The evidence basis of Transactional Analysis Psychotherapy: results from an international survey, systematic literature reviews and meta-analyse
Dr Joel Vos, PhD, MSc, MA, CPsychol, FHEA
Dr Biljana van Rijn ,DPsych, MSc, TSTA (Psychotherapy)
Since the creation of Transactional Analysis (TA) in the 1950s, almost 50,000 handbooks, theoretical articles, and personal perspectives have been published. However, there are no systematic reviews available that summarise the evidence basis of TA, and that distinguish unsupported theories and practices from those that are evidence-based. With the support from EATA, the Metanoia Institute in London has conducted a series of studies on the research evidence underpinning TA. This panel gives an overview of the key findings of these studies, in the format of four presentations given by the researchers. The first three studies include a survey amongst TA practitioners world-wide and systematic literature reviews of previous research; these three studies have been used to build an evidence-based conceptual model of TA psychotherapy. This presentation will be relevant for researchers and trainees as well as practitioners who want to understand from which practices their clients can benefit most.
- Vos, J., & van Rijn, B. (2021). The Transactional Analysis Review Survey: An Investigation Into Self-Reported Practices and Philosophies of Psychotherapists. Transactional Analysis Journal, 1-16.
The Transactional Analysis Review Survey: An Investigation Into Self-Reported Practices and Philosophies of Psychotherapists – Joel Vos.
Despite the large body of literature on TA, its application has not been systematically studied. The research described in this article involved an online survey titled the Transactional Analysis Review Survey (TARS), which consisted of ten open and 45 closed questions. Items were derived from the most frequently cited TA publications and focused on the psychotherapist’s perspective on metalevel reflection, a central clinical phenomenon, etiology of psychological problems, therapeutic mechanisms, and therapist competencies. Data were analyzed with thematic analysis, principal component analysis, and latent class analysis. The survey was filled out by 238 TA therapists, and most reported seeing TA as a therapeutic approach, a general attitude and view of the world, and their preferred model in their practice. According to their reports, TA focused on the client’s ego states and transactions, social functioning, and self-efficacy, which helped improve their psychological health, self-realization, and general and behavioral well-being. Clients’ most frequently reported problems were seen as caused by negative messages early in life (scripts), lack of development of mature coping mechanisms, transgenerational messages, life events, denial of existential givens, and genetics/temperament. Individuals were understood to have some choice in accepting or rejecting the negative impact of these messages and life events via behavior, emotions, and cognitive styles. TA was viewed as helping clients via the therapeutic work with their ego states, social functioning, and self-efficacy. The changes were facilitated by the therapist competencies of positive client-practitioner relationship, working at experiential depth in the here and now, etiological analysis, and providing treatment structure. Thus, TA seems to offer a coherent conceptual framework for psychotherapeutic practice. Further empirical validation of this framework is required.
- Vos, J., & van Rijn, B. (2021). A Systematic Review of Psychometric Transactional Analysis Instruments. Transactional Analysis Journal, 1-33.
Systematic review of psychometric Transactional Analysis instruments – Joel Vos.
Since the birth of Transactional Analysis (TA) in the 1950s by Eric Berne, many psychometric instruments have been developed to operationalise TA concepts. Several studies have provided general reviews of the available instruments, but these are not systematic and do not assess the psychometric quality. We conducted a systematic literature review of all psychometric instruments operationalising TA-concepts, by searching in Pubmed, Medline, PsycInfo, APA articles, Web-of-Knowledge, scholar.google.com. The study quality was evaluated with the consensus-based standards for the selection of health measurement instruments (COSMIN). Of the 12.287 initial search hits, we selected 56 instruments in 263 studies. The Schema Mode Inventory, Tokyo Egogram, Adjective Check List, ANINT-A36, and Life Position Scale have fair/good overall COSMIN-quality. Except for the latter scale, these scales operationalise ego states (Parent, Adult, Child), and the functional analysis concepts of Critical Parent, Nurturing Parent, Adjusted and Unadjusted/Free Child. The Life Position Scale has operationalised the positive and negative positions towards oneself and others. Other questionnaires had poor to fair COSMIN-quality, usually due to a lack of studies. Meta-analyses indicate that psychopathology and physical symptoms are associated with strong Critical Parent, strong Unadjusted Child, weak Healthy Adult, negative coping-styles, and negative positions towards oneself and others. In sum, many instruments need further validation and translation into more languages. Schema Mode Inventory, Tokyo Egogram, Adjective Check List, and Life Position Scale are the best validated questionnaires. These questionnaires could be used by researchers to test treatment effectiveness, and by psychotherapists to examine the problems and aetiology of clients.
- Vos, J., & van Rijn, B. (2021). The Evidence-Based Conceptual Model of Transactional Analysis: A Focused Review of the Research Literature. Transactional Analysis Journal, 1-42.https://doi.org/10.1080/03621537.2021.1904364
The effectiveness of Transactional Analysis treatments and their predictors: a systematic literature review and meta-analysis – Biljana van Rijn.
This research focuses on TA treatment. Despite many studies, there are no comprehensive reviews and meta-analyses on its effectiveness. Therefore, the overall aim of this study was to conduct a systematic literature review and meta-analysis on TA treatments, via three specific objectives: (1)investigating effects of TA in pre-post studies, (2)examining the effects of TA compared with other treatments in randomized clinical trials, (3)explore which factors can explain differences between studies. We conducted a systematic literature review and meta-analysis according to MOOSE/ PRISMA guidelines in Pubmed, Medline, PsycInfo, Web-of-Knowledge, scholar.google.com. Forty-one clinical trials were included. TA treatment for individuals, in groups, families and prisons, improve the clients’ psychopathology and self-efficacy, both in pre-post studies and randomized-controlled-trials. Additionally, TA treatment in groups and prisons improves social functioning. School-based TA leads to increased self-efficacy. The effects on psychopathology, behaviour and well-being were predicted by improvements in ego-states, self-efficacy, social functioning, and the client-practitioner relationship. Treatments were more effective when the practitioner focused on the clients’ experiences in-the-present, assessment, treatment stages, psycho-education, and TA-unique techniques. 4. The Evidence-Based Conceptual Model of Transactional Analysis: A Focused Review of the Research Literature – Biljana van Rijn. On the basis of the previous studies, this presentation will provide a focused review of the research literature in transactional analysis (TA). TA was developed in the 1950s as a theory of human personality and social behavior and as a comprehensive form of psychotherapy, but there has not been any systematic research to test the empirical evidence for the efficacy of TA theory and practice. The aim of this study was to develop the conceptual model of transactional analysis on the basis of a systematic review of the actual, self-reported practice of international TA psychotherapists and on the evidence found in research. The article systematically reviews common conceptual components of TA and their empirical evidence by examining the common denominator and the empirical evidence for the central clinical phenomenon, etiology, therapeutic mechanisms, therapeutic competencies, outcomes, and synthesis. TA focuses on problems in ego states (operationalized as Parent, Adult, and Child) with distinctive behavioral functions of Controlling Parent, Nurturing Parent, Adult, Adapted Child, and Free Child. Individuals can develop long-term problems in their ego states, social functioning, and self-efficacy as the result of unfavorable messages from their social context (negative parental messages in early life, lack of developing mature coping mechanisms, intergenerational messages, negative stroke balance), script decisions (accepting or rejecting unfavorable messages via behavior, emotional disconnection, or cognitive styles), life events, and genetics/temperament. TA treatment intends to help clients by developing constructive ego states, improving social functioning, and stimulating a sense of self-efficacy. Research confirms that TA improves psychopathology, behavior, and general well-being thanks to improvement in ego states, self-efficacy, and social functioning. These effects are achieved by four evidence-based therapist competencies: creating a positive client-practitioner relationship, working with experiences in the present, etiological analysis (life scripts, injunctions, counterinjunctions), and therapeutic structure (treatment contracts, treatment stages, psychoeducation/didactics). Meta-analysis of 75 studies shows that TA has moderate to large positive effects on psychopathology, self-efficacy, social functioning, and ego states. This conceptual model shows that TA can be considered a bona fide and evidence-based treatment for a wide range of clients.