Downloaded by [New York University] at 04:40 12 August 2016 Transactional Analysis for Depression Transactional Analysis for Depression is the first research-based, transactional analysis psychotherapy manual. Developed from the author’s research into TA therapy for depression, the book also draws upon a wide range of contemporary research findings relating to depression and its treatment. Mark Widdowson pro- vides the reader with a solid understanding about the nature of depression and clear guidance about how to provide effective psychotherapy for depressed clients. The book is a step-by-step guide to therapy, from the point of first contact through to ending, and covers: • The theory and practice of TA therapy • Understanding factors which maintain depression • Conceptualising depression using TA • Original material on the mechanisms of therapeutic change • Optimising the psychotherapy process • Key therapeutic processes in the therapy of depression • Tailoring the therapy to client needs • An introduction to neuroscience and the medical treatment of depression Complete with an additional resources section, including downloadable material designed to be given to clients to enhance the therapeutic process and strengthen the working alliance, Transactional Analysis for Depression provides structured, practical guidance to TA theory for therapists in practice and training. Mark Widdowson is a Teaching and Supervising Transactional Analyst and a Downloaded by [New York University] at 04:40 12 August 2016 UKCP-registered psychotherapist. He is a lecturer in counselling and psychother- apy at the University of Salford and lives in Manchester, where he also has a small psychotherapy practice. For additional resources and downloadable material, please see: https://www. routledge.com/products/9781138812345 Downloaded by [New York University] at 04:40 12 August 2016 Transactional Analysis for Depression A step-by-step treatment manual Mark Widdowson Downloaded by [New York University] at 04:40 12 August 2016 First published 2016 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2016 Mark Widdowson The right of Mark Widdowson to be identified as author of this work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Widdowson, Mark, 1973- Transactional analysis for depression: a step-by-step treatment manual / Mark Widdowson. pages cm Includes bibliographical references. 1. Psychotherapy. 2. Transactional analysis. 3. Psychotherapist and patient. I. Title. RC475.W53 2016 616.89′14—dc23 2015014489 ISBN: 978-1-138-81233-8 (hbk) ISBN: 978-1-138-81234-5 (pbk) ISBN: 978-1-315-74663-0 (ebk) Typeset in Times New Roman by Swales & Willis Ltd, Exeter, Devon, UK Downloaded by [New York University] at 04:40 12 August 2016 Contents Introduction 1 PART I TA theory and depression 7 1 The theory and practice of transactional analysis psychotherapy 9 2 Understanding depression 20 3 Depressogenic processes 26 4 Conceptualising depression using TA theory 42 5 Basic technique in TA therapy 57 6 Therapeutic processes and change mechanisms 64 PART II Therapy protocol 75 7 Structure of therapy and the initial phase of therapy 77 8 Key therapeutic processes 105 Downloaded by [New York University] at 04:40 12 August 2016 PART III Neuroscience of depression and medical treatments 149 9 A primer on the brain and the neuroscience of depression 151 10 Medical treatment for depression 158 vi Contents Conclusion 170 Appendices 173 1 Getting the most out of therapy 175 2 Self-help for depression 179 3 Basic transactional analysis (TA) theory 186 References 199 Index 214 Downloaded by [New York University] at 04:40 12 August 2016 Introduction This is the first research-based, disorder-specific transactional analysis (TA) treatment guide to be published, and has been developed from a wide range of research literature and years of clinical experience. The psychotherapy community in general has had a somewhat ambivalent relationship with such therapy manuals over the years (Addis & Krasnow, 2000; Navajits, Weiss, Shaw & Dierberger, 2000). The detailed specification of a particular approach to therapy is consid- ered to be essential to the process of building research evidence about the effec- tiveness of that type of therapy. Many practitioners, particularly beginners, scour books and journals for information about specific issues and for guidance about how to help their clients overcome their problems. Despite this, a large number of therapists also have reservations about manualised therapies, and have under- standable concerns about the prospect of using a rigid and restrictive framework which might limit their creativity and responsiveness to the needs of individual clients. Such concerns are valid; however, the use of a treatment manual does not need to limit a practitioner’s repertoire, nor does it necessarily undermine the therapeutic relationship, or turn the therapist into a mere technician. Manuals are often developed by researchers as a starting point for their explorations regarding the effectiveness of a particular therapy. The manuals are then tested in clinical practice to see if they have ‘real-world’ applicability. This treatment guide was developed from my research, which examined actual psychotherapy cases as conducted in routine clinical practice (Widdowson, 2013). From these cases, principles of best practice were identified from the participants’ feedback about the aspects of therapy they found to be the most helpful. The intention was to create a treatment manual that was suitable for use in ‘everyday Downloaded by [New York University] at 04:40 12 August 2016 settings’, which could be used flexibly and was capable of adjusting to individual client needs. To date, over 70 therapists (in the UK and the Netherlands) have been trained in the use of this manual, and the feedback and data they have pro- vided strongly suggest that this treatment guide is effective, relatively easy to use and gives them enough freedom to be creative and adapt the therapy to the needs and preferences of their clients. This guidebook has also been developed using recommendations regarding treatment manual design and content (Carroll & Rounsaville, 2008; Carroll & Nuro, 2002; Duncan, Nicol & Ager, 2004) and it is hoped that you will find it to be of immediate practical use in your client work. 2 Introduction It is also my intention to provide you, the reader, with direct access to research findings which are relevant to your work and may go some way to closing the gap that often exists between research and everyday practice (Widdowson, 2012a). Research has repeatedly shown that the quality of the therapeutic relation- ship is the most important factor in determining the outcome of psychotherapy (Horvath, Del Re, Flückiger & Symonds, 2011). This treatment guide provides guidance on how to strengthen the therapeutic relationship right from its very beginning and, as such, it is hoped that this will maximise your effectiveness with your clients and reduce treatment failure and drop-out rates. Research background of this book The past few years have seen something of a renaissance in TA research. My own research has provided evidence that TA can be effective for the treatment of depression (Widdowson, 2012b, c, d) and for mixed anxiety and depression (Widdowson, 2014a). TA has been demonstrated to be effective in short-term settings for depression and anxiety symptoms (van Rijn, Wild & Moran, 2011) and has been shown to be equally effective as integrative counselling psychol- ogy, gestalt therapy and person-centred counselling (van Rijn & Wild, 2013) for the treatment of depression and anxiety. There is also evidence for the effective- ness of TA therapy for the treatment of posttraumatic stress disorder (Harford & Widdowson, 2014) and emetophobia (Kerr, 2013) and for the usefulness of TA therapy for people with long-term health conditions (McLeod, 2013). There is more TA research under way, and I anticipate that within the next few years we will have accumulated a respectable amount of evidence for the effectiveness of TA with a range of presenting problems. As stated above, this treatment guide was developed from my doctoral research. My thesis is held by the University of Leicester research archive and is available online to anyone who would like to read more, at https://lra.le.ac.uk/ handle/2381/28382. Overview of the book The book is organised into three parts. Part I covers an introduction to TA theory, and then moves into providing the reader with a solid understanding of depression. Chapter 1 covers the history and theory of TA and some of the key aspects of Downloaded by [New York University] at 04:40 12 August 2016 TA therapy in practice. The chapter assumes that the reader has a basic under- standing of psychotherapy theory and TA concepts. Readers who are completely new to TA might find it useful to begin by reading Appendix 3 to gain some familiarity with TA theory. The detailed exploration of depression begins in Chapter 2, which addresses the diagnostic features of depression and examines some of the data on the preva- lence, course and pattern of recovery of this common mental health problem. Chapter 3 provides an overview of a wide range of research findings about processes involved in the origins and maintenance of depression (depressogenic Introduction 3 processes).