This paper relates key experiences in personal development to a pattern of growth that can be used as a model for steps in therapy. Key experiences are used to illuminate the steps. Reading references are given that represent the intellectual development that informed the life experiences.
Reflecting on my development as a therapist I see a pattern moving from ineptitude to technical skills, to understanding, to integration, and to authenticity. The pattern applies to micro learning as I did recently when I attended a workshop in Enhancing Third Party Payments and to my overall development as a therapist for the past thirty years. Further, I see the same pattern in the work I do with clients.
As a therapist, I use my self to facilitate the changes my client desires. However, I will not aid in illegal goals nor will I encourage harm to others. My preference is to aid in building bridges where relationships have faltered.
In looking at my development as a therapist there are paradigms for each of the steps.See CPE I remember as a college student offering my helpful insights to another student I'll call Ada. I made the comment as we were leaving the student union and I can still feel the sharp sting of her reply. "If you really want to be a counselor, you better. . . ." The sting was double edged. My pride at being a budding helper was hurt and I knew almost instantly that my comment had been designed more to seduce than to understand or help. My ineptitude was revealed and my need for personal development exposed, at least to myself.
My graduate degree was in theology with a specialty in Religion and Personality studies. Within that program I specialized in the counseling aspect which was heavily influenced by Carl Rogers who left the University of Chicago the previous year. My experience with Ada made me aware of a difficulty that my fellow students had with Rogers' theory. Many people thought his theory encourages non-directive interventions, when his central theme is to be client centered (Rogers, 1951, 1961). Having missed that point with Ada, I was primed to be client-centered in my clinical experiences.
Opportunities for clinical experience came in nursing homes and with undergraduate students. The experiences were frustrating. I focused on the issues that were important to individuals while knowing the meaning these issues had for the person's life was beyond my grasp. Nursing home residents were living a life I could not yet imagine. Students were dealing with the issues I still had to solve. I did notice that helping individuals to focus on the feeling content of their dialogue was helpful to them even though I did not understand how the issue involved them in the struggle with meaning for their life. Having some technical skill was helpful.
Through out graduate school, my years as a parish pastor and my training in clinical pastoral education I searched for deeper understanding of the issues that frighten people and motivate them to hide or move on in life. Theological education at the University was an exciting introduction to life meanings. The program required passing comprehensive tests in seven areas that included: history, theology, art and literature, world religions, sociology, and psychology. This broad education began to give me insight into the human condition, the hopes and fears that motivate and plague us as individuals and societies.
While I was in graduate school O. Hobart Mower, the noted researcher in behaviorism, spoke about his personal experience with mental disorder (Mower, 1961). He promoted integrity as the solution to disorder- to do what you say you will do. Later, I spent time with him when he made a workshop presentation in Montana where I was a parish pastor. While I was not yet convinced that integrity was a central issue, his taking time to single me out and share with me has had a lasting effect.
In the late fifties psychoanalysis was the only viable in-depth theory. I always have had difficulty with Freud's theory. I have ranged from seeing it as obscure, to inaccurate, to based on an outmoded theory of science. With those attitudes toward the dominate theory, I had difficulty gaining insight into life meanings from its proponents. I turned to psychodrama and group process at St. Louis State Hospital where I was an intern in Clinical Pastoral Education. Lee Fine and Barbara Seabourne were psychodrama directors who were among the few certified by Moreno. From psychodrama theory I learned the importance of two concepts of time, the moment and the duration (Moreno, 1946). I find gestalt theory weak on duration and analytic theory weak on the moment. Understanding that individuals live in both time frames simultaneously gives depth to the tensions with which people live.
The importance of understanding time comes into perspective when reflecting on my visiting people in nursing homes while in graduate school. For me the moment was the sight of bed sores, the stench of urine, the drab dormitory room. For the person being visited, the moment consisted of a new young face, a moment of change, a possibility for union or disregard. For both of us the duration determined much of the quality of the conversation. Immediate and distant past events are brought into focus through sight and sound and touch. Possibilities for the future real or imagined influence openness and content. At the time I was still in a stage predominated by acquiring technical skill. Today I am well aware of the duration of time within me as I experience myself being pulled by the seductiveness of a thirteen year girl and the warmth of a high school classmate at our fortieth reunion. I am that fifty year span out of eternity now, fuller and richer for the duration of time within and more complex- able to be more creative and more stuck in my ways.
The group process department at St. Louis State Hospital was under the direction of Bob Schaef. This training involved being a participant and eventually leader of workshops that explored the development and functioning of groups. I often found myself caught in an undertow of emotional intrigue with another intern, Anne Wilson, who later married Bob Schaef. This was my first indication that romance and supervision do not mix well.
These training programs gave me an opportunity to compare my thoughts and emotions with a wide variety of others. These useful experiences were limited by the sparse feedback from leadership. In one week long training program where I was a trainee, I spent one afternoon session sitting well removed from the rest of the group. The staff watched our interaction from behind a two way mirror. By happen stance several years later I overheard one of the leaders talking to my supervisor about the training program. She referred to the group as crazy and destructive, indicating that I was the only person with enough sense to stay out of the fray. I had thought of myself as being a wimp. The new information was reassuring, and informative about the delicate process of gaining understanding.
There is a need for full disclosure of all relevant information. We therapists like to think of therapy as a process to experience. Many of us participated in our therapy after we knew about the process but expect our clients to enter blindly into therapeutic procedures. I think for the most part that knowledge enhances the appropriation of therapeutic insights. We do need to reflect on when it is appropriate to give information about the process. There are times that foreknowledge radically changes the outcome. Commenting about the process of therapy has become part of my therapeutic style.
My training in Clinical Pastoral Education furthered my clinical skills and client-centered theory. Then most of the training revolved around written verbatim accounts of visits with patients in the mental hospital. Tape recorders were just becoming small enough to be portable (at 25 pounds!), and there was pressure to allow us to use then. I concluded that a combination of verbatim and recorded accounts is most useful. Verbatims teach concentration, memory, focus by requiring accurate accounts of visits. Recordings show what a person forgets, reveal what was actually said, helps identify emotional undercurrents that are reflected in tone and emphasis.
I conducted an experiment with my fellow interns in Clinical Pastoral Education. During a seminar session I arranged for an emotional discussion with another student which was recorded. Everyone then wrote a verbatim account. The verbatims were then compared to the recorded conversation. There were significant differences in what was heard and what was deemed important. The differences corresponded to the basic beliefs of the various students. A clear record that we hear what we already believe. New understanding is difficult to achieve. It requires a challenge to our presuppositions about the meanings of language and life. Return to Top
It was not until a fellow intern introduced me to Natalie Haimowitz and Fanita English who were conducting training programs in transactional analysis that I found myself understanding clients. Transactional analysis satisfies my whole person. I especially value the belief a therapist is responsible for providing helpful interventions with the corollary that the patient is not wrong for being resistive or playing games. For the thinker, the scientist, there are objective external clues that can be correlated with internal attitudes. It is like psychoanalysis in that the emotional life of an individual may be hidden and difficult to uncover. Unlike psychoanalysis there is no broiling cauldron of mysterious emotions. Instead there is the understanding that these emotions emerge out of interactions that are stimulated by real events although they may be augmented by imagination, confused by introjection or projection, hidden by dissociation or repression. This concept of the Child ego state fits my personal experience much better than the pessimism of Freud (Zohar, 1990, p. 18ff ).
I realize in large part, transactional analysis was the theory I studied when all my previous experiences began to jell into understanding. Still there is a significant switch in theory between transactional analysis and what preceded it. There is good reason that Berne was not passed for his psychoanalytic certification. Transactional analysis moves from seeing individuals as isolated and limited to seeing individuals in relationship with one another. A more complex switch comes in the supposition about human life. Berne (1957, 1961, 1964) proposed that people are born with a clean slate, a tabula rasa. They have an even chance in life to prosper or fail. Psychoanalysis proposes that people are born with internal conflicts which can at best be defended against. In Biblical terms, Berne starts with mankind in the Garden of Eden while Freud starts them after the expulsion from the garden. Unlike psychoanalysis, transactional analysis promotes human harmony as real and possible. While I do not remember any references to quantum physics made by Berne, his theory is compatible with the new science while psychoanalysis is inevitably linked to Freud's Newtonian concepts of mechanical physics (Gardner, 1993 Zohar, 1990). Berne's theory is a radical change from previous theory. The implications of these changes have yet to be developed by current transactional analysts.
The leap forward in understanding that transactional analysis brought to psychotherapy is immense. Psychodrama and gestalt had the techniques for uncovering the events that led to psychological trauma but transactional analysis had the simple diagrams and overview that allows most life situations to be understood and the direction to change them. As transactional analysis became popular with the publication of Games People Play, (Berne, 1964), everyone became a game analyst. The problem developed that most people analyzed games while playing "Now I Got You." I may understand you perfectly well when I analyze you, but if I do it from a position of power I distort understanding by removing myself from the human situation. That is what I did along with many other transactional analysts. My difficulty with game analysis indicated to me that I had another step to achieve in becoming a person who was a therapist- a healer.
Game analysis fell from favor due to this misuse. Recently, I started to use it as an intervention again, done with permission and from an informational point of view. A calm discussion of the steps or interactions involved often suffices to help people claim control over their interactions with others. No longer do I play Name the Game, rather I talk about what is happening between my client and another person or how I am experiencing my relationship with my client and he sneaky things I am tempted to do. Usually the sneaky things I am tempted to do correlate with the way my client is treated by friends.
Understanding without integrating that understanding into one's personality is a form of reification. When I first became aware that I played Name That Game, I understood what I was doing and could label what I was doing but the name separated me from my action. In fact whenever a psychological game ceases to be a verb and becomes a noun reification has taken place. Integration is the process of moving from being able to label to living, from noun to verb (Keepin, 1994).
The following dialogue could be heard between myself and either of my
children when they were in late adolescence.
"Dad! Stop being a therapist."
"I'm not, being a therapist; I just want you to understand.."
"Dad, stop
being a therapist!"
"I can't help it, I am a therapist. You make me so
mad..."
As I lost my temper and blamed them I would be chagrined with the knowledge that I was half way to being a therapist. I might be able to carry off the illusion that I was integrated between theory and practice with clients, but my children knew I was still more than a therapist and less than a therapist. The process of integration is a continuing one and children are good discoverers of our growing edge.
Since everything I integrate into my skill as a therapist does not fit my personality, there is another task beyond integration. That task is authenticity. Authenticity is the stage that all of us struggle with through o out life. As a high school Thespian, I attended Eugene O'Neil's play The Great God Brown which deals with authentic encounter by actors who take risks at being real and show that risk by removing their mask.
I struggle with authenticity every time I write a report for the Division of Family Services about a client I see for them. My authenticity is challenged each time I want to say something in the report that I have not discussed with the client. I find myself growing in two ways. In one way I am learning that authenticity, that life, is not isolated and solitary. My authenticity is not uniform. As I move away form one person and closer to another I change, much as one set of Bose-Einstien condensates change as they relate to another set (Zohar, 1990, pp. 83-87). The other way in which I am changing is that I find more ways to share my impressions with clients and third party payors like the Division of Family Services. I discover repeatedly it is my anxiety, my ineptitude that keeps me from speaking clearly to both parties. I would estimate that 80% of the time now I can find a language that both parties will understand that also expresses clearly what I understand to be the issue. Three languages I often contend with are: my native language of psychologized Christianity, main line Christianity and spirit based Christianity. Each language is based in a particular set of presuppositions about how the world influences the events of daily life, what events are seen and which of those events are significant (May, Angel, & Ellenberger, 1958). Finding a common theme and language to connect these people allows me to have more authenticity in my life.
This process of becoming the therapist I am today is also the process I use in helping a client move from where they are when they first come to me to where they want to be when they leave. First clients identify the problem, the ineptitude, they want to overcome. Next comes the practice new skills, developing techniques that get them by. Once there are some skills at living the person can take time to assess the source of their problem and the solutions in a way that leads to understanding. With understanding comes a desire to be the person they can now see and understand. That new person emerges as integration takes place and is shared with their world. Most clients leave well before integration is complete and certainly before they present themselves with authenticity. These are steps that people can take on their own once they have found the path that is right for them and their family and friends.
Up to this time I have not had to change my practice. I have very few people who use third party payments except for the Medicaid clients I see. I am generally pushing to close my third party payors quicker than the referring agency desires. The state, generally, wants me to see Medicaid clients longer than I think is productive. I understand that this is likely to change. With goal oriented therapy being promoted by third party payors and reviews of therapists being made in terms of outcomes and time there is a strong pressure to move away from my specialty of in-depth therapy. Personally, I doubt that in-depth therapy will go away. There are too many rewards of personal satisfaction and increased earning power connected with fine tuning one's personality. What is going to happen is that in-depth therapy will again become the province of the privileged. As a person of privilege I have tried to spread the benefits to people of various backgrounds. That may be more difficult in the future.
Jonathon Wagner, M.Div., a psychotherapist in private practice in St. Louis Missouri. This article was originally published in the Transactional Analysis Journal, Vol. 25, No. 1 January 1995. When he wrote this article Mr Wagner was the General Coordinator of USA TA Association. In addition, over the years he has held many positions of responsibility in the ITAA. The copyright for this article is held by Mr. Wagner, reproduction is prohibited by law.
Berne, E. (1957). A Layman's Guide to Psychiatry and Psychoanalysis, New
York; Ballentine Books (Original work published 1947) as The Mind In Action
Berne, E. (1961). Transactional Analysis in Psychotherapy, New York; Grove
Press