Transactional Analysis Journal

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Empathic Transactions in the Deconfusion of Child

Ego States

Barbara D. Clark

To cite this article: Barbara D. Clark (1991) Empathic Transactions in the Deconfusion of Child
Ego States, Transactional Analysis Journal, 21:2, 92-98, DOI: 10.1177/036215379102100204

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 Empathic Transactions in the
Deconfusion of Child Ego States
Barbara D. Clark
Abstract transactions according to complementarity,
Transactions are reviewed with reference directness, purity, and intensity. In literature
to Berne's original principles of treatment. on transactional analysis, much attention has
Three conclusions are presented: (1) dif- been focused on transactions classified as com-
ferent developmental levels of ego states can plementary, crossed, and ulterior.
be evoked through the therapist's technical I propose a conceptual bridge, particularly
choices during each phase of treatment, (2) in the areas of complementarity and intensity ,
a conceptual bridge between theory and that will make the theory of transactional
practice is presented through the introduc- analysis more useful in the practice of
tion of empathic transactions, and (3) a psychotherapy. I introduce the concept of em-
recommendation is made that increased em- pathic transaction and suggest that it
phasis be put on the empathic deconfusion demonstrates the importance of regulating the
of the Child ego states in order to reach intensity and directness of transactions during
Berne's goal of a comprehensive treatment different phases of treatment.
approach. The importance of empathy in the therapeutic
relationship has been discussed extensively.
Berne believed that his 1961 book, Transac- Miller (1989) noted:
tional Analysis in Psychotherapy, offered his Ever since Carl Rogers suggested that
most detailed account of the principles of trans- empathy was one of three therapeutic
actional analysis (p. 11), and he often referred variables that are necessary and sufficient
readers of his later books to it. In investigating for constructive personality change, there
the concept of transactions, these treatment has been considerable interest in empathy
principles will be reviewed, and a conceptual as a curative factor in psychotherapy.
bridge between current TA theory and practice Other theorists as diverse as cognitive
will be provided through the introduction of the therapists and psychoanalytic ego
concept of empathic transactions and an em- psychologists feel that the communication
phasis on an empathic phase in deconfusing of empathy to the patient is helpful.
Child ego states. Kohut has gone as far as saying that a step
in the curative process, as well as the aim
Empathic Transactions andresult of psychoanalytic cure, was the
According to Berne, "a transaction consists "opening of a path of empathy ... and
of a single stimulus and a single response, ver- establishment of empathic in-tuneness'
bal or nonverbal" (1972, p. 20). He stated that between the patient and the therapist, on
"anything that happens between two or more mature adult levels. (p. 531)
people can be broken down into a series of Even though not much attention has been
single transactions" (p. 20). He described given to empathy, per se, in the transactional
analysis literature or in Berne's writings, I think
Berne (1966) was alluding to this concept when
The author wishes to gratejidly acJawwledgethe members he said
ofthe Professional Development Seminar, Institute for In-
tegrative Psychotherapy, New York, New York, for the op-
as long as the vectors are parallel, com-
portunity to formulate and discuss the ideas presented in munication can proceed indefinitely. This
this paper. is a necessary but not the sole condition

92 Transactional Analysis Journal

 EMPATHIC TRANSACTIONS IN THE DECONFUSION OF CHILD EGO STATES

for a "good" relationship; if the transac- In an empathic ambiance, the patient and
tions become unpalatable enough, the therapist will be able to access the early
relationship may deteriorate even though developmental levels of the Child ego states,
the vectors remain parallel. (p. 225) which is necessary for deconfusion to occur.
Empathy is defined as "understanding so in- Once the empathic bond is established
timate that the feelings, thoughts, and motives through empathic transactions, the therapist is
of one are readily comprehended by another" able to reach different developmental levels of
(Morris, 1981, p. 428). Empathy thus defined the Child ego states by using direct and affec-
denotes the therapist's state of mind. However, tively intense transactions. The level of
the communication of empathy involves far development that the therapist evokes in the pa-
more. I have labeled the definite and unique ex- tient is determined by the degree to which the
change represented by such communication of therapist infuses his or her communication with
empathy an empathic transaction. The stimulus the affect appropriate to his or her words
in an empathic transaction stems from the (Gedo, 1989). Gedo pointed out that "the more
therapist sending an empathic message to the direct and affect-laden our communications are,
patient, with the patient's experience of the the more likely they are to tilt the analytic rela-
message as empathic or unempathic being a ma- tionship in the direction of transferences of
jor factor in his or her response. An empathic relatively archaic origin" (p. 11). The patient
transaction occurs when the therapist com- needs to be able to experience these archaic
municates his or her understanding of what the levels of the Child ego states in order to work
patient is experiencing and the patient ex- through and integrate these confusing archaic
periences being understood. Such an empathic experiences.
transaction is not the same as the use of reflec- Berne recognized that it is often useful to
tion nor does it involve agreeing with the pa- describe transactions according to their emo-
tient's experience. tional intensity. He stated that "in intimate love
An empathic transaction involves two parts: relationships, people talk to each other relevant-
the therapist's expression of understanding of ly, directly, without distraction, and intense-
the patient's experience and the patient's con- ly" (1963, p. 195). I think it is this type of in-
firmation that he or she has been understood. timacy that therapists are working to create in
The therapist's continuous use of empathic tran- treatment, especially in the deconfusion of the
sactions will lead to the establishment of an em- Child. Therapists can do this through empathic
pathic bond between the patient and therapist. transactions which are relevant, direct, without
This bond makes it possible for the patient to distraction, and emotionally intense.
feel secure enough to revive unmet needs and However, in the initial decontamination or
aborted development. If the therapist moves restructuring phase of treatment, Berne (1961,
away from empathic communication, the pa- p. 246) did not want to promote this type of
tient often reacts with disappointment, disillu- intimate, emotionally intense relationship. In-
sionment, or rage. Often these reactions are stead, his efforts were directed at demobiliz-
labeled negative transference when in actuali- ing the transference transactions. This involved
ty the therapist has stimulated them by his or bringing the patient back to the Adult ego state
her unempathic or faulty responses to the pa- from the current Child ego state which was
tient. Kahn (1989) noted "that anger and fostering the transference transaction.
hostility occur as responses to lapses of em- I think that Berne evoked this developmen-
pathy in all human relationships" (p. 217). tally older ego state (Adult) by changing the in-
When such a lapse occurs, it is important to tensity of the transaction. Gedo (1989) pointed
reestablish the empathic bond through discus- out that transactions
sion of the therapist's faulty response and its offered in a really dispassionate manner
effect upon the patient. and/or in a formal style, especially if we
This empathic bond is imperative when introduce conceptual issues as we explain
working toward deconfusion of the Child ego ourselves, call upon our patients to exer-
states. At this stage, the person has to believe cise secondary-process capacities-even
that his or her most profound emotional states those for abstract thought only available in
and needs can be understood by the therapist. mid-latency or even later. (p. 11)

Vol. 21, No.2, April 1991 93

BARBARA D. CLARK

It appears that most of the transactions used by solved. At the end of this program the in-
Berne (1961) in this restructuring phase were of dividual is in a particularly favorable posi-
low affect intensity and thereby called upon the tion, becauseof the predominance of reali-
patient's secondary-process capacities, thus ty testing, to attempt the resolution of the
leading to his goal of strengthening the Adult ego archaic conflicts and distortions. (Berne,
state. 1961, p. 3)
As therapists it is important to recognize the Even though the next treatment phase,
level of affective intensity of our transactions and reorganization, is necessary to reach the ultimate
how this effects the patient's response. We in- aims of transactional analysis, Berne offered the
vite different developmental levels of experience option of terminating treatment after the restruc-
with different intensities of transactions. Once the turing phase. However, although restructuring is
empathic bond is established and the early ego effective for establishing social control, today our
states are available for therapeutic work, it is im- understanding of developmental psychology as
portant to use empathic transactions because these well as changes in the patient population have led
mobilized archaic needs will go underground at us to see that it alone is insufficient. In fact,
the first sign of rebuff or at the first unempathic Tolpin and Kohut in 1980 stated:
response. They canonly be revived again through The most frequendy encountered group of
the use of empathic transactions that reestablish children and adults in need of psychologi-
the empathic bond. cal assistance and/or treatment are neither
neurotic or psychotic. They suffer from the
Treabnent Phases in Transactional Analysis painful endopsychic or behavioral abnor-
Berne (1961) said that "the ultimate aim of malities that are the manifestations of the
transactional analysis is structural readjustment underlying disturbances in the cohesion,
and reintegration" (p. 246). He (1961) viewed continuity, strength, and hannony of their
this goal as requiring two phases of treatment- self. (p. 431)
restructuring and reorganization (p. 246). Not only will neurotic or psychotic patients
Restructuring. Berne (1961)described the pur- benefit from continuing on in treatment through
pose of this phase, which he divided into two thestage of reorganization, but so, too, will those
steps, as to establish the predominance of the individuals diagnosed as having borderline, nar-
Adult ego state through social control. The goal cissistic, or other personality disorders.
of the first step, structural analysis, is increased ReorganUPtion. Acoording to Berne (1961) this
self-awareness and self-control through greater treatment phase "generally features reclamation
Adult control of the personality. of the Child, with emendation or replacement of
The second step is transactional analysis, which the Parent. Following this dynamic phase of
today includes transactional analysis proper, reorganization, there is a secondary analytic
game analysis, racket analysis, and script phase which is an attempt to deconfuse the
analysis. Its goal is social control, that is, "con- Child" (p, 246). Although there are extensive
trol of the individual's own tendency to clinical examples in the transactional analysis
manipulate other people in destructive or wasteful literature of successful psychotherapy involving
ways, and of his tendency to respond without in- reclamation of Child ego states, the alteration or
sight or option to the manipulations of others" replacement of the Parent ego state, and the
(Berne, 1961, p.23). resolution of conflicts between ego states, the
During these two steps of restructuring, the pa- literature describing the deconfusion process is
tient develops both social control and a less developed.
strengthened Adult, the latterof which allows for The deconfusion process is necessary for ar-
the development of a working alliance with the chaic Child ego statesthat are not just historical,
analyst. Berne maintained that these qualities had but that also are traumatically fixated (Berne,
to be attained before an attempt could be made 1961). The child at these early developmental
to deconfuse the Child or to resolve underlying levels was emotionally injured or confused, and
conflicts. these traumatic experiences were unresolved and
In the course of these therapeutic opera- became fixated. According to various authors,
tions, trawnatically fixated archaic ego such fixated Child ego states can interfere with
states have been segregated, but not re- integrated Adult ego state functioning and are

94
 EMPATIDC TRANSACTIONS IN THE DECONFUSION OF CHILD EGO STATES

therefore the focus of deconfusion (Clarkson & do not receive the required attuned responsiveness
Gilbert, 1988; Erskine, 1988; Massey, 1989; from the caregiver. The unintegratedaffect and
Moiso, 1985;Novellino, 1985;Trautmann& Er- the accompanying developmental needs are
skine, 1981). When the patient is ready for defended against and become fixated Child ego
deeonfusion of the Child ego states, transactional states.
analysts have used various techniques. The first step in deeonfusing Child ego states
Although Berne (1961) suggested traditional involvescreating an empathicbond through em-
psychoanalysis as the recommended method by pathic transactions, thus making possible the
which to deeonfuse the Child (p. 173, 177, & painstaking unfolding of the archaic ego states.
246), it seems clear that this has not been the Patients may eagerly seek or defend against
treatmentof choice for most therapists influenced establishing this attachment bond with the
by Berne. However, I think it is important to fur- therapist. A patient is likely to defend against
ther develop this secondary analytic phase, and establishing the bond out of fear that his or her
the empathic transaction provides a conceptual needs and feelings will be met with the same
bridge for this significant, but underdeveloped unempathic or faulty responses received in
phase of treatment. In the deconfusion of the childhood. Patients dread repeating with the
Child ego states, the use of empathictransactions therapist the same traumatic disappointments, re-
and concepts from self psychology may be par- jections, and deprivations that they experienced
ticularly helpful in assisting the patient to work in childhood. The therapist's consistent accep-
through the archaic drama from childhood. tance and communication of empathic under-
standing of the patient's affective statesand needs
Empathic Deconfusion of Chlld Ego States usuallyenablesthe patientto work throughthese
Berne often used the metaphor of deeonfusion defenses. The patient can then recover lost
of Child ego states but did not specify the origin developmental processes of self-articulation and
of the confusion. I think the child is often con- self-demarcation that had been aborted and ar-
fused about the legitimacyand safenessof needs rested during the formative years (Stolorow et
and emotional states. aI., 1987). However,these resistances will return
How did this confusion develop? Self- in treatment if the patientexperiences the therapist
development involves two basic processes: (1) ac- as not attuned to his or her reawakened needs
quiring a sense of cohesion and well-being in or feelings.
responseto need fulfillment, and (2) the differen- After the empathic bond is established, an in-
tiation of self from other and the establishment tegrating process emerges. This process unfolds
of our own aspirations and ideals (Stolorow, in an atmosphere in which the patient's subjec-
Brandchaft, & Atwood, 1987). Children require tive experience, including especially his or her
attuned parental responsiveness to their chang- experience of the therapist, can be freely ar-
ing needs as they go through this process (Stern, ticulated, with the therapist committed to
1985). If parents cannot adapt to the needsof the understanding that experience from the patient's
child, then the child will adapt to the parents in viewpoint. The working-through process involves
order to maintain the essential bond between dealing with the unintegrated affect and the
them. The childperceiveswhat is requiredof him revivaland responsiveness to early longings. The
or her to maintain the bond with the parent and unintegrated affect usually consists of painful feel-
then these requirements become the organizing ings that resulted from the lack of parental
principles of the child's inner life (Stolorow et responsiveness to developmental strivings or
aI., 1987). painful feelings resulting from emotional injuries
What is confusing to the child is thatevery time and/or ruptures in the bond with caretakers. The
he or she has an emotional striving that violates therapist's responsiveness to the patient's pain-
the requirement perceived as necessary to main- ful emotional reactions helps to heal the wounds,
tain the bond, he or she experiences intenseanx- integrate the affect, and allows the developmen-
iety. This leads to the child's perception that tal process to continue.
something is wrong with him or her and that The therapist's empathicresponsiveness to the
somehow these emotional states and needs con- patient's reawakened early longings is one of the
tribute to his or her perceived badness. Such in- most important parts of this treatment phase
tense feelings cannot be integrated because they (Clark, 1989b). Many patients feel ashamed of

Vol. 21, No.2, April 1991 95

BARBARA D. CLARK

their need for the therapist's responsiveness. someone to look up to who can provide inspira-
As their unmet, innate psychological needs tion and strength in order to maintain their
begin to emerge, they sometimes express the stability·when they feel threatened, frustrated,
belief that they are too old to have these needs. or in search of meaning in their lives. Being
They hesitate to present these needs out of fear able to idealize the therapist enables patients
of faulty responses and fear of losing the bond to develop their own ability to calm themselves
with the therapist (Clark, 1988a). Because of and more effectively regulate their sometimes
patients' early organizing principles, they fear intense affect.
the therapist will reject or ignore these emerg- At times patients need to experience an essen-
ing parts of them just as their childhood tial similarity to the therapist, to be seen and
caretakers did. It takes long periods of the understood by being like him or her. They
therapist's understanding of this shame and fear begin to talk about ways in which they are
before patients feel comfortable with these similar to the therapist in areas such as ap-
emerging developmental needs. pearance, occupation, hobbies, and opinions.
Patients' psychological growth requires that At these moments it is important not to point
the therapist provide responsive experiences to out the differences between therapist and pa-
these developmental needs (Clark, 1989a). tient or to discuss the importance of self-
These needed experiences include several dif- differentiation, because the patient's stability
ferent kinds of empathic responses (Clark, and cohesiveness are developing through
1989b). When patients present their need to be perceived alikeness with the therapist. Respon-
validated, they need the self to be affirmed as siveness to this need tends to help patients
being significant. This does not require the develop energy for their own skills and talents.
therapist to give approval, but requires attempt- However, as patients develop in the area of
ing to understand the patients' thoughts, feel- self-differentiation, they need a different kind
ings, and behavior. The therapist needs to of empathic response from the therapist. They
acknowledge patients' appropriate need for an need to experience the therapist as supportive
enthusiastic response to their display of and responsive to their assertive and adversarial
themselves, their achievements, and ac- attitude toward him or her. In order to be free
complishments. Patients will especially need to develop autonomy, patients need the
confirmation when they are seeking com- therapist to maintain a supportive bond with
petence in communication or in autonomous them. Many patients had to give up their
behavior. developmental strivings for autonomy because
Patients may have times of extreme stress or their emerging independence threatened their
loss when they experience the need to merge parents; in order to maintain the needed bond
or feel one with the therapist. It is important with the parents, they shut down their own core
for the therapist to acknowledge the need as ap- strivings for self-demarcation. This left them
propriate for this early developmental ego state with an internal conflict between meeting the
and attempt to stay as attuned with the patient needs of the caretaker and following their own
as possible. Some therapists may mistakenly at- inner strivings. Therefore, as patients develop
tempt to convince the patients that they are in the area of self-demarcation, it is important
already whole rather than respond with that they experience the therapeutic bond as
understanding to the need to merge with the freeing rather than restraining. In this self-
therapist. delineation process therapists sometimes ex-
At some point in this deconfusion process the perience patients as resistant when actually they
patient may begin to idealize the therapist and are attempting to protect themselves from in-
see him or her as perfect. It is important for vasion or encroachment by the therapist.
the therapist not to begin to point out his or her At such times, rather than focus on the
own humanness in order to deflate the idealiza- perceived resistance, the therapist needs to
tion. Instead, the therapist must let the patient focus on attempting to understand the patient's
idealize and must acknowledge to the patient thoughts, feelings, and behavior. Such an at-
the importance of being accepted by one who mosphere provides a safe place in which the
possesses the qualities that the patient feels he patient's needs for self-differentiation can
or she lacks (Clark, 1988b). Patients require emerge. It is important for the therapist to

Transactional Analysis Journal

 EMPATHIC TRANSACTIONS IN THE DECONFUSION OF CHILD EGO STATES

recognize these needs as appropriate to a nor- principle is simple-to discover, understand,

mal young child and to resonate empathically accept, and support the subjective experiences
with and share the patient's enthusiasm and of the patient.
pleasure in his or her emerging individuality.
At times the patient may be elated; at other Conclusion
times there may be disappointment in the face Patients are increasingly seeking help with
of his or her limitations and failures. The complicated character and behavior disorders
therapist must remain attuned and contain the resulting from early affect confusion; treatment
disappointment while at the same time show- of these problems is difficult and the outcome
ing confidence in the patient's growing abilities often unsatisfactory. In order to respond to
and ultimate success. these patients' needs, this article suggests an
Although this article has emphasized the im- increased emphasis on the secondary analytic
portance of the therapist's empathic responses phase of deconfusion of the Child using em-
to the patient's emerging needs, the patient also pathic transactions. If therapists place increased
has a need to have an impact upon the therapist. emphasis on the empathic deconfusion of the
These are called "efficacy experiences," which Child ego states and use empathic transactions
refers to the fact that the patient derives growth- to sustain this phase of treatment, the practice
promoting pleasure from having the capacity to of transactional analysis will be a more com-
achieve the desired response from the therapist prehensive treatment approach for many such
(Wolf, 1988). When patients are effective in get- patients.
ting their needs met from the therapist, they ex-
Barbara D. Clark, Ph.D., is a psychologist
perience a sense of competency. Infant research-
ers have shown that this feeling of efficacy or
and Certified Clinical Transactional Analyst.
competence helps in the consolidation of self ex-
She has a private practice in psychotherapy,
supervision, and training in College Station,
perience (Lichtenberg, 1983).
Texas, U.S.A. Please send reprint requests to
There are, of course, times when the
therapist's responses and interpretations are not
Barbara D. Clark, Ph.D., 702 E. University
Drive, F-I02 College Station, Texas 77840,
consistent with the patient's subjective ex-
perience. Discussing these inevitable failures
U.S.A.
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KOOPERATION STATT KONKURRENZ 12. KONGRESS der

DEUTSCHEN GESELLSCHAFT
COOPERATION VERSUS COMPETITION fOr TRANSAKTIONS·ANALYSE
COOPERATION AU LIEU DE COMPETITION zusammen mitdem
8. - 11. 7. 1991 KONGRESS der
OLDENBURG i. O. EUROPAISCHEN GESELLSCHAFT
GERMANY fOr TRANSAKTIONS·ANALYSE

12 'h CONFERENCE of the

GERMAN ASSOCIATION
of TRANSACTIONAL ANALYSIS
with
CONFERENCE of the
EUROPEAN ASSOCIATION
of TRANSACTIONAL ANALYSIS

12. CONGRES DE L'ASSOCIATION

ALLEMANDE de
L'ANALYSE TRANSACTIONNELLE
avec
LE CONGRES DE L'ASSOCIATION
EUROPEENNE
deL'ANALYSE TRANSACTIONNELLE

Beltragsanmeldungen:JPresenters Proposal Form:Notre Contribution: KongreBanmeldungen:JReglstmlon:llnscriptlon:

Welllslalt Psychologie, WiemkenstraBe 25, 2902 Rastede·lpwege • Germany Frau Eva Eisenbach, Taunusstr. 50, 6365 Rosbach' Germany

98 Transactional Analysis Journal