Transactional Analysis of Schizophrenia

Zefiro Mellacqua is a psychiatrist and transactional analyst. He is a former researcher at the Institute of Psychiatry, King’s College London, and psychiatrist with Lambeth Home Treatment Team, South London & Maudsley NHS Trust, UK. He is now leading the first Home Treatment Team for the Cantonal Sociopsychiatric Organization, Ticino, Switzerland.

"Zefiro Mellacqua’s book is a cornerstone in contemporary Transactional Analysis for the understanding and treatment of the broad spectrum of psychotic disorders.The Author provides a well-founded summary of Berne’s transactional analysis theory and basic approach and then he develops his own innovative ideas which help understand psychosis in a new frame of reference, well connected to recent theories on relational traumas, and the importance of context (family, society, professional network) to cure psychotic patients.At the core of Mellacqua’s sensible approach we find the body as the unconscious theater of primal affective, sensory-motor relationships, very traumatic for the psychotic patient. The body may also communicate the starting point for a co-constructive search of meaning and direction which deeply involves both the therapist and the patient.A close analysis of the transferential-countertransferential relationship and a review of specific Bernian techniques propose excellent methodological-technical tools for the clinical treatment.The Author gives many interesting and touching examples taken from his clinical practice, which allow to better understand the nature of the relational processes that he has developed in his research on the treatment of psychotic patients.Through Mellacqua’s narratives we can capture his courage, passion, humanity and creativity that found his clinical work, and which seem to be an expression of the "real philosophy of hope" that he sees at the core of Berne’s revolutionary ideas: "the hope of being able to share the almost ineffable human experience of being as "I" with a more or less large group of people, including those who are mentally suffering." - Maria Teresa Tosi, PhD, licensed psychotherapist, TSTA, Past-President European Association of Transactional Analysis"This book is a must read for anyone working with, or touched by, the unfathomable experience of schizophrenia. Examining research findings, theoretical debates, and rich case illustrations through his lens as a transactional analyst, Mellacqua enriches, and transforms, both our understanding of the phenomena he investigates and of the theory he draws on. Through the book, schizophrenia comes to light and to life as a deeply relational phenomenon, and even an avenue to examine the broader question of how selves emerge—or vanish or get fragmented—from bodies in relationships. Mellacqua’s gifted writing humanizes the suffering of mental illness without romanticizing it. He combines the observations of an astute clinician, the erudition of a seasoned scholar, the finesse of an acute theorist, and the sensitivity of a poetic writer into a volume of exceptional clarity and humanity. This book’s theories, like its stories, are an invitation to relate and examine relating. Both help approach, rather than dismiss, the uniqueness of selves longing, and failing, to do just that." - Gianpiero Petriglieri, MD, Associate professor of organisational behaviour, INSEAD"In this book Zefiro Mellacqua takes us on a rigorous intellectual journey, tracing the origins and application of the theory of transactional analysis. This book is written with eloquence and style as Mellacqua outlines the original TA paradigm, faithfully following Berne’s inspirational theories of the function and structure of ego states alongside his study of phenomenology. Mellacqua details the source of Berne’s theories referring in some detail to the influence of psychoanalysis with particular attention to Paul Federn, Edward Weiss and Roland Fairbairn. It is a fascinating account of how transactional analysis moves away from the static and fixed entity of Freud’s theory of ego by describing ego states as representing lived experiences in the present moment which, upon examination, may reflect archaic experiences and/or introjected messages from the past. In reading Mellacqua’s narrative it becomes clear how TA theory lends itself to multiple innovative expression. Mellacqua’s innovative application of TA brings us into the psychiatric arena with a specific focus on schizophrenia. In his case studies the author shows how he works humanely and thoughtfully with patients who suffer from severe mental conditions. Mellacqua’s humanity is also located in the context of his psychological and phenomenological knowledge in addition to his research into the latest scientific findings on the developing mind. This book provides the academic context for analysing the condition of schizophrenia and, at the same time, we feel emotionally connected to the author and his patients when he describes his case studies and his sensitive reflections about his patients. For these reasons I think the book has the potential to be a creative and solid support for psychiatrists in modern day practice. For the TA clinician this book will take us back to the origins of Berne’s thinking. It will be indispensable for trainees wishing to understand the structure of ego state theory for in his clarity of language Mellacqua reminds us of the potential for in depth exploration of the psyche alongside the practicality inherent in Berne’s theoretical models. In particular this book will be an inspirational text for all clinicians within the profession of psychiatry who work alongside patients who suffer from schizophrenia. Mellacqua brings a depth of integrated intelligence and thus we are invited to engage with live patients, with a real doctor working patiently, reflectively, knowledgeably and with great sensitivity and empathy. The case studies are, for me, a testimony to the power for potent clinical practice working with patients who have serious mental health conditions." - Helena Hargaden, DPsych, MSc, TSTA, Relational Transactional Analyst, UKCP Registered Integrative Psychotherapist

• List of Figures; On Burroughs' Work; List of Cases; Abbreviations; Foreword by William F. Cornell; Acknowledgements; Credit Lines; Introduction; Special Introduction to Readers with Schizophrenia; 1. The Transactional Ego in Contemporary Clinical Practice; 2. Schizophrenia or Schizophrenias?; 3. Transactional Psychopathology of Schizophrenic Psychoses; 4. Forms Of Transference And Countertransference In Encounters With So-Called "Schizophrenics"; 5. The Naked Self; 6. The Body in Action: Protocol Analysis in Schizophrenia; 7. Countertransference in the Face of Psychosis; 8. Therapeutic Transactions; 9. Dreaming Reality; 10. Don't Hide the Madness; Index