Extracts from a case study by Sylvia Rose

The following extracts are from a case-study of a client at a residential thera­peutic community for severely emotionally disturbed individuals. The therapeutic model used is Transactional Analysis. For an introduction to the theory, see TA Today, by Stuart & Joines, 1987 (Lifespace Publishing). The name of the client in this study has been changed.

[Below are brief and very simplified explanations of some of the TA terms mentioned in the extracts. When ‘Parent’, ‘Adult’ or ‘Child’ are used with a capitalized first letter, they refer to ego states. Roughly, ‘Parent’ is an ego-state which reflects the thinking, feelings and behaviour of parental figures from a person’s past; ‘Adult’ re­flects a state in which a person is responding to their current surroundings (reality testing) to inform their thoughts, feelings and actions; and ‘Child’ is a state in which a person is acting, feeling or thinking in ways that they used in their childhood.

‘Contamination’ is where a person believes themself to be in Adult (ie reality testing), when in fact they are discounting some aspect of the current situation, and responding in ways which limit them in some way. ‘Decontamination’ is when a person realizes that their response is self-limiting and based on their past, rather than their current, experience.

‘Script’ is a set of contaminated beliefs that forms a person’s internal frame of refer­ence about the world and which they reinforce by discounting certain aspects of reality.

‘Kick-me’ is a strategy (in TA called a ‘game’) where a person gets negative attention (in TA called ‘negative strokes’) by setting up a situation, out of their awareness, in which another person gets annoyed with them for some reason. The person has developed this strategy in childhood when positive attention was largely denied them. A child has a survival need to get its existence recognized, therefore negative attention is used to meet this vital need. Later in life the person still employs this, now outmoded, strategy in situations where positive strokes or attention are readily available.]

Lisa was referred to the Community by the clinical psychologist at the psychiatric hospital she was attending as a day patient. She had been in and out of the psychiatric hospital for some eleven years and was not responding to drug therapy. She had become increasingly disruptive and had recently been threatening to kill herself in front of her children. The psychologist at the hospital believed that she needed a secure and stable environment in which she could develop a trust relationship before she would begin to calm down and change. The consultant psychiatrist at the hospital predicted that Lisa would become a ‘back ward’ patient if she continued on her present path and therefore agreed that she should be given the option of having psychotherapy at the Community.

When she came for her initial interview, Lisa looked like a lost child. She was dressed in ill-fitting and mismatched clothes. Her hair was malted, her fingernails dirty, and her teeth yellowed. Her movements looked unco­ordinated and she turned her toes inwards as she walked. Her voice was high pitched and her speech was rapid. She appeared wide-eyed but every so often she would squint, put her head on one side and flinch, which gave her the appearance of a frightened rabbit. She believed that she was giving off poison and told us to stay away from her or else we would be poisoned. She also reported herself as hearing ‘the voices’ which commented on her circumstances and told her what to do. She told us that she was stupid and that she knew we would not like her, but that she had come to see us because her psychologist thought it was a good idea. She appeared to have some pride in the fact that they were finding her difficult to handle at the hospital.

Lisa was given up for adoption at six weeks old. Her adoptive mother was an alcoholic who acted out violently against her husband and her two adoptive children. She tortured Lisa both mentally and physically, locking her and her brother in a small room for days at a time. Once she held Lisa’s hands in boiling water “because they were dirty”. Lisa remembers that her skin came off her hands “like a pair of rubber gloves” and that she had them bandaged for weeks. Her mother had a fantasy daughter to whom she would compare Lisa unfavourably and taunt her with derisive comments. She forced Lisa to speak to this imaginary daughter and to apologise for being bad. Lisa’s lack of normal development was evident as early as eighteen months old, and she did not begin to walk until she was three. She remembers her mother bandaging her feet and tying her legs together to get her to “walk properly”. She also recalled her mother tying her to chairs for extended periods to make her “sit properly”.

Her adoptive father was also alcoholic. She reports that he was a passive, ineffectual man who was bullied by his aggressive wife. He sexually abused Lisa for as long as she can remember. (Medical evidence of early internal scarring suggests that she is right in believing that he started to abuse her as a baby.) She despised and yet loved him. She could and would manipulate him into being sexual with her as a way of getting physical strokes. Lisa married a man who is stern and critical of her. He treated her as if she was an inadequate child and took on the role of house-husband to the family as well as having a full time management job. She once attacked him with a broken bottle whilst he slept. Her three daughters were subjected to terrible ordeals at Lisa’s hands. For instance, when they cried as babies she would lock herself in the garden to stop herself from killing them. She would starve them or threaten to harm herself in front of them. They were on the ‘at risk’ register with Social Services.

During her fifth month of treatment, Lisa asked me to be her ‘mum’. I knew that she was attached to me and I now wanted to offer her that security. After gaining the approval of the staff, there was a formal ceremony in front of the whole Community to establish the contract. By virtue of this contract, Lisa made a commitment to take on my definitions about the world until she is well. After that she will be able to test reality sufficiently to make autonomous decisions successfully. This commitment to getting well was my only proviso in making the parenting contract with her.

By now Lisa was being held regularly and had also initiated to be re­gressed and have bottles. One day she cried whilst having her bottle and I realized that the milk was too hot, and had cooled it down before offering her any more. When I fed her the cooled milk, she stopped crying and gurgled with pleasure. After I brought her out of the regression, she told me what she had experienced whilst having the bottle, clearly relating from her Adult to mine. She told me that she had realized that she could feel when she was a baby with me, because she believed that I would respond to her when she cried in pain. She believed that her adoptive parents had not responded to her cries of pain and that she had decided not to feel, because of this. This realization explained her lack of discrimination of temperature, which had earlier led to me insisting that she get another person to check all water she used to wash and any hot drink she had, to prevent her from scalding herself. She was excited about having fathomed this out for herself, and I stroked her thinking. It was a breakthrough in her Adult reasoning.

Over the next year, Lisa’s work showed that she was decontaminating her Adult effectively and was taking in new Parenting. She now feels the differ­ence between her Adult knowledge and her Child beliefs, and finds it un­comfortable to maintain the script messages against reality. She displays a greater level of maturity in her relationships with other members of the Community. She has developed and improved her relationships with her three daughters, who come to visit for the weekend once a fortnight, so much so that they have all begun to change markedly too. The difference in Lisa’s appearance and behaviour is remarkable. She now displays a calm, grounded attitude and a friendly manner. This is in sharp contrast with her presentation at the start of treatment.

I have learned a great deal from Lisa and have done many pieces of personal therapy which have directly related to the work she has been doing at the time. I have learned to make and keep boundaries, after being faced with the sheer bombardment and intensity of the emotional manipulations that Lisa would use to attempt to draw me into her frame of reference. She would test me by attempting to provoke me emotionally. Somehow she would find any unresolved issues I had and touch on those raw points until I would respond. It seemed like I worked on nearly as many issues as Lisa, but usually at a far less intense level. Learning to ask for help by reaching out to others for support during those difficult times has been a significant and important growth for me. Lisa and I have grown together during the past three years and we both continue to grow and change as our relationship develops. She has certainly helped me to improve my technique and approach as a therapist. I feel proud of my ‘daughter’ and proud of myself as her ‘mother’.

Sylvia Rose is a Transactional Analyst with a private psychotherapy and training practice in Birmingham. She previously lived and worked for five years in the TA Community mentioned in the article, and remains ‘Lisa’s mum’.

Contact numbers: Sylvia Rose – ph: 0044 121 449 2822, THAT (Trident Housing Association Therapeutic) Community – ph: 0044 121 449 2204, ITA (Institute of Transactional Analysis) information – ph: 0044 181 958 2553.