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Methods of an Integrative Psychotherapy

Article  in  Transactional Analysis Journal · October 1996

DOI: 10.1177/036215379602600410

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Section 2. Theory and Methods

Methods of an Integrative Psychotherapy

Richard G. Erskine and Rebecca 1. Trautmann

Abstract cognitive, behavioral, physiological, and sys-

The concept of a contactful, interpersonal tems approaches to psychotherapy. A central
therapeutic relationship is the central prem- focus of an integrative psychotherapy is assess-
ise in the practice of integrative psychother- ing whether each of these domains-affective,
apy. Inquiry, attunement, and involvement behavioral, cognitive, and physiological-is
constitute the methods of a contact-oriented, open or closed to contact (internally and exter-
relationship-based psychotherapy. Eight re- nally) and applying methods that enhance con-
lational needs are defined, and reciprocal tact (Erskine, 1975, 1980, I982a). The concept
psychotherapeutic responses are described. of internal and external contact is used within a
The theoretical basis for an integrative perspective of human development in which
psychotherapy includes the concepts of ego each phase of life presents heightened develop-
states, transference, the script system, con- mental tasks, unique sensitivities in relationship
tact and interruptions to contact, and the with other people, and opportunities for new
significance of interpersonal relationships. learning. The term integrative psychotherapy, as
used in this article, includes both meanings.
Integrative psychotherapy takes into account
The term "integrative" as it is used in our many views of human functioning: psychody-
approach to integrative psychotherapy has a namic, client-centered, behaviorist, family ther-
number of meanings. Primarily it refers to the apy, Gestalt therapy, Reichian-influenced body
process of integrating the personality, which psychotherapy, object relations theories, and
includeshelping clients to become aware of and psychoanalytic self psychology in addition to
assimilate the contents of their fragmented and transactional analysis, which forms the main
fixated ego states into an integrated neopsychic basis of our theory and method. Each provides
ego, to develop a sense ofself that decreases the a valid explanation of psychological function
need for defense mechanisms and a life script, and behavior,and each is enhanced when selec-
and to reengagethe world and relationships with tively integrated with the others (Erskine &
full contact. It is the process of making whole: Moursund, 1988).
taking disowned, unaware, unresolved aspects
of the ego and making them part of a cohesive Contact and Relationships
self (Erskine & Trautmann, 1993). A major premise of integrative psychotherapy
"Integrative" also refers to the integration of is that the need for relationship constitutes a
theory-the bringing together of affective, primarymotivating experience of human behav-
ior, and contact is the means by which the need
is met. We especially emphasize the importance
The authors gratefully acknowledge the members of of contact in using the range of modalities just
the Professional Development Seminars of the Institute
for Integrative Psychotherapy, New York, NY; Kent, CT; mentioned. Contact occurs internally and exter-
Dayton, OH; Chicago,IL; and Vancouver, BC, Canada, nally: It involves the full awareness of sensa-
for theircontributions informing the ideas in this article, tions, feelings, needs, sensorimotor activity,
A special thank you to Steve Roberts, MS. w., and
thoughts, and memories that occur within the
Barbara Clark, Ph.D., for their clarification of ideas.
Portions of this article were presented as a keynote individual and a shift to full awareness of exter-
speech entitled, "A Transactional Analysis Theory of nal events as registered by each ofthe sensory
Methods, " and also as a workshop entitled, "Inquiry, organs. With internal and external contact,
Attunement, and Involvement: The Application of
experiences are continually integrated. When
Transactional Analysis Theory," at the 33rd Annual
Conference ofthe International Transactional Analysis contact is disrupted, however, needs are not
Association, San Francisco, CA, August II, 1995. satisfied. Ifthe experience of need arousal is not

316 Transactional Analysis Journal

 METHODS OF AN INTEGRATIVE PSYCHOTHERAPY

satisfied or closed naturally, it must find an The literature on human development also
artificialclosure that distracts from the discom- leads to the understanding that the sense of self
fort ofthe unmet need. These artificial closures and self-esteem emerge out of contact-in-rela-
are the substance of survival reactions and script tionship. From a theoretical foundation of
decisions that may become fixated. They are contact-in-relationship coupled with Berne's
evident in the disavowal of affect, habitual (1961) concept ofego states (particularly fixated
behavior patterns, neurological inhibitions Child ego states) (Erskine, 1987, 1988; Traut-
within the body, and the beliefs that limit spon- mann & Erskine, 1981) comes a natural focus
taneity and flexibility in problem solving and on child development. The works of Stem
relating to people. Each defensive interruption (1985, 1995) and Bowlby (1969, 1973, 1980)
to contact impedes awareness (Erskine, 1980; are presently influential in informing an integra-
Erskine & Trautmann, 1993). tive perspective, largelybecause of their empha-
Contactalso refers to the quality of the trans- sis on early attachment and the natural, lifelong
actions between two people: the awareness of need for relationship. Bowlby emphasized the
both one's selfand the other, a sensitive meeting significanceofearly as well as prolonged physi-
of the other, and an authentic acknowledgment cal bonding in the creation of a visceral core
of one's self. from which all experiences of self and other
Integrative psychotherapy correlates con- emerge. When such contact does not occur in
structs from many different theoretical schools. accordance with the child's relational needs,
For a theory to be integrative, as opposed to there is a physiological defense against the loss
merely eclectic, it must also separate out those of contact (Fraiberg, 1982).
concepts and ideas that are not theoretically Integrativepsychotherapy makes use of many
consistent to form a cohesive core of constructs perspectives on human functioning, but always
that inform and guide the psychotherapeutic from the point of view that the client-therapist
process. A review of the psychology and psy- relationship is crucial. The concepts of contact-
chotherapyliteraturereveals that the single most in-relationship, ego states and intrapsychic
consistent concept is that of relationship (Ers- function, transference and transactions, rela-
kine, 1989). From the inception of a theory of tional needs and affective reciprocity, and devel-
contact by Laura and Frederick Perls (Perls, opmental process and life script are central to
1944; Perls, Hefferline, & Goodman, 1951) to our integrative theory. The psychotherapist's
Rogers's (1951) focus on client-centered ther- self is used in a directed way to assist the cli-
apy, to Fairbairn's (1952) premise that people ent's process of developing and integrating
are relationship seeking from the beginning of contact and satisfying relational needs (Erskine,
and throughout life,to Sullivan's (1953) empha- 1982a). Of central significance is the process
sis on interpersonal contact, to Winnicott's called attunement, which involves not just a
(1965) and Guntrip's (1971) relationship theo- focus on discrete thoughts, feelings, behaviors,
ries and corresponding clinical applications, to or physical sensations, but also on what Stem
Berne's (1961, 1972) theories of ego states and (1985) termed "vitality affects" (p. 156). We
script,to Kohut(1971, 1977) and his followers' aim to create an experience of unbroken feeling-
application of "sustained empathic inquiry" connectedness. The client's sense of self and
(Stolorow, Brandchaft, & Atwood, 1987, p. 10), sense of relatednessthat develop seem crucial to
to the relationship theories developed by the the process ofintegrationand wholeness, partic-
Stone Center (Bergman, 1991; Miller, 1986; ularly when there have been specific, ego-frag-
Surrey, 1985), to Buber's (1923/1958) philoso- menting traumas in the client's life and when
phy of an l-Thou relationship, there has been a aspects of the self have been disavowed or
succession of teachers, writers, and therapists denied because of the cumulative failures of
who have emphasized that relationships-both contact-in-relationship (Erskine, 1991a, 1993,
in the early stages of life as well as throughout 1994).
adulthood-are the source of that which gives The central premise underlying the practice of
meaning and validation to the self. integrative psychotherapy is that integration can

Vol. 26, No.4, October /996 3/7

RICHARD G. ERSKINE AND REBECCA L. TRAUTMANN

occur through a varietyof modalities-affective, This type of inquiry requires a genuine inter-
behavioral, cognitive, and physiological (Ers- est in the client's subjective experiences and
kine, 1975, 1980)-but most effectively when construction of meanings. It proceeds with
there exists a respectful, contactful interpersonal questions about what the client is feeling, how
therapeutic relationship (Erskine, 1982a). he or she experiences both self and others
Inquiry,attunement, and involvement are sets of (includingthe psychotherapist), and what mean-
contact-facilitating, relationship-oriented meth- ings and conclusions are made. With sensitive
ods. Previous publications defined and de- questioning, our experience is that clients will
scribed the methods of inquiry, attunement, and reveal previouslyrepressed fantasies and out-of-
involvement (Erskine & Trautmann, 1993), awareness intrapsychic dynamics. This provides
applied the methodsto the treatment of dissocia- both the client and the therapist with an ever-
tion (Erskine, 1991a, 1993) and shame and self- increasing understanding of who the client is,
righteousness (Erskine, 1994), and demon- the experienceshe or she has had, and when and
strated the application through actual therapy how he or she interrupts contact.
transcripts (Erskine, 1982b, 1991b; Erskine & Therapeutic inquiry about the client's fears,
Moursund, 1988). What follows is an outline of anticipations, and expectations often reveals the
some of the methods that foster contact-in- transferring of historical experiences, archaic
relationship. defenses, and past relational disruptions into
current life, including the therapy relationship.
Inquiry Transferencewithin this integrative perspective
Inquiry begins with the assumption that the can be viewed as:
therapist knows nothing about the client's 1. the means whereby the client can describe
experience and therefore must continually strive his or her past, the developmental needs that
to understand the subjective meaning of the have been thwarted, and the defenses that were
client's behavior and intrapsychic process. The created to compensate;
process of inquiry involves the therapist being 2. the resistance to remembering and, para-
open to discovering the client's perspective doxically, an unaware enactment of childhood
while the client simultaneously discovers his or experiences (the repeated relationship);
her sense of self with each of the therapist's 3. the expression of an intrapsychic conflict
awareness-enhancing statements or questions. and the desire to achieve the satisfaction of
Through respectful exploration of the client's relational needs and intimacy in relationships
phenomenological experience, the client be- (the therapeutically needed relationship); or
comes increasingly aware of both current and 4. the expression of the universal psycho-
archaic relational needs, feelings, and behavior. logical striving to organize experience and
Affect, thoughts, fantasy, script beliefs, body create meaning.
movements or tensions, hopes, and memories This integrative view of transference provides
that have been kept from awareness by lack of the basis for a continual honoring of the inherent
dialogue or by repression may come to aware- communication in transference of both the
ness. With increased awareness and the nonac- repeated and the needed relationship (Stern,
tivation of internal defenses, needs and feelings 1994), as well as recognition of and respect for
that may have been fixated and left unresolved the fact that transactions may be nontrans-
due to past experiences are integrated into a ferential and may have to do only with the here-
more contactful self. and-now relationship between therapist and
It should be stressed that the process of in- client (Erskine, 1991c).
quiring is as important, if not more so, than the Inquiry may include an exploration of intra-
content. The therapist's inquiry must be em- psychic conflicts and unaware enactments of
pathic with the client's subjective experience to childhoodexperiencesand continue with histori-
be effective in discovering and revealing the cal questionsas to when an experience occurred
internal phenomena and in uncovering the and the nature of the significant relationships in
internal and external interruptions to contact. the person's life. Through inquiry we explore

318 Transactional Analysis Journal

 METHODS OF AN INTEGRATIVE PSYCHOTHERAPY

the client's script beliefs and related behaviors, the client to effectively transfer these intrapsy-
fantasies, and reinforcing experiences (Erskine chic functions to the relationship with the
& Zalcman, 1979). In accordance with the therapist. In what follows we will refer to the
client's welfare, we integrate Gestalt therapy classifications shown in Figure 1.
experiments, behavioral change contracts,
body psychotherapy, intensive Parent ego
state psychotherapy, or developmental regres-
sion (Erskine & Moursund, 1988). Through a
combination of these techniques for enhancing
self-awareness and through our respectful
inquiry, experiences that in the past were neces-
sarily excluded from awareness can again be
~I-----+---+------\~
PHENOMENOLOGICAL EXISTENCE
remembered in the context of an involved thera-
peutic relationship. With memories, fantasies, or

~
TRANSFERENTIAL SlCNlFlCANCE
dreams coming to awareness, the therapist's
inquiry may return to the client's phenom-
enological experience or proceed to the client's
i
?j
strategies of coping, that is, to an inquiry about
the defensive internal and external interruptions
to contact.
As we explore defensive processes we make 0
use of observable, external interruptions to A
E
V
R
R E
contact as representative of internal interrup- H
F E
IN
F l
Y
tions to contact. Archaically fixated defensive T
E 0 A E
T E
C P
H 1
interruptions to contact-for example, intro- M
T M 0
I
I E ~5
jections and script beliefs-interfere with the C
V N A
E T
satisfaction of today's relational needs and A
L
l
emerge in the therapeutic relationship.
To be vulnerable is to be highly aware of ATrUNEMENT
relational needs and to be open, without de-
fenses, to the other's response to those needs. Figure 1
Inquiring about vulnerabilities both outside of Methods of an Integrative Psychotherapy
and in the therapeutic relationship uncovers
relational needs and the effects within the client
of both the satisfaction or nonsatisfaction of It is essential that the therapist understand
those needs. The focus of the therapeutic dia- each client's unique need for a stabilizing,
logue may then cycle to phenomenological, validating, and reparative other person to take
transferential, or defensive levels of experience. on some of the relationship functions that the
The process of inquiryis not linear but moves in client is attempting to manage alone. A contact-
harmonywith the client's ever-increasing inter- oriented relationship therapy requires that the
nal awarenessand awareness of self-in-relation- therapist be attuned to these relationship needs
ship. and be involved,through empathic validation of
The goal of therapeutic inquiry is for the feelings and needs and by providing safety and
client and therapist together to discover and support.
distinguish the functions of intrapsychic pro- A contactful inquiry about a client's
cesses and defensive dynamics. Each defensive phenomenological experience enhances the
dynamic has unique intrapsychic functions of client's sense of self through facilitating the
identity, stability, continuity, and integrity that client's awareness of the existence of feelings,
require specificemphasis in psychotherapy. Our fantasies, internal sensations, and thought pro-
thesis is that attunement and involvement allow cesses as well as the existence of interruptions

Vol. 26, No.4, October /996 319

RICHARD G. ERSKINEAND REBECCA L. TRAUTMANN

to contact. A patient, nonhumiliating inquiry into The communication of attunement validates

the client's transferential dynamics reveals the the client's needs and feelings and lays the
significance of the internal and external inter- foundation for repairing the failures of previous
ruptions to contact, how the person organizes relationships. Attunement is communicated not
experience, and the significance of both the only by what the therapist says, but also by facial
repeated and the therapeutically needed relation- or body movements that signal to the client that
ship. The needed relationship is the client's call his or her affect and needs are perceived, are
for the reciprocal involvement by an essential significant, and make an impact on the therapist.
other who can respond to relational needs. A Attunement is often experienced by the client
respectful inquiry about the client's defensive as the therapist gently moving through the
process-his or her means of coping-reveals defenses that have prevented the awareness of
the client's integrity and unique style of resolv- relationship failures and the related needs and
ing disruptions in relationship. This level of feelings. Attunement facilitates contact with
inquiry also brings to the client's awareness long-forgotten parts of Child ego states. Over
other avenues of coping with relational disrup- time this results in a lessening of internal inter-
tions and new possibilities for resolving inter- ruptions to contact and a corresponding dissolv-
personal conflicts. A sensitive inquiry about the ing ofexternal defenses. Needs and feelings can
client's vulnerabilities and his or her unique increasingly be expressed with comfort and
combination of relational needs increases the assurance that they will receive an empathic and
client's value of self (see Figure I). In the caring response. Frequently the process of
presence ofan attuned, involved, and self-aware attunement provides a sense of safety and stabil-
therapist who can respond to those relational ity that enables the client to begin to remember
needs, the client will feel a stronger, clearer and to endure regressing into childhood experi-
sense ofselfand self-in-relationship. Psycholog- ences that may bring a fuller awareness of the
ical well-being is enhanced through full inter- pain of past traumas, past failures of relation-
personal and intrapsychic contact. ship(s), and loss of aspects of self. The process
of attunement can be categorized according to
Attunement the resonance and reciprocity required for
Attunement is a two-part process: It begins contact-in-relationship. This attunement may be
with empathy-that is, being sensitive to and to rhythm, level ofdevelopment, nature of affect,
identifying with the other person's sensations, or relational need.
needs, or feelings-and the communication of Rhythmic attunement is the pacing of the
that sensitivity to the other person. More than therapeutic inquiry and involvement at a tempo
just understanding or vicarious introspection, and cadence that best facilitates the client's
attunement is a kinesthetic and emotional sens- processing of both external information and
ing of the other-knowing his or her rhythm, internal sensations, feelings, and thoughts. In
affect, and experience by metaphorically being our experience the mental processing of affect
in his or her skin, thus going beyond empathy to often occurs at a rate different from cognitive
provide a reciprocal affect and/or resonating processing. In the presence of intense affect the
response. Attunement is more than empathy: It use of perception or cognition may be slower
is a process ofcommunion and unity of interper- than when affect is not intense. For example, the
sonal contact. Effective attunement also requires compounded affective components of shame
that the therapist simultaneously remain aware often make the processing of information and
of the boundary between client and therapist as the organizing ofbehavior occur at a diminished
well as his or her own internal processes. rate. Shame is a complex process involving the
Attunement is facilitated by the therapist's disavowal and retroflection of anger, the sadness
capacity to anticipate and observe the effects of of not being accepted as one is, the fear of
his or her behavior on the client and to decenter rejection because of who one is, and confluence
from his or her own experience to extensively and compliance with the relationship-interrupt-
focus on the client's process. ing humiliation (Erskine, 1994). The affective,

320 Transactional Analysis Journal

 METHODSOF AN INTEGRATIVE PSYCHOTHERAPY

perceptual, cognitive, behavioral, and physio- functioning and organization of experiences is

logical reactions occur at differing rhythms than essential in a contact-oriented, relationship-
would otherwise occur in the absence of shame. centered psychotherapy. The purpose of the
Some clients are quickly aware of visceral and developmental focus is to respond to the client
kinesthetic sensations while others process them at the age level at which there was a lack of
slowly. Internal interruptions to contact or any of contact-in-relationship, when fixations occurred
thecomplex psychological defenses such as desen- in the representationalsystem of self, others, and
sitizadon, disavowal, denial, or dissociationdisrupt the quality of life. The script beliefs and related
the natural rhythm of processing physical sensa- archaic defenses represent attempts of a younger
tions, affects, perceptions,and thoughts. person to cope with life situations.
Affective attunement refers to one person To attune to a client's developmental needs,
sensingthe other's affect and responding with a the therapist listenswith a "third ear" or watches
reciprocalaffect. It begins with valuing the other with a "third eye" the words and behaviors of
person's affect as an extremely important form the client in the moment to sense what may be
of human communication, being willing to be the communication of a child. Often based on
affectively aroused by the other person, and the age when a particular trauma occurred or
responding with the resonating affect. when a script decision or survival reaction was
"Affect is transactional-relational in its made, the therapist begins to develop a sensitiv-
nature, requiring a corresponding affect in ity for the Child ego states as they are uncon-
resonance" (Erskine, 1994, p. 99). The reso- sciously manifested in current transactions.
nance of one person's affect to another's pro- Having a sense of this child and its needs, its
vides affective contact that is essential to human developmental challenges, ways of thinking and
relationships. Symbolically, affective attunement organizing, unique vulnerabilities, and relation-
may be pictured as one person's yin to the ship needs guides the therapist in the way he or
other's yang, which together form a unity. she may inquire, interpret, or interact with the
Affective attunement is the resonance with the client.
other's affect that provides nonverbal interper- As an example, in response to a client who
sonal contact-a unity in the relationship. was expressing frustration at her inadequacy in
When a client feels sad, the therapist's recip- finding ways to talk about her feelings, the
rocal affect of compassion and his or her acts of therapist commented that learning to use lan-
compassion complete the interpersonal contact. guage brings a child two different experiences.
Relationally, anger requires the reciprocal On the one hand, words allow for increased
affects related to attentiveness, seriousness, and communication and understanding, which is
responsibility, with possible acts ofcorrection. gratifyingand fosters closeness. On the other, as
The client who is afraid requires that the thera- the child experiences that words do not ade-
pist respond with affect and action that conveys quately convey feelings or experiences, there is
security and protection. When clients express a greater sense of separateness and sometimes
joy the response from the therapist that com- aloneness (Stem, 1985). The tears in the client's
pletes the unityofcontact is the reciprocal affect eyes conveyed that the therapist had understood
of vitality and expression of pleasure. her developmental frustration and at least one
Affective attunement involvesnonverbal com- significant aspect of her lifelong difficulty with
munication from the therapist that acknowl- relationships-that unspoken experience of
edges, validates, and normalizes the client's aloneness.
affect. The therapist's affective presence com- Attunernent to the developmental level is
municates that affect has an important function easiest when the client enters a regressed state
in relationship and thereby values the c1ient-a or is able to describe his or her Child ego state
communicationof unconditional positive regard experiences. A subtler, and sometimes more
or "You're OK with me." powerful experience occurs when the therapist
Developmental attunement. Attunement to is attuned to the client's developmental needs,
the client's developmentallevel of psychological level of functioning, and childhood experiences

Vol. 26. No.4. October 1996 321

RICHARD G. ERSKINE AND REBECCA L. TRAUTMANN

while the client is completely unaware of them. pressing need to recede to ground and another
For example, with a client who grew up anx- relational need to become figure as a new inter-
iouslytrying to please his separated parents and est or desire.
who used compulsive checking to ward off Often it is in the absence of need satisfaction
anxiety, it seemed important not to make an that an individual becomes most aware of the
issueofhis consistent lateness until he was able presence of relational needs. When relational
to identify and express his anger at his parents. needs are not satisfied the need becomes more
Near the end of the therapy he talked about how intense and is phenomenologically experienced
significant it was to him that the therapist never as longing, emptiness, a nagging loneliness, or
confronted his lateness, making his therapy a an intense urge often accompanied by nervous-
place of safety in which he could be free of his ness. The continued absence of satisfaction of
compulsions. relational needs may be manifested as frustra-
By being attuned to the archaic level of a tion, aggression, or anger. When disruptions in
person's functioning and placing it directly in relationship are prolonged, the lack of need
the context of the therapeutic relationship, the satisfaction is manifested as a loss of energy or
therapist makes it possible for fixed ways of hope and shows up in script beliefs such as "No
being and relating to be integrated into a more one is there for me" or "What's the use?" These
dynamic whole. script beliefs are the cognitive defense against
Relational needs. The process ofattunement the awareness of needs and the feelings that
also includes responding to relational needs as occur when needs do not get a satisfying re-
they emerge in the therapeutic relationship. sponse from another person (Erskine, 1980).
Relational needs are the needs unique to inter- The satisfaction of relational needs requires
personal contact (Erskine, 1995). They are not the contactful presence of another who is sensi-
the basic needs of life-such as food, air, or tive and attuned to the relational needs and who
proper temperature-but the essential elements also provides a reciprocal response to each
that enhance the quality of life and a sense of need. The eight principal relational needs that
self-in-relationship. Relational needs are the we observe are the needs for:
componentparts ofa universal human desire for I. Security: the visceralexperience of having
intimate relationship. Although there may be a our physical and emotional vulnerabilities
large number of relational needs, the eight that protected.This involves the experience that our
we describe in this article represent those needs variety of needs and feelings are natural. Secu-
that our clients most frequently describe as they rity is a sense of simultaneously being vulnera-
talk about significant relationships. Some of ble and in harmony with another. It includes the
these relational needs have also been described absence of both actual or anticipated impinge-
in the psychotherapy literature as fixated needs ment or danger.
of early childhood, indicators of psychopathol- Attunement involves the empathic awareness
ogy, or problematic transference (Bach, 1985; of the other's need for security within the rela-
Basch, 1988; Kohut, 1971, 1977; Wolf, 1988), tionship plus a reciprocal response to that need.
while Clark's (1991) integrative perspective on The needed response is the provision of physical
empathic transactions bridges the concepts of and affective security in which the individual's
transference and relational needs. vulnerability is honored and preserved. It com-
Relational needs are not only needs of child- municates, often nonverbally, "Your needs and
hood or needs that emerge in a developmental feelings are normal and acceptable to me."
hierarchy; they are components of relationship Therapeuticattunementto the relational need for
that are present every day of our lives. Each of security has been described by clients as "total
the eight relational needs may become figure or acceptance and protection," a communication of
conscious as a longing or desire while the other "unconditional positive regard" or "I'm OK in
seven remain out of consciousness or as back- this relationship." Attunement to the need for
ground. A satisfying response by another person securityinvolves the therapist being sensitive to
to an individual's relational need allows the the importance of this need and conducting

322 Transactional Analysis Journal

 METHODS OF AN INTEGRATIVE PSYCHOTHERAPY

himself or herself both emotionally and behav- importance and necessity of idealizing as an
iorally in a way that provides security in the unaware request for intrapsychic protection.
relationship. Such a therapeutic involvement includes both
2. Validation, affirmation, and significance the client's sense of the psychotherapist's inter-
withina relationship: the need to have the other est in the client's welfare and the use of the
person validate the significance and function of therapist's integrated sense of self as the most
our intrapsychic processes of affect, fantasy, and effective therapeutic tool (Erskine, 1982a). This
constructing of meaning and to validate that our relational need to be accepted by a stable, de-
emotions are a significant intrapsychic and pendable, and protective other person provides
interpersonal communication. It includes the a client-centeredreason to conduct our lives and
need to have all of our relational needs affirmed psychotherapy practices ethically and morally.
and acceptedas natural. The therapist's affective 4. Confirmation of personal experience:
reciprocity with the client's feelings validates The need to have experience confirmed is mani-
the client's affect and provides affirmation and fested through the desire to be in the presence of
normalization of the client's relational needs. someone who is similar, who understands be-
3. Acceptance by a stable, dependable, and cause he or she has had a like experience, and
protective other person: the need to look up to whose shared experience is confirming. Attune-
and rely on parents, elders, teachers, and men- ment is provided by the therapist valuing the
tors. The relational need for acceptance by a need for confirmation by revealing carefully
consistent, reliable, dependable other person is selected personal experiences-mindfully (i.e.,
the search for protection and guidance and may client-focused) sharing vulnerabilities or similar
manifest as an idealization of the other. In psy- feelings and fantasies-and by being personally
chotherapy such idealization is also the search present and vital.
for protection from a controlling, humiliating For example, affirmation of the client's expe-
Parent ego state's intrapsychic effect on the rience may include the therapist joining in or
vulnerability of Child ego states. It can also be valuingthe client's fantasies. Rather than define
the search for protection from one's own escala- a client's internalstorytelling as 'just a fantasy,"
tion of affect or exaggeration of fantasies. it is essential to engage the client in the expres-
The therapist protects and facilitates integra- sion of the needs, hopes, relational conflicts, and
tion of affect by providing an opportunity to protectivestrategies that may constitute the core
express, contain, and/or understand the function of the fantasies. Attunement to the need for
of such dynamics. The degree to which an indi- affirmation of experience may be achieved by
vidual looks to someone and hopes that he or the therapist accepting everything said by the
she is reliable, consistent, and dependable is di- client, even when fantasy and reality are inter-
rectly proportional to the quest for intrapsychic twined, much like the telling of a dream reveals
protection, safe expression, containment, or the intrapsychic process. Fantasy images or
beneficial insight. Idealizing or depending on symbols have a significant intrapsychic and
someone is not necessarily pathological as im- interpersonal function. When the function ofthe
plied in the popular psychology term, "codepen- fantasy is acknowledged, appreciated, and
dent," or when misinterpreted as "idealizing valued, the person feels affirmed in his or her
transference" (Kohut, 1977), or as Berne's experience.
game of "Gee, You're Wonderful, Professor!" The client who needs confirmation of personal
(1964). When we refer to some clients' expres- experiencerequires a uniquely different recipro-
sions of this need to be accepted and protected cal response from the client who needs valida-
as "a Victim looking for a Rescuer," we poten- tion of affect or who needs to be accepted by a
tiallydepreciate or even pathologize an essential dependable and protective other. In neither of
human need for relationship that provides a the latter two relational needs is the sharing of
sense of stability, reliability, and dependability. personal experience or the creating of an atmo-
In psychotherapy, attunement involves the sphere of mutuality an attuned response to the
therapist's recognition, often unspoken, of the client's need.

Vol. 26, No. 4, October /996 323

RICHARD G. ERSKINE AND REBECCAL. TRAUTMANN

5. Self-definition: the relational need to The psychotherapist may be subject to a

know and express one's own uniqueness and to theory-induced countertransference when he or
receive acknowledgment and acceptance by the she universally applies the methodological
other. Self-definition is the communication of concepts of nongratification, Rescuing, or self-
one's self-chosen identity through the expres- responsibility. While waiting for the client to
sion of preferences, interests, and ideas without initiate, the psychotherapist may not be account-
humiliation or rejection. ing for the fact that some behavior that appears
In the absence of satisfying acknowledgment passive may actually be an expression of the
and acceptance,the expression of self-definition relational need to have the other initiate.
may take unconscious adversarial forms such as To respond to the client's need it may be
the person who begins sentences with "No, ..." necessaryfor the therapist to initiate a dialogue,
even when agreeing, or who constantly engages to move out of his or her chair and sit near the
in arguments or competition. People often client, or to make a phone call to the client
compete to define themselves as distinct from between sessions.The therapist's willingness to
others in order to maintain a sense of their own initiateinterpersonal contact or to take responsi-
integrity. The more alike people are the greater bility for a major share of the therapeutic work
the thrust for self-defining competition. normalizes the client's relational need to have
Therapeutic attunement occurs in the thera- someone else reach out to him or her.
pist's consistent support for the client's expres- 8. The need to express love: Love is often
sion of identity and his or her normalization of expressed through quiet gratitude, thankfulness,
the need for self-definition. It requires the thera- giving affection, or doing something for the
pist's consistent presence, contactfulness, and other person. The importance of the relational
respect even in the face of disagreement. need to give love-whether it be from children
6. The need to have an impact on the other to parents, sibling, or teacher, or from client to
person: Impactrefersto having an influence that therapist-is often overlooked in the practice of
affectsthe other in some desired way. An individ- psychotherapy. When the expression of love is
ual's sense of competency in a relationship stymied,the expression of self-in-relationship is
emerges from agency and efficacy-attracting thwarted. Too often psychotherapists have
the other's attention and interest, influencing treated clients' expression of affection as manip-
what may be of interest to the other person, and ulation, transference, or a violation of a neutral
effecting a change of affect or behavior in the therapeutic boundary.
other. Those clients for whom the absence of satis-
Attunement to the client's need to have an faction of relational needs is cumulative require
impact occurs when the psychotherapist allows a consistent and dependable attunement and
himselfor herself to be emotionally impacted by involvement by the psychotherapist that ac-
the client and to respond with compassion when knowledges, validates, and normalizes relational
the client is sad, to provide an affect of security needs and relatedaffect. It is through the psycho-
when the client is scared, to take the client therapist's sustainedcontactful presence that the
seriously when he or she is angry, and to be cumulative trauma (Khan, 1963) of the lack of
excited when the client is joyful. Attunement need satisfaction can be addressed and the needs
may include soliciting the client's criticism of respondedto withinthe therapeutic relationship.
the therapist's behavior and making the neces-
sary changes so the client has a sense of impact Involvement
within the therapeutic relationship. Therapeutic involvement that includes ac-
7. The need to have the other initiate: Initia- knowledgment, validation, normalization, and
tion refers to the impetus for making interper- presence diminishes internal defensive pro-
sonal contact with another person. It is the cesses. The therapist's acknowledgment of the
reaching out to the other in some way that client begins with an attunement to the client's
acknowledges and validates the importance of affect, relational needs, rhythm, and develop-
him or her in the relationship. mental level of functioning. Through sensitivity

324 Transactional Analysis Journal

 METHODS OF AN INTEGRATIVE PSYCHOTHERAPY

to relational needs or physiological expression and transferential communication ofthe needed

ofemotions the therapist can guide the client to relationship, thereby increasing self-esteem.
become aware of and to express needs and The intent of normalization is to change the
feelings or to acknowledge that feelings or way clients or others categorize or define their
physical sensations may be memory-the only internal experience or their behavioral attempts
way of remembering that may be available. In at coping from a pathological or "something's-
many cases of relationship failure the person's wrong-with-me" perspective to one that respects
relational needs or feelings were not acknowl- archaic attempts at resolution of conflicts. It may
edged, and it may be necessary in psychotherapy be essential for the therapist to counter societal
to heIp the person gain a vocabulary and learn to or parental messages such as "You're stupid for
voice those feelings and needs. Acknowledg- feeling scared" with "Anyone would be scared
ment of physical sensations, relational needs, in that situation." Many flashbacks, bizarre
and affect helps the client claim his or her fantasies, and nightmares as well as much confu-
own phenomenological experience. It in- sion, panic, and defensiveness are normal cop-
cludes a receptive other who knows and ing phenomena in abnormal situations. It is
communicates about the existence ofnonver- imperative that the therapist communicate that
bal movements, tensing ofmuscles, affect, or the client's experience is a normal defensive
even fantasy. reaction-a reaction that many people would
Occasionally, selectively chosen, caring con- have if they encountered similar life experi-
frontations are also a part of acknowledgment. ences.
Confrontation is a statement or question used by Presence is provided through the psycho-
the therapist to bring into the client's awareness therapist's sustained, attuned responses to both
a discrepancy between his or her perceptions verbal and nonverbal expressions of the client.
and behaviors or between script beliefs and It occurs when the behavior and communication
actual events (Erskine, 1982b, 1991 b). The goal of the psychotherapist at all times respect and
of confrontation is for both client and therapist enhance the client's integrity. Presence includes
to acknowledge the existence and then the the therapist's receptivity to clients' affect-to
significance of behaviors, interruptions to con- be impacted by their emotions, to be moved and
tact, or script beliefs. The usefulness of the yet to stay responsive to the impact of their
confrontation is related to the client's discover- emotions and not to become anxious, depressed,
ing the psychological/unction of the behavior or angry. Presence is an expression of the psy-
or defensive reaction and the therapist's valida- chotherapist's full internal and external contact.
tion of its archaic significance. Confrontations It communicates the psychotherapist's responsi-
are only effective if done respectfully and with- bility, dependability, and reliability. Through the
out humiliation so that the client experiences his therapist's full presence, the transformative
or her welfare being enhanced. potential of a relationship-oriented psychother-
There may have been times in a client's life apy is possible. Presence describes the thera-
when feelings or relational needs were a- pist's providing a safe interpersonal connection.
cknowledged but not validated. Validation More than just verbal communication, presence
communicates to the client that his or her affect, is a communion between client and therapist.
defenses, physical sensations, or behavioral Presence is enhanced when the therapist
patterns are related to something significant in decenters from his or her own needs, feelings,
his or her experience. Validation makes a link fantasies, or hopes and centers instead on the
between cause and effect; it values the individ- client's process. Presence also includes the
ual's idiosyncrasies and way of being in rela- converse of decentering, that is, being fully
tionship. It diminishes the possibility of the contactful with his or her own internal process
client internally disavowing or denying the and reactions. The therapist's history, relational
significance of affect, physical sensation, mem- needs, sensitivities, theories, professional expe-
ory, or dreams. And it supports the client in rience, own psychotherapy, and reading interests
valuing his or her phenomenological experience all shape unique reactions to the client. Presence

Vol. 26, No.4, October 1996 325

RICHARD G. ERSKINE AND REBECCA L. TRAUTMANN

involves both bringing the richness ofthe thera- client's emotional memories may indicate that
pist's experiences to the therapeutic relationship the psychotherapist is pacing the therapy faster
as well as decentering from the self of the thera- than the client can integrate the experience. In
pist and centering on the client's process. cases ofphysical and sexual abuse or cumulative
Presence also includes allowing oneself to be trauma from prolonged misattunements to affect
manipulated and shaped by the client in a way and relational needs, the client's reactions to
that provides for the client's self-expression. As juxtaposition may also indicate that the intensity
effective psychotherapists we are played with of the therapeutic involvement is too great and
and genuinely become the clay that is molded does not allow for a sense of safety. The reaction
and shaped to fit the client's expression of his or to juxtaposition occurs when the client's coping
her intrapsychic world toward the creation of a or defensive system is relaxed and the self-
new sense of self and self-in-relationship protective functions are transferred to the thera-
(Winnicott, 1965). peutic relationship faster than the homeostatic
The therapist's involvement through transac- process allows. The therapist's sensitive in-
tions that acknowledge, validate, and normalize volvement is in the continual adjustment ofthe
the client's phenomenological experience, sys- rhythmic and affective attunement, the quality of
tem oforganization, and integrity is the antidote responsiveness to relational needs, and a respect
to the toxicity of discounting the existence, for the homeostatic function of the client's
significance, or responsibility for resolving coping style and integrity.
disruptions of contact-in-relationship. The de-
pendable, attuned presence of the therapist Summary
counters the client's discounting of his or her A contact-oriented relationship psychotherapy
self-worth (Erskine, 1994). that centers on inquiry, attunement, and involve-
ment responds to the client's current needs for
Juxtaposition an emotionally nurturing relationship that is
The psychotherapist who is involved and re- reparative and sustaining. The aim of this kind
sponsive to the therapeutical1y needed relation- of therapy is the integration of affect-laden
ship may stimulate a reaction in the client to the experiences and fragmented states of the ego
juxtaposition between the attuned contact of- and an intrapsychic reorganization of the client's
fered by the therapist and the emotional memo- fixated script beliefs about self, others, and the
ries of previous misattunements (Erskine, quality oflife.
1991 a, 1993). The juxtaposition is in the con- Contact facilitates the dissolving of defenses
trast between what is provided in the therapy, and the integration of the disowned parts of the
such as the attuned, reciprocal responsiveness of personality. Through contact, the disowned,
the therapeutic relationship, and what was unaware, unresolved experiences are made part
previously needed, longed for, and not experi- of a cohesive self. In integrative psychotherapy
enced. It represents a chal1enge to the client's the concept of contact is the central focus from
script system and psychological homeostasis which clinical interventions are derived. Trans-
(Bary & Hufford, 1990). The juxtaposition stim- ference, ego state regression, activation of the
ulates emotional memories that the client may intrapsychic influence of introjection, and the
then try to push out of consciousness. Oftenjux- presence of defense mechanisms and script
taposition is manifested by pushing the therapist beliefs are al1 understood as indications of
~ after a close encounter, fmding fault with the previous contact and relationship deficits. Full
therapist for focusing on the client's "neediness," intrapsychic and interpersonal contact becomes
or coming late or cancelling a session following possible when a client experiences that the
one in which the client allowed himselfor herself therapist (l) stays attuned to the client's rhythm,
to depend on the therapist's affective reciprocity or affect, and needs; (2) is sensitive to the client's
responsiveness to relational needs. psychological functioning at the relevant devel-
Such a reaction to the juxtaposition between opmental ages; (3) respects each interruption to
the attuned involvement ofthe therapist and the contact and self-protective defense; and (4) is

326 Transactional Analysis Journal

 METHODS OF AN INTEGRATIVE PSYCHOTHERAPY

interested in understanding the client's way of Berne, E. (1961). Transactional analysis in psychother-
apy: A systematic individual and social psychiatry.
constructing meaning.
New York: Grove Press.
The four dimensions of human function- Berne, E. (1964). Games people play: The psychology of
ing-affective, behavioral, cognitive, and human relationships. New York: Grove Press.
physiological-are an important guide in deter- Berne, E. (1972). What do you say after you say hello":
The psychology of human destiny. New York: Grove
mining where someone is open or closed to Press.
contact and therefore to therapeutic support. A Bowlby, J. (1969). Attachment. Volume I of Attachment
majorgoal of integrative psychotherapy is to use and loss. New York: Basic Books.
the therapist-client relationship-the ability to Bowlby,1. (1973). Separation: Anxiety and anger. Volume
II ofAttachment and loss. New York: Basic Books.
create contact in the present-as a stepping- Bowlby,J. (1980). Loss: Sadness and depression. Volume
stone to satisfying relationships with other III ofAttachment and loss. New York: Basic Books.
people and a unified, fulfilled sense of self. Buber, M. (1958). I and thou (R. G. Smith, Trans.). New
A guiding principle of this contact-oriented, York: Scribner. (Original work published 1923)
Clark, B. D. (1991). Empathic transactions in the decon-
interactive psychotherapy is respect for the fusion of child ego states. Transactional Analysis
integrity of the client. Through respect, kind- Journal, 21, 92-98.
ness, compassion, and maintaining contact we Erskine, R. G. (1975). The ABC's of effective psychother-
apy. Transactional Analysis Journal, 5, 163-165.
establish a personal presence and allow for an
Erskine,R. G. (1980). Script cure: Behavioral, intrapsychic
interpersonal relationship that provides affirma- and physiological. Transactional Analysis Journal, 10,
tion of the client's integrity. The methods that 102-106.
ease intrapsychic conflict, facilitate script cure, Erskine, R. G. (I 982a). Supervision of psychotherapy:
Models for professional development. Transactional
resolve transference, and promote the integra- Analysis Journal, 12, 314-321.
tion of a fragmented ego are based on the belief Erskine, R. G. (I 982b ). Transactional analysis and family
that healing occurs primarily through the inter- therapy. In A. M. Home & M. M. Ohlsen and contribu-
tors, Family counseling and therapy (pp. 245-275).
personal contact of a therapeutic relationship.
Itasca, IL: F. E. Peacock Publishers.
With integration it becomes possible for the Erskine, R.G. (1987).A structural analysisofego: Eric Berne's
person to face each moment with spontaneity contribution to the theory of psychotherapy. In Keynote
and flexibility in solving life's problems and in speeches: Delivered at the EATA conference, July, 1986,
Noordwikerhout, The Netherlands. Geneva, Switzerland:
relating to people.
EuropeanAssociationfor TransactionalAnalysis.
Erskine, R. G. (1988). Ego structure, intrapsychic function,
and defense mechanisms: A commentary on Eric Berne's
Richard G. Erskine, Ph.D., and Rebecca L. original theoretical concepts. Transactional Analysis
Trautmann, R.N., MS. W, are directors ofthe Journal, 18, 15-19.
Institutefor Integrative Psychotherapy in New Erskine,R. G. (1989). A relationship therapy: Developmen-
YorkCity. Theyare both Clinical Teaching and tal perspectives. In B. R. Loria (Ed.), Developmental
theoriesand the clinical process: Conference proceed-
Supervising Transactional Analysts. Please ings of the Eastern Regional Transactional Analysis
send requests for reprints to Richard G. Ers- Conference (pp. 123-135). Madison, WI: Omnipress.
kine, Institute for Integrative Psychotherapy, Erskine, R. G. (I99Ia). The psychotherapy of dissociation:
Inquiry, attunement and involvement. In B. R. Loria
500 E. 85th Street, New York, NY /0028, U.S.A. (Ed.), The Stamford papers: Selections from the 29'"
Phone: 212-734-5291; Fax: 212-879-6618; Annual International Transactional Analysis Associa-
E-mail: [email protected]. tion Conference (pp. 53-58). Madison, WI: Omnipress.
Erskine, R. G. (I99Ib). Transactional analysis and family
therapy.In A. M. Horne & 1. L. Passmore & contributors,
REFERENCES Familycounselingand therapy (2nd ed.) (pp. 498-529).
Bach, S. (1985). Narcissistic states and the therapeutic Itasca, IL: F. E. Peacock Publishers.
process. New York: Jason Aronson. Erskine, R. G. (1991 c). Transference and transactions:
Bary, B. B., & Hufford, F. M. (1990). The six advantages Critiquefroman intrapsychic and integrative perspective.
to games and their use in treatment. Transactional Transactional Analysis Journal, 21, 63-76.
Analysis Journal, 20, 214-220. Erskine, R. G. (1993). Inquiry, attunement, and involve-
Basch, M. F. (1988). Understanding psychotherapy: The ment in the psychotherapyof dissociation. Transactional
science behind the art. New York: Basic Books. Analysis Journal, 23, 184-190.
Bergman,S. 1. (1991). Men's psychological development: Erskine, R. G. (1994). Shame and self-righteousness:
A relationship perspective. Works in progress, No. 48. Transactional analysis perspectives and clinical interven-
Wellesley, MA: The Stone Center, Wellesley College. tions. Transactional Analysis Journal, 24, 86-102.

Vol. 26, No.4, October 1996 327

RICHARD G. ERSKINE AND REBECCA L. TRAUTMANN

Erskine, R. G. (1995, August). A transactional analysis Perls, F. S. (1944). Ego, hunger and aggression: A revi-
theory ofmethods. Keynote speech presented at the 33'· sion ofFreud's theory and method. Durban, RSA: Knox
Annual Conference of the International Transactional Publishing.
AnalysisAssociation, San Francisco, CA. (Also available Perls, F. S., Hefferline, R. F., & Goodman, P. (1951).
as a cassetterecording[KN-2] from Repeat Performance, Gestalt therapy: Excitement and growth in the human
Hobart, IN.) personality. New York: Julian Press.
Erskine, R. G., & Moursund, J. P. (1988). Integrative Rogers,C. R. (1951). Client-centered therapy: Its current
psychotherapy in action. Newbury Park, CA: Sage practice, implications, and theory. Boston: Houghton
Publications. Mifflin.
Erskine, R. G., & Trautmann, R. L. (1993). The process of Stern,D. N. (1985). The interpersonal world ofthe infant:
integrative psychotherapy. In 8. R. Loria (Ed.), The A view from psychoanalysis and developmental psy-
boardwalk papers: Selections from the 1993 Eastern chology. New York: Basic Books.
Regional Transactional Analysis Association Confer- Stern, D. N. (1995). The motherhood constellation: A
ence (pp. 1-26). Madison, WI: Omnipress. unified view ofparent-infant psychotherapy. New York:
Erskine, R. G., & Zalcman, M. J. (1979). The racket Basic Books.
system: A model for racket analysis. Transactional Stern,S. (1994). Neededrelationships and repeated relation-
Analysis Journal, 9,51-59. ships: An integrated relational perspective. Psychoana-
Fairbairn, W. R. D. (1952). An object-relations theory of lytic Dialogues, 4(3),317-345.
the personality. New York: Basic Books. Stolorow, R. D., Brandchaft, 8., & Atwood, G. E. (1987).
Fraiberg, S. (1982). Pathological defenses in infancy. Psychoanalytictreatment: An intersubjective approach.
Psychoanalytic Quarterly, 51,612-635. Hillsdale, NJ: The Analytic Press.
Guntrip, H. (1971). Psychoanalytic theory, therapy and Sullivan, H. S. (1953). The interpersonal theory ofpsychi-
the self. New York: Basic Books. atry (H. S. Perry & M. L. Gawel, Eds.). New York:
Khan, M. M. R. (1963). The concept of cumulative trauma. Norton.
In R. S. Eissler,A Freud, H. Hartman, & M. Kris (Eds.), Surrey, J. L. (1985). The "self-in-relation ": A theory of
Psychoanalytic study ofthe child, XVIII (pp. 286-306). women's development. Works in progress, No. 13.
New York: International Universities Press. Wellesley, MA: The Stone Center, Wellesley College.
Kohut, H. (1971). The analysis of the self. New York: Trautmann, R. L., & Erskine, R. G. (1981). Ego state
International Universities Press. analysis: A comparative view. Transactional Analysis
Kohut, H. (1977). The restoration ofthe self.' A systematic Journal, u, 178-185.
approach to the psychoanalytic treatment ofnarcissis- Winnicott,D. W. (1965). The maturational processes and
tic personality disorder. New York: International the facilitating environment: Studies in the theory of
Universities Press. emotional development. New York: International Uni-
Miller, J. 8. (1986). What do we mean by relationships? versities Press.
Works in progress, No. 22. Wellesley, MA: The Stone Wolf, E. S. (1988). Treating the self: Elements ofclinical
Center, Wellesley College. seljpsychology. New York: Guilford Press.

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