This doctoral dissertation is based on the following three studies:

2. TransactionalAnalysisPsychotherapy (TA)Three Methodsdescribing a TransactionalAnalysisGroup Therapy This doctoral dissertation is based on the following three studies: • Study I Johnsson, R. Client Assessment in Transactional Analysis - A Study of the Reliability and Validity of the Ohlsson, Björk and Johnsson Script questionnaire. International Journal for Transactional Analysis Research, Vol. 2, No. 2, July 2011 • Retrieved from http://www.ijtar.org/article/view/8943 • Study II Johnsson, R. Transactional Analysis as psychotherapy method – A Discourse Analytic study.International Journal for Transactional Analysis Research, Vol. 2, No 2, July 2011 Retrieved from http://www.ijtar.org/ article/view/9111 • Study III Johnsson, R.och Stenlund, G.The affective dimension of alliance in Transactional Analysis psychotherapy International Journal for Transactional Analysis Research, Vol. 1, No. 1, July 2010 • Retrieved from www.ijtar.org/article/view/6144

3. Defenceof the dissertation, DepartmentofPsychology, Lund University, November 15, 2011

7. Critic of TAProchaska, J. O., Norcross, J. C. (2010) Systems of Psychotherapy – A Transtheoretical Analysis (7th edition) Pacific Grove, CA: Brooks & Cole • ” As an approach to theory and therapy construction, TA continues in the worst heritage of the clinical tradition (my italics) • Concepts are carried over from clinical observations with disregard to testing their scientific validity. • Theoretical postulates are stated in untestable terms. Berne (1972, p. 415) himself was aware of this when he wrote, “Experimental validation of script theory is not possible with human beings.” Is it possible with lower animals? Yet Berne and his followers (for example, Clarkson, 1991; Holland, 1973; Steiner, 1990) continue to write about script theory as if it were verified, let alone verifiable.

8. More Critic from Prochanska & Norcross, 2010 • Like most insight-oriented psychotherapies, TA is presented as a universal treatment, appropriate for just about any problem the clinician might encounter. • This specious universality is characteristic of therapies based on armchair philosophizing; specificity is characteristic of therapies based on scientific data. • As psychosocial treatments become more scientific, we need to be able to specify which treatments work best with which problems under which conditions. TA may work best with hypothetical constraints such as scripts, games, and ego states, but what about concrete disorders such as anxiety, addictions, and depressions?

9. Empiricaltesting and Validationofconcepts • To become scientifically respectable, • TA must specify how constructs such as Parent, Child, and Adult can be experimentally tested. • To become clinically acceptable, TA must specify with which problems it works best and under what conditions. • Otherwise, TA remains just another in a long line of psychotherapies for all seasons and all reasons (my italics)

11. Doctoral promotion ceremony at the Dome in Lund University, Sweden

12. Happiness is wearing Laurel leaves at the age of 64?

13. Every kid starts out as a natural-born scientist

14. Basic material 10 clients, who took part in transactional analysis group therapy, which they had sought voluntarily, and in which Roland Johnsson served as therapist. The therapy continued for a year and was divided into 24 sessions. The sessions were videotaped and a transcribed protocol of each session was made. 1984/85 24 sessions with 10 clients Professionaly videorecorded

15. The basic study material from the TA group therapy 1984-85.

16. The TA-therapygroup 8 women and 2 men between 23-56 years old with mixed diagnosises Carolin Barbro Seating diagram According to E. BERNE (1963) cameraman FLIP CHART Erik Greta Therapist DOOR Harriet WINDOW Session 10, 26/11 1984 Ingegerd Agneta Janet Daniel Soundman Fanny STREET OUTSIDE ENTRANCE

17. Treatmentcontracts

18. Overall Aim • The overall aim of the thesis, examining three selected aspects, was to enhance, improve and revive the practical understanding of the active ingredients in Transactional Analysis Psychotherapy (TA) and to define and lay down elements of TA, which makes it a distinct and replicable method of treatment. 
These three projects do not provide the whole answer to what Transactional Analysis psychotherapy is, but discusses the major therapeutic areas of diagnosis, treatment and therapeutic relationship to provide an overview of TA's content, approach and form. 


19. Three Key areas & Three Methods • Diagnostical client assessment with TA´s Script Analysis made as a reliability study. • Identification of different components in TA´s psycho-therapy method with the use of Discourse Analysis. • The affective dimension of the Therapeutic Alliance with a psychodynamic approach, using the CCRT method (the Core Conflictual Relationship method) by Luborsky & Crits-Christoph (1990, 1998) and the Plan – Diagnosis method by Weiss & Sampson (1986).

20. Study I: Diagnosis / Client assessment • A script questionnaire and associated checklist developed by Ohlsson, Johnsson & Björk (1992) was used by the author and two professional colleagues to independently assess the ten clients in the therapy group. • Ratings based on two occasions, from written responses at start of therapy which were compared to ratings based on videotape interviews conducted by the author six years after termination of therapy. The analyses have been compared in a reliability study. • The aim was to examine the reliability of making diagnostic Script analyses from a Script questionnaire.

21. Example: Summary of assessments for a clientAssessor AAssessor BAssessor C

22. Results for Study I • Moderately high inter-assessor reliability was found but intra-assessor reliability was low for the independent assessors; agreement increased for script components ‘primary injunction from father,’‘racket feeling’, ‘escape hatch’, ‘driver from father’ and ‘driver from mother”

23. Study II: Identificationof TAas TherapyMethod • Operational definitions of categorisations by McNeel (1975) were developed and applied by the author and an independent assessor to complete a modified discourse analysis of transcribed 72 hours of transactional analysis group therapy. • The aim was to study whether the therapy conducted was consistent with what TA as a method prescribes.

24. Operational definitions of the study’s seven main categories and 42 sub-categories • I. Contract • The client and therapist mention, quote and/or negotiate treatment contracts in some form. • 1. ‘Mutual negotiation’The therapist starts a contract-related negotiation or responds to a negotiation initiated by the client. • 2. ‘Behavioural description’The therapist defines and substantiates a contract in behavioural terms. • 3. ‘Confront Parent’ contractThe therapist confronts the communication from clients in which they express their goals from a Parent position instead of listening to their own natural needs. • 4. ‘Refer to contracts’The therapist refers to the original written treatment contract or a daily contract.

25. II. Strokes • The therapist draws attention to a statement which testifies to the client’s resources or confronts a self-devaluating statement. The therapist requests the client’s active stance. • 5. ‘Stroking strength and health’The therapist draws attention to new salutogenic behaviours and emotions in the client. • 6. ‘Repetition of positive strokes’The therapist repeats a positive assessment of the client, since it seems not to have been understood. • 7. ‘Change self-harassment to a positive fantasy’The therapist invites the client to replace self-torture with an enjoyable and positive imagination. • 8. ‘Careful use of “Will you?”’The therapist asks, “Will you ...?” in order to help clients to actively make their own decisions regarding a behaviour or a life situation. • 9. ‘Not laughing at gallows humour’. The therapist recognises and confronts a self-devaluating statement from the client disguised as humour. • 10. ‘Talking to Parent projections’The therapist speaks during double-chair work with the client while the client is playing the role of mother or father, as though the client were the parent at that present moment. • 11. ‘Support/permission’The therapist expresses himself non-judgmentally and encouragingly to help the client dare to express forbidden feelings and thoughts. • 12. ‘On the side of the Child’The therapist supports the client unconditionally in an attempt to express the needs, hopes and disappointments directed at authority figures from childhood.

26. Results for Study II • Results showed that the therapist used an average of 42% of the discourse space and that the therapy did indeed contain TA components, with the two main categories being ‘Feeling Contact’ and ‘Contracts’, and with particular use of TA techniques of ‘talking to Parent projections’, ‘make feeling statement’, ‘mutual negotiation’ and ‘specificity/clarity’. Inter-rater reliability was 46.2% (Araujo & Born 1985), Cohen’s (1960) kappa coefficient shows a spread from slight to moderate agreement, and the Odds Ratio (Viera, 2008) is above 1.0 for most categories. One intervention,”mutual negotiation”, with moderate reliability could be identified as ”TA typical”

27. Ranking of main category agreement according to kappa (κ) and OR values, as well as percentage agreement (%)

28. Ranking of sub-category agreement

29. Study III: Therapeutic alliance • The study describes an investigation of the significance of the affective dimension of the therapeutic alliance (Bordin 1979), in the group therapy. We explored the client’s pattern of affective relationships by use of CCRT by Luborsky & Crits-Christoph (1990, 1998) and examined how the therapist responds to the client’s affective messages (“tests”) by use of the Plan Diagnosis method (Weiss & Sampson, 1986). • The aim was to develop the TA method by investigating the affective dimension of the therapeutic alliance.

30. Results for Study III • We found that “emotional” aspects play a more decisive role than has been envisioned in the TA redecision method and similar approaches of TA psychotherapy that emphasise contracts, tasks of therapy and a rational approach.

31. DiscussionMain result • The results from the three studies reflect both the general and the specific nature of the TA approach, where both consistency and deviation from the therapy's expected treatment methodology is apparent. • The results indicate that TA therapists can use their standard TA terminology “Script” for client assessments. The expected main elements of the TA method can be identified. The affective dimension of the therapeutic alliance was emphasized more in practical work than the TA method prescribes.

32. Methodological considerations • The TA therapy was video-filmed 25 years ago • - New developments not included • + reduce allegiance • Author as therapist. • - allegiance • + inside understanding • Independant observers • + reduce allegiance • Triangulation - three different methods studying three different parts of TA, quantitative and qualitative interpretive methods • + strengthen the validity • Adherence – Sticking to the TA method (manualised) • + adherence is linked to positive outcome (Luborsky,1985) • - Studies the adherence and not the method • Analytical statistical data has been used • +qualitative data supported by quantitative result

33. Reliability - Scientificallytrustworthywithconsistent,repeatablemeasures • A test is considered reliable if we get the same or approximately the same result repeatedly. • My studies are naturalistic with limited number of clients, basically qualitative with additional quantitative elements. + find essence and aims, maintaining the authentic connection to a complex reality - Hard to measure • The quantification has consistently been based on pre-specified categories (script components, TA-therapy categories, CCRT standard categories), which systematically has been coded by different observers, been compared and statistically calculated. + find statistical and quantifiable results + use adequate scientifical approved statistical methods (eg Fleiss Kappa quote) Reliability problems • Human beings the source of measuring (subjectivity) - based on clinical practice, it requires a clinical and constantly modified ob- servation of the process. Consequently, the concepts will be less well defined to allow the inter-assessor reliability to be expressed in simple statistical terms (coefficients). • + multiple assessors (inter-assessor reliability), making independent assessments on several occasions (test-retest reliability or intra-assessor reliability) • + Using experienced Transactional Analysts assessors (study I) when concepts are not operationally defined otherwise no-TA persons (Study II)

34. Validity – Scientifical accuracy and relevance • Validity is the extent to which a test measures what it claims to measure. • Reliability is a prerequisite for validity but high reliability does not guarantee that the study has high relevance (validity). • Validity isn’t determined by a single statistic, but by a body of research that demonstrates the relationship between the test and the behavior it is intended to measure. How well does a script questionnaire measure script components? • If we are three skilled TSTA´s with high inter-rater reliability we can not say that measures are valid we need good operationalisations of our concepts and independent assesors from other therapy approaches using the questionnaire to make it standardized. • There are many types of validity criterias to determine the validity eg construct validity, content validity, face validity, ecological validity, on-line validation, internal validity, communicative validity, external validity, pragmatic validity and triangulation

35. Discussion of results. • Overall • The investigated areas (diagnosis, treatment method and therapeutic rela­tionship) provide an overall view of the Transactional Analytical psychotherapy. • Study II • The studied therapy follows what generally constitutes TA psychotherapy. • TA specific is contracts and mutial negotiation • Study III • affective dimension of the alliance has received more space than is ascribed to the TA method. • Study I • Moderate high high inter-assessor reliability (78% and κ = 0.48) was given to client diagnoses, based on the primary components of Script Analysis

36. Concludingremarks • By discussing the three areas of diagnosis, method and therapeutic alliance with the use of three different approaches, the following aims have been achieved: • A better understanding of TA's strengths and weaknesses in terms of diagnosis, treatment method and therapeutic relational attitude. • A clearer view of what is TA-specific and what is common to all psychotherapies. • To add and provide the benefits of academic research for practicing TA psychotherapists.