Inside Out: a Transactional Analysis Model of Trauma
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Inside Out: A Transactional Analysis Model ofTrauma Jo Stuthridge Abstract leave her with Bill. During therapy, Annie be- This article presents a transactional analy- gan to realize that despite all her efforts to sis model of trauma located within a rela- avoid the past (by using alcohol, silence, and tional paradigm. It proposes that the Adult denial), she had been reenacting the story of ego state enables us to form a narrative self her own abuse over 30 years. She used the mar- or coherent sense of identity. Trauma inter- riage to project an abusive Parent ego state and feres with this integrative capacity, creating failed to protect her children as her mother had excluded ego states and a disorganized self. failed to protect her. The pain ofher own abuse The child's experience of abusive caregivers remained safely outside awareness in an ex- is internalized in a series of toxic Parenti cluded Child ego state. Child egostates. This inner world shapes the Annie's tragic story illustrates an incoherent child's view ofthe world outside, leading to self-narrative. This is evident in the telling of patternsof transferential enactment that re- her story and also in the way her life is lived. inforce a traumatic script. Therapy is con- This article argues that when trauma impairs cerned with developing the Adult capacity to the Adult capacity to create narrative, the unin- create a coherent narrative that allows the tegrated experience is reenacted in the person's client to move from enacting to reflecting. present life. Stories like Annie's have been explained in very different ways over the past 100 years. This article is based on years of clinical ex- Freud (1905/1953) argued that unconscious perience with adult survivors ofchildhood phy- fantasies, not child abuse, were the real cause sical and sexual abuse. Its title was partly in- of hysteria. During the 1970s, with research spired by my sons' preference for wearing their into posttraumatic stress disorder (PTSD) (see trousers "low-rider," revealing a gaudy slice of van der Kolk, 2000, p. 244) and the develop- satin boxer. It occurred to me that this fashion ment of feminism, the pendulum of opinion for wearing underwear on the outside is very like swung toward actual trauma as the cause of working with adult survivors of child abuse, pathology (Masson, 1984). This historical de- where intrapsychic "garments" are worn on the velopment can be seen as a dialectic between outside in the guise oftransferential enactments. the importance ofinside (fantasy and intrapsy- I offer the following example as an illustra- chic conflict) and outside (actual abuse and tion. Annie was sexually abused by her father parental failure). Thequestionbeingaskedhere from the age of5 until 15 years, when she ran is this: Does pathology arise from real life away from home. Later she married Bill and to- monsters or from monsters ofthe mind? gether they had four children. She never al- This article considers that question by using lowed Bill any physical contact with their chil- transactional analysis to bridge the divide be- dren, describing a feeling of disgust when he tween psychoanalysis and empirical psychol- went near them. She did allow the children to ogy. I begin with a reinterpretation of the ego stay with her parents, and when her teenage state model. I then offer a briefexploration of daughters disclosed that they had beensexually the impact oftrauma on development and sug- abusedby theirgrandfather, Annie reactedwith gest a transactional analysis formulation of angry disbelief. trauma. Finally, case material is provided to il- Annie was 49 when I met her; she brought lustrate a relational approach to therapy using her baby granddaughter to sessions rather than the model described. 270 Transactional Analysis Journal Downloaded from tax.sagepub.com by Marco Mazzetti on February 3, 2014 INSIDEOUT: A TRANSACTIONAL ANALYSIS MODELOF TRAUMA A StoryofSelf: Development of I, Me, and Self The internal structure ofthe self, then, arises This section offers a theory or story about the from a matrix ofrelationships. I use the phrase emergence ofselfwithin a relational paradigm; "Parent/Child ego state dyad" to stress that a it revisits ego state theory in light ofinfant re- whole relationship is internalized, not just an search and neurobiology. introject: for example, an anxious Child ego state Is it appropriate to begin writing about incest in response to a critical Parent ego state. Little with comments about my sons' underwear? (2005) refers to a similar concept as "ego state How did this happen? Me watching I. William relational units" (p. 136). James (1892, p. 176) made this distinction be- We might assume that the mind contains mu- tween a complex reflecting self-a"me"-and ltiple ego state dyads that reflect the child's ex- the simple experiencing "I." I propose that the perience ofthe caregiving environment. Fonagy selfin James'ssense ofa transient experiencing (2001, p. 165) and Schore (1994, p. 498) refer "I" is best conceived ofin transactional analy- to multiple sets ofself-other representations in sis terms as a multiplicity of discontinuous securely attached children. Relational psycho- ChildlParent ego state configurations that pro- analysts (Bromberg, 2001, p. 181; Mitchell, duce shifts in consciousness in response to con- 1988) describe multiple relational configura- text. A sense of"me" as coherent and continu- tions within the mind. Bromberg (2001, p. 244) ous over time develops with the Adult ego state suggests it is only with maturity that we attain capacity to link ego states through story, thus an adaptive illusion of self that overrides the creating a "narrative self." This concept ofself awareness ofdiscontinuity. encompasses the paradoxical experience of This ordinary phenomenological experience changing with time or context while knowing I ofbeing many selves is summed up succinctly am the same person. It also allows for the pos- by Virginia Woolf(1928/1993): "Abiography sibility ofan "I" that is not part ofme. is considered complete ifit merely accounts for Citing infant research, several authors (Beebe six or seven selves, whereas a person may well & Lachman, 1988; Lichtenberg, 1983; Stern, have as many thousand" (p. 224). 1985) suggest that an emergent sense of self Selfas Story: The AdultEgo State. One starts develops out of repetitive reciprocal interac- to wonder, how do we experience any sense of tions between infant and caregiver. Beebe and identity, a single "me" in the midst ofthis shift- Lachman (1988, p. 306) used empirical evi- ing milieu? dence ofthe infant's capacity to recognize, re- Berne (1961) referred to the integrative func- member, and expect these recurring interac- tion of the Adult ego state but acknowledged tions to suggest that the infant forms symbolic that "the mechanism ofthis integration remains representations ofselfand other. This process to be elucidated" (p. 213). I suggest that self- of internalization involves representations of narrative is the key mechanism for integrating both infant and caregiver, a dyadic system that disparate Parentand Child ego states into a uni- cannot be described on the basis ofeither part- fied sense ofselfor "me." The capacity to tell ner alone (Beebe & Lachman, 1988, p. 305; stories about the selfinvolves a reflective pro- Fonagy, Target, & Gergely, 2000, p. 104). cess. In transactional analysis terms, we might say Fonagy, Gergely, Jurist, and Target (2002) that repeated transactions between the child argue that the development ofsuch a reflective and his or her caregivers are aggregated and capacity is dependent on attunement in early internalized to form the basis of developing relationships. When the caregiver accurately Child, Parent, and Adult ego states. As Berne represents experience for the child, this pattern (1961) put it, the mind contains "relics of the ofrelatedness is internalized, and the child de- infant who once actually existed, in a struggle velops an ability to integrate experience into with the relics ofthe parents who once actually narrative. The child learns to name his or her existed" (p. 55). He emphasized that ego states internal states and those ofothers. Fonagy et a1. are phenomenological entities, not abstractrep- (2000, pp. 108-9) cite empirical evidence to resentations (p. 4). demonstrate a high correlation between secure Vol. 36. No.4. October 2006 271 Downloaded from tax.sagepub.com by Marco Mazzetti on February 3, 2014 10 STUTHRIDGE attachment, reflective abilities, and narrative "subsymbolic" refers to affective and somatic coherence. patterns oforganization (Cornell, 2003, p. 45). In transactional analysis terms, accurate at- Implicit memory remains outside of aware- tunement facilitates the Adult capacity for re- ness. These memories are stored in emotions, flective function and self-narrative. This con- sensations, and behaviors, with no sense of cept ofneopsychic function as a process ofin- conscious recollection (LeDoux, 2002). Stories tegration, reflective function, and narrative is stored in implicit memory systems might be consistentwith recenttheoretical developments associated with Berne's (1961, p. 118) concept in transactional analysis (Allen, 2003; Erskine, of protocol, which comprises the early rela- 2003; Tudor, 2003). Allen (2003) uses the term tional patterns that form the basis of script. "psychological mindedness" to refer to "peo- Allen (2003) suggests that experience stored in pIe's ability to think about their psychodynam- implicit memory creates "nonconscious organ- ics and to put their experiences into narrative izing principles" (p. 131) that underlie later script context" (p. 132). script decisions. Implicit storytelling is not re- The mind is experienced, then, as an unruly placed but continues to exist alongside later crowd ofChild-Parentego states with their own explicit story forms (Damasio, 2000). unique modes of relating and affective tones For example, when an infant's earliest inter- that are given meaning and shape by a narrator actions are experiences of being adored and -the Adult ego state. held snugly with a full belly, this set ofsensa- The Narrative Self.