Integrative Psychotherapy Articles
Behavioral, Intrapsychic, and Physiological
Richard G. Erskine
Transactional analysis, as a social psychiatry, has emphasized the behavioral change aspects of script cure. Within this framework cure is defined as the cessation of script syntonic behavior. Yet, for many people change in behavior alone is not sufficient to effect pervasive change of their life scripts. To achieve a total script cure change must occur at the intrapsychic level of the script as well, that is, change at the cognitive and affective levels of existence. In addition, I think that in every case of script formation, be it in response to introject, traumatic experiences, or the process of survival decisions, there is a corresponding physiological inhibiting reaction, and for many people change is also necessary at the physiological level of the script.
This integrative view of script cure implies that change needs to occur in three dimensions: behavioral, intrapsychic (affective and cognitive), and physiological.
Definition of Script
In understanding script cure I start with a definition of script as a life plan based on decisions made at any developmental stage that inhibit spontaneity and limit flexibility in problem solving and in relating to people. Such script decisions are usually made when the person is under pressure and awareness of alternative choice is limited. The script decisions emerge later in life as constricting script beliefs about one’s self, others, or the quality of life. These script beliefs, along with the feelings repressed when the person was under pressure, are manifested in internal and external behavior and together with selected memories form a closed system of experiencing one’s life. This closed system is the script.
Although many of the script beliefs on which we focus in therapy are decisions that have been made in early childhood before the child has any awareness of what his or her alternatives are for being in the world, this definition of script also includes those decisions that are made during any developmental period of a person’s life when he or she is under pressures that restrict perception of options and alternatives for being and behaving. I think that at each of the passages in life, situations emerge wherein each of us must make choices. If restrictions are imposed on us that narrow our options for need fulfillment, it is likely that the decisions that are made, although they may seem to be the best possible choices under the circumstances to solve the immediate problem, will have the effect of limiting our spontaneity and flexibility in problem solving and in relating to people. In essence, any life plan made under pressure will most likely be growth inhibiting.
Within the parameters of this definition, script cure means that persons are free to contact people meaningfully and to respond to problem solving without preconceived ideas or plans that limit how they will interpret the situation and restrict behavioral choices. Cure is accomplished when each new experience is appreciated for its uniqueness and is
perceived with an internalized sense, both viscerally and intellectually, as an opportunity to learn and grow.
Script cure at the behavioral level means that the person is no longer engaging in script-related behaviors. For instance, if the script calls for being “not understood,” therapeutic work aimed at the social control or behavioral level of cure may focus on encouraging the person to say what he or she is thinking and feeling and to shift ego states so that the listener has a clear understanding of the talker’s internal experiences. The therapist’s teaching of overt and ulterior transactions and the process of these in games is aimed at the person’s using the knowledge to develop new behavior to be understood clearly in communications. Cure at this level means that the person in this example who believes “I’m not understood” would alter his or her behavior so that the listener has a thorough sense of understanding the talker. Specific change contracts are particularly relevant at the behavioral level of therapy.
When thinking of the behavioral level of script cure I also look for change in the fantasies and dreams of the person with whom I am working. I approach therapy with the concept that fantasy is an internalized behavior that occurs in the association area of the cortex without expression through the motor area. As psychotherapist I need to be aware of the content of a person’s fantasies and dreams as a possible way in which he or she may act out the script in solitaire without ever engaging in observable or social behavior. For example, a person may have integrated new script-free behaviors at an overt or observable level when in awareness, but the script may emerge in nonconscious patterns during dream state or fantasy, producing reinforcement of “I’m not understood.” Behavioral cure does not mean just the cessation of overt script actions, such as change in word usage, sentence patterns, expressions, or gestures, but also that the content and active processes of the dreams and fantasies are no longer determined by script beliefs or serve to reinforce the script.
Since behavior is a manifestation of our intrapsychic processes I think that the therapist who is concerned with achieving script cure needs to focus on the cognitive and affective levels of script as well as the behavioral. The cognitive and affective aspects form the intrapsychic process of script through the continual nonconscious stimulation between feelings suppressed at the time of script decision (primal feelings) and the script beliefs resulting from those decisions. Therapeutic approaches that result in decontamination and deconfusion are designed for intrapsychic cure.
Cognitive-level script cure has occurred when a person is no longer contaminated by believing the script beliefs and by using them in a way that narrows his or her frame of reference. For example, the person would stop defining himself or herself as unlovable, or perceiving the world as a tragic place, or seeing people as untrustworthy, but rather the frame of reference would be unobstructed to allow each experience to be interpreted with a flexible view of self, others, and the quality of life. Cure at the affective level of script is the letting go of feelings that have been repressed since the time of script decision.
To understand cure intrapsychically I look at the development of script within the young child. When the child has needs that are not met, either because of parental restrictions or environmental trauma, he or she experiences pressure or tension, and the organism responds to satisfy the need through the expression of emotions intended to draw attention to the unmet needs. If the emotions designed to meet the needs of the child are not expressed to need completion and the need remains unsatisfied, the result is an incomplete gestalt that demands closure. Once the child has reached the beginning of what Jean Piaget calls the concrete operational phase (preoperational stage) of development, closure of the incomplete gestalt occurs through a process of cognitive mediation in which the child symbolically replaces the unsatisfied need and concomitant feelings with a cognitive closure.
The cognitive closure is the child’s explanation to himself or herself of why the need was never satisfied (i.e., “Something is wrong with me”) and/or determines how to protect himself or herself (i.e., “I’ll get hurt if I ask for what I want”). This cognitive explanation is the script decision, designed to protect the child through suppression of the need and related feelings from the discomfort of the unmet need. This explanation and any related physiological reaction still does not meet the need, but it does serve as a secondary closure of the needs and feelings—a fixed gestalten—and forms the intrapsychic core of the script. The child may also create an illusion that embellishes, justifies, and makes the script decision more acceptable. This illusion then is maintained later in life as fantasy.
Imagine a little child whose need at this point in time is for affection and who, for various reasons, has caretakers who are not providing it. If the environment lacks support for the child to express feelings all the way to need completion, the child may attempt to comfort himself or herself by suppressing the feelings and need and decide “Something is wrong with me” and “I won’t get what I want.” At the time when these script decisions are made they are probably the most effective response the child can make to protect himself or herself from the discomfort, but because these decisions do not satisfy the primary need, they form a fixed gestalt, a set of rigid beliefs that serve to limit the person’s frame of reference years later. This limitation in perspective and the resulting behavioral restrictions constitute the life script.
Closing the Gestalt
Cure at the affective level is the release of the repressed emotions. When the repressed emotions are released and are no longer providing intrapsychic stimulation of the old script beliefs, the person then is free to experience feelings related to the current situation and to use the emotional sensations as an internal source of information and energy. This may be accomplished in therapy through redecision and disconnecting rubberbands by creating the environment in which the person can express the emotions that were inhibited in the original scripting situation all the way to need completion. Completion can be either in the reality of today’s life or through granting in fantasy what was not provided in the original situation. The unmet need and related primal feelings (those feelings suppressed at the time of script decision) no longer dominate the foreground in internal perceptions; the gestalt is completed and new experiences come to foreground. As people express the repressed emotions and related needs they often become aware of what they decided about themselves, other people, or life and are still holding onto today as script beliefs—the cognitive level of the script. Recognizing that the script beliefs were decisions made a long time ago to protect themselves from the discomfort of the unmet needs is an important step in changing the cognitive level of the script. New decisions are made in light of today’s realities, decision that enhance the views of self, others, or the quality of life beyond the perspective of the time when the person was under the scripting pressures. Cure at the cognitive level of script means that the person is no longer limited by the script beliefs.
Similarities may exist between script beliefs (i.e., I am all alone) and existential realities (i.e., I am all alone); however, the acceptance of existential realities is not limiting but provides a freedom to move beyond those realities, whereas script beliefs are inhibiting.
Therapy aimed at the behavioral or intrapsychic levels does not account for the pervasive physiological aspects of script, and, since rigidity in the body represents a limitation in being, the somatic aspects of script need to be an important focus of script cure. Many of the script decisions described in the psychotherapy literature and those illustrated earlier in this paper are cognitive decisions that have been made or remade after the child has developed some use of language and has some understanding, at least symbolically, of cause and effect. Prior to this level of intellectual development I think that scripts are formed at a physiological level by the very young child, who in Piaget’s framework is still operating within the sensorimotor period of development. When the child faces traumatic situations, responds to injunctions, or in some way has needs that are not being met, the child’s body reacts in a self-protective way, and the scripting process takes place within the tissue of the body as a survival reaction.
This reaction of the body is a muscular and/or chemical defense against what the child experiences as threatening. It is a physiological closure of the unmet need for comfort, a shutting down or inhibition within the body that suppresses the unmet needs and unrelated emotions, and what Wilhelm Reich postulated as the basis for the development of “character armor.”
This physiological reaction that is the primary basis of script in very early childhood also occurs to some degree in every scripting situation. Definitions of script imply inhibition in being, and with each scripting decision or script reaction I think there is always a corresponding physiological inhibition or restriction within the body. The younger the child or more severe the trauma, the greater the physiological reaction.
Physiological script reactions remain within the person much like conditioning and are the body script, the cause of many physical illnesses. Script cure at the physiological level is a letting go of the tensions, body armoring, and internal restrictions that inhibit the person from living life fully and easily within his or her own body. Changes in body script are often evident to an observer as a more relaxed appearance, freer movement, increased energy, and an established weight level that is appropriate for the person’s frame. People report having a greater sense of vitality, an ease of movement, and an increased sense of well-being.
When I engage in body-script work the treatment goal is to energize the body tissue that was inhibited and rigidified in the repression of unmet needs and primal feelings. This may be the way into the intrapsychic level of therapy or may be a concluding step in the treatment of a specific script restriction. Interventions at the level of body script include those approaches that lead to somatic change, such as deep massage work, tension relaxation, proper diet, exercise, and recreational activities that enhance the flow of energy and movement of the body.
The movement out of script may include some recycling back into script several times before the person is script free. This is the homeostatic or rubberband function of script drawing the person back to the old way of being whenever the pressures of life stimulate the unmet needs and feelings that were present at the time of script formation. Recycling may indicate that a level of script cure is still needing attention, such as emotional or body-script work that is undone even though the cognitive and/or physiological changes have occurred.
This integrative view of the intrapsychic, somatic, and behavioral levels of script cure implies that changes in a person’s emotions and cognitive processes are determined by changes in behavior and/or in how the body functions and vice versa. The more levels of treatment the therapist can integrate the greater the likelihood of script cure.
Script Cure and Beyond
Therapy as a process of growth and development is unending. Therapy that focuses on script cure is complete when the behavioral, intrapsychic, and physiological restrictions that inhibit spontaneity and limit flexibility in problem solving and relating to people are removed. Beyond script is the realm of personal growth, which includes the successful movement through developmental passages, expanding creativity, understanding life purpose, and enhancing psychic and spiritual growth.
In my frame of reference script cure is equivalent to the definition I use of OKness: the belief and associated feeling of comfort that no matter what happens to me, no matter now bad the situation, I will learn and grow from the experience.
This article was original published in the Transactional Analysis Journal, Volume 10, Number 2, April 1980, pp. 102-106.