “contact hunger” (1970, p. 210) all describe an aspect of the motivation for person-to-person connection. As he wrote, “A striving for intimacy underlies the most intense and important operations” (Berne, 1963, p. 217).

Relationships are built on interpersonal contact that includes the stimulus of physical touch and a valuing recognition by another person of an individual’s being and attributes. Relationships provide the experience from which the configuration of a sense of self, of others, and of the quality of life emerge. Although relationships are built on the stimulus of moment-by-moment verbal and nonverbal transactions, they also reflect the drive to structure pattern and meaning from an individual’s whole history of interpersonal experiences. Satisfaction of relationship hunger depends on the awareness of relational needs (internal stimulus), what the individual believes about self and others in the interpersonal relationships (structure), and the behavior of the other person in the relationship (external stimulus).

Relationship hunger is affected by and influences the drives for stimulus and structure. When an individual’s hunger for relationship is repeatedly not met by a reciprocal response from another person, the individual may overgeneralize and rigidify the conclusions drawn from this experience. The conclusions and decisions are an attempt to make sense of the cumulative rupture in relationship and thus make it (temporarily) bearable. From a perspective of transactional analysis theories of personality, the compensating structure can be viewed as splitting the ego into various Child or Parent states, making script decisions, or fantasizing and collecting selective evidence that reinforces script beliefs.

If the drive to structure experience does not compensate for a lack of need-fulfilling relationship, the drive for stimulus may be employed in its place. The compensating drive for stimulus may be manifested as emotional escalation or physical agitation or, conversely, as disavowal of affect, desensitization, or dissociation. Anxious obsessing is one of many examples of psychological phenomena in which stimulus hunger and structure hunger are both used as overcompensation for a lack of fulfillment of relationship hunger. As already described, the three hungers or drives are in dynamic balance: Any disruption in one of the hungers causes an overcompensation in at least one of the others. More specifically, the drives for stimulus and for structure, on the one hand, and relationship hunger on the other, are interactive: The satisfaction of one hunger or drive is affected by the satisfaction—or nonsatisfaction—of another.

A Theory of Methods

Transactional analysis has lacked an explicit and comprehensive theory of method emerging from the integration of motivation and personality theories with a focus on relationship. Its clinical application has been influenced primarily by its theories of personality, particularly the theory of ego states and life scripts. These theories describe the excessive reliance on structuring (scripts, ego states, etc.) to compensate for relationship hunger and the loss of awareness of internal stimuli. The overstructuring results from an individual’s loss of internal contact in an attempt to cope with repeated disruptions of relationships. For example, the development of an unconscious life plan composed of fixated core beliefs about self, others, and the quality of life is a defensive organization of experience: It impedes awareness of both relational needs and the affect resulting from the absence of satisfaction of those needs (Erskine & Zalcman, 1979). It results in inhibiting spontaneity and limiting flexibility in problem solving and relating to people (Erskine, 1980). The theory of ego states also depicts a person’s fragmentation or splitting off of a sense of “I” in an attempt to cope with either specific disruptions in significant relationships or the cumulative lack of fulfillment of relational needs (Lourie, 1996). Each of the subtheories within transactional analysis, such as games or miniscript, is a further explanation of psychological overstructuring and resulting behavior.

When the psychotherapist emphasizes only cognitive or behavioral change—such as confronting games or rackets, programming a redecision or OK miniscript, or determining how a person should behave or think—then the process of psychotherapy emphasizes replacing one overused and rigid structure with another. Instead, the use of methods that enhance increased awareness of internal stimuli (needs, sensations, memory, etc.) and the significance of interpersonal relationships increases the possibility of new meanings and understandings that may not be rigid or overstructured. The use of methods that integrate the affective, cognitive, and physiological domains of human functioning with the behavioral domain significantly lessens the likelihood that the client will merely replace one psychological structure with another. When the psychotherapist focuses on the integration of affect, bodily experiences, and thought processes there is a greater possibility of responding to all these aspects of motivation—stimulus, structure, and relationship.

Much of the transactional analysis literature has emphasized structure. In developing a theory of therapeutic method there is a need to place equal emphasis on internal and external contact, relational needs, and the function of relationship. To be useful, a theory of method must be influenced by a balanced perspective that includes stimulus, structure, and relationship-motivated drives. By putting relationship at the center of our theory of methods, we create such a balanced perspective. The premise that “healing is in the relationship” is the basis for a theory of method that emphasizes the significance of the therapeutic relationship in enhancing internal and external contact, dissolving fixated compensating structures, and responding to relational needs (Erskine, 1982, p. 316). A theory of method that emphasizes the significance of the therapeutic relationship shifts the psychotherapist’s focus from methods geared toward rebuilding structures to those that dissolve interruptions to contact. Rather than a therapy aimed at creating structure to replace structure, this theory of method centers on the dynamic relationships that underlie the structure-making process. A psychotherapy such as this will take into account where the client is open or closed to contact—affectively, cognitively, behaviorally, or physiologically.

The transactional analysis view of motivation and of the balance among stimulus, structure, and relationship hungers allows for such a shift in therapeutic focus. With my understanding that life script and ego states are compensating attempts to manage relationship hunger and a loss of internal contact, the therapeutic focus can be placed on relationship itself (Erskine, 1980, 1988). From this perspective the purpose of analyzing ego states or a life script is not to erect a new, more useful structure, but rather to gather information about which relational needs were not met, how the individual coped, and even more importantly, how the satisfaction of today’s relational needs can be achieved (Erskine & Trautmann, 1996). These therapeutic tasks are accomplished through contact-oriented, relationship-focused methods:

  • inquiry into the client’s phenomenological experience, transferential process, system of coping, and vulnerability;
  • attunement to the client’s affect, rhythm, developmental level of functioning, and relational needs; and
  • involvement that acknowledges and values the client’s uniqueness.  

These three components together validate the existence and significance of the client’s psychological functioning, normalize his or her defensive strategies, and provide a therapeutic presence that centers on the client’s intrapsychic process (Erskine, 1991, 1993, 1994; Erskine & Moursund, 1988; Erskine & Trautmann, 1993, 1996).

Consistency in the practice of transactional analysis in psychotherapy is enhanced when clinical interventions are based on a comprehensive theory of method that emphasizes the therapeutic relationship (see Figure 1). The application of such a theory must:

  • respond to the unique experience of each client;
  • emerge from knowledge of human motivation and the compensating balance in stimulus, structure, and relationship hungers;

Theory of Motivation

stimulus, structure, relationship hungers

Theory of Personality

ego states, life script, intrapsychic processes

Theory of Method

healing through a contactful relationship


inquiry, attunement, involvement 

Subsets of Methods

acknowledgment, validation, normalization, presence 

Therapeutic Transaction

“Does it seem to you that when you need to feel secure you begin to worry about

whether you have offended me?”

Figure 1
Theories of Motivation, Personality, and Method
  • use the theories of personality (ego states and life scripts);
  • account for where the client is open or closed to contact—affectively, cognitively, behaviorally, or physiologically;
  • enhance internal and external contact;
  • acknowledge and respond to relational needs; and
  • facilitate the recovery of spontaneity and flexibility in problem solving and in relating to people.

In a contactful, relationship-oriented psychotherapy the therapeutic interventions shift from an emphasis on the structure of ego states or life scripts to focusing on the client’s phenomenological experience, psychological vulnerabilities, and relational needs. To paraphrase the earlier quotation from Berne, the psychotherapist’s task is to create a contactful therapeutic relationship that facilitates decoding of the client’s transferential expression of past experiences, detoxifying introjections and rectifying fixated script beliefs and defensive structures, and helping the client identify relational needs and opportunities for need fulfillment through enhancing the client’s capacity for internal and external contact.


The hungers for stimulus, structure, and relationship (recognition) are interwoven, interactive, and interdependent. They form the foundation for a transactional analysis theory of motivation. These three hungers operate as a dynamic motivational system. The satisfaction or lack of satisfaction of one of the hungers systemically affects the other two, either satisfying or potentiating the deficits in one or both of the others. When there is a deprivation of stimulus or relationship hunger, compensating structures of fragmented ego states, life scripts, and fixated patterns of defense emerge. A psychotherapy of contact-in-relationship responds to each of the client’s hungers. It is through a respectful, attuned, and healing relationship that people gain autonomy, spontaneity, and intimacy.


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Portions of this article were presented as a keynote speech, “A Transactional Analysis Theory of Methods,” and also as a workshop with Rebecca Trautmann, R.N., M.S.W., entitled “Inquiry, Attunement, and Involvement: The Application of Transactional Analysis Theory” at the 33rd Annual Conference of the International Transactional Analysis Association, San Francisco, California, August 11, 1995. The author gratefully acknowledges the members of the Professional Development Seminars of the Institute for Integrative Psychotherapy, New York, New York; Kent, Connecticut; Dayton, Ohio; Chicago, Illinois; and Indianapolis, Indiana, for their contributions in formulating the ideas in this article.

The Institute for Integrative Psychotherapy is approved by the American Psychological Association to sponsor continuing education for psychologists, by the National Board of Certified Counselors for counselors and by the American Board of Examiners in Pastoral Counseling for pastoral counselors. The Institute for Integrative Psychotherapy maintains responsibility for this program and its content.